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 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 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 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.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 Recommendation Versus Current Status: Retrospective Analysis of Age to Circumcise in a District Hospital(2023-01-01) UPRAK, TEVFİK KIVILCIM; Ergenc M., UPRAK T. K.Introduction: Circumcision is one of the oldest and most frequently performed surgeries worldwide. The age of circumcision varies according to the country and region. We aimed to analyze the age of circumcision in our hospital. Methods: We evaluated the children who underwent circumcision at Istanbul Sultanbeyli State Hospital between February 2012 and February 2022. The following parameters were analyzed: age at operation, surgery date, and surgeon provider type. Children’s age at operation were categorized as follows: neonatal period (<30 days), infancy (≥31 days and <1 year), early childhood (≥1 year and <5 years), late childhood (≥5 years and <13 years), and adolescence (≥13 years and ≤17 years). Results: Seventeen thousand three hundred forty-five children were analyzed. Children’s ages ranged from 0 to 209 months; the median age was 4.07 [interquartile range (IQR) 1.82-6.33] years. The percentage of the neonatal period, infancy, early childhood, late childhood, and adolescence were 1.1%, 13.6%, 46.3%, 38%, and 1%, respectively. Urology performed the most circumcisions in any age group (8374, 48.3%), followed by general surgery (4818, 27.8%) and pediatric surgery (4153, 23.9%). In all surgeon provider types, circumcision was performed primarily in early childhood. Conclusion: Our study showed that most circumcision operations were performed in the inappropriate age range. A multidisciplinary effort is needed to implement healthcare professionals’ recommendations from the neonatal period. Keywords: Circumcision, male circumcision, age of circumcision, neonates, infantPublication Open Access YouTube as a source of information on Helicobacter pylori: Content and quality analysis(2023-01-01) UPRAK, TEVFİK KIVILCIM; Ergenç M., UPRAK T. K.Background: Helicobacter pylori infection is the most common cause of infectious diseases worldwide, and management is a current and vital problem for physicians and patients. One of the online platforms that people use most to access health information is YouTube. Therefore, this study aimed to evaluate the quality and reliability of H. pylori information videos on YouTube. Materials and Methods: The \"Helicobacter pylori\" keyword was searched with default filters on YouTube. Two hundred videos were evaluated. The source of videos was categorized as academic institutions, professional organizations, physicians, healthcare professionals other than physicians, health information websites, and independent users. The target audience of the videos was classified as patients and healthcare professionals. The Global Quality Scale (GQS), JAMA, and modified DISCERN video scores were obtained by taking the average of the scores given by the two authors. Results: Seventy-four videos were analyzed, and the median duration was 9.25 (range: 1.14–121) min. The target audience of 43 (58.1%) videos was healthcare professionals, and 31 (41.9%) videos were for patients. There was no correlation between likes, dislikes, views, and the quality-usefulness of the videos. Video characteristics such as duration, likes, number of views, and time since video upload day were not associated with the source. The JAMA and DISCERN scores were significantly higher in academic institutions than in other sources. Health information websites had a significantly higher GQS score than other video sources (p =.01). In comparison, there was no significant difference between the target audience (patients and healthcare professionals) in terms of JAMA, modified DISCERN, and GQS scores. Conclusions: YouTube has numerous videos for healthcare information nowadays. Although the quality and reliability of YouTube videos on H. pylori are average according to common scoring systems, we recommend videos produced by academic institutions and health information websites to inform patients.Publication Open Access Does Gastric Expansibility Affect Weight Loss Success After Laparoscopic Sleeve Gastrectomy?(2022-08-01) UPRAK, TEVFİK KIVILCIM; ERDİM, AYLİN; KARATAŞ, SABRİ ALPER; GÜNAL, ÖMER; UPRAK T. K. , ERDİM A., Karatas S. A. , GÜNAL Ö.; Marmara Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri BölümüReduced excess weight loss (EWL) or regain is a worrying problem after metabolic surgery. Factors attainable from the resected specimen that can predict this outcome are investigated. We retrospectively analyzed 64 patients who had undergone laparoscopic sleeve gastrectomy. We collected demographic data, preoperative gastric emptying measurements, volume, expansion capacity, and 6-dimensional measurements of sleeve gastrectomy specimens. Correlations between EWL, body mass index levels, and gastric specimen measurements related to gastric remnant dimensions were also scrutinized. We found a significant correlation between the gastric specimen and remnant gastric volume, the resection line length in the gastric specimen, and 12th-month EWL%. Antrum expansibility was significantly increased in patients with weight regain. There was also a negative correlation between weight loss and age at postoperative first and third years. Sleeve resection line measurement and resected antrum diameter measurements can be used to predict weight loss, especially in the first year postoperatively.