Enteral nutrition consensus report from KEPAN: Indications, choice, practical application, and follow-up.

OBJECTIVES: Clinicians are in need of guidance that will ease the application of medical nutrition therapy. In order to facilitate the application and success of medical nutrition therapy, the Turkish Clinical Enteral & Parenteral Nutrition Society (KEPAN) planned a report that is short, is clear, and has clear-cut recommendations that will guide health care professionals in the indications, choice, practical application, follow-up, and stopping of enteral nutrition. METHODS: The enteral nutrition consensus report on enteral nutrition use in medical nutrition therapy was developed by a study group (12 working group academicians and 17 expert group academicians) under the organization of KEPAN. The enteral nutrition consensus report was generated in 5 online and face-to-face phases from December 2019 through October 2022. At the end (Delphi rounds), a total of 24 questions and subjects, recommendations, and comments were sent to the enteral nutrition working group and the expert group via e-mail. They were asked to score the criteria by using the Likert scale. RESULTS: The first round of the study resulted in acceptance of all 24 recommendations. None of the criteria was rejected. Only some minor editing for wording was recommended by the panelists during the first and second rounds of the Delphi study. The final report was sent to all 29 panelists and was approved without any revision suggestions. CONCLUSION: This report provides 24 clear-cut recommendations in a question-answer format. We believe that this report could have a significant effect on the optimum use of enteral nutrition in the context of medical nutrition therapy when clinicians manage everyday patients.

A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey.

Objective: Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods: Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results: Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion: Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases.

"Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery".

OBJECTIVE: The present study makes a comparative assessment of the Floppy-Nissen (FN) and Nissen-Rossetti fundoplication (NRF) procedures. METHODS: Included in the study were 80 patients who presented to the General Surgery Department outpatient clinic of Balcali Hospital of the Cukurova University Faculty of Medicine with gastroesophageal reflux between March 2010 and March 2013 All patients were operated on by the same surgeon using the laparoscopic FN or NRF techniques in a randomized controlled manner. The preoperative and postoperative reflux-specific and nonspecific gastrointestinal symptoms of the patients were compared. RESULTS: The duration of symptoms had no effect on the level of satisfaction; regurgitation, bloating and heartburn were more common in those with a longer duration of symptoms Of the patients, 92.5% were satisfied with their resulting condition, and 92.5% were inclined toward the surgery. It was further found that there was no difference between the symptoms or satisfaction levels of the patient groups who underwent the FN procedure and those who underwent the NRF procedure, other than those related to the duration of surgery. laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery. CONCLUSION: Our study revealed no significant difference between the laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery.KEY MESSAGESThe Nissen-Rossetti technique can be used safely based on the similarity of its outcomes with those of the classical Nissen technique.Despite the documented success of laparoscopic anti-reflux surgery, the absence of studies comparing surgery and medical treatments prevents these discussions from being concluded.Comparison of Nissen Rossetti and Floppy Nissen Techniques in Laparoscopic Reflux Surgery.

The effect of D3 dissection on postoperative morbidity and early mortality in gastric cancer patients who underwent curative total gastrectomy.

AIM: The present study presents the factors associated with early complications and mortality in patients undergoing total gastrectomy. MATERIAL AND METHOD: The study included patients who underwent curative total gastrectomy for gastric adenocarcinoma between January 2001 and December 2016 in the General Surgery Department of the Çukurova University Medical Faculty Hospital. The patients were divided into D1, D2, and D3 groups depending on the lymph node dissection width, and the demographic and clinical data and mortality were compared. In addition, mortality-associated factors were analyzed. RESULTS: The study sample included 148 (62.7%) males and 88 (37.3%) females, with a mean age of 65.5±11.4 years. There were 87 patients in the D1 group, 117 in the D2 group, and 23 in the D3 group. As expected, the duration of the operation was longer in the D2 and D3 groups (179 vs. 224 vs. 252; p<0.001), and these groups had also higher numbers of lymph nodes dissected (8 vs. 20 vs. 32; p<0.001) and metastatic lymph nodes (2.6 vs. 7.5 vs. 9.2; p<0.001). The analysis of the operation type in terms of complications revealed a significant relationship only with stump blowout, which was significantly more common after D3 dissection than following D2 and D1 dissections (p:0.01). The male gender (87.5 vs 60.9 p:0.03) was more associated with mortality. CONCLUSION: D1, D2 and D3 Lymph node dissection in gastric cancer surgery can be safely performed with low mortality and morbidity rates by surgeons with sufficient technical knowledge, and in centers with sufficient hospital volume. KEY WORDS: Complications, Gastric Cancer, Mortality, Lymph Node Dissection.

Clinicopathologic characteristics and surgical management of schwannomas of the upper digestive tract.

AIM: Schwannoma is a peripheral nervous system tumor arising from Schwann cells of the neural sheath, and they are very rarely seen in the upper digestive tract. In this study, we aimed to present the clinicopathologic characteristics and surgical management of patients who underwent surgical treatment for esophageal or gastric schwannoma. MATERIAL AND METHODS: Patients who were diagnosed with esophageal or gastric schwannoma between January 2013 and January 2020 were included in the study. Demographic, clinicopathological and immunohistochemical parameters of the patients were analyzed along with the follow-up results. RESULTS: There were 13 patients in our study. Nine patients had gastric schwannoma and 4 patients had esophageal schwannoma. Female gender was dominant (61.5%). The mean age was 56 years. Esophageal tumors were all enucleated. Minimal invasive approach was preferred in 3 patients. Gastric tumors were most commonly localized in the lesser curvature. Three patients underwent laparoscopic wedge resection, 3 patients open wedge resection, 2 patients subtotal gastrectomy, and one patient proximal gastrectomy. Intraoperative or postoperative complications did not develop in any patient. No patient required reoperation, and there were no deaths within 90 days postoperatively. In the postoperative 90-day period, there was no unplanned re-admission to the hospital. The mean follow-up period was 53.4 months (range: 23-93 months). No recurrence was detected in any patients. CONCLUSIONS: Definitive diagnosis of schwannomas is made only by histopathologic examination postoperatively. S-100 expression has diagnostic significance. The preferred treatment is complete surgical excision with negative margins, and the long-term outcome is excellent as these lesions are mostly benign. KEY WORDS: Esophagus, Enucleation, Schwannoma, Stomach, Wedge resection.

Primary gastric tuberculosis mimicking gastric cancer.

A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.

Parameters predicting follicular carcinoma in thyroid nodules with indeterminate cytology.

AIM: To determine the parameters supporting the malignancy by comparing demographic features of patients and nodule features in malign and benign nodules according to the pathology results after thyroidectomy in patients with the suspicious fine needle aspiration biopsy (FNAB) results for follicular neoplasia. MATERIAL AND METHOD: Thyroidectomy performed 152 cases with the suspicion of follicular carcinoma owing to the FNAB results were included in the study. Age, radiation exposure history, and serum TSH levels of patients were recorded as well as the ultrasound findings of nodules as nodule count, diameter, internal structure, echogenicity, border features, presence of peripheral halo, and presence of internal micro calcifications. Scintigram findings of nodules were also recorded. RESULTS: The mean age of the patients was 48,14 years (range: 20-71 years). Twenty five (16,5%) of the patients were male while 127 (83,5%) were female. Among patients with higher than normal TSH levels, malignancy was more common compared with the patients with normal or lower TSH levels. Presence of intranodular calcifications [Odd's Ratio: 3,1; 95 % Confidence Interval: 1,3-7,4], increase in intranodular vascularization [Odd's Ratio: 14,7; 95% Confidence Interval: 1,4-147,7], absence of halo sign [Odd's Ratio: 0,1; 95% Confidence Interval: 0,04-0,8], and ill-defined margins [Odd's Ratio: 0,1; 95% Confidence Interval: 0,49-0,3] were statistically significantly more common in malignant cases. CONCLUSION: The ability of clinical features, and sonographic parameters to predict malignancy in indeterminate thyroid nodules should be kept in mind since ultrasound is a simple, easy and inexpensive tool in the diagnosis of thyroid nodules.

18F-FDG activitiy PET/CT and CA-19.9 levels for the prediction of histopathological features and localization of peri- ampullary tumors.

BACKGROUND/AIMS: We sought to investigate the roles of maximum standardized uptake value (SUVmax) and serum carbohydrate antigen 19-9 (CA 19-9) in predicting the histopathological features of periampullary tumors. MATERIALS AND METHODS: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUVmax was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUVmax and CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors. RESULTS: 18F-FDG PET/CT SUVmax (<2.5 vs. ≥2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUVmax were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter. CONCLUSION: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUVmax and CA 19-9 levels.

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion.

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. AIMS: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. STUDY DESIGN: Retrospective comparative study. METHODS: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. RESULTS: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. CONCLUSION: Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic dialysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymectomy should be considered as a routine part of the surgical approach regardless of the preferred technique.

Clinical characterization of unusual cystic echinococcosis in southern part of Turkey.

BACKGROUND AND OBJECTIVES: The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients. DESIGN AND SETTINGS: A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcal Hospital. PATIENTS AND METHODS: Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis. RESULTS: Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases. CONCLUSION: CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

Trends in colorectal cancer by subsite, age, and gender over a 15-year period in Adana, Turkey: 1993-2008.

BACKGROUND/AIMS: Analyzing temporal trends in cancer incidence rates can generate new insights for the significance of geographical and epidemiological variations of the disease. This study evaluated the time trends over a 15-year period in the frequencies of colon and rectum cancers at various subsites by gender and age. MATERIALS AND METHODS: Data were obtained from a populationbased cancer registry in Adana (a Mediterranean city of Turkey). Among the 47.783 microscopically-confirmed cancer cases during the 15-year period (1993 to 2008), 2.749 (5.8%) colorectal cancer cases were analyzed in three separate 5-year time periods. RESULTS: The incidence of right-sided colon cancer was found to be increasing compared to the left-sided colon cancer (p=0.048) over time in total (19.8% in 1993-1997, 24.4% in 1999-2003, and 25.6% in 2004-2008). This proximal shift of cancers demonstrated a significant increase for females (p=0.041), but not for males. The incidence of right-sided colon cancer was found to increase in advanced age groups (over 70) of males and increase in younger age groups (over 50) of females. There was a corresponding continuous decline in the percentage of rectal cancer (not in distal cancers) in both genders. CONCLUSIONS: Although the frequency of colorectal cancer cases was found to be lower in our country when compared to Western countries, a similar right-sided colon cancer shift was observed. The apparent shift of colorectal cancer in young female patients may be related to the advances in diagnostic techniques and may indicate possible diagnostic bias for the female gender. These results also emphasize the importance of collecting regular cancer statistics and of closer follow-up to generate basic epidemiological data and to draw attention to this issue in further detailed analytical research studies.

Analysis of PTEN, VEGF, HER2 and P53 status in determining colorectal cancer benefit from bevacizumab therapy.

BACKGROUND: No factor has thus far been identified to predict the efficacy of bevacizumab therapy for colorectal cancer. We here therefore studied PTEN, VEGF, HER2 and p53 by immunohistochemistry as possible prognostic and predictive factors. MATERIALS AND METHODS: A total of 34 retrospectively collected tumor samples were evaluated, all from patients receiving bevacizumab-based regimens. VEGF-A, PTEN, HER2, p53 were assessed and data was compared with clinicopathologic characteristics of patients and the bevacizumab response rate. RESULTS: In this study, the median age of the 34 metastatic colorectal cancer patients was 55.5 (24-75), twelve (35.3%) being women and 22 (64.7%) men. PTEN, VEGF, HER2, p53 expressions were compared with bevacizumab response and other chacteristics of disease. Statistical significant differences were not found between bevacizumab response rates and different expression levels of VEGF, PTEN, HER2 and p53 (respectively p=0.256, p=0.832, p=0.189, p=0.131). However, a survival difference was noted in the VEGF expression negative group (median OS:55 months; 95%CI, 22-88 months) (p=0.01). There was no statistically significant OS difference in other groups (PTEN p=0.6, HER2 p=0.189, p53 p=0.13). CONCLUSIONS: We did not find any predictive factor for BV therapy in our study. VEGF negative expression could be an important prognostic factor in metastatic colorectal carcinoma.

Laparoscopic antireflux surgery with polyglactin (vicryl) mesh.

BACKGROUND: There is no debate that laparoscopic fundoplication has become the standard procedure for surgical management of gastroesophageal reflux disease. However, there is still no consensus on whether to use prosthetic material routinely and on the preferred kind of prosthetic material. The aim of this study was to evaluate polyglactin mesh and polypropylene mesh use in laparoscopic antireflux surgery (LARS) with particular regard to symptomatic relief, patient satisfaction, and complications. METHODS: This prospective randomized study included 75 patients who underwent LARS with polypropylene mesh prosthesis and 75 patients who underwent LARS with polyglactin (vicryl) mesh prosthesis between January 2005 and January 2010. Preoperative and postoperative assessments of symptomatic and functional outcomes of patients were recorded. Outcome data analyzed included length of hospitalization, operative time, complications, and recurrence. RESULTS: Laparoscopic repair of hiatal crura with a polyglactin mesh resulted in good symptomatic and clinical outcomes similar to that of polypropylene mesh. The recurrence rate with the use of polyglactin mesh is comparable to that of synthetic or biological materials reported in the literature. CONCLUSIONS: Closure of hiatal crura with a prosthetic polyglactin (vicryl) mesh at LARS is an effective and safe procedure.

The efficiency of sucralfate in corrosive esophagitis: a randomized, prospective study.

BACKGROUND/AIMS: Ingestion of a chemical agent is a serious problem, and several treatment protocols to prevent stricture formation have been proposed. We conducted a randomized prospective study to evaluate the effectiveness of oral intensive sucralfate plus conventional therapy compared to conventional therapy alone. METHODS: Fifteen patients with stage 2b and 3 corrosive esophagitis admitted to our gastroenterology, general surgery and intensive care units between 2004 and 2007 were included. Patients were divided into two groups. The patients in the first group (n=8) received intensive sucralfate therapy plus conventional therapy, while the other group (n=7) received only conventional therapy. We performed upper endoscopic procedures on days: 0, 21, 45, 90 and 180 to identify the emergent complications. RESULTS: In the first group, only one patient had stricture formation, allowing passage of a 9.2 mm endoscope and causing no dysphagia, on day 45. There was no progression in the stricture on follow-ups at the 3rd and 6th months. In the second group, 6 patients had stricture formation causing narrowing and dysphagia. CONCLUSIONS: Intensive sucralfate therapy may decrease the frequency of stricture formation in patients with advanced corrosive esophagitis. Further studies with large groups of patients are required to confirm our findings.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

Comparison of different operation techniques and suture materials in pyloric exclusion, in an animal model.

PURPOSE: The aim of this study is to compare the results of different operating techniques and suture materials for pyloric exclusion procedures. METHODS: The study was conducted on a sample of 125 rats. Transgastric pyloric exclusions with gastrojejunostomy were performed on the first 50 rats, which were divided into two groups each of 25: a resorbable (polyglactin) suture material was used in the first group and a nonresorbable (silk) material was used in the second group. External pyloric exclusion with a gastrojejunostomy were performed in a subsequent group consisting of 50 rats, again divided into two subgroups of 25 each with an absorbable (polyglactin) suture material used in one and a nonabsorbable (silk) material used in the other. For the last 25 rats external pyloric exclusion with a gastrojejunostomy were performed and a nonresorbable (polypropylene) material was used. RESULTS: The ratio of pyloric reopening was higher in the transgastric group than the external exclusion group on the 14th day (P = 0.01). The external pyloric exclusion group with polypropylene suture material had the lowest ratio of pyloric reopening. CONCLUSION: The external pyloric exclusion technique with nonresorbable (preferably polypropylene) suture material was therefore found to provide a higher pyloric closure incidence on the 14th day, which is the necessary duration period for healing in duodenal injuries.

Preservation of the contralateral abdominal flap following harvest of unilateral deep inferior epigastric artery perforator flap for staged bilateral breast reconstruction.

Simultaneous bilateral breast reconstruction using two DIEAP flaps is considered as the gold standard. However, the operation is lengthy and requires two plastic surgery teams with high expertise. In cases where the bilateral reconstruction is staged, either another donor area is required or an implant is used, because the unused abdominal tissue is discarded in the first operation. We describe a new technique to preserve the contralateral half of the abdomen for staged bilateral breast reconstruction. This would decrease the operating time significantly especially for teams where there is only a single experienced plastic surgeon.

Isolated hepatic tuberculosis presenting as cystic-like and tumour-like mass lesions.

Hepatic tuberculosis is a rare manifestation of extra-pulmonary tuberculosis. Hepatic tuberculous lesions are especially mimicking tumour-like mass or cystic lesions in the liver and so can be misdiagnosed with several diseases. Histopathological examination of the specimen is essential in the diagnosis for hepatic tuberculosis. In this report, two cases with hepatic tuberculosis having cystic solid mass and abscess liver lesions are described.