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Öğe A case report of primary appendiceal cancer mimicking ovarian cancer(DNT Ortadoğu Yayıncılık A.Ş., 2016) Görkem, Ümit; Güngör, Tayfun; Şahiner, İbrahim Tayfun; Baş, Yılmaz; Toğrul, CihanThe case reported here describes primary appendiceal adenocarcinoma(AACa) mimicking manifestations of ovarian malignancies. A 55-year-old woman with clinical findings of ovarian cancer underwent laparatomy in which an appendiceal tumor was encountered. Total abdominal hysterectomy, bilateral salpingo-oopherectomy, appendectomy, right hemicolectomy and omentectomy were performed. Final histopathological result demonstrated mucinous adenocarcinoma with signet ring epithelial cells.Therefore, AACa should be kept in mind by gynecological surgeons for diffential diagnosis of ovarian malignancies, since therapautic approaches differ from each otherÖğe A new method in laparoscopic sleeve gastrectomy: Reverse trendelenburg with right lateral tilt position prior to trocar entry(International Scientific Information, Inc., 2017) Koç, Okay; Şahiner, İbrahim Tayfun; Ekiz, FezaBackground: The primary aim of this study was to evaluate the effectiveness of patient positioning prior to trocar entry in laparoscopic sleeve gastrectomy. Material/Methods: The records of 300 patients that had a laparoscopic sleeve gastrectomy surgery at Aydin State Hospital from January 2015 until January 2017 were analyzed retrospectively. First, 140 patients who had been placed in the surgical position after the entry of trocars (PAET) were included as the first group, and 160 patients who had been placed in the surgical position before entry of trocars (PBET) were included as the second group. A comprehensive analysis based on the comparison of age, gender, body mass index (BMI), duration of total anesthesia, and incompleteness rate of operations between the two groups was performed. Results: The PAET group was composed of 111 females (79.3%) and 29 males (20.7%). The averages of age, BMI, and duration of anesthesia for this group were 36.84, 46.3 kg/m 2 , and 161.56 minutes, respectively. The PBET group was composed of 123 females (76.9%) and 37 males (23.1%). The averages of age, BMI, and duration of anesthesia of this second group were 38.8, 47.4 kg/m 2 , and 120.8 minutes, respectively. In the PAET group, the operations for four patients (2.9%) were never completed; in the PBET group, there was no uncompleted operations (p=0.046). Conclusions: PBET is an effective method which both shortens the operation time and decreases the rate of uncompleted operations. © Med Sci Monit.Öğe A rare case of paratubal cystadenoma during pregnancy(Oxford Univ Press, 2016) Görkem, Ümit; Efetürk, Tunay; Şahiner, İbrahim Tayfun; Baş, Yılmaz; Dolapçı, Mete; Güngör, TayfunParatubal cysts (PTCs) are generally incidentally detected in pregnancy. However, paratubal cystadenomas in pregnant women are very rare cases who are reported individually. An unusually giant case of paratubal cystadenoma in a pregnant woman is presented here. A 27-year-old woman presented to our department for a routine pregnancy checkup. A giant cystic mass accompanying a 17-week gestation was detected on examination. During laparotomy, a huge right-sided PTC was resected. Histopathological evaluation revealed a benign cystadenoma originating in the ipsilateral paratubal space. PTCs are often denoted as being benign. Neoplastic transformation or malign potential will change the course of follow-up and the patients' prognosis. Treatment with surgical excision in the second trimester can safely prevent such associated adverse conditions. In conclusion, gynecologists should be careful for causes of adnexal masses in a woman with an intrauterine pregnancy. PTCs also tend to show accelerated growth patterns during pregnancy.Öğe Amyand Hernilerde Apendektomi İle Eşzamanlı Fıtık Onarımında Greft Kullanımı Güvenli Midir?(2017) Şahiner, İbrahim Tayfun; Kendirci, MuratAmaç: İnguinal herni kesesi içinde apendiks vermiformis varlığı ile tanımlanan Amyand herni inguinal hernilerin yaklaşık %1ini oluşturur. Bu durum akut apandisit tablosu ile acil servise başvuruya neden olabileceği gibi, perioperatif insidental olarak da tespit edilebilir. Amyand herni tespit edilen hastalarda apendektominin yapılıp yapılmaması, apendektomi yapılınca fıtık onarımında sentetik greft kullanımının güvenirliği halen tartışma konusudur. Bu çalışmada kliniğimizde Amyand herni tanısı konulan ve cerrahi tedavisi yapılan hastaların sonuçları bildirilmiştir. Gereç ve Yöntem: 1 Ocak 2016 ile 31 Aralık 2016 tarihleri arasında takip ve tedavisi yapılan Amyand herni olguları retrospektif olarak incelenmiştir. Hastaların demografik verileri, preoperatif laboratuvar testleri ve radyolojik incelemeleri, peroperatif tedavi yaklaşımları, postoperatif yara yeri değerlendirmeleri not edildi. Bulgular: Hastaların tamamının erkek cinsiyet olduğu görüldü. Hastaların ortalama yaşı 48 (26-68 yıl) olarak bulundu. Hastaların 3’üne (%42.8) elektif inguinal herni operasyonu planlanırken 4’ü (%57.2) inkarsere sağ inguinal herni nedeni ile acil ameliyat edilmiştir. İnkarsere sağ inguinal herni tanısı ile ameliyat edilen 4 hastanın 3’ünde (%75) akut apandisit tablosu mevcut iken diğer bir hastada (%25) apendiks enflamasyonu tespit edilmedi. Tüm hastalara herniorafiye ek olarak apendektomi uygulanırken, herni onarımı Lichtenstein prosedürü ile prolen mesh tespiti yöntemi ile yapıldığı görüldü. Sonuç: Amyand herni oldukça nadir görülen, sıklıkla operasyon sırasında tanı alan bir durumdur. Amyand herni tespit edilen hastada herni onarımına apendektominin eklenmesi ve herniorafide sentetik mesh kullanımı güvenlidir.Öğe Anti-Pneumococcal Vaccine-Induced Cellular Immune Responses in Post-Traumatic Splenectomized Individuals(Springer New York LLC, 2017) Karasartova, Djursun; Gazi, Umut; Tosun, Özgür; Güreser, Ayşe Semra; Şahiner, İbrahim Tayfun; Dolapçı, Mete; Taylan Özkan, Hikmet AyşegülSplenectomy is associated with increased risk of overwhelming post-splenectomy infections despite proper anti-pneumococcal vaccination. As most studies concentrated on vaccination-induced humoral immunity, the cellular immune responses triggered in splenectomized patients are not yet well studied. The present study aims to investigate this area as it can contribute to the development of more effective vaccination strategies.Five healthy and 14 splenectomized patients were vaccinated with pneumococcal conjugate polysaccharide vaccine (PCV) followed by pneumococcal polysaccharide vaccine according to the guidelines established by Advisory Committee on Immunization Practices. PBMC samples collected 0, 8, and 12 weeks after PCV immunization were in vitro stimulated with PCV. Levels of lymphoproliferation, T-H cell differentiation, and cytokine release were assessed by carboxyfluorescein succinimidyl ester labeling, intracellular cytokine staining, and ELISA, respectively.While T(H)1-dominated immune response was detected in both groups, asplenic individuals generated significantly lower levels of T(H)1 cells following in vitro stimulation. Similarly, levels of IFN-gamma, IL-4, and IL-17 release and lymphoproliferation were significantly lower in asplenic patients.According to our data, splenectomy negatively influences the levels of PCV-induced lymphoproliferation, T(H)1 differentiation, and cytokine release. Besides, PCV failed to induce T(H)17-dominant immune response which is crucial for protection against extracellular pathogens.Öğe Bedside percutaneous dilatational tracheostomy by griggs technique: A single-center experience(International Scientific Information, Inc., 2017) Şahiner, İbrahim Tayfun; Şahiner, YelizBackground: The study evaluated reliability and outcomes of percutaneous dilatational tracheostomy (PDT) performed via Griggs’ method in the intensive care unit. Material/Methods: We examined 78 patients who underwent bedside PDT in the intensive care unit (ICU). Demographic characteristics were recorded. In addition, ventilator-related pneumonia, duration of performing PDT, and rates of complications, mortality, and morbidity were assessed. Results: The mean age of patients was 68.7 years, and 56.4% were females (n=44). The most common indication for ICU was pneumonia (44.9%, n=35), followed by trauma (24.8%, n=13). Mean opening of PDT was 21 minutes. Mean duration of intubation prior to PDT was 21±6 days. Mean FiO2 before and after PDT was 58.7% and 49.1%, respectively. PEEP ratios before and after PDT were 5 and 3, respectively. Seventy-one patients (91%) needed no sedation after PDT. Mechanical ventilator-induced pneumonia was observed in 32.1% (n=25) of patients. The overall complication rate after PDT was 37.1%, most of which were minor. The most common and early complication of PDT was bleeding (28.2%, n=22). Other minor complications included hypotension (3.8%, n=3), desaturation (3.8%, n=3), and subcutaneous emphysema (1.3%, n=1). Conclusions: Tracheostomy offers advantages in terms of improving patient comfort, facilitating weaning of patients from the respirator, and providing clearance of pulmonary secretions by reducing pulmonary dead-spaces. PDT is a simple and reliable procedure with lower complication rates. Its advantages include implementation at bedside, with a shortened procedure duration and accelerated wound healing. © Med Sci Monit.Öğe Cerrahide Kohort Çalışmalarının Raporlanması İçin Bir Kılavuz; STROCSS Kriterlerinin Türkçe Uyarlaması(2019) Demir, Emre; Yavuz, Yasemin; Ateş, Can; Tekindal, Mustafa Agah; Şahiner, İbrahim Tayfun; Başım Doğan, Gül Bahar; Erkent, MurathanAmaç: Bu çalışmada, cerrahi alanında kohort çalışmalarının raporlama kalitesini iyileştirmek ve bir standart oluşturmak amacıyla uzmanlardan oluşan bir grup tarafından 2017 yılında yayınlanan 17 maddelik (37 alt madde) STROCSS (Cerrahide Kohort Çalışmaların Raporlanmasının Güçlendirilmesi) kriterlerinin Türkçeye uyarlanmasının yapılması amaçlanmıştır. Gereç ve Yöntem: STROCSS kriterleri, üç yazar (E.D., C.A., M.A.T.) tarafından birbirlerinden ayrı olarak Türkçeye çevrilmiş ve Y.Y.’nin liderliğinde son taslak olarak belirlenmiştir. Türkçeye uyarlanmış kontrol listesi kullanılarak 2010-2018 yılları arasında TR dizinde yayınlanan 10 cerrahi kohort araştırmasının raporlanma kalitesi beş farklı cerrahi branştaki akademisyen hekim (İ.Ş.T., G.D., Ü.M., G.D., M.E.) tarafından değerlendirilmiştir. İstatistiksel değerlendirmelerde sınıf içi korelasyon katsayısı ve Bland-Altman grafikleri kullanılmıştır. Bulgular: Cerrahi branşlardaki ikili değerlendirmeler arasında anlamlı uyum olduğu görülmüştür (p<0,001; p<0,001; p=0,007; p=0,001). En yüksek uyum iki farklı Genel Cerrah arasında bulunmuştur; 0,963 (0,857-0,991). Tüm Akademisyen Hekimler arasında ise 0,947 (0,858-0,985) uyum düzeyi bulunmuştur (p<0,001). Bland-Altman grafiklerine göre genel olarak tüm gözlemciler arasında uyuşma bulunmuştur. Sonuç: Birçok uluslararası yayıncı tarafından cerrahi alanındaki makalelerin incelemeye alınması için zorunlu hale gelen bu kılavuzun çevirilmesi ile ülkemizdeki araştırmacılara çalışmalarının raporlanmasında kolaylık sağlayacağı ve ulusal yayınlarda bir standart oluşturulacağı düşünülmektedir.Öğe Comparison of effects of vessel-sealing devices and conventional hemorrhoidectomy on postoperative pain and quality of life(International Scientific Information, Inc., 2018) Kendirci, Murat; Şahiner, İbrahim Tayfun; Şahiner, Yeliz; Güney, GüvenBackground: The aim of this study was to investigate the early and late results of use of LigaSure, Harmonic Scalpel, and conventional hemorrhoidectomy in hemorrhoidectomy, to determine the least painful method, and to investigate the relationship between pain perception and personal differences in hemorrhoid bundles. Material/Methods: Ninety patients undergoing hemorrhoidectomy between 2014 and 2017 were retrospectively evaluated. We investigated the duration of hospitalization and the presence of bleeding, incontinence, perianal wetness, urinary retention, stenosis, and recurrence during follow-up after surgery. Analgesic requirement was determined by Patient-Controlled Analgesia, as well as pain score by use of the Visual Analog Score and patient satisfaction by Short Form-36. We also assessed the relationship between pain and lateral thermal damage, the number of peripheral nerves, number of excised bundles, and the number of thrombosed vessels, as determined by histopathological examination. Results: No differences were found among the 3 methods in the duration of hospitalization, the presence of bleeding, fecal incontinence, perianal wetness, urinal retention, anal stenosis, recurrence rate, VAS, analgesic consumption, or results of the SF-36. There was no difference in the number of bundles, thrombosed vessels, or number of nerve fibers in a bundle, but the LigaSure Hemorrhoidectomy had more lateral thermal damage (p<0.001). While there was a difference between VAS of day 1 and 7 according to the hemorrhoid bundles, there was no difference in the other parameters. Conclusions: There was no difference among the 3 methods in terms of complications, postoperative pain, or patient satisfaction, and pain intensity was positively correlated with the number of excised bundles. © Med Sci Monit.Öğe Comparison of primary midline closure, limberg flap, and karydakis flap techniques in pilonidal sinus surgery(International Scientific Information, Inc., 2018) Erkent, Murathan; Şahiner, İbrahim Tayfun; Bala, Mesut; Kendirci, Murat; Yıldırım, Murat Baki; Topcu, Ramazan; Bostanoğlu, Settar; Dolapçı, MeteBackground: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). Material/Methods: The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. Results: The mean age was 28.4 years (14–77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). Conclusions: According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients. © Med Sci Monit, 2018.Öğe Does lymph node ratio (metastasis/total lymph node count) affect survival and prognosis in gastric cancer?(SAUDI MED J, 2022) Topcu, Ramazan; Şahiner, İbrahim Tayfun; Kendirci, Murat; Erkent, Murathan; Sezikli, İsmail; Tutan, Mehmet B.Objectives: To investigate the influence of the metastatic lymph node/total lymph node ratio (N- ratio) on survival and prognosis in surgically treated gastric carcinomas. Methods: A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). Results: Group 2 patients had a total lymph node mean of 25.10 +/- 13.64 while Group 1 patients had a total lymph node mean of 18.77 +/- 9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97 +/- 10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). Conclusion: The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.Öğe Early results with the Mutaf technique: A novel offmidline approach in pilonidal sinus surgery(Korean Surgical Society, 2016) Zorlu, Musa; Şahiner, İbrahim Tayfun; Zobacı, Ethem; Koçak, Cem; Yastı, Ahmet Çınar; Dolapçı, MetePurpose: The objective of the present study was to compare different off-midline techniques in terms of their advantages and disadvantages. Methods: A total of 81 patients were included in this prospective, controlled, randomized study. Patients in group 1 were treated with the Limberg flap, and patients in group 2 were treated with Mutaf technique. Patients were followed up for 9 months postsurgically and assessed at regular intervals. Results: A total of 41 and 40 patients received surgical treatment with Limberg or Mutaf techniques, respectively. The 2 groups were similar in terms of age, gender, body mass index, and Tezel pilonidal sinus classification. Also, the 2 groups were comparable with regard to the frequency of preoperative discharge from the wound site, history of abscess formation, and the resultant antibiotic use. Early results showed similar recurrence rates and surgical-site complications between the 2 groups. Although a lower visual analogue scale score was found in group 2 at postoperative day 1, seroma persistence, time to withdrawal of surgical drains, and wound healing were more prolonged. Conclusion: In this study, Mutaf technique was comparable to Limberg flap in the treatment of pilonidal sinus. Therefore, Mutaf technique may be offered as a viable surgical therapeutic option among off-midline closure approaches. © 2016, the Korean Surgical Society.Öğe Effects Of Thymoquinone, Zeolite And Platelet Rich Plasma On The Healing Of Ischemic Colonic Anastomosis(2019) Pehlivanlı, Faruk; Karaca, Gökhan; Aydın, Oktay; Altunkaya, Canan; Şahiner, İbrahim Tayfun; Özden, Hüseyin; Pekcici, Mevlüt RecepObjective: Anastomosis on ischemic intestines is a problematic issue in daily surgical routine. In this study, we investigated the potential effects of thymoquinone, zeolite and platelet rich plasma. Material and Methods: Fifty rats were divided into five groups. In the sham group all rats underwent colonic anastomosis without any ischemic insult. Colonic anastomosis was performed after mesenteric ischemia was induced by clamping the superior mesenteric artery in other study groups. In the control group, no medication was given to the rats after ishemic anastomosis. In Zeolite group and thymoquinone group, Zeolite and thymoquinone were applied locally on the anastomosis. In the platelet rich plasma group, platelet rich plasma was applied locally on the anastomosis. All the rats were sacrified on the 10th day. Blood and tissue samples were retrieved. Results: Hydroxyproline levels were not different between the groups. Bursting pressure was higher in the thymoquinone group than the control group. Reepithelization was higher than the zeolite group in the sham and thymoquinone groups. TNF-? and IL 1? levels were significantly higher in the sham group than all the other groups. TNF-? and IL 1? levels were also significantly higher in the thymoquinone, zeolite and platelet rich plasma groups than the control group and higher in the thymoquinone group than the zeolite and platelet rich plasma groups. Inflammation and ischemic necrosis levels were not different between the groups. Conclusion: Our data is suggesting that thymoquinone and platelet rich plasma have positive effects on ischemic anastomosis healing, while thymoquinone has the best results.Öğe Evolution of Inguinal Hernia Publications: A Bibliometric Analysis from 1980 to 2021(INT SCIENTIFIC INFORMATION, INC, 2023) Şahiner, İbrahim Tayfun; Altunal, ÇetinAbstract BACKGROUND Despite the increasing number of studies published worldwide focusing on inguinal hernia, a major condition in the surgical field that affects the quality of life of many patients, a bibliometric study on inguinal hernia is yet to be conducted. The present study aimed to analyze the scientific articles published on inguinal hernia using statistical methods. MATERIAL AND METHODS Articles published between 1980 and 2021 on inguinal hernia were downloaded from the Web of Science database and analyzed using statistical methods. RESULTS A total of 11 761 publications were found. The top 5 contributors to the literature were the United States (n=2109, 27%), Germany (563, 6.7%), United Kingdom (595, 5.7%), Turkey (415, 5.3%), and Japan (388, 4.9%). The top 3 most influential journals by average number of citations per article were Annals of Surgery (citations: 67.4), British Journal of Surgery (citations: 49.9), and Surgical Clinics of North America (citations: 43.2). CONCLUSIONS In the current comprehensive bibliometric study on inguinal hernia, which has demonstrated an upward trend in the number of articles published recently, we present a summary of 7810 articles published from 1980 to 2021. According to the results of the analysis conducted to identify trending topics, the keywords studied in recent years are believed to include pediatric, outcomes, minimally invasive surgery, robotic, incisional hernia, umbilical hernia, chronic pain, obesity, bariatric surgery, NSQIP, seroma, surgical site infection, abdominal wall reconstruction, ventral hernia repair, and hiatal hernia repair.Öğe Global productivity and research trends of colorectal carcinoma: A scientometric analysis of studies published between 1980 and 2021(LIPPINCOTT WILLIAMS & WILKINS, 2023) Şahiner, İbrahim Tayfun; Altunal, ÇetinAbstract Although colorectal cancer (CRC) is a serious cause of death and has a significant impact on patients’ quality of life and incidence rate of CRC has increased among the younger populations, bibliometric research of CRC has not been conducted yet. To perform a comprehensive analysis of scientific publications on CRC using various statistical and bibliometric techniques. Publications on CRC published between 1980 and 2021 were downloaded from the Web of Science database and analyzed using statistical methods. The trending topics, collaborations among countries, and citation relationships were analyzed using bibliometric network visualization mapping. The number of articles to be probably published in the next 5 years was estimated using the exponential smoothing estimator. The Spearman’s correlation rank correlation coefficient was used to analyze the correlations among the variables. A total of 122,717 publications were found in the fields of oncology, gastroenterology, hepatology, and surgery. Of the published articles, 64,774 publications were research articles. The top five countries that contributed the most to the literature were the USA (16,604; 25.6%), China (10,567; 16.3%), Japan (7932; 12.2%), the UK (5009; 7.1%), and Italy (4287; 6.6%). The most prolific author, institution, and journal in the field of CRC were Zhang Y (n = 331), University of Texas System (n = 1646), and Diseases of the Colon and Rectum (n = 2090), respectively. The most influential journal based on the average number of citations received per article was CA-A Cancer Journal for Clinicians (citations per article; 286). There was a significant positive correlation between the number of articles produced by the countries on CRC and gross domestic product and human development index (r = 0.726, P < .001; r = 0.658, P < .001, respectively). Additionally, a significant moderate correlation of CRC was found with gross domestic product per capita (r = 0.711, P < .001). Keywords like overall survival, neoadjuvant chemoradiotherapy, locally advanced rectal cancer, robotic surgery, anastomotic leakage, chemoradiotherapy, metastatic colorectal cancer, KRAS, metaanalysis, colorectal surgery, and laparoscopic surgery were studied. Abbreviations: CI = confidence interval, CRC = colorectal cancer, EMT = epithelial-mesenchymal transition, GDP = Gross Domestic Product, HDI = human development index, NC = number of citation, RNA = Ribo Nucleic AcidÖğe İnsizyonel herni gelişiminde risk faktörlerinin saptanması(Hitit Üniversitesi, 2019) Erkent, Murathan; Şahiner, İbrahim Tayfun; Kendirci, Murat; Topcu, RamazanAmaç: İnsizyonel herniler; karında uygulanan cerrahi girişimlerden sonra sık karşılaşılan sorunlardan biridir. Görülme sıklığı % 13 oranlarında bildirilmektedir. Önemli oranda iş gücü kayıplarına, morbiditeye ve hatta mortaliteye yol açıp, hayat kalitesini olumsuz yönde etkileyebilirler. Bu amaçla insizyonel herni gelişmemesi için önlem alma adına risk faktörlerini irdelemeyi amaçladık. Gereç ve Yöntem: Retrospektif olarak 2013 Kasım – 2017 Aralık tarihleri arasında kliniğimizde ameliyat edilen 128 insizyonel herni tanılı hastanın verileri analiz edildi. Hastaların demografik verileri, etyolojileri (hastalara yapılan ilk cerrahi nedenler), vücut kitle indeksleri, komorbideteleri ve ilk ameliyatı sonrasında cerrahi alan enfeksiyonu (CAE) gelişip gelişmediği gibi parametreler incelendi. Bulgular: İlk cerrahi nedenler incelendiğinde en çok %53.9 u (n:69) jinekolojik ameliyatlar ve brid ileus nedeniyle laparotomi yapılmış hastaların ameliyat edildiği gözlendi. Hastaların vücut kitle indekslerine (VKİ) bakıldığında ise %64.1 i (n:82) VKİ 25-80 olarak saptandı. Hastaların komorbiditelerine (yandaş hastalıklar) bakıldığında ise ilk sırada %38.3 (n:49) ile Kronik ostrüktif akciğer hastalığı (KOAH) saptanırken, ikinci sıklıkta %19.5 ile (25) Diyabetes Mellituslu (DM) hastalar olarak saptandı. Hastaların ilk ameliyatlarında cerrahi alan enfeksiyonu (CAE) % 87.5 (n:112) hastada saptanmadı. Sonuç: Yüksek VKİ ve obezite önemli nedenlerdendir. Bu çalışmada da hastaların büyük çoğunluğunu VKİ yüksek olan hastalar oluşturmaktadır. Ayrıca yandaş hastalık olarak KOAH ve DM in önemli birer hastalık olduğu ve risk faktörü oluşturduğu bu çalışmada da görülmüştür. Ayrıca bu çalışmada da 16 CAE gelişen hastada ek girişim veya medikal tedaviye rağmen insizyonel herni geliştiği gözlendi. Sonuç olarak değiştirilebilen risk faktörleri kontrol altına alınabilirse insizyonel herni gelişimi önlenebilir.Öğe Intragastric injection botulinum toxin A for obesity management with or without liraglutide(Verduci Editore s.r.l, 2023) Altunal, Çetin; Şahiner, İbrahim Tayfun; Yavuzer, Serap; Cengiz, Mahir; Sadıkoğlu, TümayAbstract. – OBJECTIVE: Obesity is a global public health problem with rapidly increasing prevalence in many countries, including Turkey, and different treatment modalities have been used. This study aimed to compare the effect of intragastric botulinum toxin A (BTA) injection and BTA injection combined with low-dose liraglutide in patients with obesity. PATIENTS AND METHODS: Records of 701 patients (female/male, 660:41; mean age, 45.6 ± 6.2 years) who received an intragastric injection of BTA for weight loss between November 2019 and May 2020 were reviewed retrospectively. The patients were divided into the BTA group, which included patients who received BTA injection alone, and BTA + liraglutide, which included those who used liraglutide after BTA injection. The demographic characteristics and comorbid diseases of the patients and follow-up results 6 months after the procedure were evaluated. RESULTS: In the comparison of the 3-month and 6-month weights of the patients, weight measurements were significantly lower in the BTA + liraglutide group than in the BTA group (p < 0.001 and p < 0.001, respectively). Adverse effects were observed in 212 (30.2%) of the study participants, of which 25% were observed in the BTA group and 31.8% in the BTA + liraglutide group, with no significant difference. CONCLUSIONS: The intragastric injection of BTA combined with liraglutide is a safe method that provides more effective weight loss than BTA alone, which is minimally invasive without any serious adverse effects.Öğe Malignancy rates of thyroid cytology: Cyst fluid benign or non-diagnostic?(International Scientific Information, Inc., 2017) Güney, Güven; Şahiner, İbrahim TayfunBackground: We sought to investigate subgroup distribution using Bethesda classification and risks for malignancy. We also compared the malignancy risk of cases that were denoted as non-diagnostic due to cystic contents, with cases that were denoted as non-diagnostic due to presence of other features. Material/Methods: The study included pathology test results of 1,440 thyroid nodule samples diagnosed using Bethesda classification. Results of 305 thyroidectomy excision specimens from these patients were also compared with cytology results to determine the frequency of malignancy. The non-diagnostic group was divided into two categories: those with cystic contents, and others. Malignancy rates were separately calculated for the two groups, and compared with the other classification groups. Results: Distribution of malignancy rates by Bethesda classification were as follows: non-diagnostic 12.5% (6/48), benign 1.5% (3/198), atypia of undetermined significance/follicular lesion of undetermined significance (AFLUS) 9% (1/11), suspicious for follicular neoplasm (SFN) 37.5% (3/8), suspicious malignancy 70% (8/26), malignancy 100% (14/14). Conclusions: Despite the limited number of cases, our study concluded that cystic content was closer to the benign category than the non-diagnostic category if the assessment was based on malignancy rates. In this group, similar to aspirations containing plenty of lymphocytes that indicates colloid or lymphocytic thyroiditis, it is still controversial whether criterion for adequacy of follicular epithelial cells should be sought, or if they should be regarded as benign in order to prevent unnecessarily performance of repeat aspirations. © Med Sci Monit.Öğe Malignant Tumors Misdiagnosed as Liver Hemangiomas(Frontiers Media Sa, 2021) Yıldırım, Murat Baki; Şahiner, İbrahim Tayfun; Poyanlı, Arzu; Acunaş, Bülent; Güllüoğlu, Mine; İbiş, Cem; Özden, IlgınBackground and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy. Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively. Results: Twelve patients were men and 11 were women; median (range) age was 55 (35-80). The principal diagnostic modality for the initial diagnosis was ultrasonography (n:8), magnetic resonance imaging (MRI) (n:13), and computed tomography (CT) (n:2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy (n:6) or chemoembolization (n:2). The misdiagnosis caused a median (range) 10 (0-96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each. Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions.Öğe Nadir bir akut karın nedeni: Jejunal divertikül perforasyonu(Gazi Üniversitesi Tıp Fakültesi, 2018) Topcu, Ramazan; Şahiner, İbrahim Tayfun; Kendirci, MuratJejunal divertikülozis nadir görülen bir hastalıktır. Prevalansı yaşla doğru orantılı olarak artmakta, 6. ve 7. dekadlarda en üst düzeye ulaşmaktadır. Jejunal divertiküller genellikle asemptomatik seyirlidir ancak, perforasyon geliştiğinde ciddi morbidite ve hatta mortaliteye neden olabilir. Acil servise karın ağrısı ile başvuran, ilk muayenede ve görüntülemede anormal bulgu saptanmayan, yatışının 48. Saatinde akut karın nedeniyle ameliyata alınan ve jejunal divertikül perforasyonu saptanan, intraoperatif arrest nedeniyle exitus gelişen hasta ile ilgili deneyimimizi paylaşmak istedik.Öğe Perineal approach in rectal prolapse surgery: reliability of the altemeier procedure(Galenos Publishing House, 2017) Şahiner, İbrahim Tayfun; Kendirci, MuratAim: We compared the efficacy of the Altemeier and Thiersch procedures performed in patients treated for rectal prolapse diagnosis in our clinic.Method: Twenty-three patients who underwent Altemeier and Thiersch operation in our clinic between January 2014 and December 2016 were reviewed retrospectively. Demographic data such as age, gender, accompanying diseases, physical examination findings, anesthesia risk scores, anesthesia method, operation duration, hospitalization days, complications, and follow-up periods were noted. Assessment of quality of life was done by evaluating the Wexner incontinence score.Results: Of the 23 patients operated for rectal prolapse, 78.2% were female (n=18) and the mean age of all patients was 65.7 years. On physical examination, anal tone was absent in 13 patients and decreased in 10 patients. The mean preoperative Wexner incontinence score was 13.9 . Mean duration of operation was 14.6 minutes in Thiersch method and 42.8 minutes in the Altemeier group. The duration of hospital stay was 4 days in the Thiersch group and 5.73 days in the Altemeier group. There were no major complications in 12 patients undergoing the Altemeier procedure. Hemorrhage developed on the anastomotic line in one patient, and wound infection developed in another patient. One patient died due to myocardial infarction on the 2nd postoperative day. Perianal abscess was detected in one patient in the Thiersch group. In the Altemeier group, the postoperative 6-month Wexner score was 9.13. A decrease in the Wexner scores of 14 patients was detected. In the Thiersch group, no decrease was detected in any of the patients compared to the preoperative period.Conclusion: Altemier is a safe and easy procedure because it can be performed under regional anesthesia, enables resection, and has low short-term recurrence and complication rates.
