General Surgery

Yeditepe University Hospital’s Department of General Surgery not only treats our patients, it seeks to advise and inform patients with a view to redirecting their lives towards healthy and happiness.

At Yeditepe, we combine the specialty fields of Endocrine Surgery, Breast Surgery, Surgical Gastroenterology, Liver and Bile Duct Surgery, Peripheral Vascular Surgery, Varicose Vein Disease and Obesity Surgery in a multidisciplinary approach that embraces joint efforts with the departments of Oncology, Radiology, Plastic Surgery and Psychiatry.

The most common form of cancer in women, breast cancer has a high chance of being cured if it is caught early. The probability of breast cancer increases with age. For this reason, it is essential that women over the age of 40 have an annual mammography and a physical examination by a doctor. Women should also examine themselves for signs of breast cancer once every month. These simple precautions will facilitate early diagnosis and cure.

Yeditepe University Hospital is fully aware of the vital importance of early diagnosis in breast disease. Advanced diagnostic and treatment technology combines with a highly experienced team aiming to implement Yeditepe University Hospital’s distinctive multidisciplinary approach. Yeditepe University Hospital Breast Surgery and General Surgery physicians explain that during the course of their lives, one in 8 women will suffer from breast cancer, making it the second deadliest cancer.

The American Cancer Society’s breast cancer figures for the United States indicate that every year about 230,000 new cases of invasive breast cancer are diagnosed in women, about 65,000 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer), and about 40,000 women die from breast cancer. The chance that breast cancer will be responsible for a woman’s death is about 1 in 36 (about 3%).

Our physicians explain that recent advances in terms of mammographic screening programs and hormone replacement therapy (HRT) have increased the effectiveness of treatment especially in women over the age of 40.

The fatality rates are high in cases that are not diagnosed early. All women over the age of 20 should receive a breast examination and USG / mammography once every 1-3 years, annually over the age of 40; this is the most effective facilitator of early diagnosis.

Women over the age of 40 are advised to get regular mammographic scan tests even if they do not show any symptoms of the disease. It is known that breast cancer fatality rates have declined by 19-64% (and an average of 30%) in countries where regular scanning is conducted. Younger women should also benefit from self-examination, physical examination and ultrasonography.

Indications of breast diseases include mass, structural deterioration, asymmetry between the breasts or clusters of micro-calcification. Since these symptoms can indicate both benign and malignant disease, scan test results must be evaluated by an experienced breast surgeon and radiologist. Women who notice the development of any hardness, lumps or similar issues should immediately seek medical advice even if their previous mammography tests have been normal.

Incidence of breast cancer in first degree relatives (mother, aunt, grandmother or daughter) is known to be a significant risk factor. The risk is elevated further if such cases occurred before the menopause and / or involved both breasts (bilateral breast cancer).

Hereditary breast cancer genes are responsible for the development of 5% of all breast cancers. Hereditary breast cancer syndromes are observed in 5-10% of breast cancer patients. Two genes are responsible for 80% of breast cancers: BRCA-1 and BRCA-2. The risk of a woman with the BRCA-1 gene contracting breast cancer by the age of 70 is 85%; she also has a 45% chance of getting ovarian cancer. The figures for carriers of the BRCA-R gene are 84% and 76% respectively. Genetic testing is required in order to establish the occurrence of the BRCA-1 and BRCA-2 genes.

This group is advised to undergo breast examinations from the age of 18, mammography between the ages of 25 and 35, with clinical breast examinations every six months to one years and annual MRI breast scan tests from the age of 25-35. In addition, women in this group should undergo ovarian cancer testing once every six months from the age of 30-35.

The first treatment option for breast cancer that has been caught early is surgery. Either the tumor is excised leaving unaffected tissue in place, or the whole breast is removed. The lymph glands under the armpits are also removed in order to establish whether metastasis (the spread of the cancer) has occurred. Surgical intervention allows determination of the stage that the cancer has reached and what supplementary treatments may be required (radiation, hormones, chemotherapy). Recent advances in breast cancer surgery and supplementary treatment allow excellent results.

Yeditepe University Hospital’s standards of excellence and the use of the latest technology is fully reflected in our Breast Surgery Center, where women over the age of 40 are strongly advised to get regular mammographic scan tests even if they do not show any symptoms of the disease. It is known that breast cancer fatality rates have declined by 19-64% (and an average of 30%) in countries where regular scanning is conducted. Younger women should also benefit from self-examination, physical examination and ultrasonography.

Women who notice the development of any hardness, lumps or similar issues should immediately seek medical advice even if their previous mammography tests have been normal. A family history of breast cancer in first and second degree relatives is an indication of a risk of hereditary breast cancer.

In addition, hereditary breast cancer can be associated with ovarian cancer in young women between the ages of 20 and 30. A mother or sister with breast cancer is a high risk indication.

The first treatment option for breast cancer that has been caught early is surgery. Either the tumor is excised leaving unaffected tissue in place, or the whole breast is removed. The lymph glands under the armpits are also removed in order to establish whether metastasis (the spread of the cancer) has occurred.

Surgical intervention allows determination of the stage that the cancer has reached and what supplementary treatments may be required (radiation, hormones, chemotherapy). Recent advances in breast cancer surgery and supplementary treatment allow excellent results.

Whereas in the past there was no other option than to remove the entire breast and lymph glands, nowadays, early diagnosed cases are much more rarely treated in this way. In half of cases it is possible to treat the cancer by removing the tumor alone, with subsequent breast-conserving radiotherapy.

This is because there is no real difference in the effectiveness of conserving treatment when compared to the removal of the entire breast. We can now examine approaches to surgical treatments, the breasts and lymph nodes in more detail.

Rather than removing the entire breast, excision of the tumor alone in suitable single-tumor cases is preferred because breast cancer case fatalities are caused not by systemic recurrence but by metastasis.

Brest-conserving surgery involves the removal of the tumor tissue together with about 1-2 cm of surrounding normal breast tissue (wide excision, tumorectomy or lumpectomy.) Other techniques involving the removal of tissue from a wider area are called “quandrantectomy” or “partial mastectomy.”

After the removal of any mass by the Radionuclide-Guided Occult Lesion Localization (ROLL) technique that mammography or ultrasound-guided wire testing has indicated may be malign or palpable, X-rays are taken to establish whether it has been successfully removed.

Breast-conserving surgery is most applicable in early stage (stage I – II) cases where the tumor is small and unifocal, and in patients who are suitable candidates for post-surgical radiotherapy. Post-surgical recurrence rates vary according to the exact nature of the tumor but there is a general 0.5 – 1% rate of recurrence in the same breast.

It is important to establish that the patient has been fully informed about the surgery before the procedure, and to be sure that the patient will be able to attend subsequent radiotherapy and follow-up examinations and tests.

This is because it will be necessary to monitor the patient very carefully for a prolonged period of time. If the patient requires post-surgery chemotherapy, this is completed before radiotherapy is administered.

The treatment plan at the Yeditepe University Hospital is multi-disciplinary. Specialists in the fields of general surgery, radiology, pathology, medical oncology and radiation oncology all work together in order to provide the exact treatment plan that suits the patient’s disease and condition. Generally the first specialist to evaluate the patient is the surgeon. Importance is also attached to psychological and psychiatric evaluation both before and after surgery.

Breast cancer is the most commonly occurring cancer in women throughout the world. The early diagnosis of cancer and correct staging are critical factors in determining the course of the disease and patient survival.

Other more commonly used methods such as ultrasound, mammography and MRI scans can sometimes be inadequate in the evaluation of suspicious lesions in the breast, and in establishing the correct staging of malign disease.

PEM technology has only emerged in recent years. It has the capacity to detect very small lesions in the breast that have not yet reached anatomic visibility. This equipment only exists in a few centers around the world and is one of just two in Europe.

Just as with other nuclear medicine examinations and PET scans, after waiting for about 60-90 minutes for the intravenously administered radioactive material to infiltrate the body, abnormal breast tissue involvement is precisely determined with high resolution PEM imaging up to a sensitivity of 1.6 mms.

In addition, the procedure is far more comfortable for the patient since it is designed to operate without squeezing or compressing the breast, in a motionless state.

PEM’s sensitivity in showing breast lesions has been reported as being above 90%; it therefore facilitates more accurate staging and surgical planning without unnecessary biopsies and re-excisions, and allows preventive and protective breast surgery.

It is also more accurate and specific than anatomic imaging methods in terms of assessing patients’ responses to treatment, and detecting local recurrences.

• Diagnosis of patients with mammographic or MRI results that identify suspicious breast lesions
  
• Planning and staging prior to breast cancer surgery
  
• Investigating contralateral malignancy in multicentric / multifocal tumors
  
• Axillary lymph node metastasis investigation
  
• Re-staging of locoregional recurrence
  

• Colorectal Surgery
  
• Digestive System Surgery
  
• Hepatobiliary Surgery (diseases of the Liver)
  
• Endocrinal Surgery
  
• Obesity and Metabolic Diseases Surgery
  
• Peripheral Vascular Surgery

Colorectal surgery is the field of medicine dealing with disorders of the rectum, anus, and colon. We believe that our Center at Yeditepe University Hospital offers you and your family the best option in the region for the following principle reasons:

• Yeditepe University Hospital’s Colorectal Surgery Center is here to give our international patients the highest level of care, comfort and hope.
  
• We offer the very latest surgeries for colorectal disease, some of which are not available at many other centers in the region.
  
• We provide true multidisciplinary care, bringing together a team of specialists who meet regularly to discuss each patient’s case.
  
• We realize you may come from far away for your care, so we organize your appointments in the most convenient way possible, liaising with your medical specialists in your home country to the required degree through the dedicated Recovery Specialist.

Yeditepe University Hospital’s surgeons provide patients with minimally invasive options whenever possible. Our surgeons use laparoscopic surgery to make incisions only millimeters in size. These small incisions create a passageway for special surgical instruments and a laparoscope. A laparoscope is a fiber-optic instrument that is inserted in the abdominal wall. This device transmits images from within the body to a video monitor, allowing the surgeon to see the operative area on the screen.

Advantages to the minimally invasive approach include:

• Quicker recovery
  
• Quicker return to normal activities and work
  
• Shorter hospital stay
• Reduced rate of infection
• Reduced recurrence rate
• Minimal scarring

The Yeditepe University Hospital GI Surgery Center provides comprehensive care for patients with diseases of the gastrointestinal tract, and features a highly experienced team of doctors who specialize in treating the most complex cases. Our Center uses the most advanced laparoscopic techniques to treat all types of gastrointestinal illnesses. There are many advantages to this approach, including quicker recovery and shorter hospital stays, as well as a significantly reduced risk of infection and recurrence.

Although we perform surgeries minimally invasively whenever possible, we are also very experienced in performing traditional (open) surgery. Most importantly, each treatment is tailored to meet the needs of each individual patient.

The Yeditepe University Hospital GI Surgery Center offers surgical treatment for a wide range of gastrointestinal- and abdominal-related illnesses, including:

• Peptic ulcer disease
  
• Hiatal hernia
  
• Infectious diseases of the colon and rectum
• Reflux esophagitis (or GERD) and its complications
• Barrett’s esophagus
• Radiation bowel injury
  
• Primary neoplasms of the stomach, small bowel, colon and rectum
  
• Achalasia
  
• Inflammatory bowel disease and continent reconstruction
• Gastrointestinal tumors
• Primary and metastatic liver tumors
• Benign and malignant diseases of the biliary tract
• Benign and malignant diseases of the pancreas
  

Yeditepe University Hospital’s Center for Hepatobiliary Surgery brings together the extensive resources of Yeditepe University Hospital, to focus on providing well-coordinated, multidisciplinary, international patient- and family-centered care for adults with malignant and benign conditions that affect the liver, the biliary system, and the pancreas.

Hepatobiliary cancers include those of the liver, gallbladder, bile ducts, and pancreas. Our research team also develops treatments for metastatic cancers that arise elsewhere in the body and spread to these organs.

Our team implements techniques that spare healthy tissue during surgery and result in reduced blood loss as well as nonsurgical approaches such as tumor embolization, radiofrequency ablation, and cryosurgery, when appropriate. We have also pioneered innovative chemotherapy approaches for these cancers, including new methods of delivering anticancer agents directly to the liver. Research by our pathologists and radiologists has led to advances in diagnostic and prognostic approaches.

We provide comprehensive, multidisciplinary evaluation, diagnosis, and the latest, most effective treatments to patients with the conditions listed below. We also provide second opinions. When clinically appropriate, we offer patients the latest minimally invasive approaches to surgical treatment, including robot-assisted surgery, and access to investigational therapies through clinical trials.

• Pancreatic cancer
  
• Pancreatic masses
  
• Pancreatitis Liver cancer
• Liver masses

The Endocrine Surgery Center at Yeditepe University Hospital consists of a multidisciplinary team of specialists dedicated to providing quality, innovative and comprehensive treatment of benign and malignant diseases of the endocrine system (thyroid gland, parathyroid glands, adrenal glands and pancreas).

• Quality patient care
  
• Specialized surgical expertise
  
• Advanced medical education
• Innovative clinical research

Our specialists are experts in their fields and provide the experience, knowledge, skills and enthusiasm that our international patients deserve. Under Yeditepe University Hospital’s celebrated interdisciplinary philosophy, we combine the diagnostic and treatment strengths of leading medical experts, including, endocrine surgeons, transplant surgeons, endocrinologists, geneticists, radiologists, radiation oncologists, pathologists and oncologists, to unify state-of-the-art treatment options into personalized care. Partnering with the referring physician, we can provide the highest quality and greatest continuity of care for our patients.

The Endocrine Surgery Center is one of the few in the region that is solely dedicated to the diagnosis and treatment of endocrine diseases, including complex, advanced and recurrent disease

One of the modern world’s most severe health issues, obesity is not only an esthetic issue but also affects the overall health and quality of life of millions of people.

The Yeditepe University Hospital Obesity Clinic caters for international patients and their accompanying persons, offering the latest techniques, advice, programs and surgery in liaison with international patients’ medical professionals in their home countries.

Operating as a sub-unit of the General Surgery Center, the Yeditepe University Hospital Obesity Clinic uses laparoscopic technology to perform bariatric surgery that is known as the “Permanent Weight Loss Method” as a result of significant body weight loss. This method begins to show significant results after 6 months, and takes up to 18 months in total. With the additional support and consultation of psychologists and dieticians, this can give our international weight loss surgery patients a whole new life of good health and activity.

Patients who seek information on obesity from public sources are exposed to information overload and sometimes misinformation.

Accurate and updated information can only really be obtained from fully equipped centers such as the Yeditepe University Hospital Obesity Center that specialize in obesity surgery.

Successful obesity surgery cannot only be defined as a certain degree of weight loss over a short period of time. It must also be medically acceptable and proven, and maintain the weight loss in the long term with minimum side effects or complications.

The Yeditepe University Hospital Obesity Clinic caters for international patients, their families and accompanying persons, offering the latest techniques, advice, programs and surgery in liaison with international patients’ healthcare providers and professionals in their home countries.

Yeditepe University Hospital brings together a wide array of surgical branches as part of our multidisciplinary approach to all health and obesity issues. Thus, our Obesity Surgery Unit is fully integrated into other fields of specialization including the Anesthesiology and Reanimation, Endocrinology, Psychiatry, Exercise and Nutritional Physiology, Dietetics and Plastic and Reconstructive Surgery. International patients are offered the services of other Centers as and when required.

At the Yeditepe University Hospital Center of Obesity and Weight Loss Surgery we offer international patients a comprehensive program designed to help them lose significant weight, keep it off, and improve their health and well-being over the long term.

International patients are provided with a dedicated professional at our International Services Department throughout their stay at Yeditepe University Hospital, who will assist the patient and accompanying persons in all aspects of their treatment, including liaison with healthcare professionals in their home country.

• Extensive pre-operative evaluation and preparation
  
• Psychological evaluation
  
• Pre and post-op behavior modification program run by our psychologist, dietician, in weekly support groups
  
• Personal trainer diet counseling with our registered dietician
  
• Lifelong follow up and liaison with the patient’s healthcare providers in their home countries
  

• Efforts to lose weight with diet and exercise have been unsuccessful
  
• Your body mass index (BMI) is 40 or higher (extreme obesity)
  
• Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea
  
• In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems