Fakülteler / Faculties
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Item Tension-Free Primary Closure for the Treatment of Pilonidal Disease(2015) Arer, Ilker Murat; Yabanoglu, Hakan; Caliskan, Kenan; 0000-0002-1161-3369; 0000-0003-0268-8999; 0000-0002-8767-5021; 26567718; AAJ-7865-2021; AAK-2011-2021; AAJ-7201-2021AIM: Pilonidal disease (PD) is a common disorder that usually affects young population and generally seen in intergluteal region. Conservative and surgical treatment options have been utilized. Many surgical techniques including primary closure, marsupialization and flap procedures have been described. The present study aims to evaluate the optimal surgical method for the treatment of PD. MATERIAL AND METHODS: A total of 151 patients underwent pilonidal disease surgery between January 2007 and September 2014 were enrolled in this study. Patients were compared according to age, sex, operation time, length of RESULTS: A total of 151 patients with a mean age of 25.18 years (range 14-66) presented with pilonidal disease were evaluated. Primary closure (PC) and tension-free primary closure (TFPC) were performed in 105 (69.5%) and 46 (30.5%) patients, respectively. There was no statistical difference between groups according to age, sex, operation time and length of hospital stay. Only 9 patients (8.6%) in PC and 3 patients (65%) in TFPC have postoperative recurrent disease. of 17 patients (7.9%) dehiscence was seen, 15 (14.3%) were in PC group and 2 (4.3%) were in TFPC group. Postoperative seroma or wound infection was seen in 16 patients (10.6%). CONCLUSION: Tension-free primary closure is a method that is effective as primary closure.Item Comparison of the Early Term Complications and Patency Rates of the Standard (Parachute) and Diamond-Shaped End-To-Side Anastomosis Techniques in Arteriovenous Fistulas Created for Hemodialysis(2018) Yabanoglu, Hakan; Kus, Murat; Arer, Ilker Murat; Bali, Cagla; Avci, Tevfik; Akdur, Aydincan; Caliskan, Kenan; https://orcid.org/0000-0002-1161-3369; https://orcid.org/0000-0001-6529-7579; https://orcid.org/0000-0003-2615-1918; https://orcid.org/0000-0001-5225-959X; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-8767-5021; 30060787; AAJ-7865-2021; AAJ-7870-2021; AAI-8790-2021; AAF-1698-2021; AAA-3068-2021; AAJ-7201-2021Objective: To compare the early-term patency and complication rates of the end-to-side anastomosis techniques parachute and diamond-shaped techniques in arteriovenous fistulas. Study Design: Prospective randomised study. Place and Duration of Study: Department of General Surgery, Adana Baskent University Application and Research Hospital, Adana, Turkey, between October 2014 and January 2015. Methodology: Patients with end stage renal disease who underwent arteriovenous fistula creation for hemodialysis were grouped into two according to the anastomosis technique performed. Group 1 was composed of the patients undergoing the standard parachute technique and Group 2 consisted of the patients operated with the diamond-shaped anastomosis technique. The two groups were compared with each other with respect to clinical and demographic data, operative and postoperative variables, and complication and patency rates. Results: A total of 56 patients underwent arteriovenous fistula creation. The overall complication rate was 12.5%. The early-term patency rate was higher in the diamond-shaped anastomosis technique than the standard parachute end-to-side anastomosis technique. Effective dialysis was established after 4 weeks in 48 (85.7%) patients in the overall study group, 23 (82.1%) in Group 1, and 25 (89.2%) in Group 2. However, there was no significant difference between both the techniques with respect to effectiveness of dialysis. Conclusion: Both end-to-side anastomosis techniques have their own advantages and disadvantages. Using a patient-specific suitable technique rather than a standard technique would be more appropriate in arteriovenous fistulas formation.Item The Effect of Subcutaneous Suction Drains on Surgical Site Infection in Open Abdominal Surgery. A Prospective Randomized Study(2016) Arer, Ilker Murat; Yabanoglu, Hakan; Aytac, Huseyin Ozgur; Ezer, Ali; https://orcid.org/0000-0002-1161-3369; https://orcid.org/0000-0002-3583-9282; https://orcid.org/0000-0002-3834-9924; 27025777; AAJ-7865-2021; AAJ-7913-2021; AAJ-8558-2021AIM: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and related to increased morbidity and mortality rates, healthcare costs and also incisional hernia. A negative pressure subcutaneous drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of current study was to establish the efficacy of a subcutaneous drainage system for preventing SSI after open abdominal clean-contaminated surgery. MATERIAL AND METHODS: A total of 62 patients underwent abdominal surgery, between November 2014 and March 2015, were enrolled. 48 eligible patients, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was appiled to each patient. The diagnosis of superficial SSI was made according to the Centers for Disease Control and Prevention's (CDC) definition. RESULTS: The mean age of patients was 48.77 +/- 12.62 years with a male-female ratio of 21:27. No statistical difference between groups was observed for age, sex, comorbidity, incision type, hemoglobin level, blood loss, hospital stay and operation time (P>0.05). 2 (8.7%) patients in DG and 8 (32%) patients in NDG had incisional SSI but no statistical difference was observed (P>0.05). CONCLUSION: SSI appear to be reduced with subcutaneous suction drains in open abdominal surgery however prospective randomized larger scaled studies should be performed on this topic.Item Prophylactic Oral Calcium Supplementation Therapy to Prevent Early Post Thyroidectomy Hypocalcemia and Evaluation of Postoperative Parathyroid Hormone Levels to Detect Hypocalcemia: A Prospective Randomized Study(2017) Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Caliskan, Kenan; Tarim, Mehmet Akin; 0000-0001-7392-961X; 0000-0003-0268-8999; 0000-0002-3583-9282; 0000-0001-6529-7579; 0000-0002-1161-3369; 0000-0002-8767-5021; 28039060; AAM-8548-2021; AAK-2011-2021; AAJ-7913-2021; AAJ-7870-2021; AAJ-7865-2021; AAJ-7201-2021Background: Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. Methods: A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. Results: Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p < 0.05). No statistical difference can be observed regarding the timing of serum biomarkers. Conclusion: Serum PTH levels at postoperative 12 and 24 h can predict early post-thyroidectomy hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe. (C) 2016 IJS Publishing Group Ltd.Item The Type of Specimen Retrieval in Laparoscopic Appendectomy Affects Wound Infection(2016) Aytac, Huseyin Ozgur; Torer, Nurkan; Arer, Ilker Murat; 0000-0002-3583-9282; 28070028; AAJ-7913-2021AIM: To evaluate the role of laparoscopy in appendicitis and importance of wound protection in this sense. MATERIALS AND METHODS: Data of 506 patients operated on by either open or laparoscopic appendectomy within the last four years were evaluated retrospectively for wound infection rates. Those had laparoscopic surgery were also sub grouped and analyzed in terms of retrieval type of the specimen. RESULTS: Wound infection rate was 5.7% for open appendectomy and zero for laparoscopic appendectomy in minimal or non-inflamed cases. For suppurative appendicitis and gangrenous or perforated cases wound infection rates were 9.1% versus 17.6% for open appendectomy versus laparoscopy. Laparoscopy without wound protection increased these rates to 17.9% versus 50%, where as wound protection reduced both to zero. DISCUSSION: Laparoscopy itself was protective for wound infection in non-inflamed or minimally inflamed appendectomy cases with respect to open surgery. However, for suppurative, gangrenous or perforated appendicitis, laparoscopy protects from wound infection only when contact of the specimen with incisions was avoided. CONCLUSION: Laparoscopy reduces wound infection rates in appendectomy. This advantage is prominent especially wound contamination with the specimen is prevented anywise. Using a glove finger, as a tissue bag for the retrieval of the specimen has been our favorite method that we defined as "reverse cover-up technique".Item Subcapsular Hydatid Cyst of the Liver(2017) Kus, Murat; Arer, Ilker Murat; Akkapulu, Nezih; Yabanoglu, Hakan; 0000-0001-6529-7579; 0000-0001-7392-961X; 0000-0002-1161-3369; AAJ-7870-2021; AAM-8548-2021; AAJ-7865-2021Hydatid cyst disease is an important health problem in Turkey. The disease localized in liver in most of the cases, but also be exits everywhere in the body. One of the rare complications of liver's hydatid cyst is subcapsular perforation. We present a 53 year male patient with subcapsular perforation of liver hydatid cystItem Total Versus Subtotal Gastrectomy for Signet Ring Cell Carcinoma of the Stomach(2017) Arer, Ilker Murat; Yabanoglu, Hakan; Akdur, Aydincan; Akkapulu, Nezih; Kus, Murat; 0000-0002-1161-3369; 0000-0002-8726-3369; 0000-0001-7392-961X; 0000-0001-6529-7579; 29056122; AAJ-7865-2021; AAA-3068-2021; AAM-8548-2021; AAJ-7870-2021Objective: To determine the adequate surgery type for the treatment of signet ring cell of stomach in terms of postoperative complications and survival. Study Design: Comparative analytical study. Place and Duration of Study: Baskent University Adana Teaching and Research Center, Adana, Turkey, between 2006 and 2015. Methodology: A total of 46 patients with the diagnosis of gastric signet ring cell, who underwent total or subtotal gastrectomy, were enrolled in this study. Patients were compared according to age, gender, tumor location, TNM stage, survival and mortality rates, operation time, complication and recurrence. Comparisons between groups were performed by using Mann-Whitney U-test for the data not normally distributed. The categorical data were analyzed by using the Chi-square test or Fisher's exact test, where applicable. Kaplan-Meier test was used for survival curve and Long-rank test was used for survival differences between groups. Values of p < 0.05 were considered statistically for all tests. Results: Of the 46 patients, 29 (63.0%) were male. The mean age was 56.6 +/- 13.2 years. The median tumor size was 5.0 cm (IQR: 3.0-6.6). Twenty-six (56.5%) patients were in total gastrectomy, whereas 20 (43.5%) were in subtotal gastrectomy group. Five-year cumulative survival rate was 0.487. Five-year overall survival rate for early and advanced signet ring cell carcinoma was 0.830 and 0.164, respectively (p<0.001). Five-year overall survival rate for total and subtotal gastrectomy groups were 0.422 and 0.582, respectively (P=0.417). Complications were observed in 17.4% (n=8) of all 46 patients. Conclusion: Subtotal gastrectomy can be performed safely for patients with gastric signet ring cell carcinoma and is equal to total gastrectomy with respect to prognosis and complication rates.Item Is There A Correlation Between the Severity of Idiopathic Granulomatous Mastitis and Pre-Treatment Shear-Wave Elastography Findings? Original Research(2018) Aslan, Hulya; Arer, Ilker Murat; Pourbagher, Aysin; Ozen, Merve; 0000-0002-7138-246X; 30665211; AAK-9104-2021; HCH-8774-2022AIM: The aim of this study was to analyze the correlation between the severity of idiopathic Garulomatous Mastitis (IGM) and the pre-treatment Shear-Wave Elastography (SWE) findings. MATERIAL AND METHODS: A total of 39 patients diagnosed with granulomatous mastitis were included in the study between the dates of December 2014 and February 2017. The patients were divided into two groups. Group 1 was treated using a conservative protocol and steroids. Group 2 was treated surgically. Pre-treatment SWE findings of both groups were compared. RESULTS: The mean ages of the patients in group 1 and 2 were 38.44 +/- 9.6 and 3605 +/- 7.44 years, respectively. There were not any significant differences between the groups with regard to frequency of BI-BADS categories and Virtual touch tissue imaging (VTI) patterns. The mean Shear-Wave Spead (SWS) were 1.98 +/- 1.02 m/sec and 2.82 +/- 1.66 m/sec in group 1 and 2 respectively. The difference was not significant (p >= 0.05). The BI-RADS categories and VTI patterns did not show significant difference when the recurrent and non-recurrent patients were compared. CONCLUSION: There may not be a correlation with the pre-treatment SWE findings and severity of the IGM.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 Management and Clinical Outcomes of latrogenic Injury Secondary to Endoscopic Retrograde Cholangiopancreatography(2020) Sari, Ramazan; Yabanoglu, Hakan; Kus, Murat; Arer, Ilker Murat; 0000-0002-1161-3369; 0000-0001-6529-7579; 0000-0003-3492-9953; AAG-1897-2021; AAJ-7865-2021; AAJ-7870-2021Introduction: Perforation secondary to endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication but a problematic one because of associated morbidity and mortality. In our study, we aimed to define correct timing for surgery, to analyze and present our results on suitable methods that can be used in the surgical management of perforation secondary to ERCP done for various indications. Methods: The data were collected from 19 patients who underwent surgery for perforation secondary to ERCP. We retrospectively analyzed clinical and demographic characteristics with the treatment outcomes of these patients. Results: The mean age of the patients was 57 years (range: 16-92). The ERCP procedure was for therapeutic purposes in all the patients. Perforation mostly occurred during sphincterectomy, as was seen in 12 patients (63%). The patients underwent surgical intervention at a mean of 42.5 hours (range: 3-192) after perforation. Postoperative mortality occurred in seven patients (36.8%). The mean hospitalization period was 16.5 days (range: 11-49). Conclusion: Duodenal perforation is an ERCP-related complication that carries high mortality and morbidity risks, even in experienced tertiary centers. When perforation is suspected, these patients should immediately be referred to experienced centers/units for further management. Careful scrutiny of clinical and radiological findings is critical in choosing the appropriate surgical intervention.
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