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Karakaya MF, Er E, Kırımker O, Gümüşsoy M, Bodakçi E, Özercan M, Doğanay Erdoğan B, Gökcan H, Koloğlu M, Karayalçın K, Yurdaydın C, Tüzüner A, Haznedaroğlu S, Çınar K, Özkan H, Idilman R, Idilman R. Management of Biliary Complications in Liver Transplant Recipients with Duct-To-Duct Anastomosis: A Single-Center Experience. Turk J Gastroenterol 2023; 34:177-181. [PMID: 36843302 PMCID: PMC10081117 DOI: 10.5152/tjg.2023.22724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND The aims of this study were to investigate biliary complications in liver transplant recipients with choledochocholedocho stomy anastomosis, to identify the risk factors for the development of such complications, and to evaluate the success of endoscopic approaches in liver transplant recipients. METHODS Between January 2013 and May 2021, a total of 238 patients with liver diseases underwent liver transplantation: 174 recipients undergoing choledochocholedochostomy anastomosis were included in the analysis. RESULTS Their median age was 54.0 years. The median posttransplant follow-up period was 29 months. Hepatitis B virus infection (33%) was the most common indication for liver transplantation. Most patients (87%) received living donor liver transplantation. The overall prevalence of posttransplant biliary complications was 31%. Anastomotic biliary strictures were the most common biliary complications (72%), followed by biliary leakage (13%). The median time between endoscopic retrograde cholangiography and liver transplantation was 4 months, with a mean of 3 ± 1.6 sessions. Endoscopic retrograde cholangiography-guided drainage and balloon dilation with or without stent placement was the most common treatment modalities for recipients with biliary strictures. The overall success rate of endoscopic treatment modalities was 83.3%, with 65% of the recipients exhibiting complete biochemical and endoscopic responses. The response did not differ significantly between living donor liver transplantation and cadaveric donor liver transplant recipients (P > .05). Three recipients required revision surgery for biliary complication repair. Six patients died due to biliary sepsis. CONCLUSION Biliary stricture and leakages were the most common biliary complications after liver transplantation. Endoscopic treatment was successful in most recipients.
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Affiliation(s)
| | - Erdem Er
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mesut Gümüşsoy
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emin Bodakçi
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mubin Özercan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Hale Gökcan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koloğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cihan Yurdaydın
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selçuk Haznedaroğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kubilay Çınar
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özkan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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Erkoç SK, Kırımker EO, Büyük S, Baskan EB, Yılmaz AA, Balcı D, Karayalçın K, Bayar MK. Reducing Risk for Acute Kidney Injury After Living Donor Hepatectomy by Protocolized Fluid Restriction: Single-Center Experience. Transplant Proc 2022; 54:2243-2247. [PMID: 36088129 DOI: 10.1016/j.transproceed.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a potential complication after restricted fluid therapy for major surgery. The aim of this study was to evaluate the incidence of AKI for living liver donor hepatectomy in which applied intraoperative protocolized fluid restriction was used targeting a low central venous pressure (CVP) level with high pulse pressure variation (PPV) and systolic pressure variation (SPV). MATERIAL AND METHODS Living liver donors were admitted for this retrospective observational study. Low CVP <5 mm Hg with high PPV<20% and SPV<15% were the targets of the clinical protocol to reduce intraoperative blood loss via protocolized fluid management until the end of the hepatic parenchymal division. KDIGO criteria were used for AKI definition. The SPSS version 11.5 program was used for statistical analysis. RESULTS The study included 130 patients, 79 (60.8%) men and 51 (39.2%) women, with from 18 to 58 years of age. Donors underwent right and left lobe hepatectomies (116 and 14, respectively). The baseline CVP, the lowest CVP of hepatectomy, and the highest CVP measured after hepatectomy were 7.45 ± 2.41, 4.28 ± 1.12, 7.67 ± 2.09 mm Hg, respectively. Only 4 patients with right lobe hepatectomy developed AKI stage I (3.1%) in the first 24 hours. The 4 patients were recovered at 48 hours postoperatively. CONCLUSION This study demonstrated that a CVP target of <5 mm Hg and high PPV/SPV via a simple fluid management modality with protocolized-fluid restriction until the procurement may not cause AKI in living liver donors in a closed follow-up anesthesia approach.
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Affiliation(s)
| | - Elvan Onur Kırımker
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Sevcan Büyük
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Elif Beyza Baskan
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Ali Abbas Yılmaz
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Deniz Balcı
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Kaan Karayalçın
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Mustafa Kemal Bayar
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
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Duman B, Herdi O, Sayar-Akaslan D, Onur Kırımker E, Çolak B, Ağtaş-Ertan E, Çakar G, Hasanlı J, Kocaay AF, Tüzüner A, Koloğlu M, Karayalçın K, Doğanay-Erdoğan B, Balcı D, Kumbasar H, Iacoviello BM. Live Donor Assessment Tool (LDAT): A Turkish validity and reliability study. Turk J Gastroenterol 2021; 31:917-922. [PMID: 33626005 DOI: 10.5152/tjg.2020.19980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS Psychosocial and psychiatric evaluations are crucial components of the assessment of a live donor candidate. The Live Donor Assessment Tool (LDAT) was developed for this purpose. This study aims to evaluate the validity and reliability of the Turkish version of LDAT. MATERIALS AND METHODS 132 live kidney or liver donor were referred to assess their psychosocial/psychiatric appropriateness for donation and were randomized for clinical evaluation as usual or with LDAT. The internal consistency of LDAT was measured by Chronbach's alpha coefficient. Inter-rater reliability was measured by using Spearman's correlation coefficient. The potential validity of LDAT was assessed by comparing LDAT scores to clinical decisions. The Mann-Whitney U test was used to compare LDAT scores across two clinically classified groups (acceptable/declined). Logistic regression was performed using LDAT scores to predict the clinical decision. RESULTS The Turkish version of LDAT items demonstrate good internal consistency (α=0.773). Inter-rater reliability of LDAT demonstrated strong correlation (ICC=0.72). LDAT scores differentiated the accepted/declined groups, and strongly predicted the clinical decision. With a cut-off score of 60.5, LDAT was found to have high sensitivity and specificity. CONCLUSION The Turkish version of LDAT was found to be a valid and reliable tool. LDAT could be an appropriate tool to assess live donor candidates.
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Affiliation(s)
- Berker Duman
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Oğuzhan Herdi
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Damla Sayar-Akaslan
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | | | - Burçin Çolak
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Ece Ağtaş-Ertan
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Gülsüm Çakar
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Jamal Hasanlı
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Akın Fırat Kocaay
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Koloğlu
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | | | - Deniz Balcı
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Kumbasar
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Brian M Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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Kuloglu Z, Balcı D, Haskoloğlu ZŞ, Kendirli T, Bingöl-Koloğlu M, Tuna-Kırsaçlıoğlu C, Bal S, Selbuz S, Kırımker O, Savaş B, Altuntaş C, Güner ŞN, Can ÖS, Karayalçın K, Doğu F, Kansu Tanca A, İkincioğulları A. Allogeneic hematopoietic stem cell and liver transplantation in a young girl with dedicator of cytokinesis 8 protein deficiency. Pediatr Transplant 2019; 23:e13545. [PMID: 31297914 DOI: 10.1111/petr.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/14/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022]
Abstract
DOCK8 deficiency is a rare inherited combined immunodeficiency, caused by mutations in the DOCK8 gene. We describe a case with DOCK8 deficiency associated with severe CLD in whom orthotopic LT was performed successfully after allogeneic HSCT. A 5 year-old girl with DOCK8 deficiency presented with mild direct hyperbilirubinemia and abnormal GGT level and without a previous history of jaundice. She had severe growth retardation, hepatosplenomegaly and generalized eczema. Progressive worsening of CLD was observed within 4 months. Investigations for etiology of liver disease were negative. Liver biopsy showed bridging necrosis, cholestasis and, cirrhosis. Recurrent immune hemolytic crisis and several viral infections developed in follow-up. She underwent whole cadaveric LT for end-stage liver disease (ESLD) 1 year after allogenic HSCT from a full matched related donor. The postoperative course was uneventful. The patient is alive with normal liver function and moderate skin graft versus host disease for 36 months after LT. In conclusion DOCK8 deficiency can be associated with severe CLD. Successful LT following HSCT is possible in patients with ESLD in DOCK8 deficiency. The timing of LT is challenging in patients requiring both HSCT and LT since conditioning regimens for HSCT can be highly hepatotoxic and the patients with suboptimal liver function can become decompensated during HSCT.
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Affiliation(s)
- Zarife Kuloglu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Deniz Balcı
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Zehra Şule Haskoloğlu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Bingöl-Koloğlu
- Deparment of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ceyda Tuna-Kırsaçlıoğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Sevgi Bal
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Suna Selbuz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Berna Savaş
- Deparment of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Cansu Altuntaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Şükrü Nail Güner
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Selvi Can
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan Kansu Tanca
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
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Abbasoğlu O, Tekant Y, Alper A, Aydın Ü, Balık A, Bostancı B, Coker A, Doğanay M, Gündoğdu H, Hamaloğlu E, Kapan M, Karademir S, Karayalçın K, Kılıçturgay S, Şare M, Tümer AR, Yağcı G. Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement. Ulus Cerrahi Derg 2016; 32:300-305. [PMID: 28149133 DOI: 10.5152/ucd.2016.3683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
Abstract
Gallstone disease is very common and laparoscopic cholecystectomy is one of the most common surgical procedures all over the world. Parallel to the increase in the number of laparoscopic cholecystectomies, bile duct injuries also increased. The reported incidence of bile duct injuries ranges from 0.3% to 1.4%. Many of the bile duct injuries during laparoscopic cholecystectomy are not due to inexperience, but are the result of basic technical failures and misinterpretations. A working group of expert hepatopancreatobiliary surgeons, an endoscopist, and a specialist of forensic medicine study searched and analyzed the publications on safe cholecystectomy and biliary injuries complicating laparoscopic cholecystectomy under the organization of Turkish Hepatopancreatobiliary Surgery Association. After a series of e-mail communications and two conferences, the expert panel developed consensus statements for safe cholecystectomy, management of biliary injuries and medicolegal issues. The panel concluded that iatrogenic biliary injury is an overwhelming complication of laparoscopic cholecystectomy and an important issue in malpractice claims. Misidentification of the biliary system is the major cause of biliary injuries. To avoid this, the "critical view of safety" technique should be employed in all the cases. If biliary injury is identified intraoperatively, reconstruction should only be performed by experienced hepatobiliary surgeons. In the postoperative period, any deviation from the expected clinical course of recovery should alert the surgeon about the possibility of biliary injury.
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Affiliation(s)
- Osman Abbasoğlu
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Yaman Tekant
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Aydın Alper
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Ünal Aydın
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Ahmet Balık
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Birol Bostancı
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Ahmet Coker
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Mutlu Doğanay
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Haldun Gündoğdu
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Erhan Hamaloğlu
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Metin Kapan
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Sedat Karademir
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Kaan Karayalçın
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Sadık Kılıçturgay
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Mustafa Şare
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Ali Rıza Tümer
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
| | - Gökhan Yağcı
- Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey
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Bulut AŞ, Karayalçın K. Ciliated foregut cyst of the gallbladder: report of a case and review of literature. Patholog Res Int 2010; 2010:193535. [PMID: 21152175 PMCID: PMC2997285 DOI: 10.4061/2010/193535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 09/30/2009] [Indexed: 11/22/2022]
Abstract
Cystic lesions of the gallbladder are very rare and they are generally lined by single columnar or mucinous epithelium. A ciliated cyst of foregut origin is extremely rare in gallbladder. To our knowledge, only five cases have been reported so far. Here, we present the sixth case found incidentally in ultrasonographic examination in a 41-year-old woman suffering from chronic right upper quadrant pain. Laparoscopic cholecystectomy was performed for the gallstones and a benign appearing cyst in ultrasonography. Macroscopically, a submucosal unilocular cyst was located in the neck of the gallbladder. There was no communication with the lumen. Histologically, the cyst was lined by pseudostratified ciliated epithelium containing goblet cells and had a muscular wall. The postoperative course was uneventful. Patient was discharged on the second day of the operation and was well after 2 months.
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Affiliation(s)
- Asiye Şafak Bulut
- Department of Pathology, MESA Hospital, Yasam Cad. No 5, Sogutozu, 06510 Ankara, Turkey
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