Browsing by Author "Kiyak, H."

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Preoperative Factors Associated With the Need for the Morcellation in Total Laparoscopic Hysterectomy
(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Kiyak, H.; Karaaslan, O.; Doga Seckin, K.; Karacan, T.; Ozyurek, E.S.; Yilmaz, G.; Bulut, B.
Removal of uterus during laparoscopic hysterectomy (LH) is occasionally challenging and therefore sometimes requires morcellation. Morcellation techniques for hysterectomy can spread the cancer cells which were presumed benign preoperatively in to the abdomen or pelvis. Probability of an undetected malignity should not be disregarded and accordingly must be shared with the patient prior to LH. The present study aimed to identify the demographic and the clinical factors associated with the need for morcellation in patients undergoing LH. A total of 153 patients who underwent LH for presumed benign causes were enrolled in this retrospective study. Subjects were divided into two groups according to the need for the morcellation during the LH: Morcellation group and intact vaginal removal (IVR) group (it was possible to deliver the uterine specimen vaginally). The two groups were compared with respect to demographic and clinical characteristics, indications for LH, preoperative ultrasonographic findings and postoperative complications. The frequency of the postmenopausal women was significantly higher in the morcellation group than the IVR group (p = 0.005). Preoperative uterus width (p < 0.001) and postoperative Uterus weight (p < 0.001) were significantly higher in the morcellation group compared to that of the IVR group. There were no significant differences between the groups regarding the complication rate. Uterine weight (OR: 1.020, 95% CI: 1.008-1.031, p = 0.001) and menopause (OR: 2.571, 95% CI: 1.328-4.980, p < 0.001) were predictive for the need of morcellation. A cut-off value of 287.5 gram was able to predict the need for morcellation with 87% sensitivity and 71% specificity. The present study demonstrates that uterine weight and presence of the menopause are predictive for the need of morcellation at the time of the total LH. These factors should be considered in preoperative planning and used to further guide surgeons in providing LH. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Spinal Anesthesia Is Associated With Postoperative Urinary Retention in Women Undergoing Urogynecologic Surgery
(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Yilmaz, G.; Akça, A.; Kiyak, H.; Karaaslan, O.; Salihoğlu, Z.
We hypothesized that spinal anesthesia could lead to impairment in bladder function and consequently, to postoperative urinary retention (POUR), particularly in patients undergoing urogynecologic surgery. This study was aimed to compare the rate of the POUR between the subjects receiving spinal and general anesthesia who underwent urogynecologic surgery. One hundred and eighty subjects who underwent urogynecologic surgery between June 2016 and May 2019 were retrospectively analyzed to evaluate the risk of POUR after general versus spinal anesthesia. All subjects underwent a standardized voiding trial subsequent to surgery, which was performed by backfilling the bladder with 300 ml of saline. The presence of > 100 ml volume in the post-void bladder scan was defined as POUR. The primary outcome was to compare rates of POUR between spinal and general anesthesia. Identifying the risk factors for POUR was the secondary outcome of this study. Spinal anesthesia group included 80, and the general anesthesia group consisted of 100 patients. The overall rate of the POUR was %22.8. The proportion of the patients with POUR was significantly higher in the spinal anesthesia group compared to that of the subjects in the general anesthesia group (%33.8vs%14, P=0.002). Multivariate logistic regression analysis revealed that the adoption of spinal anesthesia (Odds ratio: 3.172, 95%CI: 1.383-7.275, P=0.006) and presence of diabetes (Odds ratio: 5.840, 95% CI:2.325-14.666, P< 0.001) were independent predictors for the development of POUR. The rate of the POUR is significantly higher in patients receiving spinal anesthesia than those receiving general anesthesia among women undergoing urogynecologic surgery. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.