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Aim: The aim of this study was to compare the results of patients who underwent primary excision of the pilonidal sinus with open excision (GE), wide excision primary closure (PC) and flap application (F). Materials and Methods: The data of 249 patients were evaluated retrospectively. Twelve of these patients were excluded because of recurrent disease. 101 patients had GE, 68 had PK and 68 had F. Demographic characteristics, duration of symptoms, characteristics of gluteal cleft, perioperative complications, duration of surgery and hospital stay, drain use and dressing status, pathological volume, distance to anus, and recurrence of the disease were recorded. Results: Mean operative time was 32.62 ± 9.65 in the GE group; 53.23 ± 15.40 in the PK group; In the F group, it was 76.69 ± 17.00 minutes (p

Amac: Bu calismada, morbid obezite tanili hastalarda tedavi amaciyla uygulanan LSG’nin kilo kaybi ve yandas hastaliklarin tedavisinin yani sira metabolik ve hormonal mekanizmalar uzerindeki etkinliginin, operasyon oncesi ve operasyon sonrasi donemdeki hormon duzeyleri karsilastirilarak irdelenmesi amaclandi. Gerec ve Yontemler: Mayis 2013-Mayis 2014 tarihleri arasinda, LSG uygulanan 38 hasta calismaya dahil edildi. Prospektif olan bu calismada hastalarin demografik verileri, yandas hastaliklari, takipte kilo kaybi, morbidite ve mortalite oranlari, operasyon oncesi ve sonrasi insulin duzeyleri ile operasyon oncesi ve operasyon sonrasi sekizinci haftadaki leptin ve grelin hormonlarinin duzeyleri irdelenerek karsilastirildi. Bulgular: Calismaya dahil edilen 38 hastadan 32’si (%84.2) kadin, altisi (%15.8) ise erkekti. Operasyon oncesi alinan kandaki leptin duzeylerinin ortalamasi 11.16 ng/mL iken, operasyon sonrasi sekizinci haftadaki hormon seviyesi 4.39 ng/mL olarak belirlendi. Grelin duzeylerine bakildiginda ise; operasyon oncesi ortalama 25.72 pg/mL iken, operasyon sonrasi sekizinci haftadaki hormon seviyesi 14.16 pg/mL olarak belirlendi. Operasyon oncesi ortalama vucut kitle indeksi (VKI) 44.3, operasyon sonrasi sekizinci haftada ise 36.6 olarak belirlendi. Hicbir hastada mortalite gerceklesmedi. Sonuc: LSG, gunumuzde mukemmel kilo kaybi saglamasi ve kabul edilebilir oranlarda dusuk komplikasyon riskleri nedeniyle morbid obezite tedavisinde tek basina uygulanan bir cerrahi teknik haline gelmistir. Calismamizin sonuclarina baktigimiz zaman; bu ameliyat tekniginin sadece restriktif degil, ayni zamanda metabolik degisikliklere neden olarak da kilo kaybindaki devamliligi sagladigi kanaatindeyiz.

Aim: The aim of this study was to determine whether minimally invasive parathyroid surgery has any positive impact on cosmesis.Materials and Methods: This case control study included 28 parathyroidectomized patients, who had been operated between January 2006 – December 2008. All patients were called back for at least 8 months after surgery. Demographics were recorded. Minimally invasive parathyroidectomy versus conventional parathyroidectomy were compared by means of skin features (using Fitzpatrick’s classification), results of patient and independent observer scar assessment scales and photographic scar analysis by the blinded plastic surgeon.Results: There were no differences in demographics and Fitzpatrick’s classification between both groups. As expected, incision length of the minimal invasive group was significantly shorter (2.6 ± 0.5cm vs. 4.9±1.0 cm, p=0.02). Meanwhile, no significant difference in objective outcomes of patients between groups was recorded. There was also no significant difference in photographic scar analysis between groups, while independent observer scar assessment scale scores were better in the minimal invasive group (p=0.03). Conclusion: Although superior results of an independent observer, assessment of cosmesis by the plastic surgeon and the patient him/herself revealed no superiority of the minimally invasive approach, when compared to conventional parathyroid surgery.

Background The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery. Method In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT). Results As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots. Conclusion Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.

Purpose. The purpose of this study was to assess how frequently thyroid cancer is located only in the non-dominant nodules. Methods. A total of 111 thyroid patients, whose primary operation were carried out at our institute and were confirmed to have thyroid cancer, were evaluated. Tumor characteristics were recorded in a retrospective database. Variables analyzed included patients’ age and sex, nodule and tumor size, ultrasound features of nodules, fine needle aspiration biopsy result and the presence of multifocality of malignancy. Results. There were 91 females and 20 males. Mean age was 48±12 years (range 16-80 years). Mean dominant nodule size was 2.1±1.3 cm, while mean malignant tumor size was 1.4±1.4 cm (range 0.1-7 cm). Carcinomas were located in the dominant nodule in 61 (55%) cases, while it was present in the non-dominant nodules – without a neoplastic focus in the dominant nodule – in 50 (45%) cases. In 20 (18%) cases the carcinoma was found in both the dominant and the non-dominant nodule. Multifocality of the malignant tumor was present in 64/111 (58%) cases. Conclusions. Risk of malignancy in the non-dominant thyroid nodule should be kept in mind before carrying out a biopsy from the dominant nodule. Assessment of multinodular goiter should not be restricted to the dominant nodule.

We aimed to investigate whether simvastatin had any impact on the prevention of adhesion formation after thyroidectomy in a rat model.This study was performed in 66 Wistar albino rats randomized into three experimental groups. A right hemithyroidectomy was carried out in all the rats. Simvastatin was administered locally at a dose of 0.5 mg/kg and 0.8 mg/kg. Control rats received a saline solution only. Changes during the 1st week, 1st month and 3rd month were evaluated. Efficacy of the treatment was assessed by using a scoring system.The severity of adhesions in low-dose simvastatin group was significantly less than the control and high-dose groups during the 1st and 3rd month (p .05). In addition, adhesions were less in the high dose group during the 3rd month, when compared to the control group (p .05). Moreover, fibrosis and fibroblast scores, which represent adhesions, were significantly lower in low-dose and high-dose groups at 3rd month, compared to controls (p .05).We investigated the influence of simvastatin application on post-thyroidectomy adhesion formation in rats. Whether adhesions, causing technical difficulties during neck redo surgery, can be reduced by the use of simvastatin in human, needs to be studied.

Background/aim We compared the effects of volume-controlled equal ratio ventilation (VC-ERV) and volume-controlled conventional ratio ventilation (VC-CRV) on oxygenation, ventilation, respiratory mechanics, and hemodynamic status during mechanical ventilation with recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy. Materials and methods A total of 111 patients scheduled for laparoscopic sleeve gastrectomy were randomized to ventilation with inspiratory to expiratory ratio of 1:1 (Group VC-ERV) or 1:2 (Group VC-CRV) following tracheal intubation. RM (40 cmH2O, 15 s) and PEEP (10 cmH2O) were administered to all patients. Arterial blood gas samples were taken and peak airway pressure (Ppeak), mean airway pressure (Pmean), dynamic compliance (Cdyn), mean arterial pressure, heart rate, SpO2, and EtCO2 were recorded at 4 time points. Postoperative respiratory complications were recorded. Results Oxygenation, ventilation, Pmean levels, and hemodynamic variables were similar in both groups. VC-ERV significantly decreased Ppeak and increased Cdyn compared to VC-CRV at all time points of the operation (P < 0.05). No pulmonary complication was observed in any patients. Conclusion VC-ERV provides significantly lower Ppeak and higher Cdyn with similar oxygenation, ventilation, hemodynamic parameters, and Pmean levels when compared to VC-CRV during mechanical ventilation with RM and PEEP in laparoscopic sleeve gastrectomy.

Aim: Elevated red blood cell distribution width (RDW) and mean platelet volume (MPV) levels which are closely associated with chronic inflammation and platelet aggregation are suggested as independent predictors of obesity and cardiovascular diseases. However influence of significant weight loss following bariatric surgery on these parameters is unknown. Therefore we aimed to find out the effect of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on RDW and MPV levels. Methods: The medical data of 98 morbid obese subjects (25 male, 73 female) who were operated between February 2015 and June 2017 according to indications of bariatric surgery in current guidelines including body mass index (BMI) >40 kg/m 2 or BMI= 35-40 kg/ m 2 with additional comorbidities were recorded. The difference between baseline and values at one year was expressed as a delta (Δ). Results: The mean age of our study population was 41.89±11.99 years and mean weight loss in one year after LSG was 45.41±13.13 kg (36.5%). BMI decreased from 46.60±7.11 kg/m 2 to 29.58±4.63 kg/m 2 . Compared to the baseline, significant decreases in RDW (14.61±1.69 % vs. 13.71±2.10 %; p

Background: This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients.Methods: 141 patients who underwent LSG between September 2014 and January 2016 were included in the study.Results: The patients’ mean body mass index was 46.27 ± 6.79 kg/m2 preoperatively, 31.60 ± 5.37 kg/m2 in the 6th month postoperatively and 27.80 ± 4.25 kg/m2 in the 12th month (p

Aim: Obesity is a disease that reduces the quality and duration of life and its prevalence is also increasing in the elderly population.In this study, we aimed to investigate the results of early and midterm weight loss and treatment of concomitant diseases and evaluate the safety and efficacy of bariatric surgery in patients aged 60 years and older who underwent Laparoscopic Sleeve Gastrectomy (LSG) in our clinic. Material and Methods: We retrospectively evaluated 28 morbid obese patients ≥60 years oldwho underwent LSG between September 2014 and January 2018.Data reviewed included age, sex, preoperative weight and body mass index (BMI), comorbid conditions, early or delayed complications, mortality, length of follow-up, weight lost, BMI points lost, and effects on obesity-related comorbid conditions. Results: Of 28 patients included in the study there were 22 (78.6%) females and 6 (21.4%) males. The average age of patients was 63.4±3.39.Preoperative mean BMI was 48.4±7.0kg/m2.Average follow-up period 20.67 month. Postoperative median BMI was,36.24kg/m2 in the 6th month, 33.47kg/m2 in the 1st year and 31.17kg/m2 in the 2nd year.Present comorbid conditions included 23 (82.1%) hypertension, 16 (57.1%) diabetes mellitus and 3 (10.7%) obstructive sleep apnea. All of patients reported resolution or improvement in comorbid conditions.No mortality was observed in patients. Conclusion: Outcomes and complication rates of bariatric surgery in patients aged 60 years and older are low and acceptable. The results of our study support bariatric surgery in elderly patients. However, detailed information should be provided about the slightly increased risks and the possibility of less satisfactory outcome.

Low grade fibromyxoid sarcoma (LGFS) is a rare tumor that has a tendency to develop in deep soft tissues. Despite its histologically benign appearance it may have an aggressive clinical course with local recurrences and metastasis. It was first described by Evans in 1987. It is more often seen in young adults and especially in male patients. The tumor has a tendency to develop in deep soft tissues and less frequently in the subcutaneous tissues; the most common locations are gluteal region, chest wall, shoulder and lower extremities but rarely it may also occur in the head, cheek, jaw and the retroperitoneal area. In this case report we aimed to determine the diagnosis pathways and treatment modalities of LGFS, with regard to the literature., Düşük dereceli fibromiksoid sarkom (DDFS) derin yumuşak dokularda gelişmeye eğilimli, histolojik olarak benign görünümüne rağmen lokal nüks ve metastaz ile agresif klinik gidiş gösterebilen nadir bir tümördür. İlk kez 1987' de Evans tarafından tanımlanmıştır. Özellikle genç erişkinlerde ve erkeklerde daha sık görülmektedir. Tümör, derin yumuşak dokularda ve daha az sıklıkla da subkutan dokularda yerleşmeye eğilimli olup en sık görülen yerler gluteal bölge, göğüs duvarı, omuz ve alt ekstremiteler olmakla birlikte nadiren baş ve retroperitoneal bölgede de ortaya çıkabilir. Bu olgu sunumunda DDFS'un tanı ve tedavisinin literatür eşliğinde irdelenmesi amaçlandı.

With the wide acceptance of Fisher’s theory that breast cancer is a systemic disease from the start and in the light of improvements in adjuvant treatment, the role of surgery in the treatment of cancer was expected to gradually decrease (1). However today’s surgical treatment of breast cancer has developed into oncoplastic and reconstructive surgery (Oncoplastic Breast Surgery (OBS) + Reconstructive Breast Surgery (RBS) = ORBS). Besides establishing ideal regional oncological control, surgeons are often faced with the difficulties of conserving breast aesthetics or achieving optimal results. In a meta-analysis, Losken et al. reported that the rate of surgical margin involvement was 12.3% and 20.6% for patients who underwent OBS and Breast Conserving Surgery (BCS), respectively. In addition, they reported local recurrence rates of 3.6–4.7% and 7% for OBS and BCS, respectively (2). In another study comparing oncological outcomes for BCS and OBS, they reported tumour sizes of 17 mm and 24 mm, surgical margins of 6 mm and 14 mm, and rates of re-excision of 29% and 5.4%, respectively. They suggested that OBS has a positive effect on oncological perspective in breast cancer surgery (3). The Turkish Federation of Breast Disease Societies (TFBDS) made recommendations regarding ORBS at their first Breast Cancer Consensus Meeting in 2006 (4). In Turkey, there is no official Breast Surgery sub-specialization available to general surgeons. However, in certain teaching and research hospitals and university hospitals a small number of general surgeons do concentrate on breast surgery. Despite current publications and national guidelines, there is disparity in surgical approaches to ORBS. This is either due to limited resources in the workplace or the knowledge and experience of the individual surgeon. Our study aims to investigate the experiences, applications and approaches to OBS and RBS taken by general surgeons who focus on breast surgery in Turkey. From our exploration of the available literature (Pubmed; Cohrane Database) we believe this to be a unique study, as it is the first survey of ORBS worldwide and in Turkey to involve such a large cohort of surgeons of this nature.

WOS: 000315000900018, PubMed ID: 25207048, Objective: In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). Material and Methods: We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. Results: Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. Conclusion: Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery.