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Background/Aim: In Endoscopic retrograde cholangiopancreatography (ERCP), Ampulla of Vater is found on the posteromedial wall of the second part of the duodenum. However, ectopic expansion of the common bile duct to the 3rd or 4th part of the duodenum or the proximal stomach, pylorus, or bulb was reported in the literature. This study primarily aims to investigate the risk of complications in patients with ectopic papillae and evaluate the applicability of endoscopic sphincterotomy in these patients. Methods: In this a case-control study, the data of 3,048 patients who underwent ERCP procedure in the ERCP unit of our clinic between January 2013 and December 2018 were retrospectively analyzed, and 30 patients with ectopic bulbar papillae and 30 randomly selected patients with normally localized papillae were compared in terms of age, gender, duration of the procedure, post-procedural biochemical tests, cannulation success, precision rate, postprocedural pancreatitis complications and the need for analgesics. Power analysis was performed with the G*power 3.1.9.7 package program (1-B = 0.95, alpha = 0.05). With a power of 0.954, the sample size to be reached was thirty-three for each group. Results: The rate of pancreatitis complications was higher in patients with ectopic bulbar papillae (50%) compared to those without (16.7%) (P=0.006). Even though the rate of pre-cut was higher in patients with ectopic bulbar papillae (33.3%) compared to patients with normally localized papillae (13.3%), this difference was not statistically significant (P=0.063). Cannulation success in patients with ectopic bulbar papillae (83.3%) was insignificantly lower than in patients with normally localized papillae (90.0%) (P=0.353). The need for both narcotic and non-steroidal anti-inflammatory analgesics was higher in patients with ectopic bulbar papillae (P

Aim: In endoscopic retrograde cholangiopancreatography (ERCP), a diverticulum increases complications such as perforation and pancreatitis. We must know which type of diverticulum increases the complications to develop a strategy. The aim of this study is to examine the safety of the ERCP procedure in terms of diverticulum types.Methods: A total of 864 patients aged 65 years and over who underwent ERCP from January 2010 to November 2019 were identified and analyzed in this retrospective cohort study. Demographic findings, indications, successful cannulation rates and complications were compared between groups with and without duodenal diverticula.Results: Of the patients who underwent ERCP, 56.4% were female. The mean age of all patients was 77.39 (65-90) years. The most common indications were common bile duct stones (92.1%). Other indications included cholangitis (1.4%), sphincter Oddi dysfunction (1.6%), pancreatitis (2.1%), Mirizzi syndrome (2.7%), postoperative gallbladder fistula (0.7%), periampullary tumor formation (0.57%) and biliary stenosis (0.23%). Among all patients, 848 (98.1%) had no complications, 2 (0.34%) developed pancreatitis, 1 (0.17%) developed cholangitis and bleeding occurred in 1 (0.17%) patient in the group without a duodenal diverticulum. Among patients with a type I diverticulum, 4 (12.9%) had pancreatitis and 3 (9.6%) had bleeding. One patient (1.16%) had pancreatitis, 1 (1.16%) had cholangitis and 2 (2.33%) had bleeding among the type II group, while in the type III group, 1 (0.64%) had pancreatitis and 1(0.64%) had a perforation. Mortality was seen in 2 (0.23%) patients. A total of 5 (0.57%) periampullary tumors were detected in the study.Conclusion: Our study revealed that patients with a duodenal diverticulum experience more complications than the normal population. Among them, the rate is insignificantly increased in those with a type I duodenal diverticulum. Further studies are needed on this subject., Amaç: ERCP prosedüründe divertikül oluşumu perforasyon ve pankreatit gibi komplikasyonları artırır. Hangi tip divertikülün komplikasyonları artırdığını bilmeli ve bunun için bir strateji geliştirebilmeliyiz. Bu çalışmanın amacı, ERCP işleminin güvenliğini divertikül türleri açısından incelemektir.Yöntemler: Ocak 2010'dan Kasım 2019'a kadar ERCP prosedürü uygulanan 65 yaş ve üstü 864 hasta retrospektif bir kohort çalışmasında belirlendi ve analiz edildi. Duodenal divertikülü olan ve olmayan gruplar arasında demografik bulgular, endikasyonlar, başarılı kanülasyon oranları ve komplikasyonlar karşılaştırıldı.Bulgular: ERCP uygulanan hastaların %56,4'ü kadındı. Tüm hastaların ortalama yaşı 77,39 (65-90) yıldı. En yaygın endikasyonlar %92,1 ile safra kanalı taşlarıdır. Diğer endikasyonlar arasında %1,4 kolanjit, %1,6 sfinkter Oddi disfonksiyonu, %2,1 pankreatit, %2,7 Mirizzi sendromu, %0,7 postoperatif safra kesesi fistülü, %0,57 periampullar tümör oluşumu ve %0,23 ile safra darlığıdır. 864 hastanın 848'inde (%98,1) komplikasyon görülmedi. Duodenal divertikülü olmayan grupta 2 (%0,34) pankreatit, 1 (%0,17) kolanjit ve 1 (%0,17) kanama meydana geldi. Tip I grupta 4 (%12,9) hastada pankreatit ve 3 (%9,6) hastada kanama görüldü. Tip II grupta 1 (%1,16) hastada pankreatit, 1 (%1,16) hastada kolanjit ve 2 (%2,33) hastada kanama meydana geldi. Tip III grupta 1 (%0,64) hastada pankreatit ve 1 (%0,64) hastada perforasyon gelişti. Mortalite 2 (%0,23) hastada görüldü. Çalışmada toplam 5 (%0,57) hastada periampuller tümör tespit edildi.Sonuç: Sonuç olarak, bu çalışmada duodenal divertikülü olan hastaların normal popülasyona göre daha fazla komplikasyon yaşadıkları gösterilmiştir. Ancak duodenal divertikül tipleri arasında özellikle tip 1 duodenal divertikülü olanların daha fazla komplikasyon yaşadığı görüldü, ancak istatistiksel olarak anlamlı değildi. Bu durum bize bu konuda yeni çalışmalara ihtiyaç olduğunu gösteriyor.

T-tube drainage is a widely used procedure among surgeons for various biliary conditions. However, various complications may occur, especially due to the breaking-off of the T-tube from the area where it enters the common bile duct during retraction. These complications often require subsequent surgical procedures to remove the T-tube fragment from the common bile duct lumen. In selected cases, the T-tube fragment can be extracted from the common bile duct by endoscopic retrograde cholangiopancreatography (ERCP). ERCP has a life-saving role that eliminates reoperation for such a complication. Herein, we present a 42-year-old female patient who was referred to our hospital, which is as an advanced center, due to breakage during T-tube withdrawal. The patient had previously undergone open cholecystectomy and T-tube drainage. When removing the T-tube, a breakage occurred at 3-4 cm from the T-tube leg, which was left in the common bile duct. In the ERCP, the leg of the T-tube was removed from the common bile duct lumen by basket compression following endoscopic sphincterotomy and a temporary plastic stent was placed. One month after the procedure, the stent was removed with the help of the ERCP. This case is presented as a rare indication of ERCP. T-tüp drenajı cerrahlar arasındaki çeşitli biliyer problemler için yaygın olarak kullanılan bir prosedürdür. Bununla birlikte, özellikle T-tüpün geri çekilmesi sırasında ortak safra kanalına girdiği bölgeden kopması sonucunda çeşitli komplikasyonlar meydana gelebilir. Bu komplikasyonlar genellikle ortak safra kanalı lümeninden T-tüp fragmanını çıkarmak için ardından gelen cerrahi prosedürler gerektirebilir. Bununla birlikte seçici olgularda T-tüp fragmanı, endoskopik retrograd kolanjiyopankreatografi (ERCP) ile ortak safra kanalından çıkartılabilir. ERCP, böyle bir komplikasyon için yeniden ameliyatı ortadan kaldıran hayat kurtarıcı bir role sahiptir. Bu çalışmada, T-tüpün geri çekilmesi sırasında kopması nedeniyle ileri merkez olarak hastanemize sevk edilen 42 yaşında kadın hasta sunuldu. Hastaya daha önce açık kolesistektomi ve T-tüp drenajı uygulanmıştı. T-tüp çıkarılırken, T-tüp bacağından 3-4 cm mesafede kopma meydana geldi. T-tüp bacağı ortak safra kanalında kalmıştı. ERCP’de T-tüpün bacağı, endoskopik sfinkterotomiyi takiben basket sıkıştırması ile ortak safra kanalı lümeninden çıkarıldı ve geçici bir plastik stent yerleştirildi. İşlemden bir ay sonra, stent ERCP yardımıyla çıkarıldı. Bu olgu, ERCP’nin seyrek endikasyonu olarak sunulmuştur.

Patient: Female, 76-year-old Final Diagnosis: Left hepatic cyst hidatic fistula to gall bladder Symptoms: Biliary colic • icterus • Sepsis Medication: — Clinical Procedure: Multidiscipliner treatment Specialty: Surgery Objective: Rare disease Background: Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. Case Report: A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. Conclusions: We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Aim: The most important complication that develops after pancreaticoduodenectomy is anastomosis leak and pancreatic fistula. Pancreatic fistula is thought to be the cause of major complications such as intra-abdominal abscess. The relationship between the development of fistula after pancreaticoduodenectomy and intraoperative risk factors (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure), along with the effect of pancreatic fistula on morbidity were investigated.Methods: Forty-one patients who had undergone pancreaticoduodenectomy due to periampullary region tumors were included in this study. Patients were divided into two groups as with and without pancreatic fistula, and compared in terms of demographics, preoperative serum bilirubin and serum albumin values, and intraoperative risks (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure). In addition, the groups were evaluated for the development of post-operative complications. Results: When both groups were compared in terms of intraoperative risk factors (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure), similar results were obtained for biochemical parameters (P=0.719, 0.599, 0.250, 0.906, respectively). A statistically significant association was found between the occurrence of pancreatic fistula and delay of gastric emptying (P=0.028). No significant relationship was detected between intraabdominal collection-abscess, intraabdominal hemorrhage, wound infection parameters and pancreatic fistula (P=0.204, 0.950, 0.116, respectively).Conclusion: No factors were found to be solely associated with the development of pancreatic fistula following pancreaticoduodenectomy; however, it was concluded that pancreaticoenteric anastomosis technique and the consistency of pancreatic stump may be closely and significantly related., Amaç: Pankreatikoduodenektomi sonrası gelişen en önemli komplikasyon anastomoz kaçağı ve pankreas fistülüdür. Pankreas fistülünün karın içi apse gibi büyük komplikasyonların nedeni olduğu düşünülmektedir. Pankreatikoduodenektomi sonrası fistül gelişimi ile intraoperatif risk faktörleri (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) arasındaki ilişki araştırıldı ve pankreatik fistülün morbidite üzerine etkisi araştırıldı.Yöntemler: Bu çalışmada, periampuller bölge tümörleri nedeni ile pankreatikoduodektomi operasyonu uygulanan 41 hasta incelendi. Hastalar pankreatik anastomoz kaçağı olan ve olmayan olarak iki gruba ayrıldı. Her iki grup yüksek serum bilirübin ve düşük serum albumin değerleri ve intraoperatif riskler (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) açısından karşılaştırıldı. Ayrıca gruplar post-operatif komplikasyon gelişimi açısından da değerlendirildi. Postoperatif komplikasyonlar: İntraabdominal koleksiyon-apse, intraabdominal hemoraji, yara yeri enfeksiyonu ve mide boşalma süresinin uzaması olarak kabul edildi.Bulgular: Her iki grup da intraoperatif risk faktörleri (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) açısından karşılaştırıldığında, biyokimyasal parametreler için benzer sonuçlar elde edilmiştir. (P=0,719, 0,599, 0,250, 0,906 sırasıyla). Gruplar, postoperatif komplikasyon parametreleri ile kıyaslandığında ise pankreatik fistül ile mide boşalma süresinin gecikmesi arasında istatistiksel olarak anlamlılık tespit edildi (P=0,028). İntra-abdominal apse, karın içi kanama, yara enfeksiyonu parametreleri ve pankreatik fistül arasında istatistiksel olarak anlamlı bir fark bulunmadı (sırasıyla P=0,204, 0,950, 0,116). Sonuç: Pankreatikoduodenektomi sonrası pankreatik fistül gelişmesinde hiçbir faktör tek başına etkili bulunmadı. Ancak belirgin bir şekilde pankreatikoenterik anastomoz tekniği ve pankreatik güdüğün kıvamı ile yakından ilişkili olabileceği kanaatine varıldı.

There have been many publications indicating that especially alkaline batteries are used in adults who attempt suicide by ingesting foreign objects. In our study, a convict patient of 45-year age has been taken to the emergency service of our hospital after ingesting 12 alkaline batteries of AA type for suicide. There are not any diseases in patient’s history except chronic depression and epilepsy. The patient has been hospitalized in the general surgery service in order to follow up, determining foreign objects in patient’s stomach corpus, as a result of the performed examination, direct graphy and tomography. In patient’s follow ups (after a follow up of 6 hours), the patient has been taken under upper gastrointestinal endoscopy at the end of 6 hours and 10 alkaline batteries of AA type have been taken out from abdomen with the help of endoscope, although 2 alkaline batteries have passed the treitz ligament. In the upper gastrointestinal endoscopy, generalized erythema and ulcerations have been determined in stomach corpus. The remaining 2 alkaline batteries have been taken out from the abdomen by natural ways. While studies have advised us to wait for 48 hours in cases of battery swallowing, the literature information which has changed in 2018, advises us not to wait for 48 hours, if possible, to remove it immediately. We wanted to present you that removing the alkaline batteries out of the abdomen by endoscopy in the centres having upper gastrointestinal endoscopy, is healthier for the patient and supports the literature, as the pathology, which may occur in stomach within this 48-hour period, may progress.

Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.

Aim: The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) cancer staging system is the strongest prognostic parameter for colorectal cancer. However, additional markers are needed to improve clinical decision making. The aim of this study was to investigate the effects of lenfovascular invasion (LVI), perineural invasion (PNI) and peritumoral lymphocytic reaction (PLR) on lymph node involvement in surgically treated colon cancer patients.Materials and Methods: The historical records of patients having undergone colon cancer surgery in the Department of General Surgery were evaluated. In addition to demographic data and pathological TNM staging, parameters including tumor location, type, differentiation, LVI, PNI, PLR and tumor growth pattern were recorded and analyzed. p

Background: A successful laparoscopic cholecystectomy is associated with the knowledge about anatomic structures and the congenital anomaly of the biliary tract. The aim of this study was to become familiar with vascular variations in laparoscopic cholecystectomy.Methods: This was a retrospective clinical study. The files of patients who underwent laparoscopic cholecystectomy due to benign gallbladder diseases were analyzed. The characteristics and complications of the patients with double cystic artery were recorded and examined.Results: A total of 360 patients, 76 males and 284 females were included in the study. The mean age was 51.2 (25-81). When the files of the patients were examined, it was found that double cystic arteries were detected during the operation in two male (2.63%) and nine female patients (3.16%). Gall bladder polyp was found as an indication for operation in one of 11 patients, while multiple gallbladder stones were found as an indication for operation in the other patients. The laparoscopic cholecystectomy was converted to conventional cholecystectomy in two from 11 patients (18.1%) with double cystic arteries due to bleeding. The mean duration of hospital stay in the patients with double cystic artery is 5.2 (3-11) days, and (2.7 days) longer compared to the patients without a double cystic artery.Conclusions: Cystic artery variations and other variations can coexist. Awareness of cystic artery variations can reduce the possibility of uncontrolled intraoperative bleeding, extrahepatic biliary injury, and switching to conventional cholecystectomy.

Background: An important part of the procedures for admission to emergency surgery is incarcerated inguinal hernia repair. Minimally invasive surgical procedures have led surgeons to perform these operations laparoscopically. The aim of this study was to demonstrate the safety of laparoscopic inguinal hernia repair in patients admitted to the emergency department with incarcerated inguinal hernia.Methods: The files of patients who underwent laparoscopic surgery for incarcerated inguinal hernia between January 2015 and June 2019 in Bandirma State Hospital General Surgery Clinic was retrospectively reviewed. Pearson Chi-Square test was used as statistical method. Version 18 of the SPSS program was used. P

Amac: Bu calismanin amaci Bandirma Devlet Hastanesi’ndeki Helicobacter pylorinin (H.pylori) sikligini ve Sydney siniflamasindaki parametrelerle iliskisini incelemektir. Yontemler: Calismada Ocak 2016 ve Subat 2017 tarihleri arasinda Bandirma Devlet Hastanesi Endoskopi unitesinde tani amacli endoskopi yapilan 1029 hastanin endoskopi raporlari Sydney siniflamasi acisindan retrospektif olarak incelendi. Bulgular: Calismadaki hastalarin %60,6’si kadin, kadin hastalarda (%41,7) H.pylori orani, erkek hastalara (%54,1) gore daha dusuk duzeydedir. Yas ortalamasi cinsiyete gore degisiklik gostermemekle birlikte, butun hastalarin yas ortalamasi 48,2’dir. 1027 Hastada enflamasyon (%99,8), 515 hastada notrofil aktivasyonu (%50), 192 hastada intestinal metaplazi (%18,7), 48 hastada glanduler atrofi (%4,7) ve 258 hastada lenfoid folikul (%25,1) saptandi. 479 Hastada H.pylori pozitif (%46,6) saptandi. Sonuc: Bizim calismamizda H.pylori prevalansi %46,6 saptanmis olup literatur ortalamasinin altindadir ve gelismis ulkelerdeki sonuclarla benzerlik gostermektedir. H.pylorinin Sydney siniflamasindaki degiskenlerle olan iliskisi incelendiginde; inflamasyonun siddeti, notrofil aktivasyonu, intestinal metaplazi ve lenfoid folikul derecesi arttikca H.pylori pozitifliginin arttigi gorulmekte ancak glanduler atrofi duzeyi ile H.pylori arasindaki iliski anlamli duzeyde saptanmadi.