Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure(2020) Sari, Ramazan; Yabanoglu, Hakan; Hargura, Abdirahman Sakulen; Kus, Murat; Arer, Ilker Murat; 0000-0001-6529-7579; 0000-0002-1161-3369; 0000-0003-3492-9953; 0000-0003-0268-8999; 31931926; AAJ-7870-2021; AAG-1897-2021; AAJ-7865-2021; AAK-2011-2021Objective: To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. Study Design: A comparative study. Place and Duration of Study: Baskent University, Adana Medical and Research Center, Adana, Turkey, from January 2012 to November 2018. Methodology: Patients operated upon for refractory secondary hyperparathyroidism by the general surgery team were inducted. Overall, 25 (40%) patients underwent total parathyroidectomy with autotransplantation (Group 1), whereas 37 (60%) patients underwent subtotal parathyroidectomy (Group 2). Patient files were retrospectively analysed for recurrence or persistence of hyperparathyroidism. Results: A total of 62 patients, 32 (52%) of whom were females, with a mean age of 41.4 +/- 15.8 years for group 1; and 30 patients were males with a mean age of 43.1 +/- 16.7 years for group 2 were assessed in this study. The presenting complaints were bone pains and malaise supported by laboratory values that showed consistently elevated parathyroid hormone levels (>200 pg/ml). In the postoperative follow-up, 29 patients (46.8%) had transient hypocalcemia, while 3 (5%) had persistent hypoparathyroidism. In Group 1, one (4%) patient had a recurrence, while 4 (16%) patients had persistent hyperparathyroidism. In contrast, two (5.6%) patients in Group 2 had recurrence, whereas 8 (22%) patients had persistent hyperparathyroidism. Conclusion: Both surgical options can be safely utilised in the management of refarctory secondary hyperparathyroidism. Moreover, regardless of the procedure used, all the parathyroid glands must be explored. However, due to high morbidity and failure rates of subsequent surgeries, the surgeon should be keen and thorough in the initial procedure.Item Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach(2020) Yesilagac, Hasan; Arer, Ilker Murat; Gulalp, Betul; Yabanoglu, Hakan; Karagun, Ozlem; Karadeli, Elif; 0000-0003-0681-8375; 0000-0002-2045-2771; 0000-0002-0352-8818; 0000-0002-1365-9256; 0000-0002-1161-3369; 32322789; U-4084-2017; P-6931-2016; AAK-5399-2021; AAJ-6068-2021; AAJ-7865-2021Introduction: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. Objective: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients' therapeutic approach. Methods: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8-12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. Results: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients' mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. Conclusion: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.Item Hand-made Extracorporeal Knotting versus Hem-o-Lok Clip for Stump Closure in Laparoscopic Appendectomy(2019) Arer, Ilker Murat; Avci, Tevfik; Yabanoglu, Hakan; 31839096Objective: To compare hand-made extracorporeal knotting and hem-o-lok clip for the closure of appendix stump regarding safety, complications and cost-effectiveness. Study Design: Descriptive study. Place and Duration of Study: Baskent University Adana Teaching and Research Center, between January 2010 and December 2016. Methodology: A total of 287 patients, who underwent laparoscopic appendectomy, were enrolled in this study. Patients were divided into hand-made extracorporeal knotting and hem-o-lok clip groups. Patients were compared according to age, gender, duration of symptoms, serum leukocyte count, American Society of Anesthesiologists (ASA) score, intraoperative findings, operation time, hospital stay, pathology report and complications. Results: Of 287 patients, 149 (51.9%) were female and 138 (48.1%) were male. The mean age was found 34.9 years. No statistical difference was observed between groups according to age, gender, duration of symptoms, serum leukocyte count, ASA score, operation time and hospital stay. Intraoperative findings were different between groups (p<0.05). Overall postoperative complication rate was 6.6%. No statistical difference was observed regarding complications Conclusion: Both hand-made extracorporeal knotting and hem-o-lok clips can be used for stump closure in laparoscopic appendectomy. Hand-made extracorporeal knotting is an effective, safe and costeffective method alternative to hem-o-lok clips.Item Vascular Variations and Anastomosis Techniques in Renal Transplant Donors(2015) Haberal, Mehmet; Arer, Ilker Murat; Yabanoglu, Hakan; Caliskan, Kenan; Parlakgumus, Alper; Yildirim, Sedat; Moray, GokhanPurpose: We aimed to share our experience about vascular variations and anastomosis tecniques in renal transplant donors. Material and Methods: 128 donor nephrectomy performed in our hospital between February 2010 and June 2014 were included in our study. Donors were retrospectively analyzed according to age, sex, comorbidity, operation history, site of nephrectomy, vascular variation and anastomosis techniques. Results: 21 (% 16,4) patients have left-sided, 19 (% 14,8) have right-sided and 13 (% 10,2) have bilateral vascular variation. 29 (% 21,2) unilateral double renal artery, 8 (% 6,3) unilateral double renal artery and vein, 4 (% 3,2) unilateral triple renal artery, 3 (% 2,4) early branching renal artery, 2 (% 1,6) unilateral double renal vein and 2 (% 1,6) polar artery are vascular variations observed. of 92 (% 71,9) recepients anastomosis type was end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 32 (% 25) end to end between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 4 (% 3,1) end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein and end to side between 2nd renal artery and external iliac artery. Conclusion: Preoperative evaluation of renal vasculature of transplant donors is an important issue in means of decreasing peroperative vascular complications and decision for nephrectomy site.Item Organ Sparing Surgery for a Giant Liposarcoma(2015) Aytac, Huseyin Ozgur; Torer, Nurkan; Ozen, Merve; Arer, Ilker MuratLiposarcomas those are malignant soft tissue tumors often occur in large sizes in the retroperitoneum and abdomen due to their silent clinic. Excision with negative margins is the gold standard of treatment. A case operated on for a giant intraabdominal liposarcoma is being reported. A giant soft tissue tumor filling the whole abdomen was determined in the computed tomography scan. Core biopsy was obtained and demonstrated a well-differentiated liposarcoma. A 15 kg of mass 44x30x14 cm in size was excised en-bloc. Pathological examination of this tumor showed a well-differentiated liposarcoma with mixoid parts. No recurrence was observed in two years of follow-up despite any adjuvant therapy. This is to be one of the largest retroperitoneal sarcomas in the literature.Item Laparoscopic Repair of Morgagni Hernia(2015) Arer, Ilker Murat; Yabanoglu, Hakan; Aytac, Huseyin Ozgur; Caliskan, Kenan; Torer, NurkanMorgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect and make up about 1 % - 5 % of all types of congenital diaphragmatic hernias. Surgical repair of Morgagni hernias is usually indicated when patients are symptomatic and have a high risk of strangulation or incarceration of the contained viscera. 71-year-old male patient admitted to emergency department with a 2-day history of abdominal pain, vomiting and obstipation. Laparoscopic repair for Morgagni hernia was performed. Laparoscopic repair for Morgagni hernia with mesh repair is secure, satisfactory and easily performed.Item The Effect of the Use of Synthetic Mesh Soaked in Antibiotic Solution on the Rate of Graft Infection in Ventral Hernias: A Prospective Randomized Study(2015) Yabanoglu, Hakan; Arer, Ilker Murat; Caliskan, Kenan; 25590831Wound infections and seroma formations are important problems in ventral hernia repair operations using synthetic mesh grafts. The aim of this study was to investigate the effect of the use of synthetic mesh soaked in vancomycin solution on the rate of graft infection. The total number of subjects was 52. The subjects were randomized into 2 groups using a software program. Group 1 (n = 26) was the control group. In group 2 (n = 26), synthetic mesh was soaked in a Vancomycin solution before it was implanted. The patients were compared with respect to demographic characteristics and preoperative, intraoperative, and postoperative variables. There were no significant differences between the groups with respect to the available variables. Seroma development was significantly more common in group 2 (P < 0.041). Three patients (5.7%) developed superficial wound infection, and 9 (17%) developed surgical site infection 2-type wound-site infection. No significant difference was found between the groups in terms of infection. The use of synthetic mesh soaked in vancomycin solution had no beneficial effects on the rate of wound-site infection. Future randomized, controlled, large-scale studies using the same mesh and suture types, and meshes soaked in larger spectrum antibiotics are needed.Item Impact of surgeon factor on radiocephalic fistula patency rates(2016) Arer, Ilker Murat; Yabanoglu, Hakan; 26900457Introduction: Hemodialysis with arteriovenous fistula (AVF) has been widely accepted treatment modality for patients with chronic renal failure (CRF). Radiocephalic fistulas are considered to be the most desirable for the initial vascular access. The aim of this study is to investigate the surgeon factor on radiocephalic fistula patency rates. Methods: A total of 186 patients with diagnosis of CRF underwent Radiocephalic fistula for hemodialysis access were included. Patients were divided into 2 groups according to operating surgeon. Patients were evaluated according to demographic characteristics, secondary patency rates, second AVF creation and complications. Results: Mean age was 57.7 +/- 14.8 years. The most common etiology of CRF was idiopathic (66.6%). 40 (75.5%) patients in group 1 and 122 (91.7%) patients in group 2 were pre-dialysis patients (p < 0.05). Overall secondary patency rate was 77.4%. Patients in group 1 and group 2 have secondary patency rates of 83% and 75.2%, respectively (p = 0.458). Second AVF creation was done in 2 (3.8%) patients in group 1 and 23 (17.3%) patients in group 2 (p < 0.05). Postoperative complication rate was 9.6%. Conclusion: Operating surgeon is not a major factor of secondary patency in radiocephalic arteriovenous fistulas. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited.Item Anastomotic Leakage in a Patient with Acute Intestinal Obstruction Secondary to Appendiceal and Ileal Endometriosis: A Case Report(2016) Arer, Ilker Murat; Yabanoglu, Hakan; Hasbay, Bermal; 27190890Endometriosis is a commonly encountered problem in women of reproductive age. It usually causes chronic abdominal pain. However, it rarely causes complications such as intestinal obstruction. The most commonly performed procedure for these patients is bowel resection and anastomosis. Unless it is complicated with anastomotic leakage. We present a 39-year-old woman presented with intestinal obstruction due to appendiceal and ileal endometriosis complicated with anastomotic leakage after surgery.Item Rupture of an Aneurysm of a Small Branch of the Superior Mesenteric Artery: A Case Report(2016) Arer, Ilker Murat; Gedikoglu, Murat; Yabanoglu, Hakan; Noyan, Mustafa Turgut; 0000-0002-1161-3369; 0000-0003-0268-8999; AAJ-7865-2021; AAK-2011-2021Background: Superior mesenteric artery aneurysm (SMAA) is an uncommon vascular disorder. Complications such as rupture have been reported. Once complication has been encountered both surgical and endovascular treatment techniques can be considered. Case Report: We present a case of 68-year old male patient with SMAA rupture treated by endovascular modality. Conclusions: Endovascular therapy is an effective and less invasive option for rupture of superior mesenteric artery aneurysm.