General Surgery

Thanks to the depth of staff with different areas of interest in our hospital, pioneering practices are carried out especially in minimally invasive surgery, emergency surgery, endocrine surgery (breast, thyroid gland, and adrenal gland) and obesity surgery, as well as gastrointestinal system (digestive system) surgery and hepato-pancreato-biliary (liver, pancreas, and bile ducts) surgery. All interventions regarding colon and rectum (large intestine) diseases are performed using the most up-to-date technologies. In particular, a very wide range of treatment options is offered to patients for anal region disorders such as hemorrhoids, fistulas, or fissures.

The groups of diseases that can be examined, tested, and treated by the General Surgery Department are as follows:

• Thyroid gland diseases (goiter, hyperthyroidism)
• Breast cancer and benign breast diseases
• Esophageal cancer and benign diseases
• Anorectal diseases: tumors, hemorrhoids, anal fissures, fistulas
• Gallbladder and bile duct stones and tumors
• Abdominal wall and inguinal hernias, postoperative hernias
• Trauma and emergency surgery
• Stomach cancer
• Surgical diseases of the small intestine, bowel obstructions
• Colon – rectum tumors, inflammatory diseases
• Benign and malignant liver tumors, cysts
• Obstructive jaundice
• Pancreatic cysts and tumors
• Acute and chronic pancreatitis
• Surgical diseases of the spleen
• Various soft tissue infections
• Laparoscopic surgeries

Laparoscopy is the observation of the abdominal cavity using an optical device. This device is inserted into the abdominal cavity through a small incision of 1 cm below the navel. It allows direct observation of diseases or problems related to the uterus, ovaries, and tubes, and if necessary, treatment with auxiliary instruments inserted through 3 – 5 mm holes opened in the lower abdominal area at the same time.
In laparoscopic surgery, operations are performed by watching on a screen through a micro-camera inserted through several small holes made in the abdominal wall.

The Most Important Advantages Of Laparoscopic Surgeries Are:

• Very little bleeding occurs during surgery.
• Very small scar remains.
• Very little pain is felt after surgery.
• Since there are no large incisions, the infection rate is also lower.
• Recovery is faster, so loss of work is minimized.
• Hospital stay is short (maximum 1 day).
• Prevents long-term intestinal adhesions due to surgery.

Surgical Practices That Make A Difference In Our General Surgery Clinic

Sleeve Gastrectomy Surgery

Obesity is when a person’s weight is above the expected weight for their age, gender, and height. In the advanced stages of this disease, it is not possible for patients to get rid of excess weight through diet, exercise, or various medications. It is a common problem for these patients to regain the weight lost with diet after a while. Today, there is no effective and permanent treatment for morbid obesity other than surgery.

It is known that obesity is an important risk factor for hypertension, coronary heart disease, type 2 diabetes, insulin resistance, osteoarthritis (rheumatism), sleep apnea syndrome, depression, fatty liver, liver cirrhosis, gallstones, stroke, some skin diseases, mental illnesses, asthma, musculoskeletal system problems, and the development of prostate, breast, uterine, and colon cancer.

Sleeve gastrectomy is performed laparoscopically (closed method) by making small holes in the abdomen and removing 80% to 85% of the stomach with the help of a camera inserted through these holes. It is a restrictive surgery method that reduces the stomach’s capacity for food intake. Since the surgery is performed with a closed method, the patient is largely protected from pain, hernia, and wound infection risks. The preferred age range for this surgery is 18 to 65 years.

The operation is performed by removing the upper part, body, and part of the lower section of the stomach. After surgery, our patients can lose 40% to 60% of their current weight within 1–1.5 years. For example, a patient who undergoes surgery at 160 kg has the chance to lose 80–90 kg. About 80% of diabetic patients and 60% of hypertensive patients stop taking their medications.

It is recommended that morbidly obese individuals with these diseases undergo surgery before permanent damage occurs in the body. This surgery takes an average of 1 hour. The fact that sleeve gastrectomy can be repeated (revision) is an important feature that distinguishes it from other obesity surgeries. In other types of obesity surgery, if the patient regains weight, it is very difficult to perform an additional surgical procedure. Sleeve gastrectomy provides an advantage over other bariatric methods due to the low risk of vitamin and mineral deficiency.

The preoperative preparation process takes about 1 day. Postoperative hospital stay is 3 days. Apart from high-risk patients, intensive care follow-up is not required after surgery. Our patients can return to their daily lives and work in about 1 week. After the operation, a personalized nutrition program determined by our doctor is applied.

With this program, while the person loses weight quickly, they also have a healthy diet by receiving the necessary nutrients. Our program, which starts with liquid foods, continues with purees, soft, and normal solid foods, and our patients return to a normal diet after about 5 weeks.

Revision In Obesity Surgery

If patients lose less than 50% of their excess weight within 18 months after the first obesity surgery; if early or late complications related to the first operation develop; or if they regain weight after losing it, the first operation is considered unsuccessful, and revision surgery is considered. Many bariatric surgeons prefer to convert a failed restrictive surgery to a malabsorptive or combined (restrictive + malabsorptive) method.

Sleeve gastrectomy, in addition to being a restrictive surgery, affects metabolism by increasing GLP-1 and peptide YY levels after surgery. This feature distinguishes it from other restrictive obesity surgeries. Due to these metabolic effects, it has found its place among the revision surgery procedures that can be applied after failed restrictive operations (re-sleeve).

Revision sleeve gastrectomy (re-sleeve) has become a method that can be considered for suitable patients after failed or complicated gastric band surgery, in cases where the stomach enlarges again after the first sleeve gastrectomy operation, and after duodenal switch/pancreato-biliary diversion operations.

Revision surgery after a failed gastric band is generally recommended 3–6 months after band removal. Since it has fewer complications compared to gastric bypass surgery used for revision and its results are satisfactory, revision sleeve gastrectomy can be applied in the appropriate patient group.

Indications For Revision Sleeve Gastrectomy (Re-Sleeve):

• Weight gain after gastric band surgery
• Some complications related to the gastric band
• High-risk patients requiring revision
• Obese patients with inflammatory bowel disease (especially Crohn’s)
• Patients with severe intestinal adhesions
• Smokers
• Morbidly obese adolescent patients
• Elderly patients
• Patients who may need a second surgical procedure other than obesity surgery

In patients whose esophagus has become excessively dilated and whose esophageal movements are impaired after gastric band placement, it is more appropriate to perform gastric bypass as revision surgery after removing the band.
In patients with aspiration pneumonia due to severe reflux, Barrett’s esophagus, or chronic cough due to reflux, gastric bypass should be performed as revision surgery.

In patients whose metabolic syndrome does not resolve after restrictive surgery (band placement, sleeve gastrectomy, etc.), gastric bypass is more appropriate. In patients with severe reflux and gastric stenosis after sleeve gastrectomy, gastric bypass should be performed for revision. In obese patients with poor eating habits or those who cannot adapt to a proper eating pattern, it is more appropriate to perform gastric bypass instead of revision sleeve gastrectomy.

Transit Bipartition Surgery (Diabetes Surgery)

Due to modern lifestyle, the consumption of high glycemic index foods is increasing. Accordingly, the secretion of certain hormones from the first part of the intestines that cause diabetes increases, while the secretion of hormones secreted from the last part of the intestines that prevent diabetes decreases. Transit bipartition surgery is a metabolic surgery performed to prevent this hormonal imbalance that causes diabetes.

Transit bipartition surgery is performed using a closed (laparoscopic) method. In the first stage of the operation, sleeve gastrectomy is performed. In the second stage, the small intestines are measured from below, first up to 80 cm and marked, then measurement continues and the 260th cm is marked. The small intestine is separated from the 260th cm. The separated lower part is brought up and connected to the sleeved stomach. The separated upper part is connected to the small intestine at the previously marked 80th cm. While 1/3 of the food continues to pass through the normal route, 2/3 passes through the small intestine segment connected to the stomach.

The purpose of transit bipartition surgery is to control blood sugar without medication (without insulin injections and/or pill treatment) especially in type 2 diabetes patients whose weight is close to normal or normal (low body mass index). In transit bipartition surgeries, while blood sugar control is ensured, the normal duodenum anatomy and structure are preserved. Thus, 1/3 of the nutrients pass through this route, preventing vitamin, mineral, and nutrient absorption deficiencies. In this way, excessive weight loss in normal-weight type 2 diabetes patients is prevented; furthermore, if any endoscopic intervention (such as ERCP) is required for the gallbladder and bile ducts in the future, it can be easily performed. After this operation, most patients do not require vitamin and mineral supplements.

Breast Surgery

What You Need To Know About Oncoplastic Surgery

Breast cancer is the most common type of cancer in women. One in eight women develops breast cancer. While its mortality rate is decreasing, the detection rate of breast cancer is increasing. Early diagnosis is very important in breast cancer. Therefore, regular check-ups should not be neglected.

Today, no woman has to lose her breast because of cancer. With the developments in the last 15 years, surgical techniques adjusted according to patient demands and cancer treatment mean that women no longer have to experience breast loss due to breast cancer. Especially in almost half of the patients, breast-conserving surgery is possible. In cases where the inside of the breast must be emptied and the tissue completely removed, new breast reconstruction is possible in the same surgery with oncoplastic techniques.

In our hospital’s breast-conserving surgery, the cancerous tissue is removed together with the surrounding healthy tissue. However, in some cases, the space created by the removed breast tissue results in cosmetic collapse or deformity. In such cases, special oncoplastic techniques are used to minimize deformity through tissue shifting and tissue replacement principles.

In medical situations where the breast tissue must be completely removed, new breast reconstruction is performed using permanent silicone implants. In addition, in different situations depending on the patient’s anatomical structure and the location of the cancer, we can create a new breast by taking a muscle-skin flap from the back or using the abdominal muscles. We usually perform all these surgeries in the same session. Thus, the patient is spared from having to undergo several surgeries in succession.

In the Emsey Hospital General Surgery Clinic Breast Health Center, diagnosis and treatment of breast cancer and oncoplastic surgery procedures are performed simultaneously during tissue removal by our specialist physicians.

Laparoscopic Hernia Surgery

Hernias can develop in weak areas unique to the human body in the abdominal wall or due to weaknesses that occur congenitally or later due to surgery or injury. Hernia can cause pain, tightness, a feeling of excess, cosmetic deformity, and movement difficulty that make social life difficult for the patient. The most common general surgery operation performed worldwide is inguinal hernia surgery. The simplest and most common symptom of hernia is a swelling that can be felt by hand or seen when it enlarges. Usually, when the abdominal muscles are not contracted and the person lies on their back, the contents of the hernia sac return to the abdominal cavity and the hernia disappears. However, if the neck of the hernia is narrow or the hernia has grown excessively, the swelling may not shrink even when the abdomen is relaxed. Hernia repair can be performed by open or closed methods. In laparoscopic hernia surgeries performed from inside the abdomen by making 3 incisions, a synthetic mesh is used for support. In this surgery, the patient is completely anesthetized with general anesthesia. It has advantages such as less scarring, less pain, and earlier return to normal life in the short and long term.

Thyroid Surgery Protecting Vocal Cords With Special Device

Surgery on the thyroid gland may be necessary due to excessive enlargement of the thyroid gland, suspicion of cancer or detection of cancer in the biopsy, or toxic goiter. In these surgeries, the nerves leading to the vocal cords may be damaged. Fortunately, the possibility of permanent hoarseness is less than 1%. Special devices are used to further reduce this rate. During surgery, the nerves located on both sides that go to the vocal cords can be located with an intraoperative neuromonitoring device (nerve monitoring device). This device is used in every thyroid gland surgery.