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Öğe A case of Krukenberg tumor, eight years after treatment of gastric cancer(Marmara Univ, Fac Medicine, 2018) Karagul, Servet; Sumer, Fatih; Onur, Asim; Tardu, Ali; Dagli, Adile Ferda; Kayaalp, CuneytKrukenberg tumor is a rare metastatic tumor of the ovary. The primary tumors are usually gastrointestinal cancers. Most of the Krukenberg tumors reported in the literature occurred within the first 2 years after treatment of the primary disease. Herein, we present a case of Krukenberg tumor in a 37-year-old woman who previously underwent surgery and chemotherapy for stomach cancer. This patient is noteworthy because it is one of the few documented cases of ovarian metastasis appearing after a disease-free period of 8 years following treatment of the primary tumor. Krukenberg tumors are associated with poor prognosis; therefore, regular gynecological examination in female patients with history of gastric cancer is very important for the early diagnosis and treatment of this disease.Öğe Comparison of Harmonic scalpel and Ligasure devices in laparoscopic Roux-en-Y gastric bypass(Termedia Publishing House Ltd, 2017) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, Fatih; Yagci, Mehmet AliIntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most preferred bariatric procedures in the world for surgical treatment of morbid obesity. The Harmonic scalpel (HS) and LigaSure (LS) are the most commonly used devices in laparoscopic surgery. As far as we know, there is no comparative study of the two energy devices in LRYGB for morbid obesity. Aim: To compare the intraoperative performances of the two energy devices in LRYGB for morbid obesity. Material and methods: The HS and LS were used in 43 and 42 cases, respectively. The patient demographics of both groups were comparable. The duration of the procedures (gastric pouch creation time and total operation time), quantity of bleeding (during gastric pouch creation and total quantities of bleeding) and the number of pneumoperitoneum desufflations due to smoking that impaired sight fields were recorded prospectively. Results: Gastric pouch creation time (HS: 22.5 +/- 9.5 vs. LS: 19.5 +/- 9.7 min, p = 0.15), bleeding during gastric pouch preparation (HS: 15.3 +/- 30.5 vs. LS: 17.5 +/- 31.3 ml, p = 0.74), total operation time (HS: 183.2 +/- 47 vs. LS: 165.3 +/- 37.1 min, p = 0.06) and total bleeding (HS: 110 +/- 195.5 vs. LS: 102.5 +/- 70 ml, p = 0.81) were similar in the two groups. Only the mean number of pneumoperitoneum desufflations due to smoking was lower in the HS group (HS: 0.28 +/- 0.49 vs. LS: 0.57 +/- 0.78, p = 0.04). Conclusions: The HS and LS performed similarly in LRYGB, with fewer desufflations from smoking in the HS group.Öğe Comparison of Stapled Versus Stapleless Sleeve Gastrectomy with Natural Orifice Specimen Extraction (NOSE)(Wolters Kluwer Medknow Publications, 2021) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, FatihBackground: Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. Aims: Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure o stapled sleeve gastrectomy. Patients and Methods: In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr Bougie. The specimens were extracted from the left upper quadrant trocar site. Results: A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BM at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m(2) (range 31-39) versus stapled group: 36.5 kg/m(2) (range 31-39), p > 0.05). Conclusion: Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.Öğe Gastric bezoar after roux en Y gastric bypass for morbid obesity A case report(International journal of case reports, 2016) Ertuğrul, İsmail; Tardu, Ali; Tolan, Kerem; Kayaalp, Cüneyt; Karagül, Servet; Kırmızı, SerdarWe aimed to present a patient with gastric pouch bezoar after having a bariatric surgery. PRESENTATION OF CASE: Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely. DISCUSSION: The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints ofthese patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery. CONCLUSION: Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients.Öğe Health literacy and Helicobacter Pylori in patients who underwent endoscopic examination for dyspepsia(2020) Erdogdu, Umut Eren; Erkinuresin, Taskin; Cayci, Murat; Akar, Mustafa; Demirci, Hakan; Arslan, Ufuk; Tardu, AliAim: The main factors most frequently associated with Helicobacter pylori (HP) in studies include patient age, poor socio-economic status, and antibiotic use. Limited/inadequate Health Literacy (HL) is also associated with poor health conditions. A possible relationship between HP and HL has not been shown in the literature yet. This study aimed to explore the relationship between HL and HP infection both of which have comparable patient profile.Material and Methods: The study evaluated the data regarding 188 patients who underwent gastroscopy due to the complaint of dyspepsia in cross-sectional analytic design. Health Literacy was evaluated using European Health Literacy Survey Questionnaire (HLS-EU-Q47) scale. The presence of HP was confirmed by histopathological examination.Results: Median age was smaller in the HP-positive group (p=0.001). In Helicobacter pylori-positive patients, mean scores were only high for household and taking part in community activities questions in the HLS-EU-Q47 scale. While 47.20% of the patients in the HP (+) group were smokers, 31.30% of the patients in the HP (-) group were smokers, with a difference between HP groups in terms of smoking status (p=0.026). Conclusion: There was no relationship between HP and HL in this sample. HL probably does not play a role in HP positivity but its prognostic role can be discussed further in prospective studies.Öğe Hemobilia due to a tubulopapillary adenoma of the gallbladder(Istanbul Medical Journal, 2016) Tardu, Ali; Yağcı, Mehmet Ali; Karagül, Servet; Işık, Burak; Yılmaz, SezaiSafra kesesi adenomları pediatrik yaş grubunda oldukça seyrek rastlanır. Adenomlar nadiren hemobilia nedeni olabilirler. 7 yaşındaki erkek hasta, üst GİS endoskopisinde ampulla vateride pıhtı ve aktif kanama görülmesi üzerine tarafımıza refere edildi. Vital bulgular stabildi. Konjuktivalarında ikteri bulunan hastanın, rektal tuşede melena görüldü. Dinamik karaciğer tomografisinde genişlemiş koledok mevcuttu. Yapılan sintigrafi ve anjiografide kanama odağı saptanamadı. Tanı sürecinde hemoglobin seviyesinde düşme ve hemodinamik instabilite gelişmesi üzerine hastaya hemobilia ön tanısıyla eksplorasyon kararı alındı. Laparotomide safra kesesi içerisinde kitle palpe edildi. Kolesistektomi yapıldı. Çıkarılan safra kesesinin intraoperatif incelemesinde fundusta birbirine komşu yaklaşık 1 ve 2 cm çaplarında, üzeri pıhtılı, yüzeyi düzensiz 2 adet polipoid kitle olduğu görüldü. Hasta postoperatif 13. gün şifayla taburcu edildi. Kolesistektomi materyalinin histopatolojik incelemesinde safra kesesindeki polipoid lezyonların tubulopapiller adenoma olduğu rapor edildi. Hemobilia safra yollarında kan varlığını tanımlamak için kullanılan bir terim olup, GİS kanamasının nadir görülen bir nedenidir. Hemodinamik instabiliteye yol açan kanama ile ortaya çıkmış safra kesesi polipleri hekimler için zor bir sınavdır. Ayrıca her zaman ameliyat öncesi kanama odağı saptanamayabilir. GİS kanaması ile birlikte biliyer semptomların varlığında çocukluk çağında da hemobilia akla gelmelidir.Öğe Hemobilia due to A Tubulopapillary Adenoma of the Gallbladder(Aves, 2016) Tardu, Ali; Yagci, Mehmet Ali; Karagul, Servet; Isik, Burak; Yilmaz, SezaiAdenoma of the gallbladder is an uncommon benign tumor among pediatric patients. Rarely, it can cause of hemobilia. A 7-year-old boy was referred to our clinic due to active bleeding of the ampulla vateri, which was detected by upper gastrointestinal endoscopy. Initial hemodynamic parameters were stable. Conjunctival icterus and melena were observed on performing the physical examination. Computed tomography revealed dilatation of the common bile duct. The bleeding point was not detected on scintigraphy and angiography. During diagnosis, the hemoglobin level decreased and hemodynamic instability occurred; exploratory laparotomy was planned due to suspicion of hemobilia. A mass of gallbladder was detected, and cholecystectomy was performed. An intraoperative evaluation of the gallbladder revealed two irregular polypoid masses with coagulum; they were approximately 1 and 2 cm in diameter and on the fundus. The patient was discharged on the postoperative 13th day uneventfully. A tubulopapillary adenoma of the gallbladder was diagnosed after the patients underwent a histopathological examination. Hemobilia is a term used to describe blood in the biliary tract, and it is a rare cause of gastrointestinal bleeding. The clinical presentation of gallbladder polyps with hemodynamic instability due to tumoral hemorrhage is a challenging course for physicians. Further, preoperative determination of the source of bleeding is not always possible. Hemobilia due to gallbladder polyps must be kept in mind when gastrointestinal bleeding is present among pediatric patients.Öğe Histopathological examination of explanted liver after transplantation in patients with cryptogenic cirrhosis(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Yağcı, Mehmet Ali; Ertuğrul, İsmail; Sümer, Fatih; Kırmızı, Serdar; Yaylak, Faik; Koç, Cemalettin; Hatipoğlu, Hamit Sinan; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. Materials and Methods. A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. Results. During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-tomale ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. Conclusions. Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.Öğe Identification of Ureter during Colorectal Surgery Cannot Always Avoid Ureteral Injury: Duplicated Collecting System(Southeastern Surgical Congress, 2015) Tardu, Ali; Kayaalp, Cuneyt; Ertugrul, Ismail; Yagci, Mehmet Ali[Abstract Not Available]Öğe Influence of Liver Transplantation on Neuropsychiatric Manifestations of Wilson Disease(Transplantation Proceedings, 2015) Tardu, Ali; Karagül, Servet; Ertuğrul, İsmail; İnce, Volkan; Kırmızı, Serdar; Ünal, Bülent; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease. Materials and Methods. Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up. Results. Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 2.3 vs 2.4 1.3 (P ¼ .0005), 17.7 11.7 vs 12.7 12.5 (P ¼ .055), and 9.0 1.7 vs 7.0 2.1 (P ¼ .033). Conclusions. Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.Öğe Influence of liver transplantation on neuropsychiatric manifestations of wilson disease(Transplantation Proceedings, 2015) Yağcı, Mehmet Ali; Tardu, Ali; Karagül, Servet; Ertuğrul, İsmail; İnce, Volkan; Kırmızı, Serdar; Ünal, Bülent; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease. Materials and Methods. Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up. Results. Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 2.3 vs 2.4 1.3 (P ¼ .0005), 17.7 11.7 vs 12.7 12.5 (P ¼ .055), and 9.0 1.7 vs 7.0 2.1 (P ¼ .033). Conclusions. Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.Öğe Influence of repeated measurements on small bowel length(Springer International Publishing Ag, 2016) Karagul, Servet; Kayaalp, Cuneyt; Kirmizi, Serdar; Tardu, Ali; Ertugrul, Ismail; Tolan, Kerem; Sumer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the anti-mesenteric border of the bowel. Results: The median age was 33 (19-67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 +/- 103 vs. 485 +/- 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe Influence of repeated measurements on small bowel length(Springerplus, 2016) Karagül, Servet; Kayaalp, Cüneyt; Kırmızı, Serdar; Tardu, Ali; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the antimesenteric border of the bowel. Results: The median age was 33 (19–67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 ± 103 vs. 485 ± 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe Laparoscopic Treatment of Primary Hydatid Cyst of Omentum(Int College Of Surgeons, 2019) Ertugrul, Ismail; Kayaalp, Cuneyt; Dirican, Abuzer; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarOmental hydatid cysts usually secondarily exist after the spontaneous, traumatic, or iatrogenic perforation of primary abdominal hydatid cysts. An isolated omental hydatid cyst in the absence of other organ involvement is very rare. Here, we present a 49-year-old male with a primary omental hydatid cyst. He was living in an urban area, but he spent his childhood in rural areas and worked with livestock. The differential diagnosis was not easy because of the negative serological test. Laparoscopic exploration revealed the diagnosis of hydatid cyst and it was removed by laparoscopy without spillage of the cyst contents. After the total excision, no albendazole treatment was prescribed. Isolated omental hydatid cysts should be in the differential diagnosis of the peritoneal cysts and its laparoscopic total excision is a feasible treatment.Öğe Living donor liver transplantation with vena cava replacement(Transplantation Proceedings, 2015) Yağcı, Mehmet Ali; Tardu, Ali; Karagül, Serdar; İnce, Volkan; Ertuğrul, İbrahim; Kırmızı, Serdar; Ünal, Bülent; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, SezaiObjectives. This study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and Methods. We performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. Results. Right, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n ¼ 5, IVC n ¼ 4, iliac vein n ¼ 1) or synthetic graft (n ¼ 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). Conclusions. Although rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.Öğe Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series(Springer, 2017) Saglam, Kutay; Aktas, Aydin; Gundogan, Ersin; Ertugrul, Ismail; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarManagement of early sleeve gastrectomy leak remains challenging. The recommended approach is endoscopic stenting and abdominal drainage. Conversion to a Roux-en-Y gastric bypass (RYGB) is a common procedure used for late fistulas with distal obstruction. Here, we have presented three cases of early staple line leaks treated by conversion to RYGB. These patients had uncontrolled abdominal infections despite intensive medical treatments, and surgery was elected for abdominal drainage as well as to control the source of sepsis. All the patients were discharged without problems, and successful weight loss processes continued. Conversion to RYGB of a sleeve gastrectomy leak in an acute setting can be a feasible method in the case of inevitable surgical drainage for abdominal sepsis.Öğe Portosystemic shunt surgery in patients with idiopathic noncirrhotic portal hypertension(Annals of Transplantation, 2016) Karagül, Servet; Yağcı, Mehmet Ali; Tardu, Ali; Ertuğrul, İsmail; Kırmızı, Serdar; Sümer, Fatih; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiIdiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. MATERIAL AND METHODS Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. RESULTS A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7-69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH.Öğe Portosystemic shunt surgery in patients with ıdiopathic noncirrhotic portal hypertension(Annals of Transplantation, 2016) Karagül, Servet; Yağcı, Mehmet Ali; Tardu, Ali; Ertuğrul, İsmail; Kırmızı, Serdar; Sümer, Fatih; Işık, Burak; Kayaalp, Cüneyt; Yılmaz, SezaiBackground: Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. Material/Methods: Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. Results: A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7–69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. Conclusions: Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH. MeSH Keywords: Ascites • Gastrointestinal Hemorrhage • Hypertension, Portal • Liver Transplantation • Portasystemic Shunt, Surgical • Splenorenal Shunt, SurgicalÖğe A rare cause of gastric obstruction: Lighters swallowing(Kare publ, concord ıstanbul, dumlupınar mah, cıhan sk no 15, b blok 162 kadıkoy, ıstanbul, 00000, turkey, 2015) Aday, Ulas; Tardu, Ali; Yagci, Mehmet Ali; Yonder, HuseyinThe majority of swallowed foreign bodies are thrown spontaneously without causing complications in the digestive system. Multiple number of foreign bodies may be swallowed by psychiatric patients which delay diagnosis and increase the complication rate. Long and hard objects cannot pass through the pylorus, and may cause obstruction, ulceration, bleeding and perforation. Endoscopy is used as an effective method in such cases. An exploratory laparatomy was performed after unsuccessful endoscopic foreign object removal in a 28-year-old schizophrenic patient with gastric outlet obstruction due to multiple cigarette lighter swallowing. Ten lighters were removed from the stomach through gastrotomy and one more lighter was removed from the descending colon by milking through the anus. The aim of this paper is to discuss encountered difficulties in psychiatric patients who underwent surgery due to intake of foreign bodies.Öğe Reresection of colorectal liver metastasis with vena cava resection(Case reports in surgery, 2016) Tardu, Ali; Kayaalp, Cüneyt; Yılmaz, Sezai; Tolan, Kerem; Ersan, Veysel; Karagül, Servet; Ertuğrul, İsmail; Kırmızı, SerdarThe best known treatment of the colorectal liver metastasis is the complete surgical excision with clean surgical margins. However, liver resections sometimes cannot appear technically feasible due to the high number of metastases in the liver, in cases of recurrent resections or invasion of the tumors to the major vascular structures or neighboring organs. Here, we presented a colorectal recurrent liver metastasis invading the retrohepatic vena cava, right adrenal gland, and right diaphragm. En masse resection of the tumor with caudate hepatectomy combined with vena cava resection and surrounding adrenal and diaphragm resections was accomplished. Caval reconstruction was done by a 5 cm in length cryopreserved vena cava homograft under isolated caval clamping. Postoperative period was uneventful and she was discharged on day 11. As a conclusion, combined liver and vena cava resection for a recurrent colorectal liver metastasis is a feasible procedure even with additional neighboring organ resections. Isolated vena cava occlusion with the preservation of the hepatic blood flow may decrease the risk of liver injury in case of previous chemotherapy for liver metastasis.
