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Öğe The 2-Stage Liver Transplant: 3 Clinical Scenarios(Baskent Univ, 2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, CuneytThe 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-year-old 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 Abdominal Closure with Bogota Bag after Pediatric Liver Transplantation.(Wiley-Blackwell, 2014) Kutluturk, Koray; Otan, Emrah; Karabulut, Ertugrul; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Abo-Incompatible Liver Transplantation in Acute and Acute-On-Chronic Liver Failure(H G E Update Medical Publishing S A, 2013) Yilmaz, Sezai; Aydin, Cemalettin; BurakIsik; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ara, Cengiz; Kutlu, RamazanBackground/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 Acute Liver Failure following Sleeve Gastrectomy with Jejuno-Ileal Bypass(Elsevier Sci Ltd, 2021) Aktas, Aydin; Gokler, Cihan; Sansal, Mufit; Karadag, Nese; Kayaalp, CuneytIntroduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric surgery in recent years, and some modifications have emerged to improve its efficacy. Melissas has described SG plus jejuno-ileal bypass (JIB), which has reported good results in a few studies. We performed this procedure in 21 cases and in one case, we observed acute liver failure (ALF) that has not been reported before. Case presentation: A 38-year-old female (BMI: 56.1 kg/m(2)) underwent laparoscopic SG plus JIB. There was no sign of diarrhea, malnutrition or liver failure for eight months and her BMI was 43.0 kg/m(2). At the 9th month, she was hospitalized for abdominal pain, jaundice and ALF. The patient was treated by plasmapheresis and molecular absorptive recirculation system. She was planned to undergo liver transplantation but died of multiorgan failure on the 40th day of hospitalization. Conclusion: ALF can be observed following SG plus JIB. JIB reversal before compromising liver functions should be taken into consideration. (C) 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.Öğe Acute liver failure in Turkey: A systematic review(Aves, 2014) Kayaalp, Cuneyt; Ersan, Veysel; Yilmaz, SezaiBackground/Aims: To present the causes of acute liver failure in Turkey. Materials and Methods: International and national medical research databanks were searched for publications related to acute liver failure and originating from Turkey. Patients in the databank of acute liver failure of our center were also added to this literature search. Patients were evaluated for age, gender, etiology, treatment modality, and outcomes. Results: A total of 308 patients were analyzed. Hepatitis A (20.9%) for children and hepatitis B (34.7%) for adults were the most common causes of acute liver failure. Cryptogenic (18%) and metabolic (14%) reasons were the followings. Wilson's disease was the most common cause of metabolic diseases. Mushroom intoxication was the most frequent factor of toxic liver failure for both adults and children (13%). Firework intoxication, including yellow phosphorus, is an indigenous factor. Anti-tuberculosis agents (3.2%) were the main cause of drug-induced acute liver failures (9%). Paracetamol was responsible for only 0.7% of all acute liver failures. Survival of the transplanted patients (n=118) was better than the non-transplanted patients (n=178) (65% vs. 36% respectively, p<0.001) Conclusion: Preventable causes of acute liver failure in Turkey include hepatitis viruses and intoxication. Active vaccination and public awareness can decrease the number of acute liver failures. Paracetamol is not an emerging reason for acute liver failure in Turkey now, but selling it over the counter may increase the risks.Öğe Adverse effects of misprints in randomized controlled studies as a source of metaanalysis(Springer, 2013) Kayaalp, Cuneyt[Abstract Not Available]Öğe Amebic Acute Appendicitis: Systematic Review of 174 Cases(Springer, 2013) Otan, Emrah; Akbulut, Sami; Kayaalp, CuneytThis study aimed to determine the clinical and demographic features of acute amebic appendicitis by reviewing the reported cases. The PubMed and MEDLINE databases were searched to identify articles related to amebic appendicitis using key words. The search included all articles published between 1935 and 2012 without restricting language, journal, or country. A total of 174 cases of amebic appendicitis reported in 42 articles were analyzed. The mean age of the patients was 23.5 years (range 2 months-83 years). The majority of patients were male (74.0 %), and the majority of cases were reported from countries with high/moderate risk for amebiasis (76.5 %). A history of traveling to a high/moderate-risk country was cited in 64.0 % of the overall cases. The interval between travel and onset of clinical symptoms ranged from months to years. History of or coexisting dysenteric diarrhea was present in only 7.0 and 14.0 % of overall cases, respectively. A preoperative diagnosis of amebiasis was cited for only five cases (3.0 %). Complicated appendicitis was present in 30.7 % of cases, some of which required colon resection. Severe postoperative intraabdominal complications (e.g., liver abscess, abdominal sepsis, gastrointestinal fistula, hemorrhage) occurred in 19.4 % of surgery-treated patients. The overall mortality rate was 3.2 %. Appendectomy specimens should be routinely sent for histopathologic examination. In the case of suspected amebic acute appendicitis, extra precautions-early appendectomy, metronidazole for antibiotic prophylaxis, wet-preparation examination, obtaining a timely pathology result, increasing the awareness of uncommon complications of appendectomy-can hasten appropriate therapeutic intervention and improve outcome.Öğe Autologous Peritoneum Graft Repair of a Superior Mesenteric Vein Defect During Pancreaticoduodenectomy(Springernature, 2015) Kayaalp, Cuneyt; Sumer, Fatih; Polat, Yilmaz; Kutlu, RamazanPancreatic cancers frequently invade the portomesenteric veins. Venous resection during pancreaticoduodenectomy with curative intent is more common now than it was in the past. Most venous resections can be repaired primarily, but some require vascular grafts. Here, we describe the use of an autologous parietal peritoneum graft instead of vascular grafts for repairing a superior mesenteric vein (SMV) defect. Pylorus-preserving pancreaticoduodenectomy combined with en bloc resection of the SMV lateral wall was performed in a 70-year-old woman with cancer of the pancreatic head. The SMV defect was 2 cm long and its width was half the SMV circumference. The defect was covered with a 3 x 2 cm parietal autologous peritoneum graft obtained from the left subcostal area and using running 6/0 polypropylene suture. Tension-free patching was performed, and we retained slight bulging of the graft. Her postoperative course was uneventful. She was discharged on Day 11 after computed tomography confirmed the patency of the SMV, despite slight narrowing. She was well after 10 months of follow-up. Autologous parietal peritoneum grafts can be used for repairing partial venous defects during pancreaticoduodenectomy. They are effective and are easy, fast, and cheap to obtain.Öğe Auxiliary Reno-Portal Anastomosis in Living Donor Liver Transplantation: A Novel Technique for Recipients with Low Portal Inflow(Wiley-Blackwell, 2012) Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ozdemir, Fatih; Yilmaz, Sezai[Abstract Not Available]Öğe Auxiliary reno-portal anastomosis in living donor liver transplantation: a technique for recipients with low portal inflow(Wiley-Blackwell, 2012) Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Yilmaz, Sezai[Abstract Not Available]Öğe Basic Calculating Errors in Systematic Reviews(Springer, 2013) Kayaalp, Cuneyt[Abstract Not Available]Öğe Bursectomy at radical gastrectomy(Baishideng Publishing Group Inc, 2015) Kayaalp, CuneytRadical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum, peritoneum over the posterior lesser sac, pancreas and/or spleen was advocated at the beginning of the 1960s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However, omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursa omentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.Öğe Can rectal tube be used instead of ileostomy in patients undergoing rectal resection after neoadjuvant chemo-radiotherapy?(2020) Gundogan, Ersin; Kayaalp, CuneytAim: 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 chemo-radiotherapy 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 Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment?(Mexican Acad Surgery, 2022) Okut, Gokalp; Turgut, Emre; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, CuneytWe aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 +/- 9.47 kg/m2, be-fore SG the mean BMI was 43.41 +/- 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 +/- 6.89 months, mean excess weight loss (EWL) was 74.77 +/- 8.94%, and mean BMI was 32.65 +/- 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.Öğe A case of Krukenberg tumor, eight years after treatment of gastric cancer(Marmara Univ, Fac Medicine, 2018) Karagul, Servet; Sumer, Fatih; Onur, Asim; Tardu, Ali; Dagli, Adile Ferda; Kayaalp, CuneytKrukenberg tumor is a rare metastatic tumor of the ovary. The primary tumors are usually gastrointestinal cancers. Most of the Krukenberg tumors reported in the literature occurred within the first 2 years after treatment of the primary disease. Herein, we present a case of Krukenberg tumor in a 37-year-old woman who previously underwent surgery and chemotherapy for stomach cancer. This patient is noteworthy because it is one of the few documented cases of ovarian metastasis appearing after a disease-free period of 8 years following treatment of the primary tumor. Krukenberg tumors are associated with poor prognosis; therefore, regular gynecological examination in female patients with history of gastric cancer is very important for the early diagnosis and treatment of this disease.Öğe A case of vaginal recurrence following laparoscopic left-sided colon cancer resection combined with transvaginal specimen extraction(Wolters Kluwer Medknow Publications, 2019) Gundogan, Ersin; Cicek, Egemen; Sumer, Fatih; Kayaalp, CuneytHere, we presented a case of laparoscopic colon cancer resection who developed vaginal recurrence after transvaginal specimen extraction. To our knowledge, this is the first case report on natural orifice specimen extraction-site cancer recurrence. A 59-year-old female underwent laparoscopic left hemicolectomy due to left-sided colon adenocarcinoma, and the specimen was removed through the vagina. She was admitted to the hospital with the complaint of vaginal discharge after 1 year. Tumoural infiltration on the posterior vaginal wall was diagnosed, and biopsy was reported as adenocarcinoma. The patient underwent laparoscopic low anterior resection, total abdominal hysterectomy, bilateral salpingooferectomy and en bloc resection of the posterior vaginal wall due to the local recurrence of colon cancer. She had no recurrence or metastasis within the 3rd year after primary tumour surgery. Recurrence at the specimen extraction site after natural orifice surgery should be considered among the complications. For this reason, incision-preserving methods should not be neglected.Öğe Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult(Elsevier Sci Ltd, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Karagul, Servet; Ertugrul, Ismail; Yagci, Mehmet Ali; Onur, AsimINTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this 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. PRESENTATION OF CASE: 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 of the intrahepatic biliary duct is 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. CONCLUSION: Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.Öğe Case Report on the Demonstration of Minute Colonic Perforations Caused by Birdshot Injury(Springer Heidelberg, 2010) Emeklioglu, Ismet; Kayaalp, Cuneyt; Aydin, CemalettinPenetrating trauma of the colon is usually diagnosed intraoperatively and missed injuries cause considerable morbidity and mortality. Herein, we described an intraoperative diagnostic method for invisible openings on the colon due to a birdshot injury. A 30-year-old man was admitted to the hospital after sustaining gunshot pellet injuries to his abdomen, back, and extremities. Emergency laparotomy relieved splenic injury and free pellet fragments in the abdomen. A pellet fragment was also palpated in the descending colon. Despite meticulous inspection of the colon, it failed to show the entrance of the pellet. An 18F catheter was passed through the anus and was connected to a CO2 insufflator of the laparoscopy unit. The abdominal cavity was filled with normal saline and 1.5 l of CO2 was inflated into the rectum. Five tiny (2-mm) openings on the retroperitoneal part of the descending colon were demonstrated with the help of the air bubbles. All of the openings were suture-ligated and his postoperative course was uneventful. We believe that inflating the colon in cases of abdominal birdshot injuries may allow the demonstration of tiny perforations and provide immediate repairs of missed injuries.Öğe Caval Clamping During Total Hepatectomy with Caval Preservation in Liver Transplantation(Springer, 2011) Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Chemotherapy Related Late Enterocutaneous Fistula Following Laparoscopic Total Gastrectomy for Cancer(Gazi Univ, Fac Med, 2021) Uylas, Ufuk; Sumer, Fatih; Kayaalp, CuneytPostoperative adjuvant chemotherapy is known to be effective for survival in advanced gastric cancer. However, some severe gastrointestinal side effects during chemotherapy can interrupt adjuvant therapy. A 47-year-old woman underwent laparoscopic total gastrectomy for advanced stomach cancer (T4N2M0: Stage IIIB). Cisplatin and 5-fluorouracil chemotherapy was started postoperatively. During the third course of chemotherapy (on the postoperative 102 day) some gastrointestinal content including bile appeared through the healed laparoscopic trocar site. Computed tomography revealed a retroperitoneal abscess connected with this fistula. After percutaneous drainage of the abscess, the fistula ceased spontaneously. The patient was evaluated for chemotherapy again. Chemotherapy-induced gastrointestinal fistula can be seen postoperatively and this can interrupt the patient's chemotherapy process.
