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Item An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery(ASSOC MEDICA BRASILEIRA, 2022-01-01) Altinel, Yuksel; Cavallaro, Paul; Ricciardi, Rocco; Ozben, Volkan; Ozturk, Ersin; Bleday, Ron; Aytac, Erman; Bordeianou, Liliana; Stu, Members Turkish DiverticulitisOBJECTIVE: We investigated surgical complications of elective surgery for diverticulitis in international multi-institution to identify a prediction model for potential opportunities of quality improvement. METHODS: We identified 1225 patients who underwent elective surgery for diverticulitis between January 2010 and January 2018. The data were obtained from the National Surgical Quality Improvement Program and the Turkish Diverticulitis Study Group Collaborative, retrospectively. RESULTS: We observed that the presence of chronic obstructive pulmonary disease (OR: 3.2, 95\%CI 1.8???5.9, p<0.001) or abscess at the time of surgery (OR: 1.4, 95\%CI 1.2???1.7, p??0.001) is associated with a higher rate of minor complications, while comorbidities such as dyspnea (OR: 2.8, 95\%CI 1.6???4.9, p??0.001) and preoperative sepsis (OR: 4.1, 95\%CI 2.3???7.3, p??0.001) are associated with major complications. The centers had similar findings in minor and major complications (OR: 0.8, 95\%CI 0.5???1.4, p=0.395). The major independent predictors for complications were malnutrition (low albumin) (OR: 0.5, 95\%CI 0.4???0.6, p<0.001) and the American Society of Anesthesiology score (OR: 1.7, 95\%CI 1.2???2.4, p=0.002). CONCLUSION: Regarding the major and minor complications of diverticulitis of elective surgery, the malnutrition and higher American Society of Anesthesiology score showed higher impact among the quality improvement initiatives.Item Laparoscopic surgery for complex and recurrent Crohn's disease(BAISHIDENG PUBLISHING GROUP INC, 2017-01-01) Sevim, Yusuf; Akyol, Cihangir; Aytac, Erman; Baca, Bilgi; Bulut, Orhan; Remzi, Feza H.Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70\% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.Item Minimally invasive versus open surgery for gastric cancer in Turkish population(TURKISH SURGICAL ASSOC, 2021-01-01) Agcaoglu, Orhan; Sengun, Berke; Tarcan, Serim; Aytac, Erman; Bayram, Onur; Zenger, Serkan; Benlice, Cigdem; Ozben, Volkan; Balik, Emre; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun; Bugra, DursunObjective: In this study, it was aimed to compare short-term outcomes of minimally invasive and open surgery for gastric cancer in the Turkish population carrying both European and Asian characteristics. Material and Methods: Short-term (30-day) outcomes of the patients undergoing minimally invasive and open gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma between January 2013 and December 2017 were compared. Patient demographics, history of previous abdominal surgery, comorbidities, short-term perioperative outcomes and histopathological results were evaluated between the study groups. Results: There were a total of 179 patients. Fifty (28\%) patients underwent minimally invasive {[}laparoscopic (n= 19) and robotic (n= 31)] and 129 (72\%) patients underwent open surgery. There were no differences between the two groups in terms of age, sex, body mass index and ASA scores. While operative time was significantly longer in the minimally invasive surgery group (p< 0.0001), length of hospital stay and operative morbidity were comparable between the groups. Conclusion: While both laparoscopic and robotic surgery is safe and feasible in terms of short-term outcomes in selected patients, long operating time and increased cost are the major drawbacks of the robotic technique preventing its widespread use.Item Totally Robotic Versus Totally Laparoscopic Surgery for Rectal Cancer(LIPPINCOTT WILLIAMS \& WILKINS, 2018-01-01) Esen, Eren; Aytac, Erman; Agcaoglu, Orhan; Zenger, Serkan; Balik, Emre; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun; Bugra, DursunIn this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index >= 30 kg/m(2)), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001). In obese patients who underwent TME, the mean length of hospital stay was shorter (7 +/- 2 vs. 9 +/- 4 d, P=0.01), and the mean number of retrieved lymph nodes was higher (30 +/- 19 vs. 23 +/- 10, P=0.02) in the robotic group. Totally robotic and totally laparoscopic surgery appears to be providing similar outcomes in patients undergoing rectal resections for cancer. Selective use of a robot may have a role for improving postoperative outcomes in some challenging cases including obese patients undergoing TME.Item Surgery for Intestinal Crohn's Disease: Results of a multidisciplinary approach(TURKISH SURGICAL ASSOC, 2018-01-01) Atasoy, Deniz; Aghayeva, Afag; Aytac, Erman; Erenler, Ilknur; Celik, Aykut Ferhat; Baca, Bilgi; Karahasanoglu, Tayfun; Hamzaoglu, IsmailObjectives: Crohn's disease is a chronic inflammatory bowel disease that requires lifelong multidisciplinary management. Seventy percent of patients affected by Crohn's disease will require at least one surgical procedure over their lifetime. The aim of this retrospective study was to present our series of patients suffering from Crohn's disease who were scheduled for surgery by a multidisciplinary team. Material and methods: The data were retrieved from a review of 950 patients with Crohn's disease treated at our institution between March 2000 and March 2016. Only patients with intestinal Crohn's disease were included into the study. A multidisciplinary team assessed the decision to perform surgery. Results: There were 203 patients who underwent surgery included in this study. One hundred and sixty-six were intestinal and 37 were perianal Crohn's disease. The mean age was 36 +/- 11.5 (range, 12-75) years. Ninety-two were stricturing, 45 were fistulizing, and 12 were inflammatory. The most commonly affected site was the ileocecal region (n=109, 65.7\%), and the most common surgical procedure was the ileocecal resection (n=109, 65.6\%). Laparoscopic approach was the procedure of choice in 56 (33.7\%) patients. Of the patients enrolled, the most common early (<30 days) complications observed were the wound infection as the first (n=11) and anastomotic leak as the second (n=10). The mortality rate was 2.4\% (n=4). Conclusion: Multidisciplinary approach to Crohn's disease may decrease the surgical complications and recurrence rates leading to a better treatment.Item Robotic Rectal Cancer Surgery with the da Vinci Xi System: First 100 Cases(ISTANBUL TRAINING \& RESEARCH HOSPITAL, 2019-01-01) Ozben, Volkan; Dogruoz, Alper; Boga, Salih Anil; Aytac, Erman; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, TayfunIntroduction: The da Vinci Xi system, the latest model of the robotic technology, is proposed to enable multiquadrant abdominal surgery to be performed in a fully robotic approach without the need for a laparoscopic assistance, robot re-docking or re-positioning of the trocars. However, the literature has limited data on this topic. In this study, we aimed to evaluate the feasibility of the Xi robot use in rectal cancer surgery, a multiquadrant surgical procedure. Methods: Patients undergoing robotic mezorectal excision for rectal adenocarcinoma using the da Vinci Xi system between December 2014 and June 2017 were included in this study. Data were collected prospectively and analyzed retrospectively. Demographic data, perioperative clinical findings, histopathologic data and postoperative 30-day outcomes were analyzed. Results: One hundred patients were included in this study. There were 57 male and 43 female patients with a mean age of 61.4 +/- 12.3 years. Low anterior resection and abdominoperineal recetion were performed in 90 and 10 patients, respectively. In all the operations, the abdominal and pelvic stages of the procedure were completed robotically without a need for dual docking or trocar re-positioning. The mean operative time was 328.4 +/- 105.8 min and blood loss was 131.7 +/- 170.3 mL. Intraoperative complication occurred in 2 patients (2\%). Two procedures were converted to open surgery (2\%). The mean number of harvested lymph nodes was 25.3 +/- 12.0. All the surgical margins were clear except for four patients (4\%). The rate of incomplete mesorectal fascia was 3.2\%. The mean length of hospital stay was 6.6 +/- 3.6 days and the overall postoperative morbidity rate was 25\%. Conclusion: The da Vinci Xi model enables rectal cancer operations to be performed in a fully robotic fashion. This feature of the robot helps surgeon to benefit optimally from the advantages robotic surgery in all stages of the procedure.