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B Topal

Publications and source records attributed to B Topal.

At least 19 recordsLinked to original sources
PubMed2006

Determinants of complications in pancreaticoduodenectomy.

AIMS: The factors determining complications after pancreaticoduodenectomy (PD) have not yet been identified clearly. This retrospective study examined, using reproducible classification systems, the type and severity of complications as well as the factors to predict them. METHODS: Between 1998 and 2005 PD was performed in 351 consecutive patients with peri-ampullary tumours. Logistic regression models were used in univariate as well as in corrected, multivariate analyses in order to identify the optimally combined factors related to the occurrence of post-operative complications. RESULTS: Post-operative complication rate was 50.7%, mortality 3.1% and re-operation rate 7.1%. Pancreatic fistula (12%) was responsible for higher mortality (9.5%; p=0.011) and re-operation (30.9%; p<0.001) rates. Hospital length of stay (LOS) was (p<0.001) longer for patients with post-operative complications (median 21.5 (range 1-128) vs. 14 (7-42) days) or pancreatic fistula (28.5 (8-128) vs. 17 (1-63) days), and related to the severity of complications. Surgeon (Odds ratio [OR] 2.03; confidence interval [CI] 1.20-3.41; p=0.008), male gender (OR 1.72; CI 1.05-2.81; p=0.032), and pre-operative hyperbilirubinaemia (OR 1.04; CI 1.001-1.08; p=0.046) were independent risk factors for post-operative complications. Neither prophylactic octreotide nor pre-operative biliary drainage improved post-operative outcome. CONCLUSION: Surgeon, male gender, and pre-operative hyperbilirubinaemia determine complication rate following PD. Pancreatic fistula is the most common complication and is associated with increased mortality, re-operation rate and LOS.

Adult↗
PubMed2006

The effect of polyethylene glycol and butyrate on anastomotic healing in the rat colon.

BACKGROUND: The use of mechanical bowel preparation is much debated. METHODS: We evaluated the effects of polyethylene glycol (PEG), with or without a single dose of 3.0 mmol butyrate (BUT), on the bursting pressure (BP) of an intact colon segment and a colon anastomosis in rats. Also, histopathologic damage was studied. RESULTS: In rats without colectomy, the mean BP was 159.2 mmHg (SD=18.9) after PEG treatment and 116.7 mmHg (SD=27.5) in controls (p=0.001). In rats with colectomy, the mean BP was 90.4 mmHg (SD=45.9) in the PEG group, 108.0 mmHg (SD=31.9) in the BUT group, and 102.7 mmHg (SD=44.7) in controls (p=0.44). No significant differences in histopathologic scores were observed between rats treated with PEG and controls. CONCLUSIONS: PEG does not interfere with anastomotic healing in rats as measured by BP. No benefit of a single dose of butyrate was observed.

Administration, Oral↗
PubMed2006

Long-term outcome after surgical treatment of nonparasitic splenic cysts.

BACKGROUND: The optimal treatment for patients with nonparasitic splenic cysts is controversial. This study aimed to evaluate the clinical outcome of patients treated for a symptomatic splenic cyst, and to define a surgical strategy. METHODS: Spleen-preserving surgery (9 laparotomies and 6 laparoscopies) was performed for a primary cyst in six patients and a secondary cyst in nine patients. The median follow-up time was 37.5 months. Partial splenic resection was performed for eight patients and cyst decapsulation for seven patients. RESULTS: Cyst recurrence was observed in four patients after decapsulation of a primary splenic cyst, as compared with none after resection. Postoperative complications were encountered only after laparotomy (5/9). The median hospital stay was 3.5 days (range, 2-5 days) after laparoscopy, as compared with 9 days (range, 5-14 days) after laparotomy. CONCLUSIONS: Symptomatic splenic cysts should be treated laparoscopically. For patients with recurrent or suspected primary splenic cysts, laparoscopic partial splenectomy is preferable. For other cases, a laparoscopic decapsulation is advocated.

Adolescent↗
PubMed2006

Laparoscopic liver resection using radiofrequency coagulation.

BACKGROUND: The use of radiofrequency (RF) energy has been described to perform open liver resection safely and with minimal blood loss. Yet no data are available on the potential contribution of RF energy to the limitation of intraoperative blood loss during laparoscopic liver resection (LLR). The aim of this prospective, nonrandomized study was to investigate the potential contribution of RF energy to the limitation of intraoperative blood loss in patients undergoing LLR. METHODS: Forty-five patients [male/female ratio 22/23, age 57 years (26-80)] underwent LLR. Eleven benign and 47 malignant lesions (mostly colorectal metastases) were resected. Median number [1 (1-3)] and maximum diameter [40 mm (8-170)] of tumors as well as median tumor free margins [10 mm (1-30)] were comparable in patients undergoing LLR with (20 patients) or without (25 patients) RF-assistance. Thirty-eight minor (< or = 2 segments) and 9 major (> 3 segments) resections were performed. Eighteen patients simultaneously underwent additional surgery. RESULTS: No mortality occurred. Median intraoperative blood loss was 200 (5-4000) ml and was similar in patients undergoing LLR with or without RF-assistance. The type of surgical procedure was a determinant for the amount of intraoperative blood loss (p = 0.0002). Significant bleeding occurred from large hepatic vessels at major resections. Median operation time was 115 (45-360) minutes. RF-assistance didn't seem to reduce perioperative morbidity. CONCLUSIONS: LLR can be performed with minimal intraoperative blood loss, which is determined by the type of hepatectomy. Significant intraoperative bleeding occurs from large hepatic vessels during major resections. RF-assisted parenchymal transection in LLR doesn't seem to reduce blood loss, operation time, or perioperative morbidity.

Adult↗
PubMed2005

Cancer cell dissemination during curative surgery for colorectal liver metastases.

AIM: The amount of cancer cells disseminated during curative surgery for colorectal liver metastases (CRLM) may be responsible for recurrence. Haematogenous and intrahepatic cancer cell dissemination was evaluated, and its impact on cancer recurrence was assessed. METHOD: Twenty patients with resectable CRLM were included in a prospective study. Twelve patients underwent curative resection for 21 metastases. Ten selected metastases in eight patients were treated with radiofrequency ablation (RFA) followed by resection at the same operative session. Cancer cell dissemination was determined before, during and after surgery using 'real time' quantitative RT-PCR assay, based on detection and quantification of CEA and CK20 mRNA transcripts. RESULTS: Circulating cancer cells were detected in 80% and intrahepatic cancer cells in 37% of the patients, though without impact on cancer recurrence. The amounts of disseminated cancer cells were significantly increased after surgery. This increase was similar in patients treated with and without RFA. RFA caused complete tumour destruction. CONCLUSION: Curative surgery for CRLM significantly increases the amount of disseminated cancer cells. Radiofrequency ablation can completely destroy selected resectable CRLM without excessive cancer cell dissemination. Neither haematogenous nor intrahepatic cancer cell dissemination were related to cancer recurrence in this small patient series.

Aged↗
PubMed2004

Gastro-intestinal stromal tumour of the duodenum: extreme presentation in two cases.

Gastro-intestinal stromal tumours (GIST) are primary mesenchymal tumours arising from the gastro-intestinal tract. They are uncommon visceral tumours, preferentially located in the stomach and small intestine. The present paper will discuss the clinical presentation of GIST in a 32-year-old female (Case 1) and in a 72-year-old female (Case 2). In both cases the tumour is located in the duodenum which appears to be a rather unusual location (4%) for GIST. This work will illustrate that duodenal GIST can occur in extreme presentations, diverging from vague complaints to directly life threatening symptoms.

Adult↗
PubMed2004

Transcatheter management of hepatic artery pseudoaneurysm following pancreaticoduodenectomy: a report of three cases.

Pseudoaneurysm formation is a rare, but potentially life threatening delayed complication of major pancreatic surgery. Redo surgery several weeks after pancreaticoduodenectomy can be hazardous, especially in debilitated patients. Percutaneous, transcatheter exclusion of the pseudoaneurysm by means of embolic coils can be an efficient, safe and minimally invasive alternative to open surgery with good mid- and long-term results. We present our experience in Three patients undergoing transcatheter embolization of hepatic artery pseudoaneurysms detected several weeks after Whipple's operation.

Aged↗
PubMed2003

Aggregated colon cancer cells have a higher metastatic efficiency in the liver compared with nonaggregated cells: an experimental study.

BACKGROUND: It remains unclear whether aggregated colon cancer cells have a higher tendency for metastasis formation than nonaggregated cells. Also, the absolute number of cancer cells required for hepatic metastasis remains undefined. The aim of the present study was to compare in the liver the metastatic efficiency of viable nonaggregated colon cancer cells versus cell aggregates for equivalent numbers of cancer cells. MATERIALS AND METHODS: DHD/K12/TRb colon cancer cells were administered through the portal vein in syngeneic male BD IX rats. Surgical exploration was performed 8 weeks after injection. Four groups of rats were injected with 0.25 or 0.5 x 10(6) DHD/K12/TRb viable cancer cells, either as single nonaggregated cells or as cell aggregates. RESULTS: Hepatic metastases were observed in 81% of the rats after intraportal injection of cell aggregates equivalent to 0.5 x 10(6) cancer cells. A significant lower metastatic efficiency was found after the injection of 0.5 x 10(6) non-aggregated, and 0.25 x 10(6) aggregated or nonaggregated cancer cells i.e., 16%, 32%, and 27%, respectively. CONCLUSION: Aggregated colon cancer cells have a higher metastatic efficiency in the liver compared with non-aggregated cells, although a critical number of cancer cells are necessary.

Adenocarcinoma↗
PubMed2003

The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease.

BACKGROUND: The application of available predictive scoring systems for the detection of common bile duct (CBD) stones has not reduced the number of patients who undergo unnecessary endoscopic retrograde cholangiopancreatography. The aim of this study was to create a predictive model for CBD stones and to assess the value of magnetic resonance cholangiopancreatography (MRCP) in prediction. METHODS: In 1998, 366 patients with gallstone disease (118 males, 248 females; mean age 57 (range 8-84) years) underwent cholecystectomy. Statistical analysis was performed on patient data obtained at the time of first presentation. RESULTS: CBD stones were demonstrated in 43 (12 per cent) of 366 patients. The predictive model for common duct stones included ultrasonography showing CBD stones or bile duct dilatation, age greater than 60 years, fever, serum alkaline phosphatase level above 670 units/l and serum amylase level above 95 units/l. In patients with a predicted probability greater than 5 per cent, CBD stones were present in 11 per cent, compared with 1 per cent in patients with a probability of 5 per cent or less. MRCP had an observed sensitivity of 95 per cent, specificity of 100 per cent, positive predictive value of 100 per cent and negative predictive value of 98 per cent. CONCLUSION: In patients with a predicted probability for CBD stones of more than 5 per cent, MRCP is recommended in order to confirm the presence or absence of stones and as guidance in further management.

Adolescent↗
PubMed2003

Patterns of failure following curative resection of colorectal liver metastases.

AIMS: Several studies have focused on factors determining recurrence and survival rate after curative resection of colorectal liver metastases (LM). Data are lacking with regard to patterns of failure indicating where and when recurrences arise. METHODS: One-hundred-and-five consecutive patients [F/M: 31/74; mean age 61 years (range 36-80 y)] with primary colorectal liver metastases underwent surgical R0 curative resection between 1990-1999. Patient follow-up was closed in January 2002. The common closing date method was used for survival analysis. Multivariate analysis was performed with the Cox proportional hazard technique. RESULTS: The overall (OS) vs disease free survival (DFS) rates at 1, 2, and 5 years were 88.5 vs 63.3, 73.4 vs 40.2, and 36.8 vs 18.1%, respectively. Elevated serum CEA level was the only factor independently related to recurrent disease. Elevated serum CEA level, maximum diameter of liver metastases (LM), and satellitosis were factors significantly related to poor OS. Recurrent liver metastases developed in 43% and extra-hepatic metastases in 60% of the patients. In about half of the patients cancer recurrence was observed within 18 months, almost equally distributed between hepatic and extra-hepatic sites. CONCLUSION: Despite optimal patient selection and curative resection of colorectal liver metastases, more than a half of the patients developed cancer recurrence within 2 years.

Adult↗
PubMed2002

Laparoscopic liver resection of benign liver tumors.

OBJECTIVE: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. BACKGROUND: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. METHODS: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. RESULTS: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. CONCLUSIONS: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

Adolescent↗
PubMed2002

Rectal washout with cytotoxic solution can be extended to the whole colon.

BACKGROUND: Rectal irrigation with a cytotoxic agent does not kill viable intraluminal cancer cells proximal to the primary tumour. To prevent implantation of these cells at the time of restorative proctectomy, the feasibility of retrograde whole-colon irrigation just before surgery was explored. METHODS: The cytotoxic efficacy of different combinations of povidone-iodine (PVPI) and Gastrografin was tested with the trypan blue exclusion test on a human colon carcinoma cell line (SW620) in vitro. Subsequently, a retrograde whole-colon lavage with PVPI 5 per cent and Gastrografin 12 per cent was performed in 14 euthyroid, non-allergic patients with colorectal cancer using a colostomy irrigation set. Thyroid function and mucosal damage were assessed. RESULTS: It took 2 min and approximately 1 litre of infused solution to reach the caecum in all patients. The solution was 100 per cent tumoricidal in vitro and remained so after colonic irrigation. Total serum tri-iodothyronine (T3) levels decreased and those of reverse T3 increased, but normalized after 1 week. Superficial epithelial desquamation was observed shortly after irrigation; however, complete restoration occurred within 7 days. CONCLUSION: A rectal washout can easily be extended to a retrograde irrigation of the whole colon in elective colorectal cancer surgery. This may help to prevent anastomotic and local recurrence due to implantation of viable exfoliated tumour cells.

Adult↗
PubMed2001

Clinical value of whole-body emission tomography in potentially curable colorectal liver metastases.

AIMS: In selected patients with colorectal liver metastases, hepatic resection offers an opportunity for cure, with a 25-38% 5-year survival rate. The aim of this prospective study was to evaluate whether patient selection could be improved with pre-operative whole-body 18-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scan. METHODS: Ninety-one consecutive patients were considered to be eligible for liver resection after investigation with conventional diagnostic methods (CDM). In all these patients a whole-body PET scan with FDG was performed prior to surgery. Follow-up was complete with a mean of 23 months (2 weeks-92 months). All PET images were reviewed blinded to intraoperative and follow-up data. RESULTS: PET confirmed liver metastases in 90 (99%) patients, while it provided additional information in 10 (11%) patients, i.e., seven intra-abdominal, and three extra-abdominal. PET falsely upstaged six (6.6%) patients in whom malignancy was excluded by additional investigation, at the time of surgery, or during follow-up. PET falsely understaged seven (7.7%) patients with small intra-abdominal lesions. CONCLUSION: In patients with potentially curable colorectal liver metastases according to conventional diagnostic methods, whole-body FDG-PET can be considered as a complementary examination in order to further select patients for potentially curative liver resection, and to optimize therapeutic strategy.

Adult↗
PubMed1999

The outcome of major biliary tract injury with leakage in laparoscopic cholecystectomy.

BACKGROUND: Concern has been expressed regarding the increased rates of biliary tract injury (BTI) at laparoscopic cholecystectomy. The aim of the present investigation was to analyze the outcome of laparoscopic biliary tract injury with leakage. METHODS: Sixteen patients having major laparoscopic BTI with leakage were treated. Thirteen of them were referred to our institution for further treatment. The follow-up was complete and focused on clinical outcome and biochemical analysis. RESULTS: Eight BTI were identified at the time of laparoscopic cholecystectomy, and the procedure was converted to a laparotomy. In eight additional patients, BTI was recognized postoperatively. In this group one patient died because of lately diagnosed biliary peritonitis, whereas in the seven surviving patients nine attempts to repair the BTI and eight other interventions were performed. In the conversion group 14 attempts to repair the BTI and 11 other interventions were needed to completely solve the problems. Final restoration of the BTI was done by Roux-en-Y hepaticojejunostomy in 11 patients and suture repair with T-tube drainage of the bile duct in 4. During a median follow-up time of 63 months, three patients suffered from recurrent segmental cholangitis. In the other patients, neither clinical nor biochemical evidence of biliary disease has been found up to this writing. CONCLUSIONS: Laparoscopic BTI has a high morbidity and mortality rate that seems comparable to BTI at open cholecystectomy. The number of attempts to repair the BTI as well as additional interventions is too high, but in this patient series the final outcome seemed to be similar after BTI recognized during and after laparoscopic cholecystectomy.

Adult↗
PubMed1998

Outcome after 'curative' surgery for carcinoma of the lower third of the rectum.

BACKGROUND: Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone. METHODS: Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3.5-7.5 cm from the anal margin. Cox proportional hazards technique with univariate and corrected (multivariate) analyses and the Kaplan-Meier life-table method were used to evaluate the data. RESULTS: Tumour wall penetration and lymph node involvement, but not the tumour level or the type of surgery, were found to be significant predictors of outcome. The local recurrence rate at 1, 2 and 5 years was 10, 22 and 26 per cent respectively after APRE, and 5, 13 and 21 per cent after SSO. The disease-free survival rate at 1, 2 and 5 years was 85, 67 and 58 per cent respectively after APRE, and 88, 78 and 62 per cent after SSO. CONCLUSION: Tumour-related factors are significant predictors of outcome. The type of surgery (APRE or SSO) did not seem to be a significant variable in this non-randomized study.

Adenocarcinoma↗
PubMed1997

[Complete pre-peritoneal endoscopic closure of inguinal hernias].

BACKGROUND: Considering the high recurrence rate after conventional inguinal hernia repair, the totally preperitoneal endoscopic inguinal hernia repair has been used. METHODS: The present experience of the authors embraces 1085 patients with a total of 1717 inguinal hernias, including 200 recurrences. The operative technique is described with emphasis on pitfalls and tricks. RESULTS: Analysis of the data concerning the first 403 patients with 1 year complete follow-up reveals a mean (SEM) operating time of 42 (1.2) min for unilateral and 58 (1.0) min for bilateral hernia repair. Mean (SEM) postoperative hospital stay was 2 (0.04) days. Complication rates during and after operation were 0.3% and 3.3% respectively. The morbidity rate at 1 month after operation was 3.5%. The recurrence rate was 0.3% at 1-year follow-up. CONCLUSION: Totally preperitoneal endoscopic inguinal hernia repair is safe and reproducible for any type of primary or recurrent inguinal hernia, even in patients with previous subumbilical surgery or severe systemic disease. Careful follow-up is mandatory to assess the late recurrence rate.

Adult↗
PubMed1997

Totally preperitoneal endoscopic inguinal hernia repair.

BACKGROUND: Recurrence rate after conventional inguinal hernia repair is high. However, the Stoppa technique has provided the best results. The totally preperitoneal endoscopic inguinal hernia repair is developed in order to combine the results of the Stoppa technique with the advantages of minimally invasive surgery. METHODS: Between October 1992 and August 1994, 403 patients with a total of 632 inguinal hernias, including 82 recurrences, were treated by totally preperitoneal endoscopic inguinal hernia repair with mesh placement of at least 10 x 15 cm. RESULTS: Mean(s.e.m.) operating time was 42(1.2) min for unilateral and 58(1.0) min for bilateral hernia repair. Mean(s.e.m.) postoperative hospital stay was 2(0.04) days. Complication rates during and after operation were 0.3 and 3.3 per cent respectively. The morbidity rate at 1 month after operation was 3.5 per cent. The recurrence rate was 0.3 per cent at 1-year follow-up. CONCLUSION: Totally preperitoneal endoscopic inguinal hernia repair is safe and reproducible for any type of primary or recurrent inguinal hernia, even in patients with previous subumbilical surgery or severe systemic disease. Careful follow-up is mandatory to assess the late recurrence rate.

Adult↗