Person: YILDIZELİ, BEDRETTİN
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YILDIZELİ
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BEDRETTİN
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Publication Open Access Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy(MOSBY-ELSEVIER, 2016-02) YILDIZELİ, BEDRETTİN; Batirel, Hasan Fevzi; Metintas, Muzaffer; Caglar, Hale Basak; Ak, Guntulu; Yumuk, Perran Fulden; Yildizeli, Bedrettin; Yuksel, MustafaObjective: We changed our surgical approach to malignant pleural mesothelioma (MPM) in August 2011 and adopted pleurectomy and decortication (PD) instead of extrapleural pneumonectomy (EPP). In this study, we analyzed our perioperative and survival results during the 2 periods. Methods: All patients who underwent surgical intervention for MPM during 2003-2014 were included. Data were retrospectively analyzed from a prospective database. Before August 2011, patients underwent evaluation for EPP and adjuvant chemoradiation (group 1). After August 2011, patients were evaluated for PD and adjuvant chemotherapy and/or radiation (group 2). Demographic characteristics, surgical technique, histology, side, completeness of resection, and types of treatments were recorded. Statistics was performed using Student t test, chi(2) tests, uni- and multivariate regression, and Kaplan-Meier survival analysis. Results: The same surgical team operated on 130 patients. Median age was 55.7 years (range, 26-80 years) and 76 were men. EPP and extended PD was performed in 72 patients. Ninety-day mortality was 10%. Median survival was 17.8 months with a 5-year survival rate of 14%. Uni- and multivariate analyses showed that epithelioid histology, stage N0, and trimodality treatment were associated with better survival (P=.039, P=.012, and P<.001, respectively). Demographic variables and overall survival (15.6 vs 19.6 months, respectively) were similar between the groups, whereas nonepithelioid histology, use of preoperative chemotherapy, and incomplete resections were more frequent in group 2 (P<.001, P<.001, and P=.006, respectively). Follow-up was shorter in group 2 (22.5 +/- 20.6 vs 16.4 +/- 10.9 months; P<.001). Conclusions: Adoption of PD as the main surgical approach is not associated with survival disadvantage in the surgical treatment of MPM.Publication Open Access No Adverse Outcomes of Video-Assisted Thoracoscopic Surgery Resection of cT2 Non-Small Cell Lung Cancer during the Learning Curve Period(2017-08-05) YILDIZELİ, BEDRETTİN; Bilgi, Zeynep; Batırel, Hasan Fevzi; Yıldızeli, Bedrettin; Bostancı, Korkut; Laçin, Tunç; Yüksel, MustafaPublication Open Access Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes(OXFORD UNIV PRESS INC, 2010-05) YILDIZELİ, BEDRETTİN; Ozyurtkan, Mehmet Oguzhan; Yildizeli, Bedrettin; Kuscu, Kemal; Bekiroglu, Nural; Bostanci, Korkut; Batirel, Hasan Fevzi; Yuksel, MustafaObjective: Postoperative psychiatric disorders (PPDs) may complicate the post-surgical outcome. We analysed the types, incidences, risk factors and outcomes of the PPDs in non-cardiac thoracic surgery patients. Methods: All patients (n = 100) undergoing major non-cardiac thoracic surgery from January 2004 to March 2005 were investigated prospectively. The diagnosis of PPD was made based on the Diagnosis and Statistical Manual of Mental Disorders. The patients were grouped into two according to the presence (group I) or absence (group II) of PPD. Data on pre-, per- and postoperative factors, and the adverse outcomes were analysed. Results: Eighteen patients (18%) developed PPD, including delirium in 44%, adjustment disorders in 22%, panic attack in 17%, minor depression in 11% and psychosis in 6%. The patients who developed PPD were older (58 +/- 17 vs 50 +/- 15 years, p = 0.05), had a longer operation time (6 +/- 1 vs 5 +/- 2 h, p = 0.015) and hospital stay (13 +/- 9 vs 8 +/- 5 days, p = 0.019). The morbidity and mortality rates were not significantly different between the groups (67% vs 46%; 11% vs 1%, respectively). The causative factors in the development of PPD were older age, longer operation time, abnormal serum chemistry values of sodium, potassium, calcium and glucose, hypoalbuminaemia, the presence of the postoperative respiratory distress and infection and blood transfusion (p < 0.05). Conclusions: PPDs are associated with adverse outcomes including a longer hospital stay, and increased morbidity and mortality rates. The identification, detection and elimination of these risk factors are recommended. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.Publication Metadata only What is the optimal postoperative oral feeding timing protocol for thoracotomy patients? Prospective randomized clinical trial on postoperative complications(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2017) YILDIZELİ, BEDRETTİN; Evman, Serdar; Akoglu, Haldun; Yildizeli, Bedrettin; Batirel, Hasan Fevzi; Yuksel, MustafaBackground: This study aims to determine the optimal postoperative oral feeding initiating time with the lowest postoperative pulmonary complication rate in thoracotomy patients and compare cardiac and psychiatric complication rates caused by different feeding schemes. Methods: The study included 107 consecutive patients (84 males, 23 females; mean age 53.9 years; range 17 to 81 years) planned to undergo lung resection via elective thoracotomy for both benign and malignant pathologies in a single institution during a time period of two years. Patients were prospectively randomized into three groups according to postoperative oral intake initiation time: oral intake was initiated on the postoperative sixth hour in group 1, 24th hour in group 2, and when bowel functions resumed in group 3. Groups were then compared in terms of postoperative complication rates. Results: Groups were homogenous according to demographic properties. Twenty patients (18.7%) developed postoperative pulmonary complications: four (11.1%) in group 1, eight (22.2%) in each of groups 2 and 3. Median oral intake initiation time for group 3 was 47 hours (range 27 to 82 hours). There was no significant difference between the groups in terms of postoperative pulmonary and cardiac complications (p=0.358 and p=0.175, respectively). While postoperative incidence of delirium was significantly increased in group 3 (n=5, 14.3%, p=0.032), it was not observed in group 1 and it was observed in two patients (5.6%) in group 2. This complication was directly correlated with development of postoperative pulmonary complications (odds ratio=14.2; p=0.002). Conclusion: Early (sixth hour) initiation of postoperative oral feeding is not related with increased pulmonary complications. On the contrary, early initiation may enable rapid recovery of postoperative mental and physical conditions, prevent psychiatric disorders, and reduce pulmonary complication rates. Thus this scheme can be administrated safely in all thoracotomy patients without potential risk for preoperative aspiration.Publication Open Access Comparison of postoperative pain and pain control techniques in uniportal and biportal VATS and open surgery patients(MARMARA UNIV, FAC MEDICINE, 2021-10-29) YILDIZELİ, BEDRETTİN; Cetinkaya, Cagatay; Bilgi, Zeynep; Lacin, Tunc; Bostanci, Korkut; Yildizeli, Bedrettin; Yuksel, Mustafa; Batirel, Hasan FevziObjectives: Thoracotomy causes intense postoperative pain which may become chronic. Video-assisted thoracic surgery (VATS) leads to less postoperative pain compared with thoracotomy. In this study, we analyzed pain scores in patients who underwent lung resections with VATS or thoracotomy. Patients and Methods: Patients who underwent lung resections with uniportal, biportal VATS or thoracotomy between May 2015 - May 2017 were included in the study. Visual Analogue Scale (VAS) pain scores were recorded on postoperative day 1, 5 (or at discharge), 2nd week, 1st and 3rd months. Patients were classified in 3 groups, uniportal VATS (n=178), biportal VATS (n=15), thoracotomy (n=60). Demographics, resection type, mortality, morbidity and epidural catheter use were recorded. Results: Two hundred and fifty-three patients (average age was 57.3 +/- 12.7, 94 females) were included in the study. Median hospital stay was 5 days. Uniportal and biportal groups had significantly lower pain scores in all intervals compared with thoracotomy. No chronic pain was seen in VATS groups. Uniportal and biportal groups had similar pain scores at all times. Epidural use or size of specimen did not affect pain in VATS patients (p=0.18 vs p=0.68). Conclusion: Video-assisted thoracic surgery decreases the need for epidural patient control analgesia. Specimen size does not affect postoperative pain and chronic pain is rare.Publication Open Access Do Nuss bars compromise the blood flow of the internal mammary arteries?(OXFORD UNIV PRESS, 2013-09) YILDIZELİ, BEDRETTİN; Yuksel, Mustafa; Ozalper, Mehmet Hakan; Bostanci, Korkut; Ermerak, Nezih Onur; Cimsit, Cagatay; Tasali, Nuri; Yildizeli, Bedrettin; Batirel, Hasan FevziOBJECTIVES: Minimally invasive repair of pectus excavatum, the so-called Nuss procedure, has become a popular technique in recent years. The internal mammary arteries (IMAs) lie on the posterolateral surface of the sternum, and the Nuss bar is likely to obstruct the blood flow in these arteries. This obstruction could become important in the later stages of the lives of these young people if they were to require coronary artery bypass grafting. The goal of this study is to investigate the extent of obstruction of the IMAs caused by Nuss bars. METHODS: Data were collected prospectively on all patients who underwent the Nuss procedure between October 2011 and May 2012. Patients with a history of pectus excavatum repair by open surgery and those who were younger than 16 years of age were excluded. Computed tomography-angiography (CTA) was performed for the detection of IMA blood flow preoperatively and on the 10th postoperative day. Blood flow in the IMAs was evaluated blindly by two radiologists and classified as blood flow unaffected (group I) or affected (group II) by comparing the assessment of preoperative and postoperative CTAs. The patients in group II were also categorized as having blood flow obstructed bilaterally, blood flow obstructed unilaterally and others (diminished unilaterally/diminished on one side or obstructed on the other side). RESULTS: Thirty-four patients (31 male and three female; mean age 20.7 +/- 4.2 years) underwent surgery. Blood flow was affected in 15 patients (44%), with bilateral obstruction in five, unilateral obstruction in seven, and unilateral diminished flow in two patients. In one patient, blood flow was diminished on one side and obstructed on the other. There was no significant difference between unaffected group I patients and affected group II patients in terms of sex, age, type of deformity, Haller index and the number of bars placed. CONCLUSIONS: Nuss bars cause pressure on the IMAs, but a risk factor for this effect could not be identified. This is a relatively common clinical consequence of minimally invasive repair of pectus excavatum, and the long-term effects will be apparent following bar removal.Publication Metadata only Laparoscopic repair of a gastric volvulus occurring as a long-term complication of left pneumonectomy: Report of a case(SPRINGER, 2007) YILDIZELİ, BEDRETTİN; Batirel, Hasan Fevzi; Uygur-Bayramicli, Oya; Guler, Sevgi; Yildizeli, Bedrettin; Yuksel, MustafaGastric volvulus is an extremely rare late complication of pneumonectomy. We report the case of a 61-year-old man who presented with a 1-year history of progressive intolerance of solids and weight loss 33 years after a left pneumonectomy. Preoperative examinations showed a mesenteroaxial gastric volvulus. We performed a laparoscopic Toupet fundoplication and anterior gastropexy, following which his symptoms disappeared.Publication Metadata only Approach to fragmented central venous catheters(SAGE PUBLICATIONS LTD, 2005) YILDIZELİ, BEDRETTİN; Yildizeli, B; Lacin, T; Baltacioglu, F; Batirel, HF; Yuksel, MProlonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subdavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography.The incidence of catheter breakage was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subdavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.Publication Metadata only The Size of the Esophageal Hiatus in Gastroesophageal Reflux Pathophysiology: Outcome of Intraoperative Measurements(SPRINGER, 2010) GİRAL, ADNAN; Batirel, Hasan Fevzi; Uygur-Bayramicli, Oya; Giral, Adnan; Ekici, Buelent; Bekiroglu, Nural; Yildizeli, Bedrettin; Yueksel, MustafaThe aim of the study was to investigate the impact of the size of the esophageal hiatus on lower esophageal sphincter pressure (LESP) and acid reflux. Patients with gastroesophageal reflux disease who underwent Nissen fundoplication in 2006-2008 were included. All underwent esophageal manometry and 22 had 24-h pH monitoring. The area of the esophageal hiatus was calculated from a photograph shot during surgery. A hiatal index was calculated via division of hiatal area with body mass index (BMI). Correlation and logistic regression analysis were performed. Twenty-eight patients (average age 44, 14 males) were enrolled. The mean BMI, LESP, DeMeester score, hiatal area, and hiatal index were 27 +/- 3.9 kg/m(2), 11.7 +/- 6.6 mmHg, 43 +/- 34, 3.83 +/- 1.24 cm(2), and 0.143 +/- 0.048, respectively. There was a significant negative correlation between hiatal area, hiatal index and LESP (-0.513, p = 0.005, r = -0.439, p = 0.019 respectively). Additionally there was a negative correlation between hiatal area and total LES length (r = -0.508, p = 0.013) and a significant positive correlation between hiatal area, hiatal index, and DeMeester scores (0.452, p = 0.035, 0.537, p = 0.01, respectively). Height and hiatal area were significant factors in multiple linear regression. The size of the esophageal hiatus significantly affects LESP and acid reflux, and hiatal index is a new value, which appears to reflect the amount of acid reflux. Total LES length is also shortened in patients with a large hiatus.Publication Metadata only Factors associated with postoperative delirium after thoracic surgery(ELSEVIER SCIENCE INC, 2005) YILDIZELİ, BEDRETTİN; Yildizeli, B; Ozyurtkan, O; Batirel, HF; Kuscu, K; Bekiroglu, N; Yuksel, MBackground. Postoperative delirium is an acute confusional state characterized by fluctuating consciousness and is associated with increased morbidity and mortality. We analyzed the incidence and risk factors of delirium following thoracic surgery. Methods. All patients (n = 432) who underwent thoracotomy or sternotomy from 1996 to 2003 were analyzed retrospectively. The diagnosis of postoperative delirium was based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Results. Postoperative delirium developed in 23 patients (5.32%) between postoperative days 2 to 12 (mean, 4.4 +/- 2.6 days). There were 15 males and 8 females, with a mean age of 59.4 years (24 to 77 years). The delirium group was older (59.4 +/- 14.6 vs 51.3 +/- 15.5 years, p < 0.01) and had a longer operation time than the nondelirious group (5.34 +/- 1.58 vs 4.38 +/- 1.6 hours, p = 0.005). Morbidity and mortality rates were not significantly different between the two groups (56.5% vs 47.1%; 13.0% vs 3.66%, respectively). Univariate analysis showed that the older age, markedly abnormal postoperative levels of sodium, potassium, or glucose, sleep deprivation, operation time, and diabetes mellitus were risk factors (p < 0.05). According to multivariate analyses, four factors were selected as predictive risk factors: (1) markedly abnormal postoperative levels of sodium, potassium, or glucose (p = 0.038); (2) sleep deprivation (p = 0.05); (3) age (p = 0.033); and (4) operation time (p = 0.041). Conclusions. Postoperative delirium may cause higher morbidity and mortality rates after thoracic surgery. Close postoperative follow-up and early identification of predisposing factors such as older age, sleep deprivation, abnormal postoperative levels of sodium, potassium, or glucose, and longer operation time can prevent occurrence of postoperative delirium. (C) 2005 by The Society of Thoracic Surgeons.