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Pekcan YO, Tuncalı B, Erol V. Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study. Braz J Anesthesiol 2021; 73:85-90. [PMID: 34848318 PMCID: PMC9801190 DOI: 10.1016/j.bjane.2021.11.003] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGRAUND This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. METHODS Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values obtained from the final model. RESULTS There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. CONCLUSION In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.
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Affiliation(s)
- Yonca Ozvardar Pekcan
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Bahattin Tuncalı
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Varlık Erol
- Medicana Hospital Izmir, Department of General Surgery, Izmir, Turkey
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Elmalı F, Tekindal MA, Altın C, Ateş C, Erol V. Optimization of change in epicardial fat thickness for obese patients who lost weight via the bariatric surgery method using central composite and Box-Behnken experimental designs. PeerJ 2021; 9:e11831. [PMID: 34430075 PMCID: PMC8349161 DOI: 10.7717/peerj.11831] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery. Method In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT). Results As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots. Conclusion Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.
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Affiliation(s)
- Ferhan Elmalı
- Faculty of Medicine, Department of Biostatistics, İzmir Katip Çelebi University, İzmir, Turkey
| | - Mustafa Agâh Tekindal
- Faculty of Medicine, Department of Biostatistics, İzmir Katip Çelebi University, İzmir, Turkey
| | - Cihan Altın
- Cardiology Department, İzmir Medikal Park, İzmir, Turkey
| | - Can Ateş
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Aksaray University, Aksaray, Turkey
| | - Varlık Erol
- Department of General Surgery, Medicana International İzmir, İzmir, Turkey
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Güneşli A, Yılmaz M, Altın C, Gezmiş E, Yabanoğlu H, Erol V. Assessment of Carotid Artery Distensibility and Elasticity After Laparoscopic Sleeve Gastrectomy: a Prospective Study. Obes Surg 2020; 30:4300-4306. [PMID: 32813160 DOI: 10.1007/s11695-020-04725-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Although it is well known that obesity increases the risk of atherosclerosis in carotid arteries, it is not clear whether this risk changes after obesity surgery. The aim of this study was to investigate whether weight reduction with a laparoscopic sleeve gastrectomy (LSG) has any effect on distensibility and elasticity which show subclinical atherosclerosis in the carotid arteries of obese individuals. MATERIALS AND METHODS This prospective study included 130 patients (body mass index (BMI) 48.21 ± 6.97 kg/m2) who underwent LSG. The patients were followed up for 1 year. Comparisons were made of the distensibiliy and elasticity values calculated preoperatively and at 1, 3, 6, and 12 months, postoperatively. RESULTS There was a statistically significant increase in distensibility and elasticity values from baseline to 1, 3, 6, and 12 months postoperatively (p < 0.001 for both comparisons). The multiple linear regression analysis was used to find the variables affecting both distensibility and elasticity. According to the results, the presence of BMI decreases distensibility percentage change level by 0.38 units (β= - 0.38, 95% CI - 0.51;- 0.25, p < 0.001). The presence of fasting plasma glucose decreases elasticity percentage change level by 0.20 units. (β= - 0.20, 95% CI - 0.39; - 0.01, p = 0.037). CONCLUSION Carotid artery distensibility and elasticity values increase after LSG, and this change could be caused by the change in metabolic parameters and heart geometry. These results may indirectly suggest that subclinical atherosclerosis in carotid arteries has decreased after obesity surgery.
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Affiliation(s)
- Aylin Güneşli
- Department of Radiology, Adana Teaching and Research Center, Baskent University, 2591 sokak. No: 4/A Yüreğir, 01250, Adana, Turkey.
| | - Mustafa Yılmaz
- Department of Cardiology, Baskent University, Adana, Turkey
| | - Cihan Altın
- Department of Cardiology, Baskent University, İzmir, Turkey
| | - Esin Gezmiş
- Department of Radiology, Baskent University, İzmir, Turkey
| | - Hakan Yabanoğlu
- Department of General Surgery, Baskent University, Adana, Turkey
| | - Varlık Erol
- Department of General Surgery, Baskent University, İzmir, Turkey
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Erol V, Sümer A, Savaş OA, Pekşen Ç, Gülay H, Aktimur R, Özmen MM. Recommendations for bariatric and metabolic surgical operations during the COVID-19 pandemic in Turkey. Turk J Surg 2020; 36:132-136. [PMID: 33015558 PMCID: PMC7515644 DOI: 10.5578/turkjsurg.4875] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
The world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic.
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Affiliation(s)
- Varlık Erol
- Türk Metabolik ve Bariatrik Cerrahi Derneği Yönetim Kurulu Girişimi Adına
| | - Aziz Sümer
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Osman Anıl Savaş
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Çağhan Pekşen
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Hüseyin Gülay
- Türk Metabolik ve Bariatrik Cerrahi Derneği Yönetim Kurulu Girişimi Adına
| | - Recep Aktimur
- İstinye Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
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Abstract
Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is now being performed in increasing frequency and getting more and more attention. TOETVA is carried out through three incisions in the oral vestibular area. Thyroidectomy is performed endoscopically using conventional laparoscopic instruments, an energy based device and neuromonitoring instruments. Intraoperative neuromonitoring is one of the tools of utmost importance, used for navigation and confirmation of the functional integrity of the recurrent nerve during TOETVA. The aim of this study is to give information about the standards and technique of intraoperative neuromonitoring of the recurrent laryngeal nerves during TOETVA procedures. TOETVA is a safe technique with no visible scarring and hence resulting in an excellent cosmetic effect. We believe that neuromonitoring of the recurrent laryngeal nerves also minimizes the risk of nerve damage and is an essential safety component in this technique.
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Affiliation(s)
- Varlık Erol
- Department of General Surgery, Zubeyde Hanim Practice and Research Center, Baskent University, Izmir, Turkey
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun 130000, China
| | - Özer Makay
- Department of General Surgery, School of Medicine, Ege University, Bornova, Izmir, Turkey
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Arslan B, Erol V, Özvardar Pekcan Y. Primer pilonidal sinüs hastalığı için cerrahi tedavide geniş eksizyon-açık bırakma, primer kapama ve flep uygulama sonuçlarının karşılaştırılması. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.665148] [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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Erol V, Aydın C, Uğurlu L, Turgut E, Yalçın H, Arslan FD. Laparoskopik sleeve gastrektomi sonrası grelin, leptin ve insülin düzeylerindeki değişiklikler. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.418130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Tuncalı B, Erol V, Zeyneloğlu P. Effects of volume-controlled equal ratio ventilation with recruitment maneuver and
positive end-expiratory pressure in laparoscopic sleeve gastrectomy: a prospective,
randomized, controlled trial. Turk J Med Sci 2018; 48:768-776. [PMID: 30119152 DOI: 10.3906/sag-1712-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim We compared the effects of volume-controlled equal ratio ventilation (VC-ERV) and volume-controlled conventional
ratio ventilation (VC-CRV) on oxygenation, ventilation, respiratory mechanics, and hemodynamic status during mechanical ventilation
with recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy. Materials and methods A total of 111 patients scheduled for laparoscopic sleeve gastrectomy were randomized to ventilation with
inspiratory to expiratory ratio of 1:1 (Group VC-ERV) or 1:2 (Group VC-CRV) following tracheal intubation. RM (40 cmH2O, 15 s) and
PEEP (10 cmH2O) were administered to all patients. Arterial blood gas samples were taken and peak airway pressure (Ppeak), mean
airway pressure (Pmean), dynamic compliance (Cdyn), mean arterial pressure, heart rate, SpO2, and EtCO2 were recorded at 4 time
points. Postoperative respiratory complications were recorded. Results Oxygenation, ventilation, Pmean levels, and hemodynamic variables were similar in both groups. VC-ERV significantly
decreased Ppeak and increased Cdyn compared to VC-CRV at all time points of the operation (P < 0.05). No pulmonary complication
was observed in any patients. Conclusion VC-ERV provides significantly lower Ppeak and higher Cdyn with similar oxygenation, ventilation, hemodynamic
parameters, and Pmean levels when compared to VC-CRV during mechanical ventilation with RM and PEEP in laparoscopic sleeve
gastrectomy.
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Erol V, Yılmaz TH, Tuncalı B, Arslan B, Gülay H. Changes in serum lipid levels after laparoscopic sleeve gastrectomy in morbidly obese dyslipidemic and normolipidemic patients. Acta Chir Belg 2018; 118:233-238. [PMID: 29251221 DOI: 10.1080/00015458.2017.1417104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients. METHODS 141 patients who underwent LSG between September 2014 and January 2016 were included in the study. RESULTS The patients' mean body mass index was 46.27 ± 6.79 kg/m2 preoperatively, 31.60 ± 5.37 kg/m2 in the 6th month postoperatively and 27.80 ± 4.25 kg/m2 in the 12th month (p < .001). Preoperatively and 12 months after the operation, mean total cholesterol (TC) levels and mean LDL cholesterol, mean HDL cholesterol, and mean triglyceride (TG) levels were statistically significantly decreased (p < .01). Comparing TC levels in the 12th month with preoperative levels, dyslipidemic patients showed a statistically more significant decrease than normolipidemic patients. LDL cholesterol levels were significantly decreased in both the groups. HDL cholesterol levels increased significantly in both groups while mean TG levels decreased significantly in patients with high preoperative TG levels, but not in patients with normal preoperative TG levels. CONCLUSIONS Although this technique exerts its effect primarily by reducing gastric volume, besides its metabolic and hormonal effects, it also improves serum lipid levels (decreasing TC, LDL cholesterol and TG levels, and increasing HDL cholesterol levels). It therefore contributes to decreasing cardiovascular diseases.
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Affiliation(s)
- Varlık Erol
- Department of General Surgery, Baskent University, Izmir, Turkey
| | - Tuğba Han Yılmaz
- Department of General Surgery, Baskent University, Izmir, Turkey
| | | | - Baha Arslan
- Department of General Surgery, Baskent University, Izmir, Turkey
| | - Hüseyin Gülay
- Department of General Surgery, Baskent University, Izmir, Turkey
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Tuncalı B, Pekcan YÖ, Ayhan A, Erol V, Yılmaz TH, Kayhan Z. Retrospective Evaluation of Patients who Underwent Laparoscopic Bariatric Surgery. Turk J Anaesthesiol Reanim 2018; 46:297-304. [PMID: 30140537 PMCID: PMC6101715 DOI: 10.5152/tjar.2018.72687] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 03/22/2017] [Accepted: 02/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In the present study, we aimed to retrospectively evaluate the preoperative characteristics, intraoperative and postoperative results of patients who underwent laparoscopic obesity surgeries. METHODS After obtaining the approval of the Ethics Committee, records of patients who underwent laparoscopic obesity surgery from January 2013 to December 2016 were reviewed. Demographic characteristics, medications used in anaesthesia and analgesia, the duration of recovery unit/hospital stay, intensive care unit/mechanical ventilation requirements and complications were recorded. RESULTS A total of 329 ASA II-III patients over a 3-year period were operated. Thiopental and propofol were administered at induction, sevoflurane, isoflurane and desflurane were administered for the maintenance, and vecuronium and rocuronium were administered to aid in neuromuscular blockage. The mean durations of recovery unit and hospital stays were 30.80±6.01 minutes and 4.27±1.68 days, respectively. The hypnotic agent, muscle relaxant or inhalation anaesthetics used did not have a significant effect on the duration of recovery unit and hospital stay. Mask ventilation and intubation were noted to be difficult in 5.5% and 8.5% of the cases, respectively. The presence of obstructive sleep apnoea syndrome and high body mass index and Mallampati scores significantly increased difficult mask ventilation and difficult intubation rates. Four patients were transferred to intensive care unit for close monitoring. Two patients were re-operated on, two patients had rhabdomyolysis, one patient had Wernicke's encephalopathy and two patients had peripheral neuropathy. Perioperative mortality did not occur in any patient. CONCLUSION We believe that appropriate patient selection, the use of well-designed anaesthesia and surgical protocols play important roles in increasing the success rate of patient outcomes and early and late complications in laparoscopic obesity surgery.
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Affiliation(s)
- Bahattin Tuncalı
- Department of Anaesthesiology and Reanimation, Başkent University School of Medicine, Ankara, Turkey
| | - Yonca Özvardar Pekcan
- Department of Anaesthesiology and Reanimation, Başkent University School of Medicine, Ankara, Turkey
| | - Asude Ayhan
- Department of Anaesthesiology and Reanimation, Başkent University School of Medicine, Ankara, Turkey
| | - Varlık Erol
- Department of General Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Tuğba Han Yılmaz
- Department of General Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Zeynep Kayhan
- Department of Anaesthesiology and Reanimation, Başkent University School of Medicine, Ankara, Turkey
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Makay Ö, Erol V, İçöz G, Öztürk Ş, Akdemir Ö, Akyıldız M. Kozmetik yönüyle minimal invaziv paratiroidektomi: Minimal invaziv yaklaşım daha mı üstün? Ege Tıp Dergisi 2018. [DOI: 10.19161/etd.415654] [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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Altin C, Erol V, Aydin E, Yilmaz M, Tekindal MA, Sade LE, Gulay H, Muderrisoglu H. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study. Nutr Metab Cardiovasc Dis 2018; 28:501-509. [PMID: 29571589 DOI: 10.1016/j.numecd.2018.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/09/2018] [Accepted: 02/02/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis. METHODS AND RESULTS Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (β = 153, p = 0.001). CONCLUSION Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.
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Affiliation(s)
- C Altin
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey.
| | - V Erol
- Department of General Surgery, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - E Aydin
- Department of Radiology, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - M Yilmaz
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Adana, Turkey
| | - M A Tekindal
- Department of Biostatistics, Selcuk University, Konya, Turkey
| | - L E Sade
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Ankara, Turkey
| | - H Gulay
- Department of General Surgery, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - H Muderrisoglu
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Ankara, Turkey
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Altın C, Erol V, Yılmaz M, Bozkuş Y, Müderrisoğlu H. Effects of significant weight loss following bariatric surgery on red cell distribution width and mean platelet volume. Medeni Med J 2018. [DOI: 10.5222/mmj.2018.16442] [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: 11/05/2022] Open
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Bozbıyık O, Öztürk Ş, Ünver M, Erol V, Bayol Ü, Aydın C. Reliability of fine needle aspiration biopsy in large thyroid nodules. Turk J Surg 2017; 33:10-13. [PMID: 28589181 DOI: 10.5152/ucd.2017.3329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/14/2015] [Accepted: 11/28/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Fine needle aspiration biopsy provides one of the most important data that determines the treatment algorithm of thyroid nodules. Nevertheless, the reliability of fine needle aspiration biopsy is controversial in large nodules. The aim of this study was to evaluate the adequacy of fine needle aspiration biopsy in thyroid nodules that are four cm or greater. MATERIAL AND METHODS We retrospectively examined 219 patients files who underwent thyroidectomy for thyroid nodules that were greater than four centimeter between May 2007 and December 2012. Seventy-four patients with hyperthyroidism, and 18 patients without preoperative fine needle aspiration cytology were excluded from the study. Histopathologic results after thyroidectomy were compared with preoperative cytology results, and sensitivity and specificity rates were calculated. RESULTS False-negativity, sensitivity and specificity rates of fine needle aspiration biopsy of thyroid nodules were found to be 9.7%, 55.5%, and 85%, respectively. Within any nodule of the 127 patients, 28 (22.0%) had thyroid cancer. However, when only nodules of at least 4 cm were evaluated, thyroid cancer was detected in 22 (17.3%) patients. CONCLUSION In this study, fine needle aspiration biopsy of large thyroid nodules was found to have a high false-negativity rate. The limitations of fine-needle aspiration biopsy should be taken into consideration in treatment planning of thyroid nodules larger than four centimeters.
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Affiliation(s)
- Osman Bozbıyık
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Şafak Öztürk
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mutlu Ünver
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Varlık Erol
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ümit Bayol
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cengiz Aydın
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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Yılmaz TH, Avcı T, Erol V, Gülay H. Peutz-Jeghers sendromu. Ege Tıp Dergisi 2016. [DOI: 10.19161/etd.344215] [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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Ünver M, Öztürk Ş, Erol V, Cartı EB, Bozbıyık O, Kebapçı E, Ölmez M, Akbulut G. Retroperitoneal paraganglioma presenting with pancytopenia: A rare case with rare manifestation. Int J Surg Case Rep 2015; 14:77-9. [PMID: 26241167 PMCID: PMC4573608 DOI: 10.1016/j.ijscr.2015.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 12/03/2022] Open
Abstract
Retroperitoneal paragangliomas are mostly benign with good prognosis. Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas. Reactive thrombocytosis is a common cause of thrombocytosis after splenectomy.
Introduction Paragangliomas are tumors that arise from extraadrenal chromaffin cells and most of them are asymptomatic presenting with painless mass. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Surgical resection is still the main treatment and necessary for histological assessment. Case report A 41 year old female patient presented with 6 months of loss of appetite, weight loss, weakness and breathlessness on exertion.. The patient’s initial blood examination showed marked anemia, reduced leukocyte count with neutropenia and lymphopenia and a marked reduction in the platelet count. The patient was admitted for evaluation of her pancytopenia. Magnetic resonance imaging revealed a 8 × 7 × 8 cm sized mass closed to the pancreatic tail invading splenic hilum. A large mass was identified retroperitoneally, closed to the tail of pancreas with a splenic hilum invasion. Total mass resection and splenectomy was performed. Discussion Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as for recurrent or metastatic neoplasms. Reactive thrombocytosis is a common cause of thrombocytosis. Splenectomy was found to be one of the main causes of extreme reactive thrombocytosis. Reactive thrombocytosis is a predictable finding after splenectomy and management of the thrombocytosis and prevention of complications should be initiated.
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Affiliation(s)
- Mutlu Ünver
- İzmir University, Department of General Surgery, İzmir, Turkey.
| | - Şafak Öztürk
- İzmir University, Department of General Surgery, İzmir, Turkey
| | - Varlık Erol
- Başkent University, Department of General Surgery, İzmir, Turkey
| | | | - Osman Bozbıyık
- Afyon Kocatepe University, Department of General Surgery, Afyon, Turkey
| | - Eyüp Kebapçı
- Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey
| | - Mustafa Ölmez
- Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey
| | - Gökhan Akbulut
- Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey
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Emiroğlu M, Sert İ, İnal A, Karaali C, Peker K, İlhan E, Gülcelik M, Erol V, Güngör H, Can D, Aydın C. The approach of general surgeons to oncoplastic and reconstructive breast surgery in Turkey: a survey of practice patterns. Balkan Med J 2015; 31:307-12. [PMID: 25667784 DOI: 10.5152/balkanmedj.2014.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/24/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. AIMS To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. STUDY DESIGN Cross-sectional study. METHODS Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. RESULTS Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. CONCLUSION Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.
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Affiliation(s)
- Mustafa Emiroğlu
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İsmail Sert
- Department of General Surgery, Van Regional Training and Research Hospital, Van, Turkey
| | - Abdullah İnal
- Department of General Surgery, Erzincan University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Cem Karaali
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Kemal Peker
- Department of General Surgery, Erzincan University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Enver İlhan
- Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Gülcelik
- Department of General Surgery, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Varlık Erol
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hilmi Güngör
- Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Didem Can
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Aydın
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
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Emiroğlu M, İnal A, Sert İ, Karaali C, Peker K, İlhan E, Gülçelik MA, Erol V, Can D, Aydın C. Surgeons' Approaches and Professional Perspectives on Breast Masses: A National Survey in Turkey. J Breast Health 2015; 11:76-80. [PMID: 28331696 DOI: 10.5152/tjbh.2015.2382] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE General surgeons' approaches to breast masses in their daily practices and their perspectives for issues on breast diseases and breast surgery are investigated through a survey. MATERIALS AND METHODS Answers of 524 general surgeons for the survey "Approach to breast diseases and breast surgery" between November 2012 and February 2013 were assessed. Demographic features, approaches to the breast masses, and answers for the clinical scenerios of surgeons were questioned. Surgeons were asked about management of breast cancer and the future role of surgeons for oncoplastic breast surgery and breast diseases. RESULTS Participants were representing 14.6% of all general surgeons in Turkey. The survey revealed that breast diseases are the most common cause for admission in general surgery outpatient clinics. Needle biopsies were employed by 241 (60%) respondents. Three hundred and seventy-one (71%) participants indicated that breast cancer management could be accurately conducted by the general surgeons. Two hundred and seventy-three (52%) respondents think that oncoplastic breast surgery should be performed by a general surgeon and 241 (41%) respondents predict that the role of general surgeons for breast diseases and breast surgery will decrease in the future. CONCLUSION Basic approaches towards breast masses need to be improved in our country despite the highest frequency of breast diseases in outpatient admissions. The views and opinions of surgeons on breast diseases and the course of breast surgery in different regions and different communities need to be defined and clarified.
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Affiliation(s)
- Mustafa Emiroğlu
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Abdullah İnal
- Clinic of General Surgery, Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - İsmail Sert
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cem Karaali
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Kemal Peker
- Department of General Surgery, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Enver İlhan
- Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Ali Gülçelik
- Clinic of General Surgery, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Varlık Erol
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Didem Can
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Aydın
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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Ozturk S, Unver M, Ozturk BK, Bozbıyık O, Erol V, Kebabcı E, Olmez M, Zalluhoglu N, Bayol U. Isolated metastasis of uterine leiomyosarcoma to the pancreas: Report of a case and review of the literature. Int J Surg Case Rep 2014; 5:350-3. [PMID: 24858977 PMCID: PMC4064381 DOI: 10.1016/j.ijscr.2014.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Metastatic tumors of the pancreas are uncommon and rarely detectable clinically. Metastases to the pancreas are rare. We present a patient with pancreatic metastases from a leiomyosarcoma of the uterus and review the literature about the clinical features of pancreatic metastasis and its surgical management. PRESENTATION OF CASE A 40-year-old woman, who underwent hysterectomy, left oophorectomy, omentectomy and lymp node dissection for leiomyosarcoma of the uterus. At the follow up, the patient complained of non-specific abdominal discomfort. Preoperative diagnosis were pancreatic pseudocyst, cystadenoma or cystadenocarcinoma. At laparotomy, a cystic mass was found in the tail of the pancreas which was invased to the transverse colon mesenterium and the spleen. Distal pancreatectomy with splenectomy and transverse colon resection was performed. Histologically, the tumor was evaluated as poorly differentiated leiomyosarcoma. DISCUSSION Metastatic lesions of the pancreas are uncommon and less than 2% of all pancreatic malignancies. However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Before deciding that the lesion in the pancreas was metastasis, primary leiomyosarcoma of the pancreas had to be ruled out. Histologically, leiomyosarcoma of the pancreas contains interlacing spindle cells with varying degrees of atypia and pleomorphism. The surgical approach to the pancreatic metastases must be aimed complete excision of the tumor with a wide negative margin of clear tissue and maximum preservation of pancreatic remnant if possible. CONCLUSION In the absence of widespread metastatic disease, aggressive surgical approach with negative margins must be aimed.
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Affiliation(s)
- Safak Ozturk
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey.
| | - Mutlu Unver
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | | | - Osman Bozbıyık
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Varlık Erol
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Eyup Kebabcı
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Mustafa Olmez
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Nihat Zalluhoglu
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Umit Bayol
- T.C.S.B. Tepecik Teaching and Research Hospital, Department of Pathology, Izmir, Turkey
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Unver M, Ozturk S, Bozbıyık O, Erol V, Akbulut G. Notaras procedure for incarcerated rectal prolapse. World J Surg Proced 2014; 4:21-22. [DOI: 10.5412/wjsp.v4.i1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/24/2013] [Accepted: 11/21/2013] [Indexed: 02/06/2023] Open
Abstract
Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.
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Erol V, Makay O, Icoz G, Kose T, Yararbas U, Kumanlioglu K, Akyildiz M. Prognostic factors of survival and recurrence pattern in differentiated thyroid cancer: A retrospective study from Western Turkey. Endocr Regul 2014; 48:173-81. [DOI: 10.4149/endo_2014_04_173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Yoldaş T, Erol V, Demir B, Hoşcoşkun C. A rare cause of mechanical obstruction: Intestinal myeloid sarcoma. Ulus Cerrahi Derg 2013; 30:176-8. [PMID: 25931908 DOI: 10.5152/ucd.2013.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/02/2012] [Indexed: 12/12/2022]
Abstract
Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma.
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Affiliation(s)
- Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Batuhan Demir
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cüneyt Hoşcoşkun
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Erol V, Yoldaş T, Cin S, Çalışkan C, Akgün E, Korkut M. Complicated Meckel's diverticulum and therapeutic management. Ulus Cerrahi Derg 2013; 29:63-6. [PMID: 25931848 DOI: 10.5152/ucd.2013.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics. MATERIAL AND METHODS This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. RESULTS Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). CONCLUSION Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.
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Affiliation(s)
- Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Samet Cin
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cemil Çalışkan
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Erhan Akgün
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Korkut
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Yoldaş T, Erol V, Çalışkan C, Akgün E, Korkut M. Spontaneous intestinal intramural hematoma: What to do and not to do. Turk J Surg 2013; 29:72-5. [PMID: 25931850 DOI: 10.5152/ucd.2013.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 03/25/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. MATERIAL AND METHODS Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. RESULTS Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. CONCLUSION Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.
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Affiliation(s)
- Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cemil Çalışkan
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Erhan Akgün
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Korkut
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Erol V, Makay Ö, İçöz G, Köse T, Ertan Y, Yararbaş Ü, Akyıldız M, Yılmaz M. The importance of staging systems for the determination of prognosis of well-differentiated thyroid cancer. Ulus Cerrahi Derg 2013; 29:7-10. [PMID: 25931834 DOI: 10.5152/ucd.2013.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/09/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we aimed to determine the significance of the staging systems (EORTC, De Groot, MACIS, and TNM) on the prognosis of well-differentiated thyroid cancer patients who underwent surgery in our clinics. MATERIAL AND METHODS This retrospective study included 181 patients who were operated between December 1995-December 2007, with a diagnosis of thyroid cancer. In order to obtain data related to cancer staging, a computer program for PDA was developed to facilitate parameter recording. Survival analysis was performed. The findings were compared to the predicted rates by the staging systems. RESULTS According to the De Groot staging system, stage 1 and stage 2 patients' results were compatible, but stage 3 and 4 patients' results were different (stage 3; 87% versus 66.6%, stage 4; 35% versus 100%, p=0.04). In the MACIS staging system, 20-year survival rates are determined and comparison should not be made due to insufficient follow-up period in this study. When compared to the EORTC staging system, stage 3 and stage 4 patients' results were determined different (stage 3; 51% versus 100%, stage 4; 33% versus 50%, p=0.02). The most consistent results in terms of prognosis was determined in comparison with the TNM staging system (stage 1; 100% versus 97.8%, stage 4; 45.3% versus 50%). CONCLUSION Many classification systems are proposed for well-differentiated thyroid cancer, to predict the behavior of the tumor. In this study, we concluded that for determination of prognosis in well-differentiated thyroid cancer, the TNM staging system could best predict prognosis consistent with clinical findings.
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Affiliation(s)
- Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Özer Makay
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gökhan İçöz
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Timur Köse
- Department of Biostatistics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yeşim Ertan
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ülkem Yararbaş
- Department of Nuclear Medicine, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mahir Akyıldız
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Yılmaz
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Unalp O, Erol V, Yeniay L, Oztürk S, Coker A. Autoimmune pancreatitis and treatment approaches with case reports. Balkan Med J 2012; 29:431-3. [PMID: 25207048 DOI: 10.5152/balkanmedj.2012.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/27/2011] [Accepted: 07/05/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). MATERIAL AND METHODS We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. RESULTS Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. CONCLUSION Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery.
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Affiliation(s)
- Omer Unalp
- Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Levent Yeniay
- Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Safak Oztürk
- Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ahmet Coker
- Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
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