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ABSTRACT: BackgroundHydatic disease of the liver remains to be a complex worldwide problem especially in rural areas. Early local recurrence and
cavity-related complications are still a matter of conflict in the management of hydatic liver disease. The aim of this study
is to investigate efficacy of the type of surgical treatment in preventing early local recurrence and cavity-related complications
of this disease. Here, we present the preliminary results of our study.
MethodsThis study was performed prospectively including 32 patients who were operated for hydatic liver disease between January 2001
and January 2005. Patients were randomized into radical and conservative surgery groups. Recurrences at the primary surgical
site in the first 2years were considered as early local recurrence and biliary leakage, biliary fistula, cavity abscess,
etc. were considered as cavity-related complications.
ResultsEarly local recurrences were observed only after conservative surgical procedures (p = 0.045). Recurrent cysts were found to be due to satellite cysts or pericystic disease. Cavity-related complications were
seen in six patients in the conservative surgery group (p = 0.011).
ConclusionsIn suitable patients, radical surgical resection provides an effective surgical management option in preventing early local
recurrence and cavity-related complications when compared to conservative surgical approaches.
Journal of Gastrointestinal Surgery 04/2012; 12(3):483-489. · 2.83 Impact Factor
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ABSTRACT: Hydatic disease of the liver remains to be a complex worldwide problem especially in rural areas. Early local recurrence and cavity-related complications are still a matter of conflict in the management of hydatic liver disease. The aim of this study is to investigate efficacy of the type of surgical treatment in preventing early local recurrence and cavity-related complications of this disease. Here, we present the preliminary results of our study.
This study was performed prospectively including 32 patients who were operated for hydatic liver disease between January 2001 and January 2005. Patients were randomized into radical and conservative surgery groups. Recurrences at the primary surgical site in the first 2 years were considered as early local recurrence and biliary leakage, biliary fistula, cavity abscess, etc. were considered as cavity-related complications.
Early local recurrences were observed only after conservative surgical procedures (p=0.045). Recurrent cysts were found to be due to satellite cysts or pericystic disease. Cavity-related complications were seen in six patients in the conservative surgery group (p=0.011).
In suitable patients, radical surgical resection provides an effective surgical management option in preventing early local recurrence and cavity-related complications when compared to conservative surgical approaches.
Journal of Gastrointestinal Surgery 04/2008; 12(3):483-9. · 2.83 Impact Factor
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ABSTRACT: Intraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model.
Sixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day.
There was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001).
Our experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.
Asian Journal of Surgery 05/2007; 30(2):96-101. · 0.57 Impact Factor
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ABSTRACT: To examine the effectiveness of transcutaneous electrical nerve stimulation (TENS) on postoperative nausea and vomiting (PONV).
Randomized, prospective, controlled study.
Gazi University Medical School Hospital.
40 ASA physical status I-II patients who underwent elective laparoscopic cholecystectomy.
Patients were randomly divided into two equal groups. Group I received TENS (stimulation group), whereas group II served as the control group (nonstimulation group). In group I, one electrode was applied to the hairless skin on the neck as anode, and the other 2 (electrodes) were applied to the mastoid area. The stimulator at a frequency of 5 Hz, 50 milliseconds, with a current density of 0.5 to 4 mA was applied on the trapezoid area for 6 hours to all patients postoperatively.
All patients in both groups were evaluated for side effects, antiemetic effects, and analgesic and antiemetic need for 24 hours.
Postoperative nausea and vomiting, frequency of dizziness, additional antiemetic and analgesic need, and PONV scores were lower in group I than group II.
Electrical stimulation of the vestibular system may be useful in the prevention of PONV.
Journal of Clinical Anesthesia 03/2007; 19(1):49-52. · 1.21 Impact Factor
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ABSTRACT: Gas in hepatic portal vein is a rare entity. This may be apparent after mesenteric ischemia, blunt abdominal trauma, intestinal obstruction, and intra-abdominal infection. Intrahepatic gas was detected by direct abdominal graphy in a 58 year-old man who was admitted to our emergency service with acute abdomen. On computed tomography; portal vein gas, pneumatosis intestinalis, and occlusion of superior mesenteric vein and artery were detected. The patient who had had significant concomittant operative risks, died prior to surgery. Gas in portal vein is a good predictive factor for diagnosis, management, and prognosis. This sign may avoid unnecessary surgery and also it may help to make an early decision for surgery.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 05/2006; 12(2):167-9. · 0.33 Impact Factor
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ABSTRACT: The aim of this prospective study was to evaluate the safety and feasibility of early laparoscopic cholecystectomy for subacute cholecystitis and to compare it with interval laparoscopic cholecystectomy.
The study was performed in 74 patients who had been diagnosed with subacute cholecystitis between January 2000 and June 2005. The patients were divided into two groups. The early laparoscopic cholecystectomy group was composed of 31 patients who underwent laparoscopic cholecystectomy 24 h after admission to the hospital. The interval laparoscopic cholecystectomy group was composed of 43 patients who underwent laparoscopic cholecystectomy 8-12 weeks after medical treatment.
There was no significant difference between the conversion rate, intraoperative bleeding, need for intraoperative cholangiography, minor bile duct injury, and postoperative complications in the two groups. Eleven patients in the interval group underwent urgent laparoscopic cholecystectomy or additional procedures because of recurrent cholecystitis, choledocholithiasis, or biliary pancreatitis. The early group had a significantly shorter total hospital stay (P = 0.031), lower cost of treatment (P = 0.042), and less difficulty with Calot's triangle dissection (P = 0.008).
Early laparoscopic cholecystectomy can be done without hesitation in patients with subacute cholecystitis, in the light of obstacles observed in the interval group, such as dissection difficulty, lack of success in "cooling down", and additional problems such as choledocholithiasis and biliary pancreatitis.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2006; 13(5):421-6. · 1.60 Impact Factor
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ABSTRACT: Emergency cholecystectomy for acute cholecystitis is associated with high morbidity and mortality rates in patients with significant comorbidities and high-risk surgery. The aim of this study was to evaluate the effectiveness, possible advantages, and complications of percutaneous cholecystostomy (PC) followed by an early laparoscopic cholecystectomy (LC) in relation to conservative treatment followed by a delayed LC in high-surgical risk patients. Between 2002 and 2004, patients were randomly classified into 2 groups: the first group consisted of patients who had PC followed by an early LC (PCLC group, n = 31) and the second group consisted of patients who had conservative treatment followed by a delayed LC (DLC group, n = 30). The groups were statistically compared regarding their demographic, comorbidity, hospital stay, conversion, and complication rates. PC was technically successful in 31 patients with no attributable mortality or major complications. No difference had been found in regarding demographic, comorbidity, and complication rates. In PCLC group, all the patients experienced symptom relief within 24 hours, and early LC was attempted in 31 patients once their clinical condition was sufficiently stable, this was successfully accomplished in 29 (93.5%). In the DLC group, delayed LC was attempted in 30 patients, and this was successfully accomplished in 26 (86.6%). The hospital stay was shorter and cost was in the PCLC group was lower than in the DLC group. PC allows resolution of sepsis in patients at high surgical risk. Early LC could be safely performed once sepsis and acute infection resolved in these patients.
Surgical laparoscopy, endoscopy & percutaneous techniques 01/2006; 15(6):315-20. · 1.23 Impact Factor
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ABSTRACT: Polypoid lesions of the gallbladder (PLGs) are often incidentally identified during ultrasonographic examination of abdominal pain. The present study was designed to determine the reliability of ultrasonography (US) in the diagnosis of PLGs. The records of 853 patients who underwent laparoscopic cholecystectomy (LC) for PLGs in Gazi Medical School from January 2000 to January 2004 were reviewed. Data were collected regarding the patients' gender, age, symptoms, serum lipid levels, the size and the number of polyps on US, surgical indications for PLGs and histopathological diagnosis. In all, 56 of 853 patients had PLGs and underwent LC. Right upper quadrant pain (59%) was the most common presenting symptom that led to gallbladder US. Nearly 75% of the lesions were smaller than 10 mm. At histopathologic examination cholesterolosis was found in 17 of 56 (30%) patients, and 12 of 56 (21%) demonstrated only cholelithiasis; 17 (30%) patients had both cholesterolosis and stones. Only 10 (18%) patients had adenomatous polyp and 8 of these polyps were larger than 1 cm. Overall US-based diagnosis of gallbladder polyp was inaccurate in 82%. The sensitivity and specificity of US for polyps <1 cm was 20% and 95.1%, respectively, whereas the sensitivity and specificity of US for polyps >1 cm was 80% and 99.3%, respectively. The accuracy of US in diagnosing PLGs was poor, especially in polyps <1 cm.
HPB 02/2005; 7(2):155-8. · 1.60 Impact Factor
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ABSTRACT: Delay of laparoscopic cholecystectomy after the diagnosis of biliary colic may increase the probability of recurrent emergency admission while awaiting elective cholecystectomy. The aim of this study was to compare the possible advantages and safety of urgent laparoscopic cholecystectomy (ULC) with elective laparoscopic cholecystectomy (ELC) in patients with biliary colic.
Between 2001 and 2003, 75 patients with biliary colic were included in this study. The patients were classified into following two groups: patients who had ULC in 24 h were in group I (n = 28) and patients who had ELC (mean interval 4.22 +/- 1.42 months) were in group II (n = 35). Conversion to open cholecystectomy, operative time, postoperative hospital stay, costs, and complications were evaluated.
In group II, 9 patients made a total of 13 return visits to the emergency department with recurrent attacks of biliary colic or complications of gallstone disease. Mean operative time increased from 35.1 +/- 6.74 min for urgent laparascopic cholecystectomy to 49.9 +/- 6.12 min for ELC (p > 0.05) and hospital stay time increased from 1.06 +/- 0.4 to 2.31 +/- 2.36 days (p < 0.05). Conversion to open cholecystectomy increased from 0% in group I to 17.2% in group II (p < 0.05).
ULC for biliary colic may be the most medically efficacious and cost-effective treatment.
Digestive Surgery 01/2005; 22(1-2):95-9. · 1.22 Impact Factor
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ABSTRACT: Background/PurposeIn the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC).MethodsThis study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed.ResultsFifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively.ConclusionsA simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.
Journal of Hepato-Biliary-Pancreatic Surgery 09/2004; 11(5):357-361. · 1.60 Impact Factor
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ABSTRACT: Appendiceal mucoceles are a group of lesions in which the appendiceal lumen becomes distended with mucus. They may be associated with an unusual form of gelatinous ascites termed pseudomyxoma peritonei. We report herein a 77-year-old male patient with appendiceal mucinous cystadenocarcinoma and pseudomyxoma peritonei, whose initial symptoms were abdominal pain and distension and intestinal obstruction. He had a history of explorative laparotomy for an abdominal mass and ascites 14 months ago at another center. He was suffering from abdominal pain and intestinal obstruction on admission to the emergency service. We performed right colectomy and total resection of the mass which originated from the appendix. Pathologic examination of the specimen showed low-grade mucinous cystadenocarcinoma and pseudomyxoma peritonei. The postoperative period was uneventful.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2004; 10(1):67-70. · 0.33 Impact Factor
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ABSTRACT: In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC).
This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed.
Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively.
A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2004; 11(5):357-61. · 1.60 Impact Factor
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ABSTRACT: A 24-y-old male patient underwent elective open cholecystectomy at another center. On the third postoperative day, he developed fever and jaundice, for which he underwent reoperation at the same center on the seventh postoperative day. During the second surgery, massive bleeding was encountered, suture ligations were applied, and T-tube drainage was performed. After the surgery was completed, the patient developed hepatic microabscess, and sepsis ensued. The patient presented at this hospital for further evaluation. To rule out vascular injury, which was suspected in this patient, celiac angiography was performed; it showed that the hepatic artery was occluded near the eminence of the gastroduodenal artery, and the liver was supplied by many collaterals. After the patient's condition had stabilized and the sepsis had resolved, Roux-N-Y hepaticojejunostomy was performed on the 59th d after admission.
Advances in Therapy 24(3):639-47. · 2.11 Impact Factor
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ABSTRACT: Intestinal mucosal damage and bacterial translocation are clinical problems that may be caused by the use of ionizing radiation. Glutamine (Gln) support reduces the mucosal barrier in several ways. This study was undertaken to investigate the effect of timing of Gln-enriched enteral nutrition (EN) on bacterial translocation and mucosal damage due to radiotherapy (RT). A rat model of whole body irradiation was designed in which a single dose of 485 cGy was given. A total of 50 rats were randomly assigned to the following 5 groups, each of which comprised 10 rats: (1) balanced rat chow given for 8 days without RT (group 1); (2) balanced rat chow given 4 days before and 4 days after RT (group 2); (3) Gln-enriched EN given 4 days before RT (group 3); (4) Gln;enriched EN given 4 days after RT (group 4); and (5) Gln-enriched EN given 4 days before and 4 days after RT (group 5). Mesenteric lymph node and ileum samples were removed for evaluation of bacterial translocation (BT) and histopathologic investigation, respectively. BT and intestinal mucosal injury scores in all rats that received RT were higher than in rats without RT. No difference was seen in parameters between groups 3 and 4 (P>.05, P>.016, respectively); BT and intestinal mucosal injury scores of group 5 were significantly lower than those of groups 3 and 4 (P<.05, P<.016, respectively). Meanwhile, the BT and mesenteric injury scores of group 5 were significantly lower than those of group 2 (P<.05, P<.016, respectively). As a result, intestinal injury due to RT was significantly decreased by Gln-enriched EN support given before and after whole body RT.
Advances in Therapy 24(3):648-61. · 2.11 Impact Factor
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ABSTRACT: Expression of intracellular adhesion molecule-1 (ICAM-1) in an obstructive jaundice model and the potential protective role of platelet activating factor antagonist over small intestine and liver together with its effects on bacterial translocation are examined in this study. Forty-eight male Wistar albino rats were assigned into four equal groups of 12. In groups I and II, animals were sham operated. In groups III and IV, common bile duct ligation and division were performed. In group I and group III, 0.5 ml/day normal saline was applied intraperitoneally daily from day 2 to 6 of the study; in group II and group IV, 1 mg/kg/day BN 52021 was applied intraperitoneally daily from day 2 to 6 of the study. All animals were sacrificed on postoperative day 7. ICAM-1 expression (CD54 positivity) was analyzed in the liver and ileum tissue by immunohistochemical method. Samples from blood, liver mesenteric lymph nodes, and spleen were cultured under aerobic conditions. It is revealed that ICAM-1 expression was statistically higher in group III, with highest bacterial translocation and liver and spleen injury when compared to other groups. Serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGT), bilirubin, tumor necrosis factor alpha (TNFalpha), and interleukin 1beta(IL-1beta) values were at the highest level in group III, and there was a statistical decrease in group IV compared to group III. The administration of BN52021 in experimental obstructive jaundice is a useful way to reduce liver and intestinal mucosal villi damage by inhibiting bacterial translocation and systemic inflammatory response.
Journal of Investigative Surgery 18(5):247-56. · 1.09 Impact Factor
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ABSTRACT: Laparoscopic cholecystctomy has become the treatment of choice for symptomatic gallstones. The potential risks have dissuaded some surgeons from using the laparoscopic procedure in patients with previous abdominal surgery. Therefore, we aimed to investigate the effect of previous abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy.
This study included 600 well-documented patients with gallstones who underwent laparoscopic cholecystctomy at our surgical department between May 2000 and January 2004. The patients were classified into 3 groups: group 1, patients without a history of previous abdominal surgery (n = 408); group 2, patients with a history of upper abdominal surgery (n = 92); group 3, patients with a history of lower abdominal surgery (n = 100). The data were collected and analyzed for open conversion rates, operative times, perioperative and postoperative complications, and hospital stay.
Of the 600 study patients, 192 had undergone previous abdominal surgery (92 upper, 100 lower). Conversion rate, hospital stay, and complication rates were similar in each group. Mean operating time was the longest (57 +/- 9.8 min) in patients with previous upper abdominal surgery (P < 0.05). On the other hand, the operative time was similar in groups 1 and 3 (P > 0.05).
Previous abdominal surgery is not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with a prolonged operation time.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 9(2):178-83. · 0.98 Impact Factor
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ABSTRACT: Hydatid cyst disease can occur in all viscera and soft tissues although the liver and the lungs are the most commonly involved organs. Muscular and subcutaneous hydatidosis is very rare and accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of subcutaneous echinococcosis. A patient with isolated cyst hydatid in subcutaneous tissue were treated successfully with complete cyst excision. Preoperative assessment by ultrasound did not point to echinococcosis. Correct diagnosis was established intraoperatively and confirmed postoperatively by pathohistology and serologic tests. No other organ involvement has been detected during a 2-year follow-up. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially in regions where the disease is endemic. For ideal treatment, preoperative diagnosis must be established.
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ABSTRACT: The study aimed to investigate the effects of age, body mass index and nutritional assessment system score, levels of vitamins A, C, E and beta-carotene in surgical patients with different diagnosis. 163 patients hospitalized at Gazi University Medical School, Department of General Surgery were prospectively analyzed. Patients were grouped as younger (Group 1, n=110), and older (Group 2, n=53) than 60 years. Nutritional statuses were classified as normal, moderately malnourished, and severely malnourished. The serum vitamin levels were investigated with comparisons of age, gender, primary surgical disease (benign or malign), and BMI. Correlations between BMI, age and vitamin levels were evaluated. Group 2 had significantly worse nutritional status and more malign diseases than group 1. Vitamin A, C, E and beta carotene levels was found low in 20 %, 39%, %6, and 7 % of the patients in group 1 and 60%, 81%, 15%, 30% of patients in group 2 respectively. Vitamin levels were low in malnourished patients. BMI of the patients were in correlation with the vitamin levels. Body mass index was in correlation with the serum vitamin levels. Supplementation of vitamins A and C can be beneficial in elderly patients.
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ABSTRACT: The aim of this study was to investigate the reasons for conversion to open surgery and to evaluate the possible risk factors for conversion in patients who were assigned to laparoscopic cholecystectomy. Between September 2004 and December 2006, laparoscopic cholecystectomy was attempted in 300 well-documented patients. Patients who had to be converted were compared with laparoscopically completed cases with regard to demographics, current severity of cholecystitis (acute, chronic, subacute), previous acute attacks, previous abdominal surgery, concurrent intraabdominal diseases, surgical findings, and complications. Twenty-three patients (7.7%) were converted to open surgery. The reasons for conversion were; inability to proceed with laparoscopic dissection in 11 cases (47.8%), concurrent findings requiring open surgery in 4 (17.4%), bleeding in 3 (13%), bile duct injury in 2 (8.7%), spillage of multiple stones in 1 (4.35%), colonic perforation in 1, and gallbladder malignancy in 1 case. Conversion to open surgery was found to be significantly correlated with existence of upper abdominal incisions (OR=28.9), existence of previous acute attacks treated conservatively (OR=14.9), misdiagnosed subacute cholecystitis with inflammatory adhesions (OR=9.8), male gender (OR=5.2). Patient characteristics, such as male gender, existence of upper abdominal incisions, or history of acute attacks, indicate a higher possibility of conversion from laparoscopic to open cholecystectomy.
