The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort.

OBJECTIVE: The aim of our study was to compare the success rates of suture selection, recovery times and pain associated with local wound infection and seton placement in patients undergoing cutting seton placement for complex anal fistula. METHODS: The study included a total of 90 patients who were admitted with the diagnosis of complex anal fistula between January 2015 and July 2018. RESULTS: The first session and other revision appointments demonstrated that the number of patients who required fistulotomy was significantly higher in group-1 as the seton failed to complete the transection (p = 0.001). When the patients were asked to rate pain for 3 different conditions according to numeric rating scale (NRS), the patients in group-2 had significantly higher pain in all 3 cases compared to the patients in group-1 (p 0.001). The impact of the suture material on local infection was examined and it was determined that the results of cultures for seton material were significantly more positive in group-1 (p = 0.001). CONCLUSIONS: We conclude that a multi-stage tight seton placement with silk material can lead to satisfactory results by aiming to shorten the cutting time of silk seton.

Our results of lower gastrointestinal endoscopy: evaluation of 700 patients.

OBJECTIVE: Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. MATERIAL AND METHODS: Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. RESULTS: Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. CONCLUSION: In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy unit's being young and the low patient volume.

The impact of the Covid 19 pandemic in colorectal cancer.

AIM: COVID-19 was first seen in China at the end of December 2019. The disease spread rapidly and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. Only urgent surgi cal cases and oncological surgeries that cannot be postponed were performed during this pandemic process. As a wasting disease, colorectal cancer (CRC) itself and its corresponding treatment may weaken the immune response to respiratory bacteria, makes patients more susceptible to virus infection. Besides, colorectal cancer patients are immunosuppressed because of the side effects of chemotherapy and/or radiotherapy taken. The choice of surgical procedures and perioperative management of the patients with CRC has become even more important in the COVID-19 pandemic. The impact on CRC surgery is unknown. In this study, we aimed to evaluate the effects of the COVID-19 pandemic on the preopartive, intraoperative, and postoperative findings of patients operated for colorectal cancer in our clinic. MATERIAL-METHOD: We defined the 'COVID-19' period as occurring between 12-03-2020 and 31-08-2020. All the enrolled patients were divided into two groups, pre-COVID-19 group (Pre-CG; 66 cases) and COVID-19 group (CG; 43 cases). A total of 109 patients with CRC were included in this study. Patient characteristics, preoperative, intraoperative, and postoperative clinicopathological findings were compared between groups. RESULTS: The waiting times before admission increased in CG (Pre-CG [5.34±2.55] vs CG [18.13±9.11]; p<0.001). After admission, the waiting time before surgery was longer in CG (Pre-CG [2.04±1.34] vs CG [5.53±6.00]; p<0.001). There were no significant difference between the groups in terms of operation method (laparoscopic/open), operation type (emergency/elective), surgical procedure, combine organ resection, intraoperative blood transfusion requirment, operation time (p values, respectively; p=0.082; p=0.474; p=0.317; p=0.656; p=0.617; p=0.696). In this study, no significant difference was found between the groups in terms of postoperative complications (p=0.357) and mortality (p=0.826). It was found that the ICU stay was significantly shorter in CG (Pre-CG [11.63±2.22] vs CG [1.48±0.76]; p=0.008). CONCLUSIONS: In this study, it was seen that the COVID-19 pandemic did not affect morbidity and mortality in CRC surgery, but it prolonged admission waiting and operation waiting times. Since there is very little data in the literature regarding the effect of COVID-19 on CRC surgery, our study will guide future studies on this subject. KEY WORDS: Colorectal Cancer, Coronavirus disease 2019, COVID-19, Surgery.

The effect of Fournier gangrene severity index and microbial culture results on hospital length of stay, frequency of debridement, and mortality.

BACKGROUND: Fournier gangrene (FG) is a rapidly progressive soft-tissue necrosis that may be life-threating unless aggressive treatment is applied immediately. FG severity index was described first by Laor et al. to predict mortality rate but there are few studies on the prognostic significance of FG severity index and especially the microbial agents isolated from debridement on patient prognosis. Hence, in the present study, it has been aimed to investigate the significance of FG severity index and infective agents on hospital stay, frequency of debridement, and mortality. METHODS: Thirty-four patients who were operated with the diagnosis of FG between January 2013 and January 2018 were retrospectively analyzed. FG severity index scores in admission were calculated and patient was divided into two groups according to the cutoff value of FG severity index. Patient was categorized according to the microbial agents isolated from debridement cultures. Patient characteristics were compared between the group of survivors and non-survivors. The effect of FG severity index and microbial agent type on hospital stay, frequency of debridement, and mortality was analyzed. RESULTS: It was found that mortality rate was significantly higher in the group of FG severity index score >9 than the other group (100% vs. 6.7%; p=0.001>) and it was observed that FG severity index had predicted the mortality rate as 100% and survival rate as 93.3% but there were no significant relation between FG severity index with the frequency of debridement and hospital stay. The mortality rate (50% vs. 4.2%; p=0.005) and frequency of debridement (3.10±0.73 vs. 2.00±0.72; p=0.001) were significantly higher in the subgroup of patient infected with clostridial and atypical agents. CONCLUSION: FG severity index was found to be insufficient in determining the frequency of debridement and the hospital stay but it accurately predicts the rates of mortality and survival. The patients who were infected with clostridial and atypical agents are more likely to develop mortality and tend to be need more aggressive surgical interventions than the others.

10-years mortality risk estimation for gastric cancer patients based on clinicopathological factors.

AIM: In order to create a nomogram for the gastric cancer no comprehensive study has been performed in Turkey so far and in our study, we tried to forecast the 10-year survival by using risk factors in patients without distant metastasis, who have not previously been diagnosed with another cancer but who underwent curative surgery. MATERIAL METHOD: The data of 411 patients who underwent gastrectomy for gastric cancer between January 2010 and January 2020 in Surgical Oncology Department were retrospectively examined. RESULTS: It has been shown statistically that the high RDW value point to poor survival (p <0.001). There were 173 patients with ≤3.5g/dl and 238 patients with> 3.5g/dl. It was found out statistically significant that hypoalbuminemia indicated poor survival (p <0.001). Moreover, it was determined that high CEA and Ca19-9 with lymphovascular invasion were to be statistically significant with prognosis (p <0.001). On the based of all this data, we have created a dekstop application for the mortality estimation. CONCLUSION: We think that this model will ensure individualization of the treatment for patients and will contribute to the patient's compliance with the treatment by strengthening the communication between the physician. KEY WORDS: Gastric cancer, Gastrectomy, Survival analysis, Prognosis.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in appendix cancer A single-center experience.

AIM: The traditional treatment for appendiceal cancer with peritoneal spread is cytoreductive surgery (CRS) but added HIPEC chemotherapy to cytoreductive surgery and has shown that it improves overall survival. The aim of this study was to report the results of CRS and HIPEC treated patients with appendiceal cancers which is based on the experience of at Surgical oncology department. MATERIAL-METHOD: Ankara University School of Medicine, Deparment of Surgical Oncology. The data of patients who underwent CRS + HIPEC for appendiceal cancer between January 2008 - January 2019 was retrospectively analysed. 40 patients who underwent CRS + HIPEC were evaluated retrospectively. Patients with unresectable liver metastasis, large retroperitoneal tumor, tumoral infiltration in the intestinal mesentery and liver hilum were excluded from the study. RESULTS: The mean (±sd) PCI was 17.98 (±8.21). Twenty six patients's completeness of cytoreduction score was 0(65.0%), 10(25.0%) CCS-1, 3(7.5%) CCS-2 and 1(2.5%) CCS-3. There was statistically significant difference with prognosis between ccr score, ASA, lymphovascular invasion, PCI score, albumin categories. CONCLUSIONS: In selected patients survival can be increased. However, it is thought that cytoreductive surgery should be performed even if completeness of cytoreduction score is two. In our study we represent that >17PCI patients could be managed by CRS/HIPEC if the CC score ≤2 can be reached. Our results suggest that the CRS/HIPEC procedure can improve the benefits of larger patient group and provides longer survival. KEY WORDS: Appendiceal Neoplasms, Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy.

Can CT Pelvimetry Be Used to Predict Circumferential Resection Margin Positivity in Laparoscopic Resection of Middle and Lower Rectum Cancer?

Background Previous studies have shown that pelvimetry can be valuable in predicting surgical difficulties in rectal cancer operations. However, its usability in predicting circumferential resection margin (CRM) involvement remains debatable. This study investigated the factors affecting CRM status and the importance of computed tomography (CT) pelvimetry in predicting CRM involvement in laparoscopic resection of middle and lower rectal cancer. Methodology In this study, we retrospectively investigated the data of 111 patients who underwent a laparoscopic operation for middle and lower rectum cancer at Ankara University Faculty of Medicine, Department of Surgical Oncology between January 2014 and January 2020. The predictive value of CT pelvimetry and other variables on the CRM status was analyzed. Results The following four pelvic parameters differed significantly between the genders: transverse diameter of the pelvic inlet (p = 0.024), anteroposterior diameter of the pelvic outlet (p = 0.003), transverse diameter of the pelvic outlet (p < 0.001), and pelvic depth (p < 0.001). The effect of pelvic anatomic parameters on CRM involvement was not found to be significant. It was found that tumor height from the anal verge (p = 0.004), tumor size (p < 0.001), and gender (p = 0.033) were significant risk factors for CRM involvement. Survival was poor in patients with male gender (p = 0.032), perineural invasion (p < 0.001), and grade 3 tumor. Conclusions In this study, no benefit was found in predicting CRM positivity from CT pelvimetry in the laparoscopic resection of middle and lower rectal cancer. Besides, tumor height from the anal verge, tumor size, and gender were important factors for CRM positivity. Although our study sheds light on this issue, prospective randomized studies with larger sample sizes are needed.

Prognostic Role of Red Distribution Width (RDW) Value in Gastric Cancer.

OBJECTIVE: To investigate the prognostic effect of red distribution width (RDW) in patients with gastric cancer. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Surgical Oncology, Ankara University School of Medicine, between November 2010 and January 2020. METHODOLOGY: Patients diagnosed with adenocarcinoma by biopsy, who underwent radical surgery and lymph node dissection, and had preoperative RDW value, were inducted. Patients who had history of active inflammation in the past three months, received treatment for hematology disorder, blood transfusion, malignancy other than gastric cancer, autoimmune disease, venous thrombosis, or under 18 years of age, and those having cardiac and cerebrovascular diseases and distant metastases were excluded from the study. Apart from diagnosis, preoperative blood values, clinicopathologial, demographic features, and follow-up data were included in the study. RESULTS: RDW average value was 15.11 ± 2.87 and median value was 14.3%. For RDW cut off value, 13.4% was accepted as reference from previous studies was divided into two groups as <13.4% and ≥13.4%. While it was <13.4% in 119 patients; in 292 patients, it was "≥13.4%". High RDW value showed poor survival (p<0.001). CONCLUSION: RDW, the current hematological marker, can be used as an important indicator for monitoring the progression and prognosis of gastric cancer. Key Words: Gastrectomy, Gastric cancer, Laparoscopy, Surgical oncology, Red distribution width, survival.

Impact of Muscle Mass Depletion on Surgical Outcomes in Patients with Primary High-grade Serous Ovarian Cancer Undergoing CRS and HIPEC.

OBJECTIVE: To investigate the effect of sarcopenia on surgical outcomes in patients with primary high-grade serous ovarian cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Surgical Oncology, Faculty of Medicine, Ankara University Ankara, Turkey,  from January 2013 to January 2020. METHODOLOGY: Forty patients, who underwent CRS and HIPEC with the diagnosis of primary high-grade serous ovarian cancer and peritoneal carcinomatosis were included in the study. Preoperative staging CT images were used to determine total psoas index values by measuring psoas muscle area at the level of L3 vertebra. Patients with total psoas index values below the cut-off levels were considered sarcopenic. Demographic, clinicopathological and perioperative results were compared between sarcopenic and non-sarcopenic patients. RESULTS: Serious postoperative complications (36.4% vs. 6.9%, p=0.039)  and infective (54.5% vs. 17.2%, p=0.042) and pulmonary (72.7% vs. 34.5%, p=0.040 complications were significantly higher in sarcopenic patients. Hospital stay [20(12-25) vs. 12(9-16.5) days, p=0.017] and ICU stay [4(2-6) vs. 2(1-2.5) days, p=0.013)] were found to be longer in sarcopenic patients. In univariate analysis, advanced age (OR: 1.40 95% CI: 1.07-1.84; p=0.021) and sarcopenia (OR: 7.71% 95 CI: 1.17-51.06; p=0.039) were significantly associated with serious postoperative complications. The presence of sarcopenia (OR: 0.050 95% CI: 0.004-0.675; p=0.024) was found to be independent predictor of serious postoperative complications. CONCLUSION: Sarcopenia can easily be diagnosed without additional cost or radiation exposure with routine preoperative staging CT images. Identification of sarcopenic ovarian cancer patients in preoperative period may affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy, thus postoperative complication rates may be reduced and short-term results may be improved. Key Words: Cytoreductive surgery, Ovarian cancer, Sarcopenia.

Evaluation of Peroperative and Oncological Results in Laparoscopic Surgery of Gastric Cancer in Elderly Patients: Single-Center Study.

Introduction: Laparoscopic treatment of gastric cancer in elderly patients is still controversial. The aim of this retrospective study is to evaluate the safety and feasibility of laparoscopic gastrectomy in elderly gastric cancer patients based on the long- and short-term results of laparoscopic surgery. Materials and Methods: The data of 163 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were categorized into two groups by age based on World Health Organization (WHO) criteria: elderly (≥65 years, 80 cases) and nonelderly (<65 years, 83 cases). Patient characteristics and clinicopathological findings, surgical findings, short- and long-term results were compared between the two groups. Results: The patients in the study group were in the age range of 22-87 years and 80 (49%) patients were found out to be 65 years old or older. When all complications were categorized according to Clavien-Dindo (C-D) classification, >3 serious complication rates were similar between groups (P = .421). Although the length of hospital stay and the need for intensive care were higher in the elderly group, the difference was not significant (P = .066; P = .072). There was no significant difference between the two in terms of in-hospital mortality (P = .364). No statistically significant differences were found in the rates of overall survival (nonelderly group; 61.17 ± 3.34, 95% confidence interval [CI]: 54.61-67.74 versus elderly group; 56.48 ± 3.80, 95% CI: 49.03-63.93; P = .176) and disease-specific survival (nonelderly group; 64.24 ± 3.15, 95% CI: 58.06-70.40 versus elderly group; 61.93 ± 3.57, 95% CI: 54.93-68.93; P = .363) between the age groups. Conclusion: In conclusion, although laparoscopic gastrectomy is a feasible and safe method in elderly gastric cancer patients, further randomized prospective studies are needed.

The role of laparoscopic staging for the management of gastric cancer.

AIM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSIONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.

Long-Term Results and Current Problems in Laparoscopic Gastrectomy: Single-Center Experience.

Introduction: The study aims to evaluate the long-term results of patients who underwent laparoscopic gastrectomy for gastric cancer in Ankara University Medical Faculty, Surgical Oncology Clinic, within 5 years. Materials and Methods: We retrospectively reviewed the data of patients who underwent laparoscopic gastrectomy for gastric cancer at the Surgical Oncology Clinic of Ankara University Medical Faculty between January 2014 and September 2019. One hundred forty-six patients were included in the study. Results: Fifty-one (34.9%) of the patients were female; 95 (65.1%) were male. The mean ± standard deviation and median (minimum-maximum) values of the patients were 60.92 ± 14.13 and 64.00 (22.00-93.00), respectively (Table 1). Eighty-seven (59.6%) cases were located in the antrum, 29 (19.9%) were in the cardia region, and 30 (20.5%) were in the corpus region. Overall, 106 (72.6%) of 146 patients were alive, while 40 (27.4%) were ex. The mean survival was 21.8 months (0-69). Postoperative mortality was seen in 9 patients (6.2%) and our disease-free survival rate was 70.5%. Recurrence occurred in 14 (9.6%) of all patients. [Table: see text] Conclusion: In conclusion, although laparoscopic gastrectomy is a reliable and feasible method for gastric cancer, the standardization of laparoscopic surgery is required in clinics.

Endoscopic retrograde cholangiopancreatography for biliary system parasites.

OBJECTIVE: Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management of biliary system parasites. MATERIAL AND METHODS: Investigators retrospectively evaluated patients with biliary system parasites who underwent endoscopic retrograde cholangiopancreatography procedures over an eight-year period. We collected data regarding patient demographics, clinical features, and parasite type. We aimed to determine the utility of endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary system parasites. RESULTS: We identified 22 patients with biliary system parasites from a total of 3,450 endoscopic retrograde cholangiopancreatography procedures performed during an eight-year period. Parasite types included Echinococcus granulosus (n=19), Fasciola hepatica (n=2), and Ascaris lumbricoides (n=1). Fifteen patients with liver hydatid cysts underwent endoscopic retrograde cholangiopancreatography prior to surgery due to obstructive jaundice. The endoscopic retrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in the remaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatography due to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosis of cholangiocarcinoma. However, the final diagnosis was made using endoscopic retrograde cholangiopancreatography following inspection of flat, leaf-shaped, motile flukes extracted from the bile duct. In one patient with ascariasis, a longitudinal tubular structure was identified in the bile duct; emergency surgery was required. CONCLUSION: The diagnosis of parasitic diseases is clinically challenging, and definitive diagnosis requires endoscopic retrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatography provides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use of endoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategies for biliary system parasite infections.

Avulsion of Ampulla of Vater Secondary to a Blunt Abdominal Injury Treated with Pancreatoduodenectomy; A Case Report and Literature Review.

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.

Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy.

INTRODUCTION: Bile leak after cholecystectomy which is the frequency less than 2% is an important problem for patients. Some bile duct injuries occuring after laparoscopic cholecystectomy are the complex bile duct injuries and can cause bile leak and fistula. PRESENTATION OF CASE: A 74-year-old woman has high output bile drainage from abdominal drain after laparoscopic cholecystectomy so an ERCP was performed. It was clear that there was a complete transaction of bile ducts, however this finding was inconsistent with the patient's clinical situation. The bile drainage of the patient was ceased and she was discharged to home without any problem. Four months later the patient was admitted again for recurrent cholangitis episodes. Patient was operated to perform a biliary-enteric diversion for the suspicion of biliary stricture. There was a thin fistula tract over the duodenum that was previously seperated from the proximal choledochus. The distal part of the bile duct was ended blindly. A hepaticojejunostomy anastomosis over a transhepatic stenting was performed. DISCUSSION: The circumferential injuries are the most common and devastating injuries leading to bile leak, peritonitis and varying degrees of sepsis. The probability of a bile fistula to close spontaneously is almost impossible in cases of iatrogenic circumferential full thickness injuries. CONCLUSION: In the present case we have reported a case of Bismuth type 2 (Strasberg type E2) injury in which the biliary drainage was closed spontaneously with the formation of spontaneous biliary-duodenal fistula. It is an extremely interesting case that has not been reported in the literature previously.

A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy.

INTRODUCTION: Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. PRESENTATION OF CASE: A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. DISCUSSION: Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. CONCLUSION: Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation.

Results of the open surgery after endoscopic basket impaction during ERCP procedure.

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.