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Öğe The 2 stage liver transplant 3 clinical scenarios(Experimental and Clinical Transplantation, 2015) Gedik, Ender; Bıçakçıoğlu, Murat; Otan, Emrah; Toprak, Hüseyin İlksen; Işık, Burak; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiThe main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-yearold woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Öğe Abdominoperineal rezeksiyon sonrası masif perineal kanamaya transsakral yaklaşım(Kolon ve Rektum Hastalıkları Dergisi, 2010) Kayaalp, Cüneyt; Aydın, Cemalettin[Abstract Not Acailable]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 Alterations of Thyroid Functions in Obesity: Is There any Impact of Co-Existence of Type 2 Diabetes Mellitus?(2018) Topaloğlu, Ömercan; Sümer, Fatih; Çetin, Sedat; Yoloğlu, Saim; Kayaalp, Cüneyt; İbrahim ŞahinAbstract: Aim: Little is known about the effect of coexistent type 2 diabetes mellitus (DM) on thyroid functions in obesity. We aimed to evaluate the thyroid function in the both diabetic and nondiabetic obese patients. Materials and Methods: 145 obese patients admitted to our department, between June 2014 and May 2016, were included in the study. The patients with known thyroid dysfunction were excluded from the study. The patients were grouped according to their BMI (body mass index), co-existence of type 2 DM, and TSH (thyroid stimulating hormone). Data were collected retrospectively and analyzed. Results: No difference was observed between diabetic and nondiabetic groups for the mean age, body weight, fT3 (free T3), fT4 (free T4), BMI, TSH. Primary hypothyroidism, subclinical hypothyroidism and hyperthyroidism were determined in 1.4, 0.7 and 2.8 % of the patients, respectively; no difference was found between diabetic and nondiabetic groups (p=0.588). There was no significant correlation between BMI and TSH (r=0.030, p=0.717).Distribution of patients in different TSH groups between diabetic and nondiabetic groups were similar (p=0.533). There were positive correlations between BMI and, fT4 or fT3 (r=0.274, p=0.001; r=0.280, p=0.002; respectively). Although 1.4% of all patients had isolated elevation of fT4, there was no difference between groups (p=0.178). 24.6% of diabetic, 28.4% of nondiabetic and 26.6% of all patients had isolated elevation of fT3; however, no difference was found (p=0.634). Conclusions: Our study suggested that obesity could be associated with elevated fT4 and fT3. Elevation of fT3 and fT4 with increasing BMI may be as response to increased metabolic rate. We found no difference between diabetic and nondiabetic groups concerning to fT4 and fT3 elevation. As a result, co–existence of type 2 DM seems to have no effect on thyroid functions.Öğe Association of signal transducer and activator of transcription, interleukin-6, and interleukin-10 positivity with antiviral treatment in cirrhotic liver samples from patients with the hepatitis B or C virus(2018) Kırımlıoğlu, Vedat; Karıncaoğlu, Melih; Barut, Bora; Dirican, Abuzer; Kayaalp, Cüneyt; Gözeneli, Orhan; Yılmaz, Sezai; Kırımoğlu, Saime Hale; Tatlı, FaikAbstract: Objective: Terminal liver disease due to viral hepatitis infections is an important health problem. This study aimed to compare the expression of members of the signal transducer and activator of transcription (STAT) family (STAT-1, -2, -3, -5a, and -5b) and interleukin (IL)-6 and IL-10 in hepatectomy material from patients who received antiviral treatment and underwent a liver transplantation due to terminal liver failure. Methods: The study consisted of 45 patients who underwent a liver transplantation due to chronic liver failure associated with viral hepatitis (hepatitis C virus [HCV] or hepatitis B virus [HBV]). The patients were divided into three groups according to the drug treatments they received prior to the liver transplantation: Group A: lamivudine, Group B: adefovir, and Group C: interferon or interferon + ribavirin. Results: In the study population, 9 (20%) patients were females and 36 (80%) were males. The mean age was 45.7 (29–69) years. STAT-2, -3, and IL-6 expression were significantly higher in hepatocytes in Group A (p<0.05). Conclusion: High STAT-3, high IL-6, and low STAT-1 expression were associated with optimum hepatocyte regeneration and liver metabolic function. In this regard, lamivudine was the most effective drug in the present studyÖğe Bariatrik Cerrahi Adayı Morbid Obezite Hastalarının Yaşam Doyumunun Beden Algısı ve Benlik Saygısı ile İlişkisi(2018) Karlıdağ, Rifat; Kayaalp, Cüneyt; Evren, Bahri; Şahin, İbrahim; Akyüz, Mahmut; Gönenir Erbay, LaleÖz: Amaç: Obezitenin tıbbi sorunların yanı sıra psikososyal sorunlara da neden olduğu görülmektedir. Bu çalışmanın amacı bariatrik cerrahi adayı morbid obezite hastalarının yaşam doyumu, beden algısı ve benlik saygısı düzeylerini ve beden algısı ile benlik saygısının yaşam doyumu üzerine etkisini incelemektir. Gereç ve Yöntem: Çalışmaya Ocak-Aralık 2016 tarihleri arasında İnönü Üniversite Hastanesi Endokrinoloji Bilim Dalı’na başvuran ve vücut kitle indeksi (VKİ) en az 40 olan 136 morbid obezite hastası ve kontrol grubunu oluşturmak üzere VKİ 30’un altında olan 69 sağlıklı kişi dâhil edildi. Katılımcılar bir psikiyatri uzmanı tarafından değerlendirildi ve herhangi bir psikiyatrik hastalığı olanlar çalışma dışı bırakıldı. Hasta ve kontrol grubu-na sosyo-demografik veri formu, Coopersmith Benlik Saygısı Ölçeği, Beden Algısı Ölçeği ve Yaşam Doyumu Ölçeği uygulandı. Bulgular: Yapılan istatistiksel analizlerde morbid obezite hastalarında yaşam doyumu ve beden algısı ölçek puanları kontrol grubundan düşüktü. Benlik saygısı ölçek puanlarının ise hastalarda kontrol grubundan yüksek saptanması dikkat çekici idi. Yapılan korelasyon analizinde yaşam doyumu ve beden algısı arasında pozitif korelasyon saptandı. Sonuç: Çalışmanın bulgularına göre morbid obezite hastalarının kontrol grubuna göre yaşam doyumlarının daha düşük ve beden görünümlerinden memnuniyetsizliklerinin daha fazla olduğu, ancak benlik saygılarının yüksek olduğu görüldü. Ayrıca kişinin beden imajından memnuniyeti arttıkça yaşam doyumu da artmaktaydı. Beğeni kavramı ve güzellik anlayışı ve bunun kişi üzerinde etki derecesi toplumlar arasında farklılık göstermektedir. Benlik saygısının da kişiler arası ilişkilerden etkilendiği düşünülürse farklı toplumlarda yapılan diğer çalışmaların aksine çalışmamızda morbid obez hastalarda benlik saygısının yüksek oluşu toplumsal yapı ve/veya toplumsal kabul ve hasta sayısının değişkenliği ile ilişkili olabilir.Öğe Bulimia nervosa following bariatric surgery: a case report(2017) Erbay Gönenir, Lale; Şahin, İbrahim; Kayaalp, Cüneyt; Karlıdağ, RifatAbstract: Bariatric surgery is an obesity treatment method gaining popularity in recent years. Since it may cause rapid weight loss and improvement in comorbid conditions, it is a preferred modality in some of the obese patients. Both obesity and bariatric surgery interact with psychiatric disorders and require a thorough psychiatric evaluation. It has been shown that eating disorders diagnosed in the preoperative period may continue postoperatively as well. However, development of eating disorders in the postoperative periodfor the first time is quite rare. Here, we present a patient who was diagnosed with bulimia nervosa after she had bariatric surgery for obesity. After psychiatric evaluation, she was diagnosed with bulimia nervosa that developed after bariatric surgery. Medical and cognitive behavioral therapy programs were initiated. A partial improvement in her disturbed body perception was observed. She is still on medical and cognitive behavioral therapies. Eating disorder like bulimia nervosa may develop even in patients whose preoperative psychiatric evaluation is normal. Therefore, we suggest not only preoperative but also postoperative detailed psychiatric evaluation and follow up in obese patients who are candidate for bariatric surgeryÖğe Can rectal tube be used instead of ileostomy in patients undergoing rectal resection after neoadjuvant chemo-radiotherapy?(2020) Gündoğan, Ersin; Kayaalp, CüneytAbstract: Aim: Neoadjuvant chemo-radiotherapy and total mesorectal excision have become the standard treatment for locally advanced middle and distal rectal cancers. These types of patients carry a serious risk of anastomosis leakage. While the commonly technique is diverting ileostomy; rectal tube placement, with lower morbidity, has also been used in recent years. The aim of this study was to compare the results of ileostomy and rectal tube administration following rectal resection after neoadjuvant therapy. Material and Methods: We retrospectively reviewed the data from 25 patients with rectal cancer who received neoadjuvant chemoradiotherapy between 2013 and 2019. Patients were evaluated in two groups: ileostomy and rectal tube. Demographic data, operative findings, pathological results, and follow-up information were evaluated. Results: Twelve were in the rectal tube group and 13 were in the ileostomy group. There was no difference between the two groups in terms of tumor location in preoperative data. Patients with hepatic metastasis were found in the ileostomy group, while there were no such patients in the rectal tube group. The operation time (452±128 vs. 295±102 min, p=0.002) and blood loss (485±264 vs 105±80 ml, p=0.0001) were higher in the ileostomy group. The intraoperative complications of the patients were similar in the two groups, whereas the postoperative complications were higher in the ileostomy group (69%-25%, p=0.04). The mean follow-up period was 23.2±18.5 months. The total complication rate due to ileostomy was 20% and the stomata of 15% of the patients were not closed. The cosmetic scores of the patients were better in the rectal tube group (9.8±0.3 vs. 6.3±1.7, p=0.0001). Conclusion: The results of the rectal tube technique were not worse than those of the ileostomy technique in rectal cancers receiving neoadjuvant therapy and this technique may be preferred in appropriate cases.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 Öğe Chylous ascites after liver transplantation Incidence and risk factors(Liver Transplantation, 2012) Yılmaz, Mehmet; Akbulut, Ahmet Sami; Işık, Burak; Ara, Cengiz; Özdemir, Fatih; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiIn this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presence of ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dissection (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.Öğe Chylous ascites after liver transplantation incidence and risk factors(Liver Transpl., 0–0., 2012) Yılmaz, Sezai; Akbulut, Ahmet Sami; Işık, Burak; Ara, Cengiz; Özdemir, Ramazan; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiIn this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after livertransplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteenof these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data.Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients includedin this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developingchylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, venacava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascitesbefore transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system(LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presenceof ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors fordeveloping chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant asci-tes [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dis-section (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence ofpreoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylousascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Neverthe-less, our results should be supported by new prospective trials. Liv er Transpl 18:1046-1052, 2012.VC2012 AASLD.Öğe Circumferential Fence With the Use of Polyethylene Terephthalate Dacron Vascular Graft for All in One Hepatic Venous Reconstruction in Right Lobe Living Donor Liver Transplantation(Transplantation Proceedings, 47(5), 1458–1461., 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Circumferential fence with the use of polyethylene terephthalate dacron vascular graft for all in one hepatic venous reconstruction in right lobe living donor liver transplantation(Transplantation Proceedings, 2015) Ara, Cengiz; Akbulut, Ahmet Sami; İnce, Volkan; Aydın, Cemalettin; Gönültaş, Fatih; Kayaalp, Cüneyt; Ünal, Bülent; Yılmaz, SezaiIntegration of hepatic vein tributaries with a diameter 5 mm into the drainage system in rightlobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522e1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.Öğe Comparison of intracorporeal or extracorporeal placement of stapler anvil in colorectal NOSE surgery(2020) Gündoğan, Ersin; Kayaalp, CüneytAbstract: Aim: The aim of this study is to compare the results of the patients for whom intracorporeal or extracorporeal anvil insertions were performed. Natural orifice specimen extraction (NOSE) surgery has been started from the 21st century onwards in order to reduce wound-related complications of laparoscopy. Two types of anvil placements, including intracorporeal or extracorporeal placements, are used in the application of NOSE, which is combined with distal colorectal surgery. Material and Methods: We retrospectively collected the data from 77 patients who underwent laparoscopic distal colorectal surgery combined with NOSE in our clinic between 2013 and 2019. Patients were evaluated in two groups as intra-corporeal and extracorporeal. Selection of the technique was based on the length of sigmoid colon and mesocolon. Demographic data, operative findings, pathological results and follow-up information were evaluated. Results: Of 77 patients who underwent distal colorectal surgery and circular stapler anastomosis; 44 were in the intracorporeal group and 33 were in the extracorporeal group. There was no difference between the two groups in terms of gender, age, BMI, comorbidity, and abdominal operation history of patients. The number of patients undergoing low anterior resection was higher in the extracorporeal group, and also the number of patients undergoing anterior resection was higher in the intracorporeal group. Peroperative findings, intraoperative and postoperative complications of patients were similar in both groups. The postoperative first-day pain scale was lower in the intracorporeal group (3.3±2.1 vs. 4.4±2.3, p=0.03). No significant difference was found between the two groups in other pain scales and cosmetic scores. The oncologic results were similar during the mean follow-up of 35.5±24.1 months. Conclusion: Although anvil placement techniques are not interchangeable, it is seen that neither method predominates the other in cases where both are suitable.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 Does body mass index affect the intraoperative and early postoperative outcomes in patients with laparoscopic distal gastrectomy for gastric cancer?(2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kaplan, Kuntay; Sümer, Fatih; Kayaalp, CüneytThe effect of increased body mass index (BMI) on the short- and long-term outcomes of laparoscopic distal gastrectomy (LDG) is controversial. We aimed to evaluate the influence of BMI on intraoperative and early postoperative outcomes in patients with LDG for gastric cancer (GC). Eighty-six patients who underwent LDG for GC were included in this study retrospectively. The patients were divided into two groups as normal weighted (BMI=18.5-24.9 kg/m2, n=29) and overweighted-obese (BMI?25 kg/m2, n=57). Preoperative and intraoperative data, postoperative outcomes were retrospectively analyzed and compared between the two groups. The preoperative data were similar between the groups. The rate of the history of previous abdominal surgery (19.3% to 3.4%, p=0.05) and the median preoperative carcinoembryonic antigen (CEA) levels (1.7 ng/ml to 1 ng/ml, p=0.06) were higher in the overweighted-obese group but the differences were not significant. There were no significant differences in intraoperative data and early postoperative outcomes between the groups but the rate of postoperative serious complications (12.3% to 6.9%, p=0.71), the reoperation rate (10.5% to 6.9%, p=0.71), and 90-day-mortality rate (5.3% to 0%, p=0.5) were higher in the overweighted-obese group. Although the rates of postoperative serious com- plications, reoperation, and mortality were higher in the overweighted-obese patients, BMI had no significant effect on intraoperative and early postoperative outcomes in patients who underwent LDG for GC. LDG for GC is a feasible and safe approach for overweighted-obese patients.Öğe Early term results of the left colic artery preservation in colorectal cancer surgery(2022) Kaplan, Kuntay; Gökler, Cihan; Bağ, Yusuf Murat; Cengiz, Emrah; Sümer, Fatih; Aydın, Cemalettin; Kayaalp, CüneytIntroduction: Colorectal cancer is a common type of cancer that causes significant morbidity and mortality. Post-resection anastomosis safety is important. The most important factor affecting anastomosis safety is blood accumulation in the anastomosis. In this study, we aimed to examine the early-term results of the preservation of the left colic artery (LCA) during laparoscopic anterior and low anterior resection (LAR) for the treatment of rectum and sigmoid colon cancers based on our clinical experience. Materials and Methods: A total of 192 archive files that were operated for rectum and sigmoid colon cancer in our center between April 2019 and October 2022 were reviewed retrospectively. The patients were diagnosed using colonoscopy and biopsy during the pre-operative period. The patients and their results were discussed in the oncology council, and the patients’ treatment plans were formed based on the council’s decision. Results: The patients’ mean age was 65.4±9.33 years and nearly half of them were males (n=8, 53.3%). Of the patients, 12 (80%) of them underwent LAR, while three patients (20%) underwent AR. The mean duration of surgery was 322.66±101.8 min, while the median bleeding amount was 50 (20–150) cc. One patient (6.7%) required reoperation due to an anastomotic leak, and abscess drainage was performed using the transanal method. No mortality was observed in patients at 30 days. Conclusion: In our study, the low ligation (LL) and LCA were preserved during laparoscopic AR and LARs for rectum and sigmoid colon cancers, preserving blood accumulation in the anastomosis. However, multi-center prospective randomized controlled studies are required to demonstrate whether LL significantly reduces anastomotic leaks.
