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World Journal of Gastrointestinal Endoscopy 2014年第11期6卷 568-570页

作者： Fatih Sumer cuneyt kayaalp Mehmet Ali Yagci Emrah Otan Huseyin Kocaaslan Department of Surgery Inonu Uni-versity Malatya 44315 Turkey

This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.

关键词： Laparoscopic cholecystectomy Trocar site hernia Endoscopic retrograde cholangiopancreatogra-phy Postoperative complications

“PERISH”fl owchart for selection of the patients with resectable hepatocellular carcinoma

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Hepatoma Research 2015年第1期1卷 165-170页

作者： cuneyt kayaalp HKerem Tolan Mehmet Caglikulekci Liver Transplantation Institute Inonu University44315 MalatyaTurkey

A selection of patients with hepatocellular carcinoma(HCC)for surgical resection is crucial and algorithms/staging systems help surgeons to decide on a standard treatment for each patient and each HCC stage.However,there are always diffi culties in remembering and/or recalling the contents of the algorithms/staging systems.Moreover,most algorithms/staging systems do not include data about the extent of hepatectomy,intra-hepatic distribution of tumor(s),and technical feasibility of resection,all of which are vital in the surgeons’decision-making process.Here,we aimed to present a simple and handy mnemonic acronym for selecting resectable HCCs in surgical practice.This was reproduced from the existing well-known staging systems.The designed mnemonic acronym is a phrase“PERISH”and it includes asking for Performance of patient,Extra-hepatic disease,Reserve of the liver,Intra-hepatic distribution,Stratifying risk factors,and Hepatectomy size in order.Performance based on whether the patient is mostly bedridden or not should be the fi rst step of evaluation.Next,asking for suspicious metastasis as bone pain and radiological evaluation of abdomen/thorax is mandatory.The calculation of Child-Pugh score is only the third step.Good candidates for surgical resection should be Child-Pugh“A”with normal bilirubin levels.Technical feasibility of resection,according to the intra-hepatic distribution of tumor(s)should be done later,and the candidates preferably should not have portal hypertension(no splenomegaly,no thrombocytopenia).If the patient fulfi lls all the previous steps,the surgeon may perform indo-cyanine green clearance test.Consequently,following the PERISH fl owchart may prevent“perish”of the surgeons while selecting the appropriate resectable HCCs.

关键词： Hepatectomy hepatocellular carcinoma surgery surgical education

Bursectomy at radical gastrectomy

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World Journal of Gastrointestinal Surgery 2015年第10期7卷 249-253页

作者： cuneyt kayaalp Department of Surgery Turgut Ozal Medical CenterInonu University

Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.

关键词： Gastric cancer Gastrectomy Bursectomy Omentum Panc

Renoportal anastomosis in living donor liver transplantation with prior proximal splenorenal shunt

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World Journal of Transplantation 2017年第1期7卷 94-97页

作者： Fatih Ozdemir Koray Kutluturk Bora Barut Perviz Abbasov Ramazan Kutlu cuneyt kayaalp Sezai Y?lmaz Department of Surgery Liver Transplantation Institute of Inonu University Department of Surgery Azerbaijan Medical School Department of Radiology Liver Transplantation Institute of Inonu University

For transplant surgeons, end-stage liver disease with portal venous thrombosis and a previous splenorenal shunt(SRS) is a significant challenge during liver transplantation. Thrombosis of the portal vein can be corrected by surgical interventions, such as portal venous thrombectomy or surgical removal of the thrombosed portal vein. Even also placement of a graft between the mesenteric vein and the graft portal vein can be performed. If these maneuvers fail, a renoportal anastomosis(RPA) can be performed to achieve adequate graft inflow. A 51-year-old male patient who had a history of proximal SRS and splenectomy underwent living donor liver transplantation(LDLT) due to cryptogenic cirrhosis. LDLT was performed with RPA using a cadaveric iliac vein graft. The early postoperative course of the patient was completely uneventful and he was discharged 20 d after transplantation. To the best of our knowledge, this was the first patient to receive LDLT with RPA after surgical proximal SRS and splenectomy.

关键词： Liver transplantation Portal vein thrombosis Renoportal anastomosis Proximal splenorenal shunt

Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients

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World Journal of Gastroenterology 2013年第10期19卷 1625-1631页

作者： Sami Akbulut cuneyt kayaalp Mehmet Yilmaz Volkan Ince Dincer Ozgor Koray Karabulut Cengiz Eris Huseyin Ilksen Toprak Cemalettin Aydin Sezai Yilmaz Division of Liver Transplantation Institute Department of SurgeryInonu University Faculty of Medicine44280 MalatyaTurkey Department of Anesthesiology Inonu University Faculty of Medicine44280 MalatyaTurkey

AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) patients who underwent liver transplantation with intraoperative CATS(n = 24,CATS group) and without(n = 59,non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively.Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein(AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals.Inter-group differences in recurrence and correlations between demographic,clinical,and pathological data were assessed by ANOVA and χ 2 tests.Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.RESULTS:Of the 83 liver transplanted HCC patients,89.2% were male and the overall mean age was 51.3 ± 8.9 years(range:18-69 years).The CATS and nonCATS groups showed no statistically significant differences in age,sex ratio,body mass index,underlying disease,donor type,graft-to-recipient weight ratio,Child-Pugh and Model for End-Stage Liver Disease scores,number of tumors,tumor size,AFP level,Milan and University of California San Francisco selection criteria,tumor differentiation,macrovascular invasion,median hospital stay,recurrence rate,recurrence site,or mortality rate.The mean follow-up time of the nonCATS group was 17.9 ± 12.8 mo,during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients.The mean follow-up time for the CATS group was 25.8 ± 15.1 mo,during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients.There was no significant difference between the CATS and non-CATS groups in recurrence rate or site.Additionally,no significant differences existed between the groups in overall or disease-free survival.CONCLUSION:CATS is a safe procedure

关键词： Liver transplantation Hepatocellular carcinoma Intraoperative blood salvage autotransfusion Recurrence Tumor cell dissemination

Fibrin sealant use in pilonidal sinus: Systematic review

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World Journal of Gastrointestinal Surgery 2016年第3期8卷 266-273页

作者： cuneyt kayaalp Ismail Ertugrul Kerem Tolan Fatih Sumer Department of Gastrointestinal Surgery Inonu University

AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients(84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates(9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies(mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.

关键词： Pilonidal disease Fibrin sealant Evidence base medicine Systematic review

Hepatoduodenal ligament dissection technique during recipient hepatectomy for liver transplantation:How I do it?

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World Journal of Transplantation 2016年第2期6卷 272-277页

作者： cuneyt kayaalp Kerem Tolan Sezai Yilmaz Liver Trans-plantation Institute Turgut Ozal Medical CenterInonu University

Accurate dissection of the hepatoduodenal ligament in the recipient is vital for the success of liver transplantation surgery. High incidence of anatomic variations at the hepatic artery, portal vein and biliary ducts in the hepatoduodenal ligament is well known. Surgical experience is important to be able to foresee the most common anatomic diversities and the possible variations, in order to make a safe and accurate dissection in the hepatic hilum. Before anastomosis, all these hilar structures must be well identified, safely dissected and must also have a sufficient length for the coming implantation process. At the beginning of our program, we were starting the hepatic hilum dissection close to the liver. In time, however, we modified our surgical technique, preferring to start further away from the liver(closer to the duodenum). This length increased progressively over 1500 liver transplantations(80% living donor liver transplantation). During this process, our main purpose was the early control of the hepatic artery(artery first approach). In this paper, our aim is to share our latest version of the hepatoduodenal ligament dissection technique. We also describe alternative approaches used in extraordinary situations.

关键词： Liver transplantation Living donor liver transplantation Surgical technique

Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction

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World Journal of Gastrointestinal Endoscopy 2015年第12期7卷 1078-1082页

作者： cuneyt kayaalp Koray Kutluturk Mehmet Ali Yagci Mustafa Ates Department of Gastrointe- stinal Surgery Inonu University Department of Surgery Inonu University

AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn's disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture.RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient(adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimenswere 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up(ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the overall experience in the literature was 80%(12/15) in se

关键词： Colonoscopy Colon cancer Crohn’s disease Laparosco

经自然腔道取标本手术(NOSES)治疗结直肠癌的国际共识

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Gastroenterology Report 2019年第1期7卷 24-31,I0001页

作者： Xu Guan Zheng Liu Antonio Longo Jian-Chun Cai William Tzu-Liang Chen Lu-Chuan Chen Ho-Kyung Chun Joaquim Manuel da Costa Pereira Sergey Efetov Ricardo Escalante Qing-Si He Jun-Hong Hu cuneyt kayaalp Seon-Hahn Kim Jim S.Khan Li-Jen Kuo Atsushi Nishimura Fernanda Nogueira Junji Okuda Avanish Saklani Ali A.Shafik Ming-Yin Shen Jung-Tack Son Jun-Min Song Dong-Hui Sun Keisuke Uehara Gui-Yu Wang Ye Wei Zhi-Guo Xiong Hong-Liang Yao Gang Yu Shao-Jun Yu Hai-Tao Zhou Suk-Hwan Lee Petr V.Tsarkov Chuan-Gang Fu Xi-Shan Wang The International Alliance of NOSES Department of Colorectal Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBejingChina Department of Coloproctology and Pelvic Diseases Humanitas GavazzeniBergamoItaly Department of Gastrointestinal Surgery Zhongshan Hospital of Xiamen UniversityXiamenChina Department of Surgery China Medical University HospitalTaichungTaiwanChina Department of Abdominal Surgery Fujian Medical University Cancer HospitalFuzhouChina Department of Surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea Department of Surgery Hospital de BragaBragaPortugal Colorectal Surgery Department Sechenov First Moscow State Medical UniversityMoscowRussia Universidad Central de Venezuela Centro Medico LoiraCaracasVenezuela Department of General Surgery Shandong University Qilu HospitalJinanChina Department of General Surgery Huaihe Hospital of Henan UniversityKaifengChina Department of Gastrointestinal Surgery Inonu UniversityMalatyaTurkey Department of Surgery Korea University Anam HospitalKorea University College of MedicineSeoulSouth Korea Department of Colorectal Surgery Portsmouth Hospitals NHS TrustQueen Alexandra HospitalPortsmouthUK Division of Colorectal Surgery Taipei Medical University HospitalTaipeiTaiwanChina Department of Surgery Nagaka Chuo General HospitalNagaoka CityJapan Innovation Unit/Colorectal Cancer Osaka Medical College Hospital Cancer CenterOsakaJapan Department of GI Surgical Oncology Tata Memorial HospitalMumbaiIndia Department of Colorectal Surgery Cairo UniversityCairoEgypt Department of Anorectal Surgery First Affiliated HospitalZhengzhou UniversityZhengzhouChina Department of Gastric and Colorectal Surgery Jilin University First HospitalChangchunChina Division of Surgical Oncology Nagoya University Graduate School of MedicineNagoyaJapan Department of Colorectal Cancer Surgery The Second Affiliated Hospital of Harbin Medical

近年来,经自然腔道取标本手术(NOSES)治疗结直肠癌已引起了广泛关注。NOSES应用于结直肠手术的潜在优势包括减轻术后疼痛,减少伤口并发症,减少对术后镇痛的需求,加快肠道功能的恢复,缩短住院时间,更好的美容效果,以及给患者带来了更佳... 详细信息

近年来,经自然腔道取标本手术(NOSES)治疗结直肠癌已引起了广泛关注。NOSES应用于结直肠手术的潜在优势包括减轻术后疼痛,减少伤口并发症,减少对术后镇痛的需求,加快肠道功能的恢复,缩短住院时间,更好的美容效果,以及给患者带来了更佳的心理状态。尽管NOSES的手术创伤显著减轻,然而该技术也存在一些潜在问题。尤其随着这项新技术的兴起,人们对其无菌的把控、肿瘤学结果和病例选择等问题表示出关切。因此,迫切需要一部操作指南来规范NOSES手术在结直肠癌中的开展。经过国际NOSES联盟全体成员的三轮讨论,最终形成了该部共识。这一共识有助于NOSES在全球范围内的长远发展。

关键词： colorectal cancer natural orifice specimen extraction surgery(NOSES) laparoscopy natural orifice transluminal endoscopic surgery(NOTES) transanal total mesorectal excision(TaTME)

经自然腔道取标本手术(NOSES)治疗胃癌的国际共识(2019)

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Gastroenterology Report 2020年第1期8卷 5-10,I0001页

作者： Xu Guan Zheng Liu Amjad Parvaiz Antonio Longo Avanish Saklani Ali AShafik Jian-Chun Cai Charles Ternent Lin Chen cuneyt kayaalp Fatih Sumer Fernanda Nogueira Feng Gao Fang-Hai Han Qing-Si He Ho-Kyung Chun Chang-Ming Huang Hai-Yang Huang Rui Huang Zhi-Wei Jiang Jim S Khan Joaquim Manuel da Costa Pereira JosephWNunoo-Mensah Jung Tack Son Liang Kang Keisuke Uehara Ping Lan Le-Ping Li Han Liang Bing-Rong Liu Juan Liu Dan Ma Ming-Yin Shen Mohammad Rashidul Islam Narimantas Evaldas Samalavicius Kai Pan Petr Tsarkov Xin-Yu Qin Ricardo Escalante Sergey Efetov Seung Kyu Jeong Suk-Hwan Lee Dong-Hui Sun Li Sun Tatiana Garmanova Yan-Tao Tian Gui-Yu Wang Guo-Jun Wang Guo-Rong Wang Xiao-Qiang Wang William Tzu-Liang Chen Woo Yong Lee Su Yan Zu-Li Yang Gang Yu Pei-Wu Yu Dan Zhao Yun-Shi Zhong Jian-Ping Wang Xi-Shan Wang The International Alliance of NOSES Department of Colorectal Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP.R.China Poole Hospital NHS Trust PooleUK European Center of Coloproctology and Pelvic Diseases-Multimedica Hospital MilanItaly Department of GI Surgical Oncology Tata Memorial HospitalMumbaiIndia Department of Colorectal Surgery Cairo UniversityCairoEgypt Department of Gastrointestinal Surgery Zhongshan Hospital of Xiamen UniversityXiamenFujianP.R.China Section of Colon and Rectal Surgery Creighton University School of MedicineOmahaNEUSA Department of General Surgery Chinese People’s Liberation Army General HospitalBeijingP.R.China Department of Gastrointestinal Surgery Inonu UniversityMalatyaTurkey Department of Surgery Hospital de BragaBragaPortugal Department of Colorectal Cancer Surgery the Second Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangP.R.China Department of Gastroenterological Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China Department of General Surgery Shandong University Qilu HospitalJinanShandongP.R.China Department of Surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea Department of Gastric Surgery Fujian Medical University Union HospitalFuzhouFujianP.R.China Department of General Surgery Jiangsu Province Hospital of Traditional Chinese MedicineNanjingJiangsuP.R.China Department of Colorectal Surgery PortsmouthHospitals NHSTrustQueen Alexandra HospitalPortsmouthUK King’s College Hospital LondonUK Department of Colorectal Surgery The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Division of Surgical Oncology Department of SurgeryNagoya University School of MedicineNagoyaJapan Department of Gastrointestinal Surgery Shandong Provincial Hospital Affiliated to Shandong UniversityJinanShandongP.R.China Department of Gastric Cancer

At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.

关键词： gastric cancer natural orifice specimen extraction surgery transanal specimen extraction transvaginal specimen extraction transoral specimen extraction consensus