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Öğe The 2-Stage Liver Transplant: 3 Clinical Scenarios(Baskent Univ, 2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, CuneytThe main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Öğe Abdominal Closure with Bogota Bag after Pediatric Liver Transplantation.(Wiley-Blackwell, 2014) Kutluturk, Koray; Otan, Emrah; Karabulut, Ertugrul; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Abo-Incompatible Liver Transplantation in Acute and Acute-On-Chronic Liver Failure(H G E Update Medical Publishing S A, 2013) Yilmaz, Sezai; Aydin, Cemalettin; BurakIsik; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ara, Cengiz; Kutlu, RamazanBackground/Aims: ABO-incompatible (ABO-I) liver transplantation (LTx) may be mandatory in urgent conditions such as acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) when deceased donor (DD) is unavailable or living donor (LD) selection is limited. This study specifically addresses the problem of urgent ABO-I LTx in critically ill adult patients having ALF or severely decompensated end-stage liver disease. Methodology: This series included 16 patients, 10 underwent ABO-I LD LTx and 6 underwent 7 ABO-I DD LTx. Multiple sessions of plasmapheresis reduced isoaglutinin titres to 1/16 or below, before and after LTx. Results: Mean follow-up period was 10.37 months (1 to 38). Median for MELD scores was 22.5 (17 to 30). Median survival was 9 months and mean survival was 19.5 months. Hospital mortality was 3 (18.7%). Two patients died due to small for size graft syndrome and cerebrovascular bleeding respectively. Hepatic artery thrombosis developed in 3 patients. Two of them died at postoperative 4th and 9th months. Third patient is still alive with hepatic necrosis problem. Conclusions: ABO-I LTx remains an important and unavoidable therapeutic option in adult patients with ALF or ACLF and urgent need for an allograft without the possibility to allocate a blood group compatible liver graft.Öğe CARCINOMA ERYSIPELOIDES FROM BREAST CANCER MIMICKING AS RADIODERMATITIS: REPORT OF A CASE(Aves, 2009) Sogutlu, Gokhan; Aydin, Cemalettin; Karadag, Nese; Olmez, Aydemir; Ozgor, Dincer; Deniz, SumerCarcinoma erysipeloides (CE) is an uncommon metastatic pattern arising from visceral carcinoma. As a consequence of lymphatic blockage by the tumor cells, erysipel like appearance can occur. It may be confused with erysipelas and other infl ammatory lymphedemas. We report a case of CE in a woman previously treated by mastectomy for locally advanced breast carcinoma. The lesion was clinically mimicked a radiation dermatitis.Öğe Case Report on the Demonstration of Minute Colonic Perforations Caused by Birdshot Injury(Springer Heidelberg, 2010) Emeklioglu, Ismet; Kayaalp, Cuneyt; Aydin, CemalettinPenetrating trauma of the colon is usually diagnosed intraoperatively and missed injuries cause considerable morbidity and mortality. Herein, we described an intraoperative diagnostic method for invisible openings on the colon due to a birdshot injury. A 30-year-old man was admitted to the hospital after sustaining gunshot pellet injuries to his abdomen, back, and extremities. Emergency laparotomy relieved splenic injury and free pellet fragments in the abdomen. A pellet fragment was also palpated in the descending colon. Despite meticulous inspection of the colon, it failed to show the entrance of the pellet. An 18F catheter was passed through the anus and was connected to a CO2 insufflator of the laparoscopy unit. The abdominal cavity was filled with normal saline and 1.5 l of CO2 was inflated into the rectum. Five tiny (2-mm) openings on the retroperitoneal part of the descending colon were demonstrated with the help of the air bubbles. All of the openings were suture-ligated and his postoperative course was uneventful. We believe that inflating the colon in cases of abdominal birdshot injuries may allow the demonstration of tiny perforations and provide immediate repairs of missed injuries.Öğe Chylous ascites after liver transplantation: Incidence and risk factors(Wiley-Blackwell, 2012) Yilmaz, Mehmet; Akbulut, Sami; Isik, Burak; Ara, Cengiz; Ozdemir, Fatih; Aydin, Cemalettin; Kayaalp, CuneytIn this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean +/- SD = 8.0 +/- 3.2 days, range = 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P = 0.04), the presence of ascites before transplantation (P = 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P = 0.04, hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.1-13.5] and the use of LVSS for perihepatic dissection (P = 0.01, HR = 5.4, 95% CI = 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials. Liver Transpl, 2012. (C) 2012 AASLD.Öğe Clinical Characteristics and Outcomes of Liver Transplantation Recipients With COVID-19 Pneumonia(Elsevier Science Inc, 2021) Kose, Adem; Toplu, Sibel Altunisik; Yalcinsoy, Murat; Yakupogullari, Yusuf; Otlu, Baris; Otan, Emrah; Aydin, CemalettinBackground. We aimed to evaluate the clinical characteristics and outcomes of mild-severe COVID-19 pneumonia cases in liver transplant (LT) recipients. Methods. Ten LT recipients diagnosed as having COVID-19 pneumonia in a 6-month period in our transplantation center were included. Demographic and medical data of the recipients were retrospectively collected; clinical courses, treatment responses, and outcomes were evaluated. Results. Ten LT recipients were male, had a median age of 57 years (min-max, 36-69 years; interquartile range [IQR], 13 years), and had right lobe from living donor LT performed in a median of 11 months (min-max, 1-72 months; IQR, 12 months). Five patients had severe pneumonia, and the remaining patients had mild/moderate pneumonia. The most frequent symptoms were fever (90%) and cough (70%). Favipiravir, enoxaparin sodium, and corticosteroid were initiated at the time of the diagnosis; immunosuppressive drug doses were reduced or discontinued in 3 cases. Lymphopenia median: 510/mL (min-max, 90-1400 mL; IQR, 610 mL), increased levels of C-reactive protein median: 4.72 (min-max, 0.31-23.4; IQR, 8.5), and ferritin median: 641 (min-max, 40 to >= 1650; IQR, 1108) were frequent. Four patients required antibacterial treatments because of emerging bacterial pneumonia and/or sepsis. All patients were hospitalized for a median of 10 days. One patient with sepsis died on the 26th day after intensive care unit admission, and the remaining 9 survived. No further complication was recorded for 1-month follow-up. Conclusions. Commencing favipiravir, enoxaparin sodium, and corticosteroid treatments; close follow-up of the developing complications; the temporary reduction or cessation of immunosuppression; a multidisciplinary approach; early awareness of the bacterial infections; and the initiation appropriate antibiotic treatments can contribute to success.Öğe Comparison of Plasmapheresis and Molecular Adsorbant Recirculation System Treatment Results for Posttransplant Liver Graft Dysfunction(Lippincott Williams & Wilkins, 2015) Otan, Emrah; Akbulut, Sami; Karagul, Servet; Aydin, Cemalettin; Kirmizi, Serdar; Colak, Cemil; Yilmaz, Sezai[Abstract Not Available]Öğe Controlling massive hemorrhage from the retropancreatic portal vein as a complication of thromboendovenectomy during liver transplantation with balloon catheter tamponade: how to do it(Springer, 2014) Aydin, Cemalettin; Ersan, Veysel; Baskiran, Adil; Unal, Bulent; Kayaalp, Cuneyt; Yilmaz, SezaiWe herein describe two cases of liver transplantation with portal vein thrombosis. In both cases, a tear advancing to the retropancreatic area occurred during portal vein thrombectomy. Hemorrhage from the limited visibility retropancreatic area made it impossible to stop the bleeding by clamping or direct suturing, and the clamping and suturing efforts actually increased the hemorrhage, possibly due to the damaged and thin portal vein wall. First, finger compression over the retropancreatic area was employed to stop the bleeding, then a Foley urinary catheter was introduced into the portal vein under the finger. The balloon of the catheter was inflated with 8 cc of normal saline, and the finger was released. The bleeding was stopped temporarily, and two different venous conduits were sutured to the trimmed portal vein stump in a bloodless surgical area. The venous conduits were easily controlled with vascular clamps after deflating the balloon catheters, and implantation of the liver was then done in a standard manner. Balloon tamponade can be a lifesaving technique that can temporarily stop a hemorrhage to allow for definitive repair in cases of retropancreatic portal vein hemorrhage.Öğe Critical overview of resection for Bismuth-Corlette type IV perihilar cholangiocarcinoma(Taylor & Francis Ltd, 2023) Ersan, Veysel; Usta, Sertac; Aydin, Cemalettin; Carr, Brian, I; Karatoprak, Sinan; Yilmaz, SezaiBackground Current standard treatment for perihilar cholangiocarcinoma (pCCA) is surgical resection. Bismuth-Corlette (BC) type IV pCCA is accepted as an unresectable disease. In the present study, the results of non-transplant surgical approaches in patients with BC type IV pCCA were examined. Methods Medical records of consecutive patients with BC type IV pCCA between 2010 and 2021 were retrospectively reviewed. Patients were subdivided according to operation type. Postoperative survival rates were compared. Results Hemihepatectomy with caudate lobe and extrahepatic bile duct (EHBD) resection was performed in 15 patients and only EHBD resection was performed in 10 patients. Ten of the cases were found to be unresectable at the stage of laparotomy. Median follow-up was 41.3 (24.8-57.9) months. Overall survival rate for all 35 patients was 56.4% at 1 year, 32.2% at 2 years, and 16.1% at 3 years. When survivals were compared according to operation type, 1, 2, and 3-year survivals were 80%, 57.1% and 42.9% for the hepatectomy group; 55.6%, 44.4% and 11.1% for the EHBD resection group; 75%, 0% and 0% in laparotomy-only group, respectively (p = 0.13). The best survival rates were obtained in patients with pCCA who underwent hepatectomy and were lymph node negative, 100% for 1 year, 66.7 for 2 years and 50% for 3 years. Conclusion It is difficult to achieve high survival rates in BC type IV pCCA. However, these patients mostly benefit from resective treatments. Acceptable survival rates can be achieved, especially in the R0N0 patient group.Öğe Determination of risk factors affecting mortality in patients with gastrointestinal perforation after pediatric liver transplantation(Wiley, 2019) Barut, Bora; Akbulut, Sami; Kutluturk, Koray; Koc, Cemalettin; Ozgor, Dincer; Aydin, Cemalettin; Selimoglu, AyseGastrointestinal perforation (GIP) is one of the most serious complications occurring after liver transplantation (LT), especially in pediatric patients. This study aimed to determine the risk factors affecting mortality in pediatric patients with GIP after LT. GIP developed in 37 (10%) of 370 pediatric patients who underwent LT at our institute. Patients were divided into two groups: alive (n = 22) or dead (n = 15), and both groups were compared in terms of demographic and clinical parameters using univariate analysis. There was no statistically significant difference between groups in either demographic or clinical parameters, except for perforation site (P = 0.001) and median follow-up (P = 0.001). Stomas arose in 17 (45.9%) patients: 76% of patients with stomas and 45% of those without survived (P = 0.052). Kaplan-Meier analysis indicated that patients with stomas had a significantly higher overall survival (P = 0.029) and that patients with duodenal and colonic perforation had a significantly lower overall survival. Multivariate analysis showed that re-perforation was an independent risk factor for mortality (P = 0.035; OR: 17.674; 95% CI for OR: 1.233-253.32). Although there are many options for management of GIP, including primary repair, resection plus anastomosis, and resection plus end or loop ostomy, gastrointestinal diversion is still the best option.Öğe Effects of Body Mass Index of Living Donors On Postoperative Course of Liver Function Tests(Lippincott Williams & Wilkins, 2015) Akbulut, Sami; Karakas, Serdar; Aydin, Cemalettin; Sumer, Fatih; Kayaalp, Cuneyt; Isik, Burak; Colak, Cemil[Abstract Not Available]Öğe Emergency Liver Resection with Staplers for Spontaneous Liver Haemorrhage in a Patient Receiving Anticoagulant Therapy(Hindawi Ltd, 2013) Kutluftirk, Koray; Soyer, Vural; Dirican, Abuzer; Unal, Bulent; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, SezaiIntroduction. Emergency liver resection during active bleeding in a patient who takes anticoagulant therapy is a complicated and high-risk surgery. Aim. We described a technique that is combination of staplers, total hepatic vascular occlusion, and hemostatic agent (TachoSil) application for safe and quick hepatectomy. Patient and Method. A 72-year-old woman who uses warfarin regularly due to valvuloplasty admitted emergency unit with abdominal pain and shock. At admission, her hemoglobin, hematocrit, and INR values were 5.2g/dL, 14.9%, and 6.7, respectively. Radiologic evaluation revealed abdominal free fluid and a liver lesion on segments V, VI, and VII. Emergency laparotomy was required. There was an active bleeding from a liver hematoma that could not be controlled by packing, and an urgent hepatic resection was required. Under total hepatic vascular occlusion, segments V, VI, and VII were resected with endoscopic nonvascular staplers. Cut surface of the liver was coagulated with bipolar cautery and covered with a hemostatic material. Results. Hepatectomy took six minutes, and the duration of surgery was 80 minutes. There was no complication and no transfusion required after surgery, and the patient was discharged on 8th day, uneventfully. Conclusion. Emergency hepatectomy with staplers, under vascular control with hemostatic agents, provided a rapid and safe surgery.Öğe En Masse Resection of Pancreas, Spleen, Celiac Axis, Stomach, Kidney, Adrenal, and Colon for Invasive Pancreatic Corpus and Tail Tumor(Hindawi Ltd, 2013) Kutluturk, Koray; Alam, Abdul Hamid; Kayaalp, Cuneyt; Otan, Emrah; Aydin, CemalettinProviding a more comfortable life and a longer survival for pancreatic corpus/tail tumors without metastasis depends on the complete resection. Recently, distal pancreatectomy with celiac axis resection was reported as a feasible and favorable method in selected pancreatic corpus/tail tumors which had invaded the celiac axis. Additional organ resections to the celiac axis were rarely required, and when necessary it was included only a single extra organ resection such as adrenal or intestine. Here, we described a distal pancreatic tumor invading most of the neighboring organs-stomach, celiac axis, left renal vein, left adrenal gland, and splenic flexure were treated by en bloc resection of all these organs. The patient was a 60-year-old man without any severe medical comorbidities. Postoperative course of the patient was uneventful, and he was discharged on postoperative day eight without any complication. Histopathology and stage of the tumor were adenocarcinoma and T4 N1 M0, respectively. Preoperative back pain of the patient was completely relieved in the postoperative period. As a result, celiac axis resection for pancreatic cancer is an extensive surgery, and a combined en masse resection of the invaded neighboring organs is a more extensive surgery than the celiac axis resection alone. This more extensive surgery is safe and feasible for selected patients with pancreatic cancer.Öğe Evaluation of Liver Function Tests for Living Liver Donors in Postoperative Course(Lippincott Williams & Wilkins, 2015) Aydin, Cemalettin; Akbulut, Sami; Otan, Emrah; Karakas, Serdar; Dirican, Abuzer; Kayaalp, Cuneyt; Colak, Cemil[Abstract Not Available]Öğe Extra-Corporeal Membrane Oxygenation after Living Related Liver Transplantation.(Wiley-Blackwell, 2014) Gedik, Ender; Otan, Emrah; Celik, Reha M.; Disli, Olcay M.; Aydin, Cemalettin; Erdil, Nevzat; Kutlu, Ramazan[Abstract Not Available]Öğe Giant Hepatic Hemangioma Presenting as Gastric Outlet Obstruction(Int College Of Surgeons, 2013) Aydin, Cemalettin; Akbulut, Sami; Kutluturk, Koray; Kahraman, Aysegul; Kayaalp, Cuneyt; Yilmaz, SezaiHemangioma, a most frequently encountered primary benign tumor of the liver, is generally determined incidentally during the course of radiologic tests for other reasons. Most lesions are less than 3 cm and a significant proportion of patients are asymptomatic, although the size and location of the lesion in some patients may be associated with the onset of symptoms. Pressure on the stomach and duodenum of giant hemagiomas developing in the left lobe of the liver, in particular, may result in the development of abdominal pain, nausea, vomiting, and feeling bloated, which are characteristic of a gastric outlet obstruction. A 42-year-old man presented with findings of gastric outlet obstruction and weight loss as a result of a giant hepatic hemangioma.Öğe A giant retroperitoneal lipoma case with recurrent course(Int Scientific Literature, Inc, 2008) Dirican, Abuzer; Unal, Bulent; Aydin, Cemalettin; Unal, Demet; Kirimlioglu, VedatBackground: Retroperitoneal lipomas are very rare cases and most of them are reported as liposarcoma. We want to present a giant retroperitoneal lipoma case with recurrent course that reported as lipoma in two histopathological examinations after primary and recurrent resection. Case Report: The blood laboratory tests of a 67 year old woman who applied to hospital with constipation and abdominal swelling complaints were assessed to be normal. Retroperitoneal located mass of 43x30X14 cm in fat density was detected in abdominal computerized tomography (CT). After fine needle aspiration biopsy, the mass was found to be compatible with lipoma. Mass excision was performed on the patient (5450 gr). Histopathological examination was reported to be lipoma. The patient applied to the clinic with recurrent retroperitoneal lipoma in the postoperative first year. Second histopathological examination was reported to be compatible with lipoma. Mass was not detected in the first year check of the patient in follow-up. Conclusions: Indeed retroperitoneal lipomas are benign character, this lesions require close follow up due to their possibility of recurrence.Öğe HEPATIC ARTERY THROMBOSIS IN 153 CONSECUTIVE LIVER TRANSPLANT RECIPIENTS PERFORMED IN YEAR 2008: A NEW SURGICAL TECHNIQUE.(John Wiley & Sons Inc, 2009) Kirimlioglu, Vedat; Yilmaz, Sezai; Nisanoglu, Vedat; Ara, Cengiz; Aydin, Cemalettin; Ozgor, Dincer; Kirimlioglu, Hale[Abstract Not Available]Öğe Heterotopic Partial Liver Transplantation in Pediatric Patients(Wiley-Blackwell, 2011) Yilmaz, Sezai; Kayaalp, Cuneyt; Ara, Cengiz; Yilmaz, Mehmet; Isik, Burak; Aydin, Cemalettin; Dirican, Abuzer[Abstract Not Available]
