Person: PARLAK, AYŞE
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PARLAK
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AYŞE
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Publication Reason for inconsistency between ph monitoring and impedance in detecting acid gastroesophageal reflux: PH-only events(Galenos Publ House, 2021-08-01) Parlak, Ayşe; Doğruyol, Hasan; PARLAK, AYŞE; Doğruyol, Hasan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı; 0000-0001-7686-2561; AAH-6766-2021; ETC-9949-2022Introduction: Acid reflux events detected by pH and not identified by impedance are called 'pH only events'. We aimed to explain the incidence and the possible reasons of 'pH- only events'.Materials and Methods: The automated multichannel intraluminal impedance (Mil) analysis in 50 cases was investigated. Changes in impedance channels during pH-only acid reflux events were examined and grouped. 1. Events that fail to meet the impedance measurement criteria 2. Events with no change in impedance channels 3. Events that meet the impedance criteria, but do not have signs of reflux 4. Artifact 5. Positive deflection due to air.Results: The number of acid reflux events detected in the Mil records was 1475, the number of acid reflux events detected in the pH meter was 3093, and the number of pH-only acid reflux events was 1736. 56.1% of the acid reflux events were detected by pH meter not identified by MII. The most common reasons for this were events no changes in impedance channels (68%) and other reasons such as positive deflection due to air (14%), and events that could not meet impedance measurement criteria (10%). 8% of pH-only events that met MII criteria, but were not accepted as reflux by MII.Conclusions: There was more than half of acid reflux events detected by pH meter but not identified by MIL The reason of this situation has been not clear. For the correct decision, it is important to evaluate Mil recordings together with pH meter results rather than evaluating automatic analysis alone.Publication Double purse -string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration(W B Saunders Co-elsevier Inc, 2020-05-01) Parlak, Ayşe; PARLAK, AYŞE; Gürpınar, Arif Nuri; GÜRPINAR, ARİF NURİ; Doğruyol, Hasan; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0001-7686-2561; AAH-6766-2021; AAI-3658-2021Objective: The aim of this study was to describe a new double purse-string suturing plication method that was developed to minimize difficulties experienced in thoracoscopic plication in pediatric patients.Methods: We retrospectively analyzed the data of patients that underwent diaphragmatic eventration repair with new technique developed in our clinic. In this technique, we perform diaphragm plication with continuous double layer purse-string suturing. A third suturing may be necessary in case of wide eventrations. Thoracic drainage catheter is inserted into the thorax on a routine basis.Results: Thoracoscopic plication was performed using the double purse-string suturing technique on 16 cases that presented with diaphragmatic eventration between April 2012 and December 2018. The patients' mean age was 2.2 years (6 months-17 years). The main causes of admission were recurrent respiratory system infections (n: 14), respiratory distress with effort (n: 4), ventilator dependence (n: 1), and gastrointestinal complaints such as nutritional problems (n: 1). Diaphragmatic eventration was incidentally detected in 1 patient. No complications were observed during the postoperative period, except for 1 patient that developed pneumothorax. The mean duration of hospital stay was 4.9 days (2-7 days), except for 1 patient who had ventilator dependence and congenital myopathy. The mean descending distance of the diaphragm was 2.3 intercostal spaces at postoperative first month. The clinical outcomes were satisfactory and all patients experienced symptom improvements.Conclusions: Diaphragm plication with double purse-string suturing method enables symmetrical stretching of the diaphragmatic muscles. Therefore, the diaphragmatic surface and costophrenic sinium are protected and remain functional. The advantages of this new double purse-string suturing method are easy application and durability. We believe that this method can become a preferred thoracoscopic plication technique for treatment of diaphragmatic eventration.Publication Outcome of very low and low birth weight infants with esophageal atresia: Results of the Turkish esophageal atresia registry(Georg Thieme Verlag, 2021-06-01) Öztan, Mustafa O.; Soyer, Tutku; Öztorun, Can, I; Fırıncı, Binali; Durakbaşa, Çiğdem U.; Dökümcü, Zafer; Göllü, Gülnur; Akkoyun, İbrahim; Demirel, Dilek; Karaman, Ayşe; Çiftci, İlhan; İlhan, Hüseyin; Parlak, Ayşe; Özden, Önder; Cömert, Hatice S. Y.; Oral, Akgün; Tekant, Gonca; Kıyan, Gürsu; Erginel, Başak; Güvenç, Ünal; Erdem, Ali Onur; Ertürk, Nazile; Yıldız, Abdullah; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA).Materials and Methods The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW <1,500g), LWB=1,500-2,500g), and normal BW (NBW; >2,500g).Results Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups ( p <0.05). In patients with tracheoesophageal fistula (TEF), patients of the NBW group had significantly higher rates of full oral feedings, when compared with VLBW and LBW cases ( p <0.05). At the end of the first year, when we evaluate all patients, the number of cases with fistula recanalization and esophageal anastomotic strictures (AS) requiring esophageal dilatation was similar among the groups. The weight and height measurements at 6 months and 1 year of age of the survivors were similar in all the groups. The overall mortality rate was significantly higher in the VLBW and LBW groups, when compared with the NBW patients, even in patients with tension-free anastomosis ( p <0.05). The incidence of the associated anomalies was 90.6% in cases with mortality, which was significantly higher than in survivors (59.6%; p <0.05). According to Spitz's classification, the survival rate was 87.1% in class I, 55.3% in class II, and 16.7% in class III. The most common causes of mortality were associated with cardiovascular diseases, pneumonia, and sepsis.Conclusion The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.Publication The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the turkish esophageal atresia registry(W B Saunders Co-elsevier Inc, 2021-10-24) Soyer, Tutku; Oztorun, Can Ihsan; Firinci, Binali; Durakbasa, Cigdem Ulukaya; Bahadir, Gulnur Gollu; Karaman, Ayse; Dokumcu, Zafer; Akkoyun, Ibrahim; Demirel, Berat Dilek; Oztan, Mustafa Onur; Ciftci, Ilhan; Ilhan, Huseyin; Yalcin, Sonay; Ozden, Onder; Tekant, Gonca Topuzlu; Kiyan, Gursu; Oral, Akgun; Guvenc, Unal; Erginel, Basak; Yildiz, Abdullah; Erdem, Ali Onur; Uzunlu, Osman; Erturk, Nazile; Aydin, Emrah; Samsum, Hakan; Arslan, Umut Ece; Parlak, Ayse; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0001-7686-2561; AAH-6766-2021Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p < 0.05). The rates of primary anastomosis and ten-sioned anastomosis were similar in both groups (p > 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved.Publication The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry(Wiley, 2022-11-25) Comert, Hatice Sonay Yalcin; Guney, Dogus; Durakbasa, Cigdem Ulukaya; Dokumcu, Zafer; Soyer, Tutku; Firinci, Binali; Ciftci, Ilhan; Oztan, Mustafa Onur; Demirel, Berat Dilek; Parlak, Ayşe; Gollu, Gulnur; Karaman, Ayse; Akkoyun, Ibrahim; Gul, Cengiz; Ilhan, Huseyin; Oral, Akgun; Ozcan, Rahsan; Ozen, Onder; Kiyan, Gursu; Erdem, Ali Onur; Ozaydin, Seyithan; Uzunlu, Osman; Yildiz, Abdullah; Erginel, Basak; Erturk, Nazile; Bilici, Salim; Samsum, Hakan; Ozen, Mehmet Ali; Ozcakir, Esra; Aydin, Emrah; Mert, Mehmet; Topbas, Murat; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021ObjectivesPostoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study DesignAmong the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. ResultsAmong 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. ConclusionWe demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.Publication The evaluation of central venous catheter-related complications in pediatric acute leukemia patients: Single center experience(Lippincott Williams & Wilkins, 2023-01-01) Evim, Melike Sezgin; SEZGİN EVİM, MELİKE; Yörük, Gülce; Parlak, Ayse; YÖRÜK, GÜLCE; PARLAK, AYŞE; GÜLER, SALİH; Çelik, Fatih; ÇELİK, FATİH; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Hacımustafaoğlu, Mustafa; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Baytan, Birol; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0002-1266-4897; 0000-0001-7686-2561; 0000-0002-9375-2855; 0000-0003-4646-660X; AAI-3665-2021; AAH-6766-2021Central venous catheters (CVCs) are important for maintenance of childhood leukemia treatment but CVCs may develop complications. The aim of this study was to retrospectively evaluate the CVC-related complication rate, complication types, and outcome in children with acute leukemia. Complications developing in 310 CVCs (ports n=250, Hickman catheters n=60) inserted in 262 patients were evaluated. A total of 225,296 catheter days were screened. Median (range) CVC in-dwelling time was 661.5 (1 to 2636) days. In total, 157 complications developed of which 91 (58%) were infectious complications, 35 (22.3%) were vascular, 19 (12.1%) were surgical, and 12 (7.6%) were mechanical. Hickman catheters had a higher complication rate and were more prone to mechanical complications (P<0.01) but there was no difference for other complications. A lower absolute neutrophil count at insertion was observed in children with infectious complications (P<0.01). Seventy-eight of 136 catheters (57.3%) had to be removed prematurely. The overall complication rate was 0.65 per 1000 catheter days. In multivariate analysis, relapse leukemia, Hickman catheter and low absolute neutrophil count increased complication risk by 4.00, 1.97, and 1.92 times, respectively. Five (1.9%) deaths occurred because of catheter complications. Safe use of CVCs can be improved by early detection of complications and an experienced catheter care team.Publication Laparoscopic repair of morgagni hernia in children(Mary Ann Liebert, Inc, 2022-02-11) Parlak, Ayşe; PARLAK, AYŞE; Gürpinar, Arif Nuri; GÜRPINAR, ARİF NURİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0001-7686-2561; AAI-3658-2021; AAH-6766-2021Background: This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center.Methods: This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded.Results: Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n: 2), extracorporeal knot tying, and subcutaneous knot placement (n: 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n: 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying: intracorporeally, using a laparoscopic needle holder (n: 6), with an 18-gauge injector tip (n: 1), and extracorporeally with suture passer forceps (n: 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. There was no intraoperative complication.Conclusions: In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.