Publications by authors named "Aziz Serkan Senger"

22 Publications

  • Page 1 of 1

Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery.

Surg Infect (Larchmt) 2020 Nov 11. Epub 2020 Nov 11.

Kosuyolu Resarch and Education Hospital, Istanbul, Turkey.

Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. In this retrospective design study, data were collected for patients who underwent GC surgery between January 2013 and August 2019. The diagnosis of sarcopenia was made according to the skeletal muscle index (SMI) calculated from pre-operative computed tomography images. Patients with sarcopenia and those without sarcopenia were compared in terms of SSIs; the risk factors for SSI were also analyzed. One hundred forty-nine patients were included in the study and had a mean age of 59.3 years. Post-operative complications developed in 59 patients (39.6%) and SSIs in 28 patients (18.7%). Sarcopenia was detected in 57 (38.3%) patients; the mean age was 59.9 years in the sarcopenic group (SG) and 58.9 years in the non-sarcopenic group (NSG; p = 0.55). The mean SMI was 382.5 mm/m and 646.2 mm/m in the SG and NSG, respectively (p < 0.001). A relation between SSIs and sarcopenia was detected; 17 patients in the SG (29.8%) versus 11 patients in the NSG (11.9%; p = 0.007). Surgical site infection was not found to be statistically significantly related to obesity, hypoalbuminemia, intra-operative blood loss, or duration of operation, although the sarcopenic obesity patients were found to have the highest SSI rate (40%). The present study identified a relation between sarcopenia and SSIs occurring after GC surgery. The authors believe that studies seeking to reduce the incidence of SSIs, which are a leading cause of morbidity after GC surgery, should be supported.
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http://dx.doi.org/10.1089/sur.2020.211DOI Listing
November 2020

Prognostic Factors in Operated T3-T4 Gastric Cancer.

J Coll Physicians Surg Pak 2020 Oct;30(10):1047-1052

Department of Gastroenterological Surgery, University of Health Sciences, Kartal Kosuyolu Higher Specialty Training and Research Hospital, Istanbul, Turkey.

Objective: To investigate the prognostic factors affecting survival in patients with a deep gastric wall invasion of T3-T4 advanced gastric cancer.

Study Design: Descriptive study.

Place And Duration Of Study: Department of Gastroenterological Surgery, Kartal Koşuyolu High Specialty Training and Research Hospital, between November 2006 and December 2018.

Methodology: A retrospective review was made of 252 patients; and the clinicopathological characteristics and survival status in the presence of T1-T2 and T3-T4 patients were investigated. The cumulative survival of the two groups was analysed with a Kaplan-Meier test, and the differences were analysed with a log-rank test. The prognostic factors for T3-T4 patients were established through a stepwise Cox regression analysis.

Results: Of the total, 52 (20.6%) patients had T1-T2 and 200 (79.4%) had T3-T4 gastric wall invasion. Statistical differences were noted in the Lauren classification as gender, tumor size, presence of lymph node involvement, presence of vascular and perineural invasion, and overall survival (p <0.001). A univariate analysis of the prognostic factors affecting survival in T3-T4 patients revealed a difference in the tumor localisation, tumor size, the presence of involved lymph nodes, perineural invasion, and vascular invasion. A multivariate analysis of the prognostic factors affecting survival identified differences in tumor size, the presence of involved lymph nodes and perineural invasion.

Conclusion: The most significant prognostic factor affecting survival in patients with T3-T4 gastric cancer, based on the depth of gastric wall invasion, was the tumor size, lymph node involvement and perineural invasion. Key Words: Advanced gastric cancer, Prognostic factor, Survival.
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http://dx.doi.org/10.29271/jcpsp.2020.10.1047DOI Listing
October 2020

The safety of upper gastrointestinal endoscopic biopsy in patients receiving antithrombic drugs. A single-centre prospective observational study.

Prz Gastroenterol 2020 9;15(3):234-240. Epub 2019 Oct 9.

Gastrointestinal Surgery Department, Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey.

Introduction: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines on gastroenterological endoscopy in patients undergoing antithrombotic therapy, although the safety of endoscopic procedures in patients receiving antithrombotic drugs has yet to be sufficiently studied.

Aim: This study evaluates the safety of upper gastroenterological endoscopic biopsy in patients receiving antithrombotic drugs. We evaluated the prospective observational safety of endoscopic biopsy performed in the endoscopy unit of our patients using antithrombotic drugs.

Material And Methods: Oesophagogastroduodenoscopies (OGD) and biopsies performed at a single endoscopy unit between July 2018 and February 2019 were examined in this prospective observational study. Patients receiving antithrombotic drugs due to cardiovascular and neurological reasons, who underwent an endoscopic mucosal biopsy for diagnostic purposes, were included in the study.

Results: The study was completed with 166 patients who underwent an endoscopic biopsy, from whom a total of 327 biopsies taken. The patients were examined in two groups: those "receiving antithrombotic drugs" and those who had "stopped taking antithrombotic drugs". There was no statistically significant difference between the two groups with respect to bleeding.

Conclusions: This prospective observational study showed that performing an endoscopic biopsy without the cessation of antithrombotic drugs does not increase bleeding risk. Low-risk procedures, such as endoscopic mucosal biopsies, can be performed confidently by experienced endoscopists.
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http://dx.doi.org/10.5114/pg.2019.88622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509902PMC
October 2019

The impact of sarcopenia on pathologic complete response following neoadjuvant chemoradiation in rectal cancer.

Langenbecks Arch Surg 2020 Dec 9;405(8):1131-1138. Epub 2020 Sep 9.

Department of Gastrointestinal Surgery, Kosuyolu Research and Education Hospital, University of Health Sciences, 34865, Istanbul, Turkey.

Purpose: The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR.

Methods: The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR.

Results: The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035).

Conclusion: Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer.
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http://dx.doi.org/10.1007/s00423-020-01983-zDOI Listing
December 2020

Endoscopic and histopathological features of the upper gastrointestinal system polyps: evaluation of 12.563 procedures.

Turk J Surg 2019 Jun 13;35(2):98-104. Epub 2019 Jun 13.

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Merkezi, Gastroenteroloji Cerrahi Kliniği, İstanbul, Türkiye.

Objectives: With the widespread use of esophagogastroduodenoscopy (EGD) in recent years, upper gastrointestinal system polyps have started to be encountered more often. Although most patients with gastric polyps are asymptomatic, these are important due to their malign potential, and gastric cancer may develop if left untreated.

Material And Methods: Records of 12.563 patients who underwent EGD at Kartal Kosuyolu High Specialization Health Application and Research Center for any reason between January 2013 and June 2016 were reviewed retrospectively. Patients with at least 1 histopathologically proven polyp were included in this study.

Results: A total of 12.563 endoscopic procedures of the upper gastrointestinal system were investigated and 353 (2.8%) polypoid lesions were detected. Mean age of these patients was 56.3 years and 241 (68.3%) of the patients were female. Gastric polyps were found most commonly in the antrum (50.1%) and of all gastric polyps, 245 (69.5%) were less than 1 cm. Histopathological evaluation showed that hyperplastic polyp (HP) (n= 151, 42.8%) was the most common polyp type, followed by fundic gastric polyp (FGP) (n= 51, 14.4%). Non-polyp gastric mucosa evaluation of 298 patients revealed that 34.9% of the cases were Helicobacter pylori positive, 19.4% had intestinal metaplasia, and 11.4% had atrophic gastritis.

Conclusion: Polyps of the upper gastrointestinal system are generally detected coincidentally as they have no specific symptoms. Polypectomy is required for gastric polyps because of their potential for malign transformation according to medical evidence.
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http://dx.doi.org/10.5578/turkjsurg.4155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796076PMC
June 2019

The prognostic value of different lymph node classification systems in stage III colorectal cancer patients.

Ann Ital Chir 2020 ;91:504-511

Aim: Prognostic significance assessment of different lymph node classification systems in stage III colorectal cancer patients.

Material And Methods: A total of 85 stage III colorectal cancer patients, who had undergone surgery between January 2013 and December 2018, were divided into 3 different groups comprising of lymph node ratios (LNR) and log odds of positive lymph nodes (LODDS) as per the cutoff values of 25 and 75 percentile threshold values. They were accordingly classified as: LNR1 <0.069, LNR2 0.069-0.24, LNR3 >0.24 and LODDS1 <-0.99; -0.99≥ LODDS2 <-0.47; LODDS3 ≥-0.47. Further the LNR was assessed according to the cutoff values proposed by Berger et al. The pN statuses of all patients were also categorized as pN1 and pN2 in line with the AJCC 8th Edition. The Kaplan-Meier test and Cox regression analysis were performed to analyze the relationship among the LNR, LODDS, pN and overall survival.

Results: While 55 patients included in the study had tumors in their colons, the localization of the tumors of 30 patients was the rectum. The means for survival time was 63.3 months +/- 3.6 [95% CI(56.2-70.4)]. When univariate analyses were conducted for the factors affecting 3 and 5-year survival of the patients, it was ascertained that there was a significant relationship only between perineural invasion (PNI) and survival. Accordingly, the 3-year survival of those with PNI was found to be 31.4% in comparison to 56% of those without PNI (p=0.025), while the figure was 5.7% for the 5-year survival of the former group and 22% for the latter (p=0.040). When the relation between the survival time of the patients and the LNR classification conducted according to the staging system developed by Berger et al. was studied, no significant relationship could be found (p>0.05). Similarly, and 0.321 respectively.

Conclusion: Although numerous studies have shown that there was a significant relationship between high LNR and increased survival, as opposed to the results of our study, the greatest obstacle before LNR's survival prediction is the absence of a consensus for standard cutoff values.

Key Words: Colorectal cancer, Lymph node classification systems, Lymph node ratio.
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January 2020

Spontaneous splenic rupture related to anticoagulant and antiaggregant treatment.

Prz Gastroenterol 2019 5;14(2):152-156. Epub 2019 Jul 5.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition.

Aim: To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons.

Material And Methods: The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well.

Results: Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61-73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients.

Conclusions: Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels.
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http://dx.doi.org/10.5114/pg.2019.85900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791140PMC
July 2019

Mixed germ cell tumor of metastatic undescended testicle causing major GIS bleeding.

Urol Case Rep 2019 May 20;24:100868. Epub 2019 Mar 20.

Pathology Department, Kartal, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.eucr.2019.100868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562312PMC
May 2019

Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center.

North Clin Istanb 2018 Sep;5(3):221-226

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Objective: The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery.

Methods: Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without.

Results: A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393).

Conclusion: IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.
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http://dx.doi.org/10.14744/nci.2017.80774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323563PMC
September 2018

Closure of non-healing perianal Crohn's disease with surgery and vacuum-assisted closure (VAC) system.

Turk J Gastroenterol 2018 05;29(3):367-369

Department of Gastrointestinal Surgey, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2018.17138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284670PMC
May 2018

Gastric cancer with situs inversus totalis: does it really create difficulties for surgeons?

Prz Gastroenterol 2018 26;13(1):47-51. Epub 2018 Mar 26.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Situs inversus totalis (SIT) is a very rare condition that is seen at a rate of one in about 6000-8000 births.

Aim: To offer a general view on the coexistence of SIT and gastric cancer, accompanied by a literature review.

Material And Methods: Within the scope of this study, the case of a patient with gastric adenocarcinoma and SIT has been presented. Previous research on gastric cancer cases with SIT was reviewed through a comprehensive search of the PubMed, Medline, and Google Scholar databases. The keywords used to conduct this research were "situs inversus totalis and gastric cancer," "situs inversus totalis and gastric malignant," and "situs inversus totalis and gastric resection." The database search covered English studies published between 2000 and 2016.

Results: The results of our literature review revealed 20 studies of patients with gastric cancer and SIT, and 21 related cases. Overall, 12 of the patients were male, 9 were female, and their mean age was 61.8 ±10.97 years. The vascular assessment data showed that three out of the 13 mentioned cases had vascular anomalies. Eleven of the patients had laparoscopic resections, and one of the patients that had a surgical procedure exhibiting a postoperative mechanical obstruction.

Conclusions: The coexistence of SIT and gastric cancer is a very rare condition, and a careful preoperative radiological assessment should be conducted because there can be accompanying vascular anomalies. Laparoscopies and robotic surgeries can be performed for suitable patients at experienced centres, consistent with oncological principles.
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http://dx.doi.org/10.5114/pg.2018.74563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894452PMC
March 2018

Emergency abdominal surgery in patients with left ventricular assist device: short- and long-term results.

Postepy Kardiol Interwencyjnej 2017 29;13(4):313-319. Epub 2017 Nov 29.

Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: Emergency abdominal surgery (EAS) in patients with long-term mechanical circulatory support and strong anticoagulation is very difficult.

Aim: To present our experiences regarding the short- and long-term results of patients with a left ventricular assist device (LVAD) who underwent emergency abdominal surgery under general anesthesia at a large tertiary healthcare center.

Material And Methods: The electronic medical records of 7 patients with LVAD who underwent EAS between January 1, 2010 and December 31, 2016 were retrospectively investigated in order to evaluate perioperative management and outcomes. The patients were divided into two groups based on the need for EAS procedures.

Results: Seven (9.2%) of 76 patients with LVAD underwent EAS an average of 79.1 ±79.4 days after implantation. No statistically significant differences were found between the groups with and without EAS with regard to demographic characteristics, type of device, and rate of perioperative mortality ( > 0.05). The indications for surgery, retroperitoneal hematoma in 2 patients and in 5 other patients; ileus, iatrogenic splenic injury associated with thoracentesis, splenic abscess, acute abdominal pain and rectal cancer surgery was a pelvic abscess in a patient who is connected to the stump. In all cases laparotomy was performed with median incision. The perioperative mortality rate was 28.6% ( = 2). Two patients underwent orthotopic heart transplant during long-term follow-up.

Conclusions: The EAS is not rare during LVAD treatment but is a rather complex procedure. General surgeons will be increasingly likely to encounter such patients as their numbers rise and their life expectancies are prolonged.
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http://dx.doi.org/10.5114/aic.2017.71613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770862PMC
November 2017

Emergency cases following elective colonoscopy: Iatrogenic colonic perforation.

Turk J Surg 2017 1;33(4):248-252. Epub 2017 Dec 1.

Department of Gastroenterology Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.

Objective: Our aim in this study was to present the cases of our patients who contracted colonic perforation during elective colonoscopy and became emergency cases; we also discuss treatment modalities along with literature reports on the subject.

Material And Methods: Cases of patients who contracted iatrogenic colonic perforation following endoscopy of the colorectal system between January 2009 and December 2015 at Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital's Endoscopy Unit were reviewed retrospectively.

Results: Within the duration of the study, 5.586 patients underwent colonoscopies at our hospital; 7 (0.12%) of these patients contracted iatrogenic colonic perforation. Three (42.8%) of these patients were male, four (57.2%) were female, and their mean age was 69 years (46 to 84). Six (85.7%) patients were diagnosed intraoperationally, while one (14.3%) patient was diagnosed 12 hours after the procedure. The perforation area was the sigmoid colon in six patients and the ascending colon in one patient; all patients underwent surgery. Four patients were discharged with no complications. One of the remaining three patients had enterocutaneous fistula, one had acute renal failure, and one died of sepsis.

Conclusion: The progress of perforation due to colonoscopy varies according to the underlying diseases, the mechanism of perforation formation, the treatment modality used, and the experience of the physicians treating the patient. Special attention should be paid to senior and comorbid patients receiving therapeutic procedures during colonoscopy.
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http://dx.doi.org/10.5152/UCD.2016.3572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731559PMC
December 2017

A New Laparoscopic Manoeuvre in Median Arcuate Ligament Syndrome.

Balkan Med J 2017 12;34(6):590-592

Department of Gastroenterological Surgery, University of Health Sciences, Kartal Koşuyolu High Specialized Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.4274/balkanmedj.2017.0596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785670PMC
December 2017

Cause of mortality in aortoesophageal fistula: oesophageal sepsis. A case report.

Prz Gastroenterol 2017 30;12(3):222-225. Epub 2017 Sep 30.

Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality Education and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2017.70476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672711PMC
September 2017

Spontaneous rectus sheath hematoma in cardiac in patients: a single-center experience.

Ulus Travma Acil Cerrahi Derg 2017 Nov;23(6):483-488

Department of Gastroenterological Surgery, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul-Turkey.

Background: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.

Methods: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.

Results: Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32-84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality.

Conclusion: RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.
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http://dx.doi.org/10.5505/tjtes.2017.67672DOI Listing
November 2017

Factors affecting treatment, management and mortality in cases of retroperitoneal hematoma after cardiac catheterization: a single-center experience.

Postepy Kardiol Interwencyjnej 2017 25;13(3):218-224. Epub 2017 Sep 25.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

Introduction: There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports.

Aim: To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC).

Material And Methods: The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis.

Results: Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) ( = 0.043), duration of hospitalization ( = 0.007), and mortality rates ( = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors.

Conclusions: Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops.
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http://dx.doi.org/10.5114/aic.2017.70189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644040PMC
September 2017

Does antiaggregant administration lead to early diagnosis in proximal colon cancer?

North Clin Istanb 2017 26;4(2):173-179. Epub 2017 Aug 26.

Department of Gastroenterology Surgery, Kosuyolu High Speciality Training and Research Hospital, Kartal, Istanbul, Turkey.

Objective: Cancers of the proximal colon are often diagnosed in advanced stages with iron deficiency anemia and nonspecific symptoms. Aspirin and clopidogrel are commonly used antiaggregant agents for various clinical conditions. The aim of this study was to investigate the effects of antiaggregant medication on the early diagnosis of proximal colon cancer.

Methods: Cases of colon cancer patients who had received curative surgical procedures between January 1, 2013 and July 31, 2016 were retrospectively reviewed. The clinical and pathological results of patients who had used antiaggregant drugs were compared to those who had not.

Results: During the studied period, 246 colorectal cancer patients underwent curative surgical procedures. Of the 67 patients with proximal colon cancer who were included in the study, 27 (40.3%) had taken antiaggregant medication. The mean age of the antiaggregant group was 67.1 years (range: 34-88 years), while it was 58.3 years (range: 34-83 years) for the non-antiaggregant group; the difference between the 2 groups was statistically significant (p=0.03). A pathological evaluation revealed that 74.1% of the antiaggregant group was in the early stages (Stage I/II: 7/13), while 42.5% of the non-antiaggregant group was in the early stages (Stage I/II: 2/15); the difference was statistically significant (p=0.011).

Conclusion: Antiaggregant medication has a positive effect on diagnosing proximal colon cancer at early stages. Patients using aspirin or clopidogrel should undergo a complete colonoscopic evaluation in the presence of gastrointestinal tract bleeding or newly developed anemia.
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http://dx.doi.org/10.14744/nci.2017.80148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613266PMC
August 2017

Postrenal acute kidney injury and abdominal compartment syndrome associated with bladder pressure: type III rectus sheath hematoma.

Arch Med Sci Atheroscler Dis 2017 13;2(1):e1-e2. Epub 2017 Mar 13.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/amsad.2017.66479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596111PMC
March 2017

Anticoagulant-induced breast hematoma.

Ulus Travma Acil Cerrahi Derg 2017 Jan;23(1):72-73

Department of Gastroenterology Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul-Turkey.

Warfarin is the most commonly used oral anticoagulant and is widely prescribed to prevent thromboembolic events. Warfarin-dependent spontaneous breast hematoma is a very rare complication. Presently described is rare case of warfarin-induced breast hematoma.
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http://dx.doi.org/10.5505/tjtes.2016.01657DOI Listing
January 2017

Laparoscopic treatment of a mesenteric cyst.

Prz Gastroenterol 2016 8;11(2):143-4. Epub 2016 Feb 8.

Gastroenterological Surgery Department, Kartal Koşuyolu Education and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5114/pg.2015.55187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916233PMC
June 2016