Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Acute Appendicitis During Coronavirus Disease 2019 in Turkiye: Changes in Clinical Approach, Treatment, and Diagnosis Modalities: A Retrospective and Cohort Study(2022) Ersoz, Siyar; Bozkurt, Mehmet Abdussamet; Kulle, Cemil Burak; Elhan, Atilla Halil; Gulcu, Baris; Tarim, Ismail Alper; Bozbiyik, Osman; Yasar, Necdet Fatih; Atalay, Vafi; Yonder, Huseyin; Yalav, Orcun; Kuzu, Mehmet Ayha; Karakayali, Feza Yarbug; 36453790BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emergency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and compared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis. METHODS: A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diagnosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1-April 30, 2019) and after (pandemic period: January 1-April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/ open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pandemic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up. CONCLUSION: Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this information non-operative management can be employed for patients diagnosed with appendicitis.Item Correlation of Histological Diagnosis and Laboratory Findings in Distinguishing Acute Appendicitis and Lymphoid Hyperplasia(2022) Karabulut, Keziban Ucar; Erinanc, Hilal; Yonar, Aynur; Kisinma, Alpaslan; Ucar, Yildiz; 0000-0003-1681-9398; 0000-0001-9188-0266; 36452309; S-3177-2018; AAJ-5618-2021Purpose: Acute appendicitis (AA) is one of the most frequent causes of abdominal surgery encountered in emergency rooms. However, reactive lymphoid hyperplasia (RLH) is one of the appendicular pathologies often misdiagnosed. It is quite challenging to distinguish between AA and RLH in terms of planning treatment in an emergency. Therefore, this retrospective study aimed to compare the histological and laboratory findings of AA and RLH. Methods: The retrospective data included in the study were obtained from patients diagnosed with AA. Complete blood count (CBC) and C-reactive protein (CRP) levels of patients with AA and RLH were compared before the surgery based on the histological diagnosis of the patients. Results: A total of 187 patients who previously underwent appendectomy were included in the study. Histopathological examination revealed that 152 patients (81.3%) were diagnosed with AA, and 35 (18.7%) with RLH. While white blood cell count (P < 0.001), neutrophil (P < 0.001), and neutrophil/lymphocyte ratio (P < 0.001) were found to be significantly higher in those with AA; lymphocyte (P = 0.003) and eosinophil counts (P = 0.033) were detected to be significantly higher in those with RLH. CRP level was also significantly higher in those with AA (P = 0.002) Conclusion: We consider that CBC and CRP levels may be predictive in distinguishing between AA and RLH. We consider that these parameters may be valuable in making a distinction between patients before surgery.Item Polymeric Clips for Stump Closure in Laparoscopic Appendectomy(2017) Parlakgumus, Alper; Ezer, Ali; 0000-0002-3834-9924; 29056133; AAJ-8558-2021Many different techniques are used to perform laparoscopic appendectomy in terms of locations of trocars and closure of the appendiceal stump. They include mechanical endostaplers, endoligature, metal clips, bipolar endocoagulation, polymeric clips and intracorporeal sutures. The method of choice for appendiceal stump closure should be inexpensive and easy to perform. Non-absorbable polymer clips is an acceptable option for this purpose. Polymeric clips provide considerable cost savings as compared with endoscopic staplers, and are easy to apply in comparison to suture ligature techniques. In this study, we aimed to investigate outcomes of appendectomy carried out by using polymeric clips in 123 patients without any intraabdominal collection of pus or abscess. As such, the authors found polymeric clips to be safe, cheap and effective for stump closure in laparoscopic appendectomy.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 Does Scoring System Help Us in the Diagnosis of Acute Appendicitis? A Prospective Clinical Trial(2020) Guler, Yilmaz; Dogan, Pasa; Sengul, Serkan; Calis, Hasan; Karabulut, Zulfikar; 0000-0002-0612-8545; AAJ-9030-2021It is very important to make accurate and early diagnosis to reduce both the rate of negative laparotomy and the morbidity and mortality associated with acute appendicitis. Numerous scoring systems have been described in the diagnosis of acute appendicitis. We aimed to determine the accuracy rates of these scoring systems in the diagnosis of acute appendicitis by applying Alvarado, Eskelinen, and Ohmann clinical scoring systems to patients who underwent appendectomy. This study was performed on patients who underwent appendectomy for acute appendicitis at Baskent University Alanya Hospital and Alanya Alaaddin Keykubat University Education and Research Hospital between September 2017 and December 2018. The sensitivity and specificity of Alvarado, Eskelinen, and Ohmann scoring systems as well as the compatibility analysis of scoring systems with pathology results were investigated. A total of 554 patients undergoing appendectomy were included in the study. The sensitivity of Eskelinen scoring method was found to be 53.4%, the specificity was 68.1%; the sensitivity of Alvarado scoring method 41.6%, the specificity 79.7%; and the sensitivity of Ohmann scoring system 94.0%, the specificity was 8.7%. In conclusion, Ohmann scoring system has the highest sensitivity; it could be more efficient in exclusion of the appendicitis diagnosis due to its low specificity. It is also concluded that some clinical parameters that are scored in Eskelinen and Alvarado scoring systems may decrease the sensitivity and specificity of these methods depending on the patient population and atypical clinical presentations.Item Acute appendicitis during pregnancy: case series of 20 pregnant women(2016) Arer, Ilker Murat; Alemdaroglu, Songul; Yesilagac, Hasan; Yabanoglu, Hakan; 0000-0002-1161-3369; 0000-0003-4335-6659; 0000-0002-1365-9256; 28074461; AAJ-7865-2021; AAY-2668-2021; AAI-8400-2021; AAJ-6068-2021BACKGROUND: Acute appendicitis (AA) is the most common cause of acute abdomen during pregnancy. Most of the signs of appendicitis are also found during normal pregnancy period, however, and diagnosis of appendicitis during pregnancy remains challenging. The aim of the current study was to report our clinical experience of AA during pregnancy and investigate optimal management of this difficult situation. METHODS: Records of 20 pregnant women with diagnosis of AA who underwent appendectomy between 2005 and 2015 were included in this study. Data were collected retrospectively. Patients were evaluated according to age, signs and symptoms, gestational age, physical findings, serum white blood cell count, ultrasound (US) findings, pathology reports, surgical technique, operation time, and complications. RESULTS: Of 20 patients, 16 (80%) underwent open appendectomy and 4 (20%) underwent laparoscopic appendectomy. Mean age of patients was 29.6 +/- 5.6 years. Most common symptom was abdominal pain (95%). Six (30%) patients were in first trimester, 9 (45%) patients were in second trimester and 5 (25%) patients in were in third trimester. US findings consistent with AA were found in 12 (60%) patients. Negative appendectomy rate was 30%. Maternal complication was seen in only 1 (5%) patient. No fetal complication was observed. CONCLUSION: Accurate diagnosis and prompt surgical treatment of AA in pregnant women should be performed due to high rates of maternal and fetal complications.Item Prospective Observational Study on acute Appendicitis Worldwide (POSAW)(2018) Akkapulu, Nezih; 0000-0001-7392-961X; 29686725; AAM-8548-2021Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.