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KIYAN, GÜRSU

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GÜRSU

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Author: ERGELEN, RABİA × Has files: true ×

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    PublicationOpen Access
    Making decisions for surgical intervention in neonates with necrotizing enterocolitis and the selection of appropriate surgical intervention
    (MARMARA UNIV, FAC MEDICINE, 2017-01-15) MEMİŞOĞLU, ASLI; Karadeniz Cerit, Kivilcim; Ergelen, Rabia; Abdullayev, Tural; Unkar, Zeynep Alp; Memisoglu, Asli; Kiyan, Gursu; Dagli, E. Tolga
    Objective: Necrotizing enterocolitis (NEC) is one of the most common conditions requiring surgical intervention in the neonatal period. The decision for surgical intervention in NEC is difficult and the surgical procedures differ according to the condition of the patient. This study assesses the decision for surgical intervention in patients being followed with a preliminary diagnosis of NEC and the appropriate surgical procedure. Material and Method: The files of patients undergoing surgery with a diagnosis of NEC at the Marmara University Hospital Neonatal Intensive Care Unit between 15.07.2013-15.07.2015 were studied retrospectively. Patients were evaluated for the following: gestational age, birth weight, gender, time of onset of symptoms, abdominal distention, tenderness, presence of abdominal erythema, hypotension, acidosis, thrombocytopenia, radiological findings, surgical timing and post-operative follow up. Results: A total of 10 neonates (7 boys, 3 girls) were treated surgically with an NEC diagnosis. The average gestational age of the patients was 27.6 weeks (22-37 weeks), and the median birth weight was 710 grams (400-3750). Average onset of symptoms was found to be 8.1 days (2-30) postnatally. Abdominal distention and tenderness (10), hypotension (4), and abdominal erythema (3) were observed in patients upon physical examination. Acidosis (7) and thrombocytopenia (6) were observed in patients in laboratory findings. Free fluid (4), thickening of the intestinal wall ans (3), pneumatosis intestinalis (1), portal venous gas (1) were observed in patients during the assessment of the abdominal ultrasonography (US). Three patients whose direct x-ray evaluations were grade III underwent peritoneal drainage. The drain site of one of these patients closed by itself, and there was no need for further surgery for the patient. Laparotomy was carried out a day after clinical stabilization was achieved. Our third patient, the lowest birth weight in our series, was lost immediately following the peritoneal drainage process. Peritoneal drainage was planned in two other grade III patients based on the radiological findings. However, due to the appearance of necrotic bowel segments from the incision site, they underwent bowel resection and ileostomy during a bedside laparotomy. One of these patients improved clinically, but the other patient was lost in the early stages. Due to the deterioration seen in the clinical findings of 5 patients who were radiologically grade II, the decision for laparotomy was made initially. All of these 5 patients were discharged after an uneventful postoperative period. Conclusion: In patients who are grade II radiologically, the decision for surgical intervention in an operating room can be made according to clinical deterioration. In infants who are grade III, and whose clinical condition is poor, bedside surgical intervention in the neonatal intensive care unit is preferable..
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    PublicationOpen Access
    The effectiveness of non-operative treatment in high-grade liver and spleen injury in children
    (TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2018) KIYAN, GÜRSU; Cerit, Kivilcim Karadeniz; Ergelen, Rabia; Abdullayev, Tural; Tugtepe, Halil; Dagli, Tolga Emrullah; Kiyan, Gursu
    BACKGROUND: Although a nonoperative treatment approach is preferred for blunt liver and spleen trauma in childhood, there are significant differences between clinics in the algorithms used. The approach to high-grade liver and spleen injury is still controversial, particularly as grade V liver and spleen injuries are not included in the American Pediatric Surgical Association guideline. The aim of this study was to present experience with a non-operative treatment approach to children with high-grade liver and spleen injuries. METHODS: Pediatric patients who were referred to Marmara University Hospital's emergency department between January 2012 and January 2017 due to liver and spleen injury related to blunt abdominal trauma and who were followed up in the clinic were included in the study. The data were analyzed retrospectively in terms of age, sex, type of trauma, degree of organ damage, accompanying organ damage, duration of intensive care unit (ICU) and hospital stay, need for transfusion, and treatment method (operative-nonoperative). Grade I, II, or III organ damage was classified as low-grade, while grade IV and V organ lesions were classified as high-grade. RESULTS: Of 2800 patients who were diagnosed by radiological imaging with liver and spleen injuries due to blunt abdominal trauma and hospitalized in the clinic, 88 were included in the study. Isolated liver injury was determined in 41 patients, while 39 had an isolated spleen injury, and 8 had injuries to both organs. An accompanying organ injury was observed in 30 (34%) patients. In all, 83 (94%) patients underwent non-operative treatment and a surgical approach was required for 5 patients (6%). Patients with high-grade liver injury had a significantly longer period of hospitalization, duration of ICU stay, and greater transfusion requirement, compared with patients with low-grade liver injury (p=0.001, 0.001, and <0.001, respectively). A surgical approach was more common among patients with a high-grade liver injury than for patients with a low-grade injury (p=0.045). There was no significant difference between patients with a high- or low-grade spleen injury in terms of age, sex, duration of hospitalization, duration of ICU stay, transfusion requirement, or accompanying organ injury (p=0.254, 0.739, 0.114, 0.135, 0.057, 0.721, respectively). Similarly, there was no significant difference in terms of non-surgical or surgical treatment approach between the patients with high-grade spleen injury and those with low-grade spleen injury (p=0.488). CONCLUSION: Non-operative treatment is a feasible treatment method in pediatric patients with a high-grade blunt liver or spleen injury. Nonetheless, pediatric surgeons should bear in mind that patients with high-grade liver damage may require more surgical treatment.