Publications by authors named "Hilmi Bozkurt"

20 Publications

  • Page 1 of 1

The risk factors of intraoperative hyperlactatemia in patients undergoing laparoscopic colorectal surgery.

Ann Ital Chir 2021 ;92:277-282

Aim: The aim of this study is to determine the incidence of intraoperative hyperlactatemia and its risk factors in patients undergoing laparoscopic colorectal surgery.

Material And Methods: We retrospectively enrolled 75 patients who underwent laparoscopic resection for colorectal cancer. Initial lactate levels were determined from blood gas analysis before the incision. The end lactate values were recorded after the termination of the pneumoperitoneum. Hyperlactatemia defined as lactate levels between 2 mmol/L and 5 mmol/L without evidence of acidosis. The patients were divided into two groups as normolactatemia and hyperlactatemia according to lactate values at the end of the surgery.

Results: Of the 75 patients, 45 (60.0%) had higher lactate levels than normal at the end of the surgery. The median age of the study population was 62 (24-84) years. Forty (53.3%) of the patients were male. Most of the patients in the study had colon cancer origin [56 cases (74.7%)]. Univariate logistic regression analysis for a possible independent risk factor in terms of hyperlactatemia showed that Charlson comorbidity index (CCI) ≥ 3, body mass index (BMI) ≥ 30 kg/m2, the operative time, and the tumor size were significant (p < 0.05). Multivariate analysis found that only BMI ≥ 30 kg/m2 and the operative time were significant (p = 0.004, and p < 0.001, respectively).

Conclusion: According to our work, obesity (BMI ≥ 30 kg/m2) and the operative time in laparoscopic colorectal surgery were independent risk factors for intraoperative hyperlactatemia at the end of the operation. Therefore, clinicians should be vigilant about the inevitable consequences of surgery by making appropriate preparation.

Key Words: Colorectal cancer, Lactate, Hyperlactatemia, Laparoscopy.
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January 2021

Vaginal cancer as a late complication of radiotherapy for endometrial cancer and ileo-perineal fistula after total pelvic exenteration.

J Gynecol Oncol 2021 Jul;32(4):e63

Department of Obstetrics and Gynecology, Karadeniz Technical University Hospital, Trabzon, Turkey.

Pelvic exenteration is a highly morbid operation and remains one of the most catastrophic surgical procedures in gynecological oncology. We would like to present the case of total pelvic exenteration for vaginal cancer after radiotherapy for endometrial cancer as a secondary cancer. A 62-year-old woman, whose gravida: 3, parity: 2, body mass index: 35.9 kg/m², presented with complaints of vaginal bleeding. She had undergone a surgery because of a stage IB grade 2 endometrioid-type adenocarcinoma seventeen years previously. Following the surgery, she had external pelvic radiotherapy and brachytherapy. A palpable, solid and ulcerative mass was detected extending from the vaginal cuff area to the vestibulum vagina on the left postero-lateral wall of the vagina. The 5-cm vaginal mass was seen at vaginal examination. A punch biopsy from a pathological examination of the tumoral lesion was reported as a squamous cell carcinoma. Pelvic exenteration was performed and ileo-perineal fistula occurred after six months this surgery. In conclusion, we considered that this malignancy was a secondary malignancy induced by radiotherapy.
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http://dx.doi.org/10.3802/jgo.2021.32.e63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192226PMC
July 2021

The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study.

Sao Paulo Med J 2021;139(3):218-225. Epub 2021 Mar 22.

MD. Professor, General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.

Background: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding.

Objectives: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy.

Design And Setting: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey.

Methods: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded.

Results: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05).

Conclusion: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.
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http://dx.doi.org/10.1590/1516-3180.2020.0305.R1.10122020DOI Listing
June 2021

Social attention of the top 50 scientific articles on gastric cancer: Bibliometric and altmetric analysis.

J BUON 2020 Sep-Oct;25(5):2322-2331

Department of General Surgery, Sehit Prof. Dr. Ilhan Varank Sancaktepe Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Purpose: Bibliometric and Altmetric analyse the most influental publications and provide important perspectives regarding article impact. The Altmetric Score (AS) is an automatically calculated metric for monitoring social media attention. The hypothesis is that would citation number correlate positively with AS?

Methods: Gastric cancer as a search term was entered into Thomson Reuter's Web of Science database to identify articles in the last decade. The 50 most cited articles were analysed by topic, journal, author, year, and AS.

Results: By bibliometric criteria, it was observed that there were 63,154 articles published in the literature on gastric cancer in the last decade. The most cited article was made by Bang et al for the treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer. The study with the highest altmetric score was published by Bass et al and described the molecular evaluation of gastric cancer as part of the cancer genome atlas. The majority of the top 50 most cited article types were original scientific papers (n=39). The highest number of publications was published in the Journal of Clinical Oncology (n=9) and the most contributing country was the United States (n=22). Positive correlation was detected between the number of citations and AS. We revealed a negative correlation between AS and numbers of years since publication of the article.

Conclusion: The remarkable result of this study is that both the citation and AS of the articles provide important but different viewpoints.
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December 2020

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

Surg Infect (Larchmt) 2021 Jun 11;22(5):551-555. 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
June 2021

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

Evaluation of patients undergoing emergency surgery in a COVID-19 pandemic hospital: a cross-sectional study.

Sao Paulo Med J 2020 Jul-Aug;138(4):305-309

MD. General Surgeon, Department of General Surgery, University of Health Sciences, Haseki Research and Education Hospital, Istanbul, Turkey.

Background: The COVID-19 pandemic is threatening healthcare systems and hospital operations on a global scale. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services, with greater changes seen especially in pandemic hospitals.

Objectives: To evaluate the follow-up of patients undergoing emergency surgery in our hospital during the COVID-19 pandemic.

Design And Setting: Cross-sectional study conducted in a tertiary-level public hospital.

Methods: The emergency surgeries carried out between March 11 and April 2, 2020, in the general surgery clinic of a tertiary-care hospital that has also taken on the functions of a pandemic hospital, were retrospectively examined.

Results: A total of 25 patients were included, among whom 20 were discharged without event, one remained in the surgical intensive care unit, two are under follow-up by the surgery service and two died. Upon developing postoperative fever and shortness of breath, two patients underwent thoracic computed tomography (CT), although no characteristics indicating COVID-19 were found. The discharged patients had no COVID-19 positivity at follow-up.

Conclusion: The data that we obtained were not surgical results from patients with COVID-19 infection. They were the results from emergency surgeries on patients who were not infected with COVID-19 but were in a hospital largely dealing with the pandemic. Analysis on the cases in this study showed that both the patients with emergency surgery and the patients with COVİD infection were successfully treated, without influencing each other, through appropriate isolation measures, although managed in the same hospital. In addition, these successful results were supported by 14-day follow-up after discharge.
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http://dx.doi.org/10.1590/1516-3180.2020.0181.r1.13052020DOI Listing
October 2020

Gastric mixed adeno-neuroendocrine carcinoma with a large cell neuroendocrine component A case reports.

Ann Ital Chir 2019 Nov 28;8. Epub 2019 Nov 28.

Digestive system carcinomas containing a neuroendocrine and an exocrine component are classified as mixed adenoneuroendocrine carcinomas(manec), as one of the component represents at least 30% of the whole lesion. We herein aim to contribute to literature by presenting our rare case of gastric manec. A 58-year-old male patient had a 3 cm mass placed in the antrum in his gastroscopy. The biopsy result was signet ring cell carcinoma. After that total gastrectomy with d2 lymph node dissection and roux-en-y oesophagojejunostomy was performed. The histopathology result was signet ring cell and mucinous adenocarcinoma with large cell neuroendocrine carcinoma component(manec). Manec, a rare type of biphasic tumor, usually has a poor prognosis regardless of its stage and location. This behavior is thought to be caused by the neuroendocrine component. It is vital to know the histopathology of the tumor in order to provide certain standards diagnosis and treatment management. KEY WORDS: Gastric cancer, MANEC, Mixed adenoneuroandocrine cancer.
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November 2019

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery.

Arch Med Sci 2021 9;17(2):361-367. Epub 2019 Oct 9.

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

Introduction: Studies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality.

Material And Methods: In this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC).

Results: The study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1-2 (minor) complications were not significantly different between the groups ( = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) ( = 0.016). Length of intensive care unit (ICU) stay was longer in SG ( = 0.002) and there was no difference between 1-month and 6-month mortality rates ( = 0.273 and = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008-9.174; = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078-9.803; = 0.036) were found to be independent risk factors for POMC.

Conclusions: This study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality.
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http://dx.doi.org/10.5114/aoms.2019.88621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959052PMC
October 2019

Duodenal obstruction due to aortoduodenal syndrome.

Ann Ital Chir 2019 Jul 8;8. Epub 2019 Jul 8.

Aorta-duodenal syndrome(ADS)is a fairly rare clinic presentation of duodenum obstruction caused by dilated abdominal aortic aneurysm. The main symptoms are usually nausea, vomiting and palpable pulsatile abdominal mass. When it comes to diagnosis, the most useful imaging technique is computed tomography(CT) and the best treatment option is surgery. KEY WORDS: Aortic aneurysm, Aortoduodenal syndrome, Duodenal obstruction.
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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

Factors Affecting the Development of Gallstones Following Laparoscopic Sleeve Gastrectomy.

Obes Surg 2019 10;29(10):3174-3178

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

Sleeve gastrectomy (SG) is a widely accepted procedure that has gained popularity among both bariatric surgeons and patients. There is still limited data in the literature on the formation of gallstones following laparoscopic sleeve gastrectomy, and so the present study determines the incidence of and potential risk factors related to the development of gallstones following laparoscopic sleeve gastrectomy. The data of patients who underwent laparoscopic sleeve gastrectomy at a single center due to morbid obesity between January 2014 and December 2017 was retrospectively reviewed and analyzed. The patients were divided into two groups, as those with gallstones detected on ultrasound at 12 months and those without gallstones. Data of the two groups was compared. BMI did not differ significantly between patients with positive (+) and negative (-) ultrasound findings (p > 0.05). Aside from age, hypertension, and coronary artery disease, other preoperative parameters showed no significant association with the development of gallstones in USG (-) and USG (+) patients. The present study identified no significant relationship between a decrease in BMI following LSG and the postoperative development of gallstones. Preoperative hypertension and coronary artery disease were found to be significantly related to the development of gallstones after surgery. The authors suggest that patients with preexisting CAD and hypertension in the preoperative period must be followed-up with ultrasound more meticulously.
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http://dx.doi.org/10.1007/s11695-019-03946-wDOI Listing
October 2019

Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: A prospective observational study.

Turk J Surg 2017 1;33(4):258-266. Epub 2017 Dec 1.

Department of Anesthesiology and Reanimation, Kars State Hospital, Kars, Turkey.

Objective: Despite the recent increase in the use of laparoscopic appendectomy procedures to treat acute appendicitis, laparoscopic appendectomy is not necessarily the best treatment modality. The aim of this study is to examine the value of laparoscopic intracorporeal knotting and glove endobag in terms of various parameters and in terms of reducing the costs related to laparoscopic appendectomy procedures.

Material And Methods: Seventy-two acute appendicitis patients who underwent laparoscopic appendectomy and open appendectomy surgery were enrolled in the study and were evaluated prospectively. The patients were divided into two groups: group 1 was treated with laparoscopic appendectomy using laparoscopic intracorpreal knotting and glove endobag (n=36) and group 2 was treated with open appendectomy (n=36). The two groups were statistically compared in terms of preoperative symptoms and signs, laboratory and imaging findings, operation time and technique, pain score, gas and stool outputs, duration of hospital stay, return to normal activity, and complications.

Results: No statistically significant differences were found between the groups in relation to gender, age, body mass index, or pre-operation findings, which included loss of appetite, vomiting, time when pain started, displacement of pain, defense, rebound, imaging methods, and laboratory and pathology examinations (p>0.05). Moreover, there were no differences between the groups with respect to drain usage, hospital stay time, or complications (p>0.05). In contrast, a statistically significant difference was found between the groups in terms of operation time, pain scores, gas-stool outputs, and return to normal activity in the laparoscopic appendectomy group (p=0.001).

Conclusion: Laparoscopic appendectomy can be performed in a facile, safe, and cost-effective manner with laparoscopic intracorporeal knotting and glove endobag. By using these techniques, the use of expensive instruments can be avoided when performing laparoscopic appendectomy.
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http://dx.doi.org/10.5152/turkjsurg.2017.3583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731561PMC
December 2017

Comparison of 1869 thyroid ultrasound-guided fine-needle aspiration biopsies between general surgeons and interventional radiologists.

Ann Med Surg (Lond) 2016 Sep 2;10:92-102. Epub 2016 Aug 2.

Health Sciences University Adana Numune Training and Research Hospital, Department of Interventional Radiology, Adana, Turkey.

Background: Thyroid nodules are commonly encountered problems in clinical practice. For patients who have a thyroid nodule, the fine-needle aspiration biopsy (FNAB) is the most important test, as it is the most reliable diagnostic method for distinguishing between benign thyroid nodules and cancerous nodules. FNAB is able to be performed either via an ultrasound (USG) or alone and is the first choice when it comes to diagnosing thyroid nodules, given that it is cheap, safe and provides accurate results.

Objective: In this study-a retrospective analysis of FNAB via USG - our aim is to evaluate the multiple variables related to FNAB procedures, including the experience of the person performing the biopsy, the age and gender of the patient, the number of nodules, the size of the nodule(s) and the number of lams recorded from the cytopathology report on non-diagnostic rates, conducted at an invasive radiology clinic and at a general surgery clinic.

Materials And Methods: A total of 1062 patients involving 1869 nodules, examined using FNAB via USG, were reviewed retrospectively from records dated between November 2011 and July 2014 and from pathology reports taken from the ANEAH General Surgery clinic and Interventional Radiology clinic. Cytopathology results were classified according to the 2007 Bethesda System for Reporting. Gender, age, number of nodules, diameter of the nodules, biopsied nodules, location of the nodules, number of lams, symptoms and the date of biopsies were the parameters used to examine the factors involved in non-diagnostic cytopathology invasive radiology. These parameters were inspected at both of the clinics (ANEAH General Surgery clinic and Interventional Radiology clinic). In analyzing the results, the statistical significance level was set at 0.05, where in cases that the p value was under 0.05 (p < 0.05), it was determined that no significant relationship existed. In this study, data were analyzed using SPSS 20 software.

Results: Of the nodules reviewed, 1620 were found on females and 249 on males. The age of the patients ranged from 10 to 87 years, with the mean age being 50 years. In the general surgery clinic, 470 nodules of 341 patients were aspirated, and in the interventional radiological clinic, 1399 nodules of 721 patients were aspirated. In the literature review conducted to compare statistical assessments of FNAB via USG, no significant difference was found between the ANEAH General Surgery clinic and the Invasive Radiology clinic (p > 0.05). In the invasive radiology clinic, non-diagnostic rates decreased with the increase in experience of the person who conducted the biopsy (p = 0.001).

Conclusion: The results from both of the clinic's rates of non-diagnostic FNAB, performed via USG, were found to be acceptable. Our study also demonstrates that USG-guided FNAB can be performed with a low non-diagnostic rate as experience grows.
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http://dx.doi.org/10.1016/j.amsu.2016.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995479PMC
September 2016

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: a prospective clinical study.

Ulus Travma Acil Cerrahi Derg 2015 Jan;21(1):51-6

Department of General Surgery, Adana Numune Training and Research Hospital, Adana.

Background: This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively.

Methods: Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947).

Results: Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%.

Conclusion: Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.
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http://dx.doi.org/10.5505/tjtes.2015.64505DOI Listing
January 2015

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature.

Int J Surg Case Rep 2014 16;5(12):909-13. Epub 2014 Oct 16.

Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.

Introduction: Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.

Presentation Of Case: Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.

Discussion: PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.

Conclusion: In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.
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http://dx.doi.org/10.1016/j.ijscr.2014.09.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275820PMC
December 2014

ULTRAPRO Hernia System versus lichtenstein repair in treatment of primary inguinal hernias: a prospective randomized controlled study.

Int Surg 2014 Jul-Aug;99(4):391-7

1 General Surgery Department, Numune Training and Research Hospital, Adana, Turkey.

The Lichtenstein repair has been recommended as the gold standard for inguinal hernia repair. However, postoperative discomfort still constitutes a concern and an area for improvement. New mesh materials have been continuously introduced to achieve this goal. The goal of the present study was to investigate the outcomes of ULTRAPRO Hernia System (UHS) compared with Lichtenstein mesh repair. A total of 99 male patients with primary unilateral inguinal hernia were included in the study during the period of September 2010-January 2012. Patients with body mass index>30, comorbid diseases, and anesthetic risk of ASA-III and ASA-IV were excluded. The patients were randomly allocated to operation with the Lichtenstein technique (group L) or UHS. Demographics, operative and postoperative/recovery data, and short- and medium-term outcomes of the patients were recorded. A total of 50 patients in group L and 49 patients in group UHS were analyzed. The median follow-up time for the study was 33 months. There were no significant differences regarding demographics, complications, and rehabilitation between the groups. Overall, there was a prolonged operation time in the UHS group compared with the L group (UHS: 53.7±5.7 minutes; L: 44.5±5.5 minutes; P<0.001). UHS may provide results similar to those for the Lichtenstein technique in open repair of inguinal hernias regarding perioperative course, complications, recovery, and recurrence rates. However, because of reduced costs and the lack of need for the exploration of the preperitoneal space, we conclude that the Lichtenstein technique should be recommended as the first choice.
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http://dx.doi.org/10.9738/INTSURG-D-14-00064.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114367PMC
October 2015

Diathermy versus scalpel in Limberg flap in pilonidal sinus surgery. A prospective randomized trial.

Ann Ital Chir 2014 Mar-Apr;85(2):148-52

Background: Rhomboid excision with Limberg flap repair (RELIF) is an effective surgical procedure in pilonidal sinus disease (PSD) treatment. This study aimed to compare outcome of diathermy and scalpel in RELIF procedure in PSD surgery.

Methods: Patients undergoing RELIF procedure due to PSD at Adana Numune Training and Research Hospital between January 2012 and September 2012 were randomly assigned to diathermy (n=30) or scalpel (n=30) groups. The primary outcomes measured were duration of operation, drainage volume, postoperative numerical pain intensity scale (NPIS) scores, complications, duration of hospitalization length and time to return to daily activity.

Results: The mean age was 26.2 years (17-44 years). The mean operation duration was significantly lower in diathermy group (p=0.0001). Postoperative total NPIS score within the first 24 h was significantly lower in diathermy group (p=0.001). However, there were not any significant differences in term of NPIS scores in day 3 and day 7. There were no significant differences in terms of total drain output, drain removal time and length of hospital stay. There were no significant differences between groups in terms of duration to sit comfortably, return to daily activity and work. Recurrence of PSD was emerged in one patient in the diathermy group.

Conclusion: Diathermy dissection in RELIF procedure in pilonidal sinus surgery is a safe technique and decreased operation time and postoperative pain.
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August 2015

Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis.

World J Gastroenterol 2013 Dec;19(47):9057-62

Hasan Erdem, Süleyman Çetinkünar, Koray Daş, Enver Reyhan, Cumhur Değer, Mehmet Aziret, Hilmi Bozkurt, Selçuk Uzun, Selim Sözen, Oktay İrkörücü, Department of General Surgery, Adana Numune Training and Research Hospital, Adana 01240, Turkey.

Aim: To assess the reliability and practical applicability of the widely used Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems in patients with suspected acute appendicitis.

Methods: Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group. Patients were divided into two groups. appendicitis group (Group A) consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis, and non-appendicitis group (Group N-A) consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively. The operative findings for the patients, the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.

Results: One hundred and thirteen patients with suspected acute appendicitis were included in the study. Of the 113 patients (62 males, 51 females), the mean age was 30.2 ± 10.1 (range 18-67) years. Of the 113 patients, 94 patients underwent surgery, while the rest were followed non-operatively. Of the 94 patients, 77 patients were histopathologically diagnosed with acute appendicitis. Our study showed a sensitivity level of 81% for the Alvarado system when a cut-off value of 6.5 was used, a sensitivity level of 83.1% for the Ohmann system when a cut-off value of 13.75 was used, a sensitivity level of 80.5% for the Eskelinen system when a cut-off value of 63.72 was used, and a sensitivity level of 83.1% for the RIPASA system when a cut-off value of 10.25 was used.

Conclusion: The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.
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http://dx.doi.org/10.3748/wjg.v19.i47.9057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870559PMC
December 2013

Virginal Breast Hypertrophy and Symptomatic Treatment: A Case Report.

J Breast Health 2014 Apr 1;10(2):122-124. Epub 2014 Apr 1.

Department of General Surgery, Adana Numune Education and Research Hospital, Adana, Turkey.

Virginal breast hypertrophy is a rare benign disease. It is characterized by rapid and excessive growth of one or two breasts during peripubertal period. There is no specific treatment algorithm, subcutaneous mastectomy and prosthesis replacement, reduction mammoplasty, medical treatment with particularly tamoxifen are all recommended in the literature. Unfortunately, all treatment methods have some disadvantages in this patient group who have not completed their sexual and physical maturation. Although these treatments are usually required, it should be noted that spontaneous remission could rarely be seen in virginal hypertrophy. We aimed to present a case of virginal hypertrophy, in whom symptomatic treatment has been used and breast growth regressed spontaneously.
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http://dx.doi.org/10.5152/tjbh.2014.1552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351470PMC
April 2014
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