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Evman S, Tezel C, Vayvada M, Kanbur S, Urek S, Baysungur V, Yalçınkaya I. Comparison of Mid-Term Clinical Outcomes of Different Surgical Approaches in Symptomatic Diaphragmatic Eventration. Ann Thorac Cardiovasc Surg 2016; 22:224-9. [PMID: 27076066 DOI: 10.5761/atcs.oa.16-00018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There is no data comparing different surgical techniques for diaphragmatic re-positioning for hemi-diaphragmatic eventration in adults. Our aim was to verify the potential pros and cons of two major surgical techniques in symptomatic eventration patients. METHODS Patients undergoing thoracotomy for diaphragmatic elevation repair either by un-opened (accordion placation) or by opened (double-breasted placation) diaphragmatic technique between January 2007 and August 2013 were analyzed retrospectively, and compared in terms of operative outcomes on 12th and 24th months. RESULTS Forty-two patients underwent accordion (n = 23) or double-breasted (n = 19) plication. Postoperative drainage was significantly increased (215 ± 66 ml vs. 114 ± 48 ml; P = 0.0082) in double-breasted group. Although the corrected diaphragm was radiologically better preserved in this group, this divergence showed no additional effect on postoperative pulmonary functions or the dyspnea score on 12th or 24th months. No complication particularly related to both techniques or recurrence was noted during follow-up of 28 ± 12 months. CONCLUSIONS Radiological prospect of corrected diaphragm is better preserved with double-breasted plication, but the significant and permanent improvement of respiratory functions was similar. Since the clinical outcome is equivalent, incision of the diaphragm is not essential.
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Affiliation(s)
- Serdar Evman
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Tezel C, Vayvada M, Metin SK, Urek S, Bayram S, Baysungur V, Yalcinkaya I. P-234 * LONG-TERM RESULTS OF DIFFERENT SURGICAL CORRECTION TECHNIQUES IN DIAPHRAGMATIC EVENTRATION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Akin O, Tasci E, Urek S, Olgac G, Kutlu C. “Stripping” to Prevent Prolonged Air Leak; Is There a Future in the Past? Thorac Cardiovasc Surg 2011; 59:470-4. [DOI: 10.1055/s-0030-1270759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Orki A, Akin O, Tasci AE, Ciftci H, Urek S, Falay O, Kutlu CA. The role of positron emission tomography/computed tomography in the diagnosis of pleural diseases. Thorac Cardiovasc Surg 2009; 57:217-21. [PMID: 19670115 DOI: 10.1055/s-2008-1039314] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of the study was to assess the role of F-18 fluoro-2-D-deoxyglucose positron emission tomography ( (18)FDG-PET)/computed tomography (CT) in patients with undiagnosed pleural diseases and to compare the findings with those of invasive diagnostic procedures. METHODS The study included 83 patients with pleural lesions (63 with pleural effusion; 20 with pleural thickening) on CT scan performed between November 2005 and December 2007. The study group consisted of 63 males and 20 females; their median age was 47 years. PET-CT scan was performed for all patients before surgery. A maximum standard uptake value greater than 3.0 was accepted as positive for malignancy. For histopathological diagnosis, video-assisted thoracoscopic surgery was performed in 76 patients and a mini-thoracotomy was performed for the remaining 7 patients. RESULTS Postoperative histopathological examination revealed malignancy in 44 cases, 25 of which were malignant mesothelioma; the remaining 39 cases were benign. There were no false negative results, but two false positive results (tuberculosis). PET-CT scanning had 100 % sensitivity, 94.8 % specificity and 97.5 % accuracy. CONCLUSION Our study suggests that PET-CT may be an effective tool for the differentiation of benign and malignant pleural diseases. We believe that PET/CT may prevent redundant surgical procedures in young patients who are SUVmax negative.
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Affiliation(s)
- A Orki
- Thoracic Surgery, Maltepe University School of Medicine, Istanbul, Turkey.
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Orki A, Urek S, Patlakoglu MS, Tasci AE, Kutlu CA. Squamous Cell Carcinoma in a Postpneumonectomy Cavity. Ann Thorac Surg 2008; 85:333-4. [DOI: 10.1016/j.athoracsur.2007.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/08/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
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Eryigit H, Oztas S, Urek S, Olgac G, Kurutepe M, Kutlu CA. Management of acquired bronchobiliary fistula: 3 case reports and a literature review. J Cardiothorac Surg 2007; 2:52. [PMID: 18053192 PMCID: PMC2217537 DOI: 10.1186/1749-8090-2-52] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 12/03/2007] [Indexed: 12/18/2022] Open
Abstract
Bronchobiliary fistula (BBF), which often presents with bilioptysis, is an abnormal communication between the bronchial system and biliary tree. It is a complication associated with a high mortality rate and requires a well-planned management strategy. Although hydatid disease is still the leading cause, extensive surgical interventions and invasive procedures of the liver have altered the profile of patients in recent decades. This paper presents 3 cases of BBF and reviews the literature regarding the treatment options generally mandated by clinical presentation and the underlying disease.
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Affiliation(s)
- Hatice Eryigit
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
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Eryiğit H, Orki A, Koşar A, Akin O, Kiral H, Urek S, Arman B. [The role of video-assisted thoracoscopic surgery in the treatment of pleural empyema]. Tuberk Toraks 2007; 55:71-6. [PMID: 17401797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Pleural empyema is a serious problem which affects any age group and still there is no standard approach. Our purpose in this study was to assess the safety, feasibility and efficacy of the video-assisted thoracoscopic surgery (VATS). Between 1997 and 2004 83 patients with empyema were enrolled in this study. Fifty-four patients were male, 29 females and the mean age was 39.4. The mean duration time of symptoms before VATS was 27.3 days. Twenty-two patients were in group-5, 44 in group-6 and 17 in group-7 according to Light's classification of parapneumonic effusions and empyema. Twenty-one patients underwent chest tube before VATS because of their conditions. VATS was converted to thoracotomy in 13 patients. All patients underwent debridement and irrigation during VATS. The cure was achieved in 58 (69.9%) patients with the mean 7.63 days drainage time. Twelve patients were underwent open decortication in the follow-up period. Ten of them were group-7 and 2 in group-6 (p= 0.006). The diagnosis was achieved in 60 (72.3%) patients as nonspecific pleuritis, tuberculosis in 19 and various diagnosis in 4. There was no mortality and minor complications occured in 14 patients. VATS is a safety and efficacy procedure in the treatment of early stage empyema. Use of VATS in early period of multiloculary empyema, prevents patients from unnecessary thoracotomies.
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Affiliation(s)
- Hatice Eryiğit
- Department of Chest Surgery, Heybeliada Sanatorium, Chest Diseases and Chest Surgery Training Hospital, Istanbul, Turkey.
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Abstract
BACKGROUND Bronchopleural fistula is a serious complication of major lung resections that may lead to mortality. An experimental animal model was designed to find out the safest bronchial closure method by comparing leakage rates under pressure. METHODS The tracheobronchial trees of 50 freshly dead sheep were prepared for either manual closure or closure with a stapler. After left pneumonectomy, the specimens were divided into five groups (n = 10); 3/0 Premilene suture was used with two "u" sutures + interrupted sutures in Group I; in Group II, 3/0 Premilene sutures with continuous horizontal mattress + over-over continuous sutures were used. In Group III and IV the same techniques were used with 3/0 Vicryl. A stapler was used in Group V. Specimens were intubated with an endotracheal tube, connected to a sphygmomanometer, and subsequently positioned under water. The pressure level at which we detected air bubbles indicated the limits of the technique. RESULTS The median leakage pressure resistance was significantly lower in Group III (135 mm Hg) ( P = 0.001). The best results were achieved by using the continuous horizontal mattress + over-over continuous suture technique. No statistical significance difference was found between the stapler group, Groups I, II, and IV in terms of median leakage pressures. CONCLUSIONS This trial suggests that manual suture closure using an appropriate technique and monofilament materials is as safe as the stapler.
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Affiliation(s)
- C Tezel
- Department of Thoracic Surgery, Heybeliada Chest Disease and Thoracic Surgery Training and Research Centre, Istanbul, Turkey.
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Tezel C, Ersev AA, Kiral H, Urek S, Kosar A, Keles M, Dudu C, Arman B. The Impact of Immunohistochemical Detection of Positive Lymph Nodes in Early Stage Lung Cancer. Thorac Cardiovasc Surg 2006; 54:124-8. [PMID: 16541355 DOI: 10.1055/s-2005-872867] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Detection of micrometastatic disease is an interesting area in non-small cell lung cancer (NSCLC). We conducted a study to determine whether the detection of mediastinal lymph node spread by immunohistochemical (IHC) analysis offers some prognosis with respect to patients' disease-free survival or not. METHODS Between 1997 and 2003, twenty-one early stage lung cancer patients underwent complete resection with mediastinoscopy and systemic nodal dissection. Four hundred and twenty-six paraffin-embedded lymph node sections from 21 patients were analyzed. Epithelial specific-antigen Ab-9 and Keratin-Pan Ab-1 were used as IHC marker. RESULTS Based on nodal spread four of the 21 patients (19.04%) were up-staged after IHC analysis. Two patients with stage IB (T2N0) up-staged to stage IIIA (T2N2); two patients staged as IIB (T2N1) up-staged to IIIA (T2N2). Statistical analysis showed that the lymphatic dissemination detected with IHC analysis was associated with reduced disease-free survival (DFS) (p = 0.002). CONCLUSIONS Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.
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Affiliation(s)
- C Tezel
- Department of Thoracic Surgery, Heybeliada Chest Disease and Thoracic Surgery Center, Istanbul, Turkey.
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Kiral H, Koşar A, Orki A, Temurtürkan K, Urek S, Keleş M, Dudu CS, Arman B. [Completion pneumonectomy: indications, complications, and results]. Tuberk Toraks 2004; 52:56-62. [PMID: 15143374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when performed in patients with benign diseases. In our study we aimed to evaluate all patients underwent completion pneumonectomy in our clinic and to compare indications, complications and postoperative results with the literatures. Between January 1987 and December 2001, 27 consecutive patients who underwent completion pneumonectomy in our clinic were retrospectively reviewed. Postoperative morbidity and mortality rates were calculated according to indications and the results were compared to the standard pneumonectomies. There were 27 patients, 13 (48.1%) women and 14 (51.9%) men, with a median age of 26 (range, 10 to 62 years). Completion pneumonectomy was performed for benign diseases in 23 (85.2%) patients and for malign diseases in 4 (14.8%). Malign indications included 2 second primary tumors and 2 local recurrences. In the group with benign diseases; completion pneumonectomy was performed for tuberculosis in 5, bronchiectasis in 14, bronchopleural fistula in 2 and necrosis of lung in 2. Hospital mortality was 7.4% including 1 intraoperative and 1 postoperative deaths and both of them had undergone completion pneumonectomy for benign diseases. Complications occurred in 9 (33.3 %) patients, bronchopleural fistula + empyema were seen in 6 patients, cardiac rhythm disorders in 2 and wound infection in 1. All complications occurred in the patients operated for benign indications (39.1%). Completion pneumonectomy can be performed with an acceptable morbidity and mortality (similar to standard pneumonectomy) in selected cases. But the complication risk is higher in benign diseases, especially in tuberculosis. Surgical technique is important to avoid serious complications such as bronchopleural fistula and empyema.
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Affiliation(s)
- Hakan Kiral
- Heybeliada Pulmonary Diseases and Thoracic Surgery Hospital, Istanbul, Turkey
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Celik M, Senol C, Keles M, Halezeroglu S, Urek S, Haciibrahimoglu G, Ersev AA, Arman B. Surgical treatment of pulmonary hydatid disease in children: report of 122 cases. J Pediatr Surg 2000; 35:1710-3. [PMID: 11101720 DOI: 10.1053/jpsu.2000.19219] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to review the authors' surgical experience in pediatric pulmonary hydatid disease focusing on clinical presentation, parenchyma saving operations, and long-term results. METHODS One hundred twenty-two children with pulmonary hydatid cyst were treated surgically over the last 2 decades and were reviewed retrospectively. There were 66 boys and 56 girls with a mean age of 9 years. RESULTS Pulmonary hydatid cyst was seen in 111 (91%) patients and pulmonary and hepatic cysts in 11 (9%). Lateral thoracotomy was performed in 106 (87%) patients, thoracotomy and laparotomy in 6 (5%), median sternotomy in 5 (4%), lateral thoracotomy with phrenotomy in 4 (3%), and median sternotomy with phrenotomy in 1 (0.8%). Parenchyma-saving procedures were performed in 114 patients (93%) and lung resection in 8 (7%). There was no mortality. Postoperative complication was seen in 5 patients (4%). CONCLUSIONS Parenchyma-saving procedures without capitonnage are preferable. In patients with right or bilateral lung and coexisting cysts in the upper part of the liver, thoracotomy or median sternotomy and transdiaphragmatic approach allows the surgeon to remove the lung and liver cysts in a single operation. Median sternotomy is an alternative method for the bilateral lung hydatidosis compared with sequential thoracotomy.
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Affiliation(s)
- M Celik
- Department of Chest Surgery, Heybeliada Chest Disease and Chest Surgery Centre, Heybeliada, Istanbul, Turkey
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Abstract
OBJECTIVE Until recently, thoracoscopy had been used primarily for diagnostic purposes for more than 80 years in thoracic diseases. In this report we reviewed our video-assisted thoracoscopic surgery experience with 341 cases focusing on indications, operative procedures, complications or failure rates. PATIENTS AND METHODS Over the last 3 years, we performed 459 video-assisted thoracoscopic procedures. There were 206 male and 135 female patients. RESULTS The indications were diagnostic in 171 cases, and therapeutic in 170 cases. There were no operative mortality. Non-fatal complications were seen in 15 cases (4.4%). The mean postoperative stay was 5 days. The specific procedures performed were operations on the pleura (237 cases), lung (158 cases), mediastinum (56 cases) and pericardium (four cases). Conversion to thoracotomy was needed in 43 cases (12.6%). Definitive diagnosis was obtained in 100% of patients with pulmonary nodule/mass or diffuse lung disease, and 95.2% of patients with undiagnosed pleural effusions. The success rate of thoracoscopic approach in non-tuberculous thoracic empyema was 87.3%. CONCLUSIONS Video-assisted thoracoscopic surgery is an ideal procedure in the following situations: (1) undiagnosed pleural effusion, (2) recurrent pneumothorax or bullous lung disease, (3) stage II thoracic empyema, (4) lung cancer staging, (5) peripheral pulmonary nodule, and (6) wedge biopsy for diffuse lung disease.
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Affiliation(s)
- M Celik
- Department of Chest Surgery, Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey.
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