A. Uguz

Recurrent Pilonidal Sinus: Lay Open or Flap Closure, Does It Differ?

Treatment options of pilonidal sinus, which has high recurrence rates, is still controversial. In this study, we aimed to analyze for possible factors affecting recurrence. Forty-one patients with recurrent pilonidal sinus were included in this study. Of them, 33 were male and 9 were female (mean age, 24.9 years; age range, 16-42). Factors (i.e., risk factors) were detected in 32 patients. Excision-secondary healing and lay open was performed on 30 of the patients admitted with recurrence. Excision and flap closure was applied on 11 patients. Our recurrence rate was 9.7%. The recurrence rate of our study is compatible with the literature. Comparative studies are needed to determine the appropriate method to decrease recurrence rate.

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Management of iatrogenic bile duct injuries: Multiple logistic regression analysis of predictive factors affecting morbidity and mortality

OBJECTIVE Iatrogenic bile duct injuries remain a challenge for the surgeons to overcome. The predictive factors affecting morbidity and mortality are important for determining the best management modality. MATERIAL AND METHODS The patients who referred to Ege University Faculty of Medicine after laparoscopy associated iatrogenic bile duct injury are grouped according to Strasberg-Bismuth classification system. The type and number of prior attempts, concomitant complications, and treatment modalities are analyzed using the SPSS version 18 (IBM, Chicago, IL, USA). The variables with p<0.10 were considered for univariate analysis and then evaluated for predictive factors by forward Logistic Regression method using multiple logistic regression analysis. RESULTS According to the analysis of 105 patients who were referred during 2004-2014, the type and number of prior attempts are considered predictive factors in sepsis. In multiple logistic regression analysis, abscess formation, concomitant vascular injury, and serum bilirubin level are significantly effective in predicting mortality. CONCLUSION The management of iatrogenic bile duct injuries should be carefully planned with a multidisciplinary approach. The predictive factors affecting morbidity and mortality are important in determining the best modality for managing iatrogenic bile duct injuries. Abscess formation, vascular injury, and serum bilirubin level are the potential risk factors. Therefore, we can strongly recommend immediate assessment of patients for prompt diagnosis and referring to an HPB center, to avoid further injuries.

Results of 1001 liver transplantations in 23 years: Ege University experience

BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patients data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

A heterogeneous liver lesion in a 48-year-old woman

On performing chest radiography, rise of the right diaphragm to the superior was detected (Figure 1). A hepatobiliary ultrasound examination revealed a mostly cystic lesion with some hyperechoic structures in the liver. On performing contrast-enhanced abdominal computed tomography, a mostly cystic lesion, approximately 15.2×14.2×12.8 cm in diameter, having an appearance similar to the detached membranes of a hydatid cyst and indicating a typical type II hydatid cyst was detected in the liver (Figure 2a). Mediastinal shift and atelectasis of the lower lobe of the right lung were also present (Figure 2b).

Robot yardımlı laparoskopik bilateral adrenalektomi: Olgu sunumu

GİRİŞ Ektopik ACTH sendromu, ACTH bağımlı Cushing sendromu nedenlerinden birisidir. Başarısız hipofiz cerrahisi sonrası ısrar eden Cushing hastalığının yanı sıra, özellikle sebebi bulunamayan ve okült olarak adlandırılan ektopik ACTH sendromunda da tedavide bilateral adrenalektomi önemli bir yer tutmaktadır (1). Bilateral adrenalektomi, bu hastalıkların yanı sıra ailesel bilateral feokromasitoma (Von Hippel-Lindau hastalığı ve multipl endokrin neoplazi tip 2), doğumsal hiperplazi, bilateral kortikal adenom ve adrenokortikal hiperplazi hastalarının tedavisinde önerilmektedir (2). Laparoskopik cerrahiyi geleneksel açık cerrahi ile karşılaştıran randomize kontrollü çalışmalar henüz yapılmamış olsa da, adrenal bez hastalıklarının cerrahi tedavisinde laparoskopik cerrahinin güvenle yapılabileceğini bildiren kontrollü çalışmalar mevcuttur (3, 4). Bununla birlikte, aynı kanıt düzeyine bilateral adrenal cerrahi için ne yazık ki erişmek mümkün değildir (2, 5). Robot yardımlı eş zamanlı bilateral laparoskopik adrenalektomi ise olgu bildirileri ile sınırlıdır (6). Bu yazıda, bilgimize göre ulusal literatürde ilk olma özelliğini taşıyan robot yardımlı eş zamanlı bilateral adrenalektomi uygulanan bir ektopik ACTH sendromu hastasını sunarak konuyla ilgili uluslararası literatürü irdelemeye amaçladık. OLGU SUNUMU Halsizlik, kilo artışı, karında şişlik, kıllanmada artış, yüzde döküntü ve adet görememe yakınmaları ile hastanemiz endokrinoloji ve metabolizma hastalıkları polikliniğine başvuran 35 yaşındaki kadın hasta, başvurusundan 6 ay önce hipertansiyon ve diabetes mellitus tanısı almış ve takibi süresince mevcut yakınma ve bulgular nedeniyle Cushing Hastalığı’ndan kuşkulanılarak hastanemize yönlendirilmiştir. Hasta, endokrinoloji polikliniğimizce yatırılarak tetkik edildi. Hastanın fizik muayenesinde pletore, aydede yüzü, supraklaviküler yağ yastıkçıkları, akneleri, Buffalo hörgücü bulgusu, kolay ekimoz oluşumu, santral obezite, hirsutizm, proksimal kas güçsüzlüğü ve duygusal değişkenliğin olduğu görüldü. Hastanın vücut kitle indeksi 22.9 olarak hesaplandı. Rutin biyokimyasal incelemede potasyum düşüklüğü (3.1 mmol/L) dikkat çekmekteydi. Bazal ACTH ve kortizol değerlerinin yüksek (sırasıyla 105 pg/mL ve 39.23 mcg/dl) saptanması üzerine uygulanan 1 mg ve 2 mg deksametazon baskılama testlerinde baskılanma sağlanmadı (51.5 mcg/dl ve 48.9 mcg/dl). 8 mg deksametazon baskılama testinde kortizol yine %50’den az baskılandı. Diurnal kortizol ritmi kaybolmuştu. Yirmidört saatlik idrarda ölçülen kortizol düzeyi 3751.2 mcg/gün (n=28.5-213.7 mcg/gün) idi. CERRAHİ TEKNİK