Yazar "Ersan, Veysel" seçeneğine göre listele
Listeleniyor 1 - 20 / 64
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe ABO incompatible liver transplantation in acute and acute on chronic liver failure(Hepato-gastroenterology, 2013) Yılmaz, Sezai; Aydın, Cemalettin; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, Mehmet; Ara, Cengiz; Kutlu, Ramazan; Bayındır, Yaşar; Ersan, VeyselABO-incompatible (ABO-I) liver transplantation (LTx) is an inevitable problem in emergency conditions such as acute liver failure or acute-on-chronic liver failure when deceased donor (DD) is not available or living donor (LD) selection is limited. This study spesifically addressed the problem of emergency ABO-I LTx in critically ill adult patients having acute liver failure or severely decompensated end stage liver disease. Methodology: This series included 16 patients, of which 10 underwent ABO-I LD LTx and 6 patients underwent 7 ABO-I DD LTx. Two patients underwent ABO-compatible LD LT before ABO-I DD LT, because of hepatic artery thrombosis. Multiple sessions of plasmapheresis were used to reduce isoaglutinin titres to 1/16 or below before and after the transplantation. Splenectomy was carried out after the graft reperfusion in the last 7 cases. In the first 9 patients splenic artery ligation was performed. Data were prospectively collected and retrospectively analysed. Results: The follow-up period ranged from 1 to 38 months. The mean follw-up period was 10.37 months. Median age of patients was 50 years (17-63 years). The MELD scores ranged from 17 to 30 (median 22.5). Median survival of patients was 9 months and mean survival was 19.5 months. Hospital mortality consisted of 3 patients (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 stil living with hepatic necrosis problem. Conclusion: ABO-I LTx remains an important and unavoidable therapeutic option in adult patients with acute or acute-on-chronic liver failure awaiting an emergency procedure and in the context of living donor liver transplantation. This option should be offered to all patients in cases of immediate need for an allograft without the possibility to allocate a blood group compatible liver graft.Öğe ABO incompatible liver transplantation in acute and acute on chronic liver failure(Hepatogastroenterology, 2013) Yılmaz, Sezai; Aydın, Cemalettin; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, Mehmet; Ara, Cengiz; Kutlu, Ramazan; Bayındır, Yaşar; Ersan, VeyselAbstract BACKGROUND/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 ABO incompatible liver transplantation in acute and acute on chronic liver failure(Hepato-gastroenterology, 2013) Yılmaz, Sezai; Aydın, Cemalettin; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, Mehmet; Ara, Cengiz; Kutlu, Ramazan; Bayındır, Yaşar; Ersan, VeyselBACKGROUND/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 Acute liver failure in Turkey: A systematic review(Aves, 2014) Kayaalp, Cuneyt; Ersan, Veysel; Yilmaz, SezaiBackground/Aims: To present the causes of acute liver failure in Turkey. Materials and Methods: International and national medical research databanks were searched for publications related to acute liver failure and originating from Turkey. Patients in the databank of acute liver failure of our center were also added to this literature search. Patients were evaluated for age, gender, etiology, treatment modality, and outcomes. Results: A total of 308 patients were analyzed. Hepatitis A (20.9%) for children and hepatitis B (34.7%) for adults were the most common causes of acute liver failure. Cryptogenic (18%) and metabolic (14%) reasons were the followings. Wilson's disease was the most common cause of metabolic diseases. Mushroom intoxication was the most frequent factor of toxic liver failure for both adults and children (13%). Firework intoxication, including yellow phosphorus, is an indigenous factor. Anti-tuberculosis agents (3.2%) were the main cause of drug-induced acute liver failures (9%). Paracetamol was responsible for only 0.7% of all acute liver failures. Survival of the transplanted patients (n=118) was better than the non-transplanted patients (n=178) (65% vs. 36% respectively, p<0.001) Conclusion: Preventable causes of acute liver failure in Turkey include hepatitis viruses and intoxication. Active vaccination and public awareness can decrease the number of acute liver failures. Paracetamol is not an emerging reason for acute liver failure in Turkey now, but selling it over the counter may increase the risks.Öğe Acute traumatic diaphragmatic ruptures a retrospective study of 48 cases(Surgery Today, 2011) Dirican, Abuzer; Yılmaz, Mehmet; Ünal, Bülent; Ersan, Veysel; Pişkin, Turgut; Yılmaz, SezaiPurpose. Traumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is diffi cult. Methods. Forty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated. Results. There were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17–69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015). Conclusion. The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.Öğe Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases(Springer, 2011) Dirican, Abuzer; Yilmaz, Mehmet; Unal, Bulent; Piskin, Turgut; Ersan, Veysel; Yilmaz, SezaiPurpose. Traumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is difficult. Methods. Forty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated. Results. There were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17-69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015). Conclusion. The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.Öğe Biliary complications in 106 consecutive duct to duct biliary reconstruction in right lobe living donor liver transplantation performed in 1 year in a single center a new surgical technique(Transplant Proc., 2011) Kırımlıoğlu, Vedat; Tatlı, Faik; İnce, Volkan; Aydın, Cemalettin; Ersan, Veysel; Ara, Cengiz; Aladağ, Murat; Kutlu, Ramazan; Kırımlıoğlu, Saime Hale; Yılmaz, SezaiObjective. Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods. Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-toduct anastomosis. Results. All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion. We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.Öğe Biliary complications in 106 consecutive duct to duct biliary reconstruction in right lobe living donor liver transplantation performed in 1 year in a single center a new surgical technique(Transplant Proc, pp. 0–0, Apr. 2011., 2011) Kırımlıoğlu, Vedat; Tatlı, Faik; İnce, Volkan; Aydın, Cemalettin; Ersan, Veysel; Ara, Cengiz; Aladağ, Murat; Kutlu, Ramazan; Kırımlıoğlu, Hale; Yılmaz, SezaiABSTRACT Objective. Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods. Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-toduct anastomosis. Results. All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion. We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.Öğe Can an extended right lobe be harvested from a donor with gilbert s syndrome for living donor liver transplantation case report(Transplantation Proceedings, 2012) Yılmaz, Mehmet; Ünal, Bülent; Işık, Burak; Dinçer, Özgür; Pişkin, Turgut; Ersan, Veysel; Gönültaş ,Fatih; Yılmaz, SezaiGilbert’s syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient’s selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1–2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is 30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Can an extended right lobe be harvested from a donor with gilbert’s syndrome for living-donor liver transplantation? Case report(Transplantation Proceedings, 2012) Yılmaz, Mehmet; Ünal, Bülent; Işık, Burak; Özgör, Dinçer; Pişkin, Turgut; Ersan, Veysel; Gönültaş, Fatih; Yılmaz, SezaiGilbert’s syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient’s selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1–2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is 30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Chronic liver fibrosis induction in aging causes significant ultra-structural deterioration in liver and alteration on immune response gene expressions in liver-spleen axis(Taylor & Francis Inc, 2024) Karaca, Zeynal Mete; Karaca, Gamze; Kayhan, Basak; Gul, Mehmet; Ersan, Veysel; Bag, Harika Gozukara; Yesilada, ElifThe relationship between damage to the liver and spleen by aging and the immune response status in these two organs, which are anatomically and immunologically interconnected, is unknown. The authors investigated the histopathological, ultrastructural, and immunological effects of aging in young and aged fibrotic mice by using an experimental model. Four groups were planned, with 10 mice in each experimental group. The levels of fibrosis and ultrastructural destruction in the liver were determined by alpha-SMA staining and TEM analysis. Expression levels of immunity genes (Il2, Il4, Il6, Il10, Il12, Il17, Tnf, Ifng, Tgfb1, Gata3, Rorc, Tbx21, Foxp3, Ccl2, Ccr2, Cxcr3, Pf4, Cxcl10) were carried out by qRT-PCR. While structural disorders were detected in the mitochondria of aged healthy group, cellular destruction in the fibrosis-induced elderly group was at a dramatic level. Fibrosis induction in aged mice caused an elevation in the expression of chemokines (CCl2, CXCL10, CCR2) and cytokine (IL-17a) genes that induce autoinflammatory response in the liver. Unlike the cellular pathology and genes activated in fibrosis in youth and the natural occurrence of fibrosis with aging, induction of fibrosis during aging causes deterioration in the liver and expression of genes responsible for autoimmunity in both the liver and spleen.Öğe Colorectal stenting for obstruction due to retrorectal tumor in a patient unsuitable for surgery(Sciendo, 2017) Ersan, Veysel; Kutlu, Ramazan; Erdem, Ceyhun; Karagul, Servet; Kayaalp, CuneytFund of knowledge on palliative treatment of unresectable retrorectal tumors is scare. Here, we reported a non-surgical treatment of a huge retrorectal malignant tumor in an aged and debilitated patient complicated with colorectal obstruction. An 86-year-old male with severe comorbidities was admitted with acute colorectal obstruction owing to an untreated retrorectal malign epithelial tumor. There was a lobulated retrorectal mass, 20 cm x 15 cm at largest size, extending to the superior iliac bifurcation level, caused an obstruction of the rectal lumen. He was not suitable for surgical excision because of the severe comorbidities. Rectal obstruction was palliated by two self-expandable metallic stents. He tolerated the procedures well and post-procedural course was uneventful. After four months, stents were patent and the patient was continent. Stenting for colorectal obstruction owing to a retrorectal tumor can be feasible in patients who are not suitable for surgery (aged, debilitated, advanced tumor). It avoided the surgical trauma to a high-risk patient and ensured the continuity of continence. As far as we know, this was the first report on colorectal stenting for a retrorectal tumor.Öğe A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients(Springer, 2021) Carr, Brian, I; Bag, Harika Gozukara; Ince, Volkan; Akbulut, Sami; Ersan, Veysel; Usta, Sertac; Isik, BurakPurpose HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. Methods A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (<= 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. Results Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. Conclusion The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.Öğe CONGENITAL TRANSMESENTERIC DEFECT : INTERMITTENT INTESTINAL OBSTRUCTION DUE TO INTERNAL HERNIATION(Istanbul Univ, Faculty Medicine, Publishing Office, 2011) Ince, Volkan; Isik, Burak; Gozeneli, Orhan; Ersan, Veysel; Koc, CemalettinInternal hernias are a rare cause of intestinal obstruction. Intestinal obstruction occurs as a result of herniation, developing of congenital or acquired defects. Mortality rates reach 20% if surgical intervention is not made on time. We describe a 27-years-old female patient complained of intermittent obstruction, with no history of previous operations, treated with timely surgical intervention when irreversible changes have not been developped in herniated small bowell by only the reduction of hernia and closure the transmesenteric defect.Öğe 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, 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 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.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 Controlling massive hemorrhage from the retropancreatic portal vein as a complication of thromboendovenectomy during liver transplantation with balloon catheter tamponade how to do it(Surgery Today, 2014) Aydın, Cemalettin; Ersan, Veysel; Başkıran, Adil; Ünal, Bülent; Kayaalp, Cüneyt; Yılmaz, Sezait We 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 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 Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University(Kare Publ, 2017) Ince, Volkan; Ersan, Veysel; Ozdemir, Fatih; Barut, Bora; Koc, Cemalettin; Isik, Burak; Kayaalp, CuneytOBJECTIVE: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor. METHODS: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed. RESULTS: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively. CONCLUSION: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.
