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Öğe Aborted donor hepatectomy in living donor liver transplantation: lessons learned(Sa Medical Assoc, 2020) Kutluturk, K.; Akbulut, S.; Baskiran, A.; Gonultas, F.; Dirican, A.; Isik, B.; Yilmaz, S.Background: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. Methods: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. Results: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. Conclusions: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.Öğe Analysis of risk factors affecting the development of infection in artificial vascular grafts used for reconstruction of middle hepatic vein tributaries in LDLT(Lippincott Williams & Wilkins, 2018) Koc, C.; Akbulut, S.; Isik, B.; Yologlu, S.; Yilmaz, S.[Abstract Not Available]Öğe Can an Extended Right Lobe be Harvested from a Donor with Gilbert's Syndrome for Living-Donor Liver Transplantation? Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Unal, B.; Isik, B.; Ozgor, D.; Piskin, T.; Ersan, V.; Gonultas, F.Gilbert'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 A descriptive analysis of 188 liver transplant patient visits to an Emergency Department(Verduci Publisher, 2012) Turtay, M. G.; Oguzturk, H.; Aydin, C.; Colak, C.; Isik, B.; Yilmaz, S.Background: The aim of the study is to seek the causes of application, the demographic and clinical characteristics of liver transplant patients and to share the experiences of our Emergency Department. Materials and Methods: One hundred eighty-eight Emergency Department visits of ninety patients who underwent liver transplant operations between 2002 and 2009 were evaluated retrospectively. Results: The patients applied to the Emergency Department with the complaints of fever 28.2% and abdominal pain 30.9%. It was detected that the final diagnosis of 52.4% of the patient visits was associated with the gastrointestinal system. It was observed that the most common treatment was drug therapy by 45.2% and that antibiotics treatment was the most applied method in drug treatment. Alanine aminotransferase (ALT) median value of hospitalized patients (45.5 U/L) is significantly higher than that of discharged patients (35 U/L) (p = 0.04). From the records of the patients, positive correlations between the length of hospitalization and levels of total bilirubin, direct bilirubin, ALT and fever during the visit were detected (p = 0.001, p < 0.001, p = 0.01, p = 0.01, respectively). Conclusions: Most frequently liver transplant recipients visited the Emergency Departments with the complaints of fever and abdominal pain. The diagnosis was generally associated with gastrointestinal system disorders. The percentage of hospitalization was high and the length of stay at the hospital was long. The treatment of these patients required a multidisciplinary approach and antibiotics constituted the most used drug treatment. Also, fever and liver function tests examined at the time of admittance to the Emergency Department affected the length of hospitalization.Öğe Effects of Different Positive End-Expiratory Pressure Values on Liver Function and Indocyanine Green Clearance Test in Liver Transplantation Donors: A Prospective, Randomized, Double-Blind Study(Elsevier Science Inc, 2015) Bicakcioglu, M.; Aydogan, M. S.; Sayan, H.; Toprak, H. I.; Isik, B.; Yilmaz, S.; Yologlu, S.Introduction. The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients. Methods. ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy. Results. The positive end-expiratory pressure (PEEP) was 0 cm H2O in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P <.05). Conclusions. Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.Öğe Effects of Thoracic Epidural Anesthesia on Liver Blood Flow and Indocyanine Green Clearance Test in Living-Donor Liver Transplantation: A Prospective, Randomized, Double-Blind Study(Elsevier Science Inc, 2015) Sayan, H.; Aydogan, M. S.; Bicakcioglu, M.; Toprak, H. I.; Isik, B.; Yilmaz, S.Background. Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Our aim in this study was to compare thoracic epidural anesthesia and general anesthesia effects on liver blood flow by means of liver function tests and indocyanine green and compared with living-donor liver transplantation. Methods. Subjects were divided into 2 equal groups: the control group (group I) and the epidural block group (group II, closed envelope method). In group II patients, the epidural catheter was inserted at the T6-8 level. In all patients, anesthesia was standardized with the use of lidocaine, fentanyl, and thiopental. Indocyanine green clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), and at postoperative 24 and 72 hours were recorded. Simultaneously, hemoglobin, hematocrit, platelet count, prothrombin time (PT), international normalized ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate transaminase, and alanine transaminase values were analyzed. Results. Plasma disappearance rate (PDR) and retention at 15 minutes (R15) of indocyanine green were not statistically significant difference between groups (P > .05). Intragroup comparison of PDR and R15 values at times T1, T2, T3, and T4 showed that the values at T0 were statistically significant (P < .05). PT and INR values were significantly different for all times within each group (P < .05). It was concluded that the use of thoracic epidural anesthesia has no effect on global liver function and liver-related liability tests in patients undergoing elective liver donor surgery.Öğe First laparoscopic totally extraperitoneal repair of Laugier's hernia: a case report(Springer, 2013) Ates, M.; Dirican, A.; Kose, E.; Isik, B.; Yilmaz, S.An atypical femoral hernia developing through the lacunar ligament is called Laugier's hernia. Preoperative diagnosis of these atypical hernias is very difficult because of their rarity and similar clinical appearance to conventional femoral hernias. A 52-year-old female presented with right groin swelling. During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, a hernia sac through an opening in the lacunar ligament was diagnosed and repaired with mesh covering the inguinal floor. The surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias. A laparoscopic approach should be chosen instead of a conventional approach for the treatment of femoral hernias because of its high diagnostic and therapeutic capacity for all types of femoral hernia, including Laugier's.Öğe Futility Versus Acceptability of the Use of Grafts Taken From End of Line in the National Organ-Sharing Network(Elsevier Science Inc, 2015) Soyer, V.; Koc, S.; Onur, A.; Sarici, B.; Kayaalp, C.; Isik, B.; Unal, B.Background. The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution. Methods. The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed. Results. A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively. Conclusions. The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.Öğe How should we approach to incidentally detected neuroendocrine tumor during living donor hepatectomy?(Lippincott Williams & Wilkins, 2018) Akbulut, S.; Isik, B.; Samdanci, E.; Yilmaz, S.[Abstract Not Available]Öğe Is there any relationship between clinical parameters and histopathologic features of gallbladder specimens obtained from living liver donors(Wolters Kluwer Medknow Publications, 2019) Akbulut, S.; Uylas, U.; Tolan, K.; Samdanci, E.; Araci, A.; Isik, B.; Yologlu, S.Objective: To investigate whether there is any relationship between the clinical parameters and the histopathological features of the gallbladder (GB) specimens obtained from living liver donors (LLDs). Methods: The demographic (age, sex, height, weight, and BMI), clinical (liver graft type, liver graft weight, and GB volume), microbiological (bile culture), and histopathological (width, length, wall thickness, and microscopic properties of the GB specimen) data of 169 LLDs, who underwent living donor hepatectomy between October 2015 and October 2017, were prospectively recorded and retrospectively analyzed. The LLDs were compared with respect to sex (male vs. female) and the histopathological features of the GB (normal structure vs. chronic cholecystitis vs. cholesterolosis/polyps/cholelithiasis). Results: There were no significant differences between both sexes with respect to age, graft type, and some features of GB (volume, wall thickness, width, length, and bile culture). On one hand, there were significant differences between both sexes with regard to height (P < 0.001), weight (P < 0.001), BMI (P < 0.001), histopathological findings (P = 0.003), and graft size (P = 0.003). Comparison with regard to GB's histopathological features revealed no significant differences between the three groups with respect to age, weight, and some features of GB (volume, length, width, and bile culture). On the other hand, the three groups were significantly different in terms of sex (P = 0.003), height (P = 0.008), BMI (P = 0.002), and wall thickness (P = 0.044). Bile culture proliferation occurred in none of the patients except for one patient. Conclusion: This study is the first to assess GB's volume, dimensions, and bile culture in healthy individuals such as LLDs.Öğe Is there any relationship between clinical parameters and histopathologic features of gallbladder specimens obtained living liver donors?(Lippincott Williams & Wilkins, 2018) Akbulut, S.; Uylas, U.; Tolan, K.; Samdanci, E.; Araci, A.; Isik, B.; Yologlu, S.[Abstract Not Available]Öğe Isolated recurrence of early-stage cervical cancer in the abdominal wall with suboptimal surgery(I r o g canada, ınc, 4900 cote st-luc, apt#212, montreal, quebec h3w 2h3, canada, 2018) Yilmaz, E.; Coskun, E., I; Koc, C.; Sahin, N.; Isik, B.; Ciplak, B.In this report, the authors present the case of a 47-year-old woman with an isolated recurrence of early-stage cervical cancer treated with suboptimal surgery of the abdominal wall and that subsequently underwent radiotherapy.Öğe Isolated recurrence of early-stage cervical cancer in the abdominal wall with suboptimal surgery(I R O G Canada, Inc, 2018) Yilmaz, E.; Coskun, E., I; Koc, C.; Sahin, N.; Isik, B.; Ciplak, B.In this report, the authors present the case of a 47-year-old woman with an isolated recurrence of early-stage cervical cancer treated with suboptimal surgery of the abdominal wall and that subsequently underwent radiotherapy.Öğe Living Donor Liver Transplantation for Hepatocellular Carcinoma(Elsevier Science Inc, 2012) Isik, B.; Ince, V.; Karabulut, K.; Kayaalp, C.; Yilmaz, S.Background. Liver transplantation is a widely accepted modality in the treatment of hepatocellular carcinoma (HCC). In our center, patients with HCC limited to the liver without macrovascular invasion are accepted as candidates for living donor liver transplantation (LDLT). The aim of this study was to describe the patient characteristics and outcomes at a single institution to analyze the impact of our criteria on the survival of HCC patients. Patients and Methods. We reviewed the medical records of all HCC (n = 105) patients who underwent liver transplantation in our institution. We excluded deaths in the early postoperative period and deceased donor liver transplantation (DDLT) patients, leaving 74 subjects (65 males and 9 female). Their median age was 53 years (range, 19-69). Univariate Kaplan-Meier and multivariate Cox proportional hazards models were used to analyze overall and disease-free survivals. Results. Thirty-two (43%) patients were within the Milan criteria, and 42 (57%) exceeded them. One- and 2-year overall survival rates for patients within versus exceeding the Milan criteria were 72% versus 68% and 61% versus 58%, respectively. One- and 2-year disease-free survival rates for patients within versus exceeding the Milan criteria were 72% versus 68% and 60% versus 55%, respectively (P > .05). Tumor recurrence rates for patients within versus exceeding the Milan criteria were 0% versus 36%, respectively (P = .0002). Alpha-fetoprotein level was the only predictor of overall survival; alpha-fetoprotein level and tumor differentiation were predictors of disease-free survival. Conclusion. Although higher recurrence rates have been observed among patients exceeding the Milan criteria, LDLT is the only treatment option for the patients in countries with limited sources of cadaveric organs. As a general principle, we believe that the use of cadaveric donor liver grafts is not suitable for patients who exceed these criteria.Öğe Living Liver Donor with Fasciola Hepatica: First Case in the Liver Transplantation Society(Lippincott Williams & Wilkins, 2017) Akbulut, S.; Isik, B.; Yilmaz, S.[Abstract Not Available]Öğe Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum following Endoscopic Retrograde Cholangiopancreatography in a Living Liver Donor(Avicenna Organ Transplant Center, 2018) Akbulut, S.; Isik, B.; Karipkiz, Y.; Yilmaz, S.Despite having many advantages, living donor liver transplantation has not been adopted by western countries due to risk of nearly life-threatening complications after living donor hepatectomy (LDH). Herein, we aimed at presenting the management of a 19-year-old patient who suffered life-threatening complications after right lobe LDH. A multiple detector computed tomography (MDCT) revealed a bilioma at the cut surface of the remnant liver, for which a transhepatic drainage catheter was placed. Endoscopic retrograde cholangiopancreatography (ERCP) performed to decompress biliary tract, but the biliary tract could not be cannulized due to post-precut bleeding. On the next day, extensive crepitation was detected and MDCT showed subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum (ERCP-related duodenal perforation?). However, the patient showed significant deterioration of physical examination findings, fever, and infectious parameters, and therefore was taken to the operating room. Kocher maneuver revealed no apparent duodenal perforation. Then, a 2-mm bile duct was found open at the caudate lobe, through which bile leaked. Then, common bile duct exploration and T-tube placement were performed, followed by suture closure of the bile orifice at the caudate lobe. Massive air previously identified completely disappeared one week after the operation.Öğe Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum Following ERCP in Living Liver Donor: Apparent Life-threatening Event(Lippincott Williams & Wilkins, 2017) Akbulut, S.; Isik, B.; Yilmaz, M.; Karipkiz, Y.; Yilmaz, S.[Abstract Not Available]Öğe Outcomes of Left-Lobe Donor Hepatectomy for Living-Donor Liver Transplantation: A Single-Center Experience(Elsevier Science Inc, 2013) Usta, S.; Ates, M.; Dirican, A.; Isik, B.; Yilmaz, S.Living-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 +/- 8.9 (range, 19-63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 +/- 7.1 (range, 2-58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.Öğe Partial hepatectomy is curative for the localized type of Caroli's disease: A case report and review of the literature(Royal College Surgeons Edinburgh, 2006) Yilmaz, S.; Kirimlioglu, H.; Kirimlioglu, V.; Isik, B.; Coban, S.; Yildirim, B.; Ara, C.The case of a 58-year-old woman who was diagnosed with the localized type of Caroli's disease is presented. This disease involves the whole of the left half of the liver. A left hepatectomy was followed by complete resolution of symptoms. The current article suggests that hepatic resection may be aggressively performed in selected patients with the localized form of Caroli's diseaseÖğe Patency of middle hepatic vein tributaries and right inferior hepatic vein reconstructed with different sized PTFE vascular graft in right lobe living donor liver transplantation(Lippincott Williams & Wilkins, 2018) Yonder, H.; Akbulut, S.; Isik, B.; Yilmaz, S.[Abstract Not Available]
