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Öğe Acute abdomen due to spilled gallstones: a diagnostic dilemma 10 years after laparoscopic cholecystectomy(Oxford University Press, 2020) Kafadar, Mehmet Tolga; Çetinkaya, İsmail; Aday, Ulaş; Başol, Ömer; Bilge, HüseyinLaparoscopic cholecystectomy (LC) carries a significant risk of gallbladder perforation and resulting scattering of bile stones into the abdominal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Most cases do not create long-term problems, although some cases may be complicated in future and create uncertainties regarding the correct diagnosis. Diagnosis can be difficult, and in most cases the patient may require open surgery for management of these complications. Herein, we report a case of acute abdomen due to spilled stones occurring 10 years after LC. In the first stage, definitive diagnosis could not be made with computed tomography examination. Finally, the patient was diagnosed with explorative laparotomyÖğe Acute necrotizing pancreatitis and coronavirus disease-2019 (COVID-19)(NLM (Medline), 2021) Aday, Ulaş; Gedik, Ercan; Kafadar, Mehmet Tolga; Özbek, ErdalCoronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2) and has resulted in increased mortality worldwide. Several studies have identified the involvement of the gastrointestinal tract, respiratory tract, and other tissues. Although it has been reported that the angiotensin-converting enzyme-2 receptor affected by SARS-CoV is expressed more in the pancreas than in the lungs, the issue regarding the occurrence of pancreatitis is controversial. SARS Cov-2 rarely causes acute necrotizing pancreatitis without significantly affecting the respiratory and other systems. This paper presents a patient who underwent laparotomy due to acute necrotizing pancreatitis and hemodynamic instability caused by COVID-19 without any known risk factors.Öğe Can NLR/PLR/CEA be a marker for predicting a complete pathological response in locally advanced rectal cancer?(Bayrakol Medical Publisher, 2021) Çiyiltepe, Hüseyin; Gündeş, Ebubekir; Çetin, Durmuş Ali; Aday, Ulaş; Bozdağ, Emre; Gülmez, Selçuk; Uzun, Orhan; Senger, Aziz Serkan; Polat, Erdal; Duman, MustafaAim: The standard treatment for locally advanced (T3-4 and/or N +) rectal cancer (LARC) is Total Mesorectal Excision (TME) and adjuvant chemotherapy after neoadjuvant chemo-radiotherapy (n-CRT). Various clinical or pathological complete response (pCR) rates after neoadjuvant therapy have been reported in the literature. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) or carcinoembryonic antigen (CEA) levels are used as prognostic markers for many tumors.The aim of this study is to investigate the relationship between treatment response and the above markers in patients receiving n-CRT for LARC. Material and Methos: The pathology results of 113 patients who underwent TME after n-CRT were divided into 4 groups according to the modified ryan tumor regression grade (TRG) classification. Among these groups, NLR, PLR and CEA levels, which are considered prognostic markers in response evaluation, were compared with their changes before and after neoadjuvant treatment. Results: While 11 (9,7%) patients had pCR (TRG 0), 41 (36,3%) patients had good response (TRG 0 and 1), 72 (63,7%) patients had a poor response (TRG 2 and 3) to n-CRT. While the initial prognostic markers were similar between the groups, post-n-CRT values were found to be significantly lower in the group with good response. Discussion: It is not possible to predict n-CRT response in LARC patients at the time of diagnosis, but NLR, PLR or CEA values and changes in these values may be useful in predicting treatment response.Öğe Karaciğer kist hidatiğinde cerrahi deneyimimiz ve morbiditeye etki eden faktörler(2016) Aday, Ulaş; Taçyıldız, İbrahim HalilGiriş ve Amaç Karaciğer kist hidatiği; E. Granulosus’un larva sestodlarının neden olduğu zoonotik bir hastalıktır. Günümüzde kist hidatik tedavisinde en geçerli yöntem hala cerrahi işlemlerdir. Kistin safra yollarına açılması en sık görülen komplikasyondur. Cerrahi sonrası gelişen safra fistülü, hastanede kalış süresinin artmasına neden olmaktadır. Bu çalışmada kistin yerleşim yeri, büyüklüğü, ameliyat öncesi labaratuvar değerleri, ameliyat esnasında kist kavitesi ile safra kanalları arasındaki ilişkinin varlığı ve yapılan ameliyat tipinin komplikasyon ile hastanede kalış süresi üzerine etkilerini irdelemeyi amaçladık. Hastalar ve Yöntem Kliniğimizde Mart 2005-Ocak 2010 tarihleri arasında karaciğer kist hidatiği nedeniyle opere edilen 100 hasta retrospektif olarak incelendi. Yaş, cinsiyet, kistlerin sayısı, yerleşim yeri ve büyüklüğü, evresi, sarılık öyküsü, ameliyat öncesi labaratuvar değerleri, uygulanan cerrahi yöntem ve intrakaviter safra kanalı mevcudiyeti, postoperatif komplikasyon ve hastanede kalış süreleri kaydedildi. Bulgular Hastaların 63’ü (%63) kadın ve 37’si (%37) erkekti. Yaş ortalaması 35.6 idi. Hastaların 95’inde karın ağrısı, 12’sinde ikter ve 8’inde palpabl kitle mevcuttu. En büyük kist çapı 30 cm iken en küçük kist çapı 4 cm idi. 100 hastada toplam 134 kist mevcuttu. 9 hastada intraabdominal yerleşimli ekstrahepatik kisthidatik mevcuttu. 13 hastaya ameliyat öncesi kolanjit ve tıkanma ikteri nedeniyle ERCP yapılmıştı. Hastaların 64’ünde sağ lobda, 17’sinde sol lobda, 17’sinde bilobüler, bir hastada kaudat lobda ve bir hastada da hem sağ hem kaudat lobda kist mevcuttu. Perforasyon nedeniyle 2 hasta acil olarak opere edilirken, diğer hastalar elektif koşullarda opere edildi. Parsiyel kistektomi+drenaj+kapitonaj 45 hastaya, parsiyel kistektomi+drenaj 32 hastaya, parsiyel kistektomi+drenaj+omentoplasti 11 hastaya uygulanmıştır. Periferik yerleşimli 5 hastaya total kist eksizyonu ve 7 hastaya laparaskopik drenaj yapılmıştır. İntraoperatif 48 hastada kist kavitesinin safra yolları ile ilişkili olduğu saptanmıştır. Koledok dilatasyonu ve kistin ana biliyer duktuslarla ilişkisi olması nedeniyle 15 hastaya T-tüp uygulanmıştır. Safra yolları ile ilişkili hastalardaki kist çapı ortalama 11.8 iken, safra yolları ile ilişkisi olmayanlarda ortalama 8.6 cm idi. Safra yolları ile ilişkili kist hidatik vakalarında operasyon öncesi AST, ALP ve GGT değerleri sırasıyla 75.19 U/L, 162 U/L, 196 U/L olup safrayolları ile ilişkili olmayan hastalarda ise sırasıyla; 69.70 U/L, 124 U/L, 114 U/L idi. Hastaların %43’ünde komplikasyon gelişti. Safra fistülü ve kavite enfeksiyonu en sık gelişen komplikasyon olup, 9 hastada safra fistülü spontan kapanırken 9 hastaya endoskopik sfinkterektomi uygulandı. Bir hastada safra fistülüne eşlik eden intestinal fistül nedeniyle cerrahi işlem uygulandı. Major komlikasyon gelişme oranı safra yolları ilişkili kisti olan vakalarda %50 iken; olmayan grupta %15.4 idi. (p<0.001). Safra yolları ile ilişkili kist hidatik vakalarında hastanede kalış süresi 17,48 gün iken; safra yolları ile ilişkili olmayan vakalarda 8,46 gündü. (p<0.001). Sonuç Kist çapı büyük, ameliyat öncesi AST, ALP ve GGT değerleri yüksek olan hastalarda kistin safra yolları ile ilişkili olma riski artmaktadır. Safra yolları ile ilişkili kist hidatiklerde major komplikasyon gelişme oranı ve hastanede kalış süresi anlamlı olarak artmaktadır. Kistin yerleşim yeri, evresi ve uygulanan cerrahi yöntemin komplikasyon ve hastanede kalış süresi üzerine etkisi saptanmamıştır. Anahtar Sözcük: Karaciğer Kist Hidatiği, Cerrahi Tedavi, MorbiditeÖğe Median arcuate ligament (Dunbar) syndrome: Laparoscopic management and clinical outcomes of a single centre(Wolters Kluwer Medknow Publications, 2021) Kafadar, Mehmet Tolga; Oğuz, Abdullah; Aday, Ulaş; Bilge, Hüseyin; Başol, ÖmerBackground: Median arcuate ligament syndrome (MALS) is a condition characterised by chronic abdominal symptoms associated with median arcuate ligament (MAL) compression of the coeliac artery. Aim: In this observational study, we aimed to evaluate the outcomes of laparoscopic treatment in patients with MALS. Materials and Methods: The data of ten patients with MALS who were subjected to laparoscopic sectioning of the MAL were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic test findings, American Society of Anaesthesiologists score, operative findings and complications and mortality, hospital stay duration and hospital readmission. The diagnosis of MALS was established by computed tomography (CT) angiography. Results: Six (60%) of ten patients with MALS were female and four (40%) were male. The mean age was 42.4 +/- 12.3. The main symptoms were epigastric pain (100%) and weight loss (60%). CT angiography showed high-grade stenosis of the anterior wall of the proximal coeliac trunk and post-stenotic dilation caused by extrinsic compression of the MAL. Surgical procedure was uneventful in all patients. Operating time was 155.5 min (120-200) and intra-operative blood loss was 150 ml (100-250). Length of stay was 3.1 day (2-9), with no mortality. The post-operative complications developed in two female patients. One of them developed ileus and the other patient developed pulmonary thromboembolism. At 6-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic decompression is an effective treatment for MALS and can provide symptomatic relief. This method may be the preferred modality of treatment in view of its lack of morbidity and good results.Öğe Prognostic significance of pretreatment serum lactate dehydrogenase-to-albumin ratio in gastric cancer(Termedia Publishing House Ltd., 2020) Aday, Ulaş; Tatlı, Faruk; Akpulat, Faik V.; İnan, Mazlum; Kafadar, Mehmet Tolga; Bilge, Hüseyin; Başol, Ömer; Oǧuz, AbdullahAim of the study: To investigate the prognostic role of lactate dehydrogenase-to-albumin ratio (LAR) in gastric cancer patients undergoing curative resection. Material and methods: A retrospective study was conducted including resectable gastric cancer patients. According to the time-dependent receiver operating characteristics (ROC) analysis, the optimal threshold for pretreatment LAR was 5.5. The Kaplan-Meier method, Cox regression univariate and multivariate analyses were used to analyze the prognostic factors for disease-free survival and overall survival (OS). Results: The study cohort consisted of 81 patients, mean age was 60.2 ±13.8 (range, 29-87) years and 55 (67.9%) were male. The median OS time was 34.8 and 45 months in patients with LAR ≥ 5.5 (n = 50) and LAR < 5.5 (n = 31), respectively. Kaplan-Meier curves showed that with the increase in LAR there was reduced survival, but it was not statistically significant (p = 0.278). Multivariate analyses revealed that the positive lymph node ratio above 20% was an independent predictor in resectable gastric cancer patients (OR = 6.281, 95% CI: 1.135-34.767, p = 0.035). Conclusions: With the increase in LAR survival in gastric cancer decreased, but it was not statistically significant. Studies involving a large patient series are needed.Öğe The prognostic significance of serum lactate dehydrogenase-to-albumin ratio in colorectal cancer(Korean Surgical Society, 2020) Aday, Ulaş; Böyük, Abdullah; Akkoç, HasanPurpose: The purpose of our study was initially to explore the prognostic role of LDH-to-albumin ratio in patients with colorectal carcinoma (CRC) undergoing curative resection. Methods: The retrospective study included 295 CRC patients that underwent curative resection. According to time-dependent receiver operating characteristics (ROC) analysis, the optimal cutoff value for pretreatment LDH-to-albumin ratio was 52.7. Cox regression univariate and multivariate analyses were utilized to analyze the prognostic factors for disease-free survival (DFS) and overall survival (OS). Results: The 295 participants included 117 women (39.7%) and had an overall mean age of 55.8 ± 14.1 years. The median follow-up period was 31.8 ± 21 months (range, 6-78 months) and 53 patients (18.0%) died from cancer during the followup period. The 5-year DFS and OS rates were 65.4% and 68.5% in patients with LDH-to-albumin ratio <52.7 (n = 152), and were 55.2% and 55.4% in patients with LDH-to-albumin ratio ≥52.7 (n = 143), respectively. Kaplan-Meier curves showed that LDH-to-albumin ratio ≥52.7 was significantly associated with worse DFS and OS (P = 0.003 and P < 0.001, respectively). Multivariate analyses revealed that LDH-to-albumin ratio was an independent predictor of resectable CRC (odds ratio, 2.104; 95% confidence interval, 1.112-3.982; P = 0.022). Conclusion: Our study revealed that high pretreatment LDH-to-albumin ratio level was an unfavorable prognosticator in patients with CRC undergoing curative resection. LDH-to-albumin ratio is a candidate to be a prognostic biomarker in clinical practice. © 2020 Korean Surgical Society. All rights reserved.Öğe Protective effect of taxifolin in the prevention of cardiac tissue damage in liver ischemia and reperfusion injury: Experimental study(Merthan Tunay, 2023) Bilge, Hüseyin; Yıldızhan, İbrahim; Ülger, Burak Veli; Aday, Ulaş; Başol, Ömer; Çiçekçi, Kadriye; Yıldızhan, EdaAim: Liver ischemia and reperfusion (I/R) is a serious, irreversible health problem in clinical practice. Taxifolin (Tax) is an easy to obtain and use agent found in maritime pine bark, Douglas fir bark and Siberian larch wood. In this study, we examined the protective efficacy of Taxifolin in the correction of cardiac tissue damage that may develop in liver I/R damage. Methods: In our study, a total of 28 Wistar Albino rats, 8-10 weeks old, weighing 250-300 grams, were used. Group 1 (n=7): control group, Group 2 (n=7): Tax group with 50 mg/kg dose orally for 3 weeks, Group 3 (n=7): Liver I/R group for 30 minutes ischemia and 120 minutes of reperfusion were performed. Group 4 (n=7): Tax+Liver I/R group. Results: In our study, MDA analysis was performed to evaluate oxidative stress. In the statistical analysis of MDA values, we observed that there was a statistically significant difference between the serum MDA values of the Tax group and the Tax+Liver I/R group, and the MDA level of the Tax group was lower (p<0.05). In myocyte damage scoring, we observed that the liver I/R group had the highest damage score, while the damage score of the Tax+Liver I/R group was significantly lower than the I/R group (p<0.05). Conclusion: As a result of our study, we observed that there was an increase in serum MDA levels as a result of liver I/R and histopathological changes occurred in the heart tissue. However, Taxifolin has been successful in ameliorating this situation.Öğe Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial(Springer Science and Business Media Deutschland GmbH, 2024) Aday, Ulaş; Çetin, Erman; Kafadar, Mehmet Tolga; Oğuz, Abdullah; Bahadır, Mehmet Veysi; Ülger, Burak Veli; Gedik, Ercan; Girgin, Sadullah; Yılmaz, MehmetPurpose: Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. Methods: This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. Results: One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1–10) in the single hem-o-lok group and 1 day (range 1–12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. Conclusions: The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 (http://www.clinicaltrials.gov).Öğe Submucosal giant lipoma of the colon as an unusual cause of partial intestinal occlusion: Report on seven consecutive cases(Aves, 2021) Kafadar, Mehmet Tolga; Dalbaşı, Erkan; Oğuz, Abdullah; Aday, UlaşBackground: Colonic lipomas begin to be symptomatic when they reach a certain size, although the presentation can vary. In this study, we aimed to evaluate our experiences with the management of patients who presented with symptomatic giant colonic lipomas. Methods: The data of 7 patients with single colonic lipoma were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic findings, American Society of Anesthesiologists (ASA) score, operative findings, postoperative complications, mortality, hospital stay duration, and hospital readmission. The diagnosis of colonic lipoma was established by computed tomography (CT). Results: In this study, 4 (57.1%) of 7 patients with colonic lipoma were female, and 3 (42.9%) were male. The mean age was 56.7 years (range, 45-69). The main symptoms were abdominal pain (100%), and constipation (71.4%). The findings of intestinal occlusion detected on CT confirmed the diagnosis in all patients. Colon lipoma was located in the ascending colon in 2 patients, in the hepatic flexure in 2 patients, in the transverse colon in 2 patients, and in the cecum in 1 patient. The surgical procedure was uneventful in all patients. Four (57.1%) patients underwent laparoscopic colonic resection, while in the remaining 3 (42.9%) patients, a laparotomy was performed. The mean operating time was 185.7 min (150-210). Length of stay was 7.1 days (6-10), with no mortality. The mean diameter of the lesions was 7.4 cm (6-9). At a 6-month follow-up, all patients were asymptomatic with no signs of recurrence. Conclusion: Although colon lipomas are rare, they are of great importance because they can be symptomatic and can be confused with colon malignancies in the differential diagnosis. Being able to make a definitive preoperative diagnosis will change the surgical strategy. A minimally invasive surgical approach should be employed to resect symptomatic colonic lipomas with an experienced surgical team in eligible patients whenever possible.
