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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 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) Okkabaz, Nuri; Haksal, Mustafa; Atıcı, Ali Emre; Altuntaş, Yunus Emre; Gündoğan, Ersin; Gezen, Fazlı Cem; Öncel, 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.Öğe Laparoscopic and conventional incisional hernia repair: A retrospective analysis(Kocaeli Derince Training and Research Hospital, 2018) Haksal, Mustafa Celalettin; Gezen, Cem; Okkabaz, Nuri; Yılmaz, Merih; Öncel, MustafaINTRODUCTION: To analyze the outcomes oflaparoscopic and open techniques in incisional herniarepair.METHODS: Patients’ charts with incisional herniawere retrospectively reviewed. Demographics, diseaseand operation related variables and short term outcomeswere compared between groups.RESULTS: Nineteen [12 female (63.2%), mean±SD ageof 53.5±15.1] of 33 patients were operated on with opentechnique, whereas 14 [11 female (78.5%), mean±SDage of 59.1±14.2] patients with laparoscopic technique.Body mass index was bigger in laparoscopic group(30.3±4.6 vs. 34.4±6.3, p=0.041). Hernia size andoperation time was not different between groups(7.6±4.8 cm vs. 8.9±3.1 cm, p=0.404) and [100(40-300)vs. 77.5(35-150) minutes, p=0.071), respectively. Lengthof stay was 2 days after both techniques.DISCUSSION and CONCLUSION: Laparoscopicincisional hernia repair has similar short term outcomeswith open technique.Öğe Laparoscopic appendectomy for acute and perforated appendicitis: A comparative analysis(2019) Haksal, Mustafa Celalettin; Okkabaz, NuriObjective: The purpose of this study was to compare the short-term outcomes of laparoscopically operated uncomplicated acute appendicitis and perforated appendicitis. Methods: Laparoscopically operated uncomplicated acute and perforated appendicitis were screened, retrospectively. Demographics, operative variables, and postoperative complication rates were compared between the groups. Results: Among 155 patients, acute appendicitis was found in 130 patients (77 [59.2%] male; median age, 32 [16–72]), while 25 patients (15 [60.0%] male; median age, 39 [17–84]) had perforated appendicitis. The duration of the operation and hospitalization period were 45 (20–105) minutes and 1 (1–6) day, respectively, in the acute appendicitis group, and 60 (20–155) minutes and 2 (1–16) days, respectively, in the perforated group. Total complication rates were statistically significantly higher in the perforated group. Conclusion: Laparoscopic approach can be applied in selected cases of perforated appendicitis.Öğe Laparoscopic resection of primary tumor with synchronous conventional resection of liver metastases in patients with stage 4 colorectal cancer: A retrospective analysis(2019) Okkabaz, Nuri; Haksal, Mustafa Celalettin; Öncel, MustafaAim: Aim of this study is to analyze the short and long term results of laparoscopic colorectal cancer resection with synchronous conventional resection of liver metastasis. Method: All cases operated on synchronous colorectal cancer and liver metastasis between 2009 and 2017 were retrospectively retrieved from a prospective database. Three and more liver segment resection was considered as major resection. Demographics, patient characteristics, operative and postoperative findings and survival were analyzed. Results: A total of 35 patients [23 (65.7%) male, median age: 56 (34-79)] was included to the study. The most common primary tumor localization was rectum (n=20, 57.1%). Neoadjuvant chemoradiotherapy and chemotherapy was applied in 15 (75%) and 14 (40%) cases, respectively. Major, minor resection or only ablative therapy performance was 12 (34.3%), 19 (54.3%) and 4 (11.4%), respectively, but 13 (37.1%) cases received both resection and ablative therapy. Mean operation time was 307.8±103.6 minutes and estimated blood loss was 300 (10-2200) cc. Blood transfusion was needed in 15 (42.9%) cases. Length of stay was 7 (4-17) days. Eleven complications developed in 10 (28.6%) cases, but none required re-operation. A patient (2.9%) underwent laparoscopic low anterior resection with major hepatectomy and radiofrequency ablation was deceased in postoperative 11th day due to liver failure and subsequent multiorgan failure. Three, 5, 7 and 9-year survival rates was 63%, 35%, 35%, and 35%. Conclusion: Laparoscopic colorectal resection with synchronous conventional liver resection in patients with metastatic colorectal cancer is safe and feasible. Long term survival rates are acceptable.Öğe Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: A case-control study(Zerbinis Publications, 2019) Okkabaz, Nuri; Yılmaz, Merih; Civil, Osman; Haksal, Mustafa; Öncel, MustafaPurpose: To evaluate the incidence, risk factors and outcomes of conversion from laparoscopic to open surgery in geriatric patients with colorectal cancer (CRC). Methods: All patients subjected to laparoscopic procedures for CRC between 2006 and 2018 were included. Patients older than 70 were divided into these necessitating or not necessitating conversion to open surgery (Con>70 and Lap>70 groups, respectively), and those younger than 70 requiring conversion were evaluated in Con<70 group. The results were compared between Con>70 group and the two other groups. Results: Conversion was significantly more common in Con>70 group than Con<70 group (17.3 vs 9.6%, p=0.011). Although female gender and T4 tumors leading to multivisceral resection were significant risk factors for conversion in univariate analysis, multivariate analysis denied any variable as significant. Perioperative outcomes were significantly worse in Con>70 group than those in Lap>70 group. When conversion groups were compared, the rates of surgical site infection and evisceration were higher in geriatric patients. Pathological results revealed that Con>70 group had more advanced tumors than Lap>70 group regarding pT stage, number of malignant lymph nodes and perineural invasion rate. However, the numbers of harvested lymph nodes were similar in two groups. Conclusion: Conversion rate is higher in geriatric patients, particularly in female patients and those who necessitate multivisceral resections. Conversion worsens the perioperative outcomes in geriatric patients. Finally, since the number of harvested lymph nodes does not decrease with conversion, it probably does not threaten the quality of oncological surgery.Öğe Preoperative imaging guided no-laparotomy vs conventional diverting colostomy: A multi-institutional case-control study(Kocaeli Derince Training and Research Hospital, 2019) Haksal, Mustafa Celalettin; Okkabaz, Nuri; Şeker, Mehmet; Göret, Nuri Emrah; Altuntaş, Yunus Emre; Erol, Cengiz; Öncel, MustafaINTRODUCTION: We aimed to compare the outcomes of no-laparotomy and conventional diverting colostomy techniques and to describe the process and benefits of using preoperative imaging tools in no-laparotomy procedure. METHODS: Patients intended to receive no-laparotomy diverting colostomy, have preoperative imaging tools of 3D computerized tomography and X-ray examinations in order to predict the best location for the stoma construction. The perioperative outcomes in these cases were compared with those obtained from the patients operated with conventional diverting colostomy with laparotomy at another institution. RESULTS: Eighteen and 16 patients had a diverting colostomy with no-laparotomy technique after preoperative assessment, and conventional procedure. Demographics and most of the patient- and procedure-related factors were similar. Length of incision, (4.8±0.8 vs. 13.3±1.9cms, p<0.001) operation time (31.4±13.0 vs 46.7±7.9mins, p<0.001) and the rate of surgical site infection (0 vs 4 [25%], p=0.039) and hospitalization period (4 [3-30] vs 5 [4-34]days, p=0.01) were significantly less in no-laparotomy group. DISCUSSION and CONCLUSION: No-laparotomy technique may be safe and beneficial while performing a diverting colostomy. Length of incision, operation time and hospitalization period are shortened if a laparotomy is avoided, and the rate of surgical site infection decreases. Current study recommends preoperative imaging tools when a no-laparotomy technique is intended.Öğe Ramadan fasting in patients with a stoma: A prospective study of quality of life and nutritional status(H M P Communications, 2013) Altuntaş, Yunus Emre; Gezen, Fazlı Cem; Sahoniz, Turgut; Kement, Metin; Aydın, Halime; Şahin, Fatma; Okkabaz, Nuri; Öncel, MustafaRamadan fasting is an Islamic obligation for healthy Muslims after the age of puberty. Persons with an acute or chronic disease may be excused from this obligation; the degree of the disease is an important parameter for not fasting. Little is known about the effect of fasting on persons with a stoma. A prospective study was conducted among 56 patients with a cancer-related fecal stoma (33 [58.9%] male, mean age 55.9 +/- 13.1 years) over two periods of Ramadan to analyze the effect of fasting 15 to 16 hours on nutritional and metabolic status and quality of life. Eligible patients were divided into two groups: fasting (n = 14) and nonfasting (n = 42). Demographic and stoma information, as well aS disease and treatmentrelated variables, were evaluated. Participants completed cancer patient and colorectal cancer patient quality-of-life in and rated their religious orientation. Laboratory tests (blood urea nitrogen, creatinin, cholesterol, prealbumin, albumin, and transferrin) were performed 1 to 3 weeks before Ramadan, and questionnaires and tests were repeated 1 to 3 weeks after Ramadan in people who fasted. Demographic parameters, including religious orientation scale scores, were similar between fasting and nonfasting groups. Patients in the fasting group had significantly higher albumin levels (4.6 +/- 0.2 versus 4.1 +/- 0.4, P = 0.001), prealbumin levels (27.6 +/- 7.4 versus 21.3 +/- 8.5, P = 0.018), and global health status scores (81.5 16.7 versus 68.3 +/- 20.1, P = 0.030) than patients in the nonfasting group. Patients who fasted also had their stoma for a longer period of time than patients in the nonfasting group (average 9 months [range 3-87 months] in the fasting versus 4.5 months [range 3-36 months] in the nonfasting group, P = 0.084), and the proportion of patients with a permanent stoma was higher in the fasting group than in the nonfasting group (P = 0.051). Ramadan fasting had almostno influence on quality of life. Fasting lowered prealbumin levels (27.6 +/- 7.4 versus 21.2 +/- 4.4; P = 0.046), but did not adversely affect other nutritional or global health status variables. Most patients in the fasting group (13, 92.9%) stated they would feel sad if they were not fasting. The results of this study suggest that although fasting may decrease prealbumin levels, persons with a stoma and good nutritional status may decide for themselves whether to fast.Öğe Risk factors for early postoperative morbidity and mortality in patients underwent radical surgery for gastric carcinoma: A single center experience(Elsevier Science Bv, 2013) Vural, Selahattin; Civil, Osman; Kement, Metin; Altuntaş, Yunus Emre; Okkabaz, Nuri; Gezen, Fazlı Cem; Haksal, Mustafa; Gündoğan, Ersin; Öncel, MustafaBackground: Aim of this study is to analyze the incidence and risk factors for early postoperative morbidity and mortality that occur after gastric carcinoma surgery. Materials and methods: All consecutive patients with gastric adenocarcinoma resected with curative intent between 2005 and 2011 were included to a retrospective analysis. Patient, disease and operation related parameters were questioned as risk factors for postoperative morbidity and mortality. Results: A total of 160 patients (103 [64.8%] male and the average age was 62.4 +/- 11.5) were abstracted. Early postoperative morbidity, operation related morbidity and mortality were observed in 46 (28.7%), 31 (19.4%) and 19 (11.9%) cases, respectively. No other factors but ASA score was found to be a risk factor for overall morbidity (p = 0.021 and 0.033 in univariate and multivariate analyses, respectively). The incidence of anastomotic leak was increasing in patients who received a D2 dissection in univariate analysis (p = 0.039), but not in multivariate calculation. There were no factors effecting surgical site infection risk. Although univariate analysis revealed that age over 70 (p = 0.008), ASA score (p = 0.018), operation time (p = 0.032), D2 dissection (p = 0.026) and type of anastomosis (p = 0.023) were effecting the risk for early mortality, multivariate analysis showed that age was the only risk factor (p = 0.005). Conclusion: Current study has revealed that early morbidity and mortality are not rare after gastric cancer surgery with curative intent. Since multivariate analyses have revealed that ASA score and older age may be only risk factors for postoperative morbidity and 30-day mortality, respectively; it may be logical to consider these factors during the preoperative decision making in patients with gastric cancer.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 Surgical treatment of recurrent colorectal cancer: Short and long term outcomes(2019) Okkabaz, Nuri; Öncel, MustafaAim: The aim of this study was to investigate the effect of surgical margin positivity on short- and long-term outcomes in patients undergoing recurrent colorectal cancer surgery. Method: Demographics, parameters related to primary tumor and previous surgery, recurrent tumor characteristics and perioperative features and long-term outcomes were compared between groups (R0 vs. R1) according to surgical margin positivity. Results: Of 57 patients who underwent surgery for recurrent colorectal cancer, 49 patients (86%) in whom curative resection was achieved were included in the study. Eleven (22.4%) cases had surgical margin positivity (R1) on pathological examination. Demographics, primary tumor localization, tumor stage, time to recurrence, adjuvant oncological treatments were comparable between R0 and R1 groups. Although the surgical procedures performed differed according to the location of the recurrent lesion, they were proportionally similar between the groups. The operative time, the amount of intraoperative bleeding, the need for transfusion, and the length of hospital stay were similar (p>0.05 for each variable). There were 17 (44.7%) and four (36.4%) postoperative complications in the R0 and R1 groups, respectively, but no difference was observed between the groups. Regional recurrence rate was 18.9% (n=7) in R0 group and 27.3% (n=3) in R1 group, respectively (p=0.675). Overall survival rates of R0 and R1 patients at 1, 3 and 5 years were 78.4% vs. 81.8%, (p=0.754), 43.2% vs. 36.4%, (p=0.720) and 27.0% vs. 27.3% (p=0.866), respectively. Conclusion: Complications are higher after recurrent colorectal cancer surgery. This study emphasizes that microscopic surgical margin positivity (R1) may not adversely affect short- and long-term outcomes in patients operated for recurrent colorectal cancer, and that local recurrence rates of these cases may be similar to those with complete resection (R0).Öğe The feasibility of hepatic resections using a bipolar radiofrequency device (Habib®)(Springer, 2015) Civil, Osman; Kement, Metin; Okkabaz, Nuri; Haksal, Mustafa; Gezen, Cem; Öncel, MustafaThe bipolar radiofrequency device (HabibA (R)) has been recently introduced in order to reduce intraoperative bleeding for a safe hepatic resection as an alternative to the conventional tools. However, indications, perioperative findings, and outcome of the device for hepatic resections remain and deserve to be analyzed. The current study aims to analyze the feasibility of the bipolar radiofrequency device (HabibA (R)) for hepatic resections. Information of the patients that underwent hepatic resection using with the HabibA (R) device between 2007 and 2011 was abstracted. Patient, disease, and operation-related findings and perioperative data were investigated. A total of 71 cases (38 [53.5 %] males, mean age was 56.8 A +/- 11.9) were analyzed. Metastatic disease (n = 55; 77.5 %) was the leading indication followed by primary liver and biliary malignancies (n = 7; 9.9 %), hemangioma (n = 5; 7 %), hydatid disease (n = 3; 2.8 %), and hepatic gunshot trauma (n = 1; 1.4 %). Metastasectomy was the most commonly performed procedure (n = 31; 56.3 %), but in 24 (77.4 %) cases, it was performed in addition to extended resections. Other procedures in the study patients include segmentectomy in 17, bisegmentectomy in 19, trisegmentectomy in 17, right or left hepatectomy in 8, and extended right/left hepatectomy in 3. The mean (+/- SD) operation time was 241.7 +/- 78.2 min. The median amount of bleeding was 300 cc (range 25-2500), and 23 (32.4 %) cases required perioperative transfusion. The median hospitalization period was 5 days (range 1-47). Lengthened drainage (n = 9, 12.7 %) and intraabdominal abscess (n = 8, 11.23 %) were the most common problems. Hepatic resections using the HabibA (R) device seem to be feasible in cases with primary and metastatic hepatic lesions and benign liver masses and even those with hepatic trauma. It may lessen the amount of intraoperative hemorrhage, although lengthened drainage and intraabdominal abscess were the major postoperative problems in these cases.Öğe The Turkish society of colon and rectal surgery (TKRCD) terminology commission study report(2021) Çipe, Gökhan; Işık, Sevil; Güney, Burak; Kuzu, Mehmet Ayhan; Okkabaz, Nuri; Karabay, Önder; Öncel, Mustafa; Özben, Volkan; Şengül, Neriman; Tümay, Latif VolkanThis study aimed to explain the working order of the Terminology Commission, which was established at the workshop of the Turkish Society of Colon and Rectal Surgery (TKRCD) on February 22, 2020, the criteria and results in the preparation of the terminology report. The commission prepared a work plan to complete in three main steps. The working process continued in a way that the members expressed their opinions with equal rights and the decisions were taken by consensus or by majority vote. The main purpose of the commission study was determined as “determining the terms that need to be explained and agreed in colorectal surgery, and to define them in a way that is compatible with the literature and contributes to daily practice”. The first meeting of the commission was held on February 22, 2020, and the report was accepted by the TKRCD Board of Directors on May 25, 2021. A total of 20 meetings were held during this period. In the first step, five headings were determined for writing the terms: Anatomy, symptoms and diagnostic tools, diseases, treatments and complications. There was a consensus that the terms met the following three conditions: 1) the need for explanation and consensus in colorectal surgery, 2) literature support, and 3) use in daily practice. The terms were written in the following format: Terms and synonyms, English equivalents, definition, explanation and bibliography. In the second step, each commissioner wrote an average of 10.8±4.3 terms. The distribution of 89 terms in the final report was as follows: Anatomy (n=26, 29.2%), symptoms and diagnostic tools (n=8, 8.9%), diseases (n=20, 22.4%), treatments (n=28, 31.4%), and complications (n=7, 7.8%). Figures (n=7), all from the archives of the commission members, and figures drawn by a new commission member (n=53) were also added to the report. In the third step, the report was submitted to the TKRCD Management with the approval of the TKRCD President. The preparation process of the Terminology Commission report of TKRCD was presented. The final report is open to changes and expansions with future studies.Öğe Transabdominal preperitoneal repair for bilateral inguinal hernias: A single center experience(2018) Haksal, Mustafa Celalettin; Okkabaz, Nuri; Civil, Osman; Kement, Metin; Öncel, MustafaAim: To evaluate outcomes of transabdominal preperitoneal repair in patients with bilateral inguinal hernias. Methods: Sociodemographic data, and data about disease and operation with postoperative data of all patients with bilateral inguinal hernias, who were treated by transabdominal preperitoneal repair were prospectively collected. Patients were followed-up for recurrence and chronic pain in the long-term. Results: A total of 70 (67 [95.7%] males, mean age was 53.4±13.6 years) cases were included. Total 138 hernias (mostly Nyhus type 3 [n=116; 84.1%]) were repaired in 70 cases. Unilateral inguinal hernia was diagnosed in two cases during the operation. Mean operation time was 80.6±26.5 minutes. Inferior epigastric vein was injured in 2 (1.4%) cases. Parenteral analgesics were required in only 10 (14.3%) patients. Patients were discharged 1.21±0.67 days after the operation, and only 9 (12.8%) cases were hospitalized more than one day. Patients returned work or normal activity 10.5±4.7 days after the surgery. The mean follow-up period was 25.9±19.4 months. Symptomatic recurrence was observed in 2 (1.4%) patients. Six (8.7%) cases had chronic pain. Conclusion: Transabdominal preperitoneal repair may be an alternative approach in treatment of bilateral inguinal hernias.
