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Planned second-look laparoscopy in the management of acute mesenteric ischemia

World Journal of Gastroenterology 2007年第24期13卷 3350-3353页

作者： Hakan yanar Korhan Taviloglu Cemalettin Ertekin Beyza Ozcinar fatih yanar Recep Guloglu Mehmet Kurtoglu Istanbul University Istanbul Faculty of Medicine Department of General Surgery Istanbul Turkey

AIM： To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia （AMI）. METHODS： Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS： The average time of admission to the hospital after the initation of syrnptoms was 3 d （range, 5 h-9 d）. In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% （n = 6）. CONCLUSION： Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

关键词： Acute mesenteric ischemia Second-look laparoscopy Minimally invasive Planned Low flow state

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Rupture of abdominal aortic aneurysm into sigmoid colon:A case report

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World Journal of Gastroenterology 2006年第46期12卷 7549-7550页

作者： Murat Aksoy Hakan yanar Korhan Taviloglu Cemalettin Ertekin Kemal Ayalp fatih yanar Recep Guloglu Mehmet Kurtoglu Istanbul University Istanbul Faculty of Medicine Trauma and Emergency Surgery Service Capa-Istanbul Turkey

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

关键词： Aortocolic fistula Abdominal aort aneurysm Rupture Lower gastrointestinal bleeding Aneurysm

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Pancreatic Involvement in Von Hippel-Lindau Syndrome: Report of a Total Pancreatectomy Case and Literature Review

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Surgical Science 2013年第2期4卷 151-153页

作者： Kursat Rahmi Serin fatih yanar Orhan Agcaoglu Metin Keskin Ozgur Ceyhan Orhan Bilge Department of General Surgery Istanbul Medical Faculty Istanbul University Istanbul Turkey Department of Radiology Istanbul Medical Faculty Istanbul University Istanbul Turkey

Von Hippel-Lindau (VHL) syndrome is a rare, autosomal dominantly inherited multicancer syndrome. Disease is predisposed by hemangioblastoma, renal cell carcinoma, pheochromocytoma, pancreatic islet cell and cystic tumors or epididymis tumors under the mutation or deletion at the tumor suppressor gene. Here we report a 42-year-old woman who had been operated for cerebellar hemangioblastoma and retinal angioma, and presented with recurrent, mild abdominal pain. In radiological imaging studies, multiple pancreatic cysts without nodulation were determined. Because of the mild abdominal pain and uncertain malignant potential of the cysts, total pancreatectomy was performed. She was discharged at the fifteenth day after the surgery without any problem. The patient has been followed for 62 months without any problem, and her diabetes mellitus is being controlled by medication.

关键词： Von Hippel-Lindau Syndrome Pancreatic Cyst Malignancy

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Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention

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World Journal of Gastroenterology 2006年第44期12卷 7179-7182页

作者： Huseyin Bakkaloglu Hakan yanar Recep Guloglu Korhan Taviloglu fatih Tunca Murat Aksoy Cemalettin Ertekin Arzu Poyanli Istanbul University Istanbul Faculty of Medicine Trauma and Emergency Surgery Service Capa-Istanbul Turkey Istanbul University Istanbul Faculty of Medicine Department of Radiology Capa-Istanbul Turkey

AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia. METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases. RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 × 103 ± 1.3 × 103 μg/L vs 13 × 103 ± 1 × 103 μg/L, P < 0.05 for 24 h after PC; 13.7 × 103 ± 1.3 × 103 μg/L vs 8.3 × 103 ± 1.2 × 103 μg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2 ± 18.5 mg/L vs 27.3 ± 10.4 mg/L, P < 0.05 for 24 h after PC; 51.2 ± 18.5 mg/L vs 5.4 ± 1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38 ± 0.35℃ vs 37.3 ± 0.32℃, P < 0.05 for 24 h after PC; 38 ± 0.35℃ vs 36.9 ± 0.15℃, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recoveredwith medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter. CONCLUSION: As an alternative to surgery, percutan- eous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed c

关键词： Percutaneous cholecystostomy Acute cholecystitis Ultrasound High risk Elderly

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