Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
6 results
Search Results
Item Specimen Extraction from the Defunctioning Ileostomy Site or Pfannenstiel Incision During Total Laparoscopic Low Anterior Resection for Rectal Cancer(2015) Karakayali, Feza Y.; Tezcaner, Tugan; Moray, Gokhan; 0000-0003-2498-7287; 0000-0002-3641-8674; 0000-0002-1874-947X; 25767997; AAE-1041-2021; AAD-9865-2021; AAB-3888-2021Introduction: Laparoscopic low anterior resection is commonly performed, but there is controversy about the optimal specimen extraction site. The purpose of the study was to evaluate the outcomes of two different specimen extraction sites. Materials and Methods: In this prospective study of total laparoscopic low anterior resection for rectal cancer, we compared the outcomes of specimen extraction from a right lower quadrant trocar site that is also used for a defunctioning ileostomy (21 patients) or a Pfannenstiel incision (25 patients). Results: The median visual analog pain score on postoperative Days 1 and 3 and meperidine requirement were significantly higher in the Pfannenstiel than in the ileostomy site group. Time to resumption of oral diet and hospital stay were significantly shorter in the ileostomy site than in the Pfannenstiel group. All four parastomal hernias were observed in the ileostomy site group. Conclusions: Use of the stoma site for specimen extraction in total laparoscopic low anterior resection for rectal cancer may minimize abdominal wall incisions, decrease postoperative recovery time, decrease pain level and analgesic requirement, and improve cosmesis. Although this procedure may increase the incidence of parastomal hernia, hernia repair may be performed during ileostomy takedown surgery, and the temporary stoma site (which also is the right lower quadrant trocar entry site) may be suggested as a proper specimen extraction site.Item Emergency Cholecystectomy vs Percutaneous Cholecystostomy Plus Delayed Cholecystectomy for Patients with Acute Cholecystitis(2014) Karakayali, Feza Y.; Akdur, Aydincan; Kirnap, Mahir; Harman, Ali; Ekici, Yahya; Moray, Gokhan; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-7386-7110; https://orcid.org/0000-0003-2498-7287; 24919616; AAB-3888-2021; AAA-3068-2021; AAH-9198-2019; K-9824-2013; AAE-1041-2021BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis 272 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at 24 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding >= 100 mL [16(33%) vs 4(9%); P=0.006], a mean postoperative hospital stay (5.3 +/- 3.3 vs 3.0 +/- 2.4 days; P=0.001), and a frequency of complications [17(35%) vs 4(9%); P=0.003]. CONCLUSION: In patients with acute cholecystitis who presented to the hospital 272 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.Item Influence of Various Living Donor Kidney Measurements in Relation to Recipient Body Measurements on Posttransplant Allograft Functional Outcomes(2018) Kulah, Eyup; Ozcelik, Umit; Isiklar, Iclal; Cevik, Halime; Bircan, Huseyin Yuce; Karakayali, Feza Y.; Haberal, Mehmet; https://orcid.org/0000-0001-6041-4254; https://orcid.org/0000-0003-1073-2494; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-3462-7632; 27356006; AAJ-5764-2021; AAG-8651-2021; R-6394-2019; AAB-3888-2021; AAJ-8097-2021Objectives: Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipient's body weight and body mass index on kidney function at 6 and 12 months after transplant. Material and Methods: We included 74 patients (40 female and 34 male patients, mean age of 50.42 +/- 9.75 y) in this study. Results: Intraoperative allograft weight was 182.68 +/- 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 +/- 24.26 ml (range, 78-181 ml). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively with allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index values, as concluded by univariate analyses. From multivariate analyses, we found variables of interest presumed to significantly affect the 12-month estimated glomerular filtration rates, including recipient age, allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index. Conclusions: Transplanted allograft and recipient body values may be used as predictors of estimated glomerular filtration rates 6 and 12 months after transplant.Item Long-Term Cosmetic Results of Single-Incision Vs. Conventional Laparoscopic Appendectomy a Prospective Observational Cohort Study(2018) Tezcaner, Tugan; Arer, M. Ilker; Kidnap, Mahir; Karakayali, Feza Y.; Moray, Gokhan; 0000-0002-3641-8674; 0000-0002-1874-947X; 0000-0003-2498-7287; 30569904; AAD-9865-2021; AAB-3888-2021; AAE-1041-2021AIM: The purpose of this study was to compare cosmetic, along with surgical, results between single incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA), particularly from patients' points of view. MATERIALS AND METHODS: All of the patients who underwent surgery for suspected acute appendicitis and were eligible for laparoscopic surgery were evaluated prospectively in our center between June 2013 and January 2015. Patients were underwent CLA or SILA were compared for operative results and cosmetic outcomes by Body Image Questionnaire. Non-parametric tests were used in the intergroup comparisons of quantitative data. Chi-square test was used in the comparison of qualitative data. RESULTS: A total of consecutive 166 patients were underwent SILA (55) or CLA (111) were included to the study. There was no conversion to another procedure. Duration, of operation was significantly longer in SILA group (36.69 +/- 12.79 vs. 42.64 +/- 15.15; p = 0.009). There were no significant differences in length of stay, complications. SILA patients had more postoperative pain at first day after operation (p = 0.002). After 12 months, body image and cosmetic appearance were excellent for both groups and indistinguishable by most measures (55.79 +/- 2.31 vs. 55,76 +/- 2,13; p = 0,937). CONCLUSIONS: SILA resulted in more pain and longer operative times without improving short-term recovery or complications. Long-term body image and cosmetic appearance were similar and excellent in both groups.Item Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant(2019) Tezcaner, Tugan; Dinc, Nadire; Karakayali, Feza Y.; Kirnap, Mahir; Coskun, Mehmet; Moray, Gokhan; Haberal, Mehmet; 28128721Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods:We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.Item Surgical and interventional management of complications caused by acute pancreatitis(2014) Karakayali, Feza Y.; 25309073Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.