Person: ERGENÇ, MUHAMMER
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ERGENÇ
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MUHAMMER
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Publication Open Access A comparative study of abdominal wall hernia surgery before and after the COVID-19 pandemic: Results from a 2-year observational period(2023-08-01) ERGENÇ, MUHAMMER; UPRAK, TEVFİK KIVILCIM; Ergenç M., Uprak T. K.BACKGROUND: Abdominal wall hernia surgery is among the most common procedures in general surgery. It is thought that postponing elective hernia surgeries due to the pandemic will increase emergency presentations of hernias, but different data have been published in the literature. OBJECTIVE: This study aimed to evaluate the effect of the coronavirus disease 2019 (COVID-19) pandemic on emergency and elective hernia operations. MATERIALS AND METHODS: Patients who underwent hernia surgery in the Istanbul Sultanbeyli State Hospital between March 2018 and March 2022 were retrospectively analyzed. March 11, 2018–March 11, 2020, and March 12, 2020–March 12, 2022, were categorized as prepandemic and pandemic periods, respectively, and were evaluated as 1-year periods. All abdominal wall hernia operations performed in the hospital were examined. RESULTS: A total of 1,644 patients underwent hernia operations. Patients’ ages ranged from 18 to 87 years; the mean age was 47.5±13.6. A total of 1,319 (80%) of patients were men. There was a 50% decrease in the number of surgeries during the pandemic, but there was no significant increase in emergency surgeries (P = 0.49). Incisional and ventral hernia procedures declined dramatically over the COVID-19 pandemic compared with the prepandemic period, whereas inguinal hernia surgeries increased proportionally (P = 0.002). CONCLUSIONS: While a decrease was observed in total abdominal hernia surgeries performed during the COVID-19 pandemic compared with the prepandemic period, no significant increase was found in emergency abdominal hernia surgeries. Patients with ventral and incisional hernias can be followed up to be operated on under optimal conditions.Publication Open Access Prognostic role of the lymph node ratio in colorectal cancer: A retrospective study(2022-12-01) ERGENÇ, MUHAMMER; Derici S. T., ERGENÇ M., SÜCÜLLÜ İ., AKIN M. L.Background: Studies have been conducted to investigate more practical and useful parameters in determining the prognosis of patients with colorectal cancer (CRC), and some suggest that the lymph node ratio (LNR) may be useful in doing so, especially in patients with inadequate lymph node dissection. Objectives: We aimed to evaluate the effect of LNR (number of metastatic lymph nodes/number of total lymph nodes excised) on disease‑free survival and overall survival rates in CRC. Design: A single‑center retrospective cohort study. Setting: Tertiary care hospital. Patients and Methods: The clinical and pathological features of the patients were analyzed by dividing them into groups according to tumor localization; tumor, node, metastasis staging; and LNR. The Kaplan–Meier method and the log‑rank test were used for survival analysis. Sample Size: A total of 479 patients with CRC who were operated on between September 1991 and December 2011 were included in this study. The LNR of 439 patients could be calculated, and analyses were according to these patient groups. Main Outcome Measures: The primary objective of this study was to determine the effect of LNR on disease‑free survival and overall survival in CRC. Results: A total of 121 right‑sided colon cancers, 202 left‑sided colon cancers, and 156 rectal cancers were analyzed. The age of the patients ranged from 20 to 93 years, and the mean age was 66.8 (13.5) years. The cumulative 5‑year survival rate was 48.5% in our patients with CRC. When analyzing the tumor, node, metastasis stages of the groups according to their LNRs, the results showed that as the rate of lymph node metastasis increases, so does the tumor stage parameter (P < 0.001). The overall survival and disease‑free survival rates significantly decreased as LNR increased (P < 0.001). Conclusion: This study showed that LNR correlates well with the disease‑free and overall survival rates. A higher LNR could indicate the aggressiveness of the tumor; therefore, LNR may be a predictor of the poor prognosis of CRC. Limitations: Some patients could not be followed‑up and we could not evaluate complications because not all patients had data on postoperative complications. As a result, our study results may have been affected. Conflict of Interest: The authors have no conflict of interest to declare.Publication Open Access Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries(2023-07-01) ERGENÇ, MUHAMMER; Adisa A., Bahrami-Hessari M., Bhangu A., George C., Ghosh D., Glasbey J., Haque P., Ingabire J. C. A., Kamarajah S. K., Kudrna L., et al.Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of \"single-use\" consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.Publication Open Access Is histopathological examination necessary after sacrococcygeal pilonidal sinus excision(2023-03-01) ERGENÇ, MUHAMMER; Ergenç M.Background: Pilonidal sinus is a common disease that usually occurs in the natal cleft in the sacrococcygeal region. Many conservative and surgical methods are used in its treatment. Malignancy is rarely detected in pilonidal sinus specimens; therefore, the routine pathological examination is controversial. In the literature, studies suggest histopathological evaluation if risk factors such as atypical presentation and appearance, older age, long-term disease, and recurrent disease are present. This study aimed to evaluate the pathology results of patients who underwent sacrococcygeal pilonidal sinus excision in our clinic.Methods: The records of patients admitted to Istanbul Sultanbeyli State Hospital and who underwent pilonidal sinus excision between January 2016 and October 2021 were reviewed retrospectively. The following parameters were evaluated: age, gender, location of disease, and histopathological examination result of pilonidal sinus specimens.Results: During the study, 2091 patients underwent surgery for pilonidal sinus disease in our general surgery clinic. The data of 2068 patients were analyzed after excluding 23 patients who underwent excision for disease outside the sacrococcygeal region and had missing data. The ages of the patients ranged from 13 to 72, with a female/male ratio of 535/1533. The mean age was 24.7 ± 8.2 years. Pilonidal sinus specimen pathologies excised from the sacrococcygeal region were examined. No malignancy was detected in any patient.Conclusion: Routine histopathological examination of pilonidal sinus specimens may be unnecessary if there are no risk factors such as atypical presentation and appearance, relapse, long-term disease, and advanced age.Publication Open Access Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis(2023-08-01) UPRAK, TEVFİK KIVILCIM; AKIN, MUHAMMED İKBAL; ÇELİKEL, ÇİĞDEM; YEGEN, ŞEVKET CUMHUR; ERGENÇ, MUHAMMER; Ergenç M., Uprak T. K., Akın M. İ., Hekimoğlu E. E., Çelikel Ç., Yegen Ş. C.BackgroundTumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery.MethodsAll patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01 < LNR1 ≤ 0.1, 0.1 < LNR2 ≤ 0.25 and LNR3 > 0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups.ResultsAfter exclusion, 333 patients were analyzed. The mean age was 62 ± 14years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%,n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II—III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9months) compared to LNR 0–1–2.ConclusionOur study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients.Publication Open Access Can Gastric Specimen Measurements Defines the Laparoscopic Sleeve Gastrectomy Outcome?(2018) ERDİM, AYLİN; Günal, Ömer; Uprak, Kıvılcım; Ergenc;, Muhammer; Erdim, AylinPublication Open Access Outcomes of proximal versus total gastrectomy for proximal gastric cancer: A propensity score-matched analysis of a western center experience(2023-01-01) UPRAK, TEVFİK KIVILCIM; ERGENÇ, MUHAMMER; AKMERCAN, AHMET; YEGEN, ŞEVKET CUMHUR; UPRAK T. K., ERGENÇ M., AKMERCAN A., YEGEN Ş. C.Purpose: In this western study, we aimed to compare perioperative outcomes, postoperative complications, and overall survival in patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) for proximal gastric cancer (GC). Methods: Patients who underwent GC surgery at Marmara University Hospital between January 2014 and December 2021 were evaluated retrospectively. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients undergoing PG and TG. Data on patients’ demographics, clinicopathological features of tumors, complications, and survival rates were analyzed. Perioperative outcomes and overall survival of the patients were compared between PG and TG groups. Results: A total of 212 patients were included in this study, with 53 patients in the PG and 159 in the TG group. After 1:1 matching according to PSM, 46 patients in the PG group were matched to 46 in the TG group. After PSM, there were no differences in clinicopathological outcomes except retrieved lymph nodes. In terms of short-term outcomes, overall perioperative morbidity (Clavien Dindo ≥ 3a) was significantly higher in the PG group (p = 0.01). However, there was no significant difference when the complications were considered separately. In the long-term follow-up, reflux esophagitis was associated with the PG group (p=0.04). In multivariate analysis, positive surgical margin and lymphovascular invasion were significant factors related to overall survival. Overall, 5-year survival was 55% in matched patients. The difference in survival was not statistically significant (57 vs. 69 months, p = 0.3) between the two groups. Conclusions: Proximal gastrectomy is applicable to patients up to stage 3 disease, with no difference in overall survival, with caution in early complications and reflux esophagitis. Among all demographic and oncological factors, lymphovascular invasion and resection margin were significantly associated with worse survival.Publication Open Access Recurrent ileo-ileal intussusception caused by inflammatory fibroid polyp: a rare case report(2023-06-01) ERGENÇ, MUHAMMER; Güzel G., Ergenç M.An inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract, which can cause obstruction or intussusception when it reaches a large diameter. We present a case of a 46-year-old female admitted to our clinic with recurrent ileus attacks. We performed segmental resection of the small bowel due to a 3-cm pedunculated polypoid lesion located in the terminal ileum that caused ileo-ileal intussusception and whose pathology was reported as an inflammatory fibroid polyp. In adults presenting with ileus, the possibility of intussusception should be kept in mind.Publication Open Access Hand-sewn versus stapled anastomosis for billroth II gastrojejunostomy after distal gastrectomy: Comparison of short-term outcomes(2023-05-01) UPRAK, TEVFİK KIVILCIM; ERGENÇ, MUHAMMER; ATALAY, VAFİ; Uprak T. K., Ekdal D. C., Ergenç M., Atalay V.Introduction: Subtotal gastrectomy is usually performed in patients with distal gastric cancer. After distal gastrectomy, which reconstruction method can be used is still controversial. This study evaluated the effect of the stapler and hand-sewn techniques on postoperative results. Methods: Patients who underwent distal gastrectomy in a single center were evaluated retrospectively in this study. Patients who underwent the Billroth II reconstruction method were analyzed. Hand-sewn and stapled techniques were compared in terms of operative and short-term postoperative outcomes. Results: Two hundred fourteen patients were included. Most of the patients (66.8%) were male. The median age was 61 years. Billroth-II reconstruction with hand-sewn was performed in 161 (75%) patients, and the double stapler technique was performed in 53 (25%) patients. When the hand-sewn and stapled groups were compared, no difference was found in age, sex, or American Society of Anesthesiology scores. There was no difference in choosing antecolic or retrocolic as the surgical technique (p=0.19). A shorter length of hospital stay was detected in the stapled group (p=0.01). The overall complication rate was higher in the hand-sewn group (21.7% vs. 7.5%, p=0.02). Clavien-Dindo grade 3 and above complications were significantly higher in the hand-sewn group (13.7% vs. 3.8%, p=0.02). Conclusion: Our study showed that the stapler anastomosis technique for Billroth II gastrojejunostomy after distal gastrectomy led to fewer overall complications and shortened hospital stays.Publication Open Access Clinicopathological outcomes of microsatellite instability in colorectal cancer(2022-11-01) ERGENÇ, MUHAMMER; Gülşen T., Ergenç M., Şenol Z., Emirzeoğlu L., Güleç B.Aims:This study aims to evaluate the histopathological features and prognostic parameters of tumors withmicrosatellite instability(MSI) compared with those without MSI in patients who underwent surgery forcolorectal cancer(CRC).Setting and Design:Follow-up for CRC at Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital was retrospectively evaluated between March 2017 and March 2021.Methods and Material:The patients were divided into two groups: those with and without MSI. Groups were compared insurvivalparameters. As a secondary result, groups were compared in pathological parameters such as stage, tumor diameter, degree of differentiation, and lymphovascular, and perineural invasion.Statistical Analysis Used:Survivalcalculations were performed using the Kaplan–Meier analysis method. The effects of various prognostic factors related to tumor and patient characteristics on disease-free and overallsurvival(OS) were investigated by log-rank test.Results:Two hundred fourteen patients were analyzed. The median age of the patients was 66 (30–89), and 59.3% (n = 127) were male. There were 25 patients in the MSI group and 189 patients in the non-MSI group. We found that MSI tumors had a significantly higher differentiation degree than non-MSI tumors and larger tumor diameters. MSI tumors frequently settled in the proximal colon, and more lymph nodes were removed in the resection material. MSI tumors had longer disease-freesurvival, cancer-specificsurvival, and overallsurvival.Conclusions:By diagnosingmicrosatellite instability, CRCs can be divided into two groups. The histopathological features of the tumor and theprognosisof the disease differ between these groups. MSI can be a predictive marker in the patient’s follow-up and treatment.