Kamil Yalcin Polat

Late Complications of Incisional Hernias Following Prosthetic Mesh Repair

Abstract Background: Incisional hernias still continue to be a serious problem for surgeons. In this study, we aimed to investigate the effects of polypropylene mesh and mersilene mesh, which are frequently employed in incisional hernias, as well as the effects of their application techniques on late complications. Methods: Two-hundred-sixty-four open abdominal hernia repairs were performed between 1986–2000, using prosthetic materials: polypropylene mesh and mersilene mesh were used in hernia repair. Mesh was placed as onlay, underlay and sandwich techniques. Follow-up data were obtained from medical records. Results: Comparisons were made with respect to surgical techniques and to late complications such as recurrence, ente-rocutaneous fistula, intestinal obstruction, and infections. Enterocutaneous fistulas developed in two patients. Recurrence occurred in 6.4 per cent. Chronic infection and wound sinus formation occurred in 5 per cent. The causes of recurrence included smoking, cellulitis, chronic infection/sinus tract, upper abdominal localization, and obstruction. Fistula formation occurred in patients with no peritoneal prevention, which was statistically significant (p=0.012). Chronic infection/sinus tract was high in patients for whom mersilene mesh was used, and enterocutaneous fistula occurred in 2 patients. Conclusion: To prevent late complications, it is necessary to avoid the contact of mesh with bowel.

Percutaneous drainage of hydatid cyst of the liver: long‐term results

BACKGROUND Previously surgical operation was the only accepted treatment for hydatid liver cysts. Recently percutaneous management has become more preferable because of its low morbidity rate and lower cost. PATIENTS AND METHODS In all, 101 patients harbouring 120 hydatid cysts of the liver were treated by percutaneous drainage between October 1994 and December 1997. Of these cysts, 89 were in the right liver and 31 in the left liver.Thirty-one patients had had previous operations for hydatid disease. All cysts had an anechoic or hypoechoic unilocular appearance on ultrasound scan. The mean dimension of the cysts was 7.5+/-2.9 cm (range 3-10.4 cm). All patients received oral albendazole 10 mg/kg perioperatively. After aspiration under sonographic guidance, cysts were irrigated with 95% ethanol. RESULTS The amount of cyst fluid aspirated was 220+/-75 ml and the amount of irrigation solution used was 175+/-42 ml. Four patients developed mild fever and three had urticaria. Mean length of hospital stay was 2.1+/-0.7 (range 1-4) days, and patients were followed up for 43-62 months (mean 54+/-5.4 months). Maximal cyst diameter decreased from 7.5+/-2.9 cm to 3.2+/-15 cm (p<0.001). Sonographic examinations revealed high-level heterogeneous echoes in the cyst cavity (heterogeneous echo pattern), while the cyst cavity was completely obliterated by echogenic material (pseudotumour echo pattern). DISCUSSION Most hydatid cysts of the liver can be managed successfully by a combination of drug therapy and percutaneous drainage.

The Protective Effect of Aprotinin and α-Tocopherol on Ischemia-Reperfusion Injury of the Rat Liver

BACKGROUND Liver injury caused by ischemia-reperfusion (I/R) processes is a complication of hepatic resection surgery and transplantation, particularly using grafts from marginal donors. Despite improvements in organ preservation and advances in surgical techniques, I/R injury remains a significant clinical problem. In this study, we investigated whether aprotinin provided protection against the adverse effects of I/R injury in liver tissue. METHODS Forty rats were randomized into four groups (n = 10): group I: (control group) I/R + no medication; group II: sham-operated group + no medication or I/R; group III: I/R + aprotinin; group IV: I/R + alpha-tocopherol. Malondialdehyde (MDA) was measured in the liver tissue and superoxide dismutase (SOD), catalase (CAT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), as well as lactate dehydrogenase (LDH) in rat serum. RESULTS Administration of aprotinin and alpha-tocopherol before I/R resulted in significant reductions of MDA levels compared to the I/R alone group (group I; P = .01 and P < .01, respectively). Administration of aprotinin or alpha-tocopherol prior to I/R resulted in significant increases in SOD and CAT levels compared with the I/R group (P < .05 each). Compared to the I/R group, significant decreases in plasma AST, ALT, and LDH levels were observed both in the aprotinin and in the alpha-tocopherol group (P < .05). Histological evaluation revealed the injury grade to be relatively lower among groups III and IV compared to group I. DISCUSSION In conclusion, rat hepatic structures in aprotinin and alpha-tocopherol administered groups were well protected. Therefore, aprotinin may provide protection against the adverse effects of I/R injury in liver transplantation.

Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method.

In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volume‐related postoperative complications, especially in cases with suspected small‐for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well‐correlated with each other (r2 = 0.94 and P < 0.001 for IOM and CM; r2 = 0.91 and P < 0.001 for IOM and MDCT, and r2 = 0.95 and P < 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 ± 124 cm2, 861 ± 121 cm2, and 777 ± 168 cm2 for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small‐for‐size graft, may prove useful. Liver Transpl 13:693–698, 2007.

Hepatobiliary and pancreatic: Alveolar hydatid disease

What abnormalities are seen on the contrast-enhanced computed tomography scan shown in Figure 1? There is a large semisolid mass in the right lobe of the liver with features consistent with central necrosis. On other images, there was patchy calcification and the possibility of invasion of the portal vein and inferior vena cava. The differential diagnosis should include primary and secondary neoplasms, a large adenoma or cavernous hemangioma and perhaps a pyogenic or amebic liver abscess. A tru-cut biopsy was performed with ultrasound guidance and revealed larval membranes (Fig. 2). The diagnosis was that of alveolar hydatid disease (Echinococcus multilocularis). The patient was a 50-year-old woman who was investigated because of a 3-month history of dyspepsia and back pain. She had tenderness over the upper abdomen and changes in liver function tests. As the lesion was judged to be too large for surgical resection, she was treated with albendazole. E. multilocularis is a rare disorder that appears to be restricted to the Northern Hemisphere. The definitive hosts include foxes, dogs and wolves while the intermediate hosts are small rodents and humans. Primary infections mostly occur in the liver and invade the surrounding parenchyma as scolices are released from daughter cysts that bud on the outside of the germinal membrane. There is no cyst wall. The infection may spread through the blood stream and result in secondary foci in other organs, usually the lungs or brain. The treatment of choice is operative resection of the larval mass but this can only be achieved in a minority of patients. Patients with unresectable disease have a mortality of approximately 90% at 10 years although in some, survival can be prolonged by treatment with mebendazole or albendazole. Medical treatment may halt the progression of disease but does not appear to kill the parasite.

Stereological evaluation of treatment response in patients with non-resectable hepatic alveolar echinococcosis using computed tomography via the Cavalieri method.

Abstract: Introduction: The purposes of this study were to describe and adapt the relevant methods of computed tomography (CT) and stereology to estimate parasitic volume in the liver, to compare the efficiency of benzimidazole treatment in hepatic alveolar echinococcosis (AE), and to determine whether the response rates measured by the stereological method are correlated with those measured by simple volumetric measurements (SVM).

Endoscopic retrograde cholangiopancreatography in hepatic alveolar echinococcosis.

Background and Aim:  Hepatic alveolar echinococcosis (HAE) involves both the vascular and biliary structures of the liver. Endoscopic retrograde cholangiopancreatography (ERCP) is said to be an alternative for the diagnosis and treatment of biliary complications of HAE. We present here our experience with ERCP in HAE.

Association between hepatic alveolar echinococcosis and frequency of human leukocyte antigen class I and II alleles in Turkish patients

Background:  Human alveolar echinococcosis (AE) is a potentially fatal, chronically progressive hepatic infestation that is characterized by a long asymptomatic period in which an invasive tumor‐like lesion develops. Several studies have suggested that genetic susceptibility to AE may be linked to HLA class II alleles. We investigated the association between AE and antigen HLA‐A, B, C, DR and DQ profiles of patients with hepatic AE (HAE) in the eastern part of Turkey.

The Frequency of Familial Mediterranean Fever Related Amyloidosis in Renal Waiting List for Transplantation

OBJECTIVE Our goal is to investigate the distribution of MEFV mutations in patients with renal amyloidosis who are in renal transplant waiting list which is prepared for transplantation. MATERIALS AND METHODS FMF was diagnosed in 25 of the 297 patients between the years 2004 and 2008, who were involved in the study (15 male, 10 female; age 34±7.8). 5 out of 25 patients were transplanted, remaining were waiting for Tx. Biopsy results were amyloidosis and taken from renal (n:16), rectal (n:8) and duodenal (1).All of them were carrier of mutations in both pyrin alleles.The primer cause of chronic renal failure in our group was secondary AA amyloidosis. DNA was isolated from 25 whole blood samples. The NanoChip Molecular Biology Workstation (Nanogen) uses electronic microarrays for mutation detection. Exon 2,3,5 and 10 of pyrin gene genotypes were identified in the NanoChip. RESULTS Genetic analysis of the patients demonstrated that each subject carries either homozygote or compound heterozygote mutations of the gene. The most common mutations were M694V, V726A, E148Q and M680I. CONCLUSIONS The clinic manifestation and complain of our patients were febrile and painful attacks such as in the abdomen, chest and joints due to inflammation of the peritoneum, pleura and synovial membrane. The major problem in FMF is the occurrence of amyloidosis that primarily affects the kidneys causing proteinuria and renal failure. Dialysis and renal transplantation can be treatment, but it is important to diagnose FMF at earliest stages. The percentage of FMF patients in our waiting list was 8.4%. Moreover, in our region FMF incidence is highly frequent, so FMF should be chased by genetically so as to prevent chronic renal failure due to amyloidosis.

Spontaneous rupture of hepatocellular carcinoma: a case report and review of literature

Hepatocellular carcinoma (HCC) has a tendency for fatal spontaneous rupture leading to massive haemorrhage. A 64‐year‐old man presented with sudden, severe epigastric pain for 6 h. Systolic blood pressure was 80/50 mmHg, and pulse rate was 100/min. The patients history did not reveal any operation or disease up to date. Contrast enhancement‐axial computed tomography (CT) scan showed a tumoral lesion with a necrotic centre measuring 6 × 5 cm within 6th segment of the liver and a fluid collection (haemoperitoneum) at the periphery of the liver. At exploratory laparotomy, the liver was found to be cirrhotic, and an actively bleeding tumour confirmed in 6th segment of the liver. The tumour was resected. Post‐operative recovery was unremarkable, and the patient was discharged on the 14th post‐operative day. Ruptured HCC should be included in the differential diagnosis of non‐traumatic intra‐abdominal haemorrhage.