Gazi Hospital General Surgery Department has been organized to perform patient examination and treatment. Inpatient services, polyclinic and emergency services are carried out 24 hours a day, seven days a week.

The mission of the unit is to provide patient-centered, smiling, qualified, reliable and medical error-free service. Minimally invasive (laparoscopic – bloodless surgery) surgery and emergency surgery being first, in all clinical surgical applications, to become a center of attraction in Istanbul is determined as the vision of the unit.

Thanks to the profoundness of the staff with different interests, they provide pioneer applications in gastrointestinal (digestive system) surgery and hepato-pancreatic biliary surgery (liver, pancreas and biliary tract) surgery, especially in minimally invasive surgery, emergency surgery and endocrine (breast, goitre and adrenal glands) surgery. In terms of hernia surgery, it is becoming a reference center. Laparoscopic hernia surgery (bloodless operation), which is very popular recently, is being performed intensively.

All interventions on colon and rectum (large intestine) diseases are carried out using the most up-to-date technology. Particularly in the anal region disorders such as hemorrhoids, fistulas or fissures, our patients are offered a wide range of treatments.

Radiological examinations (X-ray, ultrasonography, computed tomography, magnetic resonance imaging, angiography, cholangiography) together with endoscopy and percutaneous biopsy methods in Gazi Hospital are used with the aim of obtaining data for the planning of patient care and treatment in coordination with relevant specialists.

The disease group that the examination, tests and treatment can be performed by General Surgery Department is as follows.

• Thyroid gland diseases (goiter, hyperthyroidism)
• Breast cancer and benign diseases of breast
• Esophageal cancer and benign diseases of esophagus
• Gastric cancer
• Surgical diseases of small intestine, intestinal obstructions
• Colon – rectum tumors, inflammatory diseases
• Anorectal diseases: Tumors, Hemorrhoids, anal fissure, fistula
• Benign and malignant hepatic tumors, cysts
• Obstructive jaundice
• Gallbladder and biliary tract stones and tumors
• Pancreatic cysts and tumors
• Acute and chronic pancreatitis
• Surgical diseases of spleen
• Abdominal wall and groin hernia, post-operative hernias
• Miscellaneous soft tissue infections
• Traumas and emergency surgery

In the foreseen clinical outcomes, there is a role for the relationship between the other departments and the operating room which is equipped with up-to-date technology. The “Surgical Intensive Care Unit”, in which in need patients are monitored, also contributes significantly to this process. A multi-disciplinary nutrition team is in charge of care for chronic patients.

With all these features, the General Surgery Department of Gazi Hospital continues to provide highly qualified health services, far beyond the standard private healthcare service.

Call Gazi Hospital 0212 650 18 19 to make an appointment with our doctors in appropriate units for examination purposes.

What is Colonoscopy?

It is the safe and effective visual examination of the entire layer covering the intestine with a long, bendable tubular device. The thickness of the device is smaller than our finger. It is used to diagnose large intestinal diseases, biopsy and removal of polyps.

Who Should Have Colonoscopy?

Problems such as changes in bowel habits, bleeding, etc. may indicate probable problems in the large intestine, and the doctor may recommend colonoscopy. Same time, colonoscopy should be done for;

• Assessment of abdominal pain and signs of unknown origin
• Assessment of inflammatory bowel diseases (Colitis, Crohn’s Disease, Ulcerative Colitis)
• When polyp or tumor is suspected on barium enema of the large intestine
• In case of occult blood in stool
• Unexplained diarrhea and changes in bowel habits
• Patients who have previously had colon polyp or cancer
• In those who have polyp or Colon Cancer history in their family.

 

Information Patient Should Give to Physician Before the Colonoscopy

Do you use blood-thinning medicine/aspirin and its derivatives (Voltaren, Apranax, Ibufen, Naprosin etc)?

Is there a health problem that requires the use of antibiotics?

Is there a tendency to bleed? (Does nose bleeding, bleeding after an accident last a long time?

Do you have Diabetes/Heart disease/Neurological disease? Are you pregnant?

How to Prepare for Colonoscopy?

Patients must be fasting on the day of examination. If used, heart, blood pressure and thyroid medications should be taken with very little water.
Special cases/Drug use

• Anyone who is allergic to any medicine, has heart and lung disease and pregnancy conditions should inform the doctor.
• Patients using insulin may consult their metabolism physician to adjust the dose of the drug on the day of procedure. They can take their medicine after the procedure by bringing them to the colonoscopy unit.
• Patients using blood thinning medication (coumadin, dipyridamole, etc.) should consult their physicians before the procedure and ask them to adjust these medications for colonoscopy.
• At least 1 week before the colonoscopy, aspirin and other anti-inflammatory drugs (ibufen, naprosin, etc.) should be discontinued.
• Fibrous food consumption and ready-made fiber products and iron preparations should not be used at least 1 week before the procedure.
• In addition to the above, if there are other medicines that the patient regularly uses, especially if there is a necessity to use antibiotics, it is necessary to inform the doctor when making an appointment.
• You should not discontinue the medicines you need to stop taking for colonoscopy unless you talk to your related physician.

 

Bowel Preparation

Intestinal cleansing should be done before colonoscopy. A good intestinal cleansing is essential for the examination of the layer covering the inner surface of the large intestine. For this reason, the doctor may recommend fibrous food restriction a day or two before the procedure. In addition to this, special solutions are given for intestinal cleansing which are taken orally and provide brief cleansing. In this period there will be excessive water loss, so plenty of water is required to be drank. (The doctor describes the intestinal cleansing in detail.)

 

How is Colonoscopy Done?

The nurse records the blood pressure and pulse in the unit where the procedure would proceed. The nurse inserts an IV line to give sedative and analgesic medication during the procedure and saline infusion is started.

For the colonoscopy procedure, patient lies on his left side and the feet are pulled toward the abdomen. The patient receives sedative anesthesia. Does not feel or remember the procedure. The doctor first examines the anal region. Using a glove, evaluates the last part of the large intestine and anus with his finger. Following this, the colonoscopy device is pushed forward and the large intestine begins to be investigated. In order to perform this examination, it is necessary to inflate the intestine by giving air. The examination continues until the large intestine merges with the small intestine. Thus, the entire large intestine (colon and rectum) is examined. During the procedure, biopsies may be taken where necessary (tissue fragments) and polyps (fluffy, benign formations in the large intestine) may be removed.

It can usually be done in less than half an hour and the patient can eat normally in the same day. After colonoscopy, the tension and feeling of bloating in the abdomen decreases with flatulence.

 

What Should be Considered After the Procedure?

Sedative drugs are given during colonoscopy. Therefore, it is necessary not to drive on that day or be alone after the procedure. Fatigue is felt after the procedure, reflexes are prolonged, and healthy decision making is suppressed. For this reason, it is the right thing to have a companion. Until you wake up well after the procedure, you should stay at the unit for a while under observation.

• For the rest of the day, it is necessary not to go to work, make important decisions, take the responsibility of small children, drink alcohol, patients should rest.
• If only colonoscopy is performed: (if no biopsy is taken)
• On the same day the normal diet can be started
• For 12 hours after the procedure, work requiring attention, driving and exercise should be avoided
• Medication can be started on the same day if blood thinners or aspirin is needed
• *If colonoscopy and biopsy or polypectomy is done: (a piece was taken)
• Normal diets can be started on the same day unless the doctor recommends the otherwise. Nuts, corn, etc. should not be eaten before 72 (seventy two) hours.
• For 12 (twelve) hours after the procedure, work requiring attention, driving and exercise should not be done.
• Aspirin and similar drugs are not used for 7 (seven) days. If necessary, acetaminophen derivatives can be used.
• You need to talk to your doctor about blood thinning medicines

 

When to Get a Biopsy (Piece/Sample)?

If the physician observes any suspicious area in the intestine during the procedure, he may want to take samples for further investigation. For this, a piece is removed through the biopsy channel of the colonoscope with the help of a special instrument. These tissue fragments (biopsy) are analyzed in the pathology laboratory.

 

What is Polypectomy?

Polyps arise with abnormal growth of the layer (mucosa) that covers the surface of the large intestine (colon and rectum) and they grow into the intestinal tract (lumen). In other words, the protuberances on the lining that covers the inner surface of the intestine are called polyps. The removal of polyps by the help of endoscopy (colonoscopy-sigmoidoscopy) is called polypectomy. Polyps can be removed with the help of special instruments during endoscopy. The diameters of the polyps can range from a few millimeters to a few centimeters. If the physician notices any polyp during the examination, it should be removed and sent for analysis. During this procedure the patient will not feel any pain.

For bigger polyps, multiple treatment modalities may be required for complete removal. However, some polyps can not be removed by endoscopic methods because of their size, position and number. In this case, the polyp containing section of the large intestine must be surgically removed. Small polyps often cause no complaints, however can cause complaints such as bleeding, abdominal pain over time. Most of the polyps are benign. Polyps should be removed early since they are precursor lesions in development of cancer.

 

What are the Benefits of Colonoscopy?

Colonoscopy removes polyps without the need for abdominal surgery, and is more sensitive than radiological methods in the examination of polyps and early stage cancers. Removal of polyps prevents complications such as bleeding and cancer development that may arise in later stages.

If the person having colonoscopy is regularly taking aspirin or other medicines that interfere with clotting, if there is a tendency to bleed or has diabetes, the physician should be warn before the procedure. Normal food may be eaten the same day after the procedure, and excessive exercise should be avoided for 12 hours. Patients who have undergone polyp removal during the procedure should not take aspirin for 7 days, patients taking other blood thinners should consult their physician about starting the medicine, and should not take any medication that would make it easier to defecate for three days.

 

Are There Side Effects of Colonoscopy?

It is an examination performed safely by experienced specialized physician. Very rarely, there are some complications. During the procedure, a tear may develop in the large intestinal wall and intestinal contents may pass into the peritoneum. This condition can cause inflammation in the inner membrane of the abdomen.

Another side effect is bleeding from the area where a piece is taken or polypectomy is performed. They usually stop spontaneously. If there is severe pain, chills, shivering, vomiting, high fever, suddenly fresh red blood coming from anus after the procedure, you should definitely call the doctor.

 

Gastroscopy

Upper Gastrointestinal Endoscopy (Gastroscopy)

It is the procedure of direct visual examination of esophagus, stomach and part of small intestine (duodenum). This examination is performed by inserting a long, bendable tube of small diameter with a bright light at the end, inside your mouth. Your doctor looks at the images reflected on the screen and searches for any disease. He can take small tissue specimens (biopsies) for more detailed laboratory analysis when it is necessary. Tissue samples are endoscopically painlessly taken with forceps.

Some treatments can also be done with the endoscope. For example, enlargement of stenosis, removal of tumors called polyps and foreign bodies, stopping bleeding blood vessels and ulcers with thermocoagulation or by injecting tissue hardener.

 

Preparation

To get a clear image, you stomach should be empty. So you will be asked not to eat or drink anything at least for 6 hours before the test. Take your medicine after the procedure if you have diabetes. If you have any allergies to medicines or if you have any infectious diseases such as jaundice please do not hesitate to tell the doctor or the nurse. Doctors will want to know the results of your previous endoscopy procedures. If you have any concerns or problems at this stage, do not be afraid to ask. Also remove your glasses, contact lenses and dentures before hand.

 

Procedure

In the examination room you will lie on your left side on the endoscopy table. The nurse will be with you throughout the procedure. A local anesthetic drug will be sprayed to your throat to numb. Sometimes a gluteal injection can be made to calm you down and keep you in the light sleep, if necessary it can be performed under anesthesia. A plastic mouthpiece will be placed between your teeth to keep your mouth slightly open and to protect your teeth.

The doctor will guide the endoscope through your mouth and throat and direct it downward. In the meantime, the endoscope does not cause any pain and does not prevent you from breathing. It takes about five minutes to get the whole of the stomach examined. The duration of examination will be shortened if you cooperate. Air can be given to your stomach during operation to allow the doctor to see better. The air will be removed at the end of the process.

 

After Procedure

After the procedure you will rest for at least 30 minutes in the recovery room. Do not take solid or liquid food until your swallowing reflex returns to normal (usually for half an hour) since your throat is locally anesthetized. After this time you can eat your normal food. There may be numbness and pain in your throat after the examination. You may also feel a little bloated if we have air left in your stomach. All of these conditions are temporary and do not require treatment.

If sedative medication is applied, you will need an assistant to take you home. It is important that you spend the rest of your day at rest when you get home. Sedation can take longer than you think. You should also not drive, use a heavy construction equipment, make important decisions, or use alcohol.

 

When Do You Get the Results?

In most cases the doctor will tell your results immediately after the procedure or as soon as you wake up if you are unconscious. If the microbial test (Helicobacter pylori urease test) was performed, you will have to wait 24 hours for the final result. However, if the biopsy was taken for the examination, it may take up to 1 week for the results to come off. If you have been sedated, it would be useful to have someone near you while talking to the doctor after the procedure. Because the patients frequently forget everything that is said to them during this conversation and there is nothing left in their mind about the process. The details of the results and which treatment is required, should be discussed with the doctor who has referred you to the procedure.

Hakkı KÖSE, MD
General Surgery Specialist