Ali Duran

IntroductionHydatid disease is a serious parasitic infection caused by Echinococcus granulosus. The mosteffective treatment method is surgery. The recurrence of disease is an important long-termpostoperative complication. The present study investigates the factors affecting recurrence inoperated cases of liver hydatid cysts.Material and MethodsThe study examines the data who underwent surgical therapy for hydatid cysts with liverlocalization between 2008-2014. Age, gender, serological test results, radiologicalexamination results, ASA score, operational technique, postoperative complications werereviewed retrospectively, making use of the hospital information system and the patientrecords.ResultsTotal 166 patients with liver hydatid cysts were analyzed. Of the study group, recurrencedeveloped in 26 (%15.6) patients and 15 (%9) patients were female. The indirecthemagglutination test (IHAT) was positive in 96 (%65.8) patients. Recurrence developed in15.6% of the IHAT (+), 20.0% (n=8) of patients with a cystic lesion of >10cm. There wasfurther no statistically significant difference between the diameter of cystic lesion,serological test results (IHAT), gender, age, Gharbi classification and recurrencedevelopment regardless of the type of surgical intervention (p>0.05). Multiple cystic lesionswere identified in 44 (%26.5) patients and recurrence rate was 29.5% (n=13). The rate ofrecurrence in this group is significantly higher than patients with a single cystic lesion(p<0.05). Recurrence was observed to develop at a lower rate among patients undergoingradical surgery groups than conservative ones (5.9% v.s 22.2%, p<0.05).Discussion and ConclusionRecurrence is a very important issue in hydatid cyst surgery. Patients with multiple cystshaving a significantly higher rate of recurrence. Likewise, radical surgical procedures reducethe development of recurrence rather than conservative ones, significantly. That said, radicalsurgical interventions are performed less frequently, as more experience is required, and thismay be associated with the high recurrence rates.Keywords: Hydatid cyst, surgery, recurrence, cyst characteristics.

Background and Objectives: Seroma formation is the most common postoperative complication following mastectomy and axillary dissection, negatively affecting wound healing and delaying adjuvant therapy. Despite numerous surgical and pharmacological approaches, no universally effective strategies have been established. This study aimed to comparatively evaluate the effects of porcine dermal collagen (PDC), tranexamic acid (TXA), and thymoquinone (TQ) on seroma formation and tissue repair. Materials and Methods: A randomized controlled experimental study was conducted using 40 female Wistar albino rats that underwent modified radical mastectomy and axillary dissection. All surgical and postoperative procedures were performed in accordance with the institutional animal welfare and ethical guidelines, including postoperative analgesic administration. The animals were divided into four groups: control, PDC, TXA, and TQ (n = 10 each). Seroma volume was measured on postoperative day 14. Histopathological evaluation, immunohistochemical analysis (FGF2, VEGF, TGF-β1, p53), and quantitative real-time PCR were performed to assess tissue remodeling and molecular responses. Results: All treatment groups demonstrated a significant reduction in seroma volume compared to the control group, with the most pronounced decrease observed in the TQ and TXA groups (p < 0.0001), while PDC showed a moderate effect (p < 0.01). Histopathological analysis revealed increased collagen deposition and fibrin formation in the PDC and TQ groups, whereas TXA exhibited a more limited remodeling profile than the others. Immunohistochemical and molecular analyses showed significant upregulation of VEGF across all groups, with broader and more consistent increases in the PDC and TQ groups. TGF-β1 and FGF2 expression demonstrated region-specific increases, particularly in the thoracic tissue. p53 expression remained relatively stable in the TXA group but was elevated in specific regions in the PDC and TQ groups. Importantly, the increased inflammatory infiltration, edema, vascular proliferation, and fibrin deposition observed in the TQ group may reflect not only active tissue remodeling processes but also prolonged inflammatory activation and enhanced fibrotic responses and should therefore be interpreted cautiously. Conclusions: PDC, TXA, and TQ differentially modulate postoperative seroma formation via distinct biological mechanisms. While TXA primarily exerts a targeted anti-seroma effect and PDC enhances extracellular matrix stabilization, TQ is associated with broader angiogenic, inflammatory, and tissue remodeling responses within this preclinical rat model. These findings should be considered exploratory and hypothesis-generating, and additional mechanistic studies and clinical investigations are necessary before definitive therapeutic conclusions can be established regarding the use of TQ in human breast surgery settings.

Çocuklarda ve ergenlerde meme kitleleri, yetişkinlerden farklı bir klinik spektrum sergiler. Bu yaş grubunda meme kitlelerinin büyük çoğunluğu benign olup, malign lezyonlar oldukça nadirdir. Çocuklarda meme dokusunun gelişimsel özellikleri, hormonal değişiklikler ve pediatrik meme patolojilerinin doğası, tanı ve tedavi yaklaşımlarını yetişkinlerden ayırır.

Cerrahi’nin Tarihçesi Adem ASLAN Cerrahi Hastalarda Sıvı ve Elektrolit Yönetimi Tuba MERT Şok Burak UÇANER Cerrahi Enfeksiyon Oğuz HANÇERLİOĞULLARI Travma Cerrahisi Çağdaş KARAMAN Cerrahi Yara İyileşmesi Mehmet Sabri ÇİFTÇİ Cerrahi Kanama ve Transfüzyon Serdar ACAR Baş Boyun Cerrahisinde Yenilikler Seda SEZEN GÖKTAŞ Tiroid Hastalıklarına Yaklaşım Zeynep ANADOLULU Paratiroid Hastalıklarına Yaklaşım Murat ÖZKARA Benign Meme Hastalıklarına Yaklaşım Nimet SÜSLÜ Malign Meme Hastalıkları Cerrahisi Murat KARTAL Meme Kanserinde Sentinel Lenf Nodu Biyopsisi Furkan SAVAŞ Onkoplastik Meme Cerrahisi Hasan Turgut AYDIN Diyafragma Cerrahisi İsa KARACA Özofagus Kanseri Cerrahisi Mevlüt YORDANAGİL Akalazya: Tanı ve Tedavi Sacit Altuğ KESİKLİ Güncel Mide Cerrahisi Ali DURAN Midenin Selim Hastalıklarına Yaklaşım Mehmet ARSLAN Güncel Bariatrik Cerrahi Yunus YAPALAK Obezitenin Cerrahi Dışı Tedavi Yöntemleri Elnur HÜSEYNOV Safra Kesesi Cerrahisi Özkan SUBAŞI Safra Yolları Girişimleri Mirkhalig JAVADOV Emrah KARATAY Pankreas Hastalıkları ve Tedavisi Gökhan GARİP Açık ve Laparoskopik Splenektomi Erhan ERÖZ Sürrenal Hastalıkları ve Cerrahisi Baran MOLLAVELİOĞLU Güncel Apandisit Cerrahisi Sibel ÖZKARA Kasık Fıtığının Açık ve Laparoskopik Cerrahisi Murat DEMİR Ventral Herni Cerrahisi Abdullah AS Malign ve Benign Hastalıklarda Karaciğer Cerrahisi Seda BAŞTÜRK Karaciğer Kistlerinin Tedavisi Mevlüt Harun AĞCA Karaciğer Kistlerinde PAIR Uygulaması Mehmet Emin UNUTMAZ Endoskopik Retrograd Kolanjiyopankreatografi ERCP Mikail UYAN HIPEC, Sıcak Kemoterapi Gözde ERTUNÇ AÇIKGÖZ Transanal Endoskopik Mikrocerrahi (TEM) Serdar ACAR İnce Bağırsak Cerrahisi Serkan YILMAZ Gastrointestinal Sistem Kanamaları Mesud FAKİRULLAHOĞLU Hasar Kontrol Cerrahisi Sümeyra GÜLER Laparoskopik Diagnostik Girişimler Bilal TURAN Endsokopik Submukozal Diseksiyon Mehmet BİÇER Laparoskopik İnce Barsak Cerrahisi Mesut YUR Güncel Kolorektal Cerrahi Barış CANDAN Benign Kolorektal Hastalıklara Yaklaşım Osman AKDOĞAN Mehmet KARAHAN Rektal Prolapsus Cerrahisi Yasin Orhan ERKUŞ Karın Duvarı Tümörlerine Yaklaşım Göktürk GÜRSOY Proktolojide Güncel Tedavi Yöntemleri Muhammet Fikri KÜNDEŞ Transplantasyon Emil HÜSEYİNOĞLU Bahtiyar MUHAMMEDOĞLU Genel Cerrahide Lazer Teknolojisinin Kullanımı Şükran ÇAVDAR Murat Bulut ÖZKAN Cerrahi Komplikasyon Yönetimi Gizem FIRTINA Perkütan Abdominal Apse, Sıvı Drenajı Tuğberk BAŞTÜRK Cerrahide Stapler Teknolojisi ve Enerji Aletleri Oğuzhan ÇÖĞÜRLÜ Jinekolojide Minimal İnvaziv Cerrahi Burcu AYDIN BOYAMA İleri Endoskopik Girişimler Girayhan ÇELİK Anormal Uterin Kanama ve Cerrahisi Cansu ÖNAL KANBAŞ Endoscopik Ultrasonografi Mahmut Baran YERLİKAYA Batın Kapama Yöntemlerinde Yenilikler İbrahim KILINÇ Pelvik Taban Kusurlarında Cerrahi Uygulamalar Tamer TOPALOĞLU Omurga Cerrahisi Furkan SOY Halil GÖK Pediatrik Yaş Grubunda Pilonidal Sinüs Tedavisine Güncel Yaklaşımlar Gonca GERÇEL Ali İhsan ANADOLULU Pediatrik Minimal İnvaziv Uygulamalar Ali İhsan ANADOLULU Gonca GERÇEL Jinekolojik Onkolojik Aciller Nur Cansu YILMAZ BALDAN Cerrahide Anestezi Yönetimi Fatma OKUCU Robotik Cerrahi Teknolojisinin Gelişimi Berke MANOĞLU

BACKGROUND: The aim of the study was to investigate the use of prophylactic nitroglycerin patch in patients who applied to our clinic with occlusion icter and underwent endoscopic retrograde cholangiopancreatography (ERCP) for complications such as pancre-atitis, bleeding, perforation that may occur during and after the procedure, duration of the procedure, length of hospitalization, precut and selective cannulation rates, and mortality.METHODS: Patients were searched retrospectively using the hospital database. Patients under the age of 18, patients with poor general condition and patients treated under emergency conditions were excluded from the study. The effects of the drug on morbid-ity, mortality, duration of procedure, length of hospital stay, and cannulation techniques were investigated in patient groups with and without nitroglycerin patch.RESULTS: It was observed that using nitroglycerin decreased the precut probability by 2.28 times (p<0.001), and decreased periop-erative bleeding by 3.4 times (p<0.001). 75.1% selective cannulation was observed in the group not administered nitroglycerin, this rate was determined as 87.3% in the group administered nitroderm(p<0.001). In the regression model, it was observed that the presence of nitroderm increased the probability of selective cannulation 2.21 times (p<0.001). The effects of nitroglycerin use on mortality, pa-tient's history of malignancy, presence of stones and mud, gender, age, post-operative pancreatitis, and perioperative bleeding variables were evaluated by regression analysis, and age increased mortality by 1.09 (p=0.023).CONCLUSION: It has been shown that the use of prophylactic nitroglycerin patch in ERCP procedure increases the prophylactic selective cannulation rate, shortens the precut rate, pre-operative bleeding, hospital stay, and procedure time.

BACKGROUND: Anastomotic leakage is the most feared complication after colonic anastomosis. The purpose of the study is to determine the effects of phenytoin applied by different application routes, on the healing process of colorectal anastomoses. METHODS: Wistar Albino rats were divided into Intraperitoneal Phenytoin Group, Oral Phenytoin Group (OAP), Rectal Phenytoin Group (RAP), and control groups. The molecular effect of phenytoin on the expression of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-beta), fibroblast growth factor 2 (FGF2), and p53 genes was evaluated at mRNA and protein level. The effects of phenytoin on anastomotic bursting pressure analysis measured as well as pathohistological examinations. RESULTS: There are statistically significant increase in anastomotic bursting pressure values between control and application groups. Inflammatory cell infiltration of all groups increased in the intestinal anastomosis region compared to control. Collagen scores were found to be significantly higher in the OAP and RAP groups compared to the control group. mRNA of TGF-beta and FGF2 expression increased in all routes of phenytoin applications. CONCLUSION: Three different administration routes show considerably increase on the bursting pressure. Regarding the results of the expression of FGF2, TGF-beta, p53, and VEGF genes, there is a significant increase FGF2 and TGF-beta at mRNA and protein level in most administration routes.

Aim: The aim of the study is to investigate whether the shock index (SI) and glomerular filtration rate (GFR) have significance in differentiating acute appendicitis from complicated perforated acute appendicitis. Materials-Methods: Patients were searched retrospectively on the hospital database. Age, gender, C-reactive protein (CRP), leukocyte (WBC), total bilirubin (T.BIL), urea, creatinine, pulse (NBZ), and arterial blood pressure (TA) values of the patients were searched retrospectively on the hospital database and a database was created by using these patient variables. GFR and SI were calculated by using these data. The surgical notes about patients were reviewed retrospectively, and they were divided into two groups, namely perforated appendicitis and non-perforated appendicitis. The data were analyzed to investigate whether GFR and SI were effective in predicting perforation. Results: It was observed that NB/TA value had more frequent pathological findings in patients with perforated appendicitis (p<0.001). It was found that age (p=0.001), CRP (p<0.001), WBC (p<0.001), T. BIL (p=0.002), NB (p=0.017), and NB/TA (p<0.001) values of the patients in the perforated appendicitis group were higher than those of the patients in the normal appendicitis group, while GFR (p<0.001) and TA (p<0.001) values were lower (p<0.05). Conclusion: It is thought that SI and GFR may be a prognostic parameter for showing both perforation and the associated increased mortality rate.

Aim: The aim of the study was to investigate the effect of temporary plastic stenting and ursodeoxycholic acid (UDCA) treatment on difficult choledochal stones that cannot be removed by basic ERCP techniques in patients who applied to our clinic with occlusion and underwent endoscopic retrograde cholangiopancreatography (ERCP). Material and Method: Patients were scanned retrospectively using the hospital database. Patients who underwent ERCP due to malignancy, biliary tract injury and benign strictures were excluded from the study. 61 patients who were not successful with basic ERCP techniques such as endoscopic sphincterotomy (EST) and mechanical lithotripsy (ML) were included in the study. 750 mg/day UDCA was given to the patients for three months and plastic stent was applied. After the treatment, ERCP was tried again. Results: Among the patients who underwent stent+UDCA, three (4.9%) patients had perioperative bleeding, one (1.6%) patient had peroperative perforation, four (6.6%) patients had postoperative pancreatitis, and one (1.6%) patient had mortality. The mean hospital stay was 1.96±2.1 days. Post-procedure total bilirubin and direct bilirubin values were observed to be lower than before the procedure (respectively, p

Amaç Çalışmanın amacı laparoskopik cerrahi tedavi uyguladığımız kist hidatik olgularını yaş, cinsiyet, kist yerleşimi, kist boyutu ve tipi, uygulanan tedavi, operasyon süresi, erken ve geç dönem komplikasyonları ve nüks açısından retrospektif olarak değerlendirmek ve bu bulguları literatürle karşılaştırmaktır. Gereç ve Yöntem Hastaların yaş, cinsiyet gibi demografik bilgileri, serolojik ve radyolojik tetkik sonuçları, kistlerin sayısı, Gharbi sınıflamasına göre tipi, boyutu, lokalizasyonu, operasyon şekli ve süresi, erken ve geç dönem komplikasyonları, hastanede kalış süreleri, mortalite ve morbidite verileri hastane kayıt sisteminden geriye dönük tarandı ve veri tabanı oluşturularak analiz edildi. Bulgular Hastaların yaş ortalaması 35.28 ±16.12 olup, %42.9’u kadın (6/14) ve %57.1’i erkek (8/14) hastalardan oluşmaktaydı. Hastaların en sık başvuru nedeni sırasıyla ağrı (%57.1) ve sarılık (%21.4) şikayetleriydi. Hastaların tamamına tanı aşamasında (Bilgisayarlı Tomografi) BT ve (Ultrasonografi) USG istendi. Medikal tedavi tüm hastalara uygulanmıştı. Tüm hastalara laparoskopik perikistektomi operasyonu yapıldı. Oral tedavi birinci gün başlandı. Hastaların üçünde (% 21.4) operasyon esnasında safra sızıntısı gelişti ve primer onarıldı. Postoperatif yedi hastada (%50.0, 7/14) safra sızıntısı gelişirken, bu hastalardan ikisinde (%14.3) ise Endoskopik Retrograd Kolanjiyo Pankreatografi (ERCP) gereksinimi oldu. Hastalar bir yıl süreyle takip edildi, bu sürede mortalite ve nüks gelişmedi. Sonuç Deneyimli merkezlerde ve tecrübeli cerrahlarca yapılan laparoskopik cerrahinin kist hidatik tedavisinde daha sık tercih edileceği düşünülmektedir.