Sabri Erguney

Laparoscopic Approach to Hepatic Hydatid Disease

Background: The aim of this paper is to present our brief experience on laparoscopic hydatid cyst surgery; we estimated the reproducibility of used techniques in conventional surgery with this relatively recent and attractive method. Methods: Fifteen cysts in 12 selected hydatid disease patients were treated laparoscopically. Cystotomy, partial cystectomy and drainage were performed in 9 patients. Omentoplasty was added to the procedure in the remaining 3 cases. Results: The mean postoperative hospital stay was 4.9 days. There was no mortality, and 1 patient developed bile leakage. Mean follow-up is 18 months. No recurrence was observed during this period. Conclusion: We suggest that laparoscopic treatment of hydatid disease is feasible in selected patients respecting the principles of open surgery and seems beneficial concerning postoperative comfort, hospital stay and return to daily activities.

Rupture of the Hydatid Disease of the Liver into the Biliary Tracts

Background: To analyze the diagnosis and the surgical treatment of intrabiliary ruptured hydatid disease of the liver. Methods: Between 1990 and 1995, 263 patients with hydatid cysts of the liver underwent surgery in a university hospital. Twenty-five (9.43%) patients with intrabiliary rupture of hepatic hydatid cyst were retrospectively reviewed. Results: Diagnosis was principally made using ultrasonography and computed tomography scanning and was confirmed by the findings of other tests. In 12 patients (48%) partial cystectomy with primary closure; 5 patients (20%) partial cystectomy with drainage; 5 patients (20%) cystotomy with drainage; 3 patients (12%) left hepatic resection (atypic, segmentary or lobar) was performed. Omentoplasty was performed in 6 patients. The common bile duct was explored in all patients and it was drained by a T-tube in 22 patients, and by a choledochoduodenostomy in 3 others. The average postoperative hospitalization time was 8.3 and 22.5 days in patients treated with choledochoduodenostomy and T-tube drainage respectively. Cholecystectomy was performed in 18 patients. Complications were seen in 4 patients (16%) with 1 pleural effusion and 3 wound infections. There was only 1 death (4%) due to duodenal peptic ulcus perforation with intrabiliary ruptured hydatid cyst. Conclusion: This study indicates that T-tube drainage and choledochoduodenostomy in intrabiliary ruptured hydatid cysts are effective procedures with low morbidity and mortality rates.

Thoracoscopic enucleation of a giant submucosal tumor of the esophagus.

Since the introduction of thoracoscopy in the surgical field, many thoracic interventions have been considered feasible via thoracoscopic route. The authors reported a case of thoracoscopic enucleation of a giant esophageal submucosal tumor (8.5 cm in diameter) situated along the left side of the midesophagus. Histopathologic evaluation revealed a gastrointestinal stromal tumor (GIST). Postoperative period was uneventful and the patient was discharged on the eighth postoperative day. Given the well-known advantages of minimally invasive surgery, we assume that the removal of esophageal submucosal tumors can first be attempted by thoracoscopic approach, even if the tumor is of a big size. In cases of histopathologically unknown tumors preoperatively, definitive examination of the complete specimen provides the basis for further therapeutic decisions.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Extended Pancreaticoduodenectomy for a Huge Cystic-Cavernous Lymphangioma: A Case Report

CONTEXT Cystic-cavernous lymphangioma is a rare cystic tumor especially for adults and pancreas. CASE REPORT We reported a case of a 33-year-old woman who presented with a visible and palpable abdominal mass found to be a huge lymphangioma of the pancreas. An abdominal magnetic resonance imaging (MRI) showed a multiloculated, lobulated T1 hypo/hyper, T2 hyperintense cystic mass extending from right subhepatic space to the pelvis measuring 155x167x100 mm. A pancreaticoduodenectomy was performed encompassing the distal stomach and a segment of the transverse colon, because of their close, inseparable relationship to the mass. The cystic mass was histopathologically diagnosed as partly cavernous and partly cystic lymphangioma. CONCLUSION To our knowledge this is the first case of pancreatic lymphangioma requiring additional organ resection besides a standard pancreaticoduodenectomy. To reduce recurrences, we recommend a complete resection for this pathology, even though its benign nature.

Late Results of Patients Undergoing Remedial Operations for Alkaline Reflux Gastritis Syndrome

Abstract Purpose: Many different remedial operations for alkaline reflux gastritis have been described. Analysis of their efficacy is difficult, because while many of the procedures have good early results, there are long-term failures due to their own complications. The aim of this study is to evaluate our experience with patients undergoing remedial operations for alkaline reflux gastritis syndrome. Material and methods: The clinical features and results of remedial operations of 65 patients with alkaline reflux gastritis syndrome were reviewed retrospectively. Data on the hospital course were collected by interviewing patients directly or by telephone contact. An assessment of each patient’s response to remedial operation was then made and a Visick score assigned. Results: All patients had been tried on a medical treatment and dietary restriction or both prior to remedial operation. Long-term follow up was possible in 46 patients. Seventy-six percent of patients who at the final state had a truncal vagotomy, distal gestrectomy and Roux-en-Y gastrojejunostomy have been found to show satisfactory results (Visick-I/Visick II). Three patients who had previously undergone a Roux-en-Y conversion later required re-operation for Roux-stasis syndrome and a near-total gastrectomy was performed on these patients. Other operations performed for alkaline reflux gastritis were converted to “uncut” Roux-en-Y in five patients and dismantling of gastrojejunostomy in two patients. Conclusions: For patients unresponsive to medical treatment, we reccommend the following strategy : a) for patients with truncal vagotomy plus gastrojejunostomy, dismantling of gastrojejunostomy should be the first choice b) for patients with prior Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its proper including Roux statis syndrome.