Publications by authors named "Eren Esen"

27 Publications

  • Page 1 of 1

Small Bowel to Ileal-Pouch Anastomosis as a Pouch Salvage Procedure in Crohn's Disease.

Dis Colon Rectum 2021 May 11. Epub 2021 May 11.

Surgery Department NYU Langone Health Inflammatory Bowel Disease Center, NYU Langone Health.

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http://dx.doi.org/10.1097/DCR.0000000000001940DOI Listing
May 2021

Hand-Sewn Versus Stapled Ileal Pouch Anal Anastomoses in Re-Do Setting: Indications, Patient Characteristics, Operative, Functional and Quality of Life Outcomes.

Dis Colon Rectum 2021 Apr 26. Epub 2021 Apr 26.

Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, NY, NY, USA Department of Surgery, Acibadem Mehmet Ali Aydinlar School of Medicine, Istanbul, Turkey.

Background: Impact of the type of anastomosis on the outcomes of re-do ileal pouch anal anastomosis (IPAA) is unknown.

Objective: The aim of this study is to assess the indications, peri-operative and functional outcomes in patients undergoing stapled vs hand-sewn re-do IPAA.

Design: This is a retrospective cohort study.

Settings: This investigation is based on a single-academic practice group experience on re-do IPAA.

Patients: Patients who underwent re-do IPAA for ileal pouch failure between 09/2016 - 05/2020 were included in the study.

Main Outcome Measures: Indications, perioperative, functional outcomes, restrictions and quality of life scores were compared between stapled and hand-sewn groups.

Results: A total of 105 patients underwent re-do IPAA for ileal pouch failure of whom 76 (72%) had hand-sewn and 29 (28%) had stapled re-anastomosis. The interval between the index and re-do IPAA was shorter in stapled re-do IPAA [median (IQR), Stapled: 3 years (1-4) vs hand-sewn: 7 years (3-17), p<0.001]. Hand-sewn anastomosis was more commonly used after pelvic sepsis [hand-sewn: n=57 (76%) vs stapled: n=13 (45%), p=0.002]. Overall postoperative morbidity was similar between the two groups [hand-sewn: n=38 (50%) vs stapled: n=16 (55%), p=0.635]. The number of bowel movements, pad use, daily restrictions and CGQL scores were similar between stapled and hand-sewn groups. While day-time seepage was more common after hand-sewn anastomosis [hand-sewn, n=20 (44%) vs stapled, n=3 (14%), p=0.013], night-time seepage was similar in both groups. Pouch survival rates were comparable and 88% vs 92% respectively (p>0.05).

Limitations: This study is limited by its low study power and limited follow-up time.

Conclusions: Patients who had pelvic sepsis after their index IPAA required hand-sewn anastomosis at higher rate than other re-do cases. Although hand-sewn anastomosis is a more complex procedure, it was associated with similar morbidity, functional outcomes and quality of life scores compared to stapled anastomosis for re-do IPAA. See Video Abstract at http://links.lww.com/DCR/B580.
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http://dx.doi.org/10.1097/DCR.0000000000001963DOI Listing
April 2021

Ileal Pouch Excision can Be Performed With Similar Outcomes in Obese Patients Compared to Nonobese Counterparts: An Assessment From American College of Surgeons National Surgical Quality Improvement Program.

Am Surg 2021 Apr 15:31348211011121. Epub 2021 Apr 15.

Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.

Background: Failed pouches may tend to be managed with only a loop ileostomy in obese patients due to some safety concerns. The effect of obesity on ileal pouch excision outcomes is poorly studied. In our study, we aimed to assess the short-term outcomes after ileal pouch excision in obese patients compared to their nonobese counterparts.

Methods: The patients who underwent pouch excision between 2005 and 2017 were included using ACS-NSQIP participant user files. The operative outcomes were compared between obese (BMI ≥30 kg/m) and nonobese (BMI<30 kg/m) groups.

Results: There were 507 pouch excision patients included of which eighty (15.7%) of them were obese. Physical status of the obese patients tended to be worse (ASA>3, 56.3 vs 42.9%, = .027). There were more patients who had diabetes mellitus (DM) and hypertension (HT) in the obese group (26.3% vs. 11.2%, = .015; 11.3 vs. 4.4%, < .001, respectively). Operative time was similar between 2 groups (mean ± SD, 275 ± 111 vs. 252±111 minutes, = .084). Deep incisional SSI was more commonly observed in the obese group (7.5 vs 2.8%, = .038). In multivariate analysis, only deep incisional SSI was found to be independently associated with obesity (OR: 2.79, 95% CI: 1.02-7.67). Obese patients were readmitted more frequently than nonobese counterparts (28.3 vs 16%, = .035). The length of hospital stay was comparable [median (IQR), 7 (4-13.5) vs. 7 (5-11) days, = .942].

Conclusion: Ileal pouch excision can be performed in obese patients with largely similar outcomes compared to their nonobese counterparts although obesity is associated with a higher rate of deep space infection.
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http://dx.doi.org/10.1177/00031348211011121DOI Listing
April 2021

Tailored total neoadjuvant therapy for locally advanced rectal cancer: One size may not fit for all!

Colorectal Dis 2021 Apr 7. Epub 2021 Apr 7.

Department of Surgery, School of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

While current neoadjuvant protocols have proven benefits on local control for majority of patients with locally advanced rectal cancer, there are certain clinical conditions that require future advances for improving the outcomes. Total neoadjuvant therapy incorporates systemic chemotherapy planned within standard neoadjuvant protocols either before or after radiotherapy for locally advanced rectal cancer as a whole. Enhanced compliance with planned oncological therapy, tumour downstaging, administration of chemotherapy at the earliest time in the disease course to help assessing chemosensitivity are the proposed benefits of total neoadjuvant therapy in patients with locally advanced rectal cancer. Patient selection criteria for administration of total neoadjuvant therapy in the recent guidelines are unclear. Since current literature is inconclusive for the optimal sequence and type of radiotherapy and chemotherapy, premature incorporation of total neoadjuvant therapy for all locally advanced rectal cancers may result in overtreatment and subsequently toxicity. This article aims to discuss the current literature and to propose a future perspective by considering real-life scenarios reflecting patients' needs for treatment of locally advanced rectal cancer.
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http://dx.doi.org/10.1111/codi.15669DOI Listing
April 2021

Sustainable Fatty Acid Modification of Cellulose in a CO-Based Switchable Solvent and Subsequent Thiol-Ene Modification.

Biomacromolecules 2021 02 8;22(2):586-593. Epub 2020 Dec 8.

Institute of Biological and Chemical Systems - Functional Molecular Systems (IBCS-FMS), Karlsruhe Institute of Technology (KIT), Straße am Forum 7, 76131 Karlsruhe, Germany.

Searching for more sustainable materials as an alternative to petroleum-based products is of increasing interest due to different environmental issues. Cellulose and fatty acids are two very promising candidates for biobased material design. Herein, we report a sustainable synthesis of fatty acid cellulose esters (FACEs) via transesterification of cellulose with methyl-10-undecenoate in a CO-based switchable solvent system. FACEs with a degree of substitution between 0.70 and 1.97 were synthesized by simple variation of reaction parameters and characterized in detail. Subsequently, a FACE with a degree of substitution (DS) of 0.70 was modified via thiol-ene reaction, demonstrating an efficient and versatile method to tune the structure and properties of the new cellulose derivatives. Films were produced from each sample via solvent casting, and their mechanical properties were examined using tensile tests. Elastic moduli () ranging from 90 to 635 MPa and elongations at break between 2 and 23% were observed, depending on the DS of the FACE and the type of thiol employed for the modification. Finally, contact angle measurements confirmed an increase in the surface hydrophobicity (75-91°) for the thiol-ene-modified samples.
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http://dx.doi.org/10.1021/acs.biomac.0c01444DOI Listing
February 2021

Association of Malnutrition with Postoperative Outcomes after Ileal Pouch-Anal Anastomosis.

J Gastrointest Surg 2021 Jun 12;25(6):1562-1564. Epub 2020 Nov 12.

Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA.

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http://dx.doi.org/10.1007/s11605-020-04861-7DOI Listing
June 2021

Reporting Templates for Magnetic Resonance Imaging and Water Soluble Contrast Enema in Patients with Ileal Pouch Anal Anastomosis: Experience from a Large Referral Center.

AJR Am J Roentgenol 2020 Sep 16. Epub 2020 Sep 16.

NYU Langone Health.

Ileal pouch anal anastomosis (IPAA) is gold standard surgical procedure for treatment of ulcerative colitis and majority of patients with familial adenomatous polyposis. This procedure allows preservation of fecal continence and gastrointestinal continuity. However, it is associated with a wide variety of complications, which often have nonspecific and overlapping clinical presentations, making imaging an important part of work up for pouch dysfunction. The purpose of this article is to propose structured reporting templates for Magnetic Resonance Imaging (MRI) and Water Soluble Contrast Enema (WSCE) in IPAA patients based on our referral pouch center's experience. Included will be a review of salient surgical technique, pouch anatomy and imaging protocols, with an emphasis on systematic search pattern for evaluation of ileal pouch complications using proposed structured reporting MRI and WSCE templates.
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http://dx.doi.org/10.2214/AJR.20.24031DOI Listing
September 2020

Operative and long-term oncological outcomes in patients undergoing robotic versus laparoscopic surgery for rectal cancer.

Int J Med Robot 2020 Dec 24;16(6):1-10. Epub 2020 Sep 24.

Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Background: This study aimed to compare short- and long-term outcomes after robotic versus laparoscopic approach in patients undergoing curative surgery for rectal cancer.

Methods: Patients undergoing elective robotic and laparoscopic resection for rectal cancer were included. Perioperative clinical characteristics, postoperative short- and long-term outcomes were compared between groups.

Results: There were 72 and 44 patients in robotic (RG) and laparoscopic (LG) groups respectively. No differences were detected regarding patients' demographics, histopathologic outcomes, conversion rates and 30-day overall postoperative complication rates. Operative time was longer in the RG (341 ± 111.7 vs. 263 ± 97.5 min, p = 0.001) and length of stay was longer in the LG (4.4 ± 1.9 vs. 6.4 ± 2.9 days, p = 0.001). The 5-year overall and disease-free survival rates were similar (97.1% and 94.9%, p = 0.78; 86.2% and 82.7%, p = 0.72) between the groups.

Conclusion: This study showed both short and long-term outcomes of a limited number of included patients between the robotic and laparoscopic surgery were similar. However, future studies and randomized trials are necessary to establish these findings.
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http://dx.doi.org/10.1002/rcs.2168DOI Listing
December 2020

Totally minimally invasive radical gastrectomy with the da Vinci Xi robotic system versus straight laparoscopy for gastric adenocarcinoma.

Int J Med Robot 2020 Dec 2;16(6):1-9. Epub 2020 Sep 2.

Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Background: Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi robotic system versus straight laparoscopy for gastric adenocarcinoma.

Methods: Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes.

Results: Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047).

Conclusion: Totally robotic technique with the da Vinci Xi robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.
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http://dx.doi.org/10.1002/rcs.2146DOI Listing
December 2020

Impact of Prolonged Neoadjuvant Treatment-surgery Interval on Histopathologic and Operative Outcomes in Patients Undergoing Total Mesorectal Excision for Locally Advanced Rectal Cancer.

Surg Laparosc Endosc Percutan Tech 2020 Dec;30(6):511-517

Acibadem Mehmet Ali Aydinlar University School of Medicine.

Background: This study primarily aimed to assess the impact of prolonged neoadjuvant treatment-surgery interval (PNSI) on histopathologic and postoperative outcomes. Impacts of the mode of neoadjuvant treatment (NT) and surgery on the outcomes were also evaluated in the same patient population.

Patients And Methods: Between February 2011 and December 2017, patients who underwent NT and total mesorectal excision for locally advanced rectal cancer were included. PNSI was defined as >4 and >8 weeks after short-course and long-course NT modalities, respectively.

Results: A total of 44 (27%) patients received short-course NT (standard interval: n=28; PNSI: n=16) and 122 (73%) patients received long-course NT (standard interval: n=39; PNSI: n=83). Postoperative morbidity was similar between the standard interval and PNSI in patients undergoing short-course [n=3 (11%) vs. n=3 (19%), P=0.455] and long-course [n=6 (15%) vs. n=16 (19%), P=0.602] NT. PNSI was associated with increased complete pathologic response in patients receiving short-course NT [0 vs. n=5 (31%), P=0.002]. Compared with short-course NT, long-course NT was superior in terms of tumor response based on the Mandard [Mandard 1 to 2: n=6 (21%) vs. 6 (38%), P=0.012] and the College of American Pathologists (CAP) [CAP 0 to 1: n=13 (46%) vs. n=8 (50%), P=0.009] scores. Postoperative morbidity was similar after open, laparoscopic, and robotic total mesorectal excision [n=1 (14.2%) vs. n=21 (21%) vs. n=6 (12.5%), P=0.455] irrespective of the interval time to surgery and the type of NT.

Conclusions: PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits. The mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.
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http://dx.doi.org/10.1097/SLE.0000000000000836DOI Listing
December 2020

Transabdominal Pouch Salvage for Failed Minimally Invasive Versus Open IPAA: A Case-Matched Study.

Dis Colon Rectum 2020 08;63(8):1102-1107

Department of Surgery, New York University Langone Health, New York, New York.

Background: Modality of index IPAA creation may affect the results after redo IPAA surgery for IPAA failure. To our knowledge, there is no study evaluating the effects of modality of index IPAA creation on redo IPAA outcomes.

Objective: This study aimed to compare short- and long-term outcomes of transabdominal redo IPAA surgery for failed minimally invasive IPAA and open IPAA.

Design: This was a retrospective cohort study.

Settings: This investigation was based on a single-surgeon experience on redo IPAA.

Patients: Patients undergoing transabdominal redo IPAA for a failed minimally invasive IPAA and open IPAA between September 2007 and September 2017 were included.

Main Outcome Measures: Short-term complications and long-term outcomes were compared between 2 groups.

Results: A total of 42 patients with failed index minimally invasive IPAA were case matched with 42 failed index open IPAA counterparts. The interval between index IPAA and redo IPAA operations was shorter in patients who had minimally invasive IPAA (median, 28.5 vs 56.0 mo; p = 0.03). A long rectal stump (>2 cm) was more common after minimally invasive IPAA (26% vs 10%; p = 0.046). Redo IPAAs were constructed more commonly with staplers in the laparoscopy group compared with open counterparts (26% vs 10%; p = 0.046), and other intraoperative details were comparable. Although short-term morbidity was similar between 2 groups, abscess formation (7% vs 24%; p = 0.035) was more frequent in patients who had index IPAA with open technique. Functional outcomes were comparable. Redo IPAA survival for failed minimally invasive IPAA and open IPAA was comparable.

Limitations: This study was limited by its retrospective, nonrandomized nature and relatively low patient number.

Conclusions: A long rectal cuff after minimally invasive IPAA is a potential and preventable risk factor for failure. Due to its technical and patient-related complexity, handsewn anastomoses in redo IPAA are associated with increased risk of abscess formation. See Video Abstract at http://links.lww.com/DCR/B252. RESCATE DEL RESERVORIO ILEO-ANAL POR VIA TRANSABDOMINAL EN CASOS DE FUGA ANASTOMÓTICA ENTRE ABORDAGE MINIMAMENTE INVASIVO Y ABORDAJE ABIERTO: ESTUDIO DE EMPAREJAMIENTO DE MUESTRAS Y CASOS: La creación de modalidades e índices de Reservorios Ileo-Anales (RIA) pueden afectar los resultados después de rehacer la cirugía de RIAs por fallas en el reservorio. Hasta donde sabemos, no hay ningún estudio que evalúe los efectos de la modalidad de creación de índices RIA en los resultados para el rescate del reservorio.Este estudio tuvo como objetivo comparar los resultados a corto y largo plazo de la cirugía transabdominal redo RIA en casos de fracaso por via mínimamente invasiva (MI-RIA) o por la vía abierta (A-RIA).Estudio de cohortes tipo retrospectivo.Investigación basada en la experiencia de un solo cirujano en redo del Reservorio Ileo-Anal.Se incluyeron aquellos pacientes sometidos a re-operación transabdominal y re-confección de un RIA por fallas en el MI-RIA y en el A-RIA durante un lapso de tiempo entre septiembre 2007 y septiembre 2017.Las complicaciones a corto plazo y los resultados a largo plazo se compararon entre los dos grupos.Un total de 42 pacientes con índice fallido de MI-RIA fueron emparejados con 42 homólogos con índice fallido de A-RIA. El intervalo entre las operaciones de RIA y redo RIA fué más corto en pacientes que tenían MI-RIA (mediana, 28,5 meses frente a 56 meses, p = 0,03). Un muñón rectal largo (> 2 cm) fue más común después de MI-RIA (26% vs 10%, p = 0.046). Redo RIAs se construyeron más comúnmente con engrampadoras en el grupo Minimalmente Invasivo en comparación con la contraparte abiertas (26% vs 10%, p = 0.046). Aunque la morbilidad a corto plazo fue similar entre los dos grupos, la aparición de abscesos (7% frente a 24%, p = 0.035) fue más frecuente en pacientes que tenían RIA con técnica abierta. Los resultados funcionales fueron comparables. La sobrevida de las redo RIAs para MI-RIA y A-RIA fallidas, también fué comparable.Este estudio estuvo limitado por su naturaleza retrospectiva, no aleatoria y el número relativamente bajo de pacientes.Un muñon rectal largo después de MI-RIA es un factor de riesgo potencial y previsible para el fracaso. Debido a su complejidad técnica y relacionada con el paciente, las anastomosis suturadas a mano en redo RIA están asociadas con un mayor riesgo de formación de abscesos. Consulte Video Resumen en http://links.lww.com/DCR/B252.
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http://dx.doi.org/10.1097/DCR.0000000000001609DOI Listing
August 2020

Is this patient's fistula caused by Crohn disease of the pouch?

JAAPA 2020 Jul;33(7):54-56

At the IBD Center at NYU Langone Health in New York City, Joanna Esterow is physician assistant, Eren Esen is a postdoctoral research fellow, and Feza Remzi is a professor of surgery and director of the IBD Center. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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http://dx.doi.org/10.1097/01.JAA.0000668856.35200.4bDOI Listing
July 2020

Live surgical demonstrations for minimally invasive colorectal training.

Langenbecks Arch Surg 2020 Feb 31;405(1):63-69. Epub 2020 Jan 31.

Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey.

Purpose: Live surgical demonstrations are considered an effective educational tool providing a chance for trainees to observe a real-time decision-making process of expert surgeons. No data exists evaluating the impact of live surgical demonstrations on the outcomes of minimally invasive colorectal surgery. This study evaluates perioperative and short-term postoperative outcomes in patients undergoing minimally invasive colorectal surgery in the setting of live surgical demonstrations.

Methods: Patients undergoing minimally invasive colorectal surgery which was performed as live surgical demonstrations (the study group) performed between 2006 and 2018 were reviewed. These patients were case-matched with those undergoing operations in routine practice (the control group). The study and control group were compared for intraoperative and short-term postoperative outcomes.

Results: Thirty-nine live surgery cases in the study group were case-matched with its thirty-nine counterparts as the control group. Operating time was longer (200 vs 165 min; p = 0.002) and estimated intraoperative blood loss was higher in the study group (100 vs 55 ml; p = 0.008). Patients in the study group stayed longer in the hospital (6 vs 5 days; p = 0.001). While conversion (n = 4 vs n = 1, p = 0.358) and intraoperative complications (n = 6 vs n = 2, p = 0.2) were more frequent in the study group, these outcomes did not reach statistical significance. Overall complications were higher in the study group (n = 22 vs n = 9, p = 0.003). One patient underwent a reoperation due to postoperative bleeding, and one mortality occurred in the live surgery group.

Conclusions: Live surgical demonstrations in minimally invasive colorectal surgery seem to be associated with increased risk of operative morbidity.
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http://dx.doi.org/10.1007/s00423-020-01858-3DOI Listing
February 2020

Management of Complicated Ostomy Dehiscence: A Case Study.

J Wound Ostomy Continence Nurs 2020 Jan/Feb;47(1):72-74

Ismail Ahmet Bilgin, MD, Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Background: Stoma creation is a common procedure in colorectal surgery. Despite improved surgical techniques, ostomy-related wound complications may prolong the recovery period and impair health-related quality of life. Negative pressure wound therapy (NPWT), autolytic debridement agents, and silver dressings are often used for managing complex wound infection and dehiscence. These applications have the potential to increase patient comfort and accelerate recovery.

Case: We report our experience in a 66 year old female who had a wound dehiscence involving the ostomy after robotic abdominoperineal resection. Her medical history was significant for a rectovaginal fistula which occurred after a low anterior resection for rectal cancer 5 years ago. Interventions for treatment of the dehiscence were use of NPWT, autolytic debriding agent, and silver dressing.

Conclusion: Combined use of these interventions for dehiscence of an ostomy can minimize patient discomfort and accelerate wound healing.
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http://dx.doi.org/10.1097/WON.0000000000000611DOI Listing
September 2020

Totally laparoscopic and totally robotic surgery in patients with left-sided colonic diverticulitis.

Int J Med Robot 2020 Feb 7;16(1):e2068. Epub 2020 Jan 7.

Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Background: Introduction of the da Vinci Xi system has facilitated the use of robotics in colorectal surgery. Nevertheless, data on the outcomes of robotic surgery for the treatment of colonic diverticulitis have remained scarce.

Methods: Patient demographics, clinical characteristics, and perioperative outcomes of the patients undergoing totally robotic with the da Vinci Xi system or laparoscopic surgery for left-sided colonic diverticulitis (LCD) were compared.

Results: Laparoscopic and robotic groups included 22 and 20 patients, respectively. There were no significant differences between the two groups in terms of patient demographics, clinical characteristics, operative time, and postoperative complications. There were three conversions in the laparoscopy group and no conversion in the robotic group (P = 0.23). Conversion to open surgery was associated with postoperative morbidity (P = 0.02).

Conclusion: Robotic surgery is an applicable alternative for the treatment of LCD. Robotic approach may potentially lower the risk of operative morbidity by reducing the requirement of conversion.
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http://dx.doi.org/10.1002/rcs.2068DOI Listing
February 2020

Thoughtful Ileostomy Creation in Patients Undergoing Redo IPAA.

Dis Colon Rectum 2020 01;63(1):117-120

Department of Surgery, New York University Langone Medical Center, New York, New York.

Introduction: Redo IPAA is a viable option to maintain intestinal continuity in patients with ileal pouch failure. Most patients with ileal pouch failure are physiologically and psychologically too deconditioned to undergo a 1- or 2-stage redo ileal pouch surgery, so a 3-staged redo ileal pouch surgery is needed. This consists of an initial proximal diverting loop ileostomy for 6 months, followed by redo ileal pouch construction with temporary stoma, and, lastly, stoma closure. The location of the initial diverting ileostomy is paramount, because 40% of cases will require pouch excision and construction of a de novo pouch, and a thoughtfully placed ileostomy will allow construction of a redo pouch without sacrificing any bowel length. In our report, we described our technique to create thoughtful ileostomy in patients who undergo redo IPAA.

Technique: We create a loop ileostomy ≈20 cm proximal to the existing ileal pouch, from the level of the tip of the J or the proximal inlet of an S-pouch. We call this a thoughtful ileostomy. By doing that, the thoughtful ileostomy site can be used as the apex of the new ileal pouch and become the ileal-anal anastomosis when a de novo ileal pouch needs to be constructed.

Results: We created a thoughtful ileostomy in 50 patients in the Inflammatory Bowel Disease Center at New York University Langone Health who either subsequently underwent or will undergo a redo IPAA between September 2016 and March 2019 (laparoscopic, n = 37; open, n = 13). Ten of the laparoscopic cases were preemptively converted to open because of dense adhesions.

Conclusion: A thoughtful ileostomy is important so as to not sacrifice bowel in patients being prepared for redo ileal pouch surgery. Initial diversion with thoughtful ileostomy 6 months before redo ileal pouch construction also allows patients to be prepared for a major operation both physiologically and psychologically.
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http://dx.doi.org/10.1097/DCR.0000000000001535DOI Listing
January 2020

Modification of Starch via the Biginelli Multicomponent Reaction.

Macromol Rapid Commun 2020 Jan 13;41(1):e1900375. Epub 2019 Sep 13.

Laboratory of Applied Chemistry, Institute of Toxicology and Genetics (ITG), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany.

An efficient and straightforward modification of starch using renewable and commercially available aromatic aldehydes (benzaldehyde, vanillin, and p-anisaldehyde) and urea via the Biginelli multicomponent reaction is reported in this work. First, starch acetoacetate (SAA) with a degree of substitution ranging from 1.4 to 2.5, depending on the reaction time or the molar ratio of reactants, is prepared. SAA is then modified with different aromatic aldehydes and urea via the Biginelli reaction. The modified products are characterized by ATR-IR, NMR, and gel permeation chromatography (GPC). The processability of the products is also investigated using a hot press instrument, revealing that glycerol is a suitable and renewable plasticizer for the Biginelli products.
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http://dx.doi.org/10.1002/marc.201900375DOI Listing
January 2020

Hand-Crafted Endoluminal Vacuum-Assisted Drainage for Anastomotic Leak After IPAA.

Dis Colon Rectum 2019 10;62(10):1259-1262

Department of Surgery, New York University Langone Medical Center, New York, New York.

Introduction: The vacuum-assisted drainage has many applications in managing complex wound healing. It quickens the recovery period by its hyperemic effect on the exposed zone, decreasing bacterial colonization, preventing tissue edema, and promoting granulation of the wound. However, its use in anastomotic leak after IPAA is scarcely studied, especially because a proprietary endoluminal vacuum-assisted closure system was removed from the US market.

Technique: We applied a hand-crafted endoluminal vacuum-assisted closure system using the existing standard wound vacuum-assisted closure supplies to 2 patients who developed an anastomotic leak with a presacral abscess after completion proctectomy with J-pouch construction.

Results: We changed the endoluminal vacuum-assisted closure drain every 2 to 3 days, and both patients had substantial improvements in their abscess cavity after the seventh and ninth applications.

Conclusions: Anastomotic leak at the IPAA traditionally takes up to a year to heal, which causes a significant toll on the psychosocial life of the patient and delayed stoma closure. Therefore, we believe that facilitating the healing process by using our hand-crafted endoluminal vacuum-assisted closure drain might provide a great value to patients' quality of life.
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http://dx.doi.org/10.1097/DCR.0000000000001453DOI Listing
October 2019

Transabdominal re-do pouch surgery in pediatric patients for failed ileal pouch anal anastomosis: a case matched study.

Pediatr Surg Int 2019 Aug 5;35(8):895-901. Epub 2019 Jun 5.

Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA.

Purpose: Data regarding safety and feasibility of re-do ileal pouch anal anastomosis (IPAA) for failed ileal pouch in children are limited. In this study, we compared the short- and long-term outcomes of re-do IPAA in pediatric and adult populations in a case-matched setting.

Methods: Between March 2007 and June 2017, pediatric patients undergoing a transabdominal re-do IPAA by single surgeon were reviewed and case matched with adult counterparts. Short- and long-term outcomes including complications, functional outcomes, and quality of life of the two groups were compared.

Results: 60 patients were included (pediatric, n = 30; adult, n = 30). Time between index IPAA and re-do IPAA was shorter in the pediatric group (30 ± 26 vs 86 ± 74 months, p = 0.001). In the pediatric population, the existing pouch was more commonly used to construct the re-do pouch (n = 19 vs n = 12, p = 0.07). There was a trend towards the presence of less postoperative complications in pediatric group (n = 13 vs n = 20, p = 0.07). There were no reoperations or mortality. Long-term pouch survival was comparable between two groups (p = 0.96). Six re-do IPAAs failed in the study period.

Conclusion: Re-do IPAA is safe and feasible in pediatric population with failed IPAA and can be performed with similar short- and long-term outcomes compared to adults in experienced hands.
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http://dx.doi.org/10.1007/s00383-019-04493-2DOI Listing
August 2019

Complete response after neoadjuvant treatment for rectal cancer.

Lancet 2019 04;393(10182):1694

Department of Surgery, Division of Colon and Rectal Surgery, New York University Langone Health, New York, NY, USA.

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http://dx.doi.org/10.1016/S0140-6736(18)33203-3DOI Listing
April 2019

Short-term Results After Totally Robotic Restorative Total Proctocolectomy With Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

Surg Laparosc Endosc Percutan Tech 2020 Feb;30(1):40-44

Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

In this study, we aimed to present our initial experience on totally robotic total restorative proctocolectomy in ulcerative colitis (UC) patients. Patients undergoing a totally robotic restorative total proctocolectomy with ileal J-pouch anal anastomosis for UC between January 2015 and November 2017 were included. The da Vinci Xi was used for the operations. Patient demographics, perioperative and short-term operative outcomes were evaluated. Ten patients were included. The median operative time was 380 minutes(range, 300 to 480 min). The median blood loss was 65 mL (range, 5 to 400 mL). No conversion to open surgery was needed. The median time to flatus was 1 day (range, 1 to 2) and length of stay was 6 (4 to 12) days. Short-term complications (≤30 d) were superficial wound infection (n=3), anal bleeding (n=1), pouchitis (n=1). No mortality was observed during the study period. Our study, which is the largest series so far, reveals that totally robotic restorative proctocolectomy is a safe and feasible option for the surgical treatment of UC.
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http://dx.doi.org/10.1097/SLE.0000000000000645DOI Listing
February 2020

Mapping of carbon monoxide related death risk in Turkey: a ten-year analysis based on news agency records.

BMC Public Health 2019 Jan 3;19(1). Epub 2019 Jan 3.

Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Koca Mustafa Paşa Mahallesi, Cerrahpaşa Caddesi No:53, 34096 Fatih, Istanbul, Turkey.

Background: Carbon-monoxide (CO) poisoning is a substantial cause of preventable mortality. In Turkey, no nationwide data are being collected nowadays. In our study, we aimed to assess the trend in deaths related to CO exposure in all provinces of Turkey in a 10-year period by using the records of a news agency which collects the news from the majority of the national newspapers, local newspapers and television channels.

Methods: In this study, 27,881 news items that were released between January 2008 to December 2017 which included keywords of "poisoning" and "death" or "carbon monoxide" and "death" were evaluated. 2667 non-fire related deaths were used in the final analyses.

Results: In a 10-year period, the risk of CO-related death in Turkey was 0.35/100000. 1371 (51.4%) of the victims were male and the median age of the patients was 45 years (range, 15 days-108 years). Most of the deaths occurred ≥50 years of age. Stoves were the predominant source [n = 2096 (78.6%)]. There was a stagnating trend of CO-related deaths. Most of the incidents occurred in winter. The Middle Anatolian region was of the highest risk in CO-related mortality.

Conclusions: In conclusion, CO poisoning is still a considerable public health concern in Turkey. Results of our study showed that stoves are still frequently being used and are the cause of death especially in rural areas with lower socioeconomic status. A better organized, nationwide surveillance and management approaches are needed to demonstrate the true burden CO related morbidity and mortality as well as its prevention in Turkey.
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http://dx.doi.org/10.1186/s12889-018-6342-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318903PMC
January 2019

En-Bloc Excision of the High-ligated Inferior Mesenteric Vein Pedicle With the Specimen in Patients Undergoing Minimally Invasive and Open Sphincter Saving Rectal Resections for Cancer.

Surg Laparosc Endosc Percutan Tech 2019 Feb;29(1):13-17

Departments of General Surgery.

Although high-ligated pedicle of the inferior mesenteric artery is usually kept in the resected specimens, the value of preserving high-ligated pedicle of the inferior mesenteric vein within the resected specimens of the sphincter saving rectal resections for cancer is not well defined. In the current study, patients undergoing open, laparoscopic, and robotic sphincter saving rectal resection for cancer were prospectively included. Lymph node invasion and presence of lymph nodes along the IMV pedicles were analyzed. In total 100 patients were included. There were lymph nodes in 63 patients at the IMV and 71 patients at the IMA pedicles. En-bloc removal of the high-ligated IMV pedicle with the resected specimen significantly increased the number of harvested lymph nodes(P<0.001) regardless of surgical modality (P=0.36). Although it increases the number of harvested lymph nodes with acceptable operative morbidity, no oncological benefits were found related to preservation of high-ligated pedicle of the inferior mesenteric vein within the resected specimen of the rectum.
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http://dx.doi.org/10.1097/SLE.0000000000000615DOI Listing
February 2019

Adoption of robotic technology in Turkey: A nationwide analysis on caseload and platform used.

Int J Med Robot 2019 Feb 17;15(1):e1962. Epub 2018 Oct 17.

Department of General Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.

Background: Limited data exist regarding adoption of evolving robotic technology in surgery. This study evaluated trends and the current condition of robotic platforms in surgical specialties and general surgical subspecialties.

Methods: Between January 2013 and December 2017, all robotic operations performed in Turkey were included.

Results: In the study period, 13 760 robotic operations were performed at 32 hospitals. The median numbers of general surgical procedures were 43and eight cases per hospital and per general surgeon, respectively. The high-volume general surgeons performed 1734 (81%) of the cases. Forty-five percent and 55% of the general surgical operations were performed with the Xi and S/Si robots, respectively.

Conclusion: Use of the Xi platform seems to increase caseload in general surgery operations possibly by facilitating robotic colorectal surgery. Targeting the high-volume centres and surgeons for further training and implantation of upcoming robotic technology can be more effective in terms of increasing case volume and improving outcomes.
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http://dx.doi.org/10.1002/rcs.1962DOI Listing
February 2019

Totally Robotic Versus Totally Laparoscopic Surgery for Rectal Cancer.

Surg Laparosc Endosc Percutan Tech 2018 Aug;28(4):245-249

Department of General Surgery, School of Medicine, Koç University, Istanbul, Turkey.

In this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index ≥30 kg/m), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001). In obese patients who underwent TME, the mean length of hospital stay was shorter (7±2 vs. 9±4 d, P=0.01), and the mean number of retrieved lymph nodes was higher (30±19 vs. 23±10, P=0.02) in the robotic group. Totally robotic and totally laparoscopic surgery appears to be providing similar outcomes in patients undergoing rectal resections for cancer. Selective use of a robot may have a role for improving postoperative outcomes in some challenging cases including obese patients undergoing TME.
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http://dx.doi.org/10.1097/SLE.0000000000000552DOI Listing
August 2018

Is Robotic Complete Mesocolic Excision Feasible for Transverse Colon Cancer?

J Laparoendosc Adv Surg Tech A 2018 Dec 7;28(12):1443-1450. Epub 2018 Jun 7.

1 Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is technically challenging. Robotic technology has been developed to reduce technical limitations of laparoscopy. Yet, no data are available on the role of robotic approach for CME of transverse colon cancer. The aim of this study is to evaluate the feasibility and short-term outcomes of robotic CME in this subset of colon cancer. A retrospective review of a prospectively maintained database of 29 consecutive patients undergoing robotic CME for transverse colon adenocarcinoma between December 2014 and December 2017 was performed. Data on demographics, tumor characteristics, postoperative 30-day complications, and oncologic outcomes were analyzed. There were 21 (72%) men and 8 women with a mean age of 62.9 ± 15.6 years and a body mass index of 26.4 ± 4.8 kg/m. Of the 29 robotic CME procedures, 12 patients underwent extended right colectomy, 10 extended left colectomy, 6 subtotal colectomy, and 1 total colectomy. The mean operative time was 321.7 ± 111.3 minutes and estimated blood loss was 106.9 ± 110.9 mL (median, 50; range, 10-400 mL). The intra- and postoperative complication rates were 7% and 24%, respectively. There were no conversions. The mean time to first bowel movement was 3.5 ± 1.3 and length of hospital stay was 7.1 ± 3.0 days. All the resections were R0. The mean number of harvested lymph nodes in extended and subtotal/total colectomy procedures was 36.6 ± 13.1 and 71.0 ± 30.3, respectively. The rate of mesocolic plane surgery was 79%. There were no statistically significant differences between the mesocolic and the intramesocolic/muscularis propria plane resections with respect to clinical characteristics, operative outcomes, and pathology results ( > .05). Robotic CME for transverse colon cancer is feasible and can be a procedure of choice to achieve a good surgical quality.
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http://dx.doi.org/10.1089/lap.2018.0239DOI Listing
December 2018

Transition from Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair to Robotic Transabdominal Preperitoneal Inguinal Hernia Repair.

World J Surg 2018 05;42(5):1559-1560

Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Acibadem Maslak Hospital, Buyukdere Caddesi No:40, 34457, Sariyer, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s00268-017-4250-xDOI Listing
May 2018