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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 Comparison of Monopolar and Bipolar Electrocautery Excision Techniques in Pilonidal Sinus Disease: A Retrospective Clinical Study(Zamensalamati Publ Co, 2023) Dogan, Serhat; Ondes, Bahadir; Kutluer, Nizamettin; Sozen, Selim; Gencturk, Mehmet; Erdem, Hasan; Aydin, AhmetBackground: There is no standard method for the treatment of pilonidal sinus disease (PSD). Today, many different treatment methods are attempted. Some of the leading methods are surgical procedures with different flap techniques and less invasive methods, such as crystallized phenol, laser pilonidoplasty, radiofrequency excision, and monopolar electrocautery excision. Objectives: This study aimed to compare the monopolar and bipolar electrocautery excision techniques that we performed in our clinic for PSD. Methods: Patients who received pilonidal sinus treatment in our clinic between January 2018 and January 2021 were analyzed retrospectively. The exclusion criteria were diabetes mellitus, renal failure, immunosuppression, and children (<16 years of age). The study included a total of 36 patients who met the criteria. Data were retrospectively obtained from hospital archive records (operative notes, discharge summary, and outpatient dressing records). The patients were then divided into two groups, namely monopolar electrocautery excision (group 1) and bipolar electrocautery excision (group 2). Results: The mean age of 36 patients included in the study was 22.9 years. There was no difference between the two groups in terms of predisposing factors (gender, obesity, hirsutism, and smoking). There was also no statistical difference in terms of mean healing time and recurrence rate. Monopolar and bipolar electrocautery excisions lasted 32.2 +/- 8.9 and 38.8 +/- 7.8 minutes, respectively (P<0.05). Accordingly, the operative time was significantly different between the groups, and it was shorter in the monopolar electrocautery excision group. Furthermore, the bipolar electrocautery group showed shorter wound infection duration, compared to the monopolar electrocautery excision group (P<0.05). Conclusion: Both excision techniques were similar in terms of wound healing, hospital stay, and recurrence rates. The operative times were longer in bipolar cautery; however, the wound infection was less.Öğe Comparison of Surgical Treatment with Crystallized Phenol Treatment in Recurrent Pilonidal Sinuses(2022) Kutluer, Nizamettin; Doğan, Serhat; Öndeş, Bahadır; kurt, feyziAim: One of the most important complications of the treatment of pilonidal sinus disease (PSD) is recurrence. Despite all treatment modalities, there is still no method that promises zero recurrence rate. Additionally, there is no clear consensus about the treatment method in primary cases and uncertainty is even greater in the treatment of recurrent patients. The aim of this study was to compare the results of surgical treatment and crystallized phenol treatment in patients with recurrent PSD. Method: This study included patients with recurrent PSD who underwent re-surgery or crystallized phenol application as secondary treatment in a general surgery clinic. Both methods were compared in terms of patients’ gender, age, complaints and duration of complaints in the preoperative period and wound infection, length of hospital stay, recurrence and time to return to work in the postoperative period. Results: Of the total of 38 patients 31 (81.6%) were male. The mean age was 25.9±4.51 years (range: 19-36 years). The site of recurrence site was at the incision line in 29 (76.3%) and lateral in 9 (23.7%). Twenty-one (53.3%) underwent surgery and 17 (44.7%) were treated with crystallized phenol application. The mean treatment-recovery time was 40.7±28.45 days in the phenol group, while it was 20.33±24.05 days in the surgery group. Recurrence was observed in 3 (17.6%) patients in the phenol group and 1 (4.76%) patient in the surgery group. There was a statistically significant difference in these two parameters. Conclusion: While the surgical method was more effective in recurrent PSD, crystallized phenol is a less invasive method. It does not require hospitalization, can be applied under local anesthesia in outpatient settings, and can be repeated for a few sessions. Crystallized phenol is a preferred treatment method for recurrent PSD only in suitable cases.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 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 Have malignancy rates increased in thyroidectomy cases(27 mart 2021) KANAT, Burhan Hakan; Çay, Ferhat; Kutluer, Nizamettin; Aksoy, Nurullah; BOZAN, Mehmet Buğra; Arslan Solmaz, Özgen; KARACA KARAGÖZ, Zühal; İrtegün, Sinan; Aydın, Yusufntroduction: This study aims to review thyroidectomy cases performed by a single surgeon in a single centre during the course of 1 year, to determine if the malignancy rate increased, and to compare the results with the liter ature. Material and methods: We retrospectively evaluated data of patients who underwent thyroidectomy between August 2018 and August 2019 in the General Surgery Clinic of our hospital. The malignancy rate was calculated and analysed according to the demographic data of the patients (gender and age), preoperative thyroid nodule sizes, and postoperative pathological mass sizes. Also, age, preoperative nodule size, and tumour size were all evaluated according to gender. Results: There were a total of 60 patients (14 (23%) male and 46 (77%) fe male). The pathology result revealed 16 (26.7%) malignant and 44 (73.3%) benign biopsies. The mean age was 46.72 ±12.08 years (20–74). We found that age, preoperative nodule size (cm), pathological tumour size (cm), and thyroid function tests were not significantly associated with malignancy. However, when age, preoperative nodule size, and tumour sizes were evalu ated according to gender, it was found that tumour sizes were significantly larger in men than in women (p < 0.001). In addition, the mean age of male patients was higher than that of women (p = 0.025). Conclusions: The malignancy rate has increased in the thyroidectomies per formed in our centre. This finding is consistent with relevant studies from the last 30 years. Therefore, it is likely that clinicians will continue to handle an increased number of thyroid malignanciesÖğe 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 Reasons for Admission of Patients to the Emergency Department after Laparoscopic Sleeve Gastrectomy(2023) Kutluer, Nizamettin; Doğan, Serhat; Öndeş, Bahadır; kurt, feyzi; kanat, burhan hakan; Aksu, Ali; Pepele, Mustafa SafaObjective: Obesity is defined as abnormal or excessive fat accumulation in the body to the extent that it impairs health in humans. It is a common health problem that is increasing in severity. Laparoscopic sleeve gastrectomy (LSG) is a preferred method because of satisfactory weight loss, resolution of comorbidities and performance safety. The increase in surgery has brought along the postoperative problems. New conditions related to bariatric surgery can be observed in all areas of life. Methods: After obtaining the necessary permission from the local clinical research ethics committee, patients who had bariatric surgery in our hospital between January 2018 and December 2021 were asked to respond by sending a mini-questionnaire about their application to the emergency department after surgery. Eighty patients who agreed to answer the questions were included in the study. Questions were asked and the results were evaluated. In addition, none of the patients who applied to the hospital were admitted to the hospital. Results: 53.38% of the patients who applied to the hospital came with stomach spasm and vomiting. Among the 80 patients, 18.8% were admitted to the hospital again after surgery. After the operation, 53.3% of the patients applied to the hospital within the first three months, 26.6% within the 4th and 6th months, and 20.1% after the 10th month. Conclusion: General practitioners and emergency specialists should master the management algorithm of these patients. If there is the slightest doubt, obese patients should be consulted, if possible, from a surgeon experienced in bariatrics or a general surgeon.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.
