Biomedical subjects

A Iğci

Publications and source records attributed to A Iğci.

5 recordsLinked to original sources

PubMed2002

Endoscopic sphincterotomy in the management of postoperative biliary fistula A complication of hepatic hydatid disease.

BACKGROUND: Intrabiliary rupture is the most common complication of hepatic hydatid disease (HHD), and persistent biliary leakage is the most frequent complication after surgery for HHD. In this study, we evaluated the outcome of endoscopic sphincterotomy (ES) performed in the management of postoperative biliary fistula in 33 patients with HHD and investigated the effects of the daily output of the fistula and the timing of the ES on the duration of the fistula. METHODS: Between January 1994 and April 2000, 33 patients (20 female, 13 male; median age, 44 years; range, 17-72) underwent ES at our clinics. The daily output of the biliary fistula ranged from 100 ml to 1000 ml (mean, 430 ml; in 18 patients < or = 400 ml; in 15 patients, >400 ml). The interval between the occurrence of the fistula and the performance of the ES ranged from 7 days to 5 months (median, 20 days; in 12 patients, < or = 2 weeks; in 21 patients >2 weeks). RESULTS: In patients with fistula output 400 ml (n = 18) and >400 ml (n = 15), the average closure times for the fistula after ES were 10.7 +/- 4.5 and 10.4 +/- 4.9 days, respectively (t-test: p = 0.847, t = 0.195). In patients (n = 2) with a short interval between the occurrence of the fistula and ES (<2 weeks), the average closure time for the fistula was 11.6 +/- 5.6 days, whereas for the patients (n = 15) with longer intervals (>2 weeks) it was 9.4 +/- 3.9 days (t = test: p = 0.254, t = 1.180). The drainage from the fistula stopped after an average of 9.88 +/- 4.83 days in all patients who underwent ES, and there were no any complications. Pearson's correlation test (PC) showed no significant relationship between the time for the complete closure time of the fistula after ES and the fistula output (PC=-0.253, p=0.155) or for the duration of the fistula before endoscopic retrograde cholangio pancreatography (ERCP) (PC = -0.333, p = 0.058). CONCLUSIONS: Endoscopic sphincterotomy is safe and effective and should be considered the minimally invasive procedure of choice for the management of postoperative biliary fistula due to HHD because it obviates the need for reoperation. If the sphincterotomy is successful, neither the daily output not the duration of the fistula has any influence on the time required for complete closure of the fistula.

Adolescent↗

PubMed1998

Laparoscopic esophagomyotomy without an antireflux procedure for the treatment of achalasia.

Various gastroenteric surgical procedures have been attempted laparoscopically. Laparoscopic esophagomyotomy (LE) with or without fundoplication, performed for achalasia, has gained popularity. In our clinic, LE (Heller's myotomy) was performed on six patients with achalasia. All patients underwent barium esophagography, endoscopy, and esophageal manometry for diagnosis. Extramucosal myotomy was started 6 cm above the cardioesophageal junction on the left anterolateral aspect of the esophagus and continued 1 cm below this area. Endoscopic control of the distal esophageal mucosa and the stomach was carried out under direct laparoscopic visualization following the completion of myotomy during the operation. LE was completed without complication in five patients. In one patient (16%), mucosal perforation occurred after myotomy during endoscopic control and was repaired with endostitches. There were no postoperative complications. The average hospital stay was 3 days. Three of the six patients agreed to 24-h pH monitoring, the results of which showed no evidence of reflux. All patients were completely symptom free in the postoperative period. The average preoperative lower esophageal sphincter pressure was 44 mm Hg, whereas in the early postoperative period and 6 months later, it was 11 mm Hg. There was no dysphagia or reflux esophagitis during the follow-up period (range 12 to 24 months). LE is associated with low morbidity and a high success rate, comparable with an open procedure, and can be done without an antireflux procedure.

Adult↗

PubMed1995

Laparoscopic treatment of duodenal ulcer by bilateral truncal vagotomy and endoscopic balloon dilatation.

The low morbidity and early recovery associated with laparoscopic procedures have shown a new direction for many types of surgery. We performed a laparoscopic bilateral truncal vagotomy (BTV) with pyloric dilatation (PD) in 20 patients (11 men, 9 women, ranging in age from 32 to 56 years, with a mean age of 42 years). All patients had chronic duodenal ulcer diagnosed endoscopically, with a mean duration of symptoms of 2.6 years (range 2-8 years). The mean length of surgery was 55 min (range 45-90 min). The mean follow-up period was 16 months (range 3-25 months). In 1 patient, esophageal perforation occurred during the dissection of the left vagus nerve and was sutured laparoscopically. Acid secretion tests under basal conditions and pentagastrin stimulation preoperatively and 1 month postoperatively showed a decrease in basal acid output (BAO) of 76% and maximal acid output (MAO) of 84.2%. Endoscopy at the second and sixth postoperative month showed healing of the ulcer in 19 of 20 patients (95%). One patient had partial pyloric stenosis due to chronic duodenal ulcer before BTV and PD and developed complete pyloric stenosis after the surgery. Despite repeated pyloric balloon dilatation, he required an open drainage procedure (gastroduodenostomy, Jaboulay). Three patients (15%) had postoperative diarrhea and responded very well to medical treatment. The preliminary results showed that laparoscopic BTV with PD is a simple and effective procedure for the treatment of chronic duodenal ulcer.

Adult↗

PubMed1995

Comparison of fine needle aspiration cytology and excisional biopsy in palpable breast cancers.

It is essential to know the nature of breast lesions before surgery. One of the well-known procedures is the cytologic diagnosis by means of Fine Needle Aspiration (FNA). We planned a prospective comparative study to assess how reliable FNA is for breast masses in our institution. 338 ladies with palpable breast lesions underwent FNA cytology and the results were malignant nature in 89 patients, atypia in 33, atypia suspicion in 24, benign in 171, and insufficient material in 21. Histopathologic examinations of the specimens confirmed that 89 of 89 malignant cytology cases were malignant (100%), 25 of 33 atypia cases were malignant (75%), 9 of 24 atypia suspicion cases were malignant (37%), 12 of 171 benign cases were malignant (7%). Most of the malignant cytology cases consisted of invasive ductal carcinomas (78%). Invasive lobular carcinoma represented suspicious cytology in 42%. FNA is 100% specific and 91% sensitive. Lesions containing rich stroma and fewer cells (lobular, colloidal carcinoma) exhibited mainly suspicious findings. We conclude that FNA is a simple, cheap and safe procedure yielding enough information to diagnose breast masses. It allows possible and accurate treatment options to be explained to the patient before surgery. Suspicious cytology should be confirmed by excisional biopsy because of its high malignant potential. If clinical and mammographic findings supports benign cytology, lesions can be followed up.

Adenocarcinoma, Mucinous↗

PubMed1993

Dysphagia lusoria.

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Abnormalities, Multiple↗