Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thy... more Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-...
The main early complications of Laparascopic Sleeve Gastrectomy are bleeding and gastric leakage.... more The main early complications of Laparascopic Sleeve Gastrectomy are bleeding and gastric leakage. Many reinforcement methods are performed in order to reduce these complications. In this prospective, random-ized study, we compared four different techniques to evaluate staple line reinforcement in Laparascopic Sleeve Gastrectomy. Between January 2012 and May 2013, 65 patients were prospectively randomized into four groups in which different techniques were used in handling the staple line during Laparascopic Sleeve Gastrectomy. Of the four groups, there wasn't any reinforcement used on 15 patients during LSG (group 1), continuous serosal 3-0 prolene sutures were used on 16 patients for staple line reinforcement (group 2), staple line was supported with v-loc suture in 16 patients (group 3), and 18 patients had Tisseel fibrin sealant applied throughout the staple line (group 4). 40 of 65 patients were females, the mean age was 36.8 years (20-58 years), and the mean BMI was 49.2 (4...
Intussusception appears to be very rare in adults. In colonic intussusceptions, there is particul... more Intussusception appears to be very rare in adults. In colonic intussusceptions, there is particularly high level of underlying malignant etiology. This case with its nonspecific symptoms and prognosis is usually diagnosed at laparotomy. Although preoperative diagnosis is difficult, after the suspicion of intussusception abdominal USG and CT usually leads to the right diagnosis. Due to a high rate of malignancy, resection without reduction in accordance with the oncological principles is recommended. We here, are presenting this colonic intussusception case which appears to be a possible chance for the treatment of colon cancer by means of early diagnosis and appropriate surgery.
Involvement of skeletal muscle in Eccinococcal infection is a relatively rare condition which cli... more Involvement of skeletal muscle in Eccinococcal infection is a relatively rare condition which clinically mimics soft tissue tumors at initial presentation. We present a case report of a 30 years old female patient presented with a painless mass on anterolateral region of her left thigh. Diagnostic work up begun with an MRI examination and it revealed a mass containing multiple cystic vesicles in vastus lateralis muscle which was identical to hydatid disease those seen elsewhere in human body. Surgical excision with Albendazole medication cured the patient. Hydatid disease may present as a painless mass in extremities thus it should be included in differential diagnosis of such masses especially in endemic areas.
BACKGROUND Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, d... more BACKGROUND Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of hyoscine-N-butylbromide as an antispasmodic during colonoscopy. METHOD Patients referred for elective colonoscopy were randomized into the study and placebo groups. Before the procedure, the study and placebo groups received 20 mg intra-venous hyoscine-N-butylbromide and intravenous saline solution of the same amount, respectively. Demographic and procedure--related data were recorded and compared between the groups. RESULTS Of 198 patients referred for elective colonoscopy, 121 were included (study group = 60, placebo group = 61). No differences were observed between the study and placebo groups in terms of demographic data, pre-procedure characteristics, and colonoscopic characteristics including the cecal intubation time, total procedure time, bowel preparation, sedation doses, hemo-dynamic findings, endoscopist s...
In this prospective study, we aimed to determine the cancer incidence of thyroid nodules larger t... more In this prospective study, we aimed to determine the cancer incidence of thyroid nodules larger than 3cm and compare the efficacy of palpation and ultrasound guided fine needle aspiration biopsy (FNAB). The study was conducted at General Surgery Departments of Istanbul Okmeydanı and Antalya Training and Research Hospitals of Turkey from March 2008 to December 2011. In our clinics, between the years 2008 and 2011, both palpation and ultrasound guided FNAB were performed in all 55 patients having thyroid nodules larger than 3 cm. The results were determined as inadequate, benign, suspicious and malignant. Histopathological findings were compared with the results of both palpation and ultrasound guided FNAB and sensitivity, specificity and accuracy rates were calculated. The specificity (98%) and accuracy rate (92.72%) of ultrasound guided FNAB corresponded to those from the literature, except the rate of sensitivity (40%). This is explained by FNAB performed only on the dominant nodul...
The aim of this manuscript is to describe an effective and simple method for the complete removal... more The aim of this manuscript is to describe an effective and simple method for the complete removal of colonic lipomas. The technique is described by using the images captured during the removal of an average sized lipoma found incidentally during colonoscopy on a single patient. The loop wire of the snare was advanced and the protruding part of lipoma firmly pinched in the loop and lipoma became dumb-bell shaped and nicely encased in the snare. It was performed a “half lipomectomy”. Diathermy dissection at the base by cutting the mucosa and gradual traction resulted into delivery of the sub-mucosal buried part of lipoma. In our method, we use only a slight traction for delivery of the lipoma in to the colonic lumen without using thermal or mechanical dissection.
Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for... more Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for post-operative complications. The aim of this study is to compare the effects of suture ligation and bipolar tissue sealer techniques on burst pressure using flesh appendectomy specimens. Appendectomy specimens of 32 patients with grade I-II disease were included in the study. Perforated or necrotic appendices and specimens ineligible for pressure measurement were excluded from the study. Appendiceal stumps of 16 patients in group 1 were double-ligated with 2/0 polyglactin sutures, then appendectomy was performed between these sutures. In group 2, the management of the stump was performed through single ligation with polyglactin suture, followed by appendectomy using a bipolar tissue sealing device. Burst pressures were recorded for all specimens. There were no differences between groups in terms of age and sex. There was no significant difference between the two groups in terms of burst pressure (p = 0.92). Also, no significant difference was found between groups in terms of localization of the perforation (p > 0.05). Bipolar tissue sealer achieves safe stump closure with satisfactory burst pressure values. Based on this, using bipolar tissue sealer for appendiceal stump closure in appendicitis may be safe and reliable.
International journal of clinical and experimental medicine, 2013
Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thy... more Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-...
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2015
Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforce... more Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of two supportive techniques on burst pressures in sleeved gastrectomy specimens. Thirty patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into three groups. Group 1 had no extra support in the staple line, Group 2 had oversewing with continuous suture on the staple line, and Group 3 had fibrin sealant (Tisseel(®); Baxter, Deerfield, IL) on the staple line. The end point was the first detectable leakage, at which point leak pressure and the anatomic site of leakage were recorded. Thirty sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences among group in terms of age, sex, and body mass index. The leak pressure was significantly higher (106±10.5 mm Hg) in Group 2 (P<.01). Leaks occurred significantly more frequently in the staple line than in the staple junction points (P=.014). Oversewing the staple line with 3-0 Vicryl(®) (Ethicon, Somerville, NJ) suture significantly increased the strength of the staple line. Increases in intraluminal pressure are known to be one of the significant risks in leak etiology. Thus, we concluded that oversewing the staple line with 3-0 Vicryl suture can be beneficial in the prevention of leaks. However, further work is necessary in this area of research.
Turkish Journal of Trauma and Emergency Surgery, 2013
We aimed to assess the effect of prophylactic injection therapy during the index gastroscopy on u... more We aimed to assess the effect of prophylactic injection therapy during the index gastroscopy on upper gastrointestinal bleeding due to Forrest type 2b duodenal ulcer. METHODS The patients who were admitted with upper gastrointestinal bleeding and who underwent emergency gastroscopy between January 2004 and January 2011 were recruited to the study retrospectively. Among those, the patients with Forrest type 2b duodenal ulcer were selected and divided into two groups. The patients in Group 1 had only diagnostic gastroscopy, whereas those in Group 2 had prophylactic injection therapy during the index gastroscopy. RESULTS Eighty-seven patients were included in the study. There were 41 patients in Group 1 and 46 patients in Group 2. There was a significant difference in the incidence of rebleeding (26.8% versus 6.5%, p=0.017). The mortality rate was similar in the two groups (9.7% versus 2.1%, p=0.184). CONCLUSION We recommend prophylactic injection therapy in patients with upper gastrointestinal bleeding who have Forrest type 2b duodenal ulcer.
Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thy... more Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-...
The main early complications of Laparascopic Sleeve Gastrectomy are bleeding and gastric leakage.... more The main early complications of Laparascopic Sleeve Gastrectomy are bleeding and gastric leakage. Many reinforcement methods are performed in order to reduce these complications. In this prospective, random-ized study, we compared four different techniques to evaluate staple line reinforcement in Laparascopic Sleeve Gastrectomy. Between January 2012 and May 2013, 65 patients were prospectively randomized into four groups in which different techniques were used in handling the staple line during Laparascopic Sleeve Gastrectomy. Of the four groups, there wasn't any reinforcement used on 15 patients during LSG (group 1), continuous serosal 3-0 prolene sutures were used on 16 patients for staple line reinforcement (group 2), staple line was supported with v-loc suture in 16 patients (group 3), and 18 patients had Tisseel fibrin sealant applied throughout the staple line (group 4). 40 of 65 patients were females, the mean age was 36.8 years (20-58 years), and the mean BMI was 49.2 (4...
Intussusception appears to be very rare in adults. In colonic intussusceptions, there is particul... more Intussusception appears to be very rare in adults. In colonic intussusceptions, there is particularly high level of underlying malignant etiology. This case with its nonspecific symptoms and prognosis is usually diagnosed at laparotomy. Although preoperative diagnosis is difficult, after the suspicion of intussusception abdominal USG and CT usually leads to the right diagnosis. Due to a high rate of malignancy, resection without reduction in accordance with the oncological principles is recommended. We here, are presenting this colonic intussusception case which appears to be a possible chance for the treatment of colon cancer by means of early diagnosis and appropriate surgery.
Involvement of skeletal muscle in Eccinococcal infection is a relatively rare condition which cli... more Involvement of skeletal muscle in Eccinococcal infection is a relatively rare condition which clinically mimics soft tissue tumors at initial presentation. We present a case report of a 30 years old female patient presented with a painless mass on anterolateral region of her left thigh. Diagnostic work up begun with an MRI examination and it revealed a mass containing multiple cystic vesicles in vastus lateralis muscle which was identical to hydatid disease those seen elsewhere in human body. Surgical excision with Albendazole medication cured the patient. Hydatid disease may present as a painless mass in extremities thus it should be included in differential diagnosis of such masses especially in endemic areas.
BACKGROUND Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, d... more BACKGROUND Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of hyoscine-N-butylbromide as an antispasmodic during colonoscopy. METHOD Patients referred for elective colonoscopy were randomized into the study and placebo groups. Before the procedure, the study and placebo groups received 20 mg intra-venous hyoscine-N-butylbromide and intravenous saline solution of the same amount, respectively. Demographic and procedure--related data were recorded and compared between the groups. RESULTS Of 198 patients referred for elective colonoscopy, 121 were included (study group = 60, placebo group = 61). No differences were observed between the study and placebo groups in terms of demographic data, pre-procedure characteristics, and colonoscopic characteristics including the cecal intubation time, total procedure time, bowel preparation, sedation doses, hemo-dynamic findings, endoscopist s...
In this prospective study, we aimed to determine the cancer incidence of thyroid nodules larger t... more In this prospective study, we aimed to determine the cancer incidence of thyroid nodules larger than 3cm and compare the efficacy of palpation and ultrasound guided fine needle aspiration biopsy (FNAB). The study was conducted at General Surgery Departments of Istanbul Okmeydanı and Antalya Training and Research Hospitals of Turkey from March 2008 to December 2011. In our clinics, between the years 2008 and 2011, both palpation and ultrasound guided FNAB were performed in all 55 patients having thyroid nodules larger than 3 cm. The results were determined as inadequate, benign, suspicious and malignant. Histopathological findings were compared with the results of both palpation and ultrasound guided FNAB and sensitivity, specificity and accuracy rates were calculated. The specificity (98%) and accuracy rate (92.72%) of ultrasound guided FNAB corresponded to those from the literature, except the rate of sensitivity (40%). This is explained by FNAB performed only on the dominant nodul...
The aim of this manuscript is to describe an effective and simple method for the complete removal... more The aim of this manuscript is to describe an effective and simple method for the complete removal of colonic lipomas. The technique is described by using the images captured during the removal of an average sized lipoma found incidentally during colonoscopy on a single patient. The loop wire of the snare was advanced and the protruding part of lipoma firmly pinched in the loop and lipoma became dumb-bell shaped and nicely encased in the snare. It was performed a “half lipomectomy”. Diathermy dissection at the base by cutting the mucosa and gradual traction resulted into delivery of the sub-mucosal buried part of lipoma. In our method, we use only a slight traction for delivery of the lipoma in to the colonic lumen without using thermal or mechanical dissection.
Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for... more Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for post-operative complications. The aim of this study is to compare the effects of suture ligation and bipolar tissue sealer techniques on burst pressure using flesh appendectomy specimens. Appendectomy specimens of 32 patients with grade I-II disease were included in the study. Perforated or necrotic appendices and specimens ineligible for pressure measurement were excluded from the study. Appendiceal stumps of 16 patients in group 1 were double-ligated with 2/0 polyglactin sutures, then appendectomy was performed between these sutures. In group 2, the management of the stump was performed through single ligation with polyglactin suture, followed by appendectomy using a bipolar tissue sealing device. Burst pressures were recorded for all specimens. There were no differences between groups in terms of age and sex. There was no significant difference between the two groups in terms of burst pressure (p = 0.92). Also, no significant difference was found between groups in terms of localization of the perforation (p > 0.05). Bipolar tissue sealer achieves safe stump closure with satisfactory burst pressure values. Based on this, using bipolar tissue sealer for appendiceal stump closure in appendicitis may be safe and reliable.
International journal of clinical and experimental medicine, 2013
Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thy... more Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-...
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2015
Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforce... more Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of two supportive techniques on burst pressures in sleeved gastrectomy specimens. Thirty patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into three groups. Group 1 had no extra support in the staple line, Group 2 had oversewing with continuous suture on the staple line, and Group 3 had fibrin sealant (Tisseel(®); Baxter, Deerfield, IL) on the staple line. The end point was the first detectable leakage, at which point leak pressure and the anatomic site of leakage were recorded. Thirty sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences among group in terms of age, sex, and body mass index. The leak pressure was significantly higher (106±10.5 mm Hg) in Group 2 (P<.01). Leaks occurred significantly more frequently in the staple line than in the staple junction points (P=.014). Oversewing the staple line with 3-0 Vicryl(®) (Ethicon, Somerville, NJ) suture significantly increased the strength of the staple line. Increases in intraluminal pressure are known to be one of the significant risks in leak etiology. Thus, we concluded that oversewing the staple line with 3-0 Vicryl suture can be beneficial in the prevention of leaks. However, further work is necessary in this area of research.
Turkish Journal of Trauma and Emergency Surgery, 2013
We aimed to assess the effect of prophylactic injection therapy during the index gastroscopy on u... more We aimed to assess the effect of prophylactic injection therapy during the index gastroscopy on upper gastrointestinal bleeding due to Forrest type 2b duodenal ulcer. METHODS The patients who were admitted with upper gastrointestinal bleeding and who underwent emergency gastroscopy between January 2004 and January 2011 were recruited to the study retrospectively. Among those, the patients with Forrest type 2b duodenal ulcer were selected and divided into two groups. The patients in Group 1 had only diagnostic gastroscopy, whereas those in Group 2 had prophylactic injection therapy during the index gastroscopy. RESULTS Eighty-seven patients were included in the study. There were 41 patients in Group 1 and 46 patients in Group 2. There was a significant difference in the incidence of rebleeding (26.8% versus 6.5%, p=0.017). The mortality rate was similar in the two groups (9.7% versus 2.1%, p=0.184). CONCLUSION We recommend prophylactic injection therapy in patients with upper gastrointestinal bleeding who have Forrest type 2b duodenal ulcer.
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