Person: KILIÇTURGAY, SADIK AYHAN
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KILIÇTURGAY
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SADIK AYHAN
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Publication Early results of conservative and surgical approach in endoscopic retrograde cholangiopancreatography (ERCP) perforations single center experience(Edizioni Luigi Pozzi, 2023-07-01) Taşar, Pınar; Kılıçturgay, Sadık Ayhan; TAŞAR, PINAR; KILIÇTURGAY, SADIK AYHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Bölümü; IIC-9825-2023; IDN-9824-2023Early results of conservative and surgical approach in Endoscopic Retrograde Cholangiopancreatography INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) +/- endoscopic sphincterotomy, and after perforation (ERCP-P), which is a common method used for the diagnosis in the past and treatment today in hepatopancreatobiliary cases, is a rare complication with high mortality. While surgery has been at the forefront in perforations after ERCP in previous years, conservative treatment is widely accepted today, except for some special conditions. The aim of this study was to determine the incidence of ERCP-P in a hepatobiliary center, the outcome of the treatment modalities applied, and the risk factors for mortality due to perforations. MATERIALS AND METHODS: Patients hospitalized in our clinic with the diagnosis of ERCP-P were retrospectively analyzed. Age, gender, ERCP indication, method of treatment applied, time between ERCP-P diagnosis and treatment, injury class, length of stay (LOS) and early results of the patients were examined. RESULTS: 45 patients were hospitalized in our clinic upon the development of ERCP-P between the years of 2006 and 2022. 37 of these patients underwent conservative and 8 patients underwent surgical treatment. When the perforation types were examined, Stapfer Type 1 was found in 4 patients, Type II in 6 patients, Type III in 3 patients and Type IV ERCP-P in 32 patients (71.1%). LOS was longer in the surgical group than in the conservative treatment group (p=0.040). Mortality was observed in 15.56% of patients. 57.1% of these patients were in the surgical group. In the multivariate analysis, the time between diagnosis and treatment of ERCP-P, which is the only factor affecting mortality, was found. The risk of death was found to be 30.61 times higher in patients with a time elapsed between ERCP-P diagnosis and treatment exceeding 24 hours compared to patients with a time elapsed <= 24 hours (p=0.030). DISCUSSION: In our study, it was observed that the prognosis of the patients in the surgical group was poor and the length of stay was significantly longer. At the same time, the only effective factor on mortality is the time between ERCPP diagnosis and treatment.Publication Our experience on feeding ostomies(Türk Cerrahi Derneği, 2008-10-01) Kırdak, Türkay; Özgüç, Halil; Keskin, Murat; İşçimen, Remzi; Kelebek, Nermin; Kıyıcı, Murat; Korun, Nusret; Kılıçturgay, Sadık; Kırdak, Türkay; Özgüç, Halil; Keskin, Murat; İŞÇİMEN, REMZİ; KELEBEK GİRGİN, NERMİN; KIYICI, MURAT; Korun, Nusret; KILIÇTURGAY, SADIK AYHAN; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anestezioloji ve Reanimasyon Anabilim Dalı.; 0000-0003-4526-4352; 0000-0002-3208-6211; 0000-0001-8111-5958; CZX-7145-2022; JIC-3640-2023; JZY-7001-2024; HKP-2533-2023; CZG-2204-2022; AAI-4213-2021; FJN-9955-2022; JGY-2962-2023Purpose: The aim of the present study is to assess patient's profiles and complications related to the tube placement in patients undergoing Percutaneous Endoscopic Gastrostomy and surgical feeding ostomies.Materials and Methods: The retrospective data of 114 consecutive hospitalized patients who underwent enteral feeding ostomy procedures was evaluated by dividing patients into two separate groups as Percutaneous Endoscopic Gastrostomy Group and Surgery Group.Results: Of the 114 patients, 57 patients underwent surgical feeding ostomy procedures, and other 57 underwent Percutaneous Endoscopic Gastrostomy. The mean age of the patients requiring surgical ostomy was greater than that of the patients with Percutaneous Endoscopic Gastrostomy. All procedures in the surgical group were performed in the operating theater, but procedures in the endoscopy group were performed in intensive care unit (61.5 %), endoscopy suit (34.6 %), or patient wards (3.8 %). The number of patients having cancer in the surgical ostomy group was higher than the Endoscopy group significantly, p<0.001. On the contrary, 93 % of the patients in the Endoscopy group had neurologic problems. Total complication rates in PEG group, surgical gastrostomy and jejunostomy groups were 26.3 %, 25 % and 24.3 %, respectively.Conclusion: In conclusion, PEG procedure has some advantages such as simplicity, low complication rates, lower cost, long term enteral nutrition. For that reason, recently, there is an increase in use of PEG procedure. However, the situation in which the use of PEG is impossible, surgical enteral tube placement techniques are still valid alternatives.Publication What has changed in the last 20 years in the postoperative specimen findings of the papillary thyroid cancer cases? A retrospective analysis(Turkish Surgical Assoc, 2022-12-01) Bakar, Burak; Taşar, Pınar; Kırdak, Türkay; Kılıçturgay, Sadık; BAKAR, BURAK; TAŞAR, PINAR; Kırdak, Türkay; KILIÇTURGAY, SADIK AYHANObjective: In this study, it was aimed to investigate the changes in surgical approaches and histopathological evaluation of the tumor according to years of patients who were operated on with the diagnosis of thyroid papillary cancer (PTC) in our center in the last 20 years.Material and Methods: The records of the cases who underwent thyroidectomy in our department were divided into four groups of five years each and analyzed retrospectively. Demographic characteristics, surgical procedures, presence of chronic lymphocytic thyroiditis, histopathological features of tumour and hospital stay of the cases in the groups were evaluated. Based on tumor size, PTCs were classified into five subgroups. PTCs of 10 (mm) or less were accepted as papillary thyroid microcarcinoma (PTMC).Results: There was a significant increase in PTC and multifocal tumors in the groups over the years (p<0.001). There was a significant increase between the groups in the presence of chronic lymphocytic thyroiditis (p<0.001). In contrast, the total number of metastatic lymph nodes (p=0.486) and the largest metastatic lymph node size were similar between the groups (p> 0.999). In our study, it was observed that there was a significant increase over the years in both the total/near-total thyroidectomy cases and the number of cases with a postoperative hospital stay of one day (p<0.001).Conclusion: In the present study, it was found that papillary cancer sizes decreased gradually and the frequency of papillary microcarcinoma increased gradually in last 20 years. Also, a significant increase was detected in the rates of total/near-total thyroidectomy and lateral neck dissection over the years.Publication A mimicker of gallbladder carcinoma: Cystic gastric heterotopia with intestinal metaplasia(De Gruyter Poland Sp Zoo, 2017-01-01) BALABAN ADIM, ŞADUMAN; Özgün, Gonca; Balaban Adım, Şaduman; Uğraş, Nesrin; KILIÇTURGAY, SADIK AYHAN; UĞRAŞ, NESRİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; AAH-2716-2021; KGL-6139-2024Heterotopic gastric mucosa in the gallbladder is an unusual entity and is usually clinically silent. We report a 75-year-old female patient who presented with intermittent upper abdomial pain radiating to the back. Abdominal imaging studies showed a sessile polypoid lesion and a gallstone in the gallbladder. Gallbladder carcinoma was suspected and cholecystectomy performed. Intraoperative frozen section examination suggested mucinous tumor, suspicious for malignancy. However, the permanent sections revealed aberrant gastric tissue consisted of gastric pyloric and fundic glands of heterotopic gastric mucosa with intestinal metaplasia in the gallbladder.Publication Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report(Turkish Assoc Trauma Emergency Surgery, 2023-03-01) Taşar, Pınar; TAŞAR, PINAR; Kılıçturgay, Sadık Ayhan; KILIÇTURGAY, SADIK AYHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphinc-terotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4th post-operative day. On the magnetic res-onance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5x5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient.Publication Early results of conservative and surgical approach in endoscopic retrograde cholangiopancreatography (ERCP) perforations single center experience(Edizioni Luigi Pozzi, 2023-07-01) Taşar, Pınar; Kılıçturgay, Sadık Ayhan; TAŞAR, PINAR; KILIÇTURGAY, SADIK AYHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; IIC-9825-2023; IDN-9824-2023INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) +/- endoscopic sphincterotomy, and after perforation (ERCP-P), which is a common method used for the diagnosis in the past and treatment today in hepatopancreatobiliary cases, is a rare complication with high mortality. While surgery has been at the forefront in perforations after ERCP in previous years, conservative treatment is widely accepted today, except for some special conditions. The aim of this study was to determine the incidence of ERCP-P in a hepatobiliary center, the outcome of the treatment modalities applied, and the risk factors for mortality due to perforations.MATERIALS AND METHODS: Patients hospitalized in our clinic with the diagnosis of ERCP-P were retrospectively analyzed. Age, gender, ERCP indication, method of treatment applied, time between ERCP-P diagnosis and treatment, injury class, length of stay (LOS) and early results of the patients were examined.RESULTS: 45 patients were hospitalized in our clinic upon the development of ERCP-P between the years of 2006 and 2022. 37 of these patients underwent conservative and 8 patients underwent surgical treatment. When the perforation types were examined, Stapfer Type 1 was found in 4 patients, Type II in 6 patients, Type III in 3 patients and Type IV ERCP-P in 32 patients (71.1%). LOS was longer in the surgical group than in the conservative treatment group (p=0.040). Mortality was observed in 15.56% of patients. 57.1% of these patients were in the surgical group. In the multivariate analysis, the time between diagnosis and treatment of ERCP-P, which is the only factor affecting mortality, was found. The risk of death was found to be 30.61 times higher in patients with a time elapsed between ERCP-P diagnosis and treatment exceeding 24 hours compared to patients with a time elapsed <= 24 hours (p=0.030).DISCUSSION: In our study, it was observed that the prognosis of the patients in the surgical group was poor and the length of stay was significantly longer. At the same time, the only effective factor on mortality is the time between ERCPP diagnosis and treatment.