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Öğe Advanced alveolar echinococcosis disease associated with Budd Chiari syndrome(International Journal of Surgery Case Reports, 2015) Soyer, Vural; Ara, Cengiz; Yaylak, Faik; Sarıcı, Kemal Barış; Özsoy, Mustafa; Koç, Okay; Yılmaz, SezaiAlveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd–Chiari syndrome. PRESENTATION OF CASE:In this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd–Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images. DISCUSSION: Initially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients. CONCLUSION: The importance of early diagnosis to prevent advanced complications such as development of Budd–Chiari syndrome and metastasis has been underlined.Öğe Consequences of the use of extended criteria donors in living donor liver transplantation(Annals of Transplantation, 2015) Dirican, Abuzer; Özsoy, Mustafa; Ateş, Mustafa; Ersan, Veysel; Gönültaş, Fatih; Işık, Burak; Yılmaz, SezaiBackground: Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center’s experience in utilizing extended criteria donors for LDLT. Material and Methods: The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. Results: There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien’s system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. Conclusions: Although there was no statistical difference between the 2 groups’ postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor’s postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.Öğe Donor postoperative biliary complications after living donor liver transplant(Experimental and Clinical Transplantation, 2015) Dirican, Abuzer; Ara, Cengiz; Kutlutürk, Koray; Özsoy, Mustafa; Ateş, Mustafa; Başkıran, Adil; Işık, Burak; Yılmaz, SezaiAlthough the main factors responsible for donor deaths after living-donor liver transplant are liver failure and sepsis, the most common donor complications are associated with the biliary tract.Between April 2006 and May 2012, five hundred ninety-three donors underwent living-donor hepatectomy procedures for living-donor liver transplants. The mean age of donors was 31.0 ± 9.9 years and the ratio of men to women was 341:252. Of all donors, 533 (89.9%) underwent a right lobe hepatectomy, 45 (7.6%) underwent a left lateral segmentectomy, and 15 (2.5%) underwent a left hepatectomy.Biliary complications were observed in 51 liver donors (8.6%). Based on the Clavien-Dindo classification, grade I and grade II complications were 3.2% and 0%, while grade IIIa and grade IIIb complications were observed in 3.5% and 1.85% of cases. Right lobe donor biliary complications occurred at the rate of 8.2% in 44 donors. Grade IV and grade V complications were not observed. Grade IIIa complications necessitating radiologic and endoscopic procedures were observed in 21 liver donors (3.5%). Bile leakage unresponsive to medical therapy was detected in 19 donors (3.2%). Nasobiliary catheters were placed in 3 of 19 donors and internal stents were placed in 1. Two sessions of balloon dilatation were performed in the 2 grade IIIb donors (0.33%). Biliary strictures observed in 2 right lobe donors and 1 left lobe donor was treated by hepaticojejunostomy an average of 14 months after surgery.Avoidance of intraoperative issues and early recognition of bile leakage are fundamental in preventing complications in living-donor liver transplant donors.Öğe Donor postoperative biliary complications after living donor liver transplant(Experimental and Clinical Transplantation, 2015) Dirican, Abuzer; Ara, Cengiz; Kutlutürk, Koray; Özsoy, Mustafa; Ateş, Mustafa; Başkıran, Adil; Işık, Burak; Yılmaz, SezaiObjectives: Although the main factors responsible for donor deaths after living-donor liver transplant are liver failure and sepsis, the most common donor complications are associated with the biliary tract. Materials and Methods: Between April 2006 and May 2012, five hundred ninety-three donors underwent living-donor hepatectomy procedures for living-donor liver transplants. The mean age of donors was 31.0 ± 9.9 years and the ratio of men to women was 341:252. Of all donors, 533 (89.9%) underwent a right lobe hepatectomy, 45 (7.6%) underwent a left lateral segmentectomy, and 15 (2.5%) underwent a left hepatectomy. Results: Biliary complications were observed in 51 liver donors (8.6%). Based on the Clavien-Dindo classification, grade I and grade II complications were 3.2% and 0%, while grade IIIa and grade IIIb complications were observed in 3.5% and 1.85% of cases. Right lobe donor biliary complications occurred at the rate of 8.2% in 44 donors. Grade IV and grade V complications were not observed. Grade IIIa complications necessitating radiologic and endoscopic procedures were observed in 21 liver donors (3.5%). Bile leakage unresponsive to medical therapy was detected in 19 donors (3.2%). Nasobiliary catheters were placed in 3 of 19 donors and internal stents were placed in 1. Two sessions of balloon dilatation were performed in the 2 grade IIIb donors (0.33%). Biliary strictures observed in 2 right lobe donors and 1 left lobe donor was treated by hepaticojejunostomy an average of 14 months after surgery. Conclusions: Avoidance of intraoperative issues and early recognition of bile leakage are fundamental in preventing complications in living-donor liver transplant donors. Key words: Liver failure, Sepsis, Bile leakage, Hepatectomy, Postoperative follow-upÖğe İleri evreli kolanjiokarsinomda safen ven yaması ile retrohepatik vena kava inferior rekonstrüksiyonu(Ulusal Cerrahi Dergisi, 2014) Dirican, Abuzer; Özsoy, Mustafa; Barut, Bora; İnce, Volkan; Ateş, Mustafa; Yılmaz, SezaiÖz: Karaciğer rezeksiyonu, primer ve metastatik karaciğer tümörlerinin bilinen tek küratif tedavi seçeneğidir. Diğer malignite türlerinden farklı olarak karaciğer malignitelerinin en iyi kemoterapi rejimlerine yanıt oranları oldukça düşüktür. Tedavi edilmeyen veya geride tümör bırakılan karaciğer malignitelerinde yaşam süresi aylarla ifade edilmektedir. Optimal sağ kalım süresi ancak negatif cerrahi sınır ile karaciğer rezeksiyonları sonrasında elde edilebilmektedir. Bu nedenle karaciğer rezeksiyonu uygulanabilecek hasta sayısını arttırmak amacıyla portal ven embolizasyonu, neoadjuvan kemoterapi, iki basamaklı hepatektomi, re-do hepatektomi, karaciğerin hipotermik perfüzyonu gibi teknikler geliştirilmiş ve halen yeni arayışlar devam etmektedir. Hepatoselüler karsinoma, kolanjiokarsinoma gibi primer karaciğer maligniteleri ve metastatik karaciğer tümörleri anatomik yakınlığı nedeniyle retrohepatik vena kavayı invaze edebilmektedir. Hepatokaval konfluensı veya vena kavayı invaze eden maligniteler intraoperatif masif hava embolisi veya hemoraji nedeniyle karaciğer rezeksiyonları için çoğunlukla kontrendike olarak kabul edilmektedir. Bu makalede kolanjiokarsinoma nedeniyle sol hepatektomi ile birlikte vena kava rezeksiyonu ve safen ven ile rekonstrüksiyon yapılan bir olguyu sunmaktayız.Öğe Metastatik rektum kanserinde eş zamanlı karaciğer rezeksiyonu: olgu sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Celep, Bahadır; Özsoy, Mustafa; Özsan, İsmail; Özkececi, Ziya Taner; Bal, AhmetBu makalede neoadjuvan radyokemoterapi sonrasında tam klinik yanıtın saptandığı karaciğere metastaz yapmış rektum kanserli olguyu literatür verileri eşliğinde sunmayı amaçladık. 66 yaşında erkek hasta, barsak alışkanlıklarında değişiklikler nedeniyle tetkik edilirken karın ultrasonografisinde karaciğer sağ lobunu dolduran solid kitleler saptandı. Kitleden ultrasonografi eşliğinde biyopsi yapıldı. Biyopsi sonucu adenokarsinom metastazı olarak değerlendirilen hastanın kolonoskopisinde anal verg'den itibaren 10. cm’de lümeni kısmen tıkayan ülserovejetan kitle saptandı. Neoadjuvan radyokemoterapi tedavi bitimi sonrasında karaciğerdeki kitlelerinin stabil seyrettiği ancak rektumdaki primer odakta belirgin regresyonun varlığı gözlendi. Hastaya eş seanslı sağ hepatektomi ve low anterior rezeksiyon uygulandı. Görüntüleme yöntemleri ve kontrol kolonoskopi incelemelerinde tam regresyonu saptanması ve bu durumun biyopsi ile doğrulanması halinde bu hastalara rektumla eş seanslı veya sadece karaciğere yönelik cerrahi tedavi şansı verilebilir.Öğe Metastatik Rektum Kanserinde Eş Zamanlı Karaciğer Rezeksiyonu: Olgu Sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Celep, Bahadır; Özsoy, Mustafa; Özsan, İsmail; Özkececi, Ziya Taner; Bal, Ahmet; Arıkan, YükselBu makalede neoadjuvan radyokemoterapi sonrasında tam klinik yanıtın saptandığı karaciğere metastaz yapmış rektum kanserli olguyu literatür verileri eşliğinde sunmayı amaçladık. 66 yaşında erkek hasta, barsak alışkanlıklarında değişiklikler nedeniyle tetkik edilirken karın ultrasonografisinde karaciğer sağ lobunu dolduran solid kitleler saptandı. Kitleden ultrasonografi eşliğinde biyopsi yapıldı. Biyopsi sonucu adenokarsinom metastazı olarak değerlendirilen hastanın kolonoskopisinde anal verg'den itibaren 10. cm’de lümeni kısmen tıkayan ülserovejetan kitle saptandı. Neoadjuvan radyokemoterapi tedavi bitimi sonrasında karaciğerdeki kitlelerinin stabil seyrettiği ancak rektumdaki primer odakta belirgin regresyonun varlığı gözlendi. Hastaya eş seanslı sağ hepatektomi ve low anterior rezeksiyon uygulandı. Görüntüleme yöntemleri ve kontrol kolonoskopi incelemelerinde tam regresyonu saptanması ve bu durumun biyopsi ile doğrulanması halinde bu hastalara rektumla eş seanslı veya sadece karaciğere yönelik cerrahi tedavi şansı verilebilir.
