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Ingrown Hair

Ingrown hair; means a cavity/cyst that contains hair, a lump of hair, and accumulated pus, which settles mostly in the coccyx area. It can also be seen in the armpits, groins, abdominal areas and between the fingers.
This disease, which used to be considered congenital, is now considered to be acquired.

There are some factors that pave the way for ingrown hair. These are as follows;

  • Excessive amount of body hair and daily hair loss
  • Since the slit between the hips is narrow and deep, the suction force on the hair increases, and thus the lost hair waits a long time in a narrow and deep groove.
  • Keeping the skin moist for a long time makes it easier for the hair to ingrow
  • The presence of cracks or cracked tissue in the slit between the buttocks
  • Due to prolonged sitting and working, the hair accumulated in this region constantly causes injury (trauma) there.
  • Poor hygiene due to insufficient cleaning of this area for a long time;

Risk groups;

  • Being between 20 and 40 years of age
  • Being a member of the group who work at a desk job by sitting for a long time, including office workers, students, and drivers.
  • Having a male character
  • Having dense hair texture
  • Being a dark skinned

What are the findings?

  • Painful swelling due to inflammation of the ingrown hair cyst
  • Chronic discharge caused by the release of the cyst contents to the skin.

How is it diagnosed?
The disease is diagnosed by detecting ingrown hair in the coccyx during physical examination. Although very rarely, magnetic resonance imaging (MRI) can be used for diagnosis in patients whose examination result is suspicious.

Treatment;
In case of ingrown hair with abscess, the abscess is drained under local or general anesthesia. Antibiotics and anti-inflammatory drugs are added to the treatment.
The exact treatment of the disease is provided by the surgical option.

  • Microsinusectomy is a procedure performed on small-diameter cysts by injecting phenol/silver nitrate into the cyst and excising (removing) the skin part of the cyst. It can be used in limited cases and recurrence occurs in up to 50% of cases
  • In the open surgical method, the cyst is removed as it is, while the tissue is left open. The recovery period is long, it is painful because it requires constant dressing, and the probability of recurrence is high after it.
  • *Closed technique includes primary closure, Limberg flap rotation, Z plasty-Karydakis (shift) etc.

Limberg Rotation flap: In this technique that we use as well, the cyst is removed with a rhombus-shaped incision. After placing a drain, the procedure is ended by closing the open area by shifting the skin/ subcutaneous fatty tissue from the right hip. The surgery is performed under spinal anesthesia (numbing the waist) within 30 minutes on average, and the patient is then discharged after an overnight stay in the hospital. After 9-10 days, the process is completed by removing the sutures. It is recommended that the patient do not sit, except while eating and using the toilet in the first postoperative week.



Hemorrhoids

Hemorrhoids are enlarged vascular cushions in the upper part of the anal canal. It is also colloquially known as piles. It is classified into internal and external hemorrhoids. Over time, along with the underlying causes, enlarged balls and vascular cushions that settle in the anal canal protrude out of the anus. There is a transition ring (dentate line) located about 2 cm proximal to the anal verge (anal opening), between the inner layer of the intestinal wall and the outer skin layer of the anus. The cushions hanging from the upper part of the dentate line level are called internal hemorrhoids, while those hanging from the lower part are called external hemorrhoids.

What Causes Hemorrhoids?

  • Changes in bowel habit, chronic constipation and persistent diarrhea
  • Pregnancy and childbirth,
  • Sedentary life,
  • Some sports activities ( horseback riding, cycling ),
  • Alcohol habit,
  • Tumors that settle in the pelvic region, ascites formation in the abdomen,

What are the Symptoms of Hemorrhoids?

  • Painful or painless bleeding during defecation,
  • Pain in the anus and palpable swelling,
  • Discharge, feeling of wetness in the anus,
  • Itching

These complaints that develop in the anus area can be the symptoms of hemorrhoids but they may also indicate cancer, tumor and colitis diseases of the large intestine. The patient should not slur over the above mentioned complaints at his/her option or based on the recommendation of those who are not a doctor; by thinking that these common complaints are caused by hemorrhoids. They should definitely contact a GENERAL SURGERY SPECIALIST.

HOW IS IT DIAGNOSED?
It is an indispensable examination for the diagnosis of hemorrhoids.   After the patient’s complaints are listened to, the examination is completed when the patient is in the prone position, on the left side with knees bent to his chest, or in the knee-elbow position on the examination table. In order to evaluate the last 6-8 cm of the large intestine, a method called rectal palpation is performed by using a finger. Colonoscopy is recommended for patients with the complaints of rectal bleeding.

Degrees of Hemorrhoids:
a) 1st degree: The anal cushions are less pronounced
b) 2nd degree: The anal cushions prolapse through the anus during defecation and then return to the previous position spontaneously. It may cause complaints of itching and bleeding in the anus
c) 3rd degree: The anal cushions prolapse through the anus during defecation, and they can be manually pushed back into the anal canal;
d) 4th degree: The anal cushions cannot be pushed back manually.

WHAT IS ITS TREATMENT?

Non-surgical treatment procedures
1. Band ligation: It ensures that the hemorrhoid piles dry out and fall out as a result of the disruption of vascular nutrition by compressing them with rubber bands. It is performed for internal hemorrhoids. It is not performed for external hemorrhoids due to the pain sensitivity of the skin around the anus.
2. Sclerotherapy: It is the procedure that involves drying the hemorrhoid piles by injecting a sclerosant into the anal cushions. Its place in treatment is limited and inadequate
3. Infrared coagulation: It contributes to the drying of the hemorrhoid piles by applying infrared rays to their vascular roots. It can be performed for 2nd degree hemorrhoids, and a few sessions may be required. The recurrence rate is high after treatment

b-) Surgical Procedures
1) Classical hemorrhoid surgery: Hemorrhoid piles are surgically removed, a node is placed in the vein that feeds the hemorrhoid piles, and the recurrence rate is minimized (I also loosen the muscle that works out of control, called the internal sphincter, around the anus, by cutting it partial. Thus, I improve post-operative comfort, while contributing to reducing the recurrence of the disease.)

2-Longo (stapler) hemorrhoidopexy: 1 to 2 cm of hemorrhoid piles that formed 4 to 5 cm above the anal canal are compressed and removed using a special stapler. Although it provides less pain and allows for earlier return to work, it is more costly and has a higher recurrence rate compared to the classical procedure.

In 1st degree with hemorrhoids of the, recommendations on nutrition and toilet habits may be sufficient.

In 2nd-3rd degree hemorrhoids, drug therapy and recommendations on nutrition and toilet habit can be sufficient.

A classic surgical procedure and longo techniques can be preferred in 4th degree hemorrhoids (for a long-term and effective result, I use the classic surgical procedure).

POINTS TO TAKE INTO CONSIDERATION AFTER THE OPERATION

A 1-night hospital stay is required after surgery. After discharge, it is necessary to use the prescribed medications regularly, in accordance with the prescription.
There may be bleeding and leakage in the rectum for 1 to 2 weeks.

The use of stool softening drugs for a period of about 1 month improves the comfort of postoperative defecation. For a period of 15 to 20 postoperative days, it is necessary to take a sitz bath in the morning, evening and after defecation, by putting hot water in the tub or basin at a temperature that will not burn the anus. This both serves as a wound dressing and contributes to reducing the feeling of pain around the anus. Sitz bath gives an effective result that cannot be achieved by applying hot water bag or hot water shower.
In order to keep the recurrence rate of the disease at the minimum level, it is recommended to consume plenty of fibrous foods, drink 6 to 8 cups of water a day, consume fruits and vegetables abundantly, avoid delaying defecation and sitting in the toilet for a long time both in the early postoperative period and in the later period of life



Thyroid

The thyroid gland is an organ located in the neck, which has a role in regulating the body’s metabolism. Thyroid gland diseases can develop both structurally and functionally.
Overall enlargement of the thyroid gland and the nodules (lumps) that form in it are the conditions that develop due to functional disorders,  under-active thyroid gland (hypothyroidism) or overactive thyroid gland (hyperthyroidism).

FUNCTIONAL THYROID DISEASES

HYPOTHYROID

  • It is a condition of inflammation and insufficient functioning of the thyroid gland (Hashimoto’s thyroiditis)
  • Congenital lack of thyroid gland and hormone
  • Insufficiency of the thyroid gland after thyroid surgery performed due to thyrotoxicosis (toxic goiter) or thyroid cancer
  • Insufficiency of the thyroid gland that develops after the treatment of the thyroid gland with radioactive iodine (atom).

HASHIMOTO’S THYROIDITIS is the most common form of the disease

Symptoms
Weakness
Intolerance to Cold
Weight Gain
Constipation
Dry Skin
Hypothyroidism may cause mental and physical deceleration in adults, and if its treatment is neglected, it may cause hypothyroidism coma called myxedema. If hypothyroidis of the baby in the womb is not treated during pregnancy, it may cause mental retardation in the expected baby.

For its diagnosis; Thyroid hormones and thyroid ultrasonography are needed.
Treatment: It is treated by administering the drug called levothyroxine, which is a thyroid hormone preparation.

HYPERTHROID
It is a condition with excessive amount of thyroid hormone caused by over-functioning of the thyroid gland.

Causes:
Basedow Graves’ disease: It is the MOST COMMON cause of hyperthyroidism. due to the antibodies produced by the body against the thyroid gland. It causes the release of excess hormones and the excessive growth of the thyroid gland.

Thyroid nodules: Overactive single or multiple nodules may cause hyperthyroidism. Excess thyroid hormone intake into the body

Symptoms
Palpitation
Sweating
Heat Intolerance
Diarrhea
Weight Loss
Irritability

Diagnosis: Thyroid hormones, thyroid ultrasound and scintigraphy are planned. Overactive nodules on scintigraphy are considered hot nodules.

Treatment

  1. Drug Therapy
    2. Radioactive (ATAOM) Treatment
    3. Surgical Treatment

Drug therapy is the primary treatment option. Radioactive substance treatment can be performed for patients whose thyroid glands are not too large, whose thyroid glands do not contain nodules, and who have no ocular findings. In cases where a cold nodule is found, surgical treatment can be performed on those with eye symptoms and large thyroid glands. The treatment modality may vary depending on the case and the patient.

STRUCTURAL THYROID DISEASES

If there are nodules in the thyroid, NODULAR THYROID diseases are mentioned. It is one of the most common thyroid diseases. There are MULTIPLE and SINGLE nodular thyroid diseases.
If these nodules are not overactive nodules, they usually progress without causing complaints and appear on diagnostic images of the neck intended for other reasons. Those which have grown excessively may cause complaints such as the feeling of suffocation, shortness of breath, and difficulty in swallowing due to the resultant pressure on the trachea and esophagus. In addition, the complaints of hyperthyroidism may also be observed in nodules, which are nıt overactive.

Diagnosis
Evaluation of Thyroid Hormones
Thyroid Ultrasonography
Thyroid Scintigraphy

WHEN AND FOR WHOM SHOULD A NEEDLE BIOPSY BE PERFORMED?

Needle biopsy is not necessary for all patients. In particular, needle biopsy should be performed on patients with nodules larger than 2 cm in diameter and patients with calcification even if their nodule diameter is smaller.
A thyroid fine-needle biopsy is the process of taking sample from the thyroid tissue by inserting needles directly or in company with ultrasound. Follow-up examination with a biopsy is useful for preventing unnecessary surgeries. However, it is a method that has limitations in terms of reliability.
In order to ensure the biopsy to fully reflect the current condition, it is usually necessary to insert a needle into many places, many times. However, in approximately one out of every four biopsies, the tissue sample taken is not adequate to give a definitive result.

If the biopsy result indicates cancer, the result is almost certainly correct, but if it does not, the situation is a bit complicated, because it is technically not possible to detect all cancers with a biopsy. The biggest handicap is that when the needle is inserted into a point, it is possible to miss a small islet of cancer immediately around that point.
In one out of every 5-6 cases, the patient with needle biopsy results reported to be benign appears to have cancer in his/her future follow-up examinations. Retrospective examinations of operated patients, whose exact pathology was found to be cancer, showed that about one in every four patients has a needle biopsy report showing negative result in his/her file.

WHO NEEDS SURGERY?
1. Patients at the risk of developing cancer
2. Patients with complaints of compression (trachea and esophagus)
3. Patients with nodules larger than 2-3 cm in diameter
4. Patients with the signs of hyperthyroidism (toxic goiter)
5. Patients who needs cosmetic surgery
6. Patients with nodules that grow rapidly and develop suddenly
7. Patients in whom hormone suppression cannot be achieved despite the use of medication.

SURGERY (SINGLE SIDE, DOUBLE SIDE )

General anesthesia (complete unconsciousness of the patient) is necessary for the procedure. The procedure usually takes 90 to120 minutes. A one-day hospital stay is  necessary.

The operation is performed by making a 4-5 cm horizontal incision on the front side of the neck. After tying its blood vessels, the thyroid gland is cut off and totally removed. During surgery, it is important to carefully monitor and preserve the parathyroid glands and nerves related to the function of making sounds, which are close to the thyroid gland.

Any surgical technique involving the removal of nodules one by one is not suitable. However only one-sided surgery (right or left thyroid lobectomy) can be performed in patients whose one lobe in the thyroid gland appears to be completely normal during the examination and ultrasound.

The thyroid gland consists of two lobes that merge into the middle line of the neck. T may be necessary to remove one or both of these during surgery. The decision is made depending on certain criteria before or during surgery.

In cases where a disease exists on both sides, the gland is completely removed. This completely eliminates the risk of developing a thyroid-related disease in the future. On the other hand, the disadvantages of the procedure are that the nerves extending to the vocal cords on both sides are at risk of being affected during the operation, and that the patient has to take pills on a daily basis for life.

If the disease develops on one side, the disease-free side can be left in its place while removing the other side. In such a case, the advantages and disadvantages of the procedure that involves complete removal of the gland change places. The patient does not have to take pills for life, and not all the nerves extending to the vocal cords but only the ones in the operated side are at risk. The disadvantage of this procedure is that the possibility of recurrence of the same disease continues on the intact side.

POSTOPERATIVE PERIOD
It is adequate for the wound to be kept closed for 2 to 3 postoperative days. No dressing is required again after the third day. If the wound is closed by using self-dissolving sutures, there is no need to remove the sutures. If it is closed using non-dissolving sutures, the sutures are removed on the 3rd postoperative day.

There is no harm in taking a bath 3 days after discharge. The possibility of wound infection is less than 1 percent. There is no need for antibiotics. Painkillers can be used for the pain of the wound in the first few days after discharge.

In some cases, patients may complain of mild sore throat. In such cases, pastille-type drugs and warm herbal teas can be soothing.

A week of rest is usually adequate for patients to return to their daily life or work environment.

A malignant disease can be detected in about one out of every ten patients when examining a sample removed after operations performed with the expectation of a benign disease. Therefore, the thyroid gland removed during surgery should definitely be sent to a laboratory for a pathological examination. The result usually comes within a week. If the result is benign, it means that the treatment has been completed.

However, if a malignant disease is detected during the pathological examination, the patient’s follow-up and treatment are continued by the endocrinology, oncology and nuclear medicine departments.



Appendicitis

The appendix (blind intestine) is a tubular organ 6-9 cm in lent, which is located at the beginning of the large intestine, in the lower right part of the abdomen. It contains lymph tissue and can produce antibodies, but its function is not known exactly. What is known for certain about it is that we can live without it.

Appendicitis is the acute inflammation of the appendix. It is the most common cause of acute abdominal syndrome (abdominal disease that requires urgent surgical intervention). It is an emergency condition that needs to be surgically removed without delay. If left untreated, the appendix may burst and the infection spreads to the inside of the abdomen. It may eventually result in death due to inflammation of the abdominal membrane (peritonitis).
One out of every 15 people suffers from appendicitis. Although it can be seen at any age, it is rare among children under the 2 years of age and is most common between the ages of 10 and 30.

SYMPTOMS AND FINDINGS

Its main symptoms include abdominal pain, loss of appetite and vomiting. The combination of these makes the diagnosis easier.

Abdominal pain is the most important symptom of appendicitis that usually starts around the navel or on the stomach. It is a blunt pain that can be aggravated and alleviated but never completely goes away. The surgical procedure usually takes 4 to 6 hours (it may range from 1 to 12 hours). The pain then settles in the lower right region of the abdomen. In some patients, the pain starts and settles in the right lower quadrant. Depending on the different locations of the appendix, the pain is likely to be felt in the back, in the right or left groin, or on the bladder and anus. If the patient consults the Doctor late and the appendix perforates, that is, it bursts, the pain  goes away for a short time. If the neglect continues, the development of abscesses in the abdomen also includes fever and then a new process begins, in which more serious complications may develop, such as portal pyemia that is also colloquially known as presence of microbes in the blood.

Loss of appetite is a sign observed earlier than pain in 90-95 percent of patients, but it is not ignored.

Nausea and vomiting are an important indicator. Nausea is observed in 75 percent of patients.

CAUSES

It occurs as a result of luminal obstruction of the blind-ending appendix (at the opening of the cavity that empties into the large intestine) mainly due to fecalith, which increases the pressure of the fluid in the appendix and leads to the development of infection by multiplying microorganisms on this ground.

DIAGNOSIS

The most important parameters in the diagnosis of appendicitis include the patient’s history of complaints and the findings obtained by the surgeon, who made the evaluation, during the physical examination. Diagnosis can sometimes be very difficult, no template is available for the diagnosis, and it can be observed in many different ways.

Examination

During palpation, SENSITIVITY develops in the lower right part of the abdomen, and stiffness (DEFENSE) is felt in the abdominal wall as a result of the contraction of the muscles in the abdominal wall as a protection reflex to pain. When the hand is pressed on the painful area for 3-4 seconds and suddenly withdrawn (REBOUND), the pain intensifies. This is an important finding for the diagnosis of abdominal disease, which requires urgent surgical intervention.

Laboratory

Laboratory findings are just supporting parameters for the general surgery specialist in the diagnosis of the disease. The safest way of diagnosing the disease is still based on the findings obtained from the examination by the general surgery specialist.

  • The number of white blood cells (LEUKOCYTES, WBC) increases in the presence of appendicitis.
  • Abdominal ULTRASOUND(USG) is performed. In case of appearance of the appendix (alone or with an accompanying disease), the place of USG in the diagnosis of appendicitis is significant; but even if appendicitis has not been observed, this does not necessarily mean that it does not exist.
  • COMPUTED TOMOGRAPHY (CT) of the abdomen can be performed. As in USG, its appearance supports the presence of the disease, but this does not necessarily mean that it does not exist when it has not been observed.

When diagnosing appendicitis, it is necessary to pay attention to the fact that it can be confused with the following conditions:

  • ¨ Extrauterine pregnancy and other gynecological diseases such as adnexal (ovary and tube) problems;
  • ¨ Urinary tract disorders;
  • ¨ Inflammation of the lymph nodes in the abdomen (mesenteric lymphadenitis)
  • ¨ Inflammatory intestinal diseases
  • ¨ Diverticulitis (bubbles that develop in the intestinal layers)
  • ¨ Gastric and intestinal perforations.

PREPARATION

If the patient has suspicions about the disease or if he/she has been informed of a suspected appendicitis by his doctor, he/she should completely stop oral food and fluid intake immediately. He/she should definitely avoid taking painkillers in order not to mislead the doctor’s assessment during the examination Despite being rare, applications such as putting a hot water bag on the painful area or similar hot applications should be avoided.

TREATMENT

For acute and perforated (punctured) appendicitis, surgery is the only way of treatment. For PLASTRONE (inner peritoneum and intestines adhered to appendix and formed a ball) appendicitis, on the other hand, the patient is hospitalized before the surgical intervention, 4-5-day antibiotic therapy is administered, and if there is no any extra problem, surgery can be scheduled to be performed after 6 to 8 weeks, when a surgically safe floor develops in the problem area.

The operation is performed using the classical open technique and closed (laparoscopic) technique.

Classic Open Technique: The lower right region of the abdomen is accessed through a 3-4 cm incision. The vascular structures of the diseased blind intestine are tied, separated from its root attached to the large intestine, and taken out of the abdomen. After controlling the bleeding, the opened wound layers are closed with sutures.

Closed- Laparoscopic Technique: In this procedure, CO2 gas is injected into the abdomen with a needle inserted through a point above the navel, in order to inflate the abdomen with about 4 liters of gas. The inside of the abdomen is evaluated by means of a tube placed above the navel and a lighted camera passed through it. If there is no obstacle to laparoscopic intervention, 2 more tubes are inserted through a 1 cm incision, the blind intestine is separated from the vascular structures, it is separated from the root, where it is attached to the large intestine, by using special instrument, and it is then removed from the abdomen. After the bleeding control, the CO2 gas is discharged and the incision sites are closed with sutures.

After both methods, if there is no extraordinary situation, the patient stays in the hospital overnight, and he/she is discharged the next day. It is recommended to avoid heavy exercises, sports, and lifting things of 10 kg or more for a period of up to 1 month.

Closed- Laparoscopic Technique
It is more advantageous than the classical open technique for many reasons including;

  • ¨ Cosmetic wellness
  • ¨ Less wound infection and herniation
  • ¨ Less postoperative pain
  • ¨ Returning to daily life and work earlier
  • ¨ Ability to detect the presence of non-appendicitis diseases.


Gallbladder

The gallbladder is a bag-shaped organ in the lower part of the liver, where bile secreted from the liver is accumulated. Approximately 500-1500 ml of bile is secreted from the liver per day and performs a variety of functions including the absorption of fats and some vitamins from the intestines, in particular. The gallbladder stores some of this bile and contracts, contracts and pushes its contents into the duodenum to help digestion, especially after the consumption of fatty foods, chocolate, eggs.

How Do Gallstones Develop?

The normal fluidity of the gallbladder is not a problem, but in cases of prolonged starvation, the fluidity of bile decreases and starts forming sediments. These formed sediments pave the way for gallstone development. Gallstones are soft, easily crushable stones gray-brown in color, which are mostly composed of cholesterol crystals. They are black, hard pigment stones, very few of which consist of calcium and bilirubin.

What is Cholecystitis (Inflammation of the Gallbladder)?

Gallstones mostly exist passively in the gallbladder, without causing any complaints, and they are detected incidentally during checkups or examinations intended for the diagnosis of other diseases. If these stones block the gallbladder duct, the flow of bile is disrupted and edema develops on the wall of the bladder, causing the impairment of its vascularity. An excess of the number of stones, the presence of millimetric ‘small stones’ and stones with a diameter greater than 2-3 cm cause increased risk of gallbladder inflammation. As the blockage lasts longer, rotting and perforation may occur on the gallbladder wall. This condition often causes symptoms such as ABDOMINAL PAIN. The pain is felt in the upper right side of the abdomen, and in the back, under the right scapula. In addition to pain, complaints such as indigestion and bloating may occur. If the gallbladder is punctured, abdominal disease (acute abdominal syndrome) develops, which occurs with a very severe abdominal disease that makes it hard to breathe and requires urgent surgical intervention. Time is important in such a case. It is necessary to see a general surgery specialist as soon as possible.

Other Diseases Associated with Gallstones

Especially when small millimetric stones fall from the liver into the main bile duct connected to the duodenum, and block the main bile duct, they may cause the disease that can cause significant damage to the liver, which darkens the color of urine, causes obstructive jaundice, which is also known as germ-free jaundice, aggravates and improves from time to time, and causes colic pain. If the symptoms also include infection and fever,, inflammation of the biliary tract called CHOLANGITIS may develop.

If stone(s) block the entrance of the duct that opens into the duodenum of the bile duct, it may cause a very serious disease called PANCREATITIS. Pancreatitis can be overcome very easily but can also be experienced so severely that it may require intensive care and even result in a fatal process.

Predisposition Groups

It is more common among people over 40 years of age, women, overweight people, and white-skinned people.

Diagnosis

  • Anamnesis and physical examination
  • Complete blood count, biochemical tests intended to determine the condition of the liver and biliary tract
  • Ultrasonography(USG), which is the easiest and fastest technique for diagnosis
  • In some cases where necessary, abdominal tomography and magnetic resonance cholangiography (MRCP) are performed in order to reveal problems, especially with the biliary tract
  • The endoscopic procedure called ERCP, which can reveal problems with the biliary tract and ensure the removal of the stones from the region.

Treatment

We usually recommend non-operational follow-up of gallstones, which are often diagnosed incidentally because they do not cause discomfort, and of patients aged 70 to 75 years and older, who do not have an inflammatory gallbladder condition called acute cholecystitis.

We recommend SURGERY in cases of;

  • Gallstones with a millimettic-diameter, which have the risk of clogging the gallbladder duct and spilling into the main bile duct, causing obstruction there
  • Gallstones with a diameter larger than 2 cm, which cause chronic gallbladder inflammation and the possibility of gallbladder cancer, albeit with a significantly low risk
  • Stones that cause complaints of pain, indigestion, bloating, and other similar complaints, regardless of their diameter
  • Gallstones in the presence of diabetes, which can lead to a risk of rapid infection, puncture, and decreased sensation of pain.
  • Gallbladder polyps (fleshy protrusions) larger than 5 mm in diameter(over 10 mm in particular) and polyps growing rapidly
  • Patients with inflammatory gallbladder disease (ACALCULOUS CHOLECYSTITIS) that does not contain stones
  • Inflammatory gallbladder disease (CHOLECYSTITIS) and perforation of the gallbladder.

The LAPAROSCOPIC(CLOSED)  technique is considered to be the gold standard in surgery because it does not involve cutting the abdominal muscles, allows for higher possibility of returning to home and work earlier, cause lower probability of infection and herniation of the wound, and provides better cosmetic appearance It is a surgical procedure intended o remove GALLSTONES TOGETHER WITH THE GALLBLADDER by accessing them through 3 or 4 skin incisions with a diameter of 1 cm. The procedure takes 20 minutes on average. There is a 1-2% possibility of switching from laparoscopic to open surgery.
An open surgical gallbladder operation may be preferred in the last months of pregnancy, in case of chronic obstructive respiratory diseases (COPD) that are advanced enough to disrupt respiratory function, and for patients who have a history of surgical interventions for upper digestive tract diseases and liver disease.

After a laparoscopic surgery, patients are discharged after 1 night hospital stay, and after an open surgery, patients are discharged after1-2 night hospital stay. Surgical removal of the gallbladder does not cause a significant health problem in the patient.



Endoscopy

Endoscopy is the process of visual examination of hollow organs. Endoscopy is a general name that varies depending on the organ being examined. For example, it is called Gastroscopy in cases where the esophagus, stomach, and duodenum are examined together. Some endoscopists also define this examination as an upper gastrointestinal endoscopy (UGI). In gastroscopy, a flexible device equipped with a camera at the tip called endoscope is inserted into the digestive tract through the mouth, and it is then progressed up to the part called the duodenum. When the endoscopy is performed for the large intestine, it can be called colonoscopy.

However, when endoscopy is mentioned in the society, it usually means gastroscopy performed to monitor the esophagus-stomach-duodenum area.
Since the endoscopic procedures are performed with the sedation method, by creating a conscious sleep state by means of a drug, the patient does not feel discomfort during the procedure. Sedation is not literally putting you to sleep in the operating room. It creates a state of sleep during the procedure so that you do not remember that period. This indicates that the common belief among patients that the procedure is difficult and uncomfortable to perform is wrong.

In which situations is gastroscopy performed?

  • In the diagnosis of diseases related to the esophagus, such as difficulty in swallowing, burning sensation and pain behind the chest, bitter water coming into the mouth;
  • In the diagnosis of diseases related to the stomach and duodenum, such as pain in the upper abdomen, burning sensation, heartburn, nausea, vomiting, treatment-resistant anemia, unexplained weight loss;
  • In the detection of bleeding in the upper digestive tract , which manifests itself by fresh blood coming from the mouth, black stool or vomit that resembles coffee grounds in texture;
  • In the diagnosis of cancers of the esophagus, stomach and duodenum, as today’s most reliable method;
  • In the detection of inflamed areas, ulcers, small tumors;
  • With the help of special instruments passed through the gastoscope, it can be used in removing tumors called polyps (fleshy protrusions) with no need for surgery, removing swallowed foreign bodies, and in treatment procedures intended for bleeding control.

In colonoscopy, an instrument called endoscope, which is flexible and longer than the gastroscope, is inserted through the anus and diseases related to the large intestines are investigated at a distance of approximately 70 to 120 cm. Endoscopic examinations of the digestive system, intended for different parts of the digestive system, are performed under different names.

In Which Situations Is Colonoscopy Performed?

  • In cases of dark or light-colored blood in the stool, black-colored stool,
  • In cases of anemia unresponsive to treatment
  • In cases of changes in the form of stool, such as flattening
  • In cases of unexplained weight loss or abdominal pain
  • In cases of chronic diarrhea or constipation
  • For early detection and treatment of intestinal polyps (fleshy protrusions)
  • Since colon cancer is a preventable and completely curable type of cancer with early diagnosis, colonoscopy is recommended at the age of 50 and in the following 5-year period even if there is no complaint,

What Is Rectosigmoidoscopy?
The operation of rectosigmoidoscopy is the short version of colonoscopy.
 Because of its resemblance to the letter S, the last 60 cm section of the large intestine is called the sigmoid colon. The technique intended to examine this part of the large intestine is called rectosigmoidoscopy. Unlike colonoscopy, it does not require preparation a day before the procedure, It is adequate to clean the bowels with the administration of an enema in the hospital.

The procedure takes about  5 minutes. It is usually performed under the effect of a mild relaxing drug, also depending on the patient’s choice. As in the colonoscopy procedure, biopsy can be taken if needed, or a polypectomy (removal of the polyp) can be performed if there is any polyp. It is recommended for young patients with bleeding accompanied by the complaints of a typical hemorrhoidal or fissure (crack, tear).



Intragastric balloon is the most suitable weight loss procedure that can be performed without surgical risks. A gastric balloon is a balloon-shaped medical implant made of a silicone material. It is used to create a volume to mechanically create a feeling of fullness in the stomach and a feeling of satiety.

Patient Selection

Patients should be selected from;

  • Those with a Body Mass Index (BMI = body weight in kg/square of height in meter) between 30 and 40
  • Those who could not lose weight with diet, exercise and medication
  • Those who have been obese in the last 5 years
  • Those who need to reduce the excess weigh in order to reduce the surgical risks before bariatric surgery
  • Those who do not have a medical obstacle. It should not be performed only for the purpose of making the patient to looking more beautiful.

Non-eligible individuals

Individuals who are not suitable candidates for this procedure include;

  • Those who have ulcers (wounds) in the esophagus, stomach or duodenum
  • Those who have undergone bariatric surgery
  • Those under 16 years of age and over 60 years of age
  • Those with psychiatric disorders
  • Those addicted to alcohol and drugs
  • Those with inflammatory bowel disease
  • Those who use blood thinners

Practice:
The procedure is performed endoscopically (gastroscopically) when the patient is conscious in a state of light sleep called sedation, in a quite simple way that takes 10 to 15 minutes with no need for general anesthesia. A fasting period of 10 to 12 hours is required before the procedure. First, the esophagus and stomach are gastroscopically examined to see if there is an obstacle to the procedure. The patient can return home after a postoperative observation of 1 to 2 hours.

How much weight can be lost
The Intragastric balloon placement alone will not be enough, and it will also be necessary to implement an eating discipline and a new standard of living. It is possible to lose 15 to 30 kilos on average in 6 months. Restriction of caloric intake is recommended after the procedure. Since much food cannot be eaten as a result of the procedure, this restriction is implemented much more easily. The weight planned to be lost is half the difference between the current body weight and ideal weight, that is, 50 percent of the excess weight. In other words, if the current weight of a person is 105 kg while his/her ideal body weight is 65 kg, the weight planned to be lost is 20 kg. The new gastric balloons can be left in the stomach for a period of 12 months and since they are adjustable, inadaptability problems can be solved in the initial period. After the gastric balloon is removed at the end of the 12th months after its placement, the weight lost can be regained if the nutrition and lifestyle are not paid attention to.

Side effects
It has almost no side effects.
Nausea, vomiting and cramps may occur in the first 2 to 3 days after the placement of the balloon. However, these complaints decrease and disappear at the end of the first week.
When the balloon gets punctured, it is excreted from the body with feces, causing a small intestinal obstruction that requires surgical intervention, but this is less common with the new generation of balloons.

Nutrition after the placement of a gastric balloon

In the first 2-3 days, only liquid foods such as water, fruit juices, milk, whipped soups should be consumed. The bites of food should be small. Oil, salt and additives containing spices should be avoided. A food consumption plan including 4 to 6 meals a day should be implemented. Coffee, chocolate and all sweets should be avoided. Cold foods such as ice cream should not be consumed. After the 4th day, you can gradually start on solid foods. It is recommended to chew bites of foods well. If your solid food tolerance is problematic, you should return to the liquid diet.

After the 2nd week, -light foods are recommended for the first month.

  • You need to eat very slowly. Make a habit of leaving your cutlery on the plate while chewing each bite of food.
  • When you start on solid foods, it is of great importance to take very small bites of food and chew each of them very well.
  • Do not consume fluids during meals, but do not forget to drink at least 10 glasses of water a day. Wait at least 1 hour before consuming liquid after the meals. You should definitely stay away from carbonated drinks.
  • Avoid coffee, hot chocolate and sweet drinks, even if they are dietary products.
  • Do not consume deli products, mayonnaise and other similar high calorie sauces.
  • Consume skimmed milk and skimmed versions of all dairy products.
  • You can eat fresh seasonal fruits instead of desserts.
  • Prefer using soy sauce and vinegar for salads. Do not use sauces containing salt, oil, olive oil or mayonnaise.
  • If you want to eat bread, prefer breads with lots of grains and fiber.
  • If vomiting or nausea occurs, consume watery foods in at least three meals. Never overexert yourself if you vomit.
  • Never lie down immediately after meals.
  • Never eat anything between meals.
  • Do not eat while watching TV, working or when you are engaged in any other thing.

Patients who have undergone an intragastric balloon placement operation can eat normal foods instead of special liquids and packaged diets.
Intragastric balloon placement, which is an easy and safe procedure among controlled weight loss procedures, is also safely performed in our hospital. Intragastric balloon placement is performed endoscopically.



What Is Obesity?

The World Health Organization defines obesity as abnormal or excessive fat accumulation that presents a risk to health In obesity evaluated based on the gender, women have a Body Mass Index (BMI) of 20 to 30 or more and men have a BMI of 25 or more.

To define obesity more comprehensively, we can say it is a condition that causes abnormal fat accumulation in the person’s body, leading to the a great variety of diseases in later stages, which arises due to conditions under which environmental, social, economic and genetic factors pave the way for it. This condition may also lead to different types of chronic diseases, and may result in death. The distribution of fat accumulation caused by obesity in the body is very important in terms of the risks that it will cause in the later stages. Excess fat accumulation in the trunk and abdominal region rather than in the arms and legs carries a risk in terms of metabolic syndrome (a group of diseases including risk factors that considerably increase the likelihood of having a heart attack).

According to the data provided by the World Health Organization, the number of obese people has doubled in the 20th and 21st centuries. These data show that people aged 20 years and over are obese, while the current data obtained today show that children under 5 years of age are also overweight and obese. Obesity, which used to be defined as a disease of developed countries in the past years, is now considered as a major disease problem even in undeveloped countries.

Obesity that affects a person’s life expectancy and poses a significant threat to his or her health is considered to be the most risky factor as a cause of death. More than 3 million people die each year as a result of being overweight or obese. Obesity, which is a preventable and curable disease, can be prevented by improving improper eating habits, genetic factors, hormonal disorders, and physical activities.

In the treatment process, the person’s body mass index (BMI) is calculated and the ratio of weight to height square meter is then taken into account. If the BMI is 40 kg/m2 and above, the person is considered to be obese at the level of disease, and the treatment is started based on this ratio. Body mass index is calculated by dividing the body weight in kilograms by height in meters squared.

Body Mass Index (BMI)= Body Weight (kg) / Square of Height (m)

In the data obtained based on the body mass index;

Below 18.5 kg/m2: Weak

Between 18.5 – 24.9 kg/m2: Normal Weight

Between 25 – 29.9 kg/m2: Overweight

Between 30 – 34.9 kg/m2: Obese Class I

Between 35 – 34.9 kg/m2: Obese Class II

Over 40 kg/m2: Obese Class III



Gastro Esophageal Reflux disease (GERD), which is also colloquially known as reflux, is the condition of reflux of stomach contents into the esophagus. Reflux is caused by acidic stomach contents coming into the esophagus that contacts it for a long time, causing it to lose its ability to protect itself from acid. Reflux is observed in about 20% of adults.

The contents of the stomach are noticeably acidic because of the hydrogen ion secreted by the stomach. If there is a reflux of bile from the duodenum into the stomach, the contents that go up from the stomach contain both acid and bile. Bile, which has alkaline properties, causes irritation of the esophagus, just like stomach acid. GERD develops when stomach contents that include acid and/or bile come into the esophagus and contact it for a long time, causing the esophagus to lose its ability to protect itself from acid and/or bile in the stomach contents.

What are the Symptoms of Reflux?

A-) Typical Symptoms

1) Burning sensation in the chest and behind the chest bone,
2) Bitter-sour liquid coming into the mouth,
3) Belching, Bloating,
4) Food residues coming into the mouth,
5) Difficulty in swallowing, a sensation that food is stuck in the esophagus.

B-) Atypical Symptoms:

1) Hoarseness,
2) Itchy cough,
3) Bad breath,
4) Palpitations, Feeling of pressure on the heart,
5) Shortness of breath, Feeling of shortness of breath,
6) Asthma,
7) Tooth decay,
8) Chronic pharyngitis,
9) Hiccups
10) Chronic Sinusitis.

Diagnosis of GERD

Gastroscopy is the first thing to do after a systematic anamnesis and examination. Gastroscopy is still the “gold standard” in the diagnosis of GERD. For almost every patient with chronic GERD or for whom Laparoscopic Surgery is planned, gastroscopy is essential in preparation.

It should be noted that a gastric hernia does not necessarily exist for the development of GERD. However, surgical treatment is inevitably needed if the patient has a GERD condition unresponsive to medications and a large stomach hernia accompanying it. We can detect some precancerous conditions such as “Barrett’s esophagus” by taking tissue parts during gastroscopy and perform an Anti-Reflux surgery without delay.

Other methods used in the diagnosis of reflux

  • PHmetry
  • Manometry
  • Barium Radiography
  • Impedance pHmetry
  • Impedance Manometry
  • Antroduodenal Manometry
  • Gastric emptying scintigraphy (GES)

Reflux Disease Appears in Three Variety of Clinical Scenarios
1) Only with typical complaints (Bitter fluid coming into the mouth and burning sensation) (45%)
2) Typical complaints are at the forefront, but atypical complaints are also present (40%)
3) Cases where atypical complaints (Complaints about the Ear, Nose, and Throat-Lung, Bad breath etc.) are at the forefront (15%)

What Are the Complications (Harms) of GERD?

  1. a) Long-term GERD can cause a serious decrease in the motility of the esophagus as a result of the chronic ulceration process, and may cause difficulty in swallowing, especially in swallowing solid foods.
  2. b) In more advanced cases, scar tissue may develop due to the ulceration/healing vicious cycle, resulting in shortening of the esophagus and even stenosis at the lower end of the esophagus, which may cause the person to completely lose his/her ability to swallow solid foods. These are too late complications that make it impossible to perform standard Laparoscopic Anti-Reflux surgeries.
  3. c) The most feared complication is cancer development at the lower end of the esophagus, which is constantly under the effect of irritation. It should be emphasized that not every GERD patient develops cancer. However, any specific ulceration condition called “Barrett’s Esophagus” that developed at the lower end of the esophagus of a patient with chronic GERD is a cancer precursor. In such cases, GERD should be surgically treated promptly. A surgical intervention cannot completely eliminate but reduce the risk of cancer development. In 5 to 15% of the cases where GERD persists for a long time, the condition we call Barrett’s Esophagus may develop. A patient diagnosed with Barrett’s Esophagus is at a 120 to 150-fold increased risk of developing esophageal cancer compared to people without GERD. This rate is approximately 40 times higher for a GERD patient who has not developed Barrett’s Esophagus.

Reflux Treatment

There are 3 methods for the treatment of GERD. These methods can be determined by the Doctor, based on the severity and progression of GERD. These are Lifestyle changes, Medication and Surgical Treatment, which enable the elimination of the disease depending on its type and stage of treatment.

a-) Lifestyle regulations

  • sleep on a high pillow
  • do not eat too close to bedtime
  • stay away from smoking and alcohol
  • do not drink acidic drinks
  • eat a healthy diet
  • do not wear tight clothes
  • get rid of your extra weight

b-) Drug Therapy

Acid-suppressing drug therapy controls the amount of acid secretion in the stomach and ensures decreased amount of stomach acid that goes upwards. However, drug therapy is not effective on bile reflux (alkaline reflux). Despite drug therapy, bile continues to go up and irritate the esophagus. Therefore, esophageal irritation may continue even during drug therapy.

In people with GERD complaints, drug therapy is definitely administered at the beginning. Although it relieves 80% of people suffering from GERD, it does not eliminate and completely cures the mechanical disorder that is the origin of GERD. Therefore, the same complaints restart in a short time in 90% GERD patients who discontinued the drug therapy.

c-) Surgical Treatment

GERD greatly affects the quality of life, especially when it is accompanied by a gastric hernia. Surgical treatment is the only method of treatment that eliminates the mechanical origin of gastroesophageal reflux disease. In real sense, treatment results can only be achieved by surgical procedures. Prospective Randomized controlled trials covering a 10-year period have shown that more than 93of surgical interventions have given definitely successful results. 93 of the patients who preferred surgical treatment had no complaints and needed no medications.

  • In cases where medical treatment is not successful (Cases in which no results could be obtained with 8-12 weeks of drug treatment and a series of diet and social life recommendations), in cases of Severe esophagitis or a gastric hernia of larger than 4 centimeters;
  • In cases where young patients do not want to use medication for a long period or for a lifetime;
  • In cases where the patient’s complaints persist after drug therapy;
  • In cases where complaints of chronic cough, hoarseness, asthma and chronic sore throat persist despite the treatments; and
  • In cases where irritations leading to cellular changes are observed in the esophagus (Barrett’s esophagus),

surgical treatment should be considered by taking into account the concerns that will be caused by lifestyle changes, and the duration and cost of drug therapy.

The fact that the Laparoscopic Nissen technique gives even better results compared to open surgery in the long term has made it the “gold standard” in the treatment of Chronic GERD.

Laparoscopic surgery is a technique performed through the abdomen without cutting the abdomen, by entering through small incisions of around 0.5 to 1 cm. It is performed using surgical instruments specially produced for this operation, through 4 or 5 ports (access hole). If there is a gastric hernia (hiatus hernia), Hernia Repair is performed first. Our team also uses a mesh to reduce the risk of recurrence when necessary, although this varies depending on the size of the hernia and the characteristics of the patient.

At this stage, which is called the fundoplication process, mostly a 360-degree (rarely a 270-degree) valve assembly is created. Thus, the forward wave movement of the esophagus pushes the food into the stomach, while the backflow of the food is prevented.

Laparoscopic reflux operations take 60 minutes on average. Afterwards, the patient is awakened and taken to his/her room within about 30 minutes. After 6 hours, he/she is prompted to walk in the room and spends the night in the hospital. The next day (at the end of the first day), after a light breakfast in the morning the patient can go home after a light breakfast.

The patient, who is able to walk and do his/her own works when at home, consumes liquid and soft foods for a period of 1 week. On the 7th postoperative day, the patient visits the surgeon, and the wound dressings are removed. Afterwards, dietary restrictions are eased a little more, and at the end of the 2nd week there will be no requirements other than well-chewing and slow eating.

To get Detailed Information and ask Questions, you can contact us at 0532 228 33 60.



SADI-S

SADI-S (single anastomosis duodeno–ileal bypass) is the surgical procedure that involves duodenal bypass, which is performed with a single anastomosis, and sleeve gastrectomy. It can also be defined as an integrated form of biliopancreatic diversion surgery or duodenal switch surgery. In this procedure, the stomach obtained as a result of sleeve gastrectomy is separated from the duodenum by cutting. An anastomosis, that is, a joining operation, is performed to connect the separated duodenum section to the second part of the small intestine called the ileum.

The sleeve stomach created in SADI-S surgery, which can also be performed laparoscopically, restricts the amount of food intake, and also aim at reducing the utilization of these foods. In addition, absorption is also reduced by inactivating a section of the small intestine that provides absorption. Thus, the procedure can help lose weight by reducing the weight gain of the patient. This surgical procedure is usually performed on people who have metabolic diseases such as hypertension, diabetes and high cholesterol, and those who cannot achieve weight loss at the planned rates or to the extent close to these rates. After the procedure, patients may experience a condition in which they need to take vitamin and mineral supplements for life.




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