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Öğe Comparison of surgical procedures and percutaneous drainage in the treatment of liver hydatide cysts: a retrospective study in an endemic area(E-Century Publishing Corp, 2014) Akkucuk, Seckin; Aydogan, Akin; Ugur, Mustafa; Yetim, Ibrahim; Davran, Ramazan; Oruc, Cem; Kilic, ErolIntroduction: Surgical procedures are still the golden standard option in the treatment of liver cystic echinococcosis. However, minimal invasive technics like percutaneous drainage are rising trends. We aimed to compare the efficacy of surgical and percutaneous options in the treatment of liver hydatidosis in an endemic area. Methods: Patients who underwent surgical or percutaneous procedures for hydatid disease between January 2007 and December 2012 were retrospectively evaluated. Recurrence rates, hospital stay time, and related factors were analyzed. Results: There were 44 (35.5%) male and 80 (64.5%) female patients in this study. Eighty two patients (Group I) had undergone surgery (66.1%) and 42 patients (Group II) had undergone percutaneous drainage (33.9%). The mean cyst size was 7.28 +/- 2.51 cm in Group I and 8.76 +/- 3.30 cm in Group II. Nine recurrences (7.3%) were detected during study. Five of the recurrences were in Group II (11.9%) and four (4.9%) of them were in Group I. The mean length of hospital stay of all patients was 5.42 +/- 3.16 days. Discussion: Percutaneous drainage techniques can be a good alternative to surgery in selected patients. In complicated cases like cystobiliary fistula, surgery is superior to percutaneous approaches. The hospital stay time, recurrence rate and postoperative complications were not enhanced when compared to percutaneous treatment in our study. Despite all controversy about the low morbidity after percutaneous treatment, surgical approach is still a preferable option in patients with liver hydatidosis when it is performed by experienced surgeons.Öğe Effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in urgent abdominal surgery(Turkish Assoc Trauma Emergency Surgery, 2018) Kilic, Erol; Ugur, MustafaBACKGROUND: Although therapeutic hypothermia has been shown to be effective on surgical site infection and postoperative pain in patients undergoing elective surgery, its exact effect on emergency laparotomy remains unclear. In this study, we aimed to investigate the effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in patients undergoing urgent open abdominal surgery. METHODS: The study included 100 patients who underwent emergency open abdominal surgery from 01/01/2016 to 01/01/2017. The patients were randomly divided into two groups: therapeutic hypothermia, group I underwent cold therapy with local sterile frozen ice compress; and control group II, underwent conventional sterile compress. Age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery were compared between the groups. Visual analog scale scores were determined every 3 hours, and the requirement for analgesics was assessed for each patient within 48 hours postoperatively. Both before and after 5 days of laparotomy, c-reactive protein (CRP), white blood cell count (WBC), albumin, serum total antioxidant status, and total oxidant status levels were measured, and oxidative stress index was calculated for each patient. The rates of superficial surgical site infection were compared between both groups. RESULTS: The two groups were similar in terms of age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery (p>0.05). Although no significant difference was found between the groups with regards to visual analog scale scores (p>0.05), requirement for analgesics was lower in the group I compared to that in the control group (p<0.05). No significant difference was found between the groups in terms of preoperative WBC, albumin, CRP, serum total antioxidant status, total oxidant status, and oxidative stress index (OSI) levels (p>0.05). At postoperative day 5, serum total antioxidant status level was significantly higher, and OSI level was significantly lower in the group I compared to the respective levels in the control group (p<0.05). Moreover, the superficial surgical site infection rate was significantly lower in the group I (p<0.05). CONCLUSION: In patients undergoing urgent open abdominal surgery, therapeutic hypothermia led to lower requirement for analgesics and lower superficial surgical site infection rates in the early postoperative period. We consider that therapeutic hypothermia exerts this effect by elevating the serum total antioxidant status level, and decreasing the effects of inflammatory mediators and OSI.Öğe Effectivity of local bupivacaine infusion in the prevention of postoperative ileus(Derman Medical Publ, 2019) Kilic, Erol; Koca, BulentAim: Inflammation is the predominant factor in the development of gastrointestinal dysmotility or postoperative ileus although dissection and neurological and inflammatory factors secondary to intestinal manipulation have been blamed. In this study, we investigated the effectivity of local bupivacaine infusion for prevention of postoperative ileus. Material and Method: This retrospective study included patients that underwent median laparotomy and received conventional analgesia alone or conventional analgesia followed by local bupivacaine. Patients that received conventional analgesia (nonsteroidal anti-inflammatory drugs (NSAIDs] + opioids) followed by local bupivacaine infusion (15 mg/h during 48h) with Pain buster pump system were classified as Group 1 (n=30) and the patients that received conventional analgesia alone ([NSAIDs) + opioids) were classified as Group 2 (n=31). Results: The groups were similar in terms of age, gender, preoperative ASA score, surgical technique, and operative time. The Visual Analog Scale (VAS) scores during the periods 8-24 and 24-48 h and the analgesic requirement during the periods 0-8, 8-24, and 24-48 h were significantly decreased in Group 1 compared to Group 2 (p<0.05). In Group 1, active postoperative bowel sounds started earlier (38 vs. 47 h) and mean time to first flatus/defecation was significantly lower than in Group 2 (64.13 +/- 9.06 vs. 77.90 +/- 10.25 h) (p<0.05). Discussion: Transfascial bupivacaine infusion appears to be an effective technique since it reduced early postoperative pain and postoperative analgesic requirement and also provided favorable effects in the prevention of postoperative ileus, thereby leading to shorter intensive care unit stay.Öğe Effects of surgical and percutaneous tracheotomy on thyroid hormones(Edizioni Luigi Pozzi, 2019) Yetim, Tulin Durgun; Ozer, Gul Soylu; Karaaslan, Kerem; Yetim, Brahim; Kilic, ErolAim: To evaluate the effects of surgical and percutaneous tracheotomy on thyroid hormones. MATERIAL AND METHOD: Sixty patients with respiratory problems who underwent surgical tracheotomy and percutaneous tracheotomy between December 2012 and December 2016 were divided into 2 groups. FT3, FT4, thyroglobulin and TSH levels of the groups were statistically evaluated preoperatively and postoperatively. RESULTS: The effects of surgical and percutaneous tracheotomy on free thyroxin (FT4), serum thyroglobulin (TG) and thyroid stimulating hormone (TSH) levels were found to be statistically significant. Although free triiodothyronine (FT3) slightly elevated in both groups, it was not statistically significant. DISCUSSION: Today, percutaneous tracheotomy (PCT) and conventional surgical tracheotomy (CT) have been widely used in intensive care units on patients who are expected to be connected to mechanical ventilation for a long time. Because of the anatomy of the surgical site, tracheotomy may cause damage to the adjacent thyroid gland and tracheal rings CONCLUSION: Surgeons should keep in mind that serum thyroid hormone levels may increase postoperatively. Particularly the patients with cardiac rhythm problems should be followed after surgical and percutaneous tracheotomy due to the systemic effects of thyroid hormones.Öğe Molecular genotyping of Echinococcus granulosus sensu stricto from human Echinococcal cysts in Hatay, Turkiye(Academic Press Inc Elsevier Science, 2023) Hamamci, Berna; Acikgoz, Gunes; Cetinkaya, Uelfet; Kilic, Erol; Kocal, Sedat; Karaaslan, Kerem; Yetim, Tuelin DurgunCystic echinococcosis (CE) is one of the zoonotic infections in human, an important global health problem. It was aimed to determine the molecular characterization and phylogenetic analysis of isolates obtained from patients diagnosed with CE in Hatay province, according to the cox1 gene region. A total of 31 patients, 14 males and 17 females, with a mean age of 35.19 (+/- 14.28) years were included in the study. 35 cyst materials obtained from patients were studied. DNA isolation was performed from the samples with protoscoleces determined in the cyst fluid. One-way DNA sequencing was performed with the Sanger Sequencing Protocol through the obtained PCR products. In the study, 35 hydatid cysts of human origin were examined and protoscoleces was detected in 11 (31.43%) of them. Twenty of the patients had liver involvement, seven had lung involvement, and four had both liver and lung involvement. All the samples with protoscoleces detected were observed of PCR product with a size of approximately 446 bp. When the sequence results of the isolates were evaluated within themselves, it was seen that there were three different sequences with 99% similarity to each other. As a result, of the phylogenetic analysis, it was determined that the isolates were identified in the Echinococcus granulosus sensu stricto (E. granulosus s. s.) (G1-G3) complex. This study is thought to contribute to the epidemiology, parasite control, effective diagnosis and treatment techniques, eradication, vaccine and drug development studies of E. granulosus s. s in Turkiye.Öğe The role of combination pre- and postoperative albendazole therapy in the surgical management of liver hydatidosis(Edizioni Luigi Pozzi, 2018) Yetim, Brahim; Kilic, ErolAIMS: ALB is the most commonly used drug for the treatment of echinococcosis. The aim of the present study was to evaluate the effect of ALB using the intraoperative and perioperative periods as dual therapy. MATERIALS AND METHODS: Material of this retrospective study were the consecutive series of 98 patients operated for hepatic hydatidosis (HC) over a period of 7 years, at a single centre. Clinical examination, ultrasonography (US) and computed tomography (CT) were used for establishing diagnosis. Ninety-eight cases of hepatic hydatidosis were treated by albendazole intraoperatively and postoperatively together with surgery. Perioperative ALB treatment was given in a dose of 12-15 mg/ kg per day in four divided doses. The treatment started 2-28 days before the surgery when the diagnosis was established and continued for 2-24 months postoperatively in a cyclic monthly form. A total of 1.7 mg/mL ALB solution was used intraoperatively. Dual albendazole treatment (DALB) includes preoperative and postoperative oral ALB treatment and intraoperative irrigation of cystic cavity with ALB. RESULTS: In the follow-up period one patient died and there was one recurrence of hepatic hydatidosis.Morbidity rates were 10.89% . CONCLUSION: Results of this study suggest that ALB treatment with HC surgery is effective in the prevention of recurrences and/or secondary hydatidosis.Öğe Treatment of colorectal injuries in the civil war and the factors affecting mortality(Edizioni Luigi Pozzi, 2018) Ugur, Mustafa; Kilic, Erol; Koca, Yavuz Savas; Yetim, Ibrahim; Temiz, Muhyittin; Koyuncu, OnurAIM: Colorectal injuries are one of the most common causes of mortality in war. Mainstay treatment of these injuries include primary repair or stoma creation. METHODS: Clinical data of the patients were evaluated retrospectively. Time from injury to hospital admission, method of treatment, the colorectal area affected, injury severity score ISS, hemodynamic instability, and mortality rate were determined. RESULTS: Of the 61 patients included in the study. Mean time from injury to hospital admission was 160 19 minutes. The injury was in the right colon in 24 patients 39.3%, in the left colon in 18 29.5%, and in the rectum in 19 31.2% patients. Median ISS value of 61 patients was 16, IQR 5. Mortality and complication rates were higher in patients with hemodynamic instability and stoma requirement was also higher in this group p<0.05. Total mortality occurred in 15 24.5% patients. Of these, 10 66.6% patients had hemodynamic instability. DISCUSSION: Hemodynamic instability is the most important factor affecting the mortality and the treatment method in wartime colorectal injuries. CONCLUSION: We believe that in victims of war with colorectal injuries, surgical intervention before the development of hemodynamic instability may reduce the rate of mortality and stoma requirement.Öğe Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital?(Turkish Assoc Trauma Emergency Surgery, 2016) Ugur, Mustafa; Akkucuk, Seckin; Koca, Yavuz Savas; Oruc, Cem; Aydogan, Akin; Kilic, Erol; Yetim, IbrahimBACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality. METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality. RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked. CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced.
