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Öğe Can an Extended Right Lobe be Harvested from a Donor with Gilbert's Syndrome for Living-Donor Liver Transplantation? Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Unal, B.; Isik, B.; Ozgor, D.; Piskin, T.; Ersan, V.; Gonultas, F.Gilbert's syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient's selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.Öğe Donor Complications Among 500 Living Donor Liver Transplantations at a Single Center(Elsevier Science Inc, 2012) Ozgor, D.; Dirican, A.; Ates, M.; Gonultas, F.; Ara, C.; Yilmaz, S.Introduction. Living donor liver transplantation (LDLT) has become necessary because of the shortage of cadaveric organs. We retrospectively analyzed 500 living donor hepatectomies using the Clavien classification system for complications to grade their severity. Materials and methods. We retrospectively identified and applied the Clavien clasification to 500 consecutive donors who underwent right for LDLT left hepatectomy between January 2007 and August 2011. Results. The 149 complications were observed in 93 of 500 (18.6%) donors who were followed for a mean 30 months. There wan no donor mortality. Complications developed in 85 (18.6%) right 5 (35.7%) left, and 3 (10%) left lateral segment hepatectomy donors. The overall incidence of reoperations was 7.2%. Seventy-seven of 149 complications were grade I (51.6%) or 9 grade II (6%). The major complications consisted of 27 (18.1%) grade IIIa, 35 (23.4%) grade IIIb, and 1 (0.6%) grade IVa. Grade IVb and grade V complications did not occur. The most common problems were biliary complications in 14 of 181 donors (7.7%). Conclusion. Donors for LDLT experienced a range of complications.Öğe The factors affecting development of low anterior resection syndrome (LARS) in patients undergoing sphincter preserving surgery for rectal cancer(Athens Medical Soc, 2020) Simsek, A.; Bayraktar, H.; Dirican, A.; Ozgor, D.; Ates, M.OBJECTIVE To investigate the incidence of major low anterior resection syndrome (LARS), using the LARS score, in patients who underwent sphincter-preserving surgery for rectal cancer, and to explore the factors affecting major LARS development. METHOD The medical records were retrospectively reviewed of patients, who were operated for rectal cancer at a tertiary center between January 2009 and October 2017. The inclusion criteria were: The absence of other colorectal or proctologic diseases, the application of anterior resection (high anterior resection, low anterior resection, extremely low anterior resection), follow-up of more than one year after the primary surgery, and follow-up of more than one year after protective ileostomy closure, and the absence of an unreversed stoma, ongoing treatment with chemotherapy or radiotherapy, recurrence, and metastatic disease. LARS was diagnosed using the LARS score developed by Emmertsen and Laurberg. RESULTS For the study period, 81 patients met the inclusion criteria, including 45 (55.5%) men and 36 (44.4%) women, with a mean age of 60.1 years. Of the 81 patients, 56 (69.1%) underwent chemotherapy and 43 (53%) underwent radiotherapy. Major LARS was detected in 29.6% of the patients. Univariate analysis revealed that radiotherapy, lower tumor location and a short interval after ileostomy closure had an effect on LARS development, and multivariate analysis indicated that incidence of LARS was higher in middle and lower rectal cancer. CONCLUSIONS There appears to be no harm in creating a protective ileostomy for LARS development, with regard to anastomosis safety and the planning of the adjuvant therapy. Neither radiotherapy, nor type of surgery had an effect on major LARS. As was expected, a high rate of major LARS was reported in lower rectal tumors.Öğe Hepatic Vein Stenosis Developed During Living Donor Hepatectomy and Corrected with Peritoneal Patch Technique: A Case Report(Elsevier Science Inc, 2012) Yilmaz, S.; Kayaalp, C.; Battaloglu, B.; Ersan, V.; Ozgor, D.; Piskin, T.An 18-year-old male living donor for his father with end-stage liver cirrhosis due to hepatitis B underwent an extended right lobe donor hepatectomy. The middle hepatic vein was visualised on the cut surface of the graft and dissected up to the confluence of the middle and left hepatic veins. After vascular clamping, right and middle hepatic veins were cut to removed the graft. While starting the stump closure, the clamp. over the middle hepatic vein slipped and the vein stump sutured quickly under suboptimal exposure. Soon after this closure, the remnant liver showed increasing congestion. Intraoperative Doppler ultrasound revealed obstruction of venous outflow at the remnant left liver due to stenosis in the left hepatic vein. Under total hepatic vascular occlusion, the sutures were removed from the narrowed left hepatic vein. A 2 x 2 cm peritoneal patch from the subcostal area that was prepared to close the defect was sutured to the edges of the left hepatic vein defect. Venous congestion of the liver disappeared when the clamps were removed. Intraoperative Doppler ultrasound confirmed normal hepatic venous flow. The postoperative course of the donor was uneventful. There was no clinical, biochemical, or radiological problems at 47 months of follow-up. An autogenous peritoneal patch may be a good option to repair vascular defects, which are not suitable for primary sutures, due to easy accessibility and size adjustment, cost effectiveness, as well as relatively low risk of infection and thrombosis. Close dissection of the left hepatic vein during parenchymal transection over the middle hepatic vein can result in narrowing, particularly at the bifurcation of the middle/left hepatic veins that can cause congestion in the remnant liver. When we include the middle hepatic vein with the right graft, we now believe that dissection away from the left hepatic vein seems much more secure for donors.Öğe Living Donor Liver Transplantation for Mushroom Intoxication Caused Acute Liver Failure(Lippincott Williams & Wilkins, 2017) Dirican, A.; Yilmaz, M.; Baskiran, A.; Ozgor, D.; Ates, M.; Koc, S.; Ince, V[Abstract Not Available]Öğe Living Donor Liver Transplantation in the Absence of Inferior Vena Cava: A Case Report(Elsevier Science Inc, 2012) Hatipoglu, S.; Olmez, A.; Ozgor, D.; Kayaalp, C.; Yilmaz, S.Because of difficulties in the supply of cadaveric organs, of living donor liver transplantations are performed in increasing numbers. Congenital hepatic fibrosis associated with fibrosis and atrophy of the inferior vena cava were present in a potential recipient of living donor liver transplantation. This case report documented living donor liver transplantation as a treatment modality for a patient with absence of the inferior vena cava due to chronic liver failure.Öğe Partial Cholecystectomy: A Technique That Makes Hilar Dissection Easier in Recipient Hepatectomy(Elsevier Science Inc, 2014) Ara, C.; Ozdemir, F.; Ates, M.; Ozgor, D.; Kutluturk, K.Background. Intraoperative blood loss and red blood cell transfusion requirements have a negative impact on outcome after orthotopic liver transplantation. In this study we compared blood transfusion requirements, bile duct injury, and dissection of hepatic artery rates in the patients with or without partial cholecystectomy during recipient hepatectomy. Methods. From December 2008 to August 2011, 100 recipient hepatectomies were performed by the same surgeon. Patients were divided into 2 groups. The first group included patients with partial cholecystectomy, and the other group patients without partial cholecystectomy. Each group consisted of 50 patients. Results. In recipient hepatectomy group without partial cholecystectomy, intraoperative blood transfusions were in the range of 3-11 units (mean, 6.3 units). In this group there were 4 hepatic artery dissections and 2 bile duct injuries. In the group with partial cholecystectomy, intraoperative blood transfusions were in the range of 0-7 units (mean, 3.1 units). In this group there was 1 hepatic artery dissection. There were no operative mortalities in either group. Conclusions. We recommend partial cholecystectomy during recipient hepatectomy of cirrhotic patients, particularly with hydropic gallbladders, because bleeding from the points of adherent gallbladder during mobilization of the liver is diminished and fewer artery dissections and bile duct injuries develop, because the procedure facilitates dissection of the hilar structures.Öğe Proximal jejunojejunal intussusception secondary to submucosal lipoma in an adult(Int Scientific Literature, Inc, 2008) Dirican, Abuzer; Unal, Bulent; Ozgor, D.; Piskin, T.; Kirimlioglu, VedatBackground: Jejunojejunal intussusception in adult is a rare condition. Jejunal lipoma induced intussusception in adult cases in literature are limited in number. Case Report: The present report describes a case of proximal jejunojejunal intussusception secondary to submucosal lipoma in a adult with history of severe nausea and vomiting. The diagnosis was suspected in computed tomography preoperatively. An intraluminal mass with a diameter of 2.5 cm was palpated at laparatomy after reduction of intussusception. Partial resection and jejunojejunostomy was performed. Pathological evaluation revealed jejunal submucosal lipoma. Conclusions: In conclusion intussusception and/or masses located in proximal part of small intestine must be kept in mind in cases with severe nausea and vomiting without a known origin and resulting in renal failure.Öğe Significance and Outcome of Living-donor Liver Transplantation in Acute Mushroom Intoxication(Wolters Kluwer Medknow Publications, 2018) Baskiran, A.; Dirican, A.; Ozgor, D.; Kement, M.; Koc, S.; Sahin, T. T.; Ates, M.Introduction: Mushroom intoxication ( MT) can lead to acute liver injury which may result in Mushroom intoxication-related liver failure ( M-ALF) requiring liver transplantation ( LT). In the present study, we want to share the experience of our institute regarding living-donor LT ( LDLT) due to mushroom poisoning. Aim: The aim of this study is to identify the predictors of poor prognosis in patients with ALF secondary to mushroom intoxication requiring LDLT. Materials and Methods: All patients with MT between 2008 and 2016 were evaluated. Demographics, symptoms, interval between symptoms and admission to our institute, laboratory data, model for end-stage liver disease ( MELD)/ pediatric end-stage liver disease ( PELD) scores, clinical course, and outcomes of supportive therapy and LT were evaluated. There were two groups in the study: Group A = responsive to supportive therapy ( n = 9) versus Group B = unresponsive to supportive therapy ( n = 9). Results: During the study, a total of 18 patients were admitted with M-ALF. Twelve ( 66.7%) of them were female, and the mean age was 39.9 +/- 18.2 years. All of the nine patients in Group A fully recovered with supportive therapy. In Group B, one patient died during waiting period for LT and 8 patients received LDLT LDLT. Three of the eight patients who were transplanted died in the postoperative early period within postoperative 5 days. The patients in Group B had significantly higher MELD/ PELD scores and encephalopathy rate than in Group A ( P < 0.05). International normalized ratio ( INR), bilirubin, ammonium levels, and platelet count were significantly different between groups ( P < 0.05). The patients in Group B had significantly longer interval before admission to our institute ( P < 0.05). Conclusion: The presence of encephalopathy, higher MELD/ PELD, INR, bilirubin, ammonium levels, and lower platelet count was related to poor prognosis in MT. LDLT provides a good therapeutic option in patients with M-ALF. The time is a crucial factor in successful treatment of MT. Early admission to a tertiary referral center with expertise in LT results in a better prognosis and increased survival following M-ALF.Öğe Surgical treatment of phytobezoars causes acute small intestinal obstruction(Comenius Univ, 2009) Dirican, A.; Unal, B.; Tatli, F.; Sofotli, I; Ozgor, D.; Piskin, T.; Kayaalp, C.Purpose: Our aim was to perform a clinical analysis of small intestinal obstructions caused by surgically treated phytobezoars. Methods: Twenty-four patients, with small intestinal obstructions caused by phytobezoars, underwent surgery in our department between 1998 to 2008, were reviewed retrospectively. Results: Twenty (83.3 %) of 24 patients had previous gastric surgery. Preoperative computed tomography (CT) was performed in nine patients and seven (77.8 %) patients, showed results consistent with a bezoar and subsequently, underwent surgery on the same day. The remaining patients had no preoperative diagnosis of a phytobezoar were typically followed-up for postoperative adhesion intestinal obstruction. Only those patients who showed no response to nonoperative treatment options underwent surgery. The phytobezoar was fragmented and milked into the cecum in 11 (45.8 %) patients or extracted via longitudinal enterotomy in 12 (50 %) patients; the remaining patient (4.2 %) was treated via laparoscopy. Three patients had gastric phytobezoars, which were extracted via gastrotomy. There was no postoperative mortality. Two patients with previous enterotomy had either postoperative wound infection or wound infection and evisceration. Conclusions: Phytobezoars should be considered in the differential diagnosis of acute small yntestinal obstruction in patients with prior gastric surgery, poor dentition, or consume fiber-rich foods. Abdominal CT is useful for both diagnosis and for the decision to perform emergency surgery. When possible, the phytobezoar should be fragmented and milked into the cecum. Laparoscopic fragmentation may be useful in such cases (Tab. 3, Ref. 28). Full Text (Free, PDF) www.bmj.sk.Öğe Torsion of wandering spleen(Comenius Univ, 2009) Dirican, A.; Burak, I; Ara, C.; Unal, B.; Ozgor, D.; Meydanli, M. M.Wandering spleen is characterized by ectopic localization of spleen owing to the lack or weakening of the major splenic ligaments. In present study, two cases with torsion of wandering spleen were reported. The first case was a 30-year-old female who was admitted to emergency department with acute abdominal pain and vomiting. Abdominal Ultrasonography and computed tomography showed a round solid hypodense mass that was located in the left hypochondriac region of abdomen. At laparotomy, the patient was found to have torsion of a wandering spleen with complete infarction and pancreatic tail infarction. Splenectomy and distal pancreatectomy were performed. The second patient was a 19-year-old female. She was admitted to emergency department with abdominal pain. Axial computed tomography (CT) showed pelvic mass that indicated a possibility of a wandering spleen. The wandering spleen was removed with its long pedicle because of infarction. Torsion of wandering spleen must be considered in differential diagnosis of acute abdomen when a palpable painful abdominal mass is present on physical examination, and the spleen is absent in its normal anatomical location on radiological examination (Fig. 4, Ref. 8). Full Text (Free, PDF) www.bmj.sk.
