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Öğe Analysis of patients with acute liver failure after liver surgery: Single center experience(2022) Sağlam, Kutay; Yılmaz, Sezai; Usta, Sertaç; Şahin, Tevfik Tolga; Zengin, Akile; İspir, MukadderLiver transplantation is the lifesaving treatment option for rare acute liver failure that develops due to iatrogenic bile duct injuries or after major hepatectomy. The aim of the study is to analyze patients with acute liver failure due to iatrogenic bile duct injury or major hepatectomy on the waiting list for emergency liver transplantation. Between the years 2011-2020, 9 patients (5 female/4 male; median age: 30 years old, (range:4-63 years)) with acute liver failure related to bile duct injury or major hepatectomy for whom urgent liver transplantation was planned were included in this study. Eight patients were accepted for urgent liver transplantation. Acute liver failure developed in 6 patients due to hepatoduodenal ligament injury during cholecystectomy, and in 3 patients due to major hepatectomy. The patients were listed for urgent transplantation within the mean of 1.5 days (range:0-3 days) after acute liver failure. Two patients had living donor and 1 patient had cadaveric liver transplantation. Acute hepatic failure, especially after iatrogenic bile duct injuries associated with vascular injuries, seems to be more fatal than post hepatectomy liver failure. In these cases of acute liver failure, which is a difficult situation to decide, emergency liver transplantation should be kept in mind as the treatment option.Öğe Early portal vein thrombosis after pediatric liver transplantation: Assesment of risk factors(2023) Karakas, Serdar; Şahin, Tevfik Tolga; Sarıcı, Barış; Usta, Sertaç; Kutlutürk, Koray; Varol, Fatma İlknur; Sağlam, KutayAim: Despite advancements in surgical techniques, early portal vein thrombosis (ePVT) continues to be one of the major complications of liver transplantation (LT) in pediatric age group. Possible risk factors are portal vein diameter < 5 mm, infancy, patient body weight < 10 kg and high graft recipient weight ratios (GRWR > 4.0). We retrospectively evaluated our records of pediatric LTs’ in terms of ePVT and possible risk factors determining development of this dreaded complication. Materials and Methods: Between January 2018 and January 2022, 228 LTs were performed for pediatric age (under the age of 18) group at Inonu University, Liver Trans- plantation Institute. Among these patients, 212 were eligible for the study. Patients with ePVT were defined as Portal Vein Thrombüs Group (PVTG) and patients with no Portal Vein thrombosis were defined in control group (CG). ePVT was described as detection of impeded portal venous outflow with imaging studies either perioperatively or within postoperative 3 days . Demographic, clinical and operative variables were retrospectively evaluated. Results: Among 212 LTs, 24 cases were complicated with ePVTs (11.3 %). Preoperative platelet counts, etiology of Budd-Chiari, postoperative hepatic artery thrombosis (HAT) and lower age were significantly higher for early PVT. In multivariate analysis, preop- erative platelet levels, etiology of Budd-Chiari and postoperative HAT were significantly higher for PVT. One and 5 years overall survivals (OS) for PVTG and CG were 50.0 % - 50.0 % and 69 % - 63 % respectively. No significant OS difference was observed despite much more patients were died in PVTG. Conclusion: High preoperative platelet counts, Budd-Chiari syndrome and postoperative HAT are predictive factors for ePVT. Anti-thrombotic prophylaxes can be considered in high-risk patients. Venous jump grafts seem to have no effect on ePVT. Despite PVT increases the mortality rates, it can be resolved easily with immediate reoperation.Öğe Laparoscopic repair in a case with Morgagni hernia(2018) Dirican, Abuzer; Sağlam, Kutay; Başkıran, AdilAbstract: Morgagni hernia is herniation of the abdominal contents through a congenital retrosternal defect to the thoracic cavity. In the present study we report a case of 40 years old male patient who was admitted to our department with signs of intestinal obstruction and dyspnea and was diagnosed as incarcerated Morgagni hernia. The diagnosis was established with direct chest radiograms and thorax computerized tomography. Following the reduction of the omentum and the colon segment in the hernia, the defect was sutured primar-ily and the repair was reinforced by a dual mesh. In patients with constipation and obstipation possibility of presence of Morgagni hernia should be kept in mind and proper investigative measures should be obtained.Öğe Laparoscopic sleeve gastrectomy technique: How we do it(2018) Şansal, Müfit; Sağlam, Kutay; Gökler, Cihan; Sümer, Fatih; Kayaalp, CüneytA total of 1002 bariatric procedures were performed at our clinic between March 2006 and December 2016.The laparoscopic Roux-en-Y gastric bypass (LRYGB) technique was performed on 833 patients. Three ofthe LRYGB procedures were revisions of a previous laparoscopic sleeve gastrectomy (LSG). In 169 patients,the sleeve gastrectomy technique was used. One procedure was performed via laparotomy, but the otherswere performed laparoscopically. Six patients’ sleeve gastrectomy lines were transected and sutured usinga laparoscopic needle holder, while the others were closed with a stapling device. Ileojejunal bypass wasadded in 21 of the LSG procedures. This clinic’s experience with morbid obesity surgery began with opengastric bypass surgery and later evolved into use of the LRYGB method. Sleeve gastrectomy, which is popular in this country and around the world, has been performed since July 2014 (handmade as of May). Thisarticle describes some of the nuances and subtleties of the LSG technique.Öğe Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Gündoğan, Ersin; Kayaalp, Cüneyt; Aktaş, Aydın; Sağlam, Kutay; Sansal, Müfit; Uylas, Ufuk; Gökler, Cihan; Çiçek, Egemen; Sümer, FatihBackground: Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. Objectives: The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. Setting: University hospital. Methods: A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. Results: A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. Conclusions: In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.Öğe Recurrent gastric bezoar after roux-en-y gastric bypass for morbid obesity(Sprınger ındıa, 7th floor, vıjaya buıldıng, 17, barakhamba road, new delhı, 110 001, ındıa, 2018) Aktaş, Aydın; Sansal, Müfit; Sağlam, Kutay; Sümer, Fatih; Kayaalp, CüneytIn this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3years ago, underwent the first endoscopic bezoar evacuation 26months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.Öğe Secure laparoscopic cholecystectomy with surgical technique modification in abdominal situs inversus(2018) Kayaalp, Cüneyt; Sağlam, Kutay; Sümer, Fatih; Çiçek, Egemen[Abstract Not Acailable]Öğe Systematic review of 241 laparoscopic isolated liver segment VII resections(2021) Sağlam, Kutay; Güneş, Örgün; Bağ, Yusuf Murat; Aydın, Mehmet Can; Sümer, Fatih; Kayaalp, CuneytLaparoscopic liver resections are performed with increasing frequency; however, they are less preferred for the deep parts of liver because of difficulty in reaching a posterior superior segment and working in a narrow area. The aim of this study is to analyze the outcomes of laparoscopic segment 7 resections with two new patients and previously published 239 patients. PubMed, Scopus, and Google Scholar databases were scanned for the topic with several keywords. Eligible studies were selected for the analysis and reference cross-check was added to the search. Surgical technique details (application of Pringle maneuver, using Cavitron ultrasonic surgical aspirator (CUSA), patient position, Glissonean approach, and intercostal trocar (ICT) placement) were examined for the outcomes (operating time, blood loss, conversion to open surgery, and post-operative complications). Total data of 239 cases were collected from 27 studies and we added two more cases from our clinic. Lateral decubitus patient position was with less post-operative complications when compared to the supine position (8.4% vs. 50.0%, p=0.01). ICT placement seemed to have less conversion rate (1.3% vs. 7.3%, p=0.07) and less post-operative complications (4.5% vs. 19.1%, p=0.05). Glissonean approach increased the operating time but had no effect on blood loss. Using CUSA for parenchymal transection lowered the rates of post-operative complications (4.4% vs. 19.5%, p<0.05) but it was not useful for blood loss or operating time. Application of Pringle maneuver had no effect on these outcomes. Laparoscopic isolated segment 7 liver resection is a feasible surgical procedure for selected patients in centers with experienced surgeons on advanced laparoscopy. Lateral decubitus patient position, ICT placement, and using CUSA for parenchymal transection seem beneficial to decrease conversion to open surgery and complication rates. Pringle maneuver or Glissonean approach were not found as useful for the outcomes.Öğe Tıkanma İkterine Yol Açan Dev Pankreas Psödokisti(Causapedia, 2018) Ocak, Sönmez; Bük, Ömer Faruk; Sağlam, Kutay; Karagül, ServetAbstract: Pancretic pseudocysts are the most common complication of pancreatitis. Clinical findings depend on the size and location of pseudocysts. Obstructive jaundice is a rare complication of pancreatic pseudocysts. In this case report, a 38-year-old female patient with a giant pancreatic pseudocyst causing obstructive jaundice was presented.Öğe Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?(2022) Zengin, Akile; Bağ, Yusuf Murat; Öğüt, Mehmet Zeki; Sağlam, KutayAbstract Aim: To investigate the clinical significance of the simple laboratory test values on differentiating complicated acute appendicitis. Materials and Methods: We retrospectively examined the medical records of 216 acute appendicitis patients. Patients were divided into two groups according to pathological results (non-complicated (n=157) and complicated (n=59)). The demographic and clinical data, laboratory findings, length of hospital stay, and pathological results were compared between the two groups. Receiver operating characteristics (ROC) curves were performed to analyze the optimal cutoff value of numerical variables which were significantly differed between the group comparisons. Results: The preoperative data were similar between the groups except for age. The length of hospital stay was longer and total/direct bilirubin levels higher in the complicated group (p=0.002, p=0.002, and p=0.002, respectively. The lymphocyte level and amylase level were lower in the complicated group (p=0.02 and p=0.004, respectively). ROC curve analysis provided a cutoff value of ?0.89 mg/dL for total bilirubin, ?0.43 mg/dL for direct bilirubin, ?1.63% for lymphocyte and ?46.5 U/L for amylase. Conclusion: Preoperative higher total and direct bilirubin levels are able to predict complicated appendicitis. Preoperative higher serum amylase levels should not have a place in the differential diagnosis of complicated appendicitis. This means that if serum amylase is elevated in a patient with suspected acute appendicitis, it does not suggest acute complicated appendicitis.
