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    Analysis of Rare Spontaneous Intraperitoneal Hydatic Cyst Rupture: a Multicentric Experience
    (Springer India, 2021) Tas, Ilhan; Aday, Ulas; Yigit, Yasemin Demir; Yigit, Ebral
    This case series analysis aims to present the clinical, operative, and follow-up results of 17 patients who were operated on for an intraperitoneal rupture in two tertiary care centers in the same region. In this study, patients who underwent emergency surgery due to ruptured liver hydatid cysts in the intraperitoneal space between January 2016 and December 2020 at two tertiary centers were retrospectively analyzed. Of the 17 patients, 14 were women (82.4%) and 3 (17.6%) were man, and the mean age was 35.9 SD15.1 (min: 17, max: 69) years. Seven (41.2%) patients had a single cyst, and 10 patients (58.8%) had two or more cysts. The time from the onset of symptoms to admission to the hospital was 16.9 SD16.1 (4-72) hours. Average operation time was 80 SD63.43 min. Complications developed in three patients in the postoperative period. These were atelectasis, ileus, and stricture in the common bile ducts. The mean hospitalization period of the patients was 8.0 SD2.78 (4-15) days. The follow-up period was 44 (IQR; 23-91) months, and recurrence occurred in 3 (17.6%) patients. The timing of medical and surgical treatment is an important factor in the morbidity and mortality of patients. Close follow-up and timely intervention are of vital importance in reducing the risk of rupture in patients who are followed up on for hydatid cysts.
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    Comparison of Early Clinical and Long-Term Oncological Outcomes of Laparoscopic Versus Converted Rectal Cancer Resection: A Retrospective Cohort Study
    (Springernature, 2024) Aday, Ulas; Akbas, Abdulkadir; Bayrak, Ferdi; Sekho, Zehra; Kozgun, Azat; Sevmis, Murat; Oguz, Abdullah
    Aim The effects of conversion to open surgery during laparoscopic resection in rectal cancer on perioperative clinical and long-term oncological outcomes are still controversial. This study aimed to evaluate and compare the impact of conversion to laparoscopic resection for rectal cancer on perioperative and long-term oncological outcomes. Material and methods Between January 2019 and December 2023, 84 consecutive patients who underwent curative surgery for rectal cancer at a single academic center were evaluated retrospectively. Patients were classified and compared as the laparoscopic (LAP-G) and converted (CONV-G) groups. Perioperative, pathological, and long-term oncological outcomes were compared. Results Of the 84 consecutive patients included, 18 were converted to open surgery, leading to a 21.4% conversion rate. Intraoperative blood loss was higher in CONV-G (180 ml vs. 80 ml, p<0.001), but early clinical outcomes were similar in both groups. The median follow-up period was 23.5 (range 3-65) and 30.5 (range 6-61) months in the LAP-G and CONV-G, respectively, and recurrence occurred in 11 (16.7%) and 3 (16.6%) patients, respectively. Three-year overall survival was 96.9% and 89.4% (p=0.609) and 3-year disease-free survival was 92.4% and 83.3% (p=0.881) in LAP-G and CONV-G, respectively, and the results were similar. Conclusion Conversion from laparoscopic rectal resection to open surgery does not have a significant negative impact on morbidity and long-term oncological outcomes.
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    Cryptogenic hepatitis simulating cyst rupture and hydatid jaundice in a patient with preexisting asymptomatic hydatid cyst
    (Babol Univ Medical Sciences, 2017) Aday, Ulas; Kayaalp, Cuneyt; Kapan, Murat
    Background: Rupture into the biliary ducts is the most frequent complication of hydatid liver disease. In endemic areas of Echinococcus granulosus, development of jaundice in a patient with liver cyst is initially suspected to have hydatid cyst. Case Presentation: A 48 year-old woman with history of asymptomatic hydatid liver cysts was admitted to the emergency department with right upper quadrant abdominal pain, increased levels of liver enzymes, bilirubin and alkaline phosphatase and the initial clinical diagnosis was the hydatid cyst rupture into the bile ducts. Surgery was planned but radiological evaluation (MRI) revealed non-dilated intra-extra biliary ducts. High suspicion of hydatid rupture required diagnostic ERCP that was normal and surgery was cancelled then. A possible diagnosis of coexistent hepatitis was suspected. Liver function tests normalized gradually and no cyst rupture was determined during surgery. Conclusion: These findings suggest considering the possible development of cryptogenic hepatitis in patients with preexisting hydatid cyst.
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    A huge ovarian serous cystadenoma with situs inversus totalis: first case report
    (Oxford Univ Press, 2021) Cetin, Erman; Oner, Eyup; Aday, Ulas; Guzelgul, Mehmet; Gokce, Ayca Orhan
    Coexistence of situs inversus totalis and ovarian serous cystadenoma in pubertal girls is extremely rare. It is important to preserve ovarian hormonal physiology and fertility if it is detected in the pubertal period. A 16-year-old girl presented with abdominal distension and pain. Radiological evaluation revealed a huge abdominal cystic mass and situs inversus totalis. In laparotomy, unilateral salpingoophorectomy and total cystectomy were performed on the ovarian cystic mass. It was confirmed as serous cystadenoma in pathological evaluation. This is the first reported case in the literature of situs inversus totalis with a huge ovarian serous cystadenoma.
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    Investigation into the effect of neoadjuvant therapy and tumor regression grade on the shrinkage of distal surgical margin in rectal cancer: A prospective case-control study
    (Wolters Kluwer Medknow Publications, 2022) Aday, Ulas; Kilicarslan, Ahmet; Boyuk, Abdullah; Akkoc, Hasan
    Background: The present study aimed to explore the effect of neoadjuvant therapy and tumor regression grade (TRG) on the shrinkage in the distal surgical margin ( DSM) induced by formalin fixation in rectal cancer. Materials and Methods: In this prospective study, the DSM of resected 61 specimens of rectal and rectosigmoid junction adenocarcinoma were measured following fresh and formalin fixation. The measurements were performed within the first 15 min after resection and at 24 h after formalin fixation without pinning and were compared with regard to neoadjuvant treatment status and TRG. Results: In the patients that received neoadjuvant therapy, the fresh and postfixation DSM values were 32.2 mm and 22.7 mm, respectively, and the mean shrinkage rate was 34.7% (P. 0.001). In the patients that did not receive neoadjuvant therapy, the fresh and postfixation DSM values were 54.03 mm and 41.9 mm, respectively, and the mean shrinkage rate was 23.7% (P. 0.001). The mean shrinkage rate was 41.9% in TRG 1, 29.4% in TRG 2, and 31.9 in TRG 3 specimens. The mean shrinkage rate was higher in specimens with a DSM of =20 mm compared to specimens with a DSM of >20 mm (46.2% vs. 24.9%). Conclusion: A complete or near-complete tumor regression in patients with rectal cancer undergoing neoadjuvant therapy increases the shrinkage of DSM. Moreover, this shrinkage rate is likely to be higher and the pathological DSM is likely to be closer than expected in cases that present a better clinical response to neoadjuvant therapy, particularly in distal rectal cancer.
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    Laparoscopic segmental resection for completeobstructive jejunal adenocarcinoma
    (2020) Yalçın, Kendal; Aday, Ulas; Akpulat, Faik Veysel
    Small bowel adenocarcinoma (SBA) is a rare entity and surgical resection is the mainstay treatment of early-stage SBA. Laparoscopic surgery has become a well-established and popular treatment method worldwide and is known to provide numerous advantages. In this report, we present an SBA patient who developed complete obstruction of the small bowel and underwent laparoscopic segmental resection.
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    Synchronous celiac artery and superior mesenteric artery compression syndrome: The effect of collateral circulation on the treatment procedure
    (Babol Univ Medical Sciences, 2023) Aday, Ulas; Oguz, Abdullah; Ozesmer, Hikmet; Bahadir, Mehmet Veysi
    Background: Maintaining collateral circulation is highly important in the stenosis of celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The SMA compression is commonly reported to be accompanied by the CA compression caused by the median arcuate ligament (MAL) while the synchronous compression of CA and SMA by other ligaments has been rarely reported.Case Presentation: In this report, we present a 64-year-old female patient who presented with a postprandial abdominal pain and weight loss. Initial evaluation indicated a synchronous compression of CA and SMA caused by MAL. The patient was planned for laparoscopic MAL division due to the presence of sufficient collateral circulation between the CA and SMA that was facilitated through the superior pancreaticoduodenal artery. Following laparoscopic release, the patient improved clinically and postoperative imaging indicated that the compression on the SMA was still present and the collateral circulation was sufficient.Conclusion: We suggest that laparoscopic MAL division can be the primary method of choice in cases with sufficient collateral circulation between the CA and SMA.