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Öğe Acil serviste santral venöz kateter uygulamaları; geriye dönük bir çalışma(2009) Acar, Fahrettin; Cander, Başar; Girişkin, Sadık; Gül, MehmetGİRİŞ: Çalışma, bir yıl boyunca hastanemiz acil servisinde yapılan santral ven uygulamalarımızın geriye dönük analizini içermektedir. GEREÇ-YÖNTEM: Bu çalışmada, 2006 yılı boyunca acil serviste santral venöz kateter uygulanan 195 hastanın dosyaları, geriye dönük olarak incelendi. Hastalar acil cerrahi, dahili olgular ile hemodiyaliz kateteri takılan hastalar olmak üzere üç grupta incelendi. BULGULAR: Santral venöz kateterizasyon için en sık internal juguler ven kullanıldı (% 78.9). Hastaların büyük çoğunluğunda kateterizasyon endikasyonu mayi replasmanı ve santral venöz basınç ölçümü idi (% 55.3). Cerrahi acil olgularda en sık acile başvuru nedeni trafik kazası (% 17,4), dahili olgularda ise serebrovasküler hastalıklar (% 10.7) idi. İnternal juguler kateterizasyonda % 14,9, subklavian kateterizasyonda % 25, femoral kateterizasyonda ise % 28.5 komplikasyon gelişti. En sık görülen komplikasyonlar internal juguler yolda arter kateterizasyonu (% 7.7), femoral yolda enfeksiyon (% 14.2), subklavyan yolda ise kateter disfonksiyonu idi (% 20). SONUÇ: Acil servisler, santral venöz kateter uygulamasının sıklıkla yapıldığı kliniklerdir. Komplikasyon azlığı nedeniyle internal juguler venin kateterize edilmesi, öncelikli olarak tercih edilebilir.Öğe Comparison of electrocautery and plasmablade on ischemia and seroma formation after modified radical mastectomy for locally advanced breast cancer(PAGEPRESS PUBL, 2017) Alptekin, Hüsnü; Yılmaz, Hüseyin; Öztürk, Bahadır; Ece, İlhan; Kafalı, Mehmet Ertuğrul; Acar, FahrettinThe aim of this study was to compare postoperative drainage volumes and IMA levels in patients who underwent modified radical mastectomy (MRM) with using PlasmaBlade (PB) or electrocautery (EC). A total of 36 patients who underwent MRM with PB or EC in our clinic between August 2012 to February 2013 were enrolled. Number of removed and positive lymph nodes, duration of drainage and total drainage volume was recorded. Seroma formation after drain removal and number of aspirations were also recorded. Serum ischemia modified albumine (IMA) levels were analysed before surgery, 1 hour and 24 hour after surgery. In total, 36 patients were treated with MRM in the study period. Of the 36 patients, 16 underwent MRM with PB, and 20 underwent MRM with EC. The patients demographics were similar in both groups. The mean drainage volume and seroma formation were significantly higher in the PB group when compared with EC group (P<0.05). Number of aspirations due to the seroma were also high in PB group. The total aspiration volume of seroma was not different in both groups. IMA levels 24 hours after surgery in the PB group was significantly higher than EC group. There was no statistical significance between the groups for IMA levels at 1st hour. PB is a monopolar energy device and is associated with increased levels of ischemia. This situation resulted with an increased volume of total axillary drainage and elevated risk of seroma formation.Öğe Comparison of mid-term clinical outcomes of laparoscopic partial cystectomy versus conventional partial cystectomy for the treatment of hepatic hydatid cyst(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017) Ece, İlhan; Yılmaz, Hüseyin; Yormaz, Serdar; Çolak, Bayram; Acar, Fahrettin; Alptekin, Hüsnü; Şahin, MustafaBackground: The aim of this study was to compare the mid-term outcomes of open and laparoscopic partial cystectomy (LPC). Methods: The medical records of patients who underwent conventional partial cystectomy (CPC) and LPC for liver hydatid cyst from May 2010 to February 2015 were retrospectively reviewed. Operative time, blood loss, length of hospital stay, post-operative morbidity, mortality and mid-term follow-up outcomes were evaluated. Results: Amongst 130 patients, 38 patients were underwent LPC and 92 underwent CPC. Blood loss and post-operative complications were similar in both groups. The mean operative time in the LPC and the CPC groups was, respectively, 95.4 +/- 13.1 and 63.5 +/- 15.6 min, which showed a significant difference between the both groups. The mean length of hospital stay in CPC group was significantly longer when compared the LPC group. The mean diameter of cyst in LPC group was 6.1 +/- 1.1 cm and 7.8 +/- 2.1 cm in CPC group with a significant difference. The overall complication rates were 13.1% in LPC group and 17.3% in CPC group without significant difference. The most common complication was biliary leakage and surgical site infection. Conclusion: LPC for the surgical treatment of liver hydatid cyst appears to be safe and effective method with low morbidity rates in selected patients.Öğe Does digestive symptoms require esophago gastroscopy prior to bariatric procedure? Assessment of 6 years' experience(EDIZIONI LUIGI POZZI, 2018) Yormaz, Serdar; Yılmaz, Kafalı; Alptekin, Hüsnü; Ece, İlhan; Acar, Fahrettin; Çolak, Bayram; Kafalı, Mehmet ErtuğrulAIM: Performance of routine preoperative esophagogastroduodenal endoscopy (EGE) in patients undergoing bariatric surgery is still a controversial subject. The purpose of our study was to evaluate the benefits of performing preoperative EGE in a cohort of bariatric patients. MATERIAL AND METHODS: The present retrospective study was performed between March 2010 and June 2016 We divided the study participants into two groups: group A comprised subjects without disturbing upper digestive signs, while group B comprised patients with disturbing upper digestive signs. Logistic regression analysis was used to identify the predictors that might be associated with abnormal outcomes. RESULTS: Our study included 232 patients (who had undergone sleeve gastrectomy, gastric bypass, ileal interposition, or transit bipartition). The average age was 41.4 +/- 10.3 years, and the average body mass index (BMI) was 43.6 +/- 5.1 kg/m(2). Of all the observed gastroscopic abnormalities, the prevalence for gastritis (17.3%), followed by esophagitis (10.2%), hiatus hernia (9.4%), and bulbitis (8.7%). In multivariate regression analysis, the Gastrointestinal Symptom Rating Scale (GSRS) score and upper gastric symptoms were found to be the only independent predictive markers (OR = 2.822, 95% CI: 1.674-3.456 and OR =2.735, 95% CL 1.827-3.946, respectively). We identified a positive correlation between abnormal EGE findings and postoperative complications. CONCLUSION: Preoperative EGE had a high rate of detection for the possible abnormalities prior to bariatric surgery. Upper gastric symptoms are significant predictive factors of postoperative complications. Performing preoperative EGE for symptomatic patients could help reduce the morbidity and mortality rates in these patients.Öğe Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study(KOREAN SURGICAL SOCIETY, 2013) Yılmaz, Hüseyin; Arun, Oğuzhan; Apilioğullari, Seza; Acar, Fahrettin; Alptekin, Hüsnü; Çalışır, Akın; Şahin, MustafaPurpose: Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. Methods: Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. Results: A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). Conclusion: In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.Öğe Effect of sex steroids on soleus muscle response in hypocalcemic medium (in vitro)(ACADEMIC PRESS INC ELSEVIER SCIENCE, 2013) Kökçam, Süleyman Said; Tekin, Şakir; Kartal, Adıl; Ayaz, Murat; Şahin, Mustafa; Acar, Fahrettin; Çakır, MuratPurpose: Postoperative hypocalcemia is a frequently encountered complication of thyroid surgery. Since hypocalcemic symptoms are closely associated with sex, the aim of this study is to investigate the effects of sex steroids on muscle tissue under hypocalcemic conditions. Methods: Six groups consisting of control male (M), control female (F), gonadectomized male (M -), gonadectomized female (F-), estradiol- applied gonadectomized male (MX), and testosterone- applied gonadectomized female (FX) rats were used. Contraction recordings were obtained from soleus muscle flaps. Maximal tension (PT), frequency required for 50% of PT (F50), contraction velocity at F50 (V50), and changes in contraction values (d[PT], d[F50], d[V50]) between normocalcemic and hypocalcemic conditions were calculated. Results: d[PT], d[F50], and d[V50] were significantly higher in M - and MX groups compared with control M group. Whereas d[PT], d[F50], and d[V50] parameters of the F- group were significantly higher than control F group, d[F50] and d[PT] of the FX group showed no significant change and d[V50] for the FX group was significantly lower. A comparison of control groups showed that d[PT], d[F50], and d[V50] of the F group were significantly higher than those of the M group. Conclusion: Whereas absence of both testosterone and estradiol caused an increase in hypocalcemia- induced changes in contraction parameters of rat skeletal muscle, presence or application of testosterone clearly stabilized contraction parameters. (C) 2013 Elsevier Inc. All rights reserved.Öğe The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass(AVES, 2017) Kafalı, Mehmet Ertuğrul; Şahin, Mustafa; Ece, İlhan; Acar, Fahrettin; Yılmaz, Hüseyin; Alptekin, Hüsnü; Ateş, LeylaObjective: The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications. Material and Methods: Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results. Results: During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group. Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.Öğe Esophageal Adenocarcinoma Presenting with Skin Metastase: Case Report(ORTADOGU AD PRES & PUBL CO, 2012) Yılmaz, Hüseyin; Alptekin, Hüsnü; Şahin, Mustafa; Acar, Fahrettin; Kafalı, M. ErtuğrulEsophageal cancer is among cancers with the highest mortality rate worldwide. The ninth most common malignancy and the sixth most frequent cause of cancer death is esophageal cancer in the world, constituting 7% of all gastrointestinal cancers. Cutaneous metastases of esophageal adenocarcinoma are very rare. Loco-regional disease recurrence has been dramatically reduced with the institution of multimodality treatment for esophageal adenocarcinoma in the recent years. Skin metastasis of internal cancer is rare. In this report, we presented a 55-year-old male with adenocarcinoma of the distal esophagus that was treated with surgical excision and adjuvant chemotherapy. After a disease free interval of fourteen months the patient presented with cutaneous metastatic disease.Öğe Experiences of Single Incision Cholecystectomy(IVYSPRING INT PUBL, 2013) Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Çiftçi, İlhan; Tekin, Ahmet; Şahin, MustafaPurpose: Single incision laparoscopic surgery in suitable cases is preferred today because it results in less postoperative pain, a more rapid recovery period, more comfort, and a better cosmetic appearance from smaller incisions. This study aims to present our experiences with single incision laparoscopic cholecystectomy to evaluate the safety and feasibility of this procedure. Methods: A total of 150 patients who underwent single incision laparoscopic cholecystectomy between January 2009 and December 2011 were evaluated retrospectively. In this serial, two different access techniques were used for single incision laparoscopy. Results: Single incision laparoscopic cholecystectomy was performed successfully on 150 patients. Median operative time was 29 (minimum-maximum=5-66) minutes. Median duration of hospital stay was found to be 1.33 (minimum-maximum=1-8) days. Patients were controlled on the seventh postoperative day. Bilier complication was not seen in the early period. Five patients showed port site hernia complications. Other major complications were not seen in the 36-month follow-up period. Conclusion: Operation time of single incision laparoscopic cholecystectomy is significantly shortened with the learning curve. Single incision laparoscopic cholecystectomy seems a safe method.Öğe Hand-assisted Laparoscopic Sleeve Gastrectomy(SPRINGER, 2013) Şahin, Mustafa; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Kafalı, E.; Çalışır, Akın[Abstract not Available]Öğe Hemodynamic and metabolic effects of nitrous oxide and carbon dioxide insufflation in laparoscopic repair of inguinal hernias(2005) Acar, Fahrettin; Aksoy, Faruk; Belviranlı, Metin; Tuncer, SemaPurpose: The aim of this study is to compare hemodynamic and metabolic effects of CO2 and N2O insufflation into extraperitoneal area. Background: In treatment of inguinal hernia, a laparoscopic technique is widely applied to total extraperitoneal hernia (TEP) in some clinics. Due to the fact that CO2 used in the extraperitoneal area contains higher hypercarbia and acidosis compared to N2O, this leads to search for alternative gas in this area. Materials and Methods: Between September 2003 and July 2004, 24 male patients who underwent one-sided inguinal hernia operation with TEP under general standard anaesthesia, have participated in this study. We used CO2 for insufflation in 12 patients (mean age; 42±18 years) and N2O in 12 patients (mean age; 46±16 years). Prolen greft was used in both groups during repair and, throughout the operation, hemodynamic and metabolic parameters were recorded at 0, 5, 15, 30, and 45th minutes. Results: Parameters obtained from these two groups such as heart rate (HR), partial CO2 pressure (PaCO2), end-tidal CO2 pressure (PETCO2), mean arterial pressure (MAP), and total gas amount insuffleted during operation were found to be significantly higher in the CO2 group than in the N2O group (p<0,001). In contrast; pH, O2 saturation (SpO2), and partial O2 pressure (PaO2) were determined as lower in CO2 group than in N2O group throughout the operation [p<0,001]. Furthermore, visual pain score (VPS) was significantly lower in N2O group. Between the two groups, no major difference was observed in terms of endtidal N2O pressure (PETN2O). Conclusion: In the laparoscopic interventions, N2O insufflation to the extraperitoneal area does not lead to the hemodynamic and metabolic changes, whereas CO2 insufflation has detrimental effect on hemodynamic levels by causing hypercarbia and acidosis. Moreover, in the postoperation period, VPS was lower in members of the N2O insufflated group than those in the CO2 insufflated group. Consequently, in the laparoscopic surgery, during extraperitoneal inguinal hernia repairment, N2O gas has more advantage than CO2 gas.Öğe Incisional Hernia Rate May Increase After Single-Port Cholecystectomy(Mary Ann Liebert Inc, 2012) Alptekin, Hüsnü; Yılmaz, Hüseyin; Acar, Fahrettin; Kafalı, M. E.; Şahin, MustafaBackground: The major concerns of single-port cholecystectomy are port-site hernia and cost. Essentially, a larger transumbilical incision is more likely to increase the incidence of incisional hernia. The effect of single-port cholecystectomy on hospital cost is controversial. This study evaluated single-port cholecystectomy and traditional four-port cholecystectomy with respect to perioperative outcomes, hospital cost, and postoperative complications. Patients and Methods: Between January 2010 and March 2011, 52 patients underwent single-port cholecystectomy, and 111 patients underwent traditional laparoscopic cholecystectomy. We used equal instruments in patients undergoing operation with the same surgical technique. Demographics, diagnosis, operative data, complications, length of hospital stay, and cost were compared between the two groups. Results: The patients undergoing laparoscopic cholecystectomy were significantly older than patients undergoing single-port cholecystectomy (55.8 +/- 13.8 years versus 48.7 +/- 12.7 years, P = .002). The trocar site hernia rate was 1.8% in laparoscopic cholecystectomy, and the port-site hernia rate was 5.8% in single-port cholecystectomy. This is the highest rate reported in the literature for port-site hernia following single-port cholecystectomy. Surgical techniques were not different in terms of conversion to open surgery, postoperative hospital stay, and operative time. The relative cost of single-port cholecystectomy versus laparoscopic cholecystectomy was 1.54. Conclusions: Although single-port cholecystectomy seems to be a feasible surgical technique, it is not superior over the traditional laparoscopic cholecystectomy. Single-port cholecystectomy is equal to laparoscopic cholecystectomy with respect to conversion to open surgery, postoperative hospital stay, and operative time, but it is associated with high hospital cost and high port-site hernia rate.Öğe Laparoskopik sleeve gastrektomi de pulmoner tromboemboli riskinin padua skoru ile değerlendirilmesi: retrospektif bir çalışma(2019) Yormaz, Serdar; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Ece, İlhan; Çolak, Bayram; Yormaz, Burcu; Kafali, Mehmet Ertuğrul; Şahin, MustafaAmaç: Pulmoner tromboemboli bariatrik cerrahide postoperatif dönemde yeterli önlem alınmazsa morbidite ve mortalitenin yüksek olduğu ve bu nedenle hızlı tanı ve tedavi gerektiren bir kompikasyondur. Toplumdaki morbid obezite oranı arttıkça pulmoner tromboemboli’ningelişme potansiyeli daha da artış göstermektedir. Çalışmamızın amacı pulmoner tromboemboli tanısı konularak tedavi edilen olgularınklinik, laboratuvar ve radyolojik sonuçlarınıretrospektif olarak değerlendirmekti.Gereç ve Yöntem: Bariatrik cerrahi kliniğimizde Mart 2014 ile Ocak 2016 tarihleri arasında morbid obezite nedeniyle laparoskopik sleevegastrektomi geçiren hastaların dosyaları retrospektif olarak incelendi. Olguların klinik, radyolojik, laboratuar, demografik özellikleri ilePadua skorları değerlendirildi. Hastaların postoperatif dönemdeki verileri ve komplikasyonları istatistiksel olarak değerlendirildi. Postoperatif pulmoner tromboemboli riskini etkileyebilecek faktörler tek değişkenli regresyon analizi ile değerlendirildi.Bulgular: Hastaların 146’sı (%55) kadın ,124’u (%45) erkekti. Ortalama yaş 44.7 4.3 (22-72) olarak belirlendi. Ayrıca ortalama operasyon sonrası hastanede kalış süresi 5.7 2.3(2-25) gündü. Hastalardan çok-yüksek-riskli(VHR) ve yüksek-riskli (HR) gruplara postoperatifdönemde pnömotik cihazı uygulanırken, orta-riskli(MR) ve düşük-riskli (LR) gruplara varis çorabı uygulandı. Uygulanan koruyucu işlemlere rağmen 3 hastada derin ven trombozu ve 2 hastada pulmoner tromboemboli görüldü (p0.05), herhangi bir mortalite saptanmadı.Hastalardaki postoperatif dönemde görülen gerileme ve postoperatif pulmoner tromboemboli riskini etkileyebilecek faktörler (vücut kitleindeksi, geçirilmiş venöz emboli öyküsü, immobilite ve komplikasyonlar ) istatistiksel olarak anlamlı olarak saptandı (p0.05).Sonuç: Bariatrik cerrahide pulmoner tromboemboli profilaksisi için öncelikle önerilen ilaç daima düşük molekül ağırlıklı heparindir. Hastalara bu koruyucu tedaviye ek olarak pnömotik cihaz ve/veya varis çorabı uygulaması gerekmektedir. Bariatrik cerrahide olası komplikasyonları önlemede pnömotik cihaz varis çorabı uygulamasına göre daha efektiftir.Öğe Laparoskopik Sleeve Gastrektomi Sonrası Stapler Hattı Kaçaklarının Genişleyebilen Metalik Stentler ile Tedavisi(2016) Ece, İlhan; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Yormaz, Serdar; Çolak, Bayram; Şahin, MustafaLaparoskopik sleeve gastrektomi (LSG) kilo kaybı ve obezite ilişkili hastalıkların tedavisinde etkili bir bariatrik yöntemdir. LSG'nin en önemli komplikasyonu stapler hattı kaçakları- dır (SHK). Dörtyüz yirmi iki LSG olgusu içeren bu çalışmada SHK oranı ve tedavi yönetimi tartışılacaktır. Gereç ve Yöntemler: Dörtyüz yirmi iki hastaya Ocak 2010- Haziran 2015 tarihleri arasında LSG uygulandı. Bir üniversite hastanesi obezite cerrahisi kliniğinde LSG sonrası kaçak teş- hisi konulan hastalar retrospektif olarak incelendi. Mide rezeksiyonu pilordan 4-6 cm mesafeden 60 mm stapler yardımı ile yapıldı. Mide tüpü 36F buji ile kalibre edildi. Stapler hattı rutin olarak devamlı dikişlerle kuvvetlendirildi. SHK gelişen hastalar genişleyebilen stentler ile tedavi edildi. Bulgular: Hastaların ortalama yaşı 41.8 (29-55) yıl ve kadın/erkek oranı 7/5 idi. Ortalama beden kitle indeksi 44.1 kg/m2 olan hastalardan birisinde gastrik band ameliyatı hikayesi vardı. Stapler hattı kaçak oranı 12/422 (%2.8) idi. Tüm olgularda kaçak alanı gastroözofajiyal bileşke komşulu- ğunda idi. SHK endoskopik genişleyebilen stent uygulaması ile tedavi edildi. Tüm hastalarda parenteral beslenme ve antibiyotikleri içeren medikal destek sağlandı. Tüm olgularda stent yerleştirilmesi başarılı bir tedavi sağladı. Sonuç: Laparoskopik sleeve gastrektomide SHK en sık görülen komplikasyon olup tüm komplikasyonların yarısını oluşturur. Genişleyebilen stent uygulaması, antibiyotik ve parenteral beslenme ile birleştirildiğinde etkili sonuçlar elde edilebilir ve durumu stabil hastalarda ilk tedavi basamağı olmalıdır.Öğe Laparoskopik sleeve gastrektomi ve laparoskopik roux n y gastrik bypass prosedürlerinin reflü semptom indeksi ile karşılaştırılmalı değerlendirilmesi: Retrospektif bir çalışma(2018) Yormaz, Serdar; Yılmaz, Hüseyin; Alptekin, Hüsnü; Ece, İlhan; Çolak, Bayram; Acar, Fahrettin; Kafalı, M. Ertuğrul; Şahin, Enes; Şahin, MustafaAmaç: Çalışmamızda laparoskopik sleeve gastrektomi velaparoskopik Roux-en-Y gastrik bypass geçiren morbidobezlerin postoperatif dönemdeki reflüyle ilgili s onuçlarınıdeğerlendirmeyi amaçladık.Materyal ve Metod: Bariatrik cerrahi kliniğimizde Ocak2013 ile Mart 2016 tarihleri arasında morbid obezitenedeniyle laparoskopik sleeve gastrektomi ve laparoskopikRoux-en-Ygastrik bypass uygulanan 112 hasta retrospektifolarak incelendi. Hasta gruplarının demografik bulguları,reflü semptom indeksi, global belirti skorları, hastanede kalışsüreleri değerlendirildi. Çalışma grubumuzdaki hastalarınvücut kitle indeksi, yaş ve eşlik eden komorbiditeleraçısından benzerlikleri mevcuttu.Bulgular: Çalışmaya katılan hastaların ortalama yaşı37.125.51 (yaş aralığı 23–57), ortalama vücut kitle indeksi46.34.7 kg/m2 (aralığı 40–57) idi. Ortalama ameliyat süresilaparoskopik Roux-en-Ygastrik bypass da 87.916.1 dakikalaparoskopik sleeve gastrektomi de 72.512.7 dakika (42–102 dakika aralığı) idi. Postoperatif dönemde ortalamahastanede kalış süresi ise laparoskopik sleeve gastrektomi de4.2 gün, laparoskopik Roux -en-Ygastrik bypass da 7.3 günolarak bulundu. Ameliyat sonrası dönemde 4 hastadakomplikasyon gözlenirken, hiçbir mortalite saptanmadı.Operasyonların hepsi laparoskopik olarak sonlandırıldı.Multivaryant regresyon analizi kullanılarak yaş, cinsiyet vevücut kitle indeksi bağımsız risk faktörleri olarak tanımlandı.İstatistiksel olarak anlamlı sonuçlar p0.05 olarak kabuledildi.Sonuç: Bariatrik cerrahide uygulanan gastrik bypassprosedürünün sleeve gastrektomiye oranla morbiditesiyüksek olmasına rağmen reflü semptomlarını azaltıcıetkilerinin ve hastalık şiddetindeki gerilemenin daha iyiolduğunun sonucuna ulaştıkÖğe Laparoskopik sleeve gastrektomide stapler hattında uygulanan barbed sütur ve fibrin adhezivlerin etkisinin kıyaslanması: retrospektif çalışma(2018) Yormaz, Serdar; Ece, İlhan; Çolak, Bayram; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Kafalı, M. ErtugrulAmaç: Araştırmamızda morbid obezite nedeniyle laparoskopik sleeve gastrektomi uygulanan ve stapler hattına destek süturu konan veya fibrin adheziv kullanılan hastaların sonuçlarını değerlendirmeyi amaçladık.Gereç ve Yöntem: Bariatrik cerrahi kliniğimizde morbid obezite nedeniyle laparoskopik sleeve gastrektomi uygulanan ve stapler hattına sütur konan ve adheziv konan 86 hasta retrospektif olarak incelendi. Hasta profilinin demografik bulguları, operasyon süreleri, komplikasyon tipleri, oranları, hastanede kalış süreleri değerlendirildi. Çalışma grubumuzdaki hastalar vücut kitle indeksi, yaş, cinsiyet ve sayı açısından benzerlik olduğu için randomize olarak kabul edildiler.Bulgular: Çalışmaya katılan hastaların ortalama yaşı 37.125.51 yıl (yaş aralığı 23–57), ortalama beden kitle indeksi 46.34.7 kg/m2 (aralığı 41–59) idi. Ortalama ameliyat süresi 87.916.1 dakika olarak hesaplandı. Operasyonun ortalama süresi 72.5 12.7 dakika (25–102 dakika aralığı) idi. Postoperatif dönemde ortalama hastanede kalış süresi ise 5.231.22 gün (3–8 gün aralığı) olarak bulundu. Ameliyat sonrası 4 hastada komplikasyon gelişirken, herhangi bir hastada majör komplikasyon veya mortalite görülmedi. Operasyonların hepsi laparoskopik olarak sonlandırıldı.Sonuç: Bariatrik cerrahide staplerle uygulanan obezite cerrahisinde stapler hattının özellikle barbed sütur ile desteklenmesi operasyonun güvenilirliğini artırıp komplikasyon oranını azaltmaktadır.Öğe Metabolik cerrahide ekstraksiyon metodlarının kıyaslanması: endo bag faydalı mı?(2018) Yormaz, Serdar; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Ece, İlhan; Çolak, Bayram; Kafalı, M. ErtugrulAmaç: Morbid obezite günümüzde global bir sorun haline gelmiştir bunu aşmak içinde farklı cerrahi yöntemler uygulanmaktadır. Araştırmamızda morbid obezite amacıyla laparoskopik sleeve gastrektomi (LSG) uygulaması sonrasında doku çıkarma yöntemlerinden endo bag ile yara koruyucu halka yöntemlerini kıyaslamayı amaçladık.Gereç ve Yöntem: Kliniğimizde ocak 2015 ile kasım 2016 tarihleri arasında morbid obezite nedeniyle laparoskopik sleeve gastrektomi uygulanan ve dokunun trokar yerinden çıkarıldığı 80 erkek, 40 kadın totalde 120 hasta kayıtlara bakılarak retrospektif olarak değerlendirildi. Opere olan hastaların demografik bulguları, operasyon süreleri, postoperatif sonuçları, hastanede kalış süreleri ve yara yeri enfeksiyonları karşılaştırıldı.Bulgular: Operasyonların ortalama süresi 72,121,4 dakika (34–97 dk) aralığı idi. Endobag uygulanan hastalarda ortalama operasyon süresi 68.26.4 iken yara koruyucu halka yönteminde bu süre 77.1 5.8 dk olup, aralarındaki fark istatistiksel olarak anlamlı idi. Postoperatif dönemde ortalama hastanede kalış süresi ise 5,761,17 gün (5.21.3, 6.30.8) olarak bulundu. Her iki grubun yara yeri enfeksiyonu oranları arasındaki fark istatistiksel olarak anlamlıydı.Sonuç: Bariatrik cerrahide gastrik piyesin intrabdominal bölgeden endo bag yöntemiyle çıkarılmasının yara koruyucu halka yöntemine oranla daha az enfeksiyon ve komplikasyona sebep olması nedeniyle daha efektif olacağı çalışmamızda tespit edilmiştir.Öğe Mide kanseri tedavisinde açık ve laparoskopik distal subtotal gastrektominin kısa dönem onkolojik sonuçları(2018) Ece, İlhan; Acar, Fahrettin; Yılmaz, Hüseyin; Çolak, Bayram; Yormaz, Serdar; Şahin, MustafaAmaç: Bu çalışmada lokal ileri evre mide kanseri için uygulanan laparoskopik ve açık distal subtotal gastrektomi olgularında kısa dönem onkolojik sonuçların karşılaştırılması amaçlandı.Gereç ve Yöntem: Lokal ileri evre mide kanseri tanısı ile Eylül 2014- Eylül 2015 tarihleri arasında distal subtotal gastrektomi uygulanan toplam 22 hasta çalışmaya dahil edildi. Tüm hastalarda bilgisayarlı tomografi ile uzak metastaz taraması yapıldı ve ameliyat öncesi dönemde patolojik olarak mide kanseri tanısı doğrulandı. Açık teknikle distal subtotal gastrektomi (DSG) ve D2 lenfadenektomi yapılan hastalar laparoskopik distal subtotal gastrektomi (LDSG) ve D2 lenfadenektomi yapılan hastalar ile yaş, cinsiyet, tümör boyutu, çıkarılan lenf nodu sayısı ve cerrahinin erken dönem sonuçları açısından karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 53,810.2 yıl, vücut kitle indeksi 26.13.9 kg/m2 idi. Her iki grupta hasta özellikleri açısından fark yoktu. Ame-liyat süresi LDSG grubunda anlamlı oranda yüksek olmasına rağmen kanama miktarı daha azdı. Cerrahi olarak çıkarılan tümörlerin boyutları ve diseke edilen lenf nodu sayısında fark yoktu. Ayrıca erken postoperatif komplikasyon oranı her iki grupta benzerdi.Sonuç: LDSG açık teknik ile benzer komplikasyon oranına sahip, eşit sayıda lenf nodu diseksiyonu sağlayan güvenli bir yöntemdir. Ayrıca LDSG daha az kanamaya neden olarak onkolojik sonuçlarda iyileşme sağlayabilir.Öğe Migration of an Adjustable Gastric Band Into Gastric Lumen: A Rare Complication of Bariatric Surgery: Case Report(ORTADOGU AD PRES & PUBL CO, 2012) Yılmaz, Hüseyin; Alptekin, Hüsnü; Şahin, Mustafa; Acar, Fahrettin; Kafalı, M. ErtuğrulLaparascopic adjustable gastric banding (LAGB) is a frequently used procedure in treatment of morbid obesity. It is the first minimally invasive method in treatment of morbid obesity. Sliding of the band and erosions are gastric band-related complications. In this study, we presented a 36-year-old morbid obese [body mass index (BMI) 53.9 kg/m(2)] female patient in whom LAGB was performed in June 2007. The patient lost 62 kg until November 2009 (BMI: 30.9 kg/m(2)). An expansion was detected in proximal pouche on fluoroscopic examination when she was investigated for the complaint of epigastric pain in March 2010. A revision surgery was planned with the pre-diagnosis of band sliding. Total migration of the band into lumen and towards terminal ileum was detected on operation. The band was removed with enterotomy and a vertical band gastroplasty was performed. This is the first case in literature that the band lost its connection with the tube and migrated into the lumen of terminal ileum. If the band is migrated into distal parts as in this case, early surgery must be planned for preventing complications as ulceration, perforation and obstruction.Öğe Minimally invasive management of anastomotic leak after bariatric Roux-en-Y gastric bypass(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2015) Ece, İlhan; Yılmaz, Hüseyin; Alptekin, Hüsnü; Acar, Fahrettin; Yormaz, Serdar; Şahin, MustafaThe aim of this retrospective study was to examine the anastomotic erosion due to drain and success of fibrin sealant in its management. Between 2013 and 2014, 102 patients underwent LRYGB and gastrojejunal anastomotic leak occurred due to drain erosion in 2 of them. The diagnosis was established with saliva drainage and was confirmed by upper gastrointestinal series. The absence of hemodynamic instability was directed us to conservative treatment. During the endoscopy, dehiscence was assessed and fibrin sealant was applied. The leaks healed progressively in a few days, and the drains removed within 6 days. Seven and 9 days later, the patients were discharged without any problem. Anastomotic leaks after bariatric surgery can cause severe morbidity, cost, and effects quality of life. Hemodynamically stable and drained patients are candidates for conservative methods. Endoscopic injection of fibrin sealant has been successful in closing gastric leaks.
