Doç. Dr. Ozan Şen’in büyük çoğunluğu Obezite ve Reflü cerrahisindeki deneyimlerini içeren çoğunluğu uluslar arası seçkin dergilerde yayınlanan bilimsel makalelerdir. Son 10 yılda Obezite ve Reflü cerrahisinde büyük deneyim kazanan Dr. Ozan Şen bu alandaki çalışmalarını sürdürmektedir.
- Ozan Şen, Ahmet G. Türkçapar. Review of our experience using modified staple line suturing technique in laparoscopic sleeve gastrectomy Surg Laparosc Endosc Percutan Tech. 2021 Doi: 10.1097/SLE.0000000000001024
Background: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric surgical method in recent years. Although LSG provides good outcomes, serious complications such as leakage, bleeding, and stenosis may develop postoperatively. Numerous staple line reinforcement methods have been used to reduce complications. Whether each one of these practices is effective remains controversial.
Aim: Our study aims to assess outcomes and safety of modified (purse-string+oversewing) staple line suturing technique for patients who underwent LSG.
Materials and methods: A total of 505 patients who underwent LSG with modified staple line suturing technique between March 2018 and February 2021 were included in this retrospective study. Age, sex, body mass index, operation time, perioperative and postoperative 30-day complications were recorded in all patients.
Results: Of 505 patients (59.6% female) with a mean age of 37.6 years (minimum to maximum: 12 to 68 y) and median body mass index of 40.2 kg/m2 (minimum to maximum: 32 to 75 kg/m2) underwent LSG. LSG was performed as revision surgery in 17 (3.4%) patients. Five (1%) patients also underwent concomitant cholecystectomy. The mean operation time was 92 minutes (75 to 110 min) in our primary LSG cases. Operative complications included minor hepatic injury in 8 (1.6%) and anesthesia awareness in 3 (0.6%) patients. Postoperative complications included bleeding which occurred in 2 (0.4%) patients, portomesenteric vein thrombosis in 1 (0.2%), and minor wound infection in 3 (0.6%) patients. There was no leak, no stenosis, and no mortality.
Conclusion: Sleeve gastrectomy with modified staple line suturing technique is an effective method and could be safely applied with low morbidity.
- Singhal R, Ludwig C, Rudge G, Gkoutos GV, Tahrani A, Şen O, Mahawar K. 30-Day morbidity and mortality of bariatric surgery during the Covid-19 pandemic: a multinational cohort study of 7704 patients from 42 countries. Obes Surg 2021;31:4272-88
Background: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.
Methods: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.
Results: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.
Conclusions: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
Keywords: Bariatric surgery; COVID-19; Obesity surgery; Pandemic; Revisionalsurgery; SARS-CoV-2.
- Singhal R, Wiggins T, Super J, Alqahtani A, Nadler EP, Ludwig C, Şen O, Tahrani A, Mahawar K. 30-Day morbidity and mortality of bariatric metabolic surgery in adolescense during the Covid-19 pandemic- The GENEVA study. Pediatr Obes. 2021;16:12832.
Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity.
Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic.
Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality.
Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2 , respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort.
Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients.
Keywords: COVID-19; SARS-CoV-2; bariatric surgery; pandemic.
- Singhal R, Wiggins T, Super J, Alqahtani A, Nadler EP, Ludwig C, Şen O, Tahrani A, Mahawar K. 30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass an done anastomosis gastric bypass: a propensity score-match analysis of the GENEVA data. Int J Obes 2021;15:1-8
Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts.
Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups.
Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07).
Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.
- Ozan Şen, Ahmet G. Türkçapar. Effect of pre-operative weight loss on patients’outcomes undergoing laparoscopic sleeve gastrectomy. Journal of Minimal Access Surgery 2021. Article in press
Background: The study aims to demonstrate whether weight loss with a low-calorie diet before laparoscopic sleeve gastrectomy (LSG) may affect the outcomes.
Materials and methods: A total of 305 patients undergoing primary LSG were included in the study. Each patient adopted a low-calorie diet (1000 calories) before LSG. The patients were stratified into two groups. Group A: Those who lost 3% or more of their total body weight loss (TBWL), Group B: Those who lost <3% of their TBWL. Two groups were compared in terms of operative time, length of hospital stay, complications and weight loss outcomes.
Results: One hundred and five patients (35%) were in Group A and 200 patients were in Group B. Median weight loss was 4 kg (3-20 kg). Pre-operative mean body mass index (BMI) was 40 ± 7.4 kg/m2 in Group A and 41 ± 5.9 kg/m2 in Group B (P = 0.06). At 1 year after the surgery, BMI regressed to 29.7 ± 4.9 kg/m2 in Group A and to 27 ± 4.2 kg/m2 in Group B (P < 0.001). One hundred and twenty-nine patients who completed 2 years of follow-up, mean BMI regressed to 29.4 ± 4.1 kg/m2 in Group A (n = 46) and to 27.2 ± 4.5 kg/m2 in Group B (n = 83) (P < 0.001). In Group B, one patient experienced post-operative bleeding. No other complications were observed in the study. There was no significant difference between the groups in terms of operative time (P = 0.53) and length of hospital stay (P = 0.9).
Conclusion: Weight loss before LSG does not improve post-operative weight loss.
Keywords: Bariatric surgery; pre-operative diet; sleeve gastrectomy; weight loss success.
- Ozan Şen, Ahmet G. Türkçapar. Risk of asymptomatic gallstones bocoming symptomatic after laparoscopic sleeve gastrectomy. The American Surgeon 2021. Article in press
Background: Whether concomitant cholecystectomy is needed during laparoscopic sleeve gastrectomy (LSG) in patients with asymptomatic cholelithiasis is controversial. In this study, our aim is to show the follow-up results in patients with asymptomatic cholelithiasis who underwent LSG alone.
Methods: Patients undergoing primary LSG between March 2018 and September 2020 with asymptomatic gallbladder stones were included in this retrospective study. All patients underwent abdominal ultrasound (US) before surgery. Patients’ demographics and postoperative outcomes were recorded.
Results: A total of 180 patients underwent primary LSG and completed the 1-year follow-up. The study population consisted of 42 patients (23%) with asymptomatic cholelithiasis. The mean age was 41.1±7.1 years (31-56, 63% female), and mean body mass index (BMI) was 44 ± 6.7 kg/m2. Average BMI decreased to 31.1 ± 4.7 kg/m2 at 6 months and to 27.3 ± 3.6 kg/m2 at 1 year. The average follow-up period was 17 ± 5.7 months (range, 12-28 months). Of the 42 patients, only 1 patient (2.4%) became symptomatic during the follow-up period.
Discussion: We do not recommend cholecystectomy in patients with asymptomatic gallstones during the same session with LSG. An observational approach should be adopted for these patients.
Keywords: asymptomatic gallstones; concomitant cholecystectomy; sleeve gastrectomy.
- Ozan Şen, Fatih Can Karaca, Seniyye Ülgen Zengin, Ahmet Gökhan Türkçapar. Intraoperative awareness during laparoscopic sleeve gastrectomy. The European Research Journal. 2021 February DOİ: 10.18621/eurj.811379
Objectives: 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.
- Ozan Şen, Ahmet Gökhan Türkçapar. Barrett’s ulcer 5 years after sleeve gastrectomy: case report and literatüre review. 2020 December;33(6):344-6
Bariatric surgery is the most effective way to treat morbid obesity. Among the surgical methods, sleeve gastrectomy’s popularity (SG) has increased tremendously in recent years. Despite the success of the SG, gastro esophageal reflux disease (GERD) remains to be an important problem, postoperatively. Barrett’s esophagus (BE) is another considerable point in patients with GERD after SG. GERD, which may occur after SG, is perhaps a serious problem that is underestimated. In such patients with GERD symptoms, preferred approach by bariatric surgeons is to start PPI treatment, which works for the majority of patients. Barrett’s esophagus is a precancerous lesion develops on the surface of GERD. Because esophageal mucosa gets desensitizes in Barrett metaplasia, some patients may be completely asymptomatic. In the long-term period after SG endoscopic follow up is very important whether patients are symptomatic or not.
Here, we present the case of a patient who had no GERD symptoms and had completely normal endoscopy preoperatively who later developed dysplastic Barrett’s ulcer 5 years after SG. Roux-en-y gastric bypass operation was performed as revisional surgery.
Key words: Bariatric surgery; Gastrectomy; Gastroesophageal reflux; Barrett esophagus
- Ozan Şen, Ahmet Gökhan Türkçapar. Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report. İnternational Journal of Surgery Case Reports 2021; 79:424-27
İntroduction: Porta-mesenteric vein thrombosis (PMVT) is a rare but fatal complication in patients who are undergoing bariatric surgery. In this report, we present a rare case of a PMVT after laparoscopic sleeve gastrectomy (LSG).
Case presentation: A 52-year-old male patient with a body mass index of 42 kg/m2 was admitted to our clinic for morbid obesity. Standart LSG was performed with 5 trocar technique. 15 days after LSG, the patient admitted to the emergency department with complaints of abdominal pain, nausea and vomiting. The patient was dehydrated. His C-reactive protein level was 138 mg/L. Abdominal computerized tomography with contrast was performed and showed thickening of a part of small bowel wall in 10 cm length. Also, major trombosis were detected in the superior mesenteric vein branches and portal vein. The patient was hospitalized and 2 × 10,000 IU/1.0 mL high dosage low moleculer weight heparin (LMWH) therapy was initiated. The patient’s clinical signs recovered rapidly following treatment.
Clinical discussion: İn LSG, if the gastroepiploic venous arcus, which runs along the greater curvatura, and has a direct connection to the portal circulation is damaged, a local thrombus may form and move towards the portal system over time. Dehydration is another significant predisposing factor for PMVT. Some patients may develop life-threatening intestinal ischemia. Abdominal tomography with contrast plays a major role in diagnosis.
Conclusion: PMVT should be considered as a serious complication after LSG in patients with abdominal pain. With early diagnosis and anticoagulant therapy, patients’s clinical symptoms may improve quicly.
Keywords: Bariatric surgery; Complication; Laparoscopic sleeve gastrectomy; Porto- Mesenteric vein trombosis.
- Ozan Şen, Ümit Sekman, Ahmet G. Türkçapar, Mehmet A. Yerdel. Does Fixation of Gastric Sleeve Prevent Functional Stenosis in Sleeve Gastrectomy Patients? Surg Laparosc Endosc Percutan Tech. 2020 Oct 29;31(2):220-222.
Aim: The aim of this study is to determine whether gastric sleeve fixation prevents functional stenosis (twist or kink) and to investigate its effects on symptoms such as nausea and vomiting after laparoscopic sleeve gastrectomy (LSG).
Methods: A total of 717 patients who underwent primary LSG for morbid obesity and completed at least 1 year of follow-up between 2012 and 2019 were included in the study. All operations were performed by the same surgical team using the same technique. The patients were divided into 2 groups, that is, group 1: standard LSG and group 2: gastric sleeve fixation with LSG. These 2 groups were compared in terms of demographic characteristics, baseline body mass index, follow-up duration, bleeding, leaks, gastric stenosis, postoperative nausea, vomiting, and the need for antiemetics. In the follow-up period, patients with suspected gastric stenosis underwent endoscopy and upper gastrointestinal series.
Results: LSG was performed in 717 patients (55.2% female) with a mean age of 37.8±11.5 years and a median body mass index of 42.2 (30.2 to 74.2) kg/m2. The 241 patients in the first group underwent LSG without fixation, and the 476 patients in the second group with fixation. Functional stenosis was detected in 8 patients, all of whom were in group 1. One patient in group 1 had a leak on the background of functional stenosis. There was bleeding that required transfusion in 2 patients (group 1) and reoperation in 2 patients (group 2). None of the study patients died. During the in-hospital period, 122 (50.6%) patients in group 1 and 159 (33.4%) patients in group 2 had nausea and vomiting that required antiemetic treatment (P<0.001).
Conclusion: Gastric sleeve fixation in LSG prevents complications that may arise because of improper gastric mobilization. This method is effective in reducing nausea and vomiting in LSG patients.
- Rishi Singhal, Abd A.Tahrani, Christian Ludwig, Kamal Mahawar, Geneva collobrators (Ozan Şen, Ahmet G. Türkçapar). Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study. The Lancet Diabetes & Endocrinology. November 2020 DOI: 10.1016/S2213-8587(20)30375-2.
- Ozan Şen, Ahmet G. Türkçapar. Combined partial posterior fundoplication with laparoscopic sleeve gastrectomy for morbid obese patients with symptomatic GERD. Video case report. International Journal of Surgery Case Reports 2020; 71:34-36
İntroduction: Gastroesophageal reflux disease (GERD), which can be seen in up to 30% in postoperative series, is perhaps the most important complication of sleeve gastrectomy(SG). The general trend for patients who are planning to have bariatric surgery and have symptomatic GERD, Roux-en-Y gastric bypass is the most common choice.
Case Presentation and Management: A 42-year-old female patient with a body mass index of 36 kg/m2 presented to our clinic with obesity and symptomatic GERD. She had been using proton pump inhibitör (PPI) regularly for 1 year. Preoperative endoscopy showed hiatal hernia but no esophagitis. The patient underwent ambulatory pH study and GERD was confirmed. The patient was scheduled to have laparoscopic hiatal hernia repair plus combined partial posterior fundoplication and sleeve gastrectomy. Hiatal hernia was repaired, gastric fundus was passed behind the esophagus and partial posterior fundoplication was performed, and than SG was completed. She stopped using PPI in the early postoperative period and her reflux symptoms disappeared completely. The patient lost 20 kg in the 3rd month (%40 ewl) and underwent controlled ambulatory pH moniterization and no reflux was detected.
Conclusion: İn some cases this technique can be proposed to obese patients with GERD as a primary treatment modality. High numbers of patients and longer follow up care are needed to assess the long term efficacy and safety of this technique.
Keywords: Bariatric surgery; Gastroesophageal reflux disease; Modified technique; Sleeve gastrectomy.
- Ozan Şen, İsmail Çalıkoğlu, Görkem Özgen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Sleeve gastrectomy in class 1 obesity: Assessment of operative outcomes. Surg Obes Relat Dis. 2021 Jan;17(1):170-176. DOI: 10.1016/j.soard.2020.08.014
Background: The risk/benefit ratio of sleeve gastrectomy (SG), especially in patients without type 2 diabetes (T2D), is unknown for patients with class 1 obesity.
Objectives: Assessment of operative outcomes of SG in class 1 obesity.
Setting: Private practice.
Methods: Candidates for a primary SG with body mass index 30-35 kg/m2 after 5 years of unsuccessful dieting were included after informed consent was obtained. Participants who did not complete 3-month follow-up and those who underwent modified SGs were excluded. Data and complications were recorded prospectively. Patients were followed up at 3, 6, and 12 months and yearly thereafter. Definition of presence and remission of T2D and insulin resistance were set according to guidelines. Effects on weight loss parameters were evaluated with Wilcoxon signed-rank test.
Results: Between 2012 and 2020, 143 consecutive SGs were performed in patients with class 1 obesity without conversion, leak, mortality, or a venous event. Two were lost to follow-up. In 141 participants, 2 bleedings and 1 colon perforation occurred (2.1% rate for acute life-threatening events). During a mean follow-up of 25.9 months; 1 case of functional stenosis and 4 cases of de novo symptomatic cholelithiasis clinically became evident in different patients, all requiring reoperation. Therefore a 5.6% rate of major complications were identified at 2 years. The benefit on weight loss was immediate and permanent (P < .001). T2D and insulin resistance were in remission in 100% and 98.1% of participants at 1 year, respectively.
Conclusion: The 5.6% major complication rate reflects a minimum because more de novo symptomatic gallstones and stenosis are yet to occur or overlooked. Additionally, this excludes patients with de novo reflux and malnutrition, dissatisfaction issues, or recidivism. Caution is required to freely operate on patients with class 1 obesity with no co-morbidity. Evidence-based outcome data are lacking to balance the reported risks.
Keywords: Adverse effect; Class 1 obesity; Complication; Sleeve gastrectomy.
- Ozan Şen, Ahmet G. Türkçapar, Mehmet A. Yerdel. Screening Esophagogastroduodenoscopy Before Laparoscopic Sleeve Gastrectomy: Results in 819 Patients. J Laparoendosc Adv Surg Tech A. 2020 Sep 2 DOI: 10.1089/lap.2020.0541.
Aim: The routine use of esophagogastroduodenoscopy (EGD) during the preoperative evaluation of surgical weight loss candidates is controversial. The aim of this study is to evaluate the findings of preoperative EGD in patients who are scheduled for a primary laparoscopic sleeve gastrectomy (LSG). The probable effect of these findings on the medical and surgical strategy that was followed is assessed.
Methods: Findings of EGD obtained from consecutive LSG candidates and all data were prospectively recorded and retrieved from the database.
Results: A total of 819 patients underwent EGD successfully. Mean age and body mass index were 38 ± 11.3 and 43.17 ± 7.2 kg/m2, respectively. Fifty-eight percent were female. EGD of 263 (32.1%) patients was normal and 687 (84%) patients were asymptomatic. At least one abnormal finding was detected in 65% of the asymptomatic patients. Abnormal findings that did not change the surgical strategy were found in 550 patients (67.2%). Findings such as gastritis or duodenitis that changed the medical management before surgery were found in 309 patients (38.2%). Helicobacter pylori was positive in 218 (26.6%) patients but eradication treatment was not applied in the preoperative period. No pathology was detected that would create absolute contraindication or change the type of surgery in any patient. Only technical modifications were required in 13% due to hiatal hernia. The timing of the planned surgery has changed in only 6 patients (0.74%) (early stage neuroendocrine tumor, leiomyoma, severe ulcer).
Conclusions: Routine EGD performed before LSG did not change the planned bariatric option in any patient, but led to 13% rate of technical modifications due to the presence of hiatal hernia. At least one abnormal finding was detected in 65% of asymptomatic patients. Due to endoscopic findings, the rate of patients who started medical acid-suppression treatment in the preoperative period was 38%.
Keywords: bariatric surgery; endoscopy; preoperative evaluation; sleeve gastrectomy.
- Ozan Şen, Hüseyin Ünübol, Ahmet G. Türkçapar, Mehmet A. Yerdel. Risk of Alcohol Use Disorder After Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A. 2021 Jan;31(1)24-28.
Aim: Several studies demonstrated increased alcohol intake after gastric bypass but not for laparoscopic sleeve gastrectomy (LSG). The purpose of this study is to determine whether there is an increased risk of developing alcohol use disorder after LSG.
Materials and Methods: LSG patients with at least 1-year follow-up who completed the alcohol use disorder identification test (AUDIT) preoperatively, and at their control visit, were the subjects. AUDIT was applied to the patients who were followed up from 1 to 6 years postoperatively. Patients were divided into two groups as those who were followed for 1-3 years and 4-6 years. AUDIT scores and risk categories were compared. According to the AUDIT results, score intervals between 0-7, 8-15, 16-19 and 20-40 identified patients with low, moderate, high risk, and alcoholism, respectively.
Results: There were 183 LSG patients eligible for inclusion. An AUDIT score of 2.79 before LSG showed prominent reduction in alcohol use in the first 3 years after LSG with a score of 2.27 (P = .033). At 4-6 years follow-up, AUDIT scores showed significant increase from 3.06 to 4.04, suggesting an increase in alcohol use in the long term (P = .042). In addition, the increase of risk after surgery in pre-LSG moderate-risk category (n = 21) turned out to be higher than pre-LSG low-risk category (n = 162).
Conclusions: This study showed reduction in AUDIT scores in the first 3-year follow-up after LSG and increase in the 4-6 years follow-up. High pre-LSG AUDIT score, a potential risk for future alcohol use disorder, was one of the key findings of our study. Screening of LSG candidates before and after surgery by AUDIT scoring according to risk categories with larger samples will provide useful input for relevant guidelines.
Keywords: alcohol use disorder; bariatric surgery; sleeve gastrectomy.
- Ozan Şen, Ahmet G. Türkçapar. Hair Loss After Sleeve Gastrectomy and Effectiveness of Biotin Supplements. J Laparoendosc Adv Surg Tech A. 2021;31(3):296-300.
Aim: In this study, we aimed to determine the incidence of hair loss in patients who underwent laparoscopic sleeve gastrectomy (LSG), and to observe whether use of Biotin has an impact on hair loss.
Methods: This study included 156 female patients who underwent LSG for obesity and completed a 1-year follow-up. All patients with vitamin deficiency were screened in the pre- and postoperative period. Hair loss was defined as the subjective perception of the women of losing a higher amount of hair when compared with normal situation.
Results: Hair loss was observed in 72% of the patients after LSG (n = 112). Seventy-nine percent of the patients reported hair loss between the third and fourth-month interval, and continued for an average of 5.5 ± 2.6 months. Permanent alopecia was not observed in any of the patients. Patients who experienced hair loss and Biotin deficiency after LSG were prescribed 1000 mcg/day of Biotin for 3 months. Of these 22 patients; only 5 (23%) patients reported a remarkable decline in hair loss. İn addition, 29 patients were found to take 1000 mcg/day of Biotin for average 2.5 months after onset of hair loss by their own initiative, despite optimal blood Biotin levels. Eleven (38%) patients reported a remarkable decline in hair loss. The effect of biotin use on hair loss in patients with and without biotin deficiency was compared. There was no significant difference (P = .2).
Conclusion: Temporary hair loss after LSG is common. It was found that biotin supplementation used to prevent hair loss does provide low efficacy.
Keywords: bariatric surgery; biotin supplements; hair loss; sleeve gastrectomy.
- Ozan Şen, Ahmet G. Türkçapar. Gastric botilinum toxin-A application for weight loss theraphy. The Turkish Journal of Gastroenterology 2020 August DOI: 10.5152/tjg.2020.20076
Background/aims: The aim of this study is to share the results of gastric botulinum toxin (BTX) application in individuals who are overweight or type 1 obese without comorbidity.
Materials and methods: In this study, 13 patients were included who were enrolled for gastric BTX application for the first time. A total of 300 U of BTX-A (Allergan Botox ®1 vial 100 U) was diluted with 8 mL of 0.9% NaCl saline, and antrum (100 U to 8 spots), corpus (100 U to 8 spots), and fundus (100 U to 8 spots) regions were injected intramuscularly. Patients were given a 1200-calorie low-carb diet and this was followed for 6 months.
Results: Gastric BTX application was applied to 13 patients with a mean age of 40.9 ± 5.2 (85% female), a mean body mass index (BMI) of 28.41 ± 1.4 kg/m2 (26-31.6) and a mean excess weight of 10.1 ± 3.6 kg. As a result of the 6-month follow-up, only four patients (30.8%) were able to lose more than 50% of their excess weight (6-15 kg). Six patients (46.2%) could not lose any weight. There was an average decrease of 3.3 kg in the weight of patients before and after BTX application (P = .03). A mean decrease of BMI was detected, 1.17 kg/m2 (P = .032).
Conclusion: It was concluded that the application of gastric BTX for weight loss does not provide effective results.
- Ozan Şen, Fatih Can Karaca, Ahmet G. Türkçapar. Neurological Complication After Laparoscopic Sleeve Gastrectomy: Foot Drop. Obesity Surgery 2020 Mar;30(3):957-960
Background: The relationship between rapid weight loss and peroneal nerve entrapment neuropathy (PNEN) was shown in various series following bariatric surgery. Thus, we aimed to determine the occurrence of PNEN in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and to reveal the factors contributing to this complication.
Methods: We evaluated our series of 635 patients in terms of neurological symptoms following laparoscopic sleeve gastrectomy, retrospectively. We recorded the preoperative data, laboratory vitamin and nutrient levels, weight loss, electromyography (EMG) findings, and treatment modalities of these patients.
Results: Seven out of 635 patients developed foot drop as a result of PNEN after bariatric surgery. The mean total weight loss for these patients was 50.6 kg in 6 months, and 63 kg in 12 months. In the laboratory analyses, we did not detect any signs of vitamin deficiency. EMG findings confirmed the diagnosis.
Conclusion: We demonstrate that rapid weight loss is correlated with the risk of foot drop incidence as a result of PNEN.
Keywords: Bariatric surgery; Drop foot; Neurological complications; Weight loss.
- Ozan Şen, Ahmet G. Türkçapar, Mehmet A. Yerdel. Cholelithiasis After Sleeve Gastrectomy and Effectiveness of Ursodeoxycholic Acid Treatment. J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1150-1152.
Aim: Few adverse effects may occur after bariatric surgery, one being the formation of gallstones. The aim of this study is to determine the incidence of cholelithiasis after laparoscopic sleeve gastrectomy (LSG) and whether ursodeoxycholic acid (UDCA) treatment reduces gallstone formation.
Materials and Methods: Gall bladders of all patients planned for LSG were preoperatively checked by ultrasonography (USG). Patients who had no documented gallbladder pathology before LSG and who had USG at 12th month and 2 years follow-up after LSG were included in the study. The incidences of newly developed cholelithiasis, cholecystectomy, and endoscopic retrograde cholangiopancreatography (ERCP) requirement in patients who did not receive any UDCA treatment (pre-2015 protocol, n = 128) was compared with the corresponding numbers in patients who regularly used 500 mg/day oral UDCA for 6 months after the LSG (post-2015 protocol, n = 152).
Results: Between January 2012 and October 2018, 717 LSGs were performed in two centers and after exclusions, 280 patients were eligible for evaluation. Sixty-four of 280 (23%) patients developed cholelithiasis after LSG and cholecystectomy was performed in 24 patients (8.6%) for symptomatic cholelithiasis. In the non-UDCA group, 48 patients developed cholelithiasis (n = 48/128, 37.5%) compared with 16 patients in the UDCA group (n = 16/152, 10.5%) (P < .001). Compared with 5 patients in the UDCA group, 19 patients underwent cholecystectomy (39.6%) in the non-UDCA group due to symptomatic cholelithiasis (P = .55) and 5 of these patients also required an ERCP. No ERCP became necessary in the UDCA group (P = .2).
Conclusions: An almost fourfold decrease in the rate of new gall stone formation with 500 mg daily UDCA treatment was impressive and may suggest routine UDCA treatment after LSG. Given the rate of exclusions and follow-up differences among the groups, certainly, randomized trials, with less exclusion are needed to provide conclusive evidence.
Keywords: cholelithiasis; sleeve gastrectomy; ursodeoxycholic acid; weight loss.
- Ozan Şen, İsmail Çalıkoğlu, Görkem Özgen, Toygar Toydemir, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Sleeve Gastrectomy in patients with previous anti-reflux surgery. Preliminary results of the ‘’ no-touch to posterior wrap’’ technique. Surgery For Obesity And Related Disease. 2019;15(10):1668-74
Background: Reported morbidity of Roux-en-Y gastric bypass in patients with previous antireflux surgery warrants caution, and data on sleeve gastrectomy (SG) are unexpectedly scarce.
Objectives: To evaluate the safety and efficiency of SG in patients who previously underwent an antireflux procedure. A new technique to preserve intact fundoplication is described.
Setting: Private practice, bariatric center of excellence, Turkey.
Methods: The following data were retrieved from our prospective data base: (1) details of previous repair; (2) clinical/endoscopic reflux status, body mass index (kg/m2), and presence of metabolic syndrome (MetS) and type 2 diabetes (T2D) before SG; (3) duration of SG, length of stay, complications; and (4) percent excess weight loss, MetS/T2D resolution, and reflux status at follow-up.
Results: Fifteen consecutive SGs were performed without conversion or major complications. The first case is excluded from the analysis because complete wrap unfolding was abandoned in favor of the described technique. Among 14, 10 had MetS, 4 had T2D, and 1 had a proven reflux recurrence before SG. Mean operating time was 118.5 minutes. All were discharged on the third postoperative day. Apart from 1 functional stenosis, no complications occurred. At 12 months, percent excess weight loss rate was 82.2, MetS resolved in 9 of 10, and T2D was in complete (n = 2) or partial remission (n = 1). No de novo reflux became evident, and absence of reflux was proved by pHmeter in 3.
Conclusions: SG is feasible in patients who previously had antireflux repair with negligible morbidity and percent excess weight loss rates similar to that with regular sleeves. Results in reflux control needs further confirmation.
Keywords: Antireflux surgery; Nissen; Sleeve gastrectomy; Toupet.
- Ozan Şen, Ahmet Türkçapar. Finding carcinoid tumor before bariatric surgery. Is preoperative endoscopy necessary? Case report. İnternational Journal of Surgery Case Reports. 2019; 62:132-134
Introduction: Carcinoid tumors are endocrine system-related lesions and 4% of the gastrointestinal tract’s neuroendocrine tumors (NET) originate from stomach. In recent years, gastric carcinoid tumors have been reported at increasing rates on endoscopies. In this article, we will present a case of gastric carcinoid tumor detected at the upper gastrointestinal (GI) endoscopy during preoperative bariatric surgery workup.
Case presentation: A 55 years old male patient with body mass index (BMI) 46 kg/m2 was scheduled for bariatric surgery. Upper GI endoscopy revealed 2 separate 4-5 mm nodular lesions at gastric corpus and antrum. Biopsies were taken and both lesions were reported as neuroendocrine tumors. It was decided that the Laparoscopic sleeve gastrectomy (LSG) operation would be performed because both lesion areas would remain in the extracted part of stomach.
Discussion: The routine use of upper GI endoscopy in preoperative evaluation of bariatric surgery patients still remains controversial.
Conclusion: Upper GI endoscopy is very important in determining various gastric pathologies and determining the most appropriate surgical method before bariatric surgery.
Keywords: Bariatric surgery; Neuroendocrine tumor; Preoperative endoscopy.
- Ozan Şen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. The effects of sleeve gastrectomy on shoe size one year after surgery. Turk J Surg 2017; 33:284-87
Objective: The aim of this study is to evaluate the effects of sleeve gastrectomy on shoe size one year after the procedure. To our knowledge, no study has yet been conducted addressing this issue.
Material and Methods: Patients who were prepared for sleeve gastrectomy were eligible for the study, and all data and preoperative shoe sizes were recorded in our prospective database. At the 12th month of follow-up, each patient’s excess weight loss % was calculated, and their shoe sizes were recorded by verbal report. Arbitrary or half-size changes were not taken into consideration. The probability of a change in shoe size and the effects of age, sex, preoperative body mass index, and 12th month excess weight loss % on this change were investigated. p<0.05 was regarded as statistically significant.
Results: The subjects of the study were 212 patients who completed their 12-month follow-ups after sleeve gastrectomy between January 2012 and February 2016. The mean shoe size was 41.5; this decreased to 40.5 one year after sleeve gastrectomy (p<0.001). In patients with body mass index (BMI)>50, both the mean decrease (p=0.008) and the percentage of at least two size decreases (p=0.009) were significantly higher than those in patients with BMI<40. Age, sex, and excess weight loss % did not have any significant effects on shoe size.
Conclusion: Sleeve gastrectomy was clearly associated with decrease in shoe size after 12 months. Only preoperative body mass index was found to be directly associated with this decrease.
Keywords: Bariatric surgery, sleeve gastrectomy, shoe size
- Mehmet Ali Yerdel, Ozan Şen, Utku Zor, Simay Kara, Bülent Acunaş. Cardiac Tamponade as a Life- Thereating Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks. Journal Of Laparoendoscopic &Advanced Surgical Techniques 2018 Sep;28(9): 1041-1046
Background: Cardiac tamponade (CT) is a dreadful complication of laparoscopic antireflux surgery (LARS) with unknown incidence, and preventive measures are yet to be defined. Incidence during LARS with respect to usage/configuration of graft deployment is analyzed. Three-dimensional (3D) analysis of tack distribution provided anatomical insight to prevent cardiac injury.
Materials and methods: Data regarding the usage and configuration of graft deployment are retrieved from the prospective database. Grafting was “posterior” or “posterior + anterior.” Incidence of CT in all hiatoplasties is calculated. Tomography is reconstructed in 3D, showing the spatial distribution of the tacks. Tacks are numbered in the surgical video. Corresponding numbering is applied to the tacks in any particular tomography slice, utilizing the 3D images as an interface. A numbering-blinded radiologist is asked to identify the offending and the nonoffending tacks as the cause of tamponade. Tack-to-pericardium distances are recorded. Tacks having no measurable distance from the pericardium are regarded as offensive.
Results: One CT occurred in 1302 consecutive LARS (0.076%). The incidence is 0% when “no” (379) or “posterior” (880) graft is used as opposed to 2.3% rate in “posterior + anterior” (43) grafting. The distribution of “offensive,” “nonoffensive but nearest,” and “safe” tacks followed a pattern. All offensive tacks belonged to the anterior graft fixation, which we referred as the critical zone.
Conclusion: CT during LARS is rare, and associated with graft fixation anterior to the hiatal opening. Avoiding graft fixation to the critical zone may prevent cardiac injury.
Keywords: cardiac tamponade; complication; helical tack; laparoscopic antireflux surgery.
- Soyder, M. Ünübol, O. Şen, S. Özbaş, S. Koçak. The predictive value of the clinical features of malignancy in cases of preoperative folliculer throid neoplasia. Minerva Chir 2012;67:475-80
Aim: It is generally impossible to make a distinction between benign and malign with a cytopathological examination using a fine needle aspiration biopsy (FNAB) in follicular lesions of the thyroid gland. This is the reason why lesions are frequently reported as follicular neoplasia (FN). Our study aims to examine the predictive value of carcinoma detection of different clinical features in cases with determined FN with FNAB.
Methods: Clinical and histopathological data of a total of 116 patients (26 male, 90 female) subjected to surgery because of thyroid gland pathology with FN between March 1997 and December 2011 were retrospectively examined in two different centers.
Results: Results of the histopathological examinations were reported as: carcinoma in 33 (28.4%) cases (18 [54.5%] cases with papillary thyroid cancer, 11 [33.3%] cases with follicular thyroid cancer and 4 [12.1%] cases with papillary thyroid cancer follicular variant), as follicular adenoma (FA) in 32 (27.6%) patients and as a benign colloidal nodule in 51 (43.9%) patients. No statistical significance was determined between advanced age, male sex, solid single nodule, increased nodule diameter, hypoactive nodule existence and malignancy (P>0.05).
Conclusion: Malignancy was found in 28.4% cases with FN detected as a result of FNAB in our study series, a ratio which is significantly higher than that reported in the literature. We think that the characteristics of the patient and the tumor are not effective in diagnosing cancer. In the case of the existence of bilateral thyroid pathology, the surgical therapy option should be bilateral total thyroidectomy due to such a high ratio of cancer occurrence.
- Ozan Şen, Ayhan Kuzu. Our Colonoscopic Screening Results According to Risk Groups in Colorectal Cancers (Pilot Study). Turkish Journal of Colorectal Disease. 2020; 30:42-48
Aim: Most of the colorectal cancers develop on a pre-existing polyp background. With the widespread use of screening tests, mortality of colorectal cancers has been shown to decrease. Our aim in this pilot study is to screen individuals according to risk groups in colorectal cancers and to obtain data that will lead in the establishment of community-based information and screening programs in this direction.
Method: Between October 2004 and February 2008, 358 people underwent colonoscopy for the purpose of screening. Individuals who had a family history of colorectal cancer or polyp, who had a history of colorectal polyps, and who were over the age of 40 years and wanted to voluntarily participate in the screening program although there were no risk factors were classified as average, low, medium and high risk groups. Individuals with a history of colorectal cancer and inflammatory bowel disease were excluded from the study.
Results: As a result of the screening, polyps were detected in 104 (29.1%) people, and masses with malignant appearance in 9 (2.5%) people. Histopathological evaluation revealed adenomatous polyp in 67 (18.7%) individuals, inflammatory polyp in 26 (7.3%) patients, malignant polyp in 11 (3.1%) patients, and invasive cancer in 9 (2.5%) patients (n=358).
Conclusion: Although the results of this pilot study do not reflect the whole society, the frequency of colorectal polyp and cancer is high in our country. In colorectal cancers, it is possible to cure the disease curatively with screening and early diagnosis before the development of cancer. In this regard, the society should be made more conscious and screening programs should be expanded.
Keywords: Colorectal cancers, screening, pilot study, colonoscopy
- Ozan Şen, Fatma Kahraman, Ahmet Gökhan Türkçapar. Beden Kitle İndeksi 30-35 Arası Hastalarda Cerrahinin Yeri. Turkiye Klinikleri J Gen Surg-Special Topics 2015;8(3)
Obezite tüm toplumlarda çok yaygın görülen bir sağlık sorunudur ve giderek küresel bir epidemi halini almaktadır. Obezite cerrahisi uygulama ölçütü olarak Beden Kitle İndeksi (BKİ) kriterleri ilk kez 1991’de National Instute of Health (NIH) konferensında önerildi ve kabul gördü. O günden bu güne bariyatrik cerrahinin faydaları ve riskleri konusunda bir çok bilimsel veri birikimi oldu. Görüldü ki; bariyatrik cerrahi sonrası sağlanan yarar sadece kilo kaybı değildir. Bu açıdan evre I obez bir hastada sadece BKİ değerine dayanarak bariyatrik cerrahinin reddi doğru görünmemektedir. Evre I obezitenin tedavi algoritmasında cerrahi dışı yöntemler öncelikli tercih olmalıdır. Cerrahi dışı uygulamalar yetersiz kalıyorsa bariyatrik cerrahi mutlaka düşünülmelidir. Uluslararası Diabet Federasyonu (İDF) BKİ < 35 kg/m2 olan medikal tedaviye yanıtsız hastalarda cerrahi tedaviyi, ”göz önünde bulundurulması gereken alternatif tedavi seçeneği” olarak ifade etmiştir. Yakın zamanda Uluslararası Obezite ve Metabolizma Cerrahisi Derneği (IFSO) evre I obezitenin cerrahi tedavisinin güvenilirliği ve etkinliği ile ilgili 10 maddelik bir tavsiye üzerinde fikir birliğine varmıştır.
Anahtar Kelimeler: Obezite; beden kitle indeksi; şişmanlık cerrahisi
Obesity is a health problem commonly seen in all nations and it is getting a worldwide epidemic. The body mass index (BMI) criteria for bariatric surgery as proposed in 1991 by the National Institude of Health Conference Panel(NIH) initially worked well. Since then, a lot of scientific data cumulated about bariatric surgery, it’s benefits and risks. And it is seen that the benefit of bariatric surgery is not just weight loss. By this aspect, refusing surgery of a class I obesity patient regarding to his BMI is not considered right. Nonsurgical therapy should be the first choice in the treatment plan but in case of inadequacy, bariatric surgery must be considered. International Diabetes Federation (IDF), is mentioned that bariatric surgery is “a type of treatment option which should take in to consideration which will apply to patients with BMI < 35 and resistance to medical theraphy.” And recently, International Federation for Surgery of Obesity and Metabolic Disorders (IFSO) build consensus including 10 items about effectiveness and safety of surgery treatment of class I obesity.
Keywords: Obesity; body mass index; bariatric surgery
- Ozan Şen, A. Bülent Erkek, Atıl Çakmak, Ulaş Sözener, Cihangir Akyol, M. Ayhan Kuzu. Genel cerrahi hastalarının ve yakınlarının bilgi arayışında internet kullanımı. Turk J Surg 2008;24(3):156-59
Bu çalışmada; bir klinikte yatarak tedavi gören hastaların ve yakınlarının, hastalıklarıyla ilişkili bilgi edinmek amacıyla internet kullanım sıklıklarının ortaya konulması amaçlanmıştır.
Gereç ve Yöntem:
700 hasta ve 700 hasta yakını olmak üzere toplam 1400 kişiden internet kullanım sıklıkları ile sosyo-demografik özelliklerinin belirlenmesi amacı ile hazırlanan bir anket formunu doldurmaları istendi.
Çalışmaya katılanların 673’ü (%48) erkek, 727’si (%52) kadındı ve yaşları 16 ile 75 (ortanca,52 yaş) arasında değişmekteydi. Eğitim düzeyi bakımından 657 (%46.9) kişi lise ve üstü, 743 (53.1) kişi ortaokul ve altı eğitim düzeyine sahipti. Ankete katılan kişilerin 504’ünün (%36) evinde bilgisayar olduğu, 418 (%29.8) kişinin günlük hayatlarında internet kullandığı saptandı. Eğitim düzeylerine göre internet kullanım oranlarına bakıldığında lise ve üstü eğitim düzeyinde 385 (%27.5), ortaokul ve altı eğitim düzeyinde 33 (%2.3) kişinin günlük hayatlarında interneti kullandıkları saptandı. Hasta ve hasta yakınlarının hastalıkları konusunda bilgi edinmek için internet kullanım sıklığına baktığımızda, 234 (%16.7) kişinin internetten araştırma yaptığı, bunlardan ancak 109 (%7.7) kişinin hastalıkları konusunda yeterli Türkçe kaynağa ulaşabildikleri saptandı. 65 (%4.6) kişinin internette düzenli olarak takip ettikleri bir sağlık sitesi mevcuttu.
Bu çalışmaya katılan hastaların ve yakınlarının hastalıklarıyla ilişkili bilgi arayışında internet kullanım sıklığının belirgin şekilde düşük olduğu saptanmıştır.Bu konuda sağlığına özen gösteren bilinçli bir toplum için gayretli çalışmalara ihtiyaç vardır.Hastaların ve yakınlarının doğru,anlaşılabilir ve güncel bilgilere kolaylıkla ulaşmalarını sağlamak için sağlık birimlerinin bu kaynaklar ile yakından ilgili olmaları gerekmektedir.
Anahtar Kelimeler: Genel Cerrahi hastaları, İnternet, Sağlık bilgileri
- Ozan Şen, Ahmet Gökhan Türkçapar. Parsiyel ve Total Fundoplikasyon Yöntemleri, Cerrahi Tekniğin Postoperatif Komplikasyon ve Nükslere Etkisi. Türkiye Klinikleri J Surg- Special Topics 2017;10(3):189-93
Gastroözofageal reflü hastalığının cerrahi tedavisinde laparoskopik anti reflü cerrahisi altın standart tedavi seçeneğidir. Laparoskopik nissen fundoplikasyonun reflü kontrolü üzerine etkisi çok iyi bilinmesine rağmen postoperatif disfaji ve gaz ilişkili fonksiyonel yan etkiler fazla oranda görülmektedir. Bu nedenle orjinal teknik zaman içinde modifikasyonlara uğramış ve alternatif teknikler ortaya çıkmıştır. Bunlardan en iyi bilineni 1963 yılında Andrea Toupet tarafından tanımlanan parsiyel fundoplikasyon tekniğidir. Anti reflü cerrahisindeki en ideal yönteme yönelik tartışmalar bugün bile devam ederken seçilen yöntem, etkili ve uzun süreli reflü konturolü sağlamalı postoperatif disfaji ve gaz ilişkili semptomlar da minimal olmalıdır. Son yıllarda yapılan bir çok karşılaştırmalı çalışma göstermiştir ki, laparoskopik nissen fundoplikasyon (LNF) ve laparoskopik toupet fundoplikasyon (LTF) reflü kontrolünü sağlamada benzer etkiye sahiptirler. Buna karşın operasyon sonrası disfaji ve gazla ilişkili fonksiyonel yan etkiler LNF sonrası daha sık görülmektedir. LTF ile bu komplikasyonlar minimalize edilebilir.
Anahtar Kelimeler: Gastroözofageal reflü; fundoplikasyon; istenmeyen etkiler; nüks
Laparoscopic anti reflux surgery is a gold standard for surgical treatment of gastroesophageal reflux disease. Although the effect of laparoscopic nissen fundoplication on reflux control is well known, postoperative dysphagia and gas related functional side effects are widely observed. Therefore, the original techniques have been modified over time and alternative techniques have emerged. One of all is well known that partial fundoplication technique was defined by Andrea Toupet in 1963. However the debate about the ideal method of anti-reflux surgery continues even today, the selected method should be effective and provide reflux control for long term and postoperative dysphagia and gas releated symptomes should be minimal. According to recent comparative studies shown that laparoscopic nissen fundoplication (LNF) and laparoscopic toupet fundoplication (LTF) have similar effect on providing reflux control. Whereas, postoperative dysphagia and gas related functional side effects are more common after LNF. These complications can be minimized with LTF.
Keywords: Gastroesophageal reflux; fundoplication; adverse effects; recurrence
- Ozan Şen, Ahmet Gökhan Türkçapar. Revizyon Anti Reflü Cerrahisi. Türkiye Klinikleri J Surg Special Topics 2017:10(39:202-6
Laparoskopik anti reflü cerrahisi gastroözofageal reflü hastalığının cerrahi tedavisinde altın standart haline gelmiştir. Bununla birlikte cerrahi sonrası nüks hala önemli bir sorundur. Hastaların bir bölümünde inatçı semptomlar nedeniyle revizyon cerrahisi gerekebilmektedir. Revizyon cerrahisi gereken hastalardaki başlıca semptomlar tekrarlayan reflü ve disfajidir. Revizyonel anti reflü cerrahisi ilk ameliyata göre oldukça zor bir ameliyattır ve bu açıdan preoperatif dönemde bu hastaların dikkatli bir şekilde değerlendirilmesi gerekir. Reflü semptomları gösteren hastalarda buna yönelik objektif kanıtların elde edilmesi önemlidir. Özofagogastroduodenoskopi, radyolojik pasaj görüntülemesi ve pH moniterizasyon uygulanmalıdır. Raporlanan serilerde revizyon cerrahisi sırasında en sık karşılaşılan intraoperatif bulgunun fundoplikasyonun transhiatal herniasyonu olduğu tespit edilmiştir. Primer cerrahiye göre kıyaslandığında revizyonel anti reflü cerrahisi, daha yüksek morbidite, mortalite ve komplikasyon oranlarına sahiptir ve semptomatik olarak da hasta memnuniyeti daha düşüktür. Bu açıdan revizyonel cerrahi belirgin disfajisi olan ya da medikal tedaviye rağmen semptomları gerilemeyen hastalarda düşünülmelidir. Laparoskopik revizyonel anti reflü cerrahisi bu alanda deneyimli cerrahlar tarafından gerçekleştirilmelidir.
Anahtar Kelimeler: Gastroözofageal reflü; fundoplikasyon; nüks; reoperasyon
Laparoscopic anti reflux surgery has been gold standard method for the surgical treatment of gastroesophageal reflux disease. However, recurrence after surgery is still an important problem. Revision surgery may be needed because of intractable symptoms of some patients. The main symptoms of patients who need revision surgery are recurrent reflux and dysphagia. Revisional anti-reflux surgery is a very difficult operation compared to the first operation and therefore it is necessary to evaluate these peitents carefully in preoperative period. Hence, it is important to obtain objective evidence of patients who have reflux symptoms. Esophagogastroduodenoscopy, radiological passage screening and pH monitoring should be performed. In the reported series, it was detected that the most commonly intraoperative finding in the revision surgery is transhiatal herniation of the fundoplication. Compared with primary surgery, revision anti-reflux surgery is associated with higher morbidity, mortality, complication rates and patient satisfaction is lower in terms of syptoms. In this respect, revision surgery should be considered in patients who have significant dysphagia or whose symptoms can not be improved despite medical treatment. Laparoscopic revision anti-reflex surgery should be performed by experienced surgeons in this field.
Keywords: Gastroesophageal reflux; fundoplication; recurrence; reoperation
- Cihangir Akyol, Atıl Çakmak, İlknur Kepenekçi, Ozan Şen, Seher Demirer. Metaplastik Meme Karsinomu: Nadir Görülen Bir Tümör. Meme Sağlığı Dergisi 2008;4:2
Memenin metaplastik karsinomu, tüm malign meme lezyonlarının %1’inden azını oluşturan, yüksek dereceli nadir bir lezyondur. Bu terim (metaplastik meme karsinomu) ilk kez Huvos ve arkadaşları tarafından 1974 yılında kul- lanılmıştır. Diğer meme kanserlerine göre daha kötü prognozlu ve agresif seyirlidir. Memenin metaplastik karsinomu, malign epitelyal ve malign me- zenkimal doku komponentlerinin birlikte bulunduğu bifazik lezyonları içine alan heterojen grubu tanımlayan genel bir terimdir.
Bu yazıda 51 yaşında bir bayan hastada, memenin metaplastik karsinomu olgusu sunulmuştur.Sağ memede, boyutlarında giderek büyüme olan kitle ile başvuran hastaya, frozen incelemeyi takiben modifiye radikal mastektomi uy- gulandı. Histopatolojik inceleme sonucu T2N1bııı, Grade III, ER(-), PR(-), cerbB2 (-) metaplastik meme karsinomu olarak değerlendirildi. Adjuvan kemoterapi uygulanan hasta, postoperatif 22. ayında nüks olmadan takip edilmektedir.
Anahtar sözcükler: metaplastik meme karsinomu, karsinosarkom, myoepitelyal hücreler.
Metaplastic carcinoma of the breast (MCB) is a rare type of breast cancer ac- counting for < 1% of breast malignancies. The term metaplastic carcinoma was first introduced by Huvos et al. MCB is an aggressive disease and has poor prognosis. MCB denotes a heterogeneous group of uncommon malignant en- tities. Conventionally the term is used to denote tumours with mixed malig- nant epithelial and malignant mesenchymal components.
We report a case of MCB in 51 years old women. She has presented with pal- pable and progresivvely enlarging mass in the right breast. Modified radical mastectomy was perfomed. Histopathologic diagnosis was reported as T2N1bııı, Grade III, ER (-), PR (-), cerbB2 (-) metaplastic breast carcinoma. Adjuvant che- motheraphy was performed. Recurrence has not been detected at 22 months after surgery.
Key words: metaplastic carcinoma of the breast, carcinosarcoma, myoepithelial cells.
1. Brian P. Jacops, Bruce Ramshaw. SAGES Fıtık Onarım El Kitabı Nobel Tıp Yayınları Ahmet Türkçapar, Ozan Şen (Kitap Bölümü)
2. Ozan Şen, Ahmet Türkçapar. Heller Miyotomi Sonrası Rekürren Disfaji. Akalazya: Güncel tanı ve tedavi yaklaşımları 1. Baskı. Türkiye Klinikleri 2019. P.65-9 (Kitap Bölümü)
1. Atıl Çakmak, Akın Fırat Kocaay, Cihangir Akyol, Erkin Orazakunov, Marlen Sulamaniov, İlknur Kepenekçi, Volkan Genç, Ozan Şen, Bülent Erkek, Selçuk Hzinedaroğlu. 5mm Throchar site fistula formation due to gallstone; Late and rare complication of laparoscopic cholesistectomy. 2008 Sugical Infection Society Europe 21st Annual Congress Antalya
2. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Eldem Erdem, Toygar Toydemir, Selma Bekir, Mehmet Ali Yerdel. Bariatrik Cerrahi Öncesi Kolonoskopik Tarama. 4th National & 1st Mediterranean Congress on Surgery for Morbid Obesity and Metabolic Disorders October 2015 Antalya
3. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Eldem Erdem, Selma Bekir, Mehmet Ali Yerdel. Sleeve gastrektomiden sonra darlık sonrası kaçak: olgu sunumu 4th National & 1st Mediterranean Congress on Surgery for Morbid Obesity and Metabolic Disorders October 2015 Antalya
4. Ozan Şen, Ahmet G. Türkçapar. Combined partial posterior fundoplication with laparoscopic sleeve gastrectomy for morbid obese patients with symptomatic GERD. ASMBS 2021 annual meeting
5. O. Şen, A.B. Erkek, U. Sözener, M.A. Kuzu. Genel Cerrahi Hastalarının Bilgi Arayışında İnternet Kullanımı S-274 Ulusal Cerrahi Kongresi 2006 Antalya
6. Cumhur Özcan, Mehmet Akif Türkoğlu, Ozan Şen, Cüneyt Köksoy, Uğur Bengisun. Akut Damar Trombozlarında Trombolitik tedavi Deneyimi. 13. Ulusal Vasküler Cerrahi Kongresi 2007
7. Mehmet Akif Türkoğlu, Cumhur Özcan, Ozan Şen, Cüneyt Köksoy, Uğur Bengisun. Aortoiliak ve İnfrainguinal Aterosklerotik Oklüzyon ve Stenozlarda Endovasküler Deneyimlerimiz. 13. Ulusal Vasküler Cerrahi Kongresi 2007
8. Mehmet Akif Türkoğlu, Cumhur Özcan, Ozan Şen, İskender Alaçayır, Uğur Bengisun. EVAR Deneyimlerimiz. 13. Ulusal Vasküler Cerrahi Kongresi 2007
9. Ozan Şen, Mehmet Akif Türkoğlu, Cumhur Özcan, Cüneyt Köksoy, Uğur Bengisun. Venöz Tromboembolide Vena Kava Filtreleri. 13. Ulusal Vasküler Cerrahi Kongresi 2007 Antalya
10. O. Şen, A.B Erkek, L.T. Şenol, H. Zeybek, P. Çakır, M.A. Kuzu. Kolorektal Kanserlerde Tarama (Pilot Çalışma) Kol-25 Ulusal Cerrahi Kongresi 2008 Antalya
11. E. Orozakunov, A. Çakmak, V. Genç, D. Balcı, G. Bora, O. Şen, S. Hazinedaroğlu. Laparoskopik Donör Nefrektomisi: Ülkemizde Uygulanabilir mi? Ulusal Cerrahi Kongresi 2008 Antalya
12. A. Çakmak, O. Şen, C. Akyol, İ. Kepenekçi, E. Anadol. Falsiform Ligamant İçinde Ektopik Yerleşimli Safra Kesesi: Vaka Takdimi. Ulusal Cerrahi Kongresi 2008 Antalya
13. V. Genç, A. Çakmak, G. Aylaz, D. Balcı, İ. Kepenekçi, O. Şen, M. Gürel. Kolon Kanserinin İzole Dalak etastazı: Vaka Takdimi. Ulusal Cerrahi Kongresi 2008 Antalya
14. C. Akyol, G. Bora, A. Çakmak, O. Şen, G. Aylaz, V. Genç, C. Bumin. Anorektal Malign Melanom: Olgu Sunumu. Ulusal Cerrahi Kongresi 2008 Antalya
15. M. Ali Yerdel, Ahmet Türkçapar, Ozan Şen. Kurs: Uygulamalı Sleeve Cerrahisi 7. Ulusal Endokrin Cerrahi Kongresi 2013 Antalya
16. M. Ali Yerdel, Ahmet Türkçapar, Ozan Şen. Kurs: Genel cerrahlara yönelik 2 günlük uygulamalı Bariatrik Cerrahi kursu İstanbul bariatrics Obezite Merkezi Ekim 2014
17. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Mehmet Ali Yerdel. Stapler hasttının üst köşe gömülerek ‘’tam kat’’ dikilmesinin sleeve komplikasyonlarına etkisi. 12. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi 2015
18. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Mehmet Ali Yerdel. Laparoskopik Sleeve Gastrektomide İntraoperatif Sorunlar. 12. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi 2015
19. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Eldem Erdem, Toygar Toydemir, Selma Bekir, Mehmet Ali Yerdel. Bariatrik Cerrahi Sonrası Ayaklar da Küçülüyor mu? Eur JSurg Sci 2015;6(Suppl 1):1-29
20. Ozan Şen, Ahmet Gökhan Türkçapar, Fatma Kahraman, Eldem Erdem, Selma Bekir, Mehmet Ali Yerdel. İstanbul Bariatrics ‘’337 Olguluk Deneyimimiz’’ Eur JSurg Sci 2015;6(Suppl 1):1-29
21. Ozan Şen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Bariatrik Cerrahi Sonrası Az Görülen Bir Komplikasyon: Düşük Ayak (Peroneal Tuzak Nöropati). 13. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi 2017
22. Ozan Şen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Bariatrik Cerrahi Öncesi Saptanan Mide Karsinoid Tümörü. 13. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi 2017
23. Ozan Şen. Sleeve Gastrektomide Preoperatif Endoskopi Gerekli midir? Obezite ve Metabolik Cerrahi Platformu Video Sempozyumu 2017 İstanbul
24. Ozan Şen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Laparoscopic Sleeve Gastrectomy After Previous Antireflux Surgery. 14. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi joint with MMESA Spring meeting 2019 Kıbrıs
25. Ozan Şen, Ahmet Gökhan Türkçapar. Barret’s Ulcer 5 Years After Sleeve Gastrectomy. 14. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi joint with MMESA Spring meeting 2019 Kıbrıs
26. Ozan Şen, Ahmet Gökhan Türkçapar, Mehmet Ali Yerdel. Nasogastric Tube Stapling During Sleeve gastrectomy. 14. Ulusal Endoskopik Laparoskopik Cerrahi Kongresi joint with MMESA Spring meeting 2019 Kıbrıs
27. Ozan Şen, Ahmet Gökhan Türkçapar. Laparoskopik nüks hiatal herni cerrahisinde pnömotoraks gelişen hastada sıra dışı tedavi yöntemi. 7. Ulusal Fıtık Kongresi. 3-6 Ekim 2019 İzmir
28. Ozan Şen, Fatih Can Karaca, Ahmet Gökhan Türkçapar. Açık hiatal herni cerrahisi sonrası gelişen nüks hiatal herni ve karın ön duvarı fıtığının laparoskopik onarımı. 7. Ulusal Fıtık Kongresi. 3-6 Ekim 2019 İzmir
29. Ozan Şen, Ahmet Gökhan Türkçapar. Anestesia awereness during bariatric surgery. 6. Ulusal 5. Akdeniz Morbid obezite ve metabolik hastalıklar kongresi 17-20 Ekim 2019 Antalya
30. Ozan Şen, fatih Can Karaca, Ahmet Gökhan Türkçapar. Sleeve gastrektomi sonrası gastroözofageal reflü hastalığı. Yaygınlığı ve teknik modifikasyonların etkinliği. 3. Bariatrik ve Metabolik Cerrahi kongresi 21-24 Kasım 2019 Antalya
31. Ozan Şen, Ahmet Gökhan Türkçapar. Obezite tedavisinde endoskopik botoks uygulaması. Etkili bir yöntem mi? 10. Ulusal Obezite Kongresi 20-23 Kasım İstanbul
32. Ozan Şen. Bariatrik cerrahi sonrası safra taşı oluşumu engellenebilir mi? Türk Obezite Cerrahisi Derneği 5. Kış Okulu 2021
33. Ozan Şen. Ülkemiz Kadınlarında Obezite ve Obezite Cerrahisinin Kadın Sağlığı Üzerine Etkisi. 4. Uluslararası Beslenme Obezite ve Toplum Sağlığı Kongresi. 2020. İstanbul
34. Ozan Şen. Bariatrik Cerrahi Öncesi Uygulanan Düşük Kalorili Diyetin Ameliyat Sonrası Kilo Vermeye Etkisi. 9. Ulusal Sağlıklı Yaşam E- Kongresi 2020
35. Ozan Şen. Laparoskopik Sleeve Gastrektomi Ameliyatı Planlanan ve Asemptomatik Kolelitiazisi Olan Morbi Obezlerde Aynı Seansta Kolesistektomi Gerekir mi? Sağlık Bilimleri Üniversitesi 4. Gastroenteroloji Günleri 2020
36. Ozan Şen. Ortak Çalışma ve Yayın Kültürü. Davetli konuşmacı. 6. Ulusal ve 5. Akdeniz Metabolik Hastalıklar Kongresi 2019 Antalya
37. Ozan Şen. Ameliyathanede Kabus. Davetli konuşmacı. 6. Ulusal ve 5. Akdeniz Metabolik Hastalıklar Kongresi 2019 Antalya