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ERGENÇ, MUHAMMER

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    PublicationOpen 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.
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    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.
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    PublicationOpen 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.
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    Laparoskopik sleeve gastrektomi sonuçlarımız
    (2015-04-26) KARPUZ, ŞAKİR; ERGENÇ, MUHAMMER; GÜNAL, ÖMER; BAT O., ATTAALLAH W., KARPUZ Ş., ERGENÇ M., ERTEKİN S. Ç., GÜNAL Ö.
    Amaç: Bu çalışmada 2,5 yılda tek cerrah tarafından yapılan sleeve gastrektomi sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Mayıs 2012 ile Aralık 2014 tarihleri arasında ardışık sleeve gastrektomi yapılan hastaların dosyaları geriye dönük incelendi. Hastaların demografik özellikleri, ameliyat süreleri, taburculuk süreleri, komplikasyon gelişimi, takip kiloları, ek hastalıklarının durumu kaydedildi. Bulgular: Çalışmaya 320 hasta alındı. Hastaların 92›si (%28,8) erkek, 228›i (%71,2) kadındı. Yaş ortalaması 36,6 yıldı. Ameliyat öncesi vücut kitle indeksi (vki) ortalamaları 45,7 kg/m2 idi. Ortalama ameliyat süresi 56,5 dakikaydı. Ortalama taburculuk süresi 3,9 (3-87) gündü. Postoperatif 30 günlük dönemde 5 (%1,6) hastada kaçak, 3 (%0,9) hastada stapler hattından kanama, 2’şer (%0,6) hastada trokar yerinden kanama, karın içi abse, cerrahi alan enfeksiyonu ve 1’er (%0,3) hastada pulmoner emboli, safra kaçağı ve pnömoni gelişti. Pulmoner emboli olan hasta postoperatif 1. gün exitus oldu. 1-3-6- 9-12-18 ve 24. aylarda fazla kilo kayıpları sırasıyla %23,7, %44,6, %58,9, %65,6, %69,2, %67,9, %62,2 olarak bulundu. Hastaların 79’unda(%24,8) hipertansiyon vardı. Bunların 63’ünde(%79,7) antihipertansif tedavi kesildi, 2’sinde(%2,5) ise ilaç dozu azaltıldı. 52(%16,4) hastada tip 2 diyabet vardı. 37’sinde(%71,1) insülin ve/veya oral antidiyabetik ilaçlar (OAD) kesildi, 6’sında(%11,5) insülinden OAD’ye geçildi, 5’inde(%9,6) ise ilaç dozu azaltıldı. 59(%18,6) hastada hiperlipidemi vardı ve bunların 26’sında(%44,1) hiperlipidemi düzeldi. 13(%4,1) hastada astım vardı ve 9’unda(%69,2) tedavi gerektiren semptomlar geriledi. Uyku apne sendromu olan 12(%3,8) hastanın 11’inde(%91,7) tamamen düzelme oldu. Sonuç: Laparoskopik sleeve gastrektomi, diğer bariatrik cerrahi yöntemlerine göre uygulanması daha kolay ve sonuçları da en az onlar kadar yüz güldürücüdür. Ancak uzun stapler hattından dolayı komplikasyon gelişimi riski de göz önünde bulundurulmalıdır.
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    PublicationOpen 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.
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    Enhanced recovery after pancreatic surgery: A prospective randomized controlled clinical trial
    (WILEY, 2021) ERGENÇ, MUHAMMER; Ergenc, Muhammer; Karpuz, Sakir; Ergenc, Merve; Yegen, Cumhur
    Background and Objectives The enhanced recovery after surgery (ERAS) protocol is a perioperative care bundle designed to achieve early healing after surgical procedures. This study aims to investigate the effect of the ERAS protocol on postoperative complications, length of hospital stay (LOS), and readmission rates in pancreatic surgery patients. Methods The study was designed as a prospective and randomized controlled study between January 2016 and November 2018 on pancreatic surgery patients. A total of 38 patients were analyzed, 18 of whom were in the ERAS group and 20 in the control group. Patient demographics, intraoperative variables, and postoperative outcomes were recorded. Results The groups were similar regarding age, sex, surgery type, American Society of Anesthesiologists scores, and laboratory results. There was no significant difference in the intraoperative variables. Early oral feeding was preferred, mostly in the ERAS group compared to the control group. Perioperative complication rates, including delayed gastric emptying and pancreatic fistula, LOS, and readmission rates, were similar between the two groups. Conclusions The ERAS protocol provided a minimal decrease in the total complication rates and had no effect on severe complications. Therefore, the ERAS protocol seems feasible and can be applied safely in pancreatic surgery patients.
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    Perkütan Endoskopik Gastrostomi
    (Akademisyen Kitabevi, 2022-01-01) ERGENÇ, MUHAMMER; ERGENÇ M.
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    PublicationOpen 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.
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    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.
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    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.