Yahya Ekici

Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.

BACKGROUND In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3+/-3.3 vs 3.0+/-2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003]. CONCLUSION In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.

Laparoscopic cholecystectomy in patients undergoing continuous ambulatory peritoneal dialysis: a case-control study.

This case-control study assesses laparoscopic cholecystectomy (LC) in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis. Eleven patients receiving peritoneal dialysis treatment and 33 patients without end-stage renal disease who had undergone an elective LC were compared. Medical records were reviewed, and laboratory values and outcomes and results were analyzed. The peritoneal dialysis group showed a higher frequency of associated disease and previous abdominal surgery; a lower hemoglobin and platelet count; and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. Statistically significant between-group differences were found with regard to postoperative complications and postoperative hospital stay days. One procedure in each group was converted to an open cholecystectomy. No patient in the peritoneal dialysis group who underwent a LC had peritonitis. No other catheter-related complications occurred. LC may be performed with low complication rates in patients undergoing continuous ambulatory peritoneal dialysis with an experienced team.

Effect of static magnetic field on experimental dermal wound strength.

Context: An animal model. Aim: We sought to evaluate the effect of static magnetic fields on cutaneous wound healing. Materials and Methods: Male Wistar rats were used. Wounds were created on the backs of all rats. Forty of these animals (M group) had NeFeB magnets placed in contact with the incisions, either parallel (Pa) and perpendicular (Pr) to the incision. The other 40 animals (sham [S] group) had nonmagnetized NeFeB bars placed in the same directions as the implanted animals. Half of the animals in each group were killed and assessed for healing on postoperative day 7 and the other half on postoperative day 14. The following assessments were done: gross healing, mechanical strength, and histopathology. Statistical Analysis Used: Intergroup differences were compared by using the Mann-Whitney U or t test. Values for P less than 0.05 were accepted as significant. Results and Conclusions: There were no differences between the magnetic and sham animals with respect to gross healing parameters. The mechanical strength was different between groups. On postoperative day 14, the MPr14 had significantly higher scores than the other groups. When static, high-power, magnetic fields are placed perpendicular to the wound, increased wound healing occurs in the skin of the experimental model.

Effect of Topical Platelet-Rich Plasma on Burn Healing After Partial-Thickness Burn Injury.

Background To investigate the effects of platelet-rich plasma on tissue maturation and burn healing in an experimental partial-thickness burn injury model. Material/Methods Thirty Wistar albino rats were divided into 3 groups of 10 rats each. Group 1 (platelet-rich plasma group) was exposed to burn injury and topical platelet-rich plasma was applied. Group 2 (control group) was exposed to burn injury only. Group 3 (blood donor group) was used as blood donors for platelet-rich plasma. The rats were killed on the seventh day after burn injury. Tissue hydroxyproline levels were measured and histopathologic changes were examined. Results Hydroxyproline levels were significantly higher in the platelet-rich plasma group than in the control group (P=.03). Histopathologically, there was significantly less inflammatory cell infiltration (P=.005) and there were no statistically significant differences between groups in fibroblast development, collagen production, vessel proliferations, or epithelization. Conclusions Platelet-rich plasma seems to partially improve burn healing in this experimental burn injury model. As an initial conclusion, it appears that platelet-rich plasma can be used in humans, although further studies should be performed with this type of treatment.

Arterial complication of irreversible electroporation procedure for locally advanced pancreatic cancer

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.

Acute Rejection Rates and Survival of Renal Transplant Recipients With Alport’s Syndrome

Alports syndrome, a hereditary disorder characterized by a combination of nephritis and deafness, was first described in 1927. Herein, we have presented 20 cases of Alports syndrome in renal transplant recipients. Between November 1975 and September 2006, we performed 1602 transplantations. 22 including 20 recipients (1.24%) with Alports syndrome. The recipients were 16 males and 4 females of overall mean age 21.3 +/- 5.6 years (range, 14-35 years). Seventeen received kidneys from living-related and 5 from cadaveric donors. We retrospectively assessed recipient features: age, gender, physical examination, routine blood biochemistry, histopathological results, and audiometric test results, as well as postoperative complications in each of these 20 recipients. Ten instances of acute rejection occurred in 8 recipients. There were 3 postoperative complications, all of which were lymphoceles. We had no vascular or urinary system complications. At the time of this report, 19 recipients are alive; the other 1 died due to Kaposis sarcoma. Sixteen recipients display good renal function and creatinine levels ranging from 0.8 to 2.9 mg/dL during a mean follow-up of 8.4 +/- 4.8 years (range, 1 to 20 years). Three of 19 recipients returned to hemodialysis at 17, 13, and 6 years after their first graft, respectively. Retransplantation was performed on 2 recipients at 18 and 7 years, respectively, after their first transplantation. In conclusion, although the number of patients in our series was small, in light of their uneventful postoperative periods and the good posttransplantation renal function in our recipients, we consider Alports syndrome recipients as good candidates for transplantation.

A Large Brunners Gland Hamartoma Caused Gastrointestinal Bleeding: CaseReport and Review of Literature

Background: Brunner’s gland hamartoma is a rare benign tumor of the duodenum. It may present with either various symptoms caused by obstruction or bleeding; or incidental mass with no symptoms. A 54-years old woman admitted to hospital for melena. Esophagogastroduodenoscopy revealed a large pedunculated polyp arising from distal portion of the duodenal bulb; erosions and hematin coatings was found overlying mucosa. Endoscopic removal was not possible due to its measures and thick stalk. The lesion was resected at the base of stalk with normal mucosa via duodenotomy. Histopathologic examination revealed that this tumor was a Brunner’s gland hamartoma, 5 cm in its greatest dimension. We described a case of Brunner’s gland hamartoma caused upper gastrointestinal bleeding four years after the first diagnosis and related literature was reviewed.

İnce barsak obstrüksiyonuna yol açan nadir nedenler ve cerrahi tedavi sonuçları

Amac: Bu calismada, ince barsak obstruksiyonlarinin etiyoloji ve cerrahi sonuclari acisindan incelenmesi amaclandi. Gerec ve Yontem: Merkezimizde Ocak 2001 ile Eylul 2015 tarihleri arasinda ileus nedeniyle basvuran hastalar retrospektif kesitsel olarak incelendi. Nadir mekanik ince barsak obstruksiyonu olan hastalar dahil edildi. Hastalar; demografik ozellikleri, etiyoloji, etiyolojiye yatkinlik olusturan durumlar, tani calismalari, tani calismalarinin basarisi, tedavi yontemleri ve sonuclari acisindan incelendi. Bulgular: Belirtilen tarihler arasinda 481 hasta mekanik ince barsak obstruksiyonu nedeniyle ameliyat edildi. Hastalarin 13’unde (%2,8) diger nedenlere bagli obstruksiyon saptandi. Bu hastalarin 5’inde bezoar (%1,0), 2’sinde B hucreli lenfoma (%0,4), 1’inde yabanci cisim (%0,2); 3’unde safra tasi (%0,6), 1’inde gastrointestinal stromal tumor (%0,2) ve bir hastada endometriyozise (%0,2) bagli ince barsak obstruksiyon mevcuttu. Cerrahi tedavide ezerek ve sagilarak bezoarin ilerletilmesi, enterotomi, enterolitotomi, segmenter ince barsak rezeksiyonu ve ileocekal rezeksiyon uygulandi. Ameliyat sonrasi tek komplikasyon, bir hastada (%7,69) gorulen yuzeyel yara yeri enfeksiyonu idi. Izlem suresinde, 3 hastada (%23,0) insizyonel herni goruldu. Hastalarin hicbirinde ince barsak tikanikligi nedeniyle yeniden ameliyat gerekliligi olmadi. Sonuc: Ince barsak obstruksiyonuna yol acan nadir nedenlerin ameliyat oncesi tani konulmasi zordur. Adezyon riski olmayan ince barsak obstruksiyonlu hastalarda bu nadir etiyolojiler de goz onunde tutularak erken donemde cerrahi tedavi dusunulmelidir.

Laparoscopic spleen-preserving distal pancreatectomy for a primary hydatid cyst mimicking a mucinous cystic neoplasia

Pancreatic hydatid cysts are fairly rare. The disease can be encountered concurrently with systemic involvement or as an isolated pancreatic involvement. We report the first case of spleen-preserving laparoscopic distal pancreatectomy for a pancreatic hydatid cyst. There was no complication or recurrence. A 55-year-old woman was admitted to our centre with epigastric and back pain. Upper abdominal magnetic resonance imaging revealed a solitary cystic lesion with septations at the pancreatic tail level measuring 24 mm × 18 mm, which was initially thought to be a pancreatic mucinous cystic neoplasia. She underwent laparoscopic spleen-preserving distal pancreatectomy and cholecystectomy. Her post-operative course was uneventful and histopathological examination revealed a hydatid cyst in the pancreatic tail.Pancreatic hydatid cysts are fairly rare. The disease can be encountered concurrently with systemic involvement or as an isolated pancreatic involvement. We report the first case of spleen-preserving laparoscopic distal pancreatectomy for a pancreatic hydatid cyst. There was no complication or recurrence. A 55-year-old woman was admitted to our centre with epigastric and back pain. Upper abdominal magnetic resonance imaging revealed a solitary cystic lesion with septations at the pancreatic tail level measuring 24 mm × 18 mm, which was initially thought to be a pancreatic mucinous cystic neoplasia. She underwent laparoscopic spleen-preserving distal pancreatectomy and cholecystectomy. Her post-operative course was uneventful and histopathological examination revealed a hydatid cyst in the pancreatic tail.

Effect of the Bioadhesive, BioGlue, on Impaired Colonic Anastomose Healing in Rats

Colonic anastomotic leakage is still a problem in general surgery practice. We sought to investigate the effect of a new tissue adhesive, BioGlue, on the healing of normal and impaired colonic anastomoses. Sixty-four rats were randomized into 4 groups. In all animals, a 1-cm segment of the left colon was resected, and an end-to-end sutured anastomosis was created. Animals were then divided into 2 groups: normal and impaired anastomosis. These 2 groups were further subdivided into 2 additional groups: animals that received BioGlue and those that did not. All rats received intraperitoneal injections of either 0.9% NaCl or 5-fluorouracil (5-FU). Anastomotic evaluation was done 7 days after surgery. Macroscopic healing, mechanical strength, and histopathologic healing parameters were evaluated. Leakage of the anastomosis was significantly higher in rats in the impaired group compared with those in the BioGlue groups (P = 0.043). The adhesion formation score was significantly higher in rats in the impaired ana...