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    Autologous Peritoneum Graft Repair of a Superior Mesenteric Vein Defect During Pancreaticoduodenectomy
    (Springernature, 2015) Kayaalp, Cuneyt; Sumer, Fatih; Polat, Yilmaz; Kutlu, Ramazan
    Pancreatic cancers frequently invade the portomesenteric veins. Venous resection during pancreaticoduodenectomy with curative intent is more common now than it was in the past. Most venous resections can be repaired primarily, but some require vascular grafts. Here, we describe the use of an autologous parietal peritoneum graft instead of vascular grafts for repairing a superior mesenteric vein (SMV) defect. Pylorus-preserving pancreaticoduodenectomy combined with en bloc resection of the SMV lateral wall was performed in a 70-year-old woman with cancer of the pancreatic head. The SMV defect was 2 cm long and its width was half the SMV circumference. The defect was covered with a 3 x 2 cm parietal autologous peritoneum graft obtained from the left subcostal area and using running 6/0 polypropylene suture. Tension-free patching was performed, and we retained slight bulging of the graft. Her postoperative course was uneventful. She was discharged on Day 11 after computed tomography confirmed the patency of the SMV, despite slight narrowing. She was well after 10 months of follow-up. Autologous parietal peritoneum grafts can be used for repairing partial venous defects during pancreaticoduodenectomy. They are effective and are easy, fast, and cheap to obtain.
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    Efficacy of ultrasound-guided bilateral erector spinae plane block for postoperative analgesia in laparoscopic sleeve gastrectomy. A retrospective cohort study
    (2020) Karaca, Omer; Polat, Yilmaz
    Aim: Laparoscopic sleeve gastrectomy (LSG) causes moderate to severe pain. The present study was planned to evaluate the efficacy and safety of bilateral erector spinae plane block (ESPB) under ultrasound.Material and Methods: A total of 38 patients who underwent LSG between November 2018 and Januvary 2020 were retrospectively analyzed. Patients were divided into two groups: The Control Group (group c, n=19) received only an intravenous (iv) patient controlled analgesia (PCA) and the ESPB Group (group E, n=19) received bilateral ESPB (bupivacaine 0.25, 50 ml) and iv PCA. Results: The numeric rating scores (NRS) at 20th min, 40th min, 1st, 2nd, 4th, 6th, 8th, 12th and 36th hour at the passive period were higher in Group C than in Group E (p0.0001 each). 24th,48th and 72nd hour NRS scores at the passive period were also higher in group C than in group E (respectively, p=0.0001, p:0.0003, p=0.01). 20th min, 40th min, 1st, 2nd, 6th, 8th, 12th, 24th and 36th hour NRS scores at the active period were also higher in Group C than in Group E (p0.0001 each). 4th, 48th and 72nd hour NRS scores at the active period were higher in Group C than in Group E (respectively, p0.0001, p0.0001, p=0.0002). The fentanyl consumption at all the periods were lower in the Group E (p0.0001). PACU and hospital stay durations were shorter in the Group E (p0.0001). Intraoperative fentanyl requirement was lower in the Group E (p=0.003). The first analgesic need time was later in group E (p=0.017). The unassisted walking time was shorter in the Group E (p0.0001). The rescue analgesic requirement was lower in the Group E (p0.0001). The PACU and hospital stays were shorter in group E (p0.0001). No block-related complications and opioid-related side effects were encountered.Conclusion: Pre-incisional bilateral ultrasound guided ESPB provide superior analgesia and shortens unassisted walking time and hospital stay after LSG.
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    Transgastric removal of a polycystic liver disease using mini-laparoscopic excision
    (Akademiai Kiado Zrt, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Polat, Yilmaz; Ertugrul, Ismail; Karagul, Servet
    Surgical treatment is often necessary for patients with symptomatic or complicated polycystic liver diseases (PLD). In this paper, we describe a 52-year-old female with symptomatic PLD that had resulted in the formation of liver cysts, the largest of which was 23 cm in diameter. The patient underwent mini-laparoscopic fenestration through 5-mm abdominal trocars. The walls of the cysts were unroofed using a harmonic scalpel. Four thickened rubber-like pieces of specimens (sizes ranged between 9 x 6 x 0.5 cm and 6 x 3 x 0.1 cm) were not suitable for extraction through the 5-mm trocars. A gastrotomy was performed, and the specimens were extracted through the stomach with the help of an endoscope. Transoral removal of the specimens was completed without any complications, and the gastrotomy was closed intracorporeally. The patient was permitted to take fluids on day one, and oral intake was gradually increased. She was discharged on day four and was asymptomatic after two months of follow-up. The combination of mini-laparoscopy and intraoperative endoscopic specimen extraction represented a minimally invasive surgical approach for the treatment of PLD. To the best of our knowledge, this was the first case report of the transoral extraction of a liver specimen.