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Today, bariatric surgery is the most effective treatment for obesity, and the techniques continue to evolve. Laparoscopic sleeve gastrectomy, which is only one step of biliopancreatic diversion/duodenal switch surgery, has become the most common bariatric procedure due to its efficacy when performed alone. Additionally, the rate of complications has decreased as a result of increased technical experience and the development of stapler technology. The widespread adoption of laparoscopic sleeve gastrectomy is also attributable to its technical simplicity. Although it is assumed to be a simple procedure, mistakes at specific stages significantly increase the risk of complications. We focus on our method in detail, including all operative steps, which we believe is the simplest and most effective technique after performing over 5000 surgeries at our institution. Paying attention to the sleeve size, selecting the appropriate stapler, not narrowing the incisura angularis, resecting the fundus without getting too close to the esophagus, creating a smooth, non-rotating staple line, and suturing the staple line are highlighted.

Background/Aims: In the present study we were aimed to investigate/compare regenerative effects of Theranekron® (TC) and Misoprostol (MS) after Partial Hepatectomy (PH) in rats. Material and Methods: This study was conducted in 38 rats, they were divided in to 5 groups and 14 days study periot. Results, and Conclusions: When considering biochemical and histopathological results; we were seen that before and after PH 7 days duration and used dozes of both drugs was not sufficient and also higher dozes and at least 10 days periot may be necessary. Althought some literatures were reported about positive effects of TC and MS on epithelial growing, we have not seen that they have not any positive effect on liver regeneration. For future research -at higher dozes and durations- may be found effective.

Background: Sclerosing encapsulating peritonitis (SEP) is a rare cause of acute abdomen and can be easily misdiagnosed. Preoperative diagnosis of the SEP can be performed with preoperative imaging studies. We aimed to evaluate the clinical features of ileus cases who were diagnosed with primary or secondary SEP in the last five years. Methods: This retrospective cohort study evaluated the patients who were admitted with ileus or acute abdomen symptoms to the Emergency Department of Elazig Training and Research Hospital and underwent surgery by the same surgical team of General Surgery Department between January 2014 and January 2019. Patients who were diagnosed with primary or secondary SEP were included. The demographic data, clinical presentation, whether the disease was primary or secondary, the treatment options performed and mortality rates were evaluated. Results: SEP was observed in 11 of the patients. Ten patients underwent surgery (90.9%), and one patient (9.1%) was treated conservatively. Of the patients, six had secondary SEP (54.5%) and five had primary SEP (45.5%). In total, five patients were female (45.5%) and six were male (54.5%). The median age of the patients was 35 years (24–69). The median age of the patients with primary disease was 48 (29–69) years, while the median age of patients with secondary disease was 34.5 (24–64) years. One patient expired in the postoperative 8th hour. Conclusion: SEP should be considered in the case of recurrent abdominal pain attacks, especially in patients undergoing peritoneal dialysis, and it should be known that the mortality rate is high when misdiagnosed.

Objectives: In this study, we consider a fibroadenoma with a size >5 cm as a giant fibroadenoma (GFA). This definition is not universally acceptedbut has been used in several studies. We retrospectively presented fibroadenoma cases that were treated in our clinic, together with a review of thecurrent literature.Materials and Methods: The GFA cases that were surgically treated in our clinic between January 2016 and December 2019 were retrospectivelyreviewed. The data were collected from patient files, discharge reports, surgical notes, pathology reports, patient follow-up forms, and digitalrecords. Patients whose data were not fully available were excluded from the study. The patients were analyzed in terms of age, duration ofsymptom, macroscopically size of the mass and location.Results: Eight patients were analyzed. The mean age of the patients was 31.5±5.8 (23-41) years. The mean time of diagnosis before the operationwas 36.75±14.49 (18-60) months. The lesion was in the left breast for five patients (62.5%) and in the right breast for three patients (37.5%). Themean size of fibroadenomas was 52.5±2 (50-56) mm.Conclusion: There is not a consensus in the ideal treatment protocol of GFAs. A careful physical examination and radiological examination aresufficient for diagnosis, but a biopsy will be beneficial in the context of a GFA. We think that excision should be done in the treatment of GFAs. Amaç: Bu çalışmada biz 5 cm ve üzeri boyutu olan fibroadenomları dev fibroadenom (DFA) olarak değerlendirdik. Her ne kadar bu tanımlama genel olarak kabul edilmese de birçok çalışmada bu şekilde tarif edilmiştir. Bu yazıda kliniğimizde tedavi ettiğimiz DFA tanılı hastaları literatür eşliğinde retrospektif olarak sunmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Ocak 2014 - Aralık 2019 tarihleri arasında DFA nedeni ile cerrahi tedavi uygulanan hastalar retrospektif olarak incelendi. Çalışma verileri hasta dosyalarından, epikrizlerden, ameliyat notlarından, patoloji raporlarından, hasta takip formlarından ve bilgisayar kayıtlarından elde edildi. Verilerine tam olarak ulaşılamayan hastalar çalışma dışına alındı. Hastalar; yaş, şikayet süresi, makroskopik olarak kitle boyutu ve yerleşim yeri açısından analiz edildi. Bulgular: Altı yıllık süreç içerisinde kliniğimizde DFA nedeni ile opere edilen dokuz hastadan bir tanesinin verilerine tam olarak ulaşılamayınca çalışma sekiz hasta üzerinden yapıldı. Hastaların yaş ortalaması 31,5±5,8 yıl olup yaş aralığı 23-41 yıl arasında değişmekteydi. Hastaların fibroadenomlarının farkındalık süreleri ortalama 36,75±14,49 ay (18-60) idi. Beş hastada (%62,5) lezyon sol memede iken üç (%37,5) hastada sağ memede idi. Fibroadenomların ortalama büyüklüğü 52,5±2 mm (50-56) idi. Sonuç: DFA’ların tedavisi konusunda henüz bir fikir birliği oluşmamıştır. Tanı için dikkatli bir fizik muayene ve radyolojik tetkikler yeterli olmakla birlikte DFA’larda biyopsi faydalıdır. Biz DFA’ların tedavisinde eksizyon yapılması gerektiğini düşünüyoruz.

A hematoma is a collection of blood in an extravascular space and is named according to its location. Rectus sheath hematoma (RSH) was first described by Hippocrates and Galen about 25 centuries ago due to abdominal trauma, which is a rare cause of acute abdomen. It is uncommon, which may lead to delayed diagnosis in patients with acute abdomen. This condition arises due to trauma or hypertension in patients with bleeding disorders, using anticoagulants, doing heavy physical exercise, pregnant women, connective tissue diseases, and hematological diseases. The diagnosis can be made by detailed anamnesis, physical examination, ultrasonography, and contrast-enhanced abdominal tomography. For a accurate diagnosis, first of all, the medical history of these patients should be carefully questioned. CT and ultrasonography (USG) are used in the diagnosis of this condition. In many patients, conservative treatment by eliminating the predisposing factor is sufficient. In conclusion, with the increase in use of anticoagulation, the incidence of RSH is expected to increase. Every physician in the surgical field should keep rectus sheath hematoma at the top of the differential diagnosis list in patients presenting with acute abdominal pain and palpable abdominal mass.

Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery? " We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.

Aim: This study was conducted to investigate the diagnostic importance of Urotensin II (UT-II) levels, which cause vasodilation as a compensation mechanism in the early phase of Acute Mesenteric Ischemia (AMI). For this purpose, human plasma urotensin was studied for the first time in the literature for the early diagnosis of mesenteric ischemia. Material and Method: The study consisted of 60 patients. The patients were divided into three groups: Group 1: group with mesenteric ischemia (n: 20); Group 2: group with abdominal pain and with no mesenteric ischemia (n: 20); Group 3: control group with no complaints (n: 20). The blood samples were taken from the patients through peripheral venous access, and Urotensin II (UT-II), Aspartate Aminotransferase (AST), Alkaline phosphatase (ALP), Lactate, and D-dimer levels were measured. Results: While a significant increase was found between Group1 and Group 2 and between Group1 and Group3 in terms of UT-II values (p0.05). A significant increase was found between Group1 and Group2 and between Group1 and Group3 regarding AST values (p0.05). There was a significant increase between Group1 and Group3 in terms of D-dimer values (p0.05). There was no significant difference between the groups concerning ALP and Lactate values (P>0.05). Conclusion: It was concluded that UT-II could be used in the diagnosis of AMI but that there was a need for comprehensive studies investigating the changes in ischemia time-related UT-II serum levels.

Background: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn’t seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores. RESUMO Racional: A cirurgia da obesidade mórbida e complicações relacionadas aumentaram com o tempo. Objetivo: Avaliar a relação entre as complicações perioperatórias antes da alta e o índice de massa corporal pré-operatório e o escore de mortalidade da cirurgia de obesidade na gastrectomia vertical laparoscópica. Método: 1.617 pacientes que atenderam aos critérios de inclusão foram avaliados retrospectivamente. Os pacientes foram examinados quanto aos dados demográficos, presença de comorbidades, ocorrência ou não de complicações, tipo de complicações e escore de mortalidade cirúrgico da obesidade. Resultados: Complicações foram observadas em 40 pacientes (2,5%) e mortalidade não foi observada no período pós-operatório imediato antes da alta. A média de idade dos pacientes com complicações foi de 36,3±10,02 anos (19-57) e sem complicações de 34,12±9,54 (15-64) anos. Os valores médios de IMC pré-operatórios dos pacientes com e sem complicações foram 45,05±3,93 (40-57) kg/m2 e 44,8±3,49 (35-67) kg/m2, respectivamente. De acordo com os grupos de IMC 40-45 kg/m2, 45-50 kg/m2 e 50 e mais, não houve qualquer significância estatística observada em três grupos em termos de positividade de complicações e taxas de complicações maiores-menores. Não houve significância estatística entre os pacientes com e sem complicações maiores e menores e o escore de mortalidade da cirurgia de obesidade. Conclusão: Não houve qualquer relação entre as taxas de complicações da gastrectomia vertical laparoscópica perioperatória antes da alta e os escores de mortalidade da cirurgia de obesidade e IMC.

Aim:In this paper, we aimed to evaluate the patients who underwent trephine stoma with sedoanalgesia in addition to local anesthesia and to share the results.Method:The patients who underwent trephine stoma with sedoanalgesia in addition to local anesthesia for fecal diversion in our general surgery clinic between June 2012 and June 2017 were evaluated retrospectively. The patients were evaluated in terms of demographic characteristics, diagnosis of primary disease and complications.Results:A total of 11 patients (F/M: 4/7) were evaluated. The mean age was 54 (±4) years. The mean follow-up period was 18 months (range 2-30). Primary disease was rectal cancer in seven patients (63.6%), Fournier’s disease in two patients (18.2%), genital cancer in one patient (9.1%), and rectovaginal fistula in one patient (9.1%). Only one patient underwent transverse colostomy and 10 patients underwent sigmoid colostomy. There were no complications related to surgical procedures. One patient died on the 14th postoperative day because of complications secondary to metastasis.Conclusion:Trephine stoma technique, which does not require laparotomy, is a fast, reliable, and easy to use method especially in high-risk patients with poor general condition.

Cerrahi kliniklerde sık rastlanılan durumların başında Akut apandisit gelmekle birlikte Klasik tedavisi cerrahidir. Bu klasik tedavi son yıllara damgasını vuran laparoskopik cerrahiden de etkilenmiştir. Laparoskopik apendektominin açık apendektomiye göre en önemli avantajı ‘tanısal laparoskopi’ yapılarak tanısı arada kalan hastalara doğru yaklaşım sağlanmış olunur. Bunun yanı sıra diğer avantajları olarak da; yara enfeksiyonu ve fıtık riskinin daha düşük olması, kozmetik olarak daha iyi yara yeri görünümü elde edilmesi, ameliyat sonrası ağrının daha az olması, günlük hayat aktivitelerine ve işe daha hızlı dönüşün sağlanabilmesi olarak sıralanabilir. Biz de bu yazımızda iki adet 5 mm'lik port kullanarak laparoskopik yardımlı minimal invaziv apendektomiyi sunmayı amaçladık.

Çay, Ferhat (Balikesir Author), Objective: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +/- 5.18 (range, 14-36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p=0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. Conclusion: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.

Amaç: Kardiyak problemi ve herhangi bir sistemik hastalığı olmayan hipertiroidili hastalarda beyin natriüretrik peptid (BNP) düzeyini ve tedavinin BNP düzeyine etkisini değerlendirmeyi planladık. Gereç ve Yöntemler: Çalışmaya 29 hipertiroidili ve 30 sağlıklı olgu dahil edildi. Hastalarda total T3, total T4, serbest T3, serbest T4, TSH, anti TPOAb, Anti TgAb ve BNP düzeylerine tedavi öncesinde ve ötiroid olduktan sonra bakıldı. Bulgular: Hipertiroidili hastalarının tedavi öncesi BNP düzeyleri kontrol grubuna göre anlamlı olarak daha yüksek bulunmuştur (P0,05). Ayrıca hastalarda Anti TgAb, ST3, ST4 ve TT4’de tedavi öncesi pozitif bir korelasyon gözlenmiş (P0,05). Sonuç: Hipertiroidili hastalarda BNP düzeyi artmıştır. Antitiroid tedavi BNP düzeyini anlamlı olarak düşürmektedir. Objective: We aimed to evaluate the Brain Natriuretic Peptide (BNP) levels in patients with hyperthyroidism who do not suffer any cardiac problems or systemic diseases and the effect of the treatment on the BNP levels as well. Material and Methods: 29 hyperthyroid patients and 30 healthy subjects participated in the study. The patients were checked for their total T3, total T4, free T3, free T4, TSH, anti TPOAb, Anti TgAb, and BNP levels before and after treatment period. Results: BNP levels of patients with hyperthyroidism before treatment were found to be significantly higher than the control group (P 0.05). In addition, a positive correlation was observed in Anti TgAb, ST3, ST4 and TT4 before treatment (P 0.05). Conclusion:BNP level is increased in patients with hyperthyroidism. Antithyroid therapy significantly reduces the BNP level.

Aim: The effects of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery is not clear. We therefore aimed to determine the effects of neoadjuvant radiotherapy and emergent surgery on conversion. Methods: The data of 67 patients, who were operated for familial adenomatosis polyposis coli, colon, and rectum malignant neoplasms by the same surgical team between October 2016 and January 2018 were evaluated retrospectively. Among them, fifty-five laparoscopically finished or converted to open surgery cases were included in the study. The exclusion criteria included cases which began as open surgery, history of previous colorectal surgery for benign or malignant diseases, morbid obesity (body mass index >40 kg/m2) and missing data. Demographic values (age, gender), localization of tumor, whether it was an emergent or elective surgery, history of preoperative chemotherapy and radiotherapy, and causes of conversion were evaluated. Results: Among 55 patients, 35 were male (63.6%) and 20 were female 20 (36.4%), with a mean age of 58.4 (13.4) (22 – 80) years. Mean ages of conversion and laparoscopically finished cases were 62.86 (8.91) (53 – 73) and 57.71 (13.84) (22 – 80) years, respectively (P=0,216). The reason for operation was right colon cancer in three patients (5.5%), left colon cancer in six (10.9%), rectum cancer in thirty-seven (67.3%), rectosigmoid junction cancer in five (9.1%) and adenocancer due to familial adenomatous polyposis coli in four patients (7.3%). In seven patients (12.7%), the need for conversion to open surgery arose. Among 55 patients, 47 patients were operated electively (85.5%) and 8 were operated under emergent conditions (14.5%). Of the 7 conversion patients, 5 were operated under emergent conditions and 2 were operated electively (P, Amaç: Laparoskopik kolorektal kanserlerde açığa geçiş üzerinde neoadjuvan radyoterapi uygulanmasının ve acil şartlarda operasyon yapılmasının etkisi açık değildir. Bu nedenle Neoadjuvan radyoterapi alınması ve acil cerrahinin preoperatif açık cerrahiye geçiş üzerine etkilerini değerlendirmek amaçlandı. Yöntemler: Ekim 2016 – Ocak 2018 tarihleri arasında aynı cerrahi ekip tarafından ailesel polipozis koli, kolon malign neoplazisi ve rektum malign neoplazisi nedeniyle aynı cerrahi ekip tarafından opere edilen 67 hastanın dosyaları retrospektif olarak incelendi. Laparoskopik tamamlanan veya laparoskopik başlanıp açık cerrahiye geçilen 55 hasta çalışmaya dahil edildi. Çalışmadan çıkarılma kriterleri; direk açık cerrahi uygulanmak, benign veya malign sebeplerle daha önce kolorektal cerrahi uygulanmış olmak, morbid obezite (vücut kitle indeksi >40 kg/m2) ve verilere ulaşılamamaktır. Hastalar demografik özellikleri (yaş, cinsiyet), tümör lokalizasyonu, cerrahinin acil ya da elektif olarak yapılması, preoperatif kemoterapi ve radyoterapi uygulanması, açığa geçiş nedenleri açısından değerlendirildi. Bulgular: Çalışmaya dahil edilen 55 hastanın 35’i erkek (%63,6), 20’si kadın (%36,4) hastaydı. Hastaların yaş ortalaması 58,4 (13,4) (22 – 80) yaştı. Açığa geçilen hastaların yaş ortalaması 62,86 (8,91) (53 – 73) ve laparoskopik tamamlanan hastaların yaş ortalaması 57,71 (13,84) (22 – 80) yaştı (P=0,216). Hastaların operasyon nedenleri; 3 sağ kolon kanseri (%5,5), 6 sol kolon kanseri (%10.9), 37 rektum kanseri (%67,3), 5 rektosigmoid bölge tümörü (%9,1) ve 4 familiyal polipozis koli sendromu zemininde gelişen adenokarsinomdu (%7,3). 7 hastada cerrahiye laparoskopik başlandı ancak açık cerrahiye geçilmek zorunda kalındı (%12,7). 47 hasta elektif şartlarda (%85,5) opere edilirken 8 hasta acil şartlarda (%14,5) opere edildi. Açığa geçilen 7 hastanın 5’i acil şartlarda opere olurken 2 hasta elektif şartlarda opere edildi (P

The aim of this study was to evaluate the effects of application of platelet-rich plasma in addition to laser pilonidoplasty for the treatment of pilonidal sinus. Twenty-five patients who were treated by laser pilonidoplasty for pilonidal sinus (group 1) and 25 patients who were treated by platelet-rich plasma in addition to laser pilonidoplasty (group 2) at this clinic were included in the study. Patients were classified according to the Irkorucu and Adana Numune’s classification and treatment concept. Duration of stay of the patients in the hospital, time to start daily activities, duration of wound healing, recurrence, and complications were evaluated. Among the 50 patients included in the study, 41 (%82) were males and 9 (%18) were females. The mean age was 25.6 ± 2.4 years and 24.8 ± 3.8 years in groups 1 and 2, respectively. The locations of the pilonidal sinus were similar in the two groups. No statistically significant differences were found in the duration of hospital stay, duration of the procedure, time to return to work, and complication rates between the two groups. Nevertheless, duration of wound healing was 6.1 ± 2.3 and 4.1 ± 0.9 weeks in groups 1 and 2, respectively, and was shorter in group 2. Duration of wound healing was statistically significantly different in the two groups. We concluded in this study that application of platelet-rich plasma in addition to laser pilonidoplasty significantly shortens the time of wound healing.

BACKGROUND: The present study aims to evaluate the use of the chlorhexidine gluconate and metronidazole impregnated compresses concerning anastomosis safety in the left colonic anastomosis in the presence of peritonitis. METHODS: This study was conducted on 21 Wistar-Albino-rats divided into three equal groups. After median laparotomy, the whole layer of the left colon was cut 2 cm over the pelvic peritoneum. The faeces were spread around the injury for fecal contamination. Then, fasia and skin were closed with 3/0 silk. After one day period, relaparatomy was performed. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in the first group and then double layer colonic anastomosis was performed. In the second Group-II, abdomen was cleared with the metronidazole impregnated compresses then double layer colonic anastomosis was performed. In the group-III, abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels and anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy. RESULTS: The highest anastomosis bursting pressure was found in Group-III (p

Aim: Benign anorectal diseases are common surgical procedures in general surgery. Various anesthetic techniques are utilized during surgical procedures. In this study, postoperative headache, urinary retention, and back pain were evaluated in patients operated under spinal anesthesia. Method: The incidence of postoperative headache, urinary retention and back pain was evaluated in patients operated under spinal anesthesia for benign anorectal disease (hemorrhoidal disease, pilonidal cyst, anal abscess, anal polyps, anal fissure, and anal fistulas) between January 1, 2016 and January 1, 2017. Patients for whom data was not available or who were operated under general or local anesthesia were excluded from the study. Results: Of the 302 patients whose data could be reached, 242 (80.1%) were operated under spinal anesthesia, 56 (18.5%) were operated under local anesthesia, and 4 (1.3%) were operated under general anesthesia within the 1-year period evaluated. Patients operated under spinal anesthesia included 152 (62.8%) patients with pilonidal cyst, 29 (12%) with hemorrhoidal disease, 41 (16.9%) with anal fistulas, 13 (5.4%) with anal abscess, 5 (2.1%) with anal fissures, and 2 (0.8%) with anal polyps. Postoperative headache was seen in 6 (2.5%) of the patients operated under spinal anesthesia, 3 (50%) of whom required rehospitalization for headache. The patients were treated conservatively with fluid replacement, caffeine, and nonsteroidal anti-inflammatory therapy. Urinary retention was seen in 6 (2.5%) patients and treated with temporary urinary catheterization. Permanent urinary retention was not seen any of the patients. None (0%) of the patients had back pain. Conclusion: Spinal anesthesia has low complication rates and can be a preferred anesthetic technique for benign anorectal disease surgery.

Objective: With the increase in life span and expectancy, elderlypatients are more frequently encountered. Advanced technology and medicalapplications enabled the elderly patients to be operated more easily andreduced their morbidity and mortality risks at the same rate. We aimed toevaluate the elderly patients who were treated electively and emergently due toventral hernia and to compare the outcomes of their treatments in this study.Material and Method: The files of the elderly patients who were diagnosedwith ventral hernia in our clinic between January-2012 and November-2014 werescreened retrospectively. Thirty-eight patients aged 65 years and over weredivided into two groups as emergently (Group-I) or electively (Group-II)operated patients. They were compared in terms of comorbid diseases (cardiac, pulmonary,endocrine and other) and complications (seroma, wound infection, ileus andothers).Results: Ten (26%) patients were determined as emergency (Group-I)and 28 patients(74%) as elective surgery group (Group-II).No statisticallysignificant difference was found between two groups in terms of ASA values (p =0.27). Of 31 patients (78%) with comorbid disease, eight (24%) were in Group-Iand 23 (76%) were observed to be in Group-II (p = 0.60). Of five patients (13.1%) who required intensive careneed, four (10.5%) were in Group- I and one (2.6%) was in Group-II (p=0.012).Complication developed in nine patients (23.6%) and three of them (7.9%) wereclassified as Group-I and six of them (15.7%) as Group-II (p = 0.44). Seromawas found in three patients (7.9%) and one of them (2.6%) was in Group-I andtwo patients (5.2%) were in Group-II (p= 0.61).Conclusion: Our study suggests that, in the future, non-operativeobservation may be preferred compared to emergency or elective surgicalprocedures for the elderly cases with asymptomatic incisional hernia., Amaç: Yaşam süresininve beklentisinin artmasıyla yaşlı hastalar ile artık daha fazlakarşılaşılmaktadır. Gelişen teknoloji ve tıbbi uygulamalar ile yaşlı hastalardaha rahat opere edilmekte ve morbidite-mortalite riskleri aynı orandaazalmaktadır. Çalışmamızda, insizyonel herni nedeniyle elektif ve acil olaraktedavi edilen ileri yaş hastaları değerlendirmek ve tedavi sonuçlarınıkarşılaştırmayı amaçladık.Gereç ve yöntem:Kliniğimizde Ocak 2012-Kasım 2014 tarihleri arasında, insizyonel herni tanısıkonmuş ileri yaş hastaların dosyaları retrospektif olarak taranmıştır. Yaşı 65ve üstü olan 38 hasta,acil ve elektif şartlarda opere edilenler olmak üzere ikigruba ayrılmış; Acil cerrahi yapılanlar Grup-I ve Elektif cerrahi yapılanlarGrup-II olarak belirlenmiştir. İki grup yandaş hastalıklar (kardiyak, pulmoner,endokrin ve diğer) ve komplikasyonlar (seroma,yara enfeksiyonu, ileus ve diğer)yönüyle karşılaştırılmıştır.Bulgular: On (% 26) hastaacil (Grup-I) ve 28 (% 74) hasta elektif cerrahi grubu (Grup-II) olarak tespitedilmiştir. Anestezi Skoru değerleri açısından iki grup arasında istatistikselolarak anlamlı fark olmadığı bulunmuştur (p=0,27).Yandaş hastalığı olan 31 (% 78) hastanın 8(% 24)’i Grup-I ve 23(% 76)'ü Grup-IIolarak görülmüştür (p=0,60). Yoğunbakım ihtiyacı gösteren 5(% 13,1) hastanın 4 (%10,5)’ü Grup-I ve 1 (%2.6)’iGrup-II olarak bulunmuştur (p=0,012).Dokuz (% 23,6) hastada komplikasyon gelişmiş, 3 (%7,9)’ü Grup-I, 6 (%15,7)hasta Grup-II olarak tespit edilmiştir (p=0,44). Seroma toplam 3 (% 7,9) hastada vardı ve bunlardan 1 (% 2,6) hastaGrup-I ve 2 (%5,2) hasta Grup-II olarak bulunmuştur (p=0,61). Sonuç: Gelecekte,asemptomatik insizyonel hernili yaşlı olgularda acil veya elektif cerrahiişlemlere kıyasla, non- operatif gözlemin tercih edilebileceğini çalışmamızbize düşündürmektedir.

Amaç: Çalışmamızın amacı Ocak 2015 – Ocak 2016 tarihleri arasında kliniğimizde hemoroit şikayeti nedeniyle Lastik Band Ligasyon (LBL) yöntemi uygulanan hastaları retrospektif olarak taramaktır. Materiyal Metot: Geriye dönük olarak Ocak 2015 – Ocak 2016 tarihleri arasında kliniğimizde hemoroid şikayeti nedeniyle LBL uygulanan hastaların kayıtları incelendi. Verileri eksik olan veya tam olarak kayıtlarına ulaşılamayan hastalar çalışmaya alınmadı. Bulgular: Polikliniğimizde 25 hastaya lastik band ligasyonu uygulandı. İki hastanın verilerine tam ulaşılamadığı için çalışma 23 hasta üzerinden yapıldı. Hastalardan 10’ u kadın, 13’ ü erkekti. Yaş ortalaması 33,4 (18-67) idi. LBL semptomatik 2. ve 3. derece hemoroidal hastalığı olan ve cerrahi dışı yöntemlerle tedavi olmak isteyen hastalara uygulandı. 15 hastada grade 2, 8 hastamızda grade 3 hemoroit pakesine işlem yapıldı. 16 hastada ( % 69) kanama, 6 hastada (% 14) prolapsus, 8 hastada (% 53) dışkılama zorluğu, 14 hastada (% 61 ) ağrı ve 11 hastada da (% 49) kaşıntı şikayetleri vardı. LBL uyguladığımız hastalarımızdan 1 olguda ağrı ve 1 olguda da minimal kanama gözlendi. Sonuç: Sonuç olarak LBL yönteminin güvenli, etkili, kolay uygulanabilen bir yöntem olması ve ayaktan tedavi protokolü olduğu için hemoroitin cerrahi dışı tedavilerinden en sık kullanılan tedavi yöntemidir. Fakat bu yöntemin uygulanma sonrasında düşen hemoroit pakesinin mikroskopik tetkikinin yapılamaması bir dezavantaj olarak görülebilir.

Pilonidal sinüs hastalığı daha sıklıkla genç-erişkin erkeklerde görülür. Tedavisinde uygulanan birçok cerrahi tedavi yöntemi ve bunların modifiye edilmiş uygulamaları mevcuttur. Ayrıca hastalığın cerrahi dışı yöntemlerle tedavisi de sürekli gündemdedir. Bu yazıda son yıllarda cerrahlar arasında ilgi uyandıran kristalize fenol yöntemini literatür eşliğinde kısaca sunmayı amaçladık.

Aim: We aimed to evaluate our phytobezoar cases who were followed up and treated due to mechanical obstruction in our clinic.Materials and Methods: The files of acute abdomen or ileus patients who were followed up in the Elazig Training and Research Hospital General Surgery Clinic between January 2013 and January 2018 were evaluated retrospectively. Patients whose data were not available and who were followed up and treated for non-phytobezoar ileus and acute abdomen were excluded from the study. Nine patients meeting the inclusion criteria were reviewed retrospectively. Demographic data (age, gender) of the patients, previous surgical histories, comorbidites, whether there is gastric or intestinal bezoar, treatment options and complications were recorded. Numerical data are given as median (minimum - maximum values); categorical data are given as n (%) for statistical evaluation.Results: Three of the patients were female (33.4%) and 6 were male (66.7%).The median age of all patients was 71(25–78) years. Seven of the patient had previous surgical intervention history (77.8%) (5 had gastric surgery and 2 had other abdominal surgery history), 2 (22.2%) had no previous surgical intervention history. Two of the patients (22.2%) whom endoscopic intervention was performed for with gastric bezoar, operated for intestinal obstruction due to migration of gastric bezoar.One of the patients (11.1%) whom had no surgical intervention history had primary intestinal bezoar and one (11.1%) had concomitant intestinal bezoar with gastric bezoar.Conclusion: Mechanical obstruciton due to bezoars, must be kept in mind in patients who had perivous gastric surgery history and habitual eating disorders.Not only the exploration of the target area but also whole exploration must be done.Close follow up for migration is important for the gastric bezoars after endoscopic interventions.

Amaç Çalışmamızda hastanemiz genel cerrahi kliniğinde yapmış olduğumuz İnkarse Karın Ön Duvarı Fıtıklarında Laparaskopik Tedavi Deneyimlerimizi sunmayı amaçladık. Materyal – Metod Kliniğimizde Ocak 2017 - Ocak 2018 tarihleri arasında Karın Ön Duvarı hernilerden laparoskopik yaklaşımla tedavi edilen hastalar retrospektif olarak incelendi. Hasta verileri bilgisayar kayıtlarından elde edildi. Verilerine tam olarak ulaşılamayan hastalar çalışma dışına alındı. Çalışmaya alınan tüm hastalara Laparoskopik intraperitoneal mesh tekniği uygulandı. Bulgular Çalışmaya 13 hasta dahil edildi. Hastaların tamamı kadın hastaydı. Yaş ortalaması 55,8 (38-70) yıl, cerrahi süreleri 60,4 (30 - 85) dakikaydı. Defekt çapı ortalama 4,7 (3-6) cm olup postoperatif hastanede yatış süreleri 2,1 (1 - 4) gündü. komplikasyon olarak 3 hastada seroma izlendi. Sonuç Sonuç olarak; kliniğimizde acil servise başvuran ön karın hernisi tanısı almış olan hastalara Dual Mesh kullanarak laparoskopik intraperitoneal onarım tekniğini kullanmanın güvenilir ve kolaylık sağladığını göstermeyi amaçladık.

Objective Mastalgia is the most common complaint of patients who are admitted for breast examination. Breast pain may originate breast tissue pathologies or non-breast pathologies adjacent organs. One of the causes of mastalgia is the varicella-zoster infection of the thoracic nerve ganglions. The zona zoster infection is painful, and vesicular lesions in the infected dermatomal regions can be observed because of the reactivation of the latent varicella (Herpes)-zoster virus (VZV) in the dorsal radix of medulla spinalis. There are no reviews of the zona cases of mastalgia patients in the literature. We aimed to investigate and represent the characteristics of these patients. Materials and methods Patients complaining of mastalgia and who were diagnosed with zona zoster infection after physical examination and clinical evaluation in the outpatients department of General Surgery were investigated retrospectively between January 2010 and January 2015. Results The study included 12 patients. All of them were female, and the mean age of patients was 51.66 (36-72) years. Eight of the zona cases were seen in the right breast (66.6%), and four of them were seen in the left breast (33.4%). Complaints of patients were pain (100%), eruption (70%), and burning sensation (60%). Underlying pathology was seen in one of the cases. Physical examination at admission revealed that four of the patients did not have any physical abnormality (33.3%). On the contrary of vesicular lesions, typical physical findings of zona, were seen in eight patients (66.7%). Conclusion Detailed history analysis and physical examination of the breast should be performed, particularly in older patients with unilateral severe mastalgia, and zona should be considered.

OBJECTIVE In this study, we aimed to present patients who have developed suture reaction and were treated in our clinic following thyroidectomy operation. MATERIAL AND METHODS Patients who had been treated for suture reaction following thyroidectomy between January 2012 and December 2014 were retrospectively evaluated. The patients were analyzed in terms of their age, gender, duration of the symptoms, type of previous operation and treatment modality. RESULTS Between January 2012 and December 2014, 559 thyroid/parathyroid operations were performed in our clinic. A total of 12 patients were admitted with suture reaction within this period thus yielding a suture reaction incidence of 2.1%. The mean age of these patients was 42±7.65 years, 75% of them were female while 25% of them were male. The types of previous operations were bilateral total thyroidectomy in 83.3%, lobectomy in 8.3% and near total thyroidectomy in 8.3% of the patients. The mean symptom duration was 7.2±4.3 (2-16) months. Two patients (16.7%) underwent a second surgical operation for suture reaction, while 10 patients (83.3%) were treated conservatively. None of the patients developed complications. CONCLUSION One of the most common complications that develop after thyroidectomy is bleeding. Ligation must be performed in order to prevent this complication. As it is known, surgical ligation with sutures may cause tissue reaction. Sutures that are absorbable and have a low risk for reaction formation should be chosen if suturing is preferred.

Summary Objective To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. Materials and methods The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records ( n = 23). Results In all the cases studied, 50% ( n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining. Conclusion The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.

Objective: The aim of the study is to report our experience with fibrin glue application in the management of bleeding from the gallbladder bed during laparoscopic cholecystectomy, which could not be controlled by conventional methods. Material and Methods: Three hundred eighty-two patients underwent laparoscopic cholecystectomy. Fourteen patients with bleeding from the gallbladder bed, which could not be controlled by conventional methods, were analyzed retrospectively. Results: Fibrin glue was used in 10 patients. Six (71%) were female and 4 were (29%) male. The mean age was 55.7 years. Fourteen patients were operated for the presence of symptomatic gallstones. Thirteen patients (92%) had a concomitant pathology. The mean time spent to maintain hemostasis was 23.9 minutes (15-35). Blood products were used in two patients with hemoglobin values under 8 mg/dL. Hemostasis could not be achieved in a patient despite fibrin glue application, and the operation was converted to open surgery. Conclusion: The application of fibrin glue for bleeding from the gallbladder bed during laparoscopic cholecystectomy can reduce conversion rates, further studies including more patients are required.

Kist hidatik hastaligi, Turkiye'nin de aralarinda bulundugu pek cok ulkede onemli bir saglik sorunudur. Daha cok karaciger ve akcigerde yerlesim gosterse de vucudun tum dokularinda gorulebilir. Karaciger kist hidatiklerinin cesitli komplikasyonlari vardir ve perforasyon bunlardan biridir. Perforasyon kendiliginden olabilecegi gibi travma sonucu da gelisebilir. Bu olgu sunumunda travma sonucu subkapsuler alana perfore olmus karaciger kist hidatigini sunuyoruz.

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6–30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.

Objective: The basis of damage control surgery rests on quick control of life-threaten‐ ing bleeding, injuries, and septic sources in the appropriate patients before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complemen‐ tary surgery. Material and methods: Knowing when to perform damage control surgery will increase the likelihood of survival. There are three main criteria that are important in the selection of patients: (1) critical physiological factors, (2) complex injury causing the loss of physiological reserves, and (3) other conditions in trauma patients. Acidosis, acquired coagulopathy, and hypothermia (death triangle/the lethal triad) which are among critical physiological factors come to the fore in patient selection. In patients predicted to undergo damage control surgery, a replacement with crystalloids is applied after establishing a wide vascular access before reaching the hospital with the purpose of maintaining acceptable vital functions until reaching the hospital. In the rapid/primary surgery stage, the purpose is controlling bleeding and contami‐ nation. With the purpose of controlling bleeding and hemostasis, packing, clamping, ligation, and shunting procedures are applied to the four quadrants or a balloon catheterization is done. Following hemorrhage control, the colon and intestines are examined. Primary suturation, simple resections, closed absorbent systems, and external drainage are preferred for controlling contamination. However, reconstruc‐ tive surgeries, stoma forming, and nutrition ostomies are not applied in this quick laparotomy. Then, abdominal closure (temporary abdominal closures; TAC) is done. In the second stage of damage control surgery (resuscitation), patients are taken into an intensive care unit for a period of 24–48 h for the enabling of aggressive resuscitation and patient monitoring. The main objective here is the elimination of problems caused by the acidosis, coagulopathy, and hypothermia triangle. Following 24–48 h of resuscitation after primary surgery in intensive care, planned definitive surgery is © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. performed (the third stage of damage control surgery). The packing materials are carefully removed. After all injuries are detected and any hemorrhages are stopped, complementary gastrointestinal repair (such as resections and anastomoses) is done and if it is not necessary, then ostomy and the opening of enteric feeding tubes are avoided. Closed system drainages and a nasoenteric feeding tube are placed if necessary. If abdominal closure cannot be fully done, temporary abdominal closure is done in the fourth stage. Results: After damage control surgery procedures, there was an improvement in survival rates. Conclusion: Damage control surgery and damage control management of the patient are important for improved survival rates and success of treatment before the lethal triad occurs deeply.

PURPOSE : To evaluate the effects of platelet rich plasma (PRP) on the healing of fascia wherein peritonitis has been created. METHODS: Twenty eight Wistar Albino rats were divided into four groups. Only a primary fascial repair following laparotomy was performed on Group 1, a primary fascial repair performed and PRP treatment applied following laparotomy on Group 2, and a fecal peritonitis created following laparotomy and a primary fascial repair carried out on Group 3. A fecal peritonitis was created following laparotomy and primary fascial repair and PRP treatment on the fascia was carried out on Group 4. RESULTS: TNF-α was found to be significantly lower in the control group (Group 1). It was detected at the highest level in the group in which fecal peritonitis was created and PRP applied (Group 4). TGF-β was determined as being significantly higher only in Group 4. Histopathologically, the differences between the groups in terms of cell infiltration and collagen deposition were not found to be significant. CONCLUSION: When platelet rich plasma was given histologically and biochemicaly as wound healing parameters cellular infiltration, collagen accumulation, and tissue hydroxyiproline levels were not increased but neovascularization, fibroblast activation and TNF Alfa levels were increased and PRP accelerated wound healing.

Purpose: Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic. Methods: Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period. Results: A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine. Conclusion: Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices.

The aim of this study was to investigate the cure rate after a one-time phenol application for pilonidal sinus disease. Forty-eight patients diagnosed with pilonidal sinus from May 2006 to September 2009 were retrospectively reviewed. They were all managed under the same polyclinic conditions in different hospitals by the same surgeon under local anesthesia. Crystallized phenol was applied a total of 97 times on 48 patients. The median follow-up was 22 months (range, six to 38 months). Two patients (4 %) could not participate in the follow-up. One of these patients had 12 sinuses and didn't continue treatment after eight applications of phenol, and the other had nine sinuses and didn't continue treatment after five applications of phenol. The one-time application cure rate was 64.5 %, and the rate of success was 95 % with two or more applications. Recurrence did not occur during this period. A one-time phenol application is an effective treatment for pilonidal sinus disease. Hence, it can be an alternative to surgical treatment.