Person: ATICI, ALİ EMRE
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ATICI
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ALİ EMRE
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Publication Metadata only Pankreati̇koduodenektomi̇ sonrasi yapilan uç yan pankreti̇kojejenostomi̇lerde stent uygulamasi pankreati̇k fi̇stül oranina etki̇li̇ mi̇?(2021-09-12) ATICI, ALİ EMRE; ÖZOCAK, AYŞEGÜL BAHAR; UPRAK, TEVFİK KIVILCIM; COŞKUN, MÜMİN; YEGEN, ŞEVKET CUMHUR; ATICI A. E., ÖZOCAK A. B., UPRAK T. K., COŞKUN M., YEGEN Ş. C.Publication Metadata only Deneysel sepsis modelinde akut kardiyopulmoner ve serebral hasarda nöropeptit W'nin etkisi(2019-12-13) ATICI, ALİ EMRE; PEKER EYÜBOĞLU, İREM; YEGEN, BERRAK; AKKİPRİK, MUSTAFA; ERCAN, FERİHA; ATICI A. E., ARABACI TAMER S., levent h. n., PEKER EYÜBOĞLU İ., ERCAN F., AKKİPRİK M., YEGEN B.Giriş ve Amaç: Ciddi enfeksiyonların neden olduğu sepsis ve beraberinde görülen çoklu organ yetmezliği, yüksek morbidite ve mortalite oranıyla en önemli klinik sendromlardan biridir. Yakın zamanda tanımlanan ve nöroendokrin düzenlemelerde işlev gördüğü gösterilen nöropeptit W (NPW)’nin, deneysel sepsis modeli oluşturularak akciğer, kalp ve beyin dokularında indüklenen oksidatif hasarda olası tedavi edici etkilerini araştırmayı amaçladık. Yöntemler: Ketamin anestezisi altında, Sprague-Dawley erkek sıçanlarda sham-operasyon (n=8) yapıldı veya çekal ligasyon ve perforasyon ile sepsis oluşturuldu (n=64). Post-operatif ciltaltına 3 doz (hemen sonra, 12. ve 24. saatlerde) serum fizyolojik (SF) veya TNF-alfa inhibitörü + antibiyotik (1 mg/kg etanersept + 100 mg/kg seftriakson) veya NPW (0,1; 0,3; 1, 3 ve 10 g/kg) uygulanırken, sham-opere gruba SF enjeksiyonları yapıldı. Yirmibeşinci saatte alınan kan örneklerinde C-reaktif protein (CRP), kortikosteron ve IL-6 düzeyleri ile çıkarılan akciğer, kalp ve beyin dokularında antioksidan glutatyon, lipit peroksidasyonunu gösteren malondialdehit ile nükleer faktör kappa-B (NF- B) mRNA ekspresyon düzeyleri ölçüldü. Hematoksilen-eozin ile histopatolojik değerlendirmeler yapıldı. Verilerin analizinde ANOVA ve Student’ın t-testleri kullanıldı. Bulgular: Etanersept+antibiyotik veya NPW (1-10 g/kg) tedavili sepsis gruplarında IL6, kortikosteron ve CRP düzeyleri SF-tedavili sepsis grubuna göre düşük bulundu (p<0,05-0,001). SFsepsis grubunda beyinde ve akciğerde malondialdehit düzeylerinin arttığı (p<0,01) ve glutatyonun düştüğü (p<0,01) gözlendi. Etanersept+antibiyotik tedavisi veya NPW beyindeki bu değişiklikleri engelledi (p<0,05-0,001). Buna karşın, akciğerde sepsisle artan malondialdehit ve azalan glutatyon düzeylerine antibiyotik+etanersept etkili olmazken, NPW (0,1-0,3 g/kg) akciğerde malondialdehit düzeyini düşürdü (p<0,05-0,01). Kalp dokusunda ölçülen malondialdehit ve glutatyon düzeyleri ile tüm dokularda ölçülen NF- B ekspresyonları açısından gruplar arasında anlamlı fark bulunmadı. SF-tedavili sepsis grubunda gözlenen dejenere nöron sayısında artış, akciğerde şiddetli kanama, alveoler yapıda bozulma ve nötrofil infiltrasyonu ile kardiyomiyositlerdeki konjesyon ve orta derecede hasar gibi değişikliklerin etanersept+antibiyotik ve NPW (10 g/kg) ile hafiflediği ve histolojik yapıların neredeyse normale döndüğü izlendi. Sonuç: Sepsisin ilk 24 saatinde uygulanan NPW, doza bağımlı olarak akciğer ve beyinde oksidatif hasara karşı koruyucu etki göstermektedir.Publication Open Access J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results(ELSEVIER SCIENCE BV, 2017-11) ATICI, ALİ EMRE; Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, MustafaPurpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Publication Open Access Optimal waiting period to surgical treatment after neoadjuvant chemoradiotherapy for locally advanced rectum cancer: A retrospective observational study(2023-12-01) ATICI, ALİ EMRE; BOZKURTLAR, EMİNE; YEGEN, ŞEVKET CUMHUR; Aslanov K., ATICI A. E., Karaman D., BOZKURTLAR E., YEGEN Ş. C.Background: The optimal waiting period after neoadjuvant treatment in patients with locally advanced rectal cancers is still controversial. The literature has different results regarding the effect of waiting periods on clinical and oncological outcomes. We aimed to investigate the effects of these different waiting periods on clinical, pathological, and oncological outcomes. Methods: Between January 2014 and December 2018, a total of 139 consecutive patients with locally advanced rectal adenocarcinoma, who were treated in the Department of General Surgery at the Marmara University Pendik Training and Research Hospital, were enrolled in the study. The patients were split into three groups according to waiting time for surgery after neoadjuvant treatment: group 1 (n = 51) included patients that have 7 weeks and less (≤ 7 weeks) time interval, group 2 (n = 45) 8 to 10 weeks (8–10 weeks), group 3 (n = 43) 11 weeks and above (11 weeks ≤). Their database records, which were entered prospectively, were analyzed retrospectively. Results: There were 83 (59.7%) males and 56 (40.3%) females. The median age was 60 years, and there was no statistical difference between the groups regarding age, gender, BMI, ASA score, ECOG performance score, tumor location, and preoperative CEA values. Also, we found no significant differences regarding operation times, intraoperative bleeding, length of hospital stay, and postoperative complications. According to the Clavien–Dindo (CD) classification, severe early postoperative complications (CD 3 and above) were observed in 9 patients. The complete pathological response (pCR, ypT0N0) was observed in 21 (15.1%) patients. The groups had no significant difference regarding 3-year disease-free and 3-year overall survival (p = 0.3, p = 0.8, respectively). Local recurrence was observed in 12 of 139 (8.6%) patients and distant metastases occurred in 30 of 139 (21.5%) patients during the follow-up period. There was no significant difference between the groups in terms of both local recurrence and distant metastasis (p = 0.98, p = 0.43, respectively). Conclusion: The optimal time for postoperative complications and sphincter-preserving surgery in patients with locally advanced rectal cancer is 8–10 weeks. The different waiting periods do not affect disease-free and overall survival. While long-term waiting time does not make a difference in pathological complete response rates, it negatively affects the TME quality rate.Publication Metadata only Pankreati̇koduodenektomi̇ sonrası hei̇delberg ve blumgart pankreati̇kojejenostomi̇ anastomoz tekni̇kleri̇ni̇n karşılaştırılmasi: yüksek volümlü referans merkezi̇ sonuçları(2021-09-12) ATICI, ALİ EMRE; ÖZOCAK, AYŞEGÜL BAHAR; UPRAK, TEVFİK KIVILCIM; COŞKUN, MÜMİN; YEGEN, ŞEVKET CUMHUR; ATICI A. E., ÖZOCAK A. B., UPRAK T. K., COŞKUN M., YEGEN Ş. C.Publication Open Access Neuropeptide w alleviates hepatorenal oxidative damage in sepsis-induced rats(2020-05-01) ATICI, ALİ EMRE; PEKER EYÜBOĞLU, İREM; ERCAN, FERİHA; AKKİPRİK, MUSTAFA; YEGEN, BERRAK; ATICI A. E., ARABACI TAMER S., levent h. n., PEKER EYÜBOĞLU İ., ERCAN F., AKKİPRİK M., YEGEN B.Background: Despite modern surgical, medical and intensive care treatments, sepsis is still one of the most frequent causes of morbidity and mortality due to multiple life-threatening organ dysfunctions. We aimed to investigate the possible protective effect of neuropeptide W (NPW), a novel peptide effective in regulating neuroendocrine functions, against sepsisinduced hepatorenal damage. Methods: In male Sprague-Dawley rats (200–250 g), sepsis was induced by cecal ligation and puncture under ketamine anesthesia (n=48). Immediately after surgery, saline or TNF-alpha inhibitor (etanercept; 1 mg/kg) plus antibiotic (ceftriaxon; 100 mg/kg) (ET+C) or NPW (0.1, 0.3, 1 or 3 mg/kg) was given subcutaneously, and repeated at 12th and 24th hours, while sham-operated control group (n=8) received three saline injections within twenty-four hours. Rats were decapitated at the 25th hour of surgery and C-reactive protein (CRP), corticosterone and IL-6 levels were measured in serum samples. Kidney and liver samples were obtained for the measurement of myeloperoxidase activity (MPO), malondialdehyde and glutathione levels and nuclear factor kappa-B (NF-kB) mRNA expression levels. Histopathological evaluations were performed in hematoxylin-eosin-stained samples. ANOVA and Student's t-tests were used for data analysis. Results: Elevated serum levels of IL-6, corticosterone and CRP (p<0.05-0.01) in saline-treated sepsis group, as compared to controls, were depressed in the ET+C- (p<0.05) or NPW- (p<0.05-0.001) treated groups. Hepatic malondialdehyde and MPO levels, which were increased in salinetreated sepsis group (p<0.05 and p<0.001), were decreased by ET+C- (p<0.01) or NPW (p<0.05-0.001) treatments. Similarly, increased renal malondialdehyde level was depressed by NPW (p<0.05), but not by ET+C; while none of the treatments had an inhibitory effect on renal MPO. In contrast to replenished renal glutathione levels by all treatments, hepatic glutathione content was not changed by any of the treatments. Hepatic and renal NF-kB mRNA expressions were similar in all groups. Severe hepatocyte degeneration, sinusoidal congestion and inflammatory cell infiltration were observed in saline-treated sepsis group, while parenchymal degeneration, congestion and Kupffer cell activation were mild in ET+Cand NPW-treated sepsis groups. Similarly, severe degeneration of renal corpuscles and tubules with glomerular and interstitial congestion in the saline-treated sepsis group was replaced by moderate glomerular and interstitial vascular congestion and mild tubular congestion in both NPW- and ET+C-treated groups. Conclusion: NPW, applied during the first 24 hours of sepsis, exerted a dose-dependent protective effect against hepatorenal damage, which appears to involve an inhibitorPublication 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 Metadata only Üst Gastrointestinal Sistem Kaçaklarının Kendinden Genişleyen Metal Stentler (SEMS )ile tedavisi, tekmerkez sonuçlarımız(2022-04-27) COŞKUN, MÜMİN; UPRAK, TEVFİK KIVILCIM; ATICI, ALİ EMRE; COŞKUN M., Verdiyev O., UPRAK T. K., ATICI A. E.Publication 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 ÖZOFAGUS REZEKSİYONU SONRASI ANOSTOMOZ KAÇAĞINDAENDOSKOPİK VAKUM TEDAVİSİ DENEYİMİMİZ: 3 HASTALIK VAKA SERİSİ(2021-10-30) AKMERCAN, TAYFUN; AKMERCAN, AHMET; UPRAK, TEVFİK KIVILCIM; ATICI, ALİ EMRE; COŞKUN, MÜMİN; AKMERCAN T., AKMERCAN A., UPRAK T. K. , ATICI A. E. , COŞKUN M.