Effect of laparoscopic cholecystectomy techniques on postoperative pain

Huseyin Yilmaz,Oguzhan Arun,Seza Apiliogullari,Fahrettin Acar,Husnu Alptekin,Akın Calisir,Mustafa Sahin 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.85 No.4

Purpose: Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. Methods: Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. Results: A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). Conclusion: In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Evaluation and Management of Antrochoanal Polyps

Huseyin Yaman, MD,Suleyman Yilmaz, MD,Elif Karali, MD,Ender Guclu, MD,Ozcan Ozturk, MD 대한이비인후과학회 2010 Clinical and Experimental Otorhinolaryngology Vol.3 No.2

Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. They occur more commonly in children and young adults, and they are almost always unilateral. The etiopathogenesis of ACPs is not clear. Nasal obstruction and nasal drainage are the most common presenting symptoms. The differential diagnosis should include the causes of unilateral nasal obstruction. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS for complete removal of ACPs are extremely safe and effective procedures. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.

Clinical Outcomes of Laparoscopic Partial Cystectomy and Conventional Partial Cystectomy for the Treatment of Hepatic Hydatid Cyst

( Ilhan Ece ),( Huseyin Yilmaz ),( Serdar Yormaz ),( Bayram Colak ),( Fahrettin Acar ),( Husnu Alptekin ),( Mustafa Sahin ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The aim of this study was to compare the mid-term outcomes of open and laparoscopic partial cystectomy (LPC). Methods: The medical records of patients who underwent conventional partial cystectomy (CPC) and LPC for liver hydatid cyst from March 2009 to January 2016 were retrospectively reviewed. Operative time, blood loss, length of hospital stay, postoperative morbidity, mortality, and follow up outcomes were evaluated. Results: Among 162 patients, 59 of patients were underwent LPC and 103 underwent CPC. Blood loss, postoperative complications were similar in both groups. The mean operative time in the LPC and the CPC groups was respectively 91.4±11.5 and 61.5±18.1 minutes, which showed a significant difference between the both groups. The mean length of hospital stay in CPC group was significantly longer when compared the LPC group. The mean diameter of cyst in LPC group was 6.1±1.1 cm, and 7.8±2.1 cm in CPC group with significant difference. The overall complication rates were 15.2 % in LPC group and 16.5 % in CPC group without significant difference. The most common complication was biliary leakage and surgical site infection. Conclusions: In the hands of experienced laparoscopic surgeons with appropriate technical tools; Laparoscopic drainage and partial cystectomy seem to be safe and effective techniques in carefully selected patients in the surgical treatment of liver hydatid cysts. Technical devices such as grinder aspirator and laparoscopic ultrasonography may expand the indication for laparoscopy.

Radiofrequency Ablation Technique in Hepatic Surgery: Clinical Experience

( Serdar Yormaz ),( Huseyin Yilmaz ),( Husnu Alptekin ),( Ilhan Ece ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The Korean Association of HBP Surgery firstly launched the protocol of Korean Surgical Quality Improvement Program (KSQIP) for cholecystectomy collaborating with NECA as a multicenter prospective study. I’d like to introduce the study protocol, web based database system and outcome. Laparoscopic cholecystectomy (LC) is the standard surgical treatment of benign gallbladder disease. However, the incidence of postoperative complication varies, and the risk factor was not well thoroughly investigated. The aim of this study is to develop and evaluate the surgical risk calculator for postoperative outcomes after laparoscopic cholecystectomy. A total of 3,002 patients were registered, and 2,514 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease from 18 academic institutes in Korea were included in this prospective, multicenter cohort study. Preoperative or intraoperative variables were evaluated as risk factors for various postoperative outcomes including overall complications, and tendency to increase use of medical facilities including prolonged duration of hospital stay. After risk factor analysis, risk calculator after cholecystectomy was developed using multiple logistic regression analysis. Using standard preoperative variables from this multi-institutional prospective database, we tried to construct a risk calculator for predicting adverse perioperative outcomes after laparoscopic cholecystectomy. Such information may be useful for risk stratification before laparoscopic cholecystectomy.

The effect of single incision laparoscopic cholecystectomy on systemic oxidative stress

Ilhan Ece,Bahadir Ozturk,Huseyin Yilmaz,Serdar Yormaz,Mustafa ?ahin 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.4

Purpose: Single incision laparoscopic cholecystectomy (SILC) has become a more frequently performed method for benign gallbladder diseases all over the world. The effects of SILC technique on oxidative stress have not been well documented. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy techniques on systemic oxidative stress by using ischemia modified albumin (IMA). Methods: In total, 70 patients who had been diagnosed with benign gallbladder pathology were enrolled for this prospective study. Twenty-one patients underwent SILC and 49 patients underwent laparoscopic cholecystectomy (LC). All operations were performed under a standard anesthesia protocol. Serum IMA levels were analysed before operation, 45 minutes and 24 hours after operation. Results: Demographics and preoperative characteristics of the patients were similiar in each group. The mean duration of operation was 37.5 ± 12.5 and 44.6 ± 14.3 minutes in LC and SILC group, respectively. In both groups, there was no statistically significant difference in hospital stay, operative time, or conversion to open surgery. Operative technique did not effect the 45th minute and 24th hour IMA levels. However, prolonged operative time (>30 minutes) caused an early increase in the level of IMA. Twenty-fourth hour IMA levels were not different. Conclusion: SILC is an effective and safe surgical prosedure for benign gallbladder diseases. Independent of the surgical technique for cholecystectomy, the prolonged operative time could increase the tissue ischemia.

Relation between Left Atrial Remodeling in Young Patients with Cryptogenic Stroke and Normal Inter-atrial Anatomy

Mustafa Gökhan Vural,Suha Cetin,Murat Yilmaz,Ramazan Akdemir,Huseyin Gunduz 대한뇌졸중학회 2015 Journal of stroke Vol.17 No.3

Background and Purpose To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. Methods Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. Results PWD was 30.1±7.0 ms and 27.4±3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4±4.5 mL/m2 and 19.9±2.4 mL/m2 in CS and control group, respectively (P=0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4±6.3% and 44.5±7.1% in CS and control group, (P=0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5±0.4% and 2.9±0.5% in CS and control group, respectively (P=0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P<0.01), and between PWD and global pLA-S (r=-0.52; P<0.01), respectively, was observed in CS. Conclusions Increased PWD is associated with impaired LA mechanical functions and enlargement, and involved in the pathophysiology of AF or an AF-like physiology in CS.

Changes in the Attitudes and Behavior of Relatives of Breast Cancer Patients Concerning Cancer Prevention and Screening

Koca, Dogan,Ozdemir, Oguzhan,Akdeniz, Huseyin,Unal, Olcun Umit,Yilmaz, Ugur Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.10

Background: Changes in the attitudes and behavior of relatives of breast cancer patients concerning cancer prevention and screening after diagnosis in a loved one were evaluated. Materials and Methods: Forty-three questions were used to collect data from the relatives of the breast cancer patients who had been living with their relatives for at least one year. Results: The study group was composed of 171 female relatives (median age: 43, range: 17-82 yr). After the patients were diagnosed with breast cancer, changes in the attitudes and behavior of their relatives toward the prevention and screening of cancer were evident in 78 (45.6%) of the study participants (e.g. eating habits, quit or reduced smoking, exercise habits). In addition, it was noted that some characteristics of the relatives had different effects on different attitudes and behavior. Conclusions: Awareness on breast cancer among the relatives of breast cancer patients is useful for the management of health and social problems that can be seen in these individuals. At the same time, this information could help countries determine whether their actual level of healthcare for early cancer diagnosis, prevention, and screening are adequate.

Specimen index may be a predictive factor for recurrence after primary closure of pilonidal disease

Husnu Alptekin,Fahrettin Acar,Mustafa Sahin,Huseyin Yilmaz,M. Ertugrul Kafali,Sinan Beyhan 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.6

Purpose: The aim of the present study was to evaluate the predictive value of volume of the specimen/body mass index (VS/BMI) ratio for recurrence after surgical therapy of pilonidal disease. Methods: Ninety-eight patients with primary pilonidal disease were enrolled in this study. The VS/BMI ratio was calculated for each patient. This ratio was defined as the specimen index (SI). VS, BMI and SI were evaluated to determine whether there is a relationship between these parameters and recurrence of pilonidal disease. In addition, the predictive ability of SI for recurrence was analyzed by receiver operating characteristic (ROC) curve. Results: VS and SI were found to be higher in patients with recurrence. ROC curve analysis showed that VS and SI are predictive factors for recurrence in patients treated with primary closure, nevertheless our new index had higher sensitivity and specificity than VS (sensitivity 85.7% vs 71.4% and specificity 90.7% vs 85.1%, respectively). The cut-off level for the greatest sensitivity and specificity for SI was 1.29. Conclusion: Recurrence is higher in patients with high VS regardless of the operation method. SI may be a predictive value in patients treated with primary closure.

Differential gene expression analysis of human cumulus cells

Demiray, Sirin Bakti,Goker, Ege Nazan Tavmergen,Tavmergen, Erol,Yilmaz, Ozlem,Calimlioglu, Nilufer,Soykam, Huseyin Okan,Oktem, Gulperi,Sezerman, Ugur The Korean Society for Reproductive Medicine 2019 Clinical and Experimental Reproductive Medicine Vol.46 No.2

Objective: This study was performed to explore the possibility that each oocyte and its surrounding cumulus cells might have different genetic expression patterns that could affect human reproduction. Methods: Differential gene expression analysis was performed for 10 clusters of cumulus cells obtained from 10 cumulus-oocyte complexes from 10 patients. Same procedures related to oocyte maturation, microinjection, and microarray analyses were performed for each group of cumulus cells. Two differential gene expression analyses were performed: one for the outcome of clinical pregnancy and one for the outcome of live birth. Results: Significant genes resulting from these analyses were selected and the top 20 affected pathways in each group were analyzed. Circadian entrainment is determined to be the most affected pathway for clinical pregnancy, and proteoglycans in cancer pathway is the most affected pathway for live birth. Circadian entrainment is also amongst the 12 pathways that are found to be in top 20 affected pathways for both outcomes, and has both lowest p-value and highest number of times found count. Conclusion: Although further confirmatory studies are necessary, findings of this study suggest that these pathways, especially circadian entrainment in cumulus cells, may be essential for embryo development and pregnancy.