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Öğe Case report of non traumatic spontaneous intrahepatic bile duct rupture in an adult(International journal of surgery case reports, 2016) Sümer, Fatih; Kayaalp, Cüneyt; Karagül, Servet; Ertuğrul, İsmail; Yağcı, Mehmet Ali; Onur, AsımSpontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment ofthis rare condition should be based on the individual’s clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture ofthe intrahepatic biliary ductis a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient’s clinical and comorbidity status.Öğe Fibrin sealant use in pilonidal sinus systematic review(World journal of gastrointestinal srgery, 2016) Kayaalp, Cüneyt; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihTo review the current data about the success rates of fibrin sealant use in pilonidal disease. METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients. CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.Öğe Gastric bezoar after roux en Y gastric bypass for morbid obesity A case report(International journal of case reports, 2016) Ertuğrul, İsmail; Tardu, Ali; Tolan, Kerem; Kayaalp, Cüneyt; Karagül, Servet; Kırmızı, SerdarWe aimed to present a patient with gastric pouch bezoar after having a bariatric surgery. PRESENTATION OF CASE: Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely. DISCUSSION: The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints ofthese patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery. CONCLUSION: Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients.Öğe Histopathological examination of explanted liver after transplantation in patients with cryptogenic cirrhosis(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Yağcı, Mehmet Ali; Ertuğrul, İsmail; Sümer, Fatih; Kırmızı, Serdar; Yaylak, Faik; Koç, Cemalettin; Hatipoğlu, Hamit Sinan; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. Materials and Methods. A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. Results. During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-tomale ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. Conclusions. Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.Öğe Influence of Liver Transplantation on Neuropsychiatric Manifestations of Wilson Disease(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Ertuğrul, İsmail; İnce, Volkan; Kırmızı, Serdar; Ünal, Bülent; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease. Materials and Methods. Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up. Results. Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 2.3 vs 2.4 1.3 (P ¼ .0005), 17.7 11.7 vs 12.7 12.5 (P ¼ .055), and 9.0 1.7 vs 7.0 2.1 (P ¼ .033). Conclusions. Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.Öğe Influence of liver transplantation on neuropsychiatric manifestations of wilson disease(Transplantation Proceedings, 2015) Yağcı, Mehmet Ali; Tardu, Ali; Karagül, Servet; Ertuğrul, İsmail; İnce, Volkan; Kırmızı, Serdar; Ünal, Bülent; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease. Materials and Methods. Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up. Results. Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 2.3 vs 2.4 1.3 (P ¼ .0005), 17.7 11.7 vs 12.7 12.5 (P ¼ .055), and 9.0 1.7 vs 7.0 2.1 (P ¼ .033). Conclusions. Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.Öğe Influence of repeated measurements on small bowel length(Springerplus, 2016) Karagül, Servet; Kayaalp, Cüneyt; Kırmızı, Serdar; Tardu, Ali; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the antimesenteric border of the bowel. Results: The median age was 33 (19–67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 ± 103 vs. 485 ± 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe Portosystemic shunt surgery in patients with idiopathic noncirrhotic portal hypertension(Annals of Transplantation, 2016) Karagül, Servet; Yağcı, Mehmet Ali; Tardu, Ali; Ertuğrul, İsmail; Kırmızı, Serdar; Sümer, Fatih; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiIdiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. MATERIAL AND METHODS Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. RESULTS A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7-69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH.Öğe Portosystemic shunt surgery in patients with ıdiopathic noncirrhotic portal hypertension(Annals of Transplantation, 2016) Karagül, Servet; Yağcı, Mehmet Ali; Tardu, Ali; Ertuğrul, İsmail; Kırmızı, Serdar; Sümer, Fatih; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiBackground: Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. Material/Methods: Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. Results: A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7–69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. Conclusions: Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH. MeSH Keywords: Ascites • Gastrointestinal Hemorrhage • Hypertension, Portal • Liver Transplantation • Portasystemic Shunt, Surgical • Splenorenal Shunt, SurgicalÖğe Reresection of colorectal liver metastasis with vena cava resection(Case reports in surgery, 2016) Tardu, Ali; Kayaalp, Cüneyt; Yılmaz, Sezai; Tolan, Kerem; Ersan, Veysel; Karagül, Servet; Ertuğrul, İsmail; Kırmızı, SerdarThe best known treatment of the colorectal liver metastasis is the complete surgical excision with clean surgical margins. However, liver resections sometimes cannot appear technically feasible due to the high number of metastases in the liver, in cases of recurrent resections or invasion of the tumors to the major vascular structures or neighboring organs. Here, we presented a colorectal recurrent liver metastasis invading the retrohepatic vena cava, right adrenal gland, and right diaphragm. En masse resection of the tumor with caudate hepatectomy combined with vena cava resection and surrounding adrenal and diaphragm resections was accomplished. Caval reconstruction was done by a 5 cm in length cryopreserved vena cava homograft under isolated caval clamping. Postoperative period was uneventful and she was discharged on day 11. As a conclusion, combined liver and vena cava resection for a recurrent colorectal liver metastasis is a feasible procedure even with additional neighboring organ resections. Isolated vena cava occlusion with the preservation of the hepatic blood flow may decrease the risk of liver injury in case of previous chemotherapy for liver metastasis.Öğe Retroperitoneal mass presenting as recurrent inguinal hernia A case report(International journal of surgery case reports, 2016) Tardu, Ali; Yağcı, Mehmet Ali; Karagül, Servet; Ertuğrul, İsmail; Kayaalp, CüneytRetroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESENTATION OF CASE: A 53 year old male admitted with the symptoms of weight loss, abdominal discomfort and left sided recurrent inguinal hernia. Physical examination demonstrated an abdominal mass in the left flank and an irreducible, painless scrotal mass. He had a history of left sided inguinal hernia surgery six years ago. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the colon, pancreas and kidney and it was going down towards the left scrotum. Unblock tumor resection including the neighboring organs (left kidney, left colon, distal pancreas with spleen) was performed. Scrotal extension of the tumor was also excised and the inguinal canal was repaired primarily. Histopathology of the mass was myxoid-liposarcoma. The patient has disease free, without hernia recurrence but poor in renal function after twenty months follow-up. DISCUSSION: Large retroperitoneal tumors may grow towards the inguinal region and they can mimic an inguinal hernia.An irreducible, painless and hard scrotal mass should be considered from this perspective.Öğe Small bowel perforation due to a migrated esophageal stent Report of a rare case and review of the literature(International Journal of Surgery Case Reports, 2015) Karagül, Servet; Yağcı, Mehmet Ali; Ara, Cengiz; Tardu, Ali; Ertuğrul, İsmail; Kırmızı, Serdar; Sümer, FatihEndoscopic esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although stent placement is safe and effective method, complications are increasing the morbidity and mortality rate.We aimed to present a patient with small bowel perforation as a consequence of migrated esophageal stent. PRESENTATION OF CASE:A 77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5 cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis. DISCUSSION: Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis. CONCLUSION: Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration.Öğe Transgastric removal of a polycystic liver disease using mini laparoscopic excision(Interventional Medicine and Applied Science, 2016) Sümer, Fatih; Kayaalp, Cüneyt; Polat, Yılmaz; Ertuğrul, İsmail; Karagül, ServetSurgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 × 6 × 0.5 cm and 6 × 3 × 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.
