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1.
Ulus Travma Acil Cerrahi Derg ; 29(1): 122-129, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36588513

ABSTRACT

BACKGROUND: The management of hepatic trauma has a historical progress from mandatory operation with selective non-operative treatment, to non-operative treatment with selective operation. Liver resection (LR) seems to have a minimal role in the management of liver injury. However, surgical treatment becomes the only life-saving treatment in cases with severe liver trauma. METHODS: It is a retrospective presentation of five cases with severe blunt liver injury whose were admitted at our center during the 8-year period. RESULTS: The median age of patients was 30.8 (23-43). The most frequent mechanism of injury was pedestrian struck (60%). Two of five cases were transferred to our hospital from rural state hospitals after initial attempt to achieving hemostasis. The majority of liver injury was grade V (80%). The right lobe of the liver was injured in different extensions. Major vascular injury was associated to liver injury in four of five cases. The right hepatectomy (n=1), resectional debridement of segments 5, 6, and 7 (n=1), posterior sectorectomy (n=2), and segment 7 resection (n=1) were performed for hemostasis. Vascular injuries in the junction of inferior vena cava and right hepatic vein (n=1), the anterior surface of the right hepatic vein (n=1), the junction of segment 7 hepatic vein and right hepatic vein (n=1), the main portal vein (n=1), and the right renal vein (n=1) were repaired. Median operation time was 162 min (120-180 min). Operative mortality was 20%. Reoperation was needed in three of four survived cases. In-hospital complications were observed in two of four survived cases. Median stay in intensive care unit and hospital was 12.4 days (1-48 days) and 28.2 days (1-65 days), respectively. CONCLUSION: When a severe liver injury is unresponsive to packing, the surgeon must always keep in mind that extensive maneuvers for vascular control and LR are required for bleeding control.


Subject(s)
Hepatectomy , Wounds, Nonpenetrating , Humans , Retrospective Studies , Liver/surgery , Liver/blood supply , Vena Cava, Inferior , Hepatic Veins , Wounds, Nonpenetrating/surgery
2.
Turk J Med Sci ; 51(3): 1388-1395, 2021 06 28.
Article in English | MEDLINE | ID: mdl-33576585

ABSTRACT

Background/aim: Operative bleeding is one of the major determinants of outcome in liver surgery. This study aimed to describe the impact of intraoperative blood loss on the postoperative course of liver resection (LR). Materials and methods: The data of 257 patients who were treated with LR between January 2007 and October 2018 were retrospectively analyzed. LRs were performed via intermittent portal triad clamping (PTC) under low central venous pressure. Results: LRs were performed for 67.7% of patients with a malignant disease and 32.3% of patients with a benign disease. Major LR was performed in 89 patients (34.6%). The mean PTC period was 20.32 min (±13.7). The median intraoperative bleeding amount was 200 mL (5­3500 mL), the 30-day mortality rate was 4.3%, and the morbidity rate was 31.9%. The hospital stay (p = 0.002), morbidity (p = 0.009), and 30-day mortality (p = 0.041) of patients with a bleeding amount of more than 500 mL significantly increased. Conclusion: Surgeons should consider the adverse effects of intraoperative bleeding during liver resection on patients' outcome. Favorable outcomes would be obtained with diligent postoperative care.


Subject(s)
Blood Loss, Surgical , Liver Neoplasms , Central Venous Pressure , Hepatectomy/adverse effects , Humans , Liver , Liver Neoplasms/surgery , Retrospective Studies
3.
Turk J Surg ; 37(2): 133-141, 2021 Jun.
Article in English | MEDLINE | ID: mdl-37275202

ABSTRACT

Objectives: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection. Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed. Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p <0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p <0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p <0.001). Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.

5.
Turk J Med Sci ; 50(6): 1491-1503, 2020 10 22.
Article in English | MEDLINE | ID: mdl-32718126

ABSTRACT

Liver surgery is one of the most complex surgical interventions with high risk and potential for complications. Posthepatectomy liver failure (PHLF) is a serious complication of liver surgery that occurs in about 10% of patients undergoing major liver surgery. It is the main source of morbidity and mortality. Appropriate surgical techniques and intensive care management are important in preventing PHLF. Early start of the liver support systems is very important for the PHLF patient to recover, survive, or be ready for a liver transplant. Nonbiological and biological liver support systems should be used in PHLF to prepare for treatment or organ transplantation. The definition of the state, underlying pathophysiology and treatment strategies will be reviewed here.


Subject(s)
Hepatectomy/adverse effects , Liver Failure , Postoperative Complications , Aged , Female , Humans , Liver/physiopathology , Liver/surgery , Male , Middle Aged , Risk Factors
6.
Am Surg ; 86(4): 313-323, 2020 Apr 01.
Article in English | MEDLINE | ID: mdl-32391755

ABSTRACT

This study aimed to investigate clinical characteristics of hepatocellular carcinoma and the outcome of our aggressive treatment policy which follows the Barcelona Clinic Liver Cancer (BCLC) guidance. In this study, we retrospectively analyzed data of 102 patients who were treated for hepatocellular carcinoma between January 2007 and October 2016. Male predominance (81.4%) and a median age of 61 years were observed. Cirrhosis was evident in 88.2 per cent of patients. Viral hepatitis (77.5%) was the most common underlying etiology. The majority of our patients (71.6%) were in BCLC B and C stages. Liver resection was performed in 53.4 per cent of patients in those stages. Transarterial chemoembolization was the leading interventional treatment. Overall survival rates at three and five years were 75 per cent and 75 per cent in BCLC 0, 69 per cent and 58 per cent in BCLC A, 50 per cent and 41 per cent in BCLC B, and 11 per cent and 11 per cent in BCLC C, respectively. The BCLC treatment algorithm should consider the role of liver resection also for intermediate stages.


Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy , Liver Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Disease-Free Survival , Female , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Postoperative Complications , Prognosis , Proportional Hazards Models , Retrospective Studies , Survival Rate , Turkey , Young Adult
7.
Exp Clin Transplant ; 2017 Dec 18.
Article in English | MEDLINE | ID: mdl-29251575

ABSTRACT

Postoperative hepatic failure is one of the most severe complications after liver resection. Treatment protocols have varied from medical support to liver transplant. Here, we describe the clinical course of an 18-year-old female patient with postoperative hepatic failure. The combined use of intra-arterial tissue plasminogen activator infusion and concurrent liver support facilities resulted in successful treatment of postoperative hepatic failure. The role of thrombolytic treatment for postoperative hepatic failure may include future placement in routine treatment protocols, as seen in liver transplant.

8.
Ulus Travma Acil Cerrahi Derg ; 23(5): 441-444, 2017 Sep.
Article in English | MEDLINE | ID: mdl-29052835

ABSTRACT

The liver is the most commonly injured intra-abdominal organ after blunt trauma. The management of massive liver injury is complex. Percutaneous transhepatic biliary drainage is the first approach considered, particularly for proximal bile duct strictures after liver surgery. A 27-year-old female patient was transferred to our emergency department with grade V blunt injury. Regarding the patient's unresponsive hemodynamic instability, right hepatectomy was performed. The patient presented with benign biliary duct stricture after surgery that were treated via the percutaneous approach.


Subject(s)
Drainage , Hepatectomy , Liver , Adult , Female , Humans , Liver/injuries , Liver/surgery , Wounds, Nonpenetrating
11.
Ulus Travma Acil Cerrahi Derg ; 21(5): 410-3, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26388281

ABSTRACT

Congenital mesenteric defects are rare and often recognized only in surgery or autopsy. Preoperative diagnosis of an internal hernia is quite rare. A common symptom of trans-mesenteric intestinal herniation is intermittent postprandial pain. If there is strangulation of the mesenteric internal herniation, there is often vomiting and constipation. Signs and symptoms of a bowel obstruction in a patient without previous abdominal surgery or inguinal hernia as well as without history of intra-abdominal operation and infection suggest the possibility of a congenital mesenteric defect with internal herniation. Early diagnosis and surgical treatment are important to reduce morbidity and mortality. This study aimed to present the case of a 20-year-old female patient on whom preoperative diagnosis of internal trans-mesenteric internal hernia was made.


Subject(s)
Hernia, Abdominal/diagnosis , Intestinal Obstruction/diagnosis , Mesentery/abnormalities , Diagnosis, Differential , Female , Hernia, Abdominal/congenital , Hernia, Abdominal/diagnostic imaging , Hernia, Abdominal/surgery , Humans , Intestinal Obstruction/congenital , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Mesentery/surgery , Tomography, X-Ray Computed , Young Adult
12.
Diagn Interv Radiol ; 21(3): 222-8, 2015.
Article in English | MEDLINE | ID: mdl-25858526

ABSTRACT

PURPOSE: We aimed to investigate the efficacy and safety of preoperative selective intra-arterial embolization (PSIAE) in the surgical treatment of large liver hemangiomas. METHODS: Data of 22 patients who underwent resection of large liver hemangiomas were retrospectively analyzed. PSIAE was performed in cases having a high risk of severe blood loss during surgery (n=11), while it was not applied in cases with a low risk of blood loss (n=11). RESULTS: A total of 19 enucleations and six anatomic resections were performed. Operative time, intraoperative bleeding amount, Pringle period, and blood transfusion were comparable between the two groups (P > 0.05, for all). The perioperative serum aspartate transaminase level was not different between groups (P = 1.000). Perioperative total bilirubin levels were significantly increased in the PSIAE group (P = 0.041). Postoperative hospital stay was longer in the PSIAE group. Surgical complications were comparable between groups (P = 0.476). CONCLUSION: Patients who underwent PSIAE due to a high risk of severe blood loss during resection of large liver hemangiomas had comparable operative success as patients with a low risk of blood loss who were operated without PSIAE. Hence, PSIAE can be used for the control of intraoperative blood loss, especially in surgically difficult cases.


Subject(s)
Embolization, Therapeutic/methods , Hemangioma/therapy , Liver Neoplasms/therapy , Adult , Blood Loss, Surgical/prevention & control , Female , Follow-Up Studies , Hemangioma/diagnostic imaging , Hemangioma/pathology , Hemangioma/surgery , Heparin, Low-Molecular-Weight/administration & dosage , Hepatectomy/adverse effects , Hepatectomy/methods , Humans , Length of Stay , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Male , Middle Aged , Postoperative Complications/etiology , Preoperative Care/methods , Radiography , Retrospective Studies , Risk Factors , Treatment Outcome
13.
Turk J Gastroenterol ; 25(2): 209-11, 2014 Apr.
Article in English | MEDLINE | ID: mdl-25003684

ABSTRACT

Occurrence of synchronous double primary liver cancer is a very rare condition. A 48-year-old man underwent lateral sectorectomy and tumor resection from segment (S) 7 and S5 for 3 separate liver tumors. Pathological examination revealed intrahepatic cholangiocarcinoma (ICC) in the lateral sector and hepatocellular carcinoma (HCC) in S7 and S5. This report presents the second case in the literature describing the resection of synchronous double cancers of HCC and ICC localized in both lobes of the liver. We also reviewed the clinical and pathological aspects of this coincidental situation.


Subject(s)
Bile Duct Neoplasms/therapy , Bile Ducts, Intrahepatic , Carcinoma, Hepatocellular/therapy , Cholangiocarcinoma/therapy , Liver Neoplasms/therapy , Neoplasms, Multiple Primary/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bile Duct Neoplasms/diagnosis , Carcinoma, Hepatocellular/diagnosis , Chemotherapy, Adjuvant , Cholangiocarcinoma/diagnosis , Hepatectomy , Humans , Liver Neoplasms/diagnosis , Male , Middle Aged , Neoplasms, Multiple Primary/diagnosis
14.
Hepatogastroenterology ; 61(130): 398-404, 2014.
Article in English | MEDLINE | ID: mdl-24901149

ABSTRACT

The liver is the most common site for neuroendocrine tumor metastasis. The characteristic feature of these tumors is related to the secretion of biologically active compounds in large amounts. Systemic chemotherapy has limited success in treating patients with neuroendocrine liver metastasis. Surgical management remains the only potentially curative option for these patients. According to the high incidence of recurrence after surgery, the role of intra-arterial therapy (IATs) in neuroendocrine tumor metastasis has been evolved. This review evaluates the potential role of IATs in the light of current literature.


Subject(s)
Chemoembolization, Therapeutic/methods , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Neuroendocrine Tumors/secondary , Neuroendocrine Tumors/therapy , Humans
15.
Exp Clin Transplant ; 12 Suppl 1: 76-80, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24635798

ABSTRACT

OBJECTIVES: Fibrin sealants may prevent hemorrhage and biliary leakage after liver resection. We evaluated the effects of topical fibrin glue application on biliary anastomosis in deceased-donor liver transplant. MATERIALS AND METHODS: From January 2011 to July 2013, fibrin glue was applied around the biliary anastomosis in 10 patients who had deceased-donor liver transplant (recipients: female, 8 patients; median age, 46.9 y) with end-to-end choledochocholedochostomy in 9 patients and hepaticojejunostomy in 1 patient. Biliary leakage was diagnosed with abdominal computed tomography. RESULTS: Biliary leakage was observed in 1 patient at 18 days after deceased-donor liver transplant with end-to-end choledochocholedochostomy. This was treated with revision laparotomy and reconstruction of the biliary anastomotic leak with a hepaticojejunostomy and placement of an internal stent and fibrin glue; the patient 's condition improved. There were no perioperative deaths. CONCLUSIONS: In deceased-donor liver transplant, application of fibrin glue at the biliary anastomosis may be associated with.


Subject(s)
Anastomotic Leak/prevention & control , Fibrin Tissue Adhesive/therapeutic use , Liver Transplantation/adverse effects , Adult , Anastomotic Leak/diagnosis , Anastomotic Leak/etiology , Anastomotic Leak/surgery , Female , Humans , Male , Middle Aged , Reoperation , Risk Factors , Time Factors , Treatment Outcome
16.
Exp Clin Transplant ; 12 Suppl 1: 95-7, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24635802

ABSTRACT

OBJECTIVES: Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We assessed the hepatotoxicity of methotrexate and prednisolone combination therapy in the background of hepatitis B virus infection. MATERIALS AND METHODS: We report the clinical course of a 55-year-old woman who underwent a deceased-donor liver transplant for fulminant liver failure. RESULTS: The patient's medical history was significant for hepatitis B virus infection and rheumatoid arthritis. Methotrexate and prednisolone combination therapy were started 5 months earlier. The patient was hospitalized because of an elevation in her liver enzymes and total bilirubin. Deterioration of liver functions and encephalopathy were developed 5 weeks after hospital admission. A deceased-donor liver transplant was performed, and pathological examination of recipient liver revealed fibrosing cholestatic hepatitis. The patient was reoperated on for bile leak and discharged 40 days after the deceased-donor liver transplant. CONCLUSIONS: The natural course of the current case was similar to previously reported cases with fibrosing cholestatic hepatitis. Clinicians should consider the potential hepatotoxicity of methotrexate and steroid therapy in hepatitis B virus infected patients.


Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Chemical and Drug Induced Liver Injury/etiology , Cholestasis, Intrahepatic/chemically induced , Hepatitis B/complications , Liver Cirrhosis/chemically induced , Methotrexate/adverse effects , Prednisone/adverse effects , Arthritis, Rheumatoid/diagnosis , Biopsy , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/surgery , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/surgery , Drug Therapy, Combination , Female , Hepatitis B/diagnosis , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/surgery , Liver Failure, Acute/diagnosis , Liver Failure, Acute/etiology , Liver Failure, Acute/surgery , Liver Transplantation , Middle Aged , Treatment Outcome
17.
ISRN Surg ; 2013: 156347, 2013.
Article in English | MEDLINE | ID: mdl-23840968

ABSTRACT

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group (n = 4) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (P = 0.01). It was increased up to 60% of baseline values 25 days after BDL (P = 0.002). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (P = 0.002). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.

18.
Biomed Res Int ; 2013: 297971, 2013.
Article in English | MEDLINE | ID: mdl-24392450

ABSTRACT

BACKGROUND: This retrospective study was designed to investigate the efficacy and safety of intermittent portal triad clamping (PTC) with low central venous pressure (CVP) in liver resections. METHODS: Between January 2007 and August 2013, 115 patients underwent liver resection with intermittent PTC. The patients' data were retrospectively analyzed. RESULTS: There were 58 males and 57 females with a mean age of 55 years (± 13.7). Cirrhosis was found in 23 patients. Resections were performed for malignant disease in 62.6% (n = 72) and for benign disease in 37.4% (n = 43). Major hepatectomy was performed in 26 patients (22.4%). Mean liver ischemia period was 27.1 min (± 13.9). The mortality rate was 1.7% and the morbidity rate was 22.6%. Cumulative clamping time (t = 3.61, P < 0.001) and operation time (t = 2.38, P < 0.019) were significantly correlated with AST alterations (D-AST). Cumulative clamping time (t = 5.16, P < 0.001) was significantly correlated with D-ALT. Operation time (t = 5.81, P < 0.001) was significantly correlated with D-LDH. CONCLUSIONS: Intermittent PTC under low CVP was performed with low morbidity and mortality. Intermittent PTC can be safely applied up to 60 minutes in both normal and impaired livers.


Subject(s)
Central Venous Pressure , Hepatectomy/methods , Liver/surgery , Adult , Aged , Female , Humans , Ischemia/pathology , Liver/pathology , Male , Middle Aged , Retrospective Studies
19.
Hepatogastroenterology ; 58(106): 311-7, 2011.
Article in English | MEDLINE | ID: mdl-21661388

ABSTRACT

BACKGROUND/AIMS: There are few anatomical studies on hepatic vein compared to hepatic artery and portal vein. The aim of this study is to clarify the branching patterns of hepatic veins, supra and infra-diaphragmatic course of suprarenal inferior vena cava and its relation with the liver. METHODOLOGY: Between March and May 2008, 103 consecutive autopsy examinations were included in the study. Hepatic vein anatomy was classified according to the Broelsch classification. The anatomic relations of supra-diaphragmatic and infra-diaphragmatic (suprarenal) inferior vena cava were revealed. RESULTS: Majority of subjects have Type a (42.7%) variation. The inferior right hepatic vein was presented alone in 26 and together with middle right hepatic vein in 15 subjects. Most of the phrenic veins were drained to the right-anterior sidewall of inferior vena cava (n=21/25 above the diaphragm and, n=144/306 below the diaphragm). Drainage of the right adrenal vein directly into the right side of the inferior vena cava was found in 82 subjects (80%). Most of subjects had 2 lumbar branches in the posterior sidewall of infradiaphragmatic inferior vena cava (n=92/103). CONCLUSIONS: The proposed classification of hepatic veins and obtained anatomical details from this study provides useful assistance for hepatic surgeons in phases of operative planning and vascular control maneuvers required in liver surgery.


Subject(s)
Hepatic Veins/anatomy & histology , Liver/surgery , Vena Cava, Inferior/anatomy & histology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged
20.
Pediatr Transplant ; 15(3): 281-4, 2011 May.
Article in English | MEDLINE | ID: mdl-21235710

ABSTRACT

FH is a hereditary inherited disorder of cholesterol metabolism. Homozygous form of the disease associates severe form of atherosclerotic disease. Clinicians have been tried to inhibit the progression of the homozygous FH with medical and surgical treatment. We here present three siblings with homozygous FH who were successfully treated with liver transplantation.


Subject(s)
Hyperlipoproteinemia Type II/therapy , Liver Transplantation/methods , Adolescent , Child , Cholesterol/metabolism , Cholesterol, LDL/metabolism , Family Health , Female , Homozygote , Humans , Hyperlipoproteinemia Type II/genetics , Lipids/chemistry , Liver/surgery , Male , Mutation , Time Factors , Treatment Outcome
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