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Öğe Biliary Complications in 106 Consecutive Duct-to-Duct Biliary Reconstruction in Right-Lobe Living Donor Liver Transplantation Performed in 1 Year in a Single Center: A New Surgical Technique(Elsevier Science Inc, 2011) Kirimlioglu, V.; Tatli, F.; Ince, V.; Aydin, C.; Ersan, V.; Ara, C.; Aladag, M.Objective. Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods. Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-to-duct anastomosis. Results. All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion. We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.Öğe Changing of antioxidant enzyme activity on the biliary obstructed rats treated with resveratrol(M H Schaper Gmbh Co Kg, 2007) Cenesiz, S.; Yarim, G. F.; Karabulut, A. B.; Ara, C.The aim of this study was to evaluate the role of antioxidant enzyme activity and nitric oxide levels induced by 28 day biliary obstruction in the rat. A total of 21 young Swiss albino rats were divided in to 3 groups. Bile duct ligations, bile duct ligations plus resveratrol, sham operated. Bile duct ligations plus resveratrol group received 10 mg/kg dose of resveratrol intraperitonealy once daily throughout for 28 days. Liver damage and cholestasis were determined by biochemical examination. SOD, CAT and GSH-PX activity decreased in BDL group compared with shame opareted groups (p < 0.001). NO levels increased in BDL groups compared with shame opareted groups (p < 0.001). SOD, CAT and GSH-PX activity was found higher in BDL+resveratrol treated groups than BDL groups (p < 0.001). In addition this NO levels decreased in BDL+resveratrol treated groups than BDL groups (p < 0.001). In conclusion, it is thought that resveratrol may be used as a protective agent in biliary obstructions; however, further clinical and experimental studies are needed to verify its antioxidative and hepatoprotective effects.Öğe Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation(Elsevier Science Inc, 2015) Ara, C.; Akbulut, S.; Ince, V.; Aydin, C.; Gonultas, F.; Kayaalp, C.; Unal, B.Integration of hepatic vein tributaries with a diameter >= 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multi-detector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Donor Complications Among 500 Living Donor Liver Transplantations at a Single Center(Elsevier Science Inc, 2012) Ozgor, D.; Dirican, A.; Ates, M.; Gonultas, F.; Ara, C.; Yilmaz, S.Introduction. Living donor liver transplantation (LDLT) has become necessary because of the shortage of cadaveric organs. We retrospectively analyzed 500 living donor hepatectomies using the Clavien classification system for complications to grade their severity. Materials and methods. We retrospectively identified and applied the Clavien clasification to 500 consecutive donors who underwent right for LDLT left hepatectomy between January 2007 and August 2011. Results. The 149 complications were observed in 93 of 500 (18.6%) donors who were followed for a mean 30 months. There wan no donor mortality. Complications developed in 85 (18.6%) right 5 (35.7%) left, and 3 (10%) left lateral segment hepatectomy donors. The overall incidence of reoperations was 7.2%. Seventy-seven of 149 complications were grade I (51.6%) or 9 grade II (6%). The major complications consisted of 27 (18.1%) grade IIIa, 35 (23.4%) grade IIIb, and 1 (0.6%) grade IVa. Grade IVb and grade V complications did not occur. The most common problems were biliary complications in 14 of 181 donors (7.7%). Conclusion. Donors for LDLT experienced a range of complications.Öğe Liver Transplant With a Marginal Donor Graft Containing a Hydatid Cyst-A Case Report(Elsevier Science Inc, 2013) Eris, C.; Akbulut, S.; Sakcak, I.; Kayaalp, C.; Ara, C.; Yilmaz, S.Liver transplantation has become the standard treatment for acute failure and end-stage liver disease, but there are fewer donor organs available than patients on the waiting list. The donor pool may be increased by using marginal donor candidates. Some infectious and metabolic diseases have been transmitted to the recipient via marginal donor grafts. Hydatid cyst disease is rarely transmitted to a recipient from the donor graft. A literature search showed only 2 previous cases of liver transplantation using a donor graft that contains a hydatid cyst. We treated a 19-year-old woman who experienced acute on chronic end-stage liver failure secondary to cryptogenic cirrhosis. The liver graft from a 97-year-old marginal cadaveric donor contained a calcified hydatid cyst. No complication was associated with the hydatid cyst at 3 years after transplantation. The present case shows that donor livers with an inactive, calcified hydatid cyst may be used for emergency liver transplantation after considering the location, size, and relation of the cyst to vascular and biliary structures. The cyst may be resected on the back table with a successful treatment outcome.Öğe Melatonin Ameliorates Tacrolimus (FK-506)'s Induced Immunosupressive Effect in Rat Liver(Elsevier Science Inc, 2009) Karabulut, A. B.; Ara, C.Tacrolimus (FK-506) is a powerful immunosuppressive agent that modulates neutrophil infiltration during inflammation. In this study, we sought to investigate the effects of melatonin on malondialdehyde (MDA), nitric oxide (NO), interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-alpha) to oppose the negative effects of the immunosupressant FK-506. Group A was sham; group B, tacrolimus (1 mg/kg/d subcutaneously); and Group C received tacrolimus (1 mg/kg/d plus melatonin). All tissues underwent histopathologic examination. The MDA level in group B increased 53% compared with the sham group (P < .001); in group C, the MDA level decreased 1.6% compared with group B (P > .05). While TNF-alpha in group B increased 68.8% compared with the sham group (P < .001) and in group C it decreased 63.5% compared with the sham group. The IL-6 level in group B increased 81%; in group C, it decreased 13% compared with group B. NO levels in group B increased 48% compared with the sham group and increased by 15% in group B compared with group C. Thus melatonin may serve as a protective agent against the side effects of tacrolimus.Öğe Partial Cholecystectomy: A Technique That Makes Hilar Dissection Easier in Recipient Hepatectomy(Elsevier Science Inc, 2014) Ara, C.; Ozdemir, F.; Ates, M.; Ozgor, D.; Kutluturk, K.Background. Intraoperative blood loss and red blood cell transfusion requirements have a negative impact on outcome after orthotopic liver transplantation. In this study we compared blood transfusion requirements, bile duct injury, and dissection of hepatic artery rates in the patients with or without partial cholecystectomy during recipient hepatectomy. Methods. From December 2008 to August 2011, 100 recipient hepatectomies were performed by the same surgeon. Patients were divided into 2 groups. The first group included patients with partial cholecystectomy, and the other group patients without partial cholecystectomy. Each group consisted of 50 patients. Results. In recipient hepatectomy group without partial cholecystectomy, intraoperative blood transfusions were in the range of 3-11 units (mean, 6.3 units). In this group there were 4 hepatic artery dissections and 2 bile duct injuries. In the group with partial cholecystectomy, intraoperative blood transfusions were in the range of 0-7 units (mean, 3.1 units). In this group there was 1 hepatic artery dissection. There were no operative mortalities in either group. Conclusions. We recommend partial cholecystectomy during recipient hepatectomy of cirrhotic patients, particularly with hydropic gallbladders, because bleeding from the points of adherent gallbladder during mobilization of the liver is diminished and fewer artery dissections and bile duct injuries develop, because the procedure facilitates dissection of the hilar structures.Öğe Partial hepatectomy is curative for the localized type of Caroli's disease: A case report and review of the literature(Royal College Surgeons Edinburgh, 2006) Yilmaz, S.; Kirimlioglu, H.; Kirimlioglu, V.; Isik, B.; Coban, S.; Yildirim, B.; Ara, C.The case of a 58-year-old woman who was diagnosed with the localized type of Caroli's disease is presented. This disease involves the whole of the left half of the liver. A left hepatectomy was followed by complete resolution of symptoms. The current article suggests that hepatic resection may be aggressively performed in selected patients with the localized form of Caroli's diseaseÖğe Torsion of wandering spleen(Comenius Univ, 2009) Dirican, A.; Burak, I; Ara, C.; Unal, B.; Ozgor, D.; Meydanli, M. M.Wandering spleen is characterized by ectopic localization of spleen owing to the lack or weakening of the major splenic ligaments. In present study, two cases with torsion of wandering spleen were reported. The first case was a 30-year-old female who was admitted to emergency department with acute abdominal pain and vomiting. Abdominal Ultrasonography and computed tomography showed a round solid hypodense mass that was located in the left hypochondriac region of abdomen. At laparotomy, the patient was found to have torsion of a wandering spleen with complete infarction and pancreatic tail infarction. Splenectomy and distal pancreatectomy were performed. The second patient was a 19-year-old female. She was admitted to emergency department with abdominal pain. Axial computed tomography (CT) showed pelvic mass that indicated a possibility of a wandering spleen. The wandering spleen was removed with its long pedicle because of infarction. Torsion of wandering spleen must be considered in differential diagnosis of acute abdomen when a palpable painful abdominal mass is present on physical examination, and the spleen is absent in its normal anatomical location on radiological examination (Fig. 4, Ref. 8). Full Text (Free, PDF) www.bmj.sk.
