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    Acute Pancreatitis: A Rare but Serious Complication for Living Liver Donors; Risk Factors and Outcomes
    (Baskent Univ, 2022) Baskiran, Adil; Kement, Metin; Barut, Bora; Ozsay, Oguzhan; Karakas, Serdar; Koc, Cemalettin; Yilmaz, Sezai
    Objectives: The purposes of this study were to determine the incidence of acute pancreatitis after living donor hepatectomy and to investigate potential risk factors and outcomes. Materials and Methods: Clinical data of all donors who underwent donor hepatectomy between January 2015 and December 2016 in our liver transplant institute were reviewed. Donor data were obtained from a prospectively maintained database. The donors were divided into 2 groups according to whether they developed postoperative pancreatitis. The following data were compared between the 2 groups: demo graphic information (age, sex), body mass index, type of hepatectomy (right, left, or left lateral), intraoperative cholangiographic findings, operative time, blood loss, graft data (graft weight, remnant liver ratio), duration of postoperative hospital stay, and postoperative morbidity and mortality (if any). Pancreatitis severity and treatment outcomes were also examined in patients with postoperative pancreatitis. Results: Our study included 348 donors who underwent donor hepatectomy for living-donor liver transplant. Postoperative pancreatitis developed in 6 donors (1.7%). We found no statistical differences between patients with and without postoperative pancreatitis in terms of demographic and intraoperative findings. Neither loco-regional nor systemic complications of pancreatitis developed in any of the patients. Therefore, all were classified as having mild pancreatitis according to revised Atlanta classification. The mean APACHE II score was 5.2 +/- 1.2 points (range, 4-7 points). All patients with postoperative pancreatitis received conservative-supportive treatment. Conclusions: Although postoperative pancreatitis is a rarely reported complication in living liver donors, it should always be considered, especially in patients who unpredictably deteriorate in the postoperative period. Proper recognition and timely treatment can help avoid serious consequences.
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    Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation
    (Lippincott Williams & Wilkins, 2019) Koc, Cemalettin; Akbulut, Sami; Ozdemir, Fatih; Kose, Adem; Isik, Burak; Yologlu, Saim; Yilmaz, Sezai
    Background. To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT). Methods. Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P <= 0.20 were taken into logistic regression model. Results. Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P <= 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection. Conclusions. This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.
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    Analysis of risk factors affecting the development of peptic ulcer perforation: case-control study
    (Termedia Publishing House Ltd, 2021) Akbulut, Sami; Caliskan, Ali Riza; Saritas, Hasan; Demyati, Khaled; Bilgic, Yilmaz; Unsal, Selver; Koc, Cemalettin
    Aim: The aim of the to determine the risk factors associated with increased risk of peptic ulcer perforation (PUP). Material and methods: The demographic, clinic, and biochemical parameters of 65 patients (PUP group) who underwent PUP surgery at our clinic between June 2009 and September 2016 were compared with the data of 134 patients (control group) who underwent endoscopy at a gastroenterology clinic for dyspeptic complaints. The control group were matched at random in a 1 : 2 ratio with the PUP group. Univariate analyses were used to compare different variables and variables with clinical significance, and p <= 0.05 was used in the backward stepwise logistic regression model. Results: This study included 65 patients with peptic ulcer perforation aged 17 to 92 years (PUP group) and 134 patients with dyspeptic complaints aged 18 to 87 years (control group). Univariate analysis showed that statistically significant differences were found between groups in terms of non-steroidal anti-inflammatory drugs usage (p = 0.042; OR = 1.868), smoking (p < 0.001; OR = 5.124), old age (p = 0.003), low body mass index (BMI) (p < 0.001), and low hemoglobin (Hb) (p = 0.002). However multivariate analysis showed that increasing age (p = 0.004; OR = 1.035), smoking (p = 0.007; OR = 3.591), decreasing Hb (p = 0.042; OR = 1.277), and decreasing BMI (p < 0.001; OR = 1.669) were independent clinically significant risk factors for development of PUP. Conclusions: This study showed that decreased BMI, decreased Hb, increased age, and smoking were independent risk factors for development of PUP. Thus, this group of patients needs particular attention paid to suggestive symptoms with early diagnosis and optimal management of peptic ulcer disease.
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    Artificial vascular graft migration into hollow viscus organs in patients who underwent right lobe living donor liver transplantation
    (Taylor & Francis Ltd, 2020) Koc, Cemalettin; Akbulut, Sami; Bilgic, Yilmaz; Otan, Emrah; Sarici, Baris; Isik, Burak; Bayindir, Yasar
    Background:To share our experience with hollow viscus migration of artificial vascular grafts (AVG) used for venous reconstruction of the right anterior sector in living donor liver transplantations (LDLT). Methods:Clinical, radiological, and endoscopic data of 13 right lobe LDLT patients (range: 26-67 years) with a diagnosis of postoperative AVG migration into adjacent hollow viscus were analyzed. Results:Biliary complications were detected in 12 patients. A median of four times endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed in 11 patients prior to AVG migration diagnosis. A median of 2.5 times various percutaneous radiological interventional procedures were performed in eight patients prior to AVG migration diagnosis. The site of migration was the duodenum in eight patients, gastric antrum in four, and Roux limb in the remaining one patient. The migrated AVS were made of polytetrafluoroethylene (PTFE) in 10 patients and polyethylene terephthalate (Dacron) in three. The migrated AVGs were endoscopically removed in seven patients and surgically removed in six. Only one patient died due to sepsis unrelated to AVG migration. Conclusion:AVG migration into the adjacent hollow viscus following right lobe LDLT is a rare and serious complication. Repetitive ERCP, interventional radiological procedures, infection related to biliary leakage, and thrombosis of AVGs are among the possible risk factors.
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    Barolith as a rare cause of acute appendicitis: a case report
    (Turkish Assoc Trauma Emergency Surgery, 2013) Ince, Volkan; Isik, Burak; Koc, Cemalettin; Baskiran, Adil; Onur, Asim
    A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90 similar to 95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.
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    Comment on A serious complication of liver hydatid cysts in children: cystobiliary fistulas
    (Springer, 2020) Akbulut, Sami; Koc, Cemalettin; Sahin, Tevfik Tolga
    [Abstract Not Available]
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    Comment on current status of liver transplantation in Asia (Int J Surg 2020; 825:4-8)
    (Elsevier, 2021) Akbulut, Sami; Koc, Cemalettin; Sahin, Tevfik Tolga; Yilmaz, Sezai
    [Abstract Not Available]
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    Comment on the high-end range of biliary reconstruction in living donor liver transplant
    (Lippincott Williams & Wilkins, 2020) Yilmaz, Sezai; Akbulut, Sami; Koc, Cemalettin; Usta, Sertac; Baskiran, Adil; Karakas, Serdar; Sahin, Tevfik Tolga
    [Abstract Not Available]
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    Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy
    (Baishideng Publishing Group Inc, 2019) Akbulut, Sami; Koc, Cemalettin; Kocaaslan, Huseyin; Gonultas, Fatih; Samdanci, Emine; Yologlu, Saim; Yilmaz, Sezai
    BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases. AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy. METHODS The demographic, biochemical, and histopathological data of 72 patients (Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients (Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1: 4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists. RESULTS Statistically significant differences were found between groups in terms of age (P = 0.044), white blood cell count (P < 0.001), neutrophil (P < 0.001), lymphocyte (P < 0.001), red cell distribution width (P = 0.036), mean corpuscular hemoglobin (P = 0.001), bilirubin (P = 0.002), appendix width (P < 0.001), and presence of acute appendicitis histopathologically (P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis (72.2%), fibrous obliteration (9.7%) and acute appendicitis (6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis (62.8%), perforated appendicitis (16.7%), lymphoid hyperplasia (8.3%), and appendix vermiformis (6.3%). CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when necessary
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    Comparison of Standard and Modified Standard Organ Procurement Techniques for Deceased Donors
    (Baskent Univ, 2020) Koc, Cemalettin; Akbulut, Sami; Yilmaz, Sezai
    Objectives: This study aimed to compare the impact of deceased-donor organ procurement techniques (standard versus modified standard) on biochemical outcomes after liver transplant. Materials and Methods: From February 2006 to December 2013, organs were recovered from 105 consecutive deceased donors by our transplant team. All organ procurement procedures were performed by a pioneer surgeon experienced in organ recovery from deceased donors. Donors were divided into those who had the abdominothoracic approach, which is referred to as the standard technique, and those who had the abdominal approach, which is referred to as the modified standard technique. Both groups were compared in terms of age, sex, weight, height, body mass index, liver graft weight, cross-clamping time, cold ischemia time, and liver function tests in recipients over the first 3 postoperative days. Results: Our study group included 66 male and 39 female donors, with an age range of 1 to 93 years (median of 44 y, means +/- standard deviation of 43.8 +/- 23.7 y). Among the deceased donors, 73 underwent the modified standard technique and 32 underwent the standard technique. There were no statistically significant differences between groups in terms of age, sex, weight, height, body mass index, graft weight, cold ischemia time, and liver function tests in recipients over the first 3 postoperative days. We observed a statistically significant difference between groups in terms of cross-clamping time (P < .001). Conclusions: Except for the decreased cross-clamping time, the modified standard technique for deceased organ retrieval had no effect on clinical outcomes in recipients after liver transplant. However, this retrospective study requires additional prospective investigations to more fully understand the differences.
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    CONGENITAL TRANSMESENTERIC DEFECT : INTERMITTENT INTESTINAL OBSTRUCTION DUE TO INTERNAL HERNIATION
    (Istanbul Univ, Faculty Medicine, Publishing Office, 2011) Ince, Volkan; Isik, Burak; Gozeneli, Orhan; Ersan, Veysel; Koc, Cemalettin
    Internal hernias are a rare cause of intestinal obstruction. Intestinal obstruction occurs as a result of herniation, developing of congenital or acquired defects. Mortality rates reach 20% if surgical intervention is not made on time. We describe a 27-years-old female patient complained of intermittent obstruction, with no history of previous operations, treated with timely surgical intervention when irreversible changes have not been developped in herniated small bowell by only the reduction of hernia and closure the transmesenteric defect.
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    Correction of Portal Venous Narrowing With Saphenous Vein Graft During Right Lobe Living Donor Hepatectomy
    (Lippincott Williams & Wilkins, 2015) Koc, Cemalettin; Ozdemir, Fatih; Soyer, H. Vural; Dirican, Abuzer; Isik, Burak; Yilmaz, Mehmet; Yilmaz, Sezai
    [Abstract Not Available]
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    Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University
    (Kare Publ, 2017) Ince, Volkan; Ersan, Veysel; Ozdemir, Fatih; Barut, Bora; Koc, Cemalettin; Isik, Burak; Kayaalp, Cuneyt
    OBJECTIVE: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor. METHODS: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed. RESULTS: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively. CONCLUSION: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.
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    Determination of risk factors affecting mortality in patients with gastrointestinal perforation after pediatric liver transplantation
    (Wiley, 2019) Barut, Bora; Akbulut, Sami; Kutluturk, Koray; Koc, Cemalettin; Ozgor, Dincer; Aydin, Cemalettin; Selimoglu, Ayse
    Gastrointestinal perforation (GIP) is one of the most serious complications occurring after liver transplantation (LT), especially in pediatric patients. This study aimed to determine the risk factors affecting mortality in pediatric patients with GIP after LT. GIP developed in 37 (10%) of 370 pediatric patients who underwent LT at our institute. Patients were divided into two groups: alive (n = 22) or dead (n = 15), and both groups were compared in terms of demographic and clinical parameters using univariate analysis. There was no statistically significant difference between groups in either demographic or clinical parameters, except for perforation site (P = 0.001) and median follow-up (P = 0.001). Stomas arose in 17 (45.9%) patients: 76% of patients with stomas and 45% of those without survived (P = 0.052). Kaplan-Meier analysis indicated that patients with stomas had a significantly higher overall survival (P = 0.029) and that patients with duodenal and colonic perforation had a significantly lower overall survival. Multivariate analysis showed that re-perforation was an independent risk factor for mortality (P = 0.035; OR: 17.674; 95% CI for OR: 1.233-253.32). Although there are many options for management of GIP, including primary repair, resection plus anastomosis, and resection plus end or loop ostomy, gastrointestinal diversion is still the best option.
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    Diaphragmatic Hernia Following Donor Hepatectomy
    (Lippincott Williams & Wilkins, 2016) Koc, Cemalettin; Ince, Volkan; Otan, Emrah; Ersan, Veysel; Barut, Bora; Baskiran, Adil; Ozdemir, Fatih
    [Abstract Not Available]
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    Differential diagnosis of the granulomatous appendicitis: Retrospective analysis of 16 cases
    (Turkish Assoc Trauma Emergency Surgery, 2021) Akbulut, Sami; Koc, Cemalettin; Sarici, Kemal Baris; Samdanci, Emine; Yakupogullari, Yusuf; Bayindir, Yasar
    BACKGROUND: This study aims to present the usability of real-time polymerase chain reaction (PCR) and interferon-gamma release assay (IGRA) in the differential diagnosis of granulomatous appendicitis (GAp), especially in areas where tuberculosis (TB) is endemic. METHODS: Sixteen patients underwent appendectomy with presumed diagnosis of acute appendicitis were retrospectively analyzed for histopathological diagnosis of GAp. Real-time PCR method was used to show the whether presence of DNA of the tubercle bacilli in paraffin-embedded tissue blocks. IGRA test was used to investigate whether tubercle bacilli-specific interferon gamma was present in peripheral blood. RESULTS: Sixteen patients (male: 10 female: 6) aged between 21 and 82 years were included in this study. All patients had acute appendicitis and three of them also had appendiceal perforation. Histopathologically, necrotizing granulomatous inflammation was detected in all appendectomy specimens. Acid-fast bacilli were not detected in any of the pathology slides stained with Ehrlich-Ziehl-Neelsen. Real-time PCR was studied in paraffin-embedded tissue blocks of all patients with GAp, but the TB bacilli DNA was amplified in only three patients. IGRA test was studied in peripheral blood samples of 12 patients with GAp and results were as follows: negative (n=9), positive (n=2) and indeterminate (n=1). CONCLUSION: We believe that the use of anamnesis, histopathological findings, tissue PCR, blood IGRA and clinical findings together are important for differential diagnosis of GAp, especially where TB is endemic. We also suggest that all appendectomy specimens should be sent to the laboratory for histopathological evaluation even if specimens appear macroscopically normal.
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    Distal Gastroduodenal Arterial Inflow as a Salvage Strategy for Extensive Intraoperative Arterial Dissection in Living Donor Liver Transplantation
    (Lippincott Williams & Wilkins, 2022) Yilmaz, Sezai; Akbulut, Sami; Usta, Sertac; Koc, Cemalettin; Kutluturk, Koray
    [Abstract Not Available]
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    Do We Need to Be Limited by Matching Milan Criteria for Survival in Living Donor Liver Transplantation?
    (Springer, 2020) Akbulut, Sami; Koc, Cemalettin
    Purpose Hepatocellular carcinoma (HCC) is the second leading cause of cancer deaths and the 7th most common cancer. It has two characteristic features: being advanced stage at diagnosis and association with liver cirrhosis. Liver transplantation (LT) offers the only curative option to treat both components of the disease. The Milan criteria have been extensively used for selecting patients with HCC for LT. However, using Milan criteria, we can only transplant 30% of the patients. The aim of the present review is to evaluate the role of LT in HCC beyond the Milan criteria. Methods We evaluated the studies that have introduced extended criteria to select patients with HCC beyond the Milan criteria. We evaluated the outcomes in terms of disease-free survival rates and HCC recurrences. Results There are patients with tumors that are beyond Milan criteria that could benefit from LT. Selection of these patients has paramount importance in the era of living donor liver transplantation. Current expanded criteria depend on either the bulk of the tumor or the additional surrogate markers of tumor biology such as alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP). Conclusion There is no ideal marker or an extended criterion for selecting patients with HCC beyond the Milan criteria and it needs further research to find an effective biomarker that has prognostic significance to select patients with advanced tumors.
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    Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review
    (Baishideng Publishing Group Inc, 2020) Akbulut, Sami; Demyati, Khaled; Ciftci, Felat; Koc, Cemalettin; Tuncer, Adem; Sahin, Emrah; Karadag, Nese
    BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue. AIM To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery. METHODS We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study. RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient. CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.