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Öğe Adipose-derived stem cells in the treatment of hepatobiliary diseases and sepsis(Baishideng Publishing Group Inc, 2022) Satilmis, Basri; Cicek, Gizem Selen; Cicek, Egemen; Akbulut, Sami; Sahin, Tevfik Tolga; Yilmaz, SezaiDetermination of the mesenchymal stem cells is one of the greatest and most exciting achievements that tissue engineering and regenerative medicine have achieved. Adipose-derived mesenchymal stem cells (AD-MSC) are easily isolated and cultured for a long time before losing their stem cell characteristics, which are self-renewal and pluripotency. AD-MSC are mesenchymal stem cells that have pluripotent lineage characteristics. They are easily accessible, and the fraction of stem cells in the adipose tissue lysates is highest among all other sources of mesenchymal stem cells. It is also HLA-DR negative and can be transplanted allogenically without the need for immunosuppression. These advantages have popularized its use in many fields including plastic reconstructive surgery. However, in the field of hepatology and liver transplantation, the progress is slower. AD-MSC have the potential to modulate inflammation, ameliorate ischemia-reperfusion injury, and support liver and biliary tract regeneration. These are very important for the treatment of various hepatobiliary diseases. Furthermore, the anti-inflammatory potential of these cells has paramount importance in the treatment of sepsis. We need alternative therapeutic approaches to treat end-stage liver failure. AD-MSC can provide a means of therapy to bridge to definitive therapeutic alternatives such as liver transplantation. Here we propose to review theoretic applications of AD-MSC in the treatment of hepatobiliary diseases and sepsis.Öğe Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature(Baishideng Publishing Group Inc, 2018) Akbulut, Sami; Cicek, Egemen; Kolu, Mehmet; Sahin, Tevfik Tolga; Yilmaz, SezaiAlveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.Öğe A case of vaginal recurrence following laparoscopic left-sided colon cancer resection combined with transvaginal specimen extraction(Wolters Kluwer Medknow Publications, 2019) Gundogan, Ersin; Cicek, Egemen; Sumer, Fatih; Kayaalp, CuneytHere, we presented a case of laparoscopic colon cancer resection who developed vaginal recurrence after transvaginal specimen extraction. To our knowledge, this is the first case report on natural orifice specimen extraction-site cancer recurrence. A 59-year-old female underwent laparoscopic left hemicolectomy due to left-sided colon adenocarcinoma, and the specimen was removed through the vagina. She was admitted to the hospital with the complaint of vaginal discharge after 1 year. Tumoural infiltration on the posterior vaginal wall was diagnosed, and biopsy was reported as adenocarcinoma. The patient underwent laparoscopic low anterior resection, total abdominal hysterectomy, bilateral salpingooferectomy and en bloc resection of the posterior vaginal wall due to the local recurrence of colon cancer. She had no recurrence or metastasis within the 3rd year after primary tumour surgery. Recurrence at the specimen extraction site after natural orifice surgery should be considered among the complications. For this reason, incision-preserving methods should not be neglected.Öğe Comparison of natural orifice and conventional transabdominal specimen extraction: literature review(Ame Publishing Company, 2023) Aktas, Aydin; Cicek, EgemenBackground and Objective: Conventional laparoscopic (CL) surgery is widely used in colorectal surgery. However, specimen extraction in CL requires an abdominal incision, which leads to increased rates of incision- related complications, such as postoperative pain, hernia, and surgical site infection (SSI). To reduce these complications, a novel and minimally invasive surgical approach known as natural orifice sample extraction (NOSE) has gained increasingly widespread use. The aim of this review is, intended to compare NOSE and CL in terms of postoperative complications and oncological outcomes in colorectal surgery. Methods: Various medical databases were searched up to May 2021. We included retrospective, cohort study, randomized controlled trials and meta-analysis on the treatment of colorectal cancer (CRC) with NOSES. Key Content and Findings: The results of this review showed that; compared with CL, NOSE showed less intraoperative bleeding, less postoperative pain and less analgesic requirement, fewer postoperative complications, better cosmetic recovery, less hospital stay, and better quality of life (QoL). While the operation time was found to be longer in NOSE, oncological results were similar in the two groups. Conclusions: NOSE can be applied in colorectal surgery with better clinical outcomes and similar oncologic outcomes. Large-scale multicenter studies are required to confirm its clinical benefits.Öğe Effects of papaverine on healing of colonic anastomosis in rats(Springer Wien, 2017) Basceken, Salim Ilksen; Sevim, Yusuf; Akyol, Cihangir; Cicek, Egemen; Aydin, Ferit; Kocaay, Akin Firat; Pasaoglu, Ozge TugceBackground Anastomotic leak is the most devastating complication after colorectal surgery, and the blood supply is a very important factor in anastomotic healing. Papaverine is a vasodilatory and antispasmodic agent which has been used in many ischemic conditions because of its potentially protective effects. The aim of this study is to investigate the effects of papaverine on healing colon anastomosis. Methods Forty 8- to 10-week-old female Wistar Albino rats were used in this study. Rats were randomized into 4 groups: control group; ischemia-reperfusion and anastomosis group; ischemia-reperfusion and anastomosis + intraperitoneal one dose papaverine group; and ischemia-reperfusion and anastomosis + intraperitoneal daily (10 days) papaverine group. Anastomotic bursting pressures, the hydroxyproline measurements and macroscopic adhesion gradings were evaluated. Results There was a significant difference between papaverine-administered groups and ischemia-reperfusion and anastomosis group for anastomotic bursting pressures, hydroxyproline measurements and macroscopic adhesion grading (p < 0.05). Conclusion In the rat model, papaverine had a favorable effect on anastomotic healing.Öğe Hepatocellular Carcinoma Tumor Microenvironment and Its Implications in Terms of Anti-tumor Immunity: Future Perspectives for New Therapeutics(Springer, 2021) Satilmis, Basri; Sahin, Tevfik Tolga; Cicek, Egemen; Akbulut, Sami; Yilmaz, SezaiPurpose Hepatocellular cancer is an insidious tumor that is often diagnosed in a later stage of life. The tumor microenvironment is the key to tumorigenesis and progression. Many cellular and non-cellular components orchestrate the intricate process of hepatocarcinogenesis. The most important feature of hepatocellular cancer is the immune evasion process. The present review aims to summarize the key components of the tumor microenvironment in the immune evasion process. Methods Google Scholar and PubMed databases have been searched for the mesh terms Hepatocellular carcinoma or Liver Cancer and microenvironment. The articles were reviewed and the components of the tumor microenvironment were summarized. Results The tumor microenvironment is composed of tumor cells and non-tumoral stromal and immune cells. HCC tumor microenvironment supports aggressive tumor behavior, provides immune evasion, and is an obstacle for current immunotherapeutic strategies. The components of the tumor microenvironment are intratumoral macrophages (tumor-associated macrophages (TAM)), bone marrow-derived suppressor cells, tumor-associated neutrophils (TAN), fibroblasts in the tumor microenvironment, and the activated hepatic stellate cells. Conclusion There are intricate mechanisms that drive hepatocarcinogenesis. The tumor microenvironment is at the center of all the complex and diverse mechanisms. Effective and multistep immunotherapies should be developed to target different components of the tumor microenvironment.Öğe Influence of Drain Placement on Postoperative Pain Following Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Randomized Controlled Trial(Springer, 2018) Gundogan, Ersin; Kayaalp, Cuneyt; Aktas, Aydin; Saglam, Kutay; Sansal, Mufit; Gokler, Cihan; Cicek, EgemenThere is currently no evidence to support the routine use of an abdominal drain following laparoscopic Roux-en-Y gastric bypass (RYGB). Our aim was to investigate drain use in laparoscopic RYGB and its effects on postoperative pain. Sixty-six patients were randomly divided into two groups as no-drain (n = 36) and with-drain (n = 30). Intraoperative (time, blood loss, complications) and postoperative outcomes (morbidities, pain scores, hospital stay) were compared. Demographics of both groups were comparable. Three patients in the no-drain group required a drain (8.3%). Median visual analog scale scores for days 1-3 for with-drain and no-drain groups were 4.5 (2-9) vs. 3 (0-8) (p = 0.02), 3 (0-7) vs. 2 (0-7) (p = 0.10), and 2 (0-7) vs. 0 (0-4) (p = 0.0004), respectively. There was no difference between the groups in terms of complications and length of hospital stay. Drain use increased the postoperative pain following laparoscopic RYGB. Drain placement following laparoscopic RYGB should be selective instead of a routine application.Öğe Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?(Baishideng Publishing Group Inc, 2020) Demyati, Khaled; Akbulut, Sami; Cicek, Egemen; Dirican, Abuzer; Koc, Cemalettin; Yilmaz, SezaiBACKGROUND Since the first living donor liver transplantation (LDLT) was performed by Raia and colleagues in December 1988, LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient. Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss. However, this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins. CASE SUMMARY Herein, we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases. CONCLUSION Thanks to this venous reconstruction model, none of the patients developed postoperative complications related to venous drainage. Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.Öğe Laparoscopic gastrectomy in remnant gastric cancer(Turkish Surgical Assoc, 2021) Cicek, Egemen; Zengin, Akile; Gunes, Orgun; Sumer, Fatih; Kayaalp, CuneytObjective: Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. Material and Methods: The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Results: Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Conclusion: Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.Öğe Neuroendocrine tumor incidentally detected during living donor hepatectomy: A case report and review of literature(Baishideng Publishing Group Inc, 2018) Akbulut, Sami; Isik, Burak; Cicek, Egemen; Samdanci, Emine; Yilmaz, SezaiTo our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy (LDH) has been reported in the English language medical literature. We present two cases in which grade. neuroendocrine tumors (NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-year-old male underwent LDH for his brother suffering from HBV-related chronic liver disease (CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm x 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus (HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealed grade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues. (c) The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.Öğe Omentopexy versus falciformopexy for peptic ulcer perforation(Turkish Assoc Trauma Emergency Surgery, 2019) Olmez, Aydemir; Cicek, Egemen; Aydin, Cemalettin; Kaplan, Kuntay; Kayaalp, CuneytBACKGROUND: Open or laparoscopic Graham's omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP. METHODS: Between 1999 and 2018, 303 patients who were followed-up and treated for PUP were included in this study. Patients who had malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery and nonoperative treatment were excluded from this study. In the remaining patients, either open ometopexy or falciformopexy were applied based on the surgeon's choice. These two techniques were compared for intraoperative and postoperative outcomes. RESULTS: Falciformopexy (n=46) and omentopexy (n=243) groups had similar demographics, but ASA scores were lower in the falciformopexy group. For ulcer size and localization, duration of operation, no difference was found between the groups. There was no significant difference between the groups concerning general postoperative morbidity and mortality. However, atelectasis was more frequently observed in the omentopexy group, whereas the pexia failure was more frequent in the falciformopexy group (2.6% and 8.7%, p=0.04). CONCLUSION: Falciformopexy is an alternative technique that can be used in situations where it is not possible to use the omentum. Falciformopexy is not superior to omentopexy for the repair of the PUP.Öğe Percutaneous gas decompression can ease endoscopic derotation in sigmoid volvulus(Turkish Surgical Assoc, 2023) Uylas, Ufuk; Cicek, Egemen; Sumer, Fatih; Kayaalp, CuneytSigmoid volvulus is a disease of elderly and debilitated patients. In sigmoid volvulus patients, colonoscopic derotation is the most commonly applied approach as the first line treatment. However, colonoscopic derotation sometimes fail and then urgent surgery is required in these frail patients with high morbidity and mortality. Percutaneous colonic gas decompression has been described to sigmoid volvulus. In case of life-threating increase intraabdominal pressure and as a primary attempt before colonoscopy. However, this technique did not find wide acceptance in the literature. Here, we aimed to present a 78-year-old male with sigmoid volvulus in whom colonoscopic derotation failed and following percutaneous gas decompression, endoscopic derotation could be done successfully. Evacuation of percutaneous colon gas in the sigmoid volvulus may facilitate endoscopic derotation when the first colonoscopic attempt failed.Öğe Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single-center prospective cohort study(Wiley, 2019) Aktas, Aydin; Kayaalp, Cuneyt; Gunes, Orgun; Gokler, Cihan; Uylas, Ufuk; Cicek, Egemen; Ersoy, YaseminIntroduction Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and Methods Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. Results A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for >= 150 minutes, surgical duration of >= 600 minutes, intraoperative hemorrhage of >= 1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61. Discussion Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.Öğe Transverse colon stenosis following laparoscopic total gastrectomy for gastric remnant carcinoma(Wolters Kluwer Medknow Publications, 2019) Cicek, Egemen; Sumer, Fatih; Gundogan, Ersin; Gokler, Cihan; Kayaalp, CuneytLaparoscopic surgery for remnant gastric cancer has been reported in a limited number of cases, and data on post-operative complications are lacking. A 58-year-old male was admitted with remnant gastric cancer. He had undergone open subtotal gastrectomy 9 years ago for gastric cancer. Laparoscopic total gastrectomy was performed, and he was discharged on the 10th day uneventfully. The patient had complained of nausea and vomiting in the 2nd post-operative month. He clinically and radiologically diagnosed as ileus and required open emergency surgery. There was a transverse colon stenosis near the splenic flexure. Hartmann's procedure was done, and he was discharged on day 17. We have limited knowledge about colonic complications after laparoscopic gastric surgery. The development of stenosis in the transverse colon is one of these complications that should be kept in mind. As far as we know, such a complication has never been reported before.
