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    Extralevator abdominoperineal excision versus conventional surgery for low rectal cancer: a single surgeon experience
    (Aves, 2016) Nessar, Gurel; Demirbag, Ali Eba; Celep, Bahadir; Elbir, Orhan Hayri; Kayaalp, Cuneyt
    Objective: Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates and poor survival outcomes for rectal cancer. The aim of this study was to compare the results of ELAPE with conventional abdominoperineal excision (APE) for low rectal cancer. Material and Methods: A total of 25 consecutive patients underwent ELAPE for low rectal cancer between November 2008 and September 2011. Fifty-six patients treated by conventional APE prior to 2008 were selected from our rectal cancer database for comparison as a historical cohort. Results: The mean follow-up was 44.7 months in the ELAPE group, and 70.6 months in the APE group. Patients undergoing ELAPE had a lower CRM positivity and IOP rate than APE (12% vs. 20%, p=0,531; 4% vs. 8,9%, p=0,826; respectively). The ELAPE group was associated with higher perineal wound complications than the APE group (16.0% vs. 1.8%, p=0.030). Local recurrence rates for patients in both groups did not differ significantly (4.0% vs. 3.6%, p=1.0). Conclusion: The results of this study suggest that ELAPE technique was associated with less CRM involvement and reduced rates of IOP but markedly higher rates of postoperative perineal complications occurred as compared to conventional surgery. ELAPE must be reserved for advanced low rectal cancers.
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    Is Cetrimide-Chlorhexidine Risky for Secondary Sclerosing Cholangitis?
    (Wroclaw Medical Univ, 2014) Aydin, Cemalettin; Kayaalp, Cuneyt; Nessar, Gurel; Zengin, Neslihan; Balkan, Mujdat; Unal, Bulent; Ozgurtas, Taner
    Background. The liver is the most frequent organ for placement of hydatid cyst disease. All known protoscolicidals that are used for echinococcus degeneration have a risk of caustic secondary sclerosing cholangitis. The cetrimide-chlorhexidine combination is an effective protoscolicidal agent for treatment of hydatid liver cysts. Objectives. The aim of this experimental study was to examine this combination for potential risks of caustic secondary sclerosing cholangitis. Material and Methods. Thirty rats were enrolled and divided into two groups. In the study group, 0.15 mL of a cetrimide (0.5%) and chlorhexidine (0.05%) combination was injected into the bile ducts for five minutes. The control group included the same amount of normal saline and waiting period. The rats were followed for 120 days and the living rats were examined for biliary injury by biochemical analysis and histopathology. Results. No specific histopathological findings for caustic sclerosing cholangitis such as bile duct stricture or periductal fibrosis were present in any groups. Other pathological criteria demonstrating inflammation including portal inflammation, bile duct proliferation and necrosis were similar in both groups. Biochemical analysis including a liver function test (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase) appeared similar to the control group. Conclusions. A cetrimide 0.5% and chlorhexidine 0.05% combination has similar liver function results and histopathological effects to normal saline on bile ducts and it appears to be safe for bile ducts.
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    Trephin ileostomy
    (Aves, 2011) Nessar, Gurel; Kayaalp, Cuneyt; Bil, Dilek; Karadag, Sercan
    Skin trephine ileostomy creation is recommended in patients for whom laparotomy is not otherwise indicated. It is a simple, fast, and minimally invasive technique. However, there are certain drawbacks of the technique as difficulties in the orientation of the bowel, limitation of the abdominal exploration, and visceral malrotation problems. Trephine ileostomy should be performed with caution.