Publications by authors named "Orcun Yalav"

22 Publications

  • Page 1 of 1

Laparoscopic revisional surgery for failed anti-reflux procedures.

Ann Ital Chir 2021 Mar 2;10. Epub 2021 Mar 2.

Aim: Failure ratio of an anti-reflux surgery is 2-17% in adults. After unsuccessful fundoplications, if necessary, revisional surgeries can be performed. Revisional surgeries are technically difficult to perform and require professionally advanced experience. On the other hand, it is still controversial which technique should be used in revisional surgery. The aim of this study is to present our experience with revisional surgical procedures for complications or recurrences after anti-reflux surgeries.

Material And Metods: A total of 18 patients, 16 of whom were referred to our clinic from other centers, and who underwent revisional surgery for failed fundoplication between 2014 and 2019 were retrospectively analyzed RESULTS: Five patients were male and 13 were female. The mean age was 40.3±11.7 years. The most common symptom was the persistence of reflux symptoms (61.2%). Indications for revisional surgery were recurrent hiatal hernia in 10 patients, thightness in 4 patients, mesh migration in 2 patients, mesh migration with recurrent hiatal hernia in 1 patient, and mesh migration with thightness in 1 patient. The mean operative time was 107.2+29.2 minutes. The median hospital stay was 2.9 days (range: 1-6 days). The most common surgical procedure performed was the repair of hiatal crura with mesh, and reconstruction of fundoplication and fixation of neo-fundoplication to the right crus (44.4%). In addition, other surgical procedures performed were takedown of the previous fundoplication (16.6%), takedown of the previous fundoplication and reconstruction of fundoplication (11.1%), cruroplasty and fundoplication with gastric wedge resection (11.1%), removal of the mesh and takedown of the previous fundoplication (5.6%), removal of sutures from the hiatal crura (5.6%), and gastric wedge resection (5.6%). Four patients (27.8%) developed morbidity due to gastric perforation and pleural opening during these procedures. The median follow-up period was 29 months (range: 6-69 months). Two cases (11.1%) who underwent revisional surgery failed, and re-revisional surgery was performed.

Conclusions: Revisionary surgical procedures performed for failed anti-reflux surgery are not limited to re-fundoplication. Different procedures such as takedown of the previous fundoplication, reconstruction of fundoplication, removal of the mesh, removal of the sutures or wedge resection may be necessary. These procedures can successfully be performed laparoscopically by experienced surgeons in well-equipped centers.

Key Words: Fundoplication, Gastroesophageal reflux, Laparoscopy, Revisional Surgery, Antireflux surgery.
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March 2021

Laparoscopic versus open complete meso-colic excision for right-sided colon cancer. Analysis of short-term outcomes.

Ann Ital Chir 2021 ;92:48-58

Scopo Dello Studio: L'emicolectomia destra per escissione mesocolica completa (EMC) laparoscopica mostrerebbe benefici comparabili a breve termine, nonché esiti patologici e oncologici per la chirurgia a cielo aperto. Lo scopo di questo studio era di confrontare la tecnica laparoscopica e la EMC aperta per i tumori del colon sul lato destro in termini di campioni patologici e risultati a breve termine.

Materiale E Metodi: I dati dei pazienti sottoposti a EMC laparoscopica (n=31) e EMC aperto (n=35) per adenocarcinoma del colon destro tra gennaio 2016 e giugno 2019 sono stati analizzati retrospettivamente. Sono stati confrontati dati demografici, parametri preoperatori, peroperatori e postoperatori e campioni di patologia dei due gruppi.

Risultati: Non ci sono state differenze statistiche tra il gruppo laparoscopico di EMC e il gruppo aperto di EMC in termini di età, sesso, indice di massa corporea, posizione del tumore, punteggio dell'American Society of Anesthesiologists (ASA), presenza di comorbidità, storia di altre neoplasie e precedente chirurgia addominale (p>0,05). I pazienti nel gruppo EMC laparoscopico presentavano lunghezze d'incisione più brevi, tempi operativi più lunghi, minore perdita di sangue operativa, tempi di mobilizzazione più brevi, recupero precoce del movimento intestinale, tempo più breve per dieta leggera, durata ridotta della degenza e dimensioni del tumore più piccole (p<0,05). Il numero medio di linfonodi raccolti in gruppi laparoscopici e di EMC aperti non era statisticamente significativo (29,83+8,90 e 31,34+13,10, rispettivamente). Non ci sono state differenze statistiche in termini di lunghezza del campione tra i gruppi laparoscopici e aperti di EMC (35,19+9,8 cm e 32,71+11,12 cm, rispettivamente). Il tasso di complicanze postoperatorie di 30 giorni era più elevato nel gruppo EMC aperto (35,5% contro 42,9%, rispettivamente), ma non statisticamente significativo (p>0,05).

Conclusioni: Patologici (lunghezze dei campioni, lunghezze dei margini di resezione, numero di linfonodi e resezione R0) e risultati a breve termine del gruppo laparoscopico di EMC erano comparabili. Inoltre, la EMC laparoscopica ha conferito benefici a breve termine in termini di lunghezze di incisione più brevi, minore perdita di sangue operativa, riduzione dei tempi di mobilizzazione, recupero precoce dei movimenti intestinali, minor tempo di dieta leggera e riduzione della durata della degenza ospedaliera. Sulla base di questi risultati, la EMC laparoscopica può essere considerata come un approccio elettivo di routine per il carcinoma del colon destro.
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January 2021

Laparoscopic versus open total radical gastrectomy for advanced gastric cancer: surgical outcomes.

Ann Ital Chir 2020 Sep 28;9. Epub 2020 Sep 28.

Aim: The aim of this study is to compare the oncologic efficacy of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) for gastric cancer and to provide our experiences regarding this surgery.

Methods: A total of 107 patients who underwent curative total gastrectomy for gastric adenocarcinoma between September 2015 and September 2018 were included in this study. Demographic characteristics, operative parameters, histopathological results, postoperative morbidity and mortality results of the patients were evaluated.

Results: Of 107 patients, 70 were men and 37 women. OTG consisted of 89 patients and LTG consisted of 18 patients. The mean age in OTG was 59.4 years, the mean age in LTG was 57.3 years. The mean number of lymph nodes harvested was 30.5±14.6 in OTG and 33.0±10.1 in LTG. The number of metastatic lymph nodes harvested was 7.4±10.5 in OTG and 10.0±11.8 in LTG (p= 0.366), and there was no statistical difference between the two groups. The time of onset of oral intake, anastomotic leakage, and postoperative mortality was similar in both groups. Operative duration and length of hospital stay were significantly higher in LTG. Postoperative survival duration was similar in both procedures CONCLUSION: Laparoscopic total gastrectomy for gastric cancer is an oncologically safe procedure but had a longer operation time and a longer hospital stay. There was no significant difference number of harvested lymph nodes, number of metastatic lymph nodes, and tumor localization between the two groups KEY WORDS: Gastric cancer, Laparoscopy, Gastrectomy.
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September 2020

The importance of anorectal physiology tests in clinical diagnosis and treatment.

Ann Ital Chir 2020 Sep 29;9. Epub 2020 Sep 29.

Aim: In this study, we aimed to convert subjective findings to objective findings and to determine the effect of anorectal physiology tests on the diagnosis and treatment of patients with defecatory complaints.

Material And Method: Two hundred and forty patients who applied to the proctology unit between January 2015 and August 2017 were included in our study. The patients were divided into 3 groups based on their presentation complaints; Group 1: Obstructive defecation syndrome(ODS), Group 2: Peroperative except anal incontinence and control after sphincter repair, Group 3: Anal incontinence.Group 2 and Group 3 were divided into subgroups. The demographic data of the patients were retrospectively analyzed. The number of anorectal physiological tests in groups and the rates of referral to surgical or medical treatment were evaluated.

Findings: Two hundred and forty patients were included in our study. The highest mean age was in Group 3 (46.2±17.8) (p: 0.356) 43.3% of the patients in our study were female. Anorectal manometry was performed in all patients. Endoanal USG was most commonly performed in Group 2 (42.6%, p:0.013), defecography in Group 1 (47.4%, p: 0.0001), and EMG in Group 3(25.3%, p: 0,001). In Group 1, 33% of the patients with pathological defecography findings had surgical treatment (p<0.05). In Group 2a, the rate of surgical treatment was higher in patients who underwent anal USG with anorectal manometry (%25.6vs %40). In Group 3, the rate of surgical treatment was higher in patients who underwent anal ultrasound with manometry (%1.9 vs %32.6 p<0.005) DISCUSSION: Anorectal physiological tests are important for accurate diagnosis and treatment planning. The combined use of anorectal physiological tests in anal incontinence groups increased the rate of referral to surgical treatment.
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September 2020

Evaluation of factors related to Clavien Dindo 3 and above complications in patients undergoing gastrectomy due to gastric cancer.

Ann Ital Chir 2020 ;91:617-626

Aim: In our study, we aimed to evaluate the complications after total gastrectomy by Clavien-Dindo classification and to determine the related risk factors.

Methods: Patients who underwent total gastrectomy due to gastric cancer between 2015-2019 were included in the study. Patients were divided into two groups according to postoperative complication classification Clavien Dindo, those with 3 or higher were Group 1 and the others were Group 2. Demographic and clinical features, laboratory parameters, tumor characteristics, postoperative results and mean survival were compared in the groups. Risk factors for Clavien Dindo 3 and above were analyzed by univariate analysis and multivariate logistic regression analysis.

Results: A total of 104 patients participated in our study. Group1 consisted of 25 and Group2 consisted of 79 patients. Male sex was high in both groups (52% vs67.1%, p:0.130). BMI (26 vs 23, p:0.023), albumin (3.24 vs 3.51, p:0,040), postoperative mortality (%28vs% 2.5, p:0.001), postoperative duration of hospitalization (17.60vs9.25 days, p:0.000) were different between the groups, but total survival (month) was not statistically significantly different (19.60vs18.53, p:0.377). In multivariate analysis, tumor Stage 3C (OR =0.177,95% CI = (0.067-0.468), p:0.000), operation duration ≥240 min (OR =2.105,95% CI = (1.080-4.100, p:0.029) and application of neoadjuvant treatment (HR =3.026,95%CI =(1.682-5.446), p:0.000) were indepent risk factors DISCUSSION: In conclusion, obesity, hypoalbuminemia, anemia, tumor stage, duration of operation, and taking neoadjuvant therapy were closely related to postoperative complications. Although the development of postoperative complication increased the length of hospitalization and postoperative mortality, it did not decrease survival in the long term.

Key Words: Gastric cancer, Postoperative complication, Total gastrectomy.
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January 2020

Giant pedunculated colonic lipoma causing colo-colic intussusception in a patient with mechanical ileus.

Ann Ital Chir 2020 Mar 3;9. Epub 2020 Mar 3.

A giant colonic lipoma causing colo-colonic intussusception is extremely rare in adults. A 35-year-old woman visited our emergency room with abdominal pain, abdominal distension, nausea and vomiting. Physical examination showed a painful distended abdomen. Abdominal computed tomography revealed that there was a soft-tissue mass with a fat density of approximately 6 cm in diameter in the distal part of the transverse colon. Since the clinical presentation was that of a mechanical ileus, a laparotomy was performed. An intussusception was detected in the transvers colon. A soft and mobile mass was palpated in the transverse colon. Therefore, an extended right hemicolectomy with ileo-transversostomy was performed. Pathological examination revealed a giant pedunculated lipoma of 7 cm in diameter with no evidence of malignancy. Colonic lipomas are the third most common benign pathology seen in the colon. They are more common in women with a peak incidence between 50 and 60 years of age. The most common site of lipomas in the large bowel is the right hemicolon. Colonic lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. Colonic lipoma causing colo-colic intussusception is extremely rare in the current literature. Surgical approach remains the treatment of choice for giant colonic lipomas. A colonic lipoma causing colo-colic intussusception should be considered in the differential diagnosis of mechanical bowel obstruction. The most important factor for establishing the diagnosis of intussusception caused by a colonic lipoma is awareness of the possibility, especially in adult patients with abdominal symptoms and episodes of intestinal obstruction. KEY WORDS: Colon, Lipoma, Colonic lipoma, Intussusception, Intestinal obstruction, Ileus.
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March 2020

Retrorectal tumor: a single-center 10-years' experience.

Ann Surg Treat Res 2020 Aug 31;99(2):110-117. Epub 2020 Jul 31.

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Purpose: Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution.

Methods: A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated.

Results: Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma.

Conclusion: RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.
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http://dx.doi.org/10.4174/astr.2020.99.2.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406398PMC
August 2020

A prospective comparative study of contrast-enhanced CT, contrast-enhanced MRI and 18F-FDG PET/CT in the preoperative staging of colorectal cancer patients.

Ann Ital Chir 2020 ;91:658-667

Aim: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to perform the most specific treatment. In this study, we aimed to evaluate the accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of regional lymph node metastases (RLNMs) and the additional value of PET/CT in the preoperative staging of colorectal cancer.

Material And Methods: From June 2015 to May 2018, 72 colorectal cancer patients were preoperatively examined using CT, MRI, and PET/CT. Histopathological examination of regional lymph nodes were performed in 53 patients who underwent colorectal surgery. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of CT, MRI, and PET/CT for RLNMs, and the additional value of PET/CT in distant metastases were determined.

Results: There were 44 male and 28 female in our study. The mean age was 61±11 years. Histopathologically, 27 patients (51%) were negative and 26 patients (49%) were positive for RLNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 88.5%, 59.3%, 67.6%, 84.2%, and 73.6%, respectively. PET/CT changed the patient management with diagnostic contribution to the suspicious lesions identified by radiological imaging modalities.

Conclusion: PET/CT is a useful tool in the evaluation of colorectal cancer, and it allows to metabolically characterize undetermined lesions suspected for recurrence of disease, to perform a complete pre-surgical staging and to identify occult metastatic disease. PET/CT should be considered an essential diagnostic tool in the management of patients with colorectal cancer, especially in the preoperative staging.

Key Words: Colorectal Cancer, Computed tomography, Magnetic resonance imaging, Positron emission tomography.
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January 2020

Primary mesenteric fibromatosis: A single Center experience.

Ann Ital Chir 2020 ;91:283-290

Aim: Primary mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. In this study, we aimed to present our surgical approach, tumor characteristics, clinical presentation and long-term follow-up results in cases of primary mesenteric fibromatosis.

Material And Metods: The data collected from 11 patients who underwent surgery due to primary mesenteric fibromatosis in our clinic between 2010 and 2019 were analyzed retrospectively.

Results: Abdominal ipain, abdominal distention, and two patients (18.2%) were operated on with a diagnosis of acute abdomen in the emergency setting due to mechanical bowel obstruction in one patient There were 11 patients in our study. Six patients were female and 5 were male. The mean age was 44.2±15.8 years. Abdominal mass was detected in 5 patients (45.5%) who had complaints of mechanical bowel obstruction such as nausea and vomitingand gastrointestinal perforation in other patient. Mesenteric mass was detected in 3 patients (27.3%) with vague abdominal pain. One patient (9.1%) presented with abdominal pain and swelling of the right leg. After a mean follow-up period of 43.4±28.4 months, only 1 patient (9.1%) had recurrence and required reoperation approximately 80 months after the first operation. One patient (9.1%) died of anastomotic leakage and sepsis in the first 30 days postoperatively, and other patient (9.1%) idied of other reasons 1 year later postoperatively.

Conclusions: Although mesenteric fibromatosis is a benign tumor pathologically, the main principle in the treatment of this tumor which is clinically aggressive and has high recurrence rate is wide surgical resection. Mesenteric fibromatoses have a varied clinical presentation. Radiological imaging methods helps diagnosis and planning the surgical treatment. Immunohistochemical characteristics confirms the diagnosis and differentiates from other similar tumors.

Key Words: Desmoid tumor, Fibromatosis, Mesentery, Mesenteric tumor,Mesenteric fibromatosis.
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January 2020

The effect of anorectal manometric examination on the surgical treatment plan in chronic anal fissure.

Ann Ital Chir 2021 ;92:59-63

Introduction: Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure.

Material And Methods: Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined.

Results: 20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p>0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p>0.05).

Conclusion: In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly.

Key Words: Anal fissure, Anal incontinence, Anal manometry.
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January 2021

Short-term results of adipose-derived stem cell therapy for the treatment of complex perianal fistula A single center experience.

Ann Ital Chir 2019 ;90:583-589

Background: In this study, we aimed to investigate the early results of the safety and efficacy of adipose-derived stem cells (ADSCs) injection along with the repair of the internal orifice in the recovery of complex perianal fistula.

Methods: The study included patients who underwent autologous adipose tissue-derived stemcell injection for complex perianal fistula between December2017 and January2018. The FDA-approved Lipogems® system was used to prepare autologous micro-fragmented adipose stem cells. Demographic characteristics, history of inflammatory bowel disease, fistula type and length of fistula tract determined by endoanal ultrasound, mean operation duration, postoperative complications, and fistula healing of the patients were evaluated. Fistula healing was evaluated on the 30th ,90th days and 9th months.

Results: A total of 10 patients, with male predominance, were included in our study. The mean age was 47±13.1 and mean BMI was 28.3±4.79. None of the patients had inflammatory bowel disease Based on endoanal ultrasound findings, fistula type was transsphincteric, extrasphincteric and suprasphincteric for 7, 2 and 1 patients, respectively. Calculated length of fistula tract based on ultrasound was 4.45±1.69(2.5-6.4). Mean duration of operation was 45±7 minutes. None of the patients had any treatment related toxicity, however, two patients experienced bruising at the liposuction site. Healing rate in the follow-up of 30-day, 90-day and 9-month was 70%, 80% and 70%, respectively.

Conclusions: In addition to surgical treatment in the form of curettage and closure of the fistula tract, autologous micro-fragmented adipose tissue injection is a safe, feasible, and reproducible procedure that can be performed based on the early results in complex anal fistula healing.

Key Words: Lipogems®, Mesenchymal stem cell, Regenerative medicine, Adipose tissue-derived mesenchymal stem cell.
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July 2020

Primary actinomycosis of the breast in postmenopausal women.

Ann Ital Chir 2019 Dec 20;8. Epub 2019 Dec 20.

Introduction: Actinomycosis is a chronic infection caused by actinomyces species characterized by an abscess formation, tissue fibrosis, and draining sinuses. Primary actinomycosis of the breast is rare.

Patients And Methods: In this paper we present a 64-year-old postmenopausal woman. For the diagnosis of primary actinomycosis of the breast, mammography, ultrasonography, MRI, and histopathologic examinations are required. Microbiological culture and histopathology are of the most importance during the process of diagnosis. In our case, at the intersection of the sternum and the lower inner quadrant of the right breast, there was a 1 cm wide fistula opening, and an abscess. A. israelii has been isolated from the microbiological culture taken from the lesion RESULTS: An optimal surgical resection of infected tissues has been performed as the treatment with the wound left open for tertiary healing The patient was given sulbactam 4*1 gr/day intravenously for 4 weeks post-op.. Recurrence was not detected during the yearly follow up procedures CONCLUSIONS: Actinomycosis should be considered when differentially diagnosing clinical instances of suppurative or granulomatous infections of the breast and mass regions that can't be ruled out as malignancies. Early diagnosis will save the patient from unnecessary surgical operations and ineffective antibiotic treatments.

Key Words: Actinomycosis, Breast abscess, Breast diseases.
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December 2019

Is radioguided occult lesion localization (ROLL) an effective and reliable method in thyroid cancer and parathyroid redo surgery?

Ann Ital Chir 2019 Nov 19;8. Epub 2019 Nov 19.

Objective: The aim of this study is to share the efficacy of the radionuclide occult lesion localization (ROLL) technique in secondary neck exploration in patients who had undergone neck exploration due to thyroid or parathyroid pathology and to share our clinical experience.

Material And Method: Data of 25 patients who underwent secondary neck exploration for recurrent thyroid cancer and parathyroid adenoma between January 2016 and December 2018 at the General Surgery Clinic of Balcalı Hospital, Çukurova University Faculty of Medicine were collected retrospectively. On the operation day, 0.5 mCi Tc-99m macroaggregate albumin was injected into the lesion under ultrasound guidance (USG). Nerve monitoring was used in all patients.

Results: Twenty-five patients (21 females, 4 males) were included in the study. The mean age of the patients was 54.5 (24-79) years. Five patients were operated for parathyroid adenoma, 6 patients for papillary cancer after subtotal thyroidectomy, 13 patients for papillary cancer recurrence, 2 patients for medullary cancer recurrence, 2 patients for papillary cancer cervical lymph node metastasis and 1 patient for anaplastic cancer recurrence.Mean operative time was 100.6 min (60-160 min). Two patients had transient hypocalcemia and no other complications were seen. Parathyroid hormone (PTH) levels in patients with hyperparathyroidism, Thyroglobulin (Tg) levels in patients with recurrent papillary cancer, were significantly lower than preoperative levels (p<0.05).

Conclusion: We believe that ROLL technique reduces the complication rate by decreasing dissection time and width. We recommend using it for thyroid cancer and parathyroid redo surgery.

Key Words: Parathyroid redo surgery, Radioguided surgery, Thyroid cancer.
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November 2019

Aggressive angiomyxoma of the pelvis presenting as an obturator hernia.

Ann Ital Chir 2019 Nov 10;8. Epub 2019 Nov 10.

İNTRODUCTION : Angiomyxoma is a rare slow-growing soft tissue myxoid cell tumor that usually arises in the pelvis and perineal regions and occurs predominantly in women in the fourth decade. Angiomyxomas usually present as often initially misdiagnosed asymptomatic masses. Most common clinical early diagnoses of aggressive angiomyxomas are in form Of Vulvar Masses, Vulvar Lipomas, Bartholin's Cysts, Levator Hernias, Inguinal Hernias Or Cervical Polyps.

Patients And Methods: This paper presents the case of the pelvic angiomyxoma diagnosis of a 41 year old with early findings of suspicious obturator hernia during the initial physical examination.

Results: The dissection was extended from the right retrorectal area to the ischiorectal cavity and the mass was reached. The capsulated mass of 10*15 cm with soft consistency was completely released and unblocked, it was excised from the abdomen through the incision using wound protection The obturator defect was repaired with interrupted sutures.

Conclusions: Angiomyxoma is a rare, benign and locally aggressive tumor, which can infiltrate locally and present unusually as perineal hernia. Due to its rarity and lack of specific diagnostic requirements, it's difficult to diagnose preoperatively KEY WORDS: Angiomyxoma, Obturator hernia, Pelvic mass.
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November 2019

BRCA mutation characteristics in a series of index cases of breast cancer selected independent of family history.

Breast J 2019 09 22;25(5):1029-1033. Epub 2019 Jun 22.

Faculty of Medicine, Medical Genetics Department of Balcali Clinic and Hospital, Cukurova University, Adana, Turkey.

Certain genetic predisposition factors, such as BRCA1 and BRCA2 mutations play a pivotal role in familial breast cancer development in both males and females. Due to this, the importance and necessity of genetic screening to identify mutations affecting the population is paramount. Undergoing genetic screenings allows for a more knowledgeable risk assessment for the patients and their care providers. The aim of this study was to evaluate the prevalence of BRCA1/BRCA2 mutated genes in the Turkish population among unselected patients. To identify the molecular markers, we utilized a gene panel analysis consisting of BRCA1 and BRCA2 genes, with a next generation sequencing platform (MiSeq System, Illumina). Sequencing was performed using leukocyte DNA from breast cancer patients. In-silico analysis for novel mutations was carried out using SIFT, PolyPhen2 and MutationTaster. BRCA1 and BRCA2 pathogenic variants were identified in 18 of 129 (14%) patients among the study population; of those 18 patients, seven (39%) were found in the BRCA1 gene and 11 (61%) in the BRCA2 gene. Ten of the eleven BRCA2 variants (90%) were novel mutations. Four of ten (40%) of the novel mutations were determined to be deleterious and six out of ten (60%) were identified as single nucleotide variations. Clinically significant mutations of the BRCA1/BRCA2 genes are related to an increased susceptibility for breast cancer. There is however, little known about BRCA mutations amongst the general population. Thus, it is important that patients are able to undergo genetic screenings and counseling. This also allows for greater care from health care providers and can only facilitate disease prevention which in turn can lead to a decreased cancer morbidity rate.
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http://dx.doi.org/10.1111/tbj.13400DOI Listing
September 2019

Primary gastric tuberculosis mimicking gastric cancer.

Ulus Cerrahi Derg 2015 1;31(3):177-9. Epub 2015 Sep 1.

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.
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http://dx.doi.org/10.5152/UCD.2014.2667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605117PMC
October 2015

Comparison of early surgical alternatives in the management of open abdomen: a randomized controlled study.

Ulus Travma Acil Cerrahi Derg 2015 May;21(3):168-74

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS.

Methods: The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared.

Results: Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group.

Conclusion: Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.
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http://dx.doi.org/10.5505/tjtes.2015.09804DOI Listing
May 2015

A rare cause of bile duct obstruction in adolescence: Neuroendocrine tumor.

Turk J Gastroenterol 2014 Dec;25 Suppl 1:311-2

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Extrahepatic bile duct is one of the rare places for neuroendocrine tumors which comprise 0.2-2% off all neuroendocrine tumors of gastrointestinal tract. The aim of this paper is to report a case of a 16-year-old boy with a neuroendocrine tumor of extra hepatic bile duct. Laboratory and imaging findings is supported obstructive jaundice. After a pre-operative detailed evaluation, the common bile and common hepatic duct with gallbladder were resected and Roux-en-Y hepaticojejunostomy was performed. After a 36 months follow up, no locoregional recurrence or metastatic disease was observed. Pre-operative diagnosis of neuroendocrine tumors are extremely difficult and often confused with cholangiocarcinoma. Treatment modality of this rare entity depends on the location of the tumor and aggressive surgery is still the best chocie of treatment. It should be kept in mind that disease-free survival for patients with neuroendocrine tumor depends on success of surgery.
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http://dx.doi.org/10.5152/tjg.2014.3565DOI Listing
December 2014

Unusual Presentation of Meckel's Diverticulum: Gangrene due to Axial Torsion.

Case Rep Emerg Med 2015 22;2015:571847. Epub 2015 Feb 22.

Department of General Surgery, Cukurova University Medical Faculty, 01330 Adana, Turkey.

Meckel's diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel's diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection.
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http://dx.doi.org/10.1155/2015/571847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352490PMC
March 2015

The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study.

Ulus Travma Acil Cerrahi Derg 2014 Sep;20(5):343-52

Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. The role of inflammatory markers (Procalcitonin (PCT), C-reactive Protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis was evaluated in this study.

Methods: On the preoperative and first, third, fifth, seventh, and fourteenth postoperative days, PCT, CRP, and thyroid hormone concentrations were measured in serum taken from eighty-four consecutive patients who were operated on for secondary peritonitis between January 2008 and January 2010. All data was entered and analyzed using the Statistical Package for Social Sciences, version 15.0 and clinical parameters were compared using the student's t-test.

Results: For the groups diagnosed with perforated viscus, PCT concentrations were significantly low in contrast to high thyroid hormone levels in patients who developed postoperative complications or died when compared to patients whose postoperative course was uneventful or discharged. The PCT concentration significantly correlated with the CRP concentration and WBC count.

Conclusion: In the absence of postoperative complications, PCT is a better predictor of outcome than CRP in secondary peritonitis. Our study showed that a low thyroid hormone level can serve as an important prognostic parameter of disease severity in secondary peritonitis.
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http://dx.doi.org/10.5505/tjtes.2014.98354DOI Listing
September 2014

A rare cause of obstructive jaundice: Fasciola hepatica mimicking cholangiocarcinoma.

Turk J Gastroenterol 2012 ;23(5):604-7

Department of General Surgery, Çukurova University School of Medicine, Adana, Turkey.

Fasciola hepatica is an endemic zoonotic disease in Turkey and neighboring countries. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of the Fasciola. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. When the flukes enter the bile ducts, the symptoms of cholestasis and cholangitis may present, which can easily be misdiagnosed as obstructive jaundice of other causes. We present a case of fascioliasis, which was difficult to differentiate from cholangiocarcinoma. A 47-year-old woman from Eastern Turkey presented with fever, right upper quadrant abdominal pain, and jaundice. Total bilirubin was 4.2 mg/dl, aspartate aminotransferase 55 IU/L, alanine aminotransferase 65 IU/L, alkaline phosphatase 325 IU/L, and gamma-glutamyl transpeptidase 172 IU/L. All tumor markers including carcinoembryonic antigen and Ca19-9 were in normal values. After extended evaluation, an explorative laparotomy with cholecystectomy, choledochostomy and T-tube drainage was performed. Multiple flukes were removed from the choledochus. One of the parasites was sent to the parasitological clinic for identification. The result of an indirect hemagglutination test for F. hepatica was 1/320 (+). In conclusion, the chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice. Thus, F. hepatica should be considered in the differential diagnosis of common bile duct obstruction, especially in endemic areas.
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http://dx.doi.org/10.4318/tjg.2012.0420DOI Listing
May 2013

Primary hepatic neuroendocrine tumor: Five cases with different preoperative diagnoses.

Turk J Gastroenterol 2012 Jun;23(3):272-8

Çukurova University Medical Faculty, Department of General Surgery, Çukurova/Adana, Turkey.

Neuroendocrine tumors, also known as carcinoid tumors, behave like benign tumors; however, they show the characteristics of carcinoma. While more than 80% of the neuroendocrine tumors found in the liver are metastatic, primary hepatic neuroendocrine tumors are very rare. Five patients with hepatic mass who admitted to our clinic between August 2003 and July 2007 were treated surgically. Ultrasonography, computerized tomography and magnetic resonance imaging were performed in all patients. Endoscopy and colonoscopy were conducted to exclude malignancy of other sites. Hepatectomy was carried out in all patients. Diagnosis was confirmed with immunohistochemical examination. The five patients treated surgically were diagnosed as primary hepatic neuroendocrine tumor histopathologically. Abdominal pain was the most common complaint of all patients. Hepatectomy was conducted in all patients due to tumors originating from the liver lobes. Only one patient (Case 2) underwent transarterial chemoembolization before hepatectomy to reduce tumor bleeding. Owing to tumor recurrence on the left lobe of the liver in Case 2, transarterial chemoembolization was performed four years after hepatectomy. R0 resection was achieved in two patients (Cases 1 and 3). In conclusion, primary hepatic neuroendocrine tumors are very rare and asymptomatic tumors. Thus, high-sensitive laboratory and imaging examinations are required. At present, hepatectomy remains the main treatment for primary hepatic neuroendocrine tumor.
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http://dx.doi.org/10.4318/tjg.2012.0465DOI Listing
June 2012