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Aday U, Çetin E, Kafadar MT, Oğuz A, Bahadır MV, Ülger BV, Gedik E, Girgin S, Yılmaz M. Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial. Langenbecks Arch Surg 2024; 409:89. [PMID: 38457041 PMCID: PMC10924000 DOI: 10.1007/s00423-024-03281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. METHODS This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. RESULTS One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1-10) in the single hem-o-lok group and 1 day (range 1-12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. CONCLUSIONS The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 ( http://www. CLINICALTRIALS gov ).
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Affiliation(s)
- Ulaş Aday
- Department of Gastroenterologycal Surgery, Dicle University School of Medicine, 21280, Sur/Diyarbakır, Turkey.
| | - Erman Çetin
- Department of General Surgery, Batman Regional Hospital, Batman, Turkey
| | - Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Ercan Gedik
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Yılmaz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Aday U, Oguz A, Özesmer H, Bahadır MV. Synchronous celiac artery and superior mesenteric artery compression syndrome: The effect of collateral circulation on the treatment procedure. Caspian J Intern Med 2023; 14:396-400. [PMID: 37223283 PMCID: PMC10201110 DOI: 10.22088/cjim.14.2.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 05/25/2023]
Abstract
Background Maintaining collateral circulation is highly important in the stenosis of celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The SMA compression is commonly reported to be accompanied by the CA compression caused by the median arcuate ligament (MAL) while the synchronous compression of CA and SMA by other ligaments has been rarely reported. Case Presentation In this report, we present a 64-year-old female patient who presented with a postprandial abdominal pain and weight loss. Initial evaluation indicated a synchronous compression of CA and SMA caused by MAL. The patient was planned for laparoscopic MAL division due to the presence of sufficient collateral circulation between the CA and SMA that was facilitated through the superior pancreaticoduodenal artery. Following laparoscopic release, the patient improved clinically and postoperative imaging indicated that the compression on the SMA was still present and the collateral circulation was sufficient. Conclusion We suggest that laparoscopic MAL division can be the primary method of choice in cases with sufficient collateral circulation between the CA and SMA.
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Affiliation(s)
- Ulaş Aday
- Department of Gastrointestinal Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Abdullah Oguz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Hikmet Özesmer
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Kafadar MT, Bahadır MV, Girgin S. Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method. Breast Care (Basel) 2021; 16:402-407. [PMID: 34602947 DOI: 10.1159/000513879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 01/20/2023] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.
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Affiliation(s)
- Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Aydın E, Yıldırım Y, Aydın FY, Bahadır MV, Kaplan İ, Kadiroğlu B, Ketani MA, Yılmaz Z, Kadiroğlu AK, Yılmaz ME. Evaluation of the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. Rev Soc Bras Med Trop 2020; 53:e20200016. [PMID: 32348434 PMCID: PMC7198067 DOI: 10.1590/0037-8682-0016-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/12/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION: Sepsis is an important cause of mortality and morbidity, and inflammatory response and oxidative stress play major roles underlying its pathophysiology. Here, we evaluated the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. METHODS: Twenty-eight adult Sprague Dawley rats were classified into Control (Group 1), Sepsis (Group 2), Sepsis+Cefazolin (Group 3), and Sepsis+Cefazolin+Etanercept (Group 4) groups. Kidney tissue and serum samples were obtained for biochemical and histopathological investigations and examined for the C reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), triggering receptor expressed on myeloid cells (TREM), and malondialdehyde (MDA) levels. RESULTS: The levels of TNF-α, TREM, and MDA in serum and kidney samples were significantly higher in rats from sepsis group than in rats from control group (p < 0.05). Group 3 showed a significant reduction in serum levels of TNF-α, CRP, and TREM as compared with Group 2 (p < 0.05). Serum TNF-α, CRP, TREM, and MDA levels and kidney TNF-α and TREM levels were significantly lower in Group 4 than in Group 2 (p < 0.05). Serum TNF-α and TREM levels in Group 4 were significantly lower than those in Group 3, and histopathological scores were significantly lower in Group 3 and Group 4 than in Group 2 (p < 0.05). Histopathological scores of Group 4 were significantly lower than those of Group 3 (p < 0.05). CONCLUSIONS: Etanercept, a TNF-α inhibitor, may ameliorate sepsis-induced oxidative stress, inflammation, and histopathological damage.
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Affiliation(s)
- Emre Aydın
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Yaşar Yıldırım
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Fatma Yılmaz Aydın
- Department of Internal Medicine, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - İbrahim Kaplan
- Department of Biochemistry, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Berfin Kadiroğlu
- Department of Virology, School of Veterinary Medicine, University of Dicle, Diyarbakır, Turkey
| | - Muzaffer Aydın Ketani
- Department of Histology and Embryology, School of Veterinary Medicine, University of Dicle, Diyarbakır, Turkey
| | - Zülfükar Yılmaz
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Ali Kemal Kadiroğlu
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Mehmet Emin Yılmaz
- Department of Nephrology, School of Medicine, University of Dicle, Diyarbakır, Turkey
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Oguz A, Uslukaya O, Ülger BV, Turkoglu A, Bahadır MV, Bozdag Z, Böyük A, Göya C. Superior mesenteric artery (Wilkie's) syndrome: a rare cause of upper gastrointestinal system obstruction. Acta Chir Belg 2016; 116:81-8. [PMID: 27385294 DOI: 10.1080/00015458.2016.1139830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery. Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014. Results All the patients were underweight, with a mean BMI of 15.73 (14-16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms. Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.
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Ay N, Bahadır MV, Anıl M, Alp V, Kaya Ş, Sevük U, Gül M, Danış R. Comparison of anti-reflux mechanism between Double-J-Stent and standart Double-J-Stent use for risk of BK nephropathy and urinary tract Infection in kidney transplantation. Int J Clin Exp Med 2015; 8:16340-16345. [PMID: 26629154 PMCID: PMC4659042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES There are studies that show that double J stenting (DJS) increase BK nephropathy (BKN) 4 fold. DJS may cause vesicoureteral reflux (VUR) with normal bladder contraction. The aim of this study is to comparison risk of BKN, urinary tract infections (UTI) and postoperative urologic complications with the use DJS with anti-reflux device (ARD-DJS) and standart double J stent (St-DJS). Matherial and methods: Ninety patients (male/female: 50/40) that had undergone kidney transplantations in Diyarbakır Training and Research Hospital and Dicle University, Faculty of Medicine Hospital between January 2012 and April 2015 were enrolled in the study. Demographic data, immunosuppression protocols, presence of rejection, graft loss, postoperative urologic complications, UTI, plasma BK levels of the patients were evaluated retrospectively. RESULTS Median and IQR follow up time for ARD-DJS and St-DJS patients were 14 (12-18) months and 25 (16-30) months respectively. Five cases (5.5%) had BK viremia (P=0.025). All 5 cases with BK viremia were St-DJS users. CONCLUSION As a result for postoperative UTI and postoperative urinary complication risk there were no statistically significant difference between ARD-DJS use and St-DJS use during ureteral anastomosis. BKN univariate analysis were significantly less than those st-DJS used. Risc factors were evaluated. But results were not statistically significant in the logistic regression analysis. We think that to demonstrate this benefit, we need randomized controlled studies with more patients and longer follow up.
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Affiliation(s)
- Nurettin Ay
- Diyarbakir Education and Research Hospital, Transplantation CenterDiyarbakir, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University Education and Research HospitalDiyarbakir, Turkey
| | - Melih Anıl
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education and Research HospitalDiyarbakır, Turkey
| | - Vahhac Alp
- Diyarbakir Education and Research Hospital, Transplantation CenterDiyarbakir, Turkey
| | - Şafak Kaya
- Department of Infectious Disease, Diyarbakır Gazi Yaşargil Training and Research HospitalDiyarbakır, Turkey
| | - Utkan Sevük
- Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research HospitalDiyarbakır, Turkey
| | - Mesut Gül
- Department of General Surgery, Dicle University Education and Research HospitalDiyarbakir, Turkey
| | - Ramazan Danış
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education and Research HospitalDiyarbakır, Turkey
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Oğuz A, Türkoğlu A, Gümüş M, Bozdağ Z, Bahadır MV, Teke F, Budak H, Böyük A. Trephine stoma: Outcomes in a single center. J Clin Exp Invest 2015. [DOI: 10.5799/ahinjs.01.2015.02.0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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