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    Can Patients Who Develop Cerebral Death in Fulminant Liver Failure Despite Liver Transplantation Be Previously Forseen?
    (Elsevier Science Inc, 2017) Sarici, K. B.; Karakas, S.; Otan, E.; Ince, V.; Koc, C.; Koc, S.; Bayraktar, H.
    Background. The outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use of living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developing in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation. Methods. In Inonu University's Liver Transplant Institute, 69 patients who made an emergency notice to the National Coordination Center for liver transplantation owing to FLF from January 2012 to December 2015 were included in the study. Patients were divided into 2 groups. Group 1 consisted of 52 patients who underwent liver transplantation and recovered normal brain function, and group 2 had 17 patients who underwent liver transplantation and did not recover normal brain function and had cerebral death. All patients were evaluated before surgery for clinical encephalopathy stage, light reflex, and convulsions. Groups were compared and assessed according to age (>40, 10-40 and <10 years), body mass index, etiologic factor, preoperative laboratory values, transplantation type, mortality, and encephalopathy level. Multivariate analysis was done for specific parameters. Results. Prothrombin time (PT), international normalized ratio (INR), and total bilirubin values were significantly different between the groups. There was no significant difference between the groups regarding ammonia and lactate levels. There was a statistically significant difference between the groups regarding sodium and potassium levels from serum electrolytes. However, the averages of both groups were within normal limits. pH and total bilirubin levels were meaningful for multivariate analysis. Conclusions. HE reversibility, mortality, and morbidity are important in patients with HE who undergo liver transplantation. Therefore, West Haven clinical staging and serum INR, PT, and total bilirubin level may be helpful in predicting the reversibility of FLF patients with HE before liver transplantation. It was determined that West Haven encephalopathy grading is important in determining the reversibility of HE after transplantation in FLF; especially the probability of reversibility of stage 4 HE decreases significantly. High PT and INR levels, hyperbilirubinemia, and serum sodium and potassium concentrations were risk factors for the reversibility of HE in this study.
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    The factors affecting development of low anterior resection syndrome (LARS) in patients undergoing sphincter preserving surgery for rectal cancer
    (Athens Medical Soc, 2020) Simsek, A.; Bayraktar, H.; Dirican, A.; Ozgor, D.; Ates, M.
    OBJECTIVE To investigate the incidence of major low anterior resection syndrome (LARS), using the LARS score, in patients who underwent sphincter-preserving surgery for rectal cancer, and to explore the factors affecting major LARS development. METHOD The medical records were retrospectively reviewed of patients, who were operated for rectal cancer at a tertiary center between January 2009 and October 2017. The inclusion criteria were: The absence of other colorectal or proctologic diseases, the application of anterior resection (high anterior resection, low anterior resection, extremely low anterior resection), follow-up of more than one year after the primary surgery, and follow-up of more than one year after protective ileostomy closure, and the absence of an unreversed stoma, ongoing treatment with chemotherapy or radiotherapy, recurrence, and metastatic disease. LARS was diagnosed using the LARS score developed by Emmertsen and Laurberg. RESULTS For the study period, 81 patients met the inclusion criteria, including 45 (55.5%) men and 36 (44.4%) women, with a mean age of 60.1 years. Of the 81 patients, 56 (69.1%) underwent chemotherapy and 43 (53%) underwent radiotherapy. Major LARS was detected in 29.6% of the patients. Univariate analysis revealed that radiotherapy, lower tumor location and a short interval after ileostomy closure had an effect on LARS development, and multivariate analysis indicated that incidence of LARS was higher in middle and lower rectal cancer. CONCLUSIONS There appears to be no harm in creating a protective ileostomy for LARS development, with regard to anastomosis safety and the planning of the adjuvant therapy. Neither radiotherapy, nor type of surgery had an effect on major LARS. As was expected, a high rate of major LARS was reported in lower rectal tumors.