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    Amyand hernia
    (2018) Dirican, Abuzer; Ateş, Mustafa; Koç, Süleyman; Özgör, Dinçer; Kocaaslan, Hüseyin
    [Abstract Not Acailable]
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    Çocuklarda primer omentum torsiyonu
    (İnönü Üniversitesi, Tıp Fakültesi, Aile Hekimliği Anabilim Dalı, Malatya., 2012) Yıldız, Turan; Ateş, Mustafa
    Öz: Primer Omentum Torsiyonu (POT) çocuklarda akut apandisiti taklit eden akut karnın çok nadir sebeplerinden biridir. Çocuklarda POT klinik ve laboratuar bulguları olarak akut apandisite çok benzediği için preoperatif ayırıcı tanısı oldukça zordur. Biz burada tecrübelerimizi paylaşmak istedik. Bizim kliniği- mizde Eylül 2005 ile Eylül 2010 yılları arasındaki POT tanısı alan çocukların kayıtları retrospektif olarak tarandı. Akut apandisit ön tanısı ile ameliyat edilen 768 hastanın 4’ünde POT tespit edildi. POT tespit edilen hastalar klinik bulgu- lar, laboratuar, tanısal radyolojik tanıları hem de cerrahi ve patolojik bulguları açısından tartışıldı. Hastaların yaş ortalaması 10.2 yıl (8-12 yaş) idi. Kiloları %90 persentilin üzerindeydi ve obezdi. Akut apandisit ön tanısı ile ameliyat edilen bu hastalarda apandiks tamamı ve sağ alt kadranda torsiyone olmuş iskemik omentum görüldü. Biz bu retrospektif calışmamızda POT’lu 4 cocuğa ait tec- rubelerimizi sunduk ve bu vakaların tanı ve tedavi yaklaşımları tartışıldı.
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    Comparison of intracorporeal knot tying suture polyglactin and titanium endoclips in laparoscopic appendiceal stump closure
    (Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012) Ateş, Mustafa; Dirican, Abuzer; İnce, Volkan; Ara, Cengiz; Işık, Burak; Yılmaz, Sezai
    Background: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. Methods: The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined—patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. Results: Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n= 30) or the knot-tying (polyglactin) suture group (n= 31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P> 0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27± 12.2 min) was shorter than that for the knot-tying group (62.81± 15.4 min) (P= 0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P> 0.05). Conclusions: In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.
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    Comparison of intracorporeal knot tying suture polyglactin and titanium endoclips in laparoscopic appendiceal stump closure a prospective randomized study
    (Surg Laparosc Endosc Percutan Tech Volume 22, Number 3, June 2012., 2012) Ateş, Mustafa; Dirican, Abuzer; İnce, Volkan; Ara, Cengiz; Işık, Burak; Yılmaz, Sezai
    Background: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. Methods: The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined—patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. Results: Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n= 30) or the knot-tying (polyglactin) suture group (n= 31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P> 0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27± 12.2 min) was shorter than that for the knot-tying group (62.81± 15.4 min) (P= 0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P> 0.05). Conclusions: In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure. Key Words: laparoscopy, appendectomy, knot-tying, endoclip
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    Comparison of ıntracorporeal knot tying suture polyglactin and titanium endoclips in laparoscopic appendiceal stump closure
    (Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012) Ateş, Mustafa; Dirican, Abuzer; İnce, Volkan; Ara, Cengiz; Işık, Burak; Yılmaz, Sezai
    Background: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. Methods: The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined—patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. Results: Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n= 30) or the knot-tying (polyglactin) suture group (n= 31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P> 0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27± 12.2 min) was shorter than that for the knot-tying group (62.81± 15.4 min) (P= 0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P> 0.05).
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    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, Sezai
    Background: 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.
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    Conversion to stoppa procedure in laparoscopic totally extraperitoneal inguinal hernia repair
    (JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2012) Ateş, Mustafa; Dirican, Abuzer; Özgör, Dinçer; Gönültaş, Fatih; Işık, Burak
    Background and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy.
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    Corona mortis in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair
    (Hernia, 2015) Ateş, Mustafa; Kınacı, Erdem; Köse, Evren; Soyer, Vural; Sarıcı, Kemal Barış; Çuğlan, Songül; Korkmaz, Mehmet Fatih; Dirican, Abuzer
    Purpose Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated. Materials The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated. Results Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (C2 mm) or thin (\2 mm). Injury of arterial CMOR during tack stapling on Cooper’s ligament was seen in six cases (1.5 %). All of them were thin (\2 mm) in structure. Venous CMOR was visible only under low pressure in work space. Conclusion During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper’s ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (\2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.
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    Delici-kesici alete bağlı diyafragma yaralanmaları: 18 olgunun analizi
    (Ulusal Cerrahi Dergisi, 2010) Dirican, Abuzer; Ateş, Mustafa; Ünal, Bülent; Yılmaz, Mehmet; Özgör, Dinçer; Yılmaz, Sezai
    Öz: Amaç: Tüm delici-kesici alete bağlı diyafragma yaralanmaları onarım gerektirmesine karşın, ameliyat öncesi tanı koymak zordur. Bu çalışmanın amacı, DKA bağlı diyafragma yaralanmaları konusunda bir genel cerrahi kliniği olarak deneyimlerimizi aktarmaktır. Hastalar ve Yöntem: Mart 2000- Haziran 2009 tarihleri arasında, İnönü Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda tedavi edilen, delici-kesici alete bağlı diyafragma yaralanmalı 18 hastanın kayıtları retrospektif olarak incelendi. Bulgular: Hastaların 3'ü kadın, 15'i erkek ve yaş ortalamaları 33 (20–69) yıl idi. En sık şikâyetler solunum güçlüğü, karın ve göğüs ağrısıydı. Onbir (%66) hastada diyafragmanın sol tarafında, 6 (%33) hastada sağ tarafında, 1 (%6) hastada ise her iki tarafında yaralanma vardı. On yedi hastaya hastaneye başvurduktan sonra ilk 24 saat içinde orta hat karın insizyonuyla, bir hastaya ise 10 gün sonra lateral torakotomiyle cerrahi müdahale yapıldı. Mortalite, 2 hastada eşlik eden ek organ yaralanmalarına bağlı kanama, bir hastada ise postoperatif gelişen sepsise bağlı olmak üzere 3 (%17) hastada oluştu. Sonuç: Delici-kesici alete bağlı diyafragma yaralanmalarında ameliyat öncesi tanı koymak zordur. Bu hastalarda yüksek oranda yandaş visseral organ yaralanması mevcuttur. Gövdenin umbilikus ile ksifoid arası seviyesinde karına nafiz bıçaklanmalarda diyafragma yaralanması akılda tutulmalıdır. Bu hastaların karın ameliyatları esnasında her iki hemidiyafragma dikkatlice eksplore edilmelidir.
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    Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies
    (2021) Hatipoğlu, Sinan; Dirican, Abuzer; Ateş, Mustafa; Çevik, Muhammer Özgür; Yumrutaş, Önder; Şık, M. Ali; Yılmaz, Sezai
    Objective: End-stage liver disease (ESLD) is a devastating condition, which leads to liver transplantation (LT). There are various proposed predisposing factors for ESLD. A significant proportion of ESLDs is of undetectable (cryptogenic) origin. Accumulation of heavy metals is a proposed but not thoroughly researched predisposing factor for ESLD. In this study, we measured the concentration of accumulated heavy metals in the explanted liver tissue of ESLD patients. Apart from various accompanying etiologies, such as rare hereditary diseases, infections, and tumors were also evaluated. Method: This prospective study aimed to evaluate the concentrations of heavy metals in the explanted liver of consecutive patients with ESLD and different etiologies who underwent elective and/or emergency LT. Bioaccumulation of nine heavy metals (Hg, As, Zn, Cr, Pb, Cu, Ni, Mg, and Fe) was evaluated by atomic absorption spectrophotometer in the explanted liver tissue of ESLD patients. Also, histopathologies of explanted livers and etiologies of patients were evaluated using data from histopathological techniques, medical records, or genetic counseling processes. Results: The male/female ratio was 33: 15. The results of our study showed no statistical significance in terms of total heavy metal levels in the explanted livers (p > 0.05), including patients with cryptogenic etiology. However, four patients with Wilson’s disease had copper levels of 250 uq/g dried liver tissue. Histopathological examinations of explanted livers revealed that four (8%) patients had Wilson’s disease, one (2%) patient had tyrosinemia, 15 (31%) patients had unknown/undetectable (cryptogenic) etiology, 24 patients had viral infections (20 had hepatitis B virus infection, one had hepatitis C virus infection, three had multiple viral infections at once), one patient had a metastatic tumor, one patient had an unidentified autoimmune disease, and one patient had polycystic liver disease. Conclusion: Accumulated total heavy metal levels in explanted livers of ESLD patients do not appear to be a differential diagnosis tool, except the copper levels for Wilson’s disease. More research is needed to further elucidate the different roles of heavy metal concentrations in both normal and disease states of heavy metals in the liver.
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    Donor complications among 500 living donor liver transplantations at a single center
    (Transplant Pro, 0–0., 2012) Özgör, Dinçer; Dirican, Abuzer; Ateş, Mustafa; Gönültaş ,Fatih; Ara, Cengiz; Yılmaz, Sezai
    ABSTRACT 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.
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    Donor complications among 500 living donor liver transplantations at a single center
    (Transplant Pro, 0–0., 2012) Özgör, Dinçer; Dirican, Abuzer; Ateş, Mustafa; Gönültaş ,Fatih; Ara, Cengiz; Yılmaz, Sezai
    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.
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    Donor complications among 500 living donor liver transplantations at a single center
    (Transplant Proc., 2012) Özgör, Dinçer; Dirican, Abuzer; Ateş, Mustafa; Gönültaş, Fatih; Ara, Cengiz; Yılmaz, Sezai
    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.
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    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, Sezai
    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.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.
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    Donor postoperative biliary complications after living donor liver transplant
    (Experimental and Clinical Transplantation, 13(6), 0–0., 2015) Dirican, Abuzer; Ara, Cengiz; Kutlutürk, Koray; Özsoy, Mustafa; Ateş, Mustafa; Başkıran, Adil; Işık, Burak; Yılmaz, Sezai
    Objectives: 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-up
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    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, Sezai
    Objectives: 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-up
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    First laparoscopic totally extraperitoneal repair of Laugier s hernia a case report
    (Hernia, 2013) Ateş, Mustafa; Dirican, Abuzer; Köse, Evren; Işık, Burak; Yılmaz, Sezai
    An atypical femoral hernia developing through the lacunar ligament is called Laugier’s hernia. Preoperative diagnosis of these atypical hernias is very difficult because of their rarity and similar clinical appearance to conventional femoral hernias. A 52-year-old female presented with right groin swelling. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, a hernia sac through an opening in the lacunar ligament was diagnosed and repaired with mesh covering the inguinal floor. The surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias. A laparoscopic approach should be chosen instead of a conventional approach for the treatment of femoral hernias because of its high diagnostic and therapeutic capacity for all types of femoral hernia, including Laugier’s.
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    First laparoscopic totally extraperitoneal repair of Laugier s hernia a case report
    (Hernia, 2013) Ateş, Mustafa; Dirican, Abuzer; Köse, Evren; Işık, Burak; Yılmaz, Sezai
    t An atypical femoral hernia developing through the lacunar ligament is called Laugier’s hernia. Preoperative diagnosis of these atypical hernias is very diYcult because of their rarity and similar clinical appearance to conventional femoral hernias. A 52-year-old female presented with right groin swelling. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, a hernia sac through an opening in the lacunar ligament was diagnosed and repaired with mesh covering the inguinal Xoor. The surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias. A laparoscopic approach should be chosen instead of a conventional approach for the treatment of femoral hernias because of its high diagnostic and therapeutic capacity for all types of femoral hernia, including Laugier’s.
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    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, Sezai
    Öz: 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.
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    Incisional hernia in recipients of adult to adult living donor liver transplantation
    (World Journal of Surgery, 2014) Özgür, Dinçer; Dirican, Abuzer; Ateş, Mustafa; Yılmaz, Mehmet; Işık, Burak; Yılmaz, Sezai
    Background After receiving a living donor liver transplant (LDLT), an incisional hernia is a potentially serious complication that can affect the patient’s quality of life. In the present study we evaluated surgical hernia repair after LDLT. Materials and methods Medical records of patients who underwent surgery to repair an incisional hernia after LDLT in Turgut Ozal Medical Center between October 2006 and January 2010 were evaluated in this retrospective study. A reverse-T incision was made for liver transplantation. The hernias were repaired with onlay polypropylene mesh. Age, gender, post-transplant relaparatomy, the type, the result of surgery for the incisional hernia, and risk factors for developing incisional hernia were evaluated. Results An incisional hernia developed in 44 of 173 (25.4 %) patients after LDLT. Incisional hernia repair was performed in 14 of 173 patients (8.1 %) who underwent LDLT from October 2006 to January 2010. Relaparatomy was associated with incisional hernia (p = 0.0002). The mean age at the time of the incisional hernia repair was 51 years, and 79 % of the patients were men. The median follow-up period was 19.2 (13–36) months after the hernia repair. Three patients with intestinal incarceration underwent emergency surgery to repair the hernia. Partial small bowel resection was required in one patient. Postoperative complications included seroma formation in one patient and wound infection in another. There was no recurrence of hernia during the follow-up period.