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Öğe The effect of dividing the sphincter of oddi at endoscopic sphincterotomy on the filling and emptying aspects of function of the gallbladder(Lippincott Williams & Wilkins, 1999) Taskin, V; Ozyilkan, E; Sare, M; Hilmioglu, FThe effect of dividing the sphincter of Oddi at endoscopic sphincteretomy (EST) on the filling and emptying aspects of gallbladder function has not been definitely established in humans. This prospective study is designed to examine the effects of EST on gallbladder emptying. In 13 patients (8 men and 5 women; mean age, 60.54 years +/- 2.14: range, 45-75 years), postprandial gallbladder emptying was measured ultrasonographically before and after EST (within 1-4 days). The fasting volumes after 8 hours of fasting, at times 0 min and before the test meal was given, residual volume (the smallest postprandial volume), gallbladder ejection fraction (EF), and total ejection volume, at 10, 20, 30, 40, 50, 60, 70, 80, and 90 min after the test meal, were studied. The fasting gallbladder volume and the residual volume tended to decrease after EST, but the differences were not significant (40.21 +/- 10.79 mt and 35.48 +/- 11.21 mt, 17.79 +/- 4.83 mt, and 13.10 +/- 4.83 mt, respectively; p > 0.05). Maximum EF was found to be 19.72% at 40 min and increased to 28.62% at 70 min after EST. Although the difference was not statistically relevant, a trend of improvement was evident after EST. The ejected volumes after EST have depicted a trend toward increase, without reaching to any statistical significance (p > 0.05). Our results demonstrate at least no adverse effects of EST and further support some positive effects on gallbladder kinetics.Öğe Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction(Blackwell Science Inc, 2000) Taskin, V; Gurer, I; Ozyilkan, E; Sare, M; Hilmioglu, FBackground. At present, the prevalence of Helicobacter pylori (H. pylori) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up. Patients and Methods. Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization. Results. The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7-24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11.1%). The mean time to ulcer recurrence was 17 months (range, 10-24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients. Conclusion. We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.Öğe Mirizzi syndrome: Choice of surgical procedure in the laparoscopic era(Lippincott Williams & Wilkins, 1998) Sare, M; Gurer, S; Taskin, V; Aladag, M; Hilmioglu, F; Gurel, MImpaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechanical impression or associated inflammation. This clinical entity is referred to as Mirizzi syndrome. Four patients were operated on for Mirizzi syndrome. This represents 0.9% of the 444 patients who underwent laparoscopic cholecystectomy in our clinic. Two cases with Mirizzi syndrome type I, one of which had a stone in a gallbladder remnant, were successfully treated by laparoscopic cholecystectomy without any complications, One patient developed a bile leakage; fistulography via a sump drain revealed bile leakage from the laceration site of the stone, and: the patient was reoperated on to perform a Roux-en-Y hepaticojejunostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type Il, the operation was converted to an open procedure due to intense inflammation and fibrosis around the area of the Calot's triangle. Subtotal cholecystectomy was done and the defect on the common hepatic duct repaired by means of a gallbladder flap over the T tube.Öğe Needle knife papillotomy(Kenya Medical Assoc, 1998) Taskin, V; Özyilkan, E; Hilmioglu, FThe use of needle knife papillotomy (NKP) to achieve a selective bile duct cannulation is controversial. Despite this, many endoscopy centres have reported successful use of NKP when conventional techniques failed. In this prospective study, we assessed the safety and efficacy of NKP in eighty seven patients. In fifty nine of these patients, cholangiogram had failed and in twenty eight patients endoscopic sphincterotomy was unsuccessful because attempts at selective bile duct cannulation had failed. NKP was found successful in fifty one cases (58.6%) during the initial procedure and overall success rate was 79.3% after the subsequent session. There were complications in four cases (4.6%). There were no procedure related mortality and only two complications required surgical intervention. Based on our results, we consider that NKP is a helpful and safe procedure in patients in whom conventional techniques have failed.
