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Objectives The purposes of this study were to determine the incidence of acute pancreatitis after living donor hepatectomy and to investigate potential risk factors and outcomes. Materials and methods Clinical data of all donors who underwent donor hepatectomy between January 2015 and December 2016 in our liver transplant institute were reviewed. Donor data were obtained from a prospectively maintained database. The donors were divided into 2 groups according to whether they developed postoperative pancreatitis. The following data were compared between the 2 groups: demo-graphic information (age, sex), body mass index, type of hepatectomy (right, left, or left lateral), intraoperative cholangiographic findings, operative time, blood loss, graft data (graft weight, remnant liver ratio), duration of postoperative hospital stay, and postoperative morbidity and mortality (if any). Pancreatitis severity and treatment outcomes were also examined in patients with postoperative pancreatitis. Results Our study included 348 donors who underwent donor hepatectomy for living-donor liver transplant. Postoperative pancreatitis developed in 6 donors (1.7%). We found no statistical differences between patients with and without postoperative pancreatitis in terms of demographic and intra-operative findings. Neither loco-regional nor systemic complications of pancreatitis developed in any of the patients. Therefore, all were classified as having mild pancreatitis according to revised Atlanta classification. The mean APACHE II score was 5.2 ± 1.2 points (range, 4-7 points). All patients with postoperative pancreatitis received conservative-supportive treatment. Conclusions Although postoperative pancreatitis is a rarely reported complication in living liver donors, it should always be considered, especially in patients who unpredictably deteriorate in the postoperative period. Proper recognition and timely treatment can help avoid serious consequences.

Pancreatic cancer is the 11th most common cancer in the world. The importance of early diagnosis and treatment for curative treatment is very high. Many studies have shown a relationship between diabetes mellitus (DM), smoking, genetic factors, obesity, nutritional habits and sedentary life and pancreatic ductal adenocarcinoma (PDAC). In this study, we aimed to investigate the relationship between DM onset age and PDAC.158 patients with PDAC and DM were compared with 244 patients with DM in the control group. We retrospectively analyzed PDAC risk factors with a focus on DM onset age.It was calculated that the risk of PDAC increased 8.5 times in patients diagnosed with DM after 60 years of age compared to those diagnosed with DM before 60 years of age (HR = 8.54, 95% CI 5.66-12.90, p0.0001). The interval between the diagnosis of DM and the diagnosis of PDAC peaked at 32 months (95% CI 27.90-35.56). When the age of DM onset was evaluated, it was observed that peaks were around 50 years in the group without PDAC and 60 years in the group with PDAC.In patients with DM onset after the age of 60, we recommend keeping in mind the increased risk of PDAC and evaluating these patients for PDAC, even if they are asymptomatic.Diabetes, Early detection of cancer, New onset diabetes, Pancreatic cancer, Relative risk, Screening.Il cancro al pancreas è l’undicesimo tumore più comune al mondo. L’importanza della diagnosi precoce e del trattamento per il trattamento curativo è molto alta. Molti studi hanno dimostrato una relazione tra diabete mellito (DM), fumo, fattori genetici, obesità, abitudini alimentari e vita sedentaria e adenocarcinoma duttale pancreatico (PDAC). In questo studio, abbiamo mirato a indagare la relazione tra età di insorgenza del DM e PDAC. MATERIALI E METODI: 158 pazienti con PDAC e DM sono stati confrontati con 244 pazienti con DM nel gruppo di controllo. Abbiamo analizzato retrospettivamente i fattori di rischio PDAC con un focus sull’età di insorgenza del DM. RISULTATI: È stato calcolato che il rischio di PDAC è aumentato di 8,5 volte nei pazienti con diagnosi di DM dopo i 60 anni di età rispetto a quelli con diagnosi di DM prima dei 60 anni di età (HR = 8,54, IC 95% 5,66-12,90, p0,0001) . L’intervallo tra la diagnosi di DM e la diagnosi di PDAC ha raggiunto il picco a 32 mesi (IC 95% 27,90-35,56). Quando è stata valutata l’età di insorgenza del DM, è stato osservato che i picchi erano di circa 50 anni nel gruppo senza PDAC e di 60 anni nel gruppo con PDAC. CONCLUSIONE: nei pazienti con insorgenza di DM dopo i 60 anni, si consiglia di tenere presente l’aumento del rischio di PDAC e di valutare questi pazienti per PDAC, anche se sono asintomatici.

Background: Complications in living liver donors are one of the main concerns about living donor liver transplantation and the most important of all are biliary complications. Objective: To present the diagnostic and therapeutic algorithm developed for the postoperative biliary complications in living liver donors (LLDs). Methods: Between September 2005 and October 2019, 2120 living liver donor candidates underwent living donor hepatectomy and postoperative biliary complications developed in 167 (7.87%). Management algorithm for various biliary complications and living liver donors who required hepaticojejunostomy were evaluated for this retrospective cohort study. Results: Fifty-one LLDs underwent 53 relaparotomy procedures due to biliary peritonitis. Endoscopic retrograde cholangiopancreatography (sphincterotomy± stenting) was performed in 104 donors but due to persistent bile duct stricture ± bile leaks, percutaneous transhepatic biliary tract drainage catheter was inserted in six donors following a failed endoscopic retrograde cholangiopancreatography assisted treatment. Ninety-seven LLDs underwent interventional radiologic procedure and twelve of them were percutaneous transhepatic biliary tract drainage. HJ was performed in 10 LLDs with right lobe LDH and 2 LLDs with left lobe LDH. Ten of the 12 LLDs underwent percutaneous transhepatic biliary tract drainage catheter assisted HJ in a median of 50 days after LDH. Following HJ, 11 LLDs did not have any complication along the median of 978 days (min-max: 139-3578) of follow-up. Conclusion: As living donor liver transplantation will continue to be performed in countries with low cadaveric organ supply and biliary complications will be encountered following LDH. Timing of management of the biliary complication is vital and HJ procedure is the ultimate treatment modality for biliary complications that cannot be solved by other minimally invasive methods especially percutaneous transhepatic biliary tract drainage.

This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy ± stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.

Background Dexmedetomidine is a potent and highly selective alpha-2 adrenoceptor agonist with sympatholytic, sedative, anxiolytic, and analgesic properties. The aim of the present study is to determine the effect of a dexmedetomidine infusion in liver transplant recipients in the early postoperative period on early and smooth extubation. Methods We performed a retrospective chart review of 21 patients undergoing liver transplantation between December 1, 2018, and February 31, 2020. Patients were divided into the dexmedetomidine and midazolam groups. The primary outcome was the extubation time. Secondary outcomes were mean arterial pressure and heart rate before and after extubation. The collected data included the patients' age, gender, surgery time, Model for End-stage Liver Disease (MELD) score, cold ischemia time, blood transfusion amount, and extubation visual analog scale (VAS) scores. Results Extubation time was significantly shorter in the dexmedetomidine group than midazolam group (median [minimum-maximum], 4 [0-6], 8 [4-13] hours, respectively, p = 0.000). Extubation VAS scores were statistically significantly lower in dexmedetomidine group (p = 0.000). Mean arterial pressure values before and after extubation were significantly higher in patients' midazolam group than the dexmedetomidine group (p = 0.003, p = 0.005, respectively). Conclusions Dexmedetomidine infusions provided early and smooth extubation with stable hemodynamics in our patients.

Objectives Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related deaths in the world. In this study, we aimed to evaluate the impact of clinicopathological factors on overall survival in the patients who underwent curative-intent gastrectomy due to gastric adenocarcinoma. Methods The medical records of 644 patients who underwent gastrectomy between January 2007 and January 2017 in our clinic were retrospectively reviewed. Among these patients, 359 patients were included in this study. The impact of several prognostic factors on survival was investigated. Results The mean age was 59.2±11.6 (29-83). Male/female ratio was 2.12. The median follow-up time was 19 months (CI=10.1-31.1). Median overall survival was 23±2.3 months (CI=18.3-27.6). Splenectomy, R1 (microscopically incomplete) resection, and advanced stage were independent risk factors for poor prognosis. Conclusion R1 resection, splenectomy, and advanced TNM stage were associated with poor prognosis in gastric cancer. Splenectomy should be avoided in the absence of direct invasion of the tumour or metastasis of lymph nodes on splenic hilum to prevent postoperative infectious complication-related mortality.

Stoma surgery is a more morbid procedure in colorectal surgery, compared to other procedures. In the predictive scoring systems, the mortality associated with colorectal surgery is evaluated by a combination of physical and operative parameters; however, stoma surgery is not addressed individually among the operative parameters. This study aims to determine whether the surgeons, who decide in the formation of stomata, own an acquired ability to predict mortality. Four hundred thirteen patients who underwent ileostomy and colostomy formation were included in the study. All patients were evaluated in two time periods: the first 30 days after surgery (short) and in the long term. As a result, short- and long-term mortality rates were observed to be high with statistical significance. When the patients with various etiologies but with the same surgery conditions, in the short term, no statistical differences were observed in the mortality rates statistically; however, by the multivariate analysis, the mortality rates were found to be 1809 times more in patients with benign etiologies. High mortality rates with statistical significance were observed in the long term in patients with malignancies. In conclusion, the decision on stoma requirement is a predictor of mortality both in the early period and in the long term. Stoma must be included in the future colorectal surgery mortality prediction scoring systems, individually and aside from the surgical intervention, as a factor increasing the potential for mortality.

Objective The aim of this study was to evaluate the outcomes of liver transplant recipients who became pregnant after transplantation. Methods The clinical data of all patients who underwent liver transplantation between January 2007 and December 2016 in our liver transplantation institute were reviewed. The following data were analyzed: indications for transplantation, recipient age at the beginning of pregnancy, the interval between transplantation and pregnancy, maternal and fetal complications, type of delivery, the health condition of neonates, and modifications in immunosuppressive therapy. Results During the study period, 1890 patients underwent liver transplantation. There were 185 women (9.8%) in childbearing age (15–45 years old), and 18 (9.7%) of them became pregnant during the study period. There were a total of 26 pregnancies. The mean age of patients at the time of operation was 25.3 ± 5.2 years, and the mean interval between operation and conception was 32.7 ± 15.3 months. Seventeen pregnancies (65.4%) ended in a live birth in the study. Six pregnancies (23%) resulted with no maternal or fetal complications. The most frequent maternal complication during pregnancy was pregnancy-induced hypertension (n = 3; 16.6%). Conclusions Despite advances in immunosuppressive therapy and increasing experience in the management of these patients, pregnancies in liver transplant recipients are still more risky than in the general population for both the mother and the fetus. Thus, the issues related to fertility should be comprehensively discussed with the patients and their partners, preferably before transplantation, and pregnancies in liver transplant recipients should be followed up more carefully by a multidisciplinary team.

A 19-year-old woman presented with painless swelling of the abdomen. During surgery, a giant mass measuring 37 cm×26 cm×12 cm within the distal pancreas invading the spleen was noted. The clinical diagnosis of a solid cystic pseudopapillary tumor of the pancreas was suspected. Distal pancreatectomy, splenectomy, and debulking surgery were performed. Histological examination showed that the tumor infiltrated the spleen and pancreatic parenchyma, and sections of the solid areas revealed a proliferation of spindle-shaped or stellate cells growing in fascicular and storiform patterns within a myxoid intercellular matrix. Cystic areas were representing the entrapped excretory pancreatic ductules. Interestingly, there were two ectopic adrenal tissues found incidentally in the peripheral portion of the tumor. The histopathologic and immunohistochemical features were consistent with a solid cystic desmoid tumor of the pancreas. Desmoid tumors of the pancreas are very rare, and if they present as a solid cystic lesion, their diagnosis may be difficult. We report the case for its rarity and huge size and to emphasize a regular follow-up because the long-term prognosis is currently unknown.

Karaisli, Serkan/0000-0001-8876-0191 WOS: 000448507400007 PubMed: 29909684 Hydatid cyst of the pancreas is a rarely seen entity even in endemic countries. Cyst may causes several symptoms due to external compression or fistulisation to pancreaticobiliary tract or small bowel. A 23-year-old female patient was referred with a complaint of abdominal pain. Preoperative imaging revealed an undefined cyst in the tail of pancreas. She underwent distal pancreatectomy and splenectomy, with a diagnosis of acute pancreatitis due to cystopancreatic duct fistula and also left-sided portal hypertension due to splenic vein thrombosis. Pathological examination reported a final diagnosis of hydatid cyst. To the best of our knowledge, coincidence of cystopancreatic duct fistula and splenic vein thrombosis due to pancreatic hydatid cyst has not previously been reported.

Transforming growth factor beta-1 (TGF- β1) is the most important inhibitory cytokine during the hepatic regeneration process. Diltiazem is a Ltype calcium channel blocker that has inhibitory effect on TGF- β1. The aim of the present study was to determine the effect of diltiazem on hepatic regeneration. Sixty female Wistar Albino rats were used. Three groups were created; the control, low dose diltiazem and high dose diltiazem groups, each consisting of 20 rats. After partial liver resection (70% hepatectomy), saline was introduced to control group, 5 mg/kg diltiazem was introduced to low dose group and 15 mg/kg diltiazem to high dose group intraperitoneally. Ten rats in each group were sacrificed on the first postoperative day and the remaining rats on the fifth day. Liver weight, mitotic rate and the Ki-67 ratio were measured for determining hepatic regeneration. Liver regeneration rate on the fifth postoperative day was significantly higher both in the low dose and high dose diltiazem groups than the control group (Low diltiazem vs control: P 0.05). The Ki-67 ratio on the first postoperative day was significantly higher both in the low dose and high dose diltiazem groups than the control group (Low diltiazem vs control: P

Intestinal duplication is a rare congenital anomaly of the digestive tract. It is often diagnosed antenatally or in the first two years of life. It is observed anywhere in the digestive tract, often in ileum and jejunum. We present a rare case of colonic duplication cyst in adult age in this paper. Our case was diagnosed by ultrasonography performed due to the complaint of chronic abdominal pain and was followed up for 18 months. The patient underwent surgery due to strong suspicion of malignancy. During the operation, the cyst was accessed only after palpation and was resected together with the right colon. The definitive diagnosis could be made by pathological examination. Duplication cysts can cause significant morbidity and even mortality if left untreated. For this reason, it is important to recognize this rare congenital anomaly.

Objectives Although the Whipple operation is an essential surgical technique, its high morbidity (30% to 60%) and mortality (5%) are problems to be addressed. The incidence of postoperative hemorrhage has been reported between 5% and 16% in the literature. In this study, the data and results regarding postoperative hemorrhage complications from our clinic were evaluated. Material and methods The files of 185 patients who had undergone Whipple operation in our hospital in the last five years were evaluated retrospectively, and the causes of hemorrhage were attempted to be determined. Results It was found that 6 out of the 13 (7%) patients who had hemorrhage died. In six of there 13 cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed in a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following the cessation of the drug. Conclusion Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple operations. In addition to standard methods, angiography and embolization have emerged as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, determination and elimination of independent risk factors, such as jaundice, affecting fistula formation and bleeding in the perioperative period, is important for prevention.

Introduction The term multiple primary tumor (MPT) is used to describe cases where two or more primary tumors show no histopathological similarities in between. Multiple primary tumor cases have begun to increase in recent years as a result of the increase in life expectancy because of the increase in life standards and progress in diagnostic methods. In this study, MPT cases with periampullary tumors that underwent Whipple procedure were discussed in the light of literature data. Materials and methods The patient files of 223 cases with periampullary tumors that underwent Whipple procedure in our hospital during the last 6 years were examined retrospectively. More than one primary tumor was detected in 21 patients. Results Periampullary carcinomas were detected as a second primary tumor in 18 patients. First primary tumor was periampullary carcinoma in 3 patients that underwent Whipple procedure. After the Whipple procedure, 5 patients died due to early complications in the first 30 days and 6 patients died due to metastases and additional problems that developed during follow-up. Discussion The incidence of MPT has been reported as 0.7 to 14.5% in the literature. Most of them are multiple primary case presentations. In patient management, it is recommended that each tumor should be evaluated independently of its own characteristics, and treatment and follow-up should be planned accordingly. Conclusion The MPT cases are increasing. The possibility of MPT as well as metastasis should be kept in mind during the evaluation of tumor foci seen during diagnosis and follow-up of patients. The characteristics of each tumor, survival, and prognosis should be evaluated separately and the most appropriate treatment should be offered to the patient. It is recommended that synchronic primary tumors which are considered to be surgically resectable without metastasis should be removed in the same session. How to cite this article: Dilek ON, Ozsay O, Karaisli S, Gür EÖ, Er A, Haciyanli SG, Kar H, Dilek FH. Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases. Euroasian J Hepato-Gastroenterol 2018;8(1):1-5.

Background Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature. Methods Between January 2008 and January 2015, a total of 9383 ERCPs were performed in endoscopy unit. A total of 29 perforations (0.33%) were identified and retrospectively reviewed. Results Of the 29 patients, 18 were female and 11 patients were male, with mean age of 70.5 years (range 33-99 years). According to Stapfer's classification, the 29 patients with ERCP related perforations included 5 type 1 perforations, 14 type 2 perforations, 7 type 3 perforations, and 3 cases of type 4 perforation. In total, 15 of 29 patients with ERCP perforation were operated on. Nine (60%) of those who underwent surgery were discharged uneventful, but 6 (40%) patients died due to postoperative complications and/or associated comorbidities. Seven (24.1%) of 29 patients had undergone endoscopic treatment and 5 of the 7 were discharged from the hospital without any problems; however, peritonitis occurred in 2 patients whose initial endoscopic treatment failed. The first of these 2 patients underwent surgery and was discharged uneventfully, but second patient, who refused surgery, died due to sepsis. Six patients were successfully treated with conservative management. Surgery could not be performed in the remaining 2 patients, who died of sepsis following peritonitis; 1 refused surgery, the other had sudden cardiopulmonary arrest during induction of general anesthesia. Mean hospital stay was 13.2 days (range: 2-57 days). In all, 9 (31%) patients died during period of the study. Conclusion ERCP-related perforation is uncommon complication, but an extremely serious condition. Early diagnosis and prompt management are most important to reduce associated significant morbidity and mortality rates. The most appropriate treatment course should be determined on case-by-case basis.