Mehmet Sertkaya

Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: a Case Report and Comprehensive Literature Review

The aim of this study is to review the reliability of laparoscopic obesity operations in patients with situs inversus totalis(SIT). A new case of SIT was presented together with a literature review of published English language studies on laparoscopic gastric banding (LAGB), laparoscopic gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic obesity surgery (LOS), and SIT, accessed via PubMed and Google Scholar databases. The case is presented of a 21-year-old female patient who underwent LSG due to SIT. A total of 12 publications in literature matched the search criteria for LAGB, LRYGB, LSG, LOS, and SIT, which reported LAGB in five cases, LRYGB in four cases, and LSG in four cases. In the rare event of SIT, LOS can be safely used following good evaluation.

Diagnosis and management of early gastric band slip after laparoscopic adjustable gastric banding.

Laparoscopic adjustable gastric banding (LAGB) used to be a very popular bariatric procedure at a certain time for the treatment of obesity as it has many advantages and is associated with low morbidity and mortality rates. Complications are often late and are rarely seen by general surgeons due to the limited number of patients, and physicians should be aware of the symptoms. We present a case of a 40-year-old female patient who underwent LAGB and was admitted for a huge gastric pouch dilatation on postoperative day 5. She had a history of food consumption on the fourth day after surgery. She was diagnosed with early gastric band slippage (EGBS). The band was repositioned and gastrogastric sutures were placed to prevent reprolapse of the band. The EGBS is an immediate postoperative complication. Diagnosis of EGBS can be made with oral contrast X-ray studies, and surgical intervention is necessary.

Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study

AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinical parameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric Mann-Whitney U test was used to compare quantitative data that were not normally distributed, and Pearson’s chi-squared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method. RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy (P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively. CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.

Assessment of risk factors affecting mortality in patients with colorectal cancer

Introduction The most important risk factors for colorectal cancer are age, high ASA score, anemia, low albumin, tumor stage, histopathological properties, tumors relationship with adjacent tissues, positivity of surgical borders and timing of the surgical procedure. Aim To determine possible risk factors for mortality in patients undergoing colorectal cancer surgery. Material and methods The medical records of 101 consecutive patients who underwent colorectal cancer surgery at the Department of Surgery, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey between January 2008 and November 2015 were retrospectively reviewed. The patients were divided into two groups: surviving (n = 76) and deceased (n = 25) groups. The groups were compared in terms of several demographic, clinical, biochemical, and histopathological parameters. In addition, risk factors for mortality were analyzed with multivariate analysis. SPSS 22.2, PAST 3, and MedCalc 14 software packages were used for statistical analyses. Results The surviving and deceased groups significantly differed with respect to age (p = 0.001), hemoglobin (p = 0.001), lymph node positivity (p = 0.009), positive lymph node/total lymph node ratio (p = 0.012), thrombocyte count (p = 0.047), lymphovascular invasion (p = 0.028), urgency of admission (emergency/elective) (p = 0.036), and postoperative carcinoembryonic antigen (CEA) level (p = 0.002). A receiver operating characteristics curve was drawn to determine the cut-off values of various parameters including age (63), hemoglobin (12.8), node positivity (3), positive/total lymph node ratio (0.435) and thrombocyte count (308), with age (p < 0.001), hemoglobin (p < 0.001), node positivity (p = 0.025) and positive/total lymph node ratio (p = 0.024) being significantly different. A multivariate analysis revealed that age (p = 0.049), hemoglobin (p = 0.045), and positive/total lymph node ratio (p = 0.025) were independent risk factors for mortality. Conclusions This study shows that older age, lower hemoglobin level, and high positive/total lymph node ratio were independent risk factors for mortality among colorectal cancer patients.

Retrospective analysis of the effects of continuous intraluminal aspiration on postoperative intestinal fistulas

Aim: The aim of this study was to present the effectiveness of continuous intraluminal aspiration for treating postoperative intestinal fistulas. Methods: Continuous intraluminal aspiration was conducted on nine patients who underwent surgery for upper or lower Gastrointestinal (GI) tract diseases in our General Surgery clinic from January 2014 to March 2016 and developed an intestinal fistula after the surgery. The clinical and demographic results of the patients were analyzed retrospectively. A double-lumen system consisting of a nasogastric catheter and an implanted endoscopic retrograde cholangiopancreatography cannula was used for aspiration. Results: Seven of the nine patients (age range: 28-71 y) were males. Nine patients had complications: six in the upper GI tract and three in the lower GI tract. The first session was technically successful in all patients. Mean hospital stay was 41.77 ± 15.74 d and mean aspiration duration was 14.12 ± 2.84 d. Neoadjuvant chemotherapy (CRT) was performed in four patients. Eight patients recovered and were discharged but one patient, who underwent laparoscopic Ivor Lewis esophagectomy after neoadjuvant CRT for esophageal cancer and developed esophagomediastinal and tracheomediastinal fistulas, died at 20th d after surgery. Clinical success was achieved in five of six patients (83%) who had a fistula and leakage in the upper GI tract, and in three patients (100%) who had a fistula and leakage in the lower GI tract system. Conclusions: Although treatment duration is longer when using continuous intraluminal double-lumen catheter aspiration, it is an effective method to treat postoperative intestinal fistulas with a low mortality rate and cost.

Clinicopathological analysis of appendiceal mucinous tumors: A single-center experience

Objective Appendiceal mucinous tumors can be encountered in four different types. The clinical approach varies according to these types and the severity of the present disease. We aimed to share clinical, radiological, and pathological features and surgical options of the patients diagnosed with mucinous tumors at our center. Material and Methods Between August 2009 and March 2016, 757 patients underwent appendectomy for presumed diagnosis of acute appendicitis at the Department of Surgery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey. Among them, demographic, clinical, and histopathological characteristics of patients who diagnosed with appendiceal mucinous tumors were retrospectively analyzed. This study was approved by our facultys human ethics committee. Results Incidence of mucinous tumor was 1.71%. Mean age of a total of 13 cases including 6 women and 7 men was 52.4±21.6 years (Range: 25-83 years). On preoperative diagnosis, acute appendicitis was detected in 8 patients, perforated appendicitis and periappendiceal abscess in two patients, and suspicious cecal mass in two patients. One patient had an operation for uterine leiomyoma. On histopathological examination, four patients were diagnosed with simple mucinous cyst, four with mucinous cystadenoma, three with mucosal hyperplasia, and two with mucinous cystadenocarcinoma. Mean duration of hospital stay was 5.1±4.7 days. One patient died from septic shock on first day, one from respiratory failure on 14th day, and one from cardiac arrest on 20th day. The average follow-up duration for the other 10 patients was 44 months (ranging from 1 to 78 months). No recurrence or death occurred in these patients over the course of follow-up. Conclusion Intraoperative clinical diagnosis of appendiceal mucinous tumors is rarely seen. Close histopathological and cytological examination of the specimen is required to separate malignant tumors from benign ones. The treatment varies depending on different types and the severity of the disease.

Giant Appendicular Mucocele Due to Mucinous Cystadenoma

ABSTRACT Mucocele of the appendix is a rare clinicopathological entity simulating acute appendicitis. The most common form of the mucocele is cystadenoma, which is characterized by luminal dilatation producing large amounts of mucin. We present a new case of a giant mucocele of appendix with mucinous cystadenoma. A 61-year-old female was admitted with complaints of severe lower right quadrant pain. Ultrasonography and computed tomography (CT) suggested that it was a mucocele, but due to severity of pain, she underwent an emergency operation. Fortunately, without a perforation, it was a giant mucocele and the operation was terminated with an uneventful appendectomy with segmental cecal resection. The histopathological evaluation of the specimen reported to be a mucocele with mucinous cystadenoma with negative surgical margins. The patient was discharged postoperative 6th day, and a control colonoscopy and abdominal CT was planned for 6 months following surgery. Appendicular mucocele is rare and difficult to diagnose preoperatively, and sometimes it may be of large size which increases the risk of perforation. Pseudomyxoma peritonei (PP) is the most feared complication of mucocele perforation. Appendectomy with negative margins is a requirement for adequate treatment for most cases. Utmost care should be taken during surgery to avoid perforation of mucocele. How to cite this article Sertkaya M, Emre A, Pircanoglu EM, Peker O, Cengiz E, Karaagaç M. Giant Appendicular Mucocele Due to Mucinous Cystadenoma. Euroasian J Hepato-Gastroenterol 2016;6(2):186-189.

A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception

ABSTRACT Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology. How to cite this article Sertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.

Neglected Fournier’s Gangrene Caused by Acinetobacter baumannii: A Rare Case Report

Fourniers gangrene, rare but life threatening disease, is characterized by an acute necrotic infection of the scrotum, penis, or perineum. Fourniers gangrene is a mixed infection caused by both aerobic and anaerobic bacteria. Fourniers gangrene caused by multidrug resistant Acinetobacter baumannii have been reported rarely. The mainstay of treatment is prompt recognition and a combination of antibiotics with radical debridement. We describe a case of a 56-year-old male patient presenting with neglected Fourniers gangrene caused by Acinetobacter baumannii. Many treatment modalities including broad-spectrum antibiotics, aggressive debridement, negative pressure wound therapy, diversion colostomy, and partial-thickness skin grafts were applied to save the patients life.