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Öğe Early Effect of Metabolic Surgery on Erectile Function and Ejaculation: a Pilot Study of Obese Men with Type 2 Diabetes Mellitus(Springer, 2020) Karaca, Fatih Can; Tas, TuncayPurpose Majority of men with type 2 diabetes mellitus (T2DM) have been reported to experience erectile dysfunction (ED) in a lifetime. The aim of our study was to prospectively evaluate the postoperative condition of ED and premature ejaculation (PE) in men who underwent metabolic surgery for the treatment of T2DM. Materials and Methods A total of 36 sexually active male individuals with T2DM who were applied for metabolic surgery were given two different questionnaire forms prior to and 6 months after the surgery. Patients filled the International Index of Erectile Function (IIEF) and the Premature Ejaculation Profile (PEP) questionnaires before and 6 months after the surgery. The BMI, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) concentrations were also measured prior to the surgery and on follow-up points of postoperative first, third, and sixth months. Results Erectile function (EF) and overall satisfaction domains of the IIEF questionnaire increased significantly after the surgery in the patient groups irrespective of the previous ED severity (p < 0.001). There were significant improvements of the PEP interpersonal difficulty related to ejaculation score and HbA1c levels in the severe/moderate EF group and IIEF EF, PEP interpersonal difficulty related to ejaculation domains, and HbA1c levels of mild to moderate/mild/no ED group after the metabolic surgery. Conclusion Metabolic surgery could improve erectile and ejaculatory function scores of obese patients with T2DM.Öğe Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes, and Nutritional Status in Type 2 Diabetes Mellitus Patients(Springer, 2020) Karaca, Fatih CanBackground Sleeve gastrectomy with transit bipartition (SG + TB) surgery is an effective treatment modality for the patients with type 2 diabetes mellitus (T2DM). Here, we aimed to present the 1-year follow-up data of our patients with T2DM who underwent SG + TB. Methods We evaluated the follow-up results of 45 patients and evaluated the remission status of T2DM. Additionally, biochemical variables including lipid status, liver function and nutritional status were presented. Results A total of 40 T2DM remissions occurred among the 45 patients (88.8%). The complete remission was present in 35 of the patients at the end of the postoperative first year. The lipid profile markers improved following the first postoperative month. The levels of the liver enzyme alanine aminotransferase (ALT) decreased after the first postoperative month, while aspartate aminotransferase (AST) levels did not alter significantly during the follow-up period. We did not observe a change regarding albumin and vitamin B12 levels following the surgery. Conclusion SG + TB is a convenient and therapeutic method for the treatment of T2DM, along with the improvement in lipid profile and liver enzyme levels.Öğe Endoloop versus intracorporeal knotting: Comparison of two appendiceal ligation methods during laparoscopic appendectomy(Laparoscopic Endoscopic Surgical Science, 2019) Karaca, Fatih CanABSTRACT: Introduction: The laparoscopic approach to appendectomy surgery led to various appendiceal ligation methods; however, the ideal technique for appendiceal stump closure has yet to be determined. This study is a comparison of intracorporeal knotting (IK) and Endoloop (Ethicon, Inc., Somerville, NJ, USA) (EL) techniques for appendiceal stump closure during laparoscopic appendectomy (LA) surgery. Materials and Methods: All of the LAs included in the study were performed by only 2 surgeons between June 2013 and June 2018 and the results were retrieved retrospectively. The patients were divided into an IK group and an EL group. Early postoperative complications (<30 days) were evaluated. All of the LAs were performed using 3 trocars. In the IK group, the appendiceal base was ligated with a manually constructed single intracorporeal knot. In the EL group, the appendiceal base was ligated with a single Endoloop tie (Vicryl ligature; Ethicon, Inc., Somerville, NJ, USA). A LigaSure device (Medtronic, Inc., Minneapolis, MN, USA) was utilized in both techniques for transection of the appendix. The specimen was extracted through the umbilical port within an Endobag (Medtronic, Inc., Minneapolis, MN, USA). A normal diet was administered within 6 hours postoperatively and the patients were discharged the day after the operation. Results: The IK group consisted of 54 patients and the EL group comprised 75 patients. The groups were similar regarding gender, age, body mass index, and American Society of Anesthesiologists score. Although the operation time tended to be longer in the IK group, the difference was not statistically significant (48.46±23.85 vs. 45.36±22.28 minutes; p=0.459). In the EL group, the drain was retained in 1 patient for 2 weeks due to liver cirrhosis and 1 patient had an intraabdominal abscess. The latter patient was treated with percutaneous drainage and antibiotherapy. Conclusion: The IK technique and the EL technique had similar results. Due to its lower cost and wider availability, IK might be suggested over the EL technique. Eliminating the dependence on commercial products and providing the means for the development of advanced laparoscopic skills are additional benefits of the IK technique.Öğe Endoloop versus intracorporeal knotting: Comparison of two appendiceal ligation methods during laparoscopic appendectomy(2019) Karaca, Fatih Can; Atasoy, DenizIntroduction: The laparoscopic approach to appendectomy surgery led to various appendiceal ligation methods; however, the ideal technique for appendiceal stump closure has yet to be determined. This study is a comparison of intracorporeal knotting (IK) and Endoloop (Ethicon, Inc., Somerville, NJ, USA) (EL) techniques for appendiceal stump closure during laparoscopic appendectomy (LA) surgery.Materials and Methods: All of the LAs included in the study were performed by only 2 surgeons between June 2013 and June 2018 and the results were retrieved retrospectively. The patients were divided into an IK group and an EL group. Early postoperative complications (<30 days) were evaluated. All of the LAs wereperformed using 3 trocars. In the IK group, the appendiceal base was ligated with a manually constructed single intracorporeal knot. In the EL group, the appendiceal base was ligated with a single Endoloop tie (Vicryl ligature; Ethicon, Inc., Somerville, NJ, USA). A LigaSure device (Medtronic, Inc., Minneapolis, MN, USA) was utilized in both techniques for transection of the appendix. The specimen was extracted through theumbilical port within an Endobag (Medtronic, Inc., Minneapolis, MN, USA). A normal diet was administered within 6 hours postoperatively and the patients were discharged the day after the operation.Results: The IK group consisted of 54 patients and the EL group comprised 75 patients. The groups were similar regarding gender, age, body mass index, and American Society of Anesthesiologists score. Although the operation time tended to be longer in the IK group, the difference was not statistically signifiant (48.46±23.85 vs. 45.36±22.28 minutes; p=0.459). In the EL group, the drain was retained in 1 patient for 2weeks due to liver cirrhosis and 1 patient had an intraabdominal abscess. The latter patient was treated with percutaneous drainage and antibiotherapy.Conclusion: The IK technique and the EL technique had similar results. Due to its lower cost and wider availability, IK might be suggested over the EL technique. Eliminating the dependence on commercial products and providing the means for the development of advanced laparoscopic skills are additional benefis of the IK technique.Öğe Evaluation of pressure ulcer risk in hospitalized patients after metabolic surgery(Selçuk BAŞAK, 2020) Karaca, Fatih Can; Ulusan, KıvılcımAim: Patients who underwent surgery are in the risk group for development of pressure ulcers (PU) due to several factors including surgery time, immobilization and preexisting comorbidities. We aimed to evaluate the PU risk using The Braden Scale in patients during their hospitalization after sleeve gastrectomy with transit bipartition (SG+TB) surgery. Methods: This is a retrospective cohort study evaluating the PU risk using The Braden Scale, which consists of six subscales including sensory perception, moisture, activity, mobility, nutrition, and friction/shear. The patients were sub-grouped in terms of PU risk based on total Braden score. Results: The study group consisted of 33 patients who underwent SG+TB. The mean Braden score was 19.2(2.77) (range 12-23) during the hospitalization period. The Braden scores of the patients were lower on the 2nd (P|Amaç: Operasyon geçiren hastalar, ameliyat süresi, immobilizasyon ve varolan komorbiditeleri nedeniyele bası yarası gelişimi için risk grubunda bulunmaktadır. Bu çalışmada sleeve gastrektomi ve transit bipartisyon (SG+TB) ameliyatı sonrası hastanede yatış sırasında bası yarası riskini Braden Ölçeği ile değerlendirmeyi amaçladık. Yöntemler: Bu retrospektif kohort çalışmada, Braden Ölçeği değerlendirmesi, duyusal algılama, nem, aktivite, hareketlilik, beslenme ve sürtünme/yırtılma olmak üzere altı alt ölçekten oluşan çizelge ile hastanede yatış süresince günlük olarak yapıldı. Hastalar bası yarası riski açısından toplam Braden skoruna göre alt gruplara ayrıldı. Bulgular: Çalışma grubu SG+TB uygulanan 33 hastadan oluşturuldu. Ortalama Braden skoru hastanede kalış süresi boyunca 19,2(2,77) idi (12-23 arası). Hastaların Braden skorları postoperatif 2. (PÖğe Intraoperative awareness during laparoscopic sleeve gastrectomy(Prusa Medical Publishing, 2021) Şen, Ozan; Karaca, Fatih Can; Zengin, Seniyye; Türkçapar, AhmetObjectives: The aim of this study is to determine the incidence of intraoperative awereness (IA) in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and the factors affecting the formation of this complication. Methods: Four hundred ten patients who underwent LSG between March 2018 and September 2020 were included in the study. By April 2019, we started using the Bispectral index (BIS) monitoring, which measures the depth of anesthesia in all of our LSG cases (n = 167). Patients with and without BIS monitorization were divided into two groups and compared. Results: In our series, IA was seen in 3 patients (2 males) in two different hospitals (0.7%; n = 410). They were all in the non BIS group (n = 243). The median duration of anesthesia was 120 minutes (ranging 90-180) in the non-BIS, and 113 minutes (ranging, 90-140) in the BIS group (p < 0.001). Hypotension developed in 63 patients in non-BIS and 12 patients in BIS group at the beginning of the operation (< 90/60 mm Hg). The total remifentanil infusion dose administered during the anesthesia period in the BIS group was 1310 ± 351 mcg, and 1330 ± 270 mcg in the non BIS group (p = 0.002). The effect of BIS monitorization between groups on IA, did not show statistical significance (p = 0.27). Conclusions: Anesthesia techniques that work well for patients with normal weight may not be safe and appropriate for obese patients. Especially in patients with intraoperative hypotension, it is necessary to be more careful about dose adjustment of anesthetic drugs.Öğe Surgical Management of Breast Cancer in Turkey: a 30-Year Single-Center Retrospective Study of 2531 Patients(Springer India, 2021) Karaca, Fatih Can; Pusane, Ali; Turna, Hande Zeynep; Celik, Varol; Oral, CeyhunMastectomy and lumpectomy are well-established surgical methods for the surgical treatment of breast cancer. The comparison of these methods within the 30-year period in terms of clinicopathological characteristics, recurrence, and survival patterns is required in order to provide aid in clinical decision-making. A total of 2531 women who underwent mastectomy or lumpectomy between 1982 and 2012 for primary invasive breast tumors were compared. Starting from 2003, similar variables for patients with primary invasive breast tumors who underwent sentinel node biopsy (SNB) were presented. Mastectomy was performed in 1870 patients and lumpectomy in 661. The median follow-up was 38 months for all patients. The ratio of mastectomy was lower for the patients who underwent SNB. There was no significant difference in breast cancer-related survival or disease-free survival between lumpectomy and mastectomy even after adjusting for the clinicopathological variables. Lumpectomy and mastectomy demonstrate similar survival rates for patients with invasive breast carcinoma. Tumor grade, stage, hormone receptor status, lymphovascular invasion, and distant recurrence have an impact on breast cancer-related survival.Öğe The effect of tack number and balloon trocar use on acute post-operative pain scores of patients who underwent TEP repair of inguinal hernia(Fatih BAŞAK, 2020) Karaca, Fatih Can; Atasoy, DenizAim: As the novel technology on surgical procedures evolve, the management and amelioration strategies for postoperative pain gains importance for surgeons to improve patients’ life quality and postoperative outcomes. In this study, we aimed to compare the number of tacks placed during surgery and the use of intra-operative balloon trocars during TEP repair of inguinal hernias with respect to post-operative early pain scores.Methods: A total of 83 patients were included in this prospective cohort study, 59 being in the 0-1 tack group and 24 in the 2 tacks group. Balloon trocar was used in 32 patients. All patients underwent laparoscopic TEP inguinal hernia repair. Groups were compared with respect to pain scores on 3rd, 12th and 24th postoperative hours. Results: Pain score was better in no balloon trocar+2 tacks group when compared to balloon trocar+2 tacks and no balloon trocar+0-1 tack group at the 24th postoperative hour (P=0.02 and P=0.007, respectively), and in the balloon trocar+0-1 tack group than that of the no balloon trocar+0-1 tack group (P=0.004). There was no statistically significant difference between these four groups in terms of pain score on the 3rd and 12th hours of surgery (P=0.46 and P=0.24, respectively). Patients in the 0-1 tack group reported less pain on the 24th postoperative hour (3.1 (6.3) vs 14.1 (21.8); P=0.32).Conclusion: Using less number of tacks and avoiding using balloon trocar result in lower pain scores following laparoscopic TEP repair of inguinal hernias. |Amaç: Cerrahi prosedürler yeni teknoloji kullanılarak geliştikçe, postoperatif dönemde hastaların yaşam kalitesinin ve ameliyat sonrası dönemin iyileştirilmesi açısından bu dönemde ağrı yönetimi ve ağrıyı azaltma stratejileri cerrahlar için önem kazanmaktadır. Bu nedenle, çalışmamızda, tack sayısı ve intraoperatif balon trokar kullanımının TEP inguinal herni operasyonu sonrası erken dönem ağrı skorlarına etkisinin retrospektif olarak karşılaştırılması amaçlanmıştır.Yöntemler: Bu prospektif kohort çalışmasına toplam 83 hasta dahil edildi; 59'u 0-1 tack kullanılan grupta ve 24'ü 2 tack kullanılan grupta idi. 32 hastada balon trokar kullanıldı. Tüm hastalara laparoskopik TEP inguinal herni onarımı yapıldı. Gruplar ameliyat sonrası 3., 12. ve 24. saatlerde ağrı skorlarına göre karşılaştırıldı.Bulgular: Ameliyattan sonraki 24. saatte balon trokar kullanılmayan ve 2 tack kullanılan grupta balon trokar + 2 tack ve balon trokar + 0-1 tack grubuna göre ağrı skoru daha iyi idi (Sırasıyla P=0,02 ve P=0,007). Ağrı skoru balon trokar + 0-1 tack grubunda, balon trokar kullanılmayan ve 0-1 tack kullanılan gruba kıyasla daha iyiydi (P=0,004). Ameliyatın 3. ve 12. saatlerinde ağrı skoru açısından bu dört grup arasında istatistiksel olarak anlamlı bir fark saptanmadı (Sırasıyla P=0,46 ve P=0.24). 0-1 tack grubundaki hastalar postoperatif 24. saatte daha az ağrı hissettiklerini bildirdi (3,1 (6,3)'e karşı 14,1(21,8); P=0,32).Sonuç: İnguinal hernilerin laparoskopik TEP onarımını takiben daha az sayıda tack kullanımı ve balon trokar kullanımının sınırlanması, daha iyi postoperatif ağrı skoru ile ilişkilidir.Öğe The short-term effects of laparoscopic sleeve gastrectomy on hematological parameters(2020) Karaca, Fatih CanIntroduction: Sleeve gastrectomy (SG) surgery is an effective method for weight loss in obese individuals.The data on the effect of this surgical intervention on iron metabolism and hematological factors are limited.This study aimed to investigate the effects of SG surgery on iron and red blood cell-related parameters.Materials and Methods: The six-month follow-up data of 33 patients who underwent SG for obesity treatment were evaluated retrospectively in this study. Whole blood levels of hemoglobin, mean corpuscularvolume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW-CV),and serum iron concentrations were evaluated.Results: Mean hemoglobin, MCHC, and RDCV levels did not show a significant difference compared to thebaseline and between months. Mean MCV levels significantly differed from baseline values at the end of thethird month. Serum iron levels were significantly higher on the 6-month follow-up visit.Conclusion: The findings suggest that the iron level and other iron-related hematological parameters of thepatients who underwent SG improved after the surgery.Öğe The short-term effects of laparoscopic sleeve gastrectomy on hematological parameters(Laparosc Endosc Surg Sc, 2020) Karaca, Fatih CanAbstract: Introduction: Sleeve gastrectomy (SG) surgery is an effective method for weight loss in obese individuals. The data on the effect of this surgical intervention on iron metabolism and hematological factors are limited. This study aimed to investigate the effects of SG surgery on iron and red blood cell-related parameters. Materials and Methods: The six-month follow-up data of 33 patients who underwent SG for obesity treatment were evaluated retrospectively in this study. Whole blood levels of hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW-CV), and serum iron concentrations were evaluated. Results: Mean hemoglobin, MCHC, and RDCV levels did not show a significant difference compared to the baseline and between months. Mean MCV levels significantly differed from baseline values at the end of the third month. Serum iron levels were significantly higher on the 6-month follow-up visit. Conclusion: The findings suggest that the iron level and other iron-related hematological parameters of the patients who underwent SG improved after the surgery.Öğe Weight loss after intragastric botulinum toxin injection in different weight individuals(2020) Karaca, Fatih CanBackground: Intragastric injection of Botulinum toxin A has been shown to induce weight loss, slowering gastric motility as a result of inhibition of the acetylcholine-mediated gastric contractions. The aim of this study was to observe the effects of endoscopic intragastric injections of intragastric injection of botulinum toxin A in obese patients. Material and Method: A total dose of 400 U intragastric injection of botulinum toxin A was injected endoscopically into the antrum, corpus and fundus regions of the stomach. The follow-up results of 102 patients sub-grouped according to body mass indices values and evaluated the weight loss status were evaluated. Weight loss data was collected on the monthly follow-up visits for three consecutive months. Results: At the end of the third month, all subjects lost body weight, with a mean total weight loss ratio ranging between 4.76-19.47%. Mean total body weight loss percentages were significantly higher in Class II and III obese subjects compared to the normal- and over-weight and Class I obese individuals. Gastrointestinal adverse effects were observed in only five (4.9%) of the patients. Conclusion: Intragastric injection of botulinum toxin A administration with a dose of 400 U is a convenient method for weight loss for the individuals of different body mass indices.
