Turgut Anuk

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture

OBJECTIVE Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. MATERIAL AND METHODS Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. RESULTS The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. CONCLUSION MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.

MATERNAL AND FETAL OUTCOMES AFTER LAPAROSCOPIC VS. OPEN APPENDECTOMY IN PREGNANT WOMEN: DATA FROM TWO TERTIARY REFERRAL CENTERS

Objectives Appendectomy is the most common cause of non-obstetric surgery in pregnant women. Our aim was to compare the clinical characteristics, peri-and post-operative data of pregnant women undergoing either laparoscopic appendectomy (LA) or open appendectomy (OA). Materials and methods This was a retrospective study of medical records of all pregnant women diagnosed and treated surgically for acute appendicitis at two referral centers of Yuzuncu Yil University Medical Faculty and Kafkas University Medical Faculty, from January 2010 to January 2015. Results The study included 48 patients, divided to two groups (12 - LA and 36 - OA). There were no significant differences in demographic characteristics of the studied population, including age, BMI, gestational age at operation, gravidity, parity, and history of cesarean sections. A far as obstetric and fetal outcomes are concerned, no significant differences were found in terms of preterm delivery, fetal loss, delivery mode, birth weight, APGAR score, and maternal death between the two investigated groups. One perioperative complication of intra-abdominal abscess was noted in the OA group. However, the LA group had shorter hospital stay (3.25±2.45 vs. 4.28±3.31, p=0.004), earlier mobilization time (8.1±2.2 vs. 10.1±1.6, p=0.025), and shorter time to first flatus (2.3±0.3 vs. 4.0±1.6, p=0.032) as compared to the OA group. The OA group had statistically shorter operation time than the LA group (38.61±11.5 vs. 49.42±11.38, p=0.007). Conclusion LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

Evaluation of patients who have undergone unintentional parathyroidectomy following thyroidectomy: a retrospective cohort study

Aim: We investigated the postoperative parathormone levels and the incidence of hypocalcemia in patients who had inadvertently underwent parathyroidectomy during thyroid surgery . Material and Methods: We retrospectively evaluated a total of 142 patients who had undergone thyroidectomy between January 2011 and March 2017 from their charts. The demographic feature sand pathology diagnoses of the thyroidectomy patients were evaluated. The number of excised parathyroid glands in the pathology specimens and their location were determined. The PTH level was checked after surgery. Calcium was measured on the 2nd day. Calcium replacement was provided for patients with low PTH and calcium. The level of calcium replacement was determined by referring to biochemical values. Following discharge, the calcium and PTH levels were checked during outpatient visits to determine whether the hypocalcemia was transient or permanent. Results: The 142 patients consisted of 23 males (16.2%) and 119 females (83.8%). The mean age was 49.5 years. The surgery performed was bilateral total thyroidectomy in 131, bilateral subtotal thyroidectomy in 3, left total right subtotal thyroidectomy in 3, right total leftsubtotalthyroidectomy in 2, left thyroid lobectomy in 2, and complementary thyroidectomy in 1. Unilateral neck dissection (level II, III, IV, V) was performed in 2 patients and central lymphnode dissection in 82 patients. Parathyroid tissue was found to have been excised during surgery in 35 patients, consisting of 33 females (94.2%) and 2 males (5.8%). The parathyroid tissue had been removed incidentally in 31 and not incidentally in 4. We found transient hypocalcemia in 42 patients and permanent hypocalcemia in 2 patients. Discussion: We found that some parathyroid glands had been inadvertently removed despite careful thyroid surgery. We believe that checking the PTH level postoperatively is important in determining hypocalcemia. Conclusion:

Do elevated blood calcium levels in patients with peptic ulcer facilitate perforation

Aim: Calcium is primarily stored in bones in the body. The increase in blood calcium level due to primary or secondary causes leads to several impairments of the gastrointestinal system like anorexia, nausea-vomiting, peptic ulcer (PU), and abdominal pain. In this study, we want to compare and analyse the difference in blood calcium levels of patients who underwent surgery for peptic ulcer perforation (PUP) and those diagnosed with PU by endoscopy. Material and Methods: Between May 2012-January 2017, patientsÂ’ data for PU disease were recorded and our study was planned retrospectively Patients were sorted into two groups: Group1 included patients operated for PUP; and Group2 included the patients with administered medical therapy for PU disease. Blood calcium levels during admission, age, gender and drug history of patients were recorded. Study exclusion criteria were patients whose data were missing (113 patients), patients who had metabolic bone disease, patients who had been using calcium channel blockers and who were administered anti-ulcer drugs. Results: Twenty-eight patients had PUP and 176 patients had PU disease. Group 1 had a lower mean age (p=0.017), and higher male gender rate (p

Expression profile and cellular localizations of mucin proteins, CK7, and cytoplasmic p27 in Barrett’s esophagus and esophageal adenocarcinoma

PURPOSE Barretts esophagus is one of the main risk factors for increased incidence of esophageal adenocarcinoma. In this study, we studied protein expression levels and cellular localizations of MUC-1, MUC-2, MUC-5AC, CK7, and cytoplasmic p27 to assess the relationship between the expression of each of these proteins and the disease progression on endoscopic biopsies. MATERIALS AND METHODS Immunohistochemical analyses were performed using antibodies produced against MUC-1, MUC-2, MUC-5AC, CK7, and p27. Endoscopic specimens of esophageal mucosa were obtained from 72 patients who underwent esophagectomy for Barretts esophagus, metaplasia, dysplasia, or esophageal adenocarcinoma developed from Barretts esophagus. RESULTS Multilayer squamous epithelium showed only MUC-1 positivity in the EAC group while MUC-2 and MUC-5AC staining could not be detected in this group. Strong and diffused membranous or cytoplasmic staining of CK7 was observed at squamous, ductal, surface columnar and/or glandular epithelium. c-p27 staining was diffused and moderate in the cellular membranes observed in all groups except for esophageal epithelial metaplasia without intestinal metaplasia. Additionally, weakly focal cytoplasmic staining in squamous epithelium of p27 in EAC was detected. CONCLUSIONS Barretts esophagus, which has a heterogeneous epithelium, might yield different diagnosis based on endoscopic evaluation and immunohistological investigation. Thus, the use of MUC1, p27, and CK7 might strengthen the truthful diagnosis. MUC-1, CK7, and c-p27 immunostaining can be used as the predictive markers for esophageal cancer progression from Barretts esophagus.

The Credibility of Fine-Needle Aspiration Biopsy for Malignancy in Patients with Hashimoto Diseases

Fatih Çiftci, Başakşehir Mahallesi Bulvar İstanbul sitesi E4 Daire 79 Başakşehir, İstanbul, Türkiye, Tel. 0505 616 42 48 Email. oprdrfatihciftci@gmail.com Geliş Tarihi: 20.06.2016 • Kabul Tarihi: 22:07:33 ABSTRACT Aim: This study aimed to research the presence of malignancy in patients with Hashimoto’s thyroiditis, and to examine the reliability of preoperative fine-needle aspiration biopsy (FNAB).

Rectosigmoid Tumor Causing Rectal Prolapse: Case Report

Rectal prolapse is believed to develop secondary to anatomical defects. Rectosigmoid tumors are rare causes of this condition. This must be kept in mind in patients with prolapse; colonoscopic examination is recommended and biopsy should be performed when necessary. In this case report, we present an elderly patient with rectal prolapse. The mass that precipitated the prolapse was biopsied and identified as adenocarcinoma. The cancer was treated and patient was discharged.

Combination of Cholecystectomy and Salpingooophorectomy in Keyless Abdominal Rope-lifting Surgical Technique

Introduction: During keyless abdominal rope-lifting surgery (KARS) the intra-abdominal operations are performed through the single intra-umbilical incision following the lifting of the abdominal wall by sutures loaded in the Veress cannula without using CO2 and trocars. However, it is unclear whether KARS is suitable for the combination of two different surgical procedures performed in the lower and upper abdominal viscera. In this paper we aimed to present the first case of the combination of cholecystectomy and salpingooophorectomy performed by using the KARS technique. Case Report: A sixty-seven year old, gravidity 7, parity 7, postmenopausal woman was referred to our center with the symptoms of nausea, vomiting and right upper abdominal pain. Physical examination was not remarkable other than a mild right upper abdominal tenderness and a positive Murphy sign. Ultrasound examination revealed a hydropic gall bladder with micro calculi and the bile duct was dilated with a width of 11–12 mm and there was an image compiled with bile sludge located distal to the dilatation area. In addition, there was a septated cyst with 95x65x46 mm diameters in the left adnexal region. Cholecystectomy and salpingoophorectomy were performed through the same single incision of KARS. The woman was discharged at the 2 postoperative day. Conclusion: To our knowledge, this is the first case report presenting the operative management of a gall-bladder disease and adnexal cyst by using a single incision and gasless minimal invasive surgical technique. KARS seems feasible for the combination of cholecystectomy and salpingoophorectomy.