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Öğe The efficiency of laparoscopy in patients with complicated appendicitis(2017) Kocatas, Ali; Kinaci, Erdem; Bozkurt, Mehmet Abdussamet; Gemici, Eyup; Akarsu, CevherAbstract Aim: Laparoscopic approach for complicated appendicitis (CA) is a controversial issue. Although it has been generally recommended, conflicting results have been reported in literature. The aim of this study is to obtain the current results regarding laparoscopic surgery for CA. Material and Methods: Patients who underwent surgery for acute appendicitis between July 2009 and January 2011 in Dr Sadi Konuk Training and Research Hospital were retrospectively analyzed. Appendicitis was considered as CA when there were one of the following criteria; existence of accompanying intra-abdominal abscess, peritonitis, gangrene or perforation confirmed by a histopathological examination. The patients with CA were divided into two groups, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. Demographics, perioperative findings and postoperative course were compared. Results: 846 patients with the diagnosis of appendicitis underwent surgery at our center. Of these, 124 cases were complicated appendicitis. Eighty-five (68.5%) and 39 (31.5%) patients underwent to LA and OA, respectively. The mean ages in two groups were compatible (p=0.224). The mean body mass index was significantly higher in LA group. Presence of accompanying abscess and use of intra-abdominal drain were similar in both groups (p>0.05). Duration of operation was significantly higher in LA group (76.133.7 vs 57.8 22.5) (p=0.001). Although postoperative intra-abdominal abscess formation was slightly higher in LA groups (7 cases vs 1 case), there was no difference in postoperative complication between two groups. Length of hospitalization was also not different in both groups. Time to oral feeding was significantly earlier in LA group. Conclusion: Laparoscopy in complicated appendicitis can be the first choice with no increase in postoperative complications. However, the longer operation time is still a problem for laparoscopic technique despite increasing experience. According to us, future studies should be focused on this problem.Öğe Grape seed protects cholestatic rats liver from ischemia/reperfusion injury(Acta Cirurgica Brasileira, 2016) Cakir, Tugrul; Aslaner, Arif; Tekeli, Seckin Ozgur; Gunes, Kasim; Kinaci, Erdem; Dogan, Ugur; Tekeli, FeyzaPURPOSE: To determine the effect of grape-seed extract against ischemia/reperfusion injury in cholestatic liver. METHODS: Eighteen Wistar albino rats were divided into three groups. In control and study groups, cholestasis was provided by bile duct ligation. Seven days later, the rats were subjected to 30 min hepatic ischemia, followed by 60 min of reperfusion. Oral administration of 50 mg/kg/day grape-seed extract was started 15 days before bile duct ligation and continued to the second operation in the study group. Serum, plasma and liver samples were taken. Laboratory analysis, tissue gluthation, malondialdehyde, myeloperoxidase levels and histopathological examination were performed. RESULTS: Significant decrease in liver gluthation level and significant increase in malondialdehyde level and myeloperoxidase activity were observed after ischemia/reperfusion in cholestatic rats. Serum and plasma levels for laboratory analysis were also significantly higher in cholestatic I/R group. Hepatic necrosis and fibrosis were detected in histopathological examination. Oral grape-seed extract administiration reversed all these parameters and histopathological findings except serum bilirubin levels. CONCLUSION: Oral grape-seed extract treatment can improve liver functions and attenuate the inflammation and oxidative stress in cholestatic ischemia/reperfusion injury.Öğe Low Pressure is Necessary to View and to Protect Corona Mortis During Totally Extraperitoneal Hernia Repair(Mary Ann Liebert, Inc, 2016) Kinaci, Erdem; Ates, Mustafa; Dirican, Abuzer; Ozgor, DincerBackground: The identification of retropubic vasculature is not easy under the pressure of insufflated gas during totally extraperitoneal (TEP) inguinal hernioplasty. We aimed to present the usefulness of a maneuver that allows the clear identification of retropubic vasculature. Methods: Vascular anatomy on the retropubic surface in 364 patients who underwent the TEP procedure from January 2005 to September 2015 was evaluated. In patients after July 2014, the pressure in the workspace was decreased from 14 to 8mmHg before fixation of the mesh to clearly identify the veins. The results before and after July 2014 were compared. Results: Demographic features were not significantly different between two periods. The number of hemipelvises in the first and second periods was 398 and 77, respectively. The rate of identification of venous corona mortis was 31% in the second period, whereas it was 1.0% in the first period (P=.000). The identification of thick (5.5% versus 10.3%; P=.123) and thin (22.8% versus 36.3%; P=.014) arterial structures and their sum were increased in the second period (28.4% versus 46.7%; P=.002). The rate of retropubic bleeding was zero in the second period, while it was 1.5% in the first period. Conclusions: During TEP hernioplasty, the pressure of insufflated gas more than 10mmHg in the preperitoneal space hinders the correct identification of vessels on the retropubic surface. The proposed maneuver, to decrease the pressure in the workspace to 8mmHg, can provide clear identification of all vessels, which decreases the potential risk of vascular injury.Öğe Portosystemic Shunts for Too Small-for-Size Syndrome After Liver Transplantation: A Systematic Review(Springer, 2016) Kinaci, Erdem; Kayaalp, CuneytPortosystemic shunts (PSSs) modulate the portal hyperperfusion against small-for-size syndrome (SFSS) after split or living donor liver transplantation. To find out the results and the limitations of PSSs against SFSS. We searched PubMed and Cochrane databanks for systematic review and analyzed the indications, types, morbidities, and survivals of the PSSs at split or living donor liver transplantations. Total 66 patients were assessed in 16 studies. Main indications for PSS were graft recipient weight ratio (GRWRs) < 0.8 % and/or portal vein pressure > 20 mmHg. Five different types of PSSs were described but hemi-portocaval shunts were the most common one. The incidence of SFSS was 12 %. Overall 90-day, 1-, and 3-year graft survivals were 80, 70, and 47 %, respectively. GRWR < 0.65 % was found as the only significant parameter on graft survival. The 90-day, 1- and 3-year graft survivals for GRWR < 0.65 and a parts per thousand yen0.65 % patients were 62.5, 42.8, and 30.0 and 95, 94, and 67 %, respectively (p = 0.03, p = 0.01, and p = 0.18). PSSs can modulate the small graft size (GRWR < 0.8 %) and/or portal hypertension (> 20 mmHg) after split or living donor liver transplantations sufficiently. However, its protective effect is not unlimited. If the GRWR is below 0.65 %, survival decreases significantly despite PSSs.Öğe Systematic Review for Small-for-Size Syndrome After Liver Transplantation-Chamber of Secrets: Reply(Springer, 2017) Kinaci, Erdem; Kayaalp, Cuneyt[Abstract Not Available]
