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 Metadata only Older is worse? Elderly patients who underwent gastrectomy: A single-center study(2023-01-01) ERGENÇ, MUHAMMER; Uprak T. K., Ergenc M.Aim:Gastric cancer is common cancer, and its incidence remains relatively high in elderly patients with increasing life expectancy. However, few studies have examined the clinical and prognostic characteristics of elderly gastric cancer patients undergoing gastrectomy. This study aimed to evaluate the clinical and prognostic features of elderly gastrectomy patients.Materials and methods:Patients over 65 years of age who underwent gastric cancer surgery at Marmara University were retrospectively analyzed. The patients\" demographics, American Society of Anesthesiologists scores, prognostic nutritional index (PNI), complications, intensive care unit duration, and length of stay were examined. The patients were divided into two groups: young-old (65-74 years old) and old-old (≥ 75 years old). Two groups were compared in terms of postoperative outcomes and overall survival.Results:Two hundred sixty-three patients were analyzed. The mean age was 79 years, and the female to male ratio was 85/178. Reoperation rates and hospital mortality were significantly higher in the old-old group (p=0.001 and p=0.01, respectively). The hospital stay was significantly longer in the old-old group (5.8 vs. 7.8 days, p= 0.02). Complications were significantly higher in the group with a PNI < 40 (49% vs. 23%, p=0.005). There was a significant difference between the two groups regarding 5-year overall survival (33% vs. 55%, p= 0.002).Conclusions:Gastrectomy can be performed on the elderly. However, an increase in complications and in-hospital mortality is recognized over 75. These problems should be considered in this old-age group.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 Metadata only Lower gastrointestinal endoscopy in elderly: A single-center experience(2022-01-01) ERGENÇ, MUHAMMER; UPRAK, TEVFİK KIVILCIM; Ergenç M., Uprak T. K.INTRODUCTION: Endoscopic procedures are frequently applied to the elderly population over 65, with the increased population of this age group. The comorbidities of this population are thought to be increased risk factors for endoscopic interventions. We need more literature on applying lower gastrointestinal endoscopy in the aged. This study aimed to evaluate the efficacy and safety of lower gastrointestinal endoscopy in the elderly population.METHODS: We performed a retrospective observational study of patients over 65 who underwent lower gastrointestinal endoscopy from January 2016 to January 2021 at the Istanbul Sultanbeyli State Hospital Endoscopy Unit. This study was approved by the local Ethics Committee and registered with ClinicalTrials.gov (NCT05012527). A total of 564 patients\" following parameters were analyzed: indications, endoscopic findings, histopathological findings, and complications of lower gastrointestinal endoscopy.RESULTS: The cecal intubation rate was 90% in colonoscopies. The inadequate bowel cleansing rate was 12,4% in colonoscopies and 13% in all lower endoscopy procedures. There was 6 percent malignancy detected. The polyp detection rate is approximately 45% in colonoscopies, and polyps are seen mainly left side of the colon. The overall diagnostic yield rate is 48.7%, and colorectal cancer (CRC) yield is 5.9% on colonoscopies. The complication rate was 1.2%.DISCUSSION AND CONCLUSION: This study showed that colonoscopy in the elderly has a high diagnostic yield and can be applied safely.Publication Metadata only Turkish surgical association annual congress abstract supplement(2018-04-01) ERGENÇ, MUHAMMER; UPRAK, TEVFİK KIVILCIM; YEGEN, ŞEVKET CUMHUR; ATICI, ALİ EMRE; DEMİRBAŞ, BAHA TOLGA; Ergenç M., Uprak T. K., Yegen Ş. C., Atıcı A. E., Demirbaş B. T.Patient with Peutz-Jeghers Syndrome Presenting with Inoperable Periampullary TumorMuhammer Ergenç, Tevfik Kıvılcım Uprak, Şevket Cumhur YeğenDepartment of General Surgery, Marmara University School of Medicine, İstanbul, TurkeyIntroduction:Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited genetic syndrome characterized by multiple hamartomatous polyps and mucocutaneous pigmentation in the gastrointestinal tract. In patients with Peutz-Jeghers syn- drome, the risk of gastrointestinal and non-gastrointestinal malignancies is increased.Case:The patient, who had complaints of weight loss, nausea and vomiting for about 2 months was admitted to the emergency service and then referred to the general surgery unit for further examination and treatment. The patient’s physical examination revealed no evidence of defense-rebound in the abdomen, palpable mass lesions in the periumbilical region were present, and hyperpigmented areas were observed on the lips. The patient had undergone laparotomy about 25 years ago and had no knowl- edge about the reason. In laboratory tests; WBC was 14200, HGB was 10,6, Creatine was 1,51, Albumin was 3,6, and Bilirubin was N. A 10 cm mass at the head of the pancreas was detected in the tomography of the abdomen and the stomach was in a pitotic state. Upper gastrointestinal endoscopy showed polypoid appearance in the stomach fundus, pylorus could not be passed. The exploratory laparotomy was performed. At the head of the pancreas, all the retroperitoneal area filled with tumoral lesion was palpated. Implants on the gall bladder and hepatoduodenal ligaments were observed. Multiple invagination sites were observed in the small intestines and the polyps were palpated after being reduced. Multiple enterotomies were performed and polyps were excised. Gastrojejunostomy was performed on the patient due to duodenal obstruction secondary to lack of oral intake. The implants were biopsied and the operation was terminated. The patient who started the regimen on the postopera- tive 2nd day passed gas on the 3rd day. On the 4th day, the patient who started tolerating the regimen was discharged from the hospital. According to the patient`s pathology, the implants were reported to be compatible with mucinous adenocarcinoma and multiple hamartomatous small intestine polyps.Conclusion:The patient was examined with the pre-diagnosis of gastric outlet obstruction and was detected a mass on the head of the pancreas. The patient was diagnosed with PJ syndrome with multiple PJS type polyps and characteristic pigmenta- tions on the lips. Pancreatic cancer has been reported in 11-36% of patients with Peutz-Jeghers syndrome. Patients and their relatives were informed about PJS family screening.Mass in the Right Lower Quadrant; Retroperitoneal Localized Gastrointestinal Stromal TumorMuhammer Ergenç, Tevfik Kıvılcım Uprak, Şevket Cumhur YeğenDepartment of General Surgery, Marmara University School of Medicine, İstanbul, TurkeyIntroduction:Gastrointestinal stromal tumors (GIST) develop from Cajal cells, which are pacemaker cells responsible for the adjustment of peristalsis in the digestive tract. The prevalence is 7-15 per million. GISTs can be seen in all gastrointestinal tract, in order of frequency; stomach (60%), jejenum and ileum (30%), duodenum (5%) and colorectal (5%). Small intestine GISs may present with a small nodule or a giant tumoral mass. Although the clinical symptoms and signs are generally nonspecific, they may cause gastrointestinal bleeding, intestinal obstruction, pelvic mass, acute pain like appendicitis, tumor rupture and acute abdomen.Case:A 58-year-old woman was admitted to the general surgery outpatient unit with a complaint of abdominal pain. Physicalexamination was unremarkable. In the abdominal USG, a well-defined hypervascular solid lesion 19x19x21 mm in size, in theright lower quadrant of the abdomen was observed; its origin could not be detected. Abdominal computed tomography showed a 21x23 mm lesion in the right lower quadrant adjacent to the psoas muscle. Laparoscopic exploration was performed. Retroperi- toneal area was entered from the ileocecal region. Retroperitoneal area was opened and surrounding of the mass was cleaned and the lesion that was found to be ileum wall originated was resected via endostapler and the operation was terminated. The patient who was comfortable during the abdominal examination on the postop 1st day was started a diet and the patient was discharged. Pathology was reported as 3.5 cm in size, gastrointestinal stromal tumor, with spindle cell, in low risk group.Conclusion:In patients presenting with a mass in the right lower quadrant, the ileal gist should be kept in mind. Laparoscopic mass excision can be performed safely.Our Laparoscopic Splenectomy Experience in Patients with Idiopathic Thrombocytopenic Purpura (ITP) DiagnosisBaha Tolga Demirbaş, Muhammer Ergenç, Ali Emre Atıcı, Şevket Cumhur YeğenDepartment of General Surgery, Marmara University Pendik Hospital, İstanbul, TurkeyObjective:ITP is an autoimmune etiology characterized by blood platelets below 100000/mm3. Its prevalence in the community is 4,000 per 100000. Patients who do not respond to steroid and intravenous immunoglobulin therapy have an indication of sple- nectomy. Laparoscopic splenectomy has been successfully performed in recent years with ITP patients with normal size spleen.Material and Methods:A total of 23 ITP patients underwent laparoscopic splenectomy at Marmara University Pendik Train- ing and Research Hospital between May 2012 and January 2018. The data of these patients were analyzed retrospectively. Of the patients who underwent laparoscopic splenectomy, 12 of them were female and 11 of them were male. The median age of the patients was 33 years. The mean duration of hospitalization of the patients was 4.1 days. No mortality was observed in any patient. Intraoperative and postoperative bleeding were minimal. Therefore, blood transfusion was not required. Atelectasis developed in 1 patient as morbidity.Results:Idiopathic thrombocytopenic purpura is a hematological disease characterized by autoimmune etiology, mucocutane- ous bleedings and low platelet counts. The cause of the disease is the formation of autoantibodies against platelets. Therefore, platelets are rapidly destroyed in the spleen and mucocutaneous and petechial hemorrhages occur as a result of thrombocyto- penia. Hemorrhage may give symptom in the form of menometrorrhagia in gingivas as hematuria or melena. The risk of intracra- nial hemorrhage is high when the platelet count falls below 10000/mm3. The first-line treatment of the disease is 1 mg/kg/day prednisone treatment. Relapses are quite common after 3 weeks of treatment. In this case, intravenous immunoglobulin treat- ment may be given. However, splenectomy is necessary if it does not respond to this treatment. Platelet counts rapidly increase to normal levels after splenectomy in 75-85% of the patients. However, complications such as surgical site infection, pancreatitis and hemorrhage can be seen in 15-20% of patients receiving steroid therapy, with immunosuppressive effect, for a long time before the surgery. Therefore, the application of minimally invasive surgery in patients with ITP suggests that good results can be obtained. In our series, the morbidity rate was 4%. No intraoperative bleeding occurred. We had no mortality.Conclusion:Laparoscopic splenectomy can be performed safely in elective conditions in patients with ITP.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 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.