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    Assessing effect of a regional block on quality of recovery after bariatric surgery
    (Springer, 2024) Toprak, Hatice; Toprak, Şükrü Salih
    We thank Huang et al. for their comments on our publication[1]. Primary; In our study, we presented the efects of a new regional anesthesia technique on the quality of recovery in bariatric surgery
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    Comparison of diaphragm thickness values ın cases of adenotonsillectomy before and after the operation
    (2023) Toprak, Hatice; Aydoğan, Eyüp; Tire, Yasin
    Aim: The ultrasonographic assessment in the operating room tends to increase daily, and ultrasonography is a method used to evaluate the thickness of the diaphragm. Measurement of the thickness of the diaphragm is a parameter that can be used to decide before separation from mechanical ventilation and extraction. In these cases where intubated and extubated at the end of the operation, it is planned to examine the ratio of the aperture muscle thickness to each other in the last inspirium and exprium before extubation. Determining the current ratio may be meaningful for determining the extubation time. Material and Method: In the study, 60 patients, who were in the physical state of ASA I and II, 3-12 age range, and who were scheduled for elective adenotonsillectomy operation were included. Age, gender, body mass index (BMI), and operation time data of patients were recorded. Before and after the procedure, inspiratory and exprituar diaphragm thicknesses were measured by ultrasonography. In addition, the ratio of the last inspirium and the diaphragm muscle thicknesses in the last expiration were also calculated. Results: There was no significant difference between the pre-operation values and the end of the operation in the diaphragm thickness measurements. The incidence of laryngospasm was 1.5 %. Conclusion: Diaphragm thickness measurements with ultrasound have many benefits but further studies are needed.
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    Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial
    (Springer Japan, 2022) Et, Tayfun; Korkusuz, Muhammet; Başaran, Betül; Yarımoğlu, Rafet; Toprak, Hatice; Bilge, Ayşegül; Kumru, Nuh; Dedeli, İlker
    Purpose: The infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is effective in functional recovery. This study compared iPACK + ACB (adductor canal block) with PAI (periarticular infiltration) + ACB and ACB alone in terms of postoperative analgesia and functional improvement. Methods: This double-blinded randomized controlled trial included 105 patients undergoing unilateral total knee arthroplasty. Patients received ACB, iPACK + ACB, and PAI + ACB along with spinal anesthesia. The primary outcome was the area under the curve (AUC) numeric rating scale (NRS) at 48 h. Secondary outcomes were cumulative postoperative analgesic consumption within 48 h, timed up-and-go test, range of motion, length of hospital stay, patient satisfaction, and adverse events. Results: The 48-h AUC movement NRS score in the iPACK + ACB group was significantly lower than in the PAI + ACB and ACB groups (p < 0.05). At the postoperative 48th h, the opioid consumption of the iPACK + ACB group was lower than those of the ACB and PAI + ACB groups (p < 0.001). The patients in the iPACK + ACB group had significantly shorter discharge and mobilization days than the ACB and PAI + ACB groups (p < 0.001). Conclusions: The adding of an iPACK block to the ACB improves postoperative analgesia and reduces opioid consumption. In addition, this approach improves functional performance and reduces hospital stay.
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    Comparison of the effects of ring block and dorsal penile nerve block on parental satisfaction for circumcision operation in children: randomized controlled trial
    (Springer Science and Business Media Deutschland GmbH, 2024) Toprak, Hatice; Kandemir, Emre
    Purpose: In children, circumcision is a procedure associated with perioperative pain and parental satisfaction is an important parameter in the evaluation of anesthesia procedures. Inadequate dorsal penile nerve block (DPNB) for the ventral shaft of the penis might impact parental satisfaction negatively. To evaluate this hypothesis, we compared the effects of penile ring block (RB) and dorsal penile nerve block (DPNB) on parental satisfaction. Postoperative pain, need for additional analgesia, intraoperative hemodynamic data, recovery status, side effects, and postoperative complications were evaluated as secondary outcomes between the blocks. Methods: Parental satisfaction and anesthetic effectiveness of RB and DPNB for circumcision in children were compared. 86 patients were randomized 1:1 to Group RB and Group DPNB, which were administered the same dose of anesthesia. Parental satisfaction was evaluated with the Pediatric Anesthesia Parental Satisfaction Questionnaire (PAPS). Postoperative pain evaluations were made with the Face, Legs, Activity, Crying, Consolability Pain Scale (FLACC). Results: In terms of parent satisfaction, no differences were detected between the groups in the pre-anesthesia, pre-anesthesia and post-anesthesia, post-anesthesia, hospital team, and anesthesia team parameters (p > 0.05). The scores of Group DPNB patients were higher only in the “Q11” subparameter in the “anesthesia team” parameter, and this difference was significant (0.024). Conclusion: RB and DPNB were compared in circumcision, which is the most common surgical procedure for children. Parental satisfaction, anesthesia, and analgesic effects of both blocks were found to be similar. Clinical trials: ACTRN12622001211752.
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    The effect of the use of a stylet and/or McGrath videolaryngoscope on intubation time in obese patients: A randomized clinical trial
    (Churchill Livingstone, 2023) Korkusuz, Muhammet; Başaran, Betül; Et, Tayfun; Toprak, Hatice; Bilge, Ayşegül; Yarımoğlu, Rafet; Kumru, Nuh
    Obese people have low oxygen reserves because of low functional capacity. For this reason, the time for airway manipulation before intubation is reduced and airway management may be difficult in obese population. Aim: The purpose of the present study was to investigate whether videolaryngoscope or stylet or both, shorten the intubation time in obese patients. Methods: A total of 120 obese patients scheduled for surgery under general anesthesia were included in the study, 30 in each group; Group DL utilizing a standardized Macintosh blade, Group DLS: DL utilizing a standardized Macintosh blade + Stylet, Group VL: McGrath VL (Series 5), Group VLS: McGrath VL (Series 5) + Stylet. Intubation time was investigated as the primary outcome. Results: Intubation times were found to be significantly different between the study groups (P < 0.001). According to the Post-Hoc Test results, the intubation time of Group DL was significantly lower than the intubation time of Group VL and Group VLS (P < 0.001, P = 0.014, respectively). Group DLS intubation time was significantly lower than those of Group VL and Group VLS (P < 0.001, P < 0.001, respectively). Intubation times were similar between the other groups (P > 0.05). Conclusions: The intubation times of obese patients were shorter with direct laryngoscopy, with or without a stylet when compared to those with a McGrath videolaryngoscope, with or without a stylet. Among the same type of laryngoscopy groups, the use of stylet did not change the intubation time. The rate of first-pass intubation was lower with the stylet-free McGrath videolaryngoscope when compared to direct laryngoscopy and direct laryngoscopy plus stylet groups.
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    Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery: A randomized controlled trial
    (Springer, 2023) Toprak, Hatice; Başaran, Betül; Toprak, Şükrü S.; Et, Tayfun; Kumru, Nuh; Korkusuz, Muhammet; Bilge, Ayşegül; Yarımoğlu, Rafet
    Background: Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia. Methods: Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes. Results: Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour (P < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P < 0.05. Conclusions: ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery. Clinical Trial Registration: NCT05020379. Graphical Abstract: [Figure not available: see fulltext.].
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    Experiencing complications after metabolic and bariatric surgeries is a risk factor for postoperative emergency department admissions: a retrospective cohort study
    (2025) Toprak, Şükrü Salih; Toprak, Hatice; Köse, Fulya
    BackgroundEmergency department admissions significantly burden hospital staff and countries' health system. Studies are encouraged for effective and correct utilization of emergency departments. Rational management of obesity-related medical problems and postoperative complications may reduce emergency department visits. This study aimed to determine the rates, characteristics, and antecedents of emergency room admissions after metabolic and bariatric surgeries (MBSs) performed in our hospital. According to our hypothesis, experiencing postoperative complications is the most common reason for emergency department admissions.MethodsThe study was designed as a single-center, retrospective, cohort study. Metabolic and bariatric surgeries performed in our hospital between June 2021 and June 2023 were evaluated. Clavien Dindo Classification was used to classify complications. The reasons for emergency department admissions, re-hospitalization and surgical requirements, time relationships, and possible antecedents were examined in stages.ResultsA total of 153 patients were evaluated in the study. The average follow-up period was found to be 609.63 +/- 222.89. The emergency department admission rate following MBSs was found to be 31%, and the admission rate within the first month was 7.8%. The major complication rate following MBSs was 4.6%. Experiencing complications was the most important antecedent for admissions 1 month postoperatively.ConclusionsIn patients with complications after MBS, the discharge decision should be provided with stricter controls, and outpatient clinic controls should be planned more frequently. Providing training to patients on managing complications should be considered as a strategy that may reduce the number of emergency department visits.Clinical Trial RegistrationACTRN12624000810516
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    Investigating the effects of metabolic and bariatric surgery on systemic immune-inflammation index and its relationship with smoking
    (Wiley, 2025) Toprak, Hatice; Toprak, Şükrü Salih
    PurposeThe contribution of obesity to inflammation may play a role in the progression of obesity-associated medical problems. The systemic immune inflammation index (SII) has recently been identified as a prognostic indicator for many adverse conditions. The primary purpose of the present study was to investigate the effects of metabolic and bariatric surgeries on white blood cell (WBC), platelet (PLT), lymphocyte (LYN), neutrophil (NEU), neutrophil/lymphocyte (NLR), platelet/neutrophil (PLR), and systemic immune inflammation index (SII). The secondary aim was to evaluate the effects of sleeve gastrectomy (SG) and gastric bypass (GB) surgeries, the most commonly performed metabolic and bariatric procedures, on individual inflammation parameters and their relationship with smoking status.MethodsThe blood inflammatory markers of the participants who underwent surgery were analyzed using the data evaluated during routine clinic follow-ups in the preoperative period and postoperative 1st, 3rd, 6th, and 12th months.ResultsThe primary result was a statistically significant decrease in WBC, NEU, NLR, and SII values in the 3rd postoperative month in those who underwent metabolic and bariatric surgery (MBS) (p values for each parameter: 0.000, 0.000, 0.028, and 0.006, respectively). A statistically significant decrease in WBC, NEU, and SII values in the 3rd postoperative month compared to preoperative values in nonsmoking individuals with obesity who underwent sleeve gastrectomy surgery was presented as our secondary result (p values for each parameter: 0.000, 0.000, and 0.015, respectively).ConclusionIn our study, MBS provided significant regression in inflammation parameters at 3 months after surgery in people smoking less than 10 cigarettes per day, although this effect did not seem to persist long term.Clinical Trial RegistrationACTRN12623000162617
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    Response to "Integrating predictive analytics and digital health innovations to reduce postoperative emergency department admissions in bariatric surgery"
    (Springer, 2025) Toprak, Şükrü Salih; Toprak, Hatice
    We thank Qiuwen Mi et al. for their valuable comments and suggestions. They suggested that it may be useful to perform individual risk analyses with artificial intelligence tools in the preoperative period for emergency department (ED) visits after metabolic and bariatric surgery (MBS) [1]. Their other suggestion was for the use of individual techno-follow-up tools in the postoperative period.
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    Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: A randomized double-blind controlled trial
    (BioMed Central Ltd, 2022) Bilge, Ayşegül; Başaran, Betül; Et, Tayfun; Korkusuz, Muhammet; Toprak, Hatice; Yarımoğlu, Rafet; Kumru, Nuh
    Background: Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface. The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC). Method: The present study was designed as a double-blind, randomized, controlled, prospective study. A total of 68 patients were included in the study. In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia. No block was performed on the group control. The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded. Results: Pain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results. Conclusion: After the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.