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    The Alvarado Score is accurate in pregnancy: a retrospective case-control study
    (Springer Heidelberg, 2019) Tatli, F.; Yucel, Y.; Gozeneli, O.; Dirican, A.; Uzunkoy, A.; Yalcin, H. C.; Ozgonul, A.
    BackgroundAcute appendicitis is the most frequent abdominal condition that requires non-obstetric surgical intervention during pregnancy. This study aims to scan pregnant patients operated on for acute appendicitis to evaluate the efficiency of using the Alvarado Score (AS) for diagnosis.MethodsOur study included 48 pregnant patients who were pre-diagnosed with acute appendicitis and operated on at our department of general surgery from January 2010 to July 2016 and whose files were accessed. Fifty-three non-pregnant female patients of reproductive age who were operated on for appendicitis during the same period were included in the study as the control group. The patients in both groups were divided into two groups based on their AS total score being 7 and 7.ResultsThe mean age of the 48 pregnant patients was 28 (19-42) years, while the mean age of the 53 control patients was 31 (18-45) years. Among pregnant and non-pregnant women, about a third of patients had an AS<7 (16 of 48 versus 18 of 53). There was no significant difference when the AS scores of both groups were compared (p=0.947). Using pathology results as reference test, the sensitivity and specificity of the AS in pregnant women was 79 and 80%.ConclusionsAs a result, when the data collected by our study are evaluated, we see that pregnancy does not have a negative effect on the efficacy of AS. Therefore, the AS system can be an easy, non-invasive auxiliary diagnostic tool with high diagnosis accuracy rates that can be used in pregnant patients suspected of having acute appendicitis.
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    Biliary Complications in 106 Consecutive Duct-to-Duct Biliary Reconstruction in Right-Lobe Living Donor Liver Transplantation Performed in 1 Year in a Single Center: A New Surgical Technique
    (Elsevier Science Inc, 2011) Kirimlioglu, V.; Tatli, F.; Ince, V.; Aydin, C.; Ersan, V.; Ara, C.; Aladag, M.
    Objective. Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods. Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-to-duct anastomosis. Results. All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion. We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.
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    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.