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Öğe Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial(Mary Ann Liebert, Inc, 2015) Ertugrul, Ismail; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Sumer, Fatih; Karagul, Servet; Tolan, KeremBackground: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and Methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6 +/- 94.6 versus 217.6 +/- 111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.Öğe Crystallized or Liquid Phenol Application in Pilonidal Sinus Treatment(Springer India, 2015) Kayaalp, Cuneyt; Tolan, Kerem[Abstract Not Available]Öğe Effect of Copper Staining in Wilson Disease: A Liver Explant Study(Baskent Univ, 2017) Karadag, Nese; Tolan, Kerem; Samdanci, Emine; Selimoglu, Ayse; Akpolat, Nusret; Yilmaz, SezaiObjectives: Wilson disease is a rare genetic disease with clinical and histopathologic differential diagnostic challenges. In this study, we evaluated the histo pathologic findings of explanted livers in Wilson disease, with special emphasis on copper histochemistry. Materials and Methods: Our study group was recruited by reviewing archived histopathology reports and the liver transplant clinic patient records retrospectively for patients who had liver transplant for Wilson disease between January 2010 and June 2015, at Turgut Ozal Medical Center. Archival slides were reevaluated. When needed, relevant clinical and laboratory data were obtained from patient medical records. Results: During the selected period, there were 33 patients fitting the study criteria (22 male, 11 female, mean age of 22 +/- 11 y). All patients had mild to moderate septal inflammation. We found that 29 patients (88%) showed glycogenated hepatocyte nuclei and 27 patients (79%) showed nuclear pleomorphism. Other histopathologic findings were cholestasis (48%) and macrovesicular steatosis (39%). There was no special finding in hilar regions except for 2 patients who had recanalized portal vein thrombosis. In terms of copper histochemistry, 2 copper stains, Timm silver sulfide and rhodanine, were performed in all cases, with orcein staining only done for 25 of the cases. Positivity rates for these copper stains were 85%, 82%, and 36%. Periodic acid-Schiff-diastase-and periodic acid-Schiff-positive granules were detected in 7 of 33 patients (21%). Iron deposition was seen in 12 patients (focal and/or minimal in 11, more than focal in 1). There was no dysplasia or malignancy in any of the patients. Conclusions. On routine hematoxylin and eosinstained slides, detection of glycogenated hepatocyte nuclei and the finding of the nuclear pleomorphism should alert the pathologist for the possibility of Wilson disease, especially with cryptogenic liver disease. Timm stain is a more convenient histo chemical stain in revealing copper deposition in liver.Öğe Fibrin sealant use in pilonidal sinus systematic review(World journal of gastrointestinal srgery, 2016) Kayaalp, Cüneyt; Ertuğrul, İsmail; Tolan, Kerem; Sümer, FatihTo review the current data about the success rates of fibrin sealant use in pilonidal disease. METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients. CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.Öğe Fibrin sealant use in pilonidal sinus: Systematic review(Baishideng Publishing Group Inc, 2016) Kayaalp, Cuneyt; Ertugrul, Ismail; Tolan, Kerem; Sumer, FatihAIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease. METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 +/- 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients. CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.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 Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report(Elsevier Sci Ltd, 2016) Ertugrul, Ismail; Tardu, Ali Tardum; Tolan, Kerem; Kayaalp, Cuneyt; Karagul, Servet; Kirmizi, SerdarINTRODUCTION: We 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 of these 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. (C) 2016 The Author( s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.Öğe Giant Meckel's diverticulum torsion that mimics adnexal pathology(Elsevier Sci Ltd, 2016) Kirmizi, Serdar; Kirmizi, Demet Aydogan; Karagul, Reyhan; Tolan, KeremMeckel's diverticulum is a real diverticulum located at the antimesenteric portion of intestinal loops and including all layers of the intestinal wall. It is the most common congenital anomaly of the gastrointestinal tract, and its incidence is 1-3%. Many asymptomatic cases are diagnosed when complications occur. A 23 year-old female patient applied to gynaecology emergency clinic with pelvic pain complaint. Laparotomy was performed with the diagnosis of acute abdomen because the physical examination and imaging studies did not exclude tuboovary pathology. Giant Meckel's diverticulitis and ischemic bowel loops that had been torsion were observed. Obstruction is the most common complication and generally originates from inflammation, adhesions, intussusception and omphalo-mesenteric band. In this case, it was seen that mobilized diverticulitis can be complicated without any fibrous band or adhesion to adjacent organs. This case supports that there can be torsion of bowel in free Meckel's diverticulum. Meckel's diverticulum settled in the pelvic region can make a clinical manifestation that is difficult to distinguish from adnexal diseases. It should be kept in mind for cases that start with pelvic pain, form adnexal pathology suspicion and cause an acute abdomen. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of US Publishing Group Ltd.Öğe Having a healthy birth with a 100 year old liver(Progress in transplantation, 2016) Tolan, Kerem; Kayaalp, Cüneyt; İspir, Mukadder; Kırmızı, Serdar; Yılmaz, SezaiIn March 2008, a 19-year-old woman required emergency liver transplantation due to acute-on-chronic liver failure. No living donor candidate was available. A marginal deceased liver that had been rejected by all the other centers was offered. The liver belonged to a 93-year-old woman and contained a hydatid cyst. Because of low donation rates in our country, we chose to accept the 93-year-old liver. The postoperative early and late courses were fortunately uneventful. Five years after transplantation, the woman became pregnant and gave birth to a healthy female baby. Today, the ages of the baby, mother, and the transplanted liver are 1, 26, and 100 years, respectively. A nonagenarian liver with hydatid disease was able to sustain its viability in a younger woman after transplant and also helped her bring in a new life into the world.Öğe Having a Healthy Birth With a 100-Year-Old Liver(Sage Publications Inc, 2016) Tolan, Kerem; Kayaalp, Cuneyt; Ispir, Mukadder; Kirmizi, Serdar; Yilmaz, SezaiIn March 2008, a 19-year-old woman required emergency liver transplantation due to acute-on-chronic liver failure. No living donor candidate was available. A marginal deceased liver that had been rejected by all the other centers was offered. The liver belonged to a 93-year-old woman and contained a hydatid cyst. Because of low donation rates in our country, we chose to accept the 93-year-old liver. The postoperative early and late courses were fortunately uneventful. Five years after transplantation, the woman became pregnant and gave birth to a healthy female baby. Today, the ages of the baby, mother, and the transplanted liver are 1, 26, and 100 years, respectively. A nonagenarian liver with hydatid disease was able to sustain its viability in a younger woman after transplant and also helped her bring in a new life into the world.Öğe Hepatoduodenal ligament dissection technique during recipient hepatectomy for liver transplantation How I do it(World journal of transplantation, 2016) Yılmaz, Sezai; Kayaalp, Cüneyt; Tolan, KeremAccurate dissection of the hepatoduodenal ligament in the recipient is vital for the success of liver transplantation surgery. High incidence of anatomic variations at the hepatic artery, portal vein and biliary ducts in the hepatoduodenal ligament is well known. Surgical experience is important to be able to foresee the most common anatomic diversities and the possible variations, in order to make a safe and accurate dissection in the hepatic hilum. Before anastomosis, all these hilar structures must be well identified, safely dissected and must also have a sufficient length for the coming implantation process. At the beginning of our program, we were starting the hepatic hilum dissection close to the liver. In time, however, we modified our surgical technique, preferring to start further away from the liver (closer to the duodenum). This length increased progressively over 1500 liver transplantations (80% living donor liver transplantation). During this process, our main purpose was the early control of the hepatic artery (artery first approach). In this paper, our aim is to share our latest version of the hepatoduodenal ligament dissection technique. We also describe alternative approaches used in extraordinary situations.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 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.Öğe Reresection of Colorectal Liver Metastasis with Vena Cava Resection(Hindawi Ltd, 2016) Tardu, Ali; Kayaalp, Cuneyt; Yilmaz, Sezai; Tolan, Kerem; Ersan, Veysel; Karagul, Servet; Ertugrul, IsmailThe 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.Öğe Resection of Adrenal Metastasis Invading Left Renal Vein Following Living Donor Liver Transplantation for Hepatocellular Carcinoma(Springer, 2020) Ince, Volkan; Gundogan, Ersin; Tolan, Kerem; Kayaalp, Cuneyt; Yilmaz, Sezai[Abstract Not Available]Öğe Transvaginal Appendectomy: A Systematic Review (vol 2014, 384706, 2014)(Hindawi Ltd, 2015) Kayaalp, Cuneyt; Tolan, Kerem; Yagci, Mehmet Ali[Abstract Not Available]
