Person: ERMERAK, NEZİH ONUR
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ERMERAK
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NEZİH ONUR
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Publication Open Access Esophageal perforation during intragastric balloon therapy: management of a patient with late referral(2023-01-01) ERMERAK, NEZİH ONUR; UPRAK, TEVFİK KIVILCIM; LAÇİN, TUNÇ; YILDIZELİ, BEDRETTİN; YEGEN, ŞEVKET CUMHUR; ERMERAK N. O., Uprak K. T., Emran M., LAÇİN T., YILDIZELİ B., YEGEN Ş. C.Minimally invasive treatment modalities like intragastric balloon therapy (IBT) gained popularity in the treatment of obesity [1]. Some morbidities have been reported in the literature, but it is limited. Esophageal perforation is the most feared complication of the procedure. Although endoscopic stent placement can be chosen as a treatment option in stable patients, most of the patients are treated with surgical drainage and primary repair [2]. We report an unusual case of intragastric balloon placement complicated with esophageal perforation which was successfully treated with a surgical approach after late referral.Publication Open Access Minimally Invasive Repair of Pectus Carinatum(ELSEVIER SCIENCE INC, 2018-03) ERMERAK, NEZİH ONUR; Yuksel, Mustafa; Lacin, Tunc; Ermerak, Nezih Onur; Sirzai, Esra Yamansavci; Sayan, BihterBackground. The second most common deformity of the anterior chest wall, pectus carinatum, is a diverse deformity that has been largely managed using open techniques. This study reviews clinical experience with a newly designed bar for minimally invasive repair of pectus carinatum. Methods. We reviewed the records of all patients recorded in our Chest Wall Deformities Clinical Database. Between January 2006 and November 2016, minimally invasive repair of pectus carinatum was performed in 172 patients. All met the criteria of a compression test of 10 to 25 kg/cm(2). The mean age was 17.3 years, and 22.7% had a positive family history of a congenital chest wall deformity. Symmetric and asymmetric deformities were treated. During our study period, we designed 4 different bar configurations and their related stabilizers. All patients are assessed every 3 to 6 months. After 2 to 3 years of follow-up, the bar and the stabilizers are removed. Results. Of 172 patients, 97.1% tolerated the procedure very well. The operation was a mean length 76.6 minutes. Average blood loss was 40 mL. Mean hospital length of stay was 3.7 days. Complications included pneumothorax, wire breakdown/rib cut, wound infection, severe pain, skin hyperpigmentation, nickel allergy, and overcorrection leading to excavatum. Patients returned to routine activity in 10 to 14 days. With a mean follow-up of 29.8 months in bar removal patients, 130 of 172 (93.8%) reported excellent results. Conclusions. Minimally invasive repair of pectus carinatum with the technically modified fourth-generation bar and its securing system has advantages of low morbidity, short hospital stay, and excellent cosmetic results, even in asymmetric cases. (C) 2018 by The Society of Thoracic SurgeonsPublication Open Access Risk of serious perioperative complications with removal of double bars following the Nuss procedure(OXFORD UNIV PRESS, 2016-10-20) ERMERAK, NEZİH ONUR; Bilgi, Zeynep; Ermerak, Nezih Onur; Cetinkaya, Cagatay; Lacin, Tunc; Yuksel, MustafaOBJECTIVES: The aim of this study is to present our experience with Nuss bar removal and evaluate potential risk factors. The Nuss procedure requires an operation to remove the bar 2-3 years after the initial correction. Although removal of the bar is generally believed to be safe, perioperative complications including major bleeding can occur. METHODS: All cases involving removal of the Nuss bar done since April 2007 were recorded in a prospective database. Data were collected on the amount of blood loss, the number of diagnostic interventions, operative management and postoperative course. RESULTS: Of a total of 246 ( 162 with single bars, 80 with double bars, 4 with triple bars) cases, 43 patients (17.5%) experienced perioperative complications. Five patients underwent secondary postoperative interventions; one patient required same-session emergency videoassisted thoracic surgery (VATS) due to major bleeding. Patients who had complications were significantly older than patients with no complications (20.5 +/- 6.5 years vs 17.2 +/- 5.9 years, P = 0.002). People having double bars removed were significantly more likely to have perioperative complications (12% vs 27%, P = 0.03) and complications requiring secondary interventions (n = 1 for a single bar, n = 5 for double bars, P = 0.01). CONCLUSIONS: Major complications after removal of the Nuss bar occur with some frequency. Although the double-bar removals in our cohort were associated with major complications, the reasons are poorly understood. Immediate management of the complications may require multidisciplinary care. Multicentric pooling of cases is needed for better risk stratification.Publication Open Access Production of 3D-printed ribs with a novel material (Nylon 680 Co-Polymer) for chest wall reconstruction on a pig model: Preliminary results of an experimental study(2023-09-01) ERMERAK, NEZİH ONUR; LAÇİN, TUNÇ; ERBARUT SEVEN, İPEK; ERMERAK N. O., YÜKSEL M., Yüksel B., LAÇİN T., ERBARUT SEVEN İ., LAÇİN B.Aim: Three-dimensional (3D) printing has gained popularity among all fields of science in recent years. New research studies about the utilization of 3D printing in the medical field, in terms of medical devices and implants, have been published recently. We tried to adapt this technology into thoracic surgery by implanting 3D produced ribs following chest wall resection with a novel material called Nylon 680 Co-Polymer. We, hereby, present the preliminary results of this experimental study. Materials and Methods: We ordered multi detector computerized tomography of the chest for 2 pigs. We measured the area that we planned to resect on chest wall and used the data for printing custom-made rib for the reconstruction of the resected area. Then, we produced ribs with a USA Food and Drug Administration approved material called Nylon 680 Co-polymer (Taulman 3D, Saint Peters, MO, USA) by using 3D printer (Afinia H480, Chanhassen, MO, USA). Pigs were operated under general anesthesia and the resected areas were reconstructed with custom-made 3D printed ribs. Results: One of the pigs passed away due to myocardial infarction while waking up from anesthesia. We followed up the other pig for 45 days. Then, we sacrificed the animal and resected the operated part for histopathological evaluation. Histopathologic evaluation revealed moderate chronic inflammation with few giant cells containing pigmented foreign bodies. Conclusion: Although we need more studies, it is an important step for adapting 3D-printing into thoracic surgery. Additionally, it is important to identify a potential new material (Nylon 680 Co-polymer) for the future studies. We can use this new material for 3D-printed implant and mesh production, which enables us to produce custom-made products with lower cost in shorter timePublication Open Access Evaluation of the internal thoracic artery blood flow before and after Nuss operation: is it reversible?(MARMARA UNIV, FAC MEDICINE, 2017-01-15) BEKİROĞLU, GÜLNAZ NURAL; Kuru-Bektasoglu, Pinar; Ermerak, Nezih Onur; Cimsit, Canan; Cetinkaya, Cagatay; Ozbakir, Hincal; Bekiroglu, Nural; Lacin, Tunc; Yuksel, MustafaObjective: Obstruction of the internal thoracic arteries (ITAs) by the Nuss bars in minimally invasive repair of pectus excavatum (MIRPE) has been documented in the literature. In this study, we aim to investigate the patency of ITAs before and after repair of the pectus excavatum with the Nuss procedure, by using color Doppler ultrasonography (US). Materials and Methods: Nineteen patients who underwent Nuss procedure were included in this study prospectively. Color Doppler US examinations were performed for comparing ITA patency after insertion of the Nuss bars and after their removal. Patients were evaluated according to gender, age, symmetry of deformity, Haller index, and the number of Nuss bars inserted. Results: Nineteen patients operated with MIRPE (17 male and 2 females with a mean age 21.78 +/- 6.35) were enrolled in the study. Eight patients (42.1%) with normal ITA blood flow preoperatively had normal blood flow after removal of the bar. In preoperative examination, 6 patients had bilateral (n=2) or unilateral (n=4) obstruction of the ITA and 5 patients had bilateral (n=2) or unilateral (n=3) abnormally disturbed flow. After the bar removal only 2 (10%) of the affected patients (57.9 %) still had obstruction whereas patent blood flow of the ITAs has been noted in 9 patients. Conclusion: We have shown that after the Nuss bar removal, only 10% of the ITAs are compromised.