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Öğe A descriptive survey study to evaluate the relationship between socio-demographic factors and quality of life in patients with a permanent colostomy(HMP Communications, LLC, 2014) Kement, Metin; Gezen, Cem; Aydın, Halime; Haksal, Mustafa; Can, Uğur; Aksakal, Nihat; Öncel, MustafaThe impact of having a stoma on quality of life is increasingly recognized and studied. A descriptive survey study was conducted between January 2006 and December 2011 among 44 patients (18 women, 26 men) with a permanent stoma receiving care at the Kartal Training and Research Hospital, Istanbul, Turkey, to evaluate socio-demographic factors that may affect the quality of life in Turkish Muslim patients with an enteral stoma. A socio-demographic questionnaire, a 10-item Religious Orientation Scale (Modified Allport-Ross ROS), and the Medical Outcomes Study Short Form 36 Quality of Life survey were administered by a stoma therapy nurse at least 6 months after completion of all surgical and oncological treatments. The mean follow-up period was 15.3 +/- 9.7 (range 6-44) months since completion of all treatments. Data were collected using paper/pencil instruments and entered for data analysis using Student's t-tests or one-way ANOVA univariate and multivariate analyses. No significant differences were observed for income, education level, surgical history, or religion score. Gender, geographic region, and household status were found independently related to quality of life in stoma patients. Female patients had significantly lower scores than males in general health perception (P=0.049), role emotion (P=0.02), mental health perception (P=0.026), and mental component (P=0.007). Patients living in a village (four) had significantly lower scores than patients living in a big city (33) in all scales (P<0.05 for all comparisons). Village-dwelling patents also had significantly lower scores than patients living in a town (seven) in physical function (P =0.001), vitality (P=0.012), social function (P=0.003), and mental component scores (P=0.021). Patients living alone (seven) had significantly lower scores than patients living with a partner (11) in three of eight scales (physical functioning [P<0.001], role-physical [P=0.047], and bodily pain [P=0.015]) and physical component scores (P<0.001); they also had significantly lower scores than patients living with their families (26) in four of eight scales (physical functioning [P <0.001], role-physical [P=0.032], bodily pain [P=0.02], and general health perception [P=0.036]) and physical component scores (P<0.001). Although these findings provide evidence for the relationship between some socio-demographic factors on quality of life of patients with a stoma, the results of the study should be interpreted with caution; multicenter, prospective, controlled studies are needed to substantiate and clarify the relationships among these variables.Öğe Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer(Korean Surgical Society, 2017) Haksal, Mustafa; Okkabaz, Nuri; Atıcı, Ali Emre; Civil, Osman; Özdenkaya, Yaşar; Erdemir, Ayhan; Aksakal, Nihat; Öncel, MustafaPurpose: The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer. Methods: All patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival. Results: Among 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143). Conclusion: Fifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rec tal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.Öğe Gallbladder perforation during elective laparoscopic cholecystectomy: Incidence, risk factors, and outcomes(Kare Publishing, 2018) Altuntaş, Yunus Emre; Öncel, Mustafa; Haksal, Mustafa; Kement, Metin; Gündoğdu, Ersin; Aksakal, Nihat; Gezen, Fazlı CemOBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7 +/- 13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4 +/- 17.5 vs 41.4 +/- 18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without.Öğe Safety and feasibility of laparoscopic sigmoid colon and rectal cancer surgery in patients with previous vertical abdominal laparotomy(Elsevier, 2015) Haksal, Mustafa; Özdenkaya, Yaşar; Atıcı, Ali Emre; Okkabaz, Nuri; Aksakal, Nihat; Erdemir, Ayhan; Civil, Osman; Öncel, MustafaIntroduction: Current study aims to analyze the impact of previous vertical laparotomy on safety and feasibility of laparoscopic sigmoid colon and rectal cancer operations. Methods: All consecutive patients who underwent a laparoscopic resection for sigmoid colon or rectal cancer were included. These aspects were abstracted and compared within no laparotomy and previous vertical laparotomy groups: demographics, perioperative aspects, pathological features and survival. Results: There were 252 patients in no laparotomy group, and 25 cases with previous vertical incisions including lower (n = 12,48%), upper (n = 7, 28%), and lower&upper (n = 2, 8%) midline and paramedian (n = 4, 16%) laparotomies. Veress insufflation and open technique were used in 19 (76%) and 6 (24%) cases, respectively, during the insertion of the first trocar in previous laparotomy group. Patients in previous laparotomy group were significantly older (59.2 +/- 13.4 vs. 66.2 +/- 0.1, p = 0.01), but gender, ASA scores, tumor and technique related factors were similar within the groups, including operation time (200 [70-600] vs. 200 [130-390] min, p = 0.353), blood loss (250 [100-1500] vs. 250 [0-2200] ml, p = 0.46), additional trocar insertion (10 [4%] vs. 3 [12%], p = 0.101), conversion (20 [7.9%] vs. 4 [16%], p = 0.25), postoperative complication (59 [23.4%] vs. 4 [16%], p = 0.06) and 30-day mortality (7 [2.8%] vs. 1 [4%], p = 0.536) rates. Oncological outcomes regarding pathological features and 5-year survival rates (65% vs. 73.2%, p = 0.678) were not different. Conclusion: The presence of a previous laparotomy does not worsen the outcomes in patients undergoing laparoscopic removal of sigmoid or rectal cancer, thus laparoscopy may be considered to be safe and feasible in these cases.Öğe Travmatik abdominal duvar herniasyonu: Olgu sunumu(2013) Altuntaş, Yunus Emre; Kement, Metin; Eser, Mehmet; Gezen, Fazlı Cem; Haksal, Mustafa Celalettin; Aksakal, Nihat; Öncel, MustafaTravma sonrası abdominal duvarın herniasyonu nadir görülen bir durumdur. Bu tip hernilerin tanımı ve tanısı zordur. Tanı ve tedavide gecikmenin morbidite ve mortalite oranlarını artıracağı aşikardır. Bu yazıda traktör devrilmesi sonrası çoklu travma tanısıyla acil servise yatırılan 53 yaşında erkek olgu sunuldu. Hasta ameliyata alındı, posterior üretra laserasyonu sorunsuz bir şekilde tamir edildi. Fakat ameliyat sonrası dördüncü günde sistemik enflamatuvar cevap sendromu bulguları gelişti. Yapılan bilgisayarlı batın tomografisinde (BBT) sigmoid kolon segmentinin batın duvarına fıtıklaştığı görüldü. Laparotomide sigmoid kolonun fıtık sahasına perfore olduğu ve alanı kontamine ettiği görüldü. Etkilenen sigmoid kolon segmenti rezeke edilerek Hartman tipi uç kolostomi uygulandı. Çevre nekrotik dokular debride edildi. Travmatik karın duvarı hernileri özellikle geç kalınması durumlarında içi boş organların inkarserasyon ve perforasyonuna yol açarak ciddi morbidite ve mortaliteye sebep olabilirler. Bu nedenle travmatik herni olasılığı ciddi künt batın travmalı olgularda mutlaka akılda tutulmalı ve şüpheli olgularda yüksek tanı değerine sahip BBT uygulanmalıdır.
