Person: UPRAK, TEVFİK KIVILCIM
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UPRAK
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TEVFİK KIVILCIM
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Publication Open Access Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Gastric Cancer(SPRINGER INDIA, 2016-03) GÜNAL, ÖMER; Attaallah, Wafi; Uprak, Kivilcim; Gunal, Omer; Yegen, CumhurResearch on the prognostic value of lymph node ratio (LNR) in gastric cancer (GC) remains limited and controversial results were obtained. In this study, we aimed to evaluate whether LNR was an independent prognostic factor for gastric carcinoma. A retrospective review of a database of gastric cancer patients was performed to determine the effect of the LNR on the overall survival (OS) and the disease-free survival (DFS). Of the total 135 patients with gastric cancer who underwent resection between March 2012 and December 2013, 44 patients with non metastatic gastric cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.37 (37 %), the one-year OS rate for LNR <= 37 % was significantly better than that for LNR > 37 % (91.3 % and 61.9 %, respectively, P = 0.02). The one-year DFS for LNR <= 37 % was significantly better than that for LNR > 37 % (91.3 % and 66.7 %, respectively, P = 0.027). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was associated with high pN stage and so associated with worse OS and DFS. Thus, the LNR 37% as a cutoff point was found not to be an independent factor for predicting the one-year OS or DFS in patients with non-metastatic GC. The LNR is a prognostic factor in GC. However, no single cut-off value was determined as an independent prognostic factor.Publication Metadata only Ruptured gastric stromal tumour into gastric lumen with an abscess(WILEY-BLACKWELL, 2014) KAYA, HANDAN; Yardimci, Samet; Uprak, Tevfik Kivilcim; Kombak, Faruk Erdem; Kaya, Handan; Yegen, Sevket CumhurPublication Open Access De novo myeloid sarcoma as a rare cause of small bowel obstruction: CT findings and histopathologic correlation(2019-12) ASLAN, BÜLENT; Aslan, Bülent; Tüney, Davut; Erçetin, Yiğit; Bozkurt, Süheyla Uyar; Uprak, Tevfik KıvılcımPublication 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 Metadata only How do we treat to incidental proximal jejunal tumors during laparoscopic bypass surgery?(2019-10-31) UPRAK, TEVFİK KIVILCIM; AKMERCAN, TAYFUN; GÜNAL, ÖMER; KARATAŞ S. A. , UPRAK T. K. , AKMERCAN T., GÜNAL Ö.Publication Open Access Can Gastric Specimen Measurements Defines the Laparoscopic Sleeve Gastrectomy Outcome?(2018) ERDİM, AYLİN; Günal, Ömer; Uprak, Kıvılcım; Ergenc;, Muhammer; Erdim, AylinPublication Metadata only Subcostal Transversus Abdominis Plane Block for Laparoscopic Sleeve Gastrectomy, Is It Worth the Time?(SPRINGER, 2019) CİNGİ, ASIM; Coskun, Muemin; Yardimci, Samet; Arslantas, Mustafa Kemal; Altun, Gulbin Tore; Uprak, Tevfik Kivilcim; Kara, Yalcin Burak; Cingi, AsimBackgroundObesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients' compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients.MethodsForty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon's choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients' pain was recorded via visual analogue scale (VAS) in postoperative periods.ResultsTwenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18-58) and median BMI was 48 (41.1-68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups' tramadol use.ConclusionsAfter LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG.Publication Metadata only Impact of body mass index on number of lymph nodes retrieved in gastric cancer patients(H.G.E. Update Medical Publishing Ltd., 2014) YEGEN, ŞEVKET CUMHUR; Attaallah W., Uprak K., Javadov M., Yegen C.Background/Aims: The aim of this study was to assess the influence of obesity on the number of the dissected lymph nodes in patients who underwent gastrectomy for gastric adenocarcinoma. Methodology: Thirty eight Patients with gastric adenocarcinoma who underwent curative gastrectomy at one center between April 2012 and December 2012 were eligible for the study. According to their body mass index (BMI) values before surgery patients with BMI >24.9 kg/m2 were defined as obese. Patients with BMI ≤24.9 kg/m2 were defined as normal group. The number of retrieved lymph nodes and metastatic lymph nodes were obtained from pathology reports. Results: Among 38 patients there were 17 (45%) patients had BMI ≤ 24.9kg/m2 (normal group), while 21(%55) patients had BMI > 24.9 kg/m2 (obese group). The median number of retrieved lymph nodes in obese patients who underwent total gastrectomy was significantly higher compared to the normal patients underwent the same procedure. Conclusion: In this study we showed that the obesity affects the outcomes of surgery in gastric cancer. Furthermore, the total number of retrieved lymph nodes in obese patients who underwent total gastrectomy was higher than that in non-obese patients. © H.G.E. Update Medical Publishing S A, Athens.Publication Metadata only Radiofrequency Ablation of Benign Symptomatic Thyroid Nodules: Prospective Safety and Efficacy Study(SPRINGER, 2015) GÜLLÜOĞLU, MAHMUT BAHADIR; Ugurlu, M. Umit; Uprak, Kivilcim; Akpinar, Ihsan N.; Attaallah, Wafi; Yegen, Cumhur; Gulluoglu, Bahadir M.Radiofrequency ablation (RFA) is a relatively novel procedure in the management of benign nodular goiter. This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous RFA for benign symptomatic thyroid nodules as an alternative to surgery. The study involved patients for whom a fine needle aspiration biopsy had proved a diagnosis of benign nodular goiter and had nodule-related symptoms such as dysphagia, cosmetic problems, sensation of foreign body in the neck, hyperthyroidism due to autonomous nodules or fear of malignancy. Percutaneous RFA was performed as an outpatient procedure under local anesthesia. The primary outcome was an evaluation of the changes in symptom scores (0-10) for pain, dysphagia and foreign body sensation at the 1st, 3rd, and 6th months after the RFA procedure. Secondary outcomes were assessing volume changes in nodules, complication rates, and changes in thyroid function status. A total of 33 patients (24 % female, 76 % male) and a total of 65 nodules were included into the study. More than one nodule was treated in 63.6 % of the patients. We found a statistically significant improvement from baseline to values at the 1st, 3rd, and 6th months, respectively, as follows: pain scores (2.9 +/- A 2.7, 2.3 +/- A 2.01, 1.8 +/- A 1.7, and 1.5 +/- A 1.2, p 0.005), dysphagia scores (3.9 +/- A 2.7, 2.6 +/- A 1.9; 1.7 +/- A 1.6, and 1.1 +/- A 0.3, p 0.032), and foreign body sensation scores 3.6 +/- A 3, 2.5 +/- A 2.2; 1.6 +/- A 1.5, and 1.1 +/- A 0.4, p 0.002).The mean pre-treatment nodule volume was 7.3 +/- A 8.3 mL. There was a statistically significant size reduction in the nodules at the 1st, 3rd, and 6th months after RFA (3.5 +/- A 3.8, 2.7 +/- A 3.4, and 1.2 +/- A 1.7 mL, p 0.002). The volume reduction was found to be 74 % at 6th months following the RFA (p 0.005). 8 patients had autonomously functioning nodules in the pre-treatment period, 50 % (n: 4) became euthyroid at the 6th month after RFA. There were no complaints other than pain (12 %). RFA can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results showed that it is a safe and effective procedure.Publication Open Access Effects of preoperative drainage on postoperative complications in patients with periampullary tumors(2019) ATICI, ALİ EMRE; Şafak COŞKUN;Tolga Baha DEMİRBAS;Kivilcim Tevfik UPRAK;Ali Emre ATICI;Cumhur Şevket YEGENAim: Preoperative biliary drainage is suggested for patients with jaundice, considering that surgical operations may increasepostoperative complications in the presence of jaundice. The aim of this study was to test the effect of biliary drainage on possibleserious complications, deaths, or period of hospital stay.Material and Methods: Between January 2012 and June 2016, 160 patients with operable and resectable periampullary tumorswho were diagnosed with periampullary tumors underwent pancreaticoduodenectomy (Whipple’s procedure) in Marmara UniversityPendik Training and Research Hospital, Department of General Surgery. The patients’ demographics, accompanying comorbiddiseases, type of biliary drainage, drainage duration, pre- and post-drainage laboratory data, emerging complications and need forre-hospitalization were recorded retrospectively from the accessible files and records.Results: It was observed that out of 158 patients with periampullary tumors, 116 that were operated with drainage had a higheroccurrence of surgical site infections and anastomotic leaks, compared to the 42 patients that were operated without drainage.Similarly, when patient results were classified according to the Clavien-Dindo complication classification, the ratio was againagainst the patients that were operated with drainage. Drainage patients stayed in the hospital for a longer period; however, in termsof pancreatic fistula, re-hospitalization, need for intensive care and relaparotomy ratios, and especially in terms of mortality ratios, adifference between two patient groups was not observed.Conclusion: Investigating the data collected from patients that were operated without drainage, and specifically considering thebilirubin values of the patients who had complications, there was no threshold identified that contributed to a higher likeliness ofcomplications. Consequently, even though there were no results to motivate recommending drainage, it was concluded that applyingdrainage does not create any difference in short-term prognosis, but drainage increases infectious complications.