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Öğe Can the Drain Fluid pH Predict Anastomotic Leakage after Sleeve Gastrectomy?(Zamensalamati Publ Co, 2022) Kutluer, Nizamettin; Dogan, Serhat; Aksu, Ali; Ayyildiz, Hakan; Kalayci, Mehmet; Karagoz, Zuhal Karaca; Kanat, Burhan HakanBackground: Laparoscopic Sleeve Gastrectomy is the most common type of surgical treatment for morbid obesity. One of the most important complications is leakage from the stapler line. Early detection of a leakage is important in preventing undesirable events. Objectives: The aim of this study was to evaluate the predictive value of postoperative drain fluid pH on early detection of leakage. Methods: This study was performed with 63 patients including 33 patients who underwent laparoscopic sleeve gastrectomy for morbid obesity (Group SG) and 30 patients who underwent laparoscopic cholecystectomy (Group LC), as the control group. Fluid sample was obtained after surgery with intra-abdominal drain. The pH value of this fluid was measured using a pH meter at the Ohaus device in the biochemistry laboratory of study hospital. Results: When the differences in the mean pH values of patients who underwent obesity surgery and gallbladder surgery were evaluated; no statistically significant difference was found between the mean pH value of patients (p: 0.808> 0.05). Conclusion: None of our patient had leakage and unable to demonstrate how would be the drain fluid pH value if there was a leak, we suggest that drain fluid pH would not be a suitable alarming sign for a leakage in the early period. Because we know that most of the leaks occur at the proximal part of the stomach and that there is more saliva drainage through the line of leakage. Although it is known that the acidic fluid of the stomach can be drained from the same leak in this condition, it is not unlikely that saliva can bring the pH to normal levels. Therefore, if the pH of the drain fluid is close to normal, it is meaning that there is no leakage from the site.Öğe The effect of stump ligation techniques on operative time in laparoscopic appendectomy(20 haziran 2021) Kutluer, Nizamettin; Aksu, Ali; Kanat, Burhan Hakan; Aday, Ulaş; Böyük, Abdullah; Doğan, SerhatIntroduction: We aimed to evaluate the effect of stump ligation techniques on operative time in laparoscopic appendectomy. Material and methods: The patients who underwent laparoscopic appen dectomy in our General Surgery Clinic between January 2016 and August 2018 were retrospectively reviewed. The effects of stump ligation tech niques used in the operations on operative times were evaluated. Results: Sixty consecutive patients were screened and 3 groups, 20 patients in each group, were formed based on stump ligation techniques. Extracor poreal knotting – loop ligation was used in Group 1; intracorporeal knotting was used in the Group 2; hem-o-lok clip was used in Group 3.There was no statistically significant difference between the groups in terms of gender distribution and mean age. However, there was a significant difference be tween the hem-o-lok clip group (Group III) and the intracorporeal knot group (Group II) in terms of operative time. Group III had a shorter operative time. The Group III patients had the shortest operative time, while the Group II patients had the longest operative time (p < 0.05). Conclusions: We can speculate that hem-o-lok clip among the stump liga tion techniques reduces the cost, is a safe method and shortens the opera tive time. However, prospective randomized studies with a large sample size comparing different techniques are needed to determine the ideal treat ment procedure. At the same time, stapler use may be considered in cases where the base of the appendix is too inflamed or necrosed. It is known that the use of a stapler and endoloop is more expensive than all other tech niques. However, the most important issue for the surgeon is patient safety; therefore the most appropriate technique should be preferred.Öğe The effects of sponges soaked with chlorhexidine gluconate and metronidazole on safety of colonic anastomosis in an experimental model of peritonitis(2021) Kanat, Burhan HakanBACKGROUND: The present study aims to evaluate the use of the chlorhexidine gluconate and metronidazole impregnated compresses concerning anastomosis safety in the left colonic anastomosis in the presence of peritonitis. METHODS: This study was conducted on 21 Wistar-Albino-rats divided into three equal groups. After median laparotomy, the whole layer of the left colon was cut 2 cm over the pelvic peritoneum. The faeces were spread around the injury for fecal contamination. Then, fasia and skin were closed with 3/0 silk. After one day period, relaparatomy was performed. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in the first group and then double layer colonic anastomosis was performed. In the second Group-II, abdomen was cleared with the metronidazole impregnated compresses then double layer colonic anastomosis was performed. In the group-III, abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels and anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy. RESULTS: The highest anastomosis bursting pressure was found in Group-III (p<0.05). The highest tissue hydroksiproline level was found in Group-III (p<0.005 Group I-III, Group II-III). When histopathologic findings were evaluated by comparing the three groups in this study, the healing of the intestine tissue score was statistically insignificant between group-II and III, for both group-II and III, healing score was statistically significant higher than Group-I (p<0.05 Group I–III and Group I-II). CONCLUSION: Cleaning the abdomen before the anastomosis using antibacterial soaked material increased resection safety in the presence of peritonitis and anastomosis safety in primary anastomosis.Öğe Evaluation of Changes in Optic Nerve Diameter in Obese Patients Undergoing Laparoscopic Surgery(Duzce Univ, Fac Medicine, 2026) Delen, Leman Acun; Oterkus, Mesut; Kasapoglu, Umut Sabri; Mizrak, Zeynep Koylu; Ondes, Bahadir; Kanat, Burhan HakanAim: During laparoscopic surgery (LC), intracranial pressure increases due to factors such as pneumoperitoneum (PP) and Trendelenburg position (TP). Measurement of the optic nerve sheath diameter is an important indicator of intracranial pressure. In this study, we compared the optic nerve diameter measurement (ONSD) during laparoscopic surgery in obese and normal weight individuals. Material and Methos: The search included 99 ills who underwent laparoscopic surgery at Malatya Training and Research Hospital. Optic nerve sheath age measurements were performed preoperatively, post-intubation, post-pneumoperitoneum, and post-extubation in obese (n: 50) and control group (n: 49) patients who underwent laparoscopic surgery. Additionally, operation information and demographic data were recorded. Result: We included 99 patients in the study. The data analysis we obtained in this study showed that although ONSD values were similar between the groups at T0 and T1 (p>0.05), they were wider in obese individuals at T2 and T3 (respectively p <0.001, p=0.044). In the within-group analysis; although there was an increase compared to T0 in the obese group at T1 and T2, there was a decrease compared to T2 at T3 (p<0.001). In normal-weight patients, the within-group measured T-times were similar to those in the obese group. In the statistical analysis performed using the SPSS 23.0 statistical package, Skewness and Kurtosis test, t-test, Mann-Whitney U test and ANOVA were used. Conclusion: Results of the analysis of research data; PP and TP in LC Cause increased intracranial pressure. In order to prevent possible complications, it is important to provide lower PP pressure, keep the operation time as short as possible, and keep EtCO2 within normal limits by making mechanical ventilator adjustments.Öğe Giant Fibroadenomas in Young Women(Galenos Yayinevi, 2020-06-09) Kanat, Burhan Hakan; Kutluer, Nizamettin; Arslan Solmaz, Özgen; Bozdağ, PınarObjectives: In this study, we consider a fibroadenoma with a size >5 cm as a giant fibroadenoma (GFA). This definition is not universally acceptedbut has been used in several studies. We retrospectively presented fibroadenoma cases that were treated in our clinic, together with a review of thecurrent literature.Materials and Methods: The GFA cases that were surgically treated in our clinic between January 2016 and December 2019 were retrospectivelyreviewed. The data were collected from patient files, discharge reports, surgical notes, pathology reports, patient follow-up forms, and digitalrecords. Patients whose data were not fully available were excluded from the study. The patients were analyzed in terms of age, duration ofsymptom, macroscopically size of the mass and location.Results: Eight patients were analyzed. The mean age of the patients was 31.5±5.8 (23-41) years. The mean time of diagnosis before the operationwas 36.75±14.49 (18-60) months. The lesion was in the left breast for five patients (62.5%) and in the right breast for three patients (37.5%). Themean size of fibroadenomas was 52.5±2 (50-56) mm.Conclusion: There is not a consensus in the ideal treatment protocol of GFAs. A careful physical examination and radiological examination aresufficient for diagnosis, but a biopsy will be beneficial in the context of a GFA. We think that excision should be done in the treatment of GFAs.Öğe Is body mass index and obesity surgery mortality score important in perioperative complications of laparoscopic sleeve gastrectomy before discharge?(Colegio Brasileiro de Cirurgia Digestiva, 2021) Bozan, Mehmet Buğra; Kutluer, Nizamettin; Aksu, Ali; Azak Bozan, Ayşe; Kanat, Burhan Hakan; Büyük, AbdullahBackground: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn’t seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15–64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40–57) kg/m2 and 44.8±3.49 (35–67) kg/m2 respectively. According to BMI groups 40–45 kg/m2, 45–50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.Öğe IS BODY MASS INDEX AND OBESITY SURGERY MORTALITY SCORE IMPORTANT IN PERIOPERATIVE COMPLICATIONS OF LAPAROSCOPIC SLEEVE GASTRECTOMY BEFORE DISCHARGE?(Colegio Brasileiro Cirurgia Digestiva-Cbcd, 2021) Bozan, Mehmet Bugra; Kutluer, Nizamettin; Aksu, Ali; Bozan, Ayse Azak; Kanat, Burhan Hakan; Boyuk, AbdullahBackground: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn't seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3 +/- 10.02 years (19-57) and without complications 34.12 +/- 9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05 +/- 3.93 (40-57) kg/m(2) and 44.8 +/- 3.49 (35-67) kg/m(2) respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m(2) and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.Öğe Is gastroscopy necessary before bariatric surgery?(World J Gastrointest Endosc, 2022) Kanat, Burhan Hakan; Doğan, SerhatObesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery? " We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.Öğe Is phenytoin a safe agent for staple line recovery after gastric sleeve surgery in rats?(Turkish Assoc Trauma Emergency Surgery, 2023) Gay, Ferhat; Duran, Ali; Tokay, Esra; Hacioglu, Nelin; Kockar, Feray; Altun, Eren; Kanat, Burhan HakanBACKGROUND: The most challenging and mortal complication of gastric sleeve surgery (SG) is staple line leakage. Although many agents have been used for increasing tissue healing on the stapler line, there is still no consensus on its effectiveness and efficacy. The aim of study is to determine the effect of phenytoin on the healing process of gastric sleeve surgery in rats. METHODS: On the 10th post-operative day, the effects of phenytoin on bursting pressure in the stapler line were evaluated alongside pathohistological examinations. To investigate the molecular impact of phenytoin on the expression of TGF-8, VEGF, FGF2, and p53 genes, quantitative real-time polymerase chain reaction was utilized. In addition, gene expressions at the protein level were determined by immunohistochemical analysis. RESULTS: No signs of intra-abdominal leakage were observed in the resected samples. A statistically essential extend in stable bursting pressure measure was observed between the control group and the group treated with phenytoin application. Pathohistological results indicate that the mean score of collagens of the study group (3.2 +/- 0.42) was significantly higher than the control group (2.3 +/- 0.48) (P=0.003). In addition, the mean epithelization score of the study group (3.4 +/- 0.52) was significantly higher than the control group (2.1 +/- 0.57) (P=0.001). mRNA of TGF8, FGF2, VEGF, and p53 genes drastically increased phenytoin treated group. High FGF2 protein expression levels were determined from phenytoin use compared to the control group. CONCLUSION: Molecular studies suggest that phenytoin may increase the healing process of Gastric sleeve following SG in rats and may become a new agent for the prevention of human gastric leaks.Öğe Routine endoscopy prior to bariatric surgery: evidence-based necessity or institutional tradition?(BioMed Central Ltd, 2025) Doğan, Serhat; Kanat, Burhan HakanObesity, a growing global health challenge, requires effective treatment modalities, among which bariatric surgery is the gold standard for patients with Class III obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities). While surgical outcomes are well established, the role of routine preoperative Esophagogastroduodenoscopy (EGD) remains debated. This study evaluates the role of EGD in preoperative planning among a Turkish cohort. We conducted a retrospective cross-sectional analysis of 117 patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) between 2018 and 2021. Data on demographics, comorbidities, endoscopic and histopathologic findings, and surgical modifications were collected. Preoperative EGD revealed pathology in 86.3% of patients, including antral gastritis (64.1%), hiatal hernia (22.2%), and erosive esophagitis (18.8%). Chronic gastritis was confirmed histopathologically in 74.4%, and active Helicobacter pylori infection was identified in 15.4% of surgical specimens. Notably, EGD findings led to changes in surgical management in 18.8% of cases. Our findings support the utility of routine EGD in bariatric surgery, emphasizing its role in identifying otherwise undetected pathologies that influence surgical decision-making. Further multicenter prospective studies are warranted. © The Author(s) 2025.Öğe Surgical management of hydatid cysts in times of crisis: Experiences from the COVID-19 pandemic and a major earthquake(Mosby-Elsevier, 2026) Ondes, Bahadir; Kanat, Burhan Hakan[Abstract Not Available]Öğe The Effect of Blood Group Phenotypes on the Ki-67 Proliferation Index in Breast Cancer(Yuzuncu Yil Universitesi Tip Fakultesi, 2026) Gökdere, Osman Gökhan; Öndeş, Bahadir; Kanat, Burhan Hakan; Kurt, FeyziThe Ki-67 proliferation index is an established biomarker reflecting tumor aggressiveness and treatment response in breast cancer. ABO blood group phenotypes have been associated with cancer susceptibility and inflammatory–immunological pathways, yet their potential influence on tumor proliferative behavior remains unclear. This study aimed to investigate the relationship between ABO/Rh blood groups and Ki-67 expression levels in breast cancer. This retrospective study included 189 patients diagnosed with breast malignancy between 2020 and 2024. Ki-67 values were recorded as the percentage of positively stained tumor nuclei. Differences among ABO phenotypes were analyzed using the Kruskal–Wallis test, followed by Dunn post-hoc analysis with Bonferroni correction. Rh groups were compared using the Mann–Whitney U test. All p-values were standardized to three decimal places. A post-hoc power analysis indicated that the sample size (n=189) was adequate to detect a moderate effect size (Cohen’s f=0.25) with 80% power at α=0.05. The overall mean Ki-67 index was 25.9 ± 18.7% (median 22%). Ki-67 levels differed across ABO groups with borderline statistical significance (p=0.060). After Bonferroni correction, the largest differences were observed between group O and groups B/AB (adjusted p=0.078 and p=0.083), suggesting a trend toward higher proliferation in non-O phenotypes. No significant association was detected between Rh factor and Ki-67 levels (p=0.810). Although statistical significance was not reached, patients with blood group O demonstrated lower Ki-67 values, whereas B and AB groups tended to exhibit higher proliferation levels. This pattern may indicate a possible biological influence of ABO antigen expression on tumor proliferation. Larger and multicenter studies are warranted to clarify this potential association. © 2026, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe Use of silver nitrate application as mini-invasive treatment of pilonidal sinus disease(Editura Celsius, 2021) Kanat, Burhan Hakan; Yazar, Fatih Mehmet; Kutluer, Nizamettin; Solmaz, Özgen Arslan; Bozan, Mehmet Buğra; Çay, Ferhat; Eröz, Erhan; Saçlı, AtakanObjective: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 ± 5.18 (range, 14-36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. Conclusion: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.Öğe Use of silver nitrate application as mini-invasive treatment of pilonidal sinus disease(Editura Celsius, 2021) Kanat, Burhan Hakan; Yazar, Fatih Mehmet; Kutluer, Nizamettin; Solmaz, Özgen Arslan; Bozan, Mehmet Bugra; Çay, Ferhat; Saçli, AtakanObjective: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 ± 5.18 (range, 14-36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. Conclusion: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients. © 2020 Editura Celsius. All rights reserved.
