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Aim: Notwithstanding the significant advantages compared to open surgery, laparoscopic surgery was considered to be contraindicated in pregnant patients. Currently, there are opposing views on the safety of laparoscopic surgery during pregnancy, especially in last trimester. The aim of this study was to examine feasibility of laparoscopic surgery in pregnant women with acute abdomen., Patients and Methods: We retrospectively reviewed records of all patients who were admitted to the Emergency Department of Cerrahpasa Medical Faculty between January 1995 and January 2013. All clinical data of pregnant patient who underwent laparoscopic surgery were analyzed including inpatient records, operative reports, pathology records, and delivery information., Results: Fourteen pregnant patients (mean gestational age 19.2 weeks, ranged from 9 to 33 weeks) who underwent laparoscopy for appendectomy (n=11), cholecystectomy (n=2), and diagnostic reasons (n=1) were included. Average time of delivery was 37.4 gestational weeks (range 35-40 weeks). Two patients had preterm labor. No complications such as uterine injury, fetal death, or maternal mortality were encountered during laparoscopic procedures, Conclusion: Laparoscopic surgery can be safely performed at all trimesters of pregnancy. Laparoscopy may be useful in differentiation of acute abdominal pain in pregnancy and may decrease fetal loss due to delay in diagnosis. shorter operative time reduces negative effects of surgery on mother and fetus.

In the present study, we aim to share our clinical experience in patients with spontaneous splenic rupture. Splenic rupture without trauma is known as spontaneous splenic rupture. The major problems in the management of spontaneous splenic rupture are missed or delayed diagnosis due to the lack of trauma in most cases. The records of all patients, who were admitted to Cerrahpaşa Medical Faculty, Istanbul University, were retrospectively reviewed from January 2000 to March 2013. Twelve patients were admitted to the emergency department and they were diagnosed with spontaneous splenic rupture. The mean age was 47.6 years. All patients had complaints of abdominal pain. The mean hematocrit value was 22%. Radiologic assessment revealed hemoperitoneum and/or subcapsular hematoma in 8 patients while splenic abscess was diagnosed in 2 patients. Eleven patients underwent splenectomy whereas one was managed conservatively. The most common cause of spontaneous splenic rupture was determined to be use of anticoagulants. Etiology was considered to be idiopathic in 1 patient. Two patients died in the postoperative period. Although rare, spontaneous splenic rupture must be suspected in emergency patients who have used especially anticoagulants and antiaggregants and who have had no recent history of trauma. One of the important causes of mortality is missed or delayed diagnosis.

A standard hepaticojejunostomy technique might be difficult to perform, especially when the bile duct is small and located deep in the liver hilum. Herein we present a new procedure, the Hand-Fan technique, that was used to enhance the exposure and ease the performance of these challenging anastomoses. Thirty-one patients who had had hepaticojejunostomy with this technique for bile duct injury and other benign biliary pathologies from July 2004 to June 2011 were included into the study. Median postoperative hospital stay was 7 days (6-25 days) and median follow-up time was 33 months (2-84 months). Liver function tests revealed that the blood bilirubin levels of the patients were normalized after hepaticojejunostomy. Follow-up showed that there were no signs of clinical recurrence or impaired bile flow. The Hand-Fan technique considerably facilitates challenging hepaticojejunostomies. Surgeon's comfort is exceptional and the clinical results are satisfactory.

Background/objective: Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite treatment on oxidative stress after partial hepatectomy. In this experimental study, the effects of clinoptilolite treatment after partial hepatectomy on oxidative stress were evaluated., Methods: There were four experimental groups (n=8): Group S, the sham group; Group H, the hepatectomy group; Group HC, the clinoptilolite treatment after partial hepatectomy group; and Group CS, the clinoptilolite-treated sham group. A 70% partial hepatectomy was performed for Group H and HC. Clinoptilolite (5mg/kg) was given to the rats orally (via gavage tube) twice a day for 10 days after hepatectomy. Malondialdehyde (MDA), Cu-Zn super oxide dismutase (SOD), and glutathione (GSH) levels were assessed to evaluate oxidative stress., Results: Plasma and liver tissue MDA levels of Group HC were significantly lower than the H group (p=0.018 and p=0.000, respectively). Liver tissue Cu-Zn SOD activity and GSH levels of Group HC were significantly higher than Group H (p=0.003, p=0.007, respectively)., Conclusion: Clinoptilolite administration reduces oxidant activity and supports antioxidant response after partial hepatectomy., (Copyright © 2011. Published by Elsevier B.V.)

Background: Few studies have been published on liver resection alone or in combination with cytoreductive surgery for liver metastases of ovarian carcinoma., Methods: Eight patients who underwent liver resection for metastasis of ovarian cancer were included in the study. Total abdominal hysterectomy and bilateral salpingo-oophorectomy had been performed before liver surgery in all patients. The demographic data, follow-up details before and after liver resection, histopathology of the primary ovarian cancer, type of surgery and outcome were evaluated., Results: The mean age of the patients was 56.1 (46-68) years. The mean hospitalization time was 8 (7-10) days. The mean disease-free interval was 5.38 years from the time of initial surgery to surgery for metastatic liver lesions, and 39 months after liver resection to secondary metastases. Four patients did not have any evidence of disease after liver surgery., Conclusion: Indications for liver resection should be considered in selected patients who have a limited extent of metastatic disease from ovarian carcinoma. Liver resection for metastases of ovarian carcinoma could be an effective and feasible approach., (Copyright © 2010 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.)

Objective: This study was conducted to evaluate the prognostic significance of the tumor DNA index in patients receiving liver transplantation for hepatocellular carcinoma (HCC) in cirrhosis., Background: In patients suffering from HCC in cirrhosis, the current selection for liver transplantation does not optimally achieve the goal to simultaneously maximize the number of viable transplant candidates and reject the smallest number of those who could have benefited. This is the first report on the prognostic significance of the tumor DNA index., Patients and Methods: From 1988 to 2007, liver transplantation for HCC in cirrhosis was performed in 246 consecutive patients. The DNA-index was determined by Feulgen staining and semiautomatical image analysis. Interpretation of DNA histograms followed the recommendations outlined in the European Society for Analytical Cellular Pathology consensus report on diagnostic DNA image cytometry., Results: A DNA-index

Background: Various techniques have been used for the division of mesoappendix, such as endoloops, endoscopic linear cutting staplers, an electrothermal vessel-sealing system (LigaSure), the Harmonic Scalpel, clips, and bipolar coagulation. In the present study, LigaSure and an endoclip were compared in laparoscopic appendectomy (LA)., Materials and Methods: This study included patients who underwent LA for acute appendicitis at Istanbul University, Cerrahpasa Medical Faculty, Emergency Unit (Istanbul, Turkey) between May 2003 and April 2007. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and endoclip groups. The main outcome measures (e.g., operating time, conversion rate, hospital stay, postoperative complications, etc.) were then compared., Results: LA was performed in 280 patients with acute appendicitis. LigaSure and endoclips were used in 127 and 153 patients, respectively. The mean operative times were 41 and 54 minutes in the LigaSure and endoclip groups, respectively. Conversions to open rates were found to be 9.4% (12 patients) in the LigaSure and 11.1% (17 patients) in endoclip groups. No statistically significant differences regarding hospital stay or complications were found, whereas significant differences were observed in surgical time and conversion rate., Conclusion: The use of LigaSure facilitates the dissection of mesoappendix and shortens the operation time in LA. We believe that LigaSure is a safe, useful tool for mesoappendix dissection.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus, and the most frequently affected organ is the liver. Diagnosis is usually based on radiological and serological findings. Even though percutaneous drainage and medical therapies are suggested for selected cases, for the most part surgery is required. The surgical strategy consists of killing the cyst, removing its contagious elements from the liver, obliterating the cystic cavity, and preventing recurrence and complications. A large spectrum of operations - from simple drainage to liver transplantation - has been proposed for reaching these objectives. Laparoscopic surgery is used increasingly for hydatid disease. This article reviews the current status of hydatid disease surgery, with special emphasis on liver cysts.

A 44-year-old woman was admitted with obvious symptoms of hypoglycemia and Whipple's triad during a 6-month period. The glucose level was as low as 32 mg/dL and insulin/glucose ratio greater than 0.5 after fasting. Abdominal magnetic resonance imaging (MRI) studies revealed a pancreatic mass at the head, 2 cm in diameter that was not suggesting because of hypointensity. Selective angiography and somatostatin-receptor scintigraphy did not reveal insulinoma. During laparotomy the tumor was palpated on the ventral surface of pancreas and intraoperative ultrasound accurately localized it. Doppler ultrasound examination clearly revealed the hypervascularity of the tumor, which was suggesting an insulinoma. After the tumor enucleation, blood glucose level increased to normal ranges. Histopathological examination revealed benign, well differentiated neuroendocrine tumor, insulinoma. The postoperative recovery was uneventful and the patient is still symptom free during a follow-up period of 6 months. Doppler ultrasound may be a simple but efficient tool for the differential diagnosis of insulinoma. If the clinical symptoms and findings suggest clearly an insulinoma, intraoperative Doppler ultrasound examination seems to be a simple but the most sensitive diagnostic method.

Purpose: To investigate the effect of mesh fixation devices on the formation of intra-abdominal adhesions., Materials and Methods: Fourteen New Zealand rabbits were used. In seven animals, nickel-titanium (nitinol) anchors (group 1) and titanium tacks (group 2) were applied by laparoscopy on the right and left sides of the abdomen, respectively. In the remaining seven rabbits, the same devices were applied on prosthetic meshes (groups 3 and 4, respectively). On day 30, the rabbits were sacrificed and macroscopic adhesion scoring was performed. All the specimens were assessed by scanning electron microscopy (SEM)., Results: All parameters of adhesion except extension were significantly higher in group 4 than group 3 (P < 0.05). Comparisons of group 1 vs. group 2 were not statistically significant (P > 0.05). All the comparisons between a nonmesh group and a mesh group resulted in significant differences. SEM results revealed that the mesothelial cell layer and connective tissue intensively covered the tacks in group 2 whereas no similar findings were observed in group 1. Comparable appearances were encountered in groups 3 and 4., Conclusion: The nitinol anchor is associated with an acceptable level of adhesion formation and its intraperitoneal use can be considered safe in this regard.

Objectives: The objectives of this study were to investigate the characteristics and outcome of patients with hydatid disease of the liver who were laparoscopically managed at our clinic and to define technical details including an effective method of omentoplasty with helical fasteners., Methods: Between January 1998 and November 2000, 13 patients, mean age 36 years (range 23 to 63 years), with hydatid disease of the liver were considered for laparoscopic surgery in our department. All the patients underwent laparoscopic surgical interventions., Results: In all patients, laparoscopic cystotomy, unroofing, and omentoplasty with helical fasteners, which were originally designed for endoscopic hernia repair procedures, were performed. No conversion to laparotomy was necessary. In 1 case, with a single cyst in the right lobe, bile leakage was observed. No radiological recurrence was observed in an average follow-up of 17 months (range 4 to 36 months)., Conclusions: Obliteration of the residual cystic cavity decreases postoperative complication rates, so an effective omentoplasty is essential especially for laparoscopic procedures. Laparoscopy is quite feasible to perform in hydatid disease of the liver, and the use of helical fasteners allows effective omental flap fixation.

Laparoscopic surgery may be performed for the treatment of pancreatic pseudocyst when decompression is indicated. Most of reported laparoscopic procedures are performed by inserting trocars via the anterior gastric wall and operating intraluminally with gastric insufflation and endoscopic guidance. We report a patient who was treated successfully with laparoscopic stapled cystogastrostomy and discuss the feasibility and features of such a technique performed with a totally abdominal approach.

Hypothesis: Tumor implantation (TI) development at the surgical wound following cancer surgery is still an unresolved concern. Trocar site recurrence, which is likely a form of TI, has become one of the most controversial topics and, with the widespread acceptance of laparoscopic surgery, has caused renewed interest in questions about TI. Honey has positive effects on wound healing. Physiological and chemical properties of honey might prevent TI when applied locally., Design, Interventions, and Main Outcome Measures: Sixty BALB/c strain mice, divided into 2 groups, were wounded in the posterior neck area. Group 1 mice formed the control group, and group 2 mice had wounds coated with honey before and after tumor inoculation. All wounds were inoculated with transplantable Ehrlich ascites tumor. The presence of TI was confirmed in the wounded area by histopathological examination on the 10th day., Results: Tumor implantation was achieved in all group 1 animals and verified by palpable mass and histopathological examination. In group 2 mice, although TI could not be detected macroscopically, it was revealed by pathological examination in 8 cases. Tumor implantation was less likely in group 2 mice (8 of 30 vs 30 of 30; P<.001)., Conclusions: Tumor implantation was markedly decreased by the application of honey pre- and postoperatively. It is possible that the physiological and chemical properties of honey protected wounds against TI. Honey could be used as a wound barrier against TI during pneumoperitoneum in laparoscopic oncological surgery and in other fields of oncological surgery.

Objective: To assess the safety and efficacy of diagnostic laparoscopy in patients with tuberculous peritonitis., Design: Retrospective clinical study., Setting: University hospital, Turkey., Subjects: 8 patients (2 women, 6 men; mean age 26 years) who presented with tuberculous peritonitis between January 1994 and January 1996., Intervention: Laparoscopy under local anaesthesia with sedation (the 4 who presented with ascites) and laparotomy (the 4 who presented with an acute abdomen)., Main Outcome Measures: Clinical and laboratory findings, biochemical and microbiological analysis of ascites, histopathological examination of specimens, morbidity, and mortality., Results: 4 patients presented with ascites, and 4 with adhesions. Ascites; adhesions between liver and diaphragm, liver and intestines, and intestines and the abdominal wall; miliary nodes on the peritoneal surface; and inflamed haemorrhagic areas on the peritoneum could all be seen at laparoscopy. One of the 8 patients who underwent laparotomy developed a spontaneous enterocutaneous fistula during the early postoperative period. Two of eight patients died, one of an early enterocutaneous fistula and the other of cor pulmonale 3 1/2 months later. The remaining 6 patients survived without complications after antituberculous medical treatment., Conclusions: Laparoscopy is a safe and accurate method of diagnosis of tuberculous peritonitis.