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Öğe Association between colonic diverticulosis and colorectal polyps, advanced neoplastic lesions, and colorectal carcinomas: A cross-sectional, retrospective study(Lippincott Williams and Wilkins, 2020) Tomaoglu, KamerPurpose:The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs).Methods:The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with ?2 test or the Fisher exact probability. P-values <0.05 (2 sided) were considered statistically significant. Statistical analyses were conducted with SPSS, version 18.Results:Of the 3496 patients, 1691 were male individuals (48.4%) and 1805 (51.6%) were female individuals. Diverticulosis was present in 12.6% of patients. A total of 870 polyps were detected in 716 patients. A total of 170 polyps (19.5%) were classified as ANLs. CRC was diagnosed in 112 (3.2%) patients. A significant relationship between diverticulosis and colorectal polyps (odds ratio: 1.99; 95% confidence interval: 1.59-0.2.48, P<0.001) was found. Similarly, adenomas and ANLs were more frequent in diverticulosis (P<0.05). There was no significant relationship between diverticulosis and CRCs (P=0.243).Conclusions:Adenomatous polyps and ANLs were more frequently observed in patients with diverticulosis, but no significant relationship was found between CRC and diverticulosis. The results of this retrospective cross-sectional study need to be confirmed by longitudinal prospective cohort studies. © 2019 Wolters Kluwer Health, Inc. All rights reserved.Öğe Diminutive Polyposis Coli: Should All Polyps be Removed during a Colonoscopy?(2021) Tomaoglu, Kamer; Ökmen, HasanIntroduction: Colorectal cancer (CRC) is the second mostcommon cause of cancer-related death. Most CRCs arise fromcolorectal polyps or adenomas. Colonoscopy with polypectomyoffers a real-time management of benign adenomas, whichbreaks the adenoma-carcinoma sequence. In this study, thefollowing question is discussed: should each polyp be excisedin patients with more than three diminutive polyps?Methods: The study was conducted in Yedikule Surp PırgiçErmeni Hospital between January 2012 and October 2020. Themedical records of 2,222 patients who underwent colonoscopywere retrospectively examined. The patients were dividedinto two groups. The first group included patients with threeor fewer polyps, whereas the second group included patientswith four or more polyps. In the first group, all polyps wereexcised regardless of the polyp’s diameter. In the secondgroup, all polyps larger than 5 mm in diameter were excised.A maximum of three polyps were excised in patients who hadmore than three diminutive polyps. Student’s t-test, chi-squaretest, and Fisher’s exact test were used for the statistical analysis.All statistical analyses were performed using SPSS version 18.0(SPSS Inc., USA). P<0.05 was considered statistically significant.Results: The total number of performed colonoscopies was2,222. Colorectal polyps were detected in 501 (22.5%) patients.The number of total polypectomies was 728. Five hundredeighty-nine (81.0%) polyps had a diameter of 1 cm or less.Diminutive polyps were detected in 352 (48.4%) patients. Themost common histopathological diagnosis in patients withdiminutive polyps was tubular adenoma with mild dysplasia(60.8%) and inflammatory polyp (31.0%).Conclusion: It is concluded that excising all polypsencountered during colonoscopy is appropriate, whether theyare diminutive or not. Further studies with a larger case seriesare needed in this area.Öğe Intraoperative Cholangiography in Laparoscopic Cholecystectomy: Technique and Changing Indications(2020) Tomaoglu, KamerIntroduction: Although laparoscopic cholecystectomy (LC) is considered as the “gold standard” of cholecystectomy, the rate of bile duct injuries seems to be elevated when compared to open cholecystectomy. Intraoperative cholangiography (IOC) may prevent iatrogenic bile duct injuries or may diagnose missed bile duct injuries. Methods: Between 1998 and 2016, 29 selective IOCs were performed in a total of 212 LCs (13.7%). At the beginning of the study (1998-2002), the indications of IOC were past history of jaundice, elevation of cholestatic enzymes and dilation of the common bile duct or suspicion of common bile duct stones on abdominal ultrasound, whereas obscure biliary anatomy became the main intraoperative criteria during the following years. Results: Of the 29 patients, 20 were female and 9 patients were male. The mean age was 54.4 years. IOC was successful in 26 cases (90%). The median IOC time was 21.9 minutes. An anatomical variation was found in one patient. In this case, the cystic duct was opening into the right hepatic duct. The Wirsung duct was visualised in another patient, which was probably due to hyperpression of the sphincter of Oddi. No complication related to the procedure itself was encountered.Conclusion: Although the routine use of IOC does not seem to be necessary, it may prevent bile duct injuries in selected cases. Surgeons should gain experience in performing the procedure, and the necessary equipment should be present in the operating room.Öğe Prosthetic mesh hernioplasty versus primary repair in incarcerated and strangulated groin and abdominal wall hernias with or without organ resection. Retrospective study(Springer Science and Business Media Deutschland GmbH, 2021) Tomaoglu, Kamer; Okmen, HasanPurpose: The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and strangulated abdominal wall hernias with or without organ resection. Methods: Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary hernia repair (group II). The outcome of patients was observed for a mean follow-up period of 18.2 months. Categorical data were analyzed with the ?2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical analyses were realized with SPSS, version 18. P values < 0.05 were considered statistically significant. For multiple comparisons between types of hernia, the significance level was set to P < 0.0083 according to Bonferroni adjustment. Results: Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17–92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not. Conclusion: Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the limited number of cases of the present study. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
