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    Choledochal cyst spontaneously rupturing the hepatic artery
    (Springer, 2000) Kirimlioglu, V; Yilmaz, S; Katz, DA; Hilmioglu, F; Caglikulekci, M; Kayaalp, C; Akoglu, M
    [Abstract Not Available]
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    Palliative decompression of obstructive hilar malignancies utilizing an extrahilar biliary approach
    (Springer, 2000) Yilmaz, S; Kirimlioglu, V; Katz, DA; Caglikulekci, M; Yilmaz, M
    Hilar cancers carry a dismal prognosis. Palliation of obstructive jaundice in patients with hilar cancer can be achieved by either surgical or nonsurgical means. Selection of the appropriate palliative measures is a challenging problem. Segmental bilioenteric anastomosis procedures were performed on 19 patients with hilar cancer. Seventeen of the bypasses were done to the segment III duct, known as the ligamentum teres approach, and two bypasses were to the segment V duct. Five patients, who had already been stented percutaneously or endoscopically, were operated on after the stents were clogged and a duodenal obstruction ensued. There were two postoperative deaths (10.5%) and four postoperative complications (21%). All of the 17 surviving patients experienced improvement in the level of jaundice postoperatively and the levels of serum total and direct bilirubin decreased by 78.9% and 84.2%, respectively. Two patients developed late cholangitis before death and were treated by external biliary drainage; one developed duodenal obstruction and was treated by gastrointestinal anastomosis. The mean length of hospital stay was 15.2 days. Mean survival was 8.2 months and the mean period of well-being was 7.8 months. Median survival was 7 months and median period of well being was 7 months. Three patients are still alive at 8, 8, and 24 months. These data suggest that the ligamentum teres approach offers effective palliation for patients with unresectable hilar cancer.
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    Randomised clinical trial of two bypass operations for unresectable cancer of the pancreatic head
    (Taylor & Francis As, 2001) Yilmaz, S; Kirimlioglu, V; Katz, DA; Kayaalp, C; Caglikulekci, M; Ara, C
    Objective: To compare two different types of prophylactic gastric bypass in patients with cancer of the pancreatic head who were not suitable for curative resection. Design: Prospective study. Setting: University hospital, Turkey. Subjects: 44 patients with unresectable cancer of the pancreatic head without duodenal obstruction who presented between May 1995 and June 2000 who were randomised into 2 groups. Interventions: 22 patients had an antecolic, isoperistaltic gastrojejunostomy, jejunojejunostomy, and hepaticojejunostomy after cholecystectomy. The remaining 22 had a hepaticojejunostomy and antecolic, antiperistaltic gastrojejunostomy procedure after cholecystectomy. Main outcome measures: Mortality, morbidity, postoperative course, and survival. Results: There were no significant differences between the groups in the incidence of postoperative complications, time until restoration of oral diet, relaparotomy rate, late upper gastrointestinal bleeding, mortality, duration of hospital stay, and survival. The isoperistaltic operation took significantly longer than the antiperistaltic operation (p < 0.001) and there was less delayed gastric emptying in the antiperistaltic group but not significantly so. Both operations caused a significant lengthening in the postoperative gastric emptying time (p = 0.04 and p = 0.01, respectively). Conclusions: Both procedures are suitable for patients with unresectable carcinoma of the pancreatic head without impending duodenal obstruction. There was a trend towards better clinical results with the isoperistaltic procedure.