Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases(2020) Gezer, Hasan Ozkan; Ezer, Semire Serin; Temiz, Abdulkerim; Ince, Emine; Hicsonmez, Akgun; 0000-0002-9597-3264; 0000-0002-4635-2613; 0000-0001-8789-6003; 32185763; AAJ-9529-2021; J-3197-2013; A-4719-2018BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (I), Meckel's diverticulum perforation (I), and perforation due to rigid endoscopy (I). CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.Item Gastroschisis Treatment: Evaluation of Surgical Techniques and Results(2020) Ince, Emine; Ezer, Semire Serin; Temiz, Abdulkerim; Gezer, Hasan Ozkan; Hicsonmez, Akgun; A-4719-2018; AAJ-9529-2021Objective: Recently, achieving good cosmetic results for patients with gastroschisis has gained popularity, as since the visceral organs can be safely positioned into the abdominal cavity. We aimed to evaluate patient outcomes while focusing on the cosmetic results to contribute to the limited amount of data on this subject in the literature. Methods: From January 2005 to May 2018, patients operated on for gastroschisis in a single institution were evaluated retrospectively. Results: Twenty-two patients with gastroschisis were treated (10 females/12 males). The mean gestational age was 38.2 +/- 2.1 weeks. The mean birth weight was 2256.9 +/- 418.2 g. Eleven patients were diagnosed prenatally. Five patients had complex gastroschisis. Others presented with necrosis (n=3), perforation (n=3), volvulus (n=1) and jejunal atresia (n=1). Primary closure (n=16) and staged closure (n=6) were performed. Patients needed mechanical ventilation and total parenteral nutrition for 3.7 +/- 1.0 days and 24.3 +/- 9.7 days, respectively. Enteral feeding was started at 15.9 +/- 10.5 days. The duration of hospitalisation was 36.7 +/- 13.3 days. Three patients died from sepsis and multi-organ failure. Conclusion: We believe that performing appropriate gastroschisis surgery at the same hospital without transferring to another centre is the main factor in achieving a successful outcome. Good cosmetic results and visceral function were achieved in this study in 86.3% patients.Item Post-necrotizing Enterocolitis Stricture: Misdiagnosis of this Complication Results in Greater Infant Mortality(2019) Ince, Emine; Ezer, Semire Serin; Temiz, Abdulkerim; Gezer, Hasan Ozkan; Hicsonmez, Akgun; J-3197-2013Objective: Intestinal stricture following necrotizing enterocolitis (NEC) is often misdiagnosed as recurrent functional constipation, enteritis, and malnutrition, and it increases the rates of morbidity and mortality in infants. Although a number of studies have focused on the potential etiologic factors leading to NEC, the information regarding the occurrence and diagnosis of post-NEC strictures is limited. The aim of this study was to evaluate the clinical presentation and diagnostic and surgical methods to treat NEC. Materials and Methods: The medical records of infants who had undergone surgery for post-NEC strictures between January 2005 and September 2018 were evaluated retrospectively in a single institution. Results: This study included 38 infants (20 males, 18 females) with post-NEC stricture. Their histories revealed that they had been treated medically (20 of 38) or surgically (18 of 38) for NEC. Symptoms typical of intestinal obstruction (vomiting, abdominal distension, constipation, growth retardation, etc.) were present in the medically treated patients. The average time of onset of symptoms after the acute episode of NEC was 1.64 +/- 0.78 months. Contrast studies revealed strictures in the small intestine in 13 (65%) medically treated patients, while 13 (72.2%) surgically treated patients had strictures in the colon. Additionally, 2 of surgically treated patients presented with ileocolic fistulae. In 11 of 38 (28.9%) patients, the contrast studies were false-negative. Conclusion: Post-NEC strictures may present with vague nutritional problems, causing the diagnosis to often be missed, which leads to high rates of morbidity and mortality in infants. Colon enemas, distal loopograms, and small bowel passage radiograms are useful in making a diagnosis, but a careful examination of the intestines for the presence of any other strictures should be done during the surgery.Item Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of "Gold Standard" from Total Fundoplication?(2019) Gezer, Hasan Ozkan; Ezer, Semire Serin; Temiz, Abdulkerim; Ince, Emine; Hicsonmez, Akgun; 0000-0002-4635-2613; 30887292; J-3197-2013Background In 4-5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation. Method In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively. Results A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 +/- 3.43 years. Neurological impairment did not affect the success rate. Conclusion Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.Item Spleen Salvaging Treatment Approaches in Non-parasitic Splenic Cysts in Childhood(2016) Gezer, Hasan Ozkan; Oguzkurt, Pelin; Temiz, Abdulkerim; Ince, Emine; Ezer, Semire Serin; Kocer, Nazim Emrah; Demir, Senay; Hicsonmez, Akgün; 27574347The aim of this study was to evaluate our experience with primary non-parasitic splenic cysts (NPSC) which are relatively rare in children and consist almost exclusively of single case reports or small case series in the literature. The medical records of all patients who presented to our clinic with NPSC between 2005 and 2015 were evaluated retrospectively. There were 22 children whose ages ranged from 2 months to 14 years (mean 9.2 +/- 4.7 years). The size of the cysts was in the range of 5 to 200 mm (mean 55.4 +/- 48.2 mm). Ten patients underwent surgery for splenic cysts. Partial splenectomy (n = 2), total cyst excision (either open n = 4 or laparoscopically n = 1), and total splenectomy (n = 3) were performed. The non-operated patients were asymptomatic and followed with ultrasound (US). The follow-up period in non-operated patients ranged from 6 months to 5 years (mean 2.27 +/- 1.29 years). Complete regression was observed in four (33 %) non-operated patients. The regressed cyst measurements were 10, 16, 30, and 40 mm, respectively. Approximately half of the NPSC is diagnosed incidentally. Small (< 5 cm) asymptomatic cysts should be under regular follow-up with US/physical examination for regression. If surgery is required, we prefer open cyst excision as it gives excellent results and preserves splenic immune function.Item Approaches to Female Congenital Genital Tract Anomalies and Complications(2017) Ince, Emine; Oguzkure, Pelin; Ezer, Semire Serin; Temiz, Abdulkerim; Gezer, Hasan Ozkan; Demir, Senay; Hicsonmez, Akgun; 0000-0002-4209-9075; 0000-0002-9597-3264; 0000-0001-8789-6003; 0000-0002-4635-2613; A-4719-2018; AAJ-9529-2021; J-3197-2013; AAK-9310-2021Objective: Female congenital genital tract anomalies may appear with quite confusing and deceptive complications. This study aims to evaluate the difficulties in diagnosis and treatment of female congenital genital tract anomalies that frequently present with complications. Summary: During a 10-year period, we evaluated 20 female patients with congenital genital tract anomalies aged between 3 days and 16 years. All patients were retrospectively analyzed in terms of the results of diagnostic studies, surgical intervention, and treatment. Methods: Ultrasonography and magnetic resonance imaging revealed hydromucocolpos or hematocolpometra, imperforate hymen, distal vaginal atresia, didelphys uterus, an obstructed right hemivagina, uterovaginal atresia, a unicornuate uterus with a noncommunicating rudimentary horn, a vesicovaginal fistula, a utero-rectal fistula, intraabdominal collection, and a vaginal calculus. Results: Two patients had Mayer-Rokitansky-Kuster-Hauser syndrome and 6 patients had obstructed hemivagina and ipsilateral renal anomaly syndrome. Definitive surgical interventions were hymenotomy, vaginal pull-through, vaginovaginostomy, and vesico-vaginal fistula repair using a transvesical approach. In conclusion, female congenital genital tract anomalies may appear with a wide range of complications. Conclusions: There is a potential to do significant harm, if the patient's anatomic problems are not understood using detailed imaging. Revealing the anatomy completely and defining the complications that have already developed are critical to tailor the optimal treatment strategies and surgical approaches.