Atila Korkmaz

Unusual locations of hydatid disease and surgical approach

Background:  Hydatid disease is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, the disease can be seen anywhere in the body. In the present study, we present our experience with uncommonly located hydatid disease diagnosed and treated between 1983 and 1999 in the Sixth Surgical Department of Ankara Numune Training and Research Hospital, Ankara, Turkey.

Occult Intrabiliary Rupture of Hydatid Cysts in the Liver

The aim of this study was to investigate the effects of various surgical modalities directed at the cavity of hydatid cysts in patients with occult intrabiliary rupture. In this respect, 324 patients with hydatid cyst of the liver operated on during 1983-2003 were analyzed; among them, 39 patients with occult intrabiliary rupture were included in the study. Clinical symptomatology, physical examination, laboratory findings, results of imaging studies, the localization and size of the cyst, and operative findings were reviewed. Twelve patients had complications, and there was no mortality. The most common complication was bile fistula. The average postoperative hospital stay was 7.0 ± 3.8 days for patients with omentoplasty and 6.0 ± 2.5 days for those who underwent cavitary drainage. For patients who do not have bile-stained cystic fluid, the utilization of scolicidal agents is appropriate. Although the opening of the duct is sutured when it is identified, the risk of biliary fistula is not clearly correlated with this approach. In such cases, omentoplasty provides a good alternative to cavitary drainage.

Hemodynamic Changes During Gaseous and Gasless Laparoscopic Cholecystectomy

Abstract.Abstract.Purpose: The main disadvantage of gaseous laparoscopic surgery is the need for CO2 insufflation and the elevation of intra-abdominal pressure. Gasless laparoscopic surgery is an alternative to gaseous laparoscopic surgery, which avoids the hazardous effects of pneumoperitoneum. This study was conducted to investigate the hemodynamic effects of pneumoperitoneum and to compare gasless and gaseous laparoscopic cholecystectomy on a hemodynamic basis.Methods: The gasless laparoscopic procedure uses an electromechanical retractor system to lift the abdominal wall. We performed 20 gaseous and 11 gasless laparoscopic cholecystectomies in a collective total of 31 patients with symptomatic gallostones. The mean arterial pressure, heart rate, end diastolic index, systemic vascular resistance index, cardiac index (CI), ejection fraction (EF), and stroke index (SI) values were monitored noninvasively by thoracic electrical bioimpedance.Results: In the gaseous group, statistically significant changes were detected in CI, EF, and SI values after insufflation as compared to the values before pneumoperitoneum. In the gasless group, only minimal changes were detected in the SI values, which were not significant.Conclusion: Gasless laparoscopy has little effect on the hemodynamic parameters of patients and provides an alternative to the gaseous technique in selected cases.

Use of Laparoscopic Splenectomy in Developing Countries: Analysis of Cost and Strategies for Reducing Cost

BACKGROUND In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. PATIENT AND METHODS Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. RESULTS The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US

Effect of hypertonic saline and alcohol on viability of daughter cysts in hepatic hydatid disease

1,055 in the LS group and

Tıkanma sarılığı modelinde büyüme hormonunun bakteriyel translokasyona ve karaciğer ile ince barsaktaki yapısal histopatolojik değişiklikler üzerine etkisi

1,664 in the OS group. The overall total cost was

Týkanma sarýlýðý modelinde büyüme hormonunun bakteriyel translokasyona ve karaciðer ile ince barsaktaki yapýsal histopatolojik deðiþiklikler üzerine etkisi The effects of growth hormone on bacterial translocation and on the structural histopathologic changes of the liver and ileum in a rat model of obstructive jaundice

1,664 for the OS group and

A Rare Cause of Hyperinsulinemic Hypoglycemia ???Nesidiodysplasia??? in an Adult Patient

2,064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. CONCLUSION The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.

N-asetilsistein'in tıkanma sarılığında bakteriyel translokasyona, karaciğer ve ileumdaki yapısal değişikliklere etkisi

OBJECTIVE To test the efficacy of hypertonic saline (20%) and absolute alcohol on the integrity of daughter cysts and the viability of the protoscoleces contained in these cysts. DESIGN Experimental study. SETTING Teaching hospital, Turkey. MATERIAL 80 daughter cysts obtained from two patients with Gharbi type III hydatid cysts of the liver. INTERVENTIONS The cysts were divided into two groups, in the first of which cysts were placed into hypertonic saline and in the second into absolute alcohol; they were kept there for 5, 15, 30 or 60 minutes. MAIN OUTCOME MEASURES Integrity of the cyst wall and viability of the contents were evaluated using a vital staining technique with 0.1% eosin. RESULTS Neither hypertonic saline nor absolute alcohol solution had any effect on the integrity of the daughter cysts or the viability of the protoscoleces. CONCLUSION Percutaneous drainage of type III hydatid cysts can lead to high recurrence rates.