Publications by authors named "Sami Akbulut"

210 Publications

Comment on Operative treatment of hepatic hydatid cysts: A single center experience.

Asian J Surg 2021 Mar 28. Epub 2021 Mar 28.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey.

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http://dx.doi.org/10.1016/j.asjsur.2021.03.004DOI Listing
March 2021

Unusual infectious agents detected in appendectomy specimens: A retrospective analysis of 42 cases.

Turk J Surg 2020 Sep 28;36(3):291-296. Epub 2020 Sep 28.

Inonu University Faculty Of Medicine, Patholgoy, Malatya, Turkey.

Objectives: The aim of this study was to evaluate the clinical and histopathological features of 42 patients with unusual infectious agents detected in their appendectomy specimens.

Material And Methods: Between January 1999 and November 2018, 2.754 patients underwent emergency or incidental appendectomy in our clinic, and their pathology reports were retrospectively reviewed. Unusual infectious agents or eosinophilic infiltration of the appendix were reported in the initial pathological examinations of 57 patients. The pathological slides of these patients were re-examined by histopathologists. The examinations revealed that 15 of these patients had no microscopic findings suggestive of parasitic infections. The remaining 42 patients with unusual appendiceal infectious agents were included into the study.

Results: A total of 42 patients (25 females and 17 males) aged 18 to 75 years were included into this study. While 32 of these patients (76%) underwent emergency appendectomy with a presumed diagnosis of acute appendicitis (AAp), the remaining 10 patients underwent incidental appendectomy for various reasons. Twenty-two patients (52.4%) had histopathological changes consistent with AAp while 20 patients had no evidence of AAp. Histopathological examination revealed infection with Enterobius vermicularis in 38 of the patients, Taenia species in 2, and Ascaris lumbricoides and Actinomyces species in 1 patient each. A total of 24 patients were treated for infections with mebendazole (n = 20), albendazole (n =1), niclosamide (n = 2), and amoxicillin (n = 1).

Conclusion: Unusual infectious agents should be considered as factors potentially triggering AAp, especially in patients living in endemic areas. The appendiceal stump should be inspected for parasite residues.
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http://dx.doi.org/10.47717/turkjsurg.2020.4713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963316PMC
September 2020

Comment on: An infected primary extrapelvic hydatid cyst presenting as perianal abscess.

Surgery 2021 Mar 17. Epub 2021 Mar 17.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1016/j.surg.2021.02.028DOI Listing
March 2021

Comment on the Clinical Utility of Autoantibodies in Patients with Idiopathic Granulomatous Mastitis.

J Invest Surg 2021 Mar 8:1-2. Epub 2021 Mar 8.

Deaprtment of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1080/08941939.2021.1893413DOI Listing
March 2021

New Year's greeting and overview of in 2021.

World J Transplant 2021 Feb;11(2):7-15

Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy.

() was launched in December 2011. While we are celebrating 's 10-year anniversary, we are very proud to share with you that since its first issue, has published 312 articles, which have been cited 2786 times (average cites per article of 9.0). Together with an excellent team effort by our authors, Editorial Board members, independent expert referees, and staff of the Editorial Office, advanced in 2020. In this editorial, we summarize the journal's bibliometrics, including its citation report, published articles in 2020, peer review rate and manuscript invitation metrics, as well as its Editorial Board members and existing problems of . The overall aim of this editorial is to promote the development of in 2021. We appreciate the continuous support and submissions from authors and the dedicated efforts and expertise by our invited reviewers. This collective support will allow us to be even more productive in 2021. In addition, we commit to working with you all to raise the academic influence of over the upcoming year. Finally, on behalf of , we wish you and your families the best for the New Year.
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http://dx.doi.org/10.5500/wjt.v11.i2.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896244PMC
February 2021

Differential diagnosis of the granulomatous appendicitis: Retrospective analysis of 16 cases.

Ulus Travma Acil Cerrahi Derg 2021 Mar;27(2):214-221

Department of Infectious Disease, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: This study aims to present the usability of real-time polymerase chain reaction (PCR) and interferon-gamma release assay (IGRA) in the differential diagnosis of granulomatous appendicitis (GAp), especially in areas where tuberculosis (TB) is endemic.

Methods: Sixteen patients underwent appendectomy with presumed diagnosis of acute appendicitis were retrospectively analyzed for histopathological diagnosis of GAp. Real-time PCR method was used to show the whether presence of DNA of the tubercle bacilli in paraffin-embedded tissue blocks. IGRA test was used to investigate whether tubercle bacilli- specific interferon gamma was present in peripheral blood.

Results: Sixteen patients (male: 10 female: 6) aged between 21 and 82 years were included in this study. All patients had acute appendicitis and three of them also had appendiceal perforation. Histopathologically, necrotizing granulomatous inflammation was detected in all appendectomy specimens. Acid-fast bacilli were not detected in any of the pathology slides stained with Ehrlich-Ziehl-Neelsen. Real-time PCR was studied in paraffin-embedded tissue blocks of all patients with GAp, but the TB bacilli DNA was amplified in only three patients. IGRA test was studied in peripheral blood samples of 12 patients with GAp and results were as follows: negative (n=9), positive (n=2) and indeterminate (n=1).

Conclusion: We believe that the use of anamnesis, histopathological findings, tissue PCR, blood IGRA and clinical findings together are important for differential diagnosis of GAp, especially where TB is endemic. We also suggest that all appendectomy specimens should be sent to the laboratory for histopathological evaluation even if specimens appear macroscopically normal.
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http://dx.doi.org/10.14744/tjtes.2020.98582DOI Listing
March 2021

Therapeutic Effects of Plasmapheresis on Acute Exacerbations of Chronic Hepatitis B Infection.

Cureus 2021 Jan 19;13(1):e12779. Epub 2021 Jan 19.

Gastroenterology and Hepatology, Inonu University, Malatya, TUR.

Objective In this study, we aimed to demonstrate the effectiveness of plasmapheresis therapy in patients with acute exacerbation of chronic Hepatitis B (CHB) infection. Methods We selected 48 patients with acute exacerbation of CHB infection who were treated by plasmapheresis in our intensive care unit between 2009 and 2016. The patients' demographic characteristics and biochemical and hematological parameters, which were recorded before and after plasmapheresis, were assessed, and the effect of plasmapheresis on the course of patients' treatment was examined. The patients were also divided into three groups according to their clinical course (discharged: 24; transplanted: six; exitus: eight). The patients were further divided into four groups and compared based on the underlying causes that led to the exacerbation (spontaneous exacerbation: 25; caused by immunosuppressive drugs: nine; hepatotoxic drugs: six; other agents: eight). Results We observed significant improvements in terms of international normalized ratio (INR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), total bilirubin, direct bilirubin, blood urea nitrogen (BUN), ammonia, and the Model for End-Stage Liver Disease (MELD) score after plasmapheresis therapy. However, there was no significant improvement in hemoglobin (Hb), white blood cell (WBC) count, platelets, albumin, and lactate values. Also, INR, ALP, and ALT values were found to be significantly correlated with transplants and exitus in patients. Conclusion Plasmapheresis therapy is a reliable treatment method that provides clinical recovery and improvement in laboratory parameters in patients with exacerbation of CHB infection.
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http://dx.doi.org/10.7759/cureus.12779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890433PMC
January 2021

Comment on Prognostic Factors in Pediatric Early Liver Retransplantation.

Liver Transpl 2021 Feb 22. Epub 2021 Feb 22.

Deaprtment of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey.

We read the recent article published by Canon Reyes and colleagues with great interest [1]. We would like to share our opinion and criticisms about this valuable work as follows. The authors have defined primary non-function (PNF) as early graft dysfunction without any associated vascular complications. However, the general consensus in the literature suggests that this definition should be limited to clinical characteristics (timing, clinical parameters ) and biochemical parameters of the patients. Primary graft dysfunction (PGD) defines the condition in which the graft dysfunction caused by ischemia reperfusion injury to the liver graft. PGD is divided in to two sub-categories which are early allograft dysfunction (EAD) and PNF.
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http://dx.doi.org/10.1002/lt.26026DOI Listing
February 2021

A Recipient and Donor Both Have COVID-19 Disease. Should We Perform a Liver Transplant?

J Gastrointest Cancer 2021 Feb 18. Epub 2021 Feb 18.

Department of Surgery, Liver Transplant Institute, Inonu University, 44280, Malatya, Turkey.

Coronavirus 2019 (COVID-19) is a new infectious disease that continues to spread globally. There is growing concern about donor-induced transmission of Coronavirus 2 (SARS -CoV-2). For liver transplantation, the COVID-19 PCR test is routine, in addition to epidemiological history and clinical and radiological examination 24-48 h before surgery. One of the liver transplant candidates was found to be infected with COVID-19, as well as the planned donor candidate. Since COVID-19 will be a high-risk operation for both the recipient and the donor, the operation was postponed by giving medical treatment. After the treatment and quarantine process was over, the patient and the donor then had a negative COVID-19 PCR test and the patient received a living donor liver transplant. We present a case of donor and recipient who initially both tested positive for COVID-19. This liver transplantation scenario has not previously been reported in the literature.
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http://dx.doi.org/10.1007/s12029-021-00590-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889703PMC
February 2021

Comment on the management of liver hydatid cyst with cystobiliary communication and acute cholangitis: a 27-year experience.

Eur J Trauma Emerg Surg 2021 Apr 15;47(2):617-618. Epub 2021 Feb 15.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey.

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http://dx.doi.org/10.1007/s00068-021-01608-0DOI Listing
April 2021

Xanthogranulomatous appendicitis: A comprehensive literature review.

World J Gastrointest Surg 2021 Jan;13(1):76-86

Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey.

Background: Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts.

Aim: To review the medical literature on xanthogranulomatous appendicitis (XGA).

Methods: We present a patient with XGA and review published articles on XGA accessed the PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used were "appendix vermiformis," "appendectomy," "acute appendicitis," and "XGA." The search included articles published before May 2020, and the publication language was not restricted. The search included letters to the editor, case reports, review articles, original articles, and meeting presentations. Articles or abstracts containing adequate information about age, sex, clinical presentation, white blood cells, initial diagnosis, surgical approach, histopathological and immunohistochemical features of appendectomy specimens were included in the study.

Results: A total of 29 articles involving 38 patients with XGA, were retrospectively analyzed. Twenty (52.6%) of the 38 patients, aged 3 to 78 years (median: 34; IQR: 31) were female, and the remaining 18 (47.4%) were male. Twenty-five patients were diagnosed with acute appendicitis, ruptured appendicitis, or subacute appendicitis, and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region. Twenty-two of the patients underwent urgent or semi-urgent surgery, and the remaining 16 patients underwent interval appendectomy.

Conclusion: Xanthogranulomatous inflammation rarely affects the appendix vermiformis. It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation. It is often associated with interval appendectomies, and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion. XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
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http://dx.doi.org/10.4240/wjgs.v13.i1.76DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830076PMC
January 2021

Comment on "A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants".

Transplantation 2021 02;105(2):e18

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1097/TP.0000000000003465DOI Listing
February 2021

Re: Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study?

ANZ J Surg 2020 07;90(7-8):1527-1528

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1111/ans.16052DOI Listing
July 2020

Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review.

World J Gastrointest Surg 2020 Dec;12(12):534-548

Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey.

Background: Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue.

Aim: To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery.

Methods: We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study.

Results: A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient.

Conclusion: Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.
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http://dx.doi.org/10.4240/wjgs.v12.i12.534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769742PMC
December 2020

Comment on: Hydatid cyst of the breast: Case report.

Int J Surg Case Rep 2021 Feb 2;79:9-10. Epub 2021 Jan 2.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey.

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http://dx.doi.org/10.1016/j.ijscr.2020.12.087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804338PMC
February 2021

Comment on: Primary hydatid cyst of the adrenal gland: A case report and a review of the literature.

Int J Surg Case Rep 2021 Jan 31;78:340-341. Epub 2020 Dec 31.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey.

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http://dx.doi.org/10.1016/j.ijscr.2020.12.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787940PMC
January 2021

Using the Recipient's Left Gastric Artery for Hepatic Artery Reconstruction in Living Donor Liver Transplantation.

Liver Transpl 2020 Dec 10. Epub 2020 Dec 10.

Department of Surgery and Liver Transplantation Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1002/lt.25966DOI Listing
December 2020

Comment on Minimally Invasive Donor Hepatectomy for Adult Living Donor Liver Transplantation: An International, Multi-Institutional Evaluation of Safety, Efficacy, and Early Outcomes.

Ann Surg 2020 Nov 16. Epub 2020 Nov 16.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1097/SLA.0000000000004281DOI Listing
November 2020

Comment on "The Risk of Going Small: Lowering GRWR and Overcoming Small-For-Size Syndrome in Adult Living Donor Liver Transplantation".

Ann Surg 2020 Nov 16. Epub 2020 Nov 16.

Deaprtment of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.1097/SLA.0000000000004443DOI Listing
November 2020

Comment on the Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis.

Healthcare (Basel) 2020 Nov 5;8(4). Epub 2020 Nov 5.

Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey.

We read the recent article published by Daldal and colleague with great interest [...].
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http://dx.doi.org/10.3390/healthcare8040461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712480PMC
November 2020

Nomenclature of appendiceal mucinous lesions according to the 2019 WHO Classification of Tumors of the Digestive System.

Turk J Gastroenterol 2020 09;31(9):649-657

Department of Surgery and Liver Transplant Institute, İnönü University School of Medicine, Malatya, Turkey.

Background/aims: To analysis the appendiceal mucinous lesions according to the World Health Organization (WHO) 2019 classification of tumors of the digestive system (non-neuroendocrine tumors of the appendix vermiformis)

Materials And Methods: Clinical and histopathological data of 37 patients with histopathologically proven appendiceal mucinous lesion from January 2010 to May 2019 were evaluated retrospectively. Pathology slides were re-evaluated by two pathologists according to the WHO 2019 classification of tumors of the digestive system.

Results: Totally 37 patients (male:19 female: 18) aged 23 to 93 years were analyzed. Majority of the patients (75.7 %) had underwent appendectomy due to preliminary diagnosis of acute appendicitis (n=22) or periappendiceal tumoral lesions (n=9), the others (n=9) underwent incidental appendectomy. Whereas acute appendicitis was histopathologically diagnosed in 16 (43.2%) patients, perforation was diagnosed in 12 (32.4%) patients (perforation without appendicitis=3, perforation with appendicitis=6). According to the initial, pathology reports were prepared as follows: mucocele (n=10), mucinous cystadenoma (n=9), low-grade mucinous neoplasm (n=6), mucinous adenocarcinoma (n=5), mucosal hyperplasia (n=5), hyperplastic polyp (n=1), adenomatous polyp (n=1). On the basis of the WHO 2019 classification, pathology reports were prepared as follows: low-grade mucinous neoplasm (n=17), simple retention cysts (n=6), hyperplastic polyp (n=6), mucinous adenocarcinoma (n=5), ruptured appendiceal diverticula (n=2), sessile serrated lesion (n=1).

Conclusion: The term of appendiceal mucinous lesion, which is recently introduced into medical literature is suitable to distinguish between lesions with and without malignancy potential. The WHO 2019 classification system has been an important step in simplifying the classification of non- neuroendocrine tumors of the appendix vermiformis.
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http://dx.doi.org/10.5152/tjg.2020.20537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577417PMC
September 2020

Fistulization between liver hydatid cyst and gallbladder. A case report and review of the literature.

Ann Ital Chir 2020 May 25;9. Epub 2020 May 25.

The most serious complications of liver hydatid cyst disease are fistulization into biliary tract, compression of adjacent vascular structures, anaphylactic reaction, and perforation. Fistulization between liver hydatid cyst and gallbladder tract is an extremely rare complication with only a few cases reported so far. Herein, we aimed to report a 43-year-old man who was diagnosed as having a cholecysto-hydatid cyst fistula. The patient presented to emergency department with signs and symptoms of cholangitis. His biochemical tests revealed elevated AST, ALT, GGT, and bilirubin levels. The radiological examinations (CT, MRCP) revealed a lesion consistent with hydatid cyst (Hydatid cyst ELISA IgG +) with an approximate size of 90*65 mm, which was posterolateral to the gallbladder and fistulized into the latter. In order to relieve pressure within the biliary tract, ERCP with sphincterotomy was performed. He was taken to the operating room a few days later. After draping sponges soaked with 3% NaCl onto the surgical field, near-total pericystectomy + omentopexy + cholecystectomy + common bile duct exploration + T-tube drainage were performed. Bile duct opening to the posterior wall of the cyst was sutured with a prolene suture. Albendazole treatment was started on first postoperative day. After taking a cholangiogram on 21st postoperative day, the T-tube was removed without any complication. In conclusion, cholecysto-hydatid cyst fistula is an extremely rare complication of hydatid cyst disease even in endemic regions. The gold standard for the diagnosis is the combined use of characteristics of clinical presentation, biochemical parameters, and radiological studies. Treatment plan is designed on the basis of the relationship of a fistulized cyst with other bile ducts. KEY WORD: Cholecysto-Hydatid Cyst Fistula, Gallbladder, Hydatid Cyst, Liver.
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May 2020

Evaluation of liver transplant recipients underwent incidental appendectomies.

North Clin Istanb 2020 11;7(4):386-390. Epub 2020 Jun 11.

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

Objective: To assess the clinicopathological features of liver transplant recipients underwent incidental appendectomies.

Methods: Between September 2002 and July 2019, 2500 patients underwent liver transplantation at our Liver Transplant Institute, including 38 (24 males, 14 females) who also underwent incidental appendectomies. Incidental appendectomies were performed on 24 patients during recipient hepatectomies and on 14 during relaparotomies due to various surgical conditions. The following patient parameters were retrospectively evaluated: age, sex, underlying liver disease, liver transplant type, appendectomy indication, appendix length (mm) and diameter (mm), presence of appendicitis, and histopathological findings.

Results: The 38 patients who underwent incidental appendectomies had a mean age of 18.3±21.7 (range: 1-66) years and median appendix lengths and diameters of 55 (range: 19-90) mm and 6 (range: 4-20) mm, respectively. Histopathologically, the appendectomy specimens were classified as follows: vermiform appendix (n=16), lymphoid hyperplasia (n=13), acute appendicitis (n=3), fibrous obliteration (n=3), perforated appendicitis (n=1), mucinous cystadenoma (n=1), and appendiceal serosa invasion by sigmoid adenocarcinoma (n=1). There were no postoperative complications, including wound infections, abscesses, or leakage from the appendiceal stumps, related to the incidental appendectomies.

Conclusion: This study demonstrated that incidental appendectomies can be successfully performed in immunosuppressed patients. However, additional studies are required to confirm these results.
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http://dx.doi.org/10.14744/nci.2019.92678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521089PMC
June 2020

Comment on: clinical study on surgical treatment of granulomatous lobular mastitis.

Gland Surg 2020 Aug;9(4):1065-1068

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.

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http://dx.doi.org/10.21037/gs-20-492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475363PMC
August 2020

Liver transplant versus non-liver transplant patients underwent appendectomy with presumed diagnosis of acute appendicitis: Case-control study.

Ulus Travma Acil Cerrahi Derg 2020 Sep;26(5):705-712

Department of Surgery and Liver Transplant Institute and, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: This study aims to compare liver transplant and non-liver transplant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis.

Methods: Demographic and clinicopathological features of 13 liver transplant recipients (transplant group) who underwent posttransplant appendectomy with a presumed diagnosis of acute appendicitis were compared with the features of 52 non-liver transplant patients (non-transplant group). They underwent appendectomy with a presumed diagnosis of acute appendicitis during the same time period. The transplant group was matched at random in a 1: 4 ratio with the non- transplant group. While the continuous variables were compared using the Mann Whitney-U test, categorical variables were compared with Fisher's exact test. A p-value of less than 0.05 was considered statistically significant.

Results: A total of 65 patients aged between one year and 84 years were included in this study. While the age of the 52 patients (32 male and 20 female) in the non- transplant group ranged from 17 years to 84 years, the age of the 13 patients (nine male and four female) in the transplant group ranged from one year to 64 years. Statistically significant differences were noted between both groups concerning WBC (p=0.002), neutrophil (p=0.002), lymphocyte (p=0.032), platelets (p=0.032), RDW (p=0.001), CRP (p=0.009), PNR (p=0.042), WNR (p=0.03), and appendiceal length (p<0.001). The negative appendectomy rate was relatively higher in transplant than the non-transplant group but this difference was not statistically significant (30.8% vs. 21.2%; p=0.477). Perforated acute appendicitis occurred more frequently in the transplant group; however, this difference was not statistically significant (30.8% vs. 9.6%; p=0.070).

Conclusion: WBC and neutrophil were lower in the LT group; however, the CRP and RDW were higher in the LT group. Further, perforation and negative appendectomy rates were higher in the LT group, although this difference was not statistically significant.
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http://dx.doi.org/10.14744/tjtes.2020.52368DOI Listing
September 2020

Intraperitoneal rupture of the hydatid cyst disease: Single-center experience and literature review.

Ulus Travma Acil Cerrahi Derg 2020 Sep;26(5):789-797

Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: The primary aim of this study was to present our experience on intraperitoneal rupture of the hydatid cyst in guidance of literature data.

Methods: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with an indication of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retropectively.

Results: Among the 29 patients with an age range of from 16 to 79 years ( median= 39, IQR=25.5), 16 were male (55.2%) and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in 7 (24.13%) (2 of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median= 90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in right lobe. Among the ruptured cysts of liver, 20 (80%) of them underwent conservative surgery (partial pericystectomy etc), remaining 5 patients (20%) underwent a radical surgical treatment (pericystectomy etc). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence.

Conclusion: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock cases require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity account for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.
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http://dx.doi.org/10.14744/tjtes.2020.32223DOI Listing
September 2020

Effect of HBV-HDV co-infection on HBV-HCC co-recurrence in patients undergoing living donor liver transplantation.

Hepatol Int 2020 Sep 7;14(5):869-880. Epub 2020 Sep 7.

Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.

Purpose: To evaluate the effect of hepatitis D virus (HDV) on hepatitis B virus-hepatocellular carcinoma (HBV-HCC) co-recurrence in patients undergoing living donor liver transplantation (LDLT) for HBV alone or HBV-HDV coinfection.

Methods: Between 2002 and 2019, 254 HBV-HCC patients underwent LDLT. The patients were divided into two groups after the application of the exclusion criteria: HBV-HCC (Group B; n = 163) and HBV-HDV-HCC (Group D; n = 31). First, the B and D groups were compared in terms of demographic and clinical parameters. Second, patients with (n = 16) and without (n = 178) post-transplant HBV-HCC co-recurrences were grouped and compared in terms of the same parameters.

Results: Although the risk of HBV-HCC co-recurrence in group D was 4.99-fold higher than in group B, the risk of HBV recurrence alone in group D was 12.5-fold lower than in group B. The AFP (OR = 4.4), Milan criteria (beyond; OR = 18.8), and HDV (OR = 8.1) were identified as the independent risk factors affecting post-transplant HBV-HCC co-recurrence. The Milan criteria (OR = 2.1) and HBV-HCC co-recurrence (OR = 10.9) were identified as the risk factors affecting post-transplant mortality. HBV-HCC co-recurrence developed in 26.5% of patients in Group B and 100% in Group D (OR = 40; p = 0.001). HCC recurrence alone developed in 10% of patients without HBV recurrence in group B and 0% of patients without HBV recurrence in group D (OR = 5.7).

Conclusion: This study showed that the risk of HBV recurrence alone was reduced by 12.5-fold in the presence of HDV; however, the HCC recurrence occurred in all patients with HDV when HBV recurrence developed.
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http://dx.doi.org/10.1007/s12072-020-10085-3DOI Listing
September 2020

Splenic Artery Transposition for Hepatic Artery Reconstruction during Liver Transplantation: Is it the Best Choice for Adequate Arterial Inflow in Extraordinary Conditions?

Liver Transpl 2020 Sep 7. Epub 2020 Sep 7.

Department of Surgery and Liver Transplantation Institute, Inonu University, Faculty of Medicine, 44280, Malatya, Turkey.

Obtaining partial allografts and performing arterial reconstruction in living donor liver transplantation (LDLT) is technically demanding. The risk of hepatic artery thrombosis (HAT) remains high in LDLT due to the small caliber of the arteries. The graft and the recipient hepatic artery (HA) cannot be directly anastomosed in certain cases due to narrow diameter or short graft HA.
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http://dx.doi.org/10.1002/lt.25884DOI Listing
September 2020

Comment on pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality.

World J Gastroenterol 2020 Aug;26(30):4564-4566

Deaprtment of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey.

Since the first successful liver transplantation was performed five decades ago, pediatric liver transplantation has become the gold standard treatment choice for pediatric liver disease, including metabolic diseases, liver tumors, and some acute liver failure. With improvements in immunosuppression, surgical techniques, and postoperative medical care, long-term outcomes of patients after liver transplantation have markedly improved, especially in pediatric patients.
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http://dx.doi.org/10.3748/wjg.v26.i30.4564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438188PMC
August 2020

Do We Need to Be Limited by Matching Milan Criteria for Survival in Living Donor Liver Transplantation?

J Gastrointest Cancer 2020 Dec;51(4):1107-1113

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 244280, Malatya, Turkey.

Purpose: Hepatocellular carcinoma (HCC) is the second leading cause of cancer deaths and the 7th most common cancer. It has two characteristic features: being advanced stage at diagnosis and association with liver cirrhosis. Liver transplantation (LT) offers the only curative option to treat both components of the disease. The Milan criteria have been extensively used for selecting patients with HCC for LT. However, using Milan criteria, we can only transplant 30% of the patients. The aim of the present review is to evaluate the role of LT in HCC beyond the Milan criteria.

Methods: We evaluated the studies that have introduced extended criteria to select patients with HCC beyond the Milan criteria. We evaluated the outcomes in terms of disease-free survival rates and HCC recurrences.

Results: There are patients with tumors that are beyond Milan criteria that could benefit from LT. Selection of these patients has paramount importance in the era of living donor liver transplantation. Current expanded criteria depend on either the bulk of the tumor or the additional surrogate markers of tumor biology such as alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP).

Conclusion: There is no ideal marker or an extended criterion for selecting patients with HCC beyond the Milan criteria and it needs further research to find an effective biomarker that has prognostic significance to select patients with advanced tumors.
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http://dx.doi.org/10.1007/s12029-020-00482-0DOI Listing
December 2020