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Amaç: Laparoskopik kolesistektomi ameliyatında, intraoperatif ve postoperatif açık ameliyata geçilen hastaların incelenerek risk faktörlerinin ortaya konması amaçlanmıştır. Gereç ve Yöntem: Ekim 1993-Mart 2009 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda aynı ekip tarafından benign safra yolları hastalığı tanısıyla laparoskopik kolesistektomi uygulanan 647 hasta ve açık ameliyata geçilen 35’i, retrospektif olarak incelendi. Açık ameliyata geçiş endikasyonlarımız literatür bilgileri ışığında tartışıldı. Bulgular: Laparoskopik kolesistektomi planlanarak ameliyatına başlanılan 647 hastanın 35’inde (%5.4) erken veya geç dönemde laparotomiye geçilmek zorunda kalınmıştır. 647 hastanın 482‘si kadın, 165’i erkekti. Açık ameliyat gerektiren olgulardan 17’si erkek, 18’i kadındı. Açığa dönülen erkek ve kadın hastaların yaş ortalamaları arasında anlamlı fark yoktu (p0.306). Ancak erkek hastalarda açığa geçiş oranı anlamlı olarak yüksekti (p0.009). İlk 100 hastanın 9’unda açığa dönüş olmuşken (%9), sonraki hastalarda bu oran % 4.75 bulundu (p0.137). En sık açık ameliyata geçiş nedenleri; mevcut akut kolesistite bağlı diseksiyon güçlüğü (13 olgu), geçirilmiş akut kolesistite bağlı yapışıklıklar (10 olgu), biliyer vasküler anomali (9 olgu) idi. Sonuç: Hastalarımızda en sık açığa geçiş nedenleri mevcut akut kolesistit ve geçirilmiş akut kolesistit atağına bağlı oluşan yapışıklıklar olarak bulundu. İlk 100 hastada açık ameliyata dönüş oranı daha yüksek idi. Erkek cinsiyetin açığa geçiş oranı, istatistiksel olarak anlamlı yüksek bulundu. Aim: The determination of the risk factors for the conversion of laparoscopic cholecystectomy to open surgery was aimed in this study. Material and Methods: The retrospective analysis of 647 patients operated on laparoscopic cholecystectomy was made. Thirty five patients were converted to open surgery. The indications for conversion to open surgery were discussed under the view of pertinent literature. Results: All of the 647 patients were planned to be operated on laparoscopic cholecystectomy. In 35 patients (5.4%), early or late open surgery (laparotomy) was needed.Four hundred and eigthy two patients were female, 165 were male. Seventeen patients converted to open surgery were male and 18 were female. There was no statistically significant difference in age between males and females who were converted to open surgery (p0.306). But the rate of male patients converted to open surgery were significantly greater than the rate of females (p0.009). In nine patients of first 100, open surgery was needed (9%); after first 100 patients the rate of conversion to open surgery became 4.5% (p0.137). The most frequent indications for open surgery were difficult dissection related with ongoing and previous acute cholecystitis (13 cases), adhesions related with old attack of acute cholecystitis and biliary vascular anomalies (9 cases). Conclusion: The most frequent indications for conversion to open surgery in laparoscopic cholecystectomy were existing acute cholecystitis and adhesions related with previous acute cholecystitis. The conversion rates in first 100 cases were more than that of later cases related with the experience. Male patients had a significantly increased rate of conversion to open surgery.

No previous study has yet reported the effects of surgical treatment of hydatid cysts on spleen volume. Our aim was to use computed tomography images to evaluate the volume differences in the spleen in postoperative periods in patients who had undergone operations for hydatid cysts. The abdominal computed tomography scans of 20 patients who had undergone drainage of a hydatid cyst and omentopexy operation were examined retrospectively. The volume of the liver, the cyst, and the spleen were estimated using the Cavalieri principle of stereological methods. The volume fraction of the hydatid cyst to the liver was also estimated using the obtained volume data. The volumes of the spleen (± SD) were 302.0 ± 115.1 cm3 and 259.5±82.4 cm3 in the postoperative 1st week and 6 months, respectively (p0.05). The volume of spleen decreased after hydatid cyst surgery. This may be due to the decreased portal venous pressure of the liver. Additionally, the loss of immune stimulation may have resulted in reduction in splenic volume. Our results also indicated that stereological methods can be used to monitor volume changes of the liver and spleen. © 2011 OMU All rights reserved.

How and when does a hydatid cyst die in humans? There is an ongoing debate in medicine about this subject. Calcification of the hydatid cyst wall is believed to indicate the death of the contents of the cyst. However, rarely, the cyst may be alive even though the wall is calcified. With this report, we presented a patient with a hydatid cyst with calcified wall. Our patient presented here was followed up for 8 years after the diagnosis and sufficient and effective treatment was not given thinking that the hydatid cyst was dead because of the calcified cyst wal, but intrabiliary rupture occurred after the follow-up. Criteria for the viability of hydatid cyst are discussed and the literature is reviewed. © 2010 OMU All rights reserved.

Fibroatosis is a mesenchymal tumor with unclear pathogenesis that are commonly seen in adults. It's characteristics change from benign fibrous lesions to fibrosarcoms with high recurrence and it has ability to increase of size rapidly. Even though its pathogenesis is unknown genetic, endocrine and physical factor are being accused. It can coexist with some other tumors like soft tissue fibroma, polyposis coli, bone tissue tumors, epidermoid tumors, thyroid and gynecological malign lesions. They can be classified as superficial or deep and depending on their anatomical locations. They are found commonly in the shoulder, thoracic wall and mesenterium. The cases originating from aponeurosis of pelvic tissue are seen rarely. In this paper, a case of fibromatosis originating from pelvic tissues was presented. Also the possible reasons for the fibromatosis and its effects are discussed in the light of available literature. © 2009 OMÜ Tüm Haklari Saklidir.

Clotting is a process that occurs following the consecutive reactions of almost 20 different molecules in the blood. The diseases that appear due to the mutation of these molecules resulted in, intravascular thrombus bleeding. Our case who admitted to our hospital due to acute abdominal pain six year before was operated under the emergency conditions and superior mesenteric vein occlusion was observed. Partial resection of 70 cm small intestine with end to end anostomosis was performed. Faktör V leiden mutation was found in the postoperative diagnostic investigations Six year later, the same patient was admitted to our clinic with abdominal distention and diagnosed to be portal vein thrombosis and appropriate treatment was in this report, we presented the diagnostic and treatment characteristics of the case. © 2009 OMÜ Tüm Haklari Saklidir.