Pancreas transplantation: experience of single center.

BACKGROUND: Diabetes is the most common cause of renal failure. In patients with type I diabetes and renal failure,dialysis and insulin therapy can prevent a clinical context that causes rapid death, but they are insufficient to prevent longterm complications. Pancreas and islet cell transplantation inpatients with type I diabetes are the only curative treatment and have recently become more common. METHODS: Between December 2006 and August 2010 a total of 10 patients underwent pancreas transplantation. The patient's data were analysed retrospectively. RESULTS: 10 patients and their data were included in this study. Six patients were male and 4 patients were female. All patients are still alive, with functional grafts. CONCLUSIONS: Pancreas transplantation is the most effective treatment for patients with type I DM. This paper discusses the feasibility of this process and presents the experience of Ankara University in pancreas transplantation.

Single-port laparoscopic surgery by use of a surgical glove port: initial experience with 25 cases.

BACKGROUND: single-port laparoscopic surgery has gained popularity over the last decade. This technique is used for several surgical procedures. This paper documents a new and cheaper access method known as "surgical glove port" or "homemade single-port", and describes our initial experience with 25 cases. METHOD: Eleven cholecystectomies, eight totally extraperitoneal inguinal hernia repairs, three splenectomies, two gastric wedge resections, and one anti-reflux procedure were performed. RESULTS: Twenty-four procedures out of twenty-five were completed without conversion to open or multiple port techniques. An individual patient who had both cholelithiasis and gastrointestinal stromal tumor underwent both cholecystectomy and gastric wedge resection in the same session with surgical glove port technique. In another case two additional 5-mm incisions were made for hemostasis. The additional operation was required and performed by using surgical glove port for a hiatal hernia repair case, because of postoperative hemorrhage. CONCLUSION: Single-port laparoscopic surgery is an applicable technique for plenty of surgical procedures. Also, surgical glove port is a newer technique and some initial experience shave already published all over the world. Surgical glove port has advantages such as cost-effectiveness, easy and safe port implantation and specimen extraction. SGP can also be used for treating post-operative complications.

Single stapler technique in laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is usually performed with at least 2 separate vascular staplers for division of the renal artery and vein. However, we used a single stapler regardless of the number of renal arteries and veins. Furthermore, the graft was quickly retrieved by hand without using an extraction bag using our technique. Herein we have presented our experience with LDN of grafts with single or multiple renal arteries and/or veins using a single stapler and hand removal. METHODS: We reviewed demographic data, operative and warm ischemia times, postoperative complications, and graft function. RESULTS: Between December 2005 and September 2009, we performed 85 cases with 1 renal artery (group LDN-1), 8 cases with two renal arteries (group LDN-2), and 5 cases with 3 or more renal arteries (group LDN-3). The demographic data among the groups were similar. The mean operative time was significantly longer among groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared with LDN-1 (76.1 ± 9.3 minutes; P < .001). Similar results were observed with respect to warm ischemia times. There were no significant differences related to graft function and outcomes among these groups. CONCLUSION: The single stapler and hand removal technique was safe, technically feasible, and cost effective regardless of the number of renal arteries and veins. This technique removes the necessity of additional staplers and extraction bags, lowers the operative and warm ischemia times, and thus decreases the cost.

Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN). METHODS: We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life. RESULTS: Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale. CONCLUSION: Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.

Living-donor hepatectomy.

BACKGROUND: Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy. METHODS: We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications. RESULTS: During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients. CONCLUSIONS: Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.

The effects of polypropylene mesh on femoral artery and femoral vein in mesh repair.

PURPOSE: Since the first description, the use of polypropylene mesh in hernia repair has gained wide acceptance. The aim of this study was to assess whether polypropylene mesh implantation has any effects on femoral blood vessels. METHODS: A 0.5 × 1.0 cm polypropylene mesh was inserted into the rat femoral artery and vein on the right side. After 14, 28 and 90 days, the rats were reoperated. The meshes were excised for histological processing. Blood flow in the dorsum of the foot skin, femoral artery and vein were measured in all groups before mesh implantation and at 14, 28, and 90 days after mesh implantation. RESULTS: Following placement of mesh graft on vascular structures, inflammation and fibrosis developed to a varying degree depending on the time elapsed. On the other hand, fibrosis did not change the histological structure of vessels. There was a decrease in both arterial and venous circulation due to the pressure of the graft. CONCLUSIONS: These data suggest that fibrosis due to mesh graft can negatively affect blood flow in vessels due to mechanical pressure.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst.

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Partial cholecystectomy is a safe and efficient method.

AIM: When there is excess inflammation, fibrosis and portal hypertension around gall bladder or in presence of Mirizzi syndrome, bile ducts and hepatic artery may be possibly damaged during dissection of Calot triangle. In this study, we examined safety and efficiency of partial cholecystectomy operation which we perform when dissection of Calot triangle is challenging. METHOD AND MATERIAL: Eighteen patients who were undergone partial cholecystectomy in our clinic between 1996 and 2008 were retrospectively evaluated. Mean age of patients was 66 years (range: 55-88 years) and ratio of male/female was 2/1 (12 men, 6 women). Fourteen patients were undergone general anesthesia, whereas 4 patients were operated under epidural anesthesia. Partial cholecystectomies were performed by right subcostal incision in 16 patients and by right paramedian incision in 2 patients. RESULTS: No intra-operative or early post-operative mortality was found among patients. Post-operative subhepatic abscess occurred in one patient (5.5%) and superficial wound site infection occurred in 4 patients (22,2%). Controlled bile fistula occurred in early post-operative period in two patients (11.1%) and fistula spontaneously closed without requiring additional surgical procedure. Escherichia coli were most common microorganism found in bile culture. Mean hospitalization period of patients was 8 days (range: 15-14 days) and mean follow-up period was 80 months (8-150 months). During follow up, hepatobiliary ultrasonography could be re-performed in 8 patients and no new stone formation was observed. In 7 patients, it was understood verbally that no postoperative gastrointestinal symptoms were present. CONCLUSION: Where dissection of Calot triangle is changeling, partial cholecystectomy can be safely and efficiently performed.