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Öğe Comparing one-stage and two-stage treatment approach of cholelithiasis and choledocholithiasis(2018) Muhammedoglu, Bahtiyar; Tolan, Huseyin KeremAim: Complicated bile duct stones with choledocholithiasis may cause serious morbidity and mortality. The aim of this study was to evaluate; cost, frequency of the imaging methods used and the length of the hospital stay after the one-stage and two-stage procedures. Material and Methods: Endoscopic Retrograde Cholangio Pancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) was performed in 16 out of 250 LC cases and was named as Group A; other 12 patients have had interval LC 6-8 weeks after the ERCP procedure and were named as Group B. All ERCP and LC were performed by the same surgeon. Results: The duration of hospitalization in Group A was 6 [4-9.5] days and was statistically significantly longer in the group B patients which was 8.5 [9.5-10.5] days (p <0.0470). The frequency of the use of the imaging methods was 3 [2-4.5] in Group A and 6 [4.5-7.0] in B (p <0.001). The cost of the procedures were significantly lower in the Group A compared to B (p <0.047) and was 2411.3 [1855.6-2819.9] and 2839.9 [2495.5-3237.1] Turkish Lira (TL) respectively. Conclusion: Simultaneous ERCP and LC are safe and a feasible in selected cases and advantageous in terms of the total cost and the length of the hospital stay. There is need for more studies to clarify the timing of the surgical treatment after the ERCP.Öğe Ectopic Balloon Device Placement to Correct the Positional Hepatic Venous Outflow Obstruction in Liver Transplantation(Baskent Univ, 2020) Tolan, Huseyin Kerem; Barut, Bora; Kutluturk, Koray; Kayaalp, Cuneyt; Yilmaz, SezaiObjectives: Hepatic vein outflow obstruction in liver transplantation can lead to graft or patient loss. We used an intrauterine balloon to overcome this complication in 13 liver transplant recipients. Here, we report the results of these cases; our report, as far as we know, involves the highest number of patients on this issue. Materials and Methods: Positional hepatic vein outflow obstruction was diagnosed in 13 of 651 liver transplant recipients between January 2014 and December 2016. The grafts were repositioned by intrauterine balloon placed to the right subdiaphragmatic area. Data of donors, recipients, and grafts and postoperative courses were analyzed. Results: Of the 13 patients, 9 were men, with age range of patients of 22 to 70 years. The amount of saline used to inflate the balloon was variable (200-450 cm(3)), and hepatic vein outflow obstruction was relieved after balloon implantation in all patients. There were no balloon-related complications. Removal was done at bedside, without any additional sedation or any additional skin incision on days 2 to 15. Doppler ultrasonography scans were performed before and after the balloon removal. There were no vascular complications after removal. Conclusions: Intrauterine balloon can be safely and efficiently used for hepatic vein outflow obstruction during liver transplant when needed.Öğe Laparoskopik kolesistektomi sonrası atrial fibrilasyona bağlı splenik arter tromboembolisi(2016) Kırmızı, Serdar; Tolan, Huseyin Kerem; Ara, Cengiz; Yılmaz, SezaiÖz: Splenik arter tromboembolisine bağlı dalak iskemisi nadir görülen bir durumdur. Tromboemboli çoğunlukla kardiak kaynaklı olup, önemli bir kısmını atrial fibrilasyon (AF) oluşturmaktadır (1). Hipertiroidi; AF ve hiperkoagübiliteye neden olabilir. Hipertiroidi tanısı alan ancak son iki aydır antitiroid ilaçlarını kullanmayan altmış yaşında erkek hasta sunulmuştur. Olgumuza akut kolesistit nedeniyle acil laparoskopik kolesistektomi uygulandı. Ameliyat sonrası onuncu gününde gelişen karın ağrısı nedeniyle yapılan tetkiklerde splenik arterde tromboemboli, dalakda ve pankreasda iskemik alanlar saptandı. Hastanın hipertiroidi tedavisi tekrar düzenlendi ve dalaktaki iskemik alan konservatif yöntemlerle tedavi edildi. Olgumuzda da olduğu gibi acil girişimlerden önce hastalar dikkatlice hipertiroidi yönünden sorgulanmalı ve tiroid fonksiyon testleri kontrol edilmelidir.Öğe Living Donor Liver Transplantation for Hepatocellular Carcinoma with Bile Duct Tumor Thrombi(Springer, 2018) Uylas, Ufuk; Tolan, Huseyin Kerem; Ince, Volkan; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Neuroendocrine tumors of the appendix(2019) Tolan, Huseyin Kerem; Canbak, TolgaAim: The objective of this study was to evaluate treatment and postoperative recurrence in patients with neuroendocrine tumors of the appendix detected.Material and Methods: Patients with neuroendocrine tumors of the appendix detected between January 2015 and January 2016 were evaluated retrospectively. Patients who underwent incidental appendectomy due to different malignancies were excluded from the study. Results: A total of 402 patients who underwent appendectomy were evaluated. Five patients with neuroendocrine tumors detected, were included in the study. The mean age was 30.1 years. There were tumors in the apex, while a second tumor was found in the corpus in one patient. The mean tumor diameter was 0.6 cm. Ki-67 was under 2% in all patients. One patient underwent right hemicolectomy in the postoperative first month due to the infiltration to the periappendiceal tissue. The mean duration of hospitalization was 2 days. The mean duration of follow-up was 38 months (range 12- 54) . Ga 68 PET CT was taken in all patients after the histopathological examination. Control of the patients was performed after the first year with thorax and abdominal CT. None of the patients developed tumor. Conclusion: In general, clinical course is good and appendectomy is curative. However, right hemicolectomy is needed in patients with poor prognostic factors. Keywords: Incidental neuroendocrine tumor; appendectomy; general surgery.Öğe Timing of cholecystectomy in the treatment of mild acute biliary pancreatitis(2020) Acar, Aylin; Canbak, Tolga; Tolan, Huseyin KeremAim: In this study, we aimed to compare the results of emergency and elective cholecystectomy in patients admitted due to acute biliary pancreatitis.Material and Methods: A total of 632 patients admitted due to acute biliary pancreatitis were retrospectively evalauted. Patients with Ranson ≥ 3 and hour 48 CRP > 15 were considered as severe pancreatitis and excluded from the study. Patients were divided into two groups. Group 1 consisted of the patients who underwent emergency cholecystectomy after 48 hours, while Group 2 included the patients who underwent interval cholecystectomy. Results: A total of 386 patients were enrolled in the study. Group 1 consisted of 214 patients. The mean Ranson score was found as 1.3±0.9 in Group 1 and 0.92±0.7 in Group 2. A total of 148 patients in Group 1 and 117 patients in Group 2 had comorbidity (p=0.81). Conversion was performed in 8 patients in Group 1 and 5 patients in Group 2 (p = 0.78). Bile duct injury was not detected in either group. Among the patients in the interval cholecystectomy group, 7 patients were admitted to the hospital due to acute pancreatitits and total 13 patients due to biliopancreatic reasons during the interval period. Conclusion: No effect of cholecystectomy timing was detected on the conversion rates and development of complications. However, development of recurrence and related complications in the waiting period of the patients could be prevented by performing early cholecystectomy.Öğe Whipple’s procedure and retrocolic gastroenteric anastomosis(2019) Muhammedoglu, Bahtiyar; Tolan, Huseyin Kerem; Topuz, Sezgin; Kokdas, SuleymanAim: Pancreatoduodenectomy (PD) is the only treatment option in patients with periampullary region tumors. Gastroenterostomy (GE) is carried out with or without Braun’s anastomosis according to preference. Material and Methods: Prospectively recorded files of 17 patients who underwent Whipple operation between September 2015 and March 2017 were retrospectively investigated for morbidity, mortality, and the way of GE anastomosis. Results: The youngest patient was 44 and the ldest was 75 years old with a mean age of 63.4. Six were male and 11 were female. Five cases (26%) were ductal adenocarcinoma, 11 (68%) were ampullary adenocarcinoma, and one (6%) was ampullary NET. Classical Whipple procedure was performed in all patients. Retrocolic GE was applied in all cases with Braun’s anastomosis in 6 and without in 11 patients. There were only two cases of panreatic fistula (grade B) (11.7%). Conclusion: Retrocolic gastroenterostomy under the omentum can provide more protected anatomical position providing advantage for lower and upper abdominal quadrant drainage in case of possible pancreaticojejunal leakages during pancreatoduodenectomy.
