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Öğe A rare case of multiple gastric duplication cysts in an adult(Turkish Surgical Society, 2024) Zülfikaroğlu, Barış; Akgül, Özgür; Özmen, Mehmet MahirIntestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Gastric duplication cysts are uncommon congenital anomalies and are rarely diagnosed in adults. However, diagnosis of the condition in an adult can be difficult as it is usually asymptomatic, or the symptoms are nonspecific. Here we report a rare case of symptomatic gastric duplication cysts in an adult who was treated successfully with surgical resection. © Copyright 2024 by Turkish Surgical Society.Öğe Association between hla class I alleles and morbid obesity(Science Direct, 2019) Özmen, Füsun; Özge Ergen, Gül; Moran, Münevver; Özmen, Mehmet MahirCancer survivors have a higher risk of type-2 diabetes mellitus and cardiovascular disease due to treatment-related effects and fatigue-related reductions in exercise.Öğe ASSOCIATION BETWEEN HLA CLASS II ALLELES AND MORBID OBESITY Basic science and research in bariatric surgery(Springer, 2019) Özmen, F.; Ergen, G. O.; Şahin, T. T.; Özmen, Mehmet MahirBackground and Aims: Morbid obesity is a multifactorial disease. Adiposity hypertrophia and activation of immune cells play very important roles in obesity pathogenesis. Human Leukocyte Antigen (HLA) class II HLA-DR and HLA-DQ loci are also related to some inflammatory and autoimmune diseases. The present study aims to analyze the association of HLA-DRB1 and HLA-DQB1 alleles with morbid obesity disease.Öğe The attitude of Turkish general surgeons during the COVID-19 pandemic: Results of "general surgery COVID-19 pandemic attitude survey"(Bilimsel Tip Yayinevi, 2020) Çolakoğlu, Muhammet Kadri; Özgün, Yiğit Mehmet; Pişkin, Erol; Bostancı, Erdal Birol; Özmen, Mehmet MahirObjective: The whole world is dealing with the COVID-19 pandemic, and healthcare professionals are the most affected group. The aim of this study was to evaluate the knowledge of general surgeons about COVID-19 and understand the attitude and current situation of our colleagues. Material and Methods: This descriptive study comprised general surgeons working in different parts of Turkey. A survey with 23 questions was prepared to determine the demographic characteristics of the participants, workplace characteristics, change in daily work practices and their attitudes in the pandemic process. Results: A total of 332 forms were evaluated. Survey results show that the majority of surgeons have changed their daily surgical practices. Many surgeons take part in the treatment of COVID-19. While most benign cases are delayed, the managemet of malignant cases differs. There are also differences in the evaluation of patients preoperatively and the type of operation. Personal protective measures are followed. While the rate of infected surgeons is low, the majority of surgeons have concerns about infection. Conclusion: Turkish surgeons have managed to get a quick reaction from the start of the pandemic. However, there are still differences in preoperative patient evaluation and operation selection and precautions during the operation. Surgeons also should be informed about the management of malignant patients.Öğe Bilateral inguinal hernia repair: robotic TAPP versus laparoscopic TEP(2020) Gündoğdu, Emre; Güldoğan, Cem Emir; Özmen, Mehmet MahirBackground: As the advantages of minimally invasive techniques in general surgery have been shown, we prefer laparoscopic total extraperitoneal (LTEP) inguinal hernia repair or robotic transabdominal preperitoneal (RTAPP) inguinal hernia repair in patients diagnosed especially with a bilateral inguinal hernia in our practice. The present study aims to evaluate the early/midterm outcomes and complications in patients who underwent LTEP and RTAPP because of bilateral inguinal hernia. Materials and methods: In total, 189 patients underwent inguinal hernia repair between June 2016 and June 2019 in our department. Data of 49 (2F) patients (33 LTEP/16 RTAPP) who had undergone bilateral inguinal hernia repair were evaluated retrospectively. Univariate analysis was performed to identify the relations between the techniques (LTEP vs. RTAPP), outcomes, and complications. Results: Patient demographics and comorbidities were similar in both groups. There was no difference between the groups in terms of American Society of Anesthesiologists (ASA) scores (P=0.09). Operative time was longer in the RTAPP group (P=0.001). Length of hospital stay was similar in both groups (P=0.11). No recurrence was observed in both groups. Mean pain scores were significantly less for the RTAPP group (P=0.05). When general complications were compared, it was found that the RTAPP group had a statistically significant lower complication rate (P=0.02). Mean follow-up was longer in the LTEP group (P=0.04). Total hospital costs for RTAPP and LTEP were 3968$ and 2506$, respectively. Conclusions: We conclude that RTAPP seems to have better results in terms of general complications and postoperative pain score when compared with LTAPP. Robotic surgery might be safely recommended for bilateral inguinal hernia repair.Öğe Challenge for bariatric surgeon: super obese patients(Springer, 2018) Özmen, Mehmet Mahir; Güldoğan, Cem Emir; Gündoğdu, Elif[No Abstract Available]Öğe Changes in HOMA-IR index levels after bariatric surgery: Comparison of single anastomosis duodenal switch-proximal approach (SADS-p) and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB)(Elsevier Ltd, 2020) Özmen, Mehmet Mahir; Güldoğan, Cem Emir; Gündoğdu, EmreBackground: Bariatric surgery plays a major role in ameliorating metabolic abnormalities of type 2 diabetes (T2DM). The aim of this study was to evaluate the early effects of “Single Anastomosis Duodenal Switch-proximal approach” (SADS-p) and “One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) on the “homeostasis model assessment of insulin resistance” (HOMA-IR) index levels in morbidly obese patients with T2DM. Methods: In this retrospective 3-year trial, outcomes of SADS-p and OAGB-MGB patients were compared considering the changes in HOMA-IR index levels. All bariatric procedures were performed by a single primary surgeon recognized as a surgeon of excellence by IFSO-EC with the assistance of one or two additional attending surgeons. SADS-p was performed on 60(10 males) patients, and 200(27 males) patients underwent OAGB-MGB. Forty-six patients (78%) in the SADS-p group and 125 (63%) in the OAGB-MGB group had T2DM. Patients were evaluated before surgery and 1,3,9,12 months after surgery. Results: In both groups, the HOMA-IR index levels decreased significantly after surgery (p < 0.05), and both procedures markedly improved glycemic control. In the SADS-p group the HOMA-IR index levels significantly decreased from 6.2 to 1.4 after the 12th month of surgery (p < 0.05), in OAGB-MGB group HOMA-IR index levels significantly decreased from 5,9 to 1.7 after the 12th month of surgery (p < 0.05). Conclusion: Both procedures are promising operations which offer excellent control on weight, HOMA-IR index and diabetes. © 2020 IJS Publishing Group LtdÖğe Commentary: cancer after the OAGB-MGB(Springer, 2020) Rutledge, Robert; Deitel, Mervyn; Carbajo, Miguel A.; Luque-de-Leon, Enrique; Chiappetta, Sonja; Inam, Aatif; Rheinwalt, Karl; Prasad, Arun; Hargroder, David E.; Samoylov, Vladimir; Özmen, Mehmet Mahir; Parmar, Chetan; Albuquerque, Antonio; Jammu, Gurvinder; Üstün, Murat; Sakran, Nasser; Aktimur, Recep; Khan, Amir; Hamza, Yasser; Rotundo, Adriana; Focquet, Marc; Van den Bossche, Michael; Tantia, Om; Greco, Francesco; Abu Sneineh, Midhat; Barrera Rodriguez, Francisco; Musella, Mario; Ilic, Miroslav; Abbas, ImranInvited response to “The first case report of a carcinoma of the gastric cardia (AEG II) after OAGB-MGB”. Gastric and esophageal cancers are common and obesity increases the risk. The mini gastric bypass-one anastomosis gastric bypass (OAGB-MGB) is growing popularity, now widely performed around the world. The confluence of these two common events is inevitable.Öğe COVID-19 infection frequency and clinical course in patients with liver transplantation: results of a single transplant center in Turkiye(TURKISH SURGICAL ASSOC, 2022) Aydın, Osman; Çolakoğlu, Muhammet Kadri; Öter, Volkan; Özgün, Yiğit Mehmet; Pişkin, Erol; Arı, Derya; Kayhan, Meral Akdoğan; Özmen, Mehmet Mahir; Bostancı, Erdal BirolObjective: In this paper, it was tried to determine the incidence of COVID-19, course of the disease, and mortality rate in liver transplant patients by evaluating all patients operated on in our center. In addition, the results of liver transplantation performed in our center during the pandemic period were also presented. Material and Methods: All patients who had undergone liver transplantation in our liver transplant center were questioned about their history of COVID-19 either at their routine controls in the clinic or by phone interview. Results: Our liver transplant unit had 195 registered liver transplantation patients (2002-2020), and 142 of these were still alive and under follow-up. During the pandemic period, 80 patients referred to our outpatient clinic for follow-up, and their records were evaluated retrospectively in January 2021. Among 142 liver transplant patients, a total of 18 (12.6%) COVID-19 patients were identified. While 13 of these patients were males, mean age of the patients at the time of interviews was 48.8 years (22-65 years). Nine of the patients had living donor liver transplant, and the rest had cadaveric liver transplant. The most common COVID-19 associated symptom in the patients was fever. During the pandemic period, 12 liver transplant operations were performed in our center. Nine of them were living donor liver transplantation and the remainder were cadaveric liver transplantations. Two of our patients got COVID-19 positive during this period. One of them who was transplanted after COVID treatment was followed-up in intesive care for a long time and was lost not related to COVID-19. Conclusion: The incidence of COVID-19 is higher in liver transplant patients than in the general population. Nonetheless, mortality rates are low. During the pandemic period, liver transplantation can be continued by following general precautions.Öğe D2 vs D2 plus para-aortic lymph node dissection for advanced gastric cancer(TURKISH SURGICAL ASSOC, 2021) Özmen, Mehmet Mahir; Zülfikaroğlu, Barış; Özmen, Füsun; Moran, Münevver; Özalp, Necdet; Seçkin, SeldaAbstract Objective: Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. Material and Methods: In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. Results: Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. Conclusion: This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.Öğe The effect of bariatric surgery on exocrine pancreatic function(Springer, 2021) Özmen, Mehmet Mahir; Gündoğdu, Emre; Güldoğan, Cem Emir; Özmen, FüsunAbstract Introduction: After bariatric surgery (BS), patients might suffer from nutrient maldigestion, malabsorption, and vitamin deficiencies. In this study, our aim was to assess pancreatic functions after BS using fecal elastase-1 assay (FE-1). Material and Methods: Sixty patients (21M) undergoing BS and 20 (6M) healthy controls were included into the study. Stool samples were collected 1 year after surgery. Ten patients from one anastomosis gastric bypass (OAGB) and single anastomosis duodenal switch (SADS) groups with the lowest value of FE-1 and GIQLI scores were given pancreatic enzyme replacement therapy (PERT). After PERT, FE-1, excess weight loss (EWL), BMI, GIQLI scores, and vitamin D levels were measured. Results: Vitamin D levels were detected as 19.04 (9–46.5) pg/ml, 15.1 (8.4–23.6) pg/ml, 17.8 (5–30) pg/ml, and 21.79 (11–40.3) pg/ml after sleeve gastrectomy (SG), OAGB, SADS, and control groups, respectively (p = 0.04). GIQLI scores in the first year were found to have increased in all patients (p = 0.02). FE-1 levels were found as 642.35 (566.3–711.4) ?g/g, 378.52 (183.5–561.1) ?g/g, 458.88 (252.5–593, 5) ?g/g, and 518.2 (351.6–691) ?g/g for the SG, OAGB, SADS, and control groups, respectively. There was a strong inverse correlation between EWL and FE-1 levels at the end of the first year (Spearman’s rho = ? 0.688, p = 0.003). After having performed PERT for patients with the lowest FE-1 levels, the levels increased to 683.39 (615.5–720) ?g/g in the OAGB and 691.5 (643.1–720) ?g/g in the SADS groups (p = 0.011). Conclusion: FE-1 measurements demonstrated that many patients suffer from malabsorption after OAGB or SADS, whereas functions remain normal after SG. PERT corrects pancreatic functions without affecting weight loss and also contributes to the normal serum level of vitamin D.Öğe The effects of bmı on respiratory and hemodynamic parameters in laparoscopic bariatric surgery: an observational study(Mary Ann Liebert, Inc, 2019) Ayyıldız, Ayşe; Pamuk, Gülsün Almıla; Üzümcügil, Filiz; Akça, Başak; Yılbaş, Aysun Ankay; Şahin, Tolga; Özmen, Mehmet Mahir; Aypar, ÜlküBackground: Previous reports addressing morbidly obese patients grouped body mass indexes (BMIs) within wide ranges, such as >40 or 40-60 kg/m(2). We aimed to investigate whether the effects of pneumoperitoneum differ in narrow ranged subgroups of BMI in morbidly obese patients. Materials and Methods: Eighteen to 65 year-old, ASA I-II 75 patients were included. The subgroups of BMI were 40 <= x < 45, 45 <= x < 50, and >= 50 kg/m(2). Plato pressure (Pp), peak inspiratory pressure, and etCO(2) were recorded beside vital parameters. Dynamic compliances (C-dyn = Vt/PIP-PEEP) were calculated. Arterial blood gases were obtained before pneumoperitoneum (t(1)), at the end of pneumoperitoneum before desufflation (t(2)), and after desufflation (t(3)). Results: Pneumoperitoneum caused similar alterations in hemodynamic parameters and respiratory mechanics in Group I (n = 24), II (n = 28) and III (n = 23). Pp at t(1) and t(2) was significantly higher in Group II and III (p < 0.017). Cdyn were significantly lower at t(1) and t(2) in Group III (p < 0.01). The number of patients who required adjustments during pneumoperitoneum was significantly higher in Group III (p < 0.01). Conclusion: The Cdyn and airway pressures in laparoscopic bariatric surgery revealed statistically significant difference between BMI >= 50 kg/m(2) and BMI of 40 <= x < 45 kg/m(2). We suggest that BMIs of 40 <= x < 45 and >= 50 kg/m(2) should not be described in one group, but grouped separately in future studies addressing respiratory mechanics.Öğe An electron microscopy study of liver and kidney damage in an experimental model of obstructive jaundice(Edizioni Luigi Pozzi, 2020) Özozan, Ömer Vefik; Dinç, Tolga; Vural, Veli; Özoğul, Candan; Özmen, Mehmet Mahir; Coşkun, FarukWith this experimental study we investigated the consequences of ligation of the common bile duct (CBD) on hepatic cells and on the renal ultrastructure by electron microscopy and also determine the effects after liberation of the ductus joint in order to clarib the mechanisms of renal failure commonly observed in cholestatic liver disease. The study was conducted on 53 Wistar albino rats divided into 4 subgroups. In the comparison group (sham) we proceeded to the simple laparotomy. After preparation of the common bile duct of all the rats of the four groups, and ligation of the duct at the level of the distal third, eight rats in each group were sacrificed on the 3rd, 7th, 10th and 14th day after surgery, taking blood samples to measure the serum levels of ALP and bilirubin, and liver and renal tissue samples for histological evaluation. In four rats of each group the common bile duct was unligated at the same deadlines to obtain free drainage of the bile for a week. At the end of this week, the rats were sacrificed by collecting blood and liver and kidney tissue samples. RESULTS: after CBD ligation in both groups, the ALP value, total and direct bilurubin levels were proportionally increased. After duct release, bilurubin levels decreased significantly. In group II, while large lipid granules were observed to indicate oxidative damage, mitochondrial swelling and crystals were observed after duct liberation. Areas of glycogen and normal mitochondria were observed in group IV. After duct release in this group, increases in Ito granules, lipid granules and normal mitochondria were observed, which may reflect the evolution of hepatic regeneration. When renal tissue was examined in group II, fusion processes in the feet, thickening of the basement membrane and mesengium were observed, and mitochondrial crystals were observed in renal tissue as well as in the liver after duct release. Damage in group III and group IV was increased parallel to prolongation of jaundice and after loosening persistent damage with mitochondrial crystals. CONCLUSION: Ultrastructural changes in rat liver tissue in conditions of obstructive jaundice may be reversible after restoration of drainage. On the other hand, ultrastructural changes in renal tissue in cases of prolonged jaundice are irreversible even if the internal drainage is restored.Öğe An electron microscopy study of liver and kidney damage in an experimental model of obstructive jaundice(Edizioni Luigi Pozzi, 2019) Özozan, Ömer Vefik; Dinç, Tolga; Vural, Veli; Özoğul, Candan; Özmen, Mehmet Mahir; Coşkun, FarukAbstract With this experimental study we investigated the consequences of ligation of the common bile duct (CBD) on hepatic cells and on the renal ultrastructure by electron microscopy and also determine the effects after liberation of the ductus joint in order to clarify the mechanisms of renal failure commonly observed in cholestatic liver disease. The study was conducted on 53 Wistar albino rats divided into 4 subgroups. In the comparison group (sham) we proceeded to the simple laparotomy. After preparation of the common bile duct of all the rats of the four groups, and ligation of the duct at the level of the distal third, eight rats in each group were sacrificed on the 3rd, 7th, 10th and 14th day after surgery, taking blood samples to measure the serum levels of ALP and bilirubin, and liver and renal tissue samples for histological evaluation. In four rats of each group the common bile duct was unligated at the same deadlines to obtain free drainage of the bile for a week. At the end of this week, the rats were sacrificed by collecting blood and liver and kidney tissue samples. RESULTS: after CBD ligation in both groups, the ALP value, total and direct bilurubin levels were proportionally increased. After duct release, bilurubin levels decreased significantly. In group II, while large lipid granules were observed to indicate oxidative damage, mitochondrial swelling and crystals were observed after duct liberation. Areas of glycogen and normal mitochondria were observed in group IV. After duct release in this group, increases in Ito granules, lipid granules and normal mitochondria were observed, which may reflect the evolution of hepatic regeneration. When renal tissue was examined in group II, fusion processes in the feet, thickening of the basement membrane and mesengium were observed, and mitochondrial crystals were observed in renal tissue as well as in the liver after duct release. Damage in group III and group IV was increased parallel to prolongation of jaundice and after loosening persistent damage with mitochondrial crystals. CONCLUSION: Ultrastructural changes in rat liver tissue in conditions of obstructive jaundice may be reversible after restoration of drainage. On the other hand, ultrastructural changes in renal tissue in cases of prolonged jaundice are irreversible even if the internal drainage is restored.Öğe ELSA recommendations for minimally invasive surgery during a community spread pandemic: a centered approach in Asia from widespread to recovery phases(Springer, 2020) Shabbir, Asim; Menon, Raj K.; Somani, Jyoti; So, Jimmy B. Y.; Özmen, Mehmet Mahir; Chiu, Philip W. Y.; Lomanto, DavideBackground The COVID-19 pandemic has resulted in significant changes to surgical practice across the worlds. Some countries are seeing a tailing down of cases, while others are still having persistent and sustained community spread. These evolving disease patterns call for a customized and dynamic approach to the selection, screening, planning, and for the conduct of surgery for these patients. Methods The current literature and various international society guidelines were reviewed and a set of recommendations were drafted. These were circulated to the Governors of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA) for expert comments and discussion. The results of these were compiled and are presented in this paper. Results The recommendations include guidance for selection and screening of patients in times of active community spread, limited community spread, during times of sporadic cases or recovery and the transition between phases. Personal protective equipment requirements are also reviewed for each phase as minimum requirements. Capability management for the re-opening of services is also discussed. The choice between open and laparoscopic surgery is patient based, and the relative advantages of laparoscopic surgery with regard to complications, and respiratory recovery after major surgery has to be weighed against the lack of safety data for laparoscopic surgery in COVID-19 positive patients. We provide recommendations on the operating room set up and conduct of general surgery. If laparoscopic surgery is to be performed, we describe circuit modifications to assist in reducing plume generation and aerosolization. Conclusion The COVID-19 pandemic requires every surgical unit to have clear guidelines to ensure both patient and staff safety. These guidelines may assist in providing guidance to units developing their own protocols. A judicious approach must be adopted as surgical units look to re-open services as the pandemic evolves.Öğe Evaluation of the effects of laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy on weight loss(2020) Gündoğdu, Emre; Bilgiç, Celal İsmail; Moran, Münevver; Güldoğan, Cem Emir; Dilektaşlı, Evren; Özmen, Mehmet MahirABSTRACT Objectives: Obesity has become one of the most serious and ever increasing health problems of our times. Diet, exercise and medical treatment have proven to be insufficient. Operations such as laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have gained popularity. The purpose of this study is to conduct a retrospective comparative analysis of the clinical results gained from patients treated with LSG and LAGB due to morbid obesity. Methods: The patients included in the study were selected among those who were diagnosed with morbid obesity and were operated with LAGB (n = 55) and LSG (n = 52) from May 2007 to December 2012. Both groups were compared in terms of the demographic characteristics, preoperative and postoperative conditions. Results: The groups were similar in terms of age, sex and BMI. In the 6th month, there was a notable loss of appetite in the LSG group patients compared to the LAGB patients (69.2% vs. 23.6%, p < 0.001). The rate of excess weight loss in the LAGB group was 23.93% ± 7.98% and 31.7% ± 7.49% in the LSG group in the postoperative 6th months (p = 0.002). The rate of excess weight loss was 45.36% ± 10.92% in the LAGB group and 60.3% ± 9.81% in the LSG group in the postoperative 12th months (p ? 0.001). Conclusions: When the two surgical operations for morbid obesity are compared LSG is found to be a more successful method in terms of body weight loss. Nevertheless, longer hospitalization can be associated with the technically more complicated nature of the operation and the fact that it requires resection.Öğe First 30 robotic versus last 30 laparoscopic sleeve gastrectomy(Mary Ann Liebert, Inc, 2019) Özmen, Mehmet Mahir; Gündoğdu, Emre; Güldoğan, Cem EmirBackground: Robotic sleeve gastrectomy (RSG) is a new and popular option for obesity surgery. This study aims to analyze our experience during the transition period from laparoscopic sleeve gastrectomy (LSG) to RSG. Patients and Methods: Sixty patients with sleeve gastrectomy (SG) were enrolled into the study. Last 30 patients in the LSG group and first 30 patients in the RSG group were included in the study. Total operative time (OT), docking time, complications (intraoperative and postoperative), hospital stay, and amount of postoperative drainage were recorded and groups were compared. Results: There were no complications during surgery. There was no mortality or conversions to another approach in any patient. There were no leaks. Hospital stay, complication rates, and excess weight loss rates were similar in both groups. OT was longer in the RSG group. Postoperative drainage was lesser in the RSG group. Conclusion: RSG is safe and feasible and might be considered as an initial procedure for surgeons who plan to move forward to more complex procedures in bariatric surgery. For an experienced surgeon, the learning curve seems shorter for this procedure.Öğe The first modified Delphi consensus statement on sleeve gastrectomy(Springer, 2021) Mahawar, Kamal K.; Omar, Islam; Singhal, Rishi; Aggarwal, Sandeep; Allouch, Mustafa Ismail; Alsabah, Salman K.; Özmen, Mehmet MahirIntroduction: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. Methods: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ? 70.0% experts was construed as a consensus. Results: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. Conclusion: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.Öğe High density optical neuroimaging predicts surgeons's subjective experience and skill levels(PLOS ONE, 2021) Keleş, Hasan Onur; Cengiz, Canberk; Demiral, İrem; Özmen, Mehmet Mahir; Omurtağ, AhmetAbstract Measuring cognitive load is important for surgical education and patient safety. Traditional approaches of measuring cognitive load of surgeons utilise behavioural metrics to measure performance and surveys and questionnaires to collect reports of subjective experience. These have disadvantages such as sporadic data, occasionally intrusive methodologies, subjective or misleading self-reporting. In addition, traditional approaches use subjective metrics that cannot distinguish between skill levels. Functional neuroimaging data was collected using a high density, wireless NIRS device from sixteen surgeons (11 attending surgeons and 5 surgery resident) and 17 students while they performed two laparoscopic tasks (Peg transfer and String pass). Participant's subjective mental load was assessed using the NASA-TLX survey. Machine learning approaches were used for predicting the subjective experience and skill levels. The Prefrontal cortex (PFC) activations were greater in students who reported higher-than-median task load, as measured by the NASA-TLX survey. However in the case of attending surgeons the opposite tendency was observed, namely higher activations in the lower v higher task loaded subjects. We found that response was greater in the left PFC of students particularly near the dorso- and ventrolateral areas. We quantified the ability of PFC activation to predict the differences in skill and task load using machine learning while focussing on the effects of NIRS channel separation distance on the results. Our results showed that the classification of skill level and subjective task load could be predicted based on PFC activation with an accuracy of nearly 90%. Our finding shows that there is sufficient information available in the optical signals to make accurate predictions about the surgeons' subjective experiences and skill levels. The high accuracy of results is encouraging and suggest the integration of the strategy developed in this study as a promising approach to design automated, more accurate and objective evaluation methods.Öğe How can surgical continuity be maintained during the COVID-19 pandemic? a quality improvement study in the pre-vaccination period(Bilimsel Tip Yayinevi, 2021) Pişkin, Şenol; Çolakoğlu, Muhammet Kadri; Öter, Volkan; Özgün, Yiğit Mehmet; Aydın, Osman; Güven, Alper; Surel, Aziz Ahmet; Özmen, Mehmet Mahir; Bostancı, Erdal BirolObjective: During the COVID-19 pandemic, most of the elective surgeries had to be postponed. However, it is not possible to delay the surgical treatment of cancer patients for a long time. The aim of this study was to present how gastrointestinal system surgery operations are managed without delay and how employee safety is ensured , together with the results of the last five months. For this purpose, a preclinical and clinical screening system was created. Material and Methods: Data of the patients who presented to our outpatient clinic between April 1st 2020 and August 31st 2020 were retrospectively reviewed. Results: During the last five months of the pandemic, a total of 387 patients were hospitalized and 309 of these patients underwent surgical procedures. 165 of the patients who underwent surgery were newly diagnosed malignancy patients. All patients who were hospitalized were subjected to a screening for COVID-19 during the preclinical, clinical and surgical period. In the preclinical period, five patients were found positive and were directed to COVID-19 treatment without hospitalization. In the clinical period, six patients were isolated by showing symptoms during the hospitalization period. Only one of these patients received surgical treatment. The remaining five patients underwent endoscopic and interventional procedures. In this process, COVID-19 positivity was detected in a total of five healthcare workers. Conclusion: With this preclinical and clinical screening method, it is shown that a COVID-19 sterile environment can be provided by early detection of positive cases in both patients and healthcare workers. In this way, the possibility of surgical continuity was demonstrated.
