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Öğe Analysis of patients with acute liver failure after liver surgery: Single center experience(2022) Sağlam, Kutay; Yılmaz, Sezai; Usta, Sertaç; Şahin, Tevfik Tolga; Zengin, Akile; İspir, MukadderLiver transplantation is the lifesaving treatment option for rare acute liver failure that develops due to iatrogenic bile duct injuries or after major hepatectomy. The aim of the study is to analyze patients with acute liver failure due to iatrogenic bile duct injury or major hepatectomy on the waiting list for emergency liver transplantation. Between the years 2011-2020, 9 patients (5 female/4 male; median age: 30 years old, (range:4-63 years)) with acute liver failure related to bile duct injury or major hepatectomy for whom urgent liver transplantation was planned were included in this study. Eight patients were accepted for urgent liver transplantation. Acute liver failure developed in 6 patients due to hepatoduodenal ligament injury during cholecystectomy, and in 3 patients due to major hepatectomy. The patients were listed for urgent transplantation within the mean of 1.5 days (range:0-3 days) after acute liver failure. Two patients had living donor and 1 patient had cadaveric liver transplantation. Acute hepatic failure, especially after iatrogenic bile duct injuries associated with vascular injuries, seems to be more fatal than post hepatectomy liver failure. In these cases of acute liver failure, which is a difficult situation to decide, emergency liver transplantation should be kept in mind as the treatment option.Öğe The association between psoas muscle area index and morbidity/mortality in laparoscopic gastric cancer surgery(2022) Turgut, Emre; Zengin, Akile; Bağ, Yusuf Murat; Kaplan, Kuntay; Güneş, Orgun; Karatoprak, Sinan; Sümer, FatihAs advanced gastric cancer often leads to obstruction or cancer-related cachexia, gastric cancer seems to have a closer association with sarcopenia than other types of cancer. Our study aim was to investigate the relationship between the psoas muscle area (PSMA) and morbidity and mortality in patients undergoing gastric cancer surgery. The data of patients who underwent laparoscopic gastric resection between November 2014 and April 2020 were analyzed retrospectively. The intervertebral disc space was verified at L3-4 in the sagittal plane. The PSMA on the right and left sides were measured separately and then added to obtain the total PSMA. This value was then divided by the patient's height (m2) to calculate the psoas muscle area index (PSMAI) (mm2/m2). The mean PSMAI of men (741.1 mm2/m2) was significantly higher than that of women (502.1 mm2/m2) (p<0.001). While there was a positive correlation between the PSMAI and BMI (r:0.352, p:0.019 in women; r:0.447, p<0.001 in men), the correlation between PSMAI and age was negative (r: -0.369, p:0.014 in women; r:-0.349, p<0.001 in men). PSMAI was statistically lower in patients with attendant morbidity (p:0.035). There was no significant relationship between PSMAI and the first 30-day mortality rate (p:0.096); however, the association between PSMAI and both the 90-day mortality rate (p:0.023) and the total mortality rate (p:0.046) were significant. In our opinion, assessing gastric cancer patients for sarcopenia and supporting them with the necessary nutrition and exercise program prior to surgery can help predict and lower postoperative morbidity and mortality rates.Öğe Conversion in laparoscopic gastric cancer surgery a highlight on the abdominal access(2021) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kayaalp, CuneytAim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completed and converted to open surgery and draw attention to complications arising from trocar entry. Materials and Methods: This study included 211 patients who underwent laparoscopic gastric cancer surgery. Patients were divided in to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative data were retrospectively analyzed. Results: The median age of the study group was 62 (19-91) years and 68.2% were males. Conversion occured in 16 patients (7.5%). The reasons for conversion were locally advanced tumor (n=6), complications due to trocar insertion (n=4), technical difficulty in performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistent bradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significant difference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperative complications, reoperation, 30-day mortality. Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancer surgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an open technique in thin patientsÖğe Conversion in laparoscopic gastric cancer surgery ahighlight on the abdominal access(2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kayaalp, CuneytAim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completedand converted to open surgery and draw attention to complications arising from trocar entry. Materials and Methods: This study included 211 patients who underwent laparoscopic gastric cancer surgery. Patients were dividedin to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative datawere retrospectively analyzed. Results: The median age of the study group was 62 (19-91) years and 68.2% were males. Conversion occured in 16 patients (7.5%).The reasons for conversion were locally advanced tumor (n=6), complications due to trocar insertion (n=4), technical difficultyin performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistentbradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significantdifference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperativecomplications, reoperation, 30-day mortality.Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancersurgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an opentechnique in thin patients.Öğe Does body mass index affect the intraoperative and early postoperative outcomes in patients with laparoscopic distal gastrectomy for gastric cancer?(2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Kaplan, Kuntay; Sümer, Fatih; Kayaalp, CüneytThe effect of increased body mass index (BMI) on the short- and long-term outcomes of laparoscopic distal gastrectomy (LDG) is controversial. We aimed to evaluate the influence of BMI on intraoperative and early postoperative outcomes in patients with LDG for gastric cancer (GC). Eighty-six patients who underwent LDG for GC were included in this study retrospectively. The patients were divided into two groups as normal weighted (BMI=18.5-24.9 kg/m2, n=29) and overweighted-obese (BMI?25 kg/m2, n=57). Preoperative and intraoperative data, postoperative outcomes were retrospectively analyzed and compared between the two groups. The preoperative data were similar between the groups. The rate of the history of previous abdominal surgery (19.3% to 3.4%, p=0.05) and the median preoperative carcinoembryonic antigen (CEA) levels (1.7 ng/ml to 1 ng/ml, p=0.06) were higher in the overweighted-obese group but the differences were not significant. There were no significant differences in intraoperative data and early postoperative outcomes between the groups but the rate of postoperative serious complications (12.3% to 6.9%, p=0.71), the reoperation rate (10.5% to 6.9%, p=0.71), and 90-day-mortality rate (5.3% to 0%, p=0.5) were higher in the overweighted-obese group. Although the rates of postoperative serious com- plications, reoperation, and mortality were higher in the overweighted-obese patients, BMI had no significant effect on intraoperative and early postoperative outcomes in patients who underwent LDG for GC. LDG for GC is a feasible and safe approach for overweighted-obese patients.Öğe Is Prognostic Nutritional Index an Indicator for Postoperative 90-Day Mortality in Laparoscopic Gastric Cancer Surgery?(Routledge Journals, Taylor & Francis Ltd, 2022) Zengin, Akile; Bag, Yusuf Murat; Aydin, Mehmet Can; Kocaaslan, Huseyin; Kaplan, Kuntay; Sumer, Fatih; Kayaalp, CuneytGastic cancer is a life-threatening malignancy in the world. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a guiding marker for gastric cancer patients with laparoscopic gastrectomy. We retrospectively examined the medical records of 138 gastric cancer patients who had adenocarcinoma pathological diagnosis and operated laparoscopically. Patients were divided into two groups (survived and death) and these groups were compared with clinical and laboratory parameters results. The PNI was calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm(3)). Logistic regression analyses were performed to identify the risk factors of 90-day mortality. The median age of the study cohort was 62.5 (19-91) years, 98 (71%) were males, and 9 (6.5%) patients died during the 90-day after laparoscopic gastrectomy. The PNI levels were significantly lower in death group compared with survived group 37.5 (25-47.1) to 46.9 (22.8-64.9). The PNI (Odds Ratio = 0.81, 95% Confidence Interval 0.70-0.92, p = 0.003) was found as an independent factor for 90-day mortality in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 45.15 is the best-cutoff value for 90-day mortality after laparoscopic gastrectomy. 90-day mortality rate of PNI > 45.15 was 2.2% and PNI <= 45.15 was 13.6% found. Lower PNI is associated with increased 90-day mortality in laparoscopic gastrectomy for gastric cancer. The PNI may be a useful marker for predicting the 90-day mortality of gastric cancer patients after laparoscopic gastrectomy.Öğe Laparoscopic gastrectomy in remnant gastric cancer(Turkish Surgical Assoc, 2021) Cicek, Egemen; Zengin, Akile; Gunes, Orgun; Sumer, Fatih; Kayaalp, CuneytObjective: Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. Material and Methods: The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Results: Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Conclusion: Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.Öğe Unplanned laparoscopic peritoneal biopsy for gastric cancer(2021) Zengin, Akile; Bağ, Yusuf Murat; Aydın, Mehmet Can; Sümer, Fatih; Kayaalp, CüneytIntroduction: It is thought that the sensitivity of computed tomography (CT) in detecting peritoneal metas tases (PM) is low. In this study, we aimed to present our experience on gastric cancer (GC) patients withintraoperatively detected PM whose preoperative CT was normal in terms of distant metastasis. Materials and Methods: We retrospectively analyzed the demographics and perioperative data of ten pa tients with gastric adenocarcinoma whose preoperative CT was normal in terms of PM, but intraoperativelyPM was detected. Results: The mean age of the patients was 68.30±9.44 years. Six patients (60%) were male. Tumors weremostly localized in the distal 1/3 of the stomach (n=5, 50%). The median carcinoembryonic antigen andcarbohydrate antigen 19.9 levels were 2.00 ng/ml (0.60–37.50) and 30.76 IU/ml (3.28–449.30), respectively.There were PM on the visceral peritoneum (small bowel mesentery) in two patients (20%) and on the parietalperitoneum in eight patients (80%). The operations were terminated in five patients (50%) when the PM de tected as they did not have any complications due to cancer. Laparoscopic feeding jejunostomy (n=2, 20%),laparoscopic tube gastrostomy (n=1, 10%), and laparoscopic gastroenterostomy (n=2, 20%) were performedon the patients with oral intake deficiency due to GC. Conclusion: Preoperative staging with CT before GC surgery is still valid. Multidetector CT scan should bepreferred. However, it is still not enough for detecting all PM before surgery. Staging laparoscopy should bein mind, especially for patients with a high risk of PM.Öğe Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?(2022) Zengin, Akile; Bağ, Yusuf Murat; Öğüt, Mehmet Zeki; Sağlam, KutayAbstract Aim: To investigate the clinical significance of the simple laboratory test values on differentiating complicated acute appendicitis. Materials and Methods: We retrospectively examined the medical records of 216 acute appendicitis patients. Patients were divided into two groups according to pathological results (non-complicated (n=157) and complicated (n=59)). The demographic and clinical data, laboratory findings, length of hospital stay, and pathological results were compared between the two groups. Receiver operating characteristics (ROC) curves were performed to analyze the optimal cutoff value of numerical variables which were significantly differed between the group comparisons. Results: The preoperative data were similar between the groups except for age. The length of hospital stay was longer and total/direct bilirubin levels higher in the complicated group (p=0.002, p=0.002, and p=0.002, respectively. The lymphocyte level and amylase level were lower in the complicated group (p=0.02 and p=0.004, respectively). ROC curve analysis provided a cutoff value of ?0.89 mg/dL for total bilirubin, ?0.43 mg/dL for direct bilirubin, ?1.63% for lymphocyte and ?46.5 U/L for amylase. Conclusion: Preoperative higher total and direct bilirubin levels are able to predict complicated appendicitis. Preoperative higher serum amylase levels should not have a place in the differential diagnosis of complicated appendicitis. This means that if serum amylase is elevated in a patient with suspected acute appendicitis, it does not suggest acute complicated appendicitis.
