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Teke E, Güneş Y, Çoruhlu B, Esen Bulut N, Fersahoglu MM, Ergin A, Sancak S. Effects of laparoscopic sleeve gastrectomy on thyroid hormones and relationship between metabolic parameters and long-term total weight loss. Surg Endosc 2024; 38:1807-1812. [PMID: 38291160 DOI: 10.1007/s00464-024-10693-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Bariatric surgery has significant effects on metabolic parameters and hormone levels. However, the specific impact of laparoscopic sleeve gastrectomy (LSG) on thyroid hormones and other metabolic parameters remains unclear. This study aimed to investigate the short and long-term effects of LSG on thyroid hormone levels, HbA1c, and other metabolic parameters. METHODS A total of 619 euthyroid patients without a history of thyroid disease or thyroid hormone replacement therapy were included in the study. Patients with diabetes were excluded from the study. Preoperative, 1-year postoperative, and 5-year postoperative levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), HbA1c, and other metabolic parameters were recorded and analyzed. RESULTS LSG resulted in significant weight loss and improvements in metabolic parameters. At 1 year postoperatively, there were significant reductions in BMI, HbA1c, TSH, fT3, and triglyceride levels, while fT4 levels increased. A statistically significant negative correlation was found between preoperative HbA1c level and percentage of total weight loss (%TWL) value at the fifth postoperative year. Additionally, a statistically significant negative correlation was found between the 5-year change in TSH and %TWL. CONCLUSION Being the first study to predict long-term total weight loss based on preoperative HbA1c, it is significant. This finding has important implications for personalized patient management and could aid clinicians in identifying individuals who may benefit most from sleeve gastrectomy as a treatment modality. This is valuable in that it emphasizes multidisciplinary work, including the endocrinologist and dietician.
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Affiliation(s)
- Emre Teke
- General Surgery Department, Haydarpaşa Numune Training and Research Hospital, Tıbbiyecaddesi No:23, Üsküdar, 34668, Istanbul, Turkey.
| | - Yasin Güneş
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Bedirhan Çoruhlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Mehmet Mahir Fersahoglu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Seda Sancak
- Department of Endocrinology and Metabolic Diseases, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
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Teke E, Esen Bulut N, Onur E, Güneş Y, Fersahoglu MM, Ergin A, Taşdelen İ, Köroğlu M, Çavuş B, Akyüz Ü, Akyüz F. Investigation of the Relationship Between Laparoscopic Sleeve Gastrectomy and Gastroesophageal Reflux Disease Using 24-hour Multichannel Intraluminal Impedance With pH Testing According to Current Consensus. Surg Laparosc Endosc Percutan Tech 2024; 34:9-13. [PMID: 38078925 DOI: 10.1097/sle.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/04/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss procedure with potential effects on gastroesophageal reflux disease (GERD). However, research on the association between LSG and GERD using objective evaluation criteria, such as multichannel intraluminal impedance combined with pH testing (MII-pH), is limited. This study aimed to investigate the impact of LSG on GERD using MII-pH and current consensus guidelines. MATERIALS AND METHODS It was conducted as a prospective clinical study on 33 patients who underwent LSG between January 2022 and August 2022. MII-pH and high-resolution manometry were performed preoperatively and 3 to 6 months postoperatively. GERD diagnosis was based on MII-pH results using the Lyon and Update Porto consensus guidelines. RESULTS Postoperative MII-pH analysis revealed a significant increase in acid reflux time, acid exposure time, reflux index, esophageal clearance, total reflux time, and longest reflux period. Weak acid reflux episodes decreased, while Demeester score and alkaline reflux showed nonsignificant increases. Pathologic reflux significantly increased postoperatively based on MII-pH diagnosis. High-resolution manometry showed a significant increase in unsuccessful motility. CONCLUSION Although the Demeester score calculation consists of 6 metrics, including acid exposure time, the acid exposure time is more specific in detecting pathologic reflux. Pathologic GERD increases significantly with LSG in the early period. Therefore, preoperative and postoperative endoscopy and MII-pH can provide valuable information regarding the need for closer follow-up after LSG.
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Affiliation(s)
| | | | | | | | | | | | | | - Mehmet Köroğlu
- Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bilger Çavuş
- Istanbul University Istanbul Medical Faculty/Gastroenterohepatology Department, İstanbul University, İstanbul Medical School, Turgut Özal Millet Street, Fatih/İstanbul
| | - Ümit Akyüz
- Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Filiz Akyüz
- Istanbul University Istanbul Medical Faculty/Gastroenterohepatology Department, İstanbul University, İstanbul Medical School, Turgut Özal Millet Street, Fatih/İstanbul
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Ergin A, Ergin E, Atasever A, Çiyiltepe H, Fersahoğlu MM, Esen Bulut N, Taşdelen İ, Güneş Y, Teke E, Yılmaz C, İlleez Ö, Usta B, Sancak S. Investigatıon of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study. Surg Obes Relat Dis 2023; 19:1357-1365. [PMID: 37673710 DOI: 10.1016/j.soard.2023.07.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 07/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND In many studies, it has been stated that obesity causes severe increases in the risks of disc degeneration, vertebral fracture, low back, and back pain. One of the most effective treatment options for obesity is bariatric surgery. OBJECTIVES In this study, the effect of weight loss on these parameters was investigated by evaluating the Cobb angle, low back, and back pain. SETTING University Hospital METHODS: A total of 89 patients were included in the study. Laparoscopic sleeve gastrectomy (SG) was performed on all patients. In addition, Cobb angle, height, weight, and body mass index (BMI) measurements were recorded at each visit. Investigating the quality and quantity of low back pain and the loss of function caused by the patients; visual analog scale (VAS), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Roland-Morris Disability Questionnaire (RMDQ), and SF-36 Quality of Life Questionnaire (SF36) were administered. RESULTS According to the preoperative Cobb angles, the decrease in the 6th month (P = .029) and 12th month (P = .007) measurements after the operation was found to be statistically significant (P < .05), but it was found to be clinically insignificant. When the changes in RMDQ, OLBPDQ, VAS, and SF-36 scores were examined, the decrease in the 6th month (P = .001) and 12th month (P = .001) scores after the operation was found to be significant compared to the preoperative scores (P < .01). CONCLUSIONS In this study, weight loss after SG improved for patients with chronic low back and back pain and significantly improved their quality of life.
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Affiliation(s)
- Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Elifnur Ergin
- Anatomy Department, Medipol Unıversity Health Sciences Institute, İstanbul, Turkey
| | - Alper Atasever
- Anatomy Department, Medipol Unıversity Health Sciences Institute, İstanbul, Turkey
| | - Hüseyin Çiyiltepe
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mehmet M Fersahoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - İksan Taşdelen
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Yasin Güneş
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Emre Teke
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cem Yılmaz
- İstanbul Breast Center, Breast Surgery Clinic, Istanbul, Turkey
| | - Özge İlleez
- Physical Therapy and Rehabilitation Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Burcu Usta
- Radiology Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Seda Sancak
- Endocrinology Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Güneş Y, Fersahoğlu MM, Bulut NE, Çakmak A, Ergin A, Teke E, Karataş TC, Şahin A, Sancak S. Effects of Sleeve Gastrectomy on Pelvic Floor Disorders in Female Patients with Severe Obesity: a Prospective Study. Obes Surg 2023; 33:3069-3076. [PMID: 37428362 DOI: 10.1007/s11695-023-06725-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Obesity is associated with pelvic floor disorders (PFD). Sleeve gastrectomy (SG) is one of the most effective weight loss methods. Although SG has been found to improve urinary incontinence (UI) and overactive bladder (OAB), its impact on fecal incontinence (FI) remains controversial. MATERIALS AND METHODS This prospective, randomized study involved 60 female patients with severe obesity who were randomly assigned to two groups: the SG group and the diet group. The SG group underwent SG, while the diet group received a low-calorie, low-lipid diet for 6 months. The patients' condition was assessed before and after the study using three questionnaires: the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Overactive Bladder 8-Question Awareness Tool (OAB-V8), and the Wexner Score (CCIS). RESULTS After 6 months, the SG group had a significantly higher percentage of total weight loss (%TWL) compared to the diet group (p<0.01). Both groups showed a decrease in the ICIQ-FLUTS, OAB-V8, and CCIS scores (p<0.05). UI, OAB, and FI improved significantly in the SG group (p<0.05), but no improvement was observed in the diet group (p>0.05). The correlation between %TWL and PFD was statistically significant but weak, with the strongest correlation between %TWL and ICIQ-FLUTS score and the weakest correlation between %TWL and CCIS score (p<0.05). CONCLUSIONS We recommend bariatric surgery for the treatment of PFD. However, given the weak correlation between %TWL and PFD after SG, further research should explore factors other than %TWL that are effective in recovery, particularly in relation to FI.
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Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey.
| | - Mehmet Mahir Fersahoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Ahmet Çakmak
- Department of General Surgery, Sinop Atatürk State Hospital, 57000, Sinop, Turkey
| | - Anıl Ergin
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Emre Teke
- Department of General Surgery, Haydarpaşa Numune Training And Research Hospital, Tıbbiye Cad. No: 23 Üsküdar, 34668, Istanbul, Turkey
| | - Tuğba Caner Karataş
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Aytaç Şahin
- Department of Urology, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Seda Sancak
- Department of Internal Medicine/Endocrinology and Metabolism Disorders, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
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Güneş Y, Taşdelen İ, Ergin A, Çakmak A, Bilgili AC, Bayram A, Aydın MT. Symptom Duration and Surgeon Volume: Impact on Early Laparoscopic Cholecystectomy for Acute Cholecystitis. Cureus 2023; 15:e47517. [PMID: 38021963 PMCID: PMC10664691 DOI: 10.7759/cureus.47517] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The 'golden 72 hours' rule from the onset of symptoms still applies in laparoscopic cholecystectomy for acute cholecystitis. This rule has been discussed with increasing experience in laparoscopic surgery in recent years. OBJECTIVE This study aims to determine the optimal symptom duration based on the surgeon's volume when deciding on early laparoscopic cholecystectomy for acute cholecystitis. MATERIALS AND METHODS The patients were categorized into two groups: Group 1 (≤3 days) and Group 2 (>3 days) based on the symptom duration, and high-volume surgeons (performing >100 laparoscopic cholecystectomies in a year) and low-volume surgeons (performing <100 laparoscopic cholecystectomies in a year) based on the surgeon volume. All surgeons had received advanced training in laparoscopic surgery. RESULTS There was no statistical difference in postoperative outcomes between groups, except for a few data (p>0.05). The operative time was longer in Group 2, the postoperative hospital stay was longer for low-volume surgeons than for high-volume surgeons after three days, and operative time was longer after three days than the first three days in low-volume surgeons (p<0.05). CONCLUSIONS Early laparoscopic cholecystectomy may be recommended for acute cholecystitis with symptom duration of more than three days, regardless of the surgeon volume, as long as they are competent in laparoscopic surgeries.
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Affiliation(s)
- Yasin Güneş
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - İksan Taşdelen
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Ahmet Çakmak
- General Surgery, Sinop Ayancık State Hospital, Sinop, TUR
| | - Ali Cihan Bilgili
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Anıl Bayram
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Mehmet T Aydın
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Güneş Y, Teke E, Aydın MT. The Optimal Timing of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Single-Center Study. Cureus 2023; 15:e38915. [PMID: 37313092 PMCID: PMC10259690 DOI: 10.7759/cureus.38915] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Early laparoscopic cholecystectomy (ELC) is a treatment option for acute cholecystitis (AC). However, the timing of ELC is controversial. Delayed laparoscopic cholecystectomy (DLC) continues to be a common practice. This study aims to determine the optimal timing of ELC in AC. Materials and methods Patients who underwent surgery for AC between 2014 and 2020 were divided into three groups: immediate laparoscopic cholecystectomy (ILC), prolonged ELC (pELC), and DLC. The demographic, laboratory, radiological findings, and postoperative results of all patients were retrospectively reviewed. Results The study included 178 patients, with 63 in the ILC group, 27 in the pELC group, and 88 in the DLC group. Postoperative outcomes, excluding hospital stay, were similar between the groups. The total hospital stay was significantly longer in the pELC and DLC groups (p<0.05). In addition, postoperative hospital stay was longer in the pELC group (p<0.05), and 17.7% of the patients who waited for delayed surgery experienced recurrent attacks during the interval period. Conclusion ILC is recommended in AC to minimize hospital stays.
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Affiliation(s)
- Yasin Güneş
- General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Emre Teke
- General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| | - Mehmet T Aydın
- General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Teke E, Güneş Y, Aydın MT, Cagiltay E, Sancak S. Insulinoma Misdiagnosed as Post-bariatric Hypoglycemia: A Case Report and Review of the Literature. Cureus 2023; 15:e38197. [PMID: 37252561 PMCID: PMC10224636 DOI: 10.7759/cureus.38197] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Hypoglycemia is seen with increasing frequency after bariatric surgery. After the diagnosis of hypoglycemia has been clarified, malnutrition, drugs, hormone deficiencies, insulinoma, extra-islet tumors, post-bariatric hypoglycemia (PBH), early or late dumping syndrome, and nesidioblastosis should be considered in the differential diagnosis. A few case reports of insulinomas presenting after bariatric surgery have been reported in the literature. The coexistence of insulinoma and type 2 diabetes mellitus (T2D) is very rare. We herein report a clinical case of insulinoma presenting with severe hypoglycemia in a patient with a history of gastric transit bipartition. A patient with type 2 diabetes mellitus underwent gastric transit bipartition surgery due to the inability of medical therapy to provide adequate hyperglycemia control. After the operation, hypoglycemic symptoms appeared, and a reversal operation was performed, considering the diagnosis as PBH. After the reverse operation, the patient's hypoglycemia symptoms did not regress. The patient was admitted to our endocrinology clinic due to the persistence of hypoglycemia and symptoms such as fatigue, palpitation, and syncope. The patient's detailed anamnesis was examined, additional tests were performed, and the patient was diagnosed with insulinoma. The symptoms of hypoglycemia and the need for treatment for diabetes mellitus disappeared after the Whipple operation. This is the first case of insulinoma after gastric transit bipartition and subsequent reversal operations. In addition, the patient's diagnosis of diabetes mellitus makes this case unique. Although this is a very rare case, clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.
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Affiliation(s)
- Emre Teke
- General Surgery, Haydarpasa Numune Training and Research Hospital, istanbul, TUR
| | - Yasin Güneş
- General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Mehmet T Aydın
- General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Eylem Cagiltay
- Endocrinology and Metabolic Diseases, University of Health Sciences, Sultan Abdulhamid Han Education and Research Hospital, Istanbul, TUR
| | - Seda Sancak
- Endocrinology and Metabolic Diseases, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Ergin A, Aydin MT, Çiyiltepe H, Karip AB, Fersahoğlu MM, Özcabi Y, Ağca B, İşcan AY, Güneş Y, Ar AY, Taşdelen İ, Memişoğlu K. Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial. Int J Surg 2021; 95:106134. [PMID: 34653721 DOI: 10.1016/j.ijsu.2021.106134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/26/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. METHODS In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. RESULTS Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. CONCLUSIONS Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.
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Affiliation(s)
- Anil Ergin
- Fatih Sultan Mehmet Training and Research Hospital, General Surgery Department, Hastane Street No: 1/8 Icerenkoy, Istanbul, 34752, Turkey Istanbul Oncology Hospital, Digestive Surgery Department, Cevizli, Toros Street No:86, 34846, Maltepe, İstanbul, Turkey Istanbul Unıversity Faculty of Medicine, General Surgery Department, Topkapı, Turgut Özal Millet Street, 34093, Fatih, İstanbul, Turkey Fatih Sultan Mehmet Training and Research Hospital, Department of Anesthesiology and Reanimation, Hastane Street No: 1/8 Icerenkoy, Istanbul, 34752, Turkey
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Güneş Y, Bostancı Ö, İlbar Tartar R, Battal M. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A 2020; 31:36-40. [PMID: 32559394 DOI: 10.1089/lap.2020.0334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/13/2022] Open
Abstract
Introduction: Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder (GB). XGC surgery is a difficult process due to its clinical, radiological, and intraoperative findings. In this study, our aim is to show the difficulties of XGC surgery and to find out if laparoscopic surgery is a sufficient procedure. Materials and Methods: Histological findings of 3339 cholecystectomy patients, who were operated between January 2015 and January 2020, were retrospectively reviewed. Age, gender, radiological results, clinical features, intraoperative findings, and surgical management of the patients with XGC were recorded. Results: XGC was observed in 70 patients (2.09%). The average age was 53.75. M:F ratio was 1.2. In radiological examinations, gallstones were found in 94.2% of the patients and GB wall thickness (≥3 mm) was increased in 58.5% of the patients. Around 45.7% of the patients came to the clinic with chronic cholecystitis and 32.9% with acute cholecystitis. In the intraoperative period, adhesions were observed in 80% and increase in GB wall thickness was observed in 77.1% of the patients. The operation started laparoscopically in 66 patients. In 14 patients (21.2%), it was converted to open surgery usually due to insufficient dissection of Calot's triangle. Gallbladder carcinoma (GBC) was suspected in 6 patients, but none of them had malignancy in frozen sections or histology. Conclusions: XGC surgery is difficult due to its radiological, clinical, and intraoperative features and mimicking GBC. It can be converted to open cholecystectomy due to difficulties in laparoscopic dissection. However, since conversion cholecystectomy rates are reasonable, laparoscopic surgery is recommended in patients with suspected XGC.
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Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Özgür Bostancı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Rümeysa İlbar Tartar
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Muharrem Battal
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Güneş Y, Yılmaz Ö. EP.86The effect of trunk training on trunk control, upper extremity, and pulmonary function in children with Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.492] [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: 11/25/2022]
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Güneş Y, Karip B, Ergin A, Esen Bulut N, Fersahoğlu MM, Memişoğlu K. The Impact of Protein Support on Weight Loss, Sarcopenia, and Quality of Life After Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Patnos State Hospital, Ağrı, Turkey
| | - Bora Karip
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Anıl Ergin
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mahir Fersahoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kemal Memişoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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12
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Abstract
The aim of this work was to study the inhibition effect of boric acid and sodium borate on the treatment of boron containing synthetic wastewater by a down flow aerobic fixed bed biofilm reactor at various chemical oxygen demand (COD)/boron ratios (0.47-20.54). The inhibitory effect of boron on activated sludge was evaluated on the basis of COD removal during the experimental period. The biofilter (effective volume = 2.5 L) was filled with a ring of plastic material inoculated with acclimated activated sludge. The synthetic wastewater composed of glucose, urea, KH2PO4, MgSO4, Fe2 SO4, ZnSO4 x 7H20, KCl, CaCl2, and di-sodium tetraborate decahydrate or boric acid (B = 100-2000 mg L(-1)). The biological treatment of boron containing wastewater resulted in a low treatment removal rate due to the reduced microbial activity as a result of toxic effects of high boron concentrations. The decrease in the COD removal rate by the presence of either boric acid or sodium borate was practically indistinguishable. It was observed from the experiments that about 90-95% of COD removal was possible at high COD/boron ratios.
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Affiliation(s)
- Y Güneş
- Department of Environmental Engineering, Namik Kemal University Corlu, Tekirdag, Turkey.
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13
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Abstract
Paravertebral block (PVB) has been used for postoperative analgesia in children since 1992. There are no prospective randomised studies comparing the use of PVB versus caudal block (CB) for outpatient inguinal hernia repair surgery. The hypothesis of this study is that a single level, single injection PVB can provide a longer duration of analgesia and less requirement for supplemental analgesia than single shot CB for children undergoing inguinal surgery. Seventy children, aged three to seven, American Society of Anesthesiologists score I to II, having unilateral inguinal surgery were enrolled in the study. The patients were divided into two randomised groups. In group PVB, a single shot of 0.2 ml/kg levobupivacaine was administered via the lumbar paravertebral route and in group CB, patients were given 1 ml/kg levobupivacaine caudally. Sevoflurane concentration was evaluated after induction and recorded during incision, sac traction and closure. Face, legs, activity, cry and consolability (FLACC) scores, heart rate, blood pressure and SpO2 were evaluated postoperatively. Only four (11.4 %) patients in the PVB group needed rescue analgesic drugs compared to 12 (34.3%) patients in the CB group (P=0.044). Patients were given tramadol as rescue analgesia in the first four postoperative hours. No other supplemental analgesic drug was given apart from tramadol. FLACC scores were the same in the both groups. Parental satisfaction was significantly higher in the PVB group compared to the CB group (74.3 vs 40%, P=0.01). This study has demonstrated that a single level single injection paravertebral block provides superior intraoperative and postoperative analgesia when compared to a caudal block for unilateral inguinal hernia repair.
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Affiliation(s)
- R. Tug
- Department of Anesthesiology, Cukurova University Medical Faculty, Balcali-Adana, Turkey
| | - D. Ozcengiz
- Department of Anesthesiology, Cukurova University Medical Faculty, Balcali-Adana, Turkey
| | - Y. Güneş
- Department of Anesthesiology, Cukurova University Medical Faculty, Balcali-Adana, Turkey
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14
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Yanardag H, Güneş Y. Occurrence of pleural effusion due to tuberculosis in patients with sarcoidosis. Indian J Chest Dis Allied Sci 2005; 47:9-11. [PMID: 15704709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease of unknown aetiology. Pleural effusion is very rare in sarcoidosis. In cases with pleural effusion, usually other etiologic factors such as tuberculosis, heart failure, renal failure and malignancy should be considered. METHODS We retrospectively reviewed the records of 512 sarcoidosis patients followed up at Ceraphasa Medical Faculty, Internal Medicine-Respiratory Disease Department, Turkey. RESULTS Only four patients with pleural effusion were documented, in three of them it was due to tuberculosis. The patients were negative for microbiological tests regarding tuberculosis and tuberculin tests as well, when the diagnosis of sarcoidosis was made. With the occurrence of effusion tuberculin tests became positive. Acid-fast bacilli (AFB) was cultured in pleural fluid and biopsy materials. After addition of antituberculosis therapy, pleural effusion regressed in all the three cases. CONCLUSIONS In a sarcoidosis patient with no active disease activity who present with a pleural effusion, if other causes are excluded, it is advisable to start anti-tuberculosis therapy since sarcoid pleural effusion is a rare form of disease occurring at advanced stage of disease. Moreover, corticosteroid therapy renders patients susceptible to tuberculosis. Tuberculin conversion could be a clue to diagnosis in these patients.
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Affiliation(s)
- H Yanardag
- Istanbul University, Cerahpasa Medical Faculty, Internal Medicine-Respiratory Disease Department, Istanbul, Turkey.
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15
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Güneş Y, Seçen M, Ozcengiz D, Gündüz M, Balcioglu O, Işik G. Comparison of caudal ropivacaine, ropivacaine plus ketamine and ropivacaine plus tramadol administration for postoperative analgesia in children. Paediatr Anaesth 2004; 14:557-63. [PMID: 15200652 DOI: 10.1111/j.1460-9592.2004.01220.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to compare the effect of single-dose caudal ropivacaine, ropivacaine plus ketamine and ropivacaine plus tramadol in children for postoperative pain management. METHODS Following ethics committee approval and informed parental consent, 99 ASA PS I or II children, between 1 and 10 years of age, scheduled for elective inguinal hernia repair with general anaesthesia, were recruited. After induction of anaesthesia and placement of a laryngeal mask airway (LMATM), the patients were randomly divided into three groups to receive either caudal ropivacaine alone (0.4%, 2 mg x kg(-1)) in group R (n = 32) or ropivacaine (0.2%, 1 mg x kg(-1)) plus ketamine (0.25 mg x kg(-1)) in group RK (n = 33) or ropivacaine (0.2%, 1 mg x kg(-1)) plus tramadol (1 mg x kg(-1)) in group RT (n = 34) with a total volume of 0.5 ml x kg(-1). Systemic blood pressure (SBP and DBP), heart rate (HR), peripheral O2 saturation (SpO2), respiratory rate (RR), sedation and pain scores were recorded at 5, 10, 15 and 30 min, 1, 3, 4 and 6 h following recovery from anaesthesia. Pain was evaluated by Children's Hospital of Eastern Ontario Pain Scale, and sedation with a five-point sedation test. RESULTS No difference was found regarding age, weight and duration of operation between the groups (P > 0.05). No patient experienced hypotension, bradycardia or respiratory depression. Duration of analgesia was longer in group RT (1377 +/- 204 min) than group R (1006 +/- 506 min) (P = 0.001). In the tramadol group, fewer patients required supplementary analgesics in the first 24 h (P = 0.005). Sedation scores were below 2 in all groups. Incidence of postoperative nausea and vomiting was higher in group RT (eight patients) and group RK (seven patients) than group R (one patient, P = 0.032). CONCLUSIONS Ropivacaine (0.4%), ropivacaine (0.2%) plus ketamine (0.25 mg x kg(-1)) and ropivacaine (0.2%) plus tramadol (0.5 mg x kg(-1)) provided sufficient analgesia in children, but the duration of analgesia was longer in the RT group.
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Affiliation(s)
- Y Güneş
- Department of Anaesthesiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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16
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Ozcengiz D, Güneş Y, Ozalevli M, Işik G. Postoperative analgesia in children: comparison of bupivacaine with a mixture of bupivacaine and alfentanil. Eur J Anaesthesiol 2001; 18:695-6. [PMID: 11553247 DOI: 10.1046/j.1365-2346.2001.0903a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Ozcengiz
- Cukurova University Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
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