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  • Küçük Resim
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    Complicated or not complicated: Stoma site marking before emergency abdominal surgery
    (Ali Cangül, 2019) Gök, Ali Fuat Kaan; Özgür, İlker; Altunsoy, Meral; Üçüncü, Muhammed Zübeyr; Bayraktar, Adem; Türker Bulut, Mehmet; Keskin, Metin
    BACKGROUND: Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting. The approach and behavior of surgical residents regarding stoma creation was also assessed. METHODS: Patients who had undergone gastrointestinal surgery between January 2012 and December 2013 were assessed. A total of 116 of those patients who had a stoma created during the initial operation were followed by a stoma therapy nurse in the postoperative period and were enrolled in the current study. In addition, a survey of the residents was conducted to evaluate their knowledge about stoma creation and stoma care. RESULTS: A total of 67 (58%) of the 116 patients included were male. The median age was 57±16 years (range: 17–87 years). A body mass index above 30 kg/m2 was detected in 16 patients (14%). The reason for surgery was malignant disease in 93 (80%) patients, and 97 cases (84%) were elective operations. Preoperative stoma marking was performed in 72 patients (62%). The stoma type was an ileostomy in 87 patients (75%). Stoma-related complications were observed in 40 patients (35%). Emergency surgery (p=0.02), preoperative stoma marking (p<0.0005), adjuvant therapy (p=0.004), and the stoma caretaker (patient or relatives) (p=0.05) were associated with stoma-related complications. Logistic regression analysis revealed that only the type of surgery (emergency or elective), preoperative stoma marking, and the stoma caretaker increased the rate of stoma-related complications. CONCLUSION: Marking the stoma location before surgery reduces the risk of stoma-related complications and has a positive effect on the patient’s quality of life. Multivariable analysis indicated that marking the stoma site before the operation was the only factor that affected the rate of stoma-related complications, regardless of emergency or elective surgical conditions. Since surgeons will encounter the need for a stoma procedure during their professional career and they will not always have the opportunity to work with stoma therapy nurse, stoma care education should be provided during their residency (internship) education, and ascertaining a stoma localization before surgery for all potential stoma cases should be encouraged in emergency shifts.
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    Our Experience With Desmoid Tumors
    (Erkan Mor, 2016) Keskin, Metin; Üçüncü, Muhammed Zübeyr; Memişoğlu, Ecem; Bayraktar, Adem; Balık, Emre; Bulut, Mehmet Türker
    Aim: Desmoid tumors originating from musculoaponeurotic tissues progress locally and aggressively and these tumors do not metastasize to distant sites. The incidence shows increase in polyposis coli syndromes. In this article, we aimed to evaluate the results of the patients treated for desmoid tumors. Method: Fifteen patients, who were diagnosed with desmoid tumors between the dates of 2000 and 2013, were evaluated in terms of demographical and clinical data, surgical interventions, complications and long-term follow-up results. Results: The median age of patients was 35 (in between 20-51 years) years and 9 (60%) of them were women. Among 13 patients with polyposis syndrome, 6 (40%) underwent restorative proctocolectomy and 5 (33%) underwent total colectomy and ileorectal anastomosis. As 2 patients were accepted as inoperable, colon-oriented surgical intervention was not performed. Following the diagnosis of polyposis coli, the mean period of time between the surgery and development of desmoid tumor was found as 24.5 months (in between 4-48 months). Intra-abdominal region was found to be the most common tumor location (n=11 patients, 74%). As eight patients (54%) were inconvenient to the surgical excision, they were accepted as inoperable when they were diagnosed with desmoid tumor. Seven patients could undergo surgical resection, but all of them had recurrence in their follow-up. The mortality rate was 74% (n=11) and the mean survival rate was 79.7 months (in between 5-312 months). Multi-visceral organ transplantation was performed to one patient. Conclusion: Following prophylactic colectomy at early ages, desmoid tumor has been the most common reason of the mortality in Polyposis syndrome. At the time of diagnosis, most patients are inoperable because of the invasion to adjacent organs, especially small-bowel meso. Although multi-visceral organ transplantation is one of the most complicated surgical procedures, it seems to be a convenient treatment option in patients with desmoid tumor.