Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
Diaphragmatic hernias (DHs) are rare complications after pediatric liver transplantation (PLT). I... more Diaphragmatic hernias (DHs) are rare complications after pediatric liver transplantation (PLT). It is now widely accepted that DHs after liver transplantation (LT) is a pediatric related condition. PLTs (under of age 18) performed between January 2013 and June 2019 at Malatya Inonu University Institute of Liver Transplantation were retrospectively scanned. Study group consisting DHs and a control group were compared. Among 280 PLTs, 8 of them were complicated with DHs (%2.9). Median age of the patients with DH was 3.0 (0.8‐9.5) years. Median graft recipient weight ratio was 2.5 (0.9‐4.4). Five patients were below 5th percentiles in terms of pediatric weight growth chart at the time of LT. Also, 6 patients were below 5th percentiles in terms of pediatric height growth chart. There was no statistical difference between study and control groups. There are many risk factors mentioned in literature that may be primarily responsible for DHs after PLT. These factors are left lobe and large...
In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorect... more In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.
In this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A... more In this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3 years ago, underwent the first endoscopic bezoar evacuation 26 months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36 months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.
Rupture into the biliary ducts is the most frequent complication of hydatid liver disease. In end... more Rupture into the biliary ducts is the most frequent complication of hydatid liver disease. In endemic areas of Echinococcus granulosus, development of jaundice in a patient with liver cyst is initially suspected to have hydatid cyst. A 48 year-old woman with history of asymptomatic hydatid liver cysts was admitted to the emergency department with right upper quadrant abdominal pain, increased levels of liver enzymes, bilirubin and alkaline phosphatase and the initial clinical diagnosis was the hydatid cyst rupture into the bile ducts. Surgery was planned but radiological evaluation (MRI) revealed non-dilated intra-extra biliary ducts. High suspicion of hydatid rupture required diagnostic ERCP that was normal and surgery was cancelled then. A possible diagnosis of coexistent hepatitis was suspected. Liver function tests normalized gradually and no cyst rupture was determined during surgery. These findings suggest considering the possible development of cryptogenic hepatitis in patien...
Informed consent statement: The patient involved in this study gave his written informed consent ... more Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
these new potential confounders in the fully adjusted Cox regression analysis, being $65 years an... more these new potential confounders in the fully adjusted Cox regression analysis, being $65 years and on a traditional perioperative protocol remained the only factors independently associated with prolonged hospital stay. This finding supports the important role of the ERP in functional recovery after RP abdominal aortic aneurysm repair. Second, they referred to the left kidney "down" technique as having potential for bleeding, developing a plane anterior to the kidney, whereas they prefer a left kidney "up" approach, except in case of retroaortic left renal vein. However, in the RP approach for both aneurysmatic and Leriche diseases, we did not experience bleeding during the dissection to maintain the left kidney down. Instead, although it is more timeconsuming, we do prefer such a technique because it is less traumatic as the kidney is not displaced and it seems easier to get further distal on the right renal artery. Third, they mentioned that many surgeons performing RP surgery see the clear physiologic benefits it offers over the transperitoneal (TP) route and speculate that the advantages of the RP one may have little to do with ERPs but may be primarily due to the approach itself. We agree that RP surgery offers such benefits over the TP approach; however, all patients included in our study were operated on through the RP approach, and control group patients showed slower functional recovery and longer hospital stay as opposed to patients who were on an ERP. Finally, although one of the general strategies of enhanced recovery methodology is to reduce the surgical trauma, we do agree that ERP is most likely to demonstrate greatest benefit for vascular operations involving the peritoneal cavity. As the magnitude of the surgical stress response increases with the invasiveness of the surgical operation, it seems sensible to implement strategies to attenuate such a response (ie, ERPs), in particular when the trauma of the operation cannot be reduced (eg, open TP surgery).
INTRODUCTION As originally described by Miles (1), abdominoperineal excision (APE) has long been ... more INTRODUCTION As originally described by Miles (1), abdominoperineal excision (APE) has long been the standard treatment for tumors of the middle and lower rectum. It achieves the greatest possible distal margin of resection by removing the anus in continuity with the rectum. Total mesorectal excision (TME), recommended by Heald et al. (2), has led to a decrease in perineal amputation numbers and has become the oncologic standard in the last 30 years. However, the rates of circumferential resection margin (CRM) positivity and of intraoperative perforation (IOP) is higher in abdominoperineal excision as compared to anterior excision. Recently, Holm's studies have generated a renewed interest on the abdominoperineal excision technique (3). In this operation, the levator muscles are excised from their origins on the pelvic side walls and removed en bloc with the tumor. The aim of this approach is to reduce both the rate of CRM positivity and IOP, which are associated with high rates of local recurrence and poor survival outcomes in patients with rectal cancer (4-8). Although there are many similarities between what Miles has previously described and what Holm recently defined, there are major differences that should be recognized e.g. Miles did not use the prone position and did not undertake a total mesorectal excision. This study was designed to compare the results of extralevator abdominoperineal excision (ELAPE) with the conventional APE approach. MATERIAL AND METHODS Patients Between November 2008 and December 2011, 25 patients with low rectal cancer underwent ELAPE in the prone jack-knife position. Nine patients (36.0%) received neoadjuvant long-term chemoradiotherapy. A consecutive series of 56 patients that were treated by conventional APE in the lithotomy position between 2003 and 2008 were selected from our prospectively collected rectal cancer database for comparison as a historical cohort. Eight of these patients (14.3%) had received neoadjuvant chemoradiotherapy. Chemoradiation indication was defined as T3-4/N+ tumors for both group of patients. Surgeries were performed at 6 to 8 weeks after neoadjuvant therapy. Low rectal cancer was defined as tumors in the lower third of the rectum. Digital rectal examination, plain chest x-ray, colonoscopy, abdominal ultrasonography, and computerized tomography were used for staging both before and after chemoradiotherapy. All operations were performed by the same consultant surgeon who had undergone additional training on the extralevator technique. All patients were followed up prospectively. Patient informed consent was obtained for the operation presented in the study. Our study has been
Radical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum... more Radical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum, peritoneum over the posterior lesser sac, pancreas and/or spleen was advocated at the beginning of the 1960s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However, omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursa omentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.
Radical surgery for liver hydatid cysts has received increasing interest over the last two decade... more Radical surgery for liver hydatid cysts has received increasing interest over the last two decades. Its proponents suggest that, whenever possible, radical methods should be the mainstay of surgical treatment. They claim that the advantages of radical surgery are lower rates of early and late complications. Despite this trend, it can simply be said that there is no clear evidence yet that radical surgery has lower early or late complication rates. There is only one randomized controlled trial that compares radical and conservative methods [1], and this study has several drawbacks that are open to discussion. At this point, I read the study of ''Is radical surgery feasible in liver hydatid cysts in contact with the inferior vena cava'' [2]. The authors compared radical and conservative surgery results of liver hydatid cysts that contact the vena cava inferior in 32 patients. This study argued that radical surgery for hydatid liver cysts, even if in contact with the inferior vena cava, was safe and the authors advocated the radical surgery. However, blood loss was threefold higher, the morbidity was twofold higher, and there was one mortality (5 %) in the radical group. And there was no recurrence in both groups. I believe that these results do not support the safety and benefit of radical surgery over the conservative methods. Liver hydatid cysts grow very slowly and most of them are asymptomatic when diagnosed. When they are diagnosed, clinicians usually ruminate on the most catastrophic scenarios for this benign disease. Favoring preventive
Although it is clearly known that there is no need of routine nasogastric decompression after som... more Although it is clearly known that there is no need of routine nasogastric decompression after some abdominal operations, we still do not know whether it is necessary for esophageal anastomosis. Traditionally, nasogastric decompression is mandatory after total gastrectomy complemented with esophagojejunostomy. Consecutive 66 patients with gastric cancer who underwent total gastrectomy and esophagojejunostomy were prospectively evaluated. Patients were divided into two groups, those with nasogastric decompression and those without decompression. Postoperative complications were similar among the groups. Vomiting, distention, belching, hiccupping, dysphagia complaints were similar among the groups, but sore throat (100% vs. 22%, p<0.001), nausea (32% vs. 13%, p=0.054), fever (35% vs. 16%, p=0.068) and pulmonary complications (26% vs. 9%. p=0.072) were much more in the nasogastric decompression than the no-tube group. Starting oral feeding and postoperative hospital stay were similar...
This well-conducted review concluded that early endoscopic retrograde cholangiopancreatography in... more This well-conducted review concluded that early endoscopic retrograde cholangiopancreatography in patients with acute biliary pancreatitis without cholangitis was an unnecessary and invasive procedure that did not lead to significant reductions to risk of overall complications or mortality. These conclusions should be considered with caution due to possibility of clinical and statistical heterogeneity within the data. Searching MEDLINE, EMBASE and unspecified Cochrane databases were searched to March 2007. Search terms for each database were reported. No language restrictions were applied. Identified articles and reviews were handsearched for additional citations. Bibliographic details Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, van Erpecum KJ, Gooszen HG. Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials.
Neoadjuvant chemo-radiotherapy and total mesorectal excision have become the standard treatment f... more Neoadjuvant chemo-radiotherapy and total mesorectal excision have become the standard treatment for locally advanced middle and distal rectal cancers. These types of patients carry a serious risk of anastomosis leakage. While the commonly technique is diverting ileostomy; rectal tube placement, with lower morbidity, has also been used in recent years. The aim of this study was to compare the results of ileostomy and rectal tube administration following rectal resection after neoadjuvant therapy. Material and Methods: We retrospectively reviewed the data from 25 patients with rectal cancer who received neoadjuvant chemoradiotherapy between 2013 and 2019. Patients were evaluated in two groups: ileostomy and rectal tube. Demographic data, operative findings, pathological results, and follow-up information were evaluated. Results: Twelve were in the rectal tube group and 13 were in the ileostomy group. There was no difference between the two groups in terms of tumor location in preoperative data. Patients with hepatic metastasis were found in the ileostomy group, while there were no such patients in the rectal tube group. The operation time (452±128 vs. 295±102 min, p=0.002) and blood loss (485±264 vs 105±80 ml, p=0.0001) were higher in the ileostomy group. The intraoperative complications of the patients were similar in the two groups, whereas the postoperative complications were higher in the ileostomy group (69%-25%, p=0.04). The mean follow-up period was 23.2±18.5 months. The total complication rate due to ileostomy was 20% and the stomata of 15% of the patients were not closed. The cosmetic scores of the patients were better in the rectal tube group (9.8±0.3 vs. 6.3±1.7, p=0.0001). Conclusion: The results of the rectal tube technique were not worse than those of the ileostomy technique in rectal cancers receiving neoadjuvant therapy and this technique may be preferred in appropriate cases.
Journal of Clinical and Investigative Surgery, 2021
Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surg... more Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero-ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery.
The aim of this study is to compare the results of the patients for whom intracorporeal or extrac... more The aim of this study is to compare the results of the patients for whom intracorporeal or extracorporeal anvil insertions were performed. Natural orifice specimen extraction (NOSE) surgery has been started from the 21st century onwards in order to reduce wound-related complications of laparoscopy. Two types of anvil placements, including intracorporeal or extracorporeal placements, are used in the application of NOSE, which is combined with distal colorectal surgery. Material and Methods: We retrospectively collected the data from 77 patients who underwent laparoscopic distal colorectal surgery combined with NOSE in our clinic between 2013 and 2019. Patients were evaluated in two groups as intra-corporeal and extracorporeal. Selection of the technique was based on the length of sigmoid colon and mesocolon. Demographic data, operative findings, pathological results and follow-up information were evaluated. Results: Of 77 patients who underwent distal colorectal surgery and circular stapler anastomosis; 44 were in the intracorporeal group and 33 were in the extracorporeal group. There was no difference between the two groups in terms of gender, age, BMI, comorbidity, and abdominal operation history of patients. The number of patients undergoing low anterior resection was higher in the extracorporeal group, and also the number of patients undergoing anterior resection was higher in the intracorporeal group. Peroperative findings, intraoperative and postoperative complications of patients were similar in both groups. The postoperative first-day pain scale was lower in the intracorporeal group (3.3±2.1 vs. 4.4±2.3, p=0.03). No significant difference was found between the two groups in other pain scales and cosmetic scores. The oncologic results were similar during the mean follow-up of 35.5±24.1 months. Conclusion: Although anvil placement techniques are not interchangeable, it is seen that neither method predominates the other in cases where both are suitable.
Uploads
Papers by Cuneyt Kayaalp