The results of SGLT-2 inhibitors use in kidney transplantation: 1-year experiences from two centers.

PURPOSE: Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) administration is associated with some concerns in regard to the increased risk of genital and urinary tract infections (UTI) in kidney transplant recipients (KTR). In this study, we present the results of SGLT-2i use in KTR, including the early post-transplant period. METHODS: Participants were divided into two groups: SGLT-2i-free diabetic KTR (Group 1, n = 21) and diabetic KTR using SGLT-2i (Group 2, n = 36). Group 2 was further divided into two subgroups according to the posttransplant prescription day of SGLT-2i; < 3 months (Group 2a) and ≥ 3 months (Group 2b). Groups were compared for development of genital and urinary tract infections, glycated hemoglobin a1c (HgbA1c), estimated glomerular filtration rate (eGFR), proteinuria, weight change, and acute rejection rate during 12-month follow-up. RESULTS: Urinary tract infections prevalence was 21.1% and UTI-related hospitalization rate was 10.5% in our cohort. Prevalence of UTI and UTI-related hospitalization, eGFR, HgbA1c levels, and weight gain were similar between the SGLT-2i group and SGLT-2i-free group, at the 12-month follow-up. UTI prevalence was similar between groups 2a and 2b (p = 0.871). No case of genital infection was recorded. Significant proteinuria reduction was observed in Group 2 (p = 0.008). Acute rejection rate was higher in the SGLT-2i-free group (p = 0.040) and had an impact on 12-month follow-up eGFR (p = 0.003). CONCLUSION: SGLT-2i in KTR is not associated with an increased risk of genital infection and UTI in diabetic KTR, even in the early posttransplant period. The use of SGLT-2i reduces proteinuria in KTR and has no adverse effects on allograft function at the 12-month follow-up.

Laparoscopic Live Donor Nephrectomy: Single-Center Experience of 200 Consecutive Cases.

Background: Renal transplantation is the ideal treatment method for end-stage renal disease. Since deceased organ donation rates cannot meet the demand, live donor kidney transplantation (LDKT) is commonly performed worldwide. Laparoscopic donor nephrectomy (LDN) is currently the most commonly preferred minimally invasive donor nephrectomy technique. However, experienced surgeons should perform this procedure since the safety of the live donor is the priority in transplant practice. In this study, we aimed to investigate this procedure's safety at the hands of a surgeon during the transition period from open donor nephrectomy (ODN) to LDN. Methods: Data of the donors and recipients who underwent LDN and LDKT in Ankara Medicana Hospital between 2016 and 2019 were included in this study. Demographic, surgical, and immunological data of the donors and recipients were collected retrospectively. Donor data, including duration of surgery, warm ischemia time (WIT), complication rates, duration of hospital stay, and recipient data such as patient and graft survival rates, were compared with the published literature. Results: Two hundred donors and 200 recipients were included. The complication rate, surgical time, WIT at the donor site, and 1- and 3-year patient and graft survival rates were all comparable with the literature. Survival rates were irrespective of the relationship status of the donors with recipients. Conclusions: The LDN procedure can be safely performed by a surgeon with extensive laparoscopic surgery experience in general surgery cases and ODN.

Single Stapler Technique for Vascular Control in Laparoscopic Donor Nephrectomy.

BACKGROUND: Recent advancements in surgical instruments, energy sources, vascular staplers, and increased experience altogether led to several modifications in the laparoscopic donor nephrectomy (LDN) technique. In the conventional approach, the renal artery and vein are divided separately by vascular stapling. This study aimed to evaluate the safety and feasibility of using single vascular stapling technique for dividing the renal artery and vein simultaneously. MATERIALS AND METHODS: Patients who underwent LDN performed by the same surgeon between January 2018 and January 2020 were included. Demographic data, body mass index, number of arteries and veins, vascular division technique, estimated blood loss, surgical time, warm ischemia time, surgical complications, and length of hospital stay were recorded. Descriptive statistics were used to describe the characteristics of the dataset. RESULTS: A total of 196 donors were included in the cohort. The mean age was 44.5 years (19-80 years, standard deviation: 13.2). A total of 132 donors (82.65%) underwent left-sided LDN, and 34 (17.35%) underwent right-sided LDN. The mean surgical time and warm ischemia time were 68.4 ± 24.7 (32-116) and 2.8 ± 1.2 (1.6-4.0) minutes, respectively. Two cases were converted to open donor nephrectomy (1.02%). The single stapling technique was successfully performed in 168 (85.7%) donors with a single renal artery and vein. CONCLUSION: Single stapling for the concurrent division of the renal artery and vein in the setting of LDN seems to be a safe and feasible approach. It also has the potential to shorten warm ischemia time and reduce the cost of LDN.

Kidney Transplantation: Single-Center Experience.

OBJECTIVES: This study aims to present our cadaveric and living related donor kidney transplantation experience. METHODS: Between September 2009 to February 2015, renal transplantations were performed to 417 patients in Medicana International Ankara Hospital organ transplantation center. RESULTS: Of the patients, 231 were male, and 186 were female. Of the transplantations, 385 came from a living donor, and 32 came from a cadaver donor. The degree of kinship; 324 (77.7%) transplants were received from relatives, 5 (14.1%) with approval by the ethical committee, 32 (7.7%) from cadavers and two (0.5%) with cross-matching. Post-Operative Complications in recipients; lymphocele was found within the graft in two cases, urinary anastomosis leakage was detected in two cases, wound infection was detected in four cases, and hematoma in one case. We had no mortality in post operative or early follow up periods. CONCLUSION: The morbidity and mortality rates in our organ transplantation center, regarding renal transplantations, are consistent with the literature.

Transplantation of a horseshoe kidney from a living donor using stapler for transsection.

Although it rather became a routine procedure to evaluate and use a cadaveric horseshoe kidney, using one from a living donor is quite rare. In this paper, we present methods we used during such a case which may benefit the procedures in the future. A 29-year-old female patient was considered for transplant and only viable living donor was her 59-year-old mother. Dynamic computed tomography revealed horseshoe anomaly with one renal artery and one renal vein for each side, a long but thin isthmus connecting lower poles with no visible arterial supply. Descending urography showed no connecting caliceal system. Donor nephrectomy was performed and isthmus separation was carried out with vascular stapler. Recipient was discharged on the 6th day with no complications. Patient was followed up for 6 months with normal creatinine levels. When properly assessed before the surgery, using a horseshoe kidney is not so challenging as thought.

Five right hepatic vein reconstructions using the autologous saphenous vein in the right lobe living-donor liver transplant: a case report.

In living-donor liver transplant, hepatic venous anomalies are not rare. Despite numerous techniques developed over the years, the best way of establishing a patent and durable hepatic drainage system remains controversial. We present a case where we successfully reconstructed 5 hepatic venous structures with a combination of direct anastomosis and saphenous vein interposition. Careful planning before surgery, and a customized approach for the patient on the back table, brought about successful results.

The therapeutic results after laparoscopic hellers' myotomy and partial fundoplication for achalasia.

BACKGROUND/AIMS: The aim of this prospectively designed study was to postoperatively assess the subjective complaints or relief of symptoms of achalasia patients' who underwent Laparoscopic Hellers' myotomy and partial fundoplication in our clinic. MATERIALS AND METHODS: 40 patients were enrolled in the study that underwent Laparoscopic Hellers' myotomy and partial fundoplication (toupet or dor) for idiopathic achalasia in our clinic between years 2002 and 2012. Postoperative follow-up was conducted at 1st, 3rd. and 6th months in each patient for symptoms and a follow-up questionnaire was completed which is classified according to Vantrappen and Hellemans' modified classification. RESULTS: 34 patients underwent Laparoscopic Heller myotomy with Toupet fundoplication whereas 6 patients underwent Laparoscopic Heller myotomy with Dor fundoplication. After 3 months, 2 patients' complaints of dysphagia were detected (5%). In the 6 month follow-up, one of these two patient dysphagia symptoms got worsened and a balloon dilatation was performed (2.5%). In the other one no clinical reason was found for dysphagia and medical therapy was initiated. In the 6 th month only three patients (7.5%) were presented with gastroesophageal reflux which successful medical treatment was initiated. CONCLUSION: Laparoscopic myotomy with fundoplication seems to be the most effective surgical technique that provides both short and long term symptomatic relief with released hospitalization time and less complication rate.

Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study.

BACKGROUND: The risk of fistula formation is a major concern after incision and drainage of an anorectal abscess. OBJECTIVE: Our objective was to the test the effects of antibiotic treatment on fistula formation after incision and drainage of anorectal abscesses. DESIGN: Randomized, placebo-controlled, double-blind study. SETTING: Multicenter trial at 3 teaching hospitals in Turkey. PATIENTS: Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility. Exclusion criteria included penicillin allergy, antimicrobial agent usage before enrolment, other infection, previous anorectal surgery, inflammatory bowel disease, suspicion of Fournier gangrene, secondary and recurrent anorectal abscesses, anal fistula at time of the surgery, immune compromised states, and pregnancy. INTERVENTION: Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage. MAIN OUTCOME MEASURES: The primary end point was rate of anorectal fistula formation at 1-year follow-up. RESULTS: : Of 334 patients assessed for eligibility, 183 entered the study (placebo, 92; antibiotics, 91). Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75) with a mean age of 37.6 years; 118 patients (78.1%) were men. Overall, 45 patients (29.8%) developed anal fistulas during 1-year follow-up. Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044). Risk of fistula formation was increased in patients with ischiorectal abscess (odds ratio, 7.82) or intersphincteric abscess (odds ratio, 3.35) compared with perianal abscess. CONCLUSION: Antibiotic treatment following the drainage of an anorectal abscess has no protective effect regarding risk of fistula formation.

Suprarenal symplastic leiomyoma of the inferior vena cava.

We report on a case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. En bloc excision of the tumor with the right adrenal gland and the involved segment of the vena cava was carried out. Histopathological work-up of the tumor revealed smooth muscle fibers and marked nuclear pleomorphism consistent with symplastic leiomyoma. This case report presents a distinct histological variant of the rarely seen primary smooth muscle tumor of the inferior vena cava.

Effects of aqueous green tea extract on activities of DNA turn-over enzymes in cancerous and non-cancerous human gastric and colon tissues.

AIM: The purpose of this study was to investigate possible effects of green tea extract on the activities of DNA turn-over enzymes, namely adenosine deaminase (ADA) and xanthine oxidase (XO) in gastric and colon tissues from patients with stomach and colon cancer. MATERIALS AND METHODS: Six cancerous and 6 non-cancerous adjacent human gastric tissues, and 7 cancerous and 7 non-cancerous adjacent colon tissues obtained surgically were treated with aqueous green tea extract at 3 different concentrations for 1 hour, and then ADA and XO activities were measured. RESULTS: In all of the tissues, XO activities were found to elevate after treatment with green tea extract. Additionally, ADA activity was found to be inhibited in the cancerous gastric tissues by the green tea extract. Elevated XO and reduced ADA activities due to treatment with green tea extract may lower salvage pathway activity and lead to inhibition in carcinogenesis. CONCLUSION: Our data suggest that green tea may support the medical treatment of stomach and colon cancer.

Trocar site hernia after laparoscopic cholecystectomy.

AIM: The aim of this study was to elucidate the influence of pre and perioperative factors on the development of trocar site hernia after a laparoscopic cholecystectomy procedure. PATIENTS AND METHODS: A total of 776 patients who underwent a laparoscopic cholecystectomy procedure in our Department of General Surgery between 1999 and 2004 were assigned as the study group. The control group included patients without trocar site hernias after a cholecystectomy. The effect of five variables, including gender, age, body mass index (BMI), operation duration, and the type of cholecystitis on the development of a trocar site hernia after a laparoscopic cholecystectomy was assessed by univariable and multivariable models. RESULTS: In the univariate analysis, female gender (P = 0.021), older age (P < 0.001), higher BMI at the time of surgery (P < 0.001), and an increased duration of surgery (P < 0.001) have been found to increase the likelihood of a trocar site hernia formation. However, in the multivariable model, the gender was not a significant variable to influence the development of this complication. CONCLUSIONS: The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.

Cannula site insertion technique prevents incisional hernia in laparoscopic fundoplication.

INTRODUCTION: Incisional hernia is a common surgical problem encountered after laparotomies. The so-called trocar-site or port-site hernia is a type of incisional one that occurs after laparoscopic procedures. It has an incidence range between 0.1% and 3%. OBJECTIVE: To evaluate our patients who underwent laparoscopic Nissen fundoplication for presence of trocar-site hernia. PATIENTS AND METHODS: This study included 405 patients who underwent laparoscopic Nissen fundoplication in Ankara University, Faculty of Medicine, Department of General Surgery, Turkey. The patients were evaluated by physical examination and anterior abdominal wall ultrasound (US). RESULTS: Trocar-site hernia was not detected in any of our cases either by physical examination or by US. CONCLUSIONS: Trocar-site hernia is a rare complication of laparoscopy. It occurs at the trocar insertion site with a diameter of 10 mm or more in adult patients. Trocar insertion away from the midline can decline the incidence.