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Öğe Amyand hernia(2018) Kocaaslan, Hüseyin; Ozgor, Dıncer; Koc, Suleyman; Ates, Mustafa; Dirican, AbuzerÖğe Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure: A Prospective Randomized Study(Lippincott Williams & Wilkins, 2012) Ates, Mustafa; Dirican, Abuzer; Ince, Volkan; Ara, Cengiz; Isik, Burak; Yilmaz, SezaiBackground: 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.Öğe Consequences of the Use of Extended Criteria Donors in Living Donor Liver Transplantation(Int Scientific Literature, Inc, 2015) Dirican, Abuzer; Ozsoy, Mustafa; Ates, Mustafa; Ersan, Veysel; Gonultas, Fatih; Isik, Burak; Yilmaz, 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/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 Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair(Soc Laparoendoscopic Surgeons, 2012) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, BurakBackground 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.Öğe Cystic Adrenal Lymphangioma - Report of two cases and review of the literature(Pakistan Medical Assoc, 2012) Cakir, Ebru; Aydin, N. Engin; Samdanci, Emine; Ates, Mustafa; Elmali, Candan; Sayin, Sadegul; Erdem, GulnurCystic adrenal lymphangiomas are very rare, benign vascular lesions. They are usually found during a work up for abdominal pain or incidentally during imaging studies for an unrelated cause. We report two cases of cystic adrenal lymphangiomas. They presented with flank discomfort, hypertension and flushing. Their laboratory findings were in normal limits. Radio logic imagings showed adrenal cystic neoplasm and the patients underwent adrenelectomy. Histopathologic examination and immunohistochemical findings were consistent with lymphangioma. Cystic lymphangiomas may imitate other adrenal neoplasms and must be kept in mind in the clinical and radiologic differential diagnosis of cystic adrenal lesions.Öğe Diffuse Cecal Ganglioneuromatosis in a Patient with von Reklinghausen's Disease: Case Report(Ortadogu Ad Pres & Publ Co, 2012) Dirican, Abuzer; Yilmaz, Mehmet; Unal, Bulent; Ates, Mustafa; Kirimlioglu, Hale; Yilmaz, SezaiA 41-year-old female with 'cafe au lait' and multiple skin neurofibromas was admitted with a complaint of constipation, abdominal pain and distention. The colonoscopic investigation was normal, however computed tomography revealed a mass in the cecal wall;Thereon, right hemicolectomy was performed to the patient. Histopathologic examination revealed ganglioneuromatosis of the cecum. There was not any recurrence after three years of follow-up. An intestinal manifestation of von Recklinghausen's disease should be kept in mind in a patient who has multiple neurofibromas and 'cafe au lait' spots with intractable constipation and intestinal obstruction.Öğe Donor Evaluation in Living Donor Liver Transplantation.(Wiley-Blackwell, 2013) Dirican, Abuzer; Baskiran, Adil; Dogan, Murat; Ates, Mustafa; Ozdemir, Fatih; Isik, Burak; Yilmaz, Sezai[Abstract Not Available]Öğe Donor Postoperative Biliary Complications After Living-Donor Liver Transplant(Baskent Univ, 2015) Dirican, Abuzer; Ara, Cengiz; Kutluturk, Koray; Ozsoy, Mustafa; Ates, Mustafa; Baskiran, Adil; Isik, BurakObjectives: 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.Öğe The evaluation of the effect of vaginal delivery and aging on anal sphincter anatomy and function(Elsevier Masson, Corporation Office, 2018) Cay, Mahmut; Cetin, Aymelek; Ates, Mustafa; Koleli, Isil; Senol, Deniz; Kose, Evren; Ozgor, DincerObjective. - This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. Method. - Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. Results. - There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. Conclusion. - The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging. (C) 2018 Elsevier Masson SAS. All rights reserved.Öğe The evaluation of the effect of vaginal delivery and aging on anal sphincter anatomy and function (vol 47, pg 309, 2018)(Elsevier Masson, Corp Off, 2020) Cay, Mahmut; Cetin, Aymelek; Ates, Mustafa; Koleli, Isil; Senol, Deniz; Kose, Evren; Ozgor, Dincer[Abstract Not Available]Öğe The evaluation of the effect of vaginal delivery and aging on anal sphincteranatomy and function(Elsevıer masson, corporatıon offıce, 65 camılle desmoulıns cs50083 ıssy-les-moulıneaux, 92442 parıs, france, 2018) Cay, Mahmut; Cetin, Aymelek; Ates, Mustafa; Koleli, Isil; Senol, Deniz; Kose, Evren; Ozgor, Dincer; Simsek, Arife; Ozbag, DavutObjective. - This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. Method. - Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. Results. - There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. Conclusion. - The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging. (C) 2018 Elsevier Masson SAS. All rights reserved.Öğe Factors Affecting Strangulation and Necrosis in Incarcerated Abdominal Wall Hernias(Aves, 2020) Simsek, Arife; Kocaaslan, Huseyin; Dirican, Abuzer; Ates, MustafaBACKGROUND/AIMS The goal of the present study was to determine the factors affecting strangulation and necrosis in incarcerated abdominal wall hernias (AWHs). MATERIAL and METHODS This was a retrospective study conducted by reviewing the medical records of 44 patients who underwent surgery for incarcerated abdominal wall hernia at a university hospital between April 2009 and January 2018. RESULTS Of the 44 study patients, 28 were men and 16 were women of mean age 68.95 years. Of all, 30 patients (68.2%) had groin hernias (femoral: 7, inguinal: 23) and 14 (31.8%) had ventral hernias (incisional: 8, umbilical: 5, epigastric: 1). The intraoperative findings were strangulation in 24 (54.5%) and necrosis in 20 (45.5%) cases. Accordingly, omental resection was performed in 4, small bowel resection in 14, and large bowel resection in two patients. The hernia was repaired using a polypropylene mesh in 33 patients (of them 20 were Lichtenstein, 8 were on-lay, and 5 were plug-mesh) and without using a mesh in ten patients. The hernia was not repaired in one patient. The mean duration of hospitalization was 7.43 (range: 1-5) days. The mortality rate was 13.6%. In univariate analysis, the mortality was positively related to necrosis (p=0.045). The duration of these symptoms was the only factor that affected strangulation and necrosis. CONCLUSION The mortality rate was high in incarcerated abdominal wall hernias, while necrosis was the most significant variable associated with mortality. The duration of the symptoms was the most significant factor that affected necrosis; therefore, it is essential to perform surgical intervention within the first 24 h of admission.Öğe Incisional Hernia in Recipients of Adult to Adult Living Donor Liver Transplantation(Springer, 2014) Ozgor, Dincer; Dirican, Abuzer; Ates, Mustafa; Yilmaz, Mehmet; Isik, Burak; Yilmaz, SezaiAfter 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. 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. 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. The incidence of incisional hernia after LDLT was 25.4 % in this study. Relaparatomy increases the probability of developing incisional hernia in recipients of LDLT. According to the results of the study, repair of an incisional hernia with onlay mesh is a suitable option.Öğe Intraoperative Vasculer Complications in Living Donor Right Hepatectomy(Lippincott Williams & Wilkins, 2015) Dirican, Abuzer; Soyer, Vural; Sarici, Baris; Ates, Mustafa; Ozdemir, Fatih; Koc, Suleyman; Yilmaz, Sezai[Abstract Not Available]Öğe Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review(Elsevier Sci Ltd, 2011) Ates, Mustafa; Dirican, Abuzer; Isik, Burak; Yilmaz, SeaziPrimary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, wereport a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach. We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of followup. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations. (C) 2011 Surgical Associates Ltd. Published by Elsevier Ltd.Öğe Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction(Baishideng Publishing Group Inc, 2015) Kayaalp, Cuneyt; Kutluturk, Koray; Yagci, Mehmet Ali; Ates, MustafaAIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn's disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture. RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the overall experience in the literature was 80% (12/15) in selected cases. CONCLUSION: Transcolonic specimen extraction for right-sided colonic resection is feasible in selected patients. Both natural orifice surgery and intracorporeal anastomosis avoids mini-laparotomy for specimen extraction or anastomosis.Öğe Life-Threatening Near-Miss Complications of Donor in Living Donor Liver Transplantation(Lippincott Williams & Wilkins, 2015) Onur, Asim; Dirican, Abuzer; Soyer, Vural; Sarici, Baris; Koc, Suleyman; Ates, Mustafa; Koc, Cemalettin[Abstract Not Available]Öğe Living Donor Liver Transplantation for Acute Liver Failure Due to the Ingestion of Fireworks Containing Yellow Phosphorus(Wiley-Blackwell, 2011) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Cemalettin, Aydin; Isik, Burak; Ara, Cengiz; Gonultas, Fatih[Abstract Not Available]Öğe Living Donor Liver Transplantation for Acute Liver Failure in Pediatric Patients Caused by the Ingestion of Fireworks Containing Yellow Phosphorus(Wiley-Blackwell, 2011) Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Aydin, Cemalettin; Isik, Burak; Ara, Cengiz; Yilmaz, MehmetYellow phosphorus is a protoplasmic toxicant that targets the liver. The ingestion of fireworks containing yellow phosphorus, either by children who accidentally consume them or by adults who are attempting suicide, often results in death due to acute liver failure (ALF). We present the outcomes of 10 children who ingested fireworks containing yellow phosphorus. There were 6 boys and 4 girls, and their ages ranged from 21 to 60 months. One patient remained stable without liver complications and was discharged. Three patients died of hepatorenal failure and cardiovascular collapse, and living donor liver transplantation (LDLT) was performed for 6 patients. The patients had grade II or III encephalopathy, a mean alanine aminotransferase level of 1148.2 IU/L, a mean aspartate aminotransferase level of 1437.5 IU/L, a mean total bilirubin level of 6.9 mg/dL, a mean international normalized ratio of 6.6, a mean Pediatric End-Stage Liver Disease score of 33.7, and a mean Child-Pugh score of 11.3. Postoperatively, 2 patients had persistent encephalopathy and died on the second or third postoperative day, and 1 patient died of cardiac arrest on the first postoperative day despite a well-functioning graft. The other 3 patients were still alive at a mean of 204 days. In conclusion, the ingestion of fireworks containing yellow phosphorus causes ALF with a high mortality rate. When signs of irreversible ALF are detected, emergency LDLT should be considered as a lifesaving procedure; however, if yellow phosphorus toxicity affects both the brain and the heart in addition to the liver, the mortality rate remains very high despite liver transplantation. Liver Transpl 17:1286-1291, 2011. (C) 2011 AASLD.Öğe Low Pressure is Necessary to View and to Protect Corona Mortis During Totally Extraperitoneal Hernia Repair(Mary Ann Liebert, Inc, 2016) Kinaci, Erdem; Ates, Mustafa; Dirican, Abuzer; Ozgor, DincerBackground: The identification of retropubic vasculature is not easy under the pressure of insufflated gas during totally extraperitoneal (TEP) inguinal hernioplasty. We aimed to present the usefulness of a maneuver that allows the clear identification of retropubic vasculature. Methods: Vascular anatomy on the retropubic surface in 364 patients who underwent the TEP procedure from January 2005 to September 2015 was evaluated. In patients after July 2014, the pressure in the workspace was decreased from 14 to 8mmHg before fixation of the mesh to clearly identify the veins. The results before and after July 2014 were compared. Results: Demographic features were not significantly different between two periods. The number of hemipelvises in the first and second periods was 398 and 77, respectively. The rate of identification of venous corona mortis was 31% in the second period, whereas it was 1.0% in the first period (P=.000). The identification of thick (5.5% versus 10.3%; P=.123) and thin (22.8% versus 36.3%; P=.014) arterial structures and their sum were increased in the second period (28.4% versus 46.7%; P=.002). The rate of retropubic bleeding was zero in the second period, while it was 1.5% in the first period. Conclusions: During TEP hernioplasty, the pressure of insufflated gas more than 10mmHg in the preperitoneal space hinders the correct identification of vessels on the retropubic surface. The proposed maneuver, to decrease the pressure in the workspace to 8mmHg, can provide clear identification of all vessels, which decreases the potential risk of vascular injury.
