Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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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 Efficacy of Cell Saver Use in Living-Donor Liver Transplant(2015) Kirnap, Mahir; Tezcaner, Tugan; Soy, Hatice Ebru Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Torgay, Adnan; Moray, Gokhan; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3641-8674; 0000-0002-6829-3300; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-0993-9917; 25894181; AAA-3068-2021; AAD-9865-2021; AAJ-5221-2021; AAE-1041-2021; AAH-9198-2019; AAJ-8097-2021; AAF-4610-2019; AAC-5566-2019Objectives: Liver transplant currently is the best treatment option for end-stage liver disease. During liver transplant, there is major blood loss due to surgery and primary disease. By using a cell saver, the need for blood transfusion is markedly reduced. In this study, we aimed to evaluate the efficacy of cell saver use on morbidity and mortality in living-donor liver transplant. Materials and Methods: We retrospectively evaluated 178 living-donor liver transplants, performed from 2005 to 2013 in our center. Child-Turcotte-Pugh A patients, deceased-donor liver transplants, and liver transplants performed for fulminant hepatic failure were not included in this study. Intraoperative blood transfusion was done in all patients to keep hemoglobin level between 10 and 12 g/dL. Cell saver was used in all liver transplants except in patients with malignancy, hepatitis B, and hepatitis C. Results: We included 126 patients in the study. Cell saver was used in 84 liver transplants (66%). In 42 patients (34%), liver transplant was performed without a cell saver. In living-donor liver transplant with cell saver use, 10 mL/kg blood (range, 2-50 mL/kg blood) was transfused from the cell saver; in addition, 5 to 10 mL/kg allogeneic blood was transfused. In living-donor liver transplant without cell saver, 20 to 25 mL/kg allogeneic blood was transfused. Conclusions: During liver transplant, major blood transfusion is needed because of surgery and primary disease. Cell saver use markedly decreases the need for allogeneic blood transfusion and avoids adverse events of massive transfusion.Item Liver and Kidney Transplant in Primary Hyperoxaluria: A Single Center Experience(2015) Moray, Gokhan; Tezcaner, Tugan; Ozcay, Figen; Baskin, Esra; Akdur, Aydincan; Kirnap, Mahir; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0002-5214-516X; 0000-0002-8726-3369; 0000-0003-4361-8508; 0000-0002-3462-7632; 0000-0002-3641-8674; 25894144; AAF-4610-2019; AAE-1041-2021; ABG-5684-2020; AAA-3068-2021; B-5785-2018; AAJ-8097-2021; AAH-9198-2019; AAD-9865-2021Objectives: Primary hyperoxaluria, especially type 1, is a severe disease with multisystem morbidity and high mortality. We present 3 primary hyperoxaluria type 1 patients who underwent liver transplant, including living-donor liver transplant or combined liver and kidney transplant in our institution. Case Reports: Patients who underwent liver transplant or combined liver/kidney transplant at our institution were evaluated, retrospectively. Between January 2002 and 2013, there were 3 patients who underwent transplant for primary hyperoxaluria. All 3 patients had disease onset in childhood, and the definitive diagnosis was established at age < 1, 6, and 8 years. Although early diagnosis was made, primary hyperoxaluria resulted in end-stage renal disease in 2 patients, and hemodialysis was introduced before liver transplant. All 3 patients underwent living-donor liver transplant. Case 1 was a 10-year-old girl who had an uneventful course after living-donor liver transplant, and she received a living-donor kidney transplant from the same donor 4 months after living-donor liver transplant. Case 2 was a 7-year-old boy who was the younger brother of the first patient; he did not have end-stage renal disease or any renal disorder after successful living-donor liver transplant. Case 3 was a 3-year-old boy who was diagnosed at age 2 months with renal disorders; although he was discharged from the hospital after living-donor liver transplant, he was readmitted because of unconsciousness that developed 1 day after discharge, and he died because of intracranial hemorrhage 2 months after liver transplant, unable to receive a kidney transplant. Conclusions: Primary hyperoxaluria is a rare disorder that is difficult to diagnose until end-organ damage is severe. Outcomes may be improved with early and accurate diagnosis, aggressive supportive treatment, and correction of the enzyme defect by liver transplant before systemic oxalosis develops. However, kidney transplant or combined liver and kidney transplant is required in many primary hyperoxaluria type 1 patients because of the delayed diagnosis or long organ waiting time.Item Results of Pediatric Liver Transplant: A Single-Center Experience(2015) Moray, Gokhan; Tezcaner, Tugan; Akdur, Aydincan; Ozcay, Figen; Sezgin, Atilla; Kirnap, Mahir; Yildirim, Sedat; Arslan, Gulnaz; Haberal, Mehmet; 0000-0002-3641-8674; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-5214-516X; 0000-0003-2498-7287; 25894129; AAH-9198-2019; AAD-9865-2021; AAA-3068-2021; AAJ-8097-2021; AAF-4610-2019; ABG-5684-2020; AAE-1041-2021Objectives: Liver transplant is an established curative therapy for children with chronic end-stage liver disease or acute liver failure. In this study, we aimed to evaluate pediatric liver transplant in terms of outcomes, complications, and long-term follow-up results. Materials and Methods: Pediatric patients who had liver transplant in our institution were included. We retrospectively evaluated demographic features including body weight, Child-Pugh score, etiology of liver disease, graft source, perioperative outcomes, perioperative complications, postoperative complications, and long-term results. Outcomes of treatment of complications and revision transplant were evaluated. Results: Between September 2001 and December 2013, there were 188 pediatric liver transplants performed in our institution. Most grafts (90.9%) were obtained from living-related donors. There were 13 patients (6.9%) who had an intervention because of a hemorrhage postoperatively. Biliary leakage was observed in 33 patients (17.5%) and biliary stricture during follow-up was observed in 32 patients (17%). Thrombosis rates in the hepatic artery and portal vein were 12.3% and 0.5%. Revision transplant was performed in 11 patients (5.8%); reason for revision transplant was rejection in 50% patients. The remaining children were alive with good graft functioning after treatment of complications and revision transplant. The overall 5- and 10-year survival rates were 82.3% and 78.9%. Conclusions: The overall outcomes of pediatric liver transplant at our center are very promising. With improved care of younger children and the combined efforts of the parents and medical team, the number of the children receiving transplants will increase in the future.Item A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis(2015) Yabanoglu, Hakan; Colakoglu, Tamer; Belli, Sedat; Aytac, Huseyin Ozgur; Bolat, Filiz Aka; Pourbagher, Aysin; Tezcaner, Tugan; Yildirim, Sedat; Haberal, Mehmet; 0000-0003-2031-7374; 0000-0002-3462-7632; 0000-0002-5735-4315; 0000-0002-3641-8674; 0000-0002-3583-9282; 0000-0002-1161-3369; 25858348; HJZ-1654-2023; AAJ-8097-2021; AAF-4610-2019; AAD-9865-2021; AAJ-7913-2021; AAJ-7865-2021The purpose of this study was to analyze the clinical features and demographic data of patients with idiopathic granulomatous mastitis (IGM) and to compare the results of conservative versus surgical treatment protocols. The demographic data, clinical findings, microbiological and pathologic features, scanning and treatment methods, recurrence, and recovery rates of 77 patients were analyzed retrospectively. The patients were divided into two groups based on the type of treatment received. Core biopsies were used to diagnose 37 patients: 26 using incisional biopsies and 14 using excisional biopsies. Of the patient population with IGM, 31 were treated with surgical excision, one with a simple mastectomy, and one with a subcutaneous mastectomy combined with a breast implant, whereas 44 were treated with steroids. The recovery rates of the 44 patients who were treated conservatively were 6 (1-15) months while for the 33 patients who were treated surgically, it was 1 (1-5) month (p=0.001). Nine patients from the conservative treatment group experienced a recurrence while there were no recurrences in the surgically treated group (p=0.009). Among all patients, the recurrence rate was 11.7% (9/77) while the average follow-up period was 16.57 +/- 18.57months. As a comparative study between conservative treatment protocols and surgical ones for patients with idiopathic granulomatous mastitis (IGM), this study is the largest to date. A wide surgical excision is the preferred approach for treating patients with IGM because of the low recurrence rate.Item Outcomes of Patients With Hepatocellular Carcinoma After Liver Transplant(2015) Moray, Gokhan; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru; Tezcaner, Tugan; Boyvat, Fatih; Ozdemir, Handan; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-3641-8674; 0000-0003-2498-7287; 0000-0002-7528-3557; 26640906; AAC-5566-2019; AAA-3068-2021; AAJ-8097-2021; AAD-9865-2021; F-4230-2011; AAH-9198-2019; AAE-1041-2021; X-8540-2019Objectives: Liver transplant is one of the few effective treatments for hepatocellular carcinoma. Our aim in this study was to evaluate the risk factors for hepatocellular carcinoma recurrence after liver transplant. Materials and Methods: In this retrospective study, conducted between October 1988 and March 2015, four hundred seventy-three liver transplants were performed at our institution. Of these, 231 were pediatric and 242 were adult. Among these patients, liver transplant was performed in 58 patients (12.3%) for treatment of hepatocellular carcinoma. Results: Hepatocellular carcinoma recurrence was detected in 14 patients (24.1%). Overall 5-year and 10-year survival rates of patients underwent liver transplant beyond the Milan criteria for hepatocellular carcinoma were 50.3% and 43.1%. Overall, 5- and 10-year survival rates of patients underwent liver transplant within the Milan criteria for hepatocellular carcinoma were 78.4% and 72.6%. The main predictive variable was whether the tumor had expensed beyond the Milan criteria. Conclusions: As expected, outcomes were significantly better in the Milan criteria group. Although the overall- and disease-free survival rates were promising in such a group of patients who had no better chance, it could be asserted that liver transplant is a safe and effective treatment option with promising results, even if the tumor expanse is beyond the Milan criteria.Item The Outcomes of Ultralow Anterior Resection or an Abdominoperineal Pull-Through Resection and Coloanal Anastomosis for Radiation-Induced Recto-Vaginal Fistula Patients(2016) Karakayali, Feza Yarbug; Tezcaner, Tugan; Ozcelik, Umit; Moray, Gokhan; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-3641-8674; https://orcid.org/0000-0003-1073-2494; https://orcid.org/0000-0003-2498-7287; 26628070; AAB-3888-2021; AAD-9865-2021; AAG-8651-2021; AAE-1041-2021The purpose of this study was to evaluate the outcomes of patients who underwent colorectal resections and coloanal anastomosis for radiation-induced recto-vaginal fistulas (RVFs). The effect of the surgical treatment technique on bowel function, fecal continence, and quality of life of patients was also evaluated. Twenty-one female patients, who received adjuvant chemotherapy and external beam pelvic radiation for cervix carcinoma after radical hysterectomy + pelvic/paraaortic lymph node dissection, having RVF but without tumor recurrence, were included. All patients underwent an ultralow anterior resection (n = 11) or an abdominoperineal pull-through resection and straight coloanal anastomosis (n = 10). A bowel functions questionnaire and a Fecal Incontinence Quality of Life (FIQLI) questionnaire were applied to patients pre-operatively and also 6 months after the ileostomy closure procedures. No recurrent RVF was observed in a mean follow-up period of 20 months after ostomy reversal procedures. The FIQLI depression, lifestyle, and embarrassment scores were significantly improved on the follow-up questionnaire. The mean pre- and post-operative incontinence scores were not significantly different. The spontaneous closure rate after a simple diverting stoma is quite low and local repair procedures usually result in failure. In selected patients, performing a nearly total rectum resection and maintaining the intestinal continuity with a coloanal anastomosis may be accepted as a safe and curative option. Recurrence-free outcome and the improvement of the quality of life of the patients represent the efficiency of this treatment modality.Item Can Strain Elastography Combined with Ultrasound Breast Imaging Reporting and Data System Be A More Effective Method in The Differentiation of Benign and Malignant Breast Lesions?(2017) Arslan, Serdar; Uslu, Nihal; Ozturk, Funda Ulu; Akcay, Eda Yilmaz; Tezcaner, Tugan; Agildere, Ahmet Muhtesem; https://orcid.org/0000-0001-7984-4326; https://orcid.org/0000-0002-6733-8669; https://orcid.org/0000-0001-6831-9585; https://orcid.org/0000-0002-3641-8674; https://orcid.org/0000-0003-4223-7017; 28154989; AAH-9796-2019; ABC-5258-2020; AAK-1960-2021; AAD-9865-2021; AAB-5802-2020To investigate whether a novel method that combines breast imaging reporting and data system (BI-RADS) with strain elastography contributes to diagnostic performance in differentiation of malignant and benign breast lesions. In 81 patients, 81 breast lesions were prospectively investigated. Breast lesions were separately evaluated with ultrasonography and strain elastography. While evaluations with ultrasonography were based on 2003 BI-RADS-US, strain elastography evaluations were based on a 5-point scale and strain ratio. Diagnostic performances of ultrasonography, strain elastography, and the combined method were compared. Among 81 lesions, 43 (53.1%) were benign and 38 (46.9%) were malignant. When a cutoff point of category 3 was used, sensitivity, specificity, positive and negative predictive values, and accuracy for BI-RADS were 100, 11.6, 50, 100, and 53%, respectively. When BI-RADS and strain ratio were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 89.5, 93, 91.9, 90.9, and 91.3%, respectively. When BI-RADS and elastography scores were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 86.8, 97.7, 97.1, 89.4, and 92.5%, respectively. The combination of strain elastography and BI-RADS was found to have better diagnostic performances to diagnose breast lesions than BI-RADS alone.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 Comparison of Mortality Rates in Patients Waiting for Liver Transplant and Patients With Colorectal Metastatic Tumors(2022) Erkent, Murathan; Aydin, H. Onur; Tezcaner, Tugan; Avci, Tevfik; Kavasoglu, Lara; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Haberal, Mehmet; 0000-0002-3592-5092; 0000-0002-0664-5147; 0000-0002-0993-9917; 0000-0002-3462-7632; 35352633; CAA-2756-2022; AAJ-8219-2021; AAC-5566-2019; AAJ-8097-2021Objectives: We aimed to identify outcomes of liver surgery in patients with hepatocellular carcinoma and colorectal cancer, which result in primary and secondary liver tumors. Materials and Methods: Our study included 51 patients with colorectal cancer and liver metastases and 63 patients with hepatocellular carcinoma who were prepared for liver transplant due to cirrhosis who underwent hepatic resection or local ablation treatments; patients were seen between January 2011 and December 2021. Results: Most patients with colorectal cancer were men (58.8%). Mean age was 65.76 +/- 13.818 years (range, 27-88 y). Most patients had planned, elective surgery (86.3%). Neoadjuvant chemotherapy was administered to 58.8% of patients. The most common location of metastasis in the liver was in the right lobe (43.1%), and the most common surgery was low anterior resection (17 patients). During simultaneous liver surgery, 31 patients required metastasectomy and 7 patients required radiofrequency ablation plus metastasectomy. No deaths occurred in the early posttransplant period, and cumulative survival was 82.624 +/- 7.962 months. Disease-free survival was 45.2 +/- 7.495 months. Most patients with hepatocellular carcinoma were men (82.5%). Mean age was 58.73 +/- 17.428 years. Hepatocellular carcinoma lesions were mostly located in both the right and left lobes (23.8%). In the hepatocellular cancer group, 60.3% had transarterial chemoembolization and 42.9% had radiofrequency ablation. The primary surgical resection was metastasectomy (17.9%) because of multiple localized lesions. Median follow-up was 22 months (range, 1-126 mo). Overall survival was 101.898 +/- 7.169 months, with 10-year overall survival of 38%. Disease-free survival was 74.081 +/- 8.732 months, with 1-year and 5-year disease-free survival of 90.5% and 54%. Conclusions: Better survival was shown in patients with hepatocellular carcinoma than in patients with colorectal cancer. Therefore, more aggressive treatment options, as used in hepatocellular carcinoma, including liver transplant, may be options for patients with colorectal cancer.
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