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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 Aborted Donor Hepatectomies for Living Donor Liver Transplantation: A Single Center Experience(Lippincott Williams & Wilkins, 2016) Kutluturk, Koray; Otan, Emrah; Dirican, Abuzer; Yilmaz, Mehmet; Isik, Burak; Ozdemir, Fatih; Ince, Volkan[Abstract Not Available]Öğe Aim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.(2019) Gonultas, Fatih; Kutluturk, Koray; Barut, Bora; Dalda, Yasin; Alan, Saadet; Unal, BulentAim: To compare thyroid fine-needle aspiration biopsy with histopathological examination results. Material and Methods: Postoperative histopathological examination results of 361 patients, who were thyroidectomized between December 2010 and October 2017 in Inonu University Turgut Ozal Medical Center Department of General Surgery and whose preoperative FNAB registries we could reach were evaluated retrospectively. Biopsies made in external centers were included in preoperative FNAB results. FNAB results were examined according to Bethesda 2007 in 6 categories: unsatisfactory, benign, atypia of undetermined significance, follicular lesion-neoplasm or suspicious for a neoplasm, suspicious for malignancy and malignant. Histopathological results of patients with incidental malignancy were presumed benign. Results: Among the 361 patients that were included in the study, 274 were female (75.9%), 87 were male(24.1%). Mean age of the patients in the benign group was 49.1±12.5 years, and 48.6±13.5 years in the malignant group. It was found that FNAB’s sensitivity was 83.9 %, specificity was 92.4%, false positive rate was 16.1% and false negative rate was 7.6%. Conclusion: FNAB is reported as the gold standard for preoperative evaluation of thyroid nodules. In our study, however, it was seen that FNAB was not adequate alone to detect malignancy. This situation suggests the importance of collaboration between radiologist, cytopathologist and clinician.Öğe Coexistence of hashimoto s thyroiditis with papillary thyroid carcinoma: a single center experience(2017) Unal, Bulent; Kutluturk, Koray; Cetin, SedatAim: A positive correlation between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) is determinated in studies based on histopathological examination of the thyroidectomy materials, but this correlation is not determinated in studies based on Fine Niddle Aspiration Biopsy (FNAB). In this study, the histopathologic results of bilateral total thyroidectomy (TT) specimens were studied for outcomes of PTC association with HT and its relationship with clinical and pathological prognostic factors.Öğe Comprehensive Analysis of Long-term Splenic Volume Changes in Pediatric Liver Transplant Patients: Does It Correlate With Adverse Graft Outcomes?(Elsevier Science Inc, 2021) Dogan, Gulec Mert; Dogan, Sait Murat; Okut, Gokalp; Karakas, Serdar; Kutluturk, Koray; Ulubaba, Hilal Er; Sahin, Tevfik TolgaObjectives. Splenomegaly and hypersplenism caused by liver failure increase the mortality and morbidity of patients even after liver transplantation if they do not regress. We evaluated the relation of splenic volume change and transplanted liver function. Material and Methods. A total of 59 of 207 pediatric patients who had liver transplantation between 2013 and 2018 in our institute were evaluated. The relation of spleen volume changes (splenic volume to standard splenic volume ratio [SV/SSV]) were measured at 0, 1, 6, 12, 24, and 36 months of follow-up by constructing electronic three-dimensional structure of the spleen at dynamic computed tomography (CT), and the course of liver functions were evaluated. Results. The SV/SSV ratio decreases in the first postoperative 6 months. After 6 months, SV increases and SV/SSV increases gradually. In a normal functioning graft, SV/SSV significantly decreased in all time points (P < .001). In patients with adverse events, SV/SSV started to increase after 6 months. In patients with fulminant hepatic failure, SV/SSV started to increase after postoperative 6 months. Adverse events in patients with fulminant hepatic failure were more than the patients with chronic liver disease (58% vs 28%). There was an inverse correlation between SV/SSV and thrombocyte levels (P < .001). Conclusions. SV/SSV seems to be correlated to the adverse events (ie, rejection). Together with thrombocyte levels, it can be used as a noninvasive test for follow-up of transplant patients in terms of adverse events in graft function.Öğe The Course of Endoscopic Treatment Success in Biliary Complications After Living Donor Liver Transplantation(Galenos Publ House, 2024) Ataman, Engin; Harputluoglu, Murat; Bilgic, Yilmaz; Cagin, Yasir Furkan; Erdogan, Mehmet Ali; Kutlu, Ramazan; Kutluturk, KorayObjective: Our aim was to present the results of endoscopic retrograde cholangiopancreatography (ERCP) after living donor liver transplantation (LDLT) between February 2015 and June 2021. Methods: Clinical data included LDLT indications, time to perform ERCP after LDLT, number of ERCP procedures, indications for ERCP, and all treatment outcomes, including ERCP, percutaneous, and surgical interventions. We compared the obtained data with our previous study published by our team in 2018, which included 446 patients who underwent ERCP for biliary complications after LDLT between 2005 and 2015. Results: We performed ERCP in 283 of 1506 patients with LDLT who underwent duct-to-duct anastomosis during transplantation and then developed biliary complications. Our endoscopic success rates were 60.9% and 71.0% in the previous and present studies, respectively. Conclusions: Our findings suggest that the success rate of endoscopic treatment of biliary complications in patients with LDLT increases in correlation with the increasing experience of clinicians treating these patients.Öğe 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, AyseGastrointestinal 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.Öğe Diaphragmatic hernias after pediatric liver transplantation: Experience of a high-volume transplant center(Wiley, 2020) Karakas, Serdar; Sahin, Tevfik Tolga; Kutluturk, Koray; Otan, Emrah; Baskiran, Adil; Sarici, Kemal Baris; Varol, IlknurDiaphragmatic hernias (DHs) are rare complications after pediatric liver transplantation (PLT). It is now widely accepted that DHs after liver transplantation (LT) is a pediatric related condition. PLTs (under of age 18) performed between January 2013 and June 2019 at Malatya Inonu University Institute of Liver Transplantation were retrospectively scanned. Study group consisting DHs and a control group were compared. Among 280 PLTs, 8 of them were complicated with DHs (%2.9). Median age of the patients with DH was 3.0 (0.8-9.5) years. Median graft recipient weight ratio was 2.5 (0.9-4.4). Five patients were below 5th percentiles in terms of pediatric weight growth chart at the time of LT. Also, 6 patients were below 5th percentiles in terms of pediatric height growth chart. There was no statistical difference between study and control groups. There are many risk factors mentioned in literature that may be primarily responsible for DHs after PLT. These factors are left lobe and large-for-size grafts, malnutrition, trauma or diathermy of diaphragmatic nerve and vessels and immunosuppressants. In our study, we could not specify any reason that differs in DHs. In our aspect, narrow diaphragma and thorax are exposed to high intra-abdominal pressure from abdomen. Large-for-size grafts, which are specific to children, also may contribute to this affect. Excessive diathermy and trauma to diaphragmatic collaterals may aggravate the risk of DH. More patients are needed to make an exact conclusion, in order to evaluate with comparable study on this aspect.Öğe 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]Öğe Does Preoperative Transarterial Chemoembolization for Hepatocellular Carcinoma Increase the Incidence of Hepatic Artery Thrombosis After Living-Donor Liver Transplant?(Baskent Univ, 2017) Ince, Volkan; Ersan, Veysel; Karakas, Serdar; Kutluturk, Koray; Karadag, Nese; Kutlu, Ramazan; Yilmaz, SezaiObjectives: Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma. Materials and Methods: Between March 2006 and December 2016, a total of 262 patients with hepa-tocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemo embolization. Results: The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the non transarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemo embolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04). Conclusions: In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retrans plantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.Öğe Donor Postoperative Biliary Complications After Living-Donor Liver Transplant(Baskent Univ, 2015) Dirican, Abuzer; Ara, Cengiz; Kutluturk, Koray; Ozsoy, Mustafa; Ates, Mustafa; Baskiran, Adil; Isik, BurakObjectives: Although the main factors responsible for donor deaths after living-donor liver transplant are liver failure and sepsis, the most common donor complications are associated with the biliary tract. Materials and Methods: Between April 2006 and May 2012, five hundred ninety-three donors underwent living-donor hepatectomy procedures for living-donor liver transplants. The mean age of donors was 31.0 +/- 9.9 years and the ratio of men to women was 341: 252. Of all donors, 533 (89.9%) underwent a right lobe hepatectomy, 45 (7.6%) underwent a left lateral segmentectomy, and 15 (2.5%) underwent a left hepatectomy. Results: Biliary complications were observed in 51 liver donors (8.6%). Based on the Clavien-Dindo classification, grade I and grade II complications were 3.2% and 0%, while grade IIIa and grade IIIb complications were observed in 3.5% and 1.85% of cases. Right lobe donor biliary complications occurred at the rate of 8.2% in 44 donors. Grade IV and grade V complications were not observed. Grade IIIa complications necessitating radiologic and endoscopic procedures were observed in 21 liver donors (3.5%). Bile leakage unresponsive to medical therapy was detected in 19 donors (3.2%). Nasobiliary catheters were placed in 3 of 19 donors and internal stents were placed in 1. Two sessions of balloon dilatation were performed in the 2 grade IIIb donors (0.33%). Biliary strictures observed in 2 right lobe donors and 1 left lobe donor was treated by hepaticojejunostomy an average of 14 months after surgery. Conclusions: Avoidance of intraoperative issues and early recognition of bile leakage are fundamental in preventing complications in living-donor liver transplant donors.Öğe Ectopic Balloon Device Placement to Correct the Positional Hepatic Venous Outflow Obstruction in Liver Transplantation(Baskent Univ, 2020) Tolan, Huseyin Kerem; Barut, Bora; Kutluturk, Koray; Kayaalp, Cuneyt; Yilmaz, SezaiObjectives: Hepatic vein outflow obstruction in liver transplantation can lead to graft or patient loss. We used an intrauterine balloon to overcome this complication in 13 liver transplant recipients. Here, we report the results of these cases; our report, as far as we know, involves the highest number of patients on this issue. Materials and Methods: Positional hepatic vein outflow obstruction was diagnosed in 13 of 651 liver transplant recipients between January 2014 and December 2016. The grafts were repositioned by intrauterine balloon placed to the right subdiaphragmatic area. Data of donors, recipients, and grafts and postoperative courses were analyzed. Results: Of the 13 patients, 9 were men, with age range of patients of 22 to 70 years. The amount of saline used to inflate the balloon was variable (200-450 cm(3)), and hepatic vein outflow obstruction was relieved after balloon implantation in all patients. There were no balloon-related complications. Removal was done at bedside, without any additional sedation or any additional skin incision on days 2 to 15. Doppler ultrasonography scans were performed before and after the balloon removal. There were no vascular complications after removal. Conclusions: Intrauterine balloon can be safely and efficiently used for hepatic vein outflow obstruction during liver transplant when needed.Öğe En Masse Resection of Pancreas, Spleen, Celiac Axis, Stomach, Kidney, Adrenal, and Colon for Invasive Pancreatic Corpus and Tail Tumor(Hindawi Ltd, 2013) Kutluturk, Koray; Alam, Abdul Hamid; Kayaalp, Cuneyt; Otan, Emrah; Aydin, CemalettinProviding a more comfortable life and a longer survival for pancreatic corpus/tail tumors without metastasis depends on the complete resection. Recently, distal pancreatectomy with celiac axis resection was reported as a feasible and favorable method in selected pancreatic corpus/tail tumors which had invaded the celiac axis. Additional organ resections to the celiac axis were rarely required, and when necessary it was included only a single extra organ resection such as adrenal or intestine. Here, we described a distal pancreatic tumor invading most of the neighboring organs-stomach, celiac axis, left renal vein, left adrenal gland, and splenic flexure were treated by en bloc resection of all these organs. The patient was a 60-year-old man without any severe medical comorbidities. Postoperative course of the patient was uneventful, and he was discharged on postoperative day eight without any complication. Histopathology and stage of the tumor were adenocarcinoma and T4 N1 M0, respectively. Preoperative back pain of the patient was completely relieved in the postoperative period. As a result, celiac axis resection for pancreatic cancer is an extensive surgery, and a combined en masse resection of the invaded neighboring organs is a more extensive surgery than the celiac axis resection alone. This more extensive surgery is safe and feasible for selected patients with pancreatic cancer.Öğe Endoscopic Sign in Sigmoid Volvulus with Mucosal Ischemia: Autumn Leaves(Springer India, 2021) Uylas, Ufuk; Kutluturk, Koray; Sumer, Fatih; Kayaalp, CuneytColonoscopic examination is used in both diagnosis and treatment of sigmoid volvulus. If colon ischemia is detected during a colonoscopy, urgent surgery is unavoidably accepted. Here we presented an ischemic sigmoid volvulus and its resolution as seen through colonoscope after successful medical treatment. The patient was a 79-year-old male with Alzheimer's disease and cerebrovascular disease. Emergency surgery was canceled, and an elective laparoscopic sigmoid resection was done 1 month later uneventfully.Öğe Giant Hepatic Hemangioma Presenting as Gastric Outlet Obstruction(Int College Of Surgeons, 2013) Aydin, Cemalettin; Akbulut, Sami; Kutluturk, Koray; Kahraman, Aysegul; Kayaalp, Cuneyt; Yilmaz, SezaiHemangioma, a most frequently encountered primary benign tumor of the liver, is generally determined incidentally during the course of radiologic tests for other reasons. Most lesions are less than 3 cm and a significant proportion of patients are asymptomatic, although the size and location of the lesion in some patients may be associated with the onset of symptoms. Pressure on the stomach and duodenum of giant hemagiomas developing in the left lobe of the liver, in particular, may result in the development of abdominal pain, nausea, vomiting, and feeling bloated, which are characteristic of a gastric outlet obstruction. A 42-year-old man presented with findings of gastric outlet obstruction and weight loss as a result of a giant hepatic hemangioma.Öğe Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers(Lippincott Williams & Wilkins, 2020) Gonultas, Fatih; Akbulut, Sami; Barut, Bora; Kutluturk, Koray; Yilmaz, SezaiObjective The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT). Methods Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated. Results There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications. Conclusion GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.Öğe Hepatic artery reconstruction technique in liver transplantation: experience with 3,000 cases(Ame Publishing Company, 2021) Akbulut, Sami; Kutluturk, Koray; Yilmaz, Sezai[Abstract Not Available]Öğe Is Autologous Peritoneal Patch a Suitable Material to Creating Circumferential Fence for Hepatic Outflow in Living Donor Liver Transplantation?(Lippincott Williams & Wilkins, 2016) Barut, Bora; Kutluturk, Koray; Baskiran, Adil; Otan, Emrah; Akbulut, Sami; Ince, Volkan; Koc, Cemalettin[Abstract Not Available]Öğe Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction(Baishideng Publishing Group Inc, 2015) Kayaalp, Cuneyt; Kutluturk, Koray; Yagci, Mehmet Ali; Ates, MustafaAIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn's disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture. RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the overall experience in the literature was 80% (12/15) in selected cases. CONCLUSION: Transcolonic specimen extraction for right-sided colonic resection is feasible in selected patients. Both natural orifice surgery and intracorporeal anastomosis avoids mini-laparotomy for specimen extraction or anastomosis.Öğe Letter to Editor in response to: Management and outcome of hepatic artery thrombosis with whole-liver transplantation using donors less than one year of age(W B Saunders Co-Elsevier Inc, 2023) Yilmaz, Sezai; Kutluturk, Koray; Koc, Cemalettin; Akbulut, Sami[Abstract Not Available]
