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Öğe İdiyopatik çekal ülser ve insidental apendiks karsinoid tümörü birlikteliği(Ulusal Cerrahi Dergisi, 2016) İnce, Volkan; Barut, Bora; Karakaş, SerdarÖz: İdiyopatik çekal ülser (İÇÜ) ya da soliter çekal ülser, oldukça nadir karşılaşılan ve kesin tanısı histopatolojik olarak konulan bir klinik durumdur. Çoğu zaman alt gastrointestinal sistem kanaması araştırılırken kolonoskopik biyopsi ile tanı konurken, nadir olarak da akut karın nedeniyle ya da çekumda kitle görüntüsüyle maligniteyi taklit etmesi nedeniyle cerrahi rezeksiyon sonrası tanı konur. Çekal karsinoid tümör, hastalığın nadir sebeplerinden biridir, ancak apendiks karsinoid tümör birlikteliği daha önce bildirilmemiştir. Bu çalışmada, akut apandisit kliniği ile başvuran ve çekumda duvar kalınlaşması saptanan 73 yaşındaki kadın hastaya sağ hemikolektomi yapılıp patoloji sonucu izole çekal ülser ve serozal apse ve eşlik eden apendiks karsinoid tümörü olan olgu sunulmaktadır. Başlık (İngilizce): Co-existence of idiopathic cecal ulcer and incidental appendix carcinoid tumor Öz (İngilizce): Idiopathic cecal ulcer or solitary cecal ulcer is a rare entity that can only be diagnosed by histopathological evaluation. Generally, it is diagnosed by histolopathological evaluation of biopsy specimens obtained by colonoscopy that is performed for lower gastrointestinal bleeding. It can also be diagnosed after surgical resection performed for acute abdomen or cecal mass mimicking malignancy. Cecal carcinoid tumor is a rare cause of this condition; however, coexistence of cecal ulcer and appendix carcinoid tumor has not been previously reported. In this case, we present a 73-year-old woman who clinically presented as acute appendicitis with cecal wall thickening, underwent right hemicolectomy and was subsequently diagnosed with cecal ulcer, serosal abscess and coexisting appendix carcinoid tumor.Öğe Intestinal perforation after regorafenib usage(AVES, BUYUKDERE CAD 105-9, MECIDIYEKOY, SISLI, ISTANBUL 34394, TURKEY, 2018) Sarıcı, Barış; Karakaş, Serdar; Uylas, Ufuk; Aktaş, Aydın; Dikilitaş, Mustafa; Kayaalp, Cüneyt[Abstract Not Acailable]Öğe Laparoscopic Transanal Endoscopic Microsurgery via Single-Port: A Case Report(Turgut Özal Tıp Merkezi Dergisi, 2015) Gönültaş, Fatih; Koç, Cemalettin; Hatipoğlu, Sinan; Yönder, Hüseyin; Karakaş, Serdar; Ateş, Mustafa; Dirican, AbuzerÖz: Transanal endoskopik mikrocerrahi, rektumda bulunan patolojiler için minimal invaziv bir girişim olup, tek portun transanal endoskopik mikrocerrahide kullanımı mümkündür. Bu çalışmada, merkezimizde ilk kez tek port transanal laparoskopik cerrahi yöntemi ile yaptığımız rektal polip eksizyonu olgusunun sunumunu amaçlandık. Tek port, anal kanala yerleştirildikten sonra perianal bölgeye sütürlerle tespit edildi. Standart ve açılı laparoskopik cerrahi aletler yardımı ile rektumdaki polip rezeksiyonu tam kat gerçekleştirildi. Operasyon sonrası komplikasyon gelişmeyen hasta postoperatif birinci günde taburcu edildi. Histopatolojik incelemede, fokal yüksek dereceli displazi tespit edilen rezeksiyon materyalinin cerrahi sınırları negatif idi. Sonuç olarak, rektal polip rezeksiyonunun, anal kanala tek port uygulanarak laparoskopik cerrahi el aletleri yardımıyla rezeksiyonunun mümkün ve güvenli olduğu görüldü.Öğe Living donor liver transplantation for Budd–Chiari syndrome(Medicine, 2016) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Karakaş, Serdar; Başkıran, Adil; Yılmaz, SezaiBackground: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). Methods:Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n=4) or aortic graft (n=2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. Results: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. Conclusion: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools. Abbreviations: BCS = Budd–Chiari Syndrome, DDLT = deceased donor liver transplantation, ERCP = endoscopic retrograde cholangiopancreatography, HV = hepatic vein, INR = International Normalized Ratio, IRHV = inferior right hepatic vein, JLTS = Japanese Liver Transplantation Society, LDLT = living donor liver transplantation, LT = liver transplantation, PTFE = polytetrafluoroethylene, VCI = vena cava inferior.Öğe Living donor liver transplantation for Budd–Chiari syndrome(Medicine, 95(43), 5136–0., 2016) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Karakaş, Serdar; Başkıran, Adil; Yılmaz, Sezai; Karakaş, SerdarAbstract Background: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). Methods:Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n=4) or aortic graft (n=2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. Results: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. Conclusion: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools. Abbreviations: BCS = Budd–Chiari Syndrome, DDLT = deceased donor liver transplantation, ERCP = endoscopic retrograde cholangiopancreatography, HV = hepatic vein, INR = International Normalized Ratio, IRHV = inferior right hepatic vein, JLTS = Japanese Liver Transplantation Society, LDLT = living donor liver transplantation, LT = liver transplantation, PTFE = polytetrafluoroethylene, VCI = vena cava inferior. Keywords: anastomosis technique, Budd–Chiari syndrome, liver transplantation, living donor liver transplantation, technical difficultiesÖğe Nadir Bir Kist Hidatik Olgusu: Birden Fazla Odaklı Dalak Kist Hidatiğine Yaklaşım(Causapedia, 2017) Karakaş, SerdarÖz: Dalak kist hidatiği, nadir görülen bir olgudur. Özellikleintraabdominal kistik hastalıklarının yaklaşık %1-4'ündegörülmektedir. Biz olgumuzda, iki odaklı dalak kisthidatiği vakasını sunmayı amaçladık. 45 yaşında kadınhasta, karın ağrısı ve karında dolgunluk şikayetleriylebaşvurdu. Yapılan tetkik ve görüntülemeleri sonucundadalakta iki lokalizasyonda biri 14 cm, diğeri 5 cmçapında iki adet kistik odak görüldü. Total splenektomiyapıldı. Patoloji sonucu dalak kist hidatiği olarakraporlandı. Dalak kist hidatikleri, kist hidatiklere bağlıorgan tutulumlarında nadiren görülmektedir. Özelliklebirden fazla odaklı veya intraparankimal tutulumlardakist drenajı zor olabilmektedir. Bu gibi durumlarda,yandaş hastalık yoksa, splenektomi, uygun antibiyotikprofilaksisi, tedavisi ve yakın takip ile güvenli birşekilde uygulanabilirÖğe Posterior sector biliary duct injury during laparoscopic cholecystectomy: Case report(2019) Karakaş, Serdar; Usta, Sertaç; Özdemir, FatihAbstract: Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45- year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.Öğe Postoperative pulmonary complications after liver transplantation assessment of risk factors for mortality(Transplantation Proceedings, 2015) Aydın, Cemalettin; Otan, Emrah; Akbulut, Ahmet Sami; Otan, Emrah; Akbulut, Ahmet Sami; Karakaş, Serdar; Kayaalp, Cüneyt; Karagül, Servet; Çolak, Cemil; Yılmaz, SezaiBackground. The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Method. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson’s c2 test, Fisher’s exact test, and Yate’s corrected c2 test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. Results. The 153 patients with pulmonary complication were divided into 2 groups: mortality (n ¼ 53) and survival (n ¼ 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P ¼ .035), duration of mechanical ventilation (P > .001), pneumonia (P ¼ .01), and endotracheal culture results (P ¼ .001). In the multivariate analysis, hemoglobin (P ¼ .03, odds ratio [OR]: 1.239), MELD score (P ¼ .027, OR: 1.064), duration of mechanical ventilation (P ¼ .003, OR: 1.091), and age (P ¼ .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). Conclusion. Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.Öğe Subcutaneous emphysema following a gun shot(Turgut Özal Tıp Merkezi Dergisi, 2014) Barut, Bora; İnce, Volkan; Koç, Cemalettin; Karakaş, Serdar; Ünal, BülentSubcutaneous emphysema following a gun shotÖğe Tek port ile laparoskopik transanal endoskopik mikrocerrahi: bir vaka takdimi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Gönültaş, Fatih; Koç, Cemalettin; Hatipoğlu, Sinan; Yönder, Hüseyin; Karakaş, Serdar; Ateş, Mustafa; Dirican, AbuzerTransanal endoskopik mikrocerrahi, rektumda bulunan patolojiler için minimal invaziv bir girişim olup, tek portun transanal endoskopik mikrocerrahide kullanımı mümkündür. Bu çalışmada, merkezimizde ilk kez tek port transanal laparoskopik cerrahi yöntemi ile yaptığımız rektal polip eksizyonu olgusunun sunumunu amaçlandık. Tek port, anal kanala yerleştirildikten sonra perianal bölgeye sütürlerle tespit edildi. Standart ve açılı laparoskopik cerrahi aletler yardımı ile rektumdaki polip rezeksiyonu tam kat gerçekleştirildi. Operasyon sonrası komplikasyon gelişmeyen hasta postoperatif birinci günde taburcu edildi. Histopatolojik incelemede, fokal yüksek dereceli displazi tespit edilen rezeksiyon materyalinin cerrahi sınırları negatif idi. Sonuç olarak, rektal polip rezeksiyonunun, anal kanala tek port uygulanarak laparoskopik cerrahi el aletleri yardımıyla rezeksiyonunun mümkün ve güvenli olduğu görüldü.
