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Article Fistulectomy and Primary Sphincteroplasty for Transsphincteric Fistula(Coll Physicians & Surgeons Pakistan, 2025) Emral, Ahmet Cihangir; Gulen, Merter; Ege, BahadirObjective: To evaluate the results of patients treated with fistulectomy and primary sphincteroplasty for uncomplicated perianal fistula. Study Design: Observational study. Place and Duration of the Study: Medicana International Hospital affiliated with Atilim University, Faculty of Medicine, Ankara, Turkiye, from January 2020 to September 2023. Methodology: In this study, patients who were operated on for perianal fistula between 2020 and 2023 were retrospectively examined. Data were obtained retrospectively. All patients underwent preoperative perianal MRI. Clinical notes were evaluated with the Cleveland Clinic Incontinence Score (CCIS) by physical examination. All patients were followed up on the first postoperative day, 1st week, 1st and 3rd postoperative months. Results: A total of 44 patients who underwent fistulectomy with primary sphincteroplasty were included in the study. Twenty-six patients (59.1%) had a history of perianal abscesses. It was observed that 34 (77.3%) of the patients had posterior, 7 (15.9%) anterior, and 3 (6.8%) lateral fistulas. A total of 3 patients (6.8%) were observed to have minor worsening in their incontinence scores. There was no statistically significant difference between the preoperative and postoperative 3rd month Cleveland Clinic Incontinence Score values of the patients (CCIS mean 1.6 vs. 1.7, respectively, p >0.05). Recurrence was observed in 1 patient (2.3%) during follow-ups. Conclusion: Fistulectomy with primary sphincteroplasty is an effective and reliable method to preserve anal continence and improve quality of life.Article Citation - WoS: 1Citation - Scopus: 2Incidental Detection of Ectopic Liver Tissue During Elective Cholecystectomy: a Case Report(Frontiers Media Sa, 2025) Emral, Ahmet CihangirIntroduction Ectopic liver tissue (ELT) is a rare embryological anomaly most commonly found in the abdominal region, particularly on the gallbladder. It is generally asymptomatic and is often discovered incidentally during surgery or autopsy. Although histologically similar to the main liver, ELT should be excised due to the potential risk of malignancy.Case presentation This study presents a case of incidental ELT discovered during elective cholecystectomy in a 34-year-old female patient. Preoperative imaging revealed multiple gallstones, and during laparoscopic exploration, an ectopic liver tissue lesion was found on the gallbladder fundus. The lesion, measuring 10 x 5 mm, was excised en bloc with the gallbladder and sent for pathological examination, which showed no malignancy.Discussion The rarity and asymptomatic nature of ELT make it difficult to diagnose preoperatively, but its association with malignant transformation warrants careful management. In cases of suspected malignancy, further surgical approaches such as extended surgical margins and regional lymph node dissection should be considered.Conclusion This case underscores the importance of early detection and excision of ectopic liver tissue due to its potential for malignant transformation.Article The Predictive Effect of "Real Amylase Value": A More Accurate Predictor for Postoperative Pancreatic Fistula(Wiley, 2025) Emral, Ahmet Cihangir; Cetinkaya, Gokay; Dikmen, Kuersat; Kerem, MustafaBackgroundPostoperative pancreatic fistula (POPF) is a common and serious complication following pancreatic surgery. While several studies have attempted to predict the development of POPF using drain amylase concentration, predictive values vary widely due to factors like abdominal irrigation and chylous drainage, which can dilute the amylase levels. This study aims to evaluate whether the "Real Amylase Value" (RAV), calculated as the product of drain amylase concentration and drainage volume, provides a more reliable prediction of POPF compared to conventional amylase concentration. Better prediction of pancreatic fistula development could lead to closer clinical monitoring of these patients, reassessment of hospital stay duration, and more careful management of drains over an extended period. Additionally, carefully managing the timing of drain removal may improve patient recovery and discharge process.MethodologyData from 198 patients who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were retrospectively analyzed. Drain amylase concentrations and drainage volumes were measured on postoperative days (POD) 1 and 3, and the RAV (U) was calculated. Real Amylase Value (RAV) (U) was calculated using the formula: RAV (U) = Drain Amylase Concentration (U/L) x Drainage Amount (L). Predictive values for POPF were evaluated using receiver operating characteristic (ROC) curve analysis, comparing conventional amylase concentration (U/L) and RAV (U).ResultsOn POD1, the RAV (U) demonstrated greater predictive value for POPF compared to the conventional drain amylase concentration (U/L) with an area under the ROC curve (AUROC) of 0.85 versus 0.79, respectively. Similarly, on POD3, RAV showed superior predictive accuracy (AUROC 0.89) compared to amylase concentration (AUROC 0.79).ConclusionThe RAV (U) offers a more accurate and reliable prediction of POPF than traditional drain amylase concentration (U/L), with improved sensitivity and specificity. This method could refine clinical management, particularly in the timing of drain removal and early intervention strategies for patients at high risk of developing pancreatic fistulas.Article Hemoroid Lastik Band Ligasyonu Komplikasyonlarının Yönetimi: Masif Rektal Kanama(Galenos Publ House, 2024) Gülen, Merter; Emral, Ahmet Cihangir; Ege, BahadırAmaç: Çalışmanın amacı, hemoroidal hastalıkta cerrahi dışı tedavi seçeneklerinden biri olan lastik band ligasyonunu (RBL) ve buna bağlı gelişen komplikasyonları irdelemektir. Morbiditesi nedeniyle önem arz eden masif rektal kanama komplikasyonunun yönetimini sunmaktır. Gereç ve Yöntem: Evre 1-2 ve 3 internal hemoroidal hastalık nedeniyle 2018-2022 yılları arasında kliniğimizde RBL yapılan 564 hasta retrospektif olarak irdelenmiştir. Gebelik durumu, geçirilmiş anorektal cerrahi, kronik karaciğer hastalığı ve antikoagülan kullanımı nedeniyle 72 hasta çalışma dışında bırakılmıştır. Hastaların 492’si çalışmaya dahil edilmiştir. Tüm hastalara proktoloji ünitesinde detaylı anorektal muayene, 50 yaş üstündekilere ise kolonoskopik değerlendirme yapılmıştır. Hastaların demografik özellikleri, gelişen komplikasyonlar (minör/majör) ve uygulanan band ligasyon sayısı standardize edilmiş formlara kayıt edildi. Bulgular: Hastaların ortalama yaşı 33,4±11 (18-65) yıl olup, 385’i (%78,3) erkek, 107’si (%21,7) kadındı. Hastaların 39’una (%8) tek kadran, 448 hastaya (%91) iki kadran ve 5 hastaya üç kadran RBL uygulandı. RBL sonrası minör komplikasyonlar (anal ağrı, vazovagal semptomlar, minör rektal kanama, üriner retansiyon) yirmi hastada (%4) gelişirken, hastaların 4’ünde (%0,8) masif rektal kanama meydana gelmiştir. Masif rektal kanama gelişen hastaların hepsi acil şartlarda hospitalize edildi ve operasyona alındı. Bu hastaların birine 3 ünite, üç hastaya ise 4 ünite eritrosit transfüzyonu yapıldı. Sonuç: Hemoroidal band ligasyonu, hemoroidal hastalık tedavisinde güvenli ve etkili bir yöntemdir. Ancak hayatı tehdit edecek ciddi kanamalara yol açabileceği göz önünde bulundurulmalıdır.Article Pankreas Cerrahisi Sonrası Histopatolojik Değerlendirme: Hpb’ye Özgü Patologlar ile Spesifik Olmayan Patologların Sonuçlarının Karşılaştırılması(Turkish Surgical Assoc, 2023) Emral, Ahmet Cihangir; Dikmen, Kürşat; Tahernejad, Maryam; Sardari, Khotan; Pour, Ali Rahman; Ekinci, Özgür; Kerem, MustafaGiriş ve Amaç: Bu çalışmanın amacı, aynı cerrahi ekip tarafından pankreatikoduodenektomi yapılan hastaların spesmenlerinin HPB-spesifik pato- loglar ve genel patologların değerlendirme sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Periampuller bölgede pankreatikoduodenektomi (PD) uygulanan 159 hastanın patoloji sonuçları retrospektif olarak incelendi. HPB-spesifik patologlar (S grubu) ve diğer patologların (NS grubu) histopatolojik değerlendirme sonuçları karşılaştırıldı. Patoloji spesmenleri değerlendirilerek, tümör boyutu (mm), total lenf nodu, metastatik lenf nodu, cerrahi sınır pozitif/negatifliği (RO/R1/R2 rezeksiyonu) ve vasküler rezeksiyon yapılan hastaların verileri gruplar karşılaştırılarak değerlendirildi. Bulgular: HPB-spesifik patologlar (S grubu) tarafından 91 hastanın, non-spesifik grupta (NS grubu) ise 68 hastanın spesmen sonuçları incelendi. Ortalama toplam lenf nodu sayısı ve diseke edilen metastatik lenf nodu sayısı açısından karşılaştırıldığında istatistiksel olarak anlamlı sonuç göz- lendi (sırasıyla p= 0,04, p< 0,01). Ayrıca cerrahi sınır pozitifliği (R1) S grubunda istatistiksel olarak daha yüksek bulundu (p= 0,02). Sonuç: HPB ameliyatlarının başarısının kliniğe yansıyabilmesi için patoloji spesmenlerinin HPB-spesifik patologlar tarafından incelenmesi önem taşımaktadır.Article Citation - WoS: 4Citation - Scopus: 5Evaluating Efficacy and Outcomes: Comparison of Laser Treatment and Crystallized Phenol in Pilonidal Sinus Disease(Frontiers Media Sa, 2025) Emral, Ahmet Cihangir; Gulen, Merter; Ege, BahadirObjective The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life.Material and method Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed.Results A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group.Conclusion Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.Article Which Technique Is Preferable for Grade 2-3 Hemorrhoidal Disease: Laser Vs. Rubber Band Ligation ? A Retrospective Study(Springernature, 2025) Emral, Ahmet Cihangir; Gulen, Merter; Ege, BahadirBackground The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent laser hemorrhoidoplasty (LH) and rubber band ligation (RBL) due to grade 2-3 hemorrhoidal disease. Methods The results of patients who underwent LH and RBL between June 2020 and June 2023 for grade 2-3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). Results A total of 260 patients were included in the study, 166 of whom underwent RBL and 94 LH. Operation time, VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. LH has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p < 0.001). Conclus & imath;ons LH and RBL both offer effective treatment options for grade 2-3 hemorrhoidal disease, with comparable recurrence rates and time to return to normal life. However, LH is associated with significantly less postoperative pain and analgesic use on the first postoperative day, potentially enhancing patient satisfaction.
