Person: UPRAK, TEVFİK KIVILCIM
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UPRAK
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TEVFİK KIVILCIM
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Publication Open Access Factors Predicting Surgical Treatment in Patients with Adhesive Small Bowel Obstruction: Retrospective Single-centre Study(2022-09-01) UPRAK, TEVFİK KIVILCIM; AKIN, MUHAMMED İKBAL; COŞKUN, MÜMİN; YEGEN, ŞEVKET CUMHUR; UPRAK T. K. , AKIN M. İ. , COŞKUN M., Yegen C.Objective: To investigate the factors which predict treatment strategy in patients with adhesive small bowel obstruction.Study Design: Descriptive study.Place and Duration of Study: General Surgery Clinic, Marmara University Medical Faculty, Istanbul, Turkey, between January 2016 and December 2020. Methodology: Data of the patients with adhesive small bowel obstruction (ASBO) was retrospectively collected. The demo-graphic characteristics and laboratory findings were evaluated. Patients, who underwent conservative treatment and surgical intervention, were compared. Differences between the two groups in terms of demographic characteristics, prognostic nutri-tional index (PNI) scores, and neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), were evaluated.Results: One-hundred thirty-seven patients were included in the study. Seventy-four (54%) of the patients had conservative treatment. There was no statistically significant difference between the surgical and conservative treatment groups according to the age, gender, and ASA score (p=0.77, 0.21 and 0.95 respectively). The patients with congenital aetiology and low PNI scores were in significantly higher numbers among the surgical treatment group (p <0.001 and p=0.004, respectively). In patients, who underwent surgery, the resection rate was found significantly higher in older age (63 vs. 52, p=0.01).Conclusion: Patients with low PNI scores and congenital adhesive small bowel obstruction undergo operative treatment more frequently than conservative treatment. Future studies focusing on diagnostic scores to predict early surgery in ASBO patients may include these variables.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 Open Access Pancreatic neuroendocrine tumor mimicking intraductal papillary mucinous neoplasm: Case report(2021-01-01) AKMERCAN, AHMET; BAĞCI ÇULÇİ, PELİN; ATICI, ALİ EMRE; YEGEN, ŞEVKET CUMHUR; UPRAK, TEVFİK KIVILCIM; AKMERCAN A., UPRAK T. K., BAĞCI ÇULÇİ P., ATICI A. E., YEGEN Ş. C.ABSTRACTPancreatic neuroendocrine tumors (PanNETs) are rare pancreatic tumors. They usually exhibit parenchymal growing, however some cases can exhibit intraductal growing. PanNET with intraductal growth may cause intraductal papillary mucinous neoplasm (IPMN)- like clinic scenario by presenting as cystic formations secondary to duct obstruction. In our case, a 69-year- old man with a history of abdominal pain and nausea underwent a computed tomography scan that showed dilated pancreatic duct and cystic lesion which was 8 cm originating from the pancreas. Imaging and laboratory findings were considered to be consistent with an IPMN so the patient underwent distal pancreatectomy and splenectomy. However, the pathological examination of the surgical specimen showed a millimeter-sized PanNET located in pancreatic tail mimicking the IPMN by obstructing the pancreatic duct.Keywords: Gastroenteropancreatic neuroendocrine tumor; pancreatic intraductal neoplasmsPublication 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 Appendiceal diverticulitis presenting as acute appendicitis and diagnosed after appendectomy(2022-03-01) UPRAK, TEVFİK KIVILCIM; Ergenc M., UPRAK T. K.IntroductionIntroduction Diverticular disease of the appendix (DDA) is a rare appendiceal pathology. It is usually present similar to acute appendicitis. Because of its rarity, the DDA is poorly comprehended. This study evaluates the incidence, clinical and pathological characteristics of appendiceal diverticulitis diagnosed after appendectomy. Methods We performed a retrospective analysis of patients who underwent appendectomy between January 2016 and January 2022 at the Istanbul Sultanbeyli State Hospital General Surgery Clinic. The following parameters were analyzed: age and gender, preoperative diagnosis, laboratory results, radiological imaging findings, surgical technique, histopathological examination of specimens, and complications. Results A total of 1586 patients were analyzed. In the pathology, diverticular disease of the appendix was detected in 10 patients (0.63%). The DDA patients’ mean age was 34.4 years, and the male to female ratio was 4:1. We detected low-grade appendiceal mucinous neoplasia in one of our patients. Conclusion Appendiceal diverticulitis is rare and usually presents as acute appendicitis. Most DDAs are detected incidentally during the postoperative period and are associated with an increased risk of appendiceal neoplasm. Appendectomy specimens should be carefully examined histopathologically to detect diverticular disease of the appendix.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 Metadata only Senkron kardioözofageal bileşke tümörü ile birlikte özofagus schwannomu - nadir bir olgu sunumu(2022-03-25) ÖZOCAK, AYŞEGÜL BAHAR; UPRAK, TEVFİK KIVILCIM; YEGEN, ŞEVKET CUMHUR; Özocak A. B., Uprak T. K., Yegen Ş. C.Publication Open Access A spontaneous transomental hernia: A rare cause of bowel obstruction(2023-01-01) UPRAK, TEVFİK KIVILCIM; Ergenc M., UPRAK T. K.Internal hernias (IH) are rare situations that account for 0.5-3% of all cases of intestinal obstruction. Transomental hernia is a rare subtype, hardly diagnosed, and represents approximately only 2% of internal hernias. In 2018, a 41-year-old female patient presented to Marmara University Hospital emergency service with abdominal pain, nausea, and vomiting. Her medical history included asthma, and she had no abdominal surgery. With the preliminary diagnosis of small bowel obstruction, laparotomy was done and showed a loop of ileum was herniated through into an unusual defect of the omentum. The obstructed loop of the small intestine into the hernia site was reduced. It was seen as viable, so no resection was necessitated. We divided the greater omentum into two parts from the edge of the defect area to prevent recurrences. The patient\"s postoperative period was uneventful, and she was discharged on the second postoperative day. Small bowel strangulation is more seen in transomental hernia than in other internal hernia types. So it is related to high morbidity and mortality. Surgery should not be delayed to reduce complications.Publication Open Access Gender-specific prevalence of sacrococcygeal pilonidal sinus disease in Turkey: A retrospective analysis of a large cohort(2022-09-01) UPRAK, TEVFİK KIVILCIM; Ergenc M., UPRAK T. K.Background Many studies have been carried out to find the optimal treatment for pilonidal sinus disease (PSD), but the gender-specific prevalence in Turkey has not been revealed. Therefore, this article evaluated patients diagnosed with pilonidal sinus disease in our hospital. We aimed to analyze the gender ratio in PSD. Methods We evaluated patients admitted and who underwent pilonidal sinus excision at the Istanbul Sultanbeyli State Hospital between January 2010 and January 2022. Patients with missing data, multiple admissions, and multiple surgeries of the same patient were excluded from the analyses. Patients were stratified according to age into two groups: = 18 (adult). Age and gender, diagnosis at admission, and operation status were analyzed. Results A total of 10,324 PSD patients were analyzed. 24.8% (n = 2559) of the patients were female and 75.2% (n = 7765) were male. Patients\" ages ranged from 13 to 86 years; the mean age was 26.5 years. Of all patients, 1621 (15.7%) had an abscess at the time of diagnosis. 4345 pilonidal sinus surgery cases were evaluated; 25.3% (n = 1100) of the patients were female and 74.7% (n = 3245) were male. The girl/boy ratio of PSD in teenagers was 0.86, and the female/male ratio of PSD in patients aged 18 years and older was 0.27. Conclusion The female gender prevalence of sacrococcygeal pilonidal sinus disease is 25% in Turkey. Pilonidal sinus disease surgery is mainly performed in secondary care hospitals; therefore, unpublished data from these centers may contribute more to pilonidal sinus disease research.