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    Comparing one-stage and two-stage treatment approach of cholelithiasis and choledocholithiasis
    (2018) Muhammedoglu, Bahtiyar; Tolan, Huseyin Kerem
    Aim: Complicated bile duct stones with choledocholithiasis may cause serious morbidity and mortality. The aim of this study was to evaluate; cost, frequency of the imaging methods used and the length of the hospital stay after the one-stage and two-stage procedures. Material and Methods: Endoscopic Retrograde Cholangio Pancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) was performed in 16 out of 250 LC cases and was named as Group A; other 12 patients have had interval LC 6-8 weeks after the ERCP procedure and were named as Group B. All ERCP and LC were performed by the same surgeon. Results: The duration of hospitalization in Group A was 6 [4-9.5] days and was statistically significantly longer in the group B patients which was 8.5 [9.5-10.5] days (p <0.0470). The frequency of the use of the imaging methods was 3 [2-4.5] in Group A and 6 [4.5-7.0] in B (p <0.001). The cost of the procedures were significantly lower in the Group A compared to B (p <0.047) and was 2411.3 [1855.6-2819.9] and 2839.9 [2495.5-3237.1] Turkish Lira (TL) respectively. Conclusion: Simultaneous ERCP and LC are safe and a feasible in selected cases and advantageous in terms of the total cost and the length of the hospital stay. There is need for more studies to clarify the timing of the surgical treatment after the ERCP.
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    Endoscopic retrograde cholangiopancreatography in patients with periampullary diverticula: Technical details, classification, and timing of surgical treatment
    (2020) Muhammedoglu, Bahtiyar; Pircanoglu, Eyup Mehmet
    Aim: Periampullary duodenal diverticula may create difficulties for selective common bile duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP).Material and Methods: For the study, the technical details and findings of ERCP and demographic features of 724 patients without duodenal diverticula and 92 patients with duodenal diverticula who underwent ERCP.Results: The mean age was 73.09 ± 15.32 years for the 92 patients with PAD (group A) and 60,2 ± 18.85 years for the 724 patients without duodenal diverticulum (group B). Forty-eight percent of the study sample was aged over 65 years, 54.3% were female and 45.7% were male. Duodenal diverticulum was present in 11.3% of the patients. In addition, 22 (23.9%) patients in the PAD group and 155 (21.4%) patients without duodenal diverticula required a second ERCP (P = 0.583). The mean duration of hospitalization was 6.67 ± 6.23 days in patients with duodenal diverticula and 6.17 ± 5.16 days in the control group and the mean cost of hospitalization was $ 442.02 ± 512.06.Conclusion: In conclusion, ERCP may not always be difficult in patients with a diverticulum in the periampullary region, and the difficulty of the procedure depends on the location of the papillary orifice and the type of the diverticulum. In patients with periampullary diverticula, it would be appropriate to consider surgical treatment in the presence of failed CBD cannulation and large stones that cannot be removed from the CBD.
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    Management of difficult gallbladder and comparison of laparoscopic subtotal cholecystectomy with open subtotal cholecystectomy
    (2019) Muhammedoglu, Bahtiyar; Sikrikci, Vehbi; Colakoglu, Muhammet Kadri; Oter, Volkan
    Aim: Laparoscopic cholecystectomy is the optimal surgical treatment for benign gallbladder diseases. Under curtain conditions it is very hard to distinguish the Calot triangle and it becomes difficult to perform safe cholecystectomy. Subtotal cholecystectomy is a salvage option in such conditions. The aim of this study is to compare the results of open and laparoscopic subtotal cholecystectomy in difficult gallbladder management.Material and Methods: In this retrospective study results of all consecutive patients who were performed subtotal cholecystectomy between July 2014 and August 2017 were collected and laparoscopic and open methods were compared. Results:Forty-five of 396 laparoscopic cholecystectomy cases underwent subtotal cholecystectomy during the study period. Subtotal cholecystectomy was performed laparoscopically in 27 of 45 patients (Group I), and open method in 18 patients (Group II). Convertion rate was %34.1. No significant difference was observed in terms of both preoperative and postoperative laboratory results. There was no difference between two groups in terms of ERCP history. The rate of open operation was statistically higher in acute cases. The duration of surgery was significantly higher in laparoscopic group but length of hospital stay was significantly higher in open group. Total cost was higher in group 2 but this result did not reach statistical significance. Total bile leak rate was 2.2%.Conclusion: Laparoscopic subtotal cholecystectomy is a safe and appropriate method which can be compared with open subtotal cholecystectomy in difficult gallbladder management.
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    Whipple’s procedure and retrocolic gastroenteric anastomosis
    (2019) Muhammedoglu, Bahtiyar; Tolan, Huseyin Kerem; Topuz, Sezgin; Kokdas, Suleyman
    Aim: Pancreatoduodenectomy (PD) is the only treatment option in patients with periampullary region tumors. Gastroenterostomy (GE) is carried out with or without Braun’s anastomosis according to preference. Material and Methods: Prospectively recorded files of 17 patients who underwent Whipple operation between September 2015 and March 2017 were retrospectively investigated for morbidity, mortality, and the way of GE anastomosis. Results: The youngest patient was 44 and the ldest was 75 years old with a mean age of 63.4. Six were male and 11 were female. Five cases (26%) were ductal adenocarcinoma, 11 (68%) were ampullary adenocarcinoma, and one (6%) was ampullary NET. Classical Whipple procedure was performed in all patients. Retrocolic GE was applied in all cases with Braun’s anastomosis in 6 and without in 11 patients. There were only two cases of panreatic fistula (grade B) (11.7%). Conclusion: Retrocolic gastroenterostomy under the omentum can provide more protected anatomical position providing advantage for lower and upper abdominal quadrant drainage in case of possible pancreaticojejunal leakages during pancreatoduodenectomy.