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Aytaç E, Özer L, Baca B, Balık E, Kapran Y, Cığ Taşkın O, Uluç BO, Ufuk Abacıoğlu M, Gönenç M, Bölükbaşı Y, Çil BE, Baran B, Aygün C, Erdem Yıldız M, Ünal K, Erkol B, Yaltı T, Özbek U, Attila T, Tözün N, Gürses B, Erdamar S, Er Ö, Beşe N, Bilge O, Onur Ceyhan G, Molinas Mandel N, Selek U, Yakıcıer C, Kayserili Karabey H, Saruç M, Özben V, Esen E, Özoran E, Vardareli E, Güner L, Hamzaoğlu İ, Buğra D, Karahasanoğlu T, İstanbul Group T. Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement. Turk J Gastroenterol 2022; 33:627-663. [PMID: 35993526 PMCID: PMC9524446 DOI: 10.5152/tjg.2022.211103] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acıbadem Mehmet Ali Aydınlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.
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Affiliation(s)
- Erman Aytaç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Özer
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Emre Balık
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Yersu Kapran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | | | - Başak Oyan Uluç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Murat Gönenç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | | | - Bülent Baran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Cem Aygün
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Erdem Yıldız
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Kemal Ünal
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Burçak Erkol
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Tunç Yaltı
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Uğur Özbek
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Tan Attila
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Nurdan Tözün
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Bengi Gürses
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Sibel Erdamar
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Özlem Er
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
- Corresponding author: Erman Aytaç, e-mail:
| | - Nuran Beşe
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Orhan Bilge
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Güralp Onur Ceyhan
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Uğur Selek
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Cengiz Yakıcıer
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Volkan Özben
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Eren Esen
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Emre Özoran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Erkan Vardareli
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Levent Güner
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Dursun Buğra
- Koç University Faculty of Medicine, İstanbul, Turkey
| | | | - The İstanbul Group
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
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Erdemli S, Alis D, Çiçek B, Göksel S, Karahasanoğlu T, Karaarslan E. Revisiting imaging features of rectosigmoid vascular malformation with emphasis on multiparametric MRI: a case report. Egypt J Radiol Nucl Med 2022. [DOI: 10.1186/s43055-022-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal vascular malformations are rare benign vascular neoplasms of the gastrointestinal tract, with the rectosigmoid region being the most frequently involved site. Patients often manifest with recurrent, intermittent rectal bleeding, which might occasionally be life-threatening.
Case presentation
A 39-year-old man with a history of hemorrhoid operations twice was presented to our gastroenterology department with blood in the stool and abdominal pain. After the colonoscopy, multiparametric MRI, and CT examinations, robotic low anterior resection was performed with the diagnosis of rectosigmoid venous malformation. The histopathological examination confirmed the diagnosis.
Conclusion
Colonoscopy is the preferred method in diagnosing rectosigmoid vascular malformation, but wrong and delayed diagnoses are common. Thus, imaging modalities might add to colonoscopy in equivocal cases.
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Ağcaoğlu O, Şengün B, Tarcan S, Aytaç E, Bayram O, Zenger S, Benlice Ç, Özben V, Balık E, Baca B, Hamzaoğlu İ, Karahasanoğlu T, Buğra D. Minimally invasive versus open surgery for gastric cancer in Turkish population. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: In this study, it was aimed to compare short-term outcomes of minimally invasive and open surgery for gastric cancer in the Turkish population carrying both European and Asian characteristics.
Material and Methods: Short-term (30-day) outcomes of the patients undergoing minimally invasive and open gastrectomy with D2 lymphadenec- tomy for gastric adenocarcinoma between January 2013 and December 2017 were compared. Patient demographics, history of previous abdominal surgery, comorbidities, short-term perioperative outcomes and histopathological results were evaluated between the study groups.
Results: There were a total of 179 patients. Fifty (28%) patients underwent minimally invasive [laparoscopic (n= 19) and robotic (n= 31)] and 129 (72%) patients underwent open surgery. There were no differences between the two groups in terms of age, sex, body mass index and ASA scores. While operative time was significantly longer in the minimally invasive surgery group (p< 0.0001), length of hospital stay and operative morbidity were com- parable between the groups.
Conclusion: While both laparoscopic and robotic surgery is safe and feasible in terms of short-term outcomes in selected patients, long operating time and increased cost are the major drawbacks of the robotic technique preventing its widespread use.
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Aytaç E, Aslan F, Çicek B, Erdamar S, Gürses B, Güven K, Falay O, Karahasanoğlu T, Selçukbiricik F, Selek U, Atalar B, Balık E, Tözün N, Rozanes İ, Arıcan A, Hamzaoğlu İ, Baca B, Molinas Mandel N, Saruç M, Göksel S, Demir G, Ağaoğlu F, Yakıcıer C, Özbek U, Özben V, Özyar E, Güner AL, Er Ö, Kaban K, Bölükbaşı Y, Buğra D, Group Tİ. Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turk J Gastroenterol 2020; 30:584-598. [PMID: 30541724 DOI: 10.5152/tjg.2018.18737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
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Affiliation(s)
- Erman Aytaç
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Fatih Aslan
- Koç University School of Medicine, İstanbul, Turkey
| | - Bahattin Çicek
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Sibel Erdamar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Bengi Gürses
- Koç University School of Medicine, İstanbul, Turkey
| | - Koray Güven
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Okan Falay
- Koç University School of Medicine, İstanbul, Turkey
| | | | | | - Uğur Selek
- Koç University School of Medicine, İstanbul, Turkey
| | - Banu Atalar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Emre Balık
- Koç University School of Medicine, İstanbul, Turkey
| | - Nurdan Tözün
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | | | - Ali Arıcan
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | | | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Süha Göksel
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Gökhan Demir
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Fulya Ağaoğlu
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Cengiz Yakıcıer
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Uğur Özbek
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Volkan Özben
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Enis Özyar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ahmet Levent Güner
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Özlem Er
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Kerim Kaban
- Koç University School of Medicine, İstanbul, Turkey
| | - Yasemin Bölükbaşı
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Dursun Buğra
- Koç University School of Medicine, İstanbul, Turkey
| | - The İstanbul Group
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Esen E, Karahasanoğlu T, Özben V, Aytaç E, Baca B, Hamzaoğlu İ, Remzi FH. Complete response after neoadjuvant treatment for rectal cancer. Lancet 2019; 393:1694. [PMID: 31034372 DOI: 10.1016/s0140-6736(18)33203-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Eren Esen
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey
| | - Tayfun Karahasanoğlu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey
| | - Volkan Özben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey
| | - Erman Aytaç
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey
| | - İsmail Hamzaoğlu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Sariyer, 34457 Istanbul, Turkey.
| | - Feza H Remzi
- Department of Surgery, Division of Colon and Rectal Surgery, New York University Langone Health, New York, NY, USA
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Özben V, Doğruöz A, Boğa SA, Aytaç E, Baca B, Hamzaoğlu İ, Karahasanoğlu T. Robotic rectal cancer surgery with the da Vinci Xi system: first 100 cases. Istanbul Med J 2019. [DOI: 10.4274/imj.30164] [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: 12/01/2022] Open
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Özben V, Doğruöz A, Boğa SA, Aytaç E, Baca B, Hamzaoğlu İ, Karahasanoğlu T. Robotic Rectal Cancer Surgery with the da Vinci Xi System: First 100 Cases. Istanbul Med J 2019. [DOI: 10.4274/imj.galenos.2018.30164] [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: 12/01/2022] Open
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Atasoy D, Aghayeva A, Bilgin İA, Erzin Y, Bayraktar İE, Baca B, Karahasanoğlu T, Hamzaoğlu İ. Predictive parameters of early postoperative complications in Crohn's disease: Single team experience. Turk J Gastroenterol 2018; 29:406-410. [PMID: 30249554 DOI: 10.5152/tjg.2018.17687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Most of the patients with Crohn's disease (CD) may require at least one surgical procedure over their lifetime. However, these patients tend to have a high incidence of postoperative complications. The aim of this retrospective study was to investigate the predictive parameters of postoperative complications in CD. MATERIALS AND METHODS All consecutive patients with CD between March 2001 and March 2016 who underwent bowel resection were included to this study. Postoperative complications were divided as; major complications including anastomotic leakage, ostomy complications, acute mechanical intestinal obstruction and hemorrhage, and minor complications including wound infection. RESULTS A total of 147 patients (74 females, 73 males) with a mean age of 36±11.9 years met the inclusion criteria. Behaviors of CD were stricturing in 90 (62%), fistulizing in 45 (30%) and inflammatory in 12 (8%) patients. Minimally invasive approach was applied in 35% (n=51) of the patients. Twentysix (17%) patients had early (≤30 days) postoperative surgical complications including anastomotic leak (n=10), intra-abdominal bleeding (n=2), complications related to ostomy (n=2), acute mechanical intestinal obstruction (n=1) and wound infection (n=11). Only fistulizing disease behavior was associated with early postoperative complications (p=0.014). CONCLUSION This study suggests that postoperative complications are still more common in fistulizing CD. Surgical approach did not affect the complication rate. The decision should be individualized according to the prominent risk factors and surgeons' preference.
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Affiliation(s)
- Deniz Atasoy
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Afag Aghayeva
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - İsmail Ahmet Bilgin
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Yusuf Erzin
- Department of Gastroenterology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İlknur Erenler Bayraktar
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Tayfun Karahasanoğlu
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Atasoy D, Aghayeva A, Aytaç E, Erenler İ, Çelik AF, Baca B, Karahasanoğlu T, Hamzaoğlu İ. Surgery for Intestinal Crohn's Disease: Results of a multidisciplinary approach. Turk J Surg 2018; 34:225-228. [PMID: 30216166 DOI: 10.5152/turkjsurg.2017.3885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/09/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Crohn's disease is a chronic inflammatory bowel disease that requires lifelong multidisciplinary management. Seventy percent of patients affected by Crohn's disease will require at least one surgical procedure over their lifetime. The aim of this retrospective study was to present our series of patients suffering from Crohn's disease who were scheduled for surgery by a multidisciplinary team. MATERIAL AND METHODS The data were retrieved from a review of 950 patients with Crohn's disease treated at our institution between March 2000 and March 2016. Only patients with intestinal Crohn's disease were included into the study. A multidisciplinary team assessed the decision to perform surgery. RESULTS There were 203 patients who underwent surgery included in this study. One hundred and sixty-six were intestinal and 37 were perianal Crohn's disease. The mean age was 36±11.5 (range, 12-75) years. Ninety-two were stricturing, 45 were fistulizing, and 12 were inflammatory. The most commonly affected site was the ileocecal region (n=109, 65.7%), and the most common surgical procedure was the ileocecal resection (n=109, 65.6%). Laparoscopic approach was the procedure of choice in 56 (33.7%) patients. Of the patients enrolled, the most common early (<30 days) complications observed were the wound infection as the first (n=11) and anastomotic leak as the second (n=10). The mortality rate was 2.4% (n=4). CONCLUSION Multidisciplinary approach to Crohn's disease may decrease the surgical complications and recurrence rates leading to a better treatment.
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Affiliation(s)
- Deniz Atasoy
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Afag Aghayeva
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Erman Aytaç
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - İlknur Erenler
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Aykut Ferhat Çelik
- Department of Gastroenterology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Tayfun Karahasanoğlu
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
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Aytaç E, Büyüktaş D, Baysal B, Atar M, Yıldız M, Baca B, Karahasanoğlu T, Çelik A, Seymen HO, Hamzaoğlu İ. Visual evoked potentials and pulse wave velocity in inflammatory bowel disease. Turk J Gastroenterol 2015; 26:15-9. [PMID: 25698265 DOI: 10.5152/tjg.2015.4349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Data about the effects of inflammatory bowel disease (IBD) on various functions of the nervous and cardiovascular systems are limited. In this study, the visual neuronal and cardiovascular functions of patients with IBD were evaluated by measuring visual evoked potentials (VEP) and pulse wave velocity (PWV), respectively. MATERIALS AND METHODS There were three study groups: the Crohn's disease (CD) group (n=25), the ulcerative colitis (UC) group (n=30), and a healthy control (C) group (n=25). The exclusion criteria were as follows: patients with IBD were in remission, had no extra-intestinal manifestations of the disease, had no additional chronic disease(s), and had been receiving medical treatment for their IBD without any previous surgical intervention. VEP amplitudes (mV) and the N2 and P2 latencies (ms) were recorded for visual-neuronal analysis of all study groups. For cardiovascular assessment in all study groups, PWV was measured noninvasively as follows: the carotid-femoral PWV with the Complior Colson device (The authors have no conflict of interest.) and the PWV along the aorta with two ultrasound strain-gauge pressure-sensitive transducers (TY-306 Fukuda pressure-sensitive transducers - Fukuda Denshi Co, Tokyo, Japan) fixed transcutaneously over the course of a pair of arteries separated by a known distance. The right femoral and right common carotid arteries were the ones used. RESULTS The PWV levels of the CD and UC groups were significantly higher than those in the C group (p<0.001). In the bilateral recording of the VEP, the N2 latencies of the CD (p<0.05) and UC (p<0.01) groups were significantly longer than those in the C group. CONCLUSION In this study, we showed vascular and visual neuronal impairments at a subclinical stage in patients with both types of IBD.
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Affiliation(s)
- Erman Aytaç
- Department of General Surgery, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey.
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Baca B, Selçuk D, Kilic IE, Erdamar S, Salihoğlu Z, Hamzaoğlu I, Karahasanoğlu T. The contributions of virtual colonoscopy to laparoscopic colorectal surgery. Hepatogastroenterology 2007; 54:1976-1982. [PMID: 18251142] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND/AIMS Operative tumor or polypectomy site localization and synchronous colonic lesions are challenging problems especially in laparoscopic surgery. We designed this prospective study to determine the contributions of virtual colonoscopy to laparoscopic colorectal surgery. METHODOLOGY Virtual colonoscopy was performed in 40 consecutive patients who had undergone laparoscopic resection for colorectal neoplasm. Preoperative findings of optical colonoscopy and virtual colonoscopy, operative data, tumor localizations and histopathologic findings were assessed. RESULTS Accuracy rates for virtual colonoscopy and optical colonoscopy were 97.5% and 55%, respectively (P<0.05). Polypectomy site was localized with virtual colonoscopy in five patients. There were nine partially obstructing tumors that did not allow optical endoscope passage. Four of six synchronous tumors (one tumor and three polyps) couldn't be shown with optical colonoscopy because of distal obstructing tumor. Histopathologic investigations revealed adenocarcinoma (n=34), adenoma demonstrating low-grade dysplasia (n=3) and high-grade dysplasia (n=2) and neuroendocrine carcinoma (n=1). Mean tumor size was 4 (1.5-10) cm. Mean proximal and distal surgical margins were 15 (5-36) cm and 7.3 (0.8-27) cm, respectively. Overall patient preference was 87.5% for virtual colonoscopy. CONCLUSIONS Correct localization of colorectal neoplasm or polypectomy site is mandatory before laparoscopic colorectal surgery. Virtual colonoscopy is a safe, minimally invasive three-dimensional imaging method and may be an alternative localization technique.
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Affiliation(s)
- Bilgi Baca
- Department of Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.
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Baca B, Hamzaoğlu I, Karahasanoğlu T, Hamzaoğlu HO. Laparoscopic treatment of pyogenic liver abscess complicating Crohn's disease: a case report. Turk J Gastroenterol 2007; 18:58-61. [PMID: 17450499] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis or treatment is delayed. Herein, we report the case of a 42-year-old man in whom multi-locular liver abscess was encountered in the right lobe of the liver as a complication of Crohn's disease. On his admission to the emergency unit, he had right upper quadrant pain, fever of 39 degrees C and hepatomegaly. Ultrasonography and abdominal computerized tomography demonstrated multi-locular pyogenic liver abscess in the right lobe of the liver. Percutaneous drainage failed because of the density of the pus; laparoscopic exploration was subsequently performed and 1500 ml pus was successfully drained. The patient became clinically stable without fever and with a decreasing white blood cell count on the third postoperative day.
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Affiliation(s)
- Bilgi Baca
- Department of General Surgery, Istanbul University Cerrahpasa Medical School, Istanbul
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Baca B, Karahasanoğlu T, Saribeyoğlu K, Arica P, Kol E. Late complication of diaphragmatic gunshot injury: appendix perforation due to colon incarceration. ULUS TRAVMA ACIL CER 2007; 13:70-3. [PMID: 17310416] [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]
Abstract
Missing the diaphragmatic injury on first admission is often associated with late complications. A 38 year-old male patient is presented here as a case of missed diaphragmatic injury due to gunshot injury resulted with fecal peritonitis. Celiotomy revealed a distended appendix perforation due to herniated left colon obstruction through the left pleural cavity. Left colon and stomach were reduced to peritoneal cavity and diaphragm was repaired with interrupted polypropylene sutures. After being sure about the viability of the colon and stomach, appendectomy with cecal exteriorization was performed. Postoperative period was uneventful. The patient was discharged on the 10th postoperative day. A thorough inspection of the diaphragm is essential in thoraco-abdominal trauma. Repair of the diaphragmatic defects should invariably carried out to avoid life-threatening complications.
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MESH Headings
- Adult
- Appendix/injuries
- Appendix/surgery
- Colonic Diseases/complications
- Colonic Diseases/diagnosis
- Colonic Diseases/diagnostic imaging
- Colonic Diseases/pathology
- Colonic Diseases/surgery
- Diagnosis, Differential
- Diagnostic Errors
- Hernia, Diaphragmatic, Traumatic/complications
- Hernia, Diaphragmatic, Traumatic/diagnosis
- Hernia, Diaphragmatic, Traumatic/pathology
- Hernia, Diaphragmatic, Traumatic/surgery
- Humans
- Intestinal Obstruction/complications
- Intestinal Obstruction/diagnosis
- Intestinal Obstruction/diagnostic imaging
- Intestinal Obstruction/pathology
- Intestinal Obstruction/surgery
- Male
- Radiography
- Wounds, Gunshot
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Affiliation(s)
- Bilgi Baca
- Department of General Surgery, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
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Altinli E, Saribeyoğlu K, Karahasanoğlu T, Hamzaoğlu I, Aydoğan F, Karabiçak I, Alemdaroğlu K. Are clips useful in the surgical repair of colonic perforations? Acta Chir Belg 2005; 105:410-2. [PMID: 16184728 DOI: 10.1080/00015458.2005.11679748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/21/2022]
Abstract
PURPOSE The objective of this study was to assess the effecacy of clip application in the surgical repair of iatrogenic colonic perforations. MATERIAL AND METHODS Twenty adult male Wistar-Albino rats were divided into two equal groups of ten. In both of the groups an iatrogenic perforation was made in the anti-mesenteric border of the left colon. The defect was closed with interrupted 6/0 polypropylene sutures in group 1 and extraluminal application of vascular clips (VCS--vascular clip system) in group 2. All animals were killed on postoperative Day 4. Wound healing was evaluated with both in situ bursting pressure and hydroxyproline levels. RESULTS There was no statistically significant difference between the two groups in respect of bursting pressure levels (p = 0.063) whereas hydroxyproline levels were higher in group 2 (p = 0.0021). CONCLUSIONS Surgical repair of iatrogenic colonic perforations by extraluminal clips gives comparable results according to wound healing parameters. This approach may be a rational alternative to suture or endoscopic repair methods.
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Affiliation(s)
- E Altinli
- Haydarpasa Numune Training and Research Hospital, Department of General Surgery
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Saribeyoğlu K, Baca B, Hamzaoğlu I, Pekmezci S, Karahasanoğlu T, Hamzaoğlu H. Does becaplermin (platelet-derived growth factor-BB) reverse detrimental effects of ischemia on colonic anastomosis? Dis Colon Rectum 2003; 46:516-20. [PMID: 12682547 DOI: 10.1007/s10350-004-6592-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 12/12/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of becaplermin on normal and ischemic colon anastomoses. METHODS Forty adult male Wistar-Albino rats were divided into four equal groups of ten. All rats underwent standard left colon resection and end-to-end anastomosis. The groups were as follows: Group 1, normal anastomosis alone; Group 2, ischemic anastomosis alone; Group 3, normal anastomosis and becaplermin therapy; and Group 4, ischemic anastomosis and becaplermin therapy. All animals were killed on postoperative Day 4. Intra-abdominal adhesions were scored, and anastomotic healing was evaluated with both in situ bursting pressure and hydroxyproline levels. RESULTS According to bursting pressure results, there was a significant difference between Group 2 and Group 4 (P < 0.05), but there was no statistically significant difference between Group 1 and Group 3 (P > 0.05). Hydroxyproline values revealed no statistically significant difference among any of the groups (P > 0.05). With regard to intra-abdominal adhesion scores, Group 3 had significantly lower values than Group 2 and Group 4 (P < 0.05). No statistically significant difference was observed between the other groups. CONCLUSIONS Detrimental effects of ischemia on colonic anastomotic healing were reversed with becaplermin therapy. However, there was no such benefit on nonischemic anastomoses. Intra-abdominal application of this gel did not lead to an increase in intra-abdominal adhesion formation.
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Affiliation(s)
- Kaya Saribeyoğlu
- Department of General Surgery, Cerrahpasa Medical School, Istanbul University, 5.Kisim, Ataköy, 34750 Istanbul, Turkey
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Hamzaoğlu I, Saribeyoğlu K, Karahasanoğlu T, Apaydin B, Bayrak I, Sirin F, Sariyar M. Can laparoscopy be performed safely early after laparotomy? Surg Laparosc Endosc Percutan Tech 2000; 10:379-81. [PMID: 11147913] [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: 02/18/2023]
Abstract
Early subsequent laparotomy has high morbidity and mortality rates. The majority of these procedures, such as control of intraabdominal bleeding, management of intraabdominal sepsis, assessment of bowel viability, or anastomotic suture line, which are performed during early subsequent laparotomy, can be managed safely by laparoscopy, with resultant decreased mortality and morbidity rates. However, fear of dehiscence and ventral hernia prevents widespread use of laparoscopy. The aim of this experimental study was to compare the deleterious effects of subsequent laparotomy with laparoscopy in abdominal wounds during the early postceliotomy period. A 4-cm median laparotomy was performed in 120 Wistar-Albino rats that were classified into three groups. The control group (1) did not receive additional treatment. On the third postoperative day, early subsequent laparotomy and pneumoperitoneum were performed in group 2 and group 3 rats, respectively. Ten rats from each group were selected randomly and killed after 5 days, 1 week, 2 weeks, and 4 weeks. Bursting pressure and tensile strength of the abdominal wound were assessed. Results of the study showed impaired abdominal wound healing in subsequent laparotomy group rats (group 2) (P < 0.05). Pneumoperitoneum did not cause statistical differences in wound healing parameters when compared with control group rats (P > 0.05). In conclusion, pneumoperitoneum does not affect abdominal wound healing adversely, but early subsequent laparotomy impairs wound healing severely. Laparoscopy would be an alternative to high-risk early subsequent relaparotomy.
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Affiliation(s)
- I Hamzaoğlu
- Department of Surgery, Istanbul University Cerrahpasa Medical School, Turkey.
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Hamzaoğlu I, Karahasanoğlu T, Aydin S, Sahin DA, Carkman S, Sariyar M, Alemdaroğlu K. The effects of hyperbaric oxygen on normal and ischemic colon anastomoses. Am J Surg 1998; 176:458-61. [PMID: 9874433 DOI: 10.1016/s0002-9610(98)00234-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [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: 12/19/2022]
Abstract
BACKGROUND Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model. METHODS Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined. RESULTS The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels (P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen (P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals (P >0.05). Group III animals had significantly higher bursting pressures than any other group (P <0.05). Group II rats had lowest bursting pressures (P <0.05). Group IV animals had significantly higher levels than group II (P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy (P <0.05). CONCLUSIONS Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.
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Affiliation(s)
- I Hamzaoğlu
- Department of Surgery, Istanbul University Cerrahpasa and Istanbul Medical Schools, Turkey
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