Kagan Karabulut

Long-term outcomes of intraoperative and perioperative albendazole treatment in hepatic hydatidosis: single center experience

Purpose The aim of this study was to evaluate long-term outcome of the intraoperative and perioperative albendazole (ALB) treatment on the recurrence and/or secondary hydatidosis. Methods One hundred and one patients with hepatic hydatidosis were treated intraoperatively and perioperatively with ALB, in addition to surgery. Perioperative ALB treatment was given in a dose of 12-15 mg/kg/day. The ALB treatment was started 13.27 ± 14.34 days before the surgery, and it was continued for 4.39 ± 3.11 months postoperatively. A total of 1.7 µg/mL of ALB solution was used as a protoscolidal agent. The follow-up period was 134.55 ± 51.56 months. Results Four patients died, with only one death was secondary to hydatid disease (cerebral eccinococcus). There was only one recurrence (1%) of hepatic hydatidosis. Early and late morbidity rates were 8.91% and 7.92%, respectively. Conclusion Our results suggest that intraoperative and perioperative ALB is effective for the prevention of hepatic hydatidosis recurrence and/or secondary hydatidosis.

The Whitehead operation procedure: Is it a useful technique?

OBJECTIVE Hemorrhoidal disease is a very common entity in the general population; however, the therapeutic approaches to hemorrhoids remain controversial. The choice of treatment method depends on the grade of the hemorrhoid as well as the experience of the surgeon. The Whitehead hemorrhoidectomy procedure is often applied for grade IV hemorrhoids. MATERIAL AND METHODS We studied 49 patients who underwent surgery between December 1982 and January 2013. The indications for the Whitehead procedure in all patients were grade IV hemorrhoidal disease. The data on these patients were evaluated retrospectively with respect to age, gender, preoperative diagnosis, and postoperative complications. RESULTS Of the patients included in this study, 34 were male and 15 were female. The mean age of the patients was 41.93±12.42, and the age range was 24-70 years. Complications of the Whitehead procedure included bleeding (6.12%, three cases), stricture (2.04%, one case), urinary retention (16.33%, eight cases), and temporary anal incontinence (2.04%, one case). No patients developed Whitehead deformities, entropion, or infectious complications. All patients were discharged from hospital between the fifth and eighth days post-surgery (6.45±1.00 days). The follow-up period was 1-234 months (70.02±54.89). CONCLUSION The Whitehead procedure is successful in patients with prevalent peripheral prolapse and/or thrombosed hemorrhoids. With the right indications, and if the surgeon has adequate experience, the morbidity rate of the Whitehead procedure is similar to that of other treatment methods.

Laparoscopic resection of retroperitoneal bronchogenic cyst clinically presenting as adrenal cyst

Bronchogenic cyst localized in the retroperitoneum is a rare clinical entity. It is a congenital malformation generally occurring in the posterior mediastinum due to the abnormal development of the foregut. We report the case of a retroperitoneal cyst presenting as left adrenal cyst. A 38-year-old female presented with left upper abdominal pain. Endocrinological evaluation was done, and no adrenal hormonal secretion was detected. The cyst was removed laparoscopically. Pathologic examination confirmed it as a bronchogenic cyst. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cysts. Laparoscopic resection of retroperitoneal cysts results in favorable outcome.

Surgical management of anorectal foreign bodies

Purpose: Anorectal foreign bodies (AFBs) inserted into anus constitute one of the most important problems needing surgical emergency due to its complications. We describe our experience in the diagnosis and treatment of AFBs retained in the rectosigmoid colon. Materials and Methods: Between the years 2006 and 2015, a total of 11 patients diagnosed with AFBs were admitted to an emergency room and general surgery clinics. They were diagnosed and treated in four different hospitals in four different cities in Turkey. Information on the AFBs, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. Results: Eleven patients were involved in this study. All patients were male with their mean age was 49.81 (range, 23–71) years. The time of the presentation to the removal of the foreign bodies ranged between 2 h and 96 h with a mean of 19.72 h. Ten patients inserted AFBs in the anus with the purpose of eroticism but one patients reason to relieve constipation. The objects were one body spray can, two bottles, three dildos, two sticks, one water hose, one corncob, and one pointed squash. Three objects were removed transanally after anal dilatation under general anesthesia. Eight of the patients required laparotomy (milking, primary suture, and colostomy). Five of the patients had perforation of the rectosigmoid colon. Abdominal abscess complicated extraction in one patient after the postoperative period. The hospitalization time of the patients was 6.18 (1–16) days. None of the patients died. Conclusions: A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.

A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma

Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.

Is single‐port laparoscopy feasible after liver transplant?

To the Editor, We have read with interest the case reports entitled “Is single-port laparoscopy feasible after liver transplant?” by Zani et al. (1). The article highlights two cases of single-port laparoscopic surgery after liver transplantation. This is the only published article of its kind in PubMed regarding single-port laparoscopic surgery after liver transplantation. In the manuscript, the authors state that “In particular, we believe that SIPES following liver transplant should be reserved to procedures that involve the inframesocolic compartment, where adhesions are more likely to be less important, native anatomy can be preserved and no major structures have to be modified. Conversely, posttransplant SIPES in the supramesocolic compartment should be avoided due to potential hazards, such as the proximity to the transplanted liver graft, the presence of possibly thicker adhesions and the complexity of surgery to the upper abdominal quadrants.” I have several comments to make on this article. Firstly, many types of different single-port laparoscopic procedures are being performed by expert laparoscopic surgeons (2, 3). Secondly, many of the previous contraindications are no longer accepted. Although Zani et al. (1) mention that SIPES should be avoided in the supramesocolic compartment due to the possibility of thicker adhesions and the complexity of surgery to the upper abdominal quadrants, we performed a single-port laparoscopic incisional hernia repair on a liver transplant recipient. The patient underwent a liver transplant two yr ago and developed incisional hernia six months after the procedure. She wanted surgery because she had been experiencing abdominal pain and discomfort. On physical examination, a 9 9 5 defect was identified at the middle of chevron incision and a 4 9 4 defect was discovered at the end of the right extension of the chevron incision. We performed a single-incision laparoscopic ventral hernia repair on the patient. We used two composite meshes, one of which was 15 9 20 cm in diameter and the other 10 9 10 cm in diameter, to fix the two hernia defects. No severe intra-abdominal adhesion was identified, which we contributed to the immunosuppressive therapy. The surgery lasted 70 min with no blood loss. The postoperative course was unevenful, and the patient was discharged on postoperative day 1 without discontinuing any of her medications. Six months after the surgery, no complaints were reported. In the liver transplant patient group, if possible, laparoscopic/single-port laparoscopic surgery should be the preferred course to minimize the operative trauma as these patients are immunosuppressive. Single-port laparoscopic hernia repair is as an ambulatory procedure. Oral immunosuppressive medications, which are crucial for liver transplant recipients, do not need to be discontinued. Another important point about single-port laparoscopic surgery on liver transplant recipients is the location of the SILS port. Great care should be taken not to damage the enlarged veins while placing the trocar. Splenomegaly is another handicap while placing the SILS trocar, especially in the case of incisional hernia repair since the usual, preferred incision for liver transplantation is right-sided subcostal incision. The ideal location for the SILS port is left flank to fix the incisional hernia after liver transplantation. In the case of a massive splenomegaly, the SILS port has to be placed away from the spleen, which can limit the exposure during the surgery. I agree with Zani et al.’s conclusion that diffuse intraperitoneal adhesions should not be considered contraindications. We showed that single-incision laparoscopic liver resection is feasible in patients who had previous colon cancer surgery although they had severe adhesions (3).

Old appendectomy scar metastasis of colon adenocarcinoma: a rare case report -

In colorectal cancer, subcutaneous metastasis is a very uncommon event. Generally, this metastasis is described after primary colon carcinoma and signifies widespread disease and poor prognosis. Skin metastasis without liver metastasis is very rare. Cutaneous and subcutaneous metastases in laparotomy or laparoscopy scar are reported but there are only a few reports about metastasis to old incision scar. In this article, we described a case of colon cancer presenting as a cutaneous metastasis in an old appendectomy scar and discussed possible pathophysiological mechanisms.

Cholangiocarcinoma Arising from a Type VI Biliary Cyst: A Case Report and Review of the Literature

Cystic dilatations of the cystic duct which are suggested as type VI biliary cysts are very rare and many of them go unrecognized or are confused with other cysts until the operation although they are obvious on imaging studies. They can present with fusiform or saccular dilatations and can be accompanied by common bile duct dilatations. It is important to identify these cysts as they share the same characteristics as the other biliary cyst types and can be complicated with malignancy. We herein present a very unusual case of a cholangiocarcinoma arising from a type VI biliary cyst in a 58-year-old female patient and review the literature. The patient presented with jaundice, weight loss, and abdominal pain. On imaging, the cystic duct and common bile duct were fusiformly dilated and had a wide communication. There was a mass filling the distal parts of both ducts. The patient was urgently operated on after perforation following ERCP. Histopathology was compatible with a type VI biliary cyst and an associated cholangiocarcinoma.

First-line therapy in Helicobacter pylori eradication therapy: experience of a surgical clinic.

OBJECTIVE Helicobacter pylori (HP) is the worlds most common infectious agent. Despite conventional therapy consisting of proton pump inhibitor (PPI), amoxicillin (AMO) and clarithromycin (CLA), approximately half of the patients remain infected. We compared the PPI-based triple therapy with quadruple treatment (BPMT) including bismuth citrate (BS), PPI, metronidazole (MET) and tetracycline (TET). MATERIAL AND METHODS Forty-three patients who used triple therapy (LAC) consisting of lansoprazole (L), AMO and CLA and 42 patients who used quadruple therapy (BPMT) for 14 days between May 2008 and November 2013 were included in the study. The LAC group included patients who received 30 mg L 2×1, 1000 mg AMO 2×1, and 500 mg CLA 2×1 for 14 days, whereas the BPMT group was designed from patients who received 600 mg BS 2×1, 40 mg omeprazole (O) 2×1 or 30 mg L 2×1, 500 mg MET 3×1 and 500 mg TET 4×1. RESULTS Demographic characteristics and endoscopic findings were similar in both groups. The eradication rate was 53.4% in the LAC group and 78.5% in the BPMT group (p<0.05). Compliance problems and side effects were significantly higher in the BPMT group as compared to the LAC group (p<0.05). CONCLUSION Due to high antibiotic resistance in Turkey, the efficacy of LAC treatment has reduced. The BPMT protocol should be kept in mind in the first line of treatment, since it provides a higher eradication rate.

Tiroit cerrahisi sonrasında görülen komplikasyonlar

Tiroit cerrahisi gunumuz cerrahi pratiginde en sik uygulanan prosedurler arasindadir. Cerrahiye bagli baslica komplikasyonlari kanama, rekurren sinir yaralanmasi ve kalici hipoparatiroidizm olarak siralanabilir. Bu derlemede tiroit cerrahisi sonrasi gorulen komplikasyonlardan ve komplikasyonlari en aza indirgeme yollarindan literatur esliginde bahsedecegiz. J. Exp. Clin. Med., 2012; 29:S349-S352 Complications of thyroid surgery Thyroid surgery is among the most frequent procedure which is applied in today’s surgery practice. The main complications related with surgery are hemorrhage , recurrent nerve injury and permanent hypoparathyroidism . In this review we discussed about complications seen after thyroid surgery and the ways of minimising complications accompanied by literature. J. Exp. Clin. Med., 2012; 29:S349-S352