Browsing by Author "Adas, Gokhan"

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Complications Following Endoscopic Retrograde Cholangiopancreatography: Minimal Invasive Surgical Recommendations
(Public Library Science, 2014) Koc, Bora; Bircan, Huseyin Yuce; Adas, Gokhan; Kemik, Ozgur; Akcakaya, Adem; Yavuz, Alpaslan; Karahan, Servet
Background: ERCP has a complication rate ranging between 4% and 16% such as post-ERCP pancreatitis, hemorrhage, cholangitis and perforation. Perforation rate was reported as 0.08% to 1% and mortality rate up to 1.5%. Besides, injury related death rate is 16% to 18%. In this study we aimed to present a retrospective review of our experience with post ERCP-related perforations, reveal the type of injuries and management recommendations with the minimally invasive approaches. Methods: Medical records of 28 patients treated for ERCP-related perforations in Okmeydani Training and Research Hospital between March 2007 and March 2013 were reviewed retrospectively. Patient age, gender, comorbidities, ERCP indication, ERCP findings and details were analyzed. All previous and current clinical history, laboratory and radiological findings were used to assess the evaluation of perforations. Results: Between March 2007 and March 2013, 2972 ERCPs were performed, 28 (0.94%) of which resulted in ERCP-related perforations. 10 of them were men (35.8%) and 18 women (64.2%). Mean age was 53.36 +/- 14.12 years with a range of 28 to 78 years. 14 (50%) patients were managed conservatively, while 14 (50%) were managed surgically. In 6 patients, laparoscopic exploration was performed due to the failure of non-surgical management. In 6 of the patients that ERC-Prelated perforation was suspected during or within 2 hours after ERCP, underwent to surgery primarily. There were two mortalities. The mean length of hospitalization stay was 10.46 +/- 2.83 days. The overall mortality rate was 7.1%. Conclusion: Successful management of ERCP-related perforation requires immediate diagnosis and early decision to decide whether to manage conservatively or surgically. Although traditionally conventional surgical approaches have been suggested for the treatment of perforations, laparoscopic techniques may be used in well-chosen cases especially in type II, III and IV perforations.
Is Combined Therapy More Effective Than Growth Hormone or Hyperbaric Oxygen Alone in the Healing of Left Ischemic and Non-Ischemic Colonic Anastomoses
(Hospital Clinicas, Univ Sao Paulo, 2013) Adas, Mine; Kemik, Ozgur; Adas, Gokhan; Arikan, Soykan; Kuntsal, Leyla; Kapran, Yersu; Toklu, Akin Savas
OBJECTIVE: Our aim was to investigate the effects of growth hormone (GH), hyperbaric oxygen and combined therapy on normal and ischemic colonic anastomoses in rats. METHODS: Eighty male Wistar rats were divided into eight groups (n = 10). In the first four groups, non-ischemic colonic anastomosis was performed, whereas in the remaining four groups, ischemic colonic anastomosis was performed. In groups 5, 6, 7, and 8, colonic ischemia was established by ligating 2 cm of the mesocolon on either side of the anastomosis. The control groups (1 and 5) received no treatment. Hyperbaric oxygen therapy was initiated immediately after surgery and continued for 4 days in groups 3 and 4. Groups 2 and 6 received recombinant human growth hormone, whereas groups 4 and 8 received GH and hyperbaric oxygen treatment. Relaparotomy was performed on postoperative day 4, and a perianastomotic colon segment 2 cm in length was excised for the detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. RESULTS: Combined treatment with hyperbaric oxygen and GH increased the mean bursting pressure values in all of the groups, and a statistically significant increase was noted in the ischemic groups compared to the controls (p < 0.05). This improvement was more evident in the ischemic and normal groups treated with combined therapy. In addition, a histopathological evaluation of anastomotic neovascularization and collagen deposition showed significant differences among the groups. CONCLUSIONS: Combined treatment with recombinant human growth hormone and hyperbaric oxygen resulted in a favorable therapeutic effect on the healing of ischemic colonic anastomoses.
Obese Patients After Laparoscopic Adjustable Gastric Banding Complications and the Influence on Body Mass Index and Comorbidities
(H G E Update Medical Publishing S A, 2014) Koc, Bora; Karahan, Servet; Adas, Gokhan; Kemik, Ozgur
Background/Aims: The aim of this study is to present the advantages of LAGB (Laparoscopic adjustable gastric banding), its effects on weight loss and influence on comorbidities such as diabetes and hypertension. Methodology: 90 middle-aged obese patients with body mass index [BMI] of 35-50 kg/m(2) underwent LAGB between October 2007 and April 2010. Results: There were 33 men and 57 women underwent LAGB. The ages of the cases ranged from 22 to 39 years [mean 29.5 years]. The percentage of decrease on BMI at the 3, 6, 12, 24 month marks were 9.85%, 14.8%, 25.8% and 32.9%, respectively. No early operative complications were recorded. Pouch dilation occured in 6 patients and band erosion-migration was observed in 3 patient. Conclusion: LAGB is a safe and effective approach in short-term management of morbid obesity. Weight loss, complications and resolution of comorbidities are comparable with the other obesity procedures.
The Use of Ercp During Pregnancy: Is It Safe and Effective
(H G E Update Medical Publishing S A, 2014) Akcakaya, Adem; Koc, Bora; Adas, Gokhan; Kemik, Ozgur
Cholangitis and pancreatitis are the most gruesome complications that can be potentially fatal for the mother and fetus. The management of bile stone disease complicated with duct stones during pregnancy is challenging. Conservative treatment instead of surgery has always been advocated due to the increased risk for fetal compromise. Minimally invasive therapy with ERCP has been suggested as an effective therapeutic option for the management of pancreaticobiliary diseases during pregnancy. The main topics of discussion are the risks stemming from the endoscopic procedure itself, drugs used for sedation and the adverse effects of radiation exposure on the fetus. In this manuscript, we want to present the efficiency and feasibility of the ERCP for the management of hepatobiliary and pancreatic diseases in pregnancy.