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    Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency
    (CUREUS INC, PO BOX 61002, PALO ALTO, CA 94306 USA, 2019) Ekici, Uğur; Kartal, Abdulcabbar; Ferhatoğlu, Murat Ferhat
    Aim: The aim of the present study was to evaluate the incidence of varicose veins among patients with hemorrhoidal disease and to compare its incidence reported in various community-based studies. Method: The study group comprised of 100 patients who underwent surgery for symptomatic internal or external hemorrhoids; the control group consisted of 100 volunteers who received no prior therapy for hemorrhoidal disease and lacked any symptoms or findings suggestive of this condition. Subjects in both the groups were inquired with respect to their demographic data and risk factors. Both groups were asked to stand for two minutes before performing leg examinations while still in the standing position. The findings were recorded for both the groups. Varicose veins were classified according to the clinical appearance section of the Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) classification that was developed by the 1994 American Venous Forum. Results: There was no significant difference between the two groups with respect to age and body mass index (BMI). Significant relationships were identified between the groups with respect to the incidence of varicose veins and chronic constipation. The incidence of C1 and C2 varicose veins observed in the study group was higher than that observed in the control group. The incidence of chronic constipation was higher in the study group than that in the control group. Discussion: Lower extremity chronic venous insufficiency is more common in patients with hemorrhoidal disease which increases intra-abdominal pressure. A chronic increase in this pressure causes conditions, such as constipation, which trigger both lower extremity chronic venous insufficiency and hemorrhoidal disease.
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    A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus
    (ELSEVIER SINGAPORE PTE LTD, 3 KILLINEY ROAD 08-01, WINSLAND HOUSE 1, SINGAPORE, 239519, SINGAPORE, 2019) Ekici, Uğur; Kanlıöz, Murat; Ferhatoğlu, Murat Ferhat; Kartal, Abdulcabbar
    Objectives: Although many surgical methods have been described for sacrococcygeal pilonidal sinus treatment, the best option is still controversial. We aimed to compare postoperative outcomes of these different methods in terms of advantages and disadvantages. Methods: The records of 320 patients undergone surgery for primary or recurrent pilonidal sinus between May 2013 and May 2017 were retrospectively analyzed. Demographical data, preoperative stories, wound site infection, seroma development, wound dehiscence, time of healing, duration of return to work, and if there is any recurrence of 303 patients included in the study were recorded. Upon wide local excision, the first surgeon performed marsupialisation and the lay open technique, second surgeon performed vertical excision and primary closure, third surgeon performed Limberg flap transposition and fourth surgeon performed Karydakis' flap transposition. Results: There was no significant difference between the patients in terms of demographical characteristics. The duration of surgery was statistically significantly higher in primary closure method (p = 0.001). The mean duration of return-to-work was statistically significantly lower in primary closure method (p = 0.002). In primary closure method, the recurrence rate was found to be statistically significantly higher than the other methods (p = 0.009). Conclusion: We do not suggest the use of primary closure method in treatment of pilonidal sinus. Because of lower rates of recurrence and shorter durations of return to work, the Karydakis and Limberg methods are seen as safer methods when compared to lay-open and marsupialization method. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association.
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    Effects of Bathing Habits on Postoperative Wound Complications Following Sacrococcygeal Pilonidal Sinus Surgery: A Retrospective Analysis of 67 Adolescent Patients
    (H M P COMMUNICATIONS, 83 GENERAL WARREN BLVD, STE 100, MALVERN, PA 19355 USA, 2019) Ferhatoğlu, Murat Ferhat; Kartal, Abdulcabbar; Ekici, Uğur; Kebudi, Abut
    Introduction. Sacrococcygeal pilonidal sinus disease generally affects young people and impacts their quality of life. Few published studies assessing the characteristics of the disease in the adolescent population exist. Objective. In this paper, the authors aim to evaluate the effects of bathing habits on wound complications in adolescent patients following Karydakis flap surgery for sacrococcygeal pilonidal sinus.Materials and Methods. The medical records of 79 adolescent patients who underwent sacrococcygeal pilonidal sinus surgery between January 2014 and December 2017 at the Surgery Clinic of Malatya State Hospital (Malatya, Turkey) were evaluated retrospectively.Following exclusion, 67 patients were evaluated for demographics, body mass index (BMI), previous abscess formation, bathing frequency,number of sinus pits, and postoperative wound infection and dehiscence. The total follow-up time for the 67 patients was 90 days. Results.The BMIs of patients with previous abscess formation were significantly higher (P =.029). In the cases with abscess, the number of pilonidal sinus pits was significantly higher (P =.039) There was a statistically significant difference between postoperative complication rates according to the number of baths per week. Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery (P =.005). No statistical significance was observed in complication rates from days 28 to 90 after the surgery between those who bathed twice weekly and more than twice weekly (P >.05). Conclusions. Postoperative wound complications in adolescent patients treated with Karydakis flap surgery for sacrococcygeal pilonidal sinus are more frequent in those who bathe more than twice weekly during the first 28 days postoperatively.
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    Effects of the Folk Medicinal Plant Extract Ankaferd BloodStopper on the Healing of Colon Anastomosis: An Experimental Study in a Rat Model
    (KARE PUBL, CONCORD ISTANBUL, DUMLUPINAR MAH, CIHAN SK NO 15, B BLOK 162 KADIKOY, ISTANBUL, TURKEY, 2019) Ekici, Uğur; Ferhatoğlu, Murat Ferhat; Çitgez, Bülent; Uludağ, Mehmet
    Objectives: Ankaferd BloodStopper (ABS) is a topical hemostatic agent that modulates the inflammatory response and accelerates wound healing. The aim of this study was to determine the effects of ABS on the colon anastomosis wound healing in a rat model. Methods: Thirty-two Wistar albino rats were divided into four groups as follows: Group A (n= 8), left colonic anastomosis plus ABS treatment (sacrificed on the 3rd day); Group B (n= 8) (control), left colonic anastomosis (sacrificed on the 3rd day); Group C (n= 8), left colonic anastomosis plus ABS treatment (sacrificed on the 7th day); and Group D (n= 8) (control), left colonic anastomosis (sacrificed on the 7th day). All rats were sacrificed at the end of the experiment to assess the anastomosis integrity and the presence of perianastomosis abscesses, peritonitis, and adhesions. Additionally, the bursting pressure and hydroxyproline (OH-pyroline) levels were determined, and a histopathologic evaluation of the perianastomosis tissue was conducted. Results: The mean bursting pressure on Day 7 was significantly higher than that on Day 3 in the ABS group (p=0.017). Overall, the bursting pressure was higher in animals treated with ABS than in the control animals, although the difference was not statistically significant. The OH-pyroline levels of both ABS groups were significantly higher than in the control groups. The mean OH-pyroline level on Day 7 was higher than that on Day 3 in the ABS-treated animals (p=0.038). Conclusion: ABS increases collagen formation and neovascularization, and it has a positive impact during the colon anastomosis healing in an experimental model of wound healing.
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    Evaluation of the Reliability, Utility, and Quality of the Information in Sleeve Gastrectomy Videos Shared on Open Access Video Sharing Platform YouTube
    (SPRINGER, ONE NEW YORK PLAZA, SUITE 4600 , NEW YORK, NY 10004, UNITED STATES, 2019) Ferhatoğlu, Murat Ferhat; Kartal, Abdulcabbar; Ekici, Uğur; Gürkan, Alp
    Background The internet is a widely used source for obtaining medical information both by patients and physicians. YouTube® is a valuable information resource which can improve the learning experience of both public and medical professionals if appropriately used. In this study, we want to evaluate quality and accuracy of videos about sleeve gastrectomy procedure. Methods We included the first 100 videos returned by YouTube® search engine in response to Bsleeve gastrectomy^ keyword query to the study. The popularity of the videos was evaluated with an index called the video power index (VPI). Educational quality of videos was measured using the DISCERN score (DISCERN), Journal of American Medical Association (JAMAS) benchmark criteria, and Global Quality Scores (GQS). The technical quality was measured by Sleeve Gastrectomy Scoring System (SGSS) which was utilized by three bariatric surgeons. Results The source in 31% of the videos was a patient. The content in 53% of the videos was surgical technique. According to sources, videos uploaded by a university-affiliated physician had significantly higher DISCERN, JAMAS, GQS, and SGSS scores. Videos uploaded by a university-affiliated physician also had lower video power index than videos uploaded by patients. Surgical technique videos had significantly higher DISCERN, JAMAS, GQS, and SGSS scores. Patient experiences and advertisement videos had higher VPI scores. Also, negative correlations were found between video power index and JAMAS, GQS, and SGSS scores. Conclusions Online information on sleeve gastrectomy is of low quality, and its contents are of unknown source and accuracy. However, educational potential of YouTube® cannot be ignored.
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    Obesity, Hypertrichosis and Sex Steroids: Are these Factors Related to the Pilonidal Sinus Disease?
    (KARE PUBL, CONCORD ISTANBUL, DUMLUPINAR MAH, CIHAN SK NO 15, B BLOK 162 KADIKOY, ISTANBUL, 00000, TURKEY, 2019) Ekici, Uğur; Ferhatoğlu, Murat Ferhat
    Objectives: Pilonidal sinus disease causes chronic inflammation of the skin and subcutaneous fatty tissue, and it commonly localises in the sacrococcygeal region. This study evaluated the effects of hypertrichosis, family history, obesity and sex steroids in 298 patients with pilonidal sinus disease. Methods: The medical records of 618 patients treated at the General Surgery Clinic of Malatya State Hospital for primary pilonidal sinus disease between January 2014 and December 2017 were evaluated retrospectively. Results: Female sex and family histories of pilonidal sinus disease and hypertrichosis were significantly higher in patients with than without hypertrichosis (p=0.030, p=0.035, p<0.001). The mean progesterone level was significantly lower in female patients with hypertrichosis than female patients without hypertrichosis (p=0.003). Conclusion: Being overweight or obese, having an occupation that requires long-time sitting and having a family history predisposed to developing pilonidal sinus disease.
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    Perioperative and Postoperative Effects of Preoperative Low-Calorie Restrictive Diets on Patients Undergoing Laparoscopic Sleeve Gastrectomy
    (SPRINGER, ONE NEW YORK PLAZA, SUITE 4600 , NEW YORK, NY 10004, UNITED STATES, 2020) Ekici, Uğur; Ferhatoğlu, Murat Ferhat
    Objective A restrictive diet applied before bariatric surgery can be required to reduce the liver volume or as a necessity imposed by insurance companies. However, the benefits of preoperative weight loss remain controversial. The present study aimed to investigate the perioperative and postoperative outcomes of a restrictive diet applied before laparoscopic sleeve gastrectomy. Materials and Methods The data of 128 patients who received surgery in 2015 and 2016 were retrospectively analyzed. All patients were advised to follow a 4-week low-calorie (1000 cal) restrictive diet. Nevertheless, approximately 50% of patients did not accept the diet plan. We divided the patients into two groups as dieters (group 1) and non-dieters (group 2). Results In group 1, changes in after-diet BMI and liver size were statistically significant (p < 0.001). In group 2, mean operation duration, mean hospitalization duration values, mean BMI values, and mean body weight at postoperative 1, 3, 6, and 12 months were statistically significantly higher than in group 1. No statistically significant difference was found between early complication rates of the groups (p = 0.844). Conclusion Low-calorie restrictive diet applied before laparoscopic sleeve gastrectomy has reduced liver volume and shortens surgery and hospitalization time but does not have any significance concerning early complications and weight loss after operation in 1 year. Also, non-adherence of the bariatric surgery candidate patients to the diet seems to be a challenge.