Browsing by Author "Sapmaz, Ali"

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The Impact of Comorbidities on Mortality in Patients with Non-Traumatic Major Lower Extremity Amputation
(2023) Yagiz, Betul Keskinkilic; Goktug, Ufuk Utku; Sapmaz, Ali; Dinc, Tolga; Budak, Ali Baran; Terzioglu, Serdar Gokay; 38060412
Objective: Major lower limb amputation is generally associated with a high risk of early and late-term mortality. In this study, 30-day, one-year and three-year mortality of non-traumatic major lower extremity amputations and comorbidities affecting the mortality rate were investigated. Method: Patients who underwent a major lower limb amputation secondary to diabetes or peripheral artery disease between the years 2010-2015 were retrospectively evaluated. Additional to patient demographic data and comorbidities, amputation level, survival and mortality time were extracted. Mortality rates after 30 days, one year and three years were analysed. The associations of the survival to different parameters were evaluated with Kaplan-Meier analysis and log rank test, while the impact of the risk factors on mortality was evaluated with the Cox regression test. Results: A total of 193 patients were enrolled in the study. Approximately 60% of patients were aged >= 65 years, and 65.8% were male. Below-knee amputation was performed in 64.8% of patients and above-knee amputation in 35.2% of patients. The mean follow-up of patients was 29.48 months (range: 0-101 months). After non-traumatic major lower extremity amputation, 30-day, one-year and three-year mortality were 16.6%, 38.3% and 60.1%, respectively. On Cox regression analysis, age >= 65 years was the only variable that had significant impact on the 30-day mortality (hazard ratio (HR): 3.4; p=0.012), while age >= 65 years (HR: 2.5, p=0.000), diabetes (HR: 2, p=0.006) and renal failure (HR: 2, p=0.001) were found to have significant impacts on three-year mortality. Conclusion: The findings of this study showed that >50% of patients with non-traumatic major lower limb amputations died within three years. Advanced age, diabetes and renal failure were the risk factors that increased the mortality. The high mortality rates revealed the importance of employing all hard-to-heal wound treatment options before making an amputation decision. Further, prospective studies are needed to determine the effects of primary disease status and timing of amputation on mortality.
Incidental Gallbladder Cancer Diagnosed During Or After Laparoscopic Cholecystectomy, What Did We Do?
(2020) Sapmaz, Ali; Guldogan, Can Emir; Yagiz, Betül Keskinkilic; Karaca, Ahmet Serdar
Objective: Gallbladder cancer is a rare neoplasm. We report our experience with gallbladder cancer that was incidentally diagnosed during or after laparoscopic cholecystectomy performed for gallstone disease. Methods: This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from January 2010 to April 2015. Exclusion criteria were suspicion of malignancy and/or existence of gallbladder polyps detected with ultrasonography preoperatively. Patients with incidentally diagnosed gallbladder cancer were recorded, and the clinical and demographic characteristics of these patients were reviewed. Results: Of 6,114 patients in whom laparoscopic cholecystectomy was attempted, 5.948 were included in this study. Incidental gallbladder cancer was found in thirty-six patients, with a mean age of 64.08 years. The histological tumor stages were adenocarcinoma in situ in seven patient, pT1b in nine patient, pT2 in eleven patient, and pT3 in nine patients. Sixteen patients who underwent laparoscopic cholecystectomy alone underwent no additional surgery because of the low stage of the tumors. The twenty remaining patients, whose laparoscopic cholecystectomies were converted to open surgeries, underwent cholecystectomy, excision of the liver bed and lymph node dissection. The overall median survival time was 28 months. Conclusions: The incidence of incidental gallbladder cancer has been reported to vary, up to 2.85%. In this single-center study, the rate of incidental gallbladder cancer was found to be 0.60%. Female gender and advanced age are demographic risk factors for gallbladder carcinoma. Although gallbladder cancer is well known for its poor prognosis, tumors that are incidentally diagnosed are often found at an early stage and have a better prognosis.
Risk factors for conversion to open surgery in laparoscopic cholecystectomy: a single center experience
(2021) Sapmaz, Ali; Karaca, Ahmet Serdar; 34585091
Objective: This study aimed to demonstrate the demographic characteristics for laparoscopic cholecystectomy surgeries performed in the general surgery clinics of our hospital and to identify the rate of conversion to open surgery and the main reasons for convert to open surgery. Material and Methods: Medical records of a total of 1.294 patients who underwent laparoscopic cholecystectomy in our hospital between October 2013 and May 2017 were retrospectively reviewed, and the rates of conversion to open surgery based on age groups were recorded. Results: Of these patients, 1191 were females (92.0%) and 103 (7.9%) were males. Mean age was 48.6 +/- 13.2 (range: 18 to 89) years. Indications for surgery were cholelithiasis in 1195 patients (92.4%), acute cholecystitis in 56 patients (4.4%), and gallbladder polyps in 43 patients (3.3%). The procedure was conversion to open surgery in 41 patients (3.16%), while 12 (0.9%) developed intraoperative complications. There was no mortality. Mean length of hospital stay was 1.2 (range: 1 to 6) days. The main reasons for conversation to open surgery were as follows: adhesions in the Calot's triangle (n = 3), acute cholecystitis (n = 29), choledocholithiasis (n = 2), adhesions due to previous surgery (n = 1), dissection difficulty (n = 2), organ damage (n = 2), anatomic variation (n = 1), and stone expulsion (n = 1). Conclusion: Acute cholecystitis appears to be the significant factor increasing the rate of conversation to open surgery during LC procedures. Male sex and older age are the other factors increasing the risk of con-vert to open surgery. However, LC should be still the first choice of intervention.