Background: Laparoscopic liver resections (LLR) are associated with improved short-term patient o... more Background: Laparoscopic liver resections (LLR) are associated with improved short-term patient outcomes. However LLR is technically demanding and complex procedures, such as major hepatectomy, take significantly longer when undertaken laparoscopically. The aim of our study was to evaluate preoperative factors that influence operating time in LLR. Methods: Retrospective analysis of a prospective database of consecutive patients undergoing LLR between January 2011 and June 2016. Univariate and multivariate analyses of factors influencing operating time were performed. Results: 159 patients underwent LLR during the study period. Median age was 67 years (IQR 57-74). Median BMI was 27 (IQR 24-30). Fifty six patients (35%) had undergone previous laparotomy and 131 patients had malignant tumours (82%). Conversion to open surgery occurred in 21 patients (13%). Median operating time was 138 minutes (IQR 105-212). Median Iwate difficulty index was 4 (IQR 3-5), including 29 patients with an index > 6. ASA grade, BMI, Iwate index, parenchymal disease and postero-superior location were all significantly associated with prolonged operating time on univariate analysis. Previous laparotomy (p=0.013), Iwate index (p<0.001) and parenchymal disease (p=0.003) were significant on multivariate analysis. Conclusion: This study has identified risk factors for prolonged operating time in laparoscopic liver resection. High risk patients should be operated by experienced surgeons, and conversion to open surgery should be considered early.
This study, it was aimed to determine the ELISA prevalence of Alveolar echinococcus parasitosis i... more This study, it was aimed to determine the ELISA prevalence of Alveolar echinococcus parasitosis in our region, to perform the speci c differentiation of species by using the WB method, to diagnose and treat this disease effectively in early periods, and to inform the patients about the results quickly. Blood Samples were provided from a total of 305 participants (volunteer patients and their relatives), including 151 females (49.50%) and 154 males (50.50%), whose ages ranged between 6-85 and were diagnosed as Alveolar echinococcosis (AE) and operated in concerned clinics. In this study, EgIgG ELISA was determined as positive in a total of 29 (9.5%) participants, including 17 (11.3%) female and 12 (7.8%) male. In addition, Em2-Em18 ELISA was also determined as positive in a total of 15 (4.9%) participants, including 9 (6%) females and 6 (3.9%) males. 12 (3.94 %) of these ndings were observed as positive in terms of both tests. Through the veri cation done by Anti-EWB IgG, EM was identi ed in 7 (21.9%) of the female participants, EG in 1 (3.1%), and both parasites in 2 (6.2%). For male participants, EM was determined in 3 (9.3%) of them, EG in 1 (3.1%), and both parasites in 1 (3.1%). This study has shown that AE continues to threaten public health in the region. We think that in families where AE is detected positive, the reason for disease is based on nutrition; thus, it will be proper to check up all family members in the terms of infection.
Incisional hernias are one of the most common complications after abdominal surgery. Surgical rep... more Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of large incisional hernias have higher complications and recurrence rates compared to smaller incisional hernia repairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of large incisional hernias. The aim of this study is to compare the results of the three most common surgical treatment methods used in a tertiary university hospital for the repair of large incisional hernias in terms of patients' characteristics, recurrence, and complication rates of the treatment methods. Methods Between 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a tertiary medical faculty hospital located in eastern Turkey were analyzed. Patients were divided into three groups according to the surgical method used: open onlay prolene mesh (OPM) method, laparoscopic intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications were divided into five groups as follows: wound complications, complications due to surgical procedures, medical complications, recurrences, and mortality. Treatment methods were compared according to the demographic characteristics of the patients and the postoperative complication rates. Results Of the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the patients, 81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with the open IPSDM. Wound complications occurred in 26.7% of patients, surgical complications in 3.2%, medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients. Total wound complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no significant difference between groups for medical complications (p = 0.540). Although no recurrence was observed in the open IPSDM group, no significant difference was observed between the groups (p = 0.099). There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092). The operative time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest in the open OPM group and lowest in the open IPSDM group (p = 0.450). Conclusions Although hernia defect is greater in the open IPSDM compared to other methods, this method is more advantageous in terms of the complication rate associated with the surgical procedure, the overall complication rate, the duration of surgery, and the recurrence rate. Laparoscopic IPSDM is a more advantageous method in terms of the overall wound and medical complications.
Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmo... more Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods: In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results: Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in...
Objective: Cystic echinococcosis (CE) is rarely encountered in the spleen, even in areas where th... more Objective: Cystic echinococcosis (CE) is rarely encountered in the spleen, even in areas where the disease is endemic. There is no consensus in the literature concerning the treatment of splenic cystic echinococcosis. This study was intended to compare the treatment results and factors affecting the selection of the spleenpreserving approach or splenectomy in treatment. Materials and Methods: Four hundred and seventy patients operated for cystic echinococcosis at a university clinic between January 2010 and December 2019 were retrospectively evaluated. Splenic cystic echinococcosis was identified in 22 patients (4.7%). Demographic features as well as clinical and laboratory findings of patients who underwent splenectomy or spleen-preserving operations were compared between the groups. Results: Spleen-preserving cystotomy was performed on 18 patients (81.8%), and splenectomy on 4 (18.2%). Eleven patients (50%) had isolated cystic echinococcosis in the spleen, while another 11 (50%) had hepatic and splenic cystic echinococcosis. The median cyst size was 10.0 cm (min: 3, max: 20). Splenectomy patients had significantly larger cyst sizes (median, min-max; 8.0 cm, 3-15 cm vs. 15.0 cm, 10-20) (Z = 2.071, P = .042). Postoperatively, 1 patient from the splenectomy group (25.0%) developed deep vein thrombosis, and another from the cystotomy group (5.5%) developed pulmonary embolism. No other serious complications, re-operation requirements, or recurrence were observed after a median follow-up period of 27.0 months (min: 5, max: 92). Conclusion: Since no collections or recurrence were observed, and splenic functions were preserved in patients who underwent spleen-preserving cystotomy, we recommend the use of spleen-protective cystotomy. Splenectomy should be employed in patients with cyst diameters exceeding 10 cm, with a central location, and in cases with difficult cavity management and a high risk of developing postoperative collections.
GradeC:1. The rate of overall morbidity was 7.2%(postoperative hemorrhage(n=1) and hepaticojejuno... more GradeC:1. The rate of overall morbidity was 7.2%(postoperative hemorrhage(n=1) and hepaticojejunostomy stricture(n=1), surgical site infection (n=1), POPF(n=1).-There was no 30-d postoperative mortality. Conclusion: This new technique for dunking LPJ anastomosis using V-Loc appears to be remarkably safe and feasible approach to pancreaticojejunostomy without adversely affecting operating time or POPF rate.
Journal of the College of Physicians and Surgeons Pakistan
Objective: To determine the effects of surgical techniques applied to arterial anastomosis for ki... more Objective: To determine the effects of surgical techniques applied to arterial anastomosis for kidney transplantation on the graft outcome.
Objective: The most important post-surgical complication of cystic echinococcosis (CE) is cystobi... more Objective: The most important post-surgical complication of cystic echinococcosis (CE) is cystobiliary communication and bile leakage in terms of mortality and morbidity. Therefore, we aimed to predict bile leakage using prognostic markers before the operation. Materials and Methods: All patients hospitalized with the diagnosis of CE in the Hepatobiliary Surgery Service of Atatürk University Research Hospital between 2011 and 2021 were retrospectively analyzed. Patients who were operated for CE and developed postoperative leakage were included in the study. Prognostic markers were calculated using preoperative laboratory tests. And these values were analyzed according to the recovery time of the patient. Results: The mean recovery time of postoperative biliary fistula was 13.97 ± 7.33 days. No mortality was observed in the patients. The mean prognostic nutritional index (PNI), the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) values were 48.68 ± 8.46, 3.09 ± ...
improved survival, but may ba a challenging task due to the risk of postoperative liver failure. ... more improved survival, but may ba a challenging task due to the risk of postoperative liver failure. [1] The use of the laparosopic approach has been widely adopted as it presents lower mortality and postoperative liver failure rates when compared to the open approach. [2] Nevertheless, the use of the laparoscopic approach to treat hepatocarcinomas with advanced vein thrombosis is rarely reported because of the technical challenges involved. [3]. Methods: The video presents a totally laparoscopic right hepatectomy with tumor thrombectomy and portal vein reconstruction to treat a large right liver hepatocarcinoma with tumor thrombosis of the right portal vein extending to the main vascular trunk in a chirrotic patient. Results: Operative time was 500 minutes.Estimated blood loss was 275 mililiters. Patient develooped mild ascitis that was managed with diuretics for one month. Patient was discharged on the tenth postoperative day. Eight months after the procedure he was submitted to a CT-scan that disclosed a patent portal vein and no signs of tumor recurrence. Conclusion: In selected patients, the laparoscopic approach may be an effective technique to treat primary liver tumors even in patients with cirrhosis and advanced portal vein tumour thrombosis. References:. [1] Xiao CZ, (2015), A prognosis model for patients with hepatocellular carcinoma and portal vein tumor thrombus following hepatic resection, Oncol Lett , 2787. [2] Belli A, (2015), 2. Liver resection for hepatocellular carcinoma in patients with portal hypertension: the role of laparoscopy, Hepatobiliary Surg Nutr, 417. [3] Nakahira S, (2014), 4. Laparoscopic left hepatectomy with tumor thrombectomy in patients with hepatocellular carcinoma concomitant with advanced portal vein tumor thrombus, Surg Endosc.
This article is available in open access under Creative Common Attribution-Non-Commercial-No Deri... more This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
Objectives: Ileosigmoid knotting (ISK) is a rare double-loop ileus form. Therefore, its physiopat... more Objectives: Ileosigmoid knotting (ISK) is a rare double-loop ileus form. Therefore, its physiopathology including the triggering factors, are not well investigated. We aimed to discuss the physiopathology, particularly the triggering factors in ISK. Methods: The data of 80 patients with ISK were analyzed retrospectively until June 1986 and prospectively thereafter. As control group, the data of 80 patients with bowel obstruction arising from adhesive ileus or strangulated inguinal hernia were evaluated prospectively during the last 24 months. As probable triggering factors in ISK, the role of acute diarrhea, body motions, overeating, coughing, and labor were investigated. Results: Prior to the main clinical features of ISK, acute diarrhea (17 patients, 21.3%, p<0.05), harvesting (9 patients, 11.3%, p<0.05), and overeating (8 patients, 10.0%, p<0.05) were found effective. Conclusion: Although there is not enough data on this subject in the literature, increased bowel motilit...
Objective: To investigate the “intra-umbilical incision”, a smaller inci-sion compared to classic... more Objective: To investigate the “intra-umbilical incision”, a smaller inci-sion compared to classic incisions, in cases of umbilical hernia, and which we believe will contribute to patient satisfaction in aesthetic terms, and also the practicability of such operations. Materials and Methods: The umbilical margins of eight patients with an umbilical hernia were marked between the levels of 6 and 12 o’clock, and a median intra-umbilical skin incision was performed between these two points. In some cases, where exploration could not be performed sufficiently, the incision was extended horizontally from 6 or 12 o’clock. Hernia repair and mesh placement was then per-formed using an intra-umbilical approach. Results: Patients were investigated according to the defect size and requirement for intra-umbilical incision extension. No requirement for intra-umbilical incision was encountered in six patients with a fa-cial defect diameter smaller than 4 cm, while the incision had to be extended in...
Clinical course and treatment are uncomplicated in majority of hepatic hydatid cyst cases. Howeve... more Clinical course and treatment are uncomplicated in majority of hepatic hydatid cyst cases. However, in hydatid cysts involving percutaneous intervention, occult biliary fistulas can drain into the cavity due to a decrease in intracystic pressure, and the cyst can become complicated. Complicated cysts may be treated using non-invasive and minimally invasive methods. The cyst must be closely observed in terms of its size and location and the patient's place of residence. Delayed surgical treatment of hydatid cysts with percutaneous intervention and abscess development leads to high morbidity and mortality. Ultrasonography-guided PAIR (punctureaspiration-injectionrespiration) was performed on a patient with a Gharbi type 1 hydatid cyst, 150x110 mm in size, located in the right hepatic lobe. Since the cyst was contiguous with the bile ducts, a percutaneous catheter was inserted and endoscopic retrograde cholangiopancreatography (ERCP) was performed. We report a case of hydatid cyst involving open surgical drainage following cavity infection and postoperative bronchobiliary fistula and pneumonia at follow-up. Patients developing percutaneous treatment-related cavity infection have worse hospital stays, treatment costs, disease-related morbidity and mortality than those undergoing open surgery. We think that patients developing cavity infection should be closely observed and that the surgical procedure should be performed without delay.
Background: Laparoscopic liver resections (LLR) are associated with improved short-term patient o... more Background: Laparoscopic liver resections (LLR) are associated with improved short-term patient outcomes. However LLR is technically demanding and complex procedures, such as major hepatectomy, take significantly longer when undertaken laparoscopically. The aim of our study was to evaluate preoperative factors that influence operating time in LLR. Methods: Retrospective analysis of a prospective database of consecutive patients undergoing LLR between January 2011 and June 2016. Univariate and multivariate analyses of factors influencing operating time were performed. Results: 159 patients underwent LLR during the study period. Median age was 67 years (IQR 57-74). Median BMI was 27 (IQR 24-30). Fifty six patients (35%) had undergone previous laparotomy and 131 patients had malignant tumours (82%). Conversion to open surgery occurred in 21 patients (13%). Median operating time was 138 minutes (IQR 105-212). Median Iwate difficulty index was 4 (IQR 3-5), including 29 patients with an index > 6. ASA grade, BMI, Iwate index, parenchymal disease and postero-superior location were all significantly associated with prolonged operating time on univariate analysis. Previous laparotomy (p=0.013), Iwate index (p<0.001) and parenchymal disease (p=0.003) were significant on multivariate analysis. Conclusion: This study has identified risk factors for prolonged operating time in laparoscopic liver resection. High risk patients should be operated by experienced surgeons, and conversion to open surgery should be considered early.
This study, it was aimed to determine the ELISA prevalence of Alveolar echinococcus parasitosis i... more This study, it was aimed to determine the ELISA prevalence of Alveolar echinococcus parasitosis in our region, to perform the speci c differentiation of species by using the WB method, to diagnose and treat this disease effectively in early periods, and to inform the patients about the results quickly. Blood Samples were provided from a total of 305 participants (volunteer patients and their relatives), including 151 females (49.50%) and 154 males (50.50%), whose ages ranged between 6-85 and were diagnosed as Alveolar echinococcosis (AE) and operated in concerned clinics. In this study, EgIgG ELISA was determined as positive in a total of 29 (9.5%) participants, including 17 (11.3%) female and 12 (7.8%) male. In addition, Em2-Em18 ELISA was also determined as positive in a total of 15 (4.9%) participants, including 9 (6%) females and 6 (3.9%) males. 12 (3.94 %) of these ndings were observed as positive in terms of both tests. Through the veri cation done by Anti-EWB IgG, EM was identi ed in 7 (21.9%) of the female participants, EG in 1 (3.1%), and both parasites in 2 (6.2%). For male participants, EM was determined in 3 (9.3%) of them, EG in 1 (3.1%), and both parasites in 1 (3.1%). This study has shown that AE continues to threaten public health in the region. We think that in families where AE is detected positive, the reason for disease is based on nutrition; thus, it will be proper to check up all family members in the terms of infection.
Incisional hernias are one of the most common complications after abdominal surgery. Surgical rep... more Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of large incisional hernias have higher complications and recurrence rates compared to smaller incisional hernia repairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of large incisional hernias. The aim of this study is to compare the results of the three most common surgical treatment methods used in a tertiary university hospital for the repair of large incisional hernias in terms of patients' characteristics, recurrence, and complication rates of the treatment methods. Methods Between 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a tertiary medical faculty hospital located in eastern Turkey were analyzed. Patients were divided into three groups according to the surgical method used: open onlay prolene mesh (OPM) method, laparoscopic intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications were divided into five groups as follows: wound complications, complications due to surgical procedures, medical complications, recurrences, and mortality. Treatment methods were compared according to the demographic characteristics of the patients and the postoperative complication rates. Results Of the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the patients, 81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with the open IPSDM. Wound complications occurred in 26.7% of patients, surgical complications in 3.2%, medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients. Total wound complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no significant difference between groups for medical complications (p = 0.540). Although no recurrence was observed in the open IPSDM group, no significant difference was observed between the groups (p = 0.099). There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092). The operative time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest in the open OPM group and lowest in the open IPSDM group (p = 0.450). Conclusions Although hernia defect is greater in the open IPSDM compared to other methods, this method is more advantageous in terms of the complication rate associated with the surgical procedure, the overall complication rate, the duration of surgery, and the recurrence rate. Laparoscopic IPSDM is a more advantageous method in terms of the overall wound and medical complications.
Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmo... more Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods: In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results: Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in...
Objective: Cystic echinococcosis (CE) is rarely encountered in the spleen, even in areas where th... more Objective: Cystic echinococcosis (CE) is rarely encountered in the spleen, even in areas where the disease is endemic. There is no consensus in the literature concerning the treatment of splenic cystic echinococcosis. This study was intended to compare the treatment results and factors affecting the selection of the spleenpreserving approach or splenectomy in treatment. Materials and Methods: Four hundred and seventy patients operated for cystic echinococcosis at a university clinic between January 2010 and December 2019 were retrospectively evaluated. Splenic cystic echinococcosis was identified in 22 patients (4.7%). Demographic features as well as clinical and laboratory findings of patients who underwent splenectomy or spleen-preserving operations were compared between the groups. Results: Spleen-preserving cystotomy was performed on 18 patients (81.8%), and splenectomy on 4 (18.2%). Eleven patients (50%) had isolated cystic echinococcosis in the spleen, while another 11 (50%) had hepatic and splenic cystic echinococcosis. The median cyst size was 10.0 cm (min: 3, max: 20). Splenectomy patients had significantly larger cyst sizes (median, min-max; 8.0 cm, 3-15 cm vs. 15.0 cm, 10-20) (Z = 2.071, P = .042). Postoperatively, 1 patient from the splenectomy group (25.0%) developed deep vein thrombosis, and another from the cystotomy group (5.5%) developed pulmonary embolism. No other serious complications, re-operation requirements, or recurrence were observed after a median follow-up period of 27.0 months (min: 5, max: 92). Conclusion: Since no collections or recurrence were observed, and splenic functions were preserved in patients who underwent spleen-preserving cystotomy, we recommend the use of spleen-protective cystotomy. Splenectomy should be employed in patients with cyst diameters exceeding 10 cm, with a central location, and in cases with difficult cavity management and a high risk of developing postoperative collections.
GradeC:1. The rate of overall morbidity was 7.2%(postoperative hemorrhage(n=1) and hepaticojejuno... more GradeC:1. The rate of overall morbidity was 7.2%(postoperative hemorrhage(n=1) and hepaticojejunostomy stricture(n=1), surgical site infection (n=1), POPF(n=1).-There was no 30-d postoperative mortality. Conclusion: This new technique for dunking LPJ anastomosis using V-Loc appears to be remarkably safe and feasible approach to pancreaticojejunostomy without adversely affecting operating time or POPF rate.
Journal of the College of Physicians and Surgeons Pakistan
Objective: To determine the effects of surgical techniques applied to arterial anastomosis for ki... more Objective: To determine the effects of surgical techniques applied to arterial anastomosis for kidney transplantation on the graft outcome.
Objective: The most important post-surgical complication of cystic echinococcosis (CE) is cystobi... more Objective: The most important post-surgical complication of cystic echinococcosis (CE) is cystobiliary communication and bile leakage in terms of mortality and morbidity. Therefore, we aimed to predict bile leakage using prognostic markers before the operation. Materials and Methods: All patients hospitalized with the diagnosis of CE in the Hepatobiliary Surgery Service of Atatürk University Research Hospital between 2011 and 2021 were retrospectively analyzed. Patients who were operated for CE and developed postoperative leakage were included in the study. Prognostic markers were calculated using preoperative laboratory tests. And these values were analyzed according to the recovery time of the patient. Results: The mean recovery time of postoperative biliary fistula was 13.97 ± 7.33 days. No mortality was observed in the patients. The mean prognostic nutritional index (PNI), the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) values were 48.68 ± 8.46, 3.09 ± ...
improved survival, but may ba a challenging task due to the risk of postoperative liver failure. ... more improved survival, but may ba a challenging task due to the risk of postoperative liver failure. [1] The use of the laparosopic approach has been widely adopted as it presents lower mortality and postoperative liver failure rates when compared to the open approach. [2] Nevertheless, the use of the laparoscopic approach to treat hepatocarcinomas with advanced vein thrombosis is rarely reported because of the technical challenges involved. [3]. Methods: The video presents a totally laparoscopic right hepatectomy with tumor thrombectomy and portal vein reconstruction to treat a large right liver hepatocarcinoma with tumor thrombosis of the right portal vein extending to the main vascular trunk in a chirrotic patient. Results: Operative time was 500 minutes.Estimated blood loss was 275 mililiters. Patient develooped mild ascitis that was managed with diuretics for one month. Patient was discharged on the tenth postoperative day. Eight months after the procedure he was submitted to a CT-scan that disclosed a patent portal vein and no signs of tumor recurrence. Conclusion: In selected patients, the laparoscopic approach may be an effective technique to treat primary liver tumors even in patients with cirrhosis and advanced portal vein tumour thrombosis. References:. [1] Xiao CZ, (2015), A prognosis model for patients with hepatocellular carcinoma and portal vein tumor thrombus following hepatic resection, Oncol Lett , 2787. [2] Belli A, (2015), 2. Liver resection for hepatocellular carcinoma in patients with portal hypertension: the role of laparoscopy, Hepatobiliary Surg Nutr, 417. [3] Nakahira S, (2014), 4. Laparoscopic left hepatectomy with tumor thrombectomy in patients with hepatocellular carcinoma concomitant with advanced portal vein tumor thrombus, Surg Endosc.
This article is available in open access under Creative Common Attribution-Non-Commercial-No Deri... more This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
Objectives: Ileosigmoid knotting (ISK) is a rare double-loop ileus form. Therefore, its physiopat... more Objectives: Ileosigmoid knotting (ISK) is a rare double-loop ileus form. Therefore, its physiopathology including the triggering factors, are not well investigated. We aimed to discuss the physiopathology, particularly the triggering factors in ISK. Methods: The data of 80 patients with ISK were analyzed retrospectively until June 1986 and prospectively thereafter. As control group, the data of 80 patients with bowel obstruction arising from adhesive ileus or strangulated inguinal hernia were evaluated prospectively during the last 24 months. As probable triggering factors in ISK, the role of acute diarrhea, body motions, overeating, coughing, and labor were investigated. Results: Prior to the main clinical features of ISK, acute diarrhea (17 patients, 21.3%, p<0.05), harvesting (9 patients, 11.3%, p<0.05), and overeating (8 patients, 10.0%, p<0.05) were found effective. Conclusion: Although there is not enough data on this subject in the literature, increased bowel motilit...
Objective: To investigate the “intra-umbilical incision”, a smaller inci-sion compared to classic... more Objective: To investigate the “intra-umbilical incision”, a smaller inci-sion compared to classic incisions, in cases of umbilical hernia, and which we believe will contribute to patient satisfaction in aesthetic terms, and also the practicability of such operations. Materials and Methods: The umbilical margins of eight patients with an umbilical hernia were marked between the levels of 6 and 12 o’clock, and a median intra-umbilical skin incision was performed between these two points. In some cases, where exploration could not be performed sufficiently, the incision was extended horizontally from 6 or 12 o’clock. Hernia repair and mesh placement was then per-formed using an intra-umbilical approach. Results: Patients were investigated according to the defect size and requirement for intra-umbilical incision extension. No requirement for intra-umbilical incision was encountered in six patients with a fa-cial defect diameter smaller than 4 cm, while the incision had to be extended in...
Clinical course and treatment are uncomplicated in majority of hepatic hydatid cyst cases. Howeve... more Clinical course and treatment are uncomplicated in majority of hepatic hydatid cyst cases. However, in hydatid cysts involving percutaneous intervention, occult biliary fistulas can drain into the cavity due to a decrease in intracystic pressure, and the cyst can become complicated. Complicated cysts may be treated using non-invasive and minimally invasive methods. The cyst must be closely observed in terms of its size and location and the patient's place of residence. Delayed surgical treatment of hydatid cysts with percutaneous intervention and abscess development leads to high morbidity and mortality. Ultrasonography-guided PAIR (punctureaspiration-injectionrespiration) was performed on a patient with a Gharbi type 1 hydatid cyst, 150x110 mm in size, located in the right hepatic lobe. Since the cyst was contiguous with the bile ducts, a percutaneous catheter was inserted and endoscopic retrograde cholangiopancreatography (ERCP) was performed. We report a case of hydatid cyst involving open surgical drainage following cavity infection and postoperative bronchobiliary fistula and pneumonia at follow-up. Patients developing percutaneous treatment-related cavity infection have worse hospital stays, treatment costs, disease-related morbidity and mortality than those undergoing open surgery. We think that patients developing cavity infection should be closely observed and that the surgical procedure should be performed without delay.
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