Faculty of Medicine

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Author: search.filters.author.Mehmet Hanifi OkurLanguage: search.filters.language.English

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    LAPAROSCOPIC VERSUS OPEN KASAI PORTOENTEROSTOMY FOR BILIARY ATRESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS BY THE PEDIATRIC SURGERY META-ANALYSIS STUDY GROUP (PESMA)
    (European Society of Paediatric Endoscopic Surgeons, 2025-10)
    Duygu Gurel
    ;
    Mustafa Azizoglu
    ;
    Carlos Delgado Miguel
    ;
    Federica Pederiva
    ;
    Mehmet Hanifi Okur
    Introduction: Biliary atresia (BA) is a rare but life-threatening neonatal liver disease requiring timely surgical intervention. The Kasai portoenterostomy (KPE) is the standard treatment, traditionally performed via laparotomy. Recently, laparoscopic approach has been introduced, but its efficacy remains debated. This systematic review and meta-analysis compared laparoscopic and open KPE in patients with BA. Methods: A comprehensive literature search of PubMed, Scopus, EMBASE, and Web of Science was conducted through April 2025. Primary outcomes were jaundice clearance, cholangitis, overall complications, 2-year native liver survival rate, and postoperative intestinal obstruction. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using Mantel–Haenszel methods under fixed- or random-effects models, based on heterogeneity (I²). We used RevMan 5.4 software meta-analysis statistic program. Results: A total of 26 studies were included. Jaundice clearance (17 studies; OR=1.10; 95%CI: 0.76–1.59; p=0.61; I²=42%) and cholangitis (15 studies; OR=1.17; 95%CI: 0.87– 1.59; p=0.30; I²=0%) rates showed no significant differences between laparoscopic and open groups. No significant differences were observed in overall complication rates (8 studies; OR=0.71; 95%CI: 0.24–2.09; p=0.54; I²=57%). Postoperative intestinal obstruction (7 studies) and 2-year native liver survival (8 studies) also showed comparable outcomes (OR=0.91; 95% CI: 0.36–2.27; p=0.83; I²=0% and OR=0.74; 95% CI: 0.49–1.10; p=0.13; I²=30% respectively). Conclusion: Laparoscopic KPE appears to be a safe and feasible alternative to the open approach, with comparable outcomes across major clinical parameters. While current evidence supports its feasibility, further high-quality prospective studies are needed to validate these findings and inform surgical practice.
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    Generative Artificial Intelligence Accuracy in Interpreting Forest Plots in Pediatric Surgery Meta-analyses: A Perspective From Pediatric Surgery Meta-analysis Study Group (PESMA)
    (Elsevier BV, 2025-04)
    Mustafa Azizoglu
    ;
    Maria Escolino
    ;
    Tahsin Onat Kamci
    ;
    Sergey Klyuev
    ;
    Sonia Perez Bertolez
    Pediatric surgery is a relatively newer specialty compared to fields such as orthopedics, internal medicine, and pediatrics. The number of pediatric surgeons worldwide is significantly lower than in many other medical disciplines. Consequently, this has resulted in a lower cumulative volume of academic research in pediatric surgery, including a smaller number of meta-analyses. However, in recent years, there has been a noticeable increase in the number of meta-analyses within this field and dedicated pediatric surgery meta-analysis study groups such as PESMA have emerged. Despite this progress, there remains a considerable need for further research in this area.
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    Hyperbilirubinemia is a predictor of appendiceal perforation in children: A meta-analysis
    (2023-04)
    Mustafa Azizoğlu
    ;
    Mehmet Hanifi Okur
    ;
    Bahattin Aydoğdu
    ;
    Tuğçe Merve Orbay
    ;
    Ayten Ceren Bakir
    Objective: In this meta-analysis, our goal was to examine the diagnostic utility of bilirubin in identifying complicated from uncomplicated pediatric appendicitis. Materials and methods: Using the databases Embase, PubMed, Scopus, and Cochrane, we carried out a thorough literature search up to 2022. Studies comparing complicated appendicitis (CA) and simple appendicitis (SA) in terms of hyperbilirubinemia in the pediatric population were included. Results: A total of 5 studies with 2740 acute appendicitis patients (1097 complicated appendicitis and 1643 simple appendicitis) were included in this meta-analysis. Five studies have discussed the diagnostic value of total bilirubin (TB). When compared to simple appendicitis, complicated appendicitis had a significantly higher TB count (I2=94%), (WMD=0.18, 95% CI -0.00 to 0.37; P=0.05), DB count (I2=0%), (WMD=0.11, 95% CI 0.04 to 0.18; P=0.002), and IB count (I2= not applicable), (WMD=0.04, 95% CI 0.01 to 0.07; P=0.02). Conclusions: In conclusion, in this meta-analysis, total bilirubin, direct bilirubin, and indirect bilirubin values were higher in complicated appendicitis compared to simple appendicitis. Both total bilirubin and direct bilirubin can be used as diagnostic parameters in childhood appendicitis to differentiate complicated appendicitis from simple appendicitis.