Ess 2012

ABSTRACT BOOK
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CONTENTS
INTRODUCTION 5
BOARDS 11
ORAL PRESENTATIONS
ORAL PRESENTATIONS 1 13

POSTER PRESENTATION 195
SUPPORTING COMPANIES 901

INDEX 903
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Addresses of the European Society of Surgery President
Address to the Opening Ceremony of the XVI. Annual Meeting of

European Society of Surgery
Cem Terzi MD Prof. of Surgery, Congress President and President of the Society
Department of Surgery, Dokuz Eylul University Hospital, Inciraltı, 35340, Izmir, Turkey
Health Care
The West and The Rest
The European Society of Surgery is a society that has clearly identified one very useful and
essential function in this changing world: to act as a bridge between Eastern and Western Europe.
Now we are having XVI. Annual Meeting of our society in Istanbul, a city where the continents
meet, where the west and the rest meets.
Thus, I feel obliged to use this opportunity to talk on global health care issues in the west and
the rest.
When I saw this photograph at the National Geographic Magazine, I was stunned. It was telling
the story of surgery as well as the story of health care. I put this photograph on the wall of my
room in the hospital 14 years ago and I looked at it every day since then.
After 23 hours and 22 rolls of film, photographer Jim Stanfield knew he got the perfect shot. He
had captured the anxious eyes of Dr. Religa tracing the vital signs of a heart-transplant patient.
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He said that “I never let him out of my sight, never turned my back on him,”. “This was the
payoff.”
It was 1987, in an old-fashioned operating room in post-Soviet Poland. Stanfield was looking
for an image that would portray the critical state of the country’s free health care system—and
that’s exactly what he got.
His lens not only focuses on a dedicated surgeon’s eyes, but also on a patient connected to
technologically outdated equipment.
Stanfield also includes an exhausted registrar (at the far right of the photograph) sleeping after
assisting Dr. Religa with two transplants during an all night session.
“Each of these elements,” says Stanfield, “gives dimension and drama to the photograph, while
helping tell a story.
He also adds an important comment: “In this day and age, you need more than a pretty
photograph, you need information”.
If it is so, what is the information that can tell us the truth, in global health care today?
Let’s look at the west and the rest!
Let’s start with the rest:
• Many more people—some 360 million—have died from hunger and treatable diseases in
peacetime in the 20 years since the end of the Cold War than have perished from wars, civil
wars, and government repression over the entire 20th century.
• And poverty continues unchanged, as the official statistics fully confirm:
• 963 million human beings are chronically starving,
• 884 million lack access to safe water,
• 2.5 billion lack access to basic sanitation
• 2 billion lack access to essential medicines
• 924 million lack adequate shelter
• 1.6 billion lack electricity.
• 774 million adults are illiterate.
• 218 million children are child laborers
• Roughly one third of all human deaths, 18 million annually, are due to poverty-related
causes, preventable through better nutrition, safe drinking water, inexpensive re-hydration
packs, vaccines, antibiotics, and other medicines.
• People of color, females, and the very young are heavily overrepresented among the global
poor,
• Children under five comprise over half or 9.2 million of the annual death toll from poverty-
related causes (1).
Now let’s look at the west (2-4).
As early as 1976, Vincent Navarro described what would prove to be the dominant issue of
health under neoliberal economic shift for the next three decades:
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‘’… it is the tendency of contemporary neoliberalism to convert public services into commodities
to be bought and sold on the private market. And in this scheme, the payment for services is
public, while the appropriation of profit is private…’’
This was a key component of the neoliberal reforms of the 70s. Previously, capital had been
content to build hospitals and sell equipment and other supplies, to publicly provided health
services.
Now, it moved to take over the services themselves.
After the second World War, nearly all countries in Europe, established an universal public health
care system that covers every citizen in the country.
People in Europe have enjoyed so much with this public health care system for many years. Then
suddenly, in a very short time, neoliberal health reforms took over without a major resistance
from the public. Why? We need to explain this.
In the rest, in the case of countries in the global ‘south’, there is no mystery: Most of their
incomes are mortgaged to servicing their debt. They become obliged by IMF-imposed structural
adjustment policies to abandon much of their state-provided services.
The same is true of the former Soviet bloc countries. They have been bankrupted by the ‘shock
doctrine’. Their populations briefly infatuated with the rhetoric of Reagan and Thatcher, and
with American health companies, advising governments and selling private insurance policies to
everybody who could afford one.
In contrast, in western Europe and other industrialized countries, where public health services
were well-established and popular, it is especially difficult to understand, how so many
governments were able to convert public health care to private health care.
Differences between national health care systems and many other historical, cultural and
political factors ensured that the explanations would differ from one country to another.
What led to the privatization of significant parts of the German hospital sector is a different
story from what led to the privatization of primary care in Sweden, or the adoption of ‘public-
private partnerships’ for the building and servicing of hospitals in Australia and Canada and UK
and Turkey.
In each case, however, some common elements can be found.
What is already clear, however, is that in all the countries where the marketization process has
been pushed forward, it is a reorientation of publicly provided health care itself to commercial
lines.
Profitability becomes a declared objective, and staffing levels and terms of service, are driven
down, with a corresponding decline in the quality of care.
An industrial concept of efficiency means health care is a commodity. Thus, as doctors, we are
not providing health care in order to meet health needs of public but rather we are selling our
services. The introduction of charges (‘copayments’) in public health sector is one of the ways to
sell the service for a growing range of treatments.
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Some authors say that it is the end of ‘golden age’ for doctors. The neoliberal health care
policies are causing reduction in medical autonomy, perhaps a striking example being the
‘proletarianization ’ in medicine. The class and statue of doctors are changing. We are losing our
power, and our destiny is transforming similar to the destiny of working class: to sell their labor in
order to survive without being able to control the whole production process. ‘Proletarianization’
of doctors is occurring due to mostly economic factors but, moreover social and political factors
such as erosion of patients’ trust in doctors and splits in medical interest groups (5).
Indeed, we see many changes taking place, inside and outside of hospitals, and most of these
changes are not initiated by us. More complicated care has to be given in a shorter period of
time, with less salary, less autonomy, more bureaucracy, and more part-time work—in other
words, there is increased workload with fewer motivations.
Doctors, all around the world, are unhappy. In 2012, they went on strikes in several countries
such as England, Germany, Turkey, Greece, Portuguese, Estonia, India, Pakistan, Bolivia,
Honduras, Egypt and Kenya...
As I near the end of my speech, I would like to go back to Dr. Religa. He died in 2009 at the age of
70. His funeral was broadcasted on TV and it was a very touching ceremony. People came from
all over the country to pay their final respects. Dr. Religa was buried with full honors normally
reserved for heads of state.
You are seeing the patient who was on the operating table in the famous photograph. Many
years after his operation this man (from the operating table) came to Dr. Religa’s funeral and
cried for him…
So, as surgeons, we should not let, public health care, slip out of our hands. We are the main
actors in healthcare. We are primarily responsible for the quality of care, and the only ones,
apart from our patients, who really care about quality.
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This is a great profession, a proud profession, a profession with a great history–a history we must
cherish–not in some sort of sentimental and backward-looking way, but as a strong foundation
on which, to build, and to move forward.
I welcome all our members and guests from throughout the world, and of course from our host
country Turkey.
Thank you for your attention and I wish you all a tremendously successful congress.
References:
1. Pogge T. Health care reform that works for the US and for the world’s poor. http://www.ghgj.
org/Pogge_Health%20Care%20Reform. pdf, accessed November 2012.
2. Mooney G. The Health of nations. Zed Boks, 2012.
3. Leys C, Player S. The Plot Against the NHS, Merlin Press, 2011.
4. Herman C, Flecker J. Privatization of Public Services. Routledge, 2012.
5. Harrison S, McDonald. The politics of health care in Britain. SAGE Publications, 2008.
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BOARDS
XVI. ANNUAL MEETING OF EUROPEAN SOCIETY OF SURGERY

ORGANIZATION COMMITTEE
President - Cem Terzi
Secretary - Haldun Gündoğdu
Members
Savaş Koçak
General Secretary of Turkish Surgical Association (TSA)
Feza Remzi
Member of International Relations Committee of TSA, Head of Dept. of Surgery, Cleveland Clinic, USA
Korhan Taviloğlu
President for the European Society for Trauma & Emergency Surgery
Ali Akyüz
President of Turkish Society of Surgical Gastroenterological Endoscopy
Ömer Alabaz
President of Turkish Society of Ostomy Surgery
Cavit Avcı
President of National Society of Endoscopic and Laparoscopic Surgery
E. Birol Bostancı
President of Turkish Society of Gastroenterology Surgery
Dursun Buğra
President of Turkish Society of Colon and Rectal Surgery
Varol Çelik
President of Turkish Federation of Breast Diseases Societies
Ahmet Çoker
President of Turkish Society of Hepatopancreaticobiliary Surgery
Emin Ersoy
President of Turkish Society of Endoscopic and Laparoscopic Surgery
Metin Ertem
President of Society of Hernia Surgery
Recep Güloğlu
President of Turkish Association of Trauma and Emergency Surgery
Adnan İşgör
President of Society of Endocrine Surgery
Gökhan Moray
Turkish Transplantation Society
Selçuk Özarmağan
President of Society of Dialogue in Endocrinology
Mustafa Taşkın
President of Turkish Obesity Surgery Society
Kaya Yorgancı
President of Society of Internal and Surgical Intensive Care
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EUROPEAN SOCIETY OF SURGERY BOARD OF DIRECTORS
President - Cem Terzi (Turkey)
Secretary General - Jan Kulig (Poland)
Treasurer - Andrew Kingsnorth (UK)
Members
Frantisek Antos (Czech Republic)

Alfonso Barbarisi (Italy)
Paul Broos (Belgium)
Lino Cutajar (Malta)
Wolfgang Feil (Austria)
Achille Gaspari (Italy)
Guido Gasparri (Italy)
Giorgi Giorgobiani (Georgia)
Luc Michel (Belgium)
Wojciech Nowak (Poland)
Harald Rosen (Austria)
Antoni Szczepanik (Poland)
*Names are sorted in alphabetical order by the lastname.
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ORAL PRESENTATIONS 1
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OP - 1 A RETROSPECTIVE ANALYSIS OF OPERATIVE FACTORS THAT
MAY PLAY ROLE IN PANCREATIC ANASTOMOSIS COMPETENCY OF
WHIPPLE PROCEDURES.
ÖMER GÜNAL , WAFI ATAALLAH , ÜMIT UĞURLU , MÜMIN COŞKUN , ENDER
DULUNDU , SAMET YARDIMCI
MARMARA UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,

PENDIK, İSTANBUL
Background&Aims:
We intend to investigate the pancreatico-duodenectomy operations retrospectively

in aspect of the pancreaticojejunostomy leaks and related factors that can be
causative to fistula.
Methods:
We have scanned all pancreaticoduodenectomies performed in our clinic during

the last two years. Pancreatic fistula formation was the main otcome measure.
Suture material, needle size, anastomosis type(duct to mucosa, invagination type)
and other operative parameters were recorded. We investigated if there is any
relationship between the operative parameters and pancreatic fistula formation.
Results:
Between 2010-2012 Seventy six pancreaticoduodenectomies were reached out for

evaluation. Only 56 patients’ records were found to be staunch. Pancreatic leakage
were detected according to ISGPF criteria. 13 Patients has developed pancreatic
fistula. Mostly used suture material was PDS in duct to mucosa anastomoses.
Silk is the predominant suture type in danking type anastomoses. Predominant
anastomosis type was the duct to mucosa. Wirsung duct diameter of leaking and
intact anastomoses were mean were 3 mm and 5 mm respectively.
Conclusion:
Anastomosis type, suture material used in construction of pancreatic-enteric

anastomosis and pancreatic duct diameter seemed to be the determinant factors
in pancreatic-enteric anastomosis leak occurence.
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OP - 2 USE OF STAPLING DEVICES FOR SAFE CHOLECYSTECTOMY
MEHMET ODABAŞI , M.A.TOLGA MÜFTÜOĞLU , ALI AKTEKIN , CENGIZ ERIŞ ,
MEHMET KAMIL YILDIZ , EMRE GÜNAY , HASAN ABUOĞLU , SAMI AKBULUT
HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
The laparoscopic cholecystectomy (LC) was considered to be a contraindication for

acute cholecystitis. The cystic duct (CD) is edematous and large in acute cholecystitis
and difficult to manage. Endo-GIA stapler used patients are reported in our study.
Methods:
From January 2008 to June 2012, 1441 patients with cholelithiasis underwent LC.
Nineteen ( 0,62 %) underwent LC with CD closure by endo-GIA. CD and cystic artery
was identified and artery ligated by titanium clips. The dilated CD was cleaned and
sufficient space existed to apply Endo-GIA stapler with 3.6 or 4.8 mm. cartridges.
Stapler must be behind CD and free of intervening tissue before firing. CD stump
was reexamined, a drain was inserted via 5 mm. trocar.
Results:
Patients were followed up with one month intervals for one year. Length of hospital
stay was 3.4 days. Length of follow up ranged from 1.0 to 50.4 months.There were
hematoma in 3 patients those resolved spontaneously and umbulical wound
infection in 4 patients easily treated by drainage and antibiotics.
Conclusion:
Endo-GIA is safe and easy method for patients with dilated and difficult CD. Vascular
Endo-GIA can be applicated in large CD, but for acute cholecystitis with edematous
CD, 3.6 or 4.8 mm.stapler should be preferred.
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OP - 3 COMBINED EN BLOC LIVER-PANCREAS TRANSPLANTATION
HALIT TOPAL , FREDERIK NEVENS , RAYMOND AERTS , DIETHARD MONBALIU ,
DAVID CASSIMAN , WIM LALEMAN , WERNER VAN STEENBERGEN , JACQUES
PIRENNE
UNIVERSITY HOSPITALS LEUVEN
Background&Aims:
Liver transplantation is being increasingly performed for oncologic and metabolic

disorders and offers good outcomes. In certain circumstances association of a
pancreas transplantation is necessary either because of associated pancreas
disease or due to technical reasons.
Methods:
We describe a series of 9 patients (5 men and 4 women) who received a combined

liver pancreas transplantation at our Abdominal Transplantation Unit. Herefore we
left both organs in continuity after being procured with their vasculature including
the donor celiac axis and superior mesenteric artery. Receptor portal drainage was
achieved by performing an end-to-side anastomosis into the donor portal vein. The
donor duodenum was anostomosed to the receptor jejunum in order to enable
exocrine pancreatic and biliary drainage.
Results:
The median age was 37 years (2 -62). In 3 patients the pancreas graft was
associated because of technical reasons. These patients received additional bowel
transplantation because of a short bowel syndrome. In another 3 patients the
indications were metabolic disorders i.e. HNF-1B mutation, PSC with DM type 1 and
hemachromatosis with diabetes. Finally, the indications of the remaining 3 patients
were splanchnic trombosis, biliary cirrosis with chronic pancreatitis and alcoholic
hepatitis with diabetes mellitus.
Conclusion:
En bloc liver and pancreas transplantation is a feasible technique. Compared to

separate implantation of each organ, it offers many advantages like rapidity,
simplicity and physiological position of the pancreas.
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OP - 4 EFFECTS OF OZONE OXIDATIVE PRECONDITIONING ON LIVER
REGENERATION AFTER PARTIAL HEPATECTOMY IN RATS.
FATMA AYCA GULTEKIN 1, GULDENIZ KARADENIZ CAKMAK 1, UMMUHANI OZEL
TURKCU 3, GAMZE YURDAKAN 2, EBRU OFLUOGLU DEMIR 4, ILHAN TASDOVEN 1,
ALI UGUR EMRE 1, MUSTAFA COMERT 1
1
BULENT ECEVIT UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, ZONGULDAK, TURKEY
2
BULENT ECEVIT UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF
PATHOLOGY , ZONGULDAK, TURKEY
3
MUGLA SITKI KOCMAN UNIVERSITY, MUGLA SCHOOL OF HEALTH SCIENCES,
MUGLA, TURKEY
4
BULENT ECEVIT UNIVERSITY, AHMET ERDOGAN VOCATIONAL SCHOOL OF HEALTH
SERVICES, KOZLU, ZONGULDAK
Background&Aims:
Similar protective effect of ischemic and ozone oxidative preconditioning (OzoneOP)

in hepatic ischemia-reperfusion (I/R) injury was demonstrated, providing evidences
that both preconditioning settings shared similar biochemical mechanisms of
protection. We investigated the effects of OzoneOP on liver regeneration after 70%
partial hepatectomy (PHx) in rats.
Methods:
Rats were divided into three groups: sham, I/R + PHx, and OzoneOP +I/R+ PHx
groups. Ozone (intraperitoneal, 1.2 mg/kg) was given to rats subjected to I/R and
70% hepatectomy daily five times before operation. At 24, and 48 h after resection,
samples were collected for the measurement of serum alanine aminotransferase
(ALT), aspartate aminotransferase (AST), tumor necrosis factor alpha (TNF-α) and
interleukin-6 (IL-6). Moreover, liver regeneration rate, proliferating cell nuclear
antigen (PCNA) labeling index, mitotic index, and histopathological examination
were evaluated.
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Results:
OzoneOP reduced liver injury determined by liver histology and serum

transaminases. There was a rise in serum TNF-α and IL-6 levels in the I/R+PHx group
whereas OzoneOP significantly decreased the rise in the level of TNF-α but not IL-6
on the 24 and 48 h of reperfusion. Moreover, liver regeneration in OzoneOP+PHx
group, as assessed by the regenerated liver weight, mitotic and PCNA labeling
index, was significantly improved when compared to I/R+PHx group.
Conclusion:
These results suggest that OzoneOP ameliorates the hepatic injury associated with
I/R and has a stimulatory effect on liver cell regeneration that may make it valuable
as a hepatoprotective modality.
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OP - 5 EFFECTS OF RESOLVIN D1 IN CERULEIN-INDUCED ACUTE
PANCREATITIS AND ASSOCIATED LUNG INJURY IN RATS.
DEMET SUMER 1, FATMA AYCA GULTEKIN 1, UMMUHANI OZEL TURKCU 2, BURAK
BAHADIR 3, ALI UGUR EMRE 1
1
2
MUGLA SITKI KOCMAN UNIVERSITY, MUGLA SCHOOL OF HEALTH SCIENCES,
MUGLA, TURKEY
3
Background&Aims:
Resolvin D1 (RvD1), an endogenous lipid molecule derived from docosahexaenoic

acid, has been described to promote inflammatory resolution. The present study
aimed to determine the effects of RvD1 on cerulein-induced acute pancreatitis (AP)
and associated lung injury in rats.
Methods:
AP was induced in rats by hourly intraperitoneal (ip) injections of cerulein (50 μg/
kg/h). RvD1 (5 μg/kg) was administered either last cerulein injection or 24 h after
last cerulein injections, and the severity of AP and associated lung injury were
assessed. Blood and tissues samples were obtained for the determination of serum
amylase, lipase, TNF-α and IL-1β levels, and pancreatic and pulmonary MPO activity,
MDA levels and histological evaluation respectively.
Results:
Cerulein injection caused AP, confirmed by an increase in serum amylase, lipase

and pancreatic MDA levels, and histopathological findings of severe AP compared
to the values obtained from the controls. In the rats received RvD1 serum levels of
TNF-α, and IL-1β, pancreatic and pulmonary MDA levels decreased, and pancreatic
and pulmonary MPO activity increased. Histologically, pancreatic and lung damage
was less severe following RvD1 administration.
Conclusion:
Treatment with RvD1 reduced cerulein-induced AP and associated lung injury in

rats. RvD1 may be of use for the treatment of the systemic complications of acute
pancreatitis.
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OP - 6 INCIDENCE OF ISCHEMIC TYPE BILIARY LESIONS AFTER
LIVER TRANSPLANTATION USING PIGGY BACK TECHNIQUE AND
RETROGRADE REPERFUSION
WAGNER DORIS 1, WERKGARTNER GEORG 2, KNIEPEISS DANIELA 1, MÜLLER
HELMUT 1, IBERER FLORIAN 1
1
MEDICAL UNIVERSITY OF GRAZ, DEPARTMENT OF SURGERY, DIVISION FOR
TRANSPLANTATION
2
GENERAL SURGERY
Background&Aims:
Biliary complications after liver transplantation (LT) occur with an incidence of 20%.
The liver graft is usually reperfused via an antegrade flow through the portal vein
and the hepatic artery. Retrograde reperfusion via the caval vein might reduce the
rate of primary non function after LT but increase biliary complications. In this study
the rate of biliary complications after LT with retrograde reperfusion was compared
to the literature.
Methods:
Patients who were transplanted between 1998 and 2010 were included into
the analysis; Ischemic type biliary lesions were defined as the necessity of an
endoscopic cholangiography (ERCP). Kaplan Meier analysis was performed as time
to event (ERCP, survival) analysis.
Results:
198 patients were included, median age was 56 (22 – 71), indications for OLT were
cryptogenic (43%) and viral (40%) cirrhosis or HCC (17%). An ERCP was performed
in 16% of the included patients during the first year after LT, 6 % received a bile
duct stent. Kaplan Meier analysis showed a median one year survival of 83% and a
median five year survival of 73% in the whole patient population.
Conclusion:
Piggy back technique with retrograde reperfusion is a suitable method for LT and
did not show a higher prevalence of biliary complications.
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OP - 7 INVESTIGATION AND MANAGEMENT OF ACUTE
PANCREATITIS
FARHANA AKTER , ZOE LITTLE , PIERRO NASTRO , AYMAN HAMADE
QEQM HOSPITAL, MARGATE, UK
Background&Aims:
Background: Acute pancreatitis accounts for approximately 3% of all cases of

abdominal pain admitted to hospital. Although most cases are mild and resolve,
severe pancreatitis has a mortality rate of 10%. Aims: Use the British Society
of Gastroenterology Guidelines (2005) to investigate whether a busy surgical
department at a district general hospital are compliant with the guidelines.
Methods:
Data for 51 patients admitted with acute pancreatitis were collected between the
months of September 2011- February 2012. A proforma and an official stamp of
the MGC were made in order to improve outcomes and comply with guidelines.
A re-audit of 50 patients with acute pancreatitis took place between March - July
2012. The scoring system for pancreatitis in this hospital is the Modified Glasgow
Criteria (MGC).
Results:
Only 27% of patients with acute pancreatitis were scored properly using the MGC.
The aetiology of pancreatitis was known in 49% of patients (guidelines recommend
>80%). One third of CT scans were ordered before 6 days inappropriately. 58% of
gallstone pancreatitis was not managed in the same admission or within 2 weeks.
The re-audit revealed the use of the MGC to score patients had improved to 88%.
The aetiology of pancreatitis was known in 65% patients. Of the patients who had
CT scan ordered before 6 days, most (80%) were appropriately ordered.
Conclusion:
Compliance with guidelines for investigating and managing pancreatitis is essential

to reduce readmission. It is also essential to score all patients with acute pancreatitis
to identify patients who have severe disease and require referral to the intensive
care unit in order to improve prognosis. We recommend the use of an official
scoring stamp in all hospitals.
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OP - 8 IS PROPHYLACTIC ANTIBIOTIC NECESSARY FOR
LAPAROSCOPIC CHOLECYSTECTOMY?
PINAR SARKUT , SADIK KILICTURGAY , HIKMET AKTAS , YILMAZ OZEN , EKREM KAYA
ULUDAG UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT
Background&Aims:
Prophylactic antibiotics have been used widely for at the laparoscopic

cholecystectomy(LC). We investigate the efficacy of prophylactic antibiotic in LC to
prevent surgical site infection (SSI).
Methods:
In this PRCT, the patients who were performed LC in our department were
randomized as three groups. Group-1 received physiologic saline as placebo,
Group-2 received a first generation cephalosporin (cefazolin;1 gr) and Group-3
received a second generation cephalosporin (cefuroxim axetil;750 mg). The bile
and epigastric and umbilical port tissue samples were taken for culture studies. All
patients were followed at the end of fourth week after surgery. The age and sex of
patients, obesity, smoking habit, the situation of cholecystitis, LOH, operation time,
using drain, SSI presence were evaluated. The patients who received preoperative
antibiotics and steroid treatment, and the patients who had pancreatitis,cholangitis,
and were pregnant were excluded.
Results:
The data of 570 patients (group-1:193; group-2:191; group-3:186) were analyzed.

Regarding all parameters above, statistically significant difference was not detected
among all the groups(p<0,005). SSI rate was 1,2% in total and in Group1-2-3
1,5%,1,04%, 1,07% respectively. There is not statistically significant difference
regarding SSI between the groups (p<0,005).
Conclusion:
Based on our data, prophylactic antibiotic is not necessary in patients undergoing

LC.
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OP - 9 ISTANBUL SISLI MEMORIAL HOSPITAL EXPERIENCE TOWARDS
500 CASES OF LIVER TRANSPLANTS
YUCEL YANKOL , NESIMI MECIT , TURAN KANMAZ , KORAY S ACARLI , MUNCI
KALAYOGLU
HEPATO-PANCREATO-BILIARY SURGERY AND ORGAN TRANSPLANTATION CENTER,

SISLI MEMORIAL HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Liver transplantation is the only treatment of the end-stage liver disease.
Methods:
We present the outcomes of our 445 liver transplant cases.
Results:
We performed 463 liver transplants between Dec 2006 and Jun 2012. The 70.6%
of cases were transplanted from living donors. Mean age was 48.7 years ( ranged
18-71) in adults and 4.8 years ( 5 month-17) in children. Mean MELD score was
16.7 and mean PELD score was 16.2. Viral hepatitis B (42%) was the most common
cause. Cholestatic liver diseases were the most common causes in pediatric cases.
20 transplantations were performed due to fulminant hepatic failure. Four patients
died during the operations and 39 patients died in the early period. Median hospital
and intensive care unit stay were 14 and 2 days, respectively. Mean follow-up
was 23 months. The main complications were hepatic arterial thrombosis (1.6%),
portal vein thrombosis (2%), biliary leak (8.3%), biliary stricture (11%), and primary
nonfunction (2.7%). One, three and five-year patient survivals were 87.9%, 82.9%,
and 76.1%, respectively.
Conclusion:
Our results are acceptable for a high volume transplantation center. The key for
success is team afford with hard working.
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OP - 10 AFFECTION OF THE BIG TOE IN PATIENTS WITH DIABETIC
FOOT
ABDULHAKIM AL-TAMIMI 1, TALAAT ALBAITY 2
1
UNIVERSITY OF ADEN - YEMEN
2
ALWALY TYPICAL HOSPITAL
Background&Aims:
The aim of this study is to assess the risk factors precipitating to big toe ulcer in
diabetic foot, healing time, the impact of this problem on the forefoot, rear foot
and whole limb and to estimate the incidence of amputation and the influence of
initial management on the outcome of the ulcer.
Methods:
This is a prospective study performed in the period between September 2004

and March 2005. One hundred twenty two patients (92 males and 30 females)
presenting to Gabir-Abuliz diabetic center in Khartoum city, complaining of diabetic
foot affecting the big toe were the base of this study.
Results:
There is a significant association between the big toe ulcer in diabetic patients and the
following risk factors: Age more than50 years (84.4%,P=0.03),males (75%,P=0.02),
occupation were retired group and housewives accounting (50%,P=0.05),duration
of diabetes >10years (82,8%,P=0.02), eye diseases (27.9% , P=0.04 ) and family
history positive in (74%,P=0.004). The right big toe was affected in (54.9%), the
left in (42.6%) and bilateral in (2.5%).Ninety patients (74%,P=0.003) had blister
appeared after wearing new or tight shoes (n=41, 33.6%) or spontaneous ( n=38
, 31.1%) Complete healing within 8 weeks occurred in (53.3%, P=0.04), healing
between 10-20 weeks (43.5%) and more than 30 weeks in (3.2%).
Conclusion:
Diabetic foot ulcer affecting the big toe is usually preceded by blisters which can be
prevented. Good debridement, control blood glucose, proper dressing and removal
of dead bones can lead to early and complete healing in most of the ulcers.
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OP - 11 CONDITIONING FACTORS OF SEPTIC COMPLICATIONS IN
SECONDARY COMMUNITY AND POSTOPERATIVE PERITONITIS.
ALEXANDER JOSé SALAZAR BAEZ , ESTELA MEMBRILLA FERNáNDEZ , XèNIA CROUS
I MASó , MARTA CARMEN CLIMENT AGUSTíN , PATRICIA SáNCHEZ VELáZQUEZ ,
MARíA JOSé PONS FRAGERO , LUIS GRANDE POSA , JUAN J. SANCHO INSENSER
HOSPITAL UNIVERSITARIO DEL MAR
Background&Aims:
The surgical site infection (SSI) remains as one of the most frequent complications
in patients with secondary peritonitis, increasing the hospital stay and morbidity -
mortality risks.
Methods:
An unicentric prospective observational study was conducted of 152 consecutive

patients with secondary peritonitis. The aim was to analyze postoperative
complications in communitary (CP) and postoperative peritonitis (POP), focusing on
SSI, mortality and the initial pathogens.
Results:
There were 126 CP (83%) and 26 POP (17%). The main source of infection was
appendicitis (32%) in CP and colonic (54%) in POP. 47% of the patients suffered
postoperative septic complications, significant higher in POP (80%vs.40%; P=0,0001).
SSI happened in 28% of patients: Superficial SSI (16%), Deep SSI (9%) and Organ/
space SSI (16%). Superficial SSI (35%vs.13%; P=0,006) and deep SSI (27%vs.6%;
P=0,0006) were significantly higher in POP. Readmission was of 7%, reintervention
rate was 10%, and mortality rate was 13%, with no significant differences between
CP and POP. Initial isolation of Enterococcus spp. was associated with higher
superficial SSI (36%vs.13%; P=0,006), deep SSI (50%vs.14%; P=0,0006) and septic
shock (30%vs.13%; P=0,02).
Conclusion:
There weren’t so many differences between CP and POP. Only the isolation of
Enterococcus spp. had significant differences in some septic complications.
-27-
OP - 12 HEMOSTASIS IN THYROID SURGERY WITH REGENERATED
OXIDIZED CELLULOSE
GIOVANNI RIZZO , GIOVANNI LOCHE , PINNA ANTONIO , SCANU ANTONIO MARIO ,
GIUSEPPE DETTORI
II° SURGICAL CLINIC, UNIVERSITY HOSPITAL OF SASSARI, ITALY
Background&Aims:
Despite new technologies have been developed in surgical bleeding control,

postoperative haemorrhage in thyroid surgery is still relatively frequent (incidence
0.5-4.5%) and potentially dangerous due to the airways compression. New devices
are now used in surgery to improve haemostasis, but few papers studied the effects
of haemostatic agents in thyroid surgery.
Methods:
We analyzed the clinical safety and efficacy of oxidized regenerated cellulose (ORC)
in a retrospective study on 182 patients. In the first group of patients we used ORC
at the end of the procedure to improve haemostasis; in the second control group
normal cauterization and ligatures were used.
Results:
In our experience the use of ORC improved the prevention of postoperative bleeding
(p 0.03); in particular it was useful in a better control of serum secretion with faster
removal of drains in case of lymphnodes dissection. Regarding the possible damage
of the laryngeal recurrent nerve caused by ORC referred in some experimental
papers, results were not statistically significative (p 0.22).
Conclusion:
The efficacy and the low cost of the haemostatic agent compared with other
devices suggest that ORC can be useful to improve haemostasis and decrease serum
secretion in selected cases (lymphnodes dissection, patients with coagulopathies
and thyroid hormones disorders).
-28-
OP - 13 LAPAROSCOPIC VERSUS OPEN SURGERY FOR COMPLICATED
APPENDICITIS WITH PERITONITIS AND ABSCESSES
WAGNER DORIS 1, MISCHINGER HANS JÖRG 2, WERKGARTNER GEORG 2
1
TRANSPLANTATION
2
GENERAL SURGERY
Background&Aims:
Complicated appendicitis (CA) is a frequent problem in adults. Laparoscopic surgery

(LS) is proposed to promote an existing peritonitis. The aim of this study was to
compare laparoscopic versus open surgery (OS) for CA with peritonitis with respect
to the persistence of the intraabdominal infection.
Methods:
769 patient records were reviewed, patients who suffered from a CA with peritonitis
were included. Operative procedure, post operative hospital stay, wound infections
and inflammatory response via leucocyte count (LC) and procalcitonin (PCT) on day
(POD) 1, 3 and 5 post surgery were compared.
Results:
143 patients were included. Appendectomy was performed via LS in 73 (51%) and
via OS in 70 (49%) patients. Patients after LS showed higher leukocytes on POD1 and
3 compared to patients after OS (POD 1: 14.200 (OS) vs. 16.300 G/L (LS), p=0.003;
POD3: 12.100 (OS) vs. 14200 G/L (LS), p=0.05) and higher PCT levels (POD1: 2.0 (OS)
vs. 3.6 (LS), p=0.01; POD3: 0.5 (OS) vs. 1.1 (LS), p=0.05). Duration of hospital stay did
not differ significantly between both groups (7 d (OS) vs. 9d (LS), p=n.s.) as well as
numbers of wound healing disorders (10% (OS) vs. 9% (LS), p=n.s.).
Conclusion:
LS is definitely feasible in patients with CA and it only seems to cause a mild

prolongation of the peritonitis. But due to the minimal invasive nature of the
procedure patients recover quicker as compared to patients after OS.
-29-
OP - 14 MICROBIAL SEALANT ON SSI
MUSTAFA OZER 1, HUSEYIN SINAN 2, MEHMET SAYDAM 2, ABDULLAH KILIÇ 3,
KAGAN COSKUN 1, ORHAN BEDIR 3, SEZAI DEMIRBAŞ 1
1
GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT OF GENERAL SURGERY
2
ANKARA MEVKI MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY
3
GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT OF MICROBIOLOGY
Background&Aims:
Surgical site infections (SSIs) are a serious concern in health care, and wound
contamination by endogenous skin flora is a major factor in the development of
SSIs. The purpose of this study was to determine the effect an n-butyl cyanoacrylate-
based microbial skin sealant (Integuseal®) in reducing the occurrence of SSIs after
surgery
Methods:
This was a prospective randomized controlled animal trial. Forty-eight Wistar albino
rats were divided into 6 groups of 8 rats each. Three groups received application
of sealant against specific bacteria, and 3 matched control groups received only
the bacteria without the sealant. Samples were taken from the abdomen of each
rat and placed in culture medium. Proliferation of the following bacteria were
observed: CoNS, GPB, PA, and MRSA
Results:
There was a statistically significant difference between the median number of

GPB in the group that received cage swabs + sealant and the group that received
cage swabs without sealant. The study results showed that Integuseal® was not as
effective in preventing CoNS or MRSA contamination as it was in preventing GPB
contamination.
Conclusion:
Use of a microbial skin sealant before surgery can lower the rate of SSIs by reducing
the migration of some specific bacterial agents.
-30-
OP - 15 INFECTIOUS PROFILE IN INONU UNIVERSITY INSTITUTE OF
LIVER TRANSPLANTATION INTENSIVE CARE UNIT
EMRAH OTAN , SERTAC USTA , CEMALETTIN AYDIN , SERDAR KARAKAS , BULENT
UNAL , CUNEYT KAYAALP , SEZAI YILMAZ
INONU UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF GENERAL SURGERY

AND INSTITUTE OF LIVER TRANSPLANTATION
Background&Aims:
Infectious complications following liver transplantation are among the most

challenging problems during postoperative period. The objective of this study is
to present the infectious profile and results in our institution’s intensive care unit
during early postoperative care.
Methods:
Results of 30 consecutive patients with a primary liver transplantation history

between August 2011 and August 2012 and a positive culture result were included
to the study. Data of age, gender, model for end stage liver disease (MELD)
score, history of diabetes mellitus (DM), preoperative hospitalisation history,
microorganisms and sites were analysed retrospectively.
Results:
Mean age of the patients was 37,77 ± 21,08 with a male dominence of 56,7%
(n=17). Mean MELD score was 26,87 ± 12,11. Rate for DM history was 36,7 % (n=11).
Preoperative hospitalisation history was present in 90% (n=27) of the patients. Among
the 68 positive culture results were 24 blood stream, 13 parasynthesis, 12 drainage
fluid, 7 urine, 5 catheter, 4 sputum, 3 wound. Microorganisms were Pseudomonas,
E.coli, Acinetobacter, Clebsiella, Enterococcus, Candida, Burkholderia, Streptococus,
Staph. aureus, Proteus, Citrobacter, Stenotrophomonas, Coagulase negative
staphylococcus, Kingella and Pseudomonas aeruginosa. Mortality was 53,3 %.
Conclusion:
Risk of infection is high for patients with increased MELD score. Mortality is
increased among patients with infection.
-31-
OP - 16 SORPTION-TRANSMEMBRANE DIALYSIS IN TREATMENT OF
SURGICAL PERITONITIS
VALERY KRYSHEN , PAVEL LYASHCHENKO , ARTEM BREUS
DNEPROPETROVSK MEDICAL ACADEMY, UKRAINE
Background&Aims:
Abdominal sepsis and systemic inflammatory response syndrome (SIRS) are the
main causes of lethal outcome at peritonitis. Its severity directly depends on the
endotoxicosis. Our aim was to improve results in treatment of surgical peritonitis,
using intra-abdominal semipermeable membranes of sorbent “Siliks.”
Methods:
Observed group (OG) - 11 patients with peritonitis, to whom the transmembrane

dialysis was conducted in postoperative period, using 4.8% suspension of sorbent
“Siliks.” In 24 hours, 12grams of sorbent were used. Clinical comparison group (CCG)
- 12 patients with peritonitis, where the transmembrane dialysis was not done. To
determine the degree of toxemia at patients with peritonitis, criteria of SIRS were
conducted.
Results:
At the majority of CCG patients SIRS effects and multiple organ failure syndrome
(MOFS) progressed during the first 5 days after surgery. In contrast, at patients of
OG starting from 3rd day, there were one and a half times fewer cases of severe
sepsis, which is agreed with other biochemical and immunological data of CCG.
Conclusion:
The usage of sorbent “Siliks” in the transmembrane dialysis of surgical patients with
peritonitis provides an adequate correction of MOFS.
-32-
OP - 17 THE ATTITUDE OF TURKISH SURGEONS TOWARDS
PERIOPERATIVE NUTRITION
BAHADIR OSMAN BOZKIRLI , RIZA HALDUN GÜNDOĞDU , SONER AKBABA ,
TURGAY SAYIN , PAMIR EREN ERSOY
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, CLINIC OF GENERAL

SURGERY
Background&Aims:
An online questionnaire was undertaken to assess, the awareness of malnutrition

and consciousness of accurate nutritional support (NS), among Turkish surgeons.
Methods:
The link of a 13 question survey was e-mailed to 2000 surgeons. Cross queries were
made over the answers in the database.
Results:
21% of the surgeons answered the questionnaire. 66%of these surgeons were
working in teaching hospitals and 34% were working in general hospitals. The
surgeons working in general hospitals joined less scientific meetings in a year. 24%
of the surgeons who answered the questionnaire assessed the nutritional status of
every hospitalized patient, whereas the rest of them assessed the nutritional status
of only the patients they considered under risk. The answers of 79%of the surgeons
on preoperative NS and 70%of them on postoperative NS were appropriate
according to the guidelines. The surgeons joining at least one scientific meeting on
nutrition in one year had a higher tendency to use immunonutrition. Only 15% of
the surgeons used ERAS protocol in their daily clinical practice.
Conclusion:
Since there was a low participation rate to the questionnaire, it was not possible to
clearly determine the attitude of all of the Turkish surgeons towards NS. However,
it is possible to come up with the idea that most of the participants are behaving
according to the current approach on nutritional practice; however, few of them
practice ERAS protocol.
-33-
-34-
-35-
OP - 18 A NOVEL APPROACH TO THYROID SKIN INCISION WITH
TUNNEL DISSECTION TECHNIQUE
HUSEYIN AYHAN KAYAOGLU , ERDINC YENIDOGAN , ISMAIL OKAN , NAMIK OZKAN
GAZIOSMANPASA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL

SURGERY, TOKAT, TURKEY
Background&Aims:
Superior and inferior flaps beneath the platysmal layer have been used to open
the midline raphe in thyroidectomy. Sometimes this flap dissection causes some
serious complications like seroma and subcutaneous hematoma formation. Here,
we described a new approach for flapless thyroidectomy.
Methods:
A total of 289 patients underwent thyroidectomy were eligible for the study. Group 1
was control. In group 2, a 5 mm width tunnel from thyroid cartilage superiorly to the
sternal notch inferiorly was used to open the midline raphe. Patient demographics
and complications were recorded and compared.
Results:
Specimen volumes, skin incision lengths and operation times of the groups
were 69.83±37.72 ml and 71.17±48.28 ml; 3.80±0.89 cm and 3.96±0.76 cm; and
115.21±26.73 min and 117.32±27.25 min, respectively (p=0.785; 0.196; and
0.875, respectively). Permanent recurrent laryngeal nerve palsy and permanent or
temporary hypocalcemia were similar (p=0.137, p=0.459 and p=0.333). Seroma and
subcutaneous hematoma was significantly higher in group 1 (p=0.024).
Conclusion:
The limited dissection of skin and subcutaneous tissue with tunnel technique may
prevent complications of unnecessary flap preparation, and thereby increase the
patient comfort and satisfaction. This less traumatic approach is technically feasible
and an alternative to conventional flap dissection with any limitations.
-36-
OP - 19 COMPARISON OF SENSITIVITY OF FINE NEEDLE ASPIRATION
BIOPSY AND ULTRASONOGRAPHY ACCORDING TO NODULE SIZE IN
PREOPERATIVE DIAGNOSIS OF THYROID CANCER
İLKER ÖZGÜR 1, YALIN İŞCAN 1, PINAR FIRAT 2, ENSAR YEKELER 3, FATIH TUNCA 1,
YASEMIN GILES ŞENYÜREK 1, SERDAR TEZELMAN 4, TARIK TERZIOĞLU 4
1
İSTANBUL MEDICAL FACULTY,İSTANBUL UNIVERSITY, DEPARTMENT OF GENERAL
SURGERY
2
İSTANBUL MEDICAL FACULTY,İSTANBUL UNIVERSITY, DEPARTMENT OF
PATHOLOGY
3
İSTANBUL MEDICAL FACULTY,İSTANBUL UNIVERSITY, DEPARTMENT OF
RADIOLOGY
4
VKV AMERICAN HOSPITAL,İSTANBUL
Background&Aims:
To investigate the effect of nodule size on the sensitivity of fine needle aspiration
biopsy (FNAB) and ultrasonography (US) in preoperative diagnosis of thyroid cancer
Methods:
A total of 726 nodules were evaluated both with FNAB and US. The sensitivity,
specificity and accuracy of both FNAB and US according to nodule size were
determined.
Results:
The overall sensitivity, specificity and accuracy of FNAB was 62,4%, 81% and
71%, respectively. The sensitivity of FNAB decreased in nodules ≥3cm compared
to nodules <3cm (34%vs71%,p=0.0001). The sensitivity of FNAB was lower in
multinodular goiter patients compared to that with solitary nodules,the difference
was not statistically significant (62% vs71%,p=0.1). Solid hypoechoic structure,
microcalcifications and irregular margin in a nodule at US was significantly associated
with thyroid cancer. The sensitivity, specificity and accuracy of these three features
ranged between 26%-69%, 38%-87% and 54%-58%, respectively. The sensitivity,
specificity and accuracy of sonographic features showed no significant difference
according to the nodule size.
Conclusion:
The sensitivity of thyroid FNAB is significantly lower in nodules ≥3cm, whereas US

have the same sensitivity for nodules both ≥3 and <3cm. In nodules ≥3cm with
benign FNAB result and suspicious sonographic features, the risk of a false negative
FNAB result should be kept in mind.
-37-
OP - 20 DAY CASE HEMITHYROIDECTOMY
KHALID MAJED ALHAJRI
PRINCE SULTAN RIYADH MILITARY MEDICAL CITY
Background&Aims:
Introduction: In the era of day case surgery, enhanced recovery programs, managed
care policies, long waiting lists, financial cutbacks, thyroid surgery continue to be
an inpatient procedure in majority of cases, so our breast and endocrine surgery
unit decided to be among the first centers to implement a day case program for
hemithyroidectomy in well selected patients Objective: To assess the safety and
impact of day case hemithyroidectomy
Methods:
• Inclusion Criteria: ASA I & II patients with thyroid nodule , limited to one lobe for
Diagnostic and/or theraputic hemithyroidectomy • Exclusion Criteria: ASA III and
above, reoperations, thyroid cancer, residency outside Riyadh, patients with no
social support at home, • period of enrollement: jan 2011 to Oct 2011• period of
follow up: 1st 24 hrs post-operative follow up by telephone, two weeks.• primary
end points: safety in terms of postoperative complications and readmission rate
and patient satisfaction in terms of pain score and control, and speed of return to
daily activities• secondary end points: cost effectiveness
Results:
• 19 patients were enrolled during this period, • none of our patients had a
significant post operative complication• 18 ( 94.7 % ) of patients were extremely
satisfied with their pain control, quality of care, and reported an early return to
daily activities within 2 days,• only 1 ( 5.2 % ) patient was dis-satisfied with pain
control in the first 24 hours• our readmission rate was 0%• costs of hospitalization
were reduced by more than 50%
Conclusion:
day case hemithyroidectomy is a safe and cost effective procedure with impressive
patient satisfaction rate, in well selected patients, which serve as a promising
evidence for extending the inclusion criteria
-38-
OP - 21 DEXAMETHASONE REDUCES POSTOPERATIVE EMESIS BY
DECREASING PGF2α AND LTC4 LEVELS
DUYGU ALTINOK , TOLGA SARACOGLU , MEDENI ARPA , OZGUR BAYKAN ,
A.OZDEMIR AKTAN
MARMARA UNIVERSITY SCHOOL OF MEDICINE
Background&Aims:
High incidence of postoperative neusea and vomiting has been reported for
thyroid and breast surgery. This study has been done to study the effectiveness of
corticosteroids in the prevention of postoperative emesis and the mechainsm of
action was investigated.
Methods:
96 patients undergoing thyroid and breast surgery were randomized as the study and
control groups. Patients in the study group recieved 8 mg i.v. dexamethasone just
before extubation. Preoperative and postoperative blood samples were obtained
at 30 minutes and 6th hour for PGF2α and LTC4 levels after surgery. Nausea and
vomitting severity was recorded with Verbal Descriptive Scale (VDS) for 24 hours
post-operatively.
Results:
Preoperative PGF2α and LTC4 levels were similar in the two groups. Postoperatively,
in the group receiving dexamethasone PGF2α levels decreased significantly at 30
minutes (p=0.002) and 6th hour (p=0.006). Similarly LTC4 levels also decreased at
30 minutes (p=0.021) and 6th hour (0.011) in the group receiving dexamethasone.
VDS scores were significantly lower in the group receiving dexamethasone (p=0.002
and p=0.012 respectively).
Conclusion:
Postoperative dexamethasone was effective in reducing neusea and vomiting

in patients undergoing breast and thyroid surgery. Dexamethasone seems to
accomplish this effect through eicasonoid metabolism by reducing PGF2α and LTC4
levels.
-39-
OP - 22 EXCISION EFFICIENCY OF RADIOGUIDED OCCULT LESION
LOCALIZATION IN REOPERATIONS OF NONPALPABLE RECURRENT
THYROID PAPILLAR CARSINOMAS
MUSTAFA TANRISEVEN , RAMAZAN YILDIZ , ERKAN OZTURK , SEMIH GORGULU ,
ONER MENTES
GULHANE MILITARY MEDICAL ACADEMY
Background&Aims:
Despite excellent overall prognosis, up to 40% of patients with papillary thyroid

cancer (PTC) will have persistent or recurrent disease, mostly in lateral (53%) or
central (28%) cervical lymph nodes. The purpose of this study was to investigate the
efficiency of a radioguided occult lesion localization(ROLL) technique in reoperative
and nonpalpable recurrent thyroid papillar carsinomas in patients who had
undergone previous neck exploration for thyroid disease.
Methods:
In all patients, all recorded suspicious lesions in central and lateral neck were
biopsied under US guidance and the biopsy proven recurrent tumoral lesions
plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin
under US guidance in the morning of surgery. Our clinic archives searched and
results of the operations which were in the same conditions but did not used ROLL
technique. After surgery histopathologic results and other collected data compared
between two groups.
Results:
There were 43 nonpalpable thyroid papillar cancer recurrent patients who went
to surgery with ROLL technique. By the searching of clinic archives 8 reoperated
patients with nonpalpable thyroid papillar recurrent carsinoma found. Sitatistacally
there were significant differences between the groups.
Conclusion:
The ROLL technique was efficient in patients who were undergoing reoperations
for nonpalpable thyroid papillar carcinomas versus did not used ROLL technique.
This radioguided technique has been highly effective for localization and surgical
treatment of suspicious lessions in PTC.
-40-
OP - 23 EXTRALARYNGEAL DIVISION OF THE RECURRENT
LARYNGEAL NERVE AS A COMMON AND AN ASYMETRIC
ANATOMICAL VARIANT.
MEHMET ULUDAG 1, GURKAN YETKIN 1, EBRU SEN ORAN 1, NURCIHAN AYGUN 1,
FEVZI CELAYIR 1, ADNAN ISGOR 2
1
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, DEPARMENT OF THE GENERAL
SURGERY
2
GOZTEPE MEDICAL PARK HOSPITAL, DEPARTMENT OF THE GENERAL SURGERY
Background&Aims:
Recognition of extralaryngeal branching of the recurrent laryngeal nerve (RLN)

is crucial, because prevention of vocal cord paralysis requires preservation of all
branches of the RLN. This study aimed to establish the prevalence of extralaryngeal
branching of the recurrent laryngeal nerve (RLN) and the distance from the division
point of it to the entry under the cricopharyngeus muscle.
Methods:
Prospective operative data on branching of the RLN were collected in 94 patients

patients having thyroid or parathyroid surgery.
Results:
A total of 161 RLN were studied (right-82, left-79). There were 77 RLNs (47.8%)
that bifurcated or trifurcated before entering the larynx. These branchings occurred
43.9% on the right, and 51.9% on the left. The branching rates of the 67 patients
who underwent a bilateral procedure are determined as bilaterally branching
28.4%, bilaterally nonbranching 31.3%, one side branching 40.3%. The median
branching distance from the cricopharyngeus muscle was 15 mm (3-60mm).
Conclusion:
Extralaryngeal divisions of RLN is a common and an asymetric anatomical variant.

Both RLN and all of its branches should be identificated and preserved. Because
inadvertent division of a branch may lead to significant vocal cord palsy despite the
operator believing the nerve was preserved.
-41-
OP - 24 INFLUENCE OF PROPHYLACTIC CENTRAL LYMPH NODE
DISSECTION ON MORBIDITY, SERUM THYROGLOBULIN LEVEL,
RECURRENCE RATE,AND POSTOPERATIVE MANAGEMENT IN
PAPILLARY THYROID CANCER
BURÇİN BATMAN 1, YALIN İŞCAN 1, İSMAİL CEM SORMAZ 1, NURDAN GÜL 2, FATİH
TUNCA 1, YASEMİN GİLES ŞENYÜREK 1, SERDAR TEZELMAN 3, TARIK TERZİOĞLU 3
1
İSTANBUL UNIVERSITY MEDICAL FACULTY DEPARTMENT OF GENERAL SURGERY
2
İSTANBUL UNIVERSITY MEDICAL FACULTY DEPARTMENT OF ENDOCRINOLOGY
AND METABOLISM
3
VKV AMERICAN HOSPITAL,İSTANBUL
Background&Aims:
The aim of this study was to investigate the influence of prophylactic central lymph
node dissection (CLND) on morbidity rate, serum thyroglobulin(Tg) levels, local
recurrence rate and postoperative management in papillary thyroid cancer (PTC)
patients.
Methods:
Retrospective analysis of prospectively collected data of 151 clinically node negative

PTC patients who underwent total or near total thyroidectomy was performed. Of
151 patients, 57 (group 1) underwent thyroidectomy in conjuction with prophylactic
CLND and 94 (group 2) underwent only thyroidectomy . We compared serum Tg
levels,local recurrence rates and morbidity between the two groups, and evaluated
the influence of CLND on postoperative management. The mean follow-up period
was 20±7 months.
Results:
In group1 and 2,the rate of recurrent laryngeal nerve injury (1.7%vs 1%,p=0.7)) and
temporary hypoparathyroidism (20%vs30%,p=0.8) showed no significant difference.
Postoperative Tg levels (8.7±20.4vs 8±17.3ng/ml,p=0.8) were similar in both groups.
Presence of central lymph node metastasis changed postoperative management
and indicated radioactive iodine treatment in 26% of patients in group 1. No local
recurrence was encountered in both groups.
Conclusion:
Prophylactic CLND has no significant influence on postoperative morbidity,serum Tg

level and recurrence rate. However, performance of prophylactic CLND might change
postoperative management and provide for more optimal treatment in nearly one
fourth of PTC patients.
-42-
OP - 25 MALIGNANCY RATE IN THYROID NODES WITH THY 3
CYTOLOGY OR INDETERMINATE HURTHLE CELL NEOPLASM
ELEONORA GUAITOLI , ANTONIO CATANIA , MATTEO NARDI , ELİSABETTA FABİANİ ,
CARLO Dİ MARCO , ROBERTO GRECO , GRAZİA SAVİNO , SALVATORE SORRENTI
DEPARTMENT OF SURGICAL SCIENCES SAPIENZA UNIVERSITY OF ROME, ROME,

ITALY.
Background&Aims:
thyroid nodules with cytology of follicular (FN) or HÜrthle (HN) cell neoplasms
indeterminated for malignancy require surgical treatment. We analyzed those nodes
to determine if there were differences in the rate and types of thyroid malignancy.
Methods:
We studied 694 FN nodules and 210 HN nodules analyzed by histopathological

analysis.
Results:
In 904 patients there were 159 (17.6%) with thyroid cancer; 120 FN and 39 HN.
Extrathyroidal invasion in papillary thyroid carcinoma (PTC) was more common in
females than in males (62% vs. 25 %, p < 0.05). The rate of thyroid cancer was
similar in FN (17.3%) and HN (18.6%). The rate of HÜrthle cell thyroid cancer was
higher in HN than in FN (5.0% vs. 0.7%, p < 0.01); the rate of oncocytic variant of PTC
was greater in HN than FN (23.1% vs. 1.7%, p < 0.05). The rate of follicular thyroid
carcinoma was almost identical(19.2% HN vs. 18.8% FN).
Conclusion:
There’s a little difference in the rate of malignancy between FN and HN nodes but
there is a difference in the types of thyroid cancers. HÜrthle cell thyroid cancer and
the oncocytic variant of PTC is more common in HN nodes.
-43-
OP - 26 PATHOLOGICAL SUBTYPE AFFECTS THE SURVIVAL OF
PAPILLARY THYROID CANCER WITH LYMPH NODE METASTASIS
KAZIM CAGLAR OZCELIK , SEVIM TURANLI , NIYAZI KARAMAN
ANKARA ONCOLOGY EDUCATION AND RESEARCH HOSPITAL DEPARTMENT OF

GENERAL SURGERY
Background&Aims:
To investigate the effects of lymph node metastasis on survival of patients with

different pathological subtypes of papillary thyroid cancer.
Methods:
Two hundred and twenty-six patients (186 female, 40 male) operated in between
1980-2007 were evaluated. Total thyroidectomy and therapeutic lymph node
dissection were performed. Thyroid stimulating hormone suppression was given to
all patients and radioactive iodine treatment was given when needed. The patients
were followed-up for a median of 86 months. (range:27-314 months).
Results:
The median age of the group was 41 (range:11-89 years). The numbers of the
patients with classical type, microcarcinoma and papillary cancer with follicular
variant were 118 (52.2%), 56 (24.8%) and 52 (23.0%), respectively. The frequency
of the cervical lymph node involvement was for each subtype was 44.1%, 3.6%
and 17.3%, respectively. The survival of the patients with and without lymph node
involvement was median 74 and 86 months, respectively (p=0.04, 95% confidence
interval: 80.8-91.2). According to the presence of lymph node involvement, the
survival of the patients with classical papillary cancer, microcarcinoma and papillary
cancer with follicular variant was 98/74 (p=0.06), 86/74 (p=0.21) and 98/62 months
(p=0.002), respectively.
Conclusion:
Lymph node involvement affects the survival adversely in patients with papillary
thyroid cancer and this effect is especially prominent in patients with papillary
carcinoma with follicular variant.
-44-
OP - 27 PREDICTING THE NEED FOR THORACIC INCISION IN THE
SURGICAL MANAGEMENT OF RETROSTERNAL THYROID GOITRE: A
SYSTEMATIC REVIEW
ALİ QUREISHI 1, GEORGE GARAS 1, AMIT SHARMA 2, MRIGANKA DE 1
1
ROYAL DERBY HOSPITAL, DERBY, DERBYSHIRE, ENGLAND
2
NOTTINGHAM CITY HOSPITAL, NOTTINGHAM, NOTTINGHAMSHIRE, ENGLAND
Background&Aims:
There are no randomised controlled trials to identify patients with retrosternal

thyroid goitre (RSG) requiring an extra-cervical surgical approach. Moreover given
the variety of definitions used for RSG the observed heterogeneity among relevant
studies makes interpretation difficult. This study aimed to review literature on the
surgical management of RSG and systematically identify preoperative indicators for
thoracic incision.
Methods:
A Medline search was performed for all papers published from January 2000 to
June 2012 regarding the management of RSG. A total of 381 papers were identified.
Based on design, number of patients and definition of RSG 16 papers were included.
Results:
Each study was scrutinised in terms of design, patient group, operative approach,
complications and factors necessitating an extracervical incision. In RSG with >50%
of the mass located below the thoracic inlet predictors for thoracic incision and
their statistical significance were identified. Postoperative complications were
compared in patients treated transcervically and with a thoracic approach.
Conclusion:
Based on the evidence it appears that 10.6% of patients with RSG are likely to
require a thoracic approach, these individuals can be identified using additional
factors. The presence of one or more should raise suspicion regarding the need for
an extra-cervical approach and surgical planning should proceed accordingly.
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OP - 28 PREVENTION OF HYPOCALCEMIA AFTER TOTAL
THYROIDECTOMY USING PARATHYROID HORMONE
AYDINCAN AKDUR , TUGAN TEZCANER , MAHIR KIRNAP , SEDAT YILDIRIM ,
GÖKHAN MORAY
BAŞKENT UNIVERSITY, DEPARTMENT OF GENERAL SURGERY
Background&Aims:
Hypocalcaemia after total thyroidectomy has traditionally required 48 hours or

longer inpatient monitoring of serum calcium levels. This study aimed to measure
the impact of a management plan based on postoperative parathyroid hormone on
achieving safe early discharge after thyroidectomy.
Methods:
The results were retrospectively analyzed from 66 patients underwent total

thyroidectomy from May 2011 to May 2012 at our center. Serum PTH level was
measured 10–12 hours postoperatively and used to stratify patients into 2 groups:
normal PTH (≥ 15 pg/mL) and low PTH (<15 pg/mL). At the low PTH group we started
oral calcium therapy and if there was no clinical hypocalcemia, we were discharge
on the first postoperative day. At the other group we discharged patients without
calcium therapy on the first postoperative day.
Results:
Of 66 patients, 47 patients were female (71.2%). Median age was 51.5 (range, 61)
and median postoperative PTH was 36.5 (range, 76.2). Fifty nine patients (%89.3)
were successfully discharged on first postoperative day with no complications
or readmissions; 12 (18.1%) of patients had low PTH levels and 7 of them were
monitored more than 24 hours. Two patients were required intravenous calcium
and no patient suffered from permanent hypoparathyroidism.
Conclusion:
A postoperative parathyroid hormone measurement can assure safe early discharge

and low readmission rate after total thyroidectomy.
-46-
OP - 29 RADIOGUIDED OCCULT LESION LOCALIZATION IN
PATIENTS WITH NONPALPABLE RECURRENT/PERSISTENT THYROID
CARCINOMAS, OUR CLINIC EXPERIENCES.
MUSTAFA TANRISEVEN , RAMAZAN YILDIZ , ERKAN OZTURK , SEMIH GORGULU ,
ONER MENTES , YUSUF PEKER
GULHANE MILITARY MEDICAL ACADEMY
Background&Aims:
Radioguided surgery enables a surgeon to identify lesions or tissues that have been
preoperatively marked with radioactive substances. The Radioguided Occult Lesion
Localization(ROLL) technique has been widely used to identify the sentinel lymph
node and occult lesions in patients with breast cancer. In this study we aimed to
improve the surgical success and reduce the complication rates in patients with
thyroid cancer recurrences in thyroid bed side and lateral cervical compartment
with ROLL.
Methods:
In all cases, injection of Tc-99m labeled macroaggregated albumin was performed,

directly inside or near by the biopsy proven recurrent/persistent tumoral lesions
guided by ultrasound. Than patients went to surgery and intraoperative lesion
detection was carried out using a gamma-probe.
Results:
We report 47 thyroid cancer recurrences cases in which preoperative markings

of the lesions were carried out using the ROLL technique. Recurrence of papillar
thyroid carcinoma in 43 (%91,5)patients, follicular thyroid carcinoma in 1 (2,1%)
patient, medullary thyroid carcinoma in 2 (4,3%) patients and anaplastic thyroid
carcinoma in 1 (2,1%) patient. Despite extensive scarring in some patients probe
safely guided to lesions and the lesions that were marked preoperatively were
ultimately successfully excised.
Conclusion:
The Radioguided Occult Lesion Localization technique has proven to be a safe and
effective alternative for the management of nonpalpable recurrent/persistent
thyroid cancer’s surgery and can be useful in selected cases where suspect lesions
may be difficult to identify intraoperatively, due to their dimensions, anatomical
location and previous surgery. The procedure allows for more conservative excisions
and reduces the surgery-related morbidity.
-47-
-48-
-49-
OP - 30 COMPARISON OF SURVIVAL AFTER D2 AND D3 LYMPH
NODE DISSECTION FOR GASTRIC CANCER ACCORDING TO 6.UICC
AND 7.UICC STAGING SYSTEMS
ERDAL BIROL BOSTANCI , ILTER OZER , TAHSIN DALGIC , MURAT CAYCI ,
MUHAMMET KADRI COLAKOGLU , MURAT ULAS , METIN ERCAN , MUSA AKOGLU
DEPARTMENT OF GASTROINTESTINAL SURGERY, TURKIYE YUKSEK IHTISAS

EDUCATION AND RESEARCH HOSPITAL, ANKARA, TURKEY.
Background&Aims:
To compare survival after D2 and D3 lymph node dissection (LND) for each stage
according to 6.UICC and 7.UICC staging systems, and to evaluate factors effecting
survival.
Methods:
Between 1998 and 2011, 596 patients with D2-LND and 112 with D3-LND
were enrolled in the study. These patients were restaged according to 7.UICC/
TNM staging system. Esophagogastric junction tumors (EGJ) were re-staged as
esophageal adenocarcinoma. Survival after D2 and D3-LND were compared. The
effects of age, gender, location, surgery type, dissection type, diameter, T and N
stages, differentiation, Borrmann classification, peritoneal cytology and additional
resection on survival were evaluated.
Results:
Median survival after D2 and D3 LND were 18 and 19.7 months for EGJ tumors, and
43 and 26 months for non-EGJ tumors, respectively. Survival after D2 and D3 LND
was similar. Moreover, survival was similar for each stage. In multivariate analysis , T
stage, N stage, additional resection and advanced age were independent predictors
of survival.
Conclusion:
D3-LND did not result in increased survival in gastric cancer patients. In

addition,survival after D2 and D3 LND was similar in each stage according to 6.UICC
and 7.UICC staging systems. The most important factors effecting survival were T
and N stages, advanced age and additional organ resection.
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OP - 31 CYTOREDUCTIVE SURGERY PLUS HYPERTHERMIC INTRA-
OPERATIVE PERITONEAL CHEMOTHERAPY WITH CISPLATIN
TO TREAT PERITONEAL CARCINOMATOSIS FROM UPPER
GASTROINTESTINAL CANCER; 1-YEAR ANALYSIS OF THE HIPCUPP-
TRIAL
HALIT TOPAL , HANS PRENEN , VINCENT VANDECAVEYE , CHRIS VERSLYPE , BAKI
TOPAL
Background&Aims:
Peritoneal carcinomatosis (PC) from gastric, biliary, and pancreatic cancer is highly
resistant to systemic chemotherapy and results in extremely poor survival. The
current ongoing phase-II study evaluates the effectiveness of cytoreductive surgery
(CRS) plus hyperthermic intra-operative peritoneal chemotherapy (HIPC) with
cisplatin.
Methods:
From August 2010 till November 2011, 23 patients underwent CRS+HIPC for biliary
(3), gastric (13), or pancreatic (7) adenocarcinoma. Median PC index (PCI) was 6
(range 3-18). Cisplatin (100mg/m2) was perfused for 60 minutes at intracavitary
temperatures around 40°C.
Results:
Complete cytoreduction (CCR-0) was obtained in all patients. No postoperative

mortality occurred. The severity of postoperative complications ranged between
TOSGS grade 1 and 4b. Surgical site complications (SSC) were observed in 6 patients
and non-SSC in 15, including 5 patients with cisplatin nephrotoxicity (creatinin
>2mg%). No patients needed haemodialysis. Postoperative length of hospital
stay was 14 days (range 9-70 d.). Cancer recurrence was observed in 11 patients
of whom 8 were diagnosed in patients with a PCI higher than 10, though current
follow-up time is too limited. Updated data will be presented during the congress.
Conclusion:
The interim 1-year evaluation of CRS+HIPC with cisplatin to treat PC from upper
gastrointestinal cancer shows acceptable morbidity, no mortality, and promising
survival rates.
-51-
OP - 32 EARLY POSTOPERATIVE OUTCOMES OF LAPAROSCOPIC
NISSEN FUNDOPLICATION OPERATIONS WITHOUT USING A
BOUGIE: RESULTS OF 180 CASES
TAHSİN DALGIÇ , ERDAL BİROL BOSTANCI , YUSUF ÖZOĞUL , İLTER ÖZER , MURAT
ULAŞ , METİN ERCAN , ALİ KEMAL KAYAPINAR , MUSA AKOĞLU
DEPARTMENT OF GASTROENTEROLOGİCAL SURGERY,TÜRKİYE YÜKSEK İHTİSAS

TEACHİNG AND RESEARCH HOSPİTAL
Background&Aims:
To report the early results of patients who underwent laparoscopic Nissen

fundoplication.
Methods:
Between January 2005 and August 2012, 180 patients underwent laparoscopic
antireflux surgery. Data of these patients were obtained from a prospectively
collected database. Symptoms,endoscopic,manometric and radiologic findings
and pH metry results were reviewed. Type and duration of surgery and intra-
postopetative complications were recorded.
Results:
Of the 180 patients,117 were male(65%) and 63(35%) were female.Mean age was
42±12.The most common symptoms were retrosternal pain and regurgitation (35%).
Esophagitis was seen in 57% of patients and 4% had Barrett’s esophagus.Of the 112
(62%) patients who underwent PH-metry, 92% had pathological reflux. Manometric
study was performed in 142(78%) cases. 57% of them had normal manometry,
16% had nonspecific esophageal motility disorders and 27% had hypotensive
lower sphincter.All patients underwent Nissen Fundoplication without using a
bougie.Conversion was needed in 2(1.1%) patients due to bleeding and anatomical
difficulties.The mean operation time was 136±49.8 minutes. Postoperative
complications were detected in only 3(1.6%) patients and they improved with
medical treatment. The mean hospitalization period was 3±1.5 days. None of the
patients had severe dysphagia in the early period.There was no mortality due to
surgery.
Conclusion:
Laparoscopic Nissen fundoplication without using a bougie can be performed safely.
-52-
OP - 33 EXTENSIVE MEDIASTINAL LYMPHADENECTOMY IN
THORACOSCOPY ASSISTED THREE-FIELD ESOPHAGECTOMY
YALIN İŞCAN , İLKER ÖZGÜR , İSMAİL CEM SORMAZ , FATİH TUNCA , YASEMİN GİLES
ŞENYÜREK , TARIK TERZİOĞLU
ISTANBUL FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY
Background&Aims:
Technical feasibility in thoracoscopy have made it possible to perform

esophagectomy with extensive lymphadenectomy ( upper mediastinal, paratracheal,
paraesophageal and subcarinal ) . Aim of this study was to assess our outcomes of
extensive mediastinal lymphadenectomy in esophageal cancer.
Methods:
Thoracoscopy assisted three-field esophagectomy was performed in 27 patients

from January 2008 to February 2012. Procedure was divided in 3 stages.
Thorocoscopic esophageal mobilization and mediastinal lymph node dissection
was followed by laparotomy, celiac lymph node dissection and creation of gastric
tube. Finally cervical lymph node dissection and hypopharyngogastrostomy was
generated via cervical insicion.
Results:
Median age was 54,9 ( 43-64) of 17 ( %63 ) men and 10 ( %37 ) women. The avarage
operation time was 214 ± 18,6 min. and the avarage thorocoscopy time was 88
± 14 min. The average number of all retrieved lymph nodes was 36 ± 14.2 and
mediastinal lymph nodes avarage was 28.2 ± 12.8. No respiratory complication
was observed, hoarseness occured in 3 ( %11 ) patients and 2 ( %7) patients have
anastomotic stenosis. Mean follow-up time was 28 month and median survival was
22 month.
Conclusion:
Minimal invasiv surgery in esophagectomy have demonstrated feasibility of

mediastinal lymph node dissection without increased complications.
-53-
OP - 34 FOLLOW-UP RESULTS OPEN AND LAPAROSCOPIC HELLER
MYOTOMY FOR ACHALASIA
PETRO FOMIN , ANTON KURBANOV
NATIONAL MEDICAL UNIVERSITY NAMED AFTER A.A.BOGOMOLETZ, KIEV, UKRAINE
Background&Aims:
Reports about outcomes for open (OHM) and laparoscopic Heller myotomy (LHM)
with fundoplication are scarce. We studied the long-term results of LHM and OHM
on different stages of achalasia.
Methods:
Between 1983 and 2010 yrs 87 patients ( age 18-80 years, an average 48,3±11.8)
were separated into four groups based on the diameter and the shape (spindle - Sp,
flask - Fk, sigmoid - Sig types) of the esophagus: group A (<4.0 cm + Sp) - 5(5,8%),
group B (4.0–6.0 cm + Sp) - 19(21,8%), group C (>6.0 cm + Fk) – 42(48,3%), group D
(>6.0 cm + Sig) – 21(24,1%) patients. Before and after surgery clinical assessments,
an X-ray and endoscopy with biopsy were performed
Results:
After LHM (39) without and OHM (48) with diaphragmotomia (group A - 4/1, B –
10/9, C – 20/22, D – 5/16) mean follow-up was 14.2 years (range 3 to 27 years).)
Complete disappearance clinical signs (Grade A) had 80(92%) patients (LHM - 87,2%,
OHM - 95,8%), ≥ 50% of improvement (Grade B) – 5(5,7%) (LHM - 10,3%, OHM -
2,1%), unchanged (Grade C)- 3(5,4%) (LHM -2,6%, OHM - 2,1%). The patients grades
B,C needed endoscopic procedures. Of the total, 96,6% of patients had resolution of
dysphagia, 98,9% of regurgitation, heartburn, chest pain. The endoscopic findings
in dynamics, the presence or absence of reflux esophagitis were analyzed.
Conclusion:
Results (Grade A) after LHM and OHM were the same in groups A, B, but outcomes
in groups C, D were better after OHM.
-54-
OP - 35 LAPAROSCOPIC WEDGE RESECTION FOR GASTRIC GISTS
HAKAN M. KÖKSAL , MEHMET MIHMANLI , ÖZGÜR BOSTANCI , UYGAR DEMIR ,
CEMAL KAYA , H.ŞEBNEM TÜRK
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL
Background&Aims:
Laparoscopic wedge resection(LWR) of the gastric gastrointestinal stromal tumors(G-

GISTs) has become the surgical option with clear surgical margin. The technical
consideration and follow-up data are important. We present our experience of
8 LWRs for G-GISTs with a mean follow-up of 38months and assess the safety of
laparoscopic surgery and oncologic validity for G-GIST.
Methods:
From April2007 to July2010, we performed 8 LWRs for G-GIST patients at our

department. Endoscopy was cooperated with laparoscopic surgery for the exact
tumor site. Patient demographics, perioperative parameters, and outcomes of the
8patients were assessed retrospectively.
Results:
The average age was 66.6years. Tumors were located in the upper third of the
stomach in 5patients, and in the middle third in 3patients. All resections were R0
with 1cm normal tissue margin width. The mean size of tumors was 3,125cm in
diameter. The duration of operation ranged from 70 to 110minutes. No conversion
to laparotomy and reoperation occured. No blood transfusion was needed in all
cases. The hospital stay ranged from 5 to 10days. The follow-up period range from
21 to 60months. There has been no evidence of tumor recurrence.
Conclusion:
LWRs for G-GISTs can be performed safely and effectively, and is feasible oncologically
and technically with a satisfactorly remissions.
-55-
OP - 36 MICROBIOLOGICAL LANDSCAPE AND I-NOS ACTIVITY
OF PERIULCEROSIS MUCOUS MEMBRANE AT PATIENTS WITH
BLEEDING GASTRO-DUODENAL ULCER
MYKOLA TROFIMOV , KRYSHEN VALERY
Background&Aims:
Treatment of bleeding gastroduodenal ulcer remains is one of the actual problems

of modern public health services.
Methods:
Complex observation of 40 patients with bleeding gastroduodenal ulcer which

were on treatment in the centre of gastroduodenal bleedings of city clinical
emergency hospital was conducted. On the third day as a rule was taken
stomach mucous membrane biopsy, which followed microbiological and specific
immunohistochemical investigation with expose of the inducible NO-synthesis
activity (i-NOS).
Results:
At 92,5% of the observed patients the we’ve exposed semination of periulcerosis

mucous membrane many kinds of microorganism with domination of faculty
pathogenic and pathogenic microorganisms. We’ve exposed in cases with
unstable local hemostasis – endosopic picture is thrombosed vessel and defect is
covered fresh clot semination periulcerosis mucous membrane microorganisms
type Klebsiella pneumoniae in 66,7% and Streptococcus β-haemoliticus in 33,3%
cases. At patient with acute bleeding we’ve exposed semination periulcerosis
mucous membrane microorganisms type Klebsiella pneumoniae in 49,3% cases,
Streptococcus β-haemoliticus in 28,6% cases, Pseudomonas Aeruginosa and
Candida Albicans in 14,3% cases. We’ve exposed in cases with periulcerosis mucous
membrane pathogenic microorganisms accumulation (especially Streptococcus
β-haemoliticus and Pseudomonas Aeruginosa) the high level of i-NOS activity.
Conclusion:
Microbiological landscape and i-NOS activity of periulcerosis mucous membrane

at patients with bleeding ulcer accompanied with each other and can be used for
recurrent of bleeding.
-56-
OP - 37 SENTINEL LYMPH NODE BIOPSY VALUABLE IN T1 BUT
NOT T2 GASTRIC CANCER PATIENTS DUE TO SKIP METASTASES
PHENOMENON
RADOSLAW PACH , PIOTR KULIG , SZYMON PIETRUSZKA , PIOTR KOLODZIEJCZYK ,
JAN KULIG
I DEPARTMENT OF GENERAL, ONCOLOGICAL AND GASTROINTESTINAL SURGERY,

JAGIELLONIAN UNIVERSITY, CRACOW, POLAND
Background&Aims:
Value of sentinel lymph node biopsy (SLNB) in patients with gastric cancer has not
been unequivocally established so far. Result of SLNB in advanced gastric cancer
(T3/T4) does not influence clinical management because of skip metastases (10%)
and complicated lymphatic stream (20%). In contrast SLNB may be relevant in
identifying micrometastatic spread from T1 and T2 neoplasms. The purpose of the
study was to determine clinical value of SLNB in patients with T1 and T2 gastric
cancer.
Methods:
SLNB was conducted in 56 patients with T1 (15 pts) or T2 (41 pts) gastric cancer,
operated on between 2008 and 2011. Lymphadenectomy D2/D2+ was performed.
Patent blue was used to delineate the lymphatic drainage of a gastric tumour to its
sentinel lymph node. All retrieved lymph nodes were analyzed by haematoxylin and
eosin staining with multiple sectioning.
Results:
Sentinel lymph node was successfully detected in all patients. In patients with T1
tumours and negative SLNB no metastases in other lymph nodes were detected. In
contrast, in patients with T2 tumours skip metastases were detected in 6 patients
(14.6%) despite negative SLNB.
Conclusion:
Sentinel lymph node biopsy should be considered only in T1 gastric cancer patients
because of high percentage of skip metastases observed in patients with T2
tumours.
-57-
OP - 38 CORRELATION OF GASTROESOPHAGEAL FLAP VALVE GRADE
WITH SURGERY RATE IN GASTROESOPHAGEAL REFLUX
HUSEYIN AYHAN KAYAOGLU

SURGERY
Background&Aims:
The importance of endoscopic evaluation and grading of gastroesophageal flap

valve (GEFV) in gastroesophageal reflux disease (GERD) patients was previously
demonstrated with increased acid exposure and high grades of esophagitis
in patients with high grade valves. On the other hand, there are no data on the
relationship between GEFV appearance and surgical rate.
Methods:
GEFV grading and 24-h ambulatory pH monitoring was performed in 453 patients
with symptoms suggestive of GERD. Of these patients, 82 underwent surgery after
failing medical management or for disease complications.
Results:
GEFV grade IV patients were younger than patients with normal GEFV (grade I and
II; p=0.017 and p<0.001, respectively) with significant male predominance. The
prevalence of hiatal hernia, degree of esophageal acid exposure, and the prevalence
and degree of erosive esophagitis significantly increased with GEFV grade (p<0.001
for all). No GEFV grade I patients underwent surgery compared to 4.9% for grade II,
20.5% for grade III, and 63.6% for grade IV patients for various indications (p<0.001).
Conclusion:
There was a strong correlation between esophagogastric opening estimated by

endoscopic grading of the GEFV and surgery rate in GERD patients. In particular,
patients with grade IV valves showed the highest rates of erosive esophagitis and
axial hiatal hernia, and frequently underwent surgery either for failing medical
management or disease complications.
-58-
-59-
OP - 39 BURNS MANAGEMENT IN TURKEY, TEN YEARS’ EXPERIENCE
AHMET CINAR YASTI , MURAT KENDIRCI
ANKARA NUMUNE EDUCATION AND RESEARCH HOSPITAL
Background&Aims:
Burns are still devastating sort of trauma worldwide. Most of them are preventable,
however, if occurred; have a painstaking management period followed up with
some uneventful consequences. In this study, we aimed to analyze our patient
charts retrospectively to share our experiences in burns management.
Methods:
This retrospective study included 3141 patients hospitalized at our hospital’s burns
treatment center between April 1st, 2001 and December 31st, 2011.
Results:
The mean age of the group was 26 years-old and 66.3% was male. Of the patients,
73,5% were in the range of 0-39 years old and the most affected was the 15-39
years-old group (37,3%). Overall mortality rate was 8.6%. Despite a clear increase
at the number of hospitalized patients (191 at 2001 and 523 at 2011) and number
of operations in years regarding increase in the number of patient beds and well
settled transfer criterion countrywide, mortality is decreased and was 5,4% at the
last year (p<0,0001). Hot liquids was the most burning agent in the group (47.7%),
hot water was the cause in 31.8%. however, non-liquid burns lead to 14.7% mortality
rate (p<0,0001).
Conclusion:
Burn is a well known devastating trauma. Mortality rates can be lowered by better
understanding of the burn pathophysiology, and application of surgical procedures
and wound coverage techniques properly and precisely were required.
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OP - 40 ETOH INTOXICATION IS ASSOCIATED WITH LOWER
INCIDENCE OF ADMISSION COAGULOPATHY AFTER STBI – A
PROSPECTIVE STUDY
EMRE SIVRIKOZ , EFSTATHIOS KARAMANOS , PEEP TALVING , KENJI INABA ,
DEMETRIOS DEMETRIADES
LOS ANGELES COUNTY + UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL

CENTER, LOS ANGELES, CALIFORNIA, USA
Background&Aims:
Coagulopathy after severe Traumatic Brain Injury (sTBI) is a common incident that
results in a 10-fold increased risk of death. The aim of this study was to investigate
the effect of ETOH intoxication on admission coagulopathy after sTBI.
Methods:
Patients with sTBI [GCS < 9 or evidence of intracranial pathology on CT] from 1/2010
to 12/2011were prospectively enrolled. Demographics, clinical characteristics,
laboratory values, head CT scan findings, physical examination, injury severity
indices and interventions were recorded. ETOH blood levels were obtained. The
incidence of admission coagulopathy was compared between patients who were
ETOH positive [ETOH (+)] and ETOH negative [ETOH (−)]. Logistic regression was
performed to identify independent risk factors.
Results:
A total of 216 patients were enrolled. 20.4% were ETOH+ and 79.6% were ETOH-.
Admission coagulopathy was significantly lower for ETOH+ patients (15.9% vs 39.0%,
adjusted-p=0.020). PT and INR on admission were significantly lower for ETOH+
(16.7 vs 14.3, adjusted-p=0.016 and 1.35 vs 1.13, adjusted-p=0.040 respectively).
Multivariate regression analysis identified ISS ≥ 25, hypotension and loss of grey
white differential as independent risk factors for development of admission
coagulopathy, and ETOH intoxication was the only protective independent predictor
from admission coagulopathy [AOR (95%CI): 0.32(0.12, 0.84), adj-p=0.021].
Conclusion:
ETOH intoxication is associated with lower incidence of admission coagulopathy in

patients with sTBI. Further research is warranted.
-61-
OP - 41 IMPLIMENTATION OF A NEW CLASSIFICATION SYSTEM FOR
COMBINED PANCREATICODUODENAL INJURIES
OZGUR ALBUZ , KENJI INABA , OBI OKOYE , EFSTATHIOS KARAMANOS , DIMITRA
SKIADA , DEMETRIOS DEMETRIADES
UNIVERSITY OF SOUTHERN CALIFORNIA
Background&Aims:
Successful treatment of complex pancreatic injury depends largely on the initial

assessment. Careful operative assessment to determine the extent of gland damage
and surrounding organs including the duodenum and duct is needed for operative
planning .
Methods:
All patients from 2002 to 2012 with a pancreatic and a concomitant duodenal
injury were retrospectively reviewed. A new scoring system [University of Southern
California Classification System(USC-CS)] was calculated combining both pancreatic
and duodenal injuries based on the AAST classification systems(AAST-CS).Predictive
models for mortality and development of complications were deployed for AAST-CS
and USC-CS.The AUC and R2 were calculated for each model.
Results:
42 patients were analyzed. Patients with a severe injury according to USC-CS (grade
IV and V) had a significantly higher mortality (45.0% vs 9.1%, p=0.008). USC-CS was
more predictive of mortality when compared to AAST-CS [AUC (95% CI), R2: 0.84
(0.70,0.98), 0.380 vs 0.74 (0.56,0.92), 0.249] and the development of complications
[0.80 (0.66,0.93), 0.352 vs 0.77 (0.64,0.92), 0.328].
Conclusion:
In combined injuries of pancreas and duodenum, the USC-CS, which integrates the
extent of injury to both organs had a better predictive ability for complications and
mortality than the previously established systems evaluating the extent of injury to
each organ separately.
-62-
OP - 42 PREDICTORS OF OUTCOME IN SURGICAL ICU PATIENTS
SANA NASIM
THE AGA KHAN UNIVERSITY HOSPITAL
Background&Aims:
Our purpose is to assess the morbidity and mortality of the surgical ICU patients
and identify predictors and parameters that affect their outcome (i.e.mortality).
Evaluate the predictive ability of APACHE II score for prognostication in our patient
population.
Methods:
All adult patients admitted in surgical ICU (General Surgery).Retrospective review

of files from January 2009 to Dec 2011. Data was entered and analyzed on SPSS 19.
Results:
A total of 157 patients were reviewed.74% of the study population were male (n=
116) and 26% (n=41) were female. The most common mode of admission was
through emergency (57%, n=91).30% (n=47.26% (n=40) of them were trauma cases,
out of them 18% were penetrating and rest were blunt (8%, n=13). 91(57%) of them
underwent emergency surgery. Mean hospital course of 15 +/- 10 days. Overall
morbidity was 63%. Surgical morbidity was seen in 20% of the patients, while non-
surgical morbidity was observed in 54% of our patient population. Acinetobacter
17% (n=27) was the most common nosocomial infection.Our in-hospital mortality
was 43% (n=68) with a ICU mortality of 35% (n=55).Mean APACHE score of the
patients in ICU was 23.Multi-variate analysis showed Male gender, APACHE score,
presence of sepsis and Acute renal failure as an independent predictor of mortality
in surgical ICU patients.
Conclusion:
Mortality is significantly higher as compared to an international institution, with

a slightly higher morbidity rates. Few significant, independent risk factors of
poor outcome were identified. An attempt to provide objective probability and
prognostic score estimates for critically ill hospitalized patients treated in ICUs.
Prospective Studies in larger, more heterogeneous ICU patient populations are
needed to confirm our observation.
-63-
OP - 43 SHORT TERM OUTCOMES OF SINGLE PORT VERSUS
CONVENTIONAL LAPAROSCOPIC APPENDECTOMY: A PROSPECTIVE
RANDOMISED TRIAL
AHMET CEM DURAL , CEVHER AKARSU , HAKAN YIRGIN , MAHMUT DOGAN ,
MUSTAFA U. KALAYCI , ALI KOCATAS , OSMAN KONES , HALIL ALIS
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL, GENERAL

SURGERY DEPARTMENT, ISTANBUL
Background&Aims:
The aim of this study was to compare short term outcomes of two laparoscopic
techniques for non-complicated acute appendicitis.
Methods:
From March to May 2012, patients were randomised in single port (SP,n=13) and
conventional laparoscopy (CL,n=30) group. Gangrene, perforation and need for
drainage were exclusion criterias. Fast-track recovery and post-operative analgesics
were standardized. Quality of life (QoL) and pain were primary outcomes. Post-
operative pain was evaluated by the visual analog scale score. The cost analysis,
operative time and length of hospital stay were secondary outcome measures. At
the end of their first month of recovery, patients were assessed by Short-Form (SF)
36 test.
Results:
Pain scores in 4th hour was higher in CL group (p=0.04). Although, the change in
post-operative pain score over eight hours was better in CL group (p=0.14). The
operation time and length of hospital stay were not significantly different between
two groups (p=0.74 and p=0.66). The cost of the equipment required for SP was
higher than CL (p=0.008). QoL of first post operative month was also better in CL
group (p=0.78).
Conclusion:
Despite its better cosmetic results; inadequate pain recovery, high cost and lower
perioperative QoL are disadvantages of single port laparoscopy.
-64-
OP - 44 THE PROTECTIVE EFFECTS OF SILDENAFIL IN ACUTE LUNG
INJURY IN A RAT MODEL OF SEVERE SCALD BURN: A BIOCHEMICAL
AND HISTOPATHOLOGICAL STUDY
ALI KAGAN GOKAKIN 1, KOKSAL DEVECI 2, ATILLA KURT 1, BORAN CIHAT KARAKUS 1,
CEVDET DUGER 3, MEHMET TUZCU 4, OMER TOPCU 1
1
CUMHURIYET UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, SIVAS/TURKEY
2
CUMHURIYET UNIVERSITY SCHOOLS OF MEDICINE, DEPARTMENT OF
BIOCHEMISTRY/TURKEY
3
ANESTHESIOLOGY, SIVAS/TURKEY
4
CUMHURIYET UNIVERSITY FACULTIES OF VETERINARY, DEPARTMENT OF
PATHOLOGY, SIVAS/TURKEY
Background&Aims:
Severe burn induces biochemical mediators such as reactive oxygen species

that leads to lipid peroxidation which may have a key role in formation of acute
lung injury (ALI). Sildenafil is a selective and potent inhibitor of cyclic guanosine
monophosphate specific phosphodiesterase-5. Sildenafil preserves alveolar growth,
angiogenesis, reduces inflammation and airway reactivity. The purpose of the
present study was to evaluate the effects of different dosages of sildenafil in ALI due
to severe scald burn injury in rats.
Methods:
Twenty-four rats were subjected to 30% total body surface area severe scald injury
and were randomly divided into three equal groups as follow: Control, 10 and 20
mg/kg sildenafil groups. Levels of malondialdehyde (MDA), activities of glutathione
peroxidase (Gpx), catalase (Cat), total oxidative stress (TOS), and total antioxidative
capacity (TAC) were measured in both tissues and serums. Oxidative stress index
(OSI) was calculated. A semi-quantitative scoring system was used for the evaluation
of histopatological findings.
Results:
Sildenafil increased Gpx, Cat, TAC and decreased MDA, TOS and OSI. Sildenafil
decreased inflammation scores in lungs
Conclusion:
Our results reveal that sildenafil is protective against scald burn related ALI by
decreasing oxidative stress and inflammation and the dosage of 10 mg/kg could be
apparently better than 20 mg/kg.
-65-
OP - 45 A RANDOMIZED CLINICAL TRIAL OF 187 PATIENTS WITH
PURULENT PERITONITIS CONDUCTED INTRAOPERATIVE AND
PERMANENT, POSTOPERATIVE PERITONEAL LAVAGE WITH
LIDOCAINE AND ANTIBIOTIC
YOVTCHEV YOVCHO 1, MINKOV GEORGI 1, PETROV ALEN 1, NIKOLOV STOYAN 1,
VLAYKOVA TATYANA 2
1
UNIVERSITY HOSPITAL STARA ZAGORA/ DEPARTMENT OF SURGERY
2
UNIVERSITY HOSPITAL STARA ZAGORA/ DEPARTMENT OF CHEMISTRY AND
BIOCHEMISTRY
Background&Aims:
The aim is to determine the efficiency of the intraperitoneal, closed lavage with
lidocaine and aminoglycoside antibiotics in patients with severe purulent peritonitis.
Methods:
There were analized 187 patients with purulent peritonitis for the period of 15
years ( 1995 – 2010 ) – 89/187 ( 38, 7 ) with total and 98/187 ( 52, 4 ) with diffuse
peritonitis. In all (187/187) was performed peritoneal lavage during the surgical
intervention. Postoperative, permanent, closed lavage was performed in 98/187 of
the patients. In the other 89/187 treatment was according to established standards.
Results:
Significant correlation was found between morbidity, mortality: and the amount of
fluid, used for intraperitoneal lavage – (ANOVA test – p<0. 0001), and the consistent
application of Lidocaine and Gentamycin in postoperative closed peritoneal lavage
in 98 patients – (chi2-test - р= 0.0066), and systemic antibiotical application (Fisher’s
exact test - р= 0.0093) as well as the need for relaparotomy – (chi 2-test - р= 0.0029).
Established early mortality in the study reached 2, 67 % ( 15 / 187 patients).
Conclusion:
Used closed postoperative permanent lavage with Lidocaine and Aminoglycoside

antibiotics in patients with purulent peritonitis was associated with high therapeutic
posibilities and significant reduction of postoperative surgical complications.
Although over the years is believed to be „method of despair” it proved that can
be effectively used in the complex treatment of these patients because of the
significant correlation with clinical outcome and one – year survival.
-66-
OP - 46 ANALYSIS OFPEDIATRIC TRAUMA SCORE INPATIENTS
WOUNDED WITH SHRAPNEL EFFECT OF EXPLOSIVES WITH HIGH
KINETIC ENERGY:RESULTS OF THE FIRST INTERVENTION CENTER.
HÜSEYİN TAŞ 1, AYHAN MESCİ 2, SUZİ DEMİRBAĞ 3, MEHMET ERYILMAZ 4, TANER
YİĞİT 2, YUSUF PEKER 2
1
DEPARTMENT OF GENERAL SURGERY, ŞIRNAK MILITARY HOSPITAL, ŞIRNAK,
TURKEY
2
DEPARTMENTS OF GENERAL SURGERY, GÜLHANE MILITARY MEDICAL ACADEMY,
ANKARA, TURKEY
3
DEPARTMENTS OF PEDIATRIK SURGERY, GÜLHANE MILITARY MEDICAL ACADEMY,
ANKARA, TURKEY
4
DEPARTMENTS OF EMERGENCY SURGERY, GÜLHANE MILITARY MEDICAL
ACADEMY, ANKARA, TURKEY
Background&Aims:
In this study,we aimed to assess pediatric trauma score analysis in pediatric trauma
cases due to shrapnel effect of explosives material with high kinetic energy using
epidemiological and clinical data obtained from our hospital as a first intervention
center.
Methods:
The data of 17pediatric injuries caused by shrapnel effect of explosives material.

The information about age,gender,trauma-hospital interval,trauma mechanism,the
injured organs,pediatric Glasgow coma score(PGCS),pediatric trauma
score(PTS),hemodynamic parameters,blood transfusion,interventions and length
of hospital stay(LHS) were investigated.
Results:
Transportation time was≤1hour in35%of cases,while>1hour in65%.WhilePTS

was found as≤8 in35.3% of cases(n=6), score was found higher than8 in64.7% of
them(n:11).Median heart rate in patients with PTS≤8 was94/min. This value was
70/min in those of PTS>8(p=0.007).Morbidity rates of PTS≤8 cases andPTS>8 cases
were 29.4%, and5.9%, respectively(p=0.026). While LHS was 22.8days in PTS≤8
cases,LHS was found only 4days inPTS>8cases.This difference was found to be
statistically significant(p=0.001).
Conclusion:
PTS is very efficient and time-saving procedure to assess the severity of trauma
caused shrapnel effect of explosives with high kinetic energy.The median heart
rate,morbidity,and HKS increase significantly in patients with PTS≤8.
-67-
OP - 47 DIGITAL ARTERY ASSESSMENT TO PREDICT NON-HEALING
OF TOE AMPUTATION SITES
MATTHEW JOE GRIMA , KEVIN CASSAR
MATER DEI HOSPITAL, MALTA
Background&Aims:
Toe(s) amputations have a healing failure rate of 30% - 45%. No toe blood pressure
threshold that guarantees healing or a toe blood pressure below which healing
failure occurs has been identified. The aim of this study was to determine whether
preoperative assessment of digital arterial flow to the toes of the foot undergoing
amputation can predict non-healing.
Methods:
Preoperatively patients having toe amputations by one vascular team in Malta

underwent spectral waveforms analysis, absolute toe pressures and toe-brachial
pressure indices as well as ankle brachial pressure indices. At one month post
operatively, the patients were examined to assess whether the amputation site was
healed, healing or developing complications.
Results:
From January 2012 till March 2012, 24 consecutive patients were recruited; 19 of
these patients had a complete follow up. The amputation sites of patients with a
recordable toe pressure in this cohort healed or were healing at one month after
amputation. Patients who did not achieve healing had either incompressible distal
arteries or no detectable flow.
Conclusion:
Patients with recordable toe pressures are unlikely to develop complications after
toe amputation. Unrecordable toe pressures due to incompressible digital arteries
or undetectable flow in the toes is highly predictive of non-healing amputation
sites.
-68-
OP - 48 INFLAMMATORY MARKERS IN ACUTE APPENDICITIS
MARK PEACOCK , TIRAMULARAJU RAJU
GOOD HOPE HOSPITAL, HEART OF ENGLAND NHS TRUST
Background&Aims:
The role of inflammatory markers in the diagnosis of acute appendicitis still remains
contentious. The aim of this study was to investigate the correlation between white
cell count (WCC) and C-reactive protein (CRP) in the diagnosis of acute appendicitis
in two age groups.
Methods:
Patients who underwent an emergency appendicectomy over a one-year period

were identified. Data was divided into Group A (n=49) ages between 5-18 and
Group B (n-148), 19-90 years of age. The threshold for WCC and CRP was >11x1011
and > 4mg/L respectively.
Results:
In group A, the median CRP (39mg/ml) and WCC (14x1011) were higher in the
positive appendicitis compared with negative appendicitis. When used alone CRP
and WCC were found to have a sensitivity of 78.9%. Specificity of WCC alone or
in combination with CRP was 100%. In group B the median CRP (48.5mg/l) and
WCC (13.85x1011) was higher in the positive appendicitis compared with negative
appendicitis. When used alone, CRP had the highest sensitivity (84.2%) followed by
WCC (72.8%).
Conclusion:
WCC and CRP have limited use in the 19-90 year group. In the older age group, clinical
acumen and suspicion play a greater role in the diagnosis of acute appendicitis.
-69-
OP - 49 INFLUENCE OF ANATOMICAL AND PATHOLOGICAL ASPECTS
AS WELL AS THE CEAP CLASSIFICATION ON VENOUS DISEASE
TREATMENT CHOICE - CLASSICAL VS. LESS INVASIVE SURGICAL
METHODS
ANEL OKIC , IBRAHIM CERO , HASIB MUJIC , HARUN SESTIC , ANHEL KOLUH
CANTONAL HOSPITAL ZENICA, BOSNIA AND HERZEGOVINA
Background&Aims:
To present the most interesant part of anatomy of venous system and ethiology of
venous disease as well as the most common cause of venous pathology, and the
best method for their classification. Point out the advantages and disadvantages of
less invasive treatments compared to standard surgical treatment of vein disease.
Anatomical advantages and pathological aspects in the treatment of venous
diseases and CEAP classification influence on the choice of treatment.
Methods:
We followed 40 patients diagnosed with primary varicose veins of lower extremities

and failure of sapheno-femoraln mouth. 23 patients were treated with conventional
“stripping” method and 17 patients with ultrasonography guided foam sclerotherapy
treatment. Patients were divided according to age and sex structure of the patient.
Applied Parameters used are: duration of procedure, preoperative preparation,
postoperative recovery, quality of life, recidives. we also made an assessment and
cost-effectiveness and cost of the treatment, and acceptability for the patient.
Results:
Results showed that the new, less invasive methods significantly better for patients
in all measured parameters. Patients were also more satisfied and new patient
made eaisier decided to change conventional surgical treatment of veins for the
new one.
Conclusion:
Foam sclerotherapy is a treatment of choice in the future for venous diseases.

Economical is more acceptable, less preparation for treatment and recovery as well,
and complications and recurrences are reduced to a minimum.
-70-
OP - 50 INITIAL EXPERIENCE WITH THE JETSTREAM™ PATHWAY
DEVICE FOR FEMORO-POPLITEAL DISEASE.
IMRAN JAVED
ARIZONA HEART INSTITUTE
Background&Aims:
To report safety and efficacy of Jetstream™ Pathway rotational atherectomy/

thrombectomy device for the treatment of femoro-popliteal arterial lesions with
special emphasis on rate of re-intervention and intervention free period.
Methods:
Duration of study is from Mar 2008 to Nov 2009 (21Months). Total numbers of
patients is 86. Males are 55(64%) & Females are 31(36%). Age range is 36 to 87
Years. All patients underwent Pathway Atherectomy during this time period
regardless of their previous status were included. Re intervention in the same limb
after atherectomy was endpoint of the study.
Results:
TLR (Target Lesion Revascularization) was 15% in patients during follow up period.
Re intervention was more common in first 3 months after first intervention. It was
more common in TASC II type B lesions and mostly managed by Balloon Angioplasty.
Conclusion:
The JetStream™ Pathway device with thrombectomy and aspiration capabilities has
added advantages to femoro-popliteal atherectomy. Adjunctive stenting remains
very low in this difficult segment. Long term follow up will definitely be needed for
durability and patency.
-71-
-72-
-73-
OP - 51 SINGLE-INCISION LAPAROSCOPIC ADRENALECTOMY
YALIN İŞCAN , SERHAT MERİÇ , BURÇİN BATMAN , İSMAİL CEM SORMAZ , FATİH
TUNCA , YASEMİN GİLES ŞENYÜREK , SERDAR TEZELMAN , TARIK TERZİOĞLU
ISTANBUL FACULTY OF MEDICINE DEPARTMENT OF GENERAL SURGERY
Background&Aims:
The aim of this study was to compare outcomes of conventional transabdominal

laparoscopic adrenalectomy and single-incision laparoscopic adrenalectomy (SILA) .
Methods:
Between January 2006 and March 2012, 156 patients underwent laparoscopic
adrenalectomy. Of these, 108 (69%) underwent conventional transabdominal
laparoscopic adrenalectomy (group 1) and 48 (31%) underwent SILA (group 2). Age,
sex ratio, tumor size, operating time, blood loss, postoperative visual analog pain
scale (VAS) scores, and duration of hospitalization were compared between the two
groups.
Results:
The mean ages of the patients in groups 1 and 2 were 44.5 ± 12.7 and 43.5 ±
11.3 years, respectively (P = 0.28). The female:male ratios in groups 1 and 2 were
2.85:1 and 5.85:1, respectively (P < 0.0001). The mean tumor size was significantly
larger in group 1 than in group 2 (4.64 ± 1.5 vs. 3.36 ± 0.9 cm, P < 0.001). No
significant difference was found between group 1 and group 2 with respect to the
mean operating time (61.2 ± 25.4 vs. 59.02 ± 15.1 min, P = 0.054) or the level of
intraoperative blood loss (31.5 ± 24.2 vs. 38.3 ± 50.2 ml, P = 0.26). VAS score was
significantly lower in group 2 than in group 1 (1.83 ± 0.6 and 3.38 ± 0.95, P < 0.001).
there was no differance in the length of hospital stay in group 1 and in group 2 (3.65
± 1.7 and 3.44 ± 2.96 days, P = 0.325).
Conclusion:
The findings of the present study suggest that SILA is as safe as conventional
transabdominal laparoscopic adrenalectomy. Furthermore, SILA is associated with
less pain and better cosmesis than the conventional laparoscopic procedure.
-74-
OP - 52 SURGERY OF THE THYROID NODULES; SUSPICIOUS LESIONS
SHOULD BE FOCUSED ON RATHER THAN LARGE OR DOMINANT
NODULE
HUSEYIN UZUN , KEMAL EYVAZ , MEHMET ESER , SALIM BALIN , YILDIRAY TUNCER,
MUSTAFA ONCEL
KARTAL EGITIM VE ARASTIRMA HASTANESI GENEL CERRAHI KLINIGI
Background&Aims:
Malignity suspicion is the major cause of surgery for treatment of thyroid gland
diseases. We would like to present pathology results of patients that we detect
thyroid disease and operate with suspect of malignancy to take attention the
possibility of malignancy of the smaller nodules.
Methods:
We retrospectively analyzed 550 patients pathology results years between 2007-

2011. We divide three groups. Nodule size smaller than 1 cm (group 1), 1-2 cm
(group2), larger than 2 cm ( group 3). The relationship between nodule size and
malignancy evaluated with Chi-Square test.
Results:
175 of patients had diffuse goitre, 270 of them had multinodular goitre and 105 of
them nodular goitre. There were 100 paitents in group 1, 120 in groups 2 and 155 in
group 3. We detected malignancy 20 patients in group 1, 7 patients in group 2 and
13 patients in group 3. Malignancy detected 8 of the patient with the non dominant
nodule. The number of malignancy in group 1 is statisticaly significant than other
groups.
Conclusion:
Indication for surgery to thyroid nodules should be determined with physical

examination, objective criterias detected with ultrasonography, other imaging
methods and fine needle aspiration biopsy rather than size of nodules.
-75-
OP - 53 THE IMPACT OF NODAL METASTASIS ON CLINICAL
OUTCOME OF PAPILLARY THYROID CARCINOMA
KAZIM CAGLAR OZCELIK , SEVIM TURANLI , NIYAZI KARAMAN

GENERAL SURGERY
Background&Aims:
To observe the clinical course of papillary thyroid carcinoma in patients with lymph
node metastasis at the time of diagnosis.
Methods:
Seventy-five patients treated with lymph node dissection in between 1994-2007

and followed for a median of 74 months (range; 9-278 months) were evaluated.
Results:
Majority of the patients were female (F/M=1.9) and 68% of them were younger than
45 years old. The distribution of histopathologic diagnosis was as follows; 82.7%
classical type papillary carcinoma, 14.7% follicular variant papillary carcinoma and
2.7% microcarcinoma. The tumor stage from T1 to T4 was 28.8%, 16.4%, 42.5% and
12.3%, respectively. Distant metastasis was also present at the time of diagnosis
in 12 patients (16%), (lung metastasis in 11 patients, lung and brain metastasis in
one patient). All patients were given postoperative radioactive iodine ablation and
thyroid hormone suppression thearpy. The median disease free survival was 62
months (range; 4-278 months ). Local recurrence was seen in 18.7% of the patients
within the median follow-up of 30 mounts (range; 4-75 mounts) and lymph node
dissection was completed. At the end of the study period, 6 patients were died from
disease progression and distant metastasis was present in three of them.
Conclusion:
The lymph node metastasis was found to increase the local recurrence and decrease
survival within74 months of follow-up.
-76-
OP - 54 THE RELATIONSHIP BETWEEN PARATHYROID HORMONE
LEVELS DURING THE PHASE OF HEMITHYROIDECTOMY OF TOTAL
THROIDECTOMY AND POSTOPERATIVE HYPOPARATHROIDISM AND
HYPOCALCEMIA
FATIH KUL , PINAR SARKUT , TURKAY KIRDAK , NUSRET KORUN
ULUDAG UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT
Background&Aims:
The aim of this study is to investigate the relationship between PTH levels measured
at the phase of hemithyroidectomy of total thyroidectomy and postoperative
hypoparathyroidism and hypocalcemia.
Methods:
94 consecutive patients operated for benign nodular thyroid disease were

included in the study. PTH levels just before the incision (PTH1), immediately
after hemithyroidectomy (PTH2), 10 minutes after total thyroidectomy (PTH3), at
postoperative 24th hours (PTH4) and in the postoperative 6th month (PTH6), Ca+2
levels at postoperative 6th, 24th hours and 6th month were measured. The patients
are also divided into two groups depending on decreasing value of PTH levels at
hemithyroidectomy as Group I (decreasing group), group II (not decreasing group).
Group I is also divided into two groups as group Ia (PTH3>12pg/ml) and group Ib (
PTH3<12 pg/ml).
Results:
The incidence of hypocalcemia in Group Ia, Ib and II respectively were 48%, 95%,
and 55%. The rate of hypocalcemia in group Ib was statistically more significiant
than all other groups (p<0,05). Hypocalcemia risk was found as increased 3.6 times
in patients with the reduction more than 31% in PTH2 values(p = 0,009).
Conclusion:
31% decrease in PTH value at the phase of hemithyroidectomy of total thyroidectomy

can be alarming point for postoperative hypocalcemia.
-77-
OP - 55 THYROID AND THYMIC EXERESIS IN THE SURGICAL
MANAGEMENT OF PRIMARY AND RENAL HYPERPARATHYROIDISM
MIHAI RADU DIACONESCU
SPITALUL UNIVERSITY, ROMANIA
Background&Aims:
Owing to the close anatomical and embriological connexions between the thyroid,
parathyroids and the thymus, manifold coexisting pathology can be identified
during the surgery of primary or renal hyperparathyroidism (Hp).
Methods:
In this retrospective study we investigated the incidence, pathology and

management of thyroid and thymic synchronous lesions in a series of 82 patients
with Hp operated on in the last three decades. Demography, clinical records,
biochemical data, imaging procedures, pathology records and surgical procedures
were revised.
Results:
Between 1983-2012, 82 cases of Hp [20 primary and 62 renal, 57 females and 25

males of 15-72 (mean 46,5) years] underwent surgery in our unit.Concomitant thyroid
exeresis were done in 32 patients (2 subtotal thyroidectomies,12 lobectomies, 8
atypical resections and 10 diagnosis biopsies, for uni or bilateral (multi)nodular
goiter. Histology showed 11 coloid goiters, 5 nodular hyperplasias, 3 follicular
adenomas, 6 thyroiditis, 3 papillary microcarcinomas and 4 normal specimens.
Excision of the fibrofatty retromanubrial tissue in total parathyroidectomy in renal
Hp (19 cases) revealed one nonmyastenic thymoma, one thymic cyst and thymic
rests in 6 patients. Morbidity in these extended operations was no significantly
increased comparing to the parathyroid exploration alone.
Conclusion:
Meticulous pre and intraoperative evaluation in all the cases of Hp enables the
actually shift from the bilaterally neck exploration to the minimally invasive surgery
rising however the potential risk of missing thyroid and thymic significant lesions.
Anyway the surgeon dedicated to this pathology must be aware of the possibility
of encountering such synchronous associations and make generous indications of
their complete cure in a single operation.
-78-
OP - 56 ULTRASONOGRAPHY CRITERIES IN PREDICTING
MALIGNANCY IN PATIENTS WITH THYROID NODULES
ERKAN ÖZTÜRK 1, ILGAR İSMAİLOV 1, MURAT URKAN 1, RAMAZAN YILDIZ 1, ÖZDEŞ
EMER 2, SEMİH GÖRGÜLÜ 1, ZAFER KILBAŞ 1, YUSUF PEKER 1
1
DEPARTMENT OF GENERAL SURGERY, GÜLHANE MILITARY MEDICAL ACADEMY,
ANKARA, TURKEY
2
DEPARTMENT OF NUCLEAR MEDICINE , GÜLHANE MILITARY MEDICAL ACADEMY,
ANKARA, TURKEY
Background&Aims:
The occurrence of nodular thyroid is frequently,but malignancies of thyroid gland

are rare(1% of all malignancies). The main objective is the determination of
malignancy and prevention of unnecessary surgery. The aims of this study are the
evaluation ultrasonografic and intraoperative criteria of malignancy in patients with
thyroid noduls and define the criteria for FNA and surgery.
Methods:
The study were carried on between 10/2010 and 03/2012. We have been recorded
the data with a specially prepeared forms( ultrasound finding,demographic data…).
These data were compared on the basis of determining malignant or benign nodules
calculated sensitivity, spesitivity and predictiv ratio of criteria.
Results:
73 patients and 147 nodules were evaluated.20 of them malign,127 of them benign.
In 75 nodules were used FNA: 8 of them malign,37 nodules benign,20 nodules
suspicious.10 nodules are nondiagnostic. There were the statistical correlation;
edge characters’ of the nodule, nodule’s calcifications and nodule’s proximity to
the capsule between the malignancy.The other statistical significant finding was
cractheristic of nodules that calls ‘’Taller than wide’’.
Conclusion:
Especially edge characters’ of the nodule, proximity to the capsule, microcalcifications

and taller then wide feature was significant for malignancy. These criteria will be
important for decision for surgical evaluation and during monitoring of thyroid
nodules.
-79-
OP - 57 WELL-DIFFERENTIATED THYROID CARCINOMA WITH
COEXISTENT HASHIMOTO’S THYROIDITIS: LESS OR MORE
AGGRESSIVE?
ELA EKMEKÇIGIL 1, ÖZER MAKAY 1, GÜLRUH EMIROĞLU 2, YEŞIM ERTAN 2, GÖKHAN
İÇÖZ 1, MAHIR AKYILDIZ 1, MUSTAFA YILMAZ 1, ENIS YETKIN 1
1
EGE UNIVERSITY HOSPITAL, DEPARTMENT OF GENERAL SURGERY
2
EGE UNIVERSITY HOSPITAL, DEPARTMENT OF PATHOLOGY
Background&Aims:
Previous studies report that Hashimoto’s thyroiditis, (HT) concomitant with well-
differentiated thyroid cancer, is unusual and improves prognosis. We aimed to
determine a relationship between these two entities and to evaluate the correlation
between coexistent HT and clinicopathological parameters.
Methods:
Data were collected from 181 thyroid cancer patients. Differences in clinicopathologic
factors, such as age, gender, size of tumor, invasion, lymph node metastasis,
recurrence, multicentricity and multifocality as well as tumor grading systems were
analyzed in patients with or without HT.
Results:
Of 181 patients with thyroid cancer, 17.7% had coexistent HT. Although it was not
statistically significant, thyroid cancer patients with HT tented to be younger (<45 age,
52% vs. 45%), to have smaller tumour size (1.1cm vs. 1.3cm), lower total radioactive
iodine ablation dose requirement (127 vs. 175mCi). Additionally, patients exhibited
no differences according gender, multicentricity and multifocality, locoregional
invasion, lymph node metastasis and recurrence during the 7.1 year mean follow-
up period. Analysis of deGroot, MACIS, TNM and EORTC grading systems revealed
a higher percentage of earlier stages in patients with HT (p<0.05 for MACIS and
EORTC).
Conclusion:
Well-differantiated thyroid cancer with HT seems to have less aggressive clinical

presentation.
-80-
OP - 58 THE RATE OF INCIDENTAL THYROID CARCINOMA
ADNAN ÖZPEK 1, MUSTAFA ÖZBAĞRIAÇIK 1, MÜJGAN ÇALIŞKAN 1, METİN YÜCEL 1,
MUSTAFA KAYA 1, GÖZDE KIR 2, GÜRHAN BAŞ 1, ORHAN ALİMOĞLU 1
1
DEPARTMENT OF GENERAL SURGERY, ÜMRANİYE EDUCATION AND RESEARCH
HOSPITAL, İSTANBUL, TURKEY.
2
DEPARTMENT OF PATHOLOGY, ÜMRANİYE EDUCATION AND RESEARCH HOSPITAL,
İSTANBUL, TURKEY.
Background&Aims:
In the last decades, treatment plans of thyroid nodules according to the results of
Fine Needle Aspiration Biopsy (FNAB) have been accepted and several algorithms
have been reported. However, FNAB appears to be an insufficient diagnostic factor
regarding the presence of inconclusive FNAB samples and incidental carcinomas.
We aimed to analyse the rate of incidental thyroid carcinoma in operated patients
in our Surgery Clinic.
Methods:
Patients who underwent unilateral or bilateral total thyroidectomy were included

in the study between January 2009 and July 2012. The preoperative FNAB samples
and definitive histopathological results prospectively evaluated.
Results:
Thyroid surgery was performed for 15 malignant and 44 suspicious FNAB samples.
Additionally, 147 patients with benign and 8 patients with inconclusive FNAB
samples were operated due to thyroid nodules ≥4cm., hyperthyroidism and
intrathoracic goitre. Seven patients with Basedow- Graves disease and five patients
requiring completion thyroidectomy underwent surgery without FNAB. The results
of the definitive histopathological examination proved malignancy; in all patients
with malignant (n=15), in 16 with suspicious (36%), in 13 with benign (9%) and in
one patient with inconclusive (13%) FNAB samples. Malignancy was found in 45
(20%) of all patients (n=226).
Conclusion:
The rate of incidental thyroid carcinoma was found to be 9%.
-81-
OP - 59 SURGICAL GRAND ROUNDS AT A UNIVERSITY HOSPITAL.
APPLYING “PUBLICATION PRESENTATION INDEX” TO EVALUATE
OUTCOMES.
MUHAMMAD SHAHRUKH EFFENDI , SYED NABEEL ZAFAR , SYED JOHAR RAZA ,
MUHAMMAD SHAHZAD SHAMIM , MOHAMMAD HAMMAD ATHER
AGA KHAN UNIVERSITY HOSPITAL, KARACHI, PAKISTAN
Background&Aims:
Grand rounds are an important educational activity in all teaching hospitals.

At our institute, grand rounds in the Department of Surgery include an original
research presentation by the residents with a faculty supervisor. The publication
of the research work acts as a measure of its success. In this study we analyzed the
outcome of this activity and reviewed the factors affecting the publication.
Methods:
It is a retrospective review of prospectively maintained data of all presentations

made at the Surgical Grand Rounds, during January 2001 and December 2010. A
Publication-Presentation Index (PPI) was used to evaluate outcomes of SGRs and
differences in PPI in each category was calculated using the chi square test.
Results:
Total of 470 presentations were made. Majority presented retrospective studies

(73%). Majority of the presentations were made by junior residents (year 1-3, 62%).
Following presentation, 279 (59.4%) studies were presented at a national conference,
80 (17%) were presented at an international forum while only 99 (21.1%) studies
were published. Mean presentation to publication time was 34.8 months. Study
design, level of resident, section of surgery, sample size and national/international
presentation were associated with conversion to a publication (all p <0.05). Overall
PPI was 0.32. Randomized controlled trials had the highest PPI (0.67).
Conclusion:
The proportion of SGR presentations converted into publications was found to

be low. The PPI has a potential to be used as a tool to study the association of
presentation to publication.
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OP - 60 THE ANALYSIS OF MALPRACTICE LITIGATION INVOLVING
BILIARY INJURIES FOLLOWING BILE TRACT SURGERY
ARİF KARAKAYA 1, AHMET FERAN AĞAÇHAN 2, HABİB BOSTAN 1, EYÜP KANDEMİR 1,
FEZA EKİZ 3, ÖMER TOPUZ 4, ERGÜN YÜKSEL 2
1
ADLİ TIP KURUMU
2
ERZURUM BÖLGE EĞİTİM VE ARAŞTIRMA HASTANESİ
3
DİYARBAKIR EĞİTİM VE ARAŞTIRMA HASTANESİ
4
KAYSERİ EĞİTİM VE ARAŞTIRMA HASTANESİ
Background&Aims:
The aim of this study is to analyze 21 cases of malpractice litigation involving

laparoscopic and open cholecystectomy and whipple procedure for biliary
injuries and benign strictures . Bile duct injuries still continue to be one of the
most serious and difficult problem to solve in surgical practice. By far iatrogenic
strictures following upper abdominal surgery, especially cholecystectomy are the
most common problem. Success of surgical treatment is due to multidisciplinary
approach and experience. Types of injuries leading to litigation and morbidity from
injures were assessed.
Methods:
Survey of 21 patients with biliary injury and strictures who were studied between
2008 and 2012 in İstanbul Forensic Medicine Institution jury for fault of treatment
investigated retrospectively according to age, gender, risk factors, management
and timing of surgery, presentation, investigation and principles of treatment,
complications,early and long-term outcomes.
Results:
Biliary injuries in all patients who were treated were occurred during laparoscopic
and open cholecystectomy and Whipple procedures. 1 patient was diagnosed
during the operation, 6 patients were diagnosed in the immediate postoperative
period with relaparotomy and 14 patients were diagnosed in late postoperative
period in the hospital. Roux-En-Y hepaticojejunostomy in 6 patients, closure of the
defect with sutures over a T-tube in 5 patients,tube duodenostomy in 2 patients,
ercp guided sphincterotomy and 10 Fr stent in 2 patients, percutaneous drainage
and stent application in 2 patients were performed to repair these injuries. Biliary
complications like bile fistula, biliary injury , bile duct strictures, ductus stenosis or
complete obstruction with clips, retained stones and duodenal perforation were
observed in these patients.
-83-
Conclusion:
Bile duct injuries during hepatobilier surgery continue to be an important clinical

entity. Injury rates have decreased; but have not reached open procedure levels.
Most injuries in our study were diagnosed postoperatively . These injuries are
serious and the earlier the patient’s care is managed by a specialist in complex
biliary surgery, the fewer complications and unsuccessful treatments there will be.
The resulting complications have led to litigation that has caused a huge financial
drain on the health care system. Delayed recognition appears to correlate with
more costly litigation.
-84-
OP - 61 THE INFLUENCE OF LAPAROSCOPIC INSTRUMENT
CALIBRATION ON DEPTH PERCEPTION FOR AN OPTICAL
INTERPRETATION BY A SURGEON: A RANDOMISED CONTROLLED
TRIAL
MOHAMMAD RIAZ 1, MANHON TANG 2, AFSHIN ALIJANI 2
1
CUSCHIERI SKILLS CENTRE
2
NINEWELLS HOSPITAL AND MEDICAL SCHOOL
Background&Aims:
Laparoscopic motor skill performance relies on the interpretation of 2-D visual

image into human cognitive framework, which is 3-D vision dependant. Depth
perception is compromised in this perplexed visual exposition. This study aims to
investigate the impact of laparoscopic instrument scale calibration on the depth
perception through a randomised controlled trail.
Methods:
Twenty medical students were randomised into two groups. Studied instrument
was calibrated with scale markings, 10 mm apart from instrument tip. Predesigned
sheet inside an endotrainer box was marked at several distances and directions (8
clockwise points). The task was repeated at different optical-axis to view (OATV)
angles. Target distance was calculated and the difference was analysed.
Results:
Calibrated group was nearest to the target in all directions and OATV angles. At
15 degrees OATV angle mean target distance was -8.4 ± 2.2 vs 1.9 ± 1 (mm ± sem)
(p <0.001) for control and scale group respectively. Similar variation was noted at
45 degrees i.e., -12 ± 1.7 vs -5.8 ± 0.9 (p<0.01). At 60 degrees; -11.7 ± 1.4 vs -4.4
± 0.8 (p<0.001) and at 90 degrees OATV the distance was -10.9 ± 1.8 vs -4.9 ± 0.8
(p<0.01).
Conclusion:
Instrument calibration significantly improves laparoscopic task performance by

enhancing depth perception.
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OP - 62 CAN WIKIPEDIA REPLACE TRADITIONAL PATIENT
INFORMATION LEAFLETS? COMPARING THE INTERNET TO OFFICIAL
PATIENT INFORMATION RESOURCES IN THYROID CANCER
ALİ QUREİSHİ 1, AMİT SHARMA 2, GEORGE GARAS 1, CHRIS NEOPHYTOU 1
1
2
Background&Aims:
Patients with a diagnosis of thyroid cancer will browse the internet in search of
information. Not all information is reliable and only a small proportion based on
good evidence. Many of the publications available provide inaccurate or confusing
advice, making it hard to know which information to use and which to discard.
Wikipedia is one of the best known and most visited websites. Our study aimed to
evaluate the quality of information available for the top 6 websites in a web search
relating to thyroid cancer and compare these to validated patient information
resources.
Methods:
Information leaflets from cancer research UK were used as the gold standard for
patient information. Searches for ‘thyroid cancer’ were performed using search
engines ‘google’, ‘bing’, ‘yahoo’ and ‘ask’. The top 6 ‘hits’ were selected and assessed
using a validated tool to assess the quality of written information.
Results:
Each website was scored using 16 criteria that assessed all aspects of information
provided and accessibility. The websites were ranked in terms of reliability.
Conclusion:
The internet is an unlimited information resource that patients access. As clinicians

it is useful to be aware of the most commonly accessed sources in order to guide
our patients to those most appropriate.
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-87-
OP - 63 COMPARISON OF HISTOPATHOLOGICAL FINDINGS AND
SURVIVAL OF BILATERAL SYNCHRONOUS, MULTIFOCAL AND
MULTICENTRIC BREAST CARCINOMA
HÜSEYIN KADIOĞLU 1, SERDAR ÖZBAŞ 2, ALPER AKCAN 3, AYKUT SOYDER 4, LUTFI
SOYLU 2, SAVAŞ KOÇAK 1, NUH ZAFER CANTÜRK 5, MAHMUT MÜSLÜMANOĞLU 1
1
BEZMIALEM VAKIF UNIVERSITY
2
GÜVEN HOSPITAL ANKARA
3
ERCIYES UNIVERSITY
4
ADNAN MENDERES UNIVERSITY
5
KOCAELI UNIVERSITY
Background&Aims:
Available data generally indicate that multifocal (MFBC), multicentric (MCBC) and
bilateral synchronous breast cancer (BSBC) is actually more aggressive and have an
equivalent or moderately poorer survival compared with unilateral cases. However,
a comparison between these multiple breast cancers is absent in the literature.
Methods:
The retrospective data of MF, MC and BS breast carcinoma patients, whom were
treated in 5 different breast cancer units in Turkey were collected
Results:
There were 507 patients (271 MF, 147 MC, 89 BS) treated in this time period. BSBC
were younger than other groups (44.8, 47.2 and 51.1years for BSBC, MFBC and
MCBC, respectively). Tumor size was bigger, histological grade was higher and
lymphatic-vascular invasion was more positive in BSBC patients (p<0.001). Analyzes
of molecular subtypes (Luminal-A, Luminal-B and triple negative) showed no
difference between groups (p=0.83). N0 patients were higher in MFBC group. Stage
dependent five year survival and distant recurrence rates were similar between
groups (p=0.996 and 0.263, respectively).
Conclusion:
The clinical significance of MFBC, MCBC and BSBC is still unclear and their influence
on prognosis is controversial. Stage dependent disease-free and overall survival
rates of BSBC are similar with MFBC and MCBC.
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OP - 64 EFFECT OF β-GLUCAN ON AMOUNT OF DRAINAGE
FOLLOWING MODIFIED RADICAL MASTECTOMY
ERDINC YENIDOGAN 1, GOKHAN GIRAY AKGUL 2, MEHMET ALI GULCELIK 2, SOYKAN
DINC 2, MUHAMMET KADRI COLAKOGLU 2, HUSEYIN AYHAN KAYAOGLU 1
1
GAZIOSMANPASA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF
GENERAL SURGERY, TOKAT, TURKEY
2
ANKARA ONCOLOGY TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
GENERAL SURGERY, ANKARA, TURKEY
Background&Aims:
To evaluate the efficacy of oral β–Glucan on daily drainage and drain removal day
in mastectomy patients.
Methods:
One hundred and thirty breast cancer patients were divided into 2 groups
by consecutive randomization (n=65 each). β–Glucan 10 mg capsules were
administered to Group 1 twice a day for 10 days. Group 2 took placebo in same
manner. Age, menarche, menopause, history of lactation, parity, oral contraceptive
use, comorbidities, postoperative daily hemovac drainage volumes and drain
remove days were recorded and compared.
Results:
There were no difference between groups in terms of age, menarche age, menopause
period, lactation period, parity, oral contraceptive use and comorbidities. Group 1
showed significantly low daily drainage volumes between days 2 and 8. Mean drain
removal day was 7.16 ± 1.72 in Group 1 and 8.59 ± 2.27 in Group 2. The difference
was significant (p < 0.001). In addition, β–Glucan significantly shortened drain
remove day in patients who have comorbidities (p = 0.018). The earliest remove
was in patients without comorbidity and who received β–Glucan (p = 0.002).
Conclusion:
β–Glucan decreased drain discharges after mastectomy. The drains were removed
earlier in β–Glucan administered patients resulting in decreased morbidity after
surgery.
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OP - 65 EXCISION MARGINS IN BREAST CONSERVING SURGERY
NOEL CASSAR , JOSEPH DEBONO
MATER DEI HOSPITAL, MSIDA, MALTA
Background&Aims:
The ideal excision margins in breast conserving surgery are still a matter of debate.
Various distances are accepted as adequate, ranging from cancer cells not touching
excision margins (<1mm), between 1 and 5mm, between 5 and 10mm, and more
than 10mm. The aim of this study is to find whether there is any correlation between
different resection margins and rates of recurrence of breast carcinoma.
Methods:
All those patients who underwent breast conserving surgery for cancer in 2009 were
recruited into the study. Their notes were reviewed and their resection margins and
any evidence of recurrence were noted.
Results:
120 patients underwent breast conserving surgery during the study period. 14%
had resection margins of more than 10mm, 11% had resection margins of more
than 5mm, 39% had margins of between 1 and 5mm, whilst 23% had margins of
less than 1mm. 13% had cancer reaching resection margins, and mostly were re-
operated. 5 patients (4%) had recurrence. The recurrences were not significantly
associated with the excision margin distance, but rather with the biological activity
of the cancer, like angiolymphatic invasion, grade and age at presentation.
Conclusion:
As long as the tumour is completely excised, the resection margin distance seems
not be correlated with the recurrence rate. This may reflect improvement in
treatment modalities, such as better chemotherapeutic agents and better adjuvant
regimes.
-90-
OP - 66 FEASIBILITY OF NIPPLE SPARING MASTECTOMY FOR EARLY
BREAST CANCER AND RISK REDUCING SURGERY
HALIL KARA 1, NESLIHAN CABIOGLU 2, DENIZ EREN BÖLER 2, SUKRU YAZAR 3, CIHAN
URAS 1
1
MASLAK ACIBADEM HOSPITAL, DEPARTMENT OF SURGERY
2
ACIBADEM UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF SURGERY
3
ACIBADEM UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PLASTIC AND
RECONSTRUCTIVE SURGERY
Background&Aims:
Nipple sparing mastectomy (NSM) has been shown to be oncologically safe in

patients with early breast cancer and for prophylaxis. In this study, the feasibility
of NSM was investigated by using a pathologically negative nipple areola complex
(NAC) flab.
Methods:
Between February 2011 to August 2012, 34 consecutive patients were prospectively

enrolled; 50 NSMs were performed. Intraoperative frozen section of the NAC base
was routinely performed. The various patient’s, and tumor characteristics, and
patient’s cosmetic satisfaction were registered.
Results:
Sixteen bilateral and 18 unilateral NSMs with permanent implant or expanders

were performed in 34 patients with stage I-II breast cancer; 36 (72 %) for cancer
and 14 (28 %) for prophylaxis. Of 36 cancers, there were 6 DCIS, and 30 invasive
cancer with T1 (n=20) and T2 (n=10) tumors. The mean age was 41(27-56). The
mean body mass index was 23 (19-27). NAC necrosis was observed in three patients
(6 %) that was eventually surgically removed. Wound infection and/or necrosis at
the incision were observed in 4 patients. Cosmetic satisfaction was good/excellent
in 75 % of patients.
Conclusion:
Our early results suggest that NSM seems to be technically feasible with a low risk
for NAC necrosis and with a good cosmetic outcome.
-91-
OP - 67 READABILITY OF PATIENT INFORMATION LEAFLETS FOR
BREAST SURGERY.
MICHAEL PAUL BARRETT , IAIN WILSON , UMESH PARAMPALLI , VERA MARTINS ,
IBRAHIM AHMED
DEPARTMENT OF BREAST SURGERY, MEDWAY MARITIME HOSPITAL, KENT, UNITED

KINGDOM
Background&Aims:
Patient information leaflets (PILs) are used to convey detailed information to

patients. The Department of Health suggest keeping the content simple, with a
maximum reading age of an eleven year old. Tthe national reading age (U.K) is that
of 9 year old. The Simplified Measure of Gobbledygook(SMOG) and Flesch-Kincaid
Reading Ease(FKRE) are validated methods of analysing the reading age of medical
text.
Methods:
We assessed the readability of the www.breastcancercare.org.uk PILs using the

SMOG and FKRE formulae.
Results:
77 PILs identified. 100% of PILs had a SMOG score higher than the recommended
11 year old level. Mean SMOG and FKRE was at the level of an 18 year old. 100% of
PIS required an education level above an 18 year old to read.
Conclusion:
PILs are difficult to read, exceed the recommend readability levels of most adults.
When producing PILs it is important to take this into account, and use simple
language and analyse the complexity of the text using tools such as SMOG and
FKRE. Patients prefer PILs that are written in simple language with a reading age
appropriate for an 11 year old.
-92-
OP - 68 THE EFFECT OF NEOADJUVANT CHEMOTHERAPY ON
HORMONE RECEPTORS AND HER-2 STATUS
ALPER OZTURK 1, ATİLLA BOZDOGAN 1, DERYA SELAMOGLU 1, MAHMUT
MUSLUMANOGLU 2, ABDULLAH İGCİ 2, VAHİT OZMEN 2
1
FLORANCE NİGHTİNGALE HOSPİTAL, DEPARTMENT OF GENERAL SURGERY ,
BREAST HEALT CENTER
2
İSTANBUL UNİVERSİTY,İSTANBUL MEDİCAL FACULTY, DEPARTMANT OF GENERAL
SURGERY, BREAST HEALT UNİT
Background&Aims:
Neoadjuvant chemotherapy is a standart choice for patients with Locally Advenced

Breast Cancer. Hormone receptors and HER-2 status are one of the most important
indications that determine the prognosis of a patient. In this study, our purpose was
to evaluate the effects of ER, PR and HER-2 gene expression on NAC patients.
Methods:
129 of the patients with LABC were treated at the Istanbul Medical Faculty General
Surgery Breast Health Unit between 2000 and 2008. All patients had undergone
tru-cut biopsy before NAC and after surgery applied complete histopathological
evaluation.
Results:
The mean age was 48 years (25 -76), 55% of the patients were pre-menopausal.
80% (n=104) of the patients had histological type invasive ductal carcinoma. 54%
(n = 70) of them were LVI positive. Prior to undergoing chemotherapy, 44% (n=56)
were ER positive, 43% (n= 55) were PR positive, and 30% (n = 31) were HER-2
positive. After undergoing NAC, the ER in 56% (n = 72) of the patients, and PR in
57% (n = 73) of them were negative and showed no differences in values than those
before neoadjuvant treatment. In 22% of the patients with ER and 24% (n = 31)
of the patients with PR, a negative change was observed; in 21% (n = 27) of those
with ER, and 18% (n = 24) of those with PR, a positive change was observed. It was
determined that, subsequent to neoadjuvant treatment, patients who displayed an
increase in ER and PR values were found to have longer overall survival periods that
were statistically significant. (P=0,029)
Conclusion:
To our results, NAC didn’t change hormone receptor status in patients with negative
hormone receptors. Overall survival rate increased in patients with higher hormonal
receptors values after NAC.
-93-
OP - 69 VALUE OF MAGNETIC RESONANCE IN BREAST CANCER
DIAGNOSIS AND ITS INFLUENCE ON SURGICAL TREATMENT
VICTOR TURRADO RODRIGUEZ , ANTONIO MORAL DUARTE , JOSE IGNACIO PEREZ
GARCIA , BEATRIZ ESPINA PEREZ , RAQUEL DOMINGUEZ CARO , OZLEM UYANIK ,
MONTSERRAT CLOS ENRIQUEZ , MANEL TRIAS FOLCH
HOSPITAL DE LA SANTA CREU I SANT PAU
Background&Aims:
The utility of breast MRI resides upon it’s power of detection of sincronous tumours
on the same breast or on the contralateral one, as in it’s ability to define the true
dimensions of the primary tumour. This allows to plan the apropriate surgery and
disminish the number of reinterventions. Our aim is to determine the efectiviness
of the MRI in our center and to analyze how it influences the sugerical strategy,
making the correlation with the pathology findings.
Methods:
We analyzed 214 women with breast carcinoma for whom the MRI was practised
between january 2006 and september 2011; collecting epidemiological, surgical
and pathological data.
Results:
The MRI gave new information in 41% of the cases. 25% of the patients were
obliged to additional explorations, 58% of which were useful. On the 18% of cases
the information given by MRI lead to a change on the treatment.
Conclusion:
The 20% of patients obtain a benefit from the MRI, at the expense of indicating
additional explorations on 25% of the patients, being 58% of them useful. Only on
selected cases has an excessive treatment being performed due to the information
provided by the MRI.
-94-
OP - 70 COMPLIANCE TO BREAST MULTIDISCIPLINARY TEAM
MEETING DECISIONS
VERONICA SAID PULLICINO , JOSEPH DEBONO , JAMES FARRUGIA
MATER DEI HOSPITAL, UNIVERSITY OF MALTA, MALTA
Background&Aims:
Multidisciplinary team meetings (MDT) have been the mainstay of breast cancer
management in Malta for the last 10 years. Evidence has shown improved results
in patients managed in units with an MDT. The aim of this study was to look at
deviations from MDT decisions and identify ways of maximizing compliance.
Methods:
56 patients discussed at the MDT over a 5 week period were studied. The decision
taken at MDT was compared to the management undertaken as derived from the
patient notes. Any deviation from the management plan was analyzed as to type
and reason for change.
Results:
Full compliance occured in 77%. Non-compliance in 9 (69%) out of 13 patients was

patient-driven. Refusal of investigation occurred in 2/ 13 patients ( 15%). Deviation
in planned surgical procedure occurred in 8/13 patients, half of these were patient
driven, another 3 had axillary clearance performed instead of sentinel node biopsy
due to technical problems and one did not have an immediate reconstruction as
planned due to delays in obtaining adequate implant. The remaining 3 patients
refused chemotherapy.
Conclusion:
Significant deviations to MDT decisions are mainly patient driven. Compliance may
be improved by better organization of sentinel lymphnode harvesting and more
patient involvement in decision taking through a named Breast Care Nurse.
-95-
OP - 71 EFFECT OF LOCAL BLEOMYCIN SULFATE APPLICATION ON
SEROMA FORMATION IN A RAT MASTECTOMY AND AXILLARY
LYMPH NODE DISSECTION MODEL
MEHMET ESER , METIN KEMENT , MEHMET GOKCEIMAM , KEMAL EYVAZ , LEVENT
KAPTANOGLU
KARTAL EDUCATION AND RESEARCH HOSPITAL
Background&Aims:
The present study aimed to investigate seroma-reducing effect of local bleomycin

application after mastectomy.
Methods:
Sixteen female Wistar Albino rats were used in this study. The rats were divided
into two equal groups. Under general anesthesia all rats underwent unilateral
mastectomy as definition by Harada. Serum physiologic was applied to animals in
Group 1 (Control group ) and Bleomycin to Group 2 respectively. Mastectomized
localization was explored on the 10th day postoperatively. Seroma and tissue samples
were obtained from axilla and thoracic wall for histopathological examination
Results:
The amount of seroma was significantly lower in the bleomycin group as compared
to the control group (p=0.002). Fibrosis, PNL infiltration and the number of
fibroblasts were significantly higher in the bleomycin group. No difference was
identified between the groups in terms of angiogenesis, edema, congestion, and
monocyte, lymphocyte and macrophage infiltration.
Conclusion:
Local bleomycin sulfate application might be a therapeutic option in patients

with seroma formation, as well as in the patients with malignant pleural effusion.
Nonetheless, further studies that compare the efficacy and adverse effects (benefit-
to-harm ratio) of Bleomycin Sulfate are needed.
-96-
-97-
OP - 72 THE EFFECT OF CRURAL CLOSURE ON QUALITY OF LIFE
AFTER ANTI-REFLUX SURGERY
HUSEYIN AYHAN KAYAOGLU , ERDINC YENIDOGAN , ISMAIL OKAN , MUSTAFA
SAHIN

Background&Aims:
There have been no randomized controlled trials comparing closure with no closure
of the crura during anti-reflux surgery. Individual reports stress the benefits of
posterior crural repair for satisfactory outcomes, but others report no difference in
outcomes. The aim of the study was to investigate the effect of crural closure during
Nissen-Rosetti fundoplication on quality of life after surgery.
Methods:
Between 2006-2008, 28 patients underwent laparoscopic Nissen-Rosetti

fundoplication for gastroesophageal reflux disease. Upper gastrointestinal
endoscopy and 24-h ambulatory pH monitoring was performed in all patients
preoperatively and if necessary postoperatively. Total fundoplication was performed
with no division of the short gastric vessels in all of the patients. Patients were
divided into 2 groups according to crural closure was performed (Group 1) or not
(Group 2). Crural closure was not done in 12 patients whose hiatal opening is not
large and has no hiatal hernia. Patients were requested to complete GERD-HRQL
questionnaire before and 6 months after the surgery.
Results:
Age, sex distribution, the percentage of time spent with pH less than 4.0 (total,
upright, and supine), number of reflux episodes, long reflux episodes greater than
or equal to 5 min, duration of the longest reflux episode, and DeMeester scores
were similar between 2 groups of the patients, preoperatively (p=0.637, p=0.445,
p=0.583, p=0.776, p=0.507, p=0.900, p=0.807, p=0.924 and p=0.607, respectively).
Mean preoperative GERD-HRQL score was 30.50±8.33 and 28.00±7.78 in groups,
respectively (p=0.427). Mean postperative GERD-HRQL score was 4.75±3.90
and 8.50±5.07 in groups, respectively (p=0.036). When GERD-HRQL scores were
compared inside the groups, the improvement was significant in both groups
(p<0.001 for both group).
Conclusion:
GERD-HRQL scores were significantly better in the patients whose crura were
closed. So, crural closure seems an important factor on life quality after anti-reflux
surgery.
-98-
OP - 73 THE EFFECT OF RABEPRAZOLE ON LOWER ESOPHAGEAL
SPHINCTER (LES) TONE IN EXPERIMENTAL RAT MODEL
MUSTAFA DUMAN 1, ERDAL POLAT 1, MAHMUT ÖZER 2, NECDET FATIH YAŞAR 1,
CEBRAIL AKYÜZ 1, KIVANÇ DERYA PEKER 1, ECE GENÇ 2, SINAN YOL 1
1
KARTAL KOSUYOLU TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
GASTROINTESTINAL SURGERY, ISTANBUL, TURKEY
2
YEDITEPE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF PHARMACOLOGY.
ISTANBUL, TURKEY
Background&Aims:
PPI therapy is found to be effective in treating the erosive esophagitis in 80-90%

of patients with GERD, however, despite adequate PPI treatment, GERD symptoms
may remain persistent. It has been reported that PPIs induce relaxation in smooth
muscles of different types of tissues, such as gallbladder and trachea. The current
study was designed to investigate effects of a PPI, rabeprazole on LES pressure in
isolated rat LES preparations.
Methods:
16 rats were grouped as control and treatment groups. After obtaining LES tissues,
contractile response was obtained by application of single dose of carbachol (10-
6 M) in the organ bath. After the contractions reached a plateau, concentration-
response relationships for rabeprazole (final organ bath concentrations of 1.5X10-6
M, 1.5X10-5 M and 4.5X10-5 M, with 15 min allotted between each dose) were
obtained in a cumulative manner in treatment group. Control experiments were
also run with only acidified distilled water.
Results:
In the carbachol contracted LES preparations 1.5X10-6 M and 1.5X10-5 M

rabeprazole caused 6.08 % and 11.34 % relaxations, respectively which were not
significant. However, mean relaxation value for 4.5X10-5 M was 17.34 %, which was
significant.
Conclusion:
High dose of rabeprazole may induce relaxation of the LES.
-99-
OP - 74 THE LAPAROSCOPIC REVISION SURGERY RESULTS
IN PATIENTS WHO HAD PREVIOUS SURGERY FOR
GASTROESOPHAGEAL REFLUX DISEASE
HAYDAR CELASIN 3, KAMIL GULPINAR 2, AHMET TURKCAPAR 1
1
ANKARA UNIVERSITY SCHOOL OF MEDICINE GENERAL SURGERY DEPARTMENT
2
UFUK UNIVERSITY SCHOOL OF MEDICINE GENERAL SURGERY DEPARTMENT
3
ANKARA OZEL KAVAKLIDERE UMUT HOSPITAL GENERAL SURGERY DEPARTMENT
Background&Aims:
To observe the mechanism of recurrent gastroesophageal reflux disease after

laparoscopic antireflux surgery and to report our results in these relapsed patients
in whom we conducted revision laparoscopic surgery.
Methods:
43 patients who had recurrent reflux disease surgery were enrolled in our study.
Surgical technique, recurrence interval, clinical symptoms, and graft usage of
previous surgeries were noted. Furthermore, revision surgery data were collected
and reported for surgical technique, perioperative morbidity and mortality, hospital
stay interval, and follow-up for percentage of recurrence.
Results:
The first surgeries were as follows; nissen fundoplication (79%) and Touppet
fundoplication (21%) with graft (41,9%) and without graft(58.1%). The symptoms
were as follows; chest pain (65, 1%), dysphagia (13, 9%), nausea (9,3%). The time
intervals between initial surgery and revision surgery were found to be 4days to
60 months. Revision surgeries were as follows; revision fundoplication and hernia
repair with graft (n:33), collis gastroplasty (n:2), suture withdrawing from the
cruses(n:2), only revision fundoplication(n:3), revision fundoplication and suturing
of the cruses(n:3). Patients follow-up showed recurrence rate of 6, 9% in 12 months.
Conclusion:
To our results revision surgery seems more difficult, risky and with high morbidity.
But is necessary and can be safely performed by experienced surgeons in specified
clinics.
-100-
OP - 75 THE PROGNOSTIC VALUE OF NEUTROPHIL LYMPHOCYTE
RATIO IN GASTROINTESTINAL STROMAL TUMORS
KORAY ATILA 1, NACIYE CIGDEM ARSLAN 1, TAYFUN BISGIN 1, SEYMEN BORA 1,
HUSEYIN GULAY 1, OZGUL SAGOL 2
1
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PATHOLOGY
Background&Aims:
Neutrophil to lymphocyte ratio (NLR) is one of the inflammatory markers suggested

as a useful predictive factor for various cancers. However data about prognostic
significance of NLR in GIST has not been reported yet. We therefore designed this
retrospective study to investigate the prognostic significance of NLR in GIST patients.
Methods:
Data of 62 patients underwent surgery for GIST between September 2004-April

2012 has been analyzed retrospectively. Regarding to preoperative complete blood
count, absolute neurtophil count/absolute lymphocyte count was recorded as NLR.
Patients were divided into two groups as NLR<3 and NLR>3.
Results:
Origins of the tumors were stomach (33), small bowel (9), rectum (6), duodenum (5),
colon (2), esophagus (1), omentum (1), retroperitoneum (1) and unknown primary
site (1). In an average follow up of 33.8 months, 5-year overall survival rate was
%87.7. Survival was significantlybetter in NLR<3 group than NLR>3 patients (%72.2
vs %92.7, p=0.029). Univariate analysis revealed NLR, mitosis, surgical margins, local
recurrence and involved lymp nodes had statistically significant relationship with
survival. In multivariate analysis only NLR was found as an independent prognostic
factor (p=0.044, HR=4.356).
Conclusion:
Preoperative NLR may be an easy and useful method to predict poor prognosis in
GIST patients.
-101-
OP - 76 THE VALUE OF I-NOS LEVEL OF PERIULCEROSIS MUCOUS
MEMBRANE AT PATIENTS WITH BLEEDING GASTRO-DUODENAL
ULCER
KRYSHEN VALERY , MYKOLA TROFIMOV
Background&Aims:
Treatment of bleeding gastroduodenal ulcer remains is one of the actual problems

of modern public health services.
Methods:
Complex observation of 40 patients with bleeding gastroduodenal ulcer which were

on treatment in the centre of gastroduodenal bleedings of city clinical emergency
hospital was conducted. On the third day all patients as a rule was taken control
endoscopic investigation and stomach mucous membrane biopsy, which followed
specific immunohistochemical investigation with expose of the inducible NO-
synthesis activity (i-NOS).
Results:
At 82,7% of the observed patients the we’ve exposed increasing i-NOS activity of
periulcerosis mucous membrane. The high i-NOS level we’ve exposed in 27,3%
patients but in cases with high degree of hemorrhage, endoscopic unstable
local hemostasis. The bleeding recurrence was observed at 12,5% of patients
with the high i-NOS activity. The heightened i-NOS activity provide to increase
NO concentration in preiulcerosis area, dilatation of capillaries and arterioles,
connected with blood flow enlargement. This changes could result in growing up
the recurrent hemorrhage risk.
Conclusion:
Thus data of the periulcerosis mucous membrane i-NOS at patients with bleeding
gastro-duodenal ulcer indicated vivid clinical parallels and allow to predict ulcer
bleeding improving in such way the proper treatment program which would to
direct to decline of i-NOS of periulcerosis mucous membrane activity.
-102-
OP - 77 CORRELATION BETWEEN TRYPTASE NUMBER AND NUMBER
OF METASTATIC LYMPH NODES IN SURGICAL GASTROINTESTINAL
TUMOURS
MICHELE AMMENDOLA 1, GAETANO GALLO 1, MARIA LUPOSELLA 2, GIUSEPPINA
VESCIO 1, GIUSEPPE SAMMARCO 1, SEVERINO MONTEMURRO 3, ROSARIO SACCO 1,
GIROLAMO RANIERI 4
1
CHAIR OF CLINICAL SURGERY, MAGNA GRAECIA UNIVERSITY, CATANZARO, ITALY
2
CHAIR OF CARDIOVASCULAR DISEASE, MAGNA GRAECIA UNIVERSITY,
CATANZARO, ITALY
3
SURGERY UNIT, NATIONAL CANCER INSTITUTE GIOVANNI PAOLO II, BARI, ITALY
4
INTERVENTIONAL RADIOLOGY UNIT WITH INTEGRATED SECTION OF
TRANSLATIONAL MEDICAL ONCOLOGY, NATIONAL CANCER INSTITUTE GIOVANNI
PAOLO II, BARI, ITALY
Background&Aims:
Tryptase is a serin protease stored in mast cells granules that plays a role in tumour
angiogenesis. Mast cells (MCs) can release tryptase following c-Kit receptor
activation.
Methods:
In this study, immunohistochemistry, image analysis methods and clinical aspects

were used in a series of 41 gastrointestinal cancer patients with stage T3-4N2a-bM0
(by AJCC for CRC 7th Edition) and T3N2-3M0 (by AJCC for Gastric Cancer 7th Edition)
to evaluate the correlations between tryptase number in tumour and the number
of metastatic lymph nodes harvested, and between tryptase number in tumour
and in metastatic lymph nodes. Four μm thick serial sections of formalin-fixed and
paraffin-embedded tumor samples were microwaved at 500 W for 10 min. Sections
were incubated with primary antibodies: monoclonal antibodies anti-C-Kit receptor
(CD117; Dako), and anti-tryptase (clone 10D11; Novo Castra). In serial sections
tryptase in tumour and in metastatic lymph node were counted by means of image
analysis at x40. Metastatic lymph nodes were counted also.
-103-
Results:
Our results demonstrate a positive correlation between tryptase number in tumour

and metastatic lymph nodes. The Pearson test correlating the number of tryptase
in tumour and the number of metastatic lymph nodes harvested was 0.88 (r) and
also the number of tryptase in tumour tissue and in metastatic lymph node was
positively correlated (r=0.86).
Conclusion:
We suggest that tryptase tissue number in gastrointestinal cancer could be a

useful tool for a valid indication of the type of surgical treatment and its radicality.
Furthermore, it might be considered for prognosis of patients after radical surgical
treatment as N in TNM classification of American Joint Committee on Cancer.
-104-
OP - 78 STAGE MIGRATION ACCORDING TO 7TH UICC/
TNM CLASSIFICATION IN GASTRIC CANCER PATIENTS AND
EFFECTIVENESS OF THE NEW CLASSIFICATION
ILTER OZER , ERDAL BIROL BOSTANCI , MURAT CAYCI , MUHAMMET KADRI
COLAKOGLU , TAHSIN DALGIC , YUSUF OZOGUL , SEDA YAMAK , MUSA AKOGLU

Background&Aims:
To Investigate stage migration after the new UICC classification and to evaluate the
effectiveness of the new classification on predicting prognosis after gastric cancer
surgery.
Methods:
Patients who underwent gastrectomy between 1998 and 2011 were restaged
according to the new staging system. We evaluated the stage migration using
Kappa coefficient. In addition, we evaluated the effectiveness of the new system on
predicting survival.
Results:
457 gastric and 134 esophagogastric junction (EGJ) tumors were available for
staging and were restaged. Kappa coefficient was 0,585 (moderately consistent) for
gastric adenocarcinoma, and 0,252 (poorly consistent) for EGJ tumors. There was a
clinically noticeable migration. There was a marked shift towards stage-III. Former
stage-III (6th UICC/TNM) patients who were restaged as stage-II and III (7th UICC/
TNM) had median survival of 84.3 and 16.0 months, respectively. The difference was
significant. Former stage IV (6th UICC/TNM) patients who were restaged as stage
III and IV (7th UICC/TNM) both had median survival of 12 months. The difference
was insignificant.
Conclusion:
With the new classification there is clinically noticeable stage migration. New
classification gives better prognostic information for stage-II patients. However it is
insufficient for patients who were stage IV formerly and were distributed to stage-III
and stage-IV.
-105-
OP - 79 GUT RESTORATION IN CASES OF BENIGN OESOPHAGEAL
STRICTURE USING ISOPERISTALTIC COLONIC GRAFT BASED ON
MIDDLE COLIC ARTERY
YOGESH KUMAR , SHARATH S HONNANI , BASAVARAJ VEERAPUR
KASTURBA MEDICAL COLLEGE, MANGALORE
Background&Aims:
Colon is a better substitute for oesophagus in cases of benign oesophageal

stricture, given its durability and vasculature. Current literature study shows that
isoperistaltic left colonic graft is ideal. Majority of the studies middle-colic artery is
not preserved. Aim is to study the possibility of isoperistaltic colonic graft based on
middle colic artery.
Methods:
Study conducted in Kasturba medical college, Mangalore. Five consecutive cases

of benign oesophageal stricture underwent this procedure from June 2011 to
June 2012. We have mobilised colon from caecum to sigmoid. Ascending colon
transected just above the caecum. Graft was placed behind the stomach in the sub-
sternal plane. All patients had feeding jejunostomy for a month. Patients followed
up to six months.
Results:
In all cases, sufficient length of graft was available without sacrificing the middle
colic artery. Blood supply was well maintained in all cases. One patient developed
cervical anastomosis leak. None required mechanical ventilation. None required
intensive unit care. Average hospital stay was 24.1±10.1 days.
Conclusion:
By mobilising the colon from caecum to sigmoid and taking it retro-gastrically, it is

possible to achieve sufficient length of graft to replace whole length of oesophagus.
By preserving middle-colic artery dual blood supply maintained.
-106-
OP - 80 LAPAROSCOPIC GASTRECTOMY IN SURGICAL TREATMENT
OF GASTRIC CANCER. FIRST UKRAINIAN EXPERIENCE.
SERGEY BAIDO 1, PETER FOMIN 2, ZHIGULIN ANDRIY 1, ALLA VINNITSKAYA 1, ZVI
BERNSTEIN 1, DMITRIY GOLUB 1, MAKSYM SILVESTROV 1, SERGEY PRYNDYUK 1
1
LISSOD CANCER HOSPITAL, KYIV, UKRAINE
2
NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
Background&Aims:
Surgical resection is only curative method for patients with gastric cancer.
Laparascopic radical D2-gastrectomy is not standard procedure for gastric cancer in
most of national and international standards in spite of advantages. At present time,
many studies showed equal oncological results between conventional surgery and
laparoscopic approach for gastric cancer. We perform first Ukrainian experience.
Methods:
We performed our own experience of laparoscopic gastrectomy for 13 gastric cancer

patients. All operations were performed on base of “LISSOD” cancer hospital in 2011-
2012. Mean age was 58.8 years, 10 men, 3 women; with stage I–1, II–3, 3A–3, 3C–6,
after neoadjuvant treatment (ECC) - 10. All patients were performed laparoscopic
total gastrectomy with Roux-anastomosis and D2-lymphnodedissection.
Results:
Mean operation time was 311 minute (range 203-420 minutes), mean hemorrhage
246 ml (range 50-1100 ml). Mean time of hospital stay was 11 days (range 7-19
days), 10 days after surgery. Mean number of resected lymphnodes was 17. All
patients had R0 resection margins. Complication: hemorrhage-1, pneumonia-3,
bypass failure-1, re-laparoscopy-1, lethality-0, recurrence-1.
Conclusion:
Laparoscopic gastrectomy with D2-lympnodedissection is acceptable method for

patients with gastric cancer. It has all advantages of laparoscopic approach with
equal oncological results.
-107-
-108-
-109-
OP - 81 LAPAROSCOPIC MANAGEMENT FOR HYDATID DISASE OF
LIVER: EXPERIENCE OF SINGLE CENTER
RIDVAN YAVUZ , FIRAT DEMIRCAN
DIYARBAKIR EDUCATION AND RESEARCH HOSPITAL
Background&Aims:
Objectives of this study were to investigate the characteristics and outcome of

patients with hydatid disease of the liver who were laparoscopically managed at
our clinic and to define technical details of approach.
Methods:
Between January 2011 and June 2012, 11 patients with hydatid disease of the
liver were considered for laparoscopic surgery in our department. All the patients
underwent laparoscopic surgical interventions.
Results:
In all patients, laparoscopic cystotomy, partial cystectomy with laparoscopic cutting

and sealing instruments for surgical dissection and omentoplasty were performed.
No conversion to laparotomy was necessary. No radiological recurrens was observed
in an average follow-up of 11 months (range 3 to 18 months).
Conclusion:
Laparoscopy is quite feasible to perform in hydatid disease of the liver and the
use of laparoscopic cutting and sealing instruments allows effective dissection and
partial cystectomy cyst size and grade is not restrict laparoscopic surgery for liver
hydatic disease. Obliteration of the residual cystic cavity decreases postoperative
complication rates, so an effective omentoplasty is essential especially for
laparoscopic procedures. The use of helical fasteners allows effective omental flap
fixation.
-110-
OP - 82 LIVER TRANSPLANTATION IN HEPATOCELLULER
CARCINOMA: ISTANBUL SISLI MEMORIAL HOSPITAL EXPERIENCE
YUCEL YANKOL 1, SERDAR TOPALOGLU 2, NESIMI MECIT 1, TURAN KANMAZ 1,
KORAY S ACARLI 1, MUNCI KALAYOGLU 1
1
SISLI MEMORIAL HOSPITAL, ISTANBUL, TURKEY
2
DEPARTMENT OF SURGERY, SCHOOL OF MEDICINE, KARADENIZ TECHNICAL
UNIVERSITY, TRABZON, TURKEY
Background&Aims:
Liver transplantation (LT) has become one of the best treatment options for
hepatocellular carcinoma (HCC) because it removes the cancer and the underlying
liver disease.
Methods:
In this study we have retrospectively analysed our HCC cases with LT.
Results:
From December 2006 to June 2012, 445 patients received LT including 102 HCC
cases (22.9%). We have only analysed 89 patients who survived at least 3 months.
Mean age was 53.7 years. 86.5% of the underlying diseases were hepatitis B and
C infection. 62.9% of the cases were within Milan criteria (MC) and 37.1% were
beyond MC. 38.2% of the liver transplants were performed from deceased donors
and 61.8% were performed from living donors. Mean follow-up was 27 months.
The recurrence rate of HCC was 8.9% within MC case and 36.4% beyond MC. One,
three and five-year patient survivals for within MC group were 93.9%, 88.1%, and
88.1%, respectively, and the survivals for beyond MC group were 76.1%, 60.1%, and
52.6%, respectively. The statistically significant risk factors for HCC recurrence were;
microvascular invasion, more than one HCC, HCC diameter> 5 cm, and AFP > 200.
Conclusion:
The timing of HCC diagnosis and LT in selected patients is very important in HCC
cases to get successful results.
-111-
OP - 83 PERFORMANCE OF THE MODEL FOR END-STAGE
LIVER DISEASE(MELD) AND CHILD-TURCOTTE-PUGH(CTP)IN
PREDICTION OF SURVIVAL IN PATIENTS AWAITING FOR LIVER
TRANSPLANTATION(LT).
ARUNKUMAR KRISHNAN , JAYANTHI VENKATARAMAN
STANLEY MEDICAL COLLEGE
Background&Aims:
Liver transplantation (LT) provides the only curative treatment option for
decompensated cirrhosis. The Model for End-Stage Liver Disease (MELD) score is
now used for allocation in LT waiting lists, replacing the Child-Turcotte-Pugh (CTP)
score. However, the optimal strategy based on scoring systems and/or waiting time
is still under debate. Aim of the present was to compare the CTP scores and MELD
score for 3, 6months survival in cirrhotic patients waiting for liver transplant.
Methods:
We investigated 216 consecutive patients listed for single-organ LT for DCLD

between April 2010 and June 2011. To assess the prediction of risk of death by
using AROC.
Results:
56 patients died during this period. The mean CTP at baseline, 3, 6 months was
7.4, 7.7 and 8.1 for patients in the waiting 7.6, 8.9 and 9.48 for patients who died.
Mean MELD at 3, 6 months was 12.2, 13.4 and 16.9 for patients in the waiting
and 14.8, 19.3 and 21.6 for patients who died. The sensitivity and specificity to
identify mortality CTP was 83.9% and 89.5%; for MELD 88.6%, 91%. There were
significant differences between them with low and intermediate range MELD at 3;
no difference in 6 months.
Conclusion:
MELD has a better performance over the CTP. Outcome with lower range MELD
cannot be reliably predicted only with their MELD and alternative prognostic
markers should be used in conjunction to enhance the predictive accuracy.
-112-
OP - 84 SPONTANEOUS HEPATIC RUPTURE ASSOCIATED WITH
HELLP SYNDROME IN PUERPERANT WOMEN
STAVROS GOURGIOTIS , STAVROS ALOIZOS , THEODOROS PAVLIS , PARASKEVI
ARAVOSITA , EFTHYMIA KANNA , CHRISTINA MYSTAKELLI
INTENSIVE CARE UNIT, “MITERA” HOSPITAL OF ATHENS
Background&Aims:
Spontaneous hepatic rupture with hemoperitoneum is an uncommon but

devastating complication of hemolysis, elevated liver enzymes and low platelets
(HELLP) syndrome.
Methods:
The purpose of this report was to describe three successfully treated cases of
extensive spontaneous hepatic rupture in puerperant women with HELLP syndrome.
Results:
In our institution, during the last 15 years, were detected 3 cases with spontaneous
hepatic rupture in 201,130 births indicating an incidence of one in 67,043 childbirths.
Among these pregnant women, 6,076 cases of pre-eclampsia / eclampsia were
detected while only 158 (2.6%) of them developed HELLP syndrome. Hepatic
rupture occurred in 0.05% of patients with pre-eclampsia / eclampsia or HELLP
syndrome. Surgery was the treatment of choice in patients with hemodynamic
instability despite adequate resuscitation and when the hematoma ruptured into
the peritoneal cavity. In our cases, almost all of the surgical hemostatic techniques
of the liver were used. Although the third patient was initially stable, arterial
embolization was not used due to the rupture of the hematoma into the peritoneal
cavity as the abdominal CT revealed.
Conclusion:
Hepatic rupture increases the perinatal and maternal morbidity and mortality.
Early diagnosis and adequate tertiary management of this rare but life-threatening
condition reduce the high maternal and newborn mortality.
-113-
OP - 85 SURGICAL MANAGEMENT, MORBIDITY AND
PROGNOSTIC FACTOR IN 70 CONSECUTIVE PATIENTS WITH HILAR
CHOLANGIOCARCINOMA: SINGLE CENTER ANALYSIS
ANDREA SAGNOTTA 1, TOMMASO BOCCHETTI 1, GIAMMAURO BERARDI 1,
ALESSANDRA SPARAGNA 1, ANDREA KAZEMI NAVA 1, VINCENZO ZIPARO 1,
ROBERTO TROISI 2
1
DEPARTMENT OF GENERAL SURGERY, ST ANDREA HOSPITAL, II FACULTY OF
MEDICINE “SAPIENZA” UNIVERSITY OF ROME, ITALY
2
GENERAL, HEPATO-BILIARY AND LIVER TRANSPLANTATION SERVICE, GHENT
UNIVERSITY HOSPITAL AND MEDICAL SCHOOL, BELGIUM
Background&Aims:
Hilar cholangiocarcinoma represent less than 1% of all malignancies. This study

was conceived to assess multimodal treatment including surgical approach and
to determine postoperative morbidity, mortality, long-term results and prognostic
factors.
Methods:
From March 2002 to December 2008, 70 patients with a Klatskin tumor were
evaluated in the UZ Ghent. Clinicopathological data were analyzed and univariate
and multivariate analyses carred out
Results:
15/70 patients were unresectable (group A) and treated with palliative stenting.
The other 55 patients underwent surgery (group B): n=3 for Bismuth type II, n=18
for type IIIa, n=23 for type IIIb and n=11 for type IV. In-hospital mortality and overall
morbidity rates were 5.5% and 32.7 % respectively. After a median FU of 29.9
months (1-87) median OS was 3.4 (group A) vs 29.9 (group B, p<0.001). Right or left
extended hepatectomies had the highest R0 rate (88.2% 15/17 patients). Three and
5 years survival rates were higher in R0 vs R1-R2 resection (55% vs 30%, 41% vs 17%
respectively, p<0.001). Identified prognostic factors were: R1-2 resection, lymphatic
and perineural invasiveness, AJCC stage and poorly differentiation.
Conclusion:
Radical surgery is the only factor improving survival with an acceptable surgical
mortality. Extended hepatectomy increased R0 resections. On multivariate analysis,
incomplete resection, poorly differentiation and perineural infiltration correlate
with shorter survival.
-114-
OP - 86 THE COMPARISON OF LIFE QUALITY IN PATIENTS
WHO HAVE SINGLE PORT OR STANDARD LAPAROSCOPIC
CHOLECYSTECTOMY
BARLAS SULU 1, ELIF DEMIR ILINGI 1, HASAN ALTUN 1, TURGUT ANUK 1, BARIS
DOGU YILDIZ 2, YUSUF GUNERHAN 1, NESET KOKSAL 1
1
KAFKAS UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY
, KARS, TURKEY
2
ANKARA NUMUNE TEACHING HOSPITAL DEPARTMENT OF GENERAL SURGERY,
ANKARA, TURKEY
Background&Aims:
The comparison and the effect of standard laparoscopic cholecystectomy(LC) and

single port laparoscopic cholecystectomy(SC) on patients’ life quality.
Methods:
Patients were included in both groups respectively. SF-36 and Gastrointestinal

Quality of Life Index(GIQLI) were subjected to patients during preoperative,
postoperative weeks 6 and 12.
Results:
Inboth groups there were 30 patients each.The patients, in-group LC were 12

male(40%), 18 female(60%), mean age was 45.76±11.18, and BMI was 28.54±5.5
kg/m2.The patients, in-group SC were 9 male(30%), 21 female(70%), mean age was
47.53±9.16 and BMI was 30.3±4.29kg/m2. No significant differences were found
between groups in terms of age, gender, ASA and BMI. According to SF-36 life
quality inquiry, at the end of week 12 a decrease in subscale of physical pain in
both groups.In group LC an increase in subscale of role were determined(p<0.05).
No significant differences were found in terms of subscales of emotional role, social
functions, mental health, vitality and general health on the weeks 6 and 12(p>0.05).
As for GIQLI, an increase in subscale of social and gastrointestinal at the end of
week 12 was established in both groups(p<0.05).
Conclusion:
No remarkable differences were found in terms of life quality after surgery for the
patients who had SC and LC.
-115-
OP - 87 THE IMPACT OF LIVER TRANSPLANTATION AFTER SURGICAL
TREATMENT OF HEPATOCELLULAR CARCINOMA
HALIT TOPAL , JOYCE TIEK , STEFFEN FIEUWS , JACQUES PIRENNE , FREDERIK
NEVENS , BAKI TOPAL
Background&Aims:
The impact of liver transplantation (LTx) after surgical treatment for HCC remains
undefined. The aim of the current study was to assess the impact of LTx and of
selection criteria for LTx on the survival of patients who underwent surgery for HCC.
Methods:
Between 2004 and 2009, 119 patients underwent surgical treatment for HCC.
Cirrhosis was present in 85 patients. Of all patients, 77 fulfilled the Milan criteria,
88 the UCSF and 87 the Up-to-7 criteria. Finally, 35 patients received a LTx, of whom
31 met the Milan, 33 the UCSF, and 33 the Up-to-7 criteria.
Results:
Patients fulfilling the Milan criteria had a better overall (OS) and disease-free (DFS)
survival than those who had tumors beyond the Milan criteria (p < 0.047). No
differences were observed in terms of OS between patients within vs. beyond the
UCSF or Up-to-7 criteria (p > 0.130). LTx after surgery had a beneficial impact on
both DFS and OS of patients in all the 3 selection criteria models of LTx (p<0.031).
Conclusion:
LTx after primary surgery seems to offer the best long-term survival for patients
suffering from HCC in cirrhosis as well as for them who fulfill the selection criteria.
-116-
OP - 88 THE MINIMALLY INVASIVE TREATMENT OF MIRIZZI’S
SYNDROME: IS THERE A SAFE WAY?
GİUSEPPE PİCCİNNİ , ANGELA GURRADO , ERASMİNA D’AMBROSİO , GİOVANNA
Dİ MEO , VALENTİNA FERRARO , FRANCESCO FRAGASSİ , ALESSANDRO PASCULLİ ,
MARİO TESTİNİ
DEPARTMENT OF BİOMEDİCAL SCİENCES AND HUMAN ONCOLOGY; UNİT OF

ENDOCRİNE, DİGESTİVE, AND EMERGENCY SURGERY. UNİVERSİTY MEDİCAL
SCHOOL “ALDO MORO” OF BARİ, ITALY.
Background&Aims:
Mirizzi’s syndrome (MS) is a rare complication of the biliary lithiasis (0.5% -1.4%).
A diagnostic and therapeutic algorithm should be carefully planned in the view of
minimally invasive treatment.
Methods:
370 cholecystectomies were performed from 2006 to 2011 . 11 patients (2.97%)

affected by MS (6 F: 5 M) were divided into 4 groups (Csendes’ classification): 5
cases of type 1, 3 of type 2, 1 of type 3 and 2 of type 4.
Results:
Type 1 was discovered intraoperatively and treated with Laparoscopic subtotal

cholecistectomy (LSC). One patient presented biliary leakage, solved with
sphincterotomy and nasobiliary drainage (NBD) . The type 2 group with obstructive
jaundice was preoperatively submitted to Endoscopic Retrograde Cholangio-
Pancreatography (ERCP) and NBD . Two underwent LSC. In one case we converted
the procedure . 1 woman (type 3) with recurrent cholangitis underwent Magnetic
Resonance Cholangio-Pancreatography , ERCP and LSC . The type 4 group underwent
open biliary reconstruction.
Conclusion:
Laparoscopic surgical skill is needed to manage complicated situations as MS. It is

desirable to achieve a widespread knowledge of MS to permit a totally endoscopic
approach in almost all cases. The discovery of MS type1 can be managed with LSC.
-117-
OP - 89 THE NECESSITY OF INTENSIVE PULMONARY CARE AFTER
LIVER SURGERY.
SERDAR TOPALOGLU 1, IRFAN INCI 1, ADNAN CALIK 1, OZGEN ARAS 2, MITHAT
KERIM ARSLAN 1, FUNDA OZTUNA 1, YILMAZ BULBUL 1
1
KARADENIZ TECHNICAL UNIVERSITY, SCHOOL OF MEDICINE, TRABZON, TURKEY
2
DUMLUPİNAR UNİVERSİTY, SCHOOL OF HEALTH SCİENCES, KUTAHYA, TURKEY
Background&Aims:
Prevention from postoperative pulmonary complications (PPCs) has been an

important topic. The aims of this study were to determine the risk factors for PPC
after liver surgery and to analyze the efficacy of postoperative pulmonary care on
PPC prevention.
Methods:
Between January 2007 and March 2012, 81 patients underwent hepatectomy and
4 patients underwent liver transplantation. We retrospectively analyzed variables
of patients.
Results:
Nineteen patients were suffered from PPCs (22.4%). Bivariate analysis identified
4 risk factors: preoperative anemia [odds ratio (OR) = 5.69], The American Society
of Anesthesiologists score of 3 or 4 (OR = 5.36), blood transfusion (OR = 2.81),
prolonged operative time (OR = 1.01). In multivariate analysis, only prolonged
operative time was an independent risk factor for PPC (OR = 1.01).
Conclusion:
The elimination of risk factors may reduce the incidence of PPCs. Postoperative
intensive pulmonary care including intensive spirometry should be adopted after
liver surgery.
-118-
-119-
OP - 90 CAN HORIZONTAL DIAMETER OF THE COLORECTAL TUMOR
HELP DETERMINE PROGNOSIS?
AHMET ZIYA BALTA 1, YAVUZ ÖZDEMIR 1, İLKER SÜCÜLLÜ 1, ERGÜN YÜCEL 1, SERHAT
TOLGA DERICI 1, AYTEKIN ÜNLÜ 2, MEHMET LEVHI AKIN 1
1
GATA HAYDARPASA EGITIM HASTANESI GENEL CERRAHI SERVISI
2
GATA GENEL CERRAHI SERVISI
Background&Aims:
The aim is to evaluate the clinical significance of horizontal diameter of colorectal

tumor, and the relationship between the horizontal diameter of the tumor and
other prognostic factors like vertical invasion and nodal metastasis.
Methods:
A total 439 patients with colorectal cancer were identified from the database. The
horizontal diameter was calculated as the widest diameter in the fixed, paraffin-
embedded specimens, and patients were stratified into 2 groups according to a
cut-off value of 4.5 cm. Demographic variables were analyzed with student’s t test
and chi-square test. Survival analysis was done with Kaplan Meier method and Log
rank test. Possible factors that may have an effect on survival were analyzed with
Cox Regression analysis.
Results:
There were 251 male patients with a mean age of 67.5±13.2 years, and 181 female
patients with a mean age of 66±13.5 years. Median overall and disease free survival
were 30.2 (0.1-237.1) and 22.6 (0-237.1) months respectively. Vertical invasion,
nodal metastasis and stage of the tumor were significantly increased with the
increase of the horizontal diameter (p<0.001 for all). Patients with horizontally
small tumors had a better overall survival time and 5-year survival rate (p=0.014).
Conclusion:
We conclude that horizontal diameter of the colorectal tumor can be used as a

prognostic factor.
-120-
OP - 91 COLORECTAL RESECTIONS DURING CYTOREDUCTIVE
SURGERY AND HIPECIN OVARIAN CARCINOMATOSIS
EVGENIA HALKIA , ELIAS EFSTATHIOU , KALIOPI KASTRINAKI , APOSTOLOS XYNOS ,
JOHN SPILIOTIS
METAXA CANCER HOPSITAL
Background&Aims:
Current standard of care of advanced ovarian cancer is CRS in order to remove all the
primary tumor and metastatic disease in combination with systemic chemotherapy.
HIPEC is an attractive modality in combination with peritoneotomy procedures to
treat patients. The aim of this study is to identify a reasonable surgical strategy for
colorectal resections in ovarian carcinomatosis.
Methods:
From a series of 40 patients with advanced ovarian carcinomatosis treated

with CS+HIPEC. 25 patients need a colorectal resection to achieve complete
cytoreduction.
Results:
Mean age was 58.7 y.o. (range 28-76). All surgical interventions are presented. The
mean PCI was 20.8 (range 7 - 31), a CC0 score was related in 55% of the patients.
All patients had a 3 week postoperative course and the 40% had an eventful
postoperative course There is a death (4%) due to postoperative bleeding. After
hospital discharge, all patients were fit for postoperative chemotherapy. The overall
5 year survival rate was 35% and the overall disease free survival was 23%. The
mean survival was 29 months and the mean disease survival rate was 25 months.
Prognostic factors correlated with long-term survival is the PCI < 16, the CC0 score
and the depth of colorectal wall invasion.
Conclusion:
In patients with ovarian peritoneal carcinomatosis colorectal resections are crucial

in order to perform maximal cytoreduction.
-121-
OP - 92 IS MORE PATHOLOGIC COMPLETE RESPONSE RATE
OBSERVED WHEN SURGERY IS DELAYED 12 WEEKS AFTER
COMPLETION OF CHEMORADIOTHERAPY VS. 8 WEEKS?
PRELIMINARY REPORT
MUSTAFA BINGUL 1, CEM TERZI 1, NACIYE CIGDEM ARSLAN 1, ARAS EMRE CANDA 1,
MEHTAT UNLU 2, ILKNUR GORKEN 3, FUNDA OBUZ 1, ILHAN OZTOP 1
1
SURGERY
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PATHOLOGY
3
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF RADIATION
ONCOLOGY
Background&Aims:
The aim of this trial is to assess whether more pathologic complete response (pCR)
rate occurs when surgery is delayed to 12 weeks after chemoradiotherapy (CRT)
compared to 8 weeks.
Methods:
Patients with locally advanced rectal cancer (T3, T4 and/or N+) were randomized
before CRT into two groups according to the neoadjuvant-surgey interval: surgery
had to be performed in 8 weeks (group I, n=15) after completion CRT, compared
with in 12 weeks (group II, n=15). We hypothesized that our historic pCR rate (10%)
with 8 weeks interval will increase to 50%. Thus, sample size of the study was
calculated as total 42 patients with 80% power, w= 0.436, α=0.05. Here we are
presenting only preliminary results with total 30 patients. The primary outcome
was to determine the pCR rate.
Results:
The groups were similar in terms of the demographic and clinical characteristics.
One patient (6.6%) had a pCR in group I and 5 patients (33.3%) had a pCR in group
II (<0.001). The number of downstaged patients were 1 (6.6%) in group I and 11
(73.3%) in goup II (p=0.002).
Conclusion:
Although this is an only preliminary report with limited number of patients, 12

weeks interval was associated with higher rates of pCR and downstaging.
-122-
OP - 93 LASER ABLATION OF FISTULA TRACT (LAFT): A SPHINCTER
PRESERVING METHOD FOR TREATING FISTULA-IN-ANO
ERSIN ÖZTÜRK , BARIŞ GÜLCÜ , PINAR SARKUT
ULUDAG UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,

BURSA, TURKEY
Background&Aims:
Laser has been used to treat various types of diseases including fistula in ano. Until
today the lasers used were radiating linear energy. In this study we present the
short term outcomes of a novel laser radiating circumferential energy.
Methods:
This study was approved by the local ethical committee of our institution. FiLaCTM
(Biolitec AG, Jena, Germany), a 15-watt laser tip using laser at a frequency of 1470
nm, producing 100-120 joule/cm energy, has been applied to 20 patients with
fistula-in-ano under general anesthesia. The short term outcomes; success rate,
complications, pain scores and time to return to normal daily activities have been
evaluated.
Results:
12 male, 8 female patients with a median age of 46 were operated on a daily

surgery basis. None of the patients required parenteral analgesics. Return to
daily activities required median 10 (5-17) days. 5 patients with inter-sphincteric,
10 patients with low trans-sphincteric and 5 patients with high trans-sphincteric
fistulas were treated. Median time of follow up was 6 (3-10) months. The success
rate was 85%. The patients with unsuccessful treatment were later operated on
traditional methods.
Conclusion:
LAFT is a safe, effective, sphincter preserving therapy that can be successfully

performed by surgeons.
-123-
OP - 94 LOW ANTERIOR RESECTION WITH A NEW ELECTRICAL
DEVICE: OUR EXPERIENCE WITH THE FIRST 10 CASES
VALENTINA GIACCAGLIA , PAOLO MERCANTINI , GIUSEPPE PROVENZA , FEDERICO
TOMASSINI , ANNALISA LO CONTE , LAURA ANTOLINO , FIORALBA PINDOZZI ,
VINCENZO ZIPARO
S. ANDREA UNIVERSITY HOSPITAL, GENERAL SURGERY UNIT
Background&Aims:
The aim of our study is to test, in terms of safety and efficacy, a new linear cutter
with servo-assisted electrical mechanism (PMI) for rectal stump section during low
anterior resection for cancer.
Methods:
Between April and June 2012, we operated on 10 patients with low rectal cancer
using PMI. Mean distance from the anal verge was 4 cm. Six patients underwent
pre-operative chemo-radiation therapy (CRT) because of advanced disease (> T3 or
N+). None of these patients had distant metastasis. Preoperative mechanical bowel
preparation was used in all cases. We performed open low anterior resection,
using PMI for the section of the rectum and EEA 28 (1 case) or 31 mm (9 cases) for
the colo-rectal transanal anastomosis sec. Knight-Griffen. Protective ileotomy was
performed in all 6 cases undergiong preoperative CRT.
Results:
Mean operative time was 154 minutes. The use of the new device was easy in all
low rectal cancer cases, even the introduction of the instrument in women´s narrow
pelvis. The suture line was very satisfactory even in the cases of previous CRT. We
did not register intraoperative complications and mean estimated blood loss was
230 ml. All patients had an uneventful recovery, except 1 infection of the surgical
site and 1 pneumonia in a patient with COPD. We did not register any anastomotic
leaks. Mean hospital stay was 7 days.
Conclusion:
PMI is safe, effective and easy to use. The electrical mechanism lowers involontary
movements during firing and gives eccellent suture line quality. Moreover, the
reusable part of the instrument might allow costs reduction.
-124-
OP - 95 MEDICAL TREATMENT OF ACUTE APPENDICITIS AND THE
ROLE OF CRP ON TREATMENT
AHMET OKUŞ , SERDEN AY , BARIŞ SEVINÇ , NERGIS AKSOY , RECEP DEMIRGÜL ,
MEHMET ALI ERYILMAZ , ÖMER KARAHAN
KONYA TRAINING AND RESEARCH HOSPITAL
Background&Aims:
The aim of this study is to evaluate medical treatment of acute appendicitis and the
role of CRP on decision for surgery.
Methods:
The patients with clinically and radiologically proved acute appendicitis were
involved in the study. Ciprofloxacin (200 mg/12 hours) and metronidazole (500
mg/8 hours) were administered intravenously. The patients were closely followed
clinically and CRP levels were recorded. Clinically resolved patients were discharged
from the hospital in the first 72 hours. Oral antibiotherapy has continued for 7 days.
Results:
There were 120 patients involved in the study in between December 2010 and
July 2012. In 11 patients the treatments was accepted as unsuccessful. During the
treatment 4 patients has left the study and chose the operation. The success rate of
medical treatment was 90%. In the follow up there were recurrences in 4 patients.
In medical treatment resistant group, CRP levels were detected as higher than 100
mg/L.
Conclusion:
The success rate of medical treatment of acute appendicitis is 90% and the
recurrence rate is lower than 10%. In detection of medical treatment resistant
group a CRP level higher than 100 mg/L is a supporting parameter.
-125-
OP - 96 NATURAL HISTORY AND OUTCOME OF DIVERTICULAR
BLEED WITH ANALYSIS OF RISK FACTORS ASSOCIATED WITH
RECURRENCE
ERMAN AYTAC , LUCA STOCCHI , GOKHAN OZUNER
DEPARTMENT OF COLORECTAL SURGERY, DIGESTIVE DISEASE INSTITUTE,

CLEVELAND CLINIC, OHIO, USA
Background&Aims:
Colonic diverticular bleeding usually stops spontaneously; however, bleeding can

recur. This study was undertaken to study the outcome of diverticular bleeding and
to identify risk factors associated with recurrence.
Methods:
Patients that were seen in the Colorectal Department at the Cleveland Clinic
between September 1993-June 2012 were reviewed and only patients with
definitive proven diverticular bleed were included from an IRB-approved database.
The characteristics of the patients who had only one episode of diverticular bleeding
were compared with the patients with recurrent diverticular bleeding.
Results:
Ninety five patients were identified and initial nonoperative management was
successful in 78 (82%) of these. Thirty-seven (39 %) of 95 (57 male) patients had
RDB. In eighty patients (84%) the origin of bleeding diverticula originated from the
left Colon. Multivariate analysis revealed age (59.33±12.8 vs. 66.53±11.5, p=0.006)
and history of previous diverticulitis ((n=10 (17.2 %) vs. n=20 (54.1 %), p=0.0003)
to be risk factors for recurrent bleeding. None of the other variables studied were
statistically significant contributors for rebleeding.
Conclusion:
Patients with diverticular bleeding have a high recurrence. In our cohort group
left sided bleeding diverticula were more common.Increased age and presence of
diverticulitis were risk factors associated with recurrence.
-126-
OP - 97 OUTCOME OF EARLY VS. DELAYED APPENDECTOMY IN
ACUTE APPENDICITIS
HASSAAN BARI
AGA KHAN UNIVERSITY HOSPITAL
Background&Aims:
Over the last few years the traditional method of managing acute appendicitis (A.A)
with immediate appendectomy has been questioned. Recent studies suggest that A.A
in patients without obvious signs of peritonitis may be managed with rather a semi-
emergent approach. The outcomes of such an approach have been shown to be not
only similar to the traditional approach, but also more cost effective. The objective
of our study was to compare the outcome of patients with acute appendicitis
who underwent early appendectomy (< 12 hours) with those who had delayed
appendectomy (12-24 hours) at our institution, in terms of intraoperative pathology
(simple vs. complicated appendicitis), postoperative morbidity rate & hospital stay.
Methods:
A retrospective study was performed by reviewing medical records of all patients
who underwent appendectomy for clinical and pathological diagnosis of acute
appendicitis at Aga Khan University Hospital from Jan. 2010 to Dec. 2011. A detailed
proforma was developed to record information on patient’s demographics, clinical
features, laboratory & radiological investigations, intraoperative findings, duration
of surgery, postoperative morbidity & length of hospital stay (LOS). Patients were
divided into early group (those who underwent appendectomy within 12 hours of
admission) and late group (those who underwent appendectomy within 12- 24 hours
of admission). Data were analyzed using SPSS v. 20.
Results:
A total of 105 patients were identified, out of these 58 underwent early appendectomy
(Group A) and 47 underwent late appendectomy (Group B). There was no significant
difference in age, gender, and ASA levels between the two groups. Time from onset
of symptoms to admission in ER (patient delay) was also similar between two groups.
Significantly more patients underwent workup for diagnosis in Group B as compared
to Group A. Almost 15 % of patients had complicated appendicitis in Group A as
compared to 19 % in Group B, p=0.62. Both groups were similar in terms of duration
of surgery (p=0.98), postoperative morbidity rate (p=0.48) & LOS (p=0.23).
Conclusion:
There was no difference in intraoperative findings, postoperative morbidity rate
& LOS in adult patients who underwent early vs. delayed appendectomy at our
institution.
-127-
OP - 98 INCIDENCE, TREATMENT AND PROGNOSIS OF COLON
PERFORATION IN 13280 COLONOSCOPIES
JESUS BOLLO RODRIGUEZ , OZLEM UYANIK , FERRAN CABELLERO MESTRES , JOSE
LUIS PALLARES SEGURA , M. CARMEN MARTINEZ SANCHEZ , CARMEN BALAGUE
PONZ , EDUARDO M. TARGARONA SOLER , MANUEL TRIAS FOLCH
HOSPITAL DE LA SANTA CREU I SANT PAU, DEPARTMENT OF GENERAL AND

DIGESTIVE SURGERY, BARCELONA, SPAIN
Background&Aims:
The incidence of colon perforation induced by colonoscopy is low being between

0.2 - 1%. Recognize the risk factors and optimize their treatment can reduce the
incidence of perforation and the likelihood of major complications.
Methods:
Study is performed on a series of 13280 colonoscopies performed in five years.
Results:
The mean age of patients was 70.6 years and 55% had an abdominal surgery history.
The incidence of colon perforation induced by colonoscopy was 0.135%, among
these 75% occurred during a diagnostic endoscopy while 25% during interventional
endoscopy. Only 20% of patients had poor mechanical bowel preparation. More
frequent location of perforation was in sigma (60%) and the most common
indication for colonoscopy was screening of colorectal cancer (35%). The most
frequent mechanism of perforation was mechanical trauma (65%).
Conclusion:
Endoscopic perforation of the colon has a high morbidity and mortality which can
be reduced by proper mechanical bowel preparation (p<0.035) and early diagnosis
of the perforation (p<0.01). Although conservative treatment is feasible in selected
patients, most patients require early surgical intervention to decrease abdominal
contamination to be able to perform simple closure or resection with primary
anastomosis, to reduce the incidence of complications (p<0,01) and the average
hospital stay.
-128-
OP - 99 PRECONDITIONING FACILITATES STOMA SELF CARE,
DECREASES PREDISPOSITION TO ANXIETY-DEPRESSION AND
IMPROVES QUALITY OF LIFE IN STOMA PATIENTS
CIHANGIR AKYOL 1, DURUCAN AYDIN KOC 1, AYHAN BULENT ERKEK 1, DERYA
GOKMEN OZTUNA 2, MEHMET AYHAN KUZU 1
1
ANKARA UNIVERTSITY SCHOOL OF MEDICINE DEPARTMENT OF SURGERY
2
ANKARA UNIVERTSITY SCHOOL OF MEDICINE DEPARTMENT OF BIOSTATISTICS
Background&Aims:
This study aims to measure the effects of preconditioning on stoma self-care,

quality of life (QOL), anxiety-depression levels.
Methods:
Eighty-two patients with fecal diversion were participated. Patients are classified
according to their enterostomal management; Group A (postoperative care, n=33),
Group B (pre and postoperative care, n=24), and Group C (preconditioning + pre and
postoperative care, n=25). Preconditioned patients trained with attached stoma
bags filled with water 48 hours before the operation. The stoma monitorization
form, Hospital Anxiety-Depression Scale (HADS) and QOL form was used to compare
the groups.
Results:
Stoma self care: There was only statistically significant difference between Groups
A and C (p<0,05). Median day of independent stoma care (A-B-C)14-13-10. HADS:
Group C has lower rates of anxiety-depression predisposition compared to other
groups (p=0,044 for HADS-A, p<0,001 for HADS-D). Median score for HADS-A (A-B-C)
9 7 7. Median score for HADS-D (A-B-C) 11 9 6. QOL: The QOL scores are significantly
higher in group C compared to other groups (data not shown).
Conclusion:
Pre-operative stoma training and preconditioning with stoma bag makes

patients manage their stoma care independently in a shorter time, decreases the
predisposition of depression-anxiety and increases the QOL.
-129-
OP - 100 RAMADAN FASTING IN PATIENTS WITH A STOMA: A
PROSPECTIVE ANALYSIS ON QUALITY OF LIFE AND NUTRITIONAL
STATUS
YUNUS EMRE ALTUNTAS , FAZLI CEM GEZEN , NURI OKKABAZ , METIN KEMENT ,
HALIME AYDIN , FATMA SAHIN , MUSTAFA ONCEL
KARTAL EDUCATION AND RESEARCH HOSPITAL, GENERAL SURGERY DEPARTMENT
Background&Aims:
Current study aims to analyze the effect of Ramadan fasting on stoma patients
regarding nutritional and metabolic status and life quality.
Methods:
Demographics, and stoma, disease and treatment related parameters were

evaluated. They were also asked to answer some questionnaires, and complete
some laboratory tests before the month of Ramadan. Cases were evaluated in two
groups regarding whether or not they were fasting.
Results:
A total number of 56 patients (33 [58.9%] male, mean[SD] age was 55.9±13.1 years)
were included. Demographic parameters, including religious orientation scale score
were similar within the groups, but fasting was tending to be more common among
the patients with a permanent stoma (p=0.051). Patients in Fasting group were
significantly in a better nutritional status regarding albumin and prealbumin levels
and were in a higher global health status (p<0.05). Ramadan fasting had almost no
influence on life quality. Most patients in fasting group (n=13, 92.9%) stated that
they would feel sad if they were not fasting.
Conclusion:
Only one forth of stoma cases fast in Turkish population. The disease related and
demographical parameters are similar within the patients who fast and who do not.
Ramadan fasting may not worsen nutritional and metabolic status and does not
have any influence on quality of life. Most fasting patients declare that they will feel
sad, if they were not fasting.
-130-
OP - 101 STANDARDIZED LAPAROSCOPIC SPHINCTER-PRESERVING
TOTAL MESORECTAL EXCISION FOR RECTAL CANCER: LONG-TERM
ONCOLOGIC OUTCOME IN 217 UNSELECTED PATIENTS
OKTAR ASOĞLU 1, ENVER KUNDUZ 1, KURSAT RAHMİ SERİN 1, YALIN ISCAN 1, HASAN
KARANLIK 1, BARIS BAKIR 2, ETHEM NEZİH ORAL 3, YERSU KAPRAN 4
1
ISTANBUL FACULTY OF MEDİCİNE, GENERAL SURGERY
2
RADİOLOGY
3
ONCOLOGY
4
PATHOLOGY
Background&Aims:
Laparoscopic surgery becomes standart procedure for rectal surgery, however too many
technics were described from too many centers. This study was designed to evaluate
the impact of a standardized laparoscopic total mesorectal excision on the long-term
oncologic outcome of unselected patients with rectal cancer.
Methods:
Patients had rectal cancer underwent a standardized laparoscopic total mesorectal
excision from medial to lateral approach encompassing nine sequential steps by single
surgeon (OA). For providing sharp disection, unipolar cautery and scissors were used
during the excision of mesorectum, identification of inferior mesenteric vessels and
colonic mobilization from medial to laterally.
Results:
From 2005 to 2012, laparoscopic sphincter-preserving total mesorectal excision was
performed in 217 patients with 6.5% (14 patients) conversion to open procedure rate.
All the procedure was sphincter-saving surgery (SSS). Postoperative complications were
observed in 38 (17.5%) patients, the most common complication was anastomotic
leakage (%4). Distal and circumferential margin positivity was detected in 2 (0.9 %)
and 4 (1.8%) cases respectively. 8 patients were pT4 tumor, only one of them required
conversion to open. The mean number of harvested and metastatic lymph nodes was
24 (4-98) and 1.5 (0-29), respectively. One hundred and twenty three patients had
received neoadjuvant treatment, staging of them were 22 (17.8%) stage 0, 22 stage
I (17.8%), 35 (28.4 %) stage II, 44 (36.0%) stage III, histopathologically. After a median
follow-up of 31 (1–89) months, tumor recurrence occurred in 27 (12.4%) of 217 patient.
All recurrent tumors were pT3 and mesorectum excised completely, except one. Overall
5-year survival (OS) rate was 87%. The five-year disease-free survival (DFS) was found
to be 81%.
Conclusion:
A standardized laparoscopic sphincter-preserving total mesorectal excision resulted in a

favorable LONG-term outcome in unselected patients with rectal cancer.
-131-
-132-
-133-
OP - 102 THE TIMING OF LAPAROSCOPIC CHOLECYSTECTOMY IN
ACUTE CHOLECYSTITIS
SEMA YÜKSEKDAG , GÜRHAN BAŞ , ATILLA KARAKELLIOĞLU , COŞKUN ÇAKIR ,
İSMAIL OKAN , ORHAN ALIMOĞLU , MUSTAFA ŞAHIN
DEPARTMENT OF GENERAL SURGERY, VAKIF GUREBA EDUCATION AND RESEARCH

HOSPITAL
Background&Aims:
Timing of laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) is still

controversial today. The aim of the study was to define the effect of duration
between the onset of symptoms and the operation on the outcome of patients.
Methods:
This prospective study included the patients admitted with the diagnosis of AC
between January 2007 and June 2009. Patients were divided into 3 groups according
to the duration of symptoms. Group I included patients operated within the first
3 days, group II comprised patients operated between the 4-7 days and group III
included patients operated after 7 days. Patients were compared according to age,
gender, duration of symptoms, operation time, complications, conversion rates and
its causes, length of hospital stay, morbidity and mortality.
Results:
Forty six patients were included in the study. The demographic features were similar.
The best outcome with regard to the operation time, adhesion score, conversion
rates, length of hospital stay was found in Group I. Group II had better outcome
than Group III.
Conclusion:
LC can be performed safely in the first 7 days after the onset of symptoms in patients
with AC. Further studies are needed to explore the use of LC after one week of
symptoms.
-134-
OP - 103 TIMING OF EARLY CHOLECYSTECTOMY IN PATIENTS
WITH ACUTE CALCULOUS CHOLECYSTITIS: IS IT RATIONALE TO BE
STRICTLY LOYAL TO THE GUIDELINES?
MURAT GONENC , AHMET CEM DURAL , CEVHER AKARSU , HAKAN YIRGIN , ALI
KOCATAS , OSMAN KONES , MUSTAFA U. KALAYCI , HALIL ALIS

Background&Aims:
The first 72-hour after the onset of symptoms in patients with acute calculous
cholecystitis is generally considered to be the golden interval for early
cholecystectomy.
Methods:
The medical records of patients who underwent cholecystectomy for acute

calculous cholecystitis during the index admission between January 2008 and
January 2012 were included to the study. The patients were divided into 2 groups.
The duration between the onset of symptoms and surgery in Group 1 was less than
72 hours, whereas it was more than 72 hours in Group 2. Primary end point was
morbidity and mortality rate. Secondary end points were operative time, the rate
of conversion to open technique, and length of hospital stay.
Results:
A hundred and eighty three patients were included to study. There were 109 and
74 patients in Group 1 and 2, respectively. Median duration between the onset of
symptoms and surgery was 48 (24-72) hours in Group 1, and 144 (72-192) hours in
Group 2. There were no significant differences in either morbidity or mortality rate
between two groups.
Conclusion:
Timing of early cholecystectomy during the index admission does not seem to affect
surgical outcomes in patients with acute calculous cholecystitis.
-135-
OP - 104 TREATMENT OF AMPULLARY NEUROENDOCRINE TUMOR
BY ENDOSCOPIC SNARE PAPILLECTOMY
MEHMET ODABAŞI , MEHMET KAMIL YILDIZ , CENGIZ ERIŞ , M.A.TOLGA
MÜFTÜOĞLU , EMRE GÜNAY , HASAN ABUOĞLU , ERKAN ÖZKAN , SAMI AKBULUT
Background&Aims:
Neuroendocrine tumor rarely arises at the ampulla of Vater. Approximately 120

cases have been reported to date. We report a case treated by endoscopic snare
papillectomy.
Methods:
A 45-year-old female patient was presented by abdominal pain who had ampullary
tumor in ERCP. Biopsies were confirmed as a low grade neuroendocrine tumor.
A mass 1.9 x 1.6 cm. in size was detected on endosonography (EUS) . Prior to
papillectomy, the absence of metastases and peripancreatic lymphadenopathy
was confirmed by abdominal ultrasonography, CT, EUS and In-111 octreotide scan.
Endoscopic snare papillectomy was performed, stents were introduced into CBD
and PD to prevent cholangitis and pancreatitis and complication was not observed
and patient was discharged on the 3rd day.
Results:
On pathologic examination, a tumoral mass was well differentiated (ENETS G1) and
invaded submucosa and muscularis propria. Specimens were stained synaptophysin
and chromogranin-A (+), and Ki-67 1%. Surgical margins were healthy. There was no
lymphovascular and perineural invasion.
Conclusion:
Endoscopic snare papillectomy may be a good therapeutic option with less

morbidity in the management of neuroendocrine tumors of the ampulla of Vater in
selected patients such as those with a low grade, tumor sized ( < 2 cm.) and without
regional or distant metastasis.
-136-
OP - 105 HEPATIC RESECTION FOR HCC ON CIRRHOSIS IN THE
ELDERLY: MID- AND LONG-TERM OUTCOME
RAFFAELE COSTANTINI , FRANCESCA MASSIMINI , FRANCESCO CALDARALO ,
PAOLO RAIMONDI , MICHELE FIORDALISO , PAOLO INNOCENTI
UNITS OF GENERAL AND LAPAROSCOPIC SURGERY AND *CLINICAL PATHOLOGY; “G.

D’ANNUNZIO” UNIVERSITY, CHIETI, ITALY
Background&Aims:
Hepatic resection represents the treatment of choice in hepatocellular carcinoma

(HCC), with a survival rate of 50-70% at 5 years. Our aim was to assess mid- and
long-term outcome of hepatic resection in HCC on cirrhosis in elderly patients.
Methods:
We reviewed resections for HCC on cirrhosis performed during 11.5 years at our
Institute for: age, lesions, type of intervention, complications and follow-up.
Results:
78 patients (52 older than 70 years) underwent wedge resections (57%), major
resections (18%), segmentectomies (25%) for single or multiple lesions (mean
dimension: 3.71cm). In the elderly: there were 3 perioperative deaths and 28
complications (21 minor, 7 major); hepatic damage indices increased postoperatively,
returning close to preoperative values after day 5; at histology, 15 tumors were
differentiated, 25 moderately differentiated and 12 scarcely differentiated. The
mean follow-up was 51 months (6-68 months). The mean survival rate in the elderly
was 79.4% at 1 year (vs 82.7% in younger patients), 68.3% at 3 years (vs 70.7%) and
58.7% (vs 61.3%) at 5 years, with no statistically significant difference between the
two groups of patients.
Conclusion:
Our results show that advanced age by itself should not be a contraindication for
curative hepatectomy in patients with HCC on cirrhosis.
-137-
OP - 106 LAPAROSCOPIC COMMON BILE DUCT EXPLORATION; NEW
TARGET FOR THE SURGEON, NEW OPPORTUNITY FOR THE PATIENT.
SHAHRAM NAZARI , SEMİRA MOUSAVİ KHOSROSHAHİ
ERFAN HOSPITAL
Background&Aims:
CBD stones are found in approximately 16% of laparoscopic cholecystectomies.

Clinical models are inaccurate in predicting CBD stones. Prior to the development
of LC, the management of these patients included CBD exploration at the time
of cholecystectomy. In the era of LC, because of an obvious lack of expertise in
laparoscopic surgery, if the diagnosis of choledocholithiasis was established
during surgery, the surgeon was confronted with the choice between conversion
to open surgery, or postoperative ERCP. With increasing experience of surgeons, it
seemed logical to develop a mini-invasive one-stage laparoscopic common bile duct
exploration (LCBDE).
Methods:
This study evaluates our results of LCBDE in a series of 690 patients treated over
56 months.
Results:
CBD stones were demonstrated in 68 patients by routine IOC. For 7 patients, ERCP
was performed. LCBDE was done in 61 patients. CBDs closed on a C-tube, T-tube or
no tube in 21, 10 & 6 patients, consecutively. In 60 cases flexible choledochoscopy
was done. Choledochoduodenostomy was performed in 24 cases. Operative time
was 90-130 minutes (mean 95).
Conclusion:
There are no debates in the detection and the management of CBD stones in the
era of LC. LCBDE is a cost-effective, efficient, and minimally invasive method of
treating choledocholithiasis.
-138-
OP - 107 LIVER METASTASIS IN COLORECTAL SURGERY:OUR
EXPERIENCE
CARMINE DI SOMMA
IRCCS S.MARTINO-IST
Background&Aims:
Surgical resection is the best option for prolonged survival in patients with
colorectal metastasis(CRLM).Surgery for CRLM has become more and more
aggressive,improving certain technical aspects.
Methods:
In Our Surgical Division we started to perform surgery for CRLM in February 2005.
Since then,we have operated with surgery alone (without others procedures as RF)
148 patients .
Results:
After surgery the mean mortality was 1.04% and the mean morbidity was 14.8%.
The 3-year survival ranged from 24 to 56%.In all cases the operative strategy
was performed to achieve an R0(no residual disease) resection emphasizing the
importance of this for prolongation of survival.
Conclusion:
Surgery of CRLM should address the key components of the extent of hepatectomy
including anatomic resection and optimal pathologic margins.The current study
confirmed such operative procedures technically complex should be taken in
dedicate Centers as a multidisciplinary effort is required for an acceptable survival
and perioperative outcome.
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OP - 108 THE EFFECT OF AGE ON MORTALITY AND MORBIDITY IN
PATIENTS TREATED WITH PANCREATICODUODENECTOMY
İLTER ÖZER , RAMAZAN SAYGIN KERIMOĞLU , TAHSIN DALGIÇ , ERDAL BIROL
BOSTANCI , EROL AKSOY , MURAT ULAŞ , YUSUF ÖZOĞUL , MUSA AKOĞLU
TÜRKIYE YÜKSEK İHTISAS HOSPITAL
Background&Aims:
This study aims to investigate the effect of older age on early postoperative
morbidity and mortality in patients with periampuller tumors treated with
pancreaticoduodenectomy (PD).
Methods:
Clinical records of 458 patients who were treated by PD between 1999 and 2012
were evaluated in three groups. Group 1 ; patients under 60 years of age, group 2
; patients between 60-69 years of age and group 3 ; patients 70 years of age and
older. Statistical procedures were performed using SPSS, version 16.0.
Results:
The median age of the patients was 57.9 (17-82). There were 235 (51.3%) patients
in Group 1, 145 (31.7%) patients in Group 2 and 78 (17%) patients in Group 3.
Morbidity rate was 63.8% (292) and mortality rate was 11.8% (53). Postoperative
complication rate was 54% (140) in Group 1, 61% (95) in Group 2 and 66% (54) in
Group 3. The risk of early postoperative mortality rate among the three groups
were observed to increase with age (p<0.05). The most influential factors on
morbidity were the diameter of the pancreatic duct and preoperative drainage
implementation. Factors affecting mortality were determined as age and bilirubin
level.
Conclusion:
Advanced age does not increase morbidity but significantly increases the mortality
rates.
-140-
OP - 109 FACTORS AFFECTING THE OUTCOME OF SURGERY IN LABC.
JAVERIA IQBAL , BANDAR ALHARTHI
KING FAHAD MEDICAL CITY RIYADH
Background&Aims:
To assess which factors have an impact on the choice of surgery in LABC in terms of
age, menopausal status, receptor status, tumor size (T), nodal status (N) and grade
of tumor.
Methods:
A retrospective review of patients with LABC that presented to King Fahad Medical
City over last 4 years was made. 56 patients were included which received 6-8 cycles
of the GORGOO1. 25.9%patients underwent Breast Conservation Surgery (BCT) and
74% underwent Modified Radical Mastectomy (MRM).
Results:
Among patients <40 years 7.41% underwent BCT and 22.22% underwent MRM.
Among the patients >40years, 18% had BCT and 52% had MRM (p=0.54). 18 % of
the premenopausal patients underwent BCT and 40% had MRM. While among
the 22 postmenopausal patients 4 had BCT and 19 MRM respectively.Among the
14 patients undergoing BCT 7(50%) were ER/PR positive .In the MRM group 65%
of patients had positive receptors.(p=0.29).Patients undergoing BCT were mostly
Her2 negative 18%(10).While in the MRM group 42% were Her2 negative and 32%
positive.(p=0.31).The BCT group had mostly low grade tumors 20% while MRM
group had mostly high grade 38.9%. (p=0.038).Among the patients undergoing
BCT 6(11%) were N0, 6(11%) were N1 and 2(3.7%) were N3 and N2 respectively.
While in the MRM group 40 %( 22) were N1, 10 (18%) N0, 8(14.8%) N2 respectively.
(p=0.15). In BCT group 7.4 %( 4) patients had T2, 12.96 %( 7) had T3 and 5.56 %( 3)
patients had T4 disease respectively. While in MRM group tumors were mostly T2
and T3 i.e. 25% and 37% respectively. (p=0.82)
Conclusion:
The only factor showing statistical significance is tumor grade. BCT should
be considered as an option for treatment of LABC however more follow up is
recommended.
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-143-
OP - 110 ADVANTAGES OF RAMIREZ TRIPLE MESH TECHNIQUE IN
THE TREATMENT OF GIANT INCISIONAL HERNIAS
GIORGI GIORGOBIANI , TAMAZ GVENETADZE
TBILISI STATE MEDICAL UNIVERSITY – AVERSI CLINIC.
Background&Aims:
Management of giant incisional hernia with loss of domain remains a surgical

challenge. Problems associated with the management are: concomitant diseases;
intraoperative anatomical and technical difficulties; postoperative complications.
Aim of the study was to show advantages of Ramirez method with triple mesh
technique in the treatment of massive incisional hernias.
Methods:
The method itself differs from classic Ramirez by utilizing additional strips of
mesh to cover midline and weak areas on both sides after relaxing incisions. No
of patients 62, 2009-2012 (from total 237 incisionals); Male/female 29/33. Mean
BMI 36.39% > 15 cm (largest 45 cm x 20 cm), Concomitant diseases – 56 patients;
obese patients (BMI > 40). Operation types: Ramirez (original) - 17. Ramirez with
triple mesh technique – 41; Ramirez with Rives - 4; Mean operation time 135 mins
(45-500).
Results:
Mean hospital stay 6.4 days (3-50); Complications 24 (38,7%) - haematoma (6),
seroma delaying hospital discharge (10), infection (7), Pulmonary/cardiac (8), Fistula
(2). 5 patients required further surgery. One late (2 years) partial mesh removal, 4
recurrences (lateral to mesh): One death (fistula, pulmonary embolus).
Conclusion:
Advantages of Ramirez method with triple mesh technique are: a. considerable

increasing of abdominal cavity, maintenance of Fflexibility of anterior abdominal
wall and reinforcement of weak areas (after relaxing incisions) are achieved at the
same time. b. low rate of complications; c. cost effectiveness.
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OP - 111 BOVINE DERMAL COLLAGEN IN THE CLOSURE OF
INCISIONAL HERNIAS OF IMMUNOSUPPRESSED PATIENTS
WERKGARTNER GEORG 1, WAGNER DORIS 2, DANIELA KNIEPEISS 2, FLORIAN IBERER
2
, HANS JÖRG MISCHINGER 1
1
GENERAL SURGERY
2
TRANSPLANTATION
Background&Aims:
Incisional hernias (IH) frequently occur after liver transplantation (OLT). Permanent
closure is always complicated due to high infection and recurrence rates.
Bovine dermal collagen (BDC) has been proposed as feasible for IH but not for
immunosuppressed patients due to its immunogenity. We aimed to investigate
the feasibility of bovine dermal collagen as closing aid in big hernias after OLT in a
prospective controlled trial.
Methods:
55 patients (OLT group: 21 pts. after OLT, CTR group: 24 pts. after median
laparotomy of other causes) who suffered from IH with a diameter above 10 cm
were implanted a BDC graft for closure. Patients were followed prospectively for 24
months. Recurrence rates of IH served as a primary, the development of infections
and wound healing disorders as secondary end points.
Results:
Baseline parameters were comparable between both groups. Recurrence rate was
15% (3/21) in OLT patients and 5% (1/24) in the CTR group (p=0.03). Patients in the
OLT group showed significantly more wound healing disorders and postoperative
infections (p=0.03) but all recovered completely. No re operation had to be
performed.
Conclusion:
BDC is a feasible tool for the closure if IH in patients with immunosuppression.

Reported postoperative infection rates and recurrence rates are lower as compared
to literature described ones for other IH procedures in those patients.
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OP - 112 ELECTROMYOGRAPHY IN EVALUATION OF INGUINAL
HERNIA REPAIR RESULTS
VALERY KRYSHEN , ANDRIY KUDRYAVTSEV , DARIIA IARYNKO
DNIPROPETROVSK MEDICAL ACADEMY, UKRAINE
Background&Aims:
The analysis of abdominal wall and inguinal canal functionality state after
hernioplasty was the aim of this work.
Methods:
The experimental group consisted of patients with one-sided hernia, operated by

the TAPP method. Arbitrary muscular activity of the same patient before and in
one month after operation is analyzed. Activity of mm. obliqus externus, mm. recti
abdomens was investigated on the side of hernial defect and on the opposite side
within 5 seconds at abdominal tension by the patient. Myograme amplitude and
frequency analysis was conducted.
Results:
The examination was conducted to 30 patients. Except the offered methods, the
life quality level was estimated using SF-36 scale. At the vast majority of patients
when analyzing the amplitude of contractions on affected side was higher after
operation than before it. According to wave characterics the myograme from
affected side was more similar to registered from healthy side after operation too.
Thus at patients who noted higher life quality level, the postoperative myograme
was closer to healthy side indications.
Conclusion:
Electromyography can be implemented at far postoperative period and rehabilitation

evaluation at patients with inguinal hernias. Сonnection between structural changes
in muscles and subjective condition of the patient was discovered.
-146-
OP - 113 FACTORS RELATED TO POSTOPERATIVE MORTALITY IN
HERNIAS REQUIRING EMERGENCY SURGERY
MUHAMMET AKYUZ , ERDOGAN SOZUER , ALPER AKCAN , MEHMET PATMANO ,
HIZIR AKYILDIZ
ERCIYES UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,

KAYSERI
Background&Aims:
Emergency hernia surgery is associated with significant morbidity and mortality.

We aimed to analyse the factors related to postoperative mortality.
Methods:
We reviewed 244 patients who underwent emergency surgery between January

2003 and December 2011. Patients demographics, comorbidities, hernia type,
clinical presentation, bowel ischemia and necrosis, postoperative complications
and mortality rate were evaluated.
Results:
There were 106 men and 137 women. Mean age of patient was 64.1±14.3. Inguinal
hernia was seen in 78 patients, umblical hernia in 61 patients, incisional hernias in
44 patients and femoral hernia in 30 patients. Thirty patients have had recurrent
hernia. Clinical characteristic of presentation was incarceration in 194 patients and
intestinal obstruction in 49 patients. Median hospital stay was 5 days. In univariate
analysis, clinical presentation( p= 0.003), postoperative complications(p<0.0001),
bowel ischemia(p=0.02) and bowel necrosis(p<0.0001) were significantly related
to mortality. In multivariate analysis of these factors revealed that only 2 factors
were independently associated with mortality: bowel necrosis(p=0.008) and
postoperative complications(p=0.005).
Conclusion:
Bowel necrosis and development of postoperative complications are the main

factors related to mortality in hernias requiring emergency surgery.
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OP - 114 NEW APPROACH TO HERNIA REPAIR: FENCE DARNING
TECHNIQUE
NAZIF ZEYBEK , YAŞAR SUBUTAY PEKER , HÜSEYIN TAŞ , MEHMET FATIH CAN ,
YUSUF PEKER

ANKARA TURKEY
Background&Aims:
Many surgical hernia repair techniques have been reported since today. Relaps in
non-mesh used techniques and inguinodynia in tension free mesh used techniques
are most frequent complications. Still new studies are needed to deal with these
complications. ,This study is designed to share the long term comperative results of
‘mesh-free, tension-free Fence Darning Technique (FDT)’ with ‘Lichtenstein Mesh
Hernioplasty (LMH)’.
Methods:
2529 patient who had FDT (group I/n=512) and LMH (group II/n=2017) between
2000 and 2011 were included to this prospective comparative study. Two groups
were compared of gender, age, type of hernia, early and late postoperative
complications, hospitalisation duration, pain and return to work duration.
Results:
Demographic values, hospitalisation duration, and type of hernia were similar in

two groups where follow up time was 69±7 months. Postoperative pain, early and
late complications were significantly lower than LMH, at FDT (p<0.05).
Conclusion:
FDT may be alternative to LMH because it is a safe, mesh-free tension-free,

compatible with abdominal wall compliance, macropored, cheap and similar to
mesh mentality technique.
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OP - 115 OPERATION BY RAMIREZ COMBINED WITH INTRAABDOMINAL
ALLOPLASTY IN CASE OF GIANT INCISIONAL HERNIAS
YAROSLAV FELESHTYNSKY , VOLODYMYR VATAMANUK , SERGEY SVYRYDOVSKY ,
MYXAILO YOSYPENKO , VITALIY SMISHCHUK
P. L. SHUPIK NATIONAL MEDICAL ACADEMY OF POST-GRADUATE EDUCATION
Background&Aims:
Surgical treatment of incisional giant hernias in 3-5% of patients is accompanied

by the appearance of abdominal compartment syndrome despite the use of
operation by Ramirez. This requires additional measures to prevent intraabdominal
hypertension. To improve results of surgical treatment of incisional giant hernias.
Methods:
The surgical treatment of 128 patients with incisional giant hernias was analyzed.
The average age of patients was 56,2±3,1 years. The patients were divided into
2 groups depending on the method of operation. In the first group (64 patients)
operation was performed by Ramirez in combination with mesh “prolen”, which
was fixed by the method of “onlay”. In the second group (64 patients) operation
by Ramirez was performed in combination with intraabdominal plastic mesh
“proceed”, which was fixed so that intraabdominal pressure was less than 5 mm Hg.
Results:
There was abdominal compartment syndrome in 3 (4,6%) patients of first group.

Abdominal compartment syndrome of two patients was eliminated conservatively,
1 (1,5%) patient died. In the second group abdominal compartment syndrome and
mortality weren’t observed.
Conclusion:
Operation by Ramirez combined with intraabdominal alloplasty in case of giant

postoperative hernias prevents intraabdominal hypertension and reduces the risk
of abdominal compartment syndrome and mortality.
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OP - 116 PREVENTION OF MALE INFERTILITY BY HERNIA REPAIR
TAMAZ GVENETADZE , ZURAB CHKHAIDZE
GUDUSHARI NATIONAL MEDICAL CENTER
Background&Aims:
Lichtenshtein hernia repair made revolutionary progress in hernia treatment,

but this method hernioplasty may be complicated by obstruction azoospermia.
Spermatic cord should be isolated from mesh in order to avoid the above
complications. Spermomorphological parameters prior and after hernia surgery in
those groups of patients who underwent Lichtenshtein and Gvenetadze’s method
hernia repairs are compared.
Methods:
There were 1000 operations performed using isolation method in men (2000-2011
period of time). The technique involves complete isolation of the spermatic cord
from the mesh. The total number of patients was allocated into two groups. First
group (66 patients) underwent bilateral Lichtenshtein hernia repair. The second
group (149 patients) underwent bilateral method hernia repairs by Gvenetadze’s
method. Complete spermomorphocitological investigations two days prior to
surgery, 30 days, and six month after surgery have been carried out in both groups.
Results:
Significant spermomorphocitological investigations between and after surgery

have been reported in the first (p<0.01) group. In the second group no significant
differences have been reported. 58 patients had children after surgery.
Conclusion:
Gvenetadze’s hernioplasty is simple and due to the complete isolation of spermatic

cord from the mesh male infertility is prevented, especially in case of bilateral
hernia repair
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OP - 117 TISSUE ADHESIVE MATERIAL COATED MESHES IN RABBITS:
EFFECTS ON WOUND HEALING USING ONLAY TECHNIQUE.
NAZIF ZEYBEK 1, ULVI MEHMET MERAL 1, SUBUTAY PEKER 1, ALI FUAT CICEK 2, NAIL
ERSOZ 1, YUSUF PEKER 1
1
GULHANE MILITARY MEDICAL ACADEMY DEPARTMENT OF GENERAL SURGERY
2
GULHANE MILITARY MEDICALACADEMY DEPARTMENTOF PATHOLOGY
Background&Aims:
The aim of our study is to evaluate the histopathological effects of mesh coating
with Tisseel® on wound healing in rabbits.
Methods:
35 New Zelland type rabbits were used. Midline defects were created in order
to simulate incisional hernia and repaired with two different types of meshes
(Heavyweight vs. Lightweight). Every mesh group were further divided in to two
groups depending on the mesh fixation method (suture vs. Tisseel®). The rabbits
were re-operated and fullthickness samples were histopathologically examined
90 days postoperatively. American Society for Testing and Materials (ASTM) scales
were used to score the inflammatory response to these meshes. Mean overall
response (MOR) scores were calculated and statistically significant differences were
examined.
Results:
In the noncovered group, histopathological examination revealed significantly

higher inflammatory response to HW meshes when compared to LW meshes.
However, the inflammatory response and MOR values were not significantly higher
when HW meshes were fixated with Tisseel®. Suprisingly; LW meshes covered with
Tisseel® led to a significantly higher inflammatory response when compared to
Tisseel® covered HW meshes, LW meshes and HW meshes without Tisseel®.
Conclusion:
HW meshes in the routine surgical practice create a higher inflammatory response

when fixated with suture materials, however Tisseel® leads to a higher inflammatory
response itself and when combined with LW meshes this response is higher than
HW meshes.
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OP - 118 THE EFFECT OF GENDER ON THE PROGNOSIS OF
FOURNIER’S GANGRENE: A CASE-MATCHED STUDY
ERSIN ÖZTÜRK 1, ALI ÖZER 1, PINAR SARKUT 1, İLKER ERCAN 2, TUNCAY YILMAZLAR 1
1
ULUDAG UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, BURSA, TURKIYE
2
ULUDAG UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF BIOSTATISTICS,
BURSA, TURKEY
Background&Aims:
Many surgeons believe that female gender is worsening prognostic factor for
patients with Fournier’s gangrene. In this case-matched retrospective study, we’ve
investigated the effect of gender on the prognosis of Fournier’s gangrene.
Methods:
32 female patients were retrieved from our prospectively maintained Fournier’s

Gangrene Database. Those patients were, then, case matched to 32 male patients
with Fournier’s gangrene for following variables: duration of symptoms, FGSI score
imaging the acute physiological status, age, co morbid conditions particularly
diabetes mellitus and etiology. Primary end point was mortality. Grade of
dissemination (which was calculated using our previously published quantitative
method; grade1: least disseminated and grade 3 the most disseminated), number of
debridement required and need for stoma were second end points. Non parametric
tests were used for comparisons and results were reported as median (min-max).
Results:
Matching variables were comparable among groups (table 1). Disease was more
disseminated in women, more debridement was required in women, and both
groups were comparable in means of need for stoma (table 2). Mortality rates were
similar in both groups (p=0.26).
Conclusion:
As long as Fournier’s gangrene is more aggressive and disseminated in women,

female gender is not a worsening factor affecting mortality rate.
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OP - 119 THE EFFECT OF THROMBOEMBOLIC PROPHYLAXIS ON
RISK OF BLEEDING
RIZA HALDUN GÜNDOĞDU , MEHMET ODUNCU , BAHADIR OSMAN BOZKIRLI ,
PAMIR EREN ERSOY , SONER AKBABA , TURGAY SAYIN
ANKARA ATATÜRK TRAINING AND RESARCH HOSPITAL
Background&Aims:
There is still no consensus about the effects of thromboembolic prophylaxis on

risk of bleeding in patients undergoing laparoscopic colecystectomy. The aim of
this study is to define whether the use of low molecular weight heparin (LMWH)
increases the risk of bleeding, or not.
Methods:
The records of the patients who underwent laparoscopic colecystectomy, between

June 2005 and July 2012 were analyzed. The deep venous trombosis (DVT) scores,
the dose and duration of LMWH given to the patients and bleeding complications
were recorded. LMWH was given to the 888 of the 1045 patients depending on
their DVT scores. Bleeding complications of the patients receiving LMWH were
compared to the patients not receiving LMWH.
Results:
1.24% of the patients receiving LMWH had bleeding complications, whereas this
was 0.64% for the patients not receiving LMWH. There was no significant difference
between the groups regarding the risk of bleeding (p>0.05). There was no recorded
thromboembolic event in any of patients.
Conclusion:
Thromboprophylaxis with LMWH does not cause an increased risk of bleeding in

patient undergoing laparoscopic colecystectomy. It decreases thromboembolic
events when given according to the DVT score.
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OP - 120 ANTIMICROBIAL SURGICAL SUTURES AND MATERIALS IN
SURGERY
HASAN HAKAN EREM 1, ERMAN AYTAC 2, AYSİN DURAL EREM 3
1
GUMUSSUYU MİLİTARY HOSPİTAL, DEPARTMENT OF BALMUMCU GENERAL
SURGERY
2
CLEVELAND CLİNİC OHİO, DEPARTMENT OF COLORECTAL SURGERY
3
ISTANBUL TECHNİCAL UNİVERSİTY, DEPARTMENT OF TEXTİLE ENGİNEERİNG
Background&Aims:
The aim of this study was to investigate antimicrobial surgical sutures, materials
used in medical and surgical applications and their potential benefits for clinical
studies.
Methods:
Articles related to antimicrobial surgical sutures and materials were examined in

detail via online databases.
Results:
Antimicrobial surgical materials and sutures are promising in the prevention and
treatment of certain diseases. Since this area will become an alternative option
against antibiotic resistance, it is intensively studied. In the literature, various
methods were used to produce antimicrobial sutures and materials (lubrication,
coating, micro or nanocomposites, etc.). Important agents for production of
antimicrobial surgical sutures and materials: Antiseptics, antibiotics, antimicrobial
peptides, inorganic antimicrobial nanoparticles, organic antimicrobial nanoparticles.
Melt spinning is the preferred method of manufacture for polymeric fibers.
Commercially marketed antimicrobial sutures and materials: Triclosan containing/
coated surgical sutures and materials, Silver containing/coated surgical sutures and
materials (Surgical instruments, implants, catheters, dressing bandages, surgical
mask, etc.). In vitro and some in vivo studies have shown antimicrobial efficiency of
antimicrobial sutures and materials. In vitro studies results may be different from
in vivo studies. For that reason further large prospective randomized studies will
evaluate the clinical outcome of antimicrobial surgical suture and materials.
Conclusion:
The prevention of hospital and postoperative infections with antimicrobial materials

and sutures may play an important role in the reduction of postoperative morbidity
and mortality.
-154-
OP - 121 PREVALENCE AND RESISTANCE PATTERNS IN SECONDARY
PERITONITIS
ALEXANDER JOSé SALAZAR BAEZ , ESTELA MEMBRILLA FERNáNDEZ , XèNIA CROUS
I MASó , MARTA CARMEN CLIMENT AGUSTíN , PATRICIA SáNCHEZ VELáZQUEZ ,
MARíA JOSé PONS FRAGERO , LUIS GRANDE POSA , JUAN J. SANCHO INSENSER
HOSPITAL UNIVERSITARIO DEL MAR
Background&Aims:
It’s imperative to know the prevalence and resistance patterns of microorganisms

in secondary peritonitis, communitary (CP) and postoperative peritonitis (POP) in
order to choose the most suitable antibiotic.
Methods:
An unicentric prospective, observational study was conducted of 152 consecutive

patients diagnosed of secondary peritonitis, between january of 2010 to december
of 2011. The peritonitis had to have at minimum two affected abdominal quadrants.
Intraoperative cultures were obtained in 151 patients (99%).
Results:
The mean age was 62 years IC95%=[59-65]. There were isolated 209 microorganisms
(1.4 per patient). The 36% of patients had monomicrobial peritonitis. The
microbiological culture was negative in 16% of cases and an additional 6% reported
generically as mixed flora. E. coli was the most prevalent pathogen (42%), 8% of which
were Extended-Spectrum Beta-Lactamase (ESBL). It was followed by Enterococcus
spp. (17%, 58% of which were E. faecium); anaerobes (17%), Streptococcus spp.
(17%) and Candida spp. (15%). Enterococcus spp. was the only isolated bacteria
significant higher in POP. Overall, the antibiotic resistance was: 24% to quinolones,
23% to amoxicilin-clavulanate, 23% to piperacilin-tazobactam, 16% to clindamycin.
Resistance to aminoglycosides was significant higher in POP (20%vs.5%; P=0,018).
Only 2% were carbapenem resistant. There weren’t resistances to linezolid or
vancomycin. Only one case of Candida spp. was fluconazole resistant.
Conclusion:
E. coli remains as the most prevalent pathogen. The prevalence of Enterococcus

spp. and Candida spp. have increased notably. ESBL have increased twofold since
the last decade.
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-157-
OP - 122 THE EFFECT OF PREOPERATIVE CHEMORADIOTHERAPY
ON LYMPH NODES HARVESTED IN LAPAROSCOPIC TME FOR RECTAL
CANCER
STEFANO SCABINI , EDOARDO RIMINI , ANDREA MASSOBRIO , EMANUELE
ROMAIRONE , VALTER FERRANDO
IRCCS SAN MARTINO IST GENOA ITALY
Background&Aims:
Adequate lymph node resection in rectal cancer is important for staging and local
control. This study aims to verify the effect of neoadjuvant chemoradiation on the
yield of lymph nodes in rectal carcinoma
Methods:
Data on consecutive patients who had total mesorectal excision for rectal
adenocarcinoma at a single cancer center between July 2005 and february 2012
were reviewed. No patient had any prior pelvic surgery or radiotherapy. Patients
had neoadjuvant chemoradiotherapy if they were stage II or III
Results:
A total of 152 patients were included. The mean age was 67.1 years (range 36-84).
Forty-seven patients (30.9%) received neoadjuvant therapy before resection. The
mean number of lymph nodes removed was 13.9 (range 0-39, SD 7.6). There was
less lymph node yield in patients who received neoadjuvant therapy (11.6 vs. 15.4,
p 0.02). 31.5% of patients who had preoperative therapy had 12 lymph nodes or
more in the specimen as opposed to 68.5% of those who had surgery upfront ( p:
0.03). Other factors associated with lower lymph node yield included stage (p 0.03)
and grade (p 0.007) of the tumour. Age, sex, site, type of operation, surgeons and
pathologists did not affect the number of lymph nodes removed.
Conclusion:
in TME surgery preoperative chemoradiotherapy for rectal cancer results in

reduction in lymph node yield. The neoadjuvant therapy is an independent factor
for lower number of nodes retrieved.
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OP - 123 USE OF AN AUTOGENOUS DERMAL GRAFT AND AN
ACELLULAR DERMAL MATRIX IN THE TREATMENT OF HIGH
TRANSSPHINCTERIC PERIANAL FISTULA IN AN ANIMAL MODEL
CIGDEM BENLICE 1, MERVE YILDIZ 2, SEMIH BAGHAKI 3, İLKNUR ERGUNER 4, DENIZ
CEBI OLGUN 5, SEBNEM BATUR 6, PINAR AMBARCIOGLU 7, BILGI BACA 8
1
SIXTH-YEAR STUDENT,ISTANBUL UNIVERSITY CERRAHPASA MEDICAL SCHOOL,
ISTANBUL
2
FORTH-YEAR STUDENT, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL SCHOOL,
ISTANBUL
3
DEPARTMENT OF PLASTIC AND RECONSTRUCTIVE SURGERY, HASEKI STATE
HOSPITAL, ISTANBUL
4
DEPARTMENT OF SURGERY, MASLAK ACIBADEM HOSPITAL, ISTANBUL
5
DEPARTMENT OF RADIOLOGY, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL
SCHOOL, ISTANBUL
6
DEPARTMENT OF PATOLOGY, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL
SCHOOL, ISTANBUL
7
DEPARTMENT OF BIOISTATISTICS, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL
SCHOOL, ISTANBUL
8
DEPARTMENT OF GENERAL SURGERY ISTANBUL UNIVERSITY CERRAHPASA
MEDICAL SCHOOL, ISTANBUL
Background&Aims:
Treatment of high transsphincteric fistula is a complex procedure which it may

sometimes be associated with the risk of recurrences and impaired fecal continence.
In this study, we use an animal model to compare different types of sphincter
preserving treatments for transsphincteric fistula.
Methods:
Sixteen female New Zealand rabbits, weighing between 2.8-4.8 kg underwent

a surgical creation of high transsphincteric fistula with a seton. After 6 weeks,
setons were removed. Magnetic resonance imaging (MRI) was performed for
confirming fistula formation. Rabbits were divided into three groups: Group 1;
received no infilled treatment (control), in the other two groups fistula tracts were
filled by acellular dermal matrix (group 2) and autologous dermal graft (group
3), respectively. All fistula tracts were curetted and both internal and external
opennings were closed by stiches. After 5 weeks of treatment, MRI was done to
evaluate the healing of fistula tract. All rabbits were killed after MRI. Anorectum
was excised en bloc and histopathological examination was done.
-159-
Results:
According to the MRI findings, fistula healing rate in terms of fistula tract shrinking
was better in the dermal graft group (66%) compared with the control (40%) and
acellular dermal matrix (29%) groups. In terms of negative healing parameters such
as neutrophil, eosinophil, lymphocyte and plasmocyte accumulation, dermal graft
and acellular dermal matrix groups showed significantly lower results compared
with those in the control group (p<0.05).
Conclusion:
In a rabbit animal model, autologous dermal graft improves the healing of

transsphincteric fistula.
-160-
OP - 124 FUNCTIONAL OUTCOME OF PATIENTS WITH
UNCOMPLICATED ACUTE SIGMOID DIVERTICULITIS AFTER
CONSERVATIVE AND SURGICAL TREATMENT: RISK FACTORS FOR
RECURRENCE
GIUSEPPE SALAMONE , JENNY ATZENI , LEO LICARI , GASPARE GULOTTA
UNIVERSITY OF PALERMO DEPARTMENT OF SURGICAL AND ONCOLOGICAL

DISCIPLINES, OPERATIVE UNIT OF GENERAL AND EMERGENCY SURGERY –
POLICLINICO P.GIACCONE, PALERMO
Background&Aims:
Sigmoid Diverticulitis (SD) is common in the West. Uncomplicated disease treatment

is broad spectrum antibiotic therapy with a recurrence rate of 36% instead of
surgical group <5%. The purpose is to assess functional outcome in both groups
and to identify risk factors (RF) for recurrence.
Methods:
Patients who underwent sigmoido-colectomy for SD were recruited retrospectively

over a 28-months period from January 2010 to May 2012. All patients were
contacted using a standardized questionnaire. Contingency tables were used to
identify RF for recurrence.
Results:
We included 51 patients (median age 59.5 years); 25 (49%) had uncomplicated

post-operative diagnosis of disease. 16 (64%) presented for their first episode and
9 (36%) had a prior history of SD in a median of 14 months. In both groups, after
surgical operation, recurrence rate and complication rate are 0% with an excellent
restoration of bowel function in 5 months. In conservative group, the history
showes a median of hospitalization for recurrence of 2.5. Covered perforation and
conservative treatment were considered RF of recurrence.
Conclusion:
Covered perforation and conservative treatment are RF for recurrence. Surgery

could be considered curative for a redundant and debilitating disease. Indications
for surgery should be based on individualized approach.
-161-
OP - 125 LAPAROSCOPIC INTERSPHINCTERIC RESECTION IN
TREATMENT OF VERY LOW RECTAL CANCER AFTER NEOADJUVANT
CHEMORADIOTHERAPY
GÖKHAN ÇİPE , SÜLEYMAN BOZKURT , ERKAN YARDIMCI , NAİM MEMMİ ,
MUSTAFA HASBAHÇECİ , HALİL COŞKUN , OĞUZHAN KARATEPE , MAHMUT
MÜSLÜMANOĞLU
BEZMIALEM VAKIF UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF

GENERAL SURGERY
Background&Aims:
Intersphincteric resection (ISR) is a valuable option for sphincter-preservation in

selected patients with very low rectal cancer. The aim of this study is to present
short-term outcomes of laparoscopic ISR after neoadjuvant chemoradiotherapy
(NC).
Methods:
From March 2011 to July 2012, the patients who underwent laparoscopic ISR after
NC included the study. The patient records were prospectively recorded in terms of
patient’s demographics, operative data, and postoperative complications.
Results:
Eleven patients (7 men and 4 women) underwent laparoscopic ISR. The median age
of the patients was 56 years (range 38-74). The median distance from the anal verge
to the tumor was 2.8 cm (range 2-4). The mean duration of surgery was 276 min
(range 189-405). The median postoperative hospital stay was 8 days (range 4-13).
There was no conversion to open surgery and there was no mortality. Postoperative
complications occurred in 2 (18%) patients. Anastomotic dehiscence was seen in
one patient, which managed conservatively. Stricture of the anastomosis was seen
in one patient, successfully managed by endoscopic dilatation. The median follow-
up period is 11 months (range 2-17). There was no local recurrence and the mean
bowel movement was 2.2/day (range 1-4).
Conclusion:
Laparoscopic ISR is feasible and a safe technique with favorable short-term oncologic
and functional outcomes after NC.
-162-
OP - 126 OUR “LIGATION OF INTERSPHINCTERIC FISTULA TRACT”
EXPERIENCE FOR COMPLEX ANORECTAL FISTULAS: IS IT A
PREFERABLE METHOD?
TAYFUN YOLDAS , ELA EKMEKCIGIL , CAN KARACA , TAYLAN OZGUR SEZER , CEMIL
CALISKAN , ERHAN AKGUN , MUSTAFA KORKUT
EGE UNIVERSITY FACULTY OF MEDICINE, GENERAL SURGERY DEPARTMENT, IZMIR,

TURKEY
Background&Aims:
Many treatment methods were described for anorectal fistulas but the best
technique is still controversial. Ligation of intersphincteric fistula tract (LIFT), is a
relatively new method which was developed escipecially for complex anorectal
fistulas. The aim of this study is to determine the results of our LIFT patients in
terms of recurrence and continence.
Methods:
Ten patients, who were operated in our department, betweeen November 2010 and
April 2012, by the same surgical team, due to complex anorectal fistulas with LIFT
method, were included in this study. Tracts were ligated from intersphincteric space
and extrasphincteric tracts were excised. Patients were evaluated retrospectively
according to age, gender, follow up time, recurrence and continence. For the
determination of recurrence and continence, patients were called for outpatient
control.
Results:
The mean age and age range of the 7 male and 3 female patients were 44.8 and 26
- 71 respectively. The median follow up time was 13.7 (4 - 21) months. Recurrence
was detected in 2 (% 20) patients while incontinence was not observed in any of
them.
Conclusion:
In conclusion, due to our limited experience, LIFT method seems to be a successful

method for complex anorectal fistulas with acceptable recurrence and incontinence
rates.
-163-
OP - 127 PEDIGREE, MISMATCH GENE DEFECT RATIO AND
MICROSATELLITE INSTABILITY RATIO COMPARISON OF LYNCH
SYNDROME, FAMILIAL AND SPORADIC COLORECTAL CANCER
PATIENTS
UTKU TANTOĞLU 1, SEHER YÜKSEL 2, HILAL ÖZDAĞ 3, HALDUN DOĞAN 3, CIHANGIR
AKYOL 1, NÜKHET KUTLAY 4, IŞINSU KUZU 2, MEHMET AYHAN KUZU 1
1
ANKARA UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY
2
ANKARA UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF PATHOLOGY
3
ANKARA UNIVERSITY, BIOTECHNOLOGY INSTITUTE
4
ANKARA UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF MEDICAL
GENETICS
Background&Aims:
Our aim is to detect MMR gene defects and MSI in the tumor tissue of the patients
that operated in our department and diagnosed as hereditary or sporadic colorectal
cancer.
Methods:
Pedigrees of the 512 patient that has been operated at our department and
diagnosed as colon or rectal cancer are evaluated by using Amsterdam II criterias.
3 groups formed; sporadic,Lynch syndrome and familial colorectal cancers (14
patients in each group).
Results:
Tumoral tissues evaluated by IHC and PCR. .Statistically significant difference

detected between sporadic colorectal cancer group and Lynch syndrome group
regarding of presence of MSI (p=0.013). Statistically significant difference detected
in this comparison (p=0.008).There was statistically significant difference between
Lynch syndorme group and sporadic group (p<0.002).Statistically significant
difference detected between familial and Lynch syndorme groups (p=0.058).In
total,14 patient has MSI and all of that patients has MMR gene deficiency.28 of
the patients were MSI negative and 10.7% (n:3) of these patients has MMR gene
deficiency.
Conclusion:
After these tests, pateints can offered to genetic tests for the absolute diagnosis.
Adequate information must be given to the patients and relatives for this disease
and appropiate refferance to the other departments for diagnosis and follow-up is
essential.
-164-
OP - 128 PREOPERATIVE CEA AND CA 19-9 LEVELS IN COLORECTAL
CANCER
ERDAL POLAT 1, UGUR DUMAN 2, MUSTAFA DUMAN 1, ALI E. ATICI 1, ENVER
REYHAN 1, TAHSIN DALGIC 3, ERDAL B. BOSTANCI 3, SINAN YOL 1
1
KARTAL KOSUYOLU HIGH SPECIALTY TRAINING AND RESEARCH HOSPITAL,
DEPARTMENT OF GASTROINTESTINAL SURGERY, ISTANBUL – TURKEY
2
BURSA SEVKET YILMAZ TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
GENERAL SURGERY, BURSA – TURKEY
3
TURKIYE YUKSEK IHTISAS TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
GASTROINTESTINAL SURGERY, ANKARA – TURKEY
Background&Aims:
Since the first introduction of tumor markers, there has been a challenging question
about the usefulness of these markers.The aim of this prospective study is to
investigate the relationship between the preoperative tumor marker levels and
different clinical aspects in colorectal cancer patients.
Methods:
One hundred thirty-one consecutive patients with confirmed diagnosis of colorectal

carcinoma and 131 subjects (age and sex matched) with no malignancy as control
group were included prospectively in this study. The relationships between tumor
markers CEA, CA 19-9 and stage of disease, tumor differentiation (grade), mucin
production, liver function tests, T stage, N stage, M stage were investigated.
Results:
CEA levels in patient group was significantly higher than the control group (p=0,001).
CEA levels in stage III (p=0,018) and IV (p=0,001) were significantly higher than in
stage I. The CEA levels were significantly elevated with spread to lymph nodes
(p=0,005) in patient group. Both tumor marker levels were significantly elevated
with the presence of distant metastasis in patient group (p=0,005 for CEA; p=0,004
for CA 19-9).
Conclusion:
Preoperative CEA and CA 19-9 levels may estimate lymph node invasion and distant
metastases in colorectal cancer patients.
-165-
OP - 129 QUANTITATIVE EVALUATION OF THE LAPAROSCOPIC
TOTAL MESORECTAL EXCISION IN MID-DISTAL RECTUM TUMORS
BY HISTOPATHOLOGIC EXAMINATION AND MAGNETIC RESONANCE
IMAGING FINDINGS
ENVER KUNDUZ 5, OKTAR ASOĞLU 1, BARIŞ BAKIR 2, EMRE BALIK 1, YERSU KAPRAN
3
, ETHEM NEZIH ORAL 4, ALI AKYUZ 1, DURSUN BUĞRA 6
1
ISTANBUL TIP FAKULTESI GENEL CERRAHI A.D
2
ISTANBUL TIP FAKULTESI RADYODIAGNOSTIK A.D
3
ISTANBUL TIP FAKULTESI PATOLOJI A.D
4
ISTANBUL UNIVERSITESI ONKOLOJI ENS. RADYASYON ONKOLOJISI
5
S.B ÇORUM BAYAT DEVLET HASTANESI
6
VKV AMERIKAN HASTANESI
Background&Aims:
Determining the quality of laparoscopic total mesorectal excision (TME) by

quantitative parameters, was aimed.
Methods:
The pelvic phase array MRI which belongs 56 rectum cancer cases, evauleted for
T-N staging, circumferential margin, mesorectum volum, tumor sizes, 9 pelvic
dimensions such as pelvic inlet and outlet diameters, sacral length , sacral depth
etc. and the angles between dimensions. Demographic datas, MRI findings and
pathologic results were compared for the confirm the impact on mesorectum
integrity after laparoscopic TME.
Results:
All pelvic dimensions except sacral length and depth were significiantly different
in males and females (p<0,02).Inunibiased samples tests dimension C (distance
between midpoint of sacral 3 vertebra and tip of coccyx) and D (Anterior-posterior
diameter of pelvic outlet) , angle 4 (between D and E (height of symphisis pubis ),
tumoral volum and lenght, LSM, which were determined in MRI 1 and MRI 2 were
related with the integrity of the mesorectum. In multivariete logistic regression
analyses no parameters were significiant.
Conclusion:
The bony pelvis may effect the pelvic dissection in rectal cancer surgery but
there is not any statistical significancy. It should show that the main effect on the
laparoscopic rectal surgery is the experience of the surgeon.
-166-
OP - 130 SAFETY AND ADVANTAGES OF LAPAROSCOPIC-ASSISTED
TRANSPERINEAL LOW RECTUM RESECTION
DUJO KOVACEVIC , AMIR IBUKIC
DEPARTMENT OF SURGERY, UNIVERSITY HOSPITAL CENTRE “SESTRE MILOSRDNICE”
Background&Aims:
Laparoscopic rectal surgery, for colorectal cancer has been developed recently.
However, due to relatively complicated anatomy and high requirements for surgery
techniques, laparoscopic resection of low rectum develops relatively slowly. This
study was designed to report our experience with new laparoscopic-assisted
transperineal rectal procedure in our Department of Surgery and the important
lessons we have learnt from this.
Methods:
Clinical and operative records of patients who have been operated using laparoscopic
techniques have been analysed and matched to open surgical procedures we
performed over the same period. All data were entered into a database and
analyzed using a statistical software package.
Results:
Mean operative time was longer for laparoscopic-assisted colectomy. Mean duration
of analgesic requirements, mean time to commencement on oral diet and mean
length of hospital stay were all shorter. Morbidity rates were lower. No respiratory
and local wound complications were found in our laparoscopic-assisted group.
Conclusion:
Laparoscopic-assisted tranasperineal rectal procedures performed in well-selected

patients have statistically and clinically significant benefits and it can be regarded as
a safe and effective procedure.
-167-
OP - 131 TREATMENT FOR HORSESHOE FISTULA WITH THE
MODIFIED HANLEY PROCEDURE USING A HYBRID SETON: RESULTS
OF 21 CASES
SEZAI LEVENTOGLU 1 , BAHADIR EGE 2 , B.BULENT MENTES 1 , MEHMET
YORUBULUT 3 , SECIL SOYDAN 1 , BÜLENT AYTAÇ 1
1
DEPARTMENT OF SURGERY, GAZI UNIVERSITY MEDICAL SCHOOL, ANKARA,
TURKEY
2
PRIVATE KORU HOSPITAL, DEPARTMENT OF SURGERY, ANKARA, TURKEY
3
PRIMER IMAGING CENTER, RADIOLOGY UNIT, ANKARA, TURKEY
Background&Aims:
To document our recent experience in managing horseshoe fistula of cryptoglandular

origin with a modification of the Hanley procedure using a hybrid elastic one-stage
cutting seton.
Methods:
Surgical outcomes by the modified Hanley procedure for horseshoe fistulae using
a hybrid seton from 2004 through 2010 were analyzed. The elasticity of a rubber
material was utilized, encircling the sphincter complex and precluding the need for
any additional maneuvers or adjustments performed by the patient or the surgeon.
In addition to excision of the superficial segments of the lateral tracts, deeper
extensions into the ischiorectal spaces were curetted, and penrose drains were
placed.
Results:
All of the patients were discharged on the first postoperative day. None required
readmission or needed narcotic analgesics after discharge. Complete healing was
achieved in all 21 cases at 8.0±3.22 weeks postoperatively. Patients were able to
return to regular work activity in 3.5±1 weeks. The postoperative Cleveland Clinic
Incontinence Score did not differ significantly from the preoperative score (p=0.317,
Wilcoxon’s test). Recurrent fistula was noted in a single patient (4.8 percent) after a
mean of 20.9-month’s follow-up.
Conclusion:
The use of the hybrid elastic seton is a useful and safe additional modification for
the treatment of horseshoe fistula with the Hanley technique.
-168-
OP - 132 PERITONEAL CARCINOMATOSIS: INTRAOPERATIVE
AND POSTOPERATIVE ASSESSMENT OF PATIENTS UNDERGOING
CYTOREDUCTION AND HIPEC
EVGENIA HALKIA , JOHN SPILIOTIS , ELIAS EFSTATHIOU , OURANIA
KALAIDOPOULOU , CHRISTOS ATHANASIOU , ANASTASIOS PAPATSAKONAS
METAXA CANCER HOPSITAL
Background&Aims:
Peritoneal carcinomatosis (PC) is associated with a poor prognosis and, once

diagnosed survival is generally less than 6 months. Cytoreductive surgery (CS) and
HIPEC plays an important therapeutic role in well selected patients with PC. The aim
of this study is to present a standard approach that has been successfully utilized In
80 patients at our center in the last 7 years.
Methods:
The population included 80 patients with peritoneal carcinomatosis (PC) from

colorectal, gastric, ovarian, sarcomas, mesothelioma and pseudomyxoma peritonei.
The peritoneal cancer index (PCI).
Results:
a) Patients with PCI< 16 were benefited from CS+ HIPEC. The mean survival in this
group of patients was 14.9 vs 6.4 months in patients with PCI> 16 (p<0.05) b) The
mean survival in patients with complete cytoreduction was 22,4m vs. 9.6m in the
patients with incomplete cytoreduction (p<0.05) c) Mortality - Morbidity There
were 2 postoperative deaths (2,5%). Thirty two patients (41%) had a grade III - IV
adverse events. d) Survival: The actual 5 year survival was 45.5 e) Hemodynamic
parameters during HIPEC are presented f) Laboratory parameters in patients g)
Anaesthesia manoeuvres In 45 from 80 patients an epidural catheter was inserted
(56,2%)
Conclusion:
Intra-operative and postoperative management is crucial and demands the

collaboration of different specialities.
-169-
OP - 133 RISK FACTORS OF POST-SURGICAL RECURRENCE IN
CROHN’S DISEASE PATIENTS: ROLE OF SUBMUCOSAL PLEXITIS.
PRELIMINARY RESULTS
GIOVANNI LOCHE 1 , GIOVANNI RIZZO 1 , SERENA LANGIU 1 , MARCO ANANIA 1 ,
PAOLO COSSU ROCCA 2 , ANTONIO MARIO SCANU 1
1
II° SURGICAL CLINIC, UNIVERSITY HOSPITAL OF SASSARI, ITALY
2
DEPARTMENT OF BIOMEDICAL SCIENCES, UNIVERSITY OF SASSARI, SASSARI, ITALY
Background&Aims:
It is known from the literature that about 80% of the patients develop relapse of
Crohn’s Disease (CD) after surgical resection. Some risk factors have been recognized
as responsible of early recurrence.
Methods:
We retrospectively analyzed a group of 38 patients that underwent surgical

intervention for CD. The patients were divided in two groups based on the presence
at follow up of disease recurrence. We analyzed general risk factors (modifiable and
not): lifestyle habits, disease history, medication and progression of the disease.
Furthermore, we reviewed the presence of submucosal plexitis in the histological
sections of the surgical resection margins of each patients.
Results:
Regarding the general risk factors our data were in agreement with the literature. In
addition, we detected the presence of sub-mucosal plexitis in 48.1% of patients with
an early recurrence and absence of sub-mucosal plexitis in patients without clinical
and instrumental evidence of recurrence (p value: 0.0063).
Conclusion:
The early identification of risk factors in patients at high risk of post-surgical relapse
allow to decide different surgical strategies, plan a strict follow-up or a more aggressive
medical therapy. Moreover, as described in some papers, our study support the
involvement of neural myoenteric plexus in the pathogenesis of the disease.
-170-
-171-
OP - 134 POSTOPERATIVE VENOUS THROMBOEMBOLISM
PROPHYLAXIS PRACTICES IN INDIA- A SURVEY
ANIKETH VENKATARAM , SHIVASHANKAR SANTHOSH , RAJASHEKARA BABU ,
SADASHIVAIAH SHIVASWAMY
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
Background&Aims:
In spite of numerous guidelines and effective prophylactic agents, audits from

several countries have demonstrated that appropriate thromboprophylaxis is not
being offered to large numbers of surgical patients. Such audits are lacking in Indian
practice. To study the existing practice of thromboprophylaxis methods amongst
general surgeons in Bangalore.
Methods:
A twenty point questionnaire covering all aspects of VTE prophylaxis practice was
distributed to a cross section of 120 active consultant surgeons in Bangalore, and
analyzed.
Results:
Majority (95%) of surgeons reported encountering VTE in their practice, with almost
50% having encountered mortality. Almost 30% of surgeons believed Indians to be
at the same risk as western populations. Despite 95% of surgeons practicing VTE
prophylaxis, only 25% reported the presence of an institute based protocol. The
remaining 75% agreed on the need for the same. The common concerns were fear
of haemorrhage, and cost. Most surgeons preferred to use low molecular weight
heparin which was continued till patient was ambulant, following which 33%
reported having encountered haemorrhagic complications.
Conclusion:
This study highlights the lack of proper enforcement of VTE prophylaxis among
Indian surgeons. In view of the perceived lower propensity of the Indian population
for VTE, there is a need for an Indian protocol of prophylaxis to be adopted by all
surgeons.
-172-
OP - 135 PREOPERATIVE BRAIN NATRIURETIC PEPTIDE (BNP) IS A
BETTER PREDICTOR OF ADVERSE CARDIAC EVENTS COMPARED TO
PREOPERATIVE SCORING SYSTEM IN PATIENTS WHO UNDERWENT
ABDOMINAL SURGERY
ANDREA KAZEMI NAVA 1, PAOLO MERCANTINI 1, ANDREA SAGNOTTA 1,
ALESANDRA SARAGNA 1, LAURA MAGRINI 2, SALVATORE DI SOMMA 2, VINCENZO
ZIPARO 2
1
DEPARTMENT OF GENERAL SURGERY, SAPIENZA UNIVERSITY OF ROME,
SANT’ANDREA HOSPITAL, ROME, ITALY
2
DEPARTMENT OF EMERGENCY, SAPIENZA UNIVERSITY OF ROME, SANT’ANDREA
HOSPITAL, ROME, ITALY
Background&Aims:
Cardiovascular disease is the leading cause of perioperative death in surgical
patients. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left
ventricular systolic dysfunction and predicts first cardiovascular event and death
in the general population. We present a prospective, single-center, observational
cohort study of patients undergoing major abdominal surgery and evaluate the role
of BNP in predicting adverse cardiac events.
Methods:
A total of 205 patients were included in the study. All patients were assessed by
a cardiological clinical evaluation, a 12-lead ECG report, and a preoperative and
postoperative blood sample for plasmatic BNP assessment. The primary end point
was the predictive power of preoperative BNP levels for adverse cardiac events
until 30 days after discharge.
Results:
Thirty-one of 205 (15%) patients had adverse cardiac events in the postoperative
period up to 30 days after discharge. Five patients (2.4%) of these died of cardiac
events. Preoperative BNP values were significantly increased in the 31 patients
compared to the other patients in the postoperative period [mean = 112.93 pg/ml
(range = 5–2,080) vs. 178.99 pg/ml (range = 5–3,980); median = 117 vs. 23 pg/ml;
95% CI = 49–181; p \ 0.0001]. At logistic regression, a preoperative BNP value of [36
pg/ml was the only effective predictor of adverse cardiac events.
Conclusion:
We have demonstrated that elevated preoperative BNP levels are independent
predictors of adverse cardiac events in a cohort of patients undergoing major
abdominal surgery in a general surgery department, and this is the first study about
this specific cohort of patients.
-173-
OP - 136 NUTRITION IN THE ACUTELY ILL SURGICAL PATIENT
UCHE ODUOZA , SANDEEP SAXENA , GEETINDER KAUR
SCUNTHORPE GENERAL HOSPITAL
Background&Aims:
There is a hypermetabolic response to acute illness, including post-surgery, burns

or trauma. Energy requirements can increase by 30%; insulin resistance also
increases. There are fluid and electrolyte losses with often significant fluid shifts.
Malnutrition can lead to many adverse outcomes including longer recovery times.
UK NICE guidance states: For patients at risk, start rehabilitation as early as clinically
possible... include nutrition support. We aimed to look at the nutritional support in
our acutely ill and post-operative patients.
Methods:
Data regarding nutritional plans was collected from 20 patient notes in a snapshot
audit of patients in the High Observation Unit (HOBS), which is a step down from
HDU and ICU. Evidence was collated and analysed.
Results:
Though about 50% patients were eating/ drinking as part of the Enhanced Recovery
program after surgery, 35% patients had no nutrition plan documented and 25%
had no nutritional information present in their records. 55% had no plan in place
before admission to HOBS and 55% had no record of dietician ever being consulted!
Conclusion:
All patients should have a nutritional plan in place, especially in the acutely ill and
post-operative periods. Along with obvious patient benefits of improved recovery
and better outcomes, thus reducing hospital stay, there are also important cost
benefits for the hospital.
-174-
OP - 137 LOCAL EXPPERIENCE OF MOIST EXPOSURE BURN
OINTMENT (MEBO) IN DIABETIC FOOT ULCERS
ABDULHAKIM AL-TAMIMI
UNIVERSITY OF ADEN - YEMEN
Background&Aims:
MEBO is an ointment made of natural component including pure honey, sesame

oil, bees wax, seventeen amino acids and fatty acids. To identify the useful effect of
MEBO in the treatment of diabetic foot ulcer. Duration of healing when using MEBO
as drug to promote the healing. Cost effectiveness of the drug.
Methods:
This is prospective study performed in the period between April 2006 and December
2007. 126 patients (90males and 36 females) Presenting to Al-Wally private clinic
Aden, Yemen .Complaining of diabetic foot ulcer All of them used MEBO after
controlled the infection. The wound cleaned first with povidone and normal saline
Results:
One twenty six patient were enrolled in this study (90 males 71%, 36females 29%)
114 of them more than 40 years (90%), and 96 patients76%) were type II diabetes.
In 108 patients the ulcer was located in the planter aspect and similar number of
patients had neuropathic ulcer and more than the half of the patients 52% had
diabetes for more than ten years. 114 patients also were retired, housewife female
and farmers. There are no much differences in the affected foot. , for 90 patients it
coasted less than 500$ until complete healing.
Conclusion:
The use of MEBO was dramatically improved the granulation tissue and wound
healing especially in deep ulcers ,MEBO was more superior than other drugs used
to promote healing and MEBO shown to be more cost effective.
-175-
OP - 138 SEAT BELT USE AND ITS EFFECT ON ABDOMINAL TRAUMA:
A NTDB STUDY
OZGUR ALBUZ , NICK NASH , OBI OKOYE , EFSTATHIOS KARAMANOS , DEMETRIOS
DEMETRIADES
UNIVERSITY OF SOUTHERN CALIFORNIA
Background&Aims:
We sought to revisit this topic with a more comprehensive patient population

using The National Trauma Databank(NTDB) to determine the demographics,
associated abdominal injuries, outcomes of those patients who are restrained
versus unrestrained.
Methods:
Univariate comparisons were performed using Chi-square tests for categorical

variables,the MannWhitneyU test for continuous variable.Logistic regression
modeling was used to identify the impact of seatbelt use on selected outcomes.
Results:
Totally154,416 motor vehicle crash victims were included in the study.72,802(47%)

were seat belted(SB)and81,614(53%)weren’t belted.SB use was associated with a
significantly lower mortality than unrestrained victims(1.9% vs.3.3%P<0.001).The
overall incidence of intra-abdominal injuries was 23806(15.4%).In SB patients,
there was a significantly lower incidence of solid organ injuries(11.9% vs.15% P
<0.001and a higher incidence of hollow viscous injuries(2.3%vs.1.5%,P<0.001).The
hospital and intensive care unit(ICU)length of stay(LOS) were significantly shorter in
belted victims(5.2 ±7.8vs6.3 ±9.7,P<0.066)(5.5 ±7.8 vs6.1±8.5,P<0.001).
Conclusion:
Accident victims that are SB have a significant reduction in mortality,a shorter

hospital stay,decreased LOS in the ICU as compared to those who aren’t restrained.
Although the overall incidence in intra-abdominal injuries was similar in SB and
nonSB patients, the nature of these injuries was significantly different,with a
higher incidence of hollow viscous injury in the SB group.There wasn’t difference in
diaphragmatic injuries between the trauma groups.
-176-
OP - 139 THE COMPLICATIONS AND TOXICITY AFTER
CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL
CHEMOTHERAPY
ARAS EMRE CANDA , SELMAN SOKMEN , CEM TERZI , CIGDEM ARSLAN , MEHMET
FUZUN
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF SURGERY
Background&Aims:
The purpose of our study was to evaluate the perioperative complications, toxicity,
mortality rates after cytoreductive surgery (CRS), and effects of hyperthermic
intraperitoneal chemotherapy (HIPEC) used in the treatment of peritoneal surface
malignancies.
Methods:
Between September 2007 and March 2012 we performed 118 CRS and HIPEC on
115 patients with peritoneal carcinomatosis (PC). Systemic toxicities were graded
according to the National Cancer Institute (NCI) Common Terminology Criteria for
Adverse Events (CTCAE) version 3.0 criteria and were analyzed from a prospectively
collected database.
Results:
Perioperative grade 3-4 morbidity and mortality rates were 21.2% and 7.6%,
respectively. We observed toxicity in 25.4% of the patients, nephrotoxicity in 18.6%,
and hematological toxicity in 13.6% of the patients. Grade 3-5 nephrotoxicity and
hematological toxicity rates were 5.9% and 8.5% respectively; 7 patients required
hemodialysis for the treatment of nephrotoxicity. The grade 3-4 surgical complication
rate was 11.9%, and 4 patients underwent 6 reoperations for perioperative surgical
complications. No significant difference was observed among age, gender, PCI and
CC scores, origin of the primary tumor, and occurrence of toxicity and surgical
complications. Prolonged operation times resulted in higher complication and
toxicity rates (P<0.01).
Conclusion:
CRS and HIPEC is a combined treatment strategy for peritoneal surface malignancies
with acceptable complication and toxicity rates.
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OP - 140 SUCCESS OF STANDARDIZED PATIENT ORIENTED SURGICAL
TECHNIQUE BY A SINGLE SURGEON FOR HEMODIALYSIS ACCESS.
TARIK ZAFER NURSAL
MEDLINE ADANA HOSPITAL
Background&Aims:
Hemodialysis access is of paramount importance for end-stage renal failure (ESRF)

patients. Creation and maintenance of arteriovenous fistula (AVF) by a dedicated
team increases the success and duration of the hemodialysis. The aim of this study
is to report a patient oriented standardized surgical technique performed by a
single surgeon on the success of AVF creation.
Methods:
The setting is a private hospital with the surgeon is experienced on AVF creation.
The patients were examined and operated on by a previously defined standard
protocol. The records of all patients who were operated for AVF creation through a
3 year period were included.
Results:
A total of 221 procedures were done for 209 patients. The mean age was 65 ±11,4
years. Immediate function rate was 96,4% (n=213). Follow-up was possible for 182
patients (%82,3). For an average follow-up time of 11,3 months the death rate was
20,8% (n=38) and the rate of AVF patency was 73,7% (n=134).
Conclusion:
Sustaining patency of AVF is difficult in these systemically deranged patients. A

focused approach by a dedicated team will increase the success rate.
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-179-
OP - 141 CONVERSION FROM LAPAROSCOPIC ADJUSTABLE GASTRIC
BANDING TO LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS:
EXPERIENCE OF A HIGH-VOLUME REVISIONAL BARIATRIC CENTRE
GOUDSMEDT FRANCIS , VERCAUTEREN CHARLOTTE , DE VISSCHERE MARIEKE
, AKIN FAKI , VANDENHAUTE SARAH , VAN CAUWENBERGE SEBASTIAAN ,
DILLEMANS BRUNO
AZ SINT JAN BRUGGE
Background&Aims:
Conversion from laparoscopic adjustable gastric banding (LAGB) to Roux-en-Y

gastric bypass (RYGB) can be mandatory to achieve additional weight loss or to
resolve complaints following LAGB. The safety of this revisional procedure has only
been reported in small study groups. The aim of this study was to determine the
early mortality and morbidity, and to evaluate whether a single-step procedure is
as safe as a two-step procedure.
Methods:
Four hundred and four patients were included between 2004 and 2011. Either a
single-step procedure (LABG removal combined with RYGB) or a two-step procedure
(LABG removal followed by RYGB in a second procedure) was performed. An analysis
of the 30 day morbidity and mortality was performed.
Results:
A single-step procedure was performed 279 patients (69.1%), a two-step procedure

in 125 (30.9%). No mortality or postoperative leakage was observed, haemorrhage
occurred in 3.0% of the patients. Increased experience led to more single-step
procedures without an increase in complications.
Conclusion:
Conversion of adjustable gastric banding to laparoscopic Roux-en-Y gastric bypass is

a therapeutic option with a very low morbidity and zero-mortality. Performing this
procedure in a single step does not increase the short-term complications when
performed in a high-volume revisional bariatric centre.
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OP - 142 STANDARDIZATION OF THE FULLY STAPLED LAPAROSCOPIC
ROUX-EN-Y GASTRIC BYPASS FOR OBESITY REDUCES EARLY
POSTOPERATIVE MORBIDITY AND MORTALITY: A SINGLE CENTER
STUDY ON 4000 PATIENTS
AKIN FAKI , GOUDSMEDT FRANCIS , VAN DESSEL ELS , MULIER JAN-PAUL , VAN
CAUWENBERGE SEBASTIAAN , DILLEMANS BRUNO
AZ SINT JAN BRUGGE
Background&Aims:
Various techniques of laparoscopic Roux-en-Y gastric bypass have been described.

We completely standardized this procedure to minimize morbidity and mortality.
This study describes our experience with the standardized Fully Stapled Laparoscopic
Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-days morbidity and
mortality.
Methods:
We retrospectively analyzed 4000 patients who underwent FS-LRYGB between

2004 and 2010. Hospital stay and readmission, re-operation and 30-day morbidity/
mortality rates were calculated.
Results:
There were 911 male and 3089 female patients with mean age 39.7 years, mean
BMI 41.51 kg/m². The mean hospital stay was 4.2 days. The overall complication
rate was 199/4000 (4.9%) with haemorrhage as most prevalent complication (2.7%).
Further complications included anastomotic leak (0.15%), intestinal obstruction
(0.10%) and others (1.80%). One patient died of a severe pneumonia within 30 days
of surgery.
Conclusion:
The systematic approach and the full standardisation of the FS-LRYGB procedure
contribute highly to the very low mortality and morbidity rates in our high volume
bariatric centre. Haemorrhage appears to be the most common complication, but
is self limiting in the majority of cases.
-181-
OP - 143 THE ROLE OF LAPAROSCOPIC SLEEVE GASTRECTOMY
IN THE TREATMENT OF MORBIDLY OBESE CHILDREN AND
ADOLESCENTS: WHERE ARE WE NOW?
VAN CAUWENBERGE SEBASTIAAN , DILLEMANS BRUNO , AKIN FAKI , GOUDSMEDT
FRANCIS
AZ SINT-JAN HOSPITAL BRUGGE
Background&Aims:
Laparoscopic sleeve gastrectomy (LSG) is a restrictive technique that nowadays

is performed more frequently by bariatric surgeons. Theoretically, LSG may be
the ultimate operation for children and adolescents, because it does not involve
malabsorptive side effects.
Methods:
This presentation focuses on the current available data in the medical literature
regarding LSG and its results in the pediatric population.
Results:
Data on LSG in children and adolescents are very limited. To date, only small series
with limited postoperative follow-up have been published in the medical literature.
However, both vitamin B12 and iron deficiencies are reported. Also on the hormonal
level, the operation is not without a risk. Ghrelin plays an important role in growth
hormone release and bone mineralization during childhood, putting a child after
LSG at a potential risk for growth disturbances and osteomalacia later in life.
Conclusion:
Until more long-term data are available, LSG should be considered investigational
and should not be implemented in a pediatric bariatric surgical practiceexcept
within the context of a controlled prospective study. In the meantime, surgeons
should be encouraged to report their long-term results and to participate in further
research regarding the procedure.
-182-
OP - 144 THE EVALUATION OF MONONUCLEAR CELLS FROM
TUMOR MICROENVIRONMENT IN GASTRIC CANCER PATIENTS.
O. BILGEHAN POYRAZOGLU 1, HIZIR YAKUP AKYILDIZ 1, ERDOGAN SOZUER 1,
ORHAN K. POYRAZOGLU 2, MUHAMMET AKYUZ 1, ALPER AKCAN 1
1
ERCIYES UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT
2
KAYSERI TRAINING AND RESEARCH HOSPITAL
Background&Aims:
There are several reports to understand the function of cellular immunity in

gastric cancer (GC). However, we do not know whether biological properties of
GC microenvironment are similar with those in peripheral blood of GC patients.
Therefore, our aim was to develop a surgical approach to collect blood from the GC
through coronary vein (CV) and characterize and compare immune cells collected
from the CV with those from peripheral blood of GC.
Methods:
33 GC and 17 elective cholecystectomy patients (control group, CP) enrolled to the

study prospectively. At the beginning of the surgical procedure blood was collected
from both CV and antecubital veins of the GC patients and only from antecubital
vein of the CP. Mononuclear cells were determined by flow-cytometry.
Results:
The percentage of T regulatory cells was significantly increased in GC patients than

CP and positively correlated with stage of the cancer. The percentage of monocyte
and dendritic cell precursors collected from tumor draining venous system was
significantly decreased compared to those from peripheral vein in GC patients. On
the other hand, natural killer cells percentage was significantly increased in CV and
negatively correlated with the stage of the cancer.
Conclusion:
Our results not only showed significantly higher percentage of T regulatory cells,
but also a decrease in the percentage of monocyte and dendritic cell precursors and
an increase of NK cells in the gastric tumor microenvironment suggesting that they
may contribute to tumor pathogenesis.
-183-
OP - 145 TUMORAL CHARACTERISTICS OF GASTRIC
ADENOCARCINOMA AFFECTING POSITIVE PERITONEAL WASHING
CYTOLOGY AND PARA-AORTIC LYMPH NODE SAMPLING.
MUSTAFA HASBAHCECI , NAIM MEMMI , GOKHAN CIPE , ERKAN YARDIMCI ,
YELIZ EMINE ERSOY , HUSEYIN KADIOGLU , SULEYMAN BOZKURT , MAHMUT
MUSLUMANOGLU
BEZMIALEM VAKIF UNIVERSITY FACULTY OF MEDICINE DEPT OF GENERAL

SURGERY
Background&Aims:
Accurate staging of gastric tumors including peritoneal spreading and extensive

lymph node involvement is important for determination of treatment strategy.
Therefore, it was aimed to evaluate T and N findings, and localizations of gastric
adenocarcinomas affecting positive peritoneal washing cytology and para-aortic
lymph node sampling.
Methods:
Intra-operative analysis of peritoneal washing cytology and para-aortic lymph nodes

were performed during surgical treatment of resectable gastric adenocarcinoma
patients.
Results:
Study group included 13 female and 21 male patients with a mean age of 61 years
(range 28-88 years). There were 8 T2, 11 T3 and 15 T4 tumors. Lymph node staging
was N0 in 2, N1 in 5, N2 in 5 and N3 in 22 cases. Upper, middle and lower gastric
tumors were found in 5, 12 and 15 patients, respectively. There were two linitis
plastic type tumors. Positive cytology was detected in nine out of 34 patients
(%26.5), and it was seen more commonly in T3-4 (%89) and N3 (%89) tumors.
Positive lymph node involvement which was seen only in N2-3 tumors was detected
in seven out of 25 patients (%28).
Conclusion:
Positive cytology and para-aortic lymph node involvement seem to be related with
T3-4 and N2-3 stages of gastric adenocarcinomas.
-184-
OP - 146 SURGICAL TREATMENT OF CERVICAL ESOPHAGUS
AND HYPOPHARYNX CANCERS. “FREE JEJUNAL AUTO-
TRANSPLANTATION WITH A GRAFT OF TWO PEDICLES
LEVENT AVTAN , CAVİT AVCI
DEPARTMENT OF GENERAL SURGERY, UNIVERSITY HOSPITAL, İSTANBUL FACULTY

OF MEDICINE, TURKEY
Background&Aims:
There are three main surgical methods for the reconstruction of the digestive
tract in the neck after the resection of the cervical esophagus and hypopharynx:
Gastroplasty, coloplasty, and free jejunoplasty. We aimed to use the free jejunoplasty
with two pedicle in a groups of patients to reduced the risk of fistulas and necrosis
of the graft.
Methods:
The method for the free jejunoplasty is less invasive, compared to the others in
which the entire stomach or a long segment of the colon with the pedicle is used.
Whereas, in the technique of free jejunal auto-transplantation only a short piece
of 10-15cm jejunum is used. However, this technique needs microsurgery with for
microvascular anastamosis. Right and good microvascular anastomosis between
the artery and the vein of the graft with the vessels of the neck is the key for the
success in this technique. In general, surgeons prepare a jejunum graft with a single
pedicle containing only one artery and one vein. If a problem occurs pre or post
operatively on this arterial or veinous microanastomosis, the circulation of the graft
can be affected, and that can be the cause of fistula or necrosis due to insufficient
or poor revascularization. To reduce and even prevent the fistula or necrosis, we
created a special technique and used it on a series of 24 consecutive patients. Our
technique consist in taking a 12-15 cm jejunal graft with two pedicles which each
contains an artery and a vein (so a total of 2 arteries and 2 veines).
Results:
On the series of 24 cervical esophagus and hypopharynx cancer patients, we had

only one minimal fistula that spontaneously recovered on the 3rd post operative
week, and we had no necrosis. All of the patients left the hospital on the 2nd
week (except the patient with the fistula), eating and drinking normally and they
were responding very well to their treatments. All the patients had a radiotherapy
complementary treatment.
-185-
Conclusion:
After performing 4 microvascular anastomoses, the graft’s revascularization was

perfect, much better than the graft of one pedicle with one artery and one veine.
This technique is secure, because if there is a problem on one or two vessels, the
others saves the vitality of graft. According to the results we have obtained, we
are able to advice the free jejunum auto-transplantation technique to reconstruct
the alimentary tract in the neck, after laryngo-pharyngo-cervical esophagectomy
due to cancers. The advantages of this technique are multiple;- The diameter of
the jejunum and the esophagus are very similar and provides a good peristaltism
to the esophagus for swallow, - The rich vascular anatomy of the jejunum and the
neck helps the revascularisation of the graft, and- The resection of only a 12-15
cm portion of the jejunum is not mutilating. Finally, reconstruction of the cervical
esophagus with the technique of double pedicle free jejunal auto-transplantation
is more efficient and less invasive according to our results of a group of patients.
-186-
-187-
OP - 147 CURENT AND FUTURE PERSPECTIVE IN LIVER TUMORS
THERAPY – MAGNETIC RESONANCE GUIDED FOCUSED
ULTRASOUND IN MOVING ORGANS - FUSIMO PROJECT
TIU CALIN
MEDIS FOUNDATION
Background&Aims:
High intensity ultrasound therapy is a method of ablative therapy, which has

imposed itself in recent years, being appreciated both for the “non touch” approach
to the patient and for the specific performances, such as: precision of the sonication
and consequently the absence of lesions in the neighboring structures, safety in
administration, lower costs, avoid hospitalization. The approach of malignant lesions
in moving organs is quite limited, at this moment the sonication can be done only in
the context of mobile organs only in association with general anesthesia, during the
controlled apnea period FUSIMO project aims at finding technical solutions targeting
and real-time tracking of moving targets by the ultrasound beam, the entire process
being guided and thermal controlled by MRI.
Methods:
It is also advisable, to use a robotic system (INNOMOTION) to transfer the planned

position of the FUS probe from the software system into the interventional situation.
Likewise, in an experimental environment, it can be shown that real-time targeting
of the focal spot (by a phased-array transducer), based on the motion of organs is
feasible.
Results:
Regarding the project FUSIMO, hepatocellular carcinoma of the liver is the main
object of study, although, if necessary, kidneys are also an alternative to consider
for this purpose (there is data available on this topic from cadaver models). Since
most of the liver is located behind the ribcage, an increased attention of FUS probe
technology is requested in this case.
Conclusion:
Above all things, the modeling – simulation process depends largely on the facilities
that can provide a Thiel cadaver. Thiel soft-fixed cadavers offer a unique “human
model”, for this reason the research validation will require characterization of
behavior and response from the Thiel tissue, in order to allow direct comparison
with clinical data obtained from living people. Among all local ablative techniques,
FUS is the most recently developed and the only truly non-invasive, since it is a
completely extracorporeal treatment
-188-
OP - 148 EVALUATION OF THE VIABILITY OF PROTOSCOLICES
SPRAYED ON SCOLICIDAL AGENT-SOAKED SPONGES AND EFFECTS
OF SCOLICIDAL AGENTS ON DAUGHTER CYSTS
ALI KAGAN GOKAKIN 1, OMER TOPCU 1, COSKUN AVCI 1, MUSTAFA ATABEY 1,
BORAN CIHAT KARAKUS 1, ZEYNEP SUMER 2
1
SURGERY, SIVAS/TURKEY
2
DEPARTMENT OF MICROBIOLOGY, FACULTY OF MEDICINE, CUMHURIYET
UNIVERSITY, SIVAS
Background&Aims:
Instillation of a scolicidal-agent is not suitable for large cysts with multiple daughter
cysts and cysto-biliary communication. To avoid fluid spillage, protecting the
pericystic area with scolicidal-agent soaked sponges is recommended. Our aim
was to evaluate the viability of protoscolices sprayed on scolicidal- agent soaked
sponges and the efficacy of scolicidal- agents on daughter cysts.
Methods:
Small (1 x 1 cm) pieces of sponge were cut and soaked in 0.04% chlorhexidine
gluconate (Chx-Glu), 0.5% silver nitrate (SN), 10% polyvinil pyrolidon iodine (PVP-I),
and 0.9% saline as a control. A drop of protoscolices rich sediment was sprayed on
each sponge. After 15 and 30 min, protoscolices were examined microscopically for
viability. Then 60 ml from each scolicidal agent and 0.9% saline were put into sterile
glass bottles and daughter cysts were added. After 5, 15, 30, and 60 min, 5 daughter
cysts from each group were punctured and the contents assessed for protoscolices
viability under light microscopy.
Results:
Chx-Glu (0.04%) were the most effective scolicidal agent and killed all the
protoscolices after 15 min.
Conclusion:
Use of sponges soaked with scolicidal- agent may provide both mechanical and
chemical barriers if the correct agent (0.04% Chx-Gu) is chosen
-189-
OP - 149 COMPARISON OF THREE TYPES OF FLAP PROCEDURES IN
THE TREATMENT OF PILONIDAL SINUS DISEASE: A PROSPECTIVE
RANDOMİZED STUDY
KEMAL ARSLAN , SAİD KÖKÇAM , HANDE KÖKSAL , ERSİN TURAN , ARİF ATAY ,
OSMAN DOĞRU
KONYA EDUCATION AND RESEARCH HOSPITAL, CLINICS OF GENERAL SURGERY.

KONYA/ TURKEY
Background&Aims:
In the treatment of pilonidal sinus many kinds of surgical procedures were defined
but each of them has its own advantage and disadvantages. The current study
analyzed the outcomes of the rhomboid excision and the Limberg flap (LF), the
modified Limberg flap (mLF) and Karydakis flap procedures (KF).
Methods:
295 patients were enrolled in this prospective randomized study between 2009
and 2010. Recurrent cases, complicated cases, patients with pilonidal abscess and
patients with co-morbid diseases which affects wound healing were excluded. In
Group 1,LF was performed on 96 patients. In Group 2, mLF was performed on 108
patients and in Group 3, KF was performed on 91 patients.
Results:
The mean follow-up period was 33.1 ± 4.9 months. There were no significant
statistical difference between the groups by means of age, gender, body mass index,
operation time, hospitalisation time, time to return to work, complete healing time,
wound complications and patient satisfaction. Recurrence rates were 6.3%, 1.9%
and 11% respectively which was significantly higher in KF group .
Conclusion:
Although mLF procedure is similar with other types of flap procedures, it seems to
have lower recurrence rates and should be the first choice in pilonidal sinus surgery.
-190-
OP - 150 CLINICAL ASSESSMENT OF INTESTINAL OBSTRUCTION IN
PATIENTS WITH PERITONEAL CARCINOMATOSIS.
DAUREN SARSENOV , AYSE ESRA ÇELEBİ , AHMET BÜLENT DOĞRUL , MEHMET
BÜLENT TIRNAKSIZ
HACETTEPE UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF GENERAL

SURGERY
Background&Aims:
The aim of this study was to reveal if computed tomography findings can be
satisfactorily reliable modality to guide the clinical choice of management in
patients with intestinal obstruction with peritoneal carcinomatosis.
Methods:
Relevant data of 95 patients who have been managed either surgically or

conservatively between January 2005 to June 2012 have been retrospectively
collected. Overall survival, parameters of quality of life were assessed.
Results:
At the time of first obstruction episode patients’mean age was 54.8±3.01 years,
of 95 patients 35.8% were male and 64.2% were female. The mean time between
diagnosis of peritoneal carcinomatosis and first obstruction episode was 7.78±0.34
months. 36 patients (37.2%) were operated, while 59 patients (62.1%) were
managed conservatively. In total, 78 patients (82.1%) had computed tomography at
admission. 27 patients in operated group (75.0%) had CT scan, 51 patients (86.4%)
in conservative management group had CT scan. Mean overall survival among
operated group was 23.02±4.45 months, in conservatively managed group it was
28.28±3.48 months.
Conclusion:
Patients known to have peritoneal carcinomatosis with clinical evidences of

obstruction don’t obligatory have to have CT scan and consequently don’t have to
be operated with some logical exception for emergent signs as for perforation signs,
intraabdominal infectious states etc.
-191-
OP - 151 COMPARISON OF Z-PLASTY, LIMBERG FLAP, AND
ASYMMETRIC MODIFIED LIMBERG FLAP TECHNIQUES FOR THE
SACROCOCCYGEAL PILONIDAL SINUS TREATMENT
BARIŞ KARAKAŞ
DEPARTMENT OF GENERAL SURGERY, ANTALYA TRAİNİNG AND RESEARCH

HOSPİTAL, ANTALYA-07030, TURKEY (CURRENTLY)
Background&Aims:
The aim of this study is to demographically and clinically analyze early complications
and recurrent results of Z-plasty, Limberg flap, and asymmetric modified Limberg
flap, which surgically provide natal cleft flattening for the sacrococcygeal pilonidal
sinus treatment. To our knowledge, this is the first comparison among the three
techniques in terms of the surgical outcome of patients.
Methods:
Between March 2009 and February 2010, a total of 45 patients with pilonidal sinus
were retrospectively analyzed. 10 of 45 patients (22.2%) required Z-plasty; 24
patients (53.3%) had surgery with Limberg flap closure, and 11 patients (24.4%)
had asymmetric modified Limberg flap.
Results:
In every case, the drain was removed after an average duration of 4.31± 2 (range,
2–12) days. We compared the length of stay in hospital, time return to usual
activities, postoperative complications, and recurrence rate. The mean follow-up
was 22.4 (range, 18–24) months. Recurrence was not seen in any of the patients.
Conclusion:
Our results were similar: the comparison of the three techniques revealed no
significant differences regarding early complications and recurrence.
-192-
OP - 152 EARLY PERIOD ANALYSIS OF 162 PATIENTS TREATED WITH
MODIFIED LIMBERG FLAP METHOD.
MUHARREM OZTAS 1, HUSEYIN SINAN 1, MEHMET SAYDAM 1, HALIL KORAY SEZER 2,
EYUP DURAN 3, MEHMET YILDIZ 1
1
GENERAL SURGERY DEPARTMENT, ANKARA MEVKI MILITARY HOSPITAL, ANKARA,
TURKEY
2
GENERAL SURGERY DEPARTMENT, BALIKESIR MILITARY HOSPITAL, BALIKESIR,
TURKEY
3
GENERAL SURGERY DEPARTMENT, ELAZIĞ MILITARY HOSPITAL, ELAZIĞ, TURKEY
Background&Aims:
The aim is to share early postoperative results after surgery for pilonidal sinus
disease using the modified Limbergflap technique.
Methods:
This retrospective study analyzed all patients in our clinical database with pilonidal
sinus disease who received surgical treatment with the modified Limberg flap
technique from September 2011 to February 2012.
Results:
During the study period, 162 patients met study criteria. All patients were males.
Mean age was 22.1±3.2 years (range, 17-34 years), mean duration of complaint was
22.1±11.1months (range, 6-60 months), and mean operation time was 37.2±5.9
minutes. Thirty-five of the 162 patients underwent surgery for recurrence of their
pilonidal sinus disease. Postoperative care for all patients included drains and double
antibiotic prophylaxis (cefoperazone and metronidazol).The drains were removed
on postoperative day 1 for 43 patients and day 2 for 104 patients. Mean drainage
volume was 36.4±13.2 cc (range, 15-90cc) on postoperative day 1, and 23.53±9.8 cc
(range, 10-60 cc) on day 2. Surgical site infection occurred in 3 patients, bleedingin
1 patient, and minimal wound dehiscence in 12 patients. For the 3 patients with
surgical site infection, we reversed the flap transposition and left the wound open
for secondary healing.
Conclusion:
A rapid healing process and short recovery time make the modified Limberg flap
transposition one of the besttreatment options for both primary pilonidal sinus
disease and recurrence.
-193-
-194-
POSTER PRESENTATIONS
-195-
PP - 1 MILK FISTULA SUCCESFULLY TREATED WITH CABERGOLINE
ALI CIHAT YILDIRIM 1, HASAN BOSTANCI 1, PINAR YILDIZ 2, MUSTAFA YILDIZ 3
1
DISKAPI YILDIRIM BEYAZIT TRAINING AND RESEARCH HOSPITAL GENERAL
SURGERY CLINIC, ANKARA,TURKEY
2
TURKISH MINISTRY OF HEALTH, MUS BULANIK STATE HOSPITAL, INTERNAL
MEDICINE CLINIC, MUS, TURKEY
3
TURKISH MINISTRY OF HEALTH, MUS BULANIK STATE HOSPITAL, GENERAL
SURGERY CLINIC, MUS, TURKEY
Introduction:
Milk fistula is a tract between a lactiferous duct and the skin, acquiring during
lactation and usually associated with a surgical operation.It is located directly to the
site of previous surgery. There are some hypotheses explaining the process.Atkins
believed milk fistula occurs due to the obstruction of the duct.
Case report:
23 years old breast feeding mother was consulted to us with mastalgia. In physical
examination there is a palpabl 1-2 cm solid mass on right breast located at lower
lateral quadrant 4 cm from areola. Ultrasonography confirmed the 21x15 mm
lobulated lesion with irregular contours .Excisional biopys was made. Postoperative
3. Day she had complaints of intensive milk drainage and dehiscence was occurred.
Wide spectrum antibiotics was given orally.Cabergoline treatment was started .In
the day 3 of treatment amount of milk was decreased. Two weeks after the wound
was clean.Pathology report confirmed lactation adenoma.
Conclusion:
Milk fistula is not common,but it is an annoying complication. It disrupts patient’s

lifestyle occupied doctors work hardly for wound care.Most breast lesion during
lactation are benign however breast cancers are % 3 coincident with pregnancy and
lactation. If a malignancy was found during lactation its prognosis might be worse
due to possible diagnostic delay.
-196-
PP - 2 BREAST CANCER IN PREGNANCY
MUJGAN CALISKAN 1, FATIH BASAK 1, MUSTAFA OZBAGRIACIK 1, METIN YUCEL 1,
TOLGA CANBAK 1, AYLIN ACAR 1, GURHAN BAS 1, ORHAN ALIMOGLU 2
1
UMRANIYE EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
SURGERY, ISTANBUL, TURKEY
2
MEDENIYET UNIVERSITY, GOZTEPE EDUCATION AND RESEARCH HOSPITAL,
DEPARTMENT OF GENERAL SURGERY, ISTANBUL, TURKEY
Introduction:
Breast cancer in pregnancy is an uncommon condition requiring special consideration

(0.2-3%). Little is known about the treatment of breast cancer during pregnancy.
We aimed to present two cases of breast cancer occuring during pregnancy.
Case report:
CASE 1: A 28-year-old woman pregnant at 31 weeks gestation presented with a

palpabl mass in the upper outer quadrant of her right breast. Mamosonografi
revealed a breasy tumor of 50 mm and biopsy confirmed microinvasive carcinoma.
Modified radical mastectomy (MRM) was performed after elective cesarean.
Adjuvant chemoradiotherapy (CRT) was planned. After 1 year of follow-up, no
local recurrences or metastases were found. CASE 2: A 41-year-old woman at 27
weeks gestation presented with a palpable mass in the upper outer quadrant of her
right breast. Mamosonography revealed the presence of two masses which breast
biopsy confirmed invasive ductal carcinoma in both lesions. After neoadjuvant
chemotherapy, elective cesarean, MRM and adjuvant CRT were performed. After 1
year of follow-up, no local recurrences or metastases were found.
Conclusion:
After the 13th week of gestation surgery and chemotherapy in pregnant woman with
breast cancer can be safely performed. However radiotherapy, endocrinotherapy
and Trastuzumab are not indicated during pregnancy. Treatment plan should be
discussed by a multidisciplinary team.
-197-
PP - 3 SPINDLE CELL METAPLASTIC BREAST CANCER: CASE REPORT
DURSUN ÖZGÜR KARAKAŞ 1, AHMET ZIYA BALTA 2, YAVUZ ÖZDEMIR 2, ALI ILKER
FILIZ 2, ERGÜN YÜCEL 2, UFUK BERBER 3, MEHMET LEVHI AKIN 2
1
AĞRI MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY, AĞRI, TURKEY
2
GÜLHANE MILITARY MEDICAL ACADEMY, HAYDARPASA TRAINING HOSPITAL,
DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY
3
DEPARTMENT OF PATHOLOGY, ANKARA, TURKEY
Introduction:
Spindle cell metaplastic breast cancer is a subtype of breast cancer, which is very
rare and hard to diagnose. There is no specific symptom in differentiation from the
other breast cancers. It can only be diagnosed by histopathologic examination.
Case report:
A fifty-one years old woman presented with a mass on left breast and invasive breast
carcinoma at tru-cut needle biopsy was diagnosed. She underwent a modified
radical mastectomy and axillar dissection, and histopathologic examination revealed
a spindle cell breast cancer. Cytokeratin and vimentin expression was positive in
immunohistochemical examination.
Conclusion:
Spindle cell metaplastic breast cancer must be considered in differential diagnosis

of breast cancers and preoperative immunohistochemical examination including
cytokeratin and vimentin must be added to pathological examination in intervening
cases.
-198-
PP - 4 ASYMPTOMATIC BREAST CARCİNOMA WITH METASTASIS TO
THE STOMACH
EBRU MENEKSE , MEHMET OZDOGAN , FARUK KARATEKE , KORAY DAS , PELİN
DEMİRTURK , CİHAN GOKLER , SEFA OZYAZİCİ , SAFA ÖNEL
ADANA NUMUNE TRAINING AND RESEARCH HOSPITAL GENERAL SURGERY CLINIC,

ADANA, TURKEY
Introduction:
Metastasis of the breast cancer in the gastrointestinal tract has rarely been
reported. We report a case of breast cancer metastasis to the stomach, which was
initially considered to represent primary gastric cancer.
Case report:
Fifty-year-old woman presented with weight loss and epigastric pain. Clinical
examination revealed no abnormality. Upper gastrointestinal endoscopy
demonstrated common hyperemic nodules in the mucosa of the greater curvature
and the corpus posterior wall, which were biopsied. Histology revealed diffuse
carcinoma with signet-ring type. Computed tomography described in a thickening
in the wall of the stomach. Total gastrectomy was performed. Histopathology
revealed involvement of the stomach by an malignant neoplasm composed
of diffuse infiltration of the muscularis propria and serosa. CK 20 negative and
CK 7, GCDFP-15, ER, PR positivity suggested that breast carcinoma metastasis.
Mammography of the left breast revealed with a solid nodule measuring 19×13
mm. Followed by a US-guided tru-cut biopsy, which revealed infiltrating lobular
carcinoma(ILC). Simple mastectomy was performed and was started on systemic
chemotherapy.
Conclusion:
According to all other types of invasive breast cancer, ILC is more often associated
with GI metastasis. Breast lobular carcinoma may produce signet ring morphology.
Therefore, this type may confuse with a primary signet ring or diffuse-type gastric
adenocarcinoma.
-199-
PP - 5 NONINVASIVE DUCTAL CARCINOMA ARISING IN BENIGN
PHYLLODES TUMOR IN 19-YEAR OLD PATIENT: A CASE REPORT
MUHAMMET KADRI COLAKOGLU 1, ERDINC YENIDOGAN 2, GOKHAN GIRAY
AKGUL 1, SULTAN CIGDEM IRKKAN 3, YILMAZ OZDEMIR 1, MEHMET ALI GULCELIK 1,
AHMET MITHAT CAMLIBEL 1
1
2
3
PATHOLOGY, ANKARA, TURKEY
Introduction:
Phyllodes tumor is a very rare type of breast tumor that accounts only 1% of all
breast cancers. We report a 19-year old patient who was diagnosed with ductal
carcinoma in situ arising in benign phyllodes tumor of the breast.
Case report:
Patient with a 2.0x2.0 cm in size painless mass in her right breast was admitted
to our clinic. Breast ultrasonography showed a 23x12 mm, regular, heterogenous,
hypoechogenic mass in her right breast. The tumor was locally excised under local
anaesthesia. Pathology result was a 18 mm benign phyllodes tumor. Histologically,
focus of an 8 mm ductal carcinoma in situ nuclear grade 2, with a cribriform pattern
was observed in the ductal part of the tumor. Immunohistochemically, estrogen and
progesterone receptors were positive in the ductal carcinoma in situ component.
The tumor was diagnosed as ductal carcinoma in situ arising in benign phyllodes
tumor.
Conclusion:
In situ carcinomas, even infiltrating ones, arising in phyllodes tumors can not be
detected preoperatively in many of the cases. Histopathological examination must
be done attentively because it is very easy to overlook small in situ lesions under the
actual pathologic diagnosis of benign phyllodes tumor. As in stromal component,
the epithelial component must be carefully searched for malignancy.
-200-
PP - 6 A RARE KIND OF BREAST CANCER
MURAT FERHAT FERHATOGLU , BÜLENT CITGEZ
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Introduction:
47-year-old female with a palpable right breast mass was admitted to the clinic. In
examination, mass was adhered to surrounding tissues, had no smooth edges.
Case report:
In patient’s USG, in right breast at level of 12, 20x23x23 mm in size, lobulated , solid
,hypodense lesion , in mammogram, at the right upper outer quadrant nodular
lesion were detected. In core biopsy, dense mixed inflammatory cell infiltration
was seen in stroma , inflammatory cells was indistinguishable from that depending
on tumor-related or inflamation, pathology reported that for differential diagnosis
the mass should be surgically excised .After surgery pathology was reported as
Metaplastic carsinoma(MC).
Conclusion:
MC is a rare type of breast cancer(BC) , that is more aggressive than other types ,
and often metastasize to the lungs and bones through the blood and lymphatics .
Survival after metastasis is 8-12 months. ER&PR, c-erbB2 expression in MC is less
common than other the types of invasive BC.Due to high local recurrence rate the
breast conserving surgery(BCS) treatment is not preferred. As a result of high rate of
bone and lung metastasis , less ER&PR, c-erbB2 expression ,MC is more aggressive
than other invasive BC types. Thus, in treatment MRM is more accurate than BCS.
-201-
PP - 7 APOCRINE CARCINOMA OF BREAST
MURAT FERHAT FERHATOGLU 1, ADEM AKCAKAYA 2
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL,ISTANBUL, TURKEY

1
BEZMIALEM VAKIF ÜNIVERSITESI, TIP FAKÜLESI HASTANESI, ISTANBUL, TURKEY

2
Introduction:
57-year-old female patient, refers to the surgical clinic ,the upper outer quadrant of
left breast mass is 1.5 cm in size has palpated.
Case report:
In mammogram, nodular opacities with irregular margins in the left upper outer
quadrant of the breast is described and ultrasonography, upper outer quadrant of
her left breast 17x16x12 mm in size, lobulated contoured, hypoechoic solid mass
and a pathological 13x7 mm lymph node is described. The core biopsy reported
as invasive breast cancer but also for the differential diagnosis metaplastic breast
carcinoma, apocrine breast carcinoma(AC), pleomorphic carcinoma was reported .
MRM procedure has been applied in surgery , apocrine carcinoma is being reported
as the final pathology report and one axillary lymph node metastasis in a 20 mm
size is being reported(pT2N1). Immunohistochemical studies of mass ER (-)&PR (-)
and cerb B2 (-) ; GCDFP 15 (+) and the cytokeratin 5/6 (+) have been reported.
Conclusion:
AC and invasive ductal carcinoma with in the similar stage have similar prognosis
. ER and PR is usually negative, half of the cases have c-erbB2 expression.
Immunohistochemical study of tumor is positive for GCDFP 15 and androgen
receptors. In differential diagnosis histiocytic tumors, oncocytic carcinoma, granular
cell tumor can be reported
-202-
PP - 8 GRANULAR CELL TUMOR OF THE AXILLA: A CASE REPORT
BULENT CITGEZ , ESN KABUL GÜRBULAK , HAMDI OZSAHIN , ISMAIL ETHEM
AKGÜN , MURAT FERHAT FERHATOGLU , CANAN TANIK , ADEM AKCAKAYA
Introduction:
Granular cell tumor(GCT), first described by Abrikossoff in 1926, is a rare neoplasm

and occasionally located in axilla. tongue is the single most common anatomic site
involved, but GCT may arise in any body site and can be multifocal. GCT of breast
is usually benign, it rarely shows malignant features.We present a patient who
underwent excisional biopsy of an axillary mass which was diagnosed as GCT as a
result of histopathological examination.
Case report:
59-year-old patient with a palpable mass in right axilla for two years refers to the
clinic. In examination, 15 mm mass in right breast is palpated. On Mammogram,
irregular, spiculated, hyper-dense lesion was determined at right axilla. On USG,
in right axilla 11x10 mm that can not be clearly demarcated, spiculated, hypo-
echoic, suspect lesion is determined. Core biopsy performed and reported as GCT.
Exsicional biopsy is scheduled for differentiation of benign and malignant. Exsicional
biopsy of patient reported as in stromal space disorganized cells with large granular
eosinophilic cytoplasm, hyperchromatic nuclei and neoplastic infiltration was
detected. immunohistochemical study S-100 , CD 68 , PAS , diastased PAS dyeing
monitored .
Conclusion:
Patients with breast and axillary mass should be multidisciplinary treatment;

surgical treatment should be planned after pathology results
-203-
PP - 9 A RARE FORM OF METAPLASTIC BREAST CARSINOMA:
ADENOSQUAMOZ CARCINOMA
RAMAZAN YILDIZ 1, ZAFER KILBAŞ 1, ERKAN ÖZTÜRK 1, ÜMİT ALAKUŞ 1, NURİ
YİĞİT 2
1
ANKARA, TURKEY
2
DEPARTMENT OF PATHOLOGY, GÜLHANE MILITARY MEDICAL ACADEMY, ANKARA,
TURKEY
Introduction:
Metaplastic carcinoma of the breast was defined in 1980’s which is a rare histological
type, characterized by the presence of non-epithelial cellular elements.
Case report:
40-year-old female patient was admitted to our clinic suffering from palpable mass
located in the left breast for last few months. Approximately 4-5cm mass in the
upper outer quadrant of left breast and left axillary lymphadenopathy was palpable.
Ultrasound and MRI placed the left breast as BI-RADS5. The patient’s FDG-PET / CT
proved multifocal breast cancer in the left breast and left axillary level 1, 2, 3 and
subclavian lymph node metastasis. Malignancy was revealed in fine needle aspiration
biopsy (FNAB) of left breast. Left modified radical mastectomy was performed.
Histopathological examination revealed 4.1 cm high-grade adenosquamoz breast
carcinoma and 15 metastatic lymph nodes.Estrogen, progesterone receptors were
both negative, HER2-neu (c-erbB2) was 3+. Chemoradiotherapy was planned.
Conclusion:
Adenosquamoz carcinoma is a rare subtype of metaplastic breast carcinoma.High-

grade adenosquamoz carcinoma is rarely reported in the literature. It is common
on 4. and 5. decades, and identified as well-circumscribed palpable lesion. There
are limitations in FNAB and histopathological examination is usually recommended
for diagnosis. Local aggressive treatment is recommended because of the high
possibility of local recurrence.
-204-
PP - 10 SENTINEL LYMPH NODE BIOPSY FOR BREAST CANCER:
ARE ONLINE NOMOGRAMS SUPPORTING SURGEON’S LEARNING
CURVE?
AHMET CEM DURAL 1, M. FERHAT CELIK 1, ILHAN GOK 1, SULEYMAN BUYUKASIK 1,
HURRIYET TURGUT 2, DENIZ GUZEY 1, M. ECE DILEGE 1, HALIL ALIS 1
1
SURGERY DEPARTMENT, ISTANBUL, TURKEY
2
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL, PATHOLOGY
DEPARTMENT, ISTANBUL, TURKEY
Background&Aims:
We aimed to share the learning curve period of our preliminary sentinel lymph
node biopsy results under the guidance of Memorial Sloan-Kettering Cancer Center
(MSKCC) nomogram for sentinel lymph node (SLN) methastasis.
Methods:
The predicted probability of SLN methastasis was calculated for each patient, using
the online MSKCC nomogram. In learning process, the patients who had positive
nodes on physical examination and verified sonographically underwent SLN biopsy
followed by axillary dissection.
Results:
Data were collected on 42 patients with SLN biopsy who underwent completion
axillary lymph node dissection. The patients were divided into two groups
according to predicted probability cut-off value: Group 1 (<50%), Group 2 (>50%).
In group 1 (n=30), SLN methastasis rate (in frozen section) was 26,6% (8/30), in
group 2 (n=12) SLN methastasis rate was 58.3% (7/12). Histopathologically yielded
axillary methastasis rate between two groups was 36.6% (11/30) and 75% (9/12)
respectively. Two of negative SLN biopsies diagnosed as micromethastasis in
histopathologic evaluation.
Conclusion:
SLN biopsy is a new era in breast surgery. In general surgery clinics which are not
specialized to breast surgery, technical adaptation needs an experience and a
period of time. A well known nomogram like MSKCC may be useful to base the
results on objective criterias.
-205-
PP - 11 MANAGEMENT OF IDIOPATHIC GRANULOMATOUS
MASTITIS: DILEMMAS IN DIAGNOSE AND TREATMENT
GÜLTEN KIYAK 1, GÜRKAN DUMLU 1, İBRAHİM KILINÇ 1, SONER AKBABA 1, AHMET
GÜRER 1, ALPER BILAL ÖZKARDEŞ 1, MEHMET KILIÇ 2
1
DEPARTMENT OF GENERAL SURGERY, ATATÜRK TRAINING AND RESEARCH
HOSPITAL, ANKARA, TURKEY
2
DEPARTMENT OF GENERAL SURGERY, YILDIRIM BEYAZIT UNIVERSITY FACULTY OF
MEDICINE,ANKARA,TURKEY
Background&Aims:
The aim of this study was to report and describe the clinical signs, radiological
findings, management, clinical course and the recurrence ratio of the patients
which were treated due to IGM.
Methods:
With this retrospective review of 24 patients diagnosed IGM histopathologically

between January2006 and December2011. Medical reports about the demographic
data, ultrasonography(US) and mammograhy(MMG) findings, follow-up information
and recurrence were obtained from clinical records.
Results:
Painful, firm and ill defined mass was the symptom of all patients. While parenchymal
heterogeneity, abscess, formation and mass were the findings of US, increased
asymmetric density was the main finding of MMG. Total excision was performed
in 15(62.5%) patients, incisional biopsy with abscess drainage was performed in
9(37.5 %) patients. Median follow-up was 34.8(range10-66) months. There was
recurrence after 24 months in one patient in the another quadrant of the breast
and treated reexcision. The mean convalescence duration of the nine patients with
abscess formation was 3.3 months(range1-8 months).
Conclusion:
While the physical examination give rise to thought breast carcinoma, the
appearance of parenchymal heterogeneity and abscess formation on US especially
with enlarged reactive axillary lymph nodes support the presence of an inflammatory
granulomatous process.
-206-
PP - 12 SENTINEL NODE BIOPSY AFTER NEOADJUVANT THERAPY
IN BREAST CANCER PATIENTS. RESULTS AFTER 2 YEARS
POSTVALIDATION.
ANTONIO MORAL , JOAN DUCH , JOSE IGNACIO PEREZ , ARIADNA TIBAU , OZLEM
UYANIK , MONTSERRAT CLOS , MONTSERRAT ESTORCH , MANUEL TRIAS
HOSPITAL DE SANT PAU, BARCELONA, SPAIN
Background&Aims:
We previously validated sentinel lymph node dissection (SLND) after neoadjuvant

therapy (NT) in a group of 30 breast cancer patients. We have evaluated the results
2 years after validation.
Methods:
Between February 2010- 2012, 47 breast cancer patients (T2-3, N0-1, M0) were
treated with NT. After then all patients were N0. After the SLND, complete axillary
dissection (ALND) was only performed in those with SN metastases or not located
Results:
Twenty-one patients (40%) were N1 before NT, but all were N0 when the treatment
was finished. Whole SLND identification rate was 91.5 %, and no significant
differences were found between initially N0 or N1 patients. In 4 patients (2 N0 and
2 N1) SLND was not found. Only 1 of these ALND was positive. Among located SN,
6 of them were positive, but the ALND were negative in 4 cases and positive in 2.
Among the 47 cases we have been able to avoid 36 axillary dissection (77%).
Conclusion:
SLND after NT is safe and feasible in breast cancer patients; not only in initially
N0 but also in initially N1. It accurately predicts the status of the axilla and avoids
unnecessary ALND.
-207-
PP - 13 A VARIABLE PRESENTATION OF PHYLLODES TUMOR, CASE
SERIES.
ASEM GHASOUP , OMAR SADIEH , AHMAD MANSOOR
AL BASHIR HOSPITAL, M.O.H, JORDAN
Background&Aims:
Phylloides tumors are rare fibroepithelial tumors accounting 0.3 -1 % of malignant

breast tumors and about 2.5% of all fibroepithelial lesions of the breast. In general,
approximately 15-30% of patients develop recurrence, mostly within 2 years after
the diagnosis.
Methods:
Twenty six patients treated for phylloides tumors at our institution from 2007 to
2011.Twenty five patients were female and one male, Age ranged from 26 to 50
years old. Size ranged from 3cm to 20cm. tumors were distributed equally in both
breasts .Type of presentation as follow (5 cases with nipple discharge, 21 cases with
masses, 15 of them as painless mass, 2 with ulcerating mass, and 4 with painful
mass.
Results:
Twelve cases underwent simple mastectomy. Other fourteen cases managed by

wide local excision. However, three of the cases required simple mastectomy at
later time as a result of the positive margin in the histopathology report. Axillary
lymph nodes involvement in cases (4/26) is generally due to reactive changes.
Conclusion:
Phylloides tumors can be presented variably in different patients, although it is an

uncommon tumor but can also be presented with features of malignancy. Age, size
and site are not predictor factors of malignancy.
-208-
PP - 14 IMAGING-HISTOLOGIC DISCORDANCE AFTER
SONOGRAPHICALLY GUIDED PERCUTANEOUS BREAST CORE BIOPSY
AYKUT SOYDER 1, FÜSUN TAŞKIN 2, SERDAR OZBAS 3
1
ADNAN MENDERES UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF
GENERAL SURGERY, AYDIN, TURKEY
2
RADIOLOGY, AYDIN, TURKEY
3
GÜVEN HOSPITAL, ANKARA, TURKEY
Background&Aims:
The objectives of this study are to determine the frequency of imaging-histologic

discordance and to compare the frequency of carcinoma between discordant
lesions in sonographically (US)-guided core-needle biopsy.
Methods:
From November 2009 to June 2012, we performed US-guided 14 gauge core-needle

biopsy on 989 breast lesions in 961 women. We reviewed 58 (5, 8%) cases that had
imaging-histologic discordance after percutaneous breast biopsy and underwent
subsequent excisionel biopsy. The clinical, radiologic and histologic findings were
reviewed for those 58 cases.
Results:
Among the 58 cases, subsequent excisions revealed 16 (27, 5%) malignancies,

which were categorized as 9 (15, 5%) invasive ducal carcinoma, 4 (6, 9%) phloxes
tumor and 3 (5, 1%) ducal carcinoma in situ.
Conclusion:
The malignancy rate of 27, 5% suggests that surgical excision should be performed
in those cases presenting imaging-histological discordance after US-guided core
biopsy. Careful correlation of clinical, radiological and histological results as well
as appropriate follow-up is essential. Key Words: Imaging-histological discordance,
breast cancer, core biopsy
-209-
PP - 15 BREAST CARCINOMA WITH CHONDROID METAPLASIA
EMIR EROLER 1, DENIZ TIHAN 1, UĞUR DUMAN 1, ÖZGÜR DANDIN 2 , SERPIL BILGIN
AKYAĞCI 1, MURAT POLAT 1
1
ŞEVKET YILMAZ TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
SURGERY, BURSA, TURKEY
2
BURSA MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY, BURSA,
TURKEY
Background&Aims:
Metaplastic breast cancer is a rare form of mammarian malignancies, forming less

than 1% of all breast carcinomas. Malign epitelial and mesenchimal cells are found
together. The mesenchimal cells can be spindle, squamous, chondroid and bone
forming cells. It has poor prognosis and high histological grade compared to the
other cancer types of the breast.
Methods:
A 45 year-old-woman was admitted to the general surgery department with a mass

on her left breast. Physical examination revealed a tumoral mass with 2.5 cm in
diameter. Mammogram demonstrated a 2x1 cm-sized macrolobular contoured
nodular opacity. Ultrasonography showed a mass including microcalcification. A
core needle biopsy result was chronic inflamation. An excisional biopsy and sentinel
lymph node biopsy was performed. According the frozen section biopsy which
was reported that the lymph node as negative and the breast tumor as invasive
carsinoma, a segmental mastectomy and axillary dissection was carried out.
Regarding the histopathological analysis, the patient had carcinoma with chondroid
metaplasia. After the surgery, a PET scan has been performed an no metastatic
focuses was found, correspondingly the tumor was considered to be a primary
breast tumor.
Results:
The patient is free of recurrence or metastasis in 11 months period.
Conclusion:
Breast cancers are most common malignancies of women. Majority of them are
diagnosed as invasive ductal carcinoma. Nevertheless, there are many other
hystological types of breast carcinomas. Despite their histological and survival
rate diversity, radical surgical excision should be performed to obtaint curative
therapeutic method.
-210-
PP - 16 OUR THORACIC PARAVERTEBRAL BLOCK EXPERIENCES IN
BREAST CANCER PATIENTS
SERBULENT GOKHAN BEYAZ 1, TOLGA ERGONENC 1, FATIH ALTINTOPRAK 2, ALI
FUAT ERDEM 1
1
SAKARYA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF ANESTHESIOLOGY,
SAKARYA,TURKEY
2
SAKARYA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, SAKARYA, TURKEY
Background&Aims:
We aimed to present our thoracic paravertebral block (TPVB) experiences in breast

cancer patients.
Methods:
Five breast cancer patients records’ who had been operated under TPVB anesthesia
at Sakarya University Faculty of Medicine between 2011-2012 were evaluated
retrospectively. Modified Radical Mastectomy (MRM) was performed in all
patients. TPVB was realized in a way to be 2.5 cm lateral from the midline in sitting
position under aseptic conditions neurostimulator guided at T2-T5 levels. From the
total 20 ml of 0.5% levobupivacaine T2-T5 levels, injections were done evenly, and
superficial cervical block was realized with 10 ml 0.5% levobupivacaine. Propofol
infusion as sedation was applied at the dosage of 20-50 mcg / kg / min.
Results:
All patients were stable as hemodynamic parameters, and postoperative

opioid requirement did not occur. The nausea-vomiting only in one patient was
encountered after the procedure. Demographic informations, Visual Analog Scale
scores, anesthesia and surgery durations, and post-operative first analgesic time
are summarized in Table 1 and 2.
Conclusion:
TPVB provides adequate anesthesia with unilateral somatic and sympathetic

blockade, stable post-operative hemodynamic status, and highly postoperative pain
control. Based on this results, TPVB seems to be an alternative method to general
anesthesia in breast cancer patients.
-211-
PP - 17 FIRST INTERVIEW OF THE PATIENT WITH MASTALGIA: WHAT
IS THE MOST COMMON CLINICAL PRESENTATION?
GULTEKIN OZAN KUCUK
SAMSUN GAZI STATE HOSPITAL, GENERAL SURGERY DEPARTMENT, SAMSUN,

TURKEY
Background&Aims:
Mastalgia is an important problem prompting women to seek medical help. The

aim of this study is to evaluate the frequency of presentation types of patients with
mastalgia.
Methods:
A clinical history chart including, breast pain localizations as quadrants and

coexisting extramammary painful areas was prepared. All physical exam findings
with patients’ self-assessments were noted on breast and whole body figures.
Results:
A total of 418 consecutive women with mastalgia between June 2010 and August
2012 were enrolled in this study. 200 women (47.8%) reported isolated breast
pain with no additional pain. The left breast upper outer quadrant was the most
frequently reported region and was reported by 214 women (51.2%), followed by
the left breast lower outer region (reported by 41.9%), the right upper outer region
(reported by 43.1%), and the right lower outer region (reported by 34%). Axillary
pain was the most frequent extramammary area, reported by 92 women (22%),
followed by upper extremity pain (reported by 21.5%), and back pain (reported by
16.7%). The most frequent breast pain presentation independent of extramammary
areas was synchron pain in the left breast upper outer and lower outer quadrants
(reported by 19.1%), followed by all four quadrants of the right breast (reported by
12.4%).
Conclusion:
Mastalgia remains an enigma and has various presentation types.
-212-
PP - 18 FIRST INTERVIEW OF THE PATIENT WITH MASTALGIA: WHAT
IS THE MOST COMMON CLINICAL PRESENTATION?
GULTEKIN OZAN KUCUK
SAMSUN GAZI STATE HOSPITAL, GENERAL SURGERY DEPARTMENT, SAMSUN,

TURKEY
Background&Aims:
Mastalgia is an important problem prompting women to seek medical help. The

aim of this study is to evaluate the frequency of presentation types of patients with
mastalgia.
Methods:
A clinical history chart including, breast pain localizations as quadrants and

coexisting extramammary painful areas was prepared. All physical exam findings
with patients’ self-assessments were noted on breast and whole body figures.
Results:
A total of 418 consecutive women with mastalgia between June 2010 and August
2012 were enrolled in this study. 200 women (47.8%) reported isolated breast
pain with no additional pain. The left breast upper outer quadrant was the most
frequently reported region and was reported by 214 women (51.2%), followed by
the left breast lower outer region (reported by 41.9%), the right upper outer region
(reported by 43.1%), and the right lower outer region (reported by 34%). Axillary
pain was the most frequent extramammary area, reported by 92 women (22%),
followed by upper extremity pain (reported by 21.5%), and back pain (reported by
16.7%). The most frequent breast pain presentation independent of extramammary
areas was synchron pain in the left breast upper outer and lower outer quadrants
(reported by 19.1%), followed by all four quadrants of the right breast (reported by
12.4%).
Conclusion:
Mastalgia remains an enigma and has various presentation types.
-213-
PP - 19 OUTCOME OF SURGICAL TREATMENT OF IDIOPATHIC
GRANULOMATOUS MASTITIS
ATILLA CELIK , HAKAN YIĞITBAŞ , SINAN BINBOĞA , HAKAN GUVEN , SULTAN
AKAYKUCUK ENHOS , GULCIN ERCAN
BAĞCILAR EĞITIM ARAŞTIRMA HASTANESI, ISTANBUL, TURKEY
Background&Aims:
Idiopathic granulomatous mastitis (IGM) is a benign lesion of the mammary gland

characterized by the presence of non-infectious inflammatory breast lesions
limited to the lobules. It is a non-malignant entity. The treatment of IGM remains
controversial. Aims of the surgical treatment of this benign condition are to achieve
a good cosmetic result and low recurrence rate.
Methods:
A retrospective analysis of 10 patients with IGM.
Results:
The mean age of patients is 44 years old. None of the patients have a history of
oral contraceptive use. Consecutive surgical excision after a follow-up period of 24
months is none and no were seen recurrence occur in same.
Conclusion:
IGM was first described by Kessler and Woloch in 1972. Mostly treatment options
are consist of steroid administrating schema. We report our experience in patients
with recurrent IGM treated by surgery using segmental mastectomy and oncoplastic
surgical options. No consensus exists on the most appropriate treatment modality
for IGM. We believe that surgical treatments should be preferred initially for
achieving good cosmetic results and low recurrence rate.
-214-
PP - 20 HORMONE RECEPTOR STATUS OF BREAST CANCER IN
PATIENTS OF DIFFERENT AGE GROUPS, LYMPH NODE STATUS AND
TUMOUR GRADE
JAVERIA IQBAL , BANDAR ALHARTHI
KING FAHAD MEDICAL CITY, RIYADH, SAUDI ARABIA
Background&Aims:
To see the relationship between receptor status and age of patients, tumour grade,
histological type and lymph node involvement in breast cancer patients
Methods:
A retrospective review of histopathology reports of breast cancer cases presenting

to KFMC from 2007 till August 2011 was made. Data was analysed with fisher exact
or chi-square test .P value <0.05 was considered significant.
Results:
420 files were reviewed of which 75 were excluded due to incomplete data .63%
of our patients were triple positive. Patients >45yrs were usually ER/PR positive
72.7% as compared to patients age <45yrs who had more ER/PR negative tumours
39.4 %( p=0.044). On comparison of ER/PR status with grade we found that ER/
PR negative tumours were mostly high grade as compared to ER/PR positive
which were mostly low grade(P=0.001).Patients with invasive ductal cancer were
mostly ER/PR negative 91.3 %( 116) as compared to ER/PR positive 87.8 %( 173).
While patients with invasive lobular carcinoma had ER/PR positive tumours mostly
16(8.1%) (p=0.003) No significant correlation was found between receptor status
and lymph node status (p=0.961)
Conclusion:
Most of our breast cancer patients are triple positive. Young patients tend to
have more receptor negative tumours as compared to older patients. High grade
tumours are mostly receptor status negative as compared to low grade ones.There
is no correlation between lymph node involvement and receptor status.
-215-
PP - 21 IMPACT OF CYCLOOXYGENASE-2 OVEREXPRESSION ON
PROGNOSIS OF TURKISH BREAST CANCER PATIENTS
M.UMIT UGURLU 1, S.ATA GULER 1, HANDAN KAYA 2, BAHADIR M. GULLUOGLU 1,
S.CUMHUR YEGEN 1
1
MARMARA UNIVERSITY SCHOOL OF MEDICINE DEPT.OF GENERAL SURGERY,
ISTANBUL, TURKEY
2
MARMARA UNIVERSITY SCHOOL OF MEDICINE DEPT. OF PATHOLOGY, ISTANBUL,
TURKEY
Background&Aims:
COX-2 is also expressed in breast cancer. Previous data revealed that COX-2
overexpression is a promising predictive and prognostic factor for breast cancer.
Aim of this present study is to assess the impact of COX-2 overexpression on breast
cancer survival.
Methods:
In this retrospective cohort study, non-metastatic invasive breast cancer patients
who received adequate loco-regional and systemic treatments were evaluated.
Patients’ demographical, clinical, pathological, treatment-related and survival data
were retrieved from their hospital files. COX-2, estrogen / progesteron receptor
(ER / PR), HER-2/neu expression and Ki67 index of the tumors were determined
immunohistochemically. As primary objective ,COX-2 positive and negative patients
were compared in terms of overall (OS), disease-free (DFS) and breast cancer-specific
survival (BCSS). Secondary objectives were to assess the independent prognostic
factors for survival. Also the correlation of COX-2 expression with conventional
prognostic and predictive factors of breast cancer was assessed.
Results:
217 patients underwent adequate breast cancer treatment between November
2000 and December 2008 were included in the study. Median follow up was 37
months (range: 5 – 107). Eighty-one (37%) patients were COX-2 positive. OS, DFS
and BCSS were similar in COX-2 positive and negative patients. Ki67 index and age
were significantly correlated with COX-2 expression. We didn’t find any correlation
between COX-2 overexpression and OS, DFS and BCSS rates. PR expression was
found to be the only independent factor for predicting OS; tumor size and molecular
subtype classification were found to be the only independent factor for predicting
DFS and again PR expression was found to be the only independent factor for
predicting BCSS.
Conclusion:
Among the independent predictive and prognostic factors of breast cancer, COX-2
overexpression was only correlated with Ki67 index and age.
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PP - 22 TRENDS IN SURGICAL STRATEGIES FOR BREAST CANCER IN
BREAST UNIT ALEXANDROVSKA, SOFIA, BULGARIA
NIKOLAY KATEV , NIKOLAY GORANOV
MEDICAL UNIVERSITY SOFIA, BULGARIA
Background&Aims:
In the last years there are substantial developments in the surgical strategies for
breast cancer. After introducing the organ preserving breast surgery (OPS), the
rates of mastectomies decline in the years. In the same time the levels of survival
for patients with breast cancer improves, mainly because of early diagnosis.
Additionally, the reconstructive surgery after mastectomy helps to improve quality
of life of the patients.
Methods:
With this study we review the trends in surgical strategies for early and for advanced
breast cancer in Breast Unit of Alexandrovska University Hospital, Sofia for a period
of time from 1994 to December 2011. 987 patients were treated by different surgical
procedures-mastectomy rate is in general 58% and organ preserving surgery is 42%.
Results:
We observe the way of change in the paradigm from the past that mastectomy is
the procedure of choice for breast cancer to the opinion that complex therapy pre
and postoperatively with radiation and chemotherapy gives the same survival and
better quality of life. The differences in the years are analyzed. The recurrence rates
and 5-years survival rates are compared.
Conclusion:
Not every patient with breast cancer is eligible for organ conserving surgery. Careful
selection of the patients from multidisciplinary team is mandatory.
-217-
PP - 23 INVASIVE DUCTAL CARCINOMA WITHIN FIBROADENOMA
CAN BAŞARAN 1, CEYHUN İRGİL 1, ÖZGÜR DANDİN 2, MURAT ÇALIKAPAN 4, EBRU
BAŞARAN 3, ŞÜKRÜ YILDIRIM 5
1
OMENA BURSA BREAST SURGERY CENTER, BURSA / TURKEY
2
BURSA MILITARY HOSPITAL GENERAL SURGERY SERVICE, BURSA, TURKEY
3
FAMILY HEALTH CENTER BURSA TURKEY
4
BURSA ONCOLOGY HOSPITAL BURSA TURKEY
5
BURSA MILITARY HOSPITAL PATHOLOGY SERVICE BURSA TURKEY
Introduction:
Fibroadenoma is one of the most common benign breast tumor composed of

epithelial and stromal components that in young women. Carcinoma arising within
a fibroadenoma is rare. Invasive ductal carcinoma within fibroadenoma is also
rare than lobular carcinoma within fibroadenoma. The presence of this tumor in a
woman with a positive family history have greater clinical importance.
Case report:
A 38-year-old married female came to our hospital complaining of a lump in her left
breast that had been present for 4 months. Ultrasonography and mammography
showed a 2x2 cm lesion which was suggestive of a malignancy. Fine neddle aspiration
cytology of the mass revealed features of malignancy which was suggestive of
invasive ductal carcinoma.The patient underwent radical modified mastectomy
of left breast. Gross examination showed a gray-colored, elastic tumoral lesion
with irregular margins measuring 2,4x2.3x1.7 cm. Histopathological examination
revealed the breast tumor to be invasive ductal carcinoma within a fibroadenoma.
The tumor cells were distributed continuously along the network of the duct system
of the fibroadenoma.
Conclusion:
Since there are no definite clinical or radiological criteria of diagnosing carcinoma

developing in a fibroadenoma, histopathological examination of all fibroadenomas
should be performed routinely to rule out malignancy.
-218-
PP - 24 BREAST INCIDENTALOMAS IN THE PET-CT
OZLEM UYANIK , ANTONIO MORAL DUARTE , JOSE IGNACIO PEREZ GARCIA ,
BEATRIZ ESPINA PEREZ , JOAN DUCH RENOM , MONTSERRAT CLOS ENRRIQUEZ ,
MANUEL TRIAS FOLCH

Background&Aims:
The use of positron emission tomography-computed tomography (PET-CT) in the

diagnosis and monitoring of cancer patients has led to detection of incidentalomas,
which means a new lesion foci. This implies a new way of dealing with the diagnostic
and therapeutic management of these patients.
Methods:
Analysis of our breast cancer data base, selecting patients diagnosed a breast
incidentaloma by PET-CT, between 2011-2012. Imaging techniques used, result
of the biopsy, treatment given and final pathology result have been collected
prospectively.
Results:
We detected 5 patients. Primary neoplasm for which they were being evaluated
was ovarian neoplasm, MALT lymphoma, pulmonary and esophagogastric junction
cancer. In four patients we realized ultrasound and mammography. In the remaining
patient we did not complete the study for presenting stage IV lung cancer. We
realized breast magnetic resonance, core biopsy, subsequently conservative breast
surgery and sentinel lymph node biopsy which were negative, in two patients being
in complete remission (ovarian neoplasm, MALT lymphoma). The two remaining
patients had significant comorbidities and an advanced stage of neoplastic disease,
so it was decided palliative treatment.
Conclusion:
In the presence of a breast incidentaloma, both radiological and pathological

study should be completed, and the management decision should be made by a
multidisciplinary committee.
-219-
PP - 25 MASTOPHOBIA(UPDATE)
CEYHUN İRGİL 1, CAN BAŞARAN 1, ÖZGÜR DANDİN 2, MURAT ÇALIKAPAN 3, SEDAT
İRGİL 4, ÜLKER HAVVA 1, HÜSNIYE ALTINTAŞ 1, ÖZLEM SEVGEL 1
1
OMENA BURSA BREAST SURGERY CENTER, BURSA, TURKEY
2
BURSA MILITARY HOSPITAL ,BURSA, TURKEY
3
BURSA ONCOLOGY HOSPITAL, BURSA, TURKEY
4
BALIKESİR MILITARY HOSPITAL, BALIKESIR, TURKEY
Background&Aims:
In our center, between 1996 and 2003, we observed a specific “fear of breast
cancer” and then categorized the medical findings of this fear, by consulting them
with psychiatry, prospectively examined and followed up the patients from 2003-
2012.
Methods:
And as a base for our findings we named this specific fear of breast cancer as
“mastophobia”. To specify our categorization, we excluded the patients anxious
about “Am I a breast cancer patient?”Under the name “mastophobia”, we
categorized the symptoms that cannot be explained with cancerophobia.
Results:
14200 women were examined and 304 women were prediagnosed as “Mastophobia”
according to our symptomatology criteria. During two years follow-up 274 patients
(mean age 43,6 years) were trained and briefed about breast cancer, breast
diseases and their fear , but “mastophobia” insisted. Patients with mastophobia
were identified according to social and cultural differences, 93 women ( 34%) were
working , 76 women (%28) were graduated from primary school, 88 women (32%)
were from high school and 110 women (40%) were graduated from university. 143
women (47%) had family stories of breast cancer.
Conclusion:
The term “mastophobia” is a new symptom that is open for discussions between
psychiatrists and clinicians interested in breast diseases.
-220-
PP - 26 RETROSPECTIVE ANALYSIS OF MALE BREAST CANCER IN A
SINGLE INSTITUTION
YAVUZ ÖZDEMIR 1, ERGÜN YÜCEL 1, AHMET ZIYA BALTA 1, DURSUN ÖZGÜR
KARAKAŞ 2, ALI İLKER FILIZ 1, BÜLENT GÜLEÇ 1, YAVUZ KURT 1
GATA HAYDARPASA EGITIM HASTANESI GENEL CERRAHI SERVISI, ANKARA, TURKEY

1
AĞRI ASKER HASTANESI GENEL CERRAHI SERVISI, AGRI, TURKEY

2
Background&Aims:
Male breast cancer is a rare disease with limited data. Current information, including
treatment recommendations and guidelines, extrapolated from data derived from
female patients. We aimed to evaluate male breast cancer patients treated in a
single institution.
Methods:
A total of 10 male breast cancer treated between 2001 and 2011 were identified.
The clinical, histopathological and survival data were reviewed retrospectively and
analyzed.
Results:
Ten patients were diagnosed with male breast cancer at our institution between
(2.8% of all breast cancers). Mean age was 67.8±12 years. While the most common
localization was the upper outer quadrant (4 patients, 40%), mean tumor diameter
was 3.3±2 cm. Half of the patients were diagnosed by excisional biopsy, and all of the
patients underwent a modified radical mastectomy. Histopathological evaluation
revealed invasive ductal carcinoma in 9 patients and invasive lobular carcinoma in
1 patient. There were 2 patients in stage I, 4 patients in stage II and 4 patients in
stage III. Mean follow-up time was 42.2±32.5 months. Two distant metastases were
detected during the follow up period. Five-year survival rate was 30%.
Conclusion:
Male breast cancer represents less than 5% percent of all breast cancer. The rate
of diagnosis with excisional biopsy is high and male breast cancer has a worse
prognosis.
-221-
PP - 27 THE CMF AND FEC ADJUVANT THERAPY IN BREAST
CANCER’S PATIENTS WITH CYTOKERATIN 19 PROVEN BONE
MARROW MICROMETASTASеS - RELATION TO METASTATIC DISEASE
DEVELOPMENT AND THE LONG-TERM OUTCOMES.
YOVTCHEV YOVCHO 1, MINKOV GEORGI 1, NIKOLOV STOYAN 1, PETROV ALEN 1,
VLAYKOVA TATYANA 2
UNIVERSITY HOSPITAL STARA ZAGORA/DEPARTMENT OF SURGERY, BULGARIA

1
TRAKIAN UNIVERSITY/DEPARTMENT OF CHEMISTRY AND BIOCHEMISTRY,

2
BULGARIA
Background&Aims:
To evaluate the standard adjuvant therapy with CMF and FEC in breast cancer
patients with bone marrow micrometastases
Methods:
We analyzed the disease-free survival and the long-term outcomes in 60 patients

with proven breast cancer - 31 were conducted adjuvant CMF therapy and 29 was
treated with FEC.
Results:
The patients with bone marrow micrometastases showed a shorter disease-free

survival (CK 19 (+) median 30.2 m, CK 19 (-) median 43 m.) (P = 0.0002, logrank test)
and a higher risk of metastases development RR = 5.098 (95% CI: 1.545 - 19.193).
In the CMF group was observed a tendency to rapid onset of metastatic disease
in patients with micrometastases (p = .06 logrank test). When comparing the two
adjuvant therapeutic approaches makes an impression a tendency to a poorer
seven year survival in patients with bone marrow micrometastases on FEC therapy
(p = 0,06 logrank test).
Conclusion:
The patients with bone marrow micrometastases are a specific group that provides
atypical response to conventional adjuvant treatment regimens. Bone marrow
micrometastases are an independent predictive factor for shorter disease-free
survival, but the results in the CMF and FEC group should be reconsidered in a
larger group of patients
-222-
PP - 28 METHYLEN BLUE DYE RELATED BREAST NECROSIS
REQUIRING MASTECTOMY
SEMIH GORGULU 1, ZAFER KILBAS 1, RAMAZAN YILDIZ 1, ERKAN OZTURK 1,
MEHMET GAMSIZKAN 2, ONER MENTES 1
1
GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT OF GENERAL SURGERY,
ANKARA, TURKEY
2
GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT OF PATHOLOGY, ANKARA,
TURKEY
Background&Aims:
Methylen blue dye(MB) is widely practiced for identifying axillary sentinel lymph
node (SLN) in clinically node negative patients with breast cancer . Although allergic
complication of the procedure are well documented, there has been limited studies
reporting local adverse effects. .
Methods:
We report a rare case of breast necrosis following subdermal injection of MB
Results:
A 56-year-old female, diagnosed with infiltrating ductal carcinoma, was treated by

her initial surgeon with breast conserving surgery and sentinel node biopsy. She had
periareolar subdermal injection of 4 ml of 1% MB. She was seen 10 days following
discharge when it was noticed that the pigmented area of the left breast had
become necrotic. Since the necrosis invaded the majority of breast, mastectomy
was to be performed.
Conclusion:
Three blue dyes (patent blue V, isosulphan blue and MB) are commonly used for SLN
procedure. While the rate of systemic allergic reactions to isosulfan blue is higher
than the others local adverse affects related to MB can cause wide skin and fat
tissue necrosis . The overall side-effect profile of patent blue is favorable compared
to isosulphan blue and MB and we recommend its usage in SLNB for breast cancer.
-223-
PP - 29 THE ROLE OF SENTINEL LYMPH NODE BIOPSY IN ASSESSING
THE AXILLARY STATUS
SAHIN KAYMAK , ZAFER KILBAS , NAIL ERSOZ , SEMIH GORGULU , YUSUF PEKER

ANKARA, TURKEY
Background&Aims:
The status of axillary lymph nodes is a very important factor in planning the adjuvant
treatment in breast cancer. Within the past 10 years, sentinel lymph node (SLN)
biopsy became popular since it has negligible morbidity when compared to axillary
lymph node dissection (ALND). In the present study, the role of SLN in breast cancer
was investigated.
Methods:
48 patients with breast cancer were enrolled in this study. Peritumoral or periareolar
injection of isosulphan blue dye was used and SLN was excised before the primary
tumor. After excision of SLN, a completion ALND was performed to all patients. The
histopathologic results of SLN and ALND were compared and sensitivity, specifivity
and PPD were calculated.
Results:
SLN was found positive in 17 of 45 patients. Non-sentinel axillary node involvement

was detected in 9 of 17 patients with positive SLNB. SLN was the only metastatic
lymh node in the remaining 8 patients. There was only a patient having axillary
lymph node metastasis although SLN was negative. The overall sensitivity, specificity,
negative predictive value and false negative rates were 90%, 73%, 95.6%, and 10%
respectively.
Conclusion:
SLN biopsy is a minimally invasive and effective method in evaluation of axillary

lymph node status in breast cancer patients.
-224-
PP - 30 CAN INTRAOPERATIVE FROZEN SECTION OF THE SENTINEL
LYMPH NODE TRULY EXAMINE AXILLARY METASTASIS IN BREAST
CANCER
ZAFER KILBAS , RAMAZAN YILDIZ , ERKAN OZTURK , ONER MENTES , SEMIH
GORGULU , YUSUF PEKER

ANKARA, TURKEY
Background&Aims:
Sentinel node biopsy (SNB) is now widely used for assessing the axillary lymph node
metastasis for patients with clinically node-negative breast cancer. But the value of
intraoperative frozen section (FS) diagnosis still remains controversial. The purpose
of this study was to investigate the usefulness and limitations of FS for the diagnosis
of SLNs.
Methods:
The results of 224 patients with clinically node negative breast cancer who
underwent a SNB were reviewed. Blue dye or combination (blue dye and
radiocolloid) were used for detecting SLNs. Periareolar subcutan injection of 4 ml
blue dye was performed and SLN were excised before the primary tumor. SLNs
were analyzed using standard FS procedures and a single section stained with H&E
was examined. Permanent sections were later prepared from the remaining frozen
tissues and examined using H&E staining. The results of FS and permanent sections
were compared.
Results:
The final pathology results showed metastasis in the SLNs in 60 patients (27.7%), of
whom 9 were diagnosed as negative by the FS diagnosis. Sensitivity, specificity and
the false-negative rate were 85, 100 and 15%, respectively.
Conclusion:
FS has the obvious advantage of enabling ALND to be performed immediately,

thereby avoiding the need for reoperation.
-225-
PP - 31 COMPARISON OF THE HORMONAL STATUS AND KI67 OVER
EXPRESSION IN INVASIVE BREAST CARCINOMAS
TÜLIN ÖZTÜRK 1, HALE DEMIR 1, ÖVGÜ AYDIN 1, ŞEBNEM BATUR 1, FATIH
AYDOĞAN 2, ŞENNUR İLVAN 1, ZERRIN CALAY 1
1
I.U.CERRAHPAŞA MEDICAL FACULTY DEPARTMENT OF PATHOLOGY, ISTANBUL,
TURKEY
2
I.U.CERRAHPAŞA MEDICAL FACULTY DEPARTMENT OF SURGERY, ISTANBUL,
TURKEY
Background&Aims:
In breast cancer, immunohistochemical (IHC) valuation of the percentage of nuclear

staining for Ki67 has become the most frequently used method for assessment of
tumor proliferation. Our objective is to determine Ki67 levels and compare with
hormonal status in invasive breast carcinomas.
Methods:
Tumors from a cohort of 116 patients with invasive ductal carcinoma 82.8%, invasive
lobular carcinoma 6% and mixt type invasive carcinoma 11.2% (ductal and lobular
carcinomas) were included to this study. Hormone receptor status, HER2 status,
and the Ki67 index were determined immunohistochemically.
Results:
Ki67 was defined as low if <10% Ki67 was detected, as Intermediate if 10–20% Ki67
was detected, and as high if >20% Ki67 was detected. Hormonal status classified
90 (77.6%) of 116 tumors as ER positive, 62 (53.4%) as PR positive, 15 (12.9%) as
HER2 positive and 17 (14.6%) triple negative. We found that ER negativity and triple
negativity were related to high Ki67 expression (P=0.004 and P<0.001).
Conclusion:
In this study high Ki67 levels were found higher in ER-negative cancer patients as
well as triple-negative cancer patients than the others. As shown in literature, the
higher Ki-67 positivity, the greater the risk of poor prognosis. Results should be
interpreted in conjunction with other clinical and laboratory findings.
-226-
PP - 32 PRIMARY LEIOMYOSARCOMA OF THE BREAST: A CASE
REPORT
ZÜLFIKAR KARABULUT
BAŞKENT UNIVERSITY, ANKARA, TURKEY
Background&Aims:
Primary leiomyosarcoma of the breast is exteremely rare tumor, accounting for

less than 1 % of all breast tumors, only 24 case reports presented in the English
literature.
Methods:
A 48-year-old female patient was referred to our hospital because of pain and a mass
in the right breast. A physical examination revealed a tender mass that was 10 cm
in size. Mammography and ultrasonography revealed a well-circumscribed tumor
mass that was 8x6 cm, and located in the upper and lower outer quadrants. Due to
evidence of malignancy in the fine needle aspiration biopsy, a total mastectomy of
the right breast, total excision of the pectoralis major muscle due to invasion, and
axillary lymph node dissection was performed.
Results:
Histopathological and immunohistochemical studies showed that tumor was

leiomyosarcoma.
Conclusion:
Based on the published case reports, the characteristics of primary leiomyosarcomas

of the breast are well-circumscribed, slow-growing tumors showing a tendency for
skin and muscle invasion. It is difficult to reach a diagnosis by cytology. However,
preoperative diagnosis can be achieved using a combination of cytology and
immunohistochemistry. In cases where diagnosis can be achieved before or during
the operation, wide resection should be performed. There is no need for axillary
lymph node dissection.
-227-
PP - 33 THE IMPACT OF TUMOR MARKERS ON THE MANAGEMENT
OF PATIENTS WITH BREAST CANCER.
ZAFER KILBAS , MUSTAFA TANRISEVEN , RAMAZAN YILDIZ , SUBUTAY PEKER ,
ERKAN OZTURK , YUSUF PEKER
GULHANE MILITARY MEDICAL ACADEMY, ANKARA, TURKEY
Background&Aims:
Breast cancer is the most common site-specific cancer in women and is the leading
cause of death from cancer for women. It is important that early diagnose of the
breast cancer for surgery to reduces the risk of death linked to breast cancer.
Biomarkers are measured in the management of breast cancer patients for the;
early detection of breast cancer, monitoring of breast cancer patients, predictive
factors for therapeutic response and prognostic factors. CA 15-3 and CEA is the
most common serum tumor markers in breast cancer patients. The aim of our study
is determine the sensitivity and specifity of serum tumor markers and investigate
the correlation between prognostic factors and serum tumor markers in patients
which were diagnosed breast cancer.
Methods:
Data of 509 patients who have been performed surgery on between years 2008-
2011 in our clinic are investigated retrospectively. Level of serum CA 15-3 and CEA
were measured in 152 of the patients which diagnosed with invasive breast cancer.
The sensitivity and specifity of serum tumor marker levels investigated for each
stages of disease.
Results:
The tumor marker levels were normal in 117 of 152(76,9%) patients and levels were
high in 35 of 152(23%) patients. 38 patients (32.5%) were in stage I, 48 patients
(41%) were in stage II and 27 patients (23.1%) were in stage III and 4 patients
(11.4%) were in stage IV of the total 117 patients whose tumor markers were
normal. Markers level were high when the size of the primer tumor incerese but
there was no sinificant sitatistical differences.
Conclusion:
CA 15.3 and CEA are the serum tumour markers most often used in breast cancer.
Levels of tumor markers in breast cancer were high only 23% of the patients.
There is no ideal tumor markers for detection of early breast cancer. The data
are insufficient to recommend the routine use of CA 15-3, CEA, c-erbB-2, p53 or
cathepsin-D. In the absence of readily measurable disease, CA 15-3 and CEA levels
can be used to document treatment failure. New markers and new evidence will be
evaluated by annual update of these guidelines
-228-
PP - 34 GASC1 GENE EXPRESSION IN BREAST CANCER
BAHRI ÇAKABAY , SABA KIREMITÇI , SANCAR BAYAR , BÜLENT AKSEL , AJLAN
TÜKÜN , GÜVEM GÜMÜŞ AKAY , SALIM DEMIRCI , HIKMET AKGÜL
ANKARA UNIVERSITY SURGICAL ONCOLOGY, ANKARA, TURKEY
Background&Aims:
In this study GASCI gene has been working in breast cancer; results to be obtained
of this study aims to contribute to breast cancer cases, genomic tumor classification
and studies of targeted therapy.
Methods:
For each case of 44 women breast cancer patients we determined two parafin
blocks to use in molecular examination, one of them included tumoral tissue and
the other one included nontumoral breast tissue. Real-time PCR procedures was
performed by using these paraffined and formalin fixed tissues.
Results:
GASC1 expression in tumor tissue was found significantly higher. Although GASC1
expression measured in tumor tissue was higher than GASC1 expression measured
in non-tumor tissue in G3 cases, this elevation was not stastically significant. GASC1
expression measurement tumor tissue and non-tumor tissue ratio was compared
with tumor size, lymph node involvement and status of ER, PR, c-erb but there was
no difference .
Conclusion:
GASC1 expression measurement in breast cancer tissue of cancer patients is higher

than normal tissue, it shows that GASC1 gene is a gene that is effective in the
development of breast cancer. In further studies that can be made by increasing
the patient number, significant results can be obtained in the relationship between
GASC1 and breast cancer.
-229-
PP - 35 ONCOLOGICAL OUTCOMES OF ONCOPLASTIC SURGERY AND
STANDART BREAST CONSERVATION SURGERY
M.ALI GULCELIK , LUTFI DOGAN , MURAT YUKSEL , MITHAT CAMLIBEL , CIHANGIR
OZASLAN , ERHAN REIS
ANKARA ONCOLOGY TEACHING AND RESEARCH HOSPITAL DEPARTMENT OF

Background&Aims:
Reduction mammoplasty, which has long been used for the treatment of
macromastia, has recently become a preferred technique in the surgical treatment
of breast cancer patients with macromastia. Like this oncoplastic techniques
are increasingly used to facilitate breast conservation (BCS) and maintain breast
aesthetics but evidence with regards to the oncological safety of oncoplastic breast
surgery (OPS) remains limited. The aim of this study was to compare oncological
outcomes of OPS and standart BCS.
Methods:
One hundered sixty two patiens BCS and one hundred six breast cancer patients
with macromastia who underwent OPS between 2003 and 2010 were enrolled in
the study.
Results:
The median follow-up time was 37 months in BCS and 33 months in OPS groups.
The 5-year disease free survival (DFS) rate was 68% and the overall survival (OAS)
rate was 77% in group OPS. The 5-year disease free survival (DFS) rate was 65% and
the overall survival (OAS) rate was 79% in BCS group.
Conclusion:
Reduction mammoplasty provides techniques to achieve good esthetic results while

also providing possibility for wide excision margins. Our findings indicate that BCS
via RM are as effective and safe as standard surgical procedures in breast cancer
patients with macromastia.
-230-
PP - 36 CAN TOPICAL STEROIDS BE AN OPTION IN THE TREATMENT
OF IDIOPATHIC GRANULOMATOUS MASTITIS?
FATIH ALTINTOPRAK 1, TANER KIVILCIM 2, ENIS DIKICIER 2, ZEYNEP KAHYAOGLU 3,
GOKHAN AKBULUT 1, OSMAN NURI DILEK 1
1
2
SAKARYA UNIVERSITY RESEARCH AND EDUCATIONAL HOSPITAL, DEPARTMENT OF
GENERAL SURGERY, SAKARYA, TURKEY
3
PATHOLOGY, SAKARYA, TURKEY
Background&Aims:
Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of

the breast. Despite the various treatment approaches described for this disease, a
‘gold standard’ treatment modality has not yet been defined.
Methods:
The records of 36 patients who were treated for IGM between 2007 and 201 were
retrospectively examined. The outcomes in 22 patients (22/36, 61.1%) treated with
topical steroids were assessed in detail.
Results:
All patients were women, and the average patient age was 37.2 years (range: 24-67
years). Fourteen patients (38.8%) underwent surgical treatment, and twenty-two
patients (61.1%) received topical steroid treatment. During the average follow-up
of 26.7 months (range: 17-48 months) in patients who received surgical treatment,
relapse occurred in two patient (2/14, 14.2%), and treatment resulted in poor
cosmetic outcomes in three patients (3/14, 21.4%). During the average follow-
up of 13.5 months (range: 1-42 months) in patients who received topical steroid
treatment, relapse was observed in two patients (2/22, 9.0%), and no side effects
or steroid-releated complications occurred.
Conclusion:
In conclusion, topical steroids, like systemic steroids, may be effective in the

treatment of IGM.
-231-
PP - 37 FREE CIRCULATING TUMOR DNA AS A DIAGNOSTIC MARKER
FOR BREAST CANCER
ABDELHAMID GHAZAL , DOAA HASHAD , AMANY SOROUR , IMAN TALAAT
UNIVERSITY OF ALEXANDRIA FACULTY OF MEDICINE, EGYPT
Background&Aims:
Cell-free DNA (cfDNA) in the plasma of patients with both malignant and benign
breast lesions was analyzed to determine whether the findings may have diagnostic
and prognostic implications and to analyze the association between the levels of
cfDNA and prognostic parameters
Methods:
Plasma samples were obtained from 99 subjects; 42 with breast cancer, 30 with
benign breast lesions and 27 healthy women as normal controls. Circulatory cfDNA
was extracted from the plasma samples and quantified by real-time PCR. Immuno-
histochemistry was done on formalin-fixed paraffin-embedded sections to evaluate
the status of hormonal receptors (Estrogen receptor (ER) and Progesterone receptor
(PR), and the protein expression of both Her2/neu and Topoisomerase IIα
Results:
The level of cfDNA in the breast cancer group was significantly higher than in the
benign lesions and control groups. cfDNA level was associated with malignant
tumour size, lymph node involvement, stage and grade as well as Her2/neu and
Topoisomerase IIα expression, while it was not associated with ER or PR status
Conclusion:
The present study suggests that the level of cfDNA can be easily quantified using
plasma samples. Thus, level of plasma cfDNA might constitute an important
noninvasive diagnostic and prognostic valuable tool in cancer breast patients’
management.
-232-
PP - 38 PROTECTIVE EFFECT OF TAMOXIFEN AGAINIST TO
DEVELOPMENT OF EXPERIMENTAL LYMPHEDEMA
ERTUĞRUL KARGI 1, TURGAY ŞIMŞEK 1, NUH ZAFER CANTÜRK 1, MUSTAFA
DÜLGER 1, HAKAN DEMIR 2, MUSTAFA ÇEKMEN 3, CENGIZ ERÇIN 4
1
KOCAELI UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GENERAL SURGERY,
KOCAELI, TURKEY
2
KOCAELI UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF NUCLEAR
MEDICINE, KOCAELI, TURKEY
3
KOCAELI UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF BIOCHEMISTRY,
KOCAELI, TURKEY
4
KOCAELI UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PATHOLOGY,
KOCAELI,TURKEY, KOCAELI, TURKEY
Background&Aims:
Lymphedema of the upper extremity is the most significant complication after

axillary dissection for breast cancer. Tamoxifen has been used for treatment of
retroperitoneal fibrosis and Riedel’s thyroiditis. In this study, we aimed to evaluate
effect of tamoxifen for preventing lymphedema due to its antifibrotic effect and to
be lighten mechanism of action.
Methods:
Forty Wistar-Albino rats were randomly divided into four groups of 10 as control and
experimental groups. In all groups lymph nodes and vessels stained by methylen
blue were removed segmentally and proximal and distal borders were ligated.
Tamoxifen was orally applied to experimental groups except control. At the end of
the 30 days, lymphedema was evaluated by lymphoscintigraphy and volumetrically.
Tissue was removed, and was histopathologically and biochemically evaluated.
Results:
Although lymphoscintigraphy of rats in all group did not showed any significant
differences among groups, volumetric changes of thigh before experiment and at
the end of the 30 days is significantly high for control rats comparisons with group 2
and 3 (p<0.05). Histopathological data demonstrated that fibrosis was significantly
decreased in preoperatively tamoxifen administrated groups.
Conclusion:
Significant decrease of MDA levels in Group 2 and Group 3 compared with control
group suggests that antifibrotic effect of tamoxifen may be due to antioxidant effect
of tamoxifen.
-233-
PP - 39 ANALYSIS OF REOPERATIONS AFTER SURGERY FOR
PRIMARY BREAST CANCER
OZLEM UYANIK , ANTONIO MORAL DUARTE , JOSE IGNACIO PEREZ GARCIA ,
MONTSERRAT CLOS ENRRIQUEZ , JAVIER ANGELO ALANEZ SAAVEDRA , ANA BELEN
MARTIN ARNAU , MANUEL TRIAS FOLCH

Background&Aims:
Most patients with primary breast cancer can be treated with conservative surgery
with the help of early diagnosis and sentinel lymph node biopsy technique which
may increase the rate of reinterventions. The aim of this study was to conduct an
analysis of reoperations after the primary breast cancer surgery.
Methods:
We analyzed our database collected prospectively, concerning the repeated

interventions in the period 2006-2011, following primary breast tumor surgery in
women.
Results:
There were 58 reoperations in 56 patients from a total of 436 interventions by

primary tumor (13%). Reoperation due to the axillary involvement was 7.4%, and
for the breast involvement after the breast-conserving surgery was 17%. Most
common causes were affected margin, and affected sentinel node. The reoperation
consisted of lumpectomy (48%), mastectomy (20%), axillary dissection (25%) and
sentinel lymph node (7%). In more than a half of the reoperations the remnants
of breast tumor were identified, but 76% of the dissections and 100% of sentinel
nodes were negative.
Conclusion:
We can consider the percentage of reoperations was acceptable, being in the

range of published series. Reoperations for breast seem more justified reason than
axillary, where the failure to find tumor in most cases, suggests an indication for
reoperation.
-234-
PP - 40 BMI AND ESTROGEN RECEPTOR RELATION IN BREAST
CANCER
MUJGAN CALISKAN 1, FATIH BASAK 1, TOLGA CANBAK 1, MUSTAFA HASBAHCECI 2,
AYLIN ACAR 1, GURHAN BAS 1, ORHAN ALIMOGLU 3
1
2
GENERAL SURGERY, FATIH, ISTANBUL, TURKEY
3
Background&Aims:
Obesity is an increase in fat tissue which is the source of carcinogens for the body
and have full of toxins. In this study, we aimed to compare body mass index and
estrogen receptor status of breast cancer patients.
Methods:
116 breast cancer patients between January 2009 and December 2012 were
prospectively included into the study. Patients were divided into 4 groups according
to body mass index. (Group 1: BMI <18, group 2: BMI: 18-24, group 3: BMI: 25-35,
group 4: BMI >35). Gender, age, BMI and Ostrogen status were evaluated.
Results:
The average age of the patients was 54,2 (range 21-88). Mean follow-up duration
was 15,5 months (5-36). The average body mass index was 28,9 (range 17,3-41,1).
The number of patients in group 1 and 2 was 24 (21%), in group 3 was 79 (68%),
in group 4 was 13 (11%). Estrogen receptor status were negative in 28 patients
(24%) and were positive in 75 patients (65%). After statistical analysis, breast tumor
estrogen receptor positivity didn’t differ according to BMI (p >0.05).
Conclusion:
There was no statistically significant relation between BMI and estrogen receptor
positivity. However, BMI increases with the increase of tumor estrogen receptor
positivity.
-235-
PP - 41 CONTRIBUTION OF RADIOISOTOPE TRACER METHOD TO
DYE-ONLY METHOD IN THE DETECTION OF SENTINEL LYMPH NODE
IN BREAST CANCER: A SIMULTANEOUS COMPARISON IN THE SAME
PATIENTS
MEHMET ESER , METIN KEMENT , HUSEYIN UZUN , MELIN GECER , EVRIM
ABAMBOR , FIRAT TUTAL , SALIM BALIN , KEMAL EYVAZ
KARTAL EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
To investigate the contribution of the radioisotope tracer method to the dye-only
method by performing sentinel lymph node biopsy (SLNB) on the same patient
group during a single surgical session.
Methods:
Forty-two patients, who were operated upon in our clinic from February
2010-October 2011, with masses under 5 cm in size and with clinically and
radiologically negative axilla (T1-2 N0), were prospectively included in this study.
After paraffin examination results were obtained, the numbers and metastatic
states of the lymph nodes that could not be noted during surgery (even though they
were stained) but were detected by a gamma probe, lymph nodes that were only
stained, lymph nodes that were only radioactive (hot), and lymph nodes that were
both stained and radioactive (stained and hot) were determined in all patients.
In patients who had axillary lymph node dissection (ALND), the total numbers of
lymph nodes removed and their metastatic states were determined separately.
Results:
In our study, at least one blue-stained sentinel lymph node was identified in all
patients during the blue-stained lymph node detection stage. The average number
of sentinel nodes removed at this stage was 2.1±1.1. In the second surgical stage
(the stage in which nodes with axillary counts were investigated with the gamma
probe) in these 41 patients, at least one additional hot node was removed, or at least
one of the nodes that was removed because it was blue was also hot. In addition
to the lymph nodes removed at the dye stage, 34 hot lymph nodes were excised
from 21 patients. Overall, the average number of hot lymph nodes removed was
2.9±1.5. In all patients, it was determined that frozen-sections and histopathologic
examinations that were performed later were 100% concordant with the sentinel
lymph nodes (SLNs) that were removed; the stained SLNs that were removed first
did not affect the decision to perform axillary curettage.
Conclusion:
The results of our study indicate that performing SLNB with dye only is sufficient
and as effective as the combined method.
-236-
PP - 42 DOES DIAGNOSTIC EXCISIONAL BIOPSY PREVENT THE
BREAST CONSERVING SURGERY?
ZAFER KILBAS , MUSTAFA TANRISEVEN , RAMAZAN YILDIZ , ONER MENTES , ERKAN
OZTURK , SEMIH GORGULU
Background&Aims:
Excisional biopsy in the diagnosis of breast cancer has decreased in recent years.
In experienced centers, preoperative tru-cut or FNAB are 75-80% breast cancer
diagnosis. Depending on this diagnosis, it is possible to find out the answers of
critical questions such as tumor type, grade, receptor status; prior to the planned
surgical operation. If pathology result is reported as breast cancer, progression takes
a negative course.In this study, we aimed to determine whether diagnosing breast
cancer with excisional biopsy is affecting the method of ideal surgical technique (i.e.
breast conserving surgery or mastectomy).
Methods:
Data of 425 patients who have been performed surgery on between years 2006-
2012 in our clinic is investigated retrospectively. First group is consisting of the
patients who are diagnosed by excisional biopsy and then performed secondary
surgical operation as complimentary treatment required. And the second group
includes the patiens diagnosed by needle biopsy. They are compared in aspect of
final pathaological stage and performed surgical technique.
Results:
Age average of patients was 52 (ranging 27-83). Absolute histopathological
examination exposed that 14 patients (42.4%) were in stage I, 14 patients
(42.4%) were in stage II and 5 patients (15.2%) were in stage III, of the total 33
patients performed excisional biopsy. Result of the study showed that ratio of the
patients performed excisional biopsy and followed by breast conserving surgery
is 3/14(21.4%), 0/14(0%) and 0/5(0%) respectively according to stage, whereas
ratio for the second group was 88/137(64.2%), 74/198(37.4%) and 11/51(21.6%)
respectively
Conclusion:
Sufficient data on prognostic factors such as tumor diameter, grade, surgical
borders, receptor status that are important to define surgical options is not
reachable as diagnosis purposed excisional biopsy processes have been carried out
by other medical centers. A successful surgical treatment requires pre-operative
diagnosis FNAP or tru-cut biopsy ideally. Consequently we desire surgery specialist
to perform diagnosis by tru-cut biopsy, instead of excisional biopsy.
-237-
PP - 43 EFFECTS OF LOCAL PHENYTOIN ON SEROMA FORMATION
AFTER MASTECTOMY AND AXILLARY LYMPH NODE DISSECTION :
AN EXPERIMENTAL STUDY ON MICE.
MEHMET ESER , FIRAT TUTAL , METIN KEMENT , MELIN GECER , HUSEYIN UZUN
, KEMAL EYVAZ
Background&Aims:
The present study investigated effect of local phenytoin application on seroma

formation after experimental mastectomy model created in rats.
Methods:
The study consisted of two groups including eight rats in each. In the first group,
normal saline was locally applied under the flap after mastectomy, whereas 1%
phenytoin was locally applied in the second group. Ten days after the surgery, seroma
formation and wound-healing processes were evaluated using histopathological
and biochemical examinations.
Results:
Phenytoin significantly reduced seroma formation. Fibrosis was significantly

augmented and angiogenesis was significantly reduced in the phenytoin group (P<
0.05). Macrophage and lymphocyte infiltration was found significantly augmented
in the control group (P < 0.05). No difference was detected between the groups in
terms of necrosis, edema, congestion, and PNL and fibroblast infiltration.
Conclusion:
Seroma formation-reducing effect of phenytoin might have occurred over its anti-
inflammatory, anti-angiogenetic, and fibrosis augmenting effects.
-238-
PP - 44 GESTATIONAL GIGANTOMASTIA , CASE PRESENTATION AND
LITERATURE REVIEW
KHALID MAJED ALHAJRI , FAISAL ALOTAIBI
PRINCE SULTAN RIYADH MILITARY MEDICAL CITY, RIYADH, SAUDI ARABIA
Background&Aims:
Gestational Gigantomastia is a very rare condition , which is related to pregnancy.

this condition mainly presenting with progressive and massive enlargment of
breasts bilaterally, some times ended by tissue necrosis and breast skin ulceration
and infection. in most of the cases acute enlargment of breast resolved in the
postpartum period.
Methods:
the authors present a 32 years old lady with Gestational hypertrophy of breasts for
whom combined medical and surgical managment successfully treating her acute
presentation.
Results:
the patient investigated by US and tissue diagnosis , histopathology showed

gestational hyperplasia. patient started on bromocriptine therapy. few weeks later
she presented with skin ulceration, tissue necrosis and infection both breasts.
antibiotics started and patient underwent segmental mastectomy . postoperative
she did fine and edema also subsided with help of bromocriptine . the patient
delivered with healthy child.
Conclusion:
Gestational Gigantomasia is a rare condtion . the acute presentation can be

treated by bromocriptine and segmental mastectomy if needed. mastectomies and
reduction mammoplasty can be delayed after delivery.
-239-
PP - 45 MANAGEMENT OF GRANULOMATOUS MASTITIS
MUJGAN CALISKAN 1, FATIH BASAK 1, TOLGA CANBAK 1, MUSTAFA HASBAHCECI 2,
SEMA YUKSEKDAG 1, AYLIN ACAR 1, GURHAN BAS 1, ORHAN ALIMOGLU 3
1
UMRANIYE TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ISTANBUL, TURKEY
2
BEZMIALEM VAKIF UNIVERSITY, FACULTY OF MEDICINE, GENERAL SURGERY
CLINIC, ISTANBUL, TURKEY
3
MEDENIYET UNIVERSITY, GOZTEPE TRAINING AND RESEARCH HOSPITAL,
GENERAL SURGERY CLINIC, ISTANBUL, TURKEY
Background&Aims:
Granulomatous mastitis is a chronic inflammatory benign diseases of the breast

that is rarely seen and characterized unknown etiology. There are only few case
studies in the literature. İn this study we aimed to present the treatment options
of our cases.
Methods:
Between January 2009 and December 2011, patients whom were detected
granulomatous mastitis by core biopsy were included in the study. Patients were
evaluated for the recurrence of the disease at last follow up.
Results:
Histopathological examination of eleven patients revealed granulomatous mastitis.

One patient was excluded because of ineligibility. The mean age was 34.6 (interval
25-49). Six patients underwent multiple surgical drainage. Four patients were
treated nonoperatively; one of the patients in nonoperative group was treated
by only steroidal agents other 3 patients were treated with antibiotics. After 15
months of follow-up, no recurrences occured.
Conclusion:
Granulomatous mastitis is one of the benign diseases of the breast that must be
considered in differential diagnosis of breast cancer. Surgical drainage is one of the
effective treatment option of these lesions but limited surgical tecniques must be
considered because of previous incisional biopsy scars and malignancies. It also has
high recurrence rates. Nonoperative treatment options are also effective.
-240-
PP - 46 PROGNOSTIC SIGNIFICANCE OF AXILLARY LYMPH NODE
RATIO
YAVUZ ÖZDEMIR , AHMET ZIYA BALTA , ERGÜN YÜCEL , ALI İLKER FILIZ , İLKER
SÜCÜLLÜ, YAVUZ KURT, MEHMET LEVHI AKIN
GATA HAYDARPASA EGITIM HASTANESI GENEL CERRAHI SERVISI, ISTANBUL,

TURKEY
Background&Aims:
The ratio of metastatic axillary lymph nodes to harvested lymph nodes (MLNR)
has been proposed as an alternative prognostic factor. In this study, prognostic
significance of MLNR was evaluated in breast cancer patients who underwent an
axillary dissection.
Methods:
A total of 339 breast cancer patients treated by mastectomy and axillary dissection
were evaluated. The ratio of metastatic lymph nodes to harvested lymph nodes was
stratified as zero, low (>0-0,2), medium (>0,2-0,65) and high (>0,65-1). Demographic
variables were evaluated with ANOVA and chi-square tests. Kaplan Meier method
and log rank test were used for cumulative survival analysis.
Results:
There was a significant correlation between the number of metastatic lymph nodes
and the MLNR (Pearson correlation (r)=0.803, p<0.001). Total number of harvested
lymph nodes was less than 12 in 164 (48.4%) patients. There were 198 patients
(58.4%) in N0, 64 patients (18.9%) in N1 and 77 patients (22.7%) in N2 groups.
There were 135 (39.8%), 53 (15.6%), 56 (16.5%) and 33 (9.7%) patients respectively
in MLNR groups. Median time for overall survival in these groups was 89.2, 86.6,
76.1 and 48.8 months respectively (p=0.008).
Conclusion:
MLNR might be an important prognostic factor in patients with insufficient axillary

dissection, and can be used as a criteria for giving adjuvant chemotherapy.
-241-
PP - 47 QUANTIFICATION OF CHANGES IN AXILLARY SURGERY FOR
BREAST CANCER DURING THE LAST DECADE
OZLEM UYANIK , ANTONIO MORAL DUARTE , BEATRIZ ESPINA PEREZ , JOSE
IGNACIO PEREZ GARCIA , MONTSERRAT CLOS ENRRIQUEZ , MANUEL TRIAS FOLCH

Background&Aims:
Surgery for breast cancer has evolved in the recent years toward the conservative
surgery, the implementation of the sentinel lymph node biopsy technique and the
subsequent extension of its indications. We quantified the evolution of axillary
surgery comparing two groups of patients in our series operated with one decade
of difference.
Methods:
After prospective data collection on primary tumor, neoadjuvant therapy, axillary

surgery type and pathology result, we compared the cases operated in 2000-2001
(group A) and in 2010-2011 (group B). Furthermore, we compared treatments
performed in each group with the hypothetical treatments as if the protocol had
been applied in the other group.
Results:
Axillary dissection performed in 100% versus 31% in the group A and B respectively.
In the later group axillary dissection realized after receiving chemotherapy,
therefore only 42% of patients conducted neoadjuvant chemotherapy is supposed
to undergo to dissection. Axillary involvement in the group A and B was 33.7% and
24% respectively. Negative dissections accounted for 66.3% in the group A while
13.7% in the group B.
Conclusion:
Changes in the last decade have reduced the axillary dissections to less than one-
third of patients, and the number of patients who undergo a negative dissection to
less than one-fifth.
-242-
PP - 48 THE EVALUATION OF BREAST CANCER CASES AT BURSA
OMENA BREAST CENTER
CAN BAŞARAN 1, ÖZGÜR DANDİN 2, CEYHUN İRGİL 1, MURAT ÇALIKAPAN 3, ŞÜKRÜ
YILDIRIM 2, AYHAN OKUMUŞ 4, ABDULLAH ETÖZ 1, BÜLENT ORHAN 4
1
2
BURSA MILITARY HOSPITAL ,BURSA, TURKEY
3
BURSA ONCOLOGY HOSPITAL, BURSA, TURKEY
4
ACIBADEM HOSPITAL, BURSA, TURKEY
Background&Aims:
In our institute (Breast Care Center, Omena, Bursa, Turkey), we performed a

retrospective study over a period of sixteen years (1996–2012).
Methods:
In this study 2465 breast cancer cases, admitted to our center, were investigated.
Results:
Of the 2465 patient, 22 were man, and 2443 were woman. Also average age was
54,11 years old. Thirteen percent of patients had a family history of breast cancer.
Fifty two percent of patients had palpable mass at physical examination. The tumor
was identified during the routine controls in %7.5 of patients A total of 109 patients
had bilateral breast cancer. Forty eight percent of patients underwent breast
conservation treatment, %38 of patients underwent modified radical mastectomy.
Also %11 of patients underwent oncoplastic surgery from 2000. Eighty three
percent of patiens were found to have invasive ductal carcinoma on final pathology.
The success of sentinel lymph node mapping procedure was 96% in 501 patients.
Patients with pathological TNM classification, %49.8 were stage II. Patients’ average
length stay in hospital was 2.1 days. Postoperative complication rate was 12 %.
Conclusion:
The most frequent postoperative complications was seroma. Atotal of 293 patients
died afters an average survival of 3,67 years.
-243-
PP - 49 THE KNOWLEDGE, AWARENESS AND THE RESPONSE OF
ADEN WOMEN TOWARD BREAST CANCER
UNIVERSITY OF ADEN, YEMEN
Background&Aims:
breast cancer is the most frequent malignancy of women, it is the leading cause
of female cancer related mortality especially when the patient present late. Breast
cancer presents most commonly as a painless breast lump, but still majority of
the patients seeks help very late and the reasons mostly related to the lack of
knowledge, awareness and the response toward breast cancer.
Methods:
this study was carried out in Aden city Yemen involving 1224 females ( governmental
and private workers and community dwelling women ) using structured
questionnaire designed by the researchers
Results:
A total 1224 women were interviewed , the mean age 34.6 (SD =12.2) years, most
were married 81%, 79%knew correctly that breast lump is usually the first symptom
of breast cancer , but differ about it could be painful or painless by equal ratio ,
positive family history was related in 49% , visiting the hospital as first reaction for
feeling breast lump in 64%, ,about 84$ they know about mets to the other breast
and other body parts , 72% have heard about self breast examination but only 10%
could correctly describe the procedure and only 7% they practice it every month.
Only 33% have heard about mammography and only 6% go for yearly screening ,
94% they know that mastectomy is best option for treatment and only 14% they
know about breast conserving surgery
Conclusion:
Despite Aden is an urban city in Yemen, the level of awareness and knowledge about
breast cancer is very low, and this reflected by late presentation, the need of health
education program about breast cancer by government and other organization may
improve and encourage the early presentation to the hospital
-244-
PP - 50 MANAGEMENT OF BİLATERAL İNGUİNAL METASTASİS FROM
ADENOCARCİNOMA OF RECTUM
ACAR AREN 1, DIDEM KARAÇETIN 2, FIKRET ÇERMIK 3, EROL BOZKURT 4
1
ISTANBUL TRAINING AND RESEARCH HOSPITAL CLINIC OF GENERAL SURGICAL
2
ISTANBUL TRAINING AND RESEARCH HOSPITAL CLINIC OF ONKOLOGY, ISTANBUL,
TURKEY
3
ISTANBUL TRAINING AND RESEARCH HOSPITAL CLINIC OF NUCLEER MEDICINE,
ISTANBUL, TURKEY
4
ISTANBUL TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PATHOLOGY,
ISTANBUL, TURKEY
Introduction:
The prognosis of patients with inguinal lymph node metastases from rectal
adenocarcinoma is poor. The purpose of this study is to discuss the management of
bilateral inguinal metastasis of adenocarcinoma of the rectum. We present a case
of adenocarcinoma of rectum with unusual metastasis to bilateral inguinal lymph
nodes.
Case report:
A 68-year-old male patient presented with bilateral inguinal mass, rectal
bleeding and signs of intestinal obstruction. Rectal biopsy revealed a large rectal
adenocarcinoma, 5 cm to the anal verge. Further examination, PET and MR revealed
rectal tumor and bilateral inguinal mass with no distant metastasis. After oncological
consultation, the patient underwent a total proctocolectomy and bilateral inguinal
lymphadenectomy. Pathology reported 1/11 right inguinal, 1/12 left inguinal, 1/1
right iliac, 1/9 mesorectum lymph node metastasis with adenocarcinoma of rectum
(10X6X2,5) free of tumor in surgical margins. The patient received concurrent
chemo-radiation therapy. There was no postoperative complications, except mild
scrotal and inguinal edema. He is still alive after a mean duration of 9 months of
follow up.
Conclusion:
The presence of inguinal metastasis in patients with rectal cancer heralds
systemic disease and, due to a poor response to the different therapies, only
palliative treatment should be indicated. But in some studies it was observed, that
synchronous solitary involvement of inguinal lymph nodes, as in our case, might
represent a distinct subset of patients with metastatic rectal adenocarcinoma and
have a more favorable prognosis. If confirmed by larger studies, our data suggest
that alternate management algorithms might be reasonable for such patients.
-245-
PP - 51 ANTITHYROID DRUG INDUCED NECROTIZING
ENTEROCOLITIS
ERDEM BARIŞ CARTI , AHMET DENİZ UÇAR , ALİ COŞKUN , MEHMET YILDIRIM ,
ERKAN OYMACI , NAZİF ERKAN
IZMIR BOZYAKA EGITIM ARASTIRMA HASTANESI, IZMIR, TURKEY
Introduction:
Neutropenic enterocolitis is an acute syndrome characterized by cecal and

ascending colon inflammation that may progress to necrosis and perforation. It has
been reported as a complication of childhood leukemia, but is now known to occur
in adults with solid malignancies, acquired immunodeficiency syndrome (AIDS) or
bone marrow transplantation (BMT). We report here on a case that was operated
for neutropenic enterocolitis that occurred when administering propylthiouracil
therapy as an antithyroid drug
Case report:
A male patient at 64 years old admitted abdominal pain, nausea, vomiting and
bad general status. His examination revealed defance, rebound, tenderness on
right lower quadrant. Laboratory showed leucopenia (900/mm³), trobocytopenia
(15000/mm³). Plain abdominal graphy was normal. CT scan showed mesenteric
inflammation and pneumatosis intestinalis. Amylase and liver function tests were
elevated moderately. Patient was operated. caecum and ascending colon were
necrotic but not perforated. Right hemicolectomy and lahey mikulicz ileocolostomy
procedure was applied. Patient had died 1st post operation day at ICU.
Conclusion:
Only one case of typhlitis associated with propylthiouracil has been previously
reported. The mortality rate varies from 50 to 100%, with most deaths being due
to bowel perforation and sepsis. Therefore, early recognition and proper medical
management of neutropenic enterocolitis is important.
-246-
PP - 52 CHILIADITI SYNDROME: CASE REPORT
AYLIN ACAR 1, FATIH BASAK 1, TOLGA CANBAK 1, MUJGAN CALISKAN 1, ALI KILIC 1,
ISMAIL KABAK 1, GURHAN BAS 1, ORHAN ALIMOGLU 2
1
2
Introduction:
Chilaiditi syndrome is defined as hepatodiaphragmatic interposition of colon

together with symptoms such as abdominal pain, nausea, vomiting and constipation.
In this study, we aimed to present a case with Chilaiditi syndrome presenting with
acute abdomen.
Case report:
Sixty-six-years-old male patient was admitted to the emergency room with abdominal
pain, nausea, vomiting, weakness and constipation. On physical examination, there
was tenderness and rebounds in abdomen. There was no significant pathology in
endoscopy. Computed tomography showed intra-abdominal gas-stophage in right
upper quadrant. The patient was given medical treatment. He was discharged after
follow-up 7 days.
Conclusion:
Chilaiditi was diagnosed by the radiological appearance of large bowel loop between
liver and diaphragm. Excessive mobility of liver causes basic pathophysiology.
Common causes are atrophic or small liver due to cirrhosis, mobile intestine,
eventration of diaphragm, increased pressure difference between abdomen and
thorax in pregnancy. Cases are often asymptomatic. The differential diagnosis of
acute abdomen is important. Treatment is usually conservative, and includes
increment of fluids and fiber food intake. Few patients need surgery.
-247-
PP - 53 SINGLE PORT LAPAROSCOPIC TOTAL COLECTOMY AND
INTRACORPOREAL ANASTOMOSIS
ARAS EMRE CANDA , NACIYE CIGDEM ARSLAN

SURGERY
Introduction:
We present our experience of single port laparoscopic total colectomy via Octoport®.
Case report:
Fifty four year old male patient diagnosed with atenue familial adenomatous
poliposis coli was performed single port total colectomy and intracorporeal
anastomosis in January 2012. Patient was operated under general anesthesia in
Lloyd-Davis position with right arm adducted. Mechanical bowel preperation was
not given. Surgical team (surgeon and camera assistant) located on the right side of
the patient. Laparoscopy system was placed on the left side. Octoport® was placed
by open method with a 5 cm left lateral umbilical incision. Endo EYE 30° 10 mm
camera, Ligasure advanced 5 mm and 5 mm articulated atravmatic grasper were
used via Octoport’s flexible soft silicon ports (two 5 mm, one 5-12 mm and one
5-10 mm). As performed in standart laparoscopic total colectomy, colon pedicle
was hanged by grasper and mesocolon was dissected by ligasure advanced with
medial to lateral approach. Colon was seperated over rectum with 2 60 mm
articulated linear cutter and specimen was taken out through self-retracted Octo-
Port® without another retractor. Ileum was seperated with a 60 mm linear cutter
and intracorporeal ileorectal anastomosis was performed with a 28 mm DST
circular stapler. Abdomen was closed, drain was not used. Patient was discharged
on postoperative day 5.
Conclusion:
Octo-Port® may provide a safe and easy approach to single port total colectomy
with mant advantages that its flexible silicon ports and 360° rotative cap reduces
instrument overlaping, and its own retractor allows the specimen to be taken out
without port displacement.
-248-
PP - 54 A RARE CAUSING OF DIFFICULTY IN DEFECATION: RECTAL
SCHWANNOMA
ÖZGÜR DANDIN 1, LEVENT TEZCAN 2, DURSUN ÖZGÜR KARAKAŞ 3, AHMET ZIYA
BALTA 4, FERHAT CÜCE 5
1
BURSA MILITARY HOSPITAL, DEPARTMENT OF SURGERY, BURSA, TURKEY
2
PRIVATE PRACTICE, DEPARTMENT OF GENERAL SURGERY, BURSA, TURKEY
3
AĞRI MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY, AGRI, TURKEY
4
5
VAN MILITARY HOSPITAL, DEPARTMENT OF RADIOLOGY, VAN, TURKEY
Introduction:
Schwannomas are mainly benign non-epithelial tumors originating from the

Schwann cells, which form nerve sheaths. Schwannomas account for about 2-8%
of all gastrointestinal mesenchymal tumors, encountered more frequently in
the stomach and the small intestine. Schwannomas of the colon and rectum are
extremely rare.
Case report:
In this report, we present a thirty-nine years old woman admitted the complaints
with rectal fullness and difficulty in defecation. At her rectal examination, a
polypoid tumor in 22x27x27mm size, filling the lumen of rectum, well-defined,
with homogeneous nature and benign appearance was found. Complete excision
of the tumor was achieved by transanal surgical approach. Histolopathological and
immunohistochemical diagnosis of tumor was reported as rectal schwannoma.
There has been no tumor recurrence at 18 months after surgical excision.
Conclusion:
Schwannoma of the rectum is rare and usually a benign tumor, can be separated
from GISTs with immunohistochemical stainig and carries a good prognosis with
local excision which is the procedure of choice.
-249-
PP - 55 THE ROLE OF PET/CT IN DETECTION UNEXPECTED DISTANT
METASTASIS IN RECTAL CANCER: CASE REPORT
GÖKHAN ÇİPE , HÜSEYİN BEKTAŞOĞLU , HÜSEYİN KADIOĞLU , YELİZ EMİNE
ERSOY , NAİM MEMMİ , ADEM AKÇAKAYA , OĞUZHAN KARATEPE , MAHMUT
MÜSLÜMANOĞLU

GENERAL SURGERY, ISTANBUL, TURKEY
Introduction:
Rectal cancer commonly metastasises to the liver but very rarely to supraclavicular
lymph node. Scanning distant metastasis with PET/CT may be helpful but the
current studies do not support to routine use of PET/CT for preoperative staging of
rectal cancer.
Case report:
We report the case of a 35-year-old male patient with lower rectal cancer.
Preoperative stage of rectal cancer was T3N1. Because of the cancer locally
advanced, neoadjuvant chemoradiotheraphy and PET/CT scanning were planned.
There was no liver or pulmonary metastasis but surprisingly left supraclavicular
lymph node metastasis was detected in PET/CT scan. After neoadjuvant theraphy,
low anterior resection and supraclavicular lymph node resection were performed.
The patient was discharged without any postoperative complication and has been
followed-up local recurrence after 1 year.
Conclusion:
This report describes the rare occurrence of a rectal cancer metastasis to the
supraclavicular lymph node without any distant metastasis. The role of PET/CT scan
in detection supraclavicular lymph node metastasis was life-saving for this patient.
Although the current studies found insufficient evidence to support the routine
use of PET/CT in primary rectal cancer, PET/CT may change the management and
survival in special subgroup of patients with rectal cancer.
-250-
PP - 56 PERIANAL PILONIDAL SINUS
HASAN HAKAN EREM
GUMUSSUYU MILITARY HOSPITAL, DEPARTMENT OF BALMUMCU GENERAL

Introduction:
Pilonidal sinus disease is a common disorder of the military-age young men.

Presacral space is quite common location and other locations are very rare. We
aimed to describe our perianal pilonidal sinus case and investigate the literature.
Case report:
21-year-old male patient was admitted our clinic for complaining itching, pain and
swelling around the anus continued nearly three months. A physical examination
was performed and suspected perianal pilonidal sinus. The patient underwent
surgery following necessary surgical preparations. At surgical exploration methylene
blue was given pilonidal orifice. There was not association between anal canal
and orifis. Perianal pilonidal sinus lesion were totally excised and closed primarily.
Pilonidal sinus was confirmed by histologically examination. Postoperative period
was unremarkable and uncomplicated. There was no recurrence during 6 months
follow-up. In the literature perianal pilonidal lesions are very rare and successfully
cured by surgical treatment.
Conclusion:
Perianal pilonidal sinus should be considered in the differential diagnosis of perianal

lesions.
-251-
PP - 57 TRANSVERSE COLON VOLVULUS
IBRAHIM TAYFUN SAHINER , HAKAN OZDEMIR , METIN SENOL , ZEHRA UNAL
OZDEMIR
MINISTRY OF HEALTH NEVSEHIR STATE HOSPITAL, DEPARTMENT OF GENERAL

SURGERY,NEVSEHİR, TURKEY
Introduction:
Transverse colon volvulus is an uncommon and acute surgical condition. Mortality

rate for transverse colon volvulus is higher in comparison to the mortality rates
associated with volvuli in other regions of the colon. In this article, an intestinal
obstruction due to transverse colon volvulus is presented.
Case report:
An 85-year-old patient was admitted with ileus. Physical examination revealed

extreme distension in the abdomen. A high degree of dilatation was observed on the
X-ray film of the abdomen. Transverse colon volvulus was identified at laparatomy.
When the colon was detorsioned, an approximately 1x1 cm fully necrotic region
was observed in the midsection of the transverse colon. This area actually became
perforated while handling. A stoma was formed for the perforated colon segment
with the right side of the abdomen.
Conclusion:
Transverse colon volvuli constitute 2-4% of colon volvuli and have a reported
mortality rate of 33%. It is observed more frequently among women, and has two
“peak periods” of occurrence: first in the twenties, and later in the seventies. For
this clinical condition with a very high rate of mortality, due to the advanced age
of the patient and concomitant respiratory pathology, colostomy was preferred in
order to keep the surgery period as brief as possible.
-252-
PP - 58 SEVERE INFECTIOUS COMPLICATIONS OF RECTAL SURGERY
CAUSED WITH ANASTOMOTIC LEAKAGE AND NEOADJUVANT
CHEMORADIOTHERAPY.
KURSAT RAHMİ SERİN 1, ENVER KUNDUZ 1, BARIS BAKIR 1, YALIN ISCAN 1, OKTAR
ASOĞLU 1
ISTANBUL FACULTY OF MEDİCİNE, GENERAL SURGERY, ISTANBUL, TURKEY

1
RADİOLOGY, ISTANBUL, TURKEY

2
Introduction:
Sphincter preserving low rectal tumor resection is rised with the improvement of
concurrent chemoradiation therapy. However nosocomial severe infection rates
are increased.
Case report:
Between 2005 and 2012, four of 327 patients (less than 2%) (278 were laparoscopic)
had developed pelvic/perineal severe infection after rectal surgery following
neoadjuvant chemoradiotherapy and were reported here. Three of them were
operated laparoscopically, all were resected with negative surgical margins. Two
of them were developed under possible early postoperative anastomotic leakage
(only one had diabetes mellitus), and the other two of them were occurred at the
late postoperative period. All were needed wide surgical debridement. Three of
them were well treated by surgery with wide spectrum antibiotics, but one was
died due to septic shock hence the surgery. One needed constituent perineal
rectum amputation.
Conclusion:
Anastomotic leakage must be kept in mind at the presentation of severe pelvic/

perineal infectious complications despite the stoma, especially in the absence of
diabetes. In fact pelvic/perineal infection can be the first finding of the possible
anastomotic problems.
-253-
PP - 59 SINGLE INCISION LAPARASCOPIC APPENDECTOMY:OUR
INITIAL EXPERINCE
HUSEYIN SINAN 1, MEHMET SAYDAM 1, MUHARREM OZTAS 2, MUSTAFA OZER 3,
SEZAI DEMIRBAS 3
1
ANKARA MEVKI MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
ANKARA, TURKEY
2
SIRNAK MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY, SIRNAK,
TURKEY
3
ANKARA, TURKEY
Introduction:
Acute appendicitis is one of the most common entity in general surgery practice.
Laparoscopic surgery is performed to heal acute appendicitis in terms of some
advantages by surgeons such as cosmesis, lower postoperative pain. Single incision
laparoscopic surgery is one step beyond of laparoscopic surgery. Breakthroughs on
technology forces to utilize new techniques to professionals. Single incision or port
technique is one of these novelties.
Case report:
We performed single incision laparascopic appendectomy to 3 male patients with

mean age of 21 and with the diagnosis of acute abdomen. To all of the patients,
25 mm vertical incision on the umbilicus were performed and later a single port
(Covidien, North Haven, CT, USA) were placed with transumbilikal method, under
general anesthesia. The appendix was taken out of the abdomen with single port.
Average duration of operations were 40 minutes.We encountered any problems
during or after surgery, and cosmetic results were very good level.
Conclusion:
The last studies show that single port or single incision laparoscopic appendectomy
has some superiorities to laparoscopic or open appendectomy. We wanted to share
our initial experience on single incision laparoscopic appendectomy.
-254-
PP - 60 BUSCHKE-LOWENSTEIN TUMOR SUCCESSFUL TREATMENT
BY SURGICAL EXCISION ALONE: REPORT OF THREE CASES
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, ISA SOZEN 1,
GIRAYHAN CELIK 1, RECEP CETIN 1
1
SULEYMAN DEMIREL UNIVERSITY FACULTY OF MEDICICINE GENERAL SURGERY
DEPARTMENT, ISPARTA, TURKEY
2
ISPARTA STATE HOSPITAL DEPARTMENT OF ANESTHESIA AND CRITICAL CARE,
ISPARTA, TURKEY
Introduction:
Buschke-Löwenstein tumor (BLT), or giant condyloma acuminatum, is a rare

sexually transmitted disease with a potentially fatal course. The virus responsible
for condyloma is human papillomavirus, usually serotype 6 or 11.
Case report:
We present two circumcised, heterosexual man and a woman for 5 years history of a
perianal BLT (12cm x 10cm and 10cm x 8cm). The tumors had evolved progressively
for about 4-5 years. The perianal lesions were then surgically by full-thickness
excision. The entire wound was left open and allowed to heal by secondary intention.
At of the 1-month follow-up, the lesions had almost completely disappeared, with
minute smooth pigmented papules remaining .
Conclusion:
The optimal treatment for BLT is still being debated because of the lack of a consistent
series of patients. Upon correct diagnosis, giant condyloma acuminata should
be treated with radical surgical excision, whenever feasible. Wide local excision,
fecal diversion, or abdominoperineal resection have been used. Chemotherapy
with 5-fluorouracil and focused radiation therapy may be used in certain cases of
recurrence or extensive pelvic disease, with unpredictable response. Controlled,
prospective, multi-institutional studies are necessary to further define the nature
and treatment of this rare disease. In our opinion the radical surgical excision of the
tumor may be considered as first-choice therapy.
-255-
PP - 61 THE CASE OF ANAL INTRAEPITHELIAL NEOPLASIA
DIAGNOSED DURING THE REMOVAL OF A FOREIGN OBJECT FROM
RECTUM
SEVIM TURANLI , NIYAZI KARAMAN , KAZIM CAGLAR OZCELIK , ERHAN REIS
ANKARA ONCOLOGY EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF

Introduction:
In this paper, a case of anal intraepithelial neoplasia treated with surgery was
presented.
Case report:
Forty-five years of male patient was presented to emergency department with the
complaint of abdominal pain and foreign object in anus. At rectal examination,
besides the object palpated there were multiple white mucosal elevated lesions
less than 1 cm in size below the dentate line. Under general anesthesia, the object
was removed from rectum by manipulating also from abdomen. The biopsy of
the lesions was reported as HPV (+) anal intraepithelial neoplasia-3. At second
surgical intervention, cylindrical mucosal excision was performed and proximal and
distal mucosal margins were approximated. The multiple high grade dysplasia foci
sustaining more than 2/3 of epithelium and extensive squamous metaplasia was
reported. Surgical resection margins were intact. The patient was not given any
adjuvant treatment and has being followed-up without any sign of recurrence for
six months.
Conclusion:
Current therapies for the treatment of anal intraepithelial neoplasia are topical
medical agents, immune modulation, cryotherapy, laser therapy, topical antibiotics
and infrared surgery. But the success of these treatments is low. Surgery with clear
surgical resection margins is also an valid treatment alternative. The patients should
be followed-up with regular anoscopic examinations and PAP smears.
-256-
PP - 62 A RARE CAUSE OF ABDOMINAL PAIN AND ANEMIA: GIANT
COLONIC LIPOMA
ÖZGÜR DANDİN 1, AHMET ZİYA BALTA 2, İLKER SÜCÜLLÜ 2, ERGUN YÜCEL 2, ŞÜKRÜ
YILDIRIM 1, DENİZ TİHAN 4, CAN BAŞARAN 5
1
2
GULHANE MILITARY MEDICAL ACADEMY HAYDARPASA TRAINING HOSPITAL,
ISTANBUL, TURKEY
3
BURSA MILITARY HOSPITAL PATHOLOGY SERVICE, BURSA, TURKEY
4
BURSA ŞEVKET YILMAZ TRAINING AND RESEARCH HOSPITAL, BURSA, TURKEY
5
Introduction:
Lipoma of the colon is a rare benign non-epithelial tumor of the gastrointestinal

tract. In general, colonic lipomas do not cause symptoms and are usually detected
incidentally at colonoscopy, surgery, or autopsy. Rarely larger ones can cause
abdominal pain, diarrhea, constipation, bleeding and intussusception Lipomas
of the colon smaller than 2 cm by endoscopy, while those larger than 2 cm by
laparotomy or laparoscopic approach can be taken out.
Case report:
Our case was a 38-year-old female patient having chronic cramping abdominal pain
and anemia which had not improved with treatment, in whose the descending
colon there was a giant lipoma causing invagination.Lipoma were detected by
colonoscopy and the histological examination was diagnosed as submucosal lipoma
and then were operated in elective conditions.
Conclusion:
Lipomas occur throughout the intestinal tract, from the hypopharynx to the rectum,
with the highest incidence in the colon, where lipoma is the commonest benign
neoplasm after adenomata. Colon lipomas, despite rare existence, should be kept
in mind in the differential diagnosis of abdominal pathologies. Colon lipomas
should be removed either endoscopically or surgically because they can cause
severe symptoms and usually a tissue diagnosis is indicated in intestinal tumours
to exclude a malignancy.
-257-
PP - 63 COCAIN RELATED TOXIC MEGACOLON
CAN KONCA , SALİM İLKSEN BAŞÇEKEN , BÜLENT AKSEL , MEHMET GÜREL
ANKARA UNIVERSITY MEDICINE FACULTY DEPARTMENT OF GENERAL SURGERY,

ANKARA, TURKEY
Introduction:
Cocaine is a commonly used illicit central nervous system stimulant in the world.
It has long been known that use of cocaine can result serious cardiovascular,
cerebrovascular and gastrointestinal disorders. In our case, we’re representing
cocaine use related toxic megacolon entity.
Case report:
39-year-old male patient came to the emergency department with a 4-day history
of cramp-like abdominal pain, nausea, vomiting and abdominal distention.
After a 3-day constipation period, patient used 100 gr Magnesie Calcinee. In the
history-taking; we learned that patient regularly used cocaine since 6 years.On
physical examination, patient has diffuse abdominal tenderness, 38.2 °C fever and
tachycardia.Laboratory data showed 20.700/mm3 WBC. Computed tomography
of abdomen with contrast showed pneumocystis intestinalis at caecum and right
colon, and dilatation of all colon segments. We decided emergency laparatomy.
Intraoperative findings were nearly 15 cm diameter of dilatation and necrotic wall
without perforation at caecum. We performed subtotal colectomy and ileosigmoid
anastomosis. With adequate post-operative care patient discharged at sixth day
after the surgery.
Conclusion:
Toxic megacolon is characterized by total or segmental non-obstructive colonic

dilatation plus systemiz toxicity. Even if gastrointestinal complications are relatively
rare; cocaine use can result gastric ulserations, intestinal ischemia, gastrointestinal
tract perforation, retroperitoneal fibrosis and visceral infarction. However these are
well known complications, cocaine use related toxic megacolon is not reported.
-258-
PP - 64 GRANULAR CELL TUMOR ON PERIANAL REGION; REPORT
OF A CASE
UGUR KESICI 1, EMINE MATARACI 2, SEVGI KESICI 3, SEZGIN ZEREN 4
1
AKCAABAT HACKALI BABA STATE HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
TRABZON, TURKEY
2
AKCAABAT HACKALI BABA STATE HOSPITAL, DEPARTMENT OF PATHOLOGY,
TRABZON, TURKEY
3
KANUNI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
ANESTHESIOLOGY, TRABZON, TURKEY
4
NUMUNE STATE HOSPITAL, DEPARTMENT OF GENERAL SURGERY, SIVAS, TURKEY
Introduction:
Granular cell tumor (GCT) was first described by Abrikossoff in 1926. GCT is a rarely
seen soft tissue tumor and is generally benign. While the tumor can be seen in all
parts of the body it is generally located on head and neck region, and especially on
the tongue. GCT is rarely seen in anal-perianal region. In accordance with literature
this case was reported because it was thought to be the 27th anal-perianal located
GCT case.
Case report:
In this case report, approximately 0,5-1 cm pedunculated polypoid lesion was

determined in the perianal region during the physical examination of a 23 year
old female patient who applied with palpable mass complaint in the perianal
region. Lesion in the patient was totally excited with healthy skin-subcutaneous
tissue under local anesthesia. A benign granular cell tumor was detected in the
histopathological examination. + staining was monitored immunohistochemically
with S-100 and neuron specific enolase (NSE).
Conclusion:
GCT is a rarely seen tumor in anal-perianal region and its malign transformation rate
is very low. Even lesions seen in perianal region have clinically a benign appearance,
a histopathological examination should be conducted and also GCT should be kept
in mind during diagnosis. Malign-benign separation of these lesions is difficult so
histopathological examination should be conducted with great care. Large local
excision in the treatment provides curative treatment. But for those presenting
malign transformation further examination must be performed for metastasis.
After the treatment local recurrence and metastasis should be considered carefully.
Prognosis of metastatic disease is very bad.
-259-
PP - 65 HYPERBARIC OXYGEN TREATMENT, AN ALTERNATIVE
TREATMENT FOR RADIATION ENTERITIS
NAIL ERSÖZ 1, YAŞAR SUBUTAY PEKER 1, MUHARREM ÖZTAŞ 1, MESUT
MUTLUOĞLU 2, ŞENOL YILDIZ 2, YUSUF PEKER 1
1
ANKARA TURKEY
2
UNDERWATER AND HYPERBARIC MEDICINE, GÜLHANE MILITARY MEDICAL
Introduction:
Hyperbaric oxygen treatment (HBOT) has many indications where radiation enteritis
is one of the current indication. In this case, we want to share our experiences
about therapeutic effects of HBOT on radiation enteritis.
Case report:
60 years old female patient with rectal adenocarsinoma was planned for neoadjuvant
chemoradiotherapy and had radiation enteritis with symptoms of nausea, vomiting
and diarrhea after completing chemoradiotherapy, where medical threrapy had no
benefit. Patient had no symptom of radiation enteritis after 10 dose of HBOT under
2.4 ATA with duration of 120 minutes. CT scan also improved the therapeutic effect
of HBOT on radiation enteritis; intestinal wall edemma was regressed.
Conclusion:
Radiotherapy is toxic for tissues with high mitosis such as gastrointestinal mucosa.
This toxic effect of radiotherapy is detoxified with oxygen, where HBOT supplies high
concentration of oxygen with high pressure. Beside the therapeutic effect of HBOT
on radiation enteritis, performing intestinal resection-anastomosis to edemateus
intestine may cause higher risk of mortality and morbidity, where HBOT also helps
the intestinal edemma to regress.
-260-
PP - 66 EMERGENCY SUBTOTAL/TOTAL COLECTOMY IN THE
MANAGEMENT OF OBSTRUCTED LEFT COLON CARCINOMA
ABDELHAMID GHAZAL , MAGDY SOROUR , MOHAMED KASSEM
UNIVERSITY OF ALEXANDRIA, FACULTY OF MEDICINE, EGYPT
Background&Aims:
Subtotal colectomy with ileosigmoid or ileorectal anastomosis is one of the

standard procedures for obstructed tumors of the left colon. The purpose of this
study was to evaluate the procedure of subtotal colectomy in the management of
acute obstructed carcinoma of the left colon as a single stage operation
Methods:
This study included 60 consecutive patients who underwent emergency operations

for obstructing primary left colorectal cancers with ileosigmoid or ileorectal
anastomosis according to tumor position
Results:
The site of left colon obstruction was the rectosigmoid in 24 patients (40%), sigmoid
colon in 28 patients (46.6%), descending colon in 3 patients (5%), and the splenic
flexure in 5 patients (8.3%). The histopathology was Dukes B2 in 15 patients (25%),
Dukes C in 25 patients (41.66%), Dukes D in 20 patients (33.33%). Fifty six patients
(93.33%) had an obstructing cancer. Four patients (6.66%) had synchronous tumors
(caecum in two patients; hepatic flexure in one patient and transverse colon in one
patient).
Conclusion:
The study has shown that patients who present with left sided colonic obstruction
may be safely treated by primary resection and anastomosis with satisfactory
outcomes
-261-
PP - 67 ADENOCARCINOMA OF THE TRANSVERSE COLON
PRESENTING AS INTRACTABLE DIARRHEA FOR TWO MONTHS
FOLLOWED BY GNAGRENOUS SMALL BOWEL
ABDULHAKIM AL-TAMIMI , MAHMOUD MAKKI , YASSER BA ASHIN
Background&Aims:
to share this unique surgical case of colonic tumor and its strange presentation
Methods:
case report of male patient of 45 years ,, healthy until he start to have change in
bowel habits that become constantly diarrhea where he passing the ingested food
within 1-2 hours , later he present in severe abdominal pain , mild distension and
melena, there is history of marked loss of weight and decreased appetite
Results:
during surgey ,, there was big tumor in the transverse colon with pressure necrosis
and fistula to the mid portion of the jejinum ,, after that the tumor eroded the
superior mesenteric artery and present with extensive gangrene of the small bowel
Conclusion:
passing undigested food promptly afetr ingestion rise up the possibility of

enerocolic fistula while gangrenous small bowel was not expected until the surgery
was performed
-262-
PP - 68 IMPROVEMENT OF COLONIC HEALING BY PREOPERATIVE
ORAL PARTIALLY HYDROLYZED GUAR GUM (BENEFIBER®) IN RATS
WHICH UNDERWENT PEROPERATIVE RADIOTHERAPY
ALİ İBRAHİM SEVİNÇ 1, BAKİ AYDOĞAN 1, ARAS EMRE CANDA 1, OĞUZ ÇETİNAYAK 2,
CEM TERZİ 1, GÜLGÜN OJKTAY 3, DUYGU GÜREL 4, MEHMET FÜZÜN 1
1
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENTS OF SURGERY,
IZMIR, TURKEY
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENTS OF RADIATION
ONCOLOGY, IZMIR, TURKEY
3
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENTS OF
BIOCHEMISTRY, IZMIR, TURKEY
4
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENTS OF PATHOLOGY,
IZMIR, TURKEY
Background&Aims:
We investigated the effects of preoperative oral Benefiber on irradiated colonic

anastomosis.
Methods:
Forty male Wistar rats were divided into four groups. Group I underwent left colon
resection and anastomosis. Group II had preoperative oral Benefiber. Group III
underwent pelvic irradiation eight and four days before the operation, Group IV
underwent pelvic irradiation and had preoperative oral Benefiber.
Results:
The mean bursting pressure was significantly low in Group III and was significantly
high in Group II (P=0.032, P=0.016). The histologic parameters of anastomotic
healing were significantly improved by the use of preoperative Benefiber. The
amount of acid-soluble collagen concentrations significantly increased in Group IV
compared to Group III (P=0.032). The amount of salt-soluble collagen concentrations
significantly increased in Group II compared to Group III (P=0.032).
Conclusion:
Certain mechanical and histological aspects of colonic anastomotic healing can

be adversely affected by preoperative radiotherapy, but orogastric feeding with
Benefiber may improve the healing process.
-263-
PP - 69 HEMORRHOIDECTOMY WITH HARMONIC SCALPEL
HAKAN BULUŞ 1, ALPER YAVUZ 1, ALİ COŞKUN 2
KECIOREN TRAINING AND RESARCH HOSPITAL, ANKARA, TURKEY

1
YILDIRIM BEYAZIT UNIVERSITY, ANKARA, TURKEY

2
Background&Aims:
Symptomatic hemoroidal disease (SHD) is a common disease which usually need

surgery for treatment. Convantional hemoroidectomy can cause complications
. Modified electro-surgical instruments “harmonic scalpel (HS)” which is an
alternative technique for hemoroidectomy, has also been preferred recently.
Methods:
151 patients who were operated for sympthomatic grade III-IV hemorroid in
Keçioren Research and Education Hospital, General Surgery Department between
May 2009 and June 2011 were enrolled into the study. Patients were randomised into
Ferguson hemorroidectomy with electrocother group and hemorroidectomy with
HS group. The present review focused on comparing HS hemorrhoidectomy versus
conventional hemorrhoidectomy with regards to operating time, postoperative
pain, duration of disease, number of issued pake, length of hospital stay, time to
return to normal activity, and postoperative complications.
Results:
The mean age of patients who underwent HS and Ferguson’s was 34.1 ±9.2 years
and 33.7 ±8.4 years respectively. The male/ female ratio of HS group and of
Ferguson’s hemorrhoidectomy group was 46/34 and 41/30 respectively. The average
postoperative stay in the HS group was 1.0±0.1days and in the Ferguson’s group
was 1.2 ±0.4 ( p= 0.001).The time of return to normal activity was shorter for the
HS groups than for the conventional hemorrhoidectomy groups( 10.6±2.1, 16.0±6.3
day respectively, p= 0.001). The mean operating time of the HS and Ferguson’s
hemorrhoidectomy groups was 25.5±7.7 min and 16.8±4.1 min respectively
(p<0.001). The VAS pain scores on preoperative day 0, 7 and 28 of HS group were
0.7±0.6, 5.4±0.7, 4.0±0.8 and 0.01±0.1 respectively and of the Ferguson’s group
were 0.7±0.4, 6.8±1.8, 5.2±1.2 and 1.4±0.2 respectively (p=0.001).
Conclusion:
In conclusion, HS hemorrhoidectomy has been preffered widely for surgical

treatment of grade III-IV hemorrhoids. It is safe and effective, causes less blood loss,
postoperative pain and complications compared to Ferguson’s hemorrhoidectomy.
-264-
PP - 70 TRANSPERINEAL PROCTOSYGMOIDECTOMIA ET
RECONSTRUCTION OF M. LEVATOR ANI DUE TO RECTAL PROLAPS
AND RECTOCELA
DUJO KOVACEVIC , AMIR IBUKIC
DEPARTMENT OF SURGERY, UNIVERSITY HOSPITAL CENTRE “SESTRE

MILOSRDNICE”, CROATIA
Background&Aims:
Rectal prolaps(intussusception), or procidentia and rectocele are anatomic disorders

in obstructed defecation syndrome. These commonly occurs with increasing age
and vaginal multiparity, the main commonly accepted risc factors. Few patients, a
lack of randomized trials and difficulties in the interpretation of studies of anorectal
physiology have made the understanding of this disorder difficult.
Methods:
The main aim of surgical management through transperineal anatomic approach

is restoring physiology by correcting the prolapse and improving continence and
constipation by reconstruction of pelvic muscle floor in only one act.
Results:
Rectal prolapse and rectocele by their clinical appirience are two different disorders,
but with the same origin-pelvic muscle floor disfunction due to collagen deficiency
and/or elastic fiber degradation. We strongly recommend that every phisical exame
of rectal prolapse should implicate investigation of rectocele.
Conclusion:
Conventional surgical management solves separately these disorders; however

in our case report we present succesfull treatment in one act using transperinal
anatomic approach.
-265-
PP - 71 TRANSANAL SINGLE PORT ACCESS MICROSURGERY FOR
LOCAL EXCISION OF THE RECTAL LESIONS
ARAS EMRE CANDA , CEM TERZI , MEHMET FUZUN
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF SURGERY,

IZMIR
Background&Aims:
Transanal single port access microsurgery (TSPAM) is an emerging minimally invasive

method for the transanal excision of large sessile adenomas and early carcinomas
of the rectum. Here we review our experience with TSPAM in 8 cases.
Methods:
Between May 2011 and June 2012, we performed 8 TSPAM procedures for local
excision of the rectal adenomas which are not attempted by endoscopic removal
either for the size or localization of the lesion. A single incision laparoscopic port
(SILS Port, Covidien) or single site laparoscopy (SSL) access system (Ethicon Endo-
Surgery) was inserted through the anus. After insufflation with CO2, with the aid
of 10 mm, 30° rigid laparoscope and variety of 5 mm rigid or articulating hand
instruments transanal excision of the specimen was performed.
Results:
Mean operative time was 58 (25-130) min. We performed full-thickness local excision
in 7 patients and excision through submucosal plane in one patient and closed
the rectal defect in 7 patients. No perioperative or postoperative complications
were observed. All lesions were removed with clear margins. Histopathology was
demonstrated a high-grade dysplasia in 5 patients, in-situ carcinoma in 1 patient,
and invasive cancer in 1 patient.
Conclusion:
Transanal local excision of the rectal adenomas and early tumors with this innovative
technique is safe and effective. TSPAM may be an affordable alternative to TEM
technique.
-266-
PP - 72 TREPHINE OSTOMY: SAFE AND SIMPLE
AYKUT SOYDER , HEDEF OZGUN

Background&Aims:
Fecal diversion is often indicated in perineal sepsis and palliation of anorectal

malignancy. This can be performed without recourse to laparotomy. This study was
aimed to assess the outcome of trephine to stoma creation.
Methods:
Trephine stoma creation was evaluated retrospectively in unselected 23 consecutive

patients including the data related with patient demographics, ASA grade,
anesthetics used and surgical complications.
Results:
Between January 2008 and June 2012, 23 patients (17 men, 73.9% and 6 women,
26.1%) underwent a trephine stoma. The mean ages of cases were 58.2±15.8
(ranged 34-83). The indications for stoma formation were perineal sepsis in 11
(47.8%) cases, inoperable anorectal cancer in 7 (30.4%), recto-vaginal fistula in
2 (8.7%), fecal incontinence in 2 (8.7%) and sigmoid volvulus in 1 (4.3%). Nine
(39.1%) had surgery under regional anesthesia because of being in ASA grade III.
Loop colostomy was preferred in all cases. One (4.3%) had laparotomy on the
postoperative period due to colostomy descent.
Conclusion:
Trephine stoma formation is a minimal invasive method and is a basic and fast
fecal diversion technique performed easily in not only those without laparotomy
indications, but also in high risk patients with low complication rates. Key Words:
Fecal diversion, trephine stoma
-267-
PP - 73 COMPARISON OF OSTOMY AND PRIMARY REPAIR IN
RECTAL INJURIES
BURAK VELİ ÜLGER , AHMET TÜRKOĞLU , ÖMER USLUKAYA , ABDULLAH OĞUZ ,
İLHAN TAŞ , MUSTAFA ALDEMİR
DICLE UNIVERSITY MEDICAL FACULTY GENERAL SURGERY CLINIC, DIYARBAKIR,

TURKEY
Background&Aims:
The presence of an ostomy is an emotional trauma for the patients and creating an
ostomy has risk of complications. The aim of this study is to compare the outcomes
of the treatment methods ostomy and primary repair , in rectal injuries.
Methods:
63 patients with rectal injury who had been treated at Dicle University Hospital
between 2000 and 2011 were retrospectively reviewed. In order to determine the
risk factors , the patients were divided into two groups (Group 1; patients which
underwent ostomy , Group 2 ; patients which underwent primary repair) and
compared.
Results:
The patients were 51 men and 12 women. The mean age was 30,16±11,38. The site
of the injury was extraperitoneal in 46(%73) patients , intraperitoneal in 11(%17,5)
patients and intra-extraperitoneal in 6(%9,5) patiens. 44 patients underwent
ostomy whereas 19 patients underwent primary repair. The mean grade of the
injury was higher in Group I(p<0,001). No morbidity was detected in both groups
with grade 2 intraperitoneal rectal injury. The outcomes of the patiens with Grade
2 intraperitoneal and extraperitoneal rectal injury were similar .
Conclusion:
In threatment of the patients with low grade rectal injuries , primary repair can be
preferred to ostomies
-268-
PP - 74 LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
SERGEY BAYDO , ANDREY ZHYGULIN , ALLA VINNITSKA , DMYTRO GOLUB , MAXIM
SILVESTROV , SERGEY PRYNDYUK
ZINA MEMORIAL LISSOD HOSPITAL, UKRAINE
Background&Aims:
Laparoscopic operations make it possible to improve intra- and postoperational

results without compromising oncological radicalism. This report is about our
experience in performing laparoscopic operations for colorectal cancer in private
oncological hospital in Ukraine.
Methods:
From 2009 till July 2012, 60 patients with colorectal cancer were operated with
laparoscopic access. Right hemicolectomy in 11 patients, left hemicolectomy- 8,
sigmoid resection- 5, anterior resection of rectum- 21, abdominoperineal resection-
15. Rectal cancer was in 36 patiens, colon- 24. Distribution for stages: I- 8, IIA-28,
IIIA-16, IIIB-6, IV-2. Male- 32, female- 28. Mean age- 54 year. The Holm position
was used for performing APR. In 3 female patients was used transvaginal access for
extraction of specimen.
Results:
Mean operative time was 115 min. Blood loss- 95ml. Length of stay- 8,2 days. The
mean number of removed lymph nodes was 18. There were no conversions neither
deaths. Level of complications was 21,2%. Among them significant were in 12,4% of
cases (pulmonary embolism, myocardial infarction, anastomotic leak, peritonitis).
Conclusion:
The usage of laparoscopy technology in colorectal oncology defines some positive

aspects: low intraoperative blood loss, low pain and anesthetic demand, faster
recovery of bowel function, short period of hospitalization.
-269-
PP - 75 SINGLE INCISION MULTIPORT LAPAROSCOPIC
APPENDECTOMY
EMEL CANBAY , SELIM YIGIT YILDIZ , TANER TURGUT , ALI CIFTCI , MEHMET
OZYILDIZ , ZEHRA BOYACIOGLU , FARUK GULUMSER
KOCAELI DERINCE EDUCATION AND RESEARCH HOSPITAL, KOCAELI, TURKEY
Background&Aims:
Acute appendicitis is one of the most common surgical disease in our everday clinical
practice. Several techniques for single incision laparoscopic appendectomy have
been described previously. We herein describe our own technique for laproscopic
appendectomy
Methods:
A total 18 patients underwent to single incision multiport laparoscopic

appendectomy for acute appendicitis between September 2011 and December
2011. Preoperative, peroperative and postoperative data were collected.
Results:
Our technique was successful in 1 out of 17 patients, while one patient required the
placement of additional trocar. None of the patients needed conversion to an open
approach. Mean operation time was 56.7 minutes. The mean length of stay was
1 day. One patient who developed postoperative ileus and readmitted to hospital
and reoperation revealed normal operative finding and the patient was discharged
in well condition.
Conclusion:
Our technique as single incision and multiport laparoscopic appendectomy is safe

feasible. Prospective randomized studies comparing the single incision laparoscopic
approach as well as conventional multiport technique with our technique are
essential to confirm the final conclusion of our early experience.
-270-
PP - 76 PERIANAL FISTULA: RETROSPECTIVE STUDY OF SURGICAL
TREATMENT OF 196 CASES.
MUSTAFA PESKERSOY 1, ERDINC KAMER 1, TURAN ACAR 1, CENGIZ TAVUSBAY 1,
OGUZ HANCERLİOGULLARI 2, AHMET .ER 1, MEHMET HACIYANLI 1
1
IZMIR KATIP CELEBI UNIVERSITY ATATURK TRAINING AND RESEARCH
HOSPITAL,DEPARTMENT OF SURGERY, IZMIR, TURKEY
2
IZMIR ARMY HOSPITAL, İZMIR, TURKEY
Background&Aims:
Fistula arising from the glands of the anal crypts is the most common form of
anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal,
a fistulous tract, and an abscess and/or secondary perineal orifice with purulent
discharge. The aim of this paper was to study retrospectively 196 cases of perianal
fistula operated The age and sex distribuition, the etiology, the surgical techniques
and the postoperative outcome were analysed.
Methods:
This is a retrospective study comprising 196 patients (148 men and 48 women)
aging 29-84 years (average 37,4 years) that underwent surgery for perianal
fistula in the period from 2006 to 2012 at the Izmir Atatürk Training and Research
Hospital,Department of Surgery,Izmir. The surgical techniques and post-operative
outcome have been analysed.
Results:
Perianal abscesses with spontaneous drainage were the predominant etiology

(138 patients;70.4%).Ninety-nine patients (35.2%) were submitted to fistulectomy
alone as the first surgical treatment. Fistulotomy and seton placement were also
performed (36.2% and 28.6%,respectively). Among the late complications fistula
recurrence (94;48%) was the most frequent.The average hospitalization time was
2.2 days.
Conclusion:
The surgical treatment of perianal fístula has a significant rate of post-operative

complications and a high recurrence rate, in spite of the short stay in hospital.
-271-
PP - 77 ADENOMATOUS POLYPOSIS LOCALIZED TO RECTUM WITH
OCCULT INVASIVE CANCER FOCI
OSMAN KRAND 1, ETHEM UNAL 1, TUNC YALTI 2
1
HAYDARPASA NUMUNE RESEARCH AND TRAINING HOSPITAL, 1. GENERAL
2
VKV AMERICAN HOSPITAL, GENERAL SURGERY DEPARTMENT, ISTANBUL, TURKEY
Background&Aims:
We herein present a case of adenomatous polyposis rectii, sparing the colon, with
occult invasive rectal cancer who underwent an intersphincteric resection surgery.
Methods:
53 year-old male patient was admitted with colorless and odorless mucous rectal
discharge symptom. His family history including colorectal cancer was negative.
APC gene study was also negative. Colonoscopy revealed a normal colon except
a rectal mucosa filled with thousands of polyps. Biopsy showed a tubulovillous
adenomatous pathology. The patient underwent surgery and an intersphincteric
rectum resection employing partial internal anal sphincter removal was done with
coloplasty, and colo-anal anastomosis. Then, smooth muscle plasty was performed
to restore internal anal sphincter function. An ileostomy was created in the right
lower quadrant. Patient was discharged home on postoperative day 5. İleostomy
was closed early, at postoperative day 12. In microscopic sections, there were
two foci of invasive adenocarcinoma within thousands of adenomatous polyposis
rectii. The tumor was classified as (T1N0M0) AJCC/TNM stage 1. There was no K-ras
mutation. However, positive p53 staining was detected
Results:
Patient did well on 2-year follow-up period.
Conclusion:
To the best of our knowledge, this represents the first reported case in the literature
of colonic polyposis syndromes consequent to its colon sparing rectum localization.
-272-
PP - 78 IS MRI SHOULD BE DONE EVERY ANAL FISTULA?
FEVZI CELAYIR , GÜRKAN YETKIN , EBRU ŞEN ORAN , MEHMET ULUDAG , İBRAHIM
ERBAŞ , NURCIHAN AYGÜN , EVREN PEKER
SISLI ETFAL TEACHING AND TRAINING HOSPITAL GENERAL SURGERY CLINIC,

ISTANBUL, TURKEY
Background&Aims:
MRI has been used increasingly in recent years at the diagnosis of anal fistula. Even
though the findings are very important, although the diagnosis is always required?
In this study questioned it.
Methods:
Made between the years 2008-2011, 40 patients were retrospectively analyzed MRI
anal fistula . In 25 patients, had a simple (intersphincteric) fistula. The remaining ;
10 patients had a complex fistula and recurrence fistula in 5 patients
Results:
Fistula operations were questioned in these 40 patients. In 25 patients who had

a simple anal fistula MRG, had no contribution to the technique of the surgeon
that performed the operation In other patients, revealing the complex anatomy,
had been very helpful in showing the relationship between the internal orifis and
sphincter.
Conclusion:
MRI increase the cost of treatment. Requires an additional procedure to the

patient. Should not be applied routinely in each patient with anal fistula There is
no additional contributions in simple anal fistulas. Therefore, the first examination
is important. The physician should pay attention more and MRI should not use
unnecessary.
-273-
PP - 79 ENDOSCOPIC MANAGEMENT OF ANASTOMOTIC
COMPLICATIONS IN COLORECTAL SURGERY
GIOVANNI RIZZO , ANTONIO PINNA , GIOVANNI LOCHE , PIETRO MAROGNA ,
ANTONIO MARIO SCANU , GIUSEPPE DETTORI
II° GENERAL SURGERY CLINIC, UNIVERSITY HOSPITAL OF SASSARI, ITALY
Background&Aims:
The safety of colorectal surgery has improved over the last years, nevertheless
anastomotic complications continue to occur (20%). The endoscopic management
of complications decrease the patient’s morbidity, re-operation rate and
hospitalization.
Methods:
Patients were analyzed by the types of complication and subsequent endoscopic

treatment. Bleeding is routinely not a major problem to solve and just for persistent
bleeding a treatment is needed. Endoscopic management includes: electro-
coagulation; epinephrine injection and application of haemostatic clips. Rectal leaks
is managed by endoscopic debridement and lavage combined with either stents,
vacuum system or fibrin glue therapy. Stricture (benign or malignant) is treated
with hydrostatic balloon dilatation combined with preceding laser or APC incision
of the stricture or bio-degradable stents. Fistulas are best managed by addressing
the sites that are involved: clips or stents are usually adopted in association with
diverting stoma.
Results:
Endoscopic treatment of complications allows a high success rate especially

considering the cost-benefit ratio for patient.
Conclusion:
A strict selection of the patients is important for its success. For this reason, an
early and correct diagnosis with an availability of experienced and dedicated staff
is mandatory. The recent development of endoscopic technical devices (clips,
biodegradable stents etc.) helps in this matter.
-274-
PP - 80 COMPARISON OF LAPAROSCOPIC AND OPEN
APPENDECTOMY: WHERE ARE WE NOW?
GÖKHAN ÇİPE , OĞUZ IDIZ , MUSTAFA HASBAHÇECİ , SÜLEYMAN BOZKURT,
HÜSEYİN KADIOĞLU , HALİL COŞKUN , OĞUZHAN KARATEPE , MAHMUT
MÜSLÜMANOĞLU

Background&Aims:
Although the advantages of laparoscopic procedure has been well studied over the
last two decade, laparoscopic appendectomy couldn’t to be a standard therapy due
to some disadvantages such as longer operative time and higher cost. The objective
of our study is to re-evaluate the outcomes LA versus OA with current data.
Methods:
Between January 2012 and July 2012, the data of patients who had appendectomy
were recorded prospectively. Patients demographics, duration of procedure, length
of hospital stay, need of analgesics, postoperative visual analogue scale (VAS) scores
and morbidity were assessed.
Results:
Of 241 patients, 120 (49.8%) underwent OA and 121(50.2%) LA. The operating time
was similar for both groups (p:0.855). The VAS score of 1st LA vs. OA (P:<0.001),
6th (P:0.001) and 12th (P:0.028) hour were higher in OA group. The total need
of analgesics significantly higher in OA group (P:0.001). There was no statistical
difference in terms of total morbidity rate between OA and LA (P:0.617).
Conclusion:
The two operative techniques are similar in terms of hospital stay, operative time,
and postoperative complications. LA reduces the need of analgesics and VAS scores;
therefore LA should be the golden standard treatment for acute appendicitis.
-275-
PP - 81 PERINEAL PROCTOSIGMOIDECTOMY (ALTEMEIER’S
PROCEDURE) FOR FULL THICKNESS RECTAL PROLAPSE IN AN
ELDERLY POPULATION.
GREGORY SIMPSON , ALI SHEKOUH , UFUK GUR
ROYAL LIVERPOOL UNIVERSITY HOSPITAL, UK
Background&Aims:
A number of perineal and abdominal procedures exist to treat full-thickness

rectal prolapse. The perineal approach is often used in the elderly and Altemeier’s
procedure is the procedure of choice in our unit. Our aim is to assess the use of
Altemeier’s procedure in conjunction with an enhanced recovery protocol in a
challenging patient population with multiple co-morbidities.
Methods:
A retrospective study examining consecutive cases of full-thickness rectal prolapse

treated with Altemeier’s procedure by a single surgeon at the Royal Liverpool
University Hospital. Clinical records, operative notes, histology and anaesthetic
records were analysed.
Results:
15 patients were identified,4 of which were treated for recurrence(25%) after a

Delorme’s procedure. Median age was 81years(range:71-87years). All patients were
aged >70 years. 7 patients were ASA-III, 9 patients were ASA-II. Median operating
time was 95 minutes(range:60-149minutes). All procedures were performed under
GA, in prone position. Median post-operative stay was 22 hours(range:5-108hours).
No complications were experienced. 1 of 16 patients experienced recurrence over a
median follow-up of 8 months. There was no mortality.
Conclusion:
Altemeier’s procedure for full-thickness rectal prolapse is safe and effective in

the elderly. It conveys minimal complication, morbidity and mortality with low
recurrence rate in this challenging patient group.
-276-
PP - 82 RANDOMIZED CLINICAL TRIAL: ULTRACISION VERSUS
FERGUSON HAEMORRHOIDECTOMY
KAZIM DUMAN 1, GÜVEN YİĞİT 1, YAVUZ OZDEMIR 2, ERDOĞAN ÜLKE 1, MUHİTTİN
ÖZÇELİK 1
1
GÜMÜŞSUYU ASKER HASTANESI GENEL CERRAHI SERVISI TAKSİM- BEYOĞLU,
İSTANBUL
2
GATA HAYDARPAŞA EĞITIM VE ARAŞTIRMA HASTANESI GENEL CERRAHI SERVISI
ÜSKÜDAR, İSTANBUL
Background&Aims:
The aim of this study was to compare the results of between the Excision by
Ultracision system and ferguson haemorrhoidectomy procedure for haemorrhoidal
disseases.
Methods:
Fifty six patients with grade 2 or 4 haemorrhoids were randomized to two groups.
1) Haemorrhoidectmy by Ultracision (n:34), and 2) Ferguson Haemorrhoidectomy
(n:22). The patient demographics, operating time, postoperative pain score, wound
healing time and time to return to normal activities, postoperative complications,
intraoperative blood loss, time off from work or normal activity, hospital stay were
documented. The patients were regularly followed-up at 1, 2, 4, 6, 8, and 12 weeks
after surgery.
Results:
Patient demographic and clinical characteristics, early and delayed postoperative

complications and degree of patient satisfaction were similar in the 2 groups. The
mean operating time for Group 1 Patients were significantly shorter than that for
the group 2 patients (12,6 ± 0,5 vs. 42,2 ± 1,7 min. P < 0.001). Group 1 Patients
had significantly less blood loss (1,5± 0,5 vs 23± 4,5 ml P < 0.001), less parenteral
analgesic requirement (P < 0.001), a better pain score (P < 0.001), and less time
off from work or normal activity (P < 0.001).shorter hospital stay (P < 0.001) than
group 2.
Conclusion:
Ultracision hemorrhoidectomy is a safe, effective procedure for haemorrhoideal

disseases. Patients derive greater short-term benefits. Long-term follow-up with
a larger number of patients is required to confirm the long-term results of this
procedure.
-277-
PP - 83 WHAT IS THE BEST CHOICE OF TREATMENT FOR
PILONIDALIS SINUS DISEASE WITH PERIANAL OPENINGS?
NAZIF ZEYBEK 1, ALI KAGAN COSKUN 1, HUSEYIN SINAN 2, ISMAIL HAKKI
OZERHAN 1, ALI HARLAK 1, YUSUF PEKER 1
1
ANKARA, TURKEY
2
ANKARA, TURKEY
Background&Aims:
In this retrospective study, we investigated the value of the treatment methods for
pilonidal sinus disease with perianal openings.
Methods:
Patients records who were operated for pilonidal sinus disease with perianal
openings between February 2008 and July 2011 were evaluated.. The procedures
included were excision of the pilonidal sinus with isolated fistulectomy or excision of
the pilonidal sinus with fistulotomy + curettage + intraflexion. All the epidemiologic
data (gender, age, disease duration, number of abscess drainage, surgical procedure,
healing time, recurrence) were evaluated through correlation of surgical notes and
discharge letters.
Results:
The mean healing time for the fistula tract excision and primary suture group
was 9.25 days (range: 7-14 days). The mean healing time for the fistulotomy and
introflexion group was 29.3 days (range: 19-37 days).No recurrences were noted in
either group.
Conclusion:
Isolated fistulectomy is recommended for the treatment of pilonidal sinus disease

with perianal openings with minimal skin defect and less risk for damage to the
sphincter mechanism.
-278-
PP - 84 MESENTERIC ISCHEMIA IN MALROTATION IN THE ELDERLY
IBONE PALOMARES , ANDONI LARZABAL , RAUL SAA , FERNANDO MúGICA ,
RAFAEL PINEDO , PAULA RUBIO , JOAQUIN LOSADA , ALBERTO COLINA
CRUCES UNIVERSITARY HOSPITAL, SPAIN
Introduction:
Intestinal malrotation is an embryological development disorder that usually

manifests in children and exceptional in the elderly
Case report:
An 81 year old woman comes to the emergency department with abdominal pain of
12 hours of evolution associated with vomits. On examination, a mass was palpated
in the right flank. The analytic was anodyne. The TC showed anomalous position
of the small bowell with no wall enhancement suggestive of intestinal volvulus.
We performed emergency surgery, aiming incomplete intestinal malrotation
with Ladd’s band, which produced a volvulus and intestinal ischemia. Band was
sectioned, ischemic bowel resection and anastomosis, leaving the remaining small
intestine at the right flank and colon at the left. The outcome was favorable
Conclusion:
Dr. Dott was the first to objectify a malrotation in an operation in 1923, but Ladd
was in 1941 who established the procedure. Malrotation is an alteration in bowel
rotary process in embryonic development. Despite being rare, there are cases that
occur in the elderly, being difficult to suspect in preoperative period. CT may be
helpful for fast diagnostic and surgical decision
-279-
PP - 85 MESENTERIC ISCHEMIA DUE TO ACUTE APPENDICITIS
IBONE PALOMARES , AINGERU SARRIUGARTE , RAUL SAA , PAULA RUBIO ,
FERNANDO MúGICA , RAFAEL PINEDO , JOAQUIN LOSADA , ALBERTO COLINA
CRUCES HOSPITAL, SPAIN
Introduction:
The appendectomy is one of the most frequently performed interventions in

emergency departments of hospitals by general surgeons, usually for acute
appendicitis, but sometimes due to other pathologies.
Case report:
A 52 year old woman went to the emergency for few hours abdominal pain in
hypogastrium, associating vomiting. The week before, presented abdominal
pain episode in right flank, treated with antibiotics suspecting UTI. On physical
examination, the patient had painful abdomen in hypogastrium. Laboratory test
shown leukocytosis with neutrophilia. The CT showed ischemic ileum caused by
twisted mesentery with partial thrombosis of superior mesenteric vein. Emergency
surgery was performed, finding an apendicitis with a fibrotic band as the cause of
the ischemic ileum. The band was sectioned with appendectomy and resection of
one meter terminal ileum with ileocecal anastomosis.
Conclusion:
Our case is unique as intestinal ischemia occurred without clinical intestinal

obstruction, due to appendicular band, after fixation the appendiceal tip in the
appendiceal mesentery in the context of acute appendicitis, producing torsion
and vascular involvement of the terminal ileum. Acute appendicitis sometimes
conditions associated disease such as intestinal obstruction and ischemia, that
should be taken into account. Radiological diagnosis is very helpful in these cases
and surgical treatment should not be delayed.
-280-
PP - 86 PERCUTANEOUS ETHANOL INJECTION THERAPY (PEI) IN
THE PALLIATIVE TREATMENT OF HEPATE METASTASES OF COLONIS
CANCER
JAN SAPİEZKO
RANKING LEKARZY HOSPITAL, POLAND
Background&Aims:
Percutaneous ethanol injection intraducced by Prof. Kunio Okuda es a method for

palliative menmagement of multifocal hepatocellular carcinoma can be used for
the treatment of hepatic metastases. Hepatic metastases are an essential cause
of mortality in patients with colonic cancer. Partial resection of the liver with
metastases is a therapeutic method of choice and the only that offers a patient a
choince of a complete cure.
Methods:
The purpose of the study was to evaluate the efficony of percutaneous ethanol
injection therapy for the palliative treatment of hepatic metastases of colonic
cancer. Biological effects of PEI: cellular dehydratation, coagulative necrosis and
vascular thrombosis within a tumour. Between 2004 and 2010 thirty eight patients
(23 males and 15 females) underwent PEI due to hepatic metastases of colonic
cancer in our department. Other patients had metachronic tumours diagnosed at a
follow-up period from 6 months to 8 years after a radical operation.
Results:
The procedure repated regularly brought good therapeutic effects in 33 patients.

Fione patients underwent PEI only 2 or 3 times due to bad toleration am no effect
the procedure. The longest survival observed in a patients since the first PEI until
now is 5 years. Neither symptoms of hepatic insufficiency nor ascites were observed
in our patients.
Conclusion:
On the basic of our observations we are of the opinion that percutaeous ethanol
injection therapy of hepatic metastases in patients with colonic cancer is an efficient
method of treatmentthat not only improves a patients quality of life but probably
also prolongs survival.
-281-
PP - 87 GLUED VERSUS STAPLED ANASTOMOSIS OF THE COLON;
COMPARISON OF RESISTANCE TO INTRALUMINAL PRESSURE: AN
EXPERIMENTAL STUDY
JIRI PARAL , PETR LOCHMAN , JAN SİMEK , ZDENEK SUBRT
FACULTY OF MILITARY HEALTH SCIENCES, UNIVERSITY OF DEFENCE, HRADEC

KRALOVE, CZECH REPUBLIC
Background&Aims:
This study compared the resistance of glued versus stapled anastomoses of the
colon to intraluminal pressures at different times during healing.
Methods:
Method Forty seven female domestic pigs, mean weight of 30.7 kg, were used.
Maximum physiological luminal pressures, i.e. the pressure resisted by a catheter
inserted into the intestinal lumen via a puncture without it being released and
without injury to the surrounding intestinal wall, was performed in 5 control animals.
The remaining 42 animals were divided into 3 groups of 14 animals each based on
time from anastomosis construction. Each group was divided into 2 subgroups with
stapled or glued anastomoses. Intraluminal pressure was measured on the first,
third, and fifth day post-surgery.
Results:
At all time points, stapled anastomoses resisted higher intraluminal pressures than
glued ones. However, glued anastomoses resisted pressures significantly higher
than physiological pressure. As healing advanced, glued anastomoses neared the
resistance to intraluminal pressures of stapled anastomoses.
Conclusion:
Healing with absorbable synthetic glue was as good as with staples. Glued
anastomoses resisted pressures that were statistically significantly higher than
physiological intraluminal colon pressures but lower than stapled ones. The work
was supported by the Project (Ministry of Defence, Czech Republic) „A long-term
organization development plan 1011“
-282-
PP - 88 STAGE AND AGE ARE THE MOST IMPORTANT FACTORS
RELATED TO THE MORTALITY IN EMERGENCY COLORECTAL CANCER
SURGERY
MUHAMMET AKYUZ , ERDOGAN SOZUER , ALPER AKCAN , MEHMET PATMANO ,
HIZIR AKYILDIZ

KAYSERI, TURKEY
Background&Aims:
Colorectal cancers can present in the emergency setting. The most common
presentation is intestinal obstruction. The presentation with perforatoin is less
common. Emergency colorectal cancer surgery is difficult and have high morbidity
and mortality rate. We aimed to research the factors related to early postoperative
mortality in emergency colorectal surgery.
Methods:
Sixty five patient who underwent emergency surgery for colorectal cancer were
reviewed between July 2009 and July 2012. Patients demographics, clinical
presentations, white blood count, creatinin level, coexisting disease, cancer stage,
pathological findings and early postoperative mortality rate (death within 30 days)
were evaluated.
Results:
Mean age of patients were 66.9±11.9 and 43 patients were men and 22 patients
were women. Forty seven patients were presented with intestinal obstruction
findings and 18 patients with acute abdominal findings. Sigmoid colon was the most
common cancer localization(n=28). Fourteen patients(%21.5) died during early
postoperative period. Coexisting disease was present in 32 patients. Univariate and
multivariate analyses demonstrated that age >65 (p=0.03) and anvanced cancer
stage (p=0.03) are significantly related to early postoperative mortality.
Conclusion:
Age > 65 and advanced cancer stage are the most important factors associated
with early postoperative mortality in emergency colorectal surgery. These factors
are not changeable and the goal in emergency colorectal surgery should focus on
emergency status espacially in elderly and patients with advanced stage cancer.
-283-
PP - 89 FDG-PET/CT METHOD IN COLORECTAL CANCER
MURAT KALEMOGLU , FIRAT GUNGOR
LIFEMED MEDICAL CENTER, ISTANBUL, TURKEY
Background&Aims:
Colorectal cancer is one of the most frequent malignancies in the Western world.
The aim of this study is to evaluate the benefits and the accuracy of whole-body
positron emission tomography (PET) using [18F]fluorodeoxyglucose (FDG) in
colorectal cancer.
Methods:
There are 1239 patients with colorectal cancer who were examined in Lifemed
Medical Center between Augusts 2011and July 2012. Our center has a PET/CT
which is the model of GE Healthcare Discovery PET/CT 690HDVCT.
Results:
We think, the indication of FDG-PET method are staging of patients with

synchronous metastases at presentation suitable for resection or patients with
equivocal findings on other imaging: for example pulmonary or liver lesions,
restaging of patients with recurrence being considered for radical treatment and/
or metastatectomy, detection of recurrence in patients with rising tumor markers
and/or clinical suspicion of recurrence with normal or equivocal findings on other
imaging, and evaluation of indeterminate presacral masses post-treatment. In
addition, precancerous adenomatous polyps can also be detected incidentally on
whole-body images performed for other indications; sensitivity increases with
increasing polyp size.
Conclusion:
The FDG-PET method is useful to diagnose, restaging end determination of

recurrence of the colon cancer. Detailed evaluation of the CT component of a PET/
CT exam, including assessment of the entire colon, is essential.
-284-
PP - 90 INTESTINAL ENDOMETRIOSIS, AN ENIGMATIC DIFFERENTIAL
DIAGNOSIS: REPORT OF FOUR CASES
OZLEM UYANIK , JESUS BOLLO RODRIGUEZ , ION LUPU , JOSE LUIS PALLARES
SEGURA , M. CARMEN MARTINEZ SANCHEZ , CARMEN BALAGUE PONZ , EDUARDO
M. TARGARONA SOLER , MANUEL TRIAS FOLCH

Background&Aims:
Endometriosis is the presence of ectopic endometrial tissue, a benign disease

affecting approximately 15% of all women at their reproductive ages, although
intestinal involvement is relatively uncommon. Endometriosis with intestinal
involvement can be easily confused with intestinal malignancies. We present four
cases with bowel endometriosis.
Methods:
We reviewed retrospectively the medical records of the cases operated and

diagnosed as intestinal endometriosis in our department between 2005 and 2012.
Results:
We detected four women in their reproductive age. No patient had a history of

endometriosis. In the three cases colonoscopy detected a stenosing lesion and
in the other an ulcerative rectal lesion. The biopsy results were inconclusive. CT
scan and/or MRI highlighted a colonic wall lesion in all patients being unable to
rule out a malignancy. We performed laporoscopic low anterior rectal resection in
two women, laparoscopic sigmoid resection in one and excision of the lesion via
transanal endoscopic microsurgery (TEM) in the other. The pathology result was the
presence of ectopic endometrial tissue in all cases with involvement of the colon
or rectum wall.
Conclusion:
The intestinal endometriosis should be considered as a differential diagnosis and

requires a high index of suspicion in evaluation of women in reproductive age
presenting nonspecific intestinal symptoms and signs.
-285-
PP - 91 CT GUIDED MARKING USING A METALLIC HARPOON PRIOR
TO RECURRENT COLORECTAL CANCER SURGERY
JESUS BOLLO RODRIGUEZ , JUAN CARLOS PERNAS CANADELL , OZLEM UYANIK ,
CARLOS EDUARDO RODRIGUEZ LUPPI , ION LUPU , JOSE LUIS PALLARES SEGURA ,
EDUARDO M. TARGARONA SOLER , MANUEL TRIAS FOLCH

Background&Aims:
The placement of a harpoon needle guided by computed tomography (CT) in the

search for intra-abdominal recurrence of colorectal cancer is a useful technique
especially when it is small and the anatomical relationships are altered resulting in
difficult surgical field exposure. We present use of this technique in recurrent colon
cancer.
Methods:
We performed CT guided marking under local anesthesia, using a metallic harpoon

on the same day prior to the recurrence surgery in five patients presenting a single
small and deep intra-abdominal lesion in the postoperative period of colon surgery.
Results:
There were no complications during the radiological technique. Recurrent lesion

was localized intraoperatively with the harpoon inside, realizing excision with
tumor-free resection margins, without injuring surrounding tissues and organs.
Conclusion:
CT guided marking using a metallic harpoon technique is feasible in patients

presenting small and deeply located intra-abdominal lesions especially when
there are postoperative adhesions or fibrosis secondary to radiation therapy or in
obese patients. Thanks to this technique, we can reduce intraoperative time and
tumor resection is performed more accurately and precisely, avoiding unnecessary
manipulations that could lead to increased perioperative morbidity.
-286-
PP - 92 ELECTIVE TREATMENT OF SIGMOID VOLVULUS: OUTCOMES
OF 938 PATIENTS INCLUDING 102 ELECTIVELY TREATED CASES OVER
45.5 YEARS
S. SELCUK ATAMANALP , M. ILHAN YILDIRGAN , GURKAN OZTURK , BULENT
AYDINLI , BUNYAMI OZOGUL , ABDULLAH KISAOGLU
DEPARTMENT OF GENERAL SURGERY, FACULTY OF MEDICINE, ATATURK

UNIVERSITY, ERZURUM, TURKEY
Background&Aims:
Recurrence after a detorsion is seen in 3-44% of sigmoid volvulus (SV) cases. The aim
of this study is to review the outcomes of elective surgical treatment of successfully
detorsioned SV patients.
Methods:
The clinical records of 938 patients who were treated between June 1966 and
January 2012 were reviewed retrospectively.
Results:
Elective surgical treatment was suggested for 472 (90.9%) of 673 nonoperatively
detorsioned patients, and 102 of whom (21.6%) received the treatment. Sigmoid
resection and anastomosis (SRA) was applied in 91 patients, while laparoscopy-
assisted SRA (LASRA) was applied in 10 patients and laparoscopic SRA (LSRA) was
applied in 1 patient. In this group, no mortality was seen. In 13 of the patients
(12.7%), complications were seen (14.3% in SRA group, while 0% in the other
groups). The mean hospital stay was 9.6 days (range: 5-26 days; mean 10 days in
SRA group, while 6.4 days in LASRA and 6 days in LSRA groups). No recurrence was
seen in the 65 followed-up patients in a mean 24.1-year follow-up period.
Conclusion:
The strategy in the treatment of detorsioned SV must be elective sigmoid resection

and anastomosis in patients with ASA 1-3, and laparoscopic methods must be
preferred.
-287-
PP - 93 HUGE SUBMUCOSAL LIPOMA OF THE TRANSVERSE COLON
GÖKHAN ŞENYÜREK 2, S. SAVAŞ YÜRÜKER 1, BÜLENT KOCA 1, İLHAN KARABIÇAK 1,
NECATİ ÖZEN 1
1
ONDOKUZ MAYIS UNIVERSITY, FACULTY OF MEDICINE, DEPARTMAN OF GENERAL
SURGERY, SAMSUN, TURKEY
2
KENT HOSPITAL, DEPARTMANT OF GENERAL SURGERY, GIRESUN, TURKEY
Background&Aims:
Lipoma in the colon is very rare but is the second most common benign tumor of
the colon. In this report, we present a colon mass which is diagnosed submucosal
lipoma after resection.
Methods:
A-83year-old male admitted to our clinic with colicy abdominal pain and distantion.
Abdominal CT scan showed a mass in the transverse colon which is narrowing an 8
cm segment of the colon. Initial diagnosis was either lenfoma or cancer. Colonoscopy
showed a submucosal 9 cm long mass, narrowing the bowel lumen. Biopsy showed
inflamed intestinal mucosa.
Results:
Laparotomy showed a 10 cm long polipoid mass protruding in to the bowel lumen.

The mass is resected and anastomosis was performed. Pathological evaluation
showed submucosal lipoma. The patient was discharged on postoperative day 8.
Conclusion:
Surgical treatment options for colonic lipoma are; colotomy and enucleation,
resection of the bowel segment and colonoscopic polipectomy for the appropriate
cases. Preoperative correct diagnosis is necessary for the appropriate treatment.
-288-
PP - 94 EXPERIENSE WITH LAPAROSCOPIC TOTAL
MEZOREKTUMEKTOMII EXTIRPATION OF THE RECTUM
SERGEY KATORKIN , ANDREY CHERNOV , PAVEL ANDREEV
SAMARA STATE MEDICAL UNIVERSITY, RUSSIA
Background&Aims:
In industrialized countries, colorectal cancer is one of the leading places among all
malignancies.The study aims to improve treatment outcomes and quality of life of
patients with colorectal cancer.
Methods:
The analysis of the treatment of eight patients. The examination included: finger
study of the rectum, sigmoidoscopy, total fibrokolonoskopiye with biopsy, KT pelvic,
transvaginal ultrasound. Quality of life was investigated using the SF-36. Patients
underwent laparoscopic total mezorektumektomiya with extirpation of the rectum
and the formation of sigmoidostoma. Laparoscopic high ligation was performed
(1 cm from the mouth), inferior mesenteric artery with the coagulator-dissector
EnSeal. Sigmoid colon crossed intrakorporalno direct sshivayusche-cutter Echelon
60. Performed to mobilize the rectum to the pelvic floor muscles using an ultrasonic
scalpel Harmonic mezorektalnoy within the fascia. Extirpation of the rectum was
performed with resection of the perineal access the rear wall of the vagina as a unit.
Results:
During the surgery had improved visualization of anatomical structures in the pelvic
cavity. Patients activated the first day after surgery and reported less severe pain,
early recovery of peristalsis and bowel function.
Conclusion:
Surgeries using laparoscopic technology has significant advantages over the

operations executed laparotomy access. This reduces the time of hospital treatment
and medical rehabilitation, to improve the quality of life for patients.
-289-
PP - 95 PROGNOSTIC IMPACT OF MIDKINE EXPRESSION AND
MICROVESSEL DENSITY IN COLORECTAL CARCINOMA
SEZER GÜRER , GÜLGÜN ERDOĞAN , ÖZLEM ELPEK , OKAN ERDOGAN
AKDENIZ ÜNIVERSITY FACULTY OF MEDICINE, ANTALYA, TURKEY
Background&Aims:
Midkine (MK) is a heparin-binding growth factor that plays important roles in cell
transformation and angiogenesis. Recent studies indicated that MK was involved in
genesis and development of colorectal carcinomas (CRC). However in these tumors
the relationship among MK expression, angiogenesis and prognosis has not been
evaluated. The purpose of this study was to investigate whether MK expression was
associated with angiogenesis and survival in patients with CRC.
Methods:
Tumor specimens from 61 patients diagnosed as CRC were included in this study.
Serial sections from paraffin embedded tissues were stained with anti-midkine and
anti-CD34 antibodies. Angiogenesis was assessed as microvessel density (MVD).
Chi-square test, Kaplan-Meier method and Cox regression analysis were used for
statistical analysis.
Results:
MK expression was observed in 36 of the cases. Non-neoplastic mucosa was

consistently negative. Any relationship was not observed between MK expression
and clinicopathologic parameters, so MK expression failed to predict tumor
behavior. Moreover MK expression was not associated with MVD. The prognosis
was significantly worse in patients with high MVD (>5.8). Survival analysis revealed
that although MK expression had no impact on prognosis, MVD was an independent
prognostic variable.
Conclusion:
Although our data needs to be clarified with further molecular studies, our results
revealed that MK expression has no prognostic relevance in CRC. However MVD
could be reliable indicator of prognosis.
-290-
PP - 96 TRANS ANAL SUTURE RECTOPEXY FOR HAEMORRHOID
SHANTIKUMAR CHIVATE , LAXMIKANT LADUKAR
JEEVAN JYOT HOSPITAL, INDIA
Background&Aims:
Aims: Chivate’s, new procedure Trans anal Suture Rectopexy for Haemrrhoids is
evaluated for safety, pain, stay, bleeding, recurrence and complications.
Methods:
from January 2006 to December, 2008, the procedure was used to treat 166 cases
of grade II, III and IV symptomatic piles at 6 different institutes. In the series 92
males and 74 cases were females, average age was 49.5 years (23-82).In grade II-
52, III -86 and IV -28 cases procedure was implemented. Procedure: The piles mass
was reduced by head low position & manually. A stitch of 0.5 – 1.0 cm transfixed
mucosa, submucosa,veins arteries to partial thickness of rectal wall. The similar
suturing was continued all along the compete circumference of the rectum first line
at 2cm. and second line at 4 cm. proximal to the dentate line was completed.
Results:
Results: There was no pain noticed in 162 cases & in 4 cases pain dull in nature.
All 166 cases were discharged after 24 hours. Intra operative bleeding from suture
line was observed in 11% cases which required temporary compression. On
proctoscopy, in 3 cases grade I haemorrhoid cushion were noticed after 6 months.
No incontinence, no recurrent bleeding, no frequency of stool, or no tenusmus was
observed.
Conclusion:
The procedure is safe & painless, requires short hospital stay. The results are better
than any costly or high technical procedures & having fewer complications and
recurrences.
-291-
PP - 97 OUTCOME OF STAPLED HEMORRHOIDOPEXY FOR GRADE
III-IV HEMORRHOIDS AND MUCOSAL RECTAL PROLAPSUS
MEHMET YILDIZ 1, MUHARREM OZTAS 1, MEHMET SAYDAM 1, HÜSEYIN
SINAN 1, EYUP DURAN 2, KUBILAY BOLUKBASI 1, GULTEKIN CANDEMIR 1
MEVKI MILITARY HOSPITAL, ANKARA, TURKEY

1
ELAZIG MILITARY HOSPITAL, ELAZIG, TURKEY

2
Background&Aims:
To evaluate early and late complication rates with grade III-IV hemorrhoids mucosal
rectal prolapsus treated by stapled hemorrhoidopexy
Methods:
Operative and follow-up patients’ data were retrospectively collected for patients
undergoing stapled hemorrhoidopexy by two surgeons during a 5-year period. Data
on demoghraphic findings, surgical endications, surgery time and postoperative
early complications were evaluated.
Results:
A total of 74 patients underwent stapled hemorrhoidopexy . surgical endications

were grade III-IV hemorrhoids and mucosal rectal prolapsus. Surgery time was
25.4 (15-45) minutes. 2 patients suffered from bleeding and primer suturation was
performed.
Conclusion:
Stapled hemorrhoidopexy causes significantly less operation time and postoperative

pain. The technique can achieve comparable outcomes as those of the Milligan
Morgan technique .Stapled hemorrhoidopexy can be though as a feasible and safe
alternative technique to conventional hemorroidectomy.
-292-
PP - 98 PROGNOSTIC SIGNIFICANCE OF SIGNET RING CELL
COMPONENT IN MUCINOUS COLORECTAL CARCINOMAS
ONDER ONGORU 1, TOLGA SENTURK 1, EYUP DURAN 2, YILDIRIM KARSLIOGLU 1,
MUSTAFA OZTURK 3, ISMAIL HAKKI OZERHAN 4, NAIL ERSOZ 4, AYHAN OZCAN 1
1
GULHANE SCHOOL OF MEDICINE PATHOLOGY DEPARTMENT, ANKARA, TURKEY
2
ELAZIG MILITARY HOSPITAL GENERAL SURGERY DEPARTMENT, ELAZIG, ANKARA
3
GULHANE SCHOOL OF MEDICINE MEDICAL ONCOLOGY DEPARTMENT, ANKARA,
TURKEY
4
GULHANE SCHOOL OF MEDICINE GENERAL SURGERY DEPARTMENT, ANKARA,
TURKEY
Background&Aims:
Mucinous carcinomas which is frequently localizated in rectum is known to have

poor prognosis than colorectal adenocarcinomas. Mucinous colorectal carcinoma
with signet ring cell component is investigated the clinicopathological and
prognostic features in this study.
Methods:
741 patients underwent resection due to colorectal carcinoma in our university

hospital between 1994 and 2008 years. Mucinous carcinoma were seen in
99 patients. Lymphatic invasion, necrosis and ulceration have been assessed.
Clinicopathologic features, survival times and statistical results were compared
with mucinous carcinoma with signet ring cell component and without signet ring
cell component in the study
Results:
Lymphatic invasion and lymph node metastasis were more frequent in mucinous
carcinoma with signet ring cell component than mucinous carcinoma without
signet ring cell component. (%32&%16 p=0.019) (p<0.0001) Signet ring cells appear
with extracellular mucin production. Signet ring cell component in mucinous
cancer patients increases lymphatic invasion and lymph node metastasis. Distant
metastases are more frequent in signet ring cell component patients.. 5 years
survive in signet ring cell component patients were %46.4 and in mucinous
carcinoma without signet ring cell component was %59.4.
Conclusion:
In conclusion signet ring cell component was evaluated as a poor prognosis factor
in mucinous carcinoma patients.
-293-
PP - 99 ALGORITHM FOR DIAGNOSTIC INVESTIGATION OF ACUTE
BOWEL OBSTRUCTION.
SULTAN MANAFOV , RENA GERAYZADE
SCIENTIFIC CENTER OF SURGERY NAMED AFTER M.A.TOPCHUBASHOV, BAKU,

AZERBAIJAN.
Background&Aims:
The aim of the study was to make an optimal diagnostic algorithm for patients with
acute bowel obstruction.
Methods:
60 patients with acute bowel obstruction underwent plain abdominal radiography

and ultrasonography.
Results:
Both methods correctly determined the presence of obstruction in all cases

and differentiated small from large bowel obstruction, which was subsequently
confirmed at operation; moreover ultrasound detected the cause of obstruction in
48 cases(80%). In the cases of small bowel obstruction, pathological dilated small
bowel loops first were examined by gray-scale ultrasound, then by color Doppler.
Retrospective analysis showed, that in all patients with intramural blood flow
velocity above 10 cm/sec, during the operation was revealed simple mechanical
obstruction without strangulation and bowel ischemia. In patients with blood flow
velocity in dilated loops below 10 cm / sec or no signs of blood flow in 87% of cases
during the operation revealed ischemic due to strangulation loops.
Conclusion:
patients with acute bowel obstruction should be carried out X-ray and ultrasound in
the gray-scale and color Doppler mode for the differential diagnosis, detection the
cause of obstruction and possible strangulation.
-294-
PP - 100 ISOLATED ADULT HYPOGANGLIONOSIS PRESENTING AS
TOXIC MEGACOLON:A CASE REPORT
ŞAHİN KAHRAMANCA 1, GÜLAY ÖZGEHAN 1, BAHADIR CELEP 1, GAYE ŞEKER 1, ATA
TÜRKER ARIKÖK 2, TEVFİK KÜÇÜKPINAR 1
1
DISKAPI YILDIRIM BEYAZIT RESEARCH AND TRAINING HOSPITAL GENERAL
SURGERY CLINIC, ANKARA, TURKEY
2
DISKAPI YILDIRIM BEYAZIT RESEARCH AND TRAINING HOSPITAL PATHOLOGY
CLINIC, ANKARA, TURKEY
Background&Aims:
Isolated hypoganglionosis (IH) is a rare cause of intestinal innervation defects. It’s

characterized by a reduced number of myenteric ganglia, a low AchE activity in the
lamina propria and hypertrophy of the muscularis mucosa and circular muscle. IH
represents only 5% of neuronal intestinal diseaes (NID). Clinically, IH resembles
classical Hirschsprung’s disease with severe constipation or even pseudo-
obstruction. Here, we report a cause of IH presenting with toxic megacolon.
Methods:
A 19 years old male patient who admitted to our emergency department with
abdominal pain, vomiting and diminished stool discharge for two days, is discussed.
Results:
He had xeroderma, epilepsia, aphasia with mental and growth retardation. He had
abdominal distention and rebound on physical examination. The leukocyte count
was 21600 /µl and there was sigmoid megacolon on X-ray. Emergency laparotomy
was performed and he underwent sigmoidectomy with Hartmann procedure. The
pathology revealed focal hypoganglionosis.
Conclusion:
IH is a rare disease with clinical and epidemiological features similar to other NID.
The radiological features may not help for differential diagnosis. Surgery is the
definitive treatment method for adult hypoganglionosis. The prognosis seems
satisfactory especially in mild type of disease, when short colonic segment is
affected and an appropriate resection is achieved.
-295-
PP - 101 COLONOSCOPIC POLYPECTOMY; ANALYSIS OF 1349 CASES
TEVFIK EKER , CIHANGIR AKYOL , TOYGAR SARI , A.BULENT ERKEK , ETHEM GECIM
ANKARA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,

ANKARA, TURKEY
Background&Aims:
The aim of this study is to investigate the distribution of age, sex, anatomic
localization and histopathologic diagnosis of polyps which removed during
colonoscopic polypectomy in our clinic.
Methods:
We retrospectively analyzed data (endoscopy, pathology, demography) of patients

who underwent colonoscopic polypectomy between 2008 and 2012.
Results:
1349 patients (894 of males and 455 of females) were underwent colonoscopic
polypectomy. The median age was 60(21-94). 144(6.4%) of the polyps were
localizated in cecum, 284(12.6%) in ascending colon, 264(11.7%) in transverse
colon, 399(17.7%) in descending colon, 627(27.8%) in sigmoid and 537(23.8%) were
localizated in rectum. Examining the histopathology of the polyps, 490(21.7%) were
hyperplastic, 1280(56.7%) were tubular adenoma, 193(8.6%) were villous adenoma,
69(3.2%) were serrated adenoma, 43(1.9%) were carcinoma in-situ and 56(2.5 %)
were invasive cancers; whereas 46(2.3%) other (inflammatory, hamartomatous and
submucosal lesions) pathologies were encountered. In total 9 patients (0.66%) had
hemorrhage (3 patients had late hemorrhage, 6 patients of had early hemorrhage)
and 1(0.07%) patient had perforation as procedure complication.
Conclusion:
Colonoscopy with a low morbidity is considered to be the gold standard for the
diagnosis and treatment of colon polyps. It is essential to diagnose these lesions
early and treat them with colonoscopy whenever possible.
-296-
PP - 102 ACUTE EOSINOPHILIC APPENDICITIS
TUFAN EGELI 1, MURAT OKUDAN 2, FATIH TASKESEN 3, VEDAT DENIZ 2, SERKAN
YASAR CELIK 4, NIHAT TASDEMIR 5
1
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GENERAL
SURGERY, IZMIR, TURKEY
2
BATMAN REGION STATE HOSPITAL CLINIC OF GENERAL SURGERY, BATMAN,
TURKEY
3
DICLE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GENERAL SURGERY,
DIYARBAKIR, TURKEY
4
BATMAN REGION STATE HOSPITAL DEPARTMENT OF PATHOLOGY, BATMAN,
TURKEY
5
BATMAN REGION STATE HOSPITAL DEPARTMENT OF RADIODIAGNOSTIC,
BATMAN, TURKEY
Background&Aims:
Acute eosinophilic appendicitis is a quite rare variant of appendix inflammation. Its

typical histologic feature is severe eosinophilic infiltration and edema in muscular
layer of appendix with no neutrophilic infiltration. Its pathogenesis has been related
to type 1 hypersensitivity reaction. In this paper, a case with acute eosinophilic
appendicitis caused by an allergic reaction against amebiasis was reported.
Methods:
A 34-year-old male presented to the general surgery clinic with the complaint of
pain in the right lower quadrant Abdominal ultrasonography and CT were consistent
with acute appendicitis and the patient was taken into urgent operation. Histologic
examination of the specimen revealed severe eosinophilic infiltration and edema in
appendix serosa and muscular layer.
Results:
The patient was diagnosed with “acute eosinophilic appendicitis”. A direct

examination of stool specimen was performed, in which trophozoites of Entamoeba
histolytica were detected; an allergic reaction against this parasite was considered
to be related with development of acute eosinophilic appendicitis.
Conclusion:
Pathologic diagnosis should be obtained in all appendectomized patients. In

addition to neoplastic diseases of appendix, factors with potential to cause allergic
reaction in gastrointestinal system should be investigated and treated accordingly
in cases with AEA.
-297-
PP - 103 METHOD OF PROPHYLACTIC AND TREATMENT DIVERSION
COLITIS AND MALABSORPTION SYNDROME IN PATIENT WITH
PROTECTIVE DOUBLE-BARRELLED ILEOSTOMY.
MYKOLA TUTCHENKO 1, VOLODYMYR ANDRIIETS 1, IVAN KLYUZKO 2, SERGIY
MARCHUK 2, ANATOLIY YAKOVENKO 2, YULIYA ANDRIIETS 1
O.O.BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, UKRAINE

1
HOSPITAL №15 OF KIEV, UKRAINE

2
Background&Aims:
To develop method of prophylactic and treatment diversion colitis and malabsorption

syndrome in patient with protective double-barrelled ileostomy.
Methods:
30 patients were operated from 2006 to 2012 with form protective double-barrelled
ileostomy. To the main group we include 20 patients. Them from 14-th day after
operations we, using special device, gather intestinal content from proximal end of
ileostomy and entered to the distal. To the control group we include 10 patients.
We didn’t do this measures them.
Results:
The results we estimated by clinical symptoms, endoscopic picture and coprogramm.

There wasn’t any clinical symptom in patient of main group. The endoscopic picture
was without the signs of inflammation (mucous membrane of pinky color, vascular
picture stored, mildly expressed). 4(20%) patients of main group had muscular
fibers, neutral fat. The feces in patient is formed. The patient of control group had
fluid feces with muscular fibers, neutral fat and undigested vegetable cellulose. In
control group endoscopic symptoms appear from 25+0,9 days, clinical symptoms –
from 55+1.3 days.
Conclusion:
1. Use of offered method bring to eliminate phenomena diversion colitis (clinical

and endoscopic symptoms). 2. Decrease the amount of cases of malabsorption
syndrome on 80% (16 patients).
-298-
PP - 104 MODERN SURGICAL APPROACHES IN COLORECTAL
SURGERY
PETROV ALEN 1, YOVTCHEV YOVCHO 1, MINKOV GEORGI 1, NIKOLOV STOYAN 1,
VLAYKOVA TATYANA 2

1
UNIVERSITY HOSPITAL STARA ZAGORA/DEPARTMENT OF CHEMISTRY AND

2
BIOCHEMISTRY, BULGARIA
Background&Aims:
This review summarizes recent trends in contemporary surgical treatment of

colorectal cancer.
Methods:
We conducted a systematic literature review that covered PUBMED, Embase, The

Cochrane Library and other important databases up to 2012
Results:
Colorectal cancer is one of the most common malignancies, a worldwide remains

unresolved question regarding early diagnosis and treatment. Today, surgical
treatment is the cornerstone in the treatment of disease, although the surgical
technique has changed considerably over the past two decades.
Conclusion:
The laparoscopic approaches in many institutions has become the standard surgical
treatment for patients with colon cancer. Infiltrated and robotic techniques in the
treatment of rectal cancer. The introduction of new cytotoxic agents and radiation
and their combination with surgery contributed to the increase in the percentage of
5-year survival and the duration of life for patients with this disease.
-299-
PP - 105 ETIOLOGICAL RISK FACTORS OF HEMORROIDAL DISEASE IN
YOUNGS
MEHMET INCE 1, YAVUZ OZDEMIR 2, OZGE KUCUKERDONMEZ 1, LEVHI AKIN 2
KONYA MILITARY HOSPITAL, KONYA, TURKEY

1
GATA MILITARY HOSPITAL, ANKARA, TURKEY

2
Background&Aims:
Although hemorrhoidal disease is a common disease, there are no enough studies

about etiological risk factors in youngs. We investigated the risk factors enrolled in
etiology of hemorrhoidal disease under 25 year-old.
Methods:
A total of 100 patients who were under 25 years-old, had a diagnosis of stage II-IV
hemorrhoidal disease and underwent a surgical operation in 2011 were admitted
to our retrospective study. Control group was selected randomly from patients
diagnosed other disease. Patients with stage I and thrombosed hemorrhoidal
disease were excluded from the study. Age, body mass index, living area, daily
smoking and bread consumption, weekly bath and defecation number, type of toilet,
occupation, family history and comorbidity were inquired from patient charts and
records for all patients. Variables being accepted as risk factors were evaluated with
t student test for continued variables and ki-square test for categorized variables. p
<0.05 was accepted as significant.
Results:
There were no statistically significant differences between groups in patient for

age, smoking, occupation, type of toilet and living area. However body mass index
(p=0.002), daily bread consumption (p<0.001) and weekly defecation (p=0.004)
were found to be statistically lower; comorbidity (p=0.046), weekly bath number
(p=0.001), family history (p<0.001) were found to be statistically higher in
hemorrhoidal group than in control group.
Conclusion:
We concluded that the risk factors for hemorrhoidal disease under 25 year-old
adults are positive family history, dietary habits and constipation.
-300-
PP - 106 SENTINEL LYMPH NODE MAPPING IN COLON CANCER
PATIENTS
RAMAZAN GUNDOGDU 1, TAHSIN COLAK 1, OZGUR TURKMENOGLU 1, ALPER
SOZUTEK 1, EBRU SERİNSOZ 2
MERSIN UNIVERSITESI TIP FAKÜLTESI GENEL CERRAHI AD., MERSIN, TURKEY

1
MERSIN UNIVERSITESI TIP FAKÜLTESI PATOLOJI AD., MERSIN, TURKEY

2
Background&Aims:
Lymph node stage of the patients with colon cancer is an important factor that
determines surviliance, recurrence and treatment. The techniques of sentinel
lymph node biopsy (SLNB) are used successfully with a low morbidity to increase
the value of pathology in many other cancers. The effect of SLNB in colon cancer
is still controversial. Hence, this study was planned in patients with colon cancer.
Methods:
In this study, 100 consecutive patients who underwent elective or urgent operation
for colon cancer between 01.10.2010 and 01.10.2011 were evaluated. The study
was approved by our ethics comithee and a written informed consent was taken
from all patients. 84 patients were included due to elect 16 patients for different
clinical reasons. The sensitivity of the method to the positivity of lymph node
and false negative rate were detected by comparing with pathologic condition of
3-4 lymph node marked with blue-dye and final pathologic conclusion. 10 of 84
patients were remained unmarked. In 74 patients, at least one marked lymph node
was detected
Results:
A mean number of 24 (5-48) lymph nodes were reported at final pathology. There
was no metastasis in dyed lymph nodes in 58 (69%) of 84 patients. Macrometastasis
was detected in 26(31%) patients. Of these patients, metastasis was detected in
16 patients with dyed SLN and 10 patients with undyed non-SLN. In our study,
the effect of SLN identification in lymph node metastasis were evaluated as low
sensitivity (61,5%), high false negativity (38,5%), spesivity (100%), detection rate
(38,5%), overall accuracy rate (81%), negative predictive value 82,7% and positive
predictive value 100%.
Conclusion:
In conclusion, if no metastatis was detected in SLNB, radical surgery could not be

performed, but it does not determine the surgical decision due to low reliability of
the technique
-301-
PP - 107 TOTALLY LAPAROSCOPIC ANTERIOR RESECTION WITH
TRANSVAGINAL SPECIMEN EXTRACTION: THE AUTHORS’ INITIAL
INSTITUTIONAL EXPERIENCE.
SERGEY BAYDO , ANDREY ZHYGULIN , ALLA VINNITSKA , DMYTRO GOLUB , MAXIM
SILVESTROV , SERGEY PRYNDYUK
ZINA MEMORIAL LISSOD HOSPITAL, UKRAINE
Background&Aims:
Most surgeons, performing totally laparoscopic anterior resection (TLAR), use a

small (5-6sm) incision for specimen extraction. This report is intended to represent
our experience in performing TLAR with transvaginal extraction of the specimen.
Methods:
In 2011, 10 patients underwent TLAR, in 3 cases transvaginal approach was used

for specimen extraction. Standard four ports technique was used to perform TLAR.
Posterior colpotomy was done with 11-mm trocar. The specimen was extracted
through vagina. Then anastomosis was done using circular stapler. The colpotomy
was sutured through vagina or using intracorporally technique.
Results:
All the patients were women with no prior pelvic surgery. Mean age- 56 years.
Average operative time- 115 minutes. No death or complications occurred. The first
stool was at second p/o day. Length of stay- 3-4 days. Mean specimen length- 28
cm. Mean number of lymph nodes retrieved- 21. The level of postoperative pain
was assessed by visual-analog pain scale. According to preliminary results it was
detected the tendency of decreasing pain level after transvaginal extraction vs
“traditional”.
Conclusion:
TLAR with trasvaginal extraction of the specimen appears to be feasible and safe.
The advantages of this approach are better cosmetic results, less postoperative pain
and faster recovery.
-302-
PP - 108 PERI-OPERATIVE RISK SCORING IN EMERGENCY
LAPAROTOMY
STEPHEN STONELAKE , PETER THOMSON , NIGEL SUGGETT
QUEEN ELIZABETH HOSPITAL BIRMINGHAM, UK
Background&Aims:
National guidance states that all patients undergoing emergency surgery should
have a mortality risk assessment on admission. Those whose risk score is predicted
> 5% mortality should be operated on by a consultant surgeon and anaesthetised
by a consultant anaesthetist. Those whose risk score is predicted > 10% mortality
should be reviewed by a consultant within 4 hours of admission. We aimed to
assess adherence to these guidelines, and compare the accuracy of different peri-
operative risk scores.
Methods:
60 consecutive emergency laparotomies, January-April 2012. Mortality risk was

calculated for each patient using 2 pre-operative (ASA, Lee index) and 3 post-
operative risk calculation tools (POSSUM, P-POSSUM and CR-POSSUM).
Results:
Actual average mortality in this series was 13.3%. Predicted mortalities were: ASA
21.7%, Lee Index 2.3%, POSSUM 24.5%, P-POSSUM 15.4%, CR-POSSUM 11.7%. 85%
and 33% of patients having >5% mortality risk were operated on and anaesthetised
by a consultant surgeon and anaesthetist respectively Less than 33% of high risk
patients were reviewed within 4 hours of admission by a consultant surgeon.
Conclusion:
Pre-operative risk prediction tools often either under-predict (Lee Index) or over-
predict (ASA) mortality risk. Modified POSSUM scores predict mortality most
accurately. The majority of high risk patients were operated on by a consultant but
review < 4 hours from admission was infrequently achieved.
-303-
PP - 109 AUDIT OF COLONOSCOPIC SURVEILLANCE FOR
PREVENTION OF COLORECTAL CANCER IN PATIENTS WITH
ADENOMAS
IOANNIS SARANTITIS , RHIANNON HARRIES , ALEXANDRA GORDON , KIRK
BOWLING , GRAHAM WHITELEY
GWYNEDD HOSPITAL, BETSI CADWALADR UNIVERSITY HEALTH BOARD, NORTH

WALES, UK
Background&Aims:
In 2002, the British Society of Gastroenterology published guidance on the

colonoscopic surveillance for prevention of colorectal cancer in patients with
adenomas, later replicated in the 2011 NICE guidelines. All patients who have had
adenoma removal should be stratified according to their risk of development of
colorectal cancer, and then offered the appropriate colonoscopic surveillance.
The aims of our audit were to assess our management of patients with adenoma
diagnosed by lower GI endoscopy in our unit, compared to the BSG guidance.
Methods:
A retrospective review of all patients who underwent adenoma removal at time

of lower GI endoscopy between January to March 2009. Data was collected from
endoscopy, histology and medical notes.
Results:
Out of a total of 144, only 95 were in accordance with guidelines. Of those aged
under 75 years, 42% were either not offered follow-up or were undertreated.
Of those that had a flexible sigmoidoscopy, 49% were not offered a completion
colonoscopy. Few endoscopists documented the risk strata in the medical records
or justified why they did not adhere to guidelines.
Conclusion:
We recommend that all endoscopists clearly document the risk strata on the
endoscopy record, in order to follow-up in compliance with the guidelines.
-304-
PP - 110 CARBON DIOXIDE INSUFFLATION DURING COLONOSCOPY
MIROSLAW SZURA , RADOSLAW PACH , ANDRZEJ MATYJA
JAGIELLONIAN UNIVERSITY, DEPARTMENT OF SURGERY, POLAND
Background&Aims:
Colonoscopy is currently most effective procedure used for detecting colon cancer
in the early stages. During colonoscopy air commonly used to insufflate the bowel
may be retained after the procedure causing pain and discomfort to the patients.
One of the methods used to reduce pain and discomfort is insufflation of carbon
dioxide (CO2) instead of air during colonoscopy. Aim of the study is evaluation of
the use of carbon dioxide insufflation during colonoscopy.
Methods:
The study was conducted in 200 consecutive patients undergoing screening

colonoscopies for the detection of early colon cancer. The patients were assigned to
Group I and II with either air or carbon dioxide insufflation. The authors compared
for the duration of the procedure, pulse rates immediately after the procedure, 15
minutes after, and subjective pain evaluation on a Visual Analogue Scale.
Results:
Duration of the procedure was about 10 min in both groups. Pain score values
measured immediately and 15 min. after the procedure were similar in both groups
(p=0.624 and p= 0.305 respectively). Lower pain score was observed only after 60
minutes in patients insufflated with CO2 (1.28 vs 1.54, p=0.008).
Conclusion:
Carbon dioxide insufflation of bowel reduces pain and discomfort after colonoscopy.
The use of carbon dioxide insufflation should be evaluated during endoscopic
surgical procedures.
-305-
PP - 111 COMPARISON OF LIMBERG FLAP AND CLEFT LIFT
PROCEDURE FOR SACROCOCCYGEAL PILONIDAL SINUS SURGERY: A
CASE CONTROL STUDY
TUGAN TEZCANER 1, CEM DURAL 3, CANDAŞ ERÇETIN 4, MAHIR KIRNAP 1, TURGUT
ANUK 2
1
BAŞKENT UNIVERSITY, DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY
2
KAFKAS UNIVERSITY, DEPARTMENT OF GENERAL SURGERY, KARS, TURKEY
3
BAKIRKÖY EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
4
TUZLUCA STATE HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Although various surgical techniques have been described for treating sacrococcygeal
pilonidal disease, controversy still exists as to be best procedure. In this study, our
aim was to compare the efficacy of the Limberg flap versus cleft lift procedure.
Methods:
Consecutive 135 patients with sacrococcygeal pilonidal sinus were included in this
study. Data was collected retrospectively and long term follow up results were
obtained in prospective manner. Patients were divided into two groups weather
were undergone excision and Limberg flap or cleft lift procedure. Primary outcome
measure was recurrence whereas secondary outcome measures were operative
time, length of hospital stay and morbidity.
Results:
There were 60 patients (46 men) in cleft lift group and 71 patients (56 men) in
Limberg flap group. Median age was 19 (range, 15) and 20 (range, 17) in cleft lift
group and Limberg flap group, respectively. Median follow-up time was 50 months
(range, 31) and 40 months (range, 26) in cleft lift group and Limberg flap group,
respectively. There was no significant difference in hospital stay, duration of drain
usage, wound infection and recurrence rates between two groups.
Conclusion:
In this study, cleft lift procedure was found to be as safe and effective as the Limberg
flap reconstruction with advantage of being easy to perform surgical technique.
-306-
PP - 112 THE EFFECT OF LATERAL PELVIC NODE INVOLVEMENT ON
OUTCOME IN RECTAL CANCER.
SIMPSON GREGORY , NICOLA EARDLEY , FRANCES MCNICOL , PAUL ROONEY
ROYAL LIVERPOOL UNIVERSITY HOSPITAL, UK
Background&Aims:
Lateral pelvic node spread outside the mesorectum in rectal cancer divides opinion
regarding its significance and treatment. We aimed to assess the significance of
lateral nodal spread in patients with rectal cancer at our centre.
Methods:
A retrospective review of patients diagnosed with rectal cancer over 4 years at our
centre. Clinical and operative records, histology and radiological data and adjuvant
therapy details were collected. Chi-squared tests were employed for analysis.
Results:
198 patients were identified with rectal cancer; 58 with enlarged lateral pelvic
nodes. Mean age was similar in both groups (lateral nodes:64.9years, no lateral
nodes:66.5years). Mean lateral node size was 7.2mm. Tumour site did not differ
between the groups. 87% of patients with lateral nodes were T3/T4 at diagnosis,
65.2% of patients without lateral nodes were T3/4 at diagnosis(p<0.01). More
patients with lateral nodes had distant metastasis at diagnosis(no lateral
nodes:7.7%, lateral nodes:18.9%,p<0.05). Over mean follow-up of 36.1months,
overall recurrence was higher in patients with lateral nodes (no lateral nodes:19.2%,
lateral nodes 35%, p<0.05). 2-year survival in patients without lateral nodes was
81.7%, in those with lateral nodes 2-year survival was 74.1%.
Conclusion:
Lateral pelvic nodes appear to be associated with more advanced disease at

diagnosis and poorer outcome.
-307-
PP - 113 THE IMPACT OF TYPE D PERSONALITY ON HEALTH RELATED
QUALITY OF LIFE IN PATIENTS WITH SYMPTOMATIC HEMORRHOIDS
MUSTAFA ŞİT 1, EDIP ERDAL YILMAZ 1, FATIH CANAN 2, OSMAN YILDIRIM 3,
MEHMET MUSTAFA ÇETİN 4
1
DEPARTMENT OF GENERAL SURGERY, ABANT IZZET BAYSAL UNIVERSITY, SCHOOL
OF MEDICINE, BOLU, TURKEY.
2
PSYCHIATRY CLINIC, BOLU IZZET BAYSAL MENTAL HEALTH HOSPITAL, BOLU,
TURKEY
3
DEPARTMENT OF PSYCHIATRY, ABANT IZZET BAYSAL UNIVERSITY, SCHOOL OF
MEDICINE, BOLU, TURKEY
4
GENERAL SURGERY CLINIC, AGRI STATE HOSPITAL, AGRI, TURKEY
Background&Aims:
We aimed to assess the prevalence of Type D personality in patients with

hemorrhoids and to investigate whether the presence of a Type D personality
would affect health related quality of life (HrQoL) in patients with hemorrhoids.
Methods:
One hundred six outpatients with symptomatic haemorrhoids with no psychiatric

comorbidity were consecutively enrolled, along with 48 healthy controls. Type D
Scale (DS14) and General Health Survey Short Form-36 (SF-36) were used in the
collection of data.
Results:
Of 106 patients evaluated, 29.2% met criteria for Type D personality. Patients with
hemorrhoids scored lower on bodily pain and vitality dimensions of SF-36 than
healthy subjects (p<0.001). Patients with a Type D personality were found to score
lower on bodily pain domain of HrQoL than patients without a Type D personality.
Linear regression analysis revealed a significant independent association of Type D
personality with bodily pain dimension of the SF-36 in patients with symptomatic
hemorrhoids (r = -.315; p <0.01).
Conclusion:
Type D personality was associated with increased perceived bodily pain in patients
with hemorrhoids. Consideration of Type D personality construct personality traits
could improve risk stratification in research and clinical practice in this patient
group.
-308-
PP - 114 SYMPTOMATIC VENOUS THROMBOEMBOLISM
FOLLOWING COLORECTAL CANCER SURGERY; A SINGLE CENTRE UK
STUDY
ANDREW BLYTH , PETER THOMSON , CHRIS KEH
QUEEN ELIZABETH HOSPITAL, BIRMINGHAM, UK
Background&Aims:
The National Institute for Clinical Excellence (NICE) recommends extended venous
thromboembolism (VTE) prophylaxis for patients undergoing major surgery for
colorectal cancer. We aimed to investigate whether the rates of VTE following
colorectal cancer surgery at our institution were comparable with those reported in
the NICE guidance, prior to the introduction of extended prophylaxis.
Methods:
Retrospective analysis of the Somerset Cancer database and electronic patient

records. We identified patients who matched the criteria for the control/placebo
group in the studies on which NICE based its guidance. Using post-operative imaging
records, admission data, and outpatient records we identified patients who were
found to have DVT / PE within 30 days of their operation.
Results:
440 patients underwent colorectal cancer surgery at QEHB between April 2009 and
December 2011. Of these, 285 fitted the “control” criteria (given less than 10 days
low molecular weight heparin as an inpatient and discharged with no extended
prophylaxis). 2/ 285 patients in our cohort (0.7%) were proven to have VTE within
30 days of their operation. The rate of symptomatic VTE across the three studies in
the NICE guidance is 3.62%.
Conclusion:
Rates of symptomatic VTE following colorectal cancer surgery between April 2009 –
December 2011 in our institution are lower than in the published literature.
-309-
PP - 115 ADULT INTUSSUSCEPTION: EXPERIENCE IN A UNIVERSITY
HOSPITAL
SILVINA LUCIA MILLETARI , H. RODOLFO SCARAVONATI , CLARA ELENA AGUIRRE
MARTINEZ , MAURICIO GABRIEL SLUTZKY , JOSE CARLOS SOTELO , MARIANO
LAPORTE , JUAN MANUEL MANOLIZI , VICTOR HUGO SERAFINI
SANATORIO GúEMES, ARGENTINA
Background&Aims:
Adult intussusception represents 5% of all cases of intussusception. Almost 90%

of the cases are secondary to a pathologic condition that serves as a lead point.
The present study reviews the experience of adult intussusception in a University
Hospital
Methods:
Retrospective analysis from a prospectively collected database. We include all

patients with diagnosis of intestinal intussusception who underwent surgery
Results:
Between January 2010 and January 2012, we performed 7 laparotomic explorations

in patients with diagnosis of intussusception (2male, 5 female). The average age
was 45 years old (range 19-53).Abdominal pain was the predominant symptom.
All patients performed abdominal CT scan; in 4 cases (57%) the diagnosis was
confirmed preoperatively. Invaginations were ileocolic in 5 cases (71%) and enteric
in 2 (19%). Invagination was due to idiopathic cause in 5 (71%) patients. Five right
hemicolectomies and 2 small-bowel resections were performed. One case required
ileostomy. There was no mortality and the morbidity was 28,5% (pneumonia,
wound infection).
Conclusion:
In this series the most frequent cause of intussusception was idiopathic. Preoperative
diagnosis is rare and usually is diagnosed intraoperatively, surgical resection is
the gold standard of treatment. Primary anastomosis should be attempted with
acceptable morbidity and extremely low mortality
-310-
PP - 116 THE SURGICAL MANAGEMENT OF EXTENSIVE
HIDRADENITISSUPPURATIVA IN THE PERIANAL AND GLUTEAL
REGION
RAMAZAN ERYILMAZ 1, ISMAIL OKAN 2, TUNA BILECIK 1, CEMAL OZBEN ENSARI 1,
MUSTAFA SAHIN 2
1
ANTALYA EDUCATION AND RESEARCH HOSPITAL, ANTALYA, TURKEY
VAKIF GUREBA TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
2
Background&Aims:
Perianal hidradenitis suppurativa is a chronic inflammatory disease. which is

severely annoying and associated with significant morbidity. Here, we aimed
to present our experiences with the treatment of extensive perianal and gluteal
hidradenitis suppurativa.
Methods:
Patients treated with the diagnosis of extensive hidradenitis suppurativa were

collected in a prospective database. The demographic feature and patient’s medical
characteristics were analyzed based on the database.
Results:
Seventeen patients with only one female patients were included into the study.
The median age was 34,2 (ranged 17-63). Wide excision and rotation flaps were
performed on 13 patients, whereas in 4 patients skin grafting was required since
the complete involvement of anal region. However, graft failure occured in two
patients necessitating the diverting colostomy. The colostomies were taken down
after the successfull wound healing. Anal stenosis was developed in one patient
who underwent V-Y anoplasty. The median hospital stay was 7,2 days (range 3-28
days). The median follow-up was 54 months (range 18-120 months). Seven patients
had wound complications. All treated conservatively with antibiotics except two
patients who underwent colostomy. No recurrences were detected during follow-
up.
Conclusion:
Wide excision with rotation flaps and skin grafting might be an effective treatment
for selected patients. However, diverting colostomy need should be kept in mind
with complete perianal involvement.
-311-
PP - 117 IMPAIRED SUBJECTIVE SLEEP QUALITY IN IRRITABLE
BOWEL SYNDROME PATIENTS WITH A TYPE D PERSONALITY
OSMAN YILDIRIM 1, AYTEKIN ALÇELIK 2, FATIH CANAN 3, GÜLALİ AKTAŞ 2, MUSTAFA
ŞİT 4, AHSEN İŞÇİ 2, ABDULLAH YALÇIN 2, EDİP ERDAL YILMAZ 4
1
DEPARTMENT OF PSYCHIATRY, ABANT IZZET BAYSAL UNIVERSITY, SCHOOL OF
MEDICINE, BOLU, TURKEY.
2
DEPARTMENT OF INTERNAL MEDICINE, ABANT IZZET BAYSAL UNIVERSITY,
SCHOOL OF MEDICINE, BOLU, TURKEY.
3
PSYCHIATRY CLINIC, BOLU IZZET BAYSAL MENTAL HEALTH HOSPITAL, BOLU,
TURKEY
4
Background&Aims:
We aimed to assess the prevalence of Type D personality in patients with irritable

bowel syndrome (IBS) and to investigate whether the presence of a Type D
personality would affect subjective sleep quality in patients with IBS.
Methods:
Ninety-seven patients who met the Rome III criteria for IBS with no psychiatric
comorbidity were consecutively enrolled, along with 39 healthy controls. Type
D Scale (DS14), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and
Depression Scale (HAD) were used in the collection of data.
Results:
Of 97 patients evaluated, 45.4% met criteria for Type D personality. Thirty-five

patients (36.1%) and 7 healthy volunteers (17.9%) were “poor” sleepers (p<0.05).
IBS patients with a Type D personality were found to score higher on sleep latency,
sleep disturbance, and global sleep quality domains of PSQI than patients without
a Type D personality. Poor sleeping was more prevalent among patients with a
Type D personality than those without (50.0% vs 33.9%; p <0.01). Linear regression
analysis revealed a significant independent association of Type D personality with
poor sleeping (r = 0.315; p <0.01).
Conclusion:
Type D personality was associated with decreased perceived sleep quality in

patients with IBS. Consideration of Type D personality construct personality traits
could improve risk stratification in research and clinical practice in this patient
group.
-312-
PP - 118 COMPARISON OF THE THREE SURGICAL TECHNIQUES IN
PYLONIDAL SINUS SURGERY
MUSTAFA ŞİT 1, EDİP ERDAL YILMAZ 1, GÜLALİ AKTAŞ 2
1
2
SCHOOL OF MEDICINE, BOLU, TURKEY
Background&Aims:
We aimed to study the efficacy of three surgical techniques in pilonidal surgery.

Pilonidal disease is characterized with chronic inflammation and infection in
sacrococcygeal region. Complication and recurration is common after treatment
and optimal treatment for the disease has not been established yet.
Methods:
We enrolled a total of 401 patients in this study. Patients have been treated
either with Karydakis (n=113), modified Limberg (n=179) or Limberg (n=109) flap
techniques.
Results:
Mean off work period, time to walk without pain, time to sit on toilet, time to taking
the drainage catheter off, maceration rates, recurrence and hypoesthesia rates
were significantly better in modified Limberg group.
Conclusion:
In conclusion, we showed that modified Limberg technique is superior than both

Limberg and Karydiakis techniques.
-313-
PP - 119 ROUTINE USE OF POSITRON-EMISSION TOMOGRAPHY
FOR STAGING OF PRIMARY COLORECTAL CANCER: DOES IT EFFECT
A MANAGEMENT?
GÖKHAN ÇİPE , NAİM MEMMİ , DENIZ FIRAT , SÜLEYMAN BOZKURT , YELIZ
EMINE ERSOY , MUSTAFA HASBAHÇECI , OĞUZHAN KARATEPE , MAHMUT
MÜSLÜMANOĞLU

Background&Aims:
The use of positron emission tomography-computed tomography (PET/CT) in the

patients with recurrent disease colon and rectal cancer has increased steadily over
the last decade. The aim of this study is to evaluate the effect of PET/CT in the
preoperative staging and in clinical management of patients with colorectal cancer.
Methods:
Between December 2010 and February 2012, consecutive patients with colorectal
cancer were evaluated with both PET/CT scan and conventional preoperative
imaging studies. PET/CT stage was compared with conventional imaging studies.
Change in management were evaluated.
Results:
PET/CT was performed in 64 patients. Thirty-nine (60.9%) patients had rectal cancer
and 25 (39.1%) had colon cancer. Based on PET/CT, 10 (15.6%) of the patients
showed additional lesions. The false positivity rate of PET/CT was 10%. There was no
down-staging. Chemotherapy regimen for metastases was given to the patient with
a 1.5 cm hepatic metastasis near to the right hepatic vein. Based on the additional
PET/CT, 1(2.5%) patient who had identified supraclavicular lymph node metastasis,
had a change in surgical management.
Conclusion:
PET/CT should not be routinely used for primary staging of colorectal cancer. More
studies are required for identifying the subgroup of patients who might benefit
from a PET/CT in their initial staging.
-314-
PP - 120 A SİGMOİDO-URACHAL-CUTANEOUS FİSTULA AFTER
ACUTE DİVERTİCUİTİS
MEHMET LARI GEDIK 1, DOGAN GONULLU 1, CAN BALCI 2, ELIFE KIMILOGLU 3,
FERDA NIHAT KOKSOY 1
1
TURKISH MINISTRY OF HEALTH, TAKSIM TRAINING AND RESEARCH HOSPITAL,
DEPARTMENT OF SURGERY, ISTANBUL, TURKEY
2
DEPARTMENT OF UROLOGY, ISTANBUL, TURKEY
3
DEPARTMENT OF PATHOLOGY, ISTANBUL, TURKEY
Background&Aims:
The urachus is an embryonic remnant of communication between the bladder
and the umbilicus. Incomplet obliteration of this, develop an patent urachus; as a
consequence of diverticulitis episode the sigmoid colon may adhere to the patent
urachus and develop a colo-urachal fistula, that are very rarely reported in the
present literature.
Methods:
An 54 year old male presented with feculent and gassy discharge from his umbilicus,
pneumaturia and blurriness of urine; the discharge had started 3 months ago
and his history revealed a undefined abdominal pain at right quadran; physical
examination showed feculent discharge from umbilicus. The magnetic resonance
showed an urachal remnant containing cystic lesion and an adjacent mass from
colonic segment; cystoscopy demonstrated feculent drainage and the colonoscopy
showed diverticular disease and obstruction at level of sigmoid colon.
Results:
The exploration of the abdomen revealed a fistulous tract from umbilicus to bladder
dome in close vicinity with sigmoid colon; we performed an “en bloc” resection of
the involved sigmoid colon, excision of the urachal remnant with the umbilicus and
the bladder cuff.
Conclusion:
The reported entero-urachal fistula were associated with Crohn’s disease, only
few cases of urachal-sigmoid fistula have been reported. The most of these cases
were without any obvious colonic pathology; our case is one of the rarely reported
sigmoid urachal cutaneous fistula associated with diverticulosis; we suppose that
the cutaneous fistula between sigmoid colon and patent urachus was developped
after an complicated diverticulitis episode.
-315-
PP - 121 EXPRESSION OF GST T1 IS DOWNREGULATED IN PATIENTS
WITH LEFT COLON CANCER
ENDER COSKUNPİNAR 2, EMEL CANBAY 1, YASEMİN OLTULU 2, DURSUN BUGRA 3
1
KOCAELİ DERİNCE EDUCATİON AND RESEARCH HOSPİTAL, KOCAELİ, TURKEY
2
ISTANBUL UNİVERSİTY, ISTANBUL, TURKEY
3
AMERİCAN HOSPİTAL, ISTANBUL, TURKEY
Background&Aims:
Glutathione S-transferase T1 (GST T1) is a subgroup of the glutathione S- transferases

(GST) that can metabolize endogenous and exogenous toxins and carcinogens
catalyzing the conjugation of diverse electrophiles with reduced glutathione (GSH).
We aimed to investigate GST T1 expression in left colon cancer.
Methods:
GST T1 expression was analyzed from matched tumor-normal tissue samples taken
from 24 patients with left colon cancer using reverse transcriptase-polymerase
chain reaction technique. Analyses were conducted to assess possible associations
between expression levels and clinicopathological characteristics of patients.
Results:
GST T1 expressions were all downregulated in tumor tissues compared to normal

tissues (p 0.001). In univaitae analysis, tumor staged T3 or grater showed significantly
lower expression in left colon tumors (p 0.001), and GST T1 expression remained an
independent predictive factor for advanced stage (p 0.001) in multivariate analysis.
Conclusion:
Our results show that GST T1 expression is down regulated in left colon tumor
and down regulation of GST T1 is associated with tumor stages. Therefore,
downregulation in GST T1 expression may be an important mechanism involved
in carcinogenesis and progress of left colon tumors. The underlying mechanisms
leading to downregulation in GST T1 expression deserve further investigation.
-316-
PP - 122 FACTORS AFFECTING MORBIDITY AND MORTALITY OF
COLOSTOMY CLOSURE.
HALDUN KAR , NECAT CIN , CENGIZ TAVUSBAY , YASIN PEKER , KURSAT YEMEZ ,
FATMA TATAR
IZMIR KATIP CELEBI UNIVERSITY ATATURK TRAINING AND RESEARCH HOSPITAL

DEPARTMENT OF GENERAL SURGERY, IZMIR, TURKEY
Background&Aims:
Colostomy closure operations that may lead to serious morbidity and mortality in
surgical procedures. In our study, we aimed to display the factors affecting morbidity
and mortality in patients undergone colostomy closure.
Methods:
This is a retrospective study of 62 patients undergoing closure of colostomy. Data

collected included general demographics, indication for colostomy, type and
location of the colostomy, surgical technique, interval between the stomal creation
and closure, type of the incision and anastomosis, presence of comorbidity, wound
infection, anastomotic dehiscence, and mortality.
Results:
Of the 62 patients, 40 were men and 22 were women, with an average of 54 years.
Colostomy was performed in 19 patients due to traumatic causes, in 43 patients
due to nontraumatic causes. 43 were end while 19 were loop colostomies. 55 were
located at left side of the abdomen, 7 were on right side. The incision was around
the colostomy in 14 patients, 48 were midline incisions. For colostomy reversal,
stapled and hand-sewn anastomoses were done in 30 and 32 patients, respectively.
The mean interval between the colostomy creation and closure was 295 days.
Comorbidities were found in 13 patients. Wound infection and anastomotic
dehiscence developed 21 and 2 patients respectively. 3 patients were died. Wound
infection was significantly high in patients undergone resection and anastomosis,
and with the use of stapler. No significant correlation was observed with the studied
parameters and anastomotic dehiscence.
Conclusion:
We consider great care should be taken to avoid wound infection, in patients with
resection and anastomosis, also with the use of stapler.
-317-
PP - 123 COLON POLYPS, LOCALIZATIONS, SIZES AND
HISTOPATHOLOGIC FINDINGS; IS IT TRUE TO LEAVE SMALL POLYPS?
ERDEM KINACI 1, MEHMET EMIN GUNES 1, ACAR AREN 1, HASAN BEKTAS 1, ESRA
PASAOGLU 2
1
ISTANBUL TRAINING AND RESEARCH HOSPITAL, DEPARTMANT OF GENERAL
2
ISTANBUL TRAINING AND RESEARCH HOSPITAL, DEPARTMANT OF PATHOLOGY,
ISTANBUL, TURKEY
Background&Aims:
Colonic polyps are precancerous lesions. The extirpation of diminutive polyps (≤5
mm) is controversial. In this study, we exhibit the relations between localizations,
sizes and histopatolojic findings of colonic polyps in 97 patiens.
Methods:
We investigate 97 patients who underwent to polypectomy in last three mounths.

Demographic findings, localizations, sizes and histopathologic findings are noted.
Results:
Totally 139 polyps are underwent to polypectomy in 97 patients. Mean age of

patients is 65,9. 53% of them are located to sigmoid colon and rectum. Polyps
are divided to six groups according to histopatologic findings (1. inflammatory
pseudopolyps or hiperplastic polyps; 2. low grade dysplasia; 3. high grade dysplasia;
4. carcinoma in situ; 5. invasive carcinoma) and three groups according to sizes (≤5
mm, >5mm and ≤10 mm, >10 mm). Great majority of (99%) the diminutive polyps
(≤5 mm) are in group of 1 or 2. But 65% of diminutive polyps are adenomateous,
even one case is invasive carcinoma.
Conclusion:
Diminutive polyps are not innocent, most of them adenomateous and reside to
anywhere in carcinomatous diffentiation. We conclude that all polyps must be
extirpated and sended to pathologic examinaton.
-318-
PP - 124 FECAL MANAGEMENT SYSTEM AS AN ALTERNATIVE OF
STOMA IN FOURNIER’S GANGRENE
NACIYE CIGDEM ARSLAN , ARAS EMRE CANDA , GULSEN ATASOY , MUCAHIT
OZBILGIN

Background&Aims:
Management of fecal incontinence is essential in Fournier’s gangrene (FG) and

stoma requirement rates are between 10-65% among these patients. Objective of
this study is to present our flexible fecal management system (FMS) experience as
an alternative to stoma.
Methods:
Between August 2005-December 2011, of 66 patients underwent surgery for FG, 28

patients had fecal diversion indication and 9 of these patienst had been managed
with FMS instead colostomy. FMS was applied with vacum assisted closure system
after necrosectomy. Rectal digital examination was performed before and after all of
the applications. All the patients were administered wide spectrum antibiotherapy
and performed consecutive debridements regarding to clinical need.
Results:
Patients were managed with FMS and vacum assisted closure system for 4-17
days. Fecal contamination was prevented successfully by FMS in all of the patients.
Mortality was seen in 5 patients and mean survival of these patients were 23 days.
Other 4 patients had been externed without any trouble. We did not see rectal
erosion or any other complications due to FMS. Mean hospital stay was 38 days.
Conclusion:
Efficient fecal diversion can be provided by FMS in Fournier gangrene patients. FMS
may be a useful and safe alternative to stoma.
-319-
PP - 125 COMPARISON BETWEEN LAPAROSCOPIC VERSUS
CONVENTIONAL SURGERY IN RECTUM CANCER
ARAS EMRE CANDA , NACIYE CIGDEM ARSLAN , CEM TERZI , MEHMET FUZUN

Background&Aims:
Comparison between laparoscopic and open surgery in curative treatment of

rectum cancer.
Methods:
Data of 166 patients underwent curative resection of rectum cancer is recorded

prospectively. Neoadjuvant chemoradiotherapy was given to all the patients
with locally advanced tumor except for radiotherapy contraindications, emergent
surgery such as bleeding or obstruction. Open and laparoscopic resections were
performed in 117 (70.5%) and 49 (29.5%) patients respectively. Clinical, pathologic
and oncological results were compared between two groups.
Results:
M/F ratio was 66/100. Mean age was 61.8 (27-90). Conversion to open surgery from
laparoscopic surgery had been occured in 4 patients. Tumor localisation was upper
third in 51 (30.7%) patients, middle third in 42 (%25.3) patients and lower third in 73
(44%) patients. Sphincter sparing surgery (SSS), abdominoperineal resection (APR)
and Hartmann operation rates were 72.3% (n=120), 23.5% (n=39) and 4.2% (n=7)
respectively. Average hospital stay was 12.7 days. In SSS group 9 (7.5%) patients
had anastomotic leakage. Mean follow up was 17.6 months. One (0.6%) patient had
perioperative mortality. Demographic characteristics were not different between
two groups. Hospital stay was significantly shorter in laparoscopic surgery group
(10.2 vs 12.6 days, p=0.025). There were no differences in complications, T and
N stages, harvested lymp nodes, CRM and distal margin, tumor perforation rates,
local or distant recurrence and survival.
Conclusion:
Laparoscopic surgery has comparable results with open surgery in curative

treatment of rectum cancer.
-320-
PP - 126 SHORT-TERM ONCOLOGICAL RESULTS OF CYTOREDUCTIVE
SURGERY AND HYPERTHERMIC INTRAPERITONEAL
CHEMOTHERAPY FOR PERITONEAL SURFACE MALIGNANCIES
CEM TERZI 1, SELMAN SOKMEN 1, ARAS EMRE CANDA 1, NACIYE CIGDEM ARSLAN 1,
OZGUL SAGOL 1, ILHAN OZTOP 2, FUNDA OBUZ 3
1
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF MEDICAL
ONCOLOGY, IZMIR, TURKEY
3
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF RADIOLOGY,
IZMIR, TURKEY
Background&Aims:
To determine the short-term oncological outcome, perioperative complications,
and toxicity after cytoreductive surgery(CRS) and hyperthermic intraperitoneal
chemotherapy(HIPEC) for the treatment of peritoneal surface malignancies.
Methods:
We performed 95 HIPEC in 93 patients with peritoneal carcinomatosis(PC) and data
were analyzed from a prospectively collected database. Median age was 53.7 years
(range, 20-82). 73.7% of patients were female. 92 patients underwent CRS and
HIPEC; HIPEC was used for ascites palliation or as a neoadjuvant treatment setting
in 3 unresectable patients. Primary tumors for PC were originated from ovaries
in 39, colon and rectum in 29, mesothelioma in 8, pseudomyxoma peritonei in 6
patients. PC was synchronous to primary cancer in 52.6%, metachronous in 40%,
and recurrent in 7.4% of patients.
Results:
PCI was ≥15 in 53(55.8%) patients and we performed CC-0 CRS in 63(68.5%)
patients. Perioperative overall morbidity and mortality rates were 56.8% and 7.4%,
respectively. In a median of 11 (range, 0-43) months of follow-up duration, 28.4% of
patients were alive without evidence of disease, 39.8% of patients were alive with
recurrent and/or metastatic disease, 30.7% of patients were dead. Median overall
survival time was 30.1 months. Prognostic factors on survival were primary disease
origin, PCI and CC score.
Conclusion:
Radical surgical approach to peritoneal surface malignancies with CRS and HIPEC
may provide a long-term survival with acceptable perioperative morbidity and
mortality rates.
-321-
PP - 127 A RETROSPECTIVE ANALYSIS OF RECURRENCE PILONIDAL
SINUS CASES
TAYFUN YOLDAS , CAN KARACA , OMER UNALP , ALPER UGUZ , CEMIL CALISKAN ,
ERHAN AKGUN , MUSTAFA KORKUT
EGE UNIVERSITY FACULTY OF MEDICINE, GENERAL SURGERY DEPARTMENT, IZMIR,

TURKEY
Background&Aims:
Treatment of pilonidal sinus, which has a high recurrence rate, is still a debate.
The surgeon should focus on both to eliminate the symptoms of the disease and
prevent recurrence, when choosing the appropriate method. In this study, we aimed
to analyse recurrence pilonidal sinus cases and search factors effecting recurrence.
Methods:
Of the 370 pilonidal sinus patients operated between March 2008 - February 2012, 41
patients with recurrence were included in this study and evaluated retrospectively.
Following data were collected; age, gender, previous surgery, family history, time
to recurrence, follow up time, risk factors, surgical approach for recurrence disease
and recurrence after final surgery.
Results:
The mean age of the 33 male and 9 female patients was 24,9. Eighteen patients had
family history. Mean follow up time after our operation was 18,3 months. Factors
which are defined as risk factors were detected in 22 patients. Only excision was
performed for 30 of the patients applying with recurrence, when excision and flap
closure was done for 11 of them. Our recurrence rate was % 9,7.
Conclusion:
The recurrence rate of our study is compatible with the literature. Comperative
studies are needed to determine the appropriate method to decrease recurrence
rate.
-322-
PP - 128 ACUTE ABDOMEN IN PATIENTS WITH COLONIC
MALIGNANT TUMORS
Background&Aims:
To evaluate those cases with malignant colorectal tumors and its incidence and the
methods of treatment that can be performed in high risky patients
Methods:
Prospective descriptive study done at one teaching hospitaland one private hospital
in Aden city –Yemen during the period March 2007-March 2009 , 84 patient (
50males and 34 females) were diagnosed as recto sigmoid and colonic cancer ,,
among them 24 present with acute abdomen
Results:
Twenty-four patients presented as emergency were surgical intervention done after

initial resuscitation ( 18 females ,6 males ) perforation at the caecum was seen in
10 cases ( 8F, 2M) three perforation at the site of the tumor seen in one male and
two females… those present with colonic obstruction were seen in 11 patients( 8 F,
3M) the site of obstruction was rectosigmoid (6) , left colon (3), transverse colon (2)
and synchronus tumor was seen in three patients. Primary resection with primary
anastomosis done for 16 cases combined with caecestomy in 2 cases. Hartmann’s
operation done in 4 cases and two cases extended right hemicolectomy, two cases
only colostomy was performed.
Conclusion:
Colorectal cancer may be present in acute abdomen with obstruction and

perforation especially in the caecum and may be fatal if delayed the treatment,
most of our patient were females more than 60 years with rectosigmoid annular
tumor.
-323-
PP - 129 DOES CLINICAL T4 COLON AND RECTUM TUMORS
PREVENT LAPAROSCOPIC SURGERY? A SELECTED GROUP OF 459
CONSEQUTIVE LAPAROSCOPIC COLORECTAL CANCER SERIAL
ENVER KUNDUZ , KURSAT RAHMİ SERİN , HASAN KARANLIK , OKTAR ASOĞLU
ISTANBUL FACUKLTY OF MEDİCİNE, GENERAL SURGERY, ISTANBUL, TURKEY
Background&Aims:
Examining the pathologic outcomes of laparoscopic surgery for clinical (c) T4 colo-
rectal tumors.
Methods:
28 of 460 colo-rectal carcinoma patients whom were operated laparoscopically

had tumor attachment to adjacent organ. Genitals, bladder, ileum, spleen, distal
pancreas or abdominal wall were resected for suspicious invasion. 9 of them
needed conversion to open procedure due to tumor size or bone invasion. The
anastomosis or reconstructions were done with endoscopic hand-made sutures or
staples in laparoscopic cases.
Results:
16 of 28 had rectum tumor, mostly located in distal (9 cases). 13 of them received

neoadjuvant chemo-radiotherapy. Mean tumor size was 40 mm (0-90) and mean
harvested lymph node was 22 (6-46). Seven each had T3 and T4, one each had T0
and T2 tumors. Mesorectum integrity was secured for 11 cases. All circumferential,
distal and proximal surgical margins were tumor free. Mean tumor size was 50 mm
(25-95) in 12 colon tumor and mean harvested lymph node number was 33 (16-62).
Eight of 12 patients had T4, two T3, one T2 and one T1 tumor. All surgical margins
were negative.
Conclusion:
cT4 colo-rectal tumors shouldn’t be a contraindication for laparoscopic resection.

Laparoscopy could provide adequate pathologic results.
-324-
PP - 130 EARLY POSTOPERATIVE OUTCOMES AFTER LAPAROSCOPIC
COLORECTAL CANCER OPERATIONS: RESULTS OF 114 CASES
ERDAL BİROL BOSTANCI , TAHSİN DALGIÇ , YUSUF ÖZOĞUL , İLTER ÖZER , MURAT
ULAŞ , METİN ERCAN , ALİ KEMAL KAYAPINAR , MUSA AKOĞLU
DEPARTMENT OF GASTROENTEROLOGICAL SURGERY, TÜRKİYE YÜKSEK İHTİSAS

EDUCATION AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
To report early results of laparoscopic colorectal cancer operations in our clinic.
Methods:
Between August 2000 and May 2012 we reviewed the data of 114 patients who
underwent laparoscopic surgery for colorectal cancer from a prospectively collected
database.
Results:
Of the 114 patients,80(70.2%) were males and 34(29.8%) were female. Mean age
was 58±13.5. Sixty-eight(60%) patients had rectal cancer,45(40%) had colon cancer
and 1 patient had rectum and right colon cancer.The operations were low anterior
resection(32), abdominoperineal resection(21), right hemicolectomy(15), anterior
resection(13), sigmoid resection(11), colostomy(9), segmental colon resection(5),
left colectomy(3), and total colectomy(5). Four operations were converted to open
surgery due to bleeding and anatomical difficulties. Postoperative complications
developed in 27(24%) patients.Four (3.5%) patients had anastomotic leakage.
The average number of lymph nodes removed were 18±11.8, mean tumor largest
diameter was 27±26.3mm, the mean operative time was 240±87.9 minutes, and
mean hospital stay was 8±6.3 days. No postoperative mortality was seen.
Conclusion:
We did not observe any negative impact of laparoscopic colorectal surgery in the
early postoperative period. Laparoscopic colorectal operations can be performed
safely in a center experienced in colorectal surgery and laparoscopic operations.
-325-
PP - 131 EVALUATION OF ACUTE APPENDICITIS CASES:
RETROSPECTIVE ANALYSIS OF 1071 PATIENTS
SAHAP TUMERDEM , KORAY KOSMAZ , METIN YUCEL , ADNAN OZPEK , İBRAHIM
ATAK , ALI KILIC , GURHAN BAS, ORHAN ALIMOGLU
UMRANIYE TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF GENERAL

Background&Aims:
Acute appendicitis is the most common cause of emergency surgery. Delay in

diagnosis and treatment is associated with high morbidity. The aim of our study is
to retrospectively analyze patients operated for acute appendicitis
Methods:
Patients, who underwent appendectomy for acute appendicitis between January

2009 and December 2011, were assessed. Age, sex, symptom duration, operation
type and findings, pathology results, and clinical follow up were evaluated.
Results:
A total of 1071 patients were operated. Seven hundred and twenty patients
(67.32%) were male and 351 (32.68%) were female. It was most commonly seen
between 16 and 40 years of age. Appendectomy was carried out in an open fashion
in 989 patients and laparoscopically in 82. Appendix stump was buried in 380 cases
whereas it was not buried in 619 patients. On histopathological assessment, 618
were suppurative, 320 were phlegmonous, 68 were focal appendicitis while 65
patients had another histopathological findings than apppendicitis. Complications
developed in eighty (7.5%) patients, mortality wasn’t observed.
Conclusion:
Acute appendicitis affected most commonly men and young patients. While the
complication (7.5%) and negative appendectomy (8.4%) rates were high, mortality
rate was low. Enterocutaneous fistulae seems to be more common in patients with
weren’t buried appendix stump.
-326-
PP - 132 EVALUATION OF PROGNOSTIC FACTORS IN COLORECTAL
CANCER AND CLINICAL SIGNIFICANCE OF METASTATIC LYMPH
NODE RATIO
SERHAT TOLGA DERICI , YAVUZ ÖZDEMIR , AHMET ZIYA BALTA , İLKER SÜCÜLLÜ ,
ERGÜN YÜCEL , MEHMET LEVHI AKIN, ALI İLKER FILIZ, YAVUZ KURT

TURKEY
Background&Aims:
We aimed to evaluate the effect of age, tumor localization, tumor stage, preoperative
carcinoembryonic antigen (CEA) and metastatic lymph node ratio on overall survival
and disease free survival.
Methods:
A total of 479 patients with colorectal cancer, who were operated between 1991
and 2011, were included. Patients were stratified into 3 groups according to their
age at surgery, 3 groups according to primary tumor localization, 4 groups according
to TNM staging, 2 groups according to preoperative serum CEA levels and 4 groups
according to ratio of metastatic lymph nodes (LNR). Survival analysis is done by
Kaplan Meier method. Factors effecting overall survival and local recurrences were
analyzed by multivariate Cox’s regression analysis.
Results:
The cumulative five-year survival rate was 48.5%. CEA, LNR and TNM stage have
an effect on overall survival and disease free survival, while age at surgery has an
effect only on overall survival but not on disease free survival in univariate analysis.
Multivariate analysis revealed that the tumor stage and LNR have an effect on
overall survival while serum CEA level and tumor stage have an effect on disease
free survival.
Conclusion:
We concluded that LNR is a useful parameter in predicting prognosis of colorectal

cancer.
-327-
PP - 133 GYTOREDUCTIVE SURGERY AND HYPERTHERMIC
INTRAOPERATIVE CHEMOTHERAPY FOR PERITONEAL
CARCINOMATOSIS IN THE ELDERLY
JOHN SPILIOTIS , EVGENIA HALKIA , ALEXANDRA PAGOULATOU , ELIAS EFSTATHIOU
METAXA CANCER HOPSITAL, GREECE
Background&Aims:
The compined treatment of peritoneal carcinomatosis with cytoreductive surgery

and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment
most suited for yound and good performance status patients. We evaluated
the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal
carcinomatosis
Methods:
All conservative patients treated the last 5 years for PC who were 70 year of age or
older at the time of surgery were included. Primary outcomes were perioperative
morbidity and mortality. Secondary outcomes were disease-free survival and
overall survival.
Results:
Thirty patients (30%) from all patients in which perform CRS+HIPEC were included
in the study (mean age 74,5 years). In eight patients (26,7%) major complication
occurred and in seven (23,3) patients the postoperative course was complicated by
minor adverse events. The total morbidity rate was 50% vs 41.5% in the group <70
years old (n.s.s.). The mortality rate was 3,3% in the elderly group vs 1,43% (n.s.s.).
Median overall survival was 30 months vs 38 months in the group <70 year old with
a 6-12 and 18 month survival rate of 94% vs 96%, 83% vs 89% and 65% vs 80%.
Conclusion:
The CRS and HIPEC for PC may be safely performed with acceptable morbidity in
selected elderly patients.
-328-
PP - 134 HAND ASSISTED VS. CONVENTIONAL LAPAROSCOPIC
COLECTOMY: A PROSPECTIVE, RANDOMIZED STUDY-PRELIMINARY
RESULTS
ERSIN ÖZTÜRK , TUNCAY YILMAZLAR , BARIŞ GÜLCÜ

BURSA, TURKIYE
Background&Aims:
This is the preliminary report of our prospective, randomized study that was
designed to compare the short term outcomes and costs of two main aspects of
minimally invasive colon surgery, hand assisted (HALC) vs. conventional laparoscopy
(CL).
Methods:
This study was approved by the local ethical committee of our institution. 30
patients were randomized into two groups (hand assisted vs. conventional) and
then underwent laparoscopic colon surgery for benign and malign diseases. Patients
were operated on intention to treat basis. Primary outcomes were operating time,
complications, length of stay (LOS), mortality, readmission, reoperation and costs.
Results:
There were 13 HALCs and 17 CLs. The patient characteristics were similar between
groups. Operating times, complication rates, LOS, mortality, read mission and
reoperation rates were similar. Total costs were significantly higher for HALC [4186
(3363-7346)] than CL [3620 (2547-6054)] (p=0,02).
Conclusion:
HALC seems to offer no benefit over CL except a significant increase in costs.
-329-
PP - 135 HOW EFFECTIVE ARE TRADITIONAL METHODS IN THE
MANAGEMENT OF ANORECTAL FISTULAE?
SARAH BRAUNGART , GEETINDER KAUR
SCUNTHORPE GENERAL HOSPITAL, UK
Background&Aims:
Anorectal fistulae are extremely common; traditional treatment includes

fistulotomy and setons, associated with high incidence of recurrence and up to
67% risk of faecal incontinence. Alternative treatment options have been tried with
limited success. There are still no clear guidelines on anal fistula management. Thus
management remains challenging, needing a balance of effective treatment with
maintenance of continence.
Methods:
We analysed a single surgeon’s results in the management of anal fistula in a district

UK hospital over a 5 year period.
Results:
Data of 48 patients who underwent surgery for anorectal fistulae was analysed. 10%
occurred in patients with IBD. Patients were investigated preoperatively with MRI,
endoanal US, or sinogram. 44% patients had only 1 procedure- 67% of which were
immediate fistulotomies, with 1 recurrence. 56% patients had complex fistulae and
underwent more than 1 procedure. Average treatment duration for those complex
fistula patients who have been discharged (78%) was 13 months. Average follow-
up was 27.2 months. Overall recurrence rate was 4 %, (1 patient discussed above,
second currently undergoing seton treatment). 2 patients experienced occasional
soiling post treatment, 1 had incontinence (undergoing treatment currently) and 1
needed a proctectomy after 15 seton changes over 13 years.
Conclusion:
Using standard treatments of fistulotomy and seton in an extremely conservative

manner, it is possible to achieve excellent results, with low rates of incontinence/
recurrence.
-330-
PP - 136 HYBRID SETON FOR THE TREATMENT OF HIGH ANAL
FISTULAS: RESULTS OF 128 CONSECUTIVE PATIENTS
BAHADIR EGE 1, SEZAİ LEVENTOĞLU 2, B.BÜLENT MENTEŞ 2, UTKU YILMAZ 2, YUSUF
GÜNER 3
1
PRIVATE KORU HOSPITAL, DEPARTMENT OF SURGERY, ANKARA, TURKEY
2
DEPARTMENT OF SURGERY, GAZI UNIVERSITY MEDICAL SCHOOL, ANKARA,
TURKEY
3
DEPARTMENT OF RADIOLOGY, GAZI UNIVERSITY MEDICAL SCHOOL, ANKARA,
TURKEY
Background&Aims:
To document our experience in managing high anal fistulas with a simple

modification of the cutting seton.
Methods:
This study is based on the retrospective review of standardized charts designed for
prospective evaluation by the use of validated scoring systems and questionnaires.
Surgical outcomes of 128 consecutive, well-documented patients treated by the
hybrid seton for high anal fistulas, were analyzed.
Results:
Complete healing was achieved in 67 cases (52.3 percent) at 1 month and in all
cases (100 percent) at 3 months, postoperatively. Recurrent fistula was noted in two
patients (1.5%) at 6 and 12 months. The mean postoperative incontinence scores at
3 and 12 months did not differ significantly from the preoperative score (p=0.061,
Wilcoxon’s test). Especially the depression, life style, and embarrassment item
scores of the fecal incontinence quality of life index (FIQLI) improved significantly
after surgical treatment.
Conclusion:
The results of this series have suggested that the hybrid seton might be a valid
alternative for the treatment of high anal fistulas, eliminating the need for
postoperative adjustments. The successful outcome is associated with significant
improvement in quality of life.
-331-
PP - 137 IMPACT OF STAPLED HEMORRHOIDOPEXY ON QUALITY OF
LIFE IN LONG TERM: A SINGLE CENTER EXPERIENCE
TUGAN TEZCANER , AYDINCAN AKDUR , YAHYA EKICI , FEZA KARAKAYALI , ELIFCAN
KOLSARICI , GÖKHAN MORAY
BASKENT UNIVERSITY, DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY
Background&Aims:
The aim of this study is to determine results of stapled hemorrhoidopexy in terms

of early postoperative course and quality of life and recurrence in long term.
Methods:
Between 2006 and 2011, consecutive patients underwent stapled hemorrhoidopexy

were evaluated for demographic features, early postoperative morbidity, and
relief of symptoms and impact of quality of life in long term. Data was collected
retrospectively and quality of life at least after 1 year from the operation. Quality of
life assessment was carried out by a short disease related survey.
Results:
Sixty percentage of patients were males and the median age was 49.5(range,
50) years. The median follow up was 42 months (range, 62). Two patients
were readmitted hospital because postoperative bleeding (5%) and pain need
intervention (5%). Bleeding (35%) and perianal discomfort (35%) were the most
troubled symptoms before the surgery. There were two recurrences (10%) of
these patients. Ninety percentage of patients noted total partial and relief in most
troubled symptoms. Quality oflife assessment was revealed very promising results
in terms of anal pain, bleeding during defecation, feeling prolapsed mucosal piles,
incontinence and itching around the anus.
Conclusion:
Stapled hemorrhoidopexy is a safe and effective procedure for treatment of

prolapsed hemorrhoids with a good impact of quality of life in long term.
-332-
PP - 138 INTRAVENOUS FLUID PRESCRIBING IN MAJOR ELECTIVE
COLORECTAL SURGERY
NIMALAN SANMUGALINGAM , MAMOON YUSAF , GEETINDER KAUR
SCUNTHORPE GENERAL HOSPITAL, UK
Background&Aims:
There is insignificant data to guide fluid prescription in elective major surgery.

Intra-operative fluids have been researched, but little done on post-operative fluid
management. We aimed to investigate effect of intra- / post-operative fluids on
patients undergoing major elective colorectal surgery.
Methods:
Data (quantity / type fluids prescribed intra- and post operatively, duration of stay,
complications, mortality, Ppossum, epidural) was collected for 3 colorectal surgeons
at our hospital over 3 months.
Results:
34 patients data was analysed. Average hospital stay was 12 days; average intra-
operative fluid given was 2.33 litres, average total post operative fluid was 7.37
litres (5.89 in first 24, 7.10 litres in first 48 hrs). 5 patients stayed > 15 days; here
intra-operative fluid given was 2.4 litres, post op 12.68 litres, 5.95 in first 24 hours,
7.15 litres in 48 hours.10 patients had significant complications (abscess, leak,
ileus); here intra-operative fluid was 2.05 litres, post op 9.16 litres, 5.2 in first 24 hrs,
6.8 litres in 48hrs. There was no statistically significant difference in intra- or post-
op fluid management between these groups, nor in mean length of stay between
Laparascopic/Open Procedures nor between those with/without Epidural. 2
patients died (Ppossum 25 & 34); fluids received 8.5 Litres.
Conclusion:
Fluid administration should be based upon clinical needs rather than formulas.
However, given the small numbers, a larger study should be undertaken to better
assess the value of goal-directed fluid therapy.
-333-
PP - 139 LAPAROSCOPIC COLORECTAL RESECTION: A SINGLE
CENTER EXPERIENCE
SAHIN

Background&Aims:
Laparoscopic colorectal resection (LapCR) is not inferior to open surgery in terms of

oncologic outcomes with other benefits of minimal access surgery. The aim of this
study was to present our experience with LapCR patients and compare them with
conventional open surgery patients.
Methods:
Between 2007 and 2012, 99 patients underwent open conventional (Group 1) and
46 patients underwent laparoscopic colorectal surgery (Group 2) for malignant
disease.
Results:
Patients in the Group 2 were significantly younger than Group 1 (60.60±13.30

vs. 66.13±13.01; p=0.02). Gender distribution was similar (p=0.982). Mean
postoperative hospital stay was significantly longer in Group 1 (14.50±12.73 vs.
9.02±5.59 days; p=0.015). Mean number of harvested lymph nodes was 20.14±10.85
in Group 1 and 25.48±10.54 in Group 2. The difference was statistically significant
(p=0.024). Metastatic lymph node numbers (2.94±4.77 vs. 2.94±7.03; p=0.999) and
morbidity ratios were similar among groups (16.2% vs. 13.04; p=0.495). There was
one mortality in Group 1 due to sepsis.
Conclusion:
According to our results, LapCR is a safe operation with shorter hospital stay. In
addition to the benefits of minimal invasive surgery, harvested lymph node numbers
were significantly higher in LapCR patients probably due to better high ligation and
preservation of colonic meso intact.
-334-
PP - 140 LONG-TERM RESULTS AFTER LAPAROSCOPIC VS
CONVENTIONAL RESECTIONS FOR RECTAL CANCER
YUNUS EMRE ALTUNTAS , FAZLI CEM GEZEN , NURI OKKABAZ , METIN KEMENT ,
MUSTAFA ONCEL
Background&Aims:
The aim of the study is to evaluate long-term survival after laparoscopic and
conventional rectal cancer resections
Methods:
A retrospective analysis has been completed for all rectal cancer patients operated
at our department between 2000 and 2012. These data were compared within
laparoscopic and conventional groups: demographics, perioperative information,
and long term results
Results:
A total number of 260 patients (159 [61.2%] male, mean[±SD] age was
59.2±13.7years) were operated either laparoscopic (n=173,66.5%) or conventional
(n=87, 33.5%) techniques. These information were identical within the groups:
demographics, presence of comorbidity, ASA score, tumor localization, necessity
of neoadjuvant chemoradiotherapy, pathological T and N stages, hospital stay,
rate of postoperative complications, 30-day mortality and requirement of an
early reoperation. The possibility of a sphincter saving procedure was increased
(78.1%vs57.5%, p=0.001), operation time was shortened (219.9±52.9vs240.6±71.1
min, p=0.023), and the requirement of perioperative transfusion was decreased
(11%vs3.4%, p=0.039) in laparoscopy group. However, the number of harvested
lymph node was decreased (11.4±6.5vs13.3±7.0, p=0.031) and the risk for an
anastomotic leak was increased in this group. The 6 and 12 year survival rates in
laparoscopy and conventional groups were 69.2% and 29.5% (p<0.001).
Conclusion:
Although the data may be criticized since they were retrospective and the groups
were heterogenous, they also support the hypothesis that laparoscopy may increase
the possibility of sphincter saving and the survival in patients with rectal cancer.
-335-
PP - 25 AUDIT OF COLONOSCOPIC SURVEILLANCE FOR PREVENTION
OF COLORECTAL CANCER IN PATIENTS WITH ADENOMAS
ALEXANDRA GORDON
YSBYTY GWYNEDD, BANGOR, GWYNEDD, UK
Background&Aims:
In 2002, the British Society of Gastroenterology published guidance on the

colonoscopic surveillance for prevention of colorectal cancer in patients with
adenomas, later replicated in the 2011 NICE guidelines. All patients who have had
adenoma removal should be stratified according to their risk of development of
colorectal cancer, and then offered the appropriate colonoscopic surveillance.
The aims of our audit were to assess our management of patients with adenoma
diagnosed by lower GI endoscopy in our unit, compared to the BSG guidance.
Methods:
A retrospective review of all patients who underwent adenoma removal at time

of lower GI endoscopy between January to March 2009. Data was collected from
endoscopy, histology and medical notes.
Results:
Out of a total of 144, only 95 were in accordance with guidelines. Of those aged
under 75 years, 42% were either not offered follow-up or were undertreated.
Of those that had a flexible sigmoidoscopy, 49% were not offered a completion
colonoscopy. Few endoscopists documented the risk strata in the medical records
or justified why they did not adhere to guidelines.
Conclusion:
We recommend that all endoscopists clearly document the risk strata on the
endoscopy record, in order to follow-up in compliance with the guidelines.
-336-
PP - 141 MAY PERITONEAL ASPIRATION WITHOUT IRRIGATION
DECREASE POSTOPERATIVE COMPLICATION RATE IN PERFORATED
APPENDICITIS?
NURAYDIN OZLEM , SADIK KESMER , KADIR YILDIRIM
SAMSUN EDUCATION AND RESEARCH HOSPITAL, SAMSUN, TURKEY
Background&Aims:
To date no study has compared peritoneal lavage with irrigation+aspiration(İA)

vs only aspiration without irrigation(Awİ)in perforated appendicitis(pa).Our aim
is to determine if irrigation in pa decreases the postoperative complications(intra
abdominal abscess,wound infection,postoperative ileus)rate,length of hospital
stay,first oral intake and operation time.
Methods:
A randomised prospective study, march2011to august2012 279consecutive patients

with acute apandicitis underwent appendectomy.
Results:
14of279patients have pa.7of those had İA,7had Awİ.There are no differences

between two groups in terms of age sex.4patients suffered from postop
complications;2have wound infections.one has intraabdominal abscess,forth patient
has postop ileus.1of4patient who has postop complication were in Awİ group. the
other tree patients were in İAgroup.We found a lower overall complication rate in
the Awİ group,compared to the İA(14.2 %vs42.8% p=0.04)
Conclusion:
It is becoming common practice routinely irrigate the peritoneal cavity during

appendectomy when perforation exists.However,no study has shown if a causative
relationship exists between use of intraoperative irrigation and the development of
postoperative intra-abdominal abscess.Moore et al’s results show a trend toward
an increase in postoperative abscess with the use of irrigation. we compared
postoperative complication rate between the two methods.this study must be
made on large group of patients According to our results, İA procedure increase
postop complication in pa.It may be avoided peritoneal lavage even in pa.
-337-
PP - 142 MODIFIED SINGLE STAPLER TECHNIQUE IN ANTERIOR
RESECTION FOR RECTAL CANCER
SONER AKBABA 1, PAMIR EREN ERSOY 1, RIZA HALDUN GÜNDOĞDU 1, MURAT
ULAŞ 2, EBRU MENEKŞE 1
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, ANKARA, TURKEY

1
YÜKSEK İHTISAS TRAINING AND RESEARCH HOSPITAL, ANKARA, TURKEY

2
Background&Aims:
Stapler technique is prefered because of its technical advantages at the colorectal

surgery. Nevertheless, rectal dissection and anastomosis are difficult processes. In
this study we report the early results of the modified single stapler technique on
eleven patients.
Methods:
Before pelvic dissection, descending colon is divided at proximal to the tumoral

segment. Tumor specific mesorectal excision was performed and two purse string
sutures were placed at the distal margin with an interval of 1-2cm. After introducing
a circular stapler via the anus, we tied the distal purse string suture around the
central shaft of stapler and the proximal purse string suture around the colonic
lumen. After the resection was completed between two sutures, the anvil shaft was
connected to the central shaft and the stapler was fired.
Results:
Minimally anastomotic leak was observed in one patient. Two patients had fat
necrosis in abdominal incision. One patient had subileus and one patient was
monitored for coronary ischemia. All patients were discharged.
Conclusion:
By means of this modified technique, pelvic dissection and distal purse string
sutures can be performed more easily and anastomosis can be done at a lower
level. This technique may be a safe alternative in patients with narrow pelvis and
distal tumors.
-338-
PP - 143 OUTCOMES OF PATIENTS WITH CROHN’S DISEASE
OPERATED BY THE FINAL DECISION OF A MULTIDISCIPLINARY TEAM
BILGI BACA 1, AFAG AGHAYEVA 1, ÇIGDEM BENLICE 2, ILKNUR ERGUNER 5, HULYA
OVER HAMZAOGLU 4, YUSUF ERZIN 3, ISMAIL HAMZAOGLU 1, AYKUT FERHAT
CELIK 3
1
DEPARTMENT OF GENERAL SURGERY, ISTANBUL UNIVERSITY CERRAHPASA
MEDICAL SCHOOL, ISTANBUL, TURKEY
2
ISTANBUL, TURKEY
3
DEPARTMENT OF GASTROENTEROLOGY, ISTANBUL UNIVERSITY CERRAHPASA
4
DEPARTMENT OF GASTROENTEROLOGY, FULYA ACIBADEM HOSPITAL, ISTANBUL,
TURKEY
5
DEPARTMENT OF SURGERY, MASLAK ACIBADEM HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Crohn’s disease is a chronic inflammatory bowel disease which may present as
a simple ulcerous luminal disease or complicated fistulous, stenosing disease.
Complicated disease usually requires a multidisiplinary approach as we present
here the treatment results of this study.
Methods:
Patients with Crohn’s disease treated by a multidisciplinary team were analyzed
retrospectively. Surgical decision was done by the final agreement of different
disciplines. Preoperative, operative and postoperative data were evaluated.
Results:
Between March 2000 and August 2012, 648 patients with Crohn’s disease have
been treated. Of these, 153 (23%) patients were operated. Surgical resection was
done for stenosing, fistulising and perforating disease in 61 (40%), 29 (19%) and
11 (7%) patients, respectively. There were three right colon cancer (2%), two toxic
colitis (1%) and one pyogenic liver abscess (1%). Laparoscopic resection was done in
44 (37%) of 117 patients. Perianal disease was seen in 35 (23%) patients. Of these,
31 patients received seton drainage. Crohn-like disease was diagnosed in 11 (7%)
patients. Mean follow-up time was 44 (1-149) months. Total number of surgical
interventions was 255. Reoperation for recurrent disease was done in 2 (2%) of 117
patients. Complication rate was 12.4% (n=19) and mortality rate was 2.6% (n=4).
Conclusion:
Multidisciplinary approach in Crohn’s disease leads correct treatment strategies
and low recurrence rate while providing less surgical and medical complications.
-339-
PP - 144 OUTCOMES OF PATIENTS WITH ULCERATIVE COLITIS
OPERATED BY THE FINAL DECISION OF A MULTIDISCIPLINARY TEAM
ISMAIL HAMZAOGLU 1, AFAG AGHAYEVA 1, BILGI BACA 1, İSMAIL AHMET BILGIN 1,
ILKNUR ERGUNER 2, TAYFUN KARAHASANOGLU 1, İBRAHIM HATEMI 3, AYKUT
FERHAT CELIK 3
1
2
3
DEPARTMENT OF GASTROENTEROLOGY, ISTANBUL UNIVERSITY CERRAHPASA
Background&Aims:
Despite the use of medical therapy, colectomy has remained a treatment option
for ulcerative colitis (UC). The decision for surgery is not easy because of the
substitution of medical complications with surgical complications. Here, we present
our multidisciplinary approach for the treatment of patients with ulcerative colitis.
Methods:
We carried out a retrospective review of patients with UC operated between March

2000 and August 2012. Surgical decision was done by the final agreement of different
disciplines. Preoperative, operative and postoperative data were evaluated.
Results:
Ninety four of 797 patients with UC have been treated by surgery. Restorative
proctocolectomy was performed in 87 patients. Colectomy in the acute severe
colitis setting, is usually performed in three steps. There were 23 (24%) patients
who underwent a colectomy for acute severe colitis. Laparoscopic resection was
done in 47 (50%) patients. Crohn-like disease was diagnosed in 11 (11%) patients.
Of the 94 UC patients who underwent a colectomy, a postoperative complication
occurred in 21 patients (22.3%) and the mortality rate was 3%. Mean follow-up time
was 66 (1-149) months. Long-term colorectal complications occurred in 21 patients
(22%) and 8 of these were directly related to Crohn-like disease (%8). Three patients
needed pouch excision.
Conclusion:
Careful evaluation with a multidisciplinary approach leads less complications to the

patients with UC. However, Crohn-like disease is still an unavoidable fact.
-340-
PP - 145 PROCALCITONIN: AN EARLY BIOMARKER OF
ANASTOMOTIC LEAK AFTER COLORECTAL SURGERY
VALENTINA GIACCAGLIA , PIER FEDERICO SALVI , GENOVEFFA BALDUCCI ,
VINCENZO ZIPARO
SANT’ANDREA HOSPITAL, ‘SAPIENZA’ UNIVERSITY OF ROME, ITALY
Background&Aims:
Procalcitonin (PCT) is a biomarker used to monitor bacterial infections and guide

antibiotic therapy. We propose PCT as a sensitive and reliable marker of anastomosis
leakage (AL), to facilitate its early recognition and a more effective and less invasive
therapy.
Methods:
Between September 2011 and June 2012, a series of 81 patients underwent

colorectal surgery for benign and malignant diseases. In all cases white blood
count (WBC), C-reactive protein (CRP) and PCT levels were measured in the 1st, 3rd
and 5th postoperative day (POD). Anastomotic leaks and all other postoperative
complications were recorded.
Results:
We registered 6 (7.4%) anastomotic leaks, in 3 cases there were clinical signs, in the
remaining 3 patients we had only a persistent increase of PCT values (subclinical
leaks). Conservative management was attempted in all cases, and was successful
in all 3 subclinical leaks. Procalcitonin had a significantly higher positive predictive
value (PPV) of AL compared to CRP and WBC (p< 0.005).
Conclusion:
Compared to more established biochemical values, such as CRP and WBC, increased
PCT levels in early postoperative days after colorectal surgery, may provide a more
effective way to detect anastomotic leakage, in a latent stadium, before clinical
symptoms appear. This allows an early effective therapy, therefore reducing septic
complications, number of reinterventions and diverting stomas
-341-
PP - 146 RECTAL ADMINISTRATION OF DICLOFENAC SODIUM
IMMEDIATELY AFTER HEMORRHIODECTOMY DECREASE THE USE OF
OTHER ANALGESIA
ABDULHAKIM AL-TAMIMI , YASSER BA ASHIN , MAHMOUD MAKKI
Background&Aims:
to assess the effectiveness of rectal administration of diclofenac sodium as the only

single dose and single drug for analgesia post hemorroidectomy.
Methods:
prospective study done in Yemen- Aden (in two hospitals) in a period between
11/1/2006-31/12/2006, 76 patients (56 males, 20 females) complaining of
haemorroids grade III and IV , all of the received two suppositories of diclofenac
sodium immediately after the operation
Results:
49 males and 19 females was tolerated mild burning sensation and never used
any analgesia, five males and one female had been received other single dose of
intramuscular diclofenac,, and only one given pethidine 100 mg intramuscular ,, all
those patient whose received other analgesia were of grade IV hemorroids.
Conclusion:
: diclofenac sodium can be used safely through rectal administration immediately

after hemorroidectomyas without further use of any analgesia,, with little
intolerance of pain especially in grade IV hemmoroids,, and the females show more
better tolerance than males.
-342-
PP - 147 RESECTIVE SURGERY OF PRIMARY TUMOR IN PATIENTS
WITH STAGE IV COLORECTAL CANCER: A RETROSPECTIVE STUDY IN
A SINGLE INSTITUTION
STEFANO SCABINI , EDOARDO RIMINI , ANDREA MASSOBRIO , EMANUELE
ROMAIRONE , VALTER FERRANDO
IRCCS SAN MARTINO IST, GENOA, ITALY
Background&Aims:
The benefit of elective primary tumor resection for non-curable stage IV colorectal
cancer (CRC) remains largely undefined. In this retrospective study we wanted
to identify the possible advantage of surgery and survival in patients affected by
asymptomatic stage IV colorectal cancer.
Methods:
In our Oncologic Surgical Unit 550 patients affected by colorectal cancer underwent
a surgical approach. 142 were asymptomatic for stage IV CRC, 97 of them resected.
Clinical variables were tested for their relationship in a univariate prognostic
analysis. The survival was explored by Kaplan-Meier’s test.
Results:
In asymptomatic stage IV CRC, the most robust univariate predictor for poor
prognosis was impossibility to cancer resection. It is associated with significative
decrease of survival. CEA, CA 19.9, depth of invasion and lack of a postoperative
tumor-specific therapy have also a significative role and are associated with worse
prognosis.
Conclusion:
Our results suggested that impossibility to perform cancer resection is associated

with poor prognosis in asymptomatic stage IV CRC. The primary colorectal cancer
resection and adjuvant therapy, when possible, may improve survival.
-343-
PP - 148 RISC FACTORS OF PERIANAL ABSCESS
TOLGA CANBAK 1, FATIH BAŞAK 1, MUSTAFA HASBAHCECI 2, ALI KILIC 1, ISMAIL
KABAK 1, AYLIN ACAR 1, GURHAN BAS 1, ORHAN ALIMOĞLU 3
1
2
3
Background&Aims:
Perianal abscesses are one of the most common general surgical emergencies. The
management of this can be variable. The aim of our study was to present risks
factors of the perianal abscess.
Methods:
The patients diagnosed with perianal abscess and managed by drainage between
January 2010- November 2011 in the Department of Surgery were retrospectively
included in the study. Demograhic data, history of diabetes mellitus and developing
complications after drainage were revealed.
Results:
Of the 158 patients, 52 (33%) were women and 106 (67%) were men and the
avarage age was 37.2 years (range: 16- 68). Ten patients were underwent drainage
with general anethesia, 144 patients with local anesthesia and 4 patients with
spinal anesthesia. Twenty-five patients (16%) had recurrent abscess. Fistulae were
identified in 21 (13%) patients and 19 of them were underwent fistulotomy or
fistulectomy. Nine of patients have history of diabetes mellitus.
Conclusion:
The disease affect most commonly the young men. In our study we did’t find any
association of history of diabetes mellitus. The incidence of recurrent abscesses or
perianal fistula after perianal abscess expected to be high.
-344-
PP - 149 SPECIALIZATION ON COLORECTAL SURGERY IMPROVES
SURVIVAL IN COLORECTAL CANCER PATIENTS
CIGDEM BENLICE 1, BILGI BACA 2, SADIYE NUR FIRIDIN 1, AYBUKE MUTI 1, ERMAN
AYTAC 2, SIBEL ERDAMAR 3, MUSTAFA SENOCAK 4, TAYFUN KARAHASANOGLU 2
1
ISTANBUL, TURKEY
2
3
DEPARTMENT OF PATOLOGY, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL
SCHOOL, ISTANBUL, TURKEY
4
DEPARTMENT OF BIOISTATISTICS, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL
SCHOOL, ISTANBUL, TURKEY
Background&Aims:
Surgery performed in accordance with the oncologic principles is the key step for
the treatment of colorectal cancer since it is the only curative treatment option. Aim
of this study was to evaluate whether the colorectal specialization and operative
experience can be a factor able to affect the prognosis.
Methods:
Patients operated by the surgeons who had been performing laparoscopic colorectal
surgeries were included to the study. Analysis of the outcomes and survival were
based on the operative experience of the operating surgeons (colorectal surgeons
vs. non-colorectal surgeons group) on colorectal surgery and operative technique
(open vs. laparoscopic).
Results:
Between April 1999 and January 2011, the records of the 815 patients were
reviewed. There were five surgeons in colorectal group and 14 surgeons in non-
colorectal group. Survival of the patients operated by colorectal group was better
compared to non –colorectal group (p =0.001). Median survival of the patients
operated by colorectal and non-colorectal group was 57 (ranged from 48 to 65)
and 33 (ranged from 26 to 39) months, respectively. Multivariate analysis of data
such as age, surgeon groups, tumor size, harvested lymph nodes, surgical margins,
operation type and t stage, colorectal group showed better survival (p=0.018).
Conclusion:
Specialization or operative experience on colorectal surgery is a factor improving
survival of patients with colorectal cancer.
-345-
PP - 150 THE EFFECT OF KOREAN RED GINSENG ON COLON
ANASTOMOTIC HEALING IN RATS
UFUK TALI 1, FATMA AYCA GULTEKIN 1, BANU DOGAN GUN 2, ALI UGUR EMRE 1,
SEREFDEN ACIKGOZ 3, MUSTAFA COMERT 1
1
2
3
BIOCHEMISTRY, ZONGULDAK, TURKEY
Background&Aims:
The aim of this study was to assess the effect of Korean red ginseng (KRG) on healing
of experimental colonic anastomosis in a rat model.
Methods:
Fourty rats were randomized into four groups; control groups (1 and 2) and KRG
groups (3 and 4). The surgical procedure consisted of a transection and handsewn
anastomosis of the ascending colon. The animals were daily received either KRG
(500mg/kg) or an equal volume of water by gavages 5 days before and after the
operation. Groups 1 and 3 rats were sacrificed on postoperative day 3. Groups
2 and 4 rats were sacrificed on postoperative day 7. Intraperitoneal adhesions,
anastomotic complications, and anastomotic bursting pressure measurements
were recorded. Following these measurements the anastomotic segment was
resected for hydroxyproline and histopathological evaluation.
Results:
No significant differences were found in peritonitis rate and anastomotic

complications. The colonic bursting pressures of the KRG groups were statistically
significantly better than the control groups. The hydroxyproline content was
also significantly higher in the KRG groups than in the control groups. Histologic
examination confirmed that KRG treatment improved anastomotic healing.
Conclusion:
The peri-operative administration of the KRG has a positive influence on the healing
of colonic anastomosis in rats.
-346-
PP - 151 USING ATELOCOLLEGEN AT THE RECONSTRUCTION OF
PERI-ANAL REGION, REPORT OF A CASE
ANKARA NUMUNE EDUCATION AND RESEARCH HOSPITAL, ANKARA, TURKEY
Introduction:
Even after proper burns management hypertrophic scarring and contracture can be
a consequent. It can cause limitations at joint motion and called contraction. Burns
also can be devastating when localized at natural orifices especially at mouth and
anus.
Case report:
A 16 years-old male with flame burn via thinner ignition and fire, referred to our
clinic. He had 85% burned total body surface area and 65% was third degree. On
the fourth day of admission, back of torso covered with skin substitute after facial
excision, left lower limb facial excision and auto-grafting. At the clinical course he
had several escharectomies, debridments and grafting procedures. Burn including
bilateral gluteal region reaching scrotum anteriorly was managed via atelocollegen
application. Atelocollegen was bordered with anal epithelium. On the third day of
peri-anal operation there were no infection and skin substitute take was good. The
area then auto-grafted on the 16th date of application operation. At 24th day of
the last operation epithelium integrity with the product was well and patient had
no defecation problems. At the third month physical examination, the pliability of
the peri-anal region seemed acceptable and patient still had no complaint with
defecation. At this patients’ clinical course, there were no fecal diversion and no
laxatives
Conclusion:
Atelocollegen can be used at natural orifices with good results including well
pliability without fecal diversion operation and with well defecation.
-347-
PP - 152 AN UNUSUAL CAUSE OF ACUTE ABDOMEN: EPIPLOIC
APPENDAGITIS
AYLIN ACAR 1, MUJGAN CALISKAN 1, TOLGA CANBAK 1, FATIH BASAK 1, SUAT
AKTAS 1, METIN YUCEL 1, GURHAN BAS 1, ORHAN ALIMOĞLU 2
1
2
MEDENIYET UNIVERSITY, UMRANIYE EDUCATION AND RESEARCH HOSPITAL,
DEPARTMENT OF GENERAL SURGERY, ISTANBUL, TURKEY.
Introduction:
Epiploic appendagitis is a rare benign inflammatory disease of the colonic epiploic

appendices. The differential diagnosis is fundamentally important, especially for
acute abdominal surgical emergency. In our study, we presented a patient diagnosed
with epiploic appendagitis.
Case report:
A 54-year-old female patient was admitted to Emergency Unit with abdominal pain
and diarrhea for one day. On physical examination, she had rebound tenderness in
the left lower quadrant. Abdominal ultrasonography and computed tomography
revealed inflammation of an epiploic appendix of the sigmoid colon. The patient
was managed conservatively and discharged from hospital after seven days.
Conclusion:
It should be kept in mind that epiploic appendagitis mimics acute abdominal

pathologies and unnecessary surgery should be avoided.
-348-
PP - 153 IDIOPATHIC GRANULOMATOUS APPENDICITIS : CASE
REPORT
FATİH BAŞAK 1, TOLGA CANBAK 1, MÜJGAN ÇALIŞKAN 1, MUSTAFA HASBAHÇECİ 2,
AYLİN ACAR 1, GÜRHAN BAŞ 1, ORHAN ALİMOĞLU 3
1
2
3
Introduction:
Idiopathic granulomatous appendicitis (IGA) is evaluated as different clinical

situation from specific causes. In this study, we presented a case of IGA and
discussed with the review of literature.
Case report:
Forty-six-years-old female patient was admitted with complaints of abdominal pain

and nausea. Physical examination showed that tenderness and rebound on right
abdominal quadrant. Laboratory examination showed leukocyte value of 13500
mm³/L. Biochemical analysis was normal. Abdominal ultrasonographic findings
were compatible with acute appendicitis. Appendectomy was planned but a
tumoral mass of 3.5 cm in the diameter was found and right hemicolectomy was
performed. In histopathological examination showed granulomatous appendicitis.
Patient was discharged uneventfully. Patient was further investigated for etiology of
granulomatous disease and the final diagnosid was IGA.
Conclusion:
Granulomatous disease detected in appendix with ratio of 2% and seems more in

young males. Crohn’s disease, sarcoidosis, mycobacterium tuberculosis, yersinia
pseudotuberculosis, parasites, and fungal infection may be the cause of IGA. It’s
usually benign. The association of systemic disease is rare. Patients usually present
with typical symptoms and signs of acute appendicitis. Ultrasound and computed
tomography does not help for diagnosis of IGA. The definitive diagnosis is usually
made by histopathologic examination of specimen. The IGA is an challenging
disease that the diagnosis is difficult.
-349-
PP - 154 ISOLATED GALLBLADDER PERFORATION DUE TO BLUNT
ABDOMINAL TRAUMA
BAHADIR CELEP 1, YASİN UÇAR 1, UTKU MAHIR YILDIRIM 2, CEM AZILI 1, OĞUZ
HASDEMIR 1, IBRAHIM ÇOLHAN 1, ŞAHIN KAHRAMANCA 1, TEVFIK KÜÇÜKPINAR 1
1
DEPARTMENT OF GENERAL SURGERY, ANKARA DIŞKAPI YILDIRIM BEYAZIT
2
DEPARTMENT OF RADIOLOGY, ANKARA DIŞKAPI YILDIRIM BEYAZIT EDUCATION
AND RESEARCH HOSPITAL, ANKARA, TURKEY
Introduction:
Perforation of the gallbladder is a rare but life-threatening emergency. Diagnosis

may be challenging due to vague symptoms. We report a case of gallbladder
perforation in which ultrasonography (USG) guided paracentesis confirmed the
diagnosis.
Case report:
34-year-old male patient was admitted to the emergency department with

complaints of abdominal pain after a blunt assault. He was unconscious due to
alcohol intake. The physical examination revealed slight abdominal distention
and generalized abdominal defense. Laboratory tests showed leukocytosis, and a
moderate elevation of aspartate amino transferase and alanine amino transferase.
Abdominal tomography showed free fluid between the bowel loops. Emergency
laparotomy was decided upon the arrival of a small amount of bilious fluid by an
USG guided abdominal paracentesis. Isolated gallbladder perforation was seen
precisely at the junction of gallbladder bed. Peritoneal lavage and cholecystectomy
was performed. The patient was discharged uneventfully on the second post-
operative day.
Conclusion:
Gallbalder perforation is a rare condition and acute cholecystitis appears to be the

main cause but penetrating or blunt abdominal trauma can also lead perforation.
The main problem is confirmation of the diagnosis. Conventional radiologic
interventions have no benefit in differentiation of intraabdominal fluids. USG guided
abdominal paracentesis offers a rapid and accurate chance of discrimination.
-350-
PP - 155 AN UNUSUAL CAUSE OF CHRONIC GASTRITIS: CHICKEN
BONE INGESTION. A CASE REPORT
BARIŞ KARAKAŞ , NURULLAH BÜLBÜLLER , ROJBIN KARAKOYUN DEMIRCI , AYŞE
MERTER ARDUÇOĞLU
DEPARTMENT OF SURGERY, ANTALYA TRAINING AND RESEARCH HOSPITAL,

ANTALYA, TURKEY
Introduction:
Unintentionally ingested sharp-pointed foreign bodies, like chicken bones, can

cause delayed diagnosis. The diagnosis is mostly made when severe complications
(i.e. perforation, bleeding, and obstruction) occur. In this presentation, we will
describe an interesting case that a sharp-pointed foreign body impaction in the
stomach had caused no complications for about a month after ingestion.
Case report:
We will report a case of a 48 years old woman who was admitted to the Emergency
Department with epigastric pain. Physical examination revealed mild tenderness
in the periumbilical region without any other signs of peritonitis. The routine
hematological and biochemical examinations of the patient were within normal
limits. In addition, her abdominal x-ray and abdominal ultrasound showed no
pathology. However, at endoscopy, we found a bone piece of 5 cm was found to
be embedded in the antrum. The foreign substance was removed with the help of
an endoscopic snare and the result of the biopsy obtained from the antrum was
compatible with chronic gastritis. The patient recalled ingesting of chicken bone a
month earlier..
Conclusion:
Our experience shows that foreign body query should be kept in mind in patients
applying with complaints of treatment resistant dyspeptic complaints and epigastric
pain without acute abdomen.
-351-
PP - 156 SPLENIC ARTERY ANEURYSM - A (NOT SO) RARE
ENCOUNTER
CHRIS NEOPHYTOU , BEN REES , AARTI VARMA
LINCOLN COUNTY HOSPITAL, LINCOLN, U.K.
Introduction:
We report a case of splenic artery aneurysm and its management
Case report:
A 44-year-old otherwise fit and well female presented to our emergency department
complaining of epigastric pain for the last few days. This was associated with nausea
but no vomiting. She did not complain of any other GI symptoms. On examination,
she had mild epigastric tenderness. Observations and blood tests were normal. A
working diagnosis of biliary colic was made and the patient had a US scan. The
scan did not show any gallstones and incidentally showed a 4 cm splenic artery
aneurysm. This was confirmed with a CT scan however an attempt for embolisation
with coils failed. It was then decided that the patient should be transferred to the
nearby tertiary referral centre where a stent graft was radiological introduced. A Ct
angiogram the next day confirmed the sealing of the aneurysm.
Conclusion:
The incidence of SAA is 0.7% of the population however incidental diagnosis of

SAA is becoming increasingly frequent. The favoured method of treatment at
present is embolization or alternatively open or laparoscopic surgery with ligation
of the splenic artery, excision of the aneurysm with reanastomosis of the artery or
splenectomy with removal of the aneurysm.
-352-
PP - 157 A RARE CAUSE OF SMALL BOWEL PERFORATION: PRIMARY
LYMPHOMA OF THE SMALL INTESTINE
EMRE GUNAY 1, MEHMET KAMIL YILDIZ 1, ERKAN OZKAN 1, CENGIZ ERIS 1, HACI
HASAN ABUOGLU 1, HACI MEHMET ODABASI 1, KAAN MERIC 2, M.A. TOLGA
MUFTUOGLU 1
1
S.B. HAYDARPASA NUMUNE RESEARCH AND TRAINING HOSPITAL DEPARTMENT
OF GENERAL SURGERY, ISTANBUL, TURKEY
2
OF RADIOLOGY, ISTANBUL, TURKEY
Introduction:
Primary lymphomas of the small intestine are rare tumors and due to the atypical
localization of these tumors, the diagnosis can be placed in advanced stages.
Lymphomas constitute 1% of gastrointestinal system tumors. In this article, we
aim that, perforated jejunal lymphoma should be kept in mind in acute abdominal
syndrome.
Case report:
28-year-old male patient with the complaint of rectal bleeding, applied to the
emergency room and internalized by internal medicine service by the diagnosis
of lower gastrointestinal bleeding. Preliminary diagnosis of intramural hematoma
of the jejunal segments as a result of investigations initiated by the conservative
treatment. 20th day of follow-up, general surgery consultation were requested for
the patient who developed acute abdomen and was operated on underwent an
exploratory laparotomy.
Conclusion:
Malignant tumors of the small intestine are rare and because of the difficulties
encountered in diagnosis, they are usually advanced stage tumors. Lymphomas
are 1% of gastrointestinal tract tumors. 50-60% of primary gastrointestinal tract
lymphomas are in the stomach, small intestine by 20% to 30% and 10-20% seen
in the colon and rectum. The annual incidence of primary gastrointestinal non-
Hodgkin’s lymphoma is 0.8 to 1.2 cases / 100 000 persons. Although the diagnosis
of intestinal lymphomas is often viewed by radiological contrast studies, they are
usually diagnosed by laparotomy and histopathological examination of resection
specimen. As a result, intestinal perforation due to primary intestinal lymphoma is
very rare, but should be kept in mind in patients presenting with acute abdomen.
-353-
PP - 158 SPLENIC ABSCESS DUE TO ACUTE CHOLECYSTITIS
EMRE GUNAY 1, BULENT KAYA 2, HACI HASAN ABUOGLU 1, ERKAN OZKAN 1,
MEHMET KAMIL YILDIZ 1, CENGIZ ERIS 1, HACI MEHMET ODABASI 1, SULEYMAN
ATALAY 1
1
2
S.B. FATIH SULTAN MEHMET RESEARCH AND TRAINING HOSPITAL DEPARTMENT
Introduction:
Splenic abscess is a rare surgical disease and it is a life-threatening condition if can’t

be diagnosed early. Clinical triad of splenic abscess is fever, left upper quadrant
abdominal pain and leukocytosis. Endocarditis, intravenous drug use, diabetes
mellitus, congenital or acquired immunodeficiency, immunosuppressive drug
use and trauma history are the predisposing factors İn most patients with splenic
abscess. In this report we aimed to present a case of acute cholecystitis associated
splenic abscess.
Case report:
A patient with right upper quadrant abdominal pain and 39 degree celcius of fever
for 4 days admitted to emergency room. Clinical and ultrasonographic evaluation
was consistent with acute cholecystitis. Patient did not respond to antibiotic
therapy. As a result of re-evaluation by USG and CT, an abscess formation about
6 cm in diameter was detected in the upper pole of spleen and percutaneous
drainage was performed. Following-up 20th day of drainage, due to the arrival of
hemorrhagic material from drainage catheter and the hemodynamic instability of
the patient, splenectomy was performed.
Conclusion:
USG is inexpensive and a noninvasive method, but BT is the most sensitive and
specific imaging modality to diagnose splenic abscesses. Surgical treatment
includes percutaneous or open surgical drainage and conventional or laparoscopic
splenectomy. Since, the symptoms are generally non-specific, a high index of
suspicion is necessary to diagnose splenic abscess in patients having acute or
chronic cholecystitis. When such patients have fever and left upper quadrant pain,
splenic abscess should be considered.
-354-
PP - 159 TORSION OF A SPERMATIC CORD LIPOMA MIMICKING AN
INCARCERATED INGUINAL HERNIA
MEHMET KAMIL YILDIZ , EMRE GUNAY , ERKAN OZKAN , CENGIZ ERIS , HACI
HASAN ABUOGLU , HACI MEHMET ODABASI , EBRU OZDEMIR , SULEYMAN ATALAY
S.B. HAYDARPASA NUMUNE RESEARCH AND TRAINING HOSPITAL DEPARTMENT OF

Introduction:
Lipoma of the cord is the most common benign tumour of the spermatic cord and
a common condition of the male population. In our literature search, we have seen
that, cases of spermatic cord lipoma mimicking whether recurrent or not inguinal
hernia have been commonly referred, but in contrast we haven’t seen any case of
torsion of the spermatic cord lipoma mimicking an incarcerated inguinal hernia.
Case report:
47-year-old male patient was admitted to the emergency room complaining of

pain and bulging in the left inguinal region. Palpation of the bulge results with
tenderness. Ultrasonographic examination was reported as omental adipose tissue
within an incarcerated inguinal hernia. Patient was operated and necrosis due to
torsion of a spermatic cord lipoma associated with inguinal hernia was observed.
Lipoma excision and inguinal hernia repair was performed.
Conclusion:
Commonly referred to as spermatic cord lipomas, they are not true tumours of fat
but are extrusions of extraperitoneal fat into the inguinal canal. Their fat content
and shared location in the inguinal canal result in confusion with fat-containing
inguinal hernias with which they often coexist.Greater awareness of the radiologists
is needed to provide accurate preoperative information.
-355-
PP - 160 AN UNCOMMON CAUSE OF ACUTE ABDOMEN: PRIMARY
EPIPLOIC APPENDAGITIS
ERDINC KAMER 1, MUSTAFA PESKERSOY 1, NESE EKINCI 2, TURAN ACAR 1, TANER
AKGUNER 1
1
2
IZMIR KATIP CELEBI UNIVERSITY ATATÜRK TRAINING AND RESEARCH HOSPITAL,
DEPARTMENT OF PATHOLOGY, IZMIR, TURKEY
Introduction:
Primary epiploic appendagitis (PEA) is an acute inflammatory response of an

appendage to infarction caused by torsion or spontaneous venous thrombosis. PEA
is a rare cause of acute onset abdominal pain that is often misdiagnosed as acute
appendicitis or diverticulitis. We report a case of this uncommon condition.
Case report:
67-year-old male presented with left lower quadrant pain for the last 12 hours.
There was tenderness in the left lower quadrant on the physical examination. US and
CT scan was performed. The patient was followed conservatively but his symptoms
did not improve with medical therapy. The mass was excised. The histopathologic
diagnosis was necrotic appendix epiploica with surrounding periappendiceal fat
inflammation (Figure1-2).The postoperative period was uneventful.
Conclusion:
PEA causes acute localized abdominal pain, thought to be the result of torsion
or spontaneous vascular thrombosis of epiploic appendices. Clinically, PEA is
characterized by sudden onset of focal abdominal pain with mild or absent
additional additional findings in the history and physical examination or laboratory
evaluation. Both US and CT scan can be used for reaching the diagnosis of PEA. In
conclusion, clinicians should be aware of this rare entity and should include it in the
differential diagnosis of acute abdominal pain.
-356-
PP - 161 PRIMARY APPENDICITIS EPIPLOICAE MIMICKING ACUTE
ABDOMEN: REPORT OF TWO CASES
ERDINC YENIDOGAN , HUSEYIN AYHAN KAYAOGLU , ISMAIL OKAN , ZEKI OZSOY ,
SERVET TALI

Introduction:
Primary appendicitis epiploicae is a rare condition. We present two cases, both with
clinical signs of acute abdomen.
Case report:
A 38 year old man with a 2-day history of colicky left lower abdominal pain.
Laboratory and ultrasonic findings were normal. There were no symptoms of
obstruction, nausea and vomiting. CT revealed a 2 cm fat density lesion with
surrounding inflammatory changes at proximal anterior sigmoid colon. Second
patient was a 42 year old man with 1-day history of colicky right lower abdominal
pain mimicking as acute appendicitis. Although laboratory and ultrasonic findings
were normal, CT revealed an oval fatty 15 mm mass with central streaky densities
adjacent to the serosal surface of caecum. Both patients were received conservative
treatment with pain medication and symptoms subsided within a week.
Conclusion:
Although diagnostic laparoscopy is an excellent tool making the correct diagnosis

in such cases, conservative medical management with CT findings can prevent
unnecessary surgery. Early radiologic examination with an abdominal CT scan is key
in making the diagnosis and potentially avoiding unnecessary surgery in such cases.
-357-
PP - 162 OPEN THROMBECTOMY AND RETROGRADE LASER
ABLATION OF THE GREAT SAPHENOUS VEIN FOR VERREL TYPE III
THROMBOPHLEBITIS: REPORT OF A CASE
EVGHENII GUTSU , DUMITRU CASIAN , VASILE CULIUC
STATE UNIVERSITY OF MEDICINE AND PHARMACY, DEPARTMENT OF GENERAL

SURGERY, CHISINAU, REPUBLIC OF MOLDOVA
Introduction:
Thrombophlebitis of the great saphenous vein (GSV) with involvement of common

femoral vein (Verrel type III) is a challenging surgical emergency with potential life-
threatening complications.
Case report:
We report a case of hybrid intervention performed for prevention of pulmonary

embolism and radical cure of varicose veins. The 60 years old female patient
was admitted with clinical signs of GSV thrombophlebitis. Duplex ultrasound
demonstrates thrombotic occlusion of a GSV from knee level to the groin with
extension of thrombus in the common femoral vein. Diameter of the GSV – 10
mm. Patient was considered for emergency surgery under local anaesthesia. The
crossectomy with thrombectomy from common femoral vein was performed
initially. As a next step the Fogarty balloon-catheter was inserted into the GSV from
the groin to the knee level and fresh thrombotic masses were extracted from the
venous trunk. The optical fibre was passed into GSV in the retrograde direction to
the level of upper leg. After perivenous anaesthetic infiltration the ablation of GSV
was performed using 940 nm diode-laser with delivery of 80J/cm of vein length and
elastic compression was applied. Postoperative course was uneventful
Conclusion:
Laser ablation in combination with open thrombectomy may be used for treatment
of Verrel type III thrombophlebitis.
-358-
PP - 163 ACUTE ABDOMEN SYNDROME CAUSED BY A PERFORATED
GASTROINTESTINAL STROMAL TUMOR – A CASE REPORT
TANER KIVILCIM 2, FATIH ALTINTOPRAK 1, FEYYAZ ONURAY 2, SERBULENT GOKHAN
BEYAZ 3, MUZAFFER YILDIRIM 4, OSMAN NURI DILEK 1
1
2
3
SAKARYA, TURKEY
4
SAKARYA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF PATHOLOGY,
SAKARYA, TURKEY
Introduction:
Gastrointestinal stromal tumors (GIST) are frequently observed in the stomach and
intestines. Although they may be presented with various symptoms depending on
their location and diameter, acute abdomen syndrome is a very rare presentation
form for GIST.
Case report:
A 54-year-old male patient was evaluated with the complaint of sudden onset
abdominal pain at the urology clinic. In examination; fever (38.5 0C), abdominal
distension and peritoneum irritation signs were detected. A mass that contained
localized necrotic areas, thought to have mesentery origins and intraabdominal
free-fluid were detected on abdominal computed tomography. The patient was
operated with acute abdomen syndome. In operation; extensive intestinal content
in the abdomen, a perforated tumoral mass which is 5x4 cm in diameter, and anti-
mesenterically localized at the ileum segment were detected. Segmental ileum
resection-end ileostomy operation was performed, and the patient was discharged
as uneventful on post-operative tenth days. As a result of a histopathological
analysis, a GIST (<5/50 mitotic growth) was detected
Conclusion:
By means of this finding, we want to remind that GISTs may be presented with
acute abdomen symptoms due to perforation, though rarely.
-359-
PP - 164 MULTIPLE INTESTINAL INJURIES ASSOCIATED WITH
FIREARM WOUNDS
IBRAHIM TAYFUN SAHINER , HAKAN OZDEMIR , ZEHRA UNAL OZDEMIR , METIN
SENOL

SURGERY, NEVSEHIR, TURKEY
Introduction:
Depending on the type of weapon that causes the wound, the range of fire, and
the affected part of the body, firearms may directly or indirectly result in serious
and life-threatening injuries. A patient with multiple abdominal organ injuries
secondary to a firearm wound was considered for this case presentation.
Case report:
A 21-years-old male patient admitted to the emergency room for injuries caused by
pellets shot from a distance of 1 meter. 20 perforation areas in the small intestines
and the colon as well as two damaged areas on the external iliac artery were
identified. No leakage of GIS contents into the peritoneum was identified. All lesions
in the patient’s intestines and also in the external iliac artery were repaired by
primary suturation, without any resection or ostomy. During postoperative follow-
up, the patient described foreign objects during micturition, so urinary cathether
was provided to the patient for 10 days following surgery.
Conclusion:
In conclusion, for multiple intestinal injuries caused by firearm wounds in young

and hemodynamically stable patients, primary repair might be preferred instead
of resection or protective ostomy in case there is limited tissue loss and risk of
infection.
-360-
PP - 165 WHITE PHOSPHORUS BURN
KEMAL TOLGA SARACOGLU 1, TAMER KUZUCUOGLU 3, SEZER YAKUPOGLU 3
1
MARMARA UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF
ANESTHESIOLOGY AND REANIMATION, ISTANBUL, TURKEY
2
KARTAL DR. LUTFI KIRDAR TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
3
KARTAL DR. LUTFI KIRDAR TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
ANESTHESIOLOGY AND REANIMATION, ISTANBUL, TURKEY
Introduction:
White Phosphorus burns are rare types of chemical burns, occuring in battle, from
fireworks or industrial accidents. Although rare, even minimal burn areas can be
fatal and require extended hospital stay.
Case report:
A 6-year-old boy watching firework displays for wedding reception was struck
in the neck by a white coloured burning material. The patient was transferred
to our burn center with mild inspiratory stridor for further management. In
physical examination the area of burn necrosis at 1.5 cm depth in tissue under the
mandible on the left side of the patient’s face, accompanying hyperemia, edema,
subcutaneous emphysema and total left peripheral facial paralysis, was observed.
Intermittent bronchodilator therapy with combined antibiotics, fluid resuscitation
and dexamethasone were administered. The cavity was filled with wet dressings
and the surgical removal of necrotic skin from the burn injury was performed daily
under sedation. After 9 days in hospital, the patient was discharged to the division
of facial plastic and reconstructive surgery without any systemic complications.
Conclusion:
Since fireworks play an important role in the etiology of chemical burns, they should
be used in a safe and careful manner. White phosporus burns should be considered
in presence of burn injuries with progressive necrosis and chemical reaction.
-361-
PP - 166 WAARDENBURG-SHAH SYNDROME: A RARE CAUSE OF
HIRSCHSPRUNG DISEASE IN THE ELDERLY
KUZEY AYDINURAZ 1, FATIH AGALAR 2, FARUK PEHLIVANLI 3, SEDAT DOM 1, AYBALA
AGAC AY 1, ORAL SAYGUN 1, CAGATAY ERDEN DAPHAN 1
1
KIRIKKALE UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,
KIRIKKALE, TURKEY
2
ANADOLU MEDICAL CENTER IN AFFILIATION WITH JOHNS HOPKINS MEDICINE,
DEPARTMENT OF GENERAL SURGERY, UK
3
KIRIKKALE UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY
(PRESENT ADRESS: KIRIKKALE HIGHER SPECIALIZATION HOSPITAL) , KIRIKKALE,
TURKEY
Introduction:
Incidence of Hirschsprung disesase in general population is 1/5000. In 30% of

the patients, the disease is syndromic.In Waardenburg-Shah Syndrome patients
exhibit congenital familial sensorineural deafness, a white forelock and pigmental
anomalies of the iris alongside with long segment Hirschsprung megacolon. Here in
we present a female patient with Waardenburg-Shah syndrome who had difficulties
in defecation since childhood but was diagnosed when 53 years old.
Case report:
Fifty three years old female patient with a history of abdominal pain, distention
and constipation of 2 weeks admitted to the emergency service. The patient
was congenitally deaf with deaf siblings, had a white forelock and fair blue eyes
with incomplete iris. The patient usually defecated once a week. In abdominal
x-ray,there were distended colonic segments which implemented sigmoid volvulus.
The patient was detortioned with colonoscopy only to be distended very soon. The
patient underwent laparotomy during which immensely dilated tranverse colon,
descending colon, sigmoid colon and proximal rectum of nearly 150 cm were
resected resulting in an end colostomy. Interestingly the rectum was distended
even under the pelvic reflection. Colonic activity started after six days.
Conclusion:
Familial deafness, white forelock and pigment anomalies alongside with chronic
constipation even in the elderly should be alarming for Waardenburg-Shah
syndrome
-362-
PP - 167 HEPATIC ARTERY ANEURYSM : REPAIR BY SPLENIC ARTERY
TRANSPOSITION
MEHMET ODABAŞI , CENGIZ ERIŞ , MEHMET KAMIL YILDIZ , M.A.TOLGA
MÜFTÜOĞLU , HASAN ABUOĞLU , EMRE GÜNAY , ABDULLAH SAĞLAM , SAMI
AKBULUT
Introduction:
Hepatic artery aneurysms ( HAAs) are rare. The rupture of aneurysm is a life
threatening emergency. It is recommended that aneurysmal repair be considered
in HAAs >2 cm.
Case report:
A 69 year-old male patient presented with right-upper quadrant pain. CT revealed

a 3 cm. aneurysm located at common hepatic artery and the trifucation of right
hepatic, left hepatic and gastroduodenal artery. Surgical repair through a right
subcostal approach was performed. Aneurysm was resected and left hepatic artery
was anastomized to common hepatic artery. Anastomosis between splenic artery
and right hepatic artery was done . Gastroduodenal artery was ligated. There was
no ischemia of spleen so it was preserved.Histopathologic result was complicated
calcified fibroatherome plaque, interstitial bleeding and thrombosis at lumen,
atrophy on media and fibrosis on adventitia with chronic inflammation.The post-
operative course was uneventful. Patient discharged at the eighth day. At the
postoperative end of the first month, CT angiography revealed patent hepatic and
transpositioned splenic artery .
Conclusion:
HAAs are life-threatening, if let untreated. Early diagnosis is essential because the
natural tendency of the lesion is to rupture. Surgical excision and vascular graft
interposition is the most common treatment modality. Transposition of splenic
artery may be an option for treatment.
-363-
PP - 168 SINGLE INCISION LAPAROSCOPIC
APPENDECTOMY&OMPHALOMESENTERIC DUCT REMNANT
EXCISION
MUHARREM OZTAS , HUSEYIN SINAN , MEHMET SAYDAM , EYUP DURAN ,
ARMAGAN GUNAL
GENERAL SURGERY DEPARTMENT, ANKARA MEVKI MILITARY HOSPITAL, ANKARA,

TURKEY
Introduction:
Omphalo-mesenteric duct (OMD) connects the developing mid-gut to the primitive

yolk sac. Incomplet regression of the duct present as varied anatomical entities
such as Meckel diverticulum, umblico-enteric fistula and OMD remmant. The aim
of this study, to share our clinical experience with the reader about that successfully
treated with single insicion laparoscopic surgery a case of OMD remnant.
Case report:
The case of the OMD remnant reported here was detected in an adult male
patient (22-year old) in that presented with acute abdomen. Under laparoscopic
examination, beside hyperemic and erectile appendicitis, OMD remnant presented
as a thin cord extending from the umbilicus towards the ileal mesentery. After
appendectomy, the tissue was removed by cutting proximal and distal tips. OMD
remmant length was about seventeen centimeters and it was most fibrous and
cord-like structure.
Conclusion:
OMD remmants present various symtoms. Intestinal obstruction is reported to be

the most serious complication of persistent OMD. Though very rare, the occurrence
of such innocent band may cause entanglement of intestinal loops around it.
Possibility of such a situation should be suspected in an acute abdominal condition
in the diferantial diagnosis. Single incision surgery can be safely used on the
treatment of these kind of cases.
-364-
PP - 169 KIDNEY PRESERVING MARGIN FREE RESECTION OF
LEIOMYOSARCOMA ARISING FROM LEFT RENAL VEIN WITH
VASCULAR RECONSTRUCTION: CASE REPORT.
MURAT URKAN 1, GÖKHAN YAĞCI 1, İSMAİL HAKKI ÖZERHAN 1, ERKAN ÖZTÜRK 1,
AYTEKİN ÜNLÜ 1, MEHMET GAMSIZKAN 2, YUSUF PEKER 1
1
ANKARA, TURKEY
2
TURKEY
Introduction:
Leiomyosarcoma is a common histology among retroperitoneal sarcomas mostly

originating from muscles. Only about 5% of leiomyosarcomas arise directly from
large blood vessels and more than 50% of cases originate from inferior vena cava.
Primary leiomyosarcomas of renal veins are extremely rare.
Case report:
A 40-year-old woman was referred for evaluation of a left retroperitoneal mass

presented with severe back pain. Computed tomography scan revealed a left
retroperitoneal mass 7 cm. in size adjacent to left renal hilum. During the operation;
a multilobular, solid tumor in 7 x 6.5 x 3 cm size, surrounding the left renal vein
was observed. Further dissection revealed that the tumor was originated from left
renal vein wall. Following total devascularization of left kidney, partial left renal
vein resection with tumor and end to end anastomosis was performed. Vascular
outflow was confirmed with intraoperative doppler examination and postoperative
follow up was uneventful. Pathology was reported as moderately differentiated
leiomyosarcoma, originated from renal vein wall with tumor free resection margins
and the patient was discharged with adjuvant chemoradiotherapy.
Conclusion:
Although the radical nephrectomy is the gold standard approach for malign tumors
of the kidney, kidney preserving tumor free resection with vascular reconstruction
is a feasible alternative followed by adjuvant chemoradiotherapy and close follow
up.
-365-
PP - 170 NONSURGICAL PNEUMOPERITONEUM DUE TO
PNEUMOTHORAX
FERİT AYDIN , CİHANGİR AKYOL , SALİM İLKSEN BAŞÇEKEN , CAN KONCA , EBRU
ESEN , ATIL ÇAKMAK

ANKARA, TURKEY
Introduction:
Pneumoperitoneum is defined as the precence of air within the peritoneal cavity,

frequently indicates a perforated abdominal viscus that requires emergent
surgical management. But in rare cases pneumoperitoneum is not an indication
for laparotomy. In our case the pneumoperitoneum is related with pneumothorax
caused by blunt trauma.
Case report:
31 years old male patient presented to the emergency department with car occupant
injury. In the iniatial evaluation we found soft-tissue injury, tachypnea, tachycardia,
dispnea and abdominal tenderness. He was hemodinamically stabile. CT scan of
the abdomen and thorax demonstrated pneumothorax, pneumoperitoneum,
hemothorax, pulmonary contusion. The patient underwent immediate intercostal
drain insertion. Because there was no signs related with acute abdomen, we decided
not to perform an emergency laparatomy. In his follow-up, patients syptoms is
normalized and discharged after 4-day hospitalization.
Conclusion:
However this is an accepted surgical emergency, %10-15 of cases pneumoperitoneum

can be related to the alternative routes that air can take into the peritoneal cavity:
through abdominal wall, diaphragm, female genital tract and retroperitoneum. In
such cases an unnecessary laparotomy may be avoided.
-366-
PP - 171 PNEUMOBILIA AFTER BLUNT TRAUMA: A RARE CASE
MEHMET ALI KOÇ , CİHANGIR AKYOL , SALİM İLKSEN BAŞÇEKEN , TEVFİK EKER ,
ATIL ÇAKMAK

ANKARA, TURKEY
Introduction:
Pneumobilia is defined as the precence of air in the biliary tree of the liver. The most
common causes are biliary surgery, incompetent sphincter of Oddi , spontaneous
biliary-enteric fistula. Blunt trauma is also reported as a rare cause of pneumobilia.
Case report:
86 years old male patient presented to the emergency department with back pain
due to fall from stairs. In the iniatial evaluation of soft tissue injury and abdominal
pain in right upper quadrant were founded. CT scan of the abdomen demonstrated
pneumobilia. After the causes of pnueumobilia other than blunt trauma were
excluded; he was managed with bed rest, antibiotics and intravenous hidration.
He was closely followed with complete blood count, liver enzymes and abdominal
examination. After the complaints of the patient regressed he was discharged.
Conclusion:
When air is identified in liver we must first dintinguish if it is in portal vein or

biliary tree. Both conditions may be life-threatening. We must investigate potantial
causes which are different for each entity. In this case the causes of pnueumobilia
other than blunt trauma were excluded. The patient was conservatively treated.
Eventually it should not forgotten that blunt trauma is a cause of pneumobilia and
unnecessary surgery must be avoided.
-367-
PP - 172 POST-TRAUMATIC PANCREATODUODENECTOMY: REPORT
OF THREE CASES
SENOL CARİLLİ , GOKSEL SECKİN , TANSU SALMAN , AYDİN ALPER , ALİ EMRE
AMERICAN HOSPITAL DEPARTMENT OF GENERAL SURGERY, NISANTASI, ISTANBUL,

TURKEY
Introduction:
Although pancreaticoduodenectomy is the gold standard procedure for malignancies

of the related organs, it is rarely performed for trauma patients. This is mainly due
to the infrequency of pancreatoduodenal injuries.
Case report:
Here, we retrospectively evaluated three posttraumatic pancreaticoduodenectomy

patients. Two patients were applied with gunshot wounds and one patient was
applied with blunt injury. Gunshot wounded patients had multiple organ injuries
including duodenum, pancreas, colon, small intestine and major vascular structures.
Blunt injury patient had pancreatic avulsion from duodenum, pancreatic ductal
rupture and duodenal laceration. All the patients were undergone to Whipple
procedures and discharged from hospital following an uneventful course.
Conclusion:
Pancreatic and duodenal injuries are relatively uncommon and diagnosis is not
easy. Physicians should be aware for these injuries because early diagnosis and
treatment are vital. Although survival rates have improved with the advances in
prehospital care, better intensive care facilities, and improved management of
associated injuries, pancreatoduodenectomy still carries a mortality rate of 31-54
% in trauma patients. Decision must be made promptly, accurately, and according
to the presence of ductal involvement
-368-
PP - 173 MINIMAL INVASIVE SURGERY IN TRAUMA: LAPAROSCOPIC
EXPLORATION-TREATMENT FOR ABDOMINAL GUNSHOT WOUND
AYTEKIN ÜNLÜ , YAŞAR SUBUTAY PEKER , İLKER AKAR , ÖNER MENTEŞ , İSMAIL
HAKKI ÖZERHAN , SEZAİ DEMİRBAŞ , YUSUF PEKER

ANKARA, TURKEY
Introduction:
Conservative approach for hemodynamically stable patient with abdominal

penetrating trauma, which is observing patient or performing explorative-
therapeutic laparoscopy is shown to be superior to routine laparotomy. In this case
we wanted to share our experience about laparoscopic approach to a patient who
got shot by low energy bullet.
Case report:
17-years-old female patient got shot from left anterior lower chest wall with
abdominal injury was seen in emergency clinic. Vitals and hemodynamics of
patient was stable with ISS:26 and GCS:15. Free abdominal fluid of 300-400 cc
and subdiaphragmatic gas with minimal left mediastinal effusion was found with
abdominal USG exam and thoracoabdominal CT without any other findings.
Laparoscopic exploration was decided for the patient who is clinically in good
condition according to trauma scoring systems and has no solid organ injuries.
In the exploration, minimal bleeding on segment two of liver with gastric fundus
and posterior diaphragma injuries were experienced. Hepatic cauterisation with
primary suturation of diaphragma and anterior-posterior wall of gastric fundus
were performed by laparoscopy. Patient was discharged on postoperative fifth day
without any complications.
Conclusion:
Performing laparoscopy to stable patient with abdominal penetrating trauma

is an alternative to nontherapeutic laparotomy. This provides less morbidity and
mortality with decreased hospitalization.
-369-
PP - 174 METHASTATIC GASTRIC SIGNET RING CELL CARCINOMA
PRESENTING AS ACUTE APPENDICITIS: A CASE REPORT
CANDAŞ ERÇETİN 1, AHMET CEM DURAL 2, YAŞAR ÖZDENKAYA 3, ÖZLEM DURAL 4,
H. GÖZDE MUHAFIZ DADA 5, GÜLÇİN YEĞEN 6, YERSU KAPRAN 6
1
IGDIR PUBLIC HOSPITAL, GENERAL SURGERY DEPARTMENT, IGDIR, TURKEY
2
3
MEDIPOL UNIVERSITY SCHOOL OF MEDICINE, GENERAL SURGERY DEPARTMENT,
ISTANBUL, TURKEY
4
KANUNI SULTAN SULEYMAN TRAINING AND RESEARCH HOSPITAL, MATERNAL &
FETAL MEDICINE DEPARTMENT, ISTANBUL, TURKEY
5
IGDIR PUBLIC HOSPITAL, PATHOLOGY DEPARTMENT, IGDIR, TURKEY
6
ISTANBUL UNIVERSITY SCHOOL OF MEDICINE, PATHOLOGY DEPARTMENT,
ISTANBUL, TURKEY
Introduction:
We report a patient who underwent laparoscopy with classical symptoms and signs
of acute appendicitis and a pathological report of methastatic gastric signet ring cell
carcinoma (GSRCC) to the appendix with the evidence of abdominal carcinomatosis.
Case report:
A 32-year-old woman admitted to our hospital with right lower abdominal pain
and leukocytosis. Under the impression of acute appendicitis, she underwent
diagnostic laparoscopy. An inflamed, edematous and non-perforated appendix,
also a large amount gelatinous ascites, omental and peritoneal implants were
seen. Due to suspicion of a gynecologic malignancy, the patient was consulted
to attending gynecologist per-operatively. No gross palpable mass was found.
Appendectomy performed and multiple biopsies were taken from omentum and
peritoneum for definitive diagnosis. Histopathogic diagnosis was a methastatic
GSRCC involving appendix and other specimens. A flat lesion involving corpus to
antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically
in a tertiary centre. The case evaluated as Stage IV gastric carcinoma. After her
second chemotherapy treatment she died due to tumor lysis syndrome.
Conclusion:
This case with no sign of gastric cancer was presented as an acute appendicitis.
Methastatic carcinoma to the appendix, causing acute appendicitis is extremely
rare in clinical practice and usually associated with high morbidity and mortality.
-370-
PP - 175 INTRAMURAL HEMATOMAS OF THE GASTROINTESTINAL
SYSTEM: A 5-YEAR SINGLE CENTER EXPERIENCE
OSMAN KONES 1, AHMET CEM DURAL 1, MURAT GONENC 1, MEHMET
KARABULUT 1, CEVHER AKARSU 1, M. ABDUSSAMET BOZKURT 2, MEHMET ILHAN 3,
HALIL ALIS 1
1
2
PERVARI PUBLIC HOSPITAL, GENERAL SURGERY DEPARTMENT, SIIRT, TURKEY
3
ISTANBUL UNIVERSITY SCHOOL OF MEDICINE, TRAUMA AND EMERGENCY
Background&Aims:
Spontaneous intramural hematomas of gastrointestinal tract (SIHGT) are very

rare, they may be observed following use of oral anticoagulant (OAC) and less
frequently in hematological malignancies and bleeding disorders. Cases diagnosed
as intramural hematoma have been assessed in our clinic.
Methods:
The cases diagnosed as SIHGT following anamnesis, physical examination,

biochemical, radiological and endoscopic findings from July 2008 – 2012 have been
assessed retrospectively.
Results:
Mean age of 13 cases was 65.1 (34-82). M/F was 6/7. Hematoma was detected
more frequently in the ileum wall (n=8). OAC use due to cardiovascular diseases
was observed in 11 cases. In 10 cases, INR values were higher than treatment range
and mean was 7.6 (1.70 – 23.13). While 12 cases were discharged with conservative
treatment, the case with acute myeloid leukemia died in the intensive care unit
following cerebrovascular attack.
Conclusion:
Spontaneous bleeding and hematomas that may arise in connection with bleeding
diathesis may be fatal in cases with long-term oral anticoagulant treatment and
insufficient follow-up. In the management of these cases; it may be necessary
to make conservative follow-up and/or initialize low molecular weight heparin,
administer vitamin K as well as replace blood products and coagulation factors
where is indicated.
-371-
PP - 176 ACUTE ABDOMEN IN PREGNANCY: RESULTS FROM A
TRAINING HOSPITAL
M. FERHAT CELIK 1, AHMET CEM DURAL 1, ABBAS ARAS 1, BURAK KANKAYA 1, M.
ECE DILEGE 1, DENIZ GUZEY 1, ATILLA CANKAYA 2, HALIL ALIS 1
1
2
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL, GYNECOLOGY
AND OBSTETRICS DEPARTMENT, ISTANBUL, TURKEY
Background&Aims:
We aimed to present our experience in pregnant patients who admitted to our

institution with acute abdominal pain.
Methods:
Pregnant patients who admitted to emergency department with acute abdominal

pain requiring surgical exploration from January 2008 to August 2012 were
retrospectively evaluated in terms of demographics, gestational age, performed
operation, operative results, length of hospital stay, complications, maternal and
fetal mortality were recorded.
Results:
Seven patients (16.3%) were in the 3rd trimester, 23 patients (53.5%) were in the
2nd trimester and 13 patients (30.2%) were in the 1st trimester on admission. Thirty
two patients underwent to appendectomy (laparoscopic:18/open:14), 5 patients
underwent to cholecystectomy (laparoscopic:3/open:2) and six patients had no
pathological findings on diagnostic laparoscopy. Uterine rupture was revealed in
one patient who underwent diagnostic laparoscopy and then primer uterine repair
was performed with laparotomy. Fetal death occurred during the surgery. Acute
edematous pancreatitis occurred in one patient after laparoscopic cholecystectomy.
The mean hospital stay was 1.8±2.17 days. No maternal mortality was observed.
Conclusion:
A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal

pathologies mimicking surgical emergencies. Laparoscopy appears to be a safe,
feasible, and efficient approach for pregnant patients with presumed acute
abdomen including third trimester in an experienced centre.
-372-
PP - 177 RECURRENT NON-VARICEAL UPPER GASTROINTESTINAL
BLEEDING: THE ROLE OF ENDOSCOPIC TREATMENT
MEHMET KARABULUT 1, AHMET CEM DURAL 1, EYUP GEMICI 1, OSMAN KONES 1,
CEMAL DENIZTAS 1, M. ABDUSSAMET BOZKURT 2, MUSTAFA U. KALAYCI 1, HALIL
ALIS 1
1
2
PERVARI PUBLIC HOSPITAL, GENERAL SURGERY DEPARTMENT, SIIRT, TURKEY
Background&Aims:
We aimed to evaluate the patients with recurrent non-variceal upper gastrointestinal

bleeding (NVUGB) and their management.
Methods:
The patients who admitted to our endoscopy unit with NVUGB from January 2010
to 2012 were enrolled in this retrospective study. The demographics, etiology,
endoscopic findings, success of endoscopic treatment and recurrent interventions
were documented.
Results:
The recurrence rate was 15.7% (n=27) in patients admitted with NVUGB (n=172).
The mean age was 59.6 (22-90) years, with a male/female ratio (M/F) of 19/8. The
most common cause was duodenal ulcer (n=13) followed by gastric ulcer (n=10),
Dieulafoy’s lesion (n=4), gastric carcinoma (n=1) respectively. Forrest Ib lesion was
observed in 37% of the patients (n=10). The average hemoglobin level was 9.04 (3.9-
14.4) g/dl, the mean arterial pressure was 74.2 (40-95) mm/Hg on admission. The
mean number of erytrocyte suspension transfused was 1.9 (0-5) units. Endoscopic
injection with 1/10000 adrenaline was used in 19 patients (33.3%). Argon coagulation
was required for hemostasis in one patient with gastric carcinoma. Three patients
(11.1%) with Forrest III lesion were treated conservatively. Four patients (14.8%)
with persistent bleeding underwent emergency surgery.
Conclusion:
In patients with recurrent NVUGB, endoscopic treatment is an appropriate option

by reason of its high efficacy and low complication rate.
-373-
PP - 178 UNEXPECTED INTRAABDOMINAL INTERORGAN FISTULA
AHMET DENİZ UÇAR , ERDEM BARIŞ CARTI , NAZİF ERKAN , ERKAN OYMACI , ALİ
COŞKUN , MEHMET YILDIRIM
İZMİR BOZYAKA EĞİTİM ARAŞTIRMA HASTANESİ, IZMIR, TURKEY
Introduction:
Even under the high-tech imaging modality such as computed tomography and
satisfactorily invasive procedure like endoscopy, sometimes an illness which seems
to be a very familiar to a physician can become a disastrous event if it is mistakenly
thought to be relatively benign pathology. In such a case it will soon be recognized
that the pathologies added to the differential diagnosis last is not in fact the least
one.
Case report:
A female patient at 45 years of age admitted with right upper quadrant pain and
mass. CT scan showed a mass between gall bladder and stomach antrum and no
obvious tissue plan between the adjacent organs. Radiologist cannot rule out
the tumoral lesion originating from gall bladder or stomach. Upper GI endoscopy
revealed a prepyloric hypertrophic mucosal lesion having suspicious fistula or
crater appearance on it. Biopsy specimen examination revealed nonmalignant
degenerative chances and gastritis. Cholecsyctogastric fistula is encountered
at laparatomy. Cholecystectomy and antrectomy with Roux & Y diversion was
performed. Pathology showed no malignant tissue.
Conclusion:
So every surgeon should put your trust in radiology, laboratory and invasive imaging,
and keep his powder dry and be ready for the worst scenario in every emergency
case.
-374-
PP - 179 ALL THE BURN SCORES MUST BE REVISITED
AHMET DENİZ UÇAR , ERDEM BARIŞ CARTI , ALİ COŞKUN , ERKAN OYMACI , NAZİF
ERKAN , MEHMET YILDIRIM
İZMIR BOZYAKA EĞITIM ARAŞTIRMA HASTANESI, IZMIR, TURKEY
Background&Aims:
Numbers of scoring system exist in the literature dealing with the burn mortality
prediction. Abbreviated Burn Severity Score (ABSI) is the only one that considers
the burn depth for mortality probability. We believe that beside any factors which
are presumably important, FTSA (full thickness surface area) should have much
more impact factor than as in the ABSI score.
Methods:
Among the 1200 burn patients 218 were hospitalized in 18 month time interval.
Results:
The mean age was 41.6 years. The average percent TBSA (total body surface area)
was 46% and percent FTSA was %26. FTSA were an independent risk factor for death
(p=0.01). Mortality prediction of FTSA in combination with any other overridden
factors at different scoring modalities was more specific than either individual
variable alone (AUROC 0.85, 95% CI 0.80-0.93). Likelihood of death for patients with
severe burn can be predicted with accuracy from percent FTSAs o more important
than said in ABSI score.
Conclusion:
Burn severity scores floating all around the literature accept burn patients as a
healthy man before they burn. Beside of coexisting chronic illness such as diabetes,
COPD, heart failure etc. area with 3rd or 4th degree burn should be more and more
important for burn victim’s outcome.
-375-
PP - 180 CARPAL TUNNEL RELEASING FASCIOTOMY IS HAND
SAVING VENTURE IN UPPER EXTREMITY FULL THICKNESS BURN
ERDEM BARIŞ CARTI , AHMET DENİZ UÇAR , ALİ COŞKUN , ERKAN OYMACI ,
MEHMET YILDIRIM , NAZİF ERKAN
İZMIR BOZYAKA EĞITIM ARAŞTIRMA HASTANESI, IZMIR, TURKEY
Background&Aims:
Fasciotomy is extremity saving procedure especially for upper limbs. Even some
machines developed for estimation of the severity of burn, compartment syndrome
is rapid and inevitable disaster unless avoided as early as possible. Fasciotomy only
applied for the fore arm muscle group may not be enough if carpal tunnel is not
released.
Methods:
Among the 1200 burn patients 218 were hospitalized in 18 month time interval. 26
patient underwent upper extremity fasciotomy with carpal tunnel releasing.
Results:
At the follow-up until now no median or ulnar nerve dysfunction was observed.
1st and 5th finger opposition, fine movemets of all fingers without limitation were
observed. Fasciotomy wound is closed secondarily leaving thin scar lengthways
through the forearm and arm. We could not compare the outcomes and difference
between the non carpal tunnel released patients because we add this procedure in
to the extremity fasciotomy routinely
Conclusion:
Carpal tunnel releasing fasciotomy in the upper extremity burn ensures the hand
perfusion beside of median and ulnar nerve function as well. Surgeon should not
hesitate to do this procedure and must be assured that hand function is not affected
badly at the late fallow-up.
-376-
PP - 181 JEJUNOJEJUNAL INVAGINATION CAUSED BY A
GASTROINTESTINAL TUMOR: CASE REPORT
METİN ESER , IBRAHIM KILINÇ , GULTEN KIYAK , BULENT DEMIRBAS , ALPER BILAL
OZKARDES , AHMET GURER

Background&Aims:
We present a case with jejunojejunal invagination that was operated for intestinal
obstruction.
Methods:
Fifty-two year old male patient was admitted to emergency room with nausea and
vomiting. Abdominal distention and diffuse abdominal tenderness were present in
physical examination.
Results:
Target sign that is known to be a finding for invagination was observed on

computed tomography scan. The patient was operated urgently. During laparotomy,
invagination was seen at jejunal level and it was reduced. Following reduction,
a 3x4 cm mass was palpated in the lumen of small bowel, thus a resection was
performed. Pathological result was Gastrointestinal Stromal Tumor (GIST).
Conclusion:
Invaginations consist of 1-3% of all reasons that cause intestinal obstructions which
are treated with surgery in adults. Etiopathogenesis of invagination is still unknown
but it is believed that an increased peristaltic activity caused by a lesion on bowel
wall or an irritant in bowel lumen induces invagination.Main treatment method
for invagination in adults is surgery. Deinvagination and resection can be a proper
approach for chosen cases to prevent unnecessary resections which may end up
with short bowel syndrome. As a conclusion, although jejunal GISTs are rare causes
of intestinal obstructions, it should be considered for patients without previous
abdominal surgery.
-377-
PP - 182 INTRAOPERATIVE UNEXPECTED SITUATIONS IN SMALL
BOWEL AND COLONIC OBSTRUCTION
AHMET GURER 2, IBRAHIM KILINÇ 2, GULTEN KIYAK 2, GURKAN DUMLU 1, ALPER
BILAL OZKARDES 2, BULENT DEMIRBAS 2, MEHMET KILIÇ 1
1
MEDICINE, ANKARA, TURKEY
2
Background&Aims:
In this study we compared patients’ preoperative diagnosis with peroperative

findings.
Methods:
Patients who were operated due to intestinal obstruction between 1989-2009 were
retrospectively evaluated
Results:
In this study 105 of cases were female and 144 were male. Among female patients;64
were diagnosed as colon carcinomas, 6 as irreduced groin hernias, 3 as volvulus, 2
as diverticulitis, 1 patient as internal herniation, 1 patient as villous adenoma, 1
patient as bile stone ileus, 25 patients as brid ileus, 1 patient as rectal-carcinoid and
1 patient as bezoar, peroperatively. When males were evaluated; 84 patients were
diagnosed as colon carcinoma, 39 as brid-ileus, 11 as volvulus, 4 as Crohn’s disease,
3 as internal herniation, 2 as intestinal malignancy and 1 patient as invagination.
Conclusion:
There was no unexpected cause of colonic obstruction in our study. Our study
is correlated also with literature about small bowel obstructions, but also some
uncommon diagnosis like bezoars, invagination and bile stone ileus are noted. As a
conclusion, rates of unexpected diagnosis for small bowel obstructions are higher
than colonic obstructions. So, these unexpected and uncommon situations must
be considered for the diagnosis of small bowel obstructions; especially for patients
who are followed-up non-operatively assuming brid ileus.
-378-
PP - 183 A RARE CAUSE OF ACUTE ABDOMEN: OMENTAL
INFARCTION
AHMET TURKOGLU 1, BURAK VELI ULGER 1, ABDULLAH OGUZ 1, OMER USLUKAYA 1,
MEMIK TEKE 2
DICLE UNIVERSITY GENERAL SURGERY, DIYARBAKIR, TURKEY

1
DICLE UNIVERSITY RADIOLOGY DEPARTMENTMENT, DIYARBAKIR, TURKEY

2
Introduction:
Omental infarction (OI) is a rare cause of acute abdominal pain mimicking acute
abdominal conditions such as appendicitis and cholecystitis. Although conservative
treatment is the main approach, it has been diagnosed only on exploratory surgery
for presumed acute appendicitis or similar abdominal emergency before the
increasing use of high-quality imaging, especially computerized tomography (CT).
We present this case to demonstrate that unnecessary operations can be avoided
in cases that omental infarction is diagnosed preoperatively.
Case report:
A previously healthy 34-year-old male presented complaining of right lower quadrant

pain of 3 days duration. Physical examination revealed peritoneal irritation signs
in the right side of the abdomen. Laboratory tests were normal, ultrasonography
showed an uncertain hyperechoic image at the level of the right middle quadrant. A
contrast-enhanced CT scan of the abdomen demonstrated a fatty lesion that contains
internal hyperechogenic streaks and measures approximately 10 centimeters in
diameter. Conservative management was decided, the pain gradually settled and
the patient was discharged with no need of surgery.
Conclusion:
OI is mostly a self-limited disease and conservative management is the main

approach. We recommend that it is important making the diagnosis of OI
preoperatively and distinguishing it from acute appendicitis in avoiding unnecessary
surgery.
-379-
PP - 184 CONSERVATIVE MANAGEMENT OF RECTUS SHEATH
HAEMATOMA: CASE REPORT
ABDULLAH OGUZ , ÖMER USLUKAYA , AHMET TURKOGLU , BURAK VELI ULGER ,
ÖMER LÜTFI AKGÜL
DICLE UNIVERSITY GENERAL SURGERY, DIYARBAKIR, TURKEY
Introduction:
Rectus sheath hematoma is a rare cause of abdominal pain. Misdiagnosis of the

disease results in unnecessary surgical intervention. Here we describe a patient
with rectus sheath hematoma that was managed without surgical intervention.
Case report:
A 54-year-old woman presented with a sharp, nonradiating right lower-quadrant

pain of a week’s duration. She only had a history of diabetes mellitus. Abdominal
examination revealed right lower quadrant tenderness with localised rigidity. There
were no ecchymoses or masses. Laboratory studies showed a WBC count of 7690
and a hematocrit level of 26,1 %. Abdominal computerized tomography showed a
right-side rectus sheath hematoma. Because her hematocrit level decreased, she
received 2 units of packed red cells and 6 of fresh frozen plasma. But she stabilized
without the need of surgical intervention.
Conclusion:
Rectus sheath hematoma should be taken into consideration in differential diagnosis

of abdominal pain. Early diagnosis may prevent unnecessary surgical intervention
and reduce long hospitalisation.
-380-
PP - 185 OUTCOMES OF ACUTE APPENDICITIS IN ELDERLY PATIENTS:
5 YEARS’ EXPERIENCE OF A SINGLE INSTITUTION.
ALI KAGAN GOKAKIN , MUSTAFA ATABEY , BORAN CIHAT KARAKUS , AYHAN
KOYUNCU

SURGERY, SIVAS, TURKEY
Background&Aims:
Urgent surgeries may cause significant morbidity and mortality in older patients.
The aim of study was to present our management experience on acute appendicitis
in elderly patient group.
Methods:
Patients who underwent appendectomy for acute appendicitis between 2007- 2012
were included in the study. With these criteria, 1382 patients were included in the
study. Patients were divided into three age groups: Group I; younger than 29, group
II; 29 to 65, and Group III; 65 and older. Variables selected for analysis included age,
sex, duration of symptoms, duration of hospitalization (total and preoperative),
operative approach, operative findings, operative time, morbidity and mortality
rates, and pathological confirmation. Kruskal-Wallis test was used for variance
analyses. Mann-Whitney U and chi square tests were used for dual comparisons
between groups where appropriate.
Results:
Duration of symptoms, hospitalization (total and preoperative) were higher in

elderly group. Post-operative outcomes were worse in patients more than 65 years
of age. However, miss diagnose rate was lower in that age group.
Conclusion:
Acute appendicitis in the elderly remains a challenge for practicing surgeons and
continues to be associated with high morbidity. With increasing life expectancy,
more such cases are likely to be encountered in the future.
-381-
PP - 186 PEPTIC ULCER PERFORATION IN ELDERLY: 10 YEARS’
EXPERIENCE OF A SINGLE INSTITUTION
ALI KAGAN GOKAKIN , MUSTAFA ATABEY , AYHAN KOYUNCU

Background&Aims:
Perforation of peptic ulcer (PUP) constitutes a unique situation characterized by

severe pain, leading almost every patient with this complication to seek help in the
hospital. However, clinical features of PUP in elderly patients are quite different
from those of young or in adult subjects; symptoms of PUP may be atypical in old
age.
Methods:
We carried out a retrospective study of patients who underwent emergency

surgery for PUP between 2002 and 20012 in our clinic and divided patients into two
groups. Patients conditions that may have had an effect on the perforation, such
as age, gender, concomitant disease, use of drugs, presence of Helicobacter pylori
infection, characteristic of pain, and duration symptoms were evaluated.
Results:
A total of 261 patients were included in the trial. Group I (n=202) was composed
of adults (<65), group II (n=59) was composed of geriatric patients (>65). Male
dominancy was detected in both groups (1/3.5, 1/5.5). Primary closure of the
perforation was the most common procedure performed. Hypertension (18.3
%, and 52.5%), and diabetes mellitus (11.9%, and 15.3) were the most detected
comorbidities in both groups, whereas mortality and morbidity rates were higher
in elderly group.
Conclusion:
It seems as if surgery for PUP will be continue to be a subject of debate despite

more than an era of published expertise, particularly in geriatric age.
-382-
PP - 187 ALTERATIONS IN SERUM VASCULAR ENDOTHELIAL
GROWTH FACTOR LEVEL IN SCALD BURN INJURY: AN
EXPERIMENTAL STUDY
ALI KAGAN GOKAKIN 2, KOKSAL DEVECI 1, MUSTAFA ATABEY 2, AYHAN KOYUNCU 2
1
BIOCHEMISTRY, TURKEY
2
Background&Aims:
Burn is associated with release of inflammatory mediators which ultimately cause

local and distant pathophysiological effects. Inflammatory cells surrounding the
microvasculature can have a profound effect on promoting new vessel growth
via vascular endothelial growth factor (VEGF) and VEGF receptors such as VEGF
Receptor (Flt-1).Our aim was to evaluate the alterations in serum levels of VEGF in
severe scald burn injury in rats, and how sildenafil affects levels of VEGF.
Methods:
(except control group)and were randomly divided into three equal groups as follows:
Control, sham, and 10 mg/kg sildenafil groups. Levels of malondialdehyde (MDA),
vascular endothelial growth factor (VEGF), VEGF receptor (Flt-1) and activities of
glutathione peroxidase (Gpx) and catalase (Cat), levels of total antioxidative capacity
(TAC), and total oxidant status (TOS) were measured in serum.
Results:
There were no differences between groups in terms of VEGF and Flt-1 levels.
However, there was a significant difference between groups in terms of ratio of Flt-
1/ VEGF levels. Sildenafil showed beneficial effects in oxidative balance.
Conclusion:
Our investigations implicate, that the alteration in Flt-1/VEGF has the potency to
play role in remote organ injury.
-383-
PP - 188 IMPROVING THE MANAGEMENT OF PAIN IN ELDERLY
SURGICAL PATIENTS
ALI QUREISHI , CHRISTODOULOS NEOPHYTOU , AMIT SHAMA, A WEBB
LINCOLN COUNTY HOSPITAL, UK
Background&Aims:
At present 20% of the UK population consists of pensioners. Studies show these

patients are less likely to seek analgesia and indicate pain. Failure to identify
perioperative pain results in delayed treatment and discharge, increased hospital
acquired complications and unnecessary cost. The aim of this audit was to
determine the management of acute pain in elderly surgical patients and initiate
improvements.
Methods:
A prospective audit was undertaken using a proforma designed using European and
British guidelines for perioperative pain. After analysis of results a pain assessment
and management tool was created and ward staff educated in its use. A re-audit
was undertaken 6 weeks later.
Results:
Adequate analgesia and pain assessment were only performed in 46% and 34% of
patients pre-intervention. This number rose to 88% and 90% respectively. Objective
and subjective reports indicated a significant improvement in pain management
and satisfaction amongst this patient group.
Conclusion:
Simple interventions can have significant implications on patient care, pain

assessment should be an integral part of ward rounds. Different methods should be
available to assess pain in elderly patients including visual analogue and facial pain
scales. Staff motivation is paramount in this process and education is a powerful aid
in achieving this.
-384-
PP - 189 CLINICAL OUTCOMES OF APPENDICECTOMY: A SINGLE
CENTRE EXPERIENCE OVER 5 YEARS.
ASHWIN SRIDHAR , MARIA ANDRIKOPOULOU , LEWIS CLARKE , CHRIS ASHLEY ,
PETER MEKHAIL , USMAN KHAN
EAST CHESHIRE NHS TRUST, UK
Background&Aims:
The aim of the study was to analyse the clinical outcomes of appendicectomy in our
hospital over a 5 year period, and to assess the utility of radiological investigations
and laparoscopy in the management of appendicitis.
Methods:
A retrospective audit of appendicectomies in our hospital over the last five years
(01/01/2007 – 31/12/2011) was conducted. Relevant radiological and pathological
data were collected. Histopathological confirmation of appendicitis was used as
the gold standard for diagnosis. A multivariate analysis was conducted to calculate
the negative appendicectomy rate, perforation rate, and complication rate. The
accuracy of radiological and pathological tests was computed.
Results:
1055 appendicectomies were performed in our hospital over the five year
period (965 open and 90 laparoscopic). The negative appendicectomy rate was
24.5% (21% for open and 28% for laparoscopic appendectomy) and perforation
rate was 14%. These rates did not vary significantly over the years even though
the prevalence of laparoscopy and the use of CT increased during this time. The
negative appendicectomy rate was significantly higher in women of child bearing
age (16 – 60, p- 0.0028).
Conclusion:
The negative appendicectomy rate and perforation rate in our hospital are similar
to those mentioned in the literature. These rates did not vary significantly with the
increased use of imaging or laparoscopy.
-385-
PP - 190 COLORECTAL INJURY IN A PERSONAL WATERCRAFT (JET
SKI) PASSENGER: CASE REPORT
DENIZ CULCU 3, CAGATAY AYDIN 1, BERRIN AYDIN 2
1
ANADOLU SAGLIK MERKEZI HASTANESI, ISTANBUL, TURKEY
2
DENIZLI DEVLET HASTANESI, DENIZLI, TURKEY
3
DR.SADIK AHMET HASTANESI, ISTANBUL, TURKEY
Background&Aims:
The popularity of jet-skis are increasing, as are injuries related to their use. Here
we describe a case of a recto-sigmoideal injury occurring in a passenger of a jet-ski.
Methods:
This is a case presentation and review of literature. We present a case of a 21 year

old female presented with generalized abdominal pain and bleeding per anus after
a jet-ski related accident. Both PubMed and Web of Science were searched using
the following keywords: colo-rectal perforations; personal watercraft; and Jet-Ski.
Results:
A full-layer perforation of the colon was noticed in the recto-sigmoid junction

secondary to hydrostatic pressure sustained. The perforation was repaired with
full-thickness interrupted sutures. After performing a loop colostomy, the abdomen
was closed. The patient made a full recovery and discharged from the hospital in
postoperative day 12. Two months later, the colostomy was closed without event.
Conclusion:
Prevention must be the main target in such jet-ski accidents. Both drivers and the
passengers are adviced to wear protective garments that could defend the victim
against the stream of water. There must be a handlebar to keep passengers stable
on the back of a jet-ski. Besides, it is recommended to provide the passenger an
auto-shutoff switch like the driver.
-386-
PP - 191 THE EFFECT OF MELATONIN ON BACTERIAL
TRANSLOCATION FOLLOWING ISCHEMIA/REPERFUSION INJURY IN
A RAT MODEL OF SUPERIOR MESENTERIC ARTERY OCCLUSION
CAGATAY AYDIN 1, NURAL CEVAHİR 1, CİGDEM YENİSEY 2, MURAT OZBAN 1,
GULİSTAN GUMRUKCU 3, BERRİN AYDIN 5, IBRAHİM BERBER 4
1
PAMUKKALE UNIVERSITY, DENIZLI, TURKEY
2
ADNAN MENDERES UNIVERSITY, AYDIN, TURKEY
3
HAYDARPASA NUMUNE TRAINING AND RESEARCH HOSPITAL
4
ACIBADEM INTERNATIONAL HOSPITAL
5
DENİZLİ STATE HOSPITAL
Background&Aims:
Acute mesenteric ischemia is a life-threatening vascular emergency resulting
in tissue destruction due to ischemia-reperfusion injury. Melatonin, the primary
hormone of the pineal gland, is a powerful scavenger of reactive oxygen species
(ROS), including the hydroxyl and peroxyl radicals, as well as singlet oxygen, and
nitric oxide. In this study, we aimed to investigate whether melatonin prevents
harmful effects of superior mesenteric ischemia-reperfusion on intestinal tissues
in rats.
Methods:
Rats were randomly divided into three groups, each having 10 animals. In group
I, the superior mesenteric artery (SMA) was isolated but not occluded. In group II
and group III, the SMA was occluded immediately distal to the aorta for 60 minutes.
After that, the clamp was removed and the reperfusion period began. In group III,
30 minutes before the start of reperfusion, 10 mg/kg melatonin was administered
intraperitonally. All animals were sacrified 24 hours after reperfusion. Tissue
samples were collected to evaluate the I/R-induced intestinal injury and bacterial
translocation (BT).
Results:
There was a statistically significant increase in myeloperoxidase activity,
malondialdehyde levels and in the incidence of bacterial translocation in group II,
along with a decrease in glutathione levels. These investigated parameters were
found to be normalized in melatonin treated animals (group III).
Conclusion:
We conclude that melatonin prevents bacterial translocation while precluding the
harmful effects of ischemia/reperfusion injury on intestinal tissues in a rat model of
superior mesenteric artery occlusion.
-387-
PP - 192 PRIMARY SMALL INTESTINAL TUMOR CASES IN
EMERGENCY SURGERY
TEVFİK KÜÇÜKKARTALLAR , EBUBEKİR GÜNDEŞ , AHMET TEKİN , SERHAT DOĞAN ,
CELALETTİN VATANSEV
NECMETTIN ERBAKAN UNIVERSITY, MERAM MEDICAL FACULTY, DEPARTMENT OF

GENERAL SURGERY, KONYA, TURKEY.
Background&Aims:
Despite advanced diagnostic methods, diagnosis of small intestinal tumors is hard

and they are generally detected at an advanced stage. We present our clinical
experiences and the short term results of 29 patients with primary small intestinal
tumors who had undergone emergency surgical procedures.
Methods:
The data of these 29 patients treated at our clinic between 2005 and 2011 were
retrospectively evaluated.
Results:
16 of the patients were male, while 13 were female, and their mean age was 62
(35-80). All the cases underwent emergency surgery. Intestinal obstruction was
detected in 16 of the cases, while invagination in 6, and mesenteric ischemia in
1. Tumors were located in the ileum in 14 patients, in the jejunum in 10, and in
the duodenum in 5. The most frequent pathological diagnoses were GIST with 7
cases and adenocarcinoma with 7 cases. The most frequently performed surgical
procedures were small intestinal resection and anastomosis. 4 patients developed
surgical site infection and 3 had anastomotic leaks in the post-op period. Mortality
was seen in 6 patients in the early post-op period.
Conclusion:
Tumors of the small intestine are very rare. The findings are non-specific and
advanced diagnostic methods are needed during the diagnostic process. They
generally cause clinical conditions that necessitate emergency surgery. The timing
of the treatment is a significant factor determining survival.
-388-
PP - 193 NECROSIS AND PERFORATION OF THE STOMACH CAUSED
BY ACUTE GASTRIC DILATATION: A CASE REPORT
EBUBEKİR GÜNDEŞ , TEVFİK KÜÇÜKKARTALLAR , AHMET TEKİN

GENERAL SURGERY, KONYA TURKEY.
Background&Aims:
Acute gastric dilatation was first defined by Duplay in 1833. We hereby present the
case of a 55-year-old male patient diagnosed with gastric necrosis and perforation
caused by acute gastric dilatation.
Methods:
The 55-year-old male patient presented with complaints of nausea, vomiting, and
abdominal pain for 4 days. Physical examination revealed abdominal distension
and the patient’s intestinal sounds were hypoactive. Defense and rebound were
present. Computerized tomography showed intra-abdominal free fluid and air,
intramural air chambers on the gastric wall.
Results:
Laparotomy was performed on the patient with the pre-diagnosis of acute surgical
abdomen within the light of current findings. The exploration revealed necrosis in
almost the entire stomach and perforation on the side of the greater curvature.
Total gastrectomy Roux-en-Y esophagojejunostomy were performed on the patient.
The patient was lost on post-op day 2 because of septic shock.
Conclusion:
Since the stomach has a rich blood circulation necrosis and perforation are rarely
seen. Clinically, more than 90% of the cases have complaints of vomiting. Early
diagnosis is significant. The most useful method in revealing the diagnosis and
etiology is CT. Medical treatment is appropriate for cases where no necroses and
peritonitis findings were detected through endoscopy. Delays in surgical treatment
increase the risk of mortality.
-389-
PP - 194 ILEOSIGMOIDAL KNOTTING: THE RESULTS OF 8 PATIENTS
EBUBEKIR GÜNDEŞ , TEVFIK KÜÇÜKKARTALLAR , MURAT ÇAKIR , K. DENİZ ERCAN ,
ŞAKİR TAVLI

Background&Aims:
We hereby present the clinical findings and treatment approaches for 8 patients
diagnosed with ileosigmoidal knotting who were treated at our clinic alongside with
literature.
Methods:
The file records of 8 patients (7 male, 1 female) who had received surgical treatment
were retrospectively evaluated.
Results:
The mean age of the patients was 45.6 (63-75). The most frequent symptoms were
abdominal pain and constipation, while the most frequent indications included
abdominal sensitivity and distension. The patients’ standing direct abdominal
radiography results revealed air-fluid levels both at the small and large intestine
levels. Emergency laparotomy was performed for all the patients. The patients were
diagnosed intraoperatively. All the patients had gangrened intestinal segments. The
most frequently preferred surgical procedure for the resection of the gangrened
segment was the Hartman procedure combined with enteroenteric or enterocolic
anastomosis (n=7). The mortality rate was 20% (n=2), while septic shock and severe
pneumonia were the leading causes of death.
Conclusion:
Ileosigmoidal knotting is a rare but significant cause of bowel obstruction. While

its preoperative diagnosis is hard, it may manifest itself as an obstructive or non-
obstructive emergency condition. Early and effective resuscitation, rapid surgical
intervention, and appropriate post-op intensive care constitute the fundamentals
of treatment.
-390-
PP - 195 SOFT TISSUE INJURIES OF THE DISTAL FOREARM AND THE
HAND AND THE NEED FOR AN EARLY SURGICAL EXPLORATION
EVANGELOS SARANTOPOULOS , HENRIK MENKE
KLINIKUM OFFENBACH GMBH, DEPARTMENT FOR PLASTIC, AESTHETIC AND HAND

SURGERY – BURN UNIT, STARKENBURGRING 66, 63069 OFFENBACH, GERMANY
Background&Aims:
Sometimes small lacerations or puncture wounds of the hand can be notoriously

innocuous in appearance but they may result to severe destruction of the underlying
tissues. We would like to show the importance for an immediate surgical procedure
in case of soft tissue injuries of the distal forearm and the hand.
Methods:
All patients sustained a soft tissue injury of the distal forearm and the hand. The
initial assessment revealed small or big lacerations, contusions and puncture
wounds. After thorough physical examination and an early surgical exploration
a number of severe injuries was discovered and all the patients undergone an
emergency surgical procedure.
Results:
The long-term clinical evaluation of the patients showed a satisfying restoration of

the primary functional loss.
Conclusion:
The distal forearm and the hand include various important anatomical structures.
An injury of these regions can often lead to a severe loss of function (i.e. injury of
a flexor tendon, rupture of a vessel). In such cases, an early surgical exploration
could be the key for the ideal treatment of the patient. In order to perform the early
surgical procedure the patients should be immediately referred to a regional center
with hand surgeons and facilities to manage the problem.
-391-
PP - 196 DEPTH OF BURN INJURIES AFTER EPILEPTIC SEIZURES: A
CONSTANT CHALLENGE FOR THE BURN SURGEON

Background&Aims:
Epilepsy is a diverse set of chronic neurological disorders characterized by seizures.

Epilepsy is usually controlled, but not cured, with medication. Over 30% of people
with epilepsy do not have seizure control even with the best available medications.
Thus, patients with epilepsy are prone to serious burn injuries.
Methods:
We would like to present 3 patients with burn injuries after epileptic seizures that
were referred to our burn unit. Seizures occurred at home, while the patient was
conducting daily household chores. Patient´s age was between 31 and 38 years old,
the total body surface area affected from the disease was between 1 and 18%. All
patients suffered full-thickness burn injuries.
Results:
In all patients débridement of the wounds was performed more than once due to
the depth of the burn injuries.
Conclusion:
Definition of the depth of burn injuries after epileptic seizures is a challenging

condition for the burn surgeon, especially due to the unknown time the skin has
been exposed. The possibility of a full-thickness burn injury should always be taken
under account, leading to several operations and a prolonged hospitalization.
Furthermore, patients with epilepsy should be better recognized as a high-risk
group in order to implement a successful burns injury-prevention program.
-392-
PP - 197 THE IMPORTANCE OF RECONSTRUCTIVE THINKING
DURING THE ACUTE TRAUMATIC PHASE

Background&Aims:
The first priority during the acute traumatic phase is to evaluate the entire patient
and to stabilize his injuries. However, modern microsurgical treatment options
enable the reconstruction of extreme complex hand injuries after crushes and
amputations. Through clinical cases we would like to show the importance of
reconstructive thinking during the acute traumatic phase.
Methods:
The first patient was transferred to us due to extended defects of the distal forearm
and the dorsum of the hand. The angiogram that was preoperatively performed
showed an occlusion of the right radial artery. Although we tried to extend the
radial artery with a saphenous vein loop, the cover of the defects with a free
flap was impossible. We decided to perform a modified pedicled ALT. The second
patient lost his left thumb after a car accident. In order to reconstruct his thumb we
decided to perform a toe-to-hand reconstruction. Intraoperatively, we realized that
the recipient artery was inappropriate for the anastomosis of the free flap. Thus, we
performed an end-to-end anastomosis to the radial artery.
Results:
Both patients were discharged with stable wounds and were very satisfied with the
reconstructive result.
Conclusion:
There is a variety of options to reconstruct complex hand injuries. It is very important

to salvage as many anatomical structures (i.e. tendons, vessels, nerves) as possible
during the acute traumatic phase. The consideration of a secondary reconstructive
procedure during the acute traumatic phase will enable better function restoration
and improve the patient’s quality of life.
-393-
PP - 198 DELAYED DECISION FOR SURGERY IN PREGNANT WOMEN
WITH ACUTE APPENDICITIS
EVGHENII GUTSU , VASILE GUZUN

Background&Aims:
It’s known that appendectomy (APE) is necessary to perform within the first 24
hours in pregnant women with acute appendicitis (AA) to prevent perforation of
appendix and to improve outcomes for both mother and fetus. Aim of study was
analysis of factors, associated with delayed APE in pregnant patients with suspected
AA.
Methods:
Of the total of 28 pregnant women with suspected AA, 21 (75%) were operated
during the first 24 hours after admission, and 7 (25%) - later than 24 hours.
Results:
The atypical abdominal pain was a little more common in women with a delayed
surgery (57.1% vs. 45.2%, not significant). Cases with histologically confirmed
appendiceal inflammation were determined significantly more frequent in patients
operated within the first 24 hours (85.7%), than in delayed surgery group (28.6%,
p <0.05). In patients with early APE compared to those with delayed surgery
abdominal ultrasound was performed less frequently (56.6% vs. 85.7%, p <0.05),
whereas its diagnostic value was higher (64.70% vs. 33.3%, p <0.05).
Conclusion:
Delay of APE in pregnant women is caused by unclear symptoms, as well as

uncertain imaging and laboratory data, and as a rule, is associated with the absence
of inflammatory changes in appendix.
-394-
PP - 199 PERFORATED ACUTE APPENDICITIS PRESENTING AS
SIGMOID COLON TUMOR
MUHARREM OZTAS 2, EYUP DURAN 3, RAMAZAN YILDIZ 1, MEHMET FATIH CAN 1,
SEZAI DEMIRBAS 1, YUSUF PEKER 1
1
TURKEY
2
MEVKI MILITARY HOSPITAL GENERAL SURGERY DEPARTMENT, ANKARA, TURKEY
3
ELAZIG MILITARY HOSPITAL GENERAL SURGERY DEPARTMENT, ELAZIG, TURKEY
Introduction:
We report a case of an atypical presentation of acute appendicitis in an elderly

patient and we discussed benefit of computed tomography in the diagnosis for
atypical presentations of appendicitis.
Case report:
A 54-year-old man who presented with abdominal pain for ten days and vomiting
was diagnosed with sigmoid colon tumor on CT scan. The patient’s rectosigmoid
region was inflamated due to undiagnosed perforated appendisitis thus resulting in
an atypical presentation of a common illness.
Conclusion:
Risk of perforation appears to be higher in males and patients older than 55

years and perforated acute appendicitis patients have more misdiagnosis. CT has
reported a sensitivity that may reach 95% and specificity higher than 95%. Despite
all medical advances, the diagnosis of acute appendicitis continues to be a medical
challenge.
-395-
PP - 200 RELATIONSHIP BETWEEN SMALL BOWEL OBSTRUCTION
AND SMALL BOWEL FECES SIGN - 4 CASES REPORT
FATIH ALTINTOPRAK 1, YASEMIN GUNDUZ 4, OMER YALKIN 2, KEMAL GUNDUGDU 2,
SERBULENT GOKHAN BEYAZ 3, OSMAN NURI DILEK 1
1
2
3
SAKARYA, TURKEY
4
SAKARYA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF RADIOLOGY,
SAKARYA, TURKEY
Background&Aims:
Small bowel obstruction (SBO) is the most commonly observed surgical disorder
of the small intestine. Small bowel feces signs (SBFs) is a CT finding that can be
detected in small bowel obstruction.
Methods:
SBFs were originally described as the presence of gas bubbles in particulate matter
in dilated segments of small bowels. The appearance of SBF along with SBO often
provides an indication of the severity of obstruction and the time of occurrence.
Additionally, have determined that SBFs presence was more frequent in moderate
and high-grade SBO in comparison to low-grade SBO.
Results:
We detected SBF appearance in four patients who were admitted to the emergency
department with the complaints of abdominal pain and vomiting. Abdominal CT
findings consisted of mild-moderate dilatation of the jejunal segments in two cases
who were treated medically, and severe dilatation in another two cases who were
treated surgically.
Conclusion:
Although SBFs indicate the presence of mechanical SBO, these symptoms are neither
sensitive nor specific for the diagnosis of SBO. It may be useful in the diagnosis of
SBO only when associated with moderate or severe small bowel dilatation.
-396-
PP - 201 A RARE REASON FOR INTESTINAL OBSTRUCTION IN THE
GERIATRIC AGE GROUP: INTESTINAL BEZOARS
FATIH ALTINTOPRAK 1, OMER YALKIN 2, ENIS DIKICIER 2, GUNER CAKMAK 2, TANER
KIVILCIM 2, YASEMIN GUNDUZ 3, GÖKHAN AKBULUT 1, OSMAN NURI DILEK 1
1
2
3
SAKARYA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF RADIOLOGY,
SAKARYA, TURKEY
Background&Aims:
Presenting the demographic findings of elderly patients who had been operated
with the diagnosis of intestinal obstruction due to bezoar.
Methods:
The records of the patients who were surgically treated between January 2004
and August 2012 with the diagnosis of intestinal obstruction owing to bezoar were
retrospectively investigated. After excluded the patients younger than 65 years of
age, 19 patients’s records were detailed examined.
Results:
Five of the patients (26.3%) were male, fourteen (73.4%) were female and the
average age was 72.5 (range: 66-84 years). Eight patients (42.1 %) had undergone
a previous abdominal surgery, and six of them (6/8, 75%) were operated due to
peptic ulcer. 13 patients (13/19, 68.4%) had poor mastication history. Ileum was
the most common bezoar localization (13/19; %68.4), and multiple bezoars were
detected in nine patients (47.3%).
Conclusion:
Post-operative adhesions and hernias are the most common reasons of intestinal
obstructions. The situation does not change for the elderly patients and bezoars
are the last etiology when listing intestinal obstruction etiologies. However, the
probability of bezoars should be kept in mind for elderly patients with intestinal
obstruction, especially if accompanied by with previous abdominal operation
history due to peptic ulcus and poor mastication history.
-397-
PP - 202 ACUTE ABDOMEN SECONDARY TO STAGHORN KIDNEY
CALCULI.PERINSPHRITIC ABSCESS WITH FISTULA TO PERITONEAL
CAVITY.
H. HASAN ABUOGLU 1, OKTAY YENER 2, M. KAMIL YILDIZ 1, H. MEHMET ODABASI 1,
CENGIZ ERIS 1, ERKAN OZKAN 1, EMRE GUNAY 1
1
SB. HAYDARPASA NUMUNE TRAINING HOSPITAL DEPARTMENT OF SURGERY,
ISTANBUL, TURKEY
2
SB. İSTANBUL MEDENIYET UNIVERSITY GÖZTEPE TRAINING HOSPITAL
Introduction:
Perinephric abcess is a life-threatening entity. The diagnosis is difficult to make from

a patient’s history and physical examination findings alone because the findings are
nonspecific. The mortality rate for perinephric abscesses can be as high as 56%.
Case report:
A 55 year old man with no significant past medical history precented to the
emercency department after the sudden onset of severe crampy abdominal pain.
On examination, he had a rigid abdomen with rebound tenderness in both right
and left upper quadrant. Plain abdominal radiography showed staghorn calcule
in right kidney. Chest radiographs showed right pleural effusion. The patient was
immediately taken to the operating room for exploration. Upon entering the
peritoneal cavity, a large purulent material was seen. Retroperitoneal space was
explorated through the told fascia. Transperitoneal approach to the right kidney
was performed with ascending colon reflected medially. Pyonephrosis, pararenal
abscess material was seen. Staghorn calcule was identified during renal pelvic
exploration
Conclusion:
Staghorn renal calculi as a cause of perinephritic abscess collection is a rare but

severe complication and usually results in retroperitoneal abscess formation.
Perinephritic abscess are diffucult to diagnose clinically but CT scan can aid in the
diagnosis. Carefully selected stable patients may be treated without surgery, but
most patients require laparotomy.
-398-
PP - 203 ENDOSCOPIC MORCELLATION OF GASTRIC PHYTOBEZOAR
LEAD TO GASTRIC OUTLET OBSTRUCTION FOLLOWING GASTRIC
SURGERY
İBRAHIM ALI ÖZEMİR , ÇAĞRI BİLGİÇ , BARIŞ BAYRAKTAR , HAYDAR YALMAN ,
SINAN ASLAN , MUSTAFA DEMİR , ENDER ANILIR , RAFET YİĞİTBAŞI
İSTANBUL MEDENIYET UNIVERSITY, GÖZTEPE EDUCATION AND RESEARCH

HOSPITAL, GENERAL SURGERY, ISTANBUL, TURKEY
Introduction:
Gastric phytobezoars are thought to be related to underlying defective gastric

motility, such as that seen following gastric surgery. A number of surgical, endoscopic
and pharmacologic treatments have been proposed with variable success. Gastric
pyhtobezoars are rare cause of gastric obstruction. Herein we report the endoscopic
treatment of gastric phytobezoar lead to gastric obstruction.
Case report:
A 63-year old man was admitted because of periumblical pain, nausea and
vomiting for 2 days. The patient’s surgery history consisted of truncal vagotomy and
pyloroplasty 15 years before admission. On examination, the patient had epigastric
tenderness and distention and a naso-gastric tube was inserted. Computed
tomographic scans of the abdomen demonstrated well-encapsulated massive
gastric mass. Gastroduodenoscopy revealed a large gastric phytobezoar cause
of the obstruction in the corpus of the stomach. Endoscopic fragmentation and
morcellation performed via endoscopic snare and forceps. After the first attempt
endoscopy repeated 2 more times at 3 days intervals and gastric phytobezoar
fragmented totally. After the endoscopic treatment N-acetyl cysteine cure
performed as a dissolving agent. No recurrence detected after18 months follow up.
Conclusion:
In presence of intestinal obstruction, physicians should always be aware of an

eventual gastrointestinal bezoar, particularly in patients with previous gastric
surgery. İnitially conservative treatments(endoscopic management and enzymatic
dissolution) must be attempted. Surgery is usually performed in cases where other
measures have failed.
-399-
PP - 204 CHARACTERISTICS OF THE CASES HOSPITALIZED TO
THE GENERAL SURGERY DEPARTMENT FROM THE EMERGENCY
DEPARTMENT
MEHMET ERYILMAZ , YUSUF EMRAH EYI , UMIT KALDIRIM , MURAT DURUSU
, IBRAHIM ARZIMAN , SUKRU ARDIC , HACI YAVUZ MERCIMEK , SALIM KEMAL
TUNCER
DEPARTMENT OF EMERGENCY MEDICINE, GULHANE MILITARY MEDICAL

Background&Aims:
Emergency general surgery reasons generate an important part of emergency

department cases. It is important to diagnose these cases correctly and managing
them suitably. In this study we aimed to evaluate the characteristics of the cases
hospitalized to the general surgery department from the emergency department
retrospectively.
Methods:
Cases hospitalized to the general surgery department from the emergency

department in the 7 months period between 13.12.2011 and 11.07.2012 has been
evaluated by analyzing the file records retrospectively. The information of age/sex,
admission types, complaints, vitals, diagnosis, consultations and the duration of the
stay in the emergency department were analyzed. Quantity, percentage, mean, and
standard error values were used in the identification of data.
Results:
It is observed that 12.72 40.35± %(n=216) of the total 1698 patients were hospitalized
to general surgery department from ED. The mean of the age is 40.35±21.83(min 17-
max91). Female/Male ratio is 2.72. only 8.3%(n=18) of the cases admitted ED with
ambulance. 70.37(n=152) had abdominal pains, 25.46(n=55) had gastrointestinal
complaints (nausea, vomiting, distention, indigestion, constipation etc.) except
pain. In 9 cases (4.17%) had atypical complaints which were related to abdominal
region. Three cases have systemic blood pressure below 90 mmHg at the time
of the arrival. These three cases were below 65 years old and two of them were
diagnosed as ileus and the third as gastric perforation. 47 (21.76%) of the patients
had tachycardia at the arrival.
-400-
Also, in six cases initial oxygen saturations were below 90%. Five old the patients
were older than 65 years old. When we evaluate the hospitalization diagnosis,
88(40.74%) were acute appendicitis, 22(10.18%) were ileus, 20(9,26%) hepatobilier
diseases, 7(n=3.24) were intestinal perforation. Only 17 (n=7.87) had consultations
from the clinics. The time period staying in ED before hospitalization is 3.89±3.93
(min: 00.5, max: 20.41)
Conclusion:
Considering the results, it can be realized that most of the surgical abdominal cases
don’t use ambulance for admission and the patients whose vitals are abnormal
are usually older patints. Furthermore, mean ED stay time is about 4 hours with all
cases and this can stay until 20 hours.
-401-
PP - 205 ACUTE MESENTERIC ISCHEMIA: SERIES OF CASES
ISMAIL KABAK , IBRAHIM ATAK , TOLGA CANBAK , MUSTAFA KAYA , SULEYMAN
KALCAN , GURHAN BAS , ALI KILIC , ORHAN ALIMOGLU

Background&Aims:
Acute mesenteric ischemia (ACI) is a rare and fatal cause of acute abdomen. The
diagnosis and management also importer challenging clinical difficulties. We aimed
to analyze the patients operated due to ACI in our surgical department.
Methods:
We retrospectively examined the patients diagnosed and operated because of ACI

and reveled the outcome of the managent of this patients.
Results:
In this study, we retrospectively evaluated the data of 10 patients managed due to

ACI between January 2009 and December 2011. The average age was 67.20 years,
ASA score was 2.6 (2/4) and WBC count was 21.370/mm3. The diagnostic tools
were computed tomography anjiography in 5 patients, magnetic resonance Imaging
angiopraghy in 3 patients, doppler ultrasonography in 1 patient and diagnostic
laparoscopy in 1 patient. Except 1 patient who died peroperatively, several
resections of small intestine and colon were performed in 9 patients. Second-look
laparoscopy was performed in 7 patients and only 1 patient underwent additional
resection. The mortality was saw in 3, the morbidity in (3) patients.
Conclusion:
ACI affect especially old patients with comorbid disorders and has currently
demonstrated high morbidity and mortality rate.
-402-
PP - 206 ATRIUM PERFORATION AND CARDIAC TAMPONADE DUE
TO BLUNT TRAUMA CASE REPORT
KEMAL GÜNDOĞDU , FEYYAZ ONURAY , ATTİLA BEŞTEMİR , OSMAN NURİ DİLEK
SAKARYA ÜNİVERSİTESİ EĞİTİM VE ARAŞTIRMA HASTANESİ, SAKARYA, TURKEY
Background&Aims:
Traffic accidents are the most common reason of blunt trauma in worldwide.
Although injuries of intraabdominal vulnerable organs like liver and spleen is more
common, isolated heart injury is very rare. A 28-years old female patient was taken
into emergency service as intubated after traffic accident that happened 20 minutes
ago.
Methods:
The patient’s Glaskow coma scala: 4, Hb: 8.2 mg/dl, blood pressure: 70/40 and pulse:
142. Pericardial effusion (Picture 1) and intraabdominal free fluid were detected
on thoracic and abdominal CT examination. The patient was taken into operation
in emergency condition and after intraabdominal haemmorrhage control, left
anterolateral thoracotomy was performed. Haemorrhage that caused pericardial
tamponade was detected.
Results:
On examination after the haemmorrhage was drained via pericardiotomy, a 2 cm

diameter, irregular contour perforation was detected at the left atrium. After the
perforation area was repaired, the patient’s haemodynamic parameters were in
normal limits for 15-minutes. But then progressive bradycardia attack developed
and the patient died after 20 minutes.
Conclusion:
In blunt traumas, fast and detailed radiological examination should be made in

order to determine the affected organ system. Additionally, pericardial USG should
not be forgotten in haemodynamically unstable patients due to the possibility of
cardiac injury.
-403-
PP - 207 ACUTE ABDOMEN IN PREGNANCY REQUIRING SURGICAL
MANAGEMENT: A 20-CASE SERIES
MEHMET ZAFER SABUNCUOGLU 1, MEHMET FATIH BENZIN 1, GULSUM TOZLU 1,
ILKER GUNYELI 2, RECEP CETIN 1
1
2
SULEYMAN DEMIREL UNIVERSITY FACULTY OF NEDICINE DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY, ISPARTA, TURKEY
Background&Aims:
The obstetrician often has a difficult task in diagnosing and managing the acute
abdomen in pregnancy. The management of acute appendicitis during pregnancy
is not fully established and in case of perforated appendicitis during pregnancy are
considered surgical emergencies due to the potentially devastating outcomes for
both mother and fetus
Methods:
Fourty-seven pregnant patients with acute abdomen requiring surgical exploration
were reviewed from 2007 to 2011.Age ranged from 19 to 35 years and gestational
period ranged from 6 to 31 weeks.
Results:
US was done in all patients while MR and BT imaging was not used.Under general
endotracheal anesthesia, appendectomy was done in all of cases. Feeding was
allowed 6 h after surgery, and the majority of the patients were discharged on the
second postoperative day.There were no intraoperative or immediate postoperative
hazards.
Conclusion:
Pregnant women have a high NA rate.We recommend careful assessment and
imaging to avoid unnecessary exploration when appendicitis is suspected in
pregnant women. Standardization of diagnostic imaging protocols or algorithms
is essential. Until national imaging standards during pregnancy are established,
institutions can initiate their own evidence-based policies.US, when read as positive,
requires no further confirmatory test other than surgery.If US is nondiagnostic and
CT is not desirable due to fetal irradiation in first trimestri. MRI imaging without
gadolinium should be considered to avoid a negative appendectomy. In the second
and third trimesters, neigher MRI or CT scan should be used to confirm or exclude
the diagnosis. Post-operatively, the patient should be monitored for any bleeding
and thromboembolism, infection, and signs of fetal distress
-404-
PP - 208 FOTHERGILL AND CARNET SIGN IN EMERGENCY SERVICE ;
19 CASE SERIES
MEHMET ZAFER SABUNCUOGLU , MEHMET FATIH BENZIN , GIRAYHAN CELIK ,
TEVFIK BULBUL , RECEP CETIN

Background&Aims:
Rectus sheath haematoma (RSH) is classically described as a rare condition,

following a relatively benign course. Notable in its’ diagnostic difficulty. It is an
accumulation of blood in the sheath of the rectus abdominis, secondary to rupture
of an epigastric vessel or muscle tear.
Methods:
Retrospective review of a prospectively maintained patient database between

2001-2011 in Suleyman Demirel University General Surgery Department, nineteen
spontaneous RSH cases of rectus sheath hematoma presenting with a mass and
pain in the abdomen and diagnosed by computerized tomography who were on
anticoagulation therapy were reviewed..
Results:
All of the patients (100%) were receiving at least one form of anticoagulation
therapy. The most common presenting signs and symptoms were abdominal pain
and mass (77%). The diagnosis was made by abdominopelvic ultrasonography (US)
and computerized tomography (CT). CT showed 100% sensitivity. The majority of
patients (87%) were treated conservatively. Three patients (13%) were operated
Conclusion:
This case series indicates the increasing prevalence and severity of rectus sheath
haematoma, largely due to increased use of anticoagulant medication in an aging
population. Early diagnosis can help to avoid increased morbidity or unnecessary
surgical intervention
-405-
PP - 209 MESENTERIC ISCHEMIA
MEHMET ZAFER SABUNCUOGLU , GULSUM TOZLU , GIRAYHAN CELIK , TEVFIK
BULBUL , RECEP CETIN

Background&Aims:
Mesenteric ischemia is a relatively rare disorder seen in the emergency department

(ED); however, it is an important diagnosis to make because of its high mortality
rate.
Methods:
Acut mesenteric ischemia cases requiring surgical exploration in Suleyman Demirel

University Department of General Surgery were reviewed from 2001 to 2011
Results:
We identified 62 patients. mean age were 69. Revascularization was achieved by

embolectomy in 37 patients. In 48 cases were applied segmental ileal esection. It
has been 38 hospital deaths due to Multiple organ dysfunction syndrome (% 78)
and cardiac disease (% 22)
Conclusion:
Mortality rates range from 60-100%, depending on the source of obstruction. With
an aggressive diagnostic and therapeutic approach, mortality can be reduced. It is
essential to act early on clinical suspicion and not to wait for the development of
hard evidence
-406-
PP - 210 ARTERIAL EMBOLUS CAUSED BY A SMALL STONE AFTER A
EXPLOSIVE INJURY.
MUHARREM OZTAS 1, DEMİR CETİNTAS 2, HAKAN EMİRKADİ 3, SELİM TURKKAN 4,
HALİS ATİL ATİLLA 4, GOKHAN YAGCİ 5
1
SIRNAK MİLİTARY HOSPİTAL, DEPARTMENT OF SURGERY, SIRNAK, TURKEY
2
SIRNAK MİLİTARY HOSPİTAL, DEPARTMENT OF CARDİOVASCULAR SURGERY,
SIRNAK, TURKEY
3
SIRNAK MİLİTARY HOSPİTAL, DEPARTMENT OF ANESTHESİA, SIRNAK, TURKEY
4
SIRNAK MİLİTARY HOSPİTAL, DEPARTMENT OF ORTHOPAEDİC SURGERY, SIRNAK,
TURKEY
5
GULHANE SCHOOL OF MEDİCİNE, DEPARTMENT OF SURGERY, ANKARA, TURKEY
Background&Aims:
A trauma as a result of explosion, may cause vascular obstructive lesions by

retraction, spasm or thrombosis.
Methods:
We report the intraroperatif findings of a young trauma patient with arterial

occlusion caused by a foreign body embolus.
Results:
23-year-old male patient, had bringed to our emergency department with serious
tissue losses at his scrotum, right forearm, left hand, and both lower extremities.
The patient had been underwent urgent surgical operation. He was bleeding from
the right superficial femoral artery which was exposed at the groin site wound.
After bleeding control, we have realised that there was no arteriel flow below the
knee. We concluded to expose and arteriotomy of the popliteal artery to find the
occlusion cause. Fogarty catheter could not pushed forward distally. We exposed
the popliteal artery at this region and after arteriotomy, we realised that the
deformation and obsruction was caused by a small piece of stone. With the removal
of the stone, biphasic arteriel flow was seen distally by doopler ultrasound.
Conclusion:
Commonly, intra-arterial foreign bodies are seen as iatrogenic or as a result of

migration of the bullet in gunshot wounds. To the our knowledge this is the first
arteriel stone embolus caused by a battle field explosion.
-407-
PP - 211 MANAGEMENT OF LEFT-SIDED THORACOABDOMINAL
STAB WOUNDS
MUJGAN CALISKAN , METIN YUCEL , ISMAIL EGE SUBASI , ABDULLAH SISIK , AYLIN
ACAR , ADNAN OZPEK , GURHAN BAS , ORHAN ALIMOGLU

Background&Aims:
Patients with penetrating abdominal stab injury are frequently admitted to the
Emergency Unit. Left thoracoabdominal stab wound is an uncommon type of
ballistic injury that needs to be considered separately. In this study, we aimed to
present our experience in patients with left-sided thoracoabdominal stab wounds.
Methods:
Forty-seven patients with left thoracoabdominal stab injury admitted to our Clinic
between April 2009 and January 2012 were prospectively included in the study.
Patients with hemodynamical instability and/or development of peritonitis signs
underwent emergency laparotomy. At the end of the 48-hour follow-up period,
a diagnostic laparoscopy was performed in stable patients to examine the left
hemidiaphragm. Gender, age, injury location, surgical techniques and operative
findings were evaluated.
Results:
Forty-three out of 47 patients were males and the mean age was 29.3 years.
The location of the stab wounds was left thoracoabdominal in 38 patients and
left thoracoabdominal plus anterior in 9. Forty-one patients were managed
conservatively, while 6 underwent emergency laparotomy. Diagnostic laparoscopy
was performed in 35 patients; six did not wish to undergo the procedure and six
underwent laparotomy. In total, diaphragmatic injury was documented in 5 patients.
Conclusion:
The use of laparoscopy can be a usefull in order to avoid a missing diaphragmatic

injury.
-408-
PP - 212 SEAT BELT SYNDROME, A NEW PATTERN OF INJURY
IN A DEVELOPING COUNTRY. CASE REPORT AND REVIEW OF
LITERATURE.
MYFTAR TORBA 1, ARBEN GJATA 2, SKENDER BUCI 1, EDMOND FABER 1, KASTRIOT
SUBASHI 1
1
NATIONAL TRAUMA CENTRE, UNIVERSITY CENTRAL MILITARY HOSPITAL, TIRANA,
ALBANIA
2
DEPARTMENT OF SURGERY, UHC “ MOTHER TERESA” TIRANA, ALBANIA
Background&Aims:
Seat belt syndrome is a result of the pressure that seat belt causes during its curve.
Classically, it appears with seat belt sign in thorax and abdomen, bowel perforation
and lumbar spine fracture.
Methods:
We present a case of seat belt syndrome and review of literature.
Results:
A 34 year-old women is involved in a Motor Vehicle Crash, was admitted to our

hospital. She complained of severe full body pain. The physical examination
revealed an ecchymosis across the chest and a transverse abdominal abrasion. The
ultrasound detected free intra abdominal fluids. The x-ray examination showed
a fracture of the left humerus, the left femur and the right tibia. At laparotomy
revealed jejunum multi perforation, the seromuscular tear of the hepatic and
splenic flexure and a defect of abdominal wall. The primary suture was performed.
On the fifth day we performed osteosynthesis. The patient was discharged on the
15th postoperative day.
Conclusion:
The variety of organs damaged by seat belts includes all the possible combinations.
The abdominal pain in the polytraumatized patients with seat belt syndrome may
be dominated by the pain of extra-abdominal injuries. The presence of a seat belt
sign across the abdomen increases suspicions of abdominal injuries.
-409-
PP - 213 INTRA-ABDOMINAL HYPERTENSION AS A COMPLICATING
FACTOR IN POST-SURGERY PERIOD
NARIMAN KARAKURSAKOV , USEIN BASNAEV , ILYA GORYELOV, ALEXANDR KOSTIRNOY
CRIMEA STATE MEDICAL UNIVERSITY NAMED AFTER S. I. GEORGIEVSKY, UKRAINE
Introduction:
It is known that the increase in intra-abdominal pressure (IAP) can lead to MODS, which
can cause patient’s death.The purpose of this research project is to study clinical and
morphological changes in patients with intra-abdominal hypertension (IAH). In order to
do this the surgery department of CSMU named after S.I. Georgievsky conducted the
following experiment.
Case report:
The experiment involved 26 animals, divided into three groups.The first group (9
animals) had IAP increased for four hours. Three animals had IAH modeled at 15mm,
three – at 20mm, the final three - 25mm.The second group (9 animals) had similar
IAP modeling conditions, but the exposure lasted for 24 hours.The third group (IAH
of 25mm for 24 hours) was treated with solkoseril (0.3 ml/kg, i.m., twice a day) and
heparin (100 units/kg, subdermal, twice a day). Performed analyses: abdominal cavity
cultures, CBC, blood glucose, histological analysis of intestines, gaster, and kidney
parenhymatous tissue.
Conclusion:
The experiment showed that after four hours of isolated increase of IAP to 25mm,
bacteria translocate through intestinal tissue and the barrier function of intestines is lost
after 24 hour increase in IAP, even if the increase goes up to 15mm.The administered
therapy supported physiological barrier function of the intestines.
-410-
PP - 214 INFERIOR VENA CAVA LEIOMYOSARCOMA - A CASE
REPORT
NUNO FRANÇA , SOFİA VALENTE , DAVİD LOPES , CAROLİNA CATANHO , VİTOR
MOURA GUEDES , PEDRO PESTANA MARQUES , JOSé LUíS NUNES , JOãO RAPOSO
DÁLMEİDA
UNIDADE DE CIRURGIA GERAL - HOSPITAL DE PULIDO VALENTE, CHLN, PORTUGAL
Background&Aims:
Leiomyosarcoma is a rare tumor of the smooth muscle, which can occur in every
structure with this tissue. Only 2% of these tumors originate in the vascular system,
mainly in the venous system. Diagnosis and treatment is often late due to its lack
of symptoms.
Methods:
The authors report the clinical case of a 74 year old woman with epigastric pain as
her sole complaint. The CT scan revealed a solid nodular lesion compressing the
inferior vena cava.
Results:
The patient underwent tumorectomy resulting in partial excision of the inferior

vena cava. Pathology revealed a high malignancy grade leiomyosarcoma with
vascular origin. The patient had an unventfull recovery currently with no symptoms
on follow-up.
Conclusion:
The authors present a rare case of tumorectomy with partial vascular ressection
documented with radiologic and post ressection images. Radical ressection of
inferior vena cava leiomyosarcomas is considered to be the treatment with the best
5 and 10 year survival rates.
-411-
PP - 215 COMBINED SUBCUTANEOUS AND INTRATHORACIC
SPLENOSIS
ONUR TUTAR 1, PINAR KOCAEL 2, OSMAN ŞİMŞEK 2, KAYA SARIBEYOĞLU 2, SALİH
PEKMEZCİ 2
1
DEPARTMENT OF RADIOLOGY, İSTANBUL UNIVERSITY CERRAHPAŞA SCHOOL OF
MEDICINE, İSTANBUL, TURKEY
2
DEPARTMENT OF GENERAL SURGERY, İSTANBUL UNIVERSITY CERRAHPAŞA
SCHOOL OF MEDICINE, İSTANBUL, TURKEY
Background&Aims:
Splenosis refers to heterotopic autotransplantation and implantation of splenic

tissue,usually occurring after splenic trauma or surgery.It results from mechanical or
hematogenous autotransplantation and ectopic growth of splenic tissue, producing
nodular lesions in variable sites and organs of the body.A 42 year old woman was
referred to our emergency department cause of left flank pain and pulmonary
masses on a routine chest roentgenogram.History of the patient revealed a
penetrating(gunshot) left thoracoabdominal trauma 11 years ago.She reported that
her spleen had been removed and her diaphragm had been repaired at that time.
Methods:
Computed tomography and magnetic resonance imaging was requested on suspect

of splenosis.
Results:
Computed tomography and magnetic resonance imaging revealed nodular pleural

based lesions and nodular lesions in subcutaneous tissue of the left posterolateral
chest wall.
Conclusion:
Intrathoracic splenosis is a condition resulting from concomitant rupture of the

spleen and left hemidiaphragm.Fewer than 35 cases have been previously published
in English literature as this condition is a rare,to our knowledge.We present a patient
with intrathoracic and subcutaneous splenosis diagnosed on the basis of enhanced
magnetic resonance and computed tomography imaging.
-412-
PP - 216 THORACOSCOPY FOR THE DIAGNOSIS AND TREATMENT OF
PENETRATING THORACOABDOMINAL INJURIES
SALIH PEKMEZCI , KAYA SARIBEYOGLU , OSMAN ŞIMŞEK , BILGI BACA
ISTANBUL UNIVERSITY CERRAHPAŞA MEDICAL FACULTY EMERGENCY UNIT,

ISTANBUL, TURKEY
Background&Aims:
We present our series of patients undergoing thoracoscopy for the diagnosis and
treatment of penetrating thoracoabdominal injuries. Occult diaphragmatic injuries
are associated with significant mortality, if the diagnosis is delayed
Methods:
The patients who undergoing thoracoscopic management of thoracoabdominal

injuries between June 2001-June 2012 were included into the study. The data were
retrospectively analyzed.
Results:
Twentyeight selected patients with diagnosis and treatment thoracoabdominal

injuries were managed by thoracoscopy. Diaphragmatic injuries were repaired by
intracorporeal sutures in ten cases and bleeding was controlled in another three
cases by electrocautery coagulation. The procedures were simply diagnostic in
fourteen patients. The mean operating time and hospital stay were 31,75 minutes
and 4.4 days respectively. There was neither intraoperative or early postoperative
complication, nor mortality. In a patient who had intra thoracic adhesions due
to prior tuberculosis, unmentioned by the patient preoperatively, adequate
exploration could not be achieved during thoracoscopy. The procedure was
converted to laparoscopy
Conclusion:
Thoracoscopy seems to be a safe, quick and efficient method in the diagnosis and
treatment of diapragmatic wounds, due to thoracoabdominal penetrating injuries.
. It must be more frequently used as a therapeutic tool Trauma surgeons should be
aware of the benefits of thoracoscopy and must have sufficient skills to carry out
this technique.
-413-
PP - 217 A RARE CAUSE OF ILEUS : OMPHALOMESENTERIC DUCT
REMNANT ACCOMPANIED BY ILEAL DUPLICATION IN ADULT
ÖZGÜR DANDİN 1, HÜSEYİN SİNAN 2, AHMET ZİYA BALTA 3, İLKER SÜCÜLLÜ 3,
ERGUN YÜCEL 3, CAN BAŞARAN 5, ŞÜKRÜ YILDIRIM 4
1
2
ANKARA MEVKI MILITARY HOSPITAL GENERAL SURGERY SERVICE, ANKARA,
TURKEY
3
GULHANE MILITARY MEDICAL ACADEMY HAYDARPASA TRAINING HOSPITAL,
ISTANBUL, TURKEY
4
5
Introduction:
Small bowel obstruction is a common cause of surgical emergency. Persistent

omphalomesenteric duct causing small bowel obstruction is an extremely rare case.
Case report:
Our case was a 26 -year-old male patient without any medical history of previous
abdominal operation presented in our department with colicky abdominal pain,
vomiting, absence of passage of gas and feces for 48-hour duration. As a result
of investigation the patient was taken to the operating room with a diagnosis of
bowel obstruction. In exploratory laparotomy, approximately 10 cm length a fibrous
cordex tending from the posterior wall of the umbilicus to the mesenter of the small
bowel, justifying the suspicion of omphalomesenteric duct remnant was identified.
Ileal duplication was detected by the proximal of the obstruction accompanying.
The duct causing ileus was resected and the obstruction was resolved without
bowel resection. The patient was discharged on the seventh day after surgery with
surgical cure.
Conclusion:
Enteric duplications and omphalomesenteric duct remnants, in rare cases, are

congenital anomalies can be seen with. Omphalomesenteric duct remnants, in
cases of mechanical bowel obstruction without any history of previous abdominal
operation, is a pathology that should be remembered.
-414-
PP - 218 AKUTE APPENDICITIS BY AN INGESTED FOREIGN BODY
BATUHAN HAZER 1, ÖZGÜR DANDİN 2, DURSUN ÖZGÜR KARAKAŞ 3
1
KASIMPASA MILITARY HOSPITAL GENERAL SURGERY SERVICE, ISTANBUL, TURKEY
2
3
AĞRI MILITARY HOSPITAL GENERAL SURGERY SERVICE, AĞRI, TURKEY
Introduction:
Acute appendicitis is one of the most frequent causes of surgical abdominal pain
presenting to the Emergency Department. Accidentally or due to mental illness
ingested foreign bodies are common in general surgical practice. The presence of
needle in the appendix is usually asymptomatic or might cause abdominal pain, but
can rarely be associated with pathologic findings of acute appendicitis.
Case report:
A 20-year-old man was admitted with signs and symptoms of acute appendicitis
to our hospital. Ten days before admission a history of recent ingestion of the
foreign body (needle) was obtained from the patient. An abdominal radiograph
showed a metallic foreign body in the right lower quadrant. Computed tomography
scanning demonstrated a needle in the appendix. Appendicectomy was performed
laparoscopically. Dissection of the appendicolith revealed a needle. The pathological
examination showed a 7-cm long and 0.9-cm wide appendix with a needle inside
with an ulcerative appendicitis. The patient was discharged 3 day after surgery, with
no post-operative complications.
Conclusion:
A symptomatic appendicular foreign body will need an appendicectomy. Because

of the risk of perforation and since there was no spontaneous passage of the object
and the endoscopy had been unsuccessful, an appendicectomy was necessary to
remove the needle.
-415-
PP - 219 APPENDICEAL MUCOCELE MIMICKING UROLITIASIS
ÖZGÜR DANDİN 1, AHMET ZİYA BALTA 2, İLKER SÜCÜLLÜ 2, CAN BAŞARAN 5, EDİZ
TEVFİK ÖZGAN 3, ŞÜKRÜ YILDIRIM 4
1
2
GULHANE MILITARY MEDICAL ACADEMY HAYDARPASA TRAINING HOSPITAL
GENERAL SURGERY SERVICE, ISTANBUL, TURKEY
3
BURSA STATE HOSPITAL, GENERAL SURGERY SERVICE, BURSA, TURKEY
4
5
Introduction:
Appendiceal mucocele is a rare clinical condition that causes distension of the

appendix lumen with mucus. İt is only found in %0.1-0.3 of all appendectomy
specimens. Twenty-five per cent of the cases is asymptomatic and incidentally
discovered either during surgery or on radiologic examination. The treatment of
appendiceal mucocele is surgery and while appendectomy is usually sufficient, ,
in some cases right hemicolectomy may appear as a treatment option. Mucoceles
are histologically subdivided into four types: retension cysts, mucosal hyperplasia,
cystadenomas, and cystadenocarcinomas.
Case report:
Herein we present the appendiceal mucocele case, 62 year old female patient with
a complaint colicky right flank pain and once occurred macroscopic hematuria
clinically mimicking urolithiasis. The patient’s abdominal ultrasonography and
abdominal CT scan showed a mass consistent with mucocele side of the right lower
quadrant of abdomen. İn colonoscopy giving the impression of mass lesion pressure
from the outside was detected. The patient operated electively. Histopathological
diagnosis was reported mucinous cystadenoma.
Conclusion:
Appendiceal mucocele or mucinous cistadenomas are usually seen the patients

undergoing surgery with the diagnosis of appendicitis but as in our case, rarely,
may occur as with clinical picture that mimic the urological diseaseses.
-416-
PP - 220 LAPAROSCOPIC MANAGEMENT OF MECKEL
DIVERTICULUM CAUSING MASSIVE GASTROINTESTINAL BLEEDING
BATUHAN HAZER 1, ÖZGÜR DANDİN 2, DURSUN ÖZGÜR KARAKAŞ 3
1
KASIMPASA MILITARY HOSPITAL GENERAL SURGERY SERVICE, ISTANBUL, TURKEY
2
3
AĞRI MILITARY HOSPITAL GENERAL SURGERY SERVICE, AGRI, TURKEY
Introduction:
Meckel’s diverticulum is the most common form of congenital abnormality of the

small intestine and a rare cause of massive lower gastrointestinal hemorrhage in
adults. Half of Meckel’s diverticulum contains heterotopic mucosa which may cause
gastrointestinal bleeding and severe complications.
Case report:
A 20-year-old man was admitted with signs and symptoms of lower gastrointestinal
hemorrhage to our hospital. Endoscopic assessment failed to identify the source of
hemorrhage. His disease was developed with severe gastrointestinal bleeding and
he developed hemorrhagic shock soon. He underwent an emergent laparoscopy.
Laparoscopic exploration revealed meckel diverticulum arising from the distal ileum
and the presence of a large blood clot within the lumen. A meckel diverticulum was
removed by laparoscopic surgery. Following excision of the patient’s hemodynamic
parameters were seen to respond to resuscitation in a dramatic way. Histopathology
confirmed the presence of inflamed, congested heterotopic gastric mucosa within
the diverticulum.
Conclusion:
The treatment of massive and with hemodynamic unstable gastrointestinal bleeding

is surgery. No specialised tests are needed when there is clear clinical suspicion
and surgery must be performed without delay in emergency cases. In appropriate
patients and conditions exploration and definitive treatment done by laparoscopic
approach, is a good option to be preferred for massive gastrointestinal bleeding.
-417-
PP - 221 SPONTANEOUS INTRAPERITONEAL MIGRATION OF
KIRSCHNER NEEDLE: A CASE REPORT
OZLEM UYANIK , JESUS BOLLO RODRIGUEZ , CARLOS EDUARDO RODRIGUEZ LUPPI
, ION LUPU , JOSE LUIS PALLARES SEGURA , M. CARMEN MARTINEZ SANCHEZ ,
EDUARDO M. TARGARONA SOLER , MANUEL TRIAS FOLCH

Background&Aims:
The osteosynthesis material migration toward peritoneal o retroperitoneal space

has been described in patients who have undergone orthopedic surgery of pelvis
fractures. We present a case of Kirschner needle migration in to the peritoneal
cavity.
Methods:
Presentation of a patient who suffered a right hip traumatic fracture repaired with
Kirschner needle placement.
Results:
A 42 year-old male with history of traumatic acetabular fracture with dislocation of

right hip underwent orthopedic surgery realizing osteosístensis with plate-screws
and placement of two Kirschner needle, came to the emergency room for anal
pain during defecation since the postoperative third month. Physical examination
revealed left iliac fossa pain and the rectal examination palpation of a spiky area
on the left anterolateral rectal wall. Abdominal X-ray highlighted migration of the
Kirschner needle to the contralateral pelvic region and CT scan revealed the needle
being in intimate contact with the wall of the rectosigmoid without signs of visceral
perforation. We realized a small Pfannenstiel incision encountering the needle in
the intraperitoneal space.
Conclusion:
The migration of the osteosynthesis material is a rare complication but may result in
perforation of sigma or bladder, and vascular injury. In the appearance of proctalgia
migration complication should be discarded.
-418-
PP - 222 DOES THE GOLDEN SURGICAL TIMING EXIST IN
CALCANEAL FRACTURE? A RETROGRADE ANALYSIS OF SOFT TISSUE
COMPLICATIONS
PENGJU HUANG , YUHMİN CHENG
KAOHSIUNG MEDICAL UNIVERSITY HOSPITAL, KAOHSIUNG MEDICAL UNIVERSITY,

TAIWAN
Background&Aims:
Previous studies had proposed that surgical treatment of calcaneal fractures

should be delayed for 7 to 10 days due to challenging soft tissue management.
In our experience, we did not observe increased wound complication risks among
patients receiving early operation.
Methods:
We performed a retrospective analysis of the patients receiving open reduction

and internal fixation by one single operator in our medical unit between 2006 to
January, 2010. There were 57 patients with 63 calcaneal fractures collected in
this period. Among them, 51 patients and 54 calcaneal fractures received surgical
treatment via extended lateral L-shaped approach with internal plating. Patient
with open fracture, those receiving percutaneous pin fixation or direct subtalar
fusion were excluded in this series. We defined the timing of operation into four
groups: immediate (with 24hours), early (between 24hours to 72 hours), moderate
(72hours to 10 days), and late (more than 10 days). We observed post-operative
soft tissue complications in admission and out patient department follow up.
Results:
Only one case presented with wound complication in the early operation group
among all patients. The patient was in elder age with poor controlled diabetes
mellitus. Wound dehiscence complicated her wound and she received debridement
with implant removal three months after initial operation. There was no evidence of
elevated wound complication risks among immediate and early operated patients.
Conclusion:
In our study, immediate or early operation was not prone to cause higher rate
of wound complications. Early surgical treatment may warrant a shorter hospital
stay and reduce suffering in the post-traumatic pending period. To patients with
calcaneal fractures in need of open reduction and internal fixation, we suggest early
operation.
-419-
PP - 223 DAMAGE CONTROL STRATEGY IN PATIENTS WITH ACUTE
ABDOMINAL PATHOLOGY
PETRO POLENOK , ALEXANDER KOSTYRNOY
Background&Aims:
The strategy of damage control is used for the surgical treatment of patients with
multiple injuries. In our clinic, we have expanded the indications for damage
control and use it with generalized peritonitis, mesenteric thrombosis, pancreatitis,
intestinal obstruction, strangulated hernia and multiple trauma.
Methods:
The surgeon at the level of the casualty ward, using a scale developed in the clinic,
decides to conduct the patient with early total care strategy or damage control. If
there are indications for damage control, then the patient is immediately transported
to the operating room, where the source of infection, obstruction, thrombosis or
haemorrhage depending on the pathology is removed. In the anterior abdominal
wall is sewn specially designed structure that serves as a porthole, and allows
to see the changes occurring in the abdominal cavity. After that, to prevent the
development of multiple organ failure patient is transported to the intensive care
room, where within 12-48 hours conducted a massive infusion therapy directed
for stabilization of haemodynamic and other vital functions, followed by the final
surgical correction.
Results:
Reducing the mortality rate in the study group by 22%.
Conclusion:
Expansion and improvement of the damage control can significantly reduce

mortality in patients with complicated abdominal pathology.
-420-
PP - 224 VIDEOLAPAROSCOPIC DIAGNOSIS OF PERITONITIS
RASIM JAFARLI , BOYUKKISHI AGAYEV , ALINIYAZ MAMMADOV
SCIENTIFIC CENTER OF SURGERY, AZERBAIJAN MEDICAL UNIVERSITY, AZERBAIJAN
Background&Aims:
In patients of old age, diagnosis and treatment of peritonitis is more complex due to
age-related changes in the organism. To assess the capabilities of videolaparoscopy
in the diagnosis and treatment of peritonitis in patients of old age.
Methods:
The study includes 64 observations with peritonitis. Peritonitis include: thrombosis

of mesenteric vessels - 12 (18.7%); perforated gastroduodenal ulcers - 30 (46.9%),
acute appendicitis - 5 (7.8%), acute cholecystitis, 8 (12.5%), acute destructive
pancreatitis-7 (10.9% ); perforation of the sigmoid colon diverticulum - 3 (4.6%).
Results:
Videolaparoscopic signs of peritonitis were diagnosed in 61 (95.3%) patients.

In three (4.6%) cases, the diagnosis was not set videolaparoscopically. Given the
stable clinical endotoxemia, they were performed laparotomy. In one case there
was observed thrombosis of mesenterial vessels with enteric necrosis, in one -
destructive retroperitonial appendicitis and in one - perforation of the sigmoid colon
diverticulum. In 5 (7.8%) cases of pancreatitis-directed drainage of the abdominal
cavity. Laparotomy, the elimination of the source of peritonitis, lavage and drainage
of the abdominal cavity was performed in 54 (84.3%) patients. 3 patients died.
Postoperative mortality constituted 4.6%.
Conclusion:
Execution of videolaparoscopy in cases of obliterated course of purulent-

inflammatory process in the abdominal cavity which often occurs in elderly
patients, makes it possible to set more concrete diagnosis and perform therapeutic
measures, which in some cases may be final.
-421-
PP - 225 THE ANALYZE OF MEAN PLATELET VOLUME AND PLATELET
DISTRIBUTION WIDTH LEVELS IN APPENDICITIS
AKIN AYDOGAN 1, SECKIN AKKUCUK 1, SECIL ARICA 2, SEDAT MOTOR 3, ALI
KARAKUS 4, IBRAHIM YETIM 1, MUHIYITTIN TEMIZ 1
1
MUSTAFA KEMAL UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, HATAY, TURKEY
2
MUSTAFA KEMAL UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF FAMILY
MEDICINE, HATAY, TURKEY
3
MUSTAFA KEMAL UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF
BIOCHEMISTRY, HATAY, TURKEY
4
MUSTAFA KEMAL UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF
EMERGENCY MEDICINE, HATAY, TURKEY
Background&Aims:
We aimed to analyze the diagnostic value of mean platelet volume and platelet
distribution width, which are also known as the markers of platelet count, in acute
and perforated appendicitis.
Methods:
The data of 202 patients who applied to general surgery clinic in Mustafa Kemal
University Hospital from 2007 to 2012 with acute appendicitis were analyzed
retrospectively. The findings were separated to 2 groups due to the perforation
status (perforated vs non-perforated). Age, sex, leucocyte, hemoglobin, hematocrit,
MPV and PDW were examined.
Results:
The mean age of the patients was 35.8. Twenty-one of all cases were perforated
appendicitis (10.4 %) and the rest were acute appendicitis (non-perforated) (n=181,
89.6%). The mean MPV value was 9.8±2.1 fL, mean thrombocyte count was 340.9
x 109/L, and the mean PDW value was 18.3%. There were statistically significant
differences between sex and age, Hb, Hct, WBC, MPV, and PDW. There was positive
correlation between MPV, PDW and PLT. Age, WBC, PLT, MPV, and PDW were higher
in cases with perforation as a comparison with non-perforated cases.
Conclusion:
We think that MPV and PDW may be valuable markers to detect the risk of
perforation in early periods of acute appendicitis.
-422-
PP - 226 ACUTE KIDNEY INJURY IN EMERGENCY SURGICAL
PATIENTS: FREQUENCY, RISK FACTORS AND MORTALITY
AHMET OKUŞ , SERDEN AY , NERGIS AKSOY , ALI KARAGÖZ , MEHMET ALI
ERYILMAZ , ÖMER KARAHAN
KONYA TRAINING AND RESEARCH HOSPITAL, KONYA, TURKEY
Background&Aims:
Mortality and length of hospital stay increases in patients with the diagnosis of
acute kidney injury. This study aims to research the frequency of acute kidney injury
and etiologic factors in emergency surgical patients.
Methods:
The patients who were admitted to our clinic from emergency service or other
services were evaluated, prospectively. Among these patients, those having acute
kidney injury criteria among the patients whose creatinine values were determined
to be higher criteria and/or decrease was determined in urine delivery according
to RIFLE criteria were accepted as acute renal failure. Demographic characteristics
of the patients, accompanying diseases, ASA score and RIFLE score were written
down. Medical treatment and surgical treatments were arranged when necessary.
The length of hospital stay and hospital mortality of the patients was written down.
Results:
Of the 288 patients taken in the study, 16 were male and 25 were female, and acute
kidney injury was determined in 41 patients. The length of hospital stay was longer
and mortality was higher in the patients with acute kidney injury.
Conclusion:
The high ASA score, advanced age and having 3 and more associated diseases were
determined as risk factors for acute kidney injury in these patients.
-423-
PP - 227 FOURNIER GANGRENE: A SINGLE CENTER EXPERIENCE
SEYFİ EMİR 1, BURHAN HAKAN KANAT 1, FATİH MEHMET YAZAR 1, SELİM SÖZEN 2 ,
BURAK KAVLAKOĞLU 1
ELAZIĞ TRAINING AND RESEARCH HOSPITAL, ELAZIG, TURKEY

1
ADANA NUMUNE TRAINING AND RESEARCH HOSPITAL, ADANA, TURKEY

2
Background&Aims:
Fournier gangrene (FG) is a surgical emergency which is requiring debridement

and antibiotic therapy. The aim of this study was to share our experience of the
management and outcomes of patients with FG.
Methods:
We retrospectively reviewed the data of patients with FG. Eleven patients treated
for FG during an 8-years period
Results:
Eleven patients with FG (10 males, 1 female; mean age, 46 ± 12.3 years; range, 34-
64 years) were analyzed. The most frequent causes of infections were colorectal
diseases and urogenital diseases. The most common predisposing factors were
diabetes mellitus (54.5), anorectal abscess (18.1). All patients underwent surgical
debridement and diversion colostomy was necessary in 4 patients (%36.3). In 54.5%
reoperations were necessary for new surgical debridement. The overall mortality
was 9.09% (which was immunocompromised patient with diabetes mellitus).
Conclusion:
Surgery with extensive debridement of all necrotic is the main stay of treatment.
Early clinical identification and prompt, aggressive treatment are essential for
reducing mortality and morbidity in patients presenting with this disease.
-424-
PP - 228 POLYTRAUMA FROM ELECTRIC ARC. CASE REPORT AND
REVIEW OF LITERATURE
SKENDER BUCI , MYFTAR TORBA , ALI LILA , EDMOND FABER , KASTRIOT SUBASHI
NATIONAL TRAUMA CENTRE, UNIVERSITY CENTRAL MILITARY HOSPITAL, TIRANA,

ALBANIA
Background&Aims:
Electric arc injuries are rare and often life-threatening. These injuries are
accompanied with high morbidity and mortality. Treatment of electrical injuries is
complicated because of diagnostic difficulties related to determination of the depth
and extent of the damage.
Methods:
We present a case with electrical injury, benefit from surgical treatment in acute
phase and secondary surgery.
Results:
A 16-year-old boy damaged by electric arc, was admitted to our hospital two hours
after accident. He was in traumatic shock. On physical examination, we found
necrosis of the right arm and hand, defect of the abdominal wall 15 x 10 cm. At
laparotomy, rupture of colon ascendens and transverse, combustion of sixth liver
segment and peritonitis was found. Right hemicolectomy with protective ileostomy
was performed. On the third day, an economic amputation of the right arm was
done. In the following days we performed repeatedly necrectomy. Fifty days
later, plastic stump arm and abdominal wall was accomplished. In the 80-day, the
intestinal transit was placed.
Conclusion:
The risks of electric arc are immediate and delayed, often with invalidity
consequences. The treatment of electrical injury is multidisciplinary. Knowing the
risks and protective measures is the most important factor in preventing these
injuries.
-425-
PP - 229 FACTORS PREDICTING MORTALITY IN EMERGENCY
ABDOMINAL SURGERY IN THE ELDERLY
SUPREET GREWAL , IQBAL SINGH , PREETINDER BRAR , R P DOLEY , ATUL JOSHI ,
RAJEEV KAPOOR , J D WIG
FORTIS HOSPITAL MOHALI, INDIA
Background&Aims:
We studied factors predicting outcome of emergency abdominal surgery in elderly

patients.
Methods:
The study included 92 patients aged 65 years or older who underwent emergency
surgery for acute abdominal conditions over two years at Fortis Hospital , Mohali.
53 patients (57.6%) were male and 39 (42.4%) were female (mean age, 71.61 ±
6.939 years). Records of the patients were reviewed and comorbidities, operative
findings, morbidity , mortality were noted.
Results:
Of the 92 patients, 72(78.3%) had co-existing medical diseases; most patients had
hypertension (58.7%). The indications for surgery were intestinal obstruction n=
23(25%), intestinal perforation, n = 23(25%), gastrointestinal bleeding n = 13(14.1%),
cholecystitis, n = 11(11.9%), pancreatitis n = 7 (7.6%) , hernia n= 6 (6.5%). 67 patients
(72.8%) had complications, most frequent were pulmonary in 44(48.2%) patients,
cardiac in 29 (31.5%) and surgical site infections in 22 (23.9%) The median length
of stay was 12 days. Postoperative mortality was 19.6% (n= 18), causes being sepsis
7(7.6%), cardiac failure 6(6.5%), renal failure 1 (1.1%),respiratory failure 2(2.2%),
cereberovascular 2(2.2%). Presence of chronic obstructive pulmonary disease was
assocatied with increased postoperative mortality.(p= 0.05)
Conclusion:
Stage of the disease, and comorbidites were the factors for unfavourable outcome.
It is safe to operate on elderly.
-426-
PP - 230 HORSESHOE APPENDIX: A RARE ANOMALY
ŞAHİN KAHRAMANCA 1, HAKAN GÜZEL 1, İBRAHİM ÇOLHAN 2, GAYE ŞEKER 1,
BURAK İREM 1, TEVFİK KÜÇÜKPINAR 1
1
DISKAPI YILDIRIM BEYAZIT RESEARCH AND TRAINING HOSPITAL GENERAL
SURGERY CLINIC, ANKARA, TURKEY
2
SIIRT KURTALAN HOSPITAL GENERAL SURGERY, SIIRT, TURKEY
Background&Aims:
Appendiceal anomalies are rare malformations and a few adult cases of appendix
duplications have been reported. Here we present a case of horseshoe appendix.
Methods:
A 70 year old man who had hypertension, pulmonary hypertension, acute renal
failure and policytemia vera, was admitted to emergency department with right
lower quadrant pain.
Results:
The patient was operated with diagnosis of acute appendicitis. On exploration an

inflamed horseshoe shaped appendix was found and removed.
Conclusion:
The incidence of appendix duplication is 0,004-0,009 % and may be associated

with other anomalies. An emergency surgeon should keep in mind the anomalies
of appendix. Although appendiceal duplication is uncommon, its mismanagement
may lead to unfavorable consequences. Our case seems to be the fourth case of
horseshoe appendix and the oldest patient reported in literature.
-427-
PP - 231 A 75 YEAR OLD MALE WİTH AUGMENTATİON
ENTEROCYSTOPLASTY STORY AND ACUTE ABDOMEN:
SPONTANEOUS PERFORATİON 15 YEARS AFTER THE PROCEDURE
ÜMİT ALAKUŞ 1, AYTEKİN ÜNLÜ 1, MURAT URKAN 1, ALİ HARLAK 1, MEHMET
SERİNDERE 2
1
ANKARA, TURKEY
2
DEPARTMENT OF RADIOLOGY, GÜLHANE MILITARY MEDICAL ACADEMY, ANKARA,
TURKEY
Introduction:
Csytectomy and augmentation cystoplasty procedures are performed for various

benign and malignant bladder diseases. We, hereby, present a case that perforated
spontaneously fifteen years after augmentation cystoplasty.
Case report:
A 75-year-old male presenting with acute abdomen was admitted to our clinic. He
had a previous history of augmentation enterocystoplasty procedure after malignant
tumor resection of the urinary bladder. Oral contrast-enhanced abdominal CT scan
showed free fluid in the abdomen. The surgical exploration revealed a perforation
on the antimesenteric wall of the augmented bladder and purulent intraabdominal
fluid. During the laparotomy, we also observed that the wall thickness of the
augmented bladder was dimished significantly. We repaired the perforation
primarily and the abdomen was irrigated. The foley catheter was used for 4 weeks
in the postoperative period. The patient received parenteral sefaperazon-sulbactam
treatment and was discharged after an uneventfull clinical follow up.
Conclusion:
Augmented bladder perforation is a life-threatening condition with a rate of 5-13%.

It usually presents with acute abdominal pain, oliguria-anuria and sepsis. Related
literature data show that the perforation may occur between the range of 6 months
to 12 years, postoperatively. In our case, the perforation occured 15 years after the
bladder reconstruction.
-428-
PP - 232 DIAGNOSTICAL AND SURGICAL TACTILE MISTAKES DURING
DIAPHRAGM INJURY
ZURAB CHKHAIDZE , TAMAZ GVENETADZE , ARCHIL TSKHVEDADZE , ZURAB TUZBAIA,
DAVID TOPHURIA
TBILISI STATE UNIVERSITY MEDICAL FACULTY, GEORGIA

Background&Aims:
The simultaneous damage of thorax and abdominal cavity always accompanied by
shock, in result of thoracic cavity organs damage usually observed; Dyspnea, cough,
pain in thorax and hemoptysis, commonly these symptoms accompanied by clinical
findings in abdominal cavity; abdominal muscle rigidity and symptoms of peritonitis,
in these case always will be injury of diaphragm. One of the most complex aspects
of modern polytraum surgery is, on time diagnosis and treatment of diaphragm
damage, by literature findings such cases are observed in o,5-5.0% of all heavy
complex traumas. In about 50% of patients with such lesion additionally accompanied
with ribs fracture, cranial trauma, pelvic fracture, damage of 3-5 anatomical regions.
Diagnostical and tactical mistakes during diaphragmal injurys commonly predicted
by: 1. Doctors and s medical stuff,s alertless and noncompotency 2. During acute
traumatic illness clinical symptoms usually less evident. 3. Low informatillity of x-ray
diagnostical methods.
Methods:
In Tbilisi national medical center during 2003-2012 years we experienced 20 patients
between 15-70 years old, with diaphragmal injury, males were 15(75%) and females
5(25%), diaphragmal lesion was observed on left side in 17 (83.3%) and in 3(16.7%) on
right side. The main cause of injury in 17 (83.3%) was car accident trauma, in 3(16.7%)
cause was fall from the height.
Results:
1. During polytraum with 3-4 anatomical regions damage, diaphragm injury rate is very
high, the algorithm of diagnostical and treatment procedures must be forwarded to
exclude or to postulate diaphragm damage. 2.Clinical symptoms of diaphragm injury
during acute stage of traumatic illness are not so evident due of trauma heaviness and
x-ray diagnostical methods are less informative.
Conclusion:
During acute stage of traumatical illness in 36.6% of patients with diaphragm injury
happens dislocation of abdominal organs into pleural cavity, which in manifesters
by cardiorespiratory syndrome, and by dislocation of mediastinum to health side
of diaphragm.The main cause of diagnostical mistakes and high lethal outcome are;
Doctors and s medical stuff,s alertless and noncompotency, x-ray diagostical methods
low informatility. Most informative diagnostical methods during diaphpagmal injurys
are laparo-and thoracoscopy
-429-
PP - 233 FACTORS AFFECTING MORBIDITY AND MORTALITY IN
HOLLOW VISSERAL INJURIES FOLLOWING BLUNT ABDOMINAL
TRAUMA
ZULFU ARIKANOGLU , AHMET TURKOGLU , FATIH TASKESEN , BURAK VELI ULGER ,
OMER USLUKAYA , OMER BASOL , MUSTAFA ALDEMIR
DEPARTMENT OF GENERAL SURGERY, DICLE UNIVERSITY FACULTY OF MEDICINE,

DIYARBAKIR, TURKEY
Background&Aims:
Hollow visseral injuries following blunt abdominal trauma are uncommon. The
potential risk factors affecting morbidity and mortality are not well known. The
purpose of our study was to evaluate the outcomes of hollow viscus perforation
after blunt abdominal trauma.
Methods:
Patient files of 56 adult patients who were treated with diagnosis hollow viscus
injuries due to blunt abdominal trauma between the years 2000 and 2011 at
the Dicle University Medical School General Surgery Clinic were retrospectively
evaluated by analyzing the relationship between morbidity-mortality and potential
risk factors.
Results:
Fifty-six patients formed the study group, with median age of 37.5±17,0 (range,
16–78) years and a significant male (80.3%) predominance. The median Injury
Severity Score was 4 (1-25). The median length of hospital stay 7.5 (1-21) days. The
mean age in the group with morbidity (47.1±17.4) was significantly higher than
the group without morbidity (34,3±15,8) (p<0.05). Also, re-operation (p=0.0013),
treatment modality (p=0.037), cause of injuries (0.0046) were other factors that
affect morbidity.
Conclusion:
These findings suggest that factors affecting morbidity were cause of injuries, re-
operation and treatment in patients with hollow viscus injury caused by blunt
abdominal trauma. And factors affecting mortality were the injured organ, the
presence of shock and median injury severity score.
-430-
PP - 234 THE COMPARISON OF CLOSURE METHODS OF THE
APPENDICEAL STUMP IN LAPAROSCOPIC APPENDECTOMY: A HIGH
VOLUME INSTITUTION’S EXPERIENCE
AHMET CEM DURAL , MURAT GONENC , NURETTIN SAHIN , ILHAN GOK , MEHMET
KARABULUT , CEVHER AKARSU , MUSTAFA U. KALAYCI , HALIL ALIS

Background&Aims:
We aimed to compare the safety of two methods (intracorporeal knotting and metal
endoclip application) for closure of the appendiceal stump during laparoscopic
appendectomy (LA).
Methods:
The patients who underwent LA from January 2008 to June 2012 were evaluated in
this retrospective study in terms of demographics, closure method of the appendiceal
stump, operative time, intraoperative and post-operative complications, length of
hospital stay. Exclusion criteria were the use of Hem-o-lok clips and linear stapler or
the use of more than one closure method.
Results:
A total of 1515 LA performed and 137 of the procedures were excluded from the
study. Complicated appendicitis rate was 14.3% (n=198). Metallic endoclipping
group (ME) and intracorporeal knotting group (IK) included 1097 and 281
patients, respectively. The rate of postoperative complications in ME and IK was
4.6% (50/1097) and 6.7% (19/281) (p=0.13).The mean operative time and length
of hospital stay were significantly shorter in ME group (p<0.001 and p<0.001
respectively). The distribution of complicated appendicitis between two groups was
imbalanced (ME:10.1%, IK:30.6%) and the complication rates were 14% and 11.6%
respectively (p=0.58).
Conclusion:
The closure of the appendiceal stump by metallic endoclipping is at least as safe as

intracorporeal knotting during LA with comparable perioperative morbidity rates.
-431-
PP - 235 URETHROCUTANEOUS FISTULA: A LATE RECOGNIZED
COMPLICATION OF CIRCUMCISION
KAZIM DUMAN 1, GÜVEN YİĞİT 1, BULENT SEN 2, MEHMET LEVHİ AKIN 3
1
GUMUSSUYU MILITARY HOSPITAL DEPARTMENT OF SURGERY, ISTANBUL, TURKEY
2
GUMUSSUYU MILITARY HOSPITAL, DEPARTMENT OF UROLOGY, ISTANBUL,
TURKEY
3
HAYDARPASA TEACHING HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Urethrocutaneous fistula is one of the rare complications encountered after

circumcision.We aim of this study was to quote this case as an axample
Methods:
A 25 year old male patient had been circumcised when he was 7 years old in a
rural area mass circumcision event. Althought the patient had had complaints
since the circumcision, he had considered those symptoms to be normal. Physical
examination showed a fistula tract, approximately 2 cm. long, at the subcoronal
level. Distal portion of the fistula was checked with a 16 F nelaton catheter. No
stricture was found up to the bladder. The patient under went urethrocutaneous
fistula repair under spinalanesthesia.
Results:
In our case, primary repair and dartoscoverage was used be cause the proximal
portion of the fistula was open up to the external meatus, and the fistula tract was
rather large. The most important criterion of success in primarily repaired cases is
tension-free anastomosis, as stated by Lau et al.
Conclusion:
As it may cause many simple or grave complications if performed incorrectly,

circumcision should be performed by experienced surgeons. We also believe that
monitoring of complications in mass circumcision campaigns is rather inadequate.
Circumcision by unauthorised performers stil constitutes a large percentage in our
country.
-432-
PP - 236 A NEW TECHNIQUE FOR PARTIAL SPLENECTOMY WITH
RADIOFREQUENCY TECHNOLOGY
KURSAT KARADAYI , MUSTAFA TURAN , METIN SEN
CUMHURIYET UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL

Background&Aims:
Management of splenic injury has changed markedly over the past few decades
with strong emphasis on spleen preservation rather than splenectomy. Partial
splenectomy is not routinely practiced because of the lack of vascular control to
arrest bleeding once the tissue is cut. Although various surgical techniques are
available for spleen preservation, results have been less satisfactory because of
significant risk of intraoperative and postoperative hemorrhage
Methods:
Twelve patients were included in this retrospective study. Patients who underwent
a splenic preservation procedure with RF between June 2009 and April 2012
were analyzed retrospectively. Data were collected from the hospital records of
the patients. We performed affected pole vascular clamping routinely during the
procedures After a demarcation line was seen, a harrow-like 6-needle (electrode) RF
probe (SURTRON SB, Laboratory for Electronic Design Spa, Aprilia, Italy) was applied
to the spleen through this magrin. Once the tissue was ablated, the division of the
splenic parenchyma was completed using a surgical scalpel through the midline of
the ablated tissue.
Results:
Six of the patients were men, whereas 6 were women. Four of the cases were
performed in elective situations, whereas the other 8 procedures were performed
to control bleeding as a result of splenic trauma in emergency situations. The
median age of the patients was 45 years in elective cases and 33 years in emergency
cases. The duration of hospitalization was 5±1 days. The average blood loss was
25±5mL. There was also detected no problem in the control examinations of the
patients, which were performed 1 and 2 months after the procedure.
Conclusion:
RF ablation can be a useful adjunct in partial splenectomy. This safe, fast, and simple
technique allows for preservation of splenic function with minimum blood loss in
suitable cases.
-433-
PP - 237 THE EFFECTS OF SILDENAFIL IN REMOTE ORGAN INJURY
IN A RAT MODEL OF SEVERE SCALD BURN: A BIOCHEMICAL AND
HISTOPATHOLOGICAL STUDY
ALI KAGAN GOKAKIN 1, KOKSAL DEVECI 2, ATILLA KURT 1, MUSTAFA AATBEY 1,
MEHMET TUZCU 3, OMER TOPCU 1
1
2
BIOCHEMISTRY, TURKEY
3
CUMHURIYET UNIVERSITY FACULTIES OF VETERINARY, DEPARTMENT OF
PATHOLOGY, SIVAS/TURKEY
Background&Aims:
Severe burn induces systemic inflammation and reactive oxygen species that leads to
lipid peroxidation which may play a role in remote organ injury. Sildenafil is a selective
and inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5.
Sildenafil reduces oxidative stress and inflammation in distant organs. Our aim was
to evaluate the effects of sildenafil in remote organ injury as a result of burn injury.
Methods:
and were randomly divided into three equal groups as follows: Control, 10, and
20 mg/kg sildenafil groups. Levels of malondialdehyde (MDA), vascular endothelial
growth factor (VEGF), VEGF receptor (Flt-1) and activities of glutathione peroxidase
(Gpx) and catalase (Cat), levels of total antioxidative capacity (TAC), and total
oxidant status (TOS) were measured in tissues, whereas TAC,TOS, VEGF, and Flt-
1 were measured in serum. A semi-quantitative scoring system was used for the
evaluation of histopathological findings.
Results:
Sildenafil increased tissue levels of Gpx, Cat and Flt-1, but decreased MDA and VEGF
levels. Sildenafil also increased serum levels of TAC and Flt-1 and decreased TOS,
OSI, and VEGF. Sildenafil decreased inflammation scores in remote organs.
Conclusion:
Sildenafil has protective effects in severe burn-related remote injuries by decreasing

oxidative stress and
-434-
PP - 238 DOES INCREASE OF INTRAOCULAR PRESSURE REFLECT THE
INTRA-ABDOMINAL PRESSURE?
ILHAN ECE 1, CELALETTIN VATANSEV 2, TEVFIK KÜÇÜKKARTALLAR 2, AHMET TEKIN 2,
ADIL KARTAL 2, MEHMET OKKA 3
1
KONYA ANIT HOSPITAL, GENERAL SURGERY, KONYA, TURKEY
2
NECMETTIN ERBAKAN UNIVERCITY, DEPARTMENT OF GENERAL SURGERY, KONYA,
TURKEY
3
NECMETTIN ERBAKAN UNIVERCITY, DEPARTMENT OF EYE SURGERY, KONYA,
TURKEY
Background&Aims:
The aim of this study is to explore the use of intraocular pressure measurement in
the early diagnosis of abdominal compartment syndrome,a serious complication
following trauma or surgery.This method is non-invasive,easy to learn and without
any additional burden to the patient.
Methods:
Forty patients at the faculty hospital were recruited into the study,divided into four
groups of 10 patients each.The control group was not subjected to laparascopic
intervention. Laparascopic surgery was performed with an intra-abdominal pressure
of 9,12 and 15 mmHg in Groups 2,3 and 4,respectively. Pressure was measured
binocularly in each patient before induction, after intubation and before waking.
Results:
A significant difference (p <0.05)related to intubation was found between the first

and second measurements in all groups. A difference (p <0.05) between the basal,
and the last measurements was seen only in groups 3 and 4. A significant difference
was also found when comparing the 3rd measurement in Group 4 to those of
groups 1 and 2. Comparison of results across groups showed similarities in Groups
1 and 2,and also between Groups 3 and 4.
Conclusion:
Intraocular pressure was increased in the groups with an intra-abdominal pressure

of 12 mm Hg or more. Measuring the intraocular pressure is a reliable, significant
method for monitoring intra-abdominal pressure
-435-
PP - 239 SPONTANEUS SPLENIC RUPTURE
PINAR KOCAEL 1, OSMAN ŞIMŞEK 1, ISMAIL AHMET BILGIN 1, ONUR TUTAR 2, KAYA
SARIBEYOĞLU 1, SALIH PEKMEZCI 1
1
DEPARTMENTS OF GENERAL SURGERY, ISTANBUL UNIVERSITY CERRAHPASA
SCHOOL OF MEDICINE, ISTANBUL, TURKEY
2
DEPARTMENTS OF RADIOLOGY, ISTANBUL UNIVERSITY CERRAHPASA SCHOOL OF
MEDICINE, ISTANBUL, TURKEY
Background&Aims:
Spleen rupture without trauma is known as spontaneus splenic rupture and it can
be fatal. It is a rare pathology which can be pathological or idiopathic in nature.
Etiological factors are infectious, neoplastic and hematological disorders. The aim
of this study is to determine symptoms, etiologic factors and our clinical experinece
in patients with spontaneus splenic rupture.
Methods:
January 2000 and March 2012, Data, surgical details and patologic results of eleven
patients were admitted to emergency with complaints of abdominal pain and
diagnosed spontaneus splenic rupture was recorded.
Results:
Four of patients were female and seven were male. All of patients had complaints
of abdominal pain. Nine of patients had hypotension. Ten patients underwent
splenectomy. One was conservatively treated. The etiological factors was
determined in six patients. These were usage of warfarin and dispril, presence of
amiloidos, hairy cell leukemia, diffuse large cell leukemia, and factor 13 deficiency.
One of patient died on postoperative sixth day who had history of hepatic cirrhosis.
Conclusion:
It must be keep in mind that, although rare, in the emergency department patients
with abdominal pain, hypotension, presence of history of hematological, infectious
disorders, usage of anticoagulants and antiaggregant, spontaneus splenic rupture
must be considered in differential diagnosis.
-436-
PP - 240 HOW CAN WE BE MORE CONSERVATIVE WHEN
PENETRATING ABDOMINAL STABBING PATIENT COMES
SELİM BİROL 1, AKGUN CELİK 2, EKREM FERLENGEZ 3, AHMET BEKİN 1, AYSUN
SİMSEK CELİK 4, SÜLEYMAN BOZKURT5, İ. RAFET KAPLAN 6
1
MALTEPE PUNISHMENT AND EXECUTION INSTITUTION STATE HOSPITAL,
ISTANBUL, TURKEY
2
PRIVATE SAFA HOSPITAL,GENERAL SURGERY, ISTANBUL, TURKEY
3
AKYAZI STATE HOSPITAL, GENERAL SURGERY, ISTANBUL, TURKEY
4
HAYDARPASA TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY DEPT. ,
ISTANBUL, TURKEY
5
BEZMİALEM FOUNDATION UNIVERSTY, GENERAL SURGERY DEPT. , ISTANBUL,
TURKEY
6
HASEKI TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY DEPT. ,
ISTANBUL, TURKEY
Background&Aims:
Untill the end of the 1970’s abdominal penetrating stab wound had been an absolute
indication for explorative laparotomy, however high rate of negative laparotomies
brought and evolved the idea of conservative treatment in these patients. Our aim
is to review our penetrating abdominal stab patients so that we shall chose those
who are apropriate for conservative therapy easier in the future, which is the only
way to prevent negative laparotomy.
Methods:
We evaluated 87 patients with abdominal penetrating stab injury who had

admitted the Emergency Clinic of Bezmi Alem Vakıf Gureba Hospital between the
years 2008 and 2010 retrospectively. All the reports, blood test results, radiology
reports,physical examination charts of first admission to emergency clinic as
well as operation reports of those who had underwent surgery were rewieved
retrospectively. All the abdominal stab wounds were classified into 9 abdominal
regions which are hipocondriums, epigastrium, lomber regions, paraumbilical
region, inguinal regions and hipogastrium. Injured visceral organ number per
stabbing region for each patient was exctracted from the surgery reports. Operated
patients with no visceral injury or these with only omental injury, these with small
vessel injury as well as patients with only serosal gatsric and intestinal injury were
recorded as negative laparotomy patients. Hospital stay was another parameter
that was taken in account.
-437-
Results:
48 of the 87 patients admitted were operated whereas 39 were conservatively

treated. The negative laparotomy rate for operated patients was 33% (16/48).
The most dangerous abdominal region for conservative therapy was the right
hipocondrium with the rate of 0.94 organ injury per region. The most reliable regions
for conservative therapy were hipogastrium, left lomber region, left hipocondrium
and right inguinal regions with the rate of; 0.00, 0.30, 0.31 and 0.33 injured
organ per region. Left hipocondrium was also the most common site in negative
laparotomy patients. Mean hospital stay periods of operated and conservatively
treated patients were 4.69 vs. 2.62 days (p=0.001). Only 37 of 87 patients was
sent to the radiology department for abdominal imaging. There was no statistical
difference between blood results of operated and conservatively treated patiens. In
patients with two or three of all three abdominal examination findings ( tenderness,
guarding and rebound) the negative laparotomy rate was 20% (5/25), while it was
57% in patients with only one abdominal finding.
Conclusion:
Neither blood results like hemotrocrit level, leukocyte count, and amilase level
nor abdominal imaging modalities like ultrasound and computed tomography
were statistically significant parameter in helping the surgeon to make the choise
between conservative or surgical therapy. Though right hipocondrium has a very
high injured organ/region rate and deserves more agressive approach in our series,
the other 8 regions have quite low rates when compared. Only the abdominal
examination findings which are tenderness, guarding and rebound seemed to be
statistically significant in distinguishing between patients needed to be operated
or conservatively followed. Serial abdominal examinations by the same surgeon
who first had examined the patient was found to be the single most important
parameter to help for the right choise of the therapy.
-438-
PP - 241 LOCAL THROMBOLYTIC THERAPY IN ACUTE MESENTERIC
ISCHEMIA
FATIH YANAR 1, ORHAN AGCAOGLU 1, MURAT AKSOY 2, I. SAMIL SARICI 1, HAKAN
YANAR 1, ENVER OZKURT 1, EMRE SIVRIKOZ 1, MEHMET KURTOGLU 1
1
ISTANBUL UNIVERSITY, ISTANBUL MEDICAL FACULTY, DEPARTMENT OF GENERAL
2
VKV AMERICAN HOSPITAL, DEPARTMENT OF PERIPHERAL VASCULAR SURGERY,
ISTANBUL, TURKEY
Background&Aims:
The aim of the study was to evaluate the local thrombolytic therapy (LTT) in
combination with laparoscopy in management of acute mesenteric ischemia (AMI).
Methods:
From January 2000 to January 2010, 76 patients were admitted to the hospital
with AMI due to acute arterial occlusion. LTT was performed in 13 (17.1%) patients.
The median age was 62 years (45-87). There were 11 (84.6%) males and 2 (15.4%)
females. LTT was carried out before or after laparoscopy or laparotomy.
Results:
The median duration of symptoms was 24 hours. Four (30.7%) patients presented
within 24 hours of onset of symptoms, whilst 9 (69.3%) patients presented after 24
hours of the onset of symptoms. There were 5 (39.5%) patients, who presented with
abdominal pain without peritoneal signs on physical examination and 8 (61.5%)
patients, who had peritoneal signs. The mortality rate was 20% (1/5) in the first
group, whilst it was 62.5% (5/8) in the latter group of patients.
Conclusion:
Early intervention in AMI is the key to better results. Computerized tomography

angiography combined with early laparoscopy and LTT may have beneficial effects
at this setting.
-439-
PP - 242 NECROTIZING FASCIITIS - A CHALLENGE TO THE SURGEON
ALINE GOMES , JúLIO CONSTATINO , CONCEIÇãO MARQUES , LUIS FILIPE PINHEIRO
SERVIÇO CIRURGIA 1 CENTRO HOSPITALAR TONDELA VISEU, PORTUGAL
Background&Aims:
Necrotizing fasciitis (NF) is a rare infection of the fascia and soft tissues, rapidly
progressive and life-threatening. In its early stage, requires a high level of diagnostic
suspicion, because it can be difficult to differentiate from any other infections of the
skin and soft tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC)
is a useful tool that can help in the diagnosis ( > 6 - moderate to high risk ).
Methods:
We present 14 patients with NF that were admitted in our Department of Surgery,

between October 2004 to October 2009.
Results:
NF was initially suspected in 12 patients and promptly resulted in large debridement.

The other two were admitted with septic shock and died in the next 24 hours. Seven
patients didn’t have co-morbidities. The mean hospitalization duration was 44.5
days. Nine patients required re-operation and seven were admitted in the ICU. The
overall mortality was 5 patients, mostly associated with Streptococcus pyogenes
infection. Thirteen patients had a score > 6 at admission.
Conclusion:
NF can occur in otherwise healthy individuals, after minor trauma or without any
identifiable cause. Prognosis depends on early diagnosis and aggressive treatment.
Morbidity is often associated with mutilation. Treatment is difficult, resources and
time consuming and requires a multidisciplinary approach.
-440-
PP - 243 AN UNEXPECTED POSTOPERATIVE COURSE OF A YOUNG
PATIENT UNDERVENT APPENDECTOMY IN A SMALL STATE
HOSPITAL:NEGATIVE PRESSURE PULMONARY EDEMA
FATMA UMİT MALYA
TOSYA STATE HOSPİTAL, KASTAMONU
Background&Aims:
Negative pressure pulmonary edema is a form of non cardiogenic pulmonary edema

which is a potentially life threatining complication in which pulmonary edema
occurs following any surgery in which patient was intubated . İn this article we
aimed to mention on this rare syndrome and it’ s management in poor conditions.
Methods:
A 18 years-old man presenting with acute apendicitis was taken to the operating
room. During general anesthesia he received 1000ml of Ringer’s lactate with 400
ml of urine output
Results:
6 hours after surgery he had respiratory distress, tachipnea; bilateral rales and ronci
on oscultation and frothy pink pulmonary secretions. His SpO2 was 60-80% on
room air. Observing bilateral alveolar infiltrations on chest radiography , the patient
treated with 6-8ml/minutes O2 via facemask, 40mg furosemid, 40 mg prednisolone
intravenosly. Control chest radiograpy revelead a dramatic resolution of infiltrative
findings. He was discharged on the 3th postoperative day.
Conclusion:
Negative pressure pulmonary edema is well known to develop with acute upper
airway obstruction. It is reported more commonly in young patients after surgery
when laryngospasm complicates extubation . It is importante to say that the early
detection of the signs of this syndrome is vital to the treatment and to patient
outcome.
-441-
PP - 244 ANALYSES OF MORTALITY RELATED TO TRAUMA
ADNAN ÖZPEK , MÜJGAN ÇALIŞKAN , METİN YÜCEL , İBRAHİM ATAK , ABDULLAH
ŞİŞİK , SÜLEYMAN KALCAN , GÜRHAN BAŞ , ORHAN ALİMOĞLU
DEPARTMENT OF GENERAL SURGERY, ÜMRANİYE EDUCATION AND RESEARCH

HOSPITAL, ISTANBUL, TURKEY.
Background&Aims:
Mortality related to trauma affects more frequently the young population group
(0-44 years). In this study, we aimed to analyze the mortality rates in traumatized
patients treated in our clinic.
Methods:
Four hundred fifteen patients suffering from stab wounds (SW), gunshot wounds
(GSW) and blunt trauma injuries who were admitted to our Surgical Clinic between
January 2009 and June 2012 were prospectively included in the study. Patient
demographics and mortality rates were evaluated.
Results:
Of a total of 415 patients; 354 (85.3%) were males, 61 (14.7%) were females and the
mean age was 33.1 (3-81). Blunt trauma was documented in 197 patients (47.6%),
SW in 186 (44.7%) and GSW in 32 (7.7%). Surgery was performed in 35 patients
with blunt trauma (17.7%), in 38 (20.4%) with SW and in 17 (53%) with GSW. Totally,
90 patients (21.7%) underwent surgery. Mortality occurs; in 18 patients with blunt
trauma (9.1%), in 3 with SW (1.6%) and in 3 with GSW (9.4%). Total mortality rate
was 5.8% (n=24).
Conclusion:
SW were associated with a lower mortality rate compared with blunt trauma
and GSW (%1.6). Additionaly, an accompanying thoracic and pelvic trauma in
patients with blunt trauma and an accompanying thoracic trauma in patients with
penetrating trauma increased mortality rates.
-442-
PP - 245 APPENDICEAL MALIGNANCY: REVIEW OF
HISTOPATHOLOGICAL FINDINGS IN 4,108 APPENDECTOMY
SPECIMENS.
EMRE SIVRIKOZ , PEDRO TEIXEIRA , KENJI INABA , LYDIA LAM , PEEP TALVING ,
DEMETRIOS DEMETRIADES

Background&Aims:
Malignancies are an uncommon histopathological finding in surgical specimens

after appendectomy for suspected appendicitis. We aimed to identify the incidence
and types of malignancy identified in appendectomy specimens.
Methods:
This is a retrospective review of all patients undergoing appendectomy for suspected

appendicitis from July/2003 to June/2011. Patient characteristics abstracted
included age, gender, admission white blood cell count (WBC), pathology report.
Imaging studies performed in cases with appendiceal malignancy were reviewed.
Logistic regression was performed to identify possible predictors of malignancy.
Results:
4,108 patients underwent appendectomy for suspected appendicitis. Histological

examination identified a malignancy in 0.75% (31) of all appendectomy surgical
specimens. Mean age was 25.8±14.6 years, 65% were male and 7% had WBC>16,000.
Carcinoid was the most common tumor, identified in 87% (27) of the specimens
with a malignancy. Two mucinous tumors of uncertain malignant potential, one
mucinous adenocarcinoma, and one granular cell tumor were also identified.
Overall, 71% (22) of the patients with malignancy underwent pre-operative imaging.
CT was obtained in 55% and ultrasound in 16% of those patients. Pre-operative
imaging did not suggest the possibility of malignancy in any of the cases. Stepwise
logistic regression did not identify any independent predictor of malignancy.
Conclusion:
Malignancy is rare after appendectomy for suspected appendicitis, with carcinoid

being the most common tumor. Pre-operative imaging did not add information in
these patients.
-443-
PP - 246 BLAST INJURIES AND HOSPITAL MANAGEMENT DURING
AUGUST WAR IN GEORGIA
ZURAB CHKHAIDZE , TAMAZ GVENETADZE , ARCHIL TSKHVEDADZE , DAVID
TOPHURIA , ABHISEK CHATTERJEE
TBILISI STATE UNIVERSITY MEDICAL FACULTY, GEORGIA
Background&Aims:
to present our experience of surgical care at Gudushauri National Medical Center

during the 2008 august war in Georgia. After the war activities began military
medical divisi initially provided first medical aid directly(daireqtli) at the battle field.
On the second stage first surgical care was provided by Gori military hospital which
was the nearest hospital to the battle zone. Our center’s function was the 3rd stage
qualified
Methods:
The management of patients, with chest and abdominal cavity penetrative wounds,
were carried out according to the ATLS principles.. As to the patients with stabile
hemodynamics, they were undergone the investigations such as X-ray, US, CT-scan,
and then were monitored.
Results:
Injury types in Conventional explosives were with – Blunt trauma, Penetrating

trauma, Inhalation injury, Thermal injury and Burns. They had however relatively
less primary blast injury. In Enhanced blast devices in vehicles or enclosed spaces
primary blast injury and pressure-related effects
Conclusion:
In conclusion we suggest some principles of surgical management of war injuries,

which are as follows: • Correct structural transformation of civil hospital into
the military one, which is provided with modern equipment and highly qualified
personnel. • Correct triage for right surgical treatment of patients.
-444-
PP - 247 CHEMICAL BURN INJURIES: THE INCIDENCE AND
OUTCOMES
AYTEN SARACOGLU, TAMER KUZUCUOGLU, SEZER YAKUPOGLU
DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION, KARTAL DR. LUTFI KIRDAR

TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
We aimed to determine the mechanisms, epidemiology and mortality associated

with different types of chemical burns.
Methods:
Forty patients admitted to our regional burn unit during the period from January
2009 to June 2012, were analysed and compared.
Results:
There were 2 female and 38 male workers. The average age was 34.6±11.9, total
body surface area was 18.4±18.1% (in a range of 1 to 79%). Five patients died in
intensive care unit. Thirty eight cases were caused by acids and 8 were caused by
strong alkaline chemicals. Chemical causative agent types were: sodium hydroxide,
potassium hydroxide, lime, caustic soda, hydrofluoric acid, acetic acid, formic acid,
boric acid, phosphoric acid, nitric acid, melting flaming plastic, paint thinner, copper
sulphate and molten aluminum. Twenty three patients (57.5%) needed surgery and
17 healed without any surgical intervention.
Conclusion:
Although our burn center is situated near the industrial district, the incidence of
chemical burns by accident wasn’t high. However a large percentage of burn victims
needed surgical procedures. This may have been due to inappropriate first aid,
because most of patients tried an alternative treatment in conventional medicine
before addmission to primary hospitals. We concluded that educational programs
and protection for workers may reduce this incidence in industrial areas.
-445-
PP - 248 DOES THE HIGH OBSERVATION UNIT HAVE A ROLE IN THE
MANAGEMENT OF THE ACUTELY ILL SURGICAL PATIENT?
CHARLES PROWDE , SANDEEP SAXENA , GEETINDER KAUR
SCUNTHORPE GENERAL HOSPITAL,UK
Background&Aims:
The aim of High Observation unit (HOBS) is to provide higher level of observation
postoperatively as compared to normal ward, increase availability of ICU beds,
reduce postponement of major surgery previously requiring ICU beds and reduce
length of patient hospitalization. The cost of HOBS bed is almost half that of ICU
bed. We aimed to audit the effectiveness of HOBS with these facts in mind.
Methods:
Data was collected of all patients admitted to HOBS from 3-29 April 2012. Evidence,
including length of admission to HOBS and discharge destination was collated and
analysed.
Results:
Mean length of admission was 3.5 days (range <1-8 days). Discharge from HOBS
was to wards in 92%, ICU 4%, other areas 4% and home in 0% patients. The shortest
admission was 10 hours in a patient who had undergone Hartmann’s procedure,
returned to theatre, admitted to ICU, suggesting inappropriate admission to HOBS
earlier. 8% patients were not discharged to a ward due to complications, returning
to theatre or ICU suggesting that these higher risk patients were not correctly
identified.
Conclusion:
We found that used appropriately, HOBS acts as a cost-effective intermediate

between ICU and ward care, increasing the availability of ICU beds. Using outcome
measures (P-possum/CR-possum) may guide admission of appropriate patients to
HOBS.
-446-
PP - 249 ENDOSCOPIC STENTING AS A BRIDGE TO SURGERY FOR
OBSTRUCTIVE LEFT-SIDED COLON CANCER: HOW LONG SHOULD
THAT BRIDGE BE?
MURAT GONENC , AHMET CEM DURAL , MEHMET KARABULUT , BAHA
TEMIZGONUL , ALI KOCATAS , OSMAN KONES , MUSTAFA U. KALAYCI , HALIL ALIS

Background&Aims:
There is no consensus about the management of obstructive left-sided colon cancer.

Currently, the treatment options in patients with a resectable disease include
elective surgery after endoscopic stenting and emergency surgery.
Methods:
The medical records of patients who underwent endoscopic colonic stenting for
obstructive left-sided colon cancer between January 2009 and January 2012 were
reviewed. Among those, who had successful endoscopic intervention as a bridge
to surgery were included to the study. The duration between endoscopic stenting
and surgery, re-obstruction rate, stoma creation rate, anastomotic leak rate, and
in-hospital mortality rate.
Results:
The medical records of 71 patients who underwent endoscopic stenting for

obstructive left-sided colon cancer were reviewed, and 33 were included to the
study. The median and mean duration between colonic stenting and surgery was
8 and 9.3±8.4 (5-33) days. Overall primary anastomosis, overall stoma creation,
anastomotic leak, and in-hospital mortality rate was 97%, 3%, 12%, and 9%,
respectively.
Conclusion:
A median duration of 8 days between endoscopic stenting and subsequent surgery

in patients with obstructive left-sided colon cancer is enough to do a safe surgical
procedure, and extending this duration exposes the patient to the risk of re-
obstruction and emergency surgery.
-447-
PP - 250 EVALUATION OF FACTORS AFFECTING MORTALITY RATE
AFTER ELECTRICAL BURN INJURIES
AYTEN SARACOGLU 1, BURAK ERSOY 2, SEZER YAKUPOGLU 1, TAMER
KUZUCUOGLU 1, OGUZHAN KILAVUZ 1
1
DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION, KARTAL DR. LUTFI
KIRDAR TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
2
CLINIC OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, MARDIN
KIZILTEPE STATE HOSPITAL , MARDIN, TURKEY
Background&Aims:
Electrical burns are among the most shattering of burn injuries with wide-ranging
deep tissue damage. We aimed to document the factors affecting the mortality of
electrical burns presenting to our regional burn center.
Methods:
This retrospective study was conducted of 101 patients from January 2009 to June
2012. Factors were classified under 11 topics and evaluated according to mortality.
Results:
The major causes of death in burn victims included multiple organ failure and
infection. Twenty-six percent of the 101 patients died, all of whom were male.
One (1.4%) of alive patients was female, 73 (98.6%) male. The mean age in exitus
group was statistically higher than the other patients (32.7 vs 35.6 years). All-cause
mortality was 2.79 times higher for larger burns (>25% TBSA). The values for CPK,
CPK-MB, TBSA of burn, hospitalized period in the intensive care unit, intubation
rate were significantly higher in exitus group. Hemofiltration was associated with a
12.03-fold increased risk for mortality. There wasn’t significant difference between
patients regarding surgical interventions.
Conclusion:
Electrical injury has become a major cause of mortality and long term disability
among young people. Our data demonstrate the identified several risk factors
related to mortality rate in electrical burn patients.
-448-
PP - 251 FEASIBILITY OF FAST TRACK SURGERY FOR PERFORATED
PEPTIC ULCER DISEASE
M. FERHAT CELIK , OSMAN KONES , NURETTIN SAHIN , AHMET CEM DURAL ,
MURAT GONENC , MAHMUT DOGAN , ABBAS ARAS , HALIL ALIS

Background&Aims:
To evaluate the feasibility of fast track surgery in patients with perforated peptic
ulcer disease (PPU) during early admission (first twelve hours) period.
Methods:
The patients admitted earlier to our hospital with symptoms of PPU and who
underwent Graham Patch Technique (GPT) from December 2007 to August 2012
were evaluated retrospectively. Primary outcome measure was postoperative
complications, whereas secondary outcome measures were the time of oral intake
and length of hospital stay. The patients were divided into 2 groups: Group 1 (before
12th hours, oral intake started in 36th hours), Group 2 (after 48th hours, oral intake
started after flatus).
Results:
One hundred one patients were included to study. The mean age was 37 (16-91)
years and male/female ratio was 89/12. There were 46 and 55 patients in group
1 and 2, respectively. The mean time of oral intake and length of hospital stay
were significantly shorter in group 1(<0.001 and 0.004, respectively). There was no
significant difference in morbidity rate between two groups (p=0.88).
Conclusion:
Fast track surgery seems feasible for PPU with comparable morbidity rate in
patients in early admission period. Large prospective randomized controlled trials
are needed to generalize the use of this modality.
-449-
PP - 252 ISOLATED BLUNT PULMONARY CONTUSIONS ARE
ASSOCIATED WITH MINIMAL ADVERSE OUTCOMES
EMRE SIVRIKOZ 1, KENJI INABA 1, PEDRO TEIXEIRA 1, HAKAN YANAR 2,
TIMOTHY VOSSLER 1, OZGUR ALBUZ 1, EFSTATHIOS KARAMANOS 1, DEMETRIOS
DEMETRIADES 1
1
2
TRAUMA AND EMERGENCY SURGERY UNIT, DEPARTMENT OF GENERAL SURGERY,
ISTANBUL SCHOOL OF MEDICINE, ISTANBUL UNIVERSITY, ISTANBUL, TURKEY
Background&Aims:
Pulmonary contusion volume ≥20% has been associated with increased mechanical
ventilation requirements and adverse outcomes. The outcomes of minor pulmonary
contusions in the setting of isolated moderate, blunt chest trauma however remain
unclear.
Methods:
Institutional trauma registry was queried for patients with chest AIS≥3, all other
regional AIS < 2 and pulmonary contusion utilizing the admission CT from 04/2009–
08/2011. Diagnosis relied on <24h admission CAT scans. Demographics, admission
physiology and associated injuries were abstracted.
Results:
80 patients were available: 10.0% age≥55, 22.5% ISS>10, 1.3% GCS≤8, 82.5% male,
17.5% rib fractures >4, 13.8% sternum fracture, 31.3% pneumothorax, 13.8%
hemothorax, 10% pleural effusion, 43.8% atelectasis, 5.0% flail chest. The mean
contusion volume was 2±3 (%). 16.3% required ICU admission, and mean ICU LOS
was 6±10 days. Atelectasis and rib fractures >4 but not pulmonary contusion were
identified as independent predictors of ICU admission (AOR=5.64 [1.02-31.26],
p=0.048 and AOR=5.91 [1.16-30.07], p=0.032 respectively). Only 2.5% patients
required mechanical ventilation, due to depressed GCS or flail chest. There was no
mortality.
Conclusion:
Minor pulmonary contusions associated with isolated, moderate, blunt chest

trauma were not associated with the need for mechanical ventilation or ICU
admission and consequently are of no clinical significance.
-450-
PP - 253 NONOPERATIVE MANAGEMENT IN PATIENTS WITH
PENETRATING ABDOMINAL STAB INJURIES
METIN YUCEL , ABDULLAH SISIK , ADNAN OZPEK , MUJGAN CALISKAN , FATIH
BASAK , ISMAIL EGE SUBASI , GURHAN BAS , ORHAN ALIMOGLU
UMRANIYE EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
The main current therapeutic approach in penetrating abdominal stab injuries is

conservative therapy to limit unnecessary laparotomies and to reserve laparotomy
for necessary conditions. The aim of our study was to analyze outcomes of patients
Methods:
Patients with penetrating abdominal stab injury between April 2009 and August
2012 were prospectively analyzed. Urgent laparotomy was carried out in those
with hemodynamically unstable, organ evisceration or signs of peritonitis, whereas
other patients were treated conservatively. Laparotomy was classified as urgent,
early or late in terms of timing of operation and as therapeutic, nontherapeutic and
negative in terms of findings of operation. Outcomes of patients were assessed.
Results:
One hundred and ninety-three patients were included. Thirteen patients underwent
urgent laparotomy on the basis of first examination while others were monitored
nonoperatively. In conservative group, a total of 26 patients underwent laparotomy
whom 16 early and 10 late laparotomy. While laparotomy was therapeutic in 33
(85%) patients, it was unnecessary in 6 (15%) patients. The remaining 154 (80%)
patients were discharged after nonoperative treatment.
Conclusion:
In penetrating abdominal stab injuries, a selective nonoperative management is

appropriate approach to minimize unnecessary laparotomy rates associated with
routine laparotomy approach.
-451-
PP - 254 NON-TRAUMATIC BOWEL PERFORATION: A
RETROSPECTIVE STUDY
STAVROS GOURGIOTIS , NIKOLAOS LIAKOS , GEORGE GEMENETZIS, CHARALAMPOS
SERETIS , STAVROS ALOIZOS , VASILIS VOUGAS , SPYROS DRAKOPOULOS
FIRST SURGICAL DEPARTMENT, EVANGELISMOS GENERAL HOSPITAL OF ATHENS,

GREECE
Background&Aims:
Non-traumatic bowel perforation has always been a consideration for surgeons

because of associated morbidity and mortality. The aim of this study is to define
etiologies, treatment, and outcomes as well as to highlight difficulties in the
diagnosis and management of this life-threatening situation.
Methods:
We conducted a retrospective study of 35 patients with non-traumatic bowel

perforations hospitalized during a 6-year period. The clinical profile and management
of these patients were studied.
Results:
The most common cause of non-traumatic bowel perforation was ulcerative colitis
(34.3%). Abdominal pain was the constant symptom present in all patients. Physical
examination showed signs of peritoneal irritation in 29 cases. The abdominal X-ray
did not reveal any abnormal findings in 2 patients, while the abdominal CT confirmed
the diagnosis in all cases. Twenty patients (57.1%) were operated on within 24 hours
of developing perforation while 7 patients (20%) were initially misdiagnosed. Most
of the perforations were located only in the large intestine (60%). There was only
one perforation in 25 patients (71.5%) and two or more perforations in 10 patients
(28.5%). Postoperatively, 4 patients (11.4%) died.
Conclusion:
Early diagnosis before the patient’s general condition deteriorates decreases

mortality and morbidity rates. Adequate resuscitation and emergency laparotomy
followed by resection with or without anastomosis remains the treatment of choice.
-452-
PP - 255 PATIENTS WITH TOXIC EPIDERMAL NECROLYSIS IN A
SURGICAL INTENSIVE CARE UNIT OF REGIONAL BURN CENTER
TAMER KUZUCUOGLU 1, AYTEN SARACOGLU 1, SEZER YAKUPOGLU 1, BURAK
ERSOY 3, ERHAN TUNCAY 2
1
KARTAL DR. LUTFI KIRDAR TRAINING AND RESEARCH HOSPITAL ISTANBUL,
DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION, ISTANBUL, TURKEY
2
KARTAL DR. LUTFI KIRDAR TRAINING AND RESEARCH HOSPITAL ISTANBUL,
3
MARDIN STATE HOSPITAL, CLINIC OF PLASTIC AND AESTHETIC SURGERY, MARDIN,
TURKEY
Background&Aims:
We aimed to determine the mortality rate, associated comorbidities, the clinical and
epidemiological characteristics of TEN patients, hospitalized in our burn intensive
care unit.
Methods:
Twelve patients with TEN admitted to the burn intensive care unit from January
2009 to June 2012 were included and documented in a retrospective manner.
Results:
Patients were between 9 and 64 years (mean 35 ± 5.7). The ratio of males to females
was 5:7 and the average APACHE II score was 15.4 ± 3.2. Epidermal detachment was
greater than 75% of the body surface area with a mean hospitalization time of 17
± 1.2 days. One patient had a history of paracetamol and etodolac, 3 had fenitoin
medication. TEN symptoms were seen following anti-tuberculosis treatment in
another patient and appeared in four patients after sultamicilin. Infectious ocular
complications were seen in two patients. The mean mechanical ventilation time for
the patients was 3.2 ± 0.7 days. The mortality rate was 16.6 %. Intravenous steroid
therapy and washing the wounds thoroughly with sterile distilled water under
sedation was used as main treatment regimen.
Conclusion:
Early identification and interception of the responsible drug with specialized

supportive care in a burn intensive care unit may reduce the mortality rate for TEN.
-453-
PP - 256 PATTERNS, PROBLEMS OF ACUTE ADULT POISONINGS AND
SPECTRUM OF ACUTE CORROSIVE INJURY IN A TERTIARY CENTER
STANLEY MEDICAL COLLEGE, INDIA
Background&Aims:
In developed and developing countries, corrosive injury(CI) to the GI tract as a

consequence of corrosive ingestion or self-harm has become less of a common
phenomenon Aim of the present was to determine the immediate clinical
presentation and outcome and its CI sequel after 6 months.
Methods:
38 patients with history of acute CI were included. Upper endoscopy to assess the
degree and extent of injury was done and graded based on Zargar’s classification.
Reassessment was done after 6 months.
Results:
34 had oral lesion, 25 laryngeal edema and 18 aspiration pneumonia. The mean
quantum of acid was 62.8 ml for Grade III, 33.8 ml for Grade II injury. The grade of
injury at 24 hours in 13 was III in 3 II and I in 5 patients each. There were 7 deaths,
one due to respiratory failure and 6 due to esophageal perforation. Three patients
developed esophageal stricture; one patient had Bilroth I for antral stricture, one
patient with esophageal and antral stricture required dilatation for esophageal
stricture
Conclusion:
Early endoscopy is important in establishing the extent of the injury. During the
acute phase, intensive care admittance is often necessary. Total parenteral nutrition
is a useful adjunct. Death is often due to esophageal perforation.
-454-
PP - 257 PREDICTORS OF IN-HOSPITAL MORTALITY IN
OCTOGENARIANS UNDERGOING EMERGENCY GENERAL SURGERY –
THE MEDWAY EXPERIENCE
MICHAEL PAUL BARRETT , ASH SINHA , IAIN WILSON , PETER WEBB , SHIRLEY
CHAN
DEPARTMENT OF GENERAL SURGERY, MEDWAY MARITIME HOSPITAL, KENT,

UNITED KINGDOM
Background&Aims:
This study identified risk factors predictive of in-hospital mortality amongst patients
aged 80 years or over undergoing emergency general surgery.
Methods:
A retrospective notes review of octogenarians undergoing emergency general

surgery over 3 years. Data were collected on demographics, medical co-morbidities,
previous cancer; medications; ASA grade, time to surgery from decision to operate,
ICU admission and return-to-theatre within 30 days. Parametric survival analysis(Cox
multivariate regression model) was used to identify risk factors predictive of in-
hospital mortality. Hazard ratios(HR) and corresponding 95% confidence interval
were calculated (p-value <0.05 statistically significant).
Results:
73 patients (50 females) with median age of 84 years (range 80-98) underwent
emergency general surgery. 18 underwent small bowel resection, 25 had colonic
surgery, 6 had strangulated hernia and 5 had peptic perforation. Over a median
length of stay of 23 days (range 2- 71), 28 (38%) died post-operatively. Multivariate
analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38-230, p=0.007) and COPD
(HR 3.35 95% CI 1.15-9.69 p=0.026) to be the only significant and independent
predictors of in-hospital mortality. Prior CVA, AF, COPD, functional status, and post-
operative ICU or HDU stay and return-to-theatre were predictive of poor outcome
in univariate analysis only.
Conclusion:
Emergency surgery in octogenarians is associated with significant mortality. Early

anaesthetic opinion should be sought to triage potential surgical candidates.
-455-
PP - 258 RELATIONSHIP BETWEEN LEUKOCYTOSIS AND INJURY
SEVERITY SCORE IN BLUNT TRAUMA INJURIES
ADNAN ÖZPEK , MÜJGAN ÇALIŞKAN , METIN YÜCEL , İBRAHIM ATAK , ABDULLAH
ŞIŞIK , GÜRHAN BAŞ , ORHAN ALIMOĞLU
DEPARTMENT OF GENERAL SURGERY, ÜMRANIYE EDUCATION AND RESEARCH

HOSPITAL, ISTANBUL, TURKEY.
Background&Aims:
Leukocytosis is usually a parameter found in conjunction with neutrophilia in

traumatized patients early in the initial evaluation. In this study, we aimed to
analyse the relationship between leukocytosis and Injury Severity Score (ISS) in
blunt trauma injuries.
Methods:
Hundred eighty-nine patients suffering from blunt trauma injuries who were
admitted to our Surgical Clinic between January 2009 and June 2012 were
prospectively included in the study. Patient demographics, ISS and the most high
leukocyte counts during the initial two hours of follow-up were reviewed in a
prospective database. According to ISS, patients were classified as severe (>15) and
mild (<15) trauma group. Independent Samples T test was used for comparison of
data and a p<0.05 was chosen as the level of statistical significance.
Results:
Of a total of 189 patients; 149 (78.8%) were males, 40 (21.2%) were females and
the mean age was 36.8 (3-81). The mean ISS and leukocyte count were found to be
16.9 (4-57) and17.075/mm3 (6.500-34.900/mm3), respectively. In the severe and
mild trauma group, the mean ISS values were 28.4 (16-57) and 8.7 (4-13); while the
leukocyte count was 18.330/mm3 (7.700-34.900 mm3) and 16.200/mm3 (6.500-
27.500/mm3), respectively.
Conclusion:
The mean leukocyte count was higher than normal in both groups. In patients with
ISS >15, leukocyte count was significantly higher than the other group (p =0.016).
-456-
PP - 259 SURGICAL MANAGEMENT OF LIVER TRAUMAS IN A HIGH
VOLUME LIVER TRANSPLANTATION CENTER
EMRAH OTAN , KORAY KUTLUTURK , CEMALETTIN AYDIN , BULENT UNAL , CUNEYT
KAYAALP , SEZAI YILMAZ
INONU UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF GENERAL SURGERY

AND INSTITUTE OF LIVER TRANSPLANTATION, MALATYA, TURKEY
Background&Aims:
Despite the advances in management, liver traumas remain a major challenging

issue for surgeons. The objective of this study is to present the two years experience
of a high volume liver transplantation and surgery center and results of liver traumas
treated surgically.
Methods:
In a retrospective analysis of 30 consecutive patients with liver injuries surgically

treated at our tertiarry referral center were reviewed. Mechanisms of injury,number
of injuries to the liver, coexisting injuries, type of surgery, mortality rate were
evaluated.
Results:
Among 30 patients (23 male, 7 female), age ranging from 5 to 75, mechanism of
liver injury was due to traffic accident in 14 of our patients . Stab wound accounted
for 14 of the patients and gunshot wound was responsible in 1 patient. 1 patient
wounded due to falling from height. Number of injuries was 1 in 13, 2 was in 8,
3 was in 4 and over 3 in 5 patients. Twenty two patients had coexisting organ
injuries. Nine patients (%30) underwent damage control procedure, 21 patients
(%70) underwent definitive surgical procedures ranging from simple procedures
to advanced procedures (hepatotomy, selective ligation, debridement, hepatic
resection, liver transplantation). 22 of the patients had coexisting injuries. The
mortality rate was 10,4 %.
Conclusion:
As a result of coexisting injuries and necessity of advanced surgical techniques,

severe liver traumas require to be managed with experienced liver surgeons.
-457-
PP - 260 THE EVALUATION OF MORTALITY CAUSES DURING 3 YEARS
OF PERIOD IN A SURGICAL CLINIC.
SUAT AKTAS , ABDULLAH SISIK , METIN YUCEL , GÜRHAN BAS
UMRANIYE EDUCATION AND RESEARCH HOSPITAL
Background&Aims:
Mortality may be a result of the treatment in some patients in the surgical

department. In this study, we evaluated the causes of mortality in patiens treated
by hospitalization in our surgical clinic.
Methods:
We reviewed the records of patients via the hospital’s data registration system
whom died during their management in our surgical clinic between January 2009
and December 2011. The demograhpic data, diagnosis and cause of mortality were
examined .
Results:
Of the 83 patients, 66 were emergent and 17 were elective cases. Thirtysix of the
emergent cases were male and 30 were female . In emergent group, the average
age was 58,2 (4-93) and the most common cause of mortality was traffic accidents
(n:14). Six of the elective cases were male and 11 were female. In elective group,
the average age was 71,9 (55-84). All of the elective cases were diagnosed as tumor.
Conclusion:
While the traffic accidents were the most common mortality cause in emergent
cases, malignancy was lead cause of mortality in elective cases. In regards of
National Health and Transportation policies, we conclude that the priorities should
be given in the direction of traffic safety and cancer diagnosis programmes.
-458-
PP - 261 THE EXTENT OF NECROSIS AND RENAL INSUFFICIENCY
PREDICT THE OUTCOME IN ACUTE MESENTERIC ISCHEMIA
HIZIR YAKUP AKYILDIZ , MUHAMMET AKYÜZ , ERDOGAN SOZUER , HASAN UZER ,
MEHMET BAYKAN , ALPER AKCAN
ERCIYES UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT
Background&Aims:
Acute mesenteric ischemia (AMI) is a potentially life-threatening condition due to

its diagnostic difficulty, operative challenges and patients’ comorbidities. The aim
of this study was to identify variables associated with adverse outcomes in patients
with AMI.
Methods:
Hospital records and clinical data of all patients with AMI were reviewed during a
recent 4-year period. Clinical outcomes as well as factors influencing mortality were
analyzed.
Results:
A total of 104 patients (46 females, 58 males, overall mean age 66±13.4 years) were
included in the study. Arterial pathology was the cause of AMI in 74 patients, (71%),
venous thrombosis in 15 (14%) and non-occlusive ischemia in 12 patients (12%).
Abdominal pain was the most common presenting symptom (97%). The 30-day
mortality rate was (66%). Univariate analysis showed renal insufficiency (p=0.004),
age >70 (p=0.02), comorbidity (p=0.001), leukocyte count >18000 /ml (p=0.04),
and necrosis more than 100 cm of small bowel (p=0.0007) were associated with
mortality. Logistic regression analysis showed renal insufficiency (p=0.04) and
necrosis more than 100 cm (p=0.002) were independent predictors of mortality.
Conclusion:
Renal insufficiency and the extent of the necrosis are the main factors resulting to
poor outcome in AMI patients. Prompt diagnostic evaluation and early therapeutic
interventions may help to prevent the development of these two fatal predictors.
-459-
PP - 262 THE FACTORS AFFECTING ON MORTALITY OF SIGMOID
VOLVULUS
FATIH OZDEMIR 1, EMRAH OTAN 1, CEMALETTIN AYDIN 1, FATIH SUMER 2, MEHMET
YILMAZ 1, CUNEYT KAYAALP 1
1
INONU UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GENERAL SURGERY
AND LIVER TRANSPLANTATION INSTITUTE
2
TURKEY YUKSEK IHTISAS HOSTIPAL ANKARA
Background&Aims:
Sigmoid volvulus is an important cause of colonic obstruction, which constitutes

the practice of emergency surgery. We aimed to determine the factors contributing
to the sigmoid volvulus mortality.
Methods:
One hundred and thirty two patients admitted to our institute with a diagnosis
of sigmoid volvulus from 1992 to 2012 were identified retrospectively.Six patients
were excluded, and 127 patients were included. The age , gender, white blood
count, duration of symptoms, the history of previous attacks, the concomitant
diseases, the presence of gangrene and the type of surgery were evaluated.
Results:
Sixty six of 127 patients have undergone sigmoidoscopy. Twenty five of them were
detortioned, 41 attempts were unsuccessful, 25 patients were subjected to elective
surgical procedures. The mortality of these patients were % 0. Emergent surgical
procedures were performed to 102 patients and the mortality of these patients
were % 10,6. Age , gender, white blood count, duration of symptoms, previous
attacks, presence of gangrene and surgery type were not statistically significant
on mortality. Only the concomitant disease had statistically significant effect on
mortality.
Conclusion:
In order to decrease the mortality rates of sigmoid volvulus, the first choice of
treatment should be endoscopic interventions before the elective surgery.
-460-
PP - 263 THE IMPORTANCE OF SCORING PAIN IN THE ACUTELY ILL
SURGICAL PATIENT
ELIZABETH CULPIN , SANDEEP SAXENA , GEETINDER KAUR
Background&Aims:
Assessment of pain is critical to its accurate management. It is important to

appreciate that pain changes over time. Also, psychosocial factors can affect pain
severity. There are different types of pain scoring used on surgical wards (Visual
analogue scale (VAS), Verbal rating scale (VRS), Numerical rating scale (NRS),
Faces and McGill Pain Questionnaire). We aimed to investigate the scoring and
management of pain in our acutely ill and post-operative patients on the High
Observation bay (HOBS).
Methods:
Data regarding pain management was collected from 13 patient notes in a snapshot
audit of patients in HOBS. Evidence was collated and analysed, including pain
scoring and frequency, modality of pain relief given etc.
Results:
28% patients were not scored. Of those that were, 69% were scored hourly, 8%
2 hourly, 8% half hourly and 15% once. 50% of those scored were given PCA
paracetamol. No patients scored pain >3. VAS and NRS were found superior to VRS
as they were better at detecting intensity of pain.
Conclusion:
There is no doubt that all patients should have their pain scored, especially in
the acutely ill and post-operative periods. There are obvious patient benefits of
improved recovery and better outcomes as well as important cost benefits for the
hospital with reduced hospital stay.
-461-
PP - 264 THE MANAGEMENT OF PENETRATING ABDOMINAL
STAB WOUNDS WITH ORGAN OR OMENTUM EVISCERATION: THE
RESULTS OF CLINICAL TRIAL.
METIN YUCEL , ABDULLAH SISIK , ADNAN OZPEK , MÜJGAN CALISKAN , IBRAHİM
ATAK , İSMAİL EGE SUBASI , GÜRHAN BAS , ORHAN ALIMOGLU
UMRANIYE EDUCATION AND RESEARCH HOSPITAL
Background&Aims:
Therapeutic approach to penetrating abdominal stab injuries changed over years

from routine laparotomy to nonoperative management. In case of organ or omental
evisceration, although laparotomy need is greater, nonoperative treatment may be
appropriated in select cases. The aim of our study was to assess the outcomes of
patients.
Methods:
Patients with organ or omental evisceration due to penetrating abdominal stab

injuries were prospectively evaluated between April 2009 and July 2012. While
presence of hemodynamic instability, organ evisceration or peritonitis were
accepted for emergent laparotomy, other patients were managed conservatively.
In patients with omentum evisceration having no need for emergent laparotomy,
nonoperative monitoring was applied. Patients’ follow up and treatment outcomes
were assessed.
Results:
A total of 18 patients were evaluated. Six (33.3%) patients underwent emergent

laparotomy, 12 (66.7%) patients underwent conservative follow up. In the emergent
laparotomy group, 5 of 6 patients underwent therapeutic, 1 negative laparotomy. In
the nonoperative follow up group, therapeutic laparotomy was carried out in total
of 7 patients, whereas 5 (28%) patients were managed conservatively.
Conclusion:
Although organ or omental eviscerations due to penetrating abdominal stab injuries

have a high rate a therapeutic laparotomy, selective conservative therapy is a safe
method in select cases.
-462-
PP - 265 THE USEFULNESS OF POSSUM SCORES IN THE HIGH
OBSERVATION SURGICAL UNIT
RICHARD BURNE , SANDEEP SAXENA , GEETINDER KAUR
Background&Aims:
POSSUM (Physiological and Operative Severity Score for the enUmeration of

Mortality and Morbidity) scores are widely used as surgical culture moves towards
outcome measures. 18 parameters (12 physiological and 6 surgical) are used to
calculate mortality and morbidity risk in surgical patients via P-Possum scores. CR
(Colorectal)-Possum uses 6 physiological and 4 operation-related Parameters. We
aimed to investigate Scores and outcomes of our acutely ill and post-operative
patients on the High Observation Unit (HOBS).
Methods:
Data was collected on or as near as possible to the date of admission to HOBS from
18 patient notes (12 Surgical (9 CR)) in a snapshot audit. Evidence was collated and
analysed.
Results:
P-possum morbidity ranged from 17-90 % (mean 52 %); P-possum mortality ranged
from 0.7-44 % (mean 7.39 %). CR-possum mortality ranged from 0.7-6.6 % (mean
1.8 %). The difference is statistically significant; it is also very relevant because more
than 50% of our HOBS patients are post-CR surgery.
Conclusion:
The high morbidity and mortality estimates suggest that the patients were
appropriately admitted to HOBS bay. Based on P-possum, patients on HOBS bay
had a likelihood of high morbidity post-surgery. However CR-POSSUM suggests
that P-possum overestimates mortality for CR patients. Hence, though P-possum is
useful to assess how ill the patient is, patients post-CR surgery may be better served
by using CR-possum.
-463-
PP - 266 VASCULAR INJURIES ON THE TACTICAL FIELD: A 2-YEAR
EXPERIENCE FROM A COMBAT SUPPORT HOSPITAL
AYTEKİN ÜNLÜ 1, MURAT URKAN 1, MEHMET FATİH CAN 1, AHMET ZİYA BALTA 2,
RAMAZAN YILDIZ 1, PATRIZIO PETRONE 3
1
DEPARTMENT OF SURGERY, GULHANE MILITARY MEDICAL ACADEMY, ANKARA,
TURKEY
2
DEPARTMENT OF SURGERY, GULHANE MILITARY MEDICAL ACADEMY
HAYDARPASA TRAINING HOSPITAL, İSTANBUL, TURKEY
3
UNIVERSITY OF SOUTERN CALIFORNIA, DEPARTMENT OF TRAUMA AND
EMERGENCY SURGERY, LOS ANGELES, CA, U.S.A.
Background&Aims:
Hemorrhage due to vascular injuries is the leading cause of combat related mortality
and morbidity. Nonetheless, effective and expedited prehospital trauma care and
hospital capability with expertise are sine qua non for the management of these
casualties.
Methods:
We retrospectively reviewed our vascular injury data from January 2005 through
2007 at our combat support hospital. We also analyzed the casualty outcomes
through echelons of care and follow up charts until March, 2012.
Results:
Out of 163 casualties, eight (5%) had vascular injuries. All vascular injuries
underwent surgery at our hospital. Gunshot wounds and improvised explosives
were the mechanisms of injury. The data revealed two subclavian vein, two brachial
artery, two popliteal artery, one femoral artery and one anterior tibial artery
injuries. We routinely used saphenous vein graft for vascular reconstruction except
in one case with injury to the popliteal artery that was repaired primarily. None of
the casualties inflicted limb loss.
Conclusion:
Widely available advanced weapon systems and high explosives have led to an
increase in combat related vascular injuries. Our vascular injury rate and outcomes
we report here are similar to recently published reports.
-464-
PP - 267 DIAGNOSTIC EFFICIENCY OF ULTRASOUND FOR
CYTOLOGICALLY “SUSPICIOUS” THYROID NODULES IN FINE NEEDLE
ASPIRATION BIOPSY
AHMET CEM DURAL 1, CEVHER AKARSU 1, SULEYMAN BUYUKASIK 1, AHMET
YILMAZ 2, EYUP GEMICI 1, MURAT GONENC 1, NURTEN SEVER 3, HALIL ALIS 1
1
2
ISTANBUL
3
DEPARTMENT, ISTANBUL
Background&Aims:
We aimed to evaluate the diagnostic efficiency of ultrasonographic (US) findings in

patients with cytologically suspicious nodules for papillary thyroid carcinoma (CS-
PTC).
Methods:
From January 2009 to June 2012, US findings of the patients who had thyroid
nodules with a fine-needle aspiration biopsy (FNAB) evaluating as CS-PTC and
underwent surgery were analyzed retrospectively. US findings were classified as
suspicious for malignancy (margin irregularity, microcalcification and echogenicity)
or probably benign.
Results:
CS-PTC nodules were 18.5% of 367 patients who underwent surgery for nodular
thyroid diseases. The rate of malignancy was 66.1% (n=45) in patients with CS-
PTC. 78.8% (n=41) of the 52 lesions that had suspicious US findings were found
to be malignant at surgery. 25% of the 16 lesions that had probably benign US
findings were malignant. Sensitivity, positive predictive value, accuracy, negative
predictive value and specificity of the US were 91.1%, 78.9%, 78%, 75%, and 52.1%,
respectively in nodules evaluated as CS-PTC.
Conclusion:
The US and FNAB are supplementary to each other and they should be considered
before surgery. US alone is not sufficient to determine the need for surgery
especially in the centers including radiology and pathology departments which are
not specialized in endocrinology.
-465-
PP - 268 SUTURLESS THYROIDECTOMY
AHMET SERDAR KARACA , MUZAFFER ÇAPAR , RIDVAN ALI
BARTIN DEVLET HASTANESI
Background&Aims:
We hypothesized that the use of the harmonic scalpel could lead to a significant
reduction in operative time as compared with knot tying in thyroid surgery.
Methods:
786 consecutive patients undergoing total thyroidectomy by three surgeons

The 2 groups were similar regarding age and sex. There were no intraoperative
complications. Between january 2007 and December 2011, 786 patients underwent
various thyroid surgical procedures performed by three surgeon using either
conventional knot tying (n = 394) or the harmonic scalpel (n = 391) for vessel
control. Those patients undergoing total thyroidectomy form the subject of this
study for practical considerations.
Results:
Mean ± SD operative time was shorter in the harmonic scalpel group compared
with the conventional technique procedures. There was no difference between the
2 techniques regarding the amount of blood loss for different procedures. There
was no effect of tumor size on operative time
Conclusion:
The use of the harmonic scalpel for the control of thyroid vessels during thyroid
surgery is safe, and it shortens the operative time by almost 30 minutes compared
with the conventional technique procedures.
-466-
PP - 269 EFECTIVITY OF FIBRIN SEALANT TISSUCOL DUO IN
THYROID SURGERY
ANTONIO MORAL 1, JOSE IGNACIO PEREZ 1, MONTSERRAT CLOS 1, OZLEM
UYANIK 1, JAVIER ALANEZ 1, ANA BELEN MARTIN 1, MANUEL TRIAS 1
HOSPITAL DE SANT PAU, BARCELONA, SPAIN

1
UNIVERSITAT AUTONOMA DE BARCELONA, SPAIN

2
Background&Aims:
The most important complication after thyroid surgery is the development of

hematoma. Among the available mesures to prevent this eventuality we have the
fibrin sealant. We have been using the fibrin sealant (Tissucol Duo) from 2006 and
have performed a prospective study to study the efficacy.
Methods:
The study includes 206 patients who underwent thyroid surgery for benign and
malignant diseases. Thyroidectomy or hemithyroidectomy with or without central
or lateral neck dissection was performed. In all cases we use fibrin sealant to
minimize the posibility of complications. There is no control group because of the
use of fibrine sealant in every case. Beside, the low incidence of hemorragia in
this kind of operations would obligate a comparison of two groups with thousands
patients to find significance differences.
Results:
The results showed a lowest complication rates, without hematomas nor

hemorragias. Postoperative stay was 2.59±1,75 days, (total thyroidectomy 2,83;
hemithyroidectomy 1,56; neck dissection with or without thyroidectomy 2,97).
Conclusion:
Despite of the most important factor to prevent the morbidity in thyroid surgery is an
accurate technique, the use of fibrin sealant can help us to minimize complications
and improves the outcomes.
-467-
PP - 270 CENTRAL LYMPH NODE METASTASIS IN T1 PAPILLARY
THYROID CARCINOMA
AYKUT SOYDER 1, LUTFI SOYLU 2, SERDAR OZBAS 2, SAVAS KOCAK 2
1
2
GÜVEN HOSPITAL, ANKARA, TURKEY
Background&Aims:
The objective of the study was to examine some of the clinicopathological features
and central lymph node metastasis (CLNMs) of T1 papillary thyroid carcinoma (PTC)
and to compare the difference between the tumors ≤1 cm (PTMC) and >1 cm in
diameter.
Methods:
Between January 2009 and December 2011, a total of 85 patients (69 women-81.2%
and 16 men-18.8%) with T1 PTC underwent bilateral total thyroidectomy (BTT) and
central neck dissection (CND). Group I included patients with tumors ≤1 cm (n: 45,
52, 9%), and group II included those with tumors >1 cm (n: 40, 47, 1%) in diameter.
Mean follow-up period is 14, 1 ± 6, 4 (3-35) months.
Results:
Mean age of the patients was 43.7±11.6 (17-82). The overall CLNMs ratio is 28, 2%
for T1 PTC (26, 7% and 35% for Group I and II, respectively). Statistical significance
was determined in CLNMs between Group I and II (p<0.05). Follow-up revealed
3 (3.5%) [Group I: 1 (2.2%) and II: 2 (5%)] cases with recurrences in lateral lymph
nodes. No recurrence was observed at the central region.
Conclusion:
CLNMs are relatively common in PTC. T1 tumors that are >1cm in diameter are
more likely to metastasize to CLNs than the PTMC. Key Words: Papillary thyroid
carcinoma, microcarcinoma, central lymph node dissection
-468-
PP - 271 MANAGEMENT OF HYPERTENSIVE CRISIS DURING THE
SURGERY OF PHEOCHROMOCYTOMA’S PATIENT
FATİH BAŞAK 1, TOLGA CANBAK 1, MÜJGAN ÇALIŞKAN 1, AYLİN ACAR 1, ALİ KILIÇ 1,
ADNAN ÖZPEK 1, GÜRHAN BAŞ 1, ORHAN ALİMOĞLU 2
1
2
Background&Aims:
Pheochromocytoma is a rare tumor arising from chromaffin cells of the adrenal

medulla, sympathetic nervous system or by other paraganglion. In this study,
we aimed to present a case of pheochromocytoma which was complicated by
hypertensive crisis attack during surgical intervention.
Methods:
Sixty-six-years-old male patient with phaeochromocytoma was planned to operate.

Operation was performed with no-touch technique and extreme caution with
the initial venous output control. Tachyarrhythmia and hypertension episodes
developed four times during operation. Emergency managements was underwent
by anesthesiologist after episodes. The mass was excised with standart techniques.
Operation was ended uneventfully.
Results:
Treatment of pheochromocytoma is surgery. Ensuring control of hypertensive crisis

during surgery reduces the mortality rate significantly. Anesthetic management of
patients with pheochromocytoma is extremely difficult. High systemic arterial blood
pressure caused to be life-threatening cerebrovascular hemorrhage, heart failure,
arrhythmias, and myocardial infarction. The excessive release of catecholamines
during the operation can be seen in depending on manipulation thus the minimal
touch technic and initial venous control is important. Various medical treatments
used to the intraoperative crisis successfully.
Conclusion:
The surgical team must be extremely careful during manipulation and removal.
The management of hypertensive crisis should be performed with multidisciplinary
approach that consists of anesthesiologist and surgeon.
-469-
PP - 272 PAPILLARY THYROID MICROCARCINOMA:
CLINICOPATHOLOGICAL CHARACTERISTICS AND RESULTS OF 115
PATIENTS
EBUBEKIR GÜNDEŞ , FARUK AKSOY , H.İBRAHİM TAŞCI , TEVFİK KÜÇÜKKARTALLAR ,
ADNAN KAYNAK

Background&Aims:
This study aims to present our clinic experiences about the incidence, biological
behavior, clinical characteristics, and treatment options of papillary thyroid
microcarcinomas (PTMC) among thyroid cancers.
Methods:
The files of 115 patients who had undergone thyroidectomy and who had been
pathologically diagnosed with PTMC at our clinic between 2005 and 2012 were
retrospectively evaluated.
Results:
During the mentioned time span 416 thyroid cancer cases were detected at our clinic
and 115 of them were diagnosed with PTMC. 96 of the PTMC patients were female,
while 19 were male, and their mean age was 50(18-70). The mean tumor size was
found to be 4.2(1-9) mm, according to the longest size of the tumor. The mean
follow-up period was 44(4-84) months. During this time 3 patients had recurrences.
One patient had metastasis to the brain, while one other had metastasis to the
costa. The patients with recurrences had complementary thyroidectomy and central
neck dissection.
Conclusion:
The general view proposes that the treatment of PTMC is total or near-total
thyroidectomy. Same side central neck dissection might be added to the surgery in
selected cases. Although they are able to have metastases to the neck lymph nodes
and even have distant metastases, they are benign and have very good prognoses.
-470-
PP - 273 COEXISTENCE OF PARATHYROID ADENOMA AND
PAPILLARY THYROID CARCINOMA: EXPERIENCE OF OUR CLINIC
EBUBEKİR GÜNDEŞ , FARUK AKSOY , TEVFİK KÜÇÜKKARTALLAR , M.HALDUN
ÇOLAK, H. İBRAHİM TAŞÇI

Background&Aims:
The aim of this study was to describe experiences with concurrent parathyroid
adenoma and papillary thyroid carcinoma.
Methods:
Eight patients with concurrent parathyroid adenoma and papillary thyroid

carcinoma were identified between 2005 and 2012, and their medical records were
reviewed retrospectively.
Results:
Of the eight patients identified, two were male and six were female; their mean
age was 53.6 years. The mean serum calcium concentration was 11.7 mg/dL . Intact
parathyroid hormone (iPTH) concentrations were high in all patients, with a mean
concentration of 338 pg/mL. The most frequently used surgical technique was total
thyroidectomy + parathyroid adenoma excision (n=4). The mean size of the thyroid
carcinoma was 1.2 cm, and one case showed metastatic lymph nodes in the central
compartment. The mean parathyroid adenoma size was found to be 2.1(0.6-9)
cm, according to the longest size of the adenom. Six patients (75%) developed
postoperative complications, including temporary symptomatic hypocalcemia in 4
patients (50%), hematoma development in 1 patient (12.5%) and temporary vocal
cord paralysis in 1 patients (12.5%).
Conclusion:
Thyroid carcinoma and parathyriod adenoma are rarely concomitant. Rarely

hyperparathyroidy may be accompanied with thyroid carcinomas so preoperatively
tyroid gland should be properly examined. Thyroid with parathyroid surgery are risk
factors of recurrent laryngeal nerve injury and hypoparathyroidism.
-471-
PP - 274 THE IMPACT OF HARMONIC SCALPEL ON COMPLICATIONS
AFTER NECK DISSECTION IN PAPILLARY THYROID CARCINOMA: A
PROSPECTIVE RANDOMIZED STUDY
FAHRI YETISIR 1, BANU YÜREKLI 2, A.EBRU SALMAN 3, MUSTAFA ÜNAL 4, H. ZAFER
AÇAR 5, M.BAKI YILDIRIM 1, MEHMET KILIÇ 1
1
ANKARA ATATÜRK RESEARCH AND TRAINNING HOSPITAL, GENERAL SURGERY
DEPARTMENT, ANKARA, TURKEY
2
BOZYAKA RESEARCH AND TRAINNING HOSPITAL, ENDOCRINOLOGY, IZMIR,
TURKEY
3
ANKARA ATATÜRK RESEARCH AND TRAINNING HOSPITAL, ANESTHESIOLOGY AND
REANIMATION DEPARTMENT, ANKARA, TURKEY.
4
ETLIK RESEARCH AND TRAINNING HOSPITAL, ENDOCRINOLOGY, ANKARA, TURKEY
5
YOZGAT BOZOK UNIVERSITY ,GENERAL SURGERY, YOZGAT, TURKEY.
6
YILDIRIM BEYAZIT UNİVERSİTY, GENERAL SURGERY DEPARTMENT, ANKARA,
TURKEY.
Background&Aims:
The aim of this study was to investigate whether Harmonic Scalpel (HS) increases
the complication rate in the patients undergoing neck dissection in patients with
papillary thyroid carcinoma(PTC).
Methods:
95 patients with PTC undergoing bilateral total thyroidectomy and central or lateral
neck dissection were included in to study. Patients whom heamostasis was carried
out using HS at each stage of the operation were classified as group I(n=52), and
patients whom heamostasis was performed without HS in the dissection of nerves
and in the dissection of regions containing parathyroids and ductus thoracicus as
Group II(n=43). Groups were compared in terms of operation time, postoperative
nerve injury, hypoparathyroidsm and development of chylous fistula
Results:
Demographic data, stage of tumor and type of operation were similar between
groups. Mean operation time was 19 min. shorter in group I.(p=0.003) There was no
difference in nerve injury and hypoparathyroidsm between groups. Chylous fistula
was seen in 3(5.7%) patients in group I. It was not seen in group II.
Conclusion:
Use of HS in patients with PTC undergoing neck dissection decreases operation time
significantly without increasing the rate of nerve and parathyroid injury, but may
increase the risk of development of chylous fistula.
-472-
PP - 275 PARATHYROID CYSTADENOMA: A CASE REPORT
MURAT BAKI YILDIRIM 1, FAHRI YETISIR 1, A.EBRU SALMAN 2, MEHMET TOKAÇ 1,
GÜRKAN DUMLU 1, MEHMET KILIÇ 3
1
ATATÜRK RESEARCH AND TRAINNING HOSPITAL, GENERAL SURGERY
DEPARTMENT, ANKARA, TURKEY.
2
3
YILDIRIM BEYAZID UNIVERSITY GENERAL SURGERY DEPARTMENT, ANKARA,
TURKEY
Background&Aims:
Parathyroid cystadenomas are rare medical conditions. Three hundred cases had
been reported since it was first described by Goris. Parathyroid cystadenomas are
established only 3 percent of patients who underwent parathyroidectomy.
Methods:
Parathyroid cysts are divided into two groups as functional and non-functional.
These two types are far more different from each other clinically. Functional cysts
present with hyperparathyroidism symptoms, while non-functional cycts show
themselves with compressive symptoms. In addition, parathormone levels are high
in functional cysts and at normal level in nonfunctional cysts .
Results:
In this case, a functional parathyroid cyst was present and our patient was admitted
with hyperparathyroidism symptoms to our hospital. This giant parathyroid
adenoma was missed in first surgical operation. Ultrasonography, magnetic
resonance imaging, parathyroid syntigraphy and computed tomography can be used
for imaging parathyroid cysts. A 4 cm parathyroid cyst that localised at right side
and posterior of trachea compressing to esophagus was visualized with radiological
imaging. Following the incision on previous incision line, the zone of right total
thyroidectomy done before was reached and 4 cm parathyroid cystadenoma was
found and excised
Conclusion:
In this case report, the diagnosis and management of parathyroid cystadenoma was
evaluated in the light of the literature.
-473-
PP - 276 EVALUATION OF THE RLN FUNCTION OF THE PATIENTS
WITH PREOPERATIVE VOCAL CORD PARALYSES BY INTRAOPERATIVE
NEUROMONITORING DURING THE SECONDARY THYROIDECTOMY
MEHMET ULUDAG 1, GURKAN YETKIN 1, EBRU SEN ORAN 1, NURCIHAN AYGUN 1,
FEVZI CELAYIR 1, A CABBAR KARTAL 1, ADNAN ISGOR 2

1
GOZTEPE MEDICAL PARK HOSPITAL, ISTANBUL, TURKEY

2
Background&Aims:
Our aim is to evaluate findings of intraoperative nerve monitoring in two cases

having vocal cord palsy preoperatively.
Methods:
Two patients were evaluated
Results:
Case 1: 61-year-old female with recurrent goitre had secondary tyroidectomy

because of the suspicion of malignancy on the FNAB. Preoperative evaluation
of vocal cords revealed right vocal cord paralyses. Right nervus vagus and RLN
were identified and stimulated intraoperatively. Electrical responses of the vocal
cords were reported via EMG. Meticulous dissection of the RLN showed that
it was anatomically intact till the entry of the larynx. Case 2: 26-year-old male,
who presented with preoperative right vocal cord palsy, underwent completion
thyroidectomy secondary to papillary carcinoma. Right vocal cord was paralytic on
the preoperative examination. There was no positive signal from vagal and the right
RLN during stimulation intraoperatively. Recurrent nerve was explored and found
as being tied and interrupted 1 cm before the entry point in the first operation.
Conclusion:
Nerve monitoring should be used in secondary thyroidectomies. In cases with vocal

cord palsy preoperatively, nerve should be explored intraoperatively and never be
sacrified before the evaluation by nerve monitoring. Electrical response can be
achieved from vocal cords in particularly anatomically intact nerves which might
have incomplete injury and residual innervation.
-474-
PP - 277 EVALUATION OF THE EXTERNAL BRANCH OF SUPERIOR
LARYNGEAL NERVE’S MOTOR FUNCTION BY INTRAOPERATIVE
NERVE MONITORING
MEHMET ULUDAG , GURKAN YETKIN , NURCIHAN AYGUN , FEVZI CELAYIR , EBRU
SEN ORAN , ADNAN ISGOR
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF THE GENERAL

Background&Aims:
External branch of superior laryngeal nerve (EBSLN) innervating the cricothyroid

muscle, then continues on and may provide contribution to the innervation of the
anterior thyroarytenoid muscle region.
Methods:
We aimed to evaluate the EBSLN’s motor contribution to the cricothyroid and

intrinsic laryngeal muscles’ function by the intraoperative nerve monitoring (IONM).
METHODS: The function of the EBSLN, identified during the thyroidectomy, was
evaluated by the IONM. A positive signal was determined by observing contractions
of the cricothyroid muscle (“cricothyroid twitch”) and in some cases by hearing an
auditory signal and an EMG response on the monitor.
Results:
A total of 24 EBSLNs were identified in 14 patients. EBSLN was comfirmed by

observing the cricothyroid twitch during stimulation of the nerve with IONM in all
the patients. A positive auditory signal and a corresponding EMG waveform was
observed in 12 of 24 (50%) identified EBSLN.
Conclusion:
EBSLN, as playing the main role for the motor function of the cricothyroid muscle, its
motor contribution to the thyroarytenoid muscle is not rare. Thus, the preservation
of EBSLN is also crucial for the other vocal cord functions. The differences in cord
positions seen with RLN injuries may be explained by the EBSLN’s motor contribution
to the thyroarytenoid muscle.
-475-
PP - 278 LAPAROSCOPIC ADRENALECTOMY FOR FUNCTIONING AND
NON-FUNCTIONING ADRENAL TUMOURS.
MUHAMMET AKYUZ , ALPER AKCAN , ERDOGAN SOZUER , RIDVAN KULU , HIZIR
AKYILDIZ , ENGIN OKK , ZEKI YILMAZ

KAYSERI, TURKEY
Background&Aims:
Laparoscopic adrenalectomy has become a standard surgical procedure for the most
of adrenal gland disorders. The purpose of this study was a retrospective analysis
of outcomes following laparoscopic adrenalectomy (LA) performed for benign
adrenal tumours responsible for various endocrinological disorders. The patients
were diagnosed with non-functioning (NFT) and functioning adrenal tumours (FT)
including pheochromocytoma, Conn’s syndrome and Cushing’s syndrome.
Methods:
A total of 100 LAs were carried out between January 2007 and August 2012. The
analysed factors included demographic data of patients, indication for surgery,
tumour size and side, intraoperative and postoperative outcome of LA including
duration of surgery, length of hospital stay, the complication rate, as well as the
conversion rate to open adrenalectomy.
Results:
There were 34 patients with NFT and 66 with FT. No significant differences were
found between the groups in terms of age, tumour size and localization, lenght of
surgery, rate of conversion to open adrenalectomy. However, despite the different
characteristic and clinical disorders related to laparoscopically removed adrenal
tumours, the intraoperative and postoperative outcomes did not significantly differ
in most cases between the analysed groups of patients. No mortality occured in
intraoperative and early postoperative period. Mean postoperative hospital stay
was 2 days (1-5 days).
Conclusion:
This study shows that LA is a safe, effective, and well-tolerated procedure despite
the hormonal activity of the removed lesions. Minimal invasive surgery may be
recommended as the ‘gold standard’ in the treatment of both functioning and non-
functioning benign tumours of the adrenal gland.
-476-
PP - 279 LAPAROSCOPIC TRANSPERITONEAL SURGERY IN
ADRENALECTOMY
BULENT CITGEZ , SAYID S. ZUHUR , RÜMEYSA SELVINAZ VELET , ISMAIL ETHEM
AKGÜN , MURAT FERHAT FERHATOGLU , ADEM AKCAKAYA
Background&Aims:
Diagnostic laboratory tests and advanced imaging techniques, simplifies the

diagnosis of adrenal masses. Adrenal masses in many different clinical, laboratory
and radiological findings can be seen.Laparoscopic adrenalectomy(LA) is considered
the standard technique for surgical removal of adrenal gland. We herein present
our transperitoneal LA experiences on adult patients.
Methods:
Within one year who were operated in our clinic due to adrenal mass 5 Patients’
age and gender, duration of surgery, intra-operative complications, hospitalization
time, diameter of adrenal mass , histopathology results, and follow up time were
recorded.
Results:
Patients’ mean age was 40.3±10.3 (range 35-66) years, while 5 (100 %) patients
were female ,masses were all localized on left side. Mean duration of surgery was
95.2±17.5 (range 80- 120) minutes, and mean diameter of the adrenal mass was
6.4±3 (range 3-14) cm. There was no converted to open surgery. Histopathological
examination revealed adenoma (n=3), pheochromocytoma (n=2), There were no
postoperative complications. Mean hospital stay of the patients was 3.3±0.7 (range
2-5) days, and mean follow up time was 10.4±2.21 (range 2-12) months.
Conclusion:
LA is technically feasible and reproducible, offers a shorter length of stay, a decrease

in postoperative pain, faster return to preoperative activity level, improved cosmetc
results , and reduced morbidity.
-477-
PP - 280 HYPERPARATHYROIDISM SURGERY GUIDED BY
INTRAOPERATIVE SESTAMIBI SCAN AND PORTABLE GAMMA
CAMERA
ANTONIO MORAL DUARTE , OZLEM UYANIK , JOSE IGNACIO PEREZ GARCIA , JOAN
DUCH RENOM , MONTSERRAT ESTORCH CABRERA , MANUEL TRIAS FOLCH

Background&Aims:
Intraoperative scintigraphy was tested and ruled out its beneficial use previously in
cases of primary hyperparathyroidism. We communicate our experience on its use
in the hyperparathyroidism surgery of complicated cases.
Methods:
Case 1: Patient with primary hyperparathyroidism whose imaging studies were

negative during three years until finally a scintigraphy and a CT scan detected the
presence of an ectopic right parapharyngeal parathyroid gland. Case 2: Patient with
MEN 1 underwent resection of two glands and a thyroid lobe due to the intrathyroidal
parathyroid glands 13 years ago and reoperated for recurrence without finding the
remaining gland 10 years ago. In both case we used intraoperative sestamibi scan
using a detector probe and a portable gamma camera.
Results:
In Case 1 the portable gamma camera and detector probe identified the exact
location of the ectopic adenoma prior to incision. In case 2 they allowed to localize
an intrathyroidal parathyroid. AP study and PTH levels confirmed the removal of
the adenomas.
Conclusion:
Intraoperative scintigraphy in selected cases such as ectopic adenomas, recurrences

and reoperations seems to simplify the dissection and increase the safety of the
surgery. Nevertheless, a good surgical strategy based on the preoperative studies
continues to be fundamental.
-478-
PP - 281 CORRELATION OF THE RESULTS OF FINE-NEEDLE
ASPIRATION BIOPSY WITH HISTOPATHOLOGICAL DIAGNOSIS IN
THYROID NODULES: ANALYSIS OF 462 PATIENTS
RAMAZAN SAYGIN KERIMOĞLU 1, UĞUR GÖZALAN 2, NURI AYDIN KAMA 2
TÜRKIYE YÜKSEK IHTISAS HOSPITAL, ANKARA, TURKEY

1
ANKARA NUMUNE HOSPITAL, ANKARA, TURKEY

2
Background&Aims:
This study aims to compare the results of fine-needle aspiration biopsy (FNAB) of
the patients with thyroid nodules with histopathological diagnosis obtained from
thyroidectomy material.
Methods:
The clinical data of 462 patients who underwent FNAB and thyroidectomy between
1995-2005 were evaluated. The FNAB results were investigated in four groups
as following: negative, positive, non-diagnostic and intermediate. Sensitivity,
specificity, positive predictive value (PPV), and negative predictive value (NPV) of
FNAB for the prediction of malignity were calculated.
Results:
Results of FNAB were reported as benign in 356 (77%), malignant in 17 (3.6%), non-
diagnostic in 34 (7.3%) and intermediate in 55 (11.9%) patients. As a result of the
histopathological evaluation, 50 (10.8%) patients were diagnosed with malignancy.
Histological confirmation of malignancy was 14 out of 17 patients with a 95.7%
accuracy rate. When intermediate and malignant cases were considered as positive
cases, FNAB had a sensitivity of 51.1%, a specificity of 87.2%, PPV of 31.9% and
NPV of 93.8% in the diagnosis of thyroid malignancies. When only malignant cases
of FNAB were considered as positive; sensitivity, specificity, PPV and NPV were
calculated to be 38.9%, 99.1%, 82.4% and 93.8%, respectively.
Conclusion:
The detection of a considerable level of malignancy in the intermediate group

suggests that, in terms of management of intermediate FNAB cytology, the patients
should be evaluated carefully with additional methods.
-479-
PP - 282 CORRELATION OF THE RESULTS OF PHYSICAL
EXAMINATION AND IMAGING METHODS WITH MALIGNANCY IN
THYROID DISEASES
RAMAZAN SAYGIN KERİMOĞLU 1, UĞUR GÖZALAN 2, NURİ AYDIN KAMA 2
TÜRKIYE YÜKSEK IHTISAS HOSPITAL, ANKARA, TURKEY

1
ANKARA NUMUNE HOSPITAL, ANKARA, TURKEY

2
Background&Aims:
This study aims to investigate the correlation between the results of physical
examination and imaging methods with malignancy in thyroid diseases.
Methods:
The data of this study were generated by retrospectively examining the clinical
records of 1159 patients who underwent thyroid surgery in our hospital between
1995 and 2004. Intergroup differences were evaluated using chi-square and Fisher’s
Exact tests. P<0.05 was considered to be significant in the 95% confidence interval.
Results:
For 1159 patients enrolled to the study, mean age was 43.3. In the physical
examination and ultrasound (US), most commonly observed pathological finding
was multiple nodules, with the rates of 44.9% and 79.6%, respectively. Detection
of hard nodule (p=0.01) and cervical lymphadenopathy (p=0.01) in the physical
examination, calcification in US (p=0.02) and retrosternal extension in the chest
x-ray (p=0.01) were correlated with malignancy. Mean diameter of dominant
nodule detected in US was not superior in the malignant patients compared to
benign patients (2.86±1.38 cm vs. 2.26±1.29 cm, p=0.09).
Conclusion:
US and chest x-ray are simple and helpful imaging techniques in the prediction
of malignancies in the thyroid diseases. They should remain in the evaluation
algorithm as a part of initial approach.
-480-
PP - 283 BILATERALITY AND MULTIFOCALITY IN MICROPAPILLARY
THYROID CARCINOMA
KAZIM CAGLAR OZCELIK 1, SEVIM TURANLI 1, YAVUZ PIRHAN 2
1
2
SUNGURLU GOVERNMENT HOSPITAL DEPARTMENT OF GENERAL SURGERY,
ÇORUM, TURKEY
Background&Aims:
Surgical method selection for thyroid papillary microcarcinoma patients has been
controversial. Bilaterality and multifocality rate and its clinical importance is
examined.
Methods:
Fifty-six patients with papillary thyroid microcarcinoma operated from 1994 to 2007
were reviewed. Forty-two of the patients were operated for total thyroidectomy at
initially and reminder patients were operated for completion thyroidectomy after
median 2 months from the lobectomy. Therapeutic lymph node dissection was
carried out in 2 of the patients.
Results:
Six of the patients were male and rest were female (89.3 %). The average age was
44.1±1.7. The tumor was bilateral in the 15 of the patients (26.8%) and multifocal in
the 24 of the patients (42.9%). Except the 5 of the them, all patients were received
one time radioactive iodine ablation and thyrotropin suppression treatment were
given in all patients. The median follow-up time was 86 months (range; 62- 218
months). Recurrence and died was not seen in the non of the patients.
Conclusion:
In the patients underwent total thyroidectomy, clinical results of having multifocal

and/or bilateral tumor is similar as long as adjuvant treatment is received. However,
because of disease nature, it is early to have this judgment.
-481-
PP - 284 THE RELATİONSHİP OF THYROİD CANCER WİTH
DOMİNANT NODULE ON PATHOLOGİCAL SPECİMENS OF TOTAL
THYROİDECTOMİES
KORAY ARISOY 1, DOGAN GONULLU 1, AYSENUR IGDEM 2, FERDA NIHAT KOKSOY 1
1
2
TURKİSH MİNİSTRY OF HEALTH, TAKSİM TRAİNİNG AND RESEARCH HOSPİTAL,
Background&Aims:
Examining the sufficiency of dominant nodule FNAB, in terms of planning the

treatment and diagnosis of thyroid cancer.
Methods:
161 patients whose pathological examination showed thyroid cancer were

retrospectively examined, in the period of 1998-2010. We reviewed the pathological
findings of 142 patients with FNAB directed to nodule with diameter exeed 1cm,
palpable or ultrasonographically detected and termed as dominant nodule. Number
of malign focus, diameter of the malign areas, localization in the dominant nodule
and/or out of it, localization in the dominant nodule lobe /or out of it, and their
histological types were recorded.
Results:
It was observed that 65.5% of the 208 cancerous areas is single and 34.5%
patients are multisentric; histological type of the all multicentric cases is papillary.
Additionally, 57.7% of the cancerous areas was observed outside of the dominant
nodule and 34.5% of the cancerous areas was observed in the contralateral lobe of
the dominant nodule.
Conclusion:
Our results indicate that if FNAB is applied only to the dominant nodule, more than
half of the thyroid cancer focuses wil be missed; and the thyroidetomy applied to
dominant nodule lobe may overlook one third of thyroid cancer. It was concluded
that FNAB should be applied at least to another area of dominant nodule, especially
to the contralateral lobe if there are souspicious area; in the case of the papillary
cancer suspicion, because of possible multicentricity total thyroidectomy should be
considered.
-482-
PP - 285 THE ROLE OF SCORING SYSTEMS IN PREDICTING
LOCOREGIONAL RECURRENCE IN DIFFERENTIATED THYROID
CANCER
BEKIR OZDEMIR 1, ZAFER KILBAS 2, TANER YIGIT 2, ORHAN KOZAK 2, ISMAIL
ARSLAN 2
1
CANAKKALE MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
CANAKKALE, TURKEY
2
ANKARA, TURKEY
Background&Aims:
Despite excellent survival in differentiated thyroid cancer(DTC), locoregional

recurrence rates still remain high and constitutes a major problem. Many scoring
systems (MACIS, AGES, MSKCC system etc) have been developped to predict the
prognosis. But the role of scoring systems in evaluating the locoregional recurrence
have not been well documented. In this retrospective study the effectiveness of the
scoring system in predicting recurrence were investigated
Methods:
We retrospectively reviewed 156 patients with DTC (papillary, folicular and hurthle
cell) and the patients were divided into risk groups based on MACIS and MSKCC
system. Locoregional recurrence rate were calculated according to the risk groups.
Results:
In the low risk groups, locoregional recurrence rate for MACIS and MSKCC were
9.1% and 4% respectively. On the other hand, high risk groups have the recurrence
rates of 42.9% and 38.5% respectively. Postoperative complication rate was higher
in patients who underwent extended and repeated surgery.
Conclusion:
Risk scoring systems especially MACIS and MSKCC classification can truly predict
the locoregional and distant metastasis and so, every patients wih DTC should be
classified and the extend of surgery should be planned according o the risk scores.
-483-
PP - 286 THE ROLE OF LOCALIZING STUDIES IN PARATHYROID
SURGERY.
ZAFER KILBAS 1, RAMAZAN YILDIZ 1, EYUP DURAN 2, ERKAN OZTURK 1, ONER
MENTES 1, SEMIH GORGULU 1

1
ANKARA, TURKEY
ELAZIG MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY, ELAZIG,

2
TURKEY
Background&Aims:
Parathyroidectomy for primary hyperparathyroidism(HPT) has shifted from a

bilateral neck exploration to minimally invasive surgery. Improved imaging studies
had a considerable influence on this shift. The aim of this study was to investigate
the role of imaging methods based on the combination of 99mTc-MIBI scintigraphy
and neck ultrasound.
Methods:
102 patients with hyperparathyroidism were enrolled in the study. All patients were
operated on by the same instutition. In patients with scan/ultrasound evidence
of a solitary parathyroid gland and with a normal thyroid gland, minimal invazive
parathyroidectomy was planned. Postoperative normocalcaemia was considered
success independent of serum parathyroid hormone levels.
Results:
The patients had a median age of 53 years. Of the 102 patients, 80 were female and
23 male. Separately, a MIBI scan and US lateralised the side of the lesion in 85%
and 90% of cases respectively. When US and the MIBI scan agreed, the predictive
accuracy of localisation studies was 96%. Surgical success (normocalcemia) was
achieved in the majority of patients (94%).
Conclusion:
The results of our study confirmed that combination of MIBI scanning and neck
ultrasonography could be useful in planning the extent of the surgery (minimally
invasive parathyroidectomy or bilateral neck exploration).
-484-
PP - 287 BILATERAL SURRENAL METASTASIS IN COLORECTAL
CARCINOMA
TOLGA CANBAK 1, MUJGAN CALISKAN 1, FATIH BASAK 1, ALI KILIC 1, MUSTAFA
OZBAGRIACIK 1, AYLIN ACAR 1, GURHAN BAS 1, ORHAN ALIMOGLU 2
1
2
Introduction:
The adrenal gland metastasis incidence of colorectal cancer is 4.8%-14% and

metastasis to bilateral adrenal gland is very rare. In this study, we aimed to present
a case of bilateral adrenal metastasis of colorectal carcinoma.
Case report:
Forty-five-year-old male patient was operated due to rectum cancer. After 12 month
follow-up, Magnetic resonance imaging was detected 14 cm lesion in the right and
11 cm in the left adrenal gland. Bilateral adrenalectomy was performed with two
phase in one week. Patient was discharged uneventfully with substitution therapy.
There was no complications in 8 months follow-up.
Conclusion:
Adrenal metastasis is seen rarely in colorectal carcinoma follow-up. But, this

condition is usually related with systemic spread and poor outcome.
-485-
PP - 288 PRIMARY HYPERPARATHYROIDISM AND SARCOIDOSIS
WITHOUT ORGAN INVOLVEMENT IN A PATIENT WITH
ASYMPTOMATIC HYPERCALCEMIA AND NORMAL VITAMIN-D AND
ACE CONCENTRATIONS
MUHAMMET KADRI COLAKOGLU 1, ERDINC YENIDOGAN 2, MEHMET ALI
GULCELIK 1, GULAY BILIR 3, NESE ERSOZ GULCELIK 4, GOKHAN GIRAY AKGUL 1,
YILMAZ OZDEMIR 1
1
2
3
4
HACETTEPE UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF
ENDOCRINOLOGY AND METABOLISM, ANKARA, TURKEY
Introduction:
Primary hyperparathyroidism is the most common cause of hypercalcemia.
Hypercalcemia is also a laboratory finding of granulomatous diseases like
sarcoidosis. We report an interesting case that presented with elevated calcium
and parathyroid hormon levels, normal vitamin 1,25(OH)2D3 concentration and no
imaging and laboratory investigations were suggestive of granulomatous disease.
Case report:
56 year old woman admitted with hypercalcemia incidentally without another
abnormalities. On admission, we determined high plasma parathyroid hormone
level but ultrasonography and Tc-99m MIBI were unremarkable for parathyroid mass.
PET CT scan revealed multiple F-18 FDG involvement in mediastinum. Interestingly,
patients preoperative tests revealed normal 1,25(OH)2D3 concentration and
normal serum ACE levels that we eliminated diagnosis of sarcoidosis before surgery.
According to the findings, considering her age and the risk of malignancy, our
patient undergo surgery and exploration of mediastinum, thymectomy and ectopic
parathyroidectomy was performed. But surprisingly pathology results present
regular thymus tissue and non-caseating granulomatous lympadenitis which
histologically confirmed sarcoidosis.
Conclusion:
To our knowledge, we reported the first patient with coexisting primary
hyperparathyroidism and sarcoidosis with high serum calcium levels and normal
serum vitamin D concentrations. The diagnosis of sarcoidosis should be kept in
mind even in patients without laboratory, radiologic and scintigraphic findings.
-486-
PP - 289 BREAST CANCER PRESENTING WITH THYROID AND
CERVICAL LYMPH NODE METASTASES
ERKAN OZTURK 1, EYUP DURAN 2, RAMAZAN YILDIZ 1, MEHMET FATIH CAN 1, SALIH
DEVECI 3, TURGUT TUFAN 1
1
TURKEY
2
3
GULHANE SCHOOL OF MEDICINE PATHOLOGY DEPARTMENT, ANKARA, TURKEY
Introduction:
In this case report we mentioned a patient who was operated for the thyroid
nodule. microscopic evaluation revealed thyroid and cervical lymph nodes all were
metastased by breast cancer.
Case report:
72-years old female patient presenting with hoarseness admitted to our hospital.
Ultrasound examination revealed bilateral solitary nodules in thyroid gland with a
maximal diameter of 37x23x19mm and bilateral cervical lymph nodes with a maximal
diameter of 15.5x10x5mm. Pathological examination of the Fine Needle Aspiration
Biopsy material from the thyroid nodule revealed metastatic adenocarcinoma. total
thyroidectomy and bilateral central lymphadenectomy was performed. Patient was
operated seventeen years ago for breast cancer. Pathological report was metastasis
to thyroid gland and bilateral cervcial nodes. Histologically, the tumor resembled
signs of invasive ductal adenocancer.
Conclusion:
In conclusion metastases to the thyroid are uncommon. In some studies breast

cancer is the most common primary site found in thyroid metastases. Thyroid
metastases should be borne in mind even a long time after modified radical
mastectomy for breast cancer. When we detect a suspicious lesion of thyroid, we
must do FNAB and then if the pathology is breast cancer metastases, we must do
operation as it is a primary thyroid cancer.
-487-
PP - 290 INTRATRAKEAL SILICONE STENT PLACEMENT TO
TREATMENT SCHEMA OF RIEDEL’S THYROIDITIS: A CASE REPORT
GÜRKAN DUMLU 1, FAHRI YETISIR 1, MURAT BAKI YILDIRIM 1, MEHMET TOKAÇ 1,
İBRAHIM KILINÇ 1, ŞEFIKA BURÇAK POLAT 2, TÜLIN GÜMÜŞ 3, MEHMET KILIÇ 1
1
ATATÜRK RESEARCH AND TRAINNING HOSPITAL, GENERAL SURGERY
DEPARTMENT, ANKARA, TURKEY.
2
ATATÜRK RESEARCH AND TRAINNING HOSPITAL, ENDOCRINOLOGY, ANKARA,
TURKEY.
3
Introduction:
Riedel’s thyroiditis is a form of inflamatur proliferative fibrosis is characterized

by the process of thyroiditis. Although It is benign and self-limited disease, It can
destroye all the thyroid gland and surrounding tissue. The etiology is still unclear.
Clinical symptoms are usually associated with symptoms of compression. There
is an indication for surgical treatment if tracheal and esophageal compression
symptoms develops. However, due to adhesion to surrounding tissues excessive
surgical excision is usually impossible.
Case report:
Male, 25-year-old patient with symptoms of compression and respiratory distress

admitted to another hospital. Riedel thyroiditis was diagnosed and partial
thyroidectomy was made. The patient was admitted to our hospital with symptoms
of recurrent respiratory distress. Extention and fixation of the thyroid tissue has
been identified as starting from anterior of trachea and extending posterior to the
esophagus. Patient treated with 40 mg/day tamoxifen and 20 mg/day prednol for six
months . The patient had not recovered with this treatment. Partial thyroidectomy
and permanent intratracheal silicone stent was performed. The shortage of
complaint concerning the patient’s respiratory system has declined during early
follow-up.
Conclusion:
Intratrakeal silicone stent placement to treatment schema of Riedel’s thyroiditis is

scrutinized with literatüre
-488-
PP - 291 LIFE-THREATENING PARATHYROIDECTOMY FOR
HYPERCALCEMIC CRISIS. CASE REPORT AND LITERATURE REVIEW.
ANGELA GURRADO , PASQUALE DI FRONZO , FRANCESCO VITTORE , GIOVANNA
DI MEO , VALENTINA FERRARO, FRANCESCO FRAGASSI , ALESSANDRO PASCULLI ,
MARIO TESTINI
DEPARTMENT OF BIOMEDICAL SCIENCES AND HUMAN ONCOLOGY; UNIT OF

ENDOCRINE, DIGESTIVE, AND EMERGENCY SURGERY. UNIVERSITY MEDICAL
SCHOOL “ALDO MORO” OF BARI, ITALY.
Introduction:
Hypercalcemic crisis is an uncommon and potentially life-threatening manifestation

of primary hyperparathyroidism, and it is associated with rapid deterioration of
central nervous system, cardiac, gastrointestinal, and renal function.
Case report:
We present a case of a 76-year-old man in sudden coma due to hypercalcemic

crisis, as first manifestation of primary hyperparathyroidism. At first, the patient
was treated conservatively, with gradually improving of the mental status. On
the ninth day after the initiation of therapy, a minimally invasive radioguided
parathyroidectomy was performed, with normazilation of calcaemia and PTH.
Histologically, the tumor consisted of parathiroid adenoma.
Conclusion:
A Systematic review was performed by consulting PubMed Medline for publications

from 1958 to 2011 collecting a total of 499 reported cases of hypercalcemic crisis
due to primary hyperparathyroidism. Manifestations are neurological, cardiac, renal
and gastrointestinal dysfunctions associated with markedly elevated calcaemia
and PTH. The most frequent histology is the parathyroid adenoma. In untreated
cases, mortality is 100%. Despite the advances in the management, mortality rate
is still 93.5% in only conservatively treated patients. Medical therapy followed by
expeditious parathyroidectomy should be considered as the treatment of choice
for patients affected by hypercalcemic crisis due to a primary hyperparathyroidism.
-489-
PP - 292 LAPARAXCOPIC ADRENALECTOMY IN VHL SYNDROME
BULENT CITGEZ , OGUZHAN KARATEPE , SAYID S. ZUHUR , ISMAIL ETHEM AKGÜN ,
MURAT FERHAT FERHATOGLU , MUHARREM BATTAL , ADEM AKCAKAYA
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, ISTANBUL
Introduction:
Von Hippel–Lindau disease (VHL) is an autosomal dominant tumor predisposition

syndrome, characterized by multiple benign and malignant tumors of the central
nervous system, kidneys, pancreas, adrenal pheochromocytoma, and paraganglia.
Technique of laparoscopic adrenalectomy may be more preferred technique than
open adrenalectomy because of having less morbidity, quicker recovery time,
less postoperative pain, less hospitalisation time. In this case, we aim to present
laparoscopic adrenalectomy technique in VHL patient.
Case report:
43-year-old female patient diagnosed with VHL three years ago, because of
pheochromocytoma and RCC. She had a right nephrectomy and adrenalectomy
operation in open technique. Three years later, high blood pressure and tachycardia
is determined. The laboratory tests and imaging studies measuring 3 cm mass in
the left adrenal consistent with pheochromocytoma is detected.The patient were
performed transperitoneal adrenalectomy surgery. Transperitoneal laparascopic
adrenalectomy surgery performed and patient was discharged on the second day
without any post-operative complications.
Conclusion:
After many years, in other adrenal gland pheochromocytoma can be occur in

patients with VHL. Laparoscopic adrenalectomy is a minimal invasive method that
can be performed safely with low morbidity, shorter hospitalization time and better
cosmetic results
-490-
PP - 293 SIMULTANEUS HYPERTHYROIDSM WITH
HYPERPARATHYROIDSM
MURAT FERHAT FERHATOGLU
Introduction:
Simultaneus hyperthyroidsm with hyperparathyroidsm is a rare situation without

story of neck irradiation . Hyperthyroidsm may cause hypercalcemia but after
threatment calcium level should become normal. İn this case we aimed to present
a hypercalcemic patient with elevated parathormone levels and hyperthyroidsm.
Case report:
33 year-old female patient with complain of tachicardia refers to clinic,

hypercalcemia with elevated parathormone levels seen in her test results and her
thyroid hormone levels were elevated ,also thyroid autoantibody determination
was negative . İn parathyroid scintigraphy a PTH producing parathyroid adenoma
seen in the inferior pole of left thyroid gland and diffuse thyroidites seen in neck
usg. Patient has threated with propylthiouracil and propranolol for hyperthroidsm
and tachicardia. The patient was operated for parathyroid adenoma with minimally
invasive approach after become euthyroid with medical treatment.
Conclusion:
The most common cause of hypercalcemia in society is hyperparathyroidsm, but

hyperthyroidsm should be kept on mind for reason of hypercalcemia,operating a
patient with hyperthyroidsm can be dangerous for the surgeon and anestesiologist,
so for safer parathyroid surgery carrying out thyroid function test may be reasonable
attitude for all surgeons
-491-
PP - 294 PERSISTENT PRIMARY HYPERPARATHYROIDISM
TERESA CIAMPORCERO , GIORGIA GAVELLO , FRANCESCO GHIGLIONE , CLEMENTE
RONCHETTA , SILVIA CATALANO , GUIDO GASPARRI
AZIENDA OSPEDALIERA UNIVERSITARIA SAN GIOVANNI BATTISTA, TORINO

CHIRURGIA GENERALE III° ED ESOFAGEA, ITALY
Introduction:
More than 95% of patients with primary hyperparathyroidism are successfully

treated at the initial operation when the operation is done by an experienced
surgeon. Before surgery, in reoperations, is necessary to confirm diagnosis and to
use precise localization procedures. Re-exploration after one or more previously
failed parathyrodectomy is unfortunately associated with a higher morbidity and a
lower success rate.
Case report:
We present a case of a female, 38 years old patient, with a kidney cancer,

benign uterine disease and juvenile hypertension associated with primary
hyperparatyrodism (suspect of VHL disease). In January 2006 she underwent a
subtotal parathyrodectomy with total thimectomy in an Hospital in Milan. After
surgery a persistent hyperparathyroidism was documented. Parathyroid scintigraphy
showed persistence of hyperfixation inferior to the right thyroid lobe without
evidence of other hyperplastic parathyroids; furthermore blood exams documented
hypercalcemia, hypophosphoremia, and high PTH level. In January 2012 she went
to our Hospital and we decided to re-operate the patient. We removed an atipic
adenoma of right superior parathyroid, in the posterior mediastinum. The post-
operative course was uneventful with a normalization of calcium and PTH levels.
Conclusion:
We didn’t confirm VHL disease. Furthermore we suspected a mutation of the gene

CDC73, related to an Hyperparatyrodism - jaw tumor syndrome .
-492-
PP - 295 ABDOMINAL SPLENOSIS MIMICKING ADRENAL MASS
YALIN İŞCAN , İSMAİL CEM SORMAZ , BURÇİN BATMAN , İLKER ÖZGÜR , FATİH
TUNCA , YASEMİN GİLES ŞENYÜREK , SERDAR TEZELMAN , TARIK TERZİOĞLU
ISTANBUL FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY, ISTANBUL,

TURKEY
Introduction:
Splenosis is the autotransplantation of splenic tissue following traumatic rupture

of spleen, laparotomy or splenectomy. We describe a case of abdominal spleenosis
mimicking left adrenal tumor.
Case report:
A 31-year-old man who had a history of splenectomy due to abdominal gun-shut

wound was hospitalized for chronic abdominal pain. Computer tomography (CT)
was performed and solid mass, measured as 33×35×28 mm, originating from left
adrenal gland was detected. A magnetic resonance imaging could not performed
due to femur fracture instrumentation. Endocrine work-up for the adrenal masses
were negative. Surgical treatment was not necessary and he was discharged from
hospital. Six month later he was evaluated again by a CT scan. The solid mass grew
up to 70x54x32 mm. Before performing biopsy, a (99m) technnetium heat-damaged
red blood cell scan was performed and the mass turned out to be splenic tissue in
origin.
Conclusion:
In the diagnosis of adrenal masses, splenosis should be kept in algorithme in

patients with a history of splenectomy.
-493-
PP - 296 MINIMALLY INVASIVE THYROIDECTOMY:A CASE REPORT
OF THE FIRST CLINICAL EXPERIENCE.
ABDOLREZA PAZOUKI , SINA SAFAMANESH , ZEINAB TAMANNAIE
MINIMALLY INVASIVE SURGERY RESEARCH CENTER, TEHRAN UNIVERSITY OF

MEDICAL SCIENCE, TEHRAN, IRAN
Introduction:
The minimally invasive procedure offers better magnification of anatomy, improves

illumination and illumination of the operative field, leads to earlier recovery, better
pain control , and has better cosmetic results. Few centers use this method of
surgery but this is the first time in Iran
Case report:
we present a report of a patient presenting with right lobe thyroid nodule that
minimally invasive lobectomy-isthmectomy through an axillary incision was
prepared for her.This procedure is reportedbecause this is the first minimally
invasive thyroidectomy in Iran.
Conclusion:
Minimally invasive thyroidectomy was done successfully for a young lady with a
cold nodule of thyroid in Rasoole-akram hospital . she tolerated the procedure well
without any complication and discharged with a very good condition.
-494-
PP - 297 COMPOSITE ADRENAL MEDULLARY TUMOR: A CASE
REPORT
AHMET CEM DURAL 1, HALIL FIRAT BAYTEKIN 2, IRFAN BASOGLU 1, CEVHER
AKARSU 1, ERCAN INCI 3, MERAL MERT 4, ALI KOCATAS 1, HALIL ALIS 1
1
2
3
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL, RADIOLOGY
4
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL,
ENDOCRINOLOGY DEPARTMENT, ISTANBUL, TURKEY
Introduction:
Adrenal neoplasms composed of more than one cell type and demonstrating a
mixed histologic appearance are uncommon.
Case report:
A 57-year-old woman presented with history of hypertension and abdominal pain.

Epinephrine level was 140µg/day (4-20), dopamine level was 3279µg/day (190-450)
metanephrine was 2254 µg/day (52-34) in 24 hour urine collection. Blood cortisol
level was 27.3µg/dL (5-25) and ACTH level was 50.7pg/mL (0-46). Computerized
tomography scan revealed a 50x35mm lobulated, solid-cystic, heterogenously
enhancing mass in the right suprarenal region. Magnetic resonance imaging yielded
a 52x33x42mm mass, hyperintense on T2 weighted and isointense heterogenous
on T1 weighted images. The patient underwent laparoscopic right adrenalectomy.
Perioperative period was uneventful. In histopathologic evaluation, the cut surface
showed a firm, tan colored tumor with cyst-like areas. Pheochromocytoma
component of the tumor highlighted by chromogranin, synaptophysin and protein
S100. The ganglioneuromatous component consisted of bundles of spindle cells.
Pheochromocytoma of the Adrenal gland Scaled Score (PASS) of the tumor was 13.
The patient was disease and symptom free at ninth months.
Conclusion:
Composite adrenal medullary tumors are rare and benign tumors but a distant
metastasis has been reported in one patient. It can be suggested these patients
should have life-long clinical and biochemical follow-up.
-495-
PP - 298 MULTIFOCAL PAPILLARY CARCINOMA AND MEDULLARY
MICRO CARCINOMA OF THE THYROID GLAND: A CASE REPORT
AHMET CEM DURAL 1, CEVHER AKARSU 1, IRFAN BASOGLU 1, AHMET YILMAZ 2,
M.ARIF KARAKAYA 1, NURTEN SEVER 3, ALI KOCATAS 1, HALIL ALIS 1
1
2
ISTANBUL, TURKEY
3
Introduction:
We report a case of synchronous multifocal papillary thyroid carcinoma (PTC) and

medullary microcarcinoma (MTC) diagnosed after thyroidectomy for goitre with
irregular postoperative follow-up.
Case report:
A 36-year-old woman admitted with a history of thyroidectomy followed by

radioiodine ablation (100mCi) based on the histopathological diagnosis of MTC and
PTC. A bilateral cervical lymphadenopathy and rest thyroid tissue on the right side
were seen on sonography. Parathormon, calcium, thyroglobulin and calcitonin levels
were in normal range (42pg/mL, 9.7mg/dl, 0.2ng/mL and 2pg/mL respectively).
Magnetic resonance imaging (MRI) revealed potential benign cervical and right
upper mediastinal lymphadenopathies on T2 weighted images. Abdominal MRI and
RET proto-oncogene mutation analysis were done for the investigation of multiple
endocrine neoplasia 2A syndrome and familial MTC. No pathological or genetic
findings was found in favor of familial or syndromic disease. A neck exploration and
bilateral central and lateral lymphadenectomy were performed. Histopathologic
evaluation yielded 13 reactive lymph nodes and no methastasis or recurrence was
found. A chylous fistula and severe hypocalcemia occured in postoperative period
and treated conservatively.
Conclusion:
Definitive histopathologic evaluation and reliability of patients are very important

for diagnosis and follow-up period. All patients with MTC should be screened for
syndromic or familial counterparts.
-496-
PP - 299 LAPAROSCOPIC ADRENALECTOMY: REVIEW OF 21 CASES
SAHIN

Background&Aims:
Laparoscopy is now considered the standard of care for the treatment of functioning
and nonfunctioning adrenal pathology, even in case of potentially malignant tumor.
Here we present patient demographics, pathology, surgical procedure and outcome
of the patients who underwent laparoscopic adrenalectomy in our department.
Methods:
From 2006, 13 patients underwent laparoscopic total and 8 patients underwent

laparoscopic partial or cortical-sparing adrenalectomy. The indications for total
adrenalectomy were pheochromocytoma (n=9), Cushing’s syndrome (n=1),
and adrenal incidentaloma (n=3). Partial adrenalectomy was performed for
pheochromocytoma (n=2), aldosterenoma (n=2), adrenal cyst (n=2) and Cushing’s
syndrome (n=2) whose lesions were located far from the adrenal central vein, and
the vein could be preserved. Energy-based devices were used during the surgery.
Results:
Thirteen of the patients was female and mean age of the patients was 46.09 (31-
66). There was no conversion to open surgery. Mean operation time was 84.28 min
(40-180) and mean postoperative hospital stay was 2.14 days (2-4). No significant
morbidity was happened. Mean follow-up period was 31.47 months (1-73). No
recurrence was detected. Control blood and urine analyses for the functioning
tumors were normal in both total and partial adrenelectomy patients during follow-
up period.
Conclusion:
Our results indicate that both total and partial laparoscopic adrenalectomy is a
safe operation that incorporates all the benefits of minimal access surgery and is
associated with a satisfactory postoperative outcome. For the partial or cortical-
sparing adrenalectomy, sufficient venous drainage is important. Preservation of the
adrenal central vein allows a good functioning of the remnant adrenal gland.
-497-
PP - 300 THYROID INCIDENTALOMAS DIAGNOSED BY POSITRON
EMISSION TOMOGRAPHY-COMPUTED TOMOGRAPHY
ANTONIO MORAL DUARTE , OZLEM UYANIK , JOSE IGNACIO PEREZ GARCIA ,
BEATRIZ ESPINA PEREZ , JOAN DUCH RENOM , MONTSERRAT CLOS ENRRIQUEZ ,
MANUEL TRIAS FOLCH

Background&Aims:
The use of positron emission tomography-computed tomography (PET-CT) in the

diagnosis and monitoring of cancer patients has led to increased detection of
thyroid incidentalomas. Proper assessment and management of these lesions is a
new challenge for the clinician and the surgeon.
Methods:
We collected the patients referred to the surgery out patient clinic for thyroid
incidentaloma diagnosed by PET-CT. Were recorded prospectively underlying
disease, information provided by PET-CT, ultrasound and cytology.
Results:
We detected 11 patients with a mean age of 62. The most common underlying
disease was lung carcinoma. In all cases the PET-CT exhibited a focal pattern
corresponding to a hypermetabolic lesion. Nine cases were operated and in the
remaining two patients intervention was ruled out due to the poor prognosis.
In seven patients the pathology result was thyroid carcinoma. One case had
adenomatous hyperplasia and the other without any thyroid disorder.
Conclusion:
Most malignant incidentalomas are primary tumors of the thyroid, papillary

carcinoma being the most frequent. The likelihood of being a thyroid metastasis is
very low. In the presence of focal reuptake it should be performed an ultrasound
and biopsy of the lesion and thyroidectomy should be considered depending on the
patient’s underlying disease.
-498-
PP - 301 DISTANT METASTASIS IN THYROID PAPILLARY CANCER
KAZIM CAGLAR OZCELIK 1, SEVIM TURANLI 1, YAVUZ PIRHAN 2
1
GENERAL SURGERY, ANKARA TURKEY
2
SUNGURLU GOVERNMENT HOSPITAL DEPARTMENT OF GENERAL SURGERY,
ANKARA TURKEY
Background&Aims:
Distant metastasis is rare in patients with thyroid papillary cancer initially.
Methods:
Among the 250 patients diagnosed with papillary carcinoma between 1994-
2007, distant metastasis was detected in 19 patients (7,6%). All of the patients
underwent total thyroidectomy and 13 patients (68,4%) who had cervical lymph
node metastasis also underwent lymph node dissection. Patients were followed-up
median 80 months (range; 9-158 months).
Results:
Sixty-three point two percent of the patients with distant organ involvement
were female and 52,6% of them were below 45 years old. Classical type papillary
carcinoma, follicular variant and tall cell variant were reported 68,4%, 21.1%
and %10.4 of the patients respectively. Thyroid capsule invasion, multifocality
and vascular invasion were detected 79.0%, 44.4% and 10.5% of the patients
respectively. The most common metastasis site was in lung (89,4%). Isolated bone
metastasis were detected in 10.6% of the patients. Progression were developed in
66,8% of the patients. Progression free survival was 61 months (range;4-158), 80%
of the progression was systemic, 20% of it was locoregional. At the end of the study,
31.6% of the patients were died because of the disease.
Conclusion:
Although pulmonary metastasis is the most prevalent distant metastasis survival of

it is relatively long.
-499-
PP - 302 THE EFFECTS OF ELEVATED INTRAABDOMINAL PRESSURE
THAT WAS MADE BY PNöMOPERITONEUM ON STRESS HORMONES
BASED FROM HYPOPHYSIS CORTISOLE AND THYROID HORMONE’S
PROFILE
ERDAL UYSAL 1, TÜRKAY KIRDAK 2, NUSRET KORUN 2
ÖZEL SANI KONUKOĞLU HASTANESI, GAZIANTEP, TURKEY

1
ULUDAG UNIVERSITY MEDICAL FACULTY, BURSA, TURKEY

2
Background&Aims:
The effects of elevated intrabdominal pressure that was made by pnömoperitoneum

on stress hormones based from hypophysis, cortisole and thyroid hormone’s profile
was investigated.
Methods:
The 150 “wistar albino” female rat was used in the present study. There were five
mean groups of rats. Group 1: , Group 2 and Group 3 were exposed to 15 mmHg
pressure, Group 4 and Group 5 were exposed to 25 mmHg pressure. Blood tests
were taken before decompression in Group 2 and Group 4, after decompression in
Group 3 and Group 5. There were 10 rats in each group. Blood TSH, T3, T4, ACTH,
vasopressin and cortisole levels were evaluated.
Results:
TSH levels in Group 4 and Group 5 that had been exposed to high pressure were
significantly lower (p<0.001), free T3 and total T3 levels in Group 4 was detected
elevated (p<0.05). significant increase in free T3 levels only in Group 3. Significant
increases in vasopressin, ACTH and cortisole, levels were parallel to increase in
intraabdominal pressure.
Conclusion:
An increase in intraabdominal pressure causes increased secretion of vasopressin,

ACTH and cortisole. While TSH secretion is suppressed T3 secretion increases due
to increase intraabdominal pressure.The results are not clear yet in this subject. To
understand the differences of TSH values in the increasing intraabdominal pressure
and to get good results in clinical study, we need new study.
-500-
PP - 303 SURGECAL MANAGEMENT OF HIPERPARATHYROIDISM
AND USES OF ROLL WITH TC-99M LABELED MACROAGGREGATED
ALBUMIN
MUSTAFA TANRISEVEN , RAMAZAN YILDIZ , ERKAN OZTURK , ZAFER KILBAS ,
SEMİH GORGULU
Background&Aims:
The purpose of this study was to investigate the efficiency of a radioguided occult
lesion localization technique in hyperparathyroidism. We also used firstly Tc-99m
labeled macroaggregated albumin for marking the pathologic lessions under US
guidance.
Methods:
Data were prospectively collected on patients who underwent surgery for the
hyperparathyroidism with or without ROLL marking between February 2008 and
April 2012. Patients who were treated previously with surgery or had palpable
lessions were excluded. Before surgery the lessions were marked by ROLL
application with Tc-99m labeled macroaggregated albumin. Patients who didn’t
marked anyway found in clinic old records as the control group. Investigated the
effectiveness of surgery in both hyperparathyroidism group due to marked and not
marked pathologic lessions by ROLL applications.
Results:
There were totally 30 patients in groups, 10 patients marked and 20 patients did not
marked. The 98%of pathologic lessions which marked by ROLL applications and did
not marked extracted in whole hyperparathyroidism patients group. There was no
sitastically significant differences between the groups.
Conclusion:
It is shown that the radioguided occult lesion localization technique was efficient
in the perioperative identification of hyperparathyroid lessions. In the litherature
Tc-99m sestamibi usually used for ROLL applications and especially effective in
multiglandular and ectopic placement of lession.
-501-
PP - 304 AN UNUSUAL PRESENTATION OF BOERHAAVE SYNDROME
AND ITS SURGICAL AND ENDOSCOPIC THERAPY : A CASE REPORT
GÜRHAN ÇELİK , ACAR AREN , HASAN BEKTAŞ , MEHMET EMİN GÜNEŞ
ISTANBUL EDUCATION AND RESEARCH HOSPITAL CLINIC OF GENERAL SURGERY,

ISTANBUL, TURKEY
Introduction:
Boerhaave’s syndrome is esophageal rupture as a result of forceful vomiting or

retching against a closed cricopharyngeus. We presented an unusual presentation
of Boerhaave Syndrome and discussed its surgical and endoscopic therapy.
Case report:
71-year-old man after a forceful vomiting had an acute abdomen due to esophageal
rupture and brought to Emergency Clinic of a private hospital in Samsun. He had
undergone laparotomy with a repair of the esophageal perforation and feeding
jejunostomy. In the postoperative 6 th day, pleural abscess had developed and right
chest tube had been inserted. An esophageal fistula had developed. After he had
been transfered to our Clinic, with the help further investigations esophagography,
tomography and endoscopy the site of esophageal fistula was established. A
covered stent was inserted and placed over the 3 cm large fistula orifis in lower
part of esophagus. Control esophagography revealed that the leakage had stopped.
After oral feeding the patient had distention and signs of intestinal obstruction.
Laparotomy was done and a jejunal torsion was found and revised, feeding
jejunostomy closed. After 6 weeks of insertion, the covered stent was teken out.
Control esophagography was normal and oral feeding was started.
Conclusion:
Boerhaave’s syndrome could be a complication of pre-existent gastrointestinal

disease, as in our case. Early diagnosis and carefully selected therapeutic tactics
can reduce the mortality rate of Boerhaave’s syndrome to an acceptably low level.
-502-
PP - 305 ESOPHAGEAL CARCINOMA WITH RARE METASTASIS TO
MUSCLE
AFAQ ZAMAN KHAN 1, IQBAL KHAN 2, MAJOR ASAD ZAMAN KHAN 3, SHAHBANO
JAMALİ 4
1
HAYS MEDICAL CENTER, USA
2
MAYO GENERAL HOSPITAL, IRELAND
3
ARMY MEDICAL COLLEGE, PAKISTAN
4
FLORIDA HOSPITAL ALTAMONTE, USA
Introduction:
The link between esophageal carcinoma and metastasis to skeletal muscles is

extremely rare. Only eight cases have been reported in medical literature so far.
Case report:
We report a 79 year old lady presenting with worsening dysphagia. EGD revealed
a large mass extending from mid to distal esophagus partially occluding the
lumen. Histopathology came back consistent with moderately differentiated
adenocarcinoma of the esophagus. Staging CT scans showed a large hiatal hernia
with thickening of distal esophagus. A 1.6 cm lesion in the liver and 1.8 cm enlarged
perigastric lymph node were seen as well. PET scan showed multiple soft tissue
abnormalities in left shoulder, erector spinae and pelvic musculature. Core needle
biopsy of the gluteal musculature showed metastatic adeno-carcinoma of gastro-
esophageal origin.
Conclusion:
Metastasis to skeletal muscles represents less than 1% of all hematogenous

spread from solid tumors. Inspite of skeletal muscles being well vascularised, the
rarity of metastasis may be secondary to proteases and other inhibitors blocking
tumor invasion. Treatment options include observation, excision, radiotherapy
and chemotherapy. This case report highlights multiple asymptomatic muscle
metastases. It also elucidates the advantage of PET scan over a CT scan in identifying
metastatic lesions
-503-
PP - 306 FULLY COVERED REMOVABLE NITINOL SELF-EXPANDABLE
METAL STENT (FCRN-SEMS) APPLICATION FOR FISTULA IN NISSEN
FUNDOPLICATION
İHSAN TAŞÇI , SÜLEYMAN DEMİRYAS , AKİF ENES ARIKAN , YUSUF ÇİÇEK
ISTANBUL UNIVERSITY CERRAHPASA MEDICAL FACULTY DEPARTMENT OF GENERAL

Introduction:
Laparoscopic Nissen fundoplication (LNF) is golden standard operation for

gastroesophageal reflux (GER) disease (1-3). Some complications of LNF are
dysphagia, gastrointestinal (GI) perforation (4, 5). Endoscopy is a priority option in
diagnosis and treatment of GI leakages.
Case report:
Case 1: A 61-year-old man who underwent to LNF in another clinic three weeks
ago admitted to hospital with leakage from drainage catheter. The upper
gastrointestinal series (UGIS) showed slower passage of contrast fluid to stomach
and leakage to the drainage catheter through the posteriolateral wall of lower
esophageal sphincter (LES). Case 2: A 19-year-old woman with history of NF eight
years ago admitted to hospital for retrosternal burn. UGIS showed grade 3 GER due
to adhesive band lying between fundus and corpus of stomach. Patient underwent
to NF and adhesiolysis. On the 1st week of operation endoscopical examination
was performed for suspicion of leakage and revealed a fistula opening in the LES. In
both cases a FCRN-SEMS placed over the defect in the esophagus endoscopically.
FCRN-SEMS was removed after six weeks and there is no complication in one-year
follow-up period.
Conclusion:
Fistula is a short-term complication. GI leakages are life threatening complications.

Endoscopical FCRN-SEMS is an efficient minimally invasive option for leakages after
LNF or NF when applied on time.
-504-
PP - 307 ECTOPIC PANCREAS TISSUE IN THE STOMACH -REPORT OF
A CASE
HASAN BOSTANCI , ALI CIHAT YILDIRIM , GOKTURK GURSOY , HULAGU KARGICI
DISKAPI YILDIRIM BEYAZIT TRAINING AND RESEARCH HOSPITAL GENERAL SURGERY

Introduction:
Heterotopic or ectopic pancreas is the presence of an abnormality located focus

of normally developed pancreatic tissue outside the boundaries of the orthotopic
pancreas without anatomical or vascular connections Heterotopic pancreas is
usually found incidentally and generally is asymptomatic. Occasionally ectopic
pancreatic mass can become symptomatic depending on the size, location and
histopathological changes. Complications of heterotopic pancreas are secondary to
histopathological changes or caused by mass effect.
Case report:
We report a case of a 55 year old woman that has epigastric pain and was admitted
to our clinic in order to investigate submucosal gastric solid mass appeared in upper
GIS examination. On exploratory laparatomy; 4x4 cm sized lesion on the posterior
wall of the stomach was revealed. Wedge resection was performed. Frozen section
examination showed that this lesion was ectopic pancreatic tissue
Conclusion:
The differentiation of ectopic pancreas from submucosal tumors is difficult. The

diagnosis may be difficult intraoperatively due to macroscopic similarity with
gastrointestinal stromal tumour, gastrointestinal autonomic nerve tumour (GANT),
carcinoid tumor, lmpyhoma or gastric carcinoma. In unclear cases; frozen section
is very helpful to establish the diagnosis during surgery. This approach can avoid
unnecessary extensive operations
-505-
PP - 308 GALLSTONE ILEUS - A RARE PRESENTATION
CHRIS NEOPHYTOU , ALI QUREISHI , ANTHONY RAMSANAHIE , YASSER KHOLEIF
LINCOLN COUNTY HOSPITAL, LINCOLN, UK
Introduction:
We report a rare case of gallstone ileus and its management
Case report:
A 54-year-old with known liver cancer, inpatient under the oncology team for
chemotherapy, was review by the surgical team due to constipation for a few days
and distended abdomen. Examination revealed a tense abdomen with hyperactive
bowel sounds but no focal tenderness. Abdominal Xray showed prominent small
bowel loops. CT scan revealed a 4cm gallstone in the large bowel but no obvious
cholecystocolonic fistula. Given the findings, the case was treated conservatively.
Unfortunately the patient’s abdomen was becoming more distended and despite
enemas, he did not open his bowels over a period of one week following the
diagnosis of gallstone ileus. It was then decided to undergo a colonoscopy in an
attempt to retrieve or hydrolyse the gallstone. This was found to be in the proximal
rectum and several attempts to hydrolyse it were unsuccessful. The patient
underwent a laparotomy and colotomy for the removal of the gallstone.
Conclusion:
Gallstone ileus accounts up to 10% of the bowel obstruction in the elderly

population. This is only the 5th reported case of gallstone ileus with the gallstone
being impacted in the rectum and the only one treated with an invasive method.
-506-
PP - 309 STRANGULATED PARASTOMAL HERNIA; A CASE REPORT
DOĞAN ALBAYRAK 1, HÜSEYIN AKSOY 1, SEZGIN YILMAZ 2, YÜKSEL ARIKAN 2
TRAKYA UNIVERSITY MEDICAL FACULTY, EDIRNE, TURKEY

1
AFYON KOCATEPE UNIVERSITY MEDICAL FACULTY, AFYON, TURKEY

2
Introduction:
Parastomal hernia is a relatively freuquent complication of intestinal stoma but

strangulation of it is rare. In this report, we aimed to describe a case of parastomal
hernia and her surgical treatment together with reviewing of literature.
Case report:
A 68-year-old woman was evaluated in emergency department. The patient was

previously operated due to volvulus and sigmoid resection + colostomy were
performed in another hospital; however there was no remission of ileus in early
post-operative period. Patient with abdominal distantion was on 7th postoperative
day. It is seen that a 5 cm bowel segment was eviscerated and strangulated at
medial margin of Mikulicz colostomy (Fig.1-2). Emergency laparotomy was carried
out. On exploration, necrosis was seen in strangulated bowel segment. İntestinal
resection + end to end double layered small intestinal anastomosis + hernia repair
was performed.
Conclusion:
A great majority of patients with parastomal hernia remains asymptomatic.

Nevertheless swelling in the area of stoma, feeling of distension and discomfort,
rarely evisceration, intestinal obstruction, strangulation, and even perforation can
be seen in symptomatic parastomal hernias. Evisceration and strangulation are
fairly seldom and mortal affairs. Enterostomy should be constructed by an adequate
procedure through the center of the rectus sheath in order to prevent parastomal
hernia.
-507-
PP - 310 PRIMARY OMENTAL EXTRA-GASTROINTESTINAL STROMAL
TUMOR ON A YOUNG MAN: A CASE REPORT AND REVIEW OF THE
LITERATURE
ERDINC KAMER 1, MUSTAFA PESKERSOY 1, NESE EKINCI 2, TANER AKGUNER 1,
MEHMET HACIYANLI 1
1
HOSPITAL,DEPARTMENT OF SURGERY,IZMIR, TURKEY
2
DEPARTMENT OF PATHOLOGY, IZMIR, TURKEY
Introduction:
Generally, gastrointestinal stromal tumor (GIST) occurs in the digestive tract, and
the incidence of primary GIST lesions in the greater omentum has been reported to
be less than 1%.Here,we report a rare case of primary omental GIST which we have
verified immunohistochemically.
Case report:
A 25-year-old woman was referred to our hospital with an abdominal mass. At

laparoscopy, a well-encapsulated tumor was found in the greater omentum. The
mass was removed en-block with the greater omentum. Final pathology showed
a GIST. The cellularity was relatively high and the frequency of mitotic figures
was 5/50 high power fields (HPF). The tumor cells were diffuse immunoreactive
for myeloid stem cell antigen (CD34), weakly and focally positive for c-kit proto-
oncogene protein product (CD117). The patient had a complete tumor resection
and an uneventful postoperative course.
Conclusion:
GISTs are mesenchymal tumors originating primarily from interstitial cells of Cajal
or related stem cell-like precursors of the gastrointestinal tract wall. Typically, they
are characterized by the expression of the receptor tyrosine kinase Kit (CD117).
Stromal tumors of extra-gastrointestinal origin are rare. A good prognosis would be
expected by a complete resection with negative surgical margins in young patients
with extra-gastrointestinal stromal tumor (EGIST).
-508-
PP - 311 A MALIGNANT NEUROENDOCRINE TUMOR OF ILEUM IN
AN 83-YEAR OLD PATIENT WITH NEUROFIBROMATOSIS 1
ISMAIL OKAN 1, ERDINC YENIDOGAN 1, SERVET TALI 1, HUSEYIN AYHAN
KAYAOGLU 1, FATMA MARKOC 2, ZEKI OZSOY 1, MUSTAFA SAHIN 1
1
2
PATHOLOGY, TOKAT, TURKEY
Introduction:
Neurofibromatosis is a rare autosomal dominant disease involving both males and

females. It is associated with increased susceptibility of tumors with an incidence of
5 to 15 %. Although sarcomas, endocrine tumors, and central or peripheral nervous
system tumors are the main tumors encountered, neuroendocrine tumors are rare
in the literature. Here we presented a ileal neuroendocrine tumor in a patient with
diagnosis of Neurofibromatosis 1.
Case report:
83-year old female patient with neurofibromatosis was presented to our clinic with
abdominal pain. The colonoscopic evaluation of patient revealed an ulcerative
lesion involving ileocecal valve. The biopsy, however, revealed no malignancy.
Abdominal CT examination showed no metastasis to intraabdominal organs. The
patient underwent laparoscopic right hemicolectomy. She recovered uneventfully
and discharged without complication. The pathological examination revealed an
ileal well-differentiated neuroendocrine tumor with 2.5 cm in diameter. Tumor
infiltrated serosa and the 3 out of 30 dissected regional lymph nodes were
metastatic. She received depot octreotide prescribed by the oncologist. The patient
completed 1 year during her follow-up without any noticeable problem.
Conclusion:
The increased risk for malignancy in Neurofibromatosis patients and relatives

mandates a prompt genetic counseling and close surveillance to detect putative
tumors earlier.
-509-
PP - 312 JEJUNAL INTUSSUSCEPTION: A RARE CAUSE OF UPPER
GASTROINTESTINAL BLEEDING IN ADULTS
FARHANA AKTER , MOHANRAJ HARILINGAM
QEQM HOSPITAL, MARGATE, UK
Introduction:
Intussusception is an important cause of abdominal pain in the paediatric

population and is the most common abdominal emergency in early childhood.
Intussusception in adults is however rare and can lead to diagnostic challenges for
admitting physicians/surgeons.
Case report:
A 76 year old female, with a history of vasculitis and myocardial infarction presented
with an episode of a large melaena and per rectum (PR) bleed and associated
abdominal pain. She was afebrile, tachypnoeic, tachycardic and hypotensive. Rectal
examination demonstrated melaena and some fresh blood. Bowel sounds were
present and there were no clinical signs of peritonitis. Gastroscopy performed
initially, revealed no abnormalities. Colonoscopy was attempted however was
inconclusive due to active bleeding. An urgent CT angiogram of the abdomen was
performed which revealed the characteristic target lesion (lumen within lumen)- a
hallmark of intussusception.
Conclusion:
This case highlights the importance of a CT angiogram in finding the site and
possible cause of GI bleeding. Although the first line investigation for upper GI
bleeding should be gastroscopy one must not forget the importance of further
imaging to identify the source of bleeding and rule out other bowel pathology.
Jejunal intussusception can cause obstruction, haemorrhage and perforation and
patients may require surgery when presenting with these complications.
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PP - 313 ISOLATED DUODENAL CROHN’S DISEASE
FARUK KARATEKE , KORAY DAŞ , EBRU MENKSE , SEFA ÖZYAZICI , CIHAN GÖKLER ,
MEHMET ÖZDOĞAN
ADANA NUMUNE TRAINING AND RESEARCH HOSPITAL,GENERAL SURGERY CLINIC,

ADANA, TURKEY
Introduction:
Duodenal Crohn’s disease (DCD) has been reported to occur in 0.5% to 4% of

patients with Crohn’s disease. In this report we described an isolated case of DCD
and reviewed of the surgical options.
Case report:
A 33-year old male was referred to our clinic with a 6-month history of intermittent,
crampy abdominal pain accompained by progressive nausea,emesis and weight
loss. On physical examinations, only fullness was observed in the epigastric region.
Routine blood work revealed a mild normocytic anemia. Colonoscopy was normal.
Upper endoscopy revealed stricture with mucosal edema and the longitudinal
ulcerations in the duodenal bulb. The biopsy specimens of the duodenum showed
severe inflammation with the evidence of DCD. Following parenteral nutrition
therapy over a period of 15 days, laparoscopic gastrojejunostomy was performed.
The patient was discharged without any adverse event.
Conclusion:
Patients with DCD usually present with Crohn’s disease affecting other areas
of the gastrointestinal tract but isolated DCD is very rare. The most common
indication for surgical intervention is progressive obstruction, failure of medical
management with intractable pain, bleeding, perforation and fistulous disease.
Options for surgical management of complicated duodenal Crohn’s disease include
resection, bypass or strictureplasty. The operative procedure of choice should be
individualized on a case-by-case basis. Surgical resection procedures have been
associated with significant morbidity and mortality in this setting. Therefore,
bypass procedures and strictureplasty have become the preferred methods of
surgical treatment to preserve the duodenum and prevent these complications. in
conclusion laparoscopic gastro-jejunal bypass is a safe alternative in the treatment
of DCD with stricture.
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PP - 314 A GIANT INFLAMMATORY FIBRINOID POLYP IN STOMACH
PRESENTING WITH IRON DEFICIENCY ANEMIA: A CASE REPORT
ARİF ATAY , OSMAN DOĞRU , HANDE KÖKSAL , KEMAL ARSLAN
KONYA EDUCATION AND RESEARCH HOSPITAL, CLINICS OF GENERAL SURGERY,

KONYA, TURKEY
Introduction:
Inflammatory fibrinoid polyp is a rare, localized, non-neoplastic lesion originating

from the submucosa of the gastrointestinal tract. The stomach and ileum are
the most commonly affected sites. It usually presents with intussusception or
obstruction. Herein we report a giant gastric fibrinoid polyp in a young female
patient representing with anemia.
Case report:
A 35-year-old female was admitted to our hospital with complaints of weakness,

nause and vomiting for five months. Physical examination was normal except
paleness. The complete blood count revealed hypochromic-microcytic anemia
and iron deficiency anemia was diagnosed. The upper gastrointestinal endoscopy
revealed a submucosal lesion, 7 cm in diameter, arising from antrum and extending
to the bulbus and the pylor was deformed. The polyp is resected by wedge
resection. Macroscopically, it was a solid, polipoid lesion 14x6x3 cm in diameter.
Microscopically, the surface of the polipoid lesion was covered by ulcerated mucosa
characterized by inflammatory exudate and granulation tissue. Inflammatory
fibrinoid polyp was diagnosed. She was discharged uneventfully and her anemia
was treated successfully and did not occured again.
Conclusion:
This case is a reminder that inflammatory fibrinoid tumor may be an infrequent

cause of iron deficiency anemia in some cases.
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PP - 315 AN UNUSUAL CASE OF GASTRIC OUTLET OBSTRUCTION:
GASTROLITHIAZIS
ARİF ATAY , OSMAN DOĞRU , HANDE KÖKSAL , KEMAL ARSLAN

KONYA, TURKEY
Introduction:
Bezoars are masses of indigestable materials found in the gastrointestinal tract,

usually in the stomach. They are usually classified according to their composition
into trichobezoars, phytobezoars, lactobezoars and medication bezoars. Herein we
present a patient with a giant gastric bezoar causing obtruction.
Case report:
A 50-year-old woman with a history of gastroenterostomy 30 years ago admitted

with a complaint of dropping stone-like particles from rectum during defecation.
She has epigastric pain followed by nausea and vomiting for 5 years. In her medical
history she had no psychiatric illness. Gastroscopy diagnosed a huge stone-like
substance located on antrum and causing obstruction. Laparotomy was performed
and the particle 15x13 cm in diameter was removed by gastrostomy. Laboratory
analysis revealed the giant stone-like particle as an organic material. The patient
made an uneventful recovery.
Conclusion:
Bezoars may present with gastric outlet obstructions and are easily diagnosed on an
upper GI series or endoscopy. Surgical removal is necessary for retrieval if it is not
possible endoscopically. To our knowledge up to date such a case like our patient
with a giant stone-like bezoar in the stomach was not introduced in the literature.
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PP - 316 TREATMENT OF A GASTROINTESTINAL STROMAL TUMOR
(GIST) BY LAPAROSCOPIC PARTIAL GASTRIC RESECTION
MEHMET ODABAŞI , M.A.TOLGA MÜFTÜOĞLU , CENGIZ ERIŞ , MEHMET KAMIL
YILDIZ , EMRE GÜNAY , HASAN ABUOĞLU , ALI AKTEKIN
Introduction:
Because microscopically negative margins seem to be less important in determining

survival and lymph node staging is unnecessary given the rarity of lymph node
metastases, the role of laparoscopy in GIST surgery has increased.
Case report:
A 61 year old female admitted to our hospital with gastric disturbance. Endoscopy,
endosonography and computarized tomography examination revealed a 3 cm.
tumor that was located on submucosa of anterior part of the greater curvature
of corpus and serosa was intact. Therefore, preopertatively the lesion’s borders
tattooed with sterile indian ink for determination of accurate resection margins.
The tumor was resected by laparoscopic Endo-GIA Universal 4.8 mm. stapler. On
pathologic examination tumor was 3x3 cm in size. It was gastrointestinal stromal
tumor with intermediate risc. In immunhistochemical staining CD117, CD 34 and
S-100 were positive, SMA and desmin negative, and Kİ 67 proliferation index was
5-6 %. Tumor’s growing patern was expansive. There were no necrosis, bleeding
and mitosis. Surgical margins were negative.
Conclusion:
GISTs located in the proximal stomach, especially on the greater curvature, may
be amenable to partial resection. The most important point is to avoid rupture.
Therefore , laparoscopic resection of GIST is technically feasible and can be safely
performed.
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PP - 317 SUPERIOR MESENTERIC ARTERY (WILKIE’S) SYNDROME: A
CASE REPORT
OSMAN ANİL SAVAS 1, TAMER KARSIDAG 1, ISHAK SEFA TUZUN 1, RİDVAN
KARAHASANOGLU 2, AYTUL MUTLU 3
1
DEPARTMENT OF GENERAL SURGERY, HASEKI RESEARCH AND TRAINING
HOSPITAL, ISTANBUL, TURKEY
2
DEPARTMENT OF RADIOLOGY, HASEKI RESEARCH AND TRAINING HOSPITAL,
ISTANBUL, TURKEY
3
DEPARTMENT OF NEUROLOGY, HASEKI RESEARCH AND TRAINING HOSPITAL,
ISTANBUL, TURKEY
Introduction:
The superior mesenteric artery syndrome (SMAS) was first described by Rokitanski in
1861. SMAS is a rare disorder, recognized as weight loss, nausea, vomiting, and post-
prandial pain due to compression and partial obstruction of the third portion of the
duodenum by the SMA. In general population the incidence with the help of upper
gastrointestinal barium studies were reported to be around 0.013-0.3 %(Ylinen et
al 1989). Patients are usually young, and women are affected more often than men.
This has been reported in patients with scoliosis, burns, immobilization in body
casts, and idiopathic weight loss. Surgical therapy is indicated when conservative
management fails. SMA normally forms an angle of approximately 45 degrees with
the abdominal aorta, with third part of duodenum passing through this angle. In
SMAS, the patients have a narrow aortomesentericangle in the range of 6° to 11°
(mean=8°) leading to high intestinal obstruction. Side to side duodenojejunostomy
is easy and effective surgical approach with a lower complication rate. Other
technical approaches include lysis of the ligament of Treitz or gastro-jejunostomy
which may be less effective; a duodenojejunostomy is required if these fail.
Case report:
36 years old female patient was admitted to neurology clinic for chronic vomiting
and weight loss. Chronic vomiting has been started few years ago. Vomiting was
precipitated by eating and worse last months. Laboratory results and radiology was
not reported any neurological pathology. Nothing was found except aggravated
weigh loss and tachycardia at examination. Neurologic examination was normal.
Body-mass index was 16.6 and body-fat ratio was 15.9%. Then she was referred
for further investigation to general surgery department. Barium contrast passage
graphy showed a pressure sign at duodenum third segment . Gastroscopy showed
only ulcer in duodenal bulbus but passage was open. Contrasted computerized
abdominal tomography showed a restriction on third segment of duodenum and
-515-
decrease in the distance between SMA and aorta . The distance between SMA and
aorta was measured 2.1 mm and the angle between SMA and aorta measured
7 degrees on Doppler ultrasonography . According to these symptoms, SMA
Syndrom has been thought. After preparations patient was taken under operation.
Duodenojejunostomy was made between first part of duodenum and jejunum
roughly 30 cm distal to Treitz ligment. Oral feeding was started after 3rd day of
operation. After 6th day of operation patient was discharged from hospital without
any complication.
Conclusion:
SMA syndrome was first described by von Rokitanski in 1861.The first successful
operative treatment, a duodenojejunostomy was performed by Stavely in 1908.
Later, Wilkie provided a more detailed clinical and pathophysiologic description
in a series of 64 patients and suggested treatment approaches. The defining
feature of this entity is upper gastrointestinal obstruction caused by compression
of the third part of the duodenum between the SMA anteriorly and the aorta
posteriorly. Normally, fat and lymphatic tissues around the SMA provide protection
to the duodenum against compression. Normally, the aortomesenteric angle and
aortomesenteric distance is 25 degrees to 60 degrees and 10 to 28mm, respectively.
In SMA syndrome, both parameters are reduced, with values of 6 degrees to 15
degrees and 2 to 8mm. Conditions like increased spinal lordosis, application of a body
cast, short ligament of Treitz, or unusually low origin of SMA may also precipitate
this syndrome. The diagnosis of SMA syndrome is based on clinical symptoms and
radiologic evidence of obstruction. Plain radiograph demonstrates a dilated, fluid-
and gas-filled stomach. Barium radiography shows dilatation of the first and second
part of the duodenum, extrinsic compression of the third part, and a collapsed small
bowel distal to the crossing of the SMA. Contrastenhanced CT scan or magnetic
resonance angiography (MRA) enable visualization of vascular compression of the
duodenum and measurement of aortomesenteric distance precisely. Both these
procedures are noninvasive and are probably equivalent to angiography, which has
previously been suggested as the reference standard for establishing the diagnosis,.
Endoscopic examination may visualize a pulsatile extrinsic compression suggestive
of this condition Traditionally, treatment has consisted of conservative measures
such as nasogastric decompression and hyperalimentation followed by oral feeding
with frequent small meals. Posturing maneuvers during meals and motility agents
may be helpful in some patients. Surgery may be considered if conservative
treatment fails. Duodenojejunostomy is effective in the majority of patients.
Laparoscopic duodenojejunostomy offers a new minimally invasive therapeutic
approach to SMA syndrome. Laparoscopic surgery involving lysis of the ligament of
Treitz with mobilization of the duodenum is another minimally invasive approach.
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PP - 318 PARATHYROID CYSTS, A RARE CAUSE OF SERVICAL MASS
SEDAT DÖM , AYBALA AĞAÇ AY , OKTAY AYDIN , KUZEY AYDINURAZ , ORAL SAYGUN,
ÇAĞATAY DAPHAN
KIRIKKALE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL

SURGERY, KIRIKKALE, TURKEY
Introduction:
Parathyroid cysts are very rare in endocrine surgery. About 300 parathyroid cysts
were reported in the literature. Diagnosis may be diffucult because cysts mimic
thyroidal cystic lesion and other servical masses.
Case report:
A 34 years old female referred to our clinic for pain and palpable mass on her neck.
The onset of the syptoms were six months. On physical examination, a 2 x 2 cm mass
was found on left side of the neck adjacent to the thyroid lobe. Labarotory findings
including calcium, thyroid hormone and parathyroid hormone levels were normal.
On thyroid ultrasonography 22 mm cystic lesion with a solid component adjacent
to the left lobe and bilateral milimetric nodules were found. Computed tomography
of the neck revealed a 22 x 22 mm hypodense lesion, posterior to the left thyroid
lobe. Fine-needle aspiration showed no atypic cells. The left lobectomy including
the cystic lesion was carried out. Hysthopathological examination confirmed cystic
mass as a parathyroid tissue.
Conclusion:
Parathyroid cysts constitute 0.6% of all thyroid and parathyroid lesions.

Asypmtomatic neck mass is typically presentation. Majority of cases (91%) are non-
functioning cysts which are more frequent in females. Functional cyts are frequently
seen in males. Aetiology of these cysts are still unclear. The definitive treatment for
functioning cysts is surgical removal. Non-functional cysts are treated by aspiration,
injection of sclerosing agents and surgical excision. Paratyhroid cysts should be kept
in mind in the differential diagnosis of anterior neck masses.
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PP - 319 INTESTINAL TUBERCULOSIS: A RARE DISEASE WITH
DIAGNOSTIC DIFFICULTY
SELAMİ ILGAZ KAYILIOĞLU , CİHANGİR AKYOL , ERKİNBEK OROZAKUNOV ,
ERCÜMENT KUTERDEM
ANKARA UNIVERSITY, ANKARA, TURKEY
Introduction:
Tuberculosis is an important global public health issue, with a steadily increasing

incidence. Intestinal tuberculosis covers approximately 1% of all tuberculosis cases.
Great similarity between clinical features of intestinal tuberculosis and especially
inflammatory bowel diseases causes great difficulty in diagnosis.
Case report:
Here, we report a 31 year-old female with intestinal tuberculosis, which was

misdiagnosed and mistreated as gastritis and irritable bowel syndrome for 18
months. After readmission to the same clinic, colonoscopy and histopathological
examination revealed obstruction in terminal ileum and superficial ulceration
with intensive granulation, respectively. Thereupon, budesonide and mesalazine
treatment is given, on the grounds of diagnosis of Crohn’s disease. Symptoms
worsening, the patient applied to us. Computerized tomography revealed micro
acinar nodules in both lungs and acid-resistant bacteria was seen in broncoalveolar
lavage samples. Tuberculosis skin test was negative and viral etiologies are eliminated.
Anti-tuberculosis therapy is given. When patient suffered from distention, vomiting
and abdominal pain, laparotomy is performed for intestinal obstruction. Ascending
colon and a segment of jejunum was ischemic and resected. There were countless
nodules on peritoneum in all quadrants of abdomen. Patient is treated in intensive
care unit for 19 days, and 12 days of which, was with mechanical ventilation. After
recovering, she is discharged for out-patient treatment of tuberculosis.
Conclusion:
Although, detection of pulmonary tuberculosis made the diagnosis easier in

this case; isolated intestinal tuberculosis may mimic Crohn’s disease and cause
mistreatment which is extremely harmful to these patients. In conclusion, this case
indicates that the differential diagnosis of chronic intestinal symptoms must include
intestinal tuberculosis.
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PP - 320 ILEO-ILEAL INTUSSUSCEPTION CAUSED BY INFLAMMATORY
FIBROID POLYP: A CASE REPORT
TAYFUN YOLDAS 1, ERMAN ALCI 1, RASIM FARAJOV 1, MURAT SEZAK 2, MURAT
SOZBILEN 1
1
EGE UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,
IZMIR, TURKEY
2
EGE UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF PATHOLOGY, IZMIR,
TURKEY
Introduction:
Inflammatory fibroid polyps (IFP) are rare benign lesions originating from
submucosal layer of the gastrointestinal tract. Patients with IFP located in the small
bowel, usually present with episodes of relapsing abdominal colics and intermittent
episodes of intestinal bowel intussusceptions.
Case report:
A 50 year old man, applied to our hospital with a generalised abdominal pain,
distension, nause and vomitting, for 3 months. Computerised tomography
demonstrated intussusception of the small bowel. The patient underwent an
emergency laparotomy demonstrating a 16-cm invaginated terminal ileal segment
due to IFP. This segment was resected and anastomosis was performed.
Conclusion:
Intussusception due to inflammatory fibroid polyps is uncommon. Moreover, ileo-

ileal intussusception in adult was rarely reported in the literature. The patient
presented in this study has both entities proven by surgery and immunohistochemical
study.
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PP - 321 LAPAROSCOPIC RESECTION OF A LARGE SUBMUCOSAL
TUMOR OF THE STOMACH USING TECHNIQUES LEARNED IN
BARIATRIC SURGERY
DONALD VAN DER FRAENEN , FAKİ AKİN , BERT DEYLGAT , SEBASTIAAN VAN
CAUWENBERGE , BRUNO DILLEMANS
AZ SINT JAN BRUGES, BELGIUM
Introduction:
Gastro-intestinal stromal tumors (GISTs) are rare mesenchymal tumors of the

alimentary tract, originating from the stomach in 50-60% of cases. The cornerstone
of therapy remains surgical resection without tumor-spillage and minimal morbidity.
In the modern era of surgery, this means laparoscopically whenever feasible.
Case report:
A 58 year old female patient was referred to our center because of epigastric
discomfort. Gastroscopy and CT-scan showed a large submucosal tumor of 5.2 cm
diameter at the lesser curvature. There was no invasion in surrounding organs.
A laparoscopic resection was performed using a reversed sleeve gastrectomy
technique. The procedure and postoperative course were uneventfull and the
patient was discharged on the sixth postoperative day. Pathology confirmed the
diagnosis of GIST with negative surgical margins and a low differentiation grade.
Adjuvant therapy was not indicated. After twenty months of follow-up there has
been no recurrence and patient doesn’t have any complaints.
Conclusion:
In this presentation a laparoscopic resection of a GIST of the lesser curvature is

described. Our technique has the advantage that no anastomosis is needed, despite
resection of a large part of the stomach.
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PP - 322 LAPAROSCOPIC RESECTION OF AN ALMOST CIRCULAR
LEIOMYOMA AT THE DISTAL ESOPHAGUS
DONALD VAN DER FRAENEN , FRANCIS GOUDSMIDT , SEBASTIAAN VAN
CAUWENBERGE , BRUNO DILLEMANS
AZ SINT JAN HOSPITAL BRUGES, BELGIUM
Introduction:
Leiomyomas are the most frequent benign tumors of the oesophagus, ranging in
size from less than 0.5 cm to 30 cm. Therapy is indicated for symptomatic lesions
or lesions larger than 2 cm and varies from endoscopic resection to partial or total
esophagectomy.
Case report:
A 38-year old female patient suffering from dysphagia was diagnosed with a
horseshoe shaped leiomyoma just proximal of the gastro-oesophageal junction.
Endoscopy and CT scan showed an almost circular tumor, significantly narrowing
the lumen and without invasion of surrounding tissues. A laparoscopic resection
was performed. The submucosal mass was dissected carefully and totally from
the oesophagus without perforating the mucosal tissue. The procedure and
postoperative course were uneventfull and the patient was discharged on the third
postoperative day. Pathology confirmed the diagnosis. The resected specimen
measures 9,5 x 1,5 cm.
Conclusion:
Laparoscopic resection of a large, almost circular leiomyoma of the distal oesophagus

is feasible without the need to perform a distal oesophagectomy.
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PP - 323 THE ROLE OF THE ULTRASOUND EXAMINATION IN
IDENTIFICATION OF POSTOPERATIVE ABDOMINAL COMPLICATIONS
ABBAS SAFAROV , VUGAR ABBASOV
AZERBAIJAN MEDICAL UNIVERSITY, BAKU, AZERBAIJAN
Introduction:
Background and Aims. Ultrasound examination is one of the important diagnostic

methods for finding of postoperative abdominal complications. We were performed
assessment of ultrasonography capabilities in the detection of postoperative
complications.
Case report:
Methods and results. Experience was performed at the department of surgery II of

AMU in Aloka-SSD-500 apparatus. 28 patients at the age of 34-80 were examined.
During examinations in 8 patients was postoperative peritonitis, in 7 patients -
abscess. Location of abscess subdiaphragmatic in two cases, transintestinal loops in
two cases, subhepatic in three cases, local peritonitis in four cases, it was seemed in
the form of local fluid clusters in the abdominal cavity. Diffuse peritonitis in 4 cases,
was determined the presence of free fluid in the abdominal cavity, rare intestinal
peristalsis or absence of peristalsis, expansion lumen of the small intestinal loop
with fluid content. In 7 cases was determined abscess. Volume of exudate was from
2 to 15 ml. In 3 patients abscess was drainaged under ultrasonography control.
Conclusion:
Conclusion. Ultrasonography is a high effective method in timely diagnosis of

postoperative complications.
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PP - 324 ULTRASOUND EXAMINATION OF GASTRIC AND DUODENAL
ULCER
ABBAS SAFAROV , VUGAR ABBASOV
AZERBAIJAN MEDICAL UNIVERSITY, BAKU, AZERBAIJAN
Introduction:
Background and Aims. Ultrasound examination is an alternative diagnostic method

of gastric and duodenal ulcer. Aim of the experience is to diagnosis gastric and
duodenal ulcer by using ultrasound examination and study its possibilities.
Case report:
Methods and results. Observed 65 patients suspicious for gastric and duodenal ulcer.
Transabdominal ultrasound examination made in Aloka-SSD-500 apparatus with the
3.5 MHz convex sensor. During echography determined location, size, spreading,
layering of the wall, inflammatory shaft around the affected area. Layering of gastric
wall of the control group seemed better in the distal and antral gastric section. In
the acute gastric ulcer disease was noticed inflammatory shaft around ulcer defect
which bordered from the periferic side with gastric stratum. Real size of ulcer was
average four times more, layering of the wall was not differentiated.
Conclusion:
Conclusion. Ultrasonography at the complex examination helps to make better

diagnosis of gastric and duodenal ulcer and it is one of the alternative methods for
noticing effect of treatment.
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PP - 325 GIANT MESENTERIC CYSTIC LYMPHANGIOMA
NAZIF ZEYBEK 1, AYTEKIN ÜNLÜ 1, YAŞAR SUBUTAY PEKER 1, YÜKSEL BALDAN 1,
MEHMET GAMSIZKAN 2, EMRAH ÖZCAN 3, YUSUF PEKER 1
1
ANKARA, TURKEY
2
TURKEY
3
DEPARTMENT OF RADIOLOGY, GÜLHANE MILITARY MEDICAL ACADEMY, ANKARA,
TURKEY
Introduction:
Mesenteric cystic lympangioma (MCL) is a benign, early childhood abdominal

tumour. In this case, we want to share our experiences about evaluation and
treatment of MCL with literature review.
Case report:
23 years old male patient with abdominal pain and nausea was examined where
abdominal distansion with mass from xiphoid to pubis was found. Hemogram,
routine biochemistry, hydatid cyst immunologic tests and tumour markers were
found to be normal. 28x22x12 cm cystic mass was shown with abdominal USG,
CT and MRI. Percutaneous drainage catheter was placed by invasive radiology and
7150 cc liquid was aspirated from catheter in 7 days. Cytologic examination of
cystic liquid was reported as benign cystic lesion with lymphocytes. Surgery was
decided when daily catheter drainage was lower than 100 cc. Percutanous catheter
was pulled out intraoperatively and total cyst excision was performed. Patient
with histopathologic diagnosis of MCL was discharged on postoperative sixth day
without any complication.
Conclusion:
We recommand percutanous drainage of MCL instead of fine-needle aspirastion

biopsy. Percutanous drainage will provide more sample for pathologic examination
and drain the cyst completely. We believe that perfoming surgery to drained giant
MCL such as our case which is the biggest MCL reported in the literature, will
increase the success of surgery.
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PP - 326 SISTER MARY JOSEPH’S NODULE DERIVED FROM GASTRIC
CANCER
ÖZGÜR DANDIN 1, AHMET ZIYA BALTA 2, YAVUZ ÖZDEMIR 2, İLKER SÜCÜLLÜ 2,
ERGÜN YÜCEL 2, MEHMET LEVHI AKIN 2
BURSA ASKER HASTANESI GENEL CERRAHI SERVISI, BURSA, TURKEY

1

2
TURKEY
Introduction:
Sister Mary Joseph’s nodule (SMJN) is the umbilical metastasis of the gastric cancer,
and it is characterized by a hard and endurated nodule or plaques.
Case report:
The patient was a 57-year-old man presenting with an firm, irregular and painful
umbilical nodule. He had a history of weight loss. Gastric carcinoma was found in
the upper gastrointestinal endoscopy. Tissue biopsy of the umbilical mass revealed
adenocarcinoma.
Conclusion:
Umbilical metastasis or SJMN is a rare entity and may be the first sign of a gastric
cancer. Careful examination of all umbilical lesions must be needed for diagnosis of
a possible internal malignity.
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PP - 327 AN UNUSUAL COMPLICATION; MIGRATION OF
GASTROSTOMY TUBE
ZEHRA ÜNAL ÖZDEMİR , HAKAN ÖZDEMİR , İBRAHİM TAYFUN ŞAHİNER , METİN
ŞENOL
MINISTRY OF HEALTH NEVSEHIR STATE HOSPITAL,DEPARTMENT OF GENERAL

Introduction:
In malignant patients that are unable to feed orally or with impaired swallowing,
gastrostomy is the preferred method for enteral feeding. Gastrostomies can be
opened endoscopically or surgically. In this article, we present a case with migration
of the gastrostomy tube into the pelvis 5 months after surgery.
Case report:
Gastrostomy was done to a 43-years-old female patient with duchenne muscular

dystrophy in intensive care unit for enteral feeding by laparatomy. It was reported a
month later that the gastrostomy tube had detached from its location. From the tract
previously, a no.20 foley cathether was attached. Five months later, a consultation
was requested for the obstruction of the cathether. A physical examination the
balloon of the foley cathether was palped on the left of the pelvis. The balloon of
the foley cathether was emptied and then removed from the abdomen.
Conclusion:
For patients experiencing difficulties in oral feeding, gastrostomy is the preferred

method for avoiding the complications associated with parenteral feeding.
Complications that may arise from the implanted feeding cathether are usually
observed in the short-term. While obstruction is generally observed as a long-term
complication with cathethers, the detachment and migration to the pelvis seen in
our case presented a quite unusual situation.
-526-
PP - 328 IMPORTANCE OF PRESERVING ILEOCECAL VALVE AT
MESENTERIC ISCHEMIA CASES
ZEHRA UNAL OZDEMIR , HAKAN OZDEMIR , METIN SENOL , IBRAHIM TAYFUN
SAHINER

Introduction:
Depending on the difficulties associated with diagnosis and the surgical treatment,
mesenteric ischemia can lead to complications that significantly affect a patient’s
quality of life. We are presenting two mesenteric ischemia cases to whom
embolectomy was performed but unfortunately in only one patient ileocecal valve
could be preserved.
Case report:
38-years-old female and 60-years-old male patients were operated for acute
abdomen. Mesenteric ischemia was identified and embolectomy was done to the
patients. An approximately 110 cm necrotic area was resected and ostomy was
done to both patients. As the ileocecal valve of the male patient was fully necrotic,
it was included within the limits of the area to be resected. On the other hand, it’s
preserved at female patient.
Conclusion:
As it can lead to the development of short bowel syndrome, and also to an

increased frequency of defecation in cases where the ileocecal valve is not
preserved, mesenteric ischemia can cause serious alimentation problems and a
significant reduction in quality of life for patients. It is important to bear in mind
that preservation of the ileocecal valve is a key factor that affects the quality of life
in patients and reduces or fully removes their need to follow a particular diet.
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PP - 329 LAPAROSCOPIC ADRENALECTOMY FOR
PHEOCHROMOCYTOMA IN A CHILD
ABDOLREZA PAZOUKI , FAHIME SOHEILIPOUR , ZEINAB TAMANNAIE

Introduction:
Pheochromocytoma is a rare catecholamine-secreting tumor of the adrenal medulla

during childhood. It has wide and subtle range of clinical manifestations and is fatal
cause of hypertension in about 1% of pediatric patients. Although Laparoscopic
adrenalectomy is the gold standard treatment method in adult patients, few reports
have described the outcome of this technique in children
Case report:
We report the case of a child with unilateral pheochromocytoma that presented

with uncommon symptoms of poor weight gain, polyuria and polydipsia. Diagnosis
confirmed by clinical and laboratory findings and the patients was treated
successfully by a non-complicated laparoscopic adrenalectomy.
Conclusion:
The case is interesting since this is a rare diseasein the pediatric practice. Consider
its advantages we believe that laparoscopic adrenalectomy should be considered
in all pediatric patients which require resection of adrenal masses. Also with
presenting this case we emphasize that polyuria and polydypsia might be the only
clinical manifestation of pheochromocytoma in children. References
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PP - 330 OUR CLINICAL EXPERIENCES IN GASTROINTESTINAL
STROMAL TUMORS
ADEM AKÇAKAYA , ABDULCABBAR KARTAL , ISMAIL ETHEM AKGÜN , ESIN KABUL
GÜRBULAK , MUHARREM BATTAL
ŞIŞLI ETFAL TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
GISTs are the most common mesenchymal tumor of gastrointestinal(GI) tract, but
they constitute a small part of all gastrointestinal tumors(%0.2). GISTs are thought
to arise from interstitial cells of Cajal. Approximately 95% of GISTs are positive for
KIT (CD117), GISTs most commonly arise in the stomach (60%) but can be found
throughout the GI tract.
Methods:
Between Januay 2007 and August 2012, five patients with GIST who underwent
surgery at ŞEEA Hospital were included. Median age were 56. Two patients were
diagnosed by upper GIS endoscopy insidentaly,three patients presented with non-
spesific clinical symptoms and one patient with acute abdomen. Four patients
presented with stomach GIST and one patient with small intestine GIST.
Results:
4 patients underwent endoscopy, two were diagnosed by endoscopic biopsy. One

patient underwent total gastrectomy and liver resection, one total gastrectomy and
splenectomy, two subtotal gastrectomy and one bowel resection and anastomosis.
One patient had postoperative chylous acid, one had wound infection. All patient
discharged and received imatinib 400 mg/day postoperatively.All patient are
healthy
Conclusion:
For localized GİST, surgical resection is the preferable treatment. Imatinib, a tyrosine
kinase inhibitor, is indicated as an adjuvant for GISTs with a high risk of malignancy,
as well as for metastatic or unresectable tumours
-529-
PP - 331 LAPAROSCOPIC APPENDECTOMY,ŞIşLI ETFAL EXPERIENCES
ISMAIL ETHEM AKGÜN , ABDULCABBAR KARTAL , ADEM AKÇAKAYA , ESIN KABUL
GÜRBULAK , BÜLENT ÇITGEZ , MURAT FERHAT FERHATOĞLU
ŞIŞLI ETFAL TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Appendectomy is one of the most common emergency operation performed

in emergency services. Laparoscopic surgery has diagnostic and therapeutic
advantages over conventional surgery in terms of postoperative pain, hospital stay,
aesthetic outcome and easier exploration of the peritoneal cavity.We aim to analyze
laparoscopic approach in the surgical treatment of acute appendicitis.
Methods:
A retrospective study carried out on patients over 18-years-old operated on for

acute appendicitis between January 2009 and June 2012. The patients were
evaluated for demographic characteristics and complications
Results:
276 appendicectomies have been performed on adult patients(174 man and 102
woman). Mean age was 32. Mean operative time was 65 minutes. In 276 patients
the surgery was completed laparoscopically. The conversion rate was %2.51. Drain
used in 34 complicated appendicitis with diffuse peritonitis. Mean hospital stay was
1.8 days. 13 patients had complications(3 wound infection, 2 ileus, 2 urine tract
infection 2 pulmoner infection and 4 intraabdominal abscesses diagnosed with
conputed tomography).11 treated with antibiotic and 2 treated with percutaneous
drainage.
Conclusion:
Laparoscopy is useful in terms of convalescence, postoperative pain, hospital

stay, aesthetic outcome and easy exploration of peritoneal cavity. LA can be
safely performed by junior surgeons both for acute and complicated appendicitis,
especially in young women.
-530-
PP - 332 MINIMAL INVASIVE MANAGEMENT OF SYNCHRONOUS
GRANULAR CELL TUMORS IN THE COLON AND POSTERIOR
MEDIASTINUM
ALI KOCATAS 1, AHMET CEM DURAL 1, NURTEN SEVER 2, BURAK KANKAYA 1, GULCIN
YEGEN 3, MURAT GONENC 1, BILGE BILGIC 3, HALIL ALIS 1
1
2
DEPARTMENT, TURKEY
3
ISTANBUL UNIVERSITY SCHOOL OF MEDICINE, PATHOLOGY DEPARTMENT,
ISTANBUL, TURKEY
Introduction:
Granular cell tumor (GCT) is a rare and usually benign tumor derivate from
nerve sheath that may affect various locations in the body. Colon and especially
mediastinum are also sporadic locations to arise from. We report the first case of
synchronous GCTs of the colon and mediastinum.
Case report:
A peritracheal posterior mediastinal mass was discovered in a 52 year-old woman

status-post right modified radical mastectomy in November 2007 for a T2N1M0,
stage 2B invasive ductal carcinoma of the breast. By reason of prior history of breast
cancer, mediastinoscopic removal was performed and histopathologic evaluation
revealed benign. Nine months later, an endoscopic mucosal resection was done for
a submucosal mass in hepatic flexure in her screening colonoscopy. The lesion was
characterised by solid masses of plump histiocyte-like cells with abundant granular
eosinophilic cytoplasm with acidophilic periodic acid-Schiff (PAS) positive diastase
resistant granules. Immunohistochemical analysis showed diffuse expression of
S100 protein. Her mediastinal and colonic submucosal lesions were evaluated
immunohistochemically with broad panel of antibodies. Both lesions revealed
similar histologic and immunohistological pattern and the diagnosis was consistant
with “granular cell tumor”.
Conclusion:
Both lesions were removed by minimal invasive methods and diagnosis was
corroborated by accurate histopathologic evaluation.
-531-
PP - 333 MESENTERİC CYST: CASE REPORT
GURKAN DUMLU 1, MESUT ÖZDEDEOĞLU 1, SAMET YALCIN 2, EMIN CELIK 1, ALPER
BILAL OZKARDES 1, BULENT DEMIRBAS 1, AHMET GURER 1, MEHMET KILIÇ 2
1
2
Background&Aims:
Mesenteric cysts are rare intraabdominal masses. Although they are usually
asymptomatic, they could cause abdominal pain and feel of distension according to
their sizes. Here, we present a case with mesenteric cyst.
Methods:
Female patient was admitted to general surgery policlinics with nonspecific

abdominal pain and feel of distension. There was no obvious sign except minimal
distension in physical examination.
Results:
A mass with a size of 80x70 mm interrelated with mesentery was visualized on CT

scan. Laparotomy was performed. It was excised totally.
Conclusion:
Mesenteric cysts are rare intraabdominal masses with a prevalance of one in

25000-250000. They all contain fat and connective tissue, blood-lymph vessels and
nerves. So, cysts that develop from these structures are called mesenteric cysts.
Although ileal mesentery is the most common localization, they can be seen on
any mesentery from duodenum to rectum. Some cysts may present with symptoms
of acute abdomen. Computed tomography scan seems to be the most sensitive
method for diagnosis. The treatment is surgical removal for either symptomatic
or asymptomatic mesenteric cysts. Main indication for surgery is to prevent
recurrences and malign transformation. If it is not possible to remove mass totally,
a partial excision and marsupialisation are alternate methods.
-532-
PP - 334 PROTECTIVE EFFECTS OF PINOCEMPRIN ON THE
INTESTINAL ISCHEMIA AND REPERFUSION DAMAGE
ALİ UZUNKOY , OSMAN BARDAKCI , HAKİM ÇELİK , ILYAS OZARDALİ
HARRAN UNIVERSITY SCHOOL OF MEDICINE, SANLIURFA, TURKEY
Background&Aims:
Intestinal ischemia and reperfusion damage(IIRD) is an important problem. In the

studies have shown that pinocemprin has protective effect on cerebral ischemia
and reperfusion damage, but there is no study about the effect of pinocemprin on
the IIRD. We aimed to investigate the effect of pinocemprin on the IIRD.
Methods:
Thirty Wistar Albino rats were divided into three groups as sham, control and
pinocemprin groups. In control and pinocemprin groups, 60 minutes intestinal
ischemia and 60 minutes reperfusion were performed. In pinocemprin groups,
pimocemprin were intraperitoneally given 5 mg/kg before ischemia and reperfusion.
Blood samples and intestinal tissue samples were taken. Plasma ad tissue AST, ALT,
LDH, total antioxidant capacity (TAC) , catalase, total oxidant status (TOS), oxidative
stress index (OSI), myeloperocsidase, prolidase levels were measured. Tissue
samples were evaluated histopathologically.
Results:
In the pinocemprin group, AST, ALT, LDH, myeloperoxidase, TOS, OSI, prolidase
levels were significantly lower than control group (p<0.05). Catalase levels were
significantly higher than control group (p<0.05). The changes of the TAC were not
significantly different (p>0.05). The intestinal tissue damage were significantly
lower in the pinecemprin group (p<0.05).
Conclusion:
This is first study about the effect of pinocemprin on the IIRD and it was shown that
pinocemprin has protective effect.
-533-
PP - 335 OUR FIRST ROBOTIC HELLER MYOTOMY EXPERIENCE IN
ACHALASIA
ALPER BILAL OZKARDES , MEHMET TOKAC , FAHRI YETISIR , GULTEN KIYAK ,
AHMET GURER , BIRKAN BOZKURT , MEHMET KILIC
ATATURK TRAINING AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
Achalasia is a motility disorder which presents with peristaltism disorders in the

lower end of the esophagus, increased lower esophageal sphincter (LES) pressure
and problems in relaxation of the LES. It’s well known that perfect results are achieved
with laparoscopic myotomy and fundoplication. With the help of three dimensional
magnified view and ability of the robotic instruments’ improved movement
capacity, computer enhanced robotic Heller myotomy and fundoplication can easily
be performed with reduced intraoperative complications.
Methods:
Robotic surgery system (DaVinci; Intuitive Surgical Cooperation, Sunnyvale, Calif)

was used for the first time in our institution in order to operate a 44 years old male
patient with the diagnosis of achalasia.
Results:
Heller myotomy with Dor fundiplication was successfully performed. Postoperative

course was uneventful. At 3 months of follow-up the patient was free of significant
dysphagia and was free of reflux symptoms.
Conclusion:
Minimally invasive Heller myotomy has become the gold standard procedure for
achalasia. Whenever a robot is available, it can be safely and effectively used for
this procedure due to its advantages of instrumentation mobility and improved
operation site view.
-534-
PP - 336 CLINICAL EXPERIENCES OF PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY
HAKAN BULUŞ 1, ALPER YAVUZ 1, ALİ COŞKUN 2
KECIOREN TRAINING AND RESARCH HOSPITAL, ANKARA, TURKEY

1
YILDIRIM BEYAZIT UNIVERSITY, ANKARA, TURKEY

2
Background&Aims:
The aim of the present study is to evaluate demograhic characteristics, indications

and complications of patients who were performed percutaneous endoscopic
gastroenterostomy in our endoscopy unit.
Methods:
36 patients with different indications were performed percutaneous endoscopic

gastroenterostomy between January 2007 and March 2012 in our endoscopy unit.
PEG were placed in all of the patients by Pull method. Demographic characters,
indications, major and minor complications were determined retrospectively.
Results:
Results: Patients who were enrolled in the study were consisted of 22 (%61.2) male
and 14 (% 38.8) female patients. Patients with norologic disease comes first with
the rate of % 77 between the indications of PEG. There was one major complication
One patient was died because of major complication and septic shock that was
occured during and after the procedure. Furthermore systemic candidiasis because
of gastroenterostomy tube was seen in one patient. Different minor complications
including the superficial infections (% 22.2, 8 patients) which was the most common
were occured
Conclusion:
Percutaneous endoscopic gastroenterostomy is the long standing enteral nutrition

tecnique that is cheap, is performed easily and does not need operation room.
Although low rates of complications, it must not be forgetted that this is an invasive
procedure and can cause fatal complications.
-535-
PP - 337 PREOPERATIVE SERUM ALBUMIN IS AN INDEPENDENT
PROGNOSTIC PREDICTOR OF SURVIVAL IN GASTRIC CANCER
ARDA ISIK 1, ISMAIL OKAN 2, ADEM AKCAKAYA 3, BAHRI YILMAZ 4, GURHAN BAS 5,
MUSTAFA SAHIN 2
1
ERZINCAN UNIVERSITY HOSPITAL, ERZINCAN, TURKEY
2
GAZIOSMANPASA UNIVERSITY HOSPITAL, TOKAT, TURKEY
3
BEZMIALEM VAKIF UNIVERSITY HOSPITAL, ISTANBUL, TURKEY
4
ELESKIRT STATE HOSPITAL, AGRI, TURKEY
5
UMRANIYE TRAINING RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
We aimed to evaluate the prognostic significance of preoperative serum albumin

value for gastric cancer patients after curative surgery.
Methods:
The study was carried out in 1st Department of General Surgery, Vakif Gureba
Training and Research Hospital between January 2004-December 2010. After
Institutional review, the demographic data, clinical and laboratory findings including
preoperative platelet, lymphocyte, CRP, ALP, total protein, albumin, albumin/
globulin, CA19-9, CEA values, operative findings (tumor localisation, extent and
type of surgery), pathological findings (histologic subtype, perineural invasion,
the tumor presence in peritoneal washing, metastatic lymph node ratio, the stage
of the tumor, the depth of tumor) were retrievd from patient records. The above
mentioned factors were evaluated for the putative effect on survival using Log rank
test and Cox regression test for univariant and multivariant analysis and p value less
than 0,05 was accepted significant.
Results:
A total of 67 patients with the mean age of 58,7±11,4 was included. The majority
of the patients was male (n: 53, male ; n: 14 female). The majority of patients were
in advanced stage on admission with 67.2%. The overall survival of patients with
all stages was 35,3 %. Preoperative albumin level less than 3,5 gr/dl (p:0,01) has a
negative impact on survival.
Conclusion:
Preoperative albumin level less than 3,5 gr/dl is a negative prognostic factor for
resectable gastric cancers. Therefore, preoperative albumin level could be a marker
to select patients for multidisciplinary treatment modalities.
-536-
PP - 338 CALCIFYING FIBROUS TUMOR OF THE STOMACH: A CASE
REPORT
BAHADIR OSMAN BOZKIRLI 1, HANDE TEMEL 1, TURGAY SAYIN 1, SİBEL ORHUN 2,
PAMİR EREN ERSOY 1
1
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
2
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
PATHOLOGY, ANKARA,TURKEY
Background&Aims:
Calcifying fibrous tumor(CFT), is a rare benign lesion that usually arises in the
subcutaneous or deep soft tissues, or in other visceral sites. CFT of the tubular
gastrointestinal tract is quite unusually encountered.
Methods:
We present a case CFT operated in our clinic.
Results:
A 52 year old male patient presented with a three year history of nonspesific
epigastric pain and dispeptic symptoms. The upper gastrointestinal endoscopy
revealed a 2 cm submucosal lesion in the proximal gastric corpus. Abdominal
computerised tomography showed a 20x15 mm solid lesion with amorpheous
calcifications, protruding into the abdominal cavity. A laparotomy was undertaken
with a suggested diagnosis of GIST. The lesion was detected on the posterior wall
of the greater curvature of the gastric corpus as a 2 cm exophytic tumor. A wedge
resection was performed. After hystopathological examination, the lesion was
reported to be a CFT.
Conclusion:
To our knowledge, there are 20 gastric CFT cases in the literature together with our
own case. Many of these tumors were diagnosed in the last 10 years. We believe,
gastric CFTs may be much more prevalent than they are thought and CFT should be
kept in mind in the differential diagnosis of gastric mesenchymal tumors.
-537-
PP - 339 A COMPARISON STUDY OF PREOPERATIVE RESULTS OF
HYDRO-MULTIDETECTOR ROW CT WITH PATHOLOGICAL AND
SURGICAL FINDINGS FOR STAGING OF GASTRIC CANCER
ERKAN DEMİRCİ 1, ROJBİN KARAKOYUN 2, MUSTAFA KARAKOYUN 3, BARIŞ
KARAKAŞ 4, UMUT GÜNDÜZ 4, ARİF ASLANER 4, ZEYNEP ŞENER 2
1
DEPARTMENT OF RADIOLOGY, ANKARA UNIVERSITY SCHOOL OF MEDICINE,
ANKARA, TURKEY
2
DEPARTMENT OF SURGERY, ANKARA UNIVERSITY SCHOOL OF MEDICINE,
ANKARA, TURKEY
3
DEPARTMENT OF RADIOLOGY, VENI VIDI HOSPITAL, DIYARBAKIR, TURKEY
4
DEPARTMENT OF GENERAL SURGERY, ANTALYA TRAINING AND RESEARCH
HOSPITAL, ANTALYA, TURKEY
Background&Aims:
In this poster, we evaluate the value of thin-slice hydro-multidetector row computed

tomography (MDCT) for the preoperative diagnosis and staging of gastric cancer in
comparison with pathologic and surgical results.
Methods:
Forty-four patients (29 males, 15 female; mean age 61 years) with gastric cancer,
and whose surgery was planned, were included in this study. We looked at the
gastric mass localization, depth of tumor invasion into the gastric wall, presence of
lymph node involvement and invasion into other adjacent organs, peritoneal and
hepatic metastases, and the presence of ascites on the CT images produced with
multiplanar reconstruction (MPR) and hydro-CT technique. We then compared the
results with pathological and surgical findings. Diagnostic accuracy was analyzed.
Results:
Of the 44 patients, the identification rate of the primary tumor by MDCT was 95%
(42 in 44). The overall accuracy of MDCT in the determination of the depth of
invasion and serosal involvement when compared with pathological staging were
84% and 95%, respectively; and the overall accuracy rate in lymph node staging was
71% (27 in 38).
Conclusion:
Our findings show that MDCT with multiplanar reformation and hydro-CT technique
is an important modality of choice for the preoperative staging of stomach cancers
and for follow-up.
-538-
PP - 340 ACUTE SMALL BOWEL OBSTRUCTION CAUSED BY
ENDOMETRIOSIS COMPLICATED WITH CANDIDA PERITONITIS: A
CASE REPORT
BESARION REVAZISHVILI , NIKOLOZ LOMINADZE , EMZAR NADIRADZE , VAKTTANG
MAGALTADZE
NEW HOSPITALS, TBILISI; MULTI PROFILE MEDICAL CENTER OF MTSKHETA OF GEO

HOSPITALS, MTSKHETA; GEORGIA
Background&Aims:
Background: Localization of endometriosis on the ileum is very rare (1%-7%).
Methods:
Case: A 46 year old woman was delivered to hospital with diffuse abdominal pain,
vomiting, abdominal distention, constipation. Earlier diarrhea with mild abdominal
pain was once in every year in last 3 years. She had regular menses and no history
of dyspareunia. Preoperative examination showed fluid and air in small intestine
and free fluid in abdominal cavity. No other symptoms were present. Emergency
laparotomy was performed. There was serosal fluid in abdominal cavity. At about
3cm from the ileocecal valve was conglomerate-obstructing mass was formed by
distal ileum loops of length 22-23cm with enlarged mesenteric lymph nodes. Above
the obstructing mass the small intestine was diffuse dilated. A right hemicolectomy
with resection of 40cm of distal ileum was performed. Bacteriological investigation
of liquid from abdominal cavity showed candida albicans – candida peritonitis. The
postoperative course was uneventful.
Results:
Histology of the resected specimen showed endometriosis involving the ileum and
causing a stricture. Endometriosis was mainly prevalent in the muscularis propria
and submucosa. The mucosal involvement showed inflammation and glandular
alteration.
Conclusion:
Conclusion: The preoperative diagnosis of small bowel endometriosis is extremely

difficult and diagnosis is only made at histological examination.
-539-
PP - 341 NASOGASTRIC DECOMPRESSION IN PATIENTS WITH PEPTIC
ULCER PERFORATION
BÜLENT ÜNAL , CEMALETTIN AYDIN , AYDEMIR ÖLMEZ , FATIH SÜMER , EMRAH
OTAN , CÜNEYT KAYAALP
İNÖNÜ UNIVERSITY, FACULTY OF MEDICINE, MALATYA, TURKEY
Background&Aims:
Traditionally, nasogastric decompression (NGD) is routinely used after repair of

perforated peptic ulcer (PU). The aim of this study was to evaluate whether it is
necessary or not in patients with peptic ulcer perforation.
Methods:
This prospective study included total of 156 patients (18 females = 11.5% and 138
males = 88.5%) who were operated for perforated PU. Mean age was 49.56 (min
16y-max 95y). Patients were divided into two groups, those with NGD (n=126,%80.8)
and those without decompression (n=30, 19.2%). Postoperative complications,
morbidity and mortality were evaluated according to use of the NGD. There was
no comorbidity in all the patients. American Society of Anesthesiologist (ASA)
status was same in the all patients. There were no significant differences when
we compared the age, diamater and site of the perforation, preoperatif status and
surgical procedure.
Results:
Total 34 postoperatif complications (such as pnemonia, postoperative ileus,

wound infection, leak of the intestine, evisseration) were present in 14.2% (n:22)
of patients. Total mortality rate was 3.8% ( n=6) and all of the patients were in
NGD group. There were 2 dehiscences on perforated site because of the leak from
the suture line. This two patients were in NGD group. Total complication rate was
14.3% in NGD group and 13.8% in non- NGD group (p=0.606). The rates of vomiting,
distention, belching, hiccupping, dysphagia complaints were similar among the
groups. Starting time for oral feeding and postoperative hospital stay were similar
in both groups.
Conclusion:
Nasogastric decompression can be omitted after perforated PU surgery. Omission

of NGD does not increase postoperative complications, on the contrary it may
increase patient comfort and quality of life. Therefore, we do not recommend the
routine use of nasogastric tubes in perforated PU surgery.
-540-
PP - 342 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: AN
EFFECTIVE APPROACH WITH LOW COMPLICATION RATES FOR
ENTERAL NUTRITION
SELIM MISIRLIOĞLU , UĞUR DUMAN , DENIZ TIHAN , FATIH EROL , MURAT
UZUNER , MURAT POLAT

Background&Aims:
Percutaneous endoscopic gastrostomy (PEG) is a common preferred option to

provide adequate enteral nutrition for the patients especially with neurologic
disorders resulting in impaired nutritional status. The rationales for the usage of PEG
are the complications of parenteral nutrition and feeding via nasogastric tube over
a period of 15 days. Aim of this study is to review the advantages / disadvantages of
PEG in intensive care unit patients.
Methods:
The data of patients who underwent PEG between January 2010 - January 2012
were collected prospectively. The demographic properties and complications in the
follow up period were analyzed.
Results:
There were thirty seven patients underwent PEG. There were 3 complications in the
follow up period. Two of them were surgical site infection and one of them was the
dislodgement by the patient.
Conclusion:
Enteral nutrition is the only physiological way for alimentation. In patients who may
not be able to have oral feeding, PEG should be route of choice to maintain enough
nutritional status with low complication rates and satisfactory safety of patients.
-541-
PP - 343 DOES MEAN PLATELET VOLUME PREDICT THE DIAGNOSIS
OF ACUTE MESENTERIC ISCHEMIA?
SAHIN KAHRAMANCA 1, DURAY SEKER 1, ALPER OZKARDES 2, GAYE SEKER 1,
MEHMET KILIC 2, HAKAN KULACOGLU 1
1
DISKAPI YILDIRIM BEYAZIT TEACHING AND RESEARCH HOSPITAL, ANKARA,
TURKEY
2
ETLIK SPECIALITY HOSPITAL, ANKARA, TURKEY
Background&Aims:
Mean platelet volume (mpv), is available with routine blood counts and therefore
is an attractive index to study in clinical scenarios. It is known that MPV can be
helpful in possible diagnosis of stroke, thrombosis, and coronary artery diseases.
The aim of this study is to determine whether early detection of platelet activation
via increased mean platelet volume would help in diagnosis of the mesenteric
ischemia and predicting the severity of this entity.
Methods:
Retrospectively, hospital records of 35 mesenteric ischemia and 36 elective

laparoscopic cholecystectomy (for control group) patients were reviewed. Pre-
operative values of fibrinojen, mpv, platelet distrubution width (pdw), and lactate
were recorded. Statistical analysis was done by Mann-Whitney test.
Results:
The mean pre-operative mpv values were 8.83fL (SD±1.59), and 8.20fL (SD±0.93)
for ischemia and ontrol groups respectively. There was no significant difference in
mpv values (p=0.215) between ischemia and control groups. The mean fibrinogen
and lactate levels were 565.56mg/dL(SD±204.52) and 4.55mmol/L(SD±2.55) in
ischemia group respectively and 322.54(SD±78.66) and 1.04(SD±0.48) in control
group respectively. The mean fibrinogen and lactate levels were significicantly
higher in ischemia group (p<0.001).
Conclusion:
Pre-operative lactate and fibrinogen levels are predictive for the diagnosis of
intestinal ischemia, but mpv values are not.
-542-
PP - 344 NEUROENDOCRINE HYPERPLASIA OF GASTRIC MUCOSA.
ERDEM KINACI 1, MEHMET EMIN GUNES 1, ESRA PASAOGLU 2, ADNAN HASLAK 3,
ACAR AREN 1
1
ISTANBUL TRAINING AND RESEARCH HOSPITAL, DEPARTMANT OF GENERAL
2
ISTANBUL TRAINING AND RESEARCH HOSPITAL, DEPARTMANT OF PATHOLOGY,
ISTANBUL, TURKEY
3
DIYARBAKIR ERGANI MINISTRY HOSPITAL, CLINICS OF GENERAL SURGERY,
DIYARBAKIR, TURKEY
Background&Aims:
Neuroendocrine hyperplasia is a rare histpathologic finding of gastric mucosa.

In literature, there is a few data about it. In this study we provide data about
neuroendocrine hyperplasia in a relatively large patient serial.
Methods:
In this study we investigate retrospectively histopathologic findings in patients

underwent gastroscopy between 2005 – 2012. In patients with neuroendocrine
hyperplasia of gastric mucosa were investigated, the demographics and
histopathologic findings were exhibited. It is relation with presence of helicobacter
pylori were alsa examined.
Results:
Data of gastroscopies and pathologic examinations between 2005 -2012 were

investigated, there were neuroendocrine hyperplasia of gastric mucosa in 68
patients. Mean age of patients was 53,6 (between 23 and 85). It was more common
in women (60%,n=48) than in men (40%,n=26). In great majority of patients
(82%,n=56) there was helicobacter pylori infection.
Conclusion:
In literature, data about neuroendocrine hyperplasia and its clinical meaning is

not enough. Patients series are commonly very small. In this study we exhibit that
neuroendocrine hyperplasia is more common in women and strongly related with
helicobacter pylori infection. Long term follow up is necessary to conclude about its
clinical meaning and relation with malignancies.
-543-
PP - 345 IS THERE A ROLE OF ABDOMINAL DRAINAGE IN PRIMARILY
REPAIRED PERFORATED PEPTIC ULCERS?
MUSTAFA PESKERSOY , ERDINC KAMER , TURAN ACAR , CENGIZ TAVUSBAY ,
AHMET .ER , MEHMET HACIYANLI

DEPARTMENT OF SURGERY, IZMIR, TURKEY
Background&Aims:
To the best of our knowledge,only one prospective controlled study has appeared
in the English literature,which has documented that the routine use of drains
is neither safe nor effective in patients of perforated duodenal ulcer treated by
omental patch closure. Therefore, our aim is to assess the value of intraperitoneal
drainage placement in patients with perforated peptic ulcer.
Methods:
Patients with perforated peptic ulcer who underwent surgery in Izmir Atatürk
Training and Research Hospital,Department of 4.Surgery,formed the body of the
present retrospective study during a period from 2008 to 2011.
Results:
Overall mean age of the 65(%77.4) patients were found 49±3 years.Intraabdominal
drains were placed sub-hepatic and pelvic area.Majority of patients (69.3%) in our
study presented between 48 to 72 hours of onset of symptoms while 15.8% of
patients presented between 24-48 hours of onset. Removal of abdominal drains
were 2.3±1.25 days for the pelvic drain and 3.1±1.5 days for the sub-hepatic drain.
Discharge from the hospital was 4.1±1.14 days.
Conclusion:
To conclude, the present study confirms the suggestion of Petrowsky that peptic
perforation closure with omental patch technique appears to be safe without
prophylactic drainage and in view of the high local drain-related complications,
routine drainage cannot be recommended after this procedure.
-544-
PP - 346 DEXMEDETOMIDINE PRETREATMENT ATTENUATES
MESENTERIC ISCHEMIA REPERFUSION INJURY IN RATS
A.EBRU SALMAN 1, FAHRI YETISIR 2, AHMET DOSBIL 1, DILARA ZEYBEK 5, BANU
YUREKLI 4, MUSTAFA AKSOY 1, AYŞEGÜL SEZER 5, MEHMET KILIÇ 3
1
REANIMATION DEPARTMENT, ANKARA, TURKEY
2
ANKARA ATATÜRK RESEARCH AND TRAINNING HOSPITAL, GENERAL SURGERY
DEPARTMENT, ANKARA, TURKEY
3
YILDIRIM BEYAZID UNIVERSITY ,GENERAL SURGERY ,TURKEY, ANKARA, TURKEY
4
BOZYAKA RESEARCH AND TRAINNING HOSPITAL, ENDOCRINOLOGY, IZMIR,
TURKEY
5
HACETTEPE UNIVERSITY, PATHOLOGY ,TURKEY, ANKARA, TURKEY
Background&Aims:
To investigate the effect of dexmedetomidine pretreatment in a rat model of
mesenteric ischemia-reperfusion injury using biochemical, histopathological
methods.
Methods:
A total of 28 female rats weighing between 230-300 gr were randomly devided in
to 4 groups, 7 rats in each. Group I in which sham surgical preparation including
isolation of SMA without occlusion was performed. Group II in which intestinal I/R
was produced by clamping SMA for 1 hour and declamping for 3 hours, group III
sham operated dexmedetomidine received dex at a dose of 25 mcg/kg i.p. Group
IV dexmedetomidine was given at a dose of 25 mcg/kg i.p 30 min before intestinal
ischemia induced. Malondialdehyde (MDA), protein carbonyl(PC), superoxide
dismutase(SOD), catalase, and gluthathione peroxide (GPx) levels were analyzed in
intestinal tissue samples. Tissue antioxidant status(TAS), tissue oxidant status(TOS),
TNFalpha, IL6, IL10 values were measured from serum samples 3 hours after
reperfusion. The histopathological examination scores were determined using the
intestinal tissues.
Results:
There were significant difference in the mean PC, TNF alpha and IL6 values between
group II and group IV. The histopathological examination scores of intestinal tissues
were significantly higher in group II compared to group IV. (P<0.05)
Conclusion:
Pretreatment with dexmedetomidine attenuates intestinal ischemia-reperfusion

injury in rats.
-545-
PP - 347 INTESTINAL OBSTRUCTION DUE TO METASTATIC
MELANOMA: REPORT OF 5 CASES
CARLOS AUGUSTO CUTINI CINGOZOGLU , H. RODOLFO SCARAVONATI , LUCIANA
CONTINO , SILVINA LUCIA MILLETARI , PATRICIO E. DONNELLY , RODRIGO MORAN
AZZI , VICTOR HUGO SERAFINI , SANTIAGO LENZI
Background&Aims:
Small bowel obstruction is a common and serious medical complication in the

oncologic patient population. Most melanomas of the small intestine are metastases
from primary cutaneous lesions. We present 5 cases of intestinal occlusion, an
unusual presentation of metastatic melanoma
Methods:
Retrospective analysis from a prospectively collected database.All patients with

cutaneous melanoma who underwent surgery for intestinal occlusion were included
Results:
Between May 2010 and May 2012, 5 laparotomic explorations due to intestinal
occlusion in patients with cutaneous melanoma were performed. (2 male,3 females).
The average age was 58 years old (range 40-72 ). Small bowl intussusception was
reported in 2 cases. The average operative time was about 147 min (range 110-
160). Bowel resection was performed in all patients. One case required ileostomy.
All were performed in the emergently. The average post operative stay was 7 days
(range 5-10). There was neither mortality nor major complications. Amelanotic
melanoma was informed in 3 patients’ histipathology
Conclusion:
Intestinal occlusion is an unusual presentation of metastatic melanoma. Owing to

late diagnosis, patients often undergo emergency surgery. Intestinal resection and
anastomosis seem to be a safe procedure for both curative and palliative purposes.
-546-
PP - 348 INFLUENCE OF BURSECTOMY ON MORTALITY AND
MORBIDITY IN RADICAL GASTRIC RESECTIONS: SHORT-TERM
OUTCOMES
HAKAN YIĞITBAŞ , ATILLA CELIK , HAKAN GUVEN , SULTAN AKAYKUCUK ENHOS ,
FAZIL SAGLAM
BAĞCILAR EĞITIM VE ARASTIRMA HASTANESI, ISTANBUL
Background&Aims:
Aimed to detect whether implementation of bursectomy on early mortality and

morbidity in radical gastric resections.
Methods:
38 radical gastrectomies + D2 dissection that were performed due to cancer

between January 1, 2010 and December 31, 2010.
Results:
Total and Subtotal Gastrectomy were performed on 27 and 11 cases. 30 (79%)

patients underwent bursectomy. Additional organ resection (spleen, pancreas, gall
bladder, and diaphragm) was performed besides gastrectomy on 11 patients. The
average time duration of the operation in the first 10 patients with bursectomy
was 35 minutes however it decreased to 15 minutes for the subsequent cases with
no bursectomy. There was no significant difference between the blood losses. The
durations of the hospital stay for the groups with and without bursectomy were 16
and 13 days.
Conclusion:
The radical resections and added extended lymph node dissections has good
results for the long-term patient follow-up. The addition of the front leaf of the
bursa omentalis that may result in a potential of the extended dissection of tumor
recurrence is considered to improve survival. Bursectomy that is avoided because
of the fear of additional morbidity and mortality can be done in experienced hands
without any problem to survival of the patients.
-547-
PP - 349 ESOPHAGOILEOSTOMY AS AN UNCOMMON
COMPLICATION AFTER TOTAL GASTRECTOMY FOR GASTRIC
CANCER
HALDUN KAR 1, NECAT CIN 1, CENGIZ TAVUSBAY 1, YASIN PEKER 1, FATIH ASLAN 2,
ONUR DULGEROGLU 1, FATMA TATAR 1
1
IZMIR KATIP CELEBI UNIVERSITY ATATURK TRAINING AND RESEARCH HOSPITAL,
DEPARTMENT OF GENERAL SURGERY, IZMIR, TURKEY
2
IZMIR KATIP CELEBI UNIVERSITY ATATURK TRAINING AND RESEARCH HOSPITAL,
DEPARTMENT OF GASTROENTEROLOGY, IZMIR, TURKEY
Introduction:
The surgical error of anastomosing the esophagus to the ileum instead of the
jejunum is uncommon. Here we present a patient with esophagoileostomy leakage
after total gastrectomy.
Case report:
67 year-old-male patient with cardia cancer was performed total gastrectomy,

Roux-en-Y osephagojejunostomy at another health center. He was then referred
to our hospital at seventh postoperative day with the suspection of anastomotic
leak. Physical examination and laboratory tests revealed anastomotic leak and
intraabdominal sepsis. At emergent laparotomy, total gastrectomy, instead of Roux
en-Y osephagojejunostomy, an end to side osephagoileostomy at 30 cm proximal to
ileocecal valve, leak at the posterior portion of the anastomosis, and 40 cm distal
to the anastomosis ileoileostomy were observed. Preserving the ileoileostomy, the
proximal part of the anastomosis was converted to mucous fistula by the use of
staplers. A feeding jejunostomy was performed and the osephagoileostomy region
was drained. At intensive care unit, as the leak continued, a stent was endoscopically
inserted at the leak site and the leak was then under control. The patient survived
well and discharged from the hospital at 44th day postoperatively. One month later,
no leak was observed at barium examination. However, abdominal scan revealed
multiple hypodense hepatic metastases. The stent was removed endoscopically.
Mediastinitis developed and was controlled by medical treatment, but the patient
was died because of progressive hepatic failure.
Conclusion:
Following surgical resections, the gastrointestinal continuity should be maintained

with the most physiological anostomosis.
-548-
PP - 350 SINGLE PORT INTRA-GASTRIC FULL THICKNESS RESECTION
HOGOON KIM , SEONG YEOB RYU , DONGYI KIM
DIVISION OF GASTOENTEROLOGIC SURGERY, CHONNAM NATIONAL UNIVERSITY

MEDICAL SCHOOL, KOREA
Background&Aims:
Recently, minimize incisions has led to a reduction in the number of ports, and
has led to transumbilical single-port surgery. We introduce a novel intracorporeal
knot tying method and result of single-port, intragastric, full thickness resections
for gastric SMTs.
Methods:
From August 2010 to March 2011, five patients underwent single-port intragastric,
full thickness gastric wedge resections. After performing a gastrostomy, an single
port was inserted into the stomach. After full thickness resection, the defect in the
gastric wall was sutured by full thickness interrupted suture and a new knot tying
technique.
Results:
The mean operative time was 129 21.0 min and the mean mass size was 3.0 There
were two very low-risk GISTs, 2 leiomyomas, and 1 carcinoid. The post-operative
course was uneventful in all patients. The mean hospital stay was 7.2 1.2 days.
Conclusion:
Single-port intra-gastric full thickness resection with RRSIT is feasible and safe.
RRSIT is a very useful knot tying method. We expect the application of RRSIT to be
diverse and broad.
-549-
PP - 351 SURGICAL TREATMENT OF BLEEDING STOMACH CANCER
SERGIY ODARCHENKO , OLEG KANIKOVSKY , IGOR PAVLYK
NATIONAL M.I. PIROGOV MEMORIAL MEDICAL UNIVERSITY IN VINNITSA, UKRAINE
Background&Aims:
The structure of mortality from stomach cancer ranks second in men and fourth in
women in Ukraine. Choice of surgical treatment in patients with complicated gastric
cancer remains uncertain. The aim of study is detect the place of surgical treatment
for bleeding stomach cancer.
Methods:
We study 114 patients with gastric cancer complicated by bleeding. According to

the stages of the cancer II stage (T1-3N0-2M0) were diagnosed in 9.2% of patients,
III (T2a-3N0-2M0) - 58,9%, IV (T1-4N1-3M0-1) – 31,9%. All patients performed
endoscopy with biopsy and staging the bleeding by Forrest.
Results:
In 105 (92.1%) patients were used an endoscopic hemostatic therapy. In the case
of F1haemostasis (62) used a clipping of the vessel (7), injection therapy (55).
Recurrence of bleeding appeared in 25 (40.3%) patients. When hemostasis F2
(43), clipping of the vessel was performed in 3 patients with hemostasis F2a, all
the rest (40) used the application of hemostatic agents on the source of bleeding.
Recurrence of bleeding appeared in 15 (34.8%) patients. Surgery due to profuse or
recurrent bleeding were done to 37 patients. In 7 were curative, 16 - palliative, 14 -
symptomatic operations. Postoperative mortality were 12.1% (4). 68 patients with
hemostasis F2 operated on early delayed period. In 26 patients underwent curative
and palliative, in 38 symptomatic surgery. Postoperative mortality were 4.4% (3).
Conclusion:
All patients with gastric cancer complicated by hemorrhage shoud follow the
endoscopic therapy, which efficiency is 61.9%. Surgical treatment possible in the
early delayed period.
-550-
PP - 352 PROPERTIES OF DIGESTIVE ANASTOMOSIS WITH SHAPE
MEMORY IMPLANTS
OLEG KANIKOVSKY , IGOR PAVLYK , VALERIY NADOLSKY
Background&Aims:
The quality of manual suture (MS) or stapler suture of the alimentary canal is worse
in peritonitis or intestinal obstruction (IO). Therefore important researches of
sutureless connection tissues with compression by shape memory implants (SMI).
The aim of study to evaluate the safety and efficacy of digestive anastomosis (DA)
with SMI in condition of peritonitis or IO.
Methods:
The study included 196 patients [median age 57,8 (17 –87), male : female 89 :
107] with acute abdominal pathology, peritonitis were in 154 (78,6%), intestinal
obstruction - 144 (73.5%). All patients were operated for urgent indications, and
were needed creation of DA. 122 (62.2%) patients had MS DA, 74 (37.8%) – DA SMI.
For MS DA we use vicryl, for DA SMI - nickel titanium implants that change its form
in different temperature.
Results:
Median duration of surgery was for MS DA 127 ± 8,2, while DA SMI - 79 ± 4,6 min (p
<0.05). The average length of MS DA formation was 34 ± 7,6, with SMI - 12 ± 5,4 min
(p <0,001). Medium elimination time of implants was 9,2 ± 1,26 days. The process
resulted in a natural way, not accompanied by unpleasant feelings in patients.
Postoperative complications developed in 33 (27.05%) with MS DA, and 8 (10.81%)
in DA SMI (p <0.05). Leak of anastomosis were in 8 (6.6%)patients with MS DA.
Conclusion:
DA SMI is supreme on the MS DA in different parameters, but need further

investigation.
-551-
PP - 353 GASTROINTESTINAL STROMAL TUMOR OF THE STOMACH
TREATED WITH LAPAROSCOPIC WEDGE RESECTION IN A PATIENT
WITH NEUROFIBROMATOSIS TYPE 1
IBRAHIM ATAK , METIN YUCEL , ADNAN OZPEK , SULEYMAN KALCAN , GURHAN
BAS , ORHAN ALIMOGLU

Background&Aims:
Neurofibromatosis type 1 (NF-1) is an autosomal dominant seurocutaneus disease

characterized by abnormal skin pigmentations, cutaneous fibromas, skeletal
dysplasias and lisch nodules. We aimed to present a NF-1 case presenting with
gastrointestinal system bleeding due to gastrointestinal stromal tumor (GIST) in the
stomach and treated with laparoscopic gastric wedge resection
Methods:
A-79-old woman with NF-1 having multiple neurofibromas and cafe-au-lait spots
greater than 5 mm in diameter presented to emergency room with compliants
of abdominal pain and bloody vomiting. Physical examination of the patient
was unremarkable except epigastric tenderness. Upper gastrointestinal system
endoscopy revealed a submucosal tumoral mass in the fundus of the stomach.
Laparoscopic gastric wedge resection was performed.
Results:
The patient had uneventful postoperative period and she was discharged on fifth
postoperative day. A GIST arising from gastric fundus in size of 9x6x5 cm was
detected at histopatological examination. Surgical margins were intact.
Conclusion:
Patients with NF-1 have an increased risk of GİST. When GİST is detected it should
be resected. Laparoscopic surgery can be used fort he treatment. In addition to
excision of the tumor with clear surgical margins a careful dissection should be
performed to avoid performed to avoid perforation and intraperitoneal seeding.
-552-
PP - 354 A CASE WITH MECKEL DIVERTICULE PRESENTED AS ILEUS
İBRAHİM KILINÇ 1, METİN ESER 1, MESUT ÖZDEDEOĞLU 1, SAMET YALÇIN 2,
MEHMET KILIÇ 2
1
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL SURGERY CLINIC,
ANKARA, TURKEY
2
YILDIRIM BEYAZIT UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF GENERAL
SURGERY, ANKARA, TURKEY
Background&Aims:
Meckel diverticules are the most common congenital abnormality of gastrointestinal

tract with a prevalance of %1-3. Here we aimed to present a case who was presented
as ileus because of a meckel diverticule.
Methods:
21 year-old female were admitted with severe abdominal pain and obstipation-
constipation. There was no history of previous surgery. Abdominal distantion,
tenderness and rebound tenderness were apparent in physical examination.
Results:
Labarotory findings marked leucocytosis. Direct X-ray showed air-fluid levels.

Patient was urgently operated. During exploration, a long meckel diverticule that
adhered to anterior abdominal wall was noticed. It slang an intestinal segment and
caused an obstruction in intestinal passage. Ileal segments were dilated prior to this
level. Following removal of adherence, a resection were performed.
Conclusion:
Despite usually meckel diverticules cause no symptoms, patients could present with
serious complications. Many complications such as gangrenous Meckel diverticule,
partial intestinal obstruction due to mesodiverticular adherences, ceacal volvulus,
masive gastrointestinl hemorrhage, diverticule perforation were reported. For
this case, adherence to anterior abdominal wall at tip of Meckel diverticule slang
an intestinal segment and prevents distal intestinal passage. As a conclusion,
complications of Meckel diverticules should be considered for patients without
previous surgery who presented with intestinal obstruction symptoms.
-553-
PP - 355 LYMPHOMA WHICH PRETENDS INGUINAL HERNIA: A CASE
PRESENTATION
İBRAHIM KILINÇ 1, METIN ESER 1, EMIN ÇELIK 1, SAMET YALÇIN 2, MEHMET KILIÇ 2
1
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL SURGERY CLINIC,
ANKARA, TURKEY
2
YILDIRIM BEYAZIT UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF GENERAL
Background&Aims:
Non-Hodgkin lenfoma is a heterogen group of lymphoproliferative diseases which

have different behaviour patterns. In this study, we aim to present a lymphoma fact
which can be confused with irreducted inguinal hernia.
Methods:
32 year-old male patient admitted with a complaint of swelling crotch which exists
for 2 months. During the physical examination, there was a mass in the left inguinal
area reaching out to scrotuma.
Results:
Patient was taken into operation with a pre-diagnosis of inguinal hernia. During the
operation, it is observed that the mass was not inguinal hernia but a mass which
spread out to left testis. Left high orchiectomy was done. Pathological result was
reported as a diffused B celled lymphoma which took hold of diffused spermatic
cord and infiltered to testis.
Conclusion:
The most common type of lymphoma in adults is diffuse large B cell lymphoma
which is characterized by proliferation of malign mature B cells. Approximately
1/3 of the patients present with extranodal presentation. It indicates aggressive
progress and it can cause life threatening complications early. As a result, at patients
who present with a hard mass in the inguinal region lying to the scrotum, diagnosis
of lymphoma should be kept in mind.
-554-
PP - 356 THE IMPACT OF ENDOSCOPY TRAINING DURING
RESIDENCY ON DIAGNOSIS
MEHMET ALI ERYILMAZ , NERGIZ AKSOY , AHMET OKUŞ , ÖMER KARAHAN
, SERDEN AY , BARIŞ SEVINÇ , RECEP DEMIRGÜL
KONYA EDUCATION AND RESEARCH HOSPITAL, CLINIC OF GENERAL SURGERY,

KONYA, TURKEY.
Background&Aims:
The aim of the study is to evaluate the impact of endoscopy training during
residency on endoscopic diagnosis.
Methods:
The patients files who had undergone endoscopy between 2009 and 2011 in
surgical endoscopy unit, retrospectively evaluated. Endoscopists were divided into
2 groups as endoscopy training during residency (group 1) or than after (group 2).
Histopathological evaluation was accepted as the method to confirm the diagnosis.
Endoscopic and pathological diagnoses were compared and the consistencies of
the Endoscopists were calculated.
Results:
There were 9055 endoscopic evaluation and 1285 biopsies were taken in 3 years
period. The mean age of the patients were 54 (15-94). There were 15 surgeons, 8 in
group 1, 7 in group 2. In upper gastrointestinal system endoscopy the consistency
rates were 79% in group 1 and 72% in group 2 (p=0,035). In lower gastrointestinal
system endoscopy, the consistency rates were 79% in group 1 and 80% in group 2
(p=0,709).
Conclusion:
Endoscopy training during residency has positive impact on identification of upper

gastrointestinal system lesions.
-555-
PP - 357 MINIMALLY INVASIVE SURGERY USING MINI ANTERIOR
INCISION FOR THYROID DISEASES
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, ISA SOZEN 1, MEHMET
FATIH BENZIN 1, GIRAYHAN CELIK 1, RECEP CETIN 1
1
2
ISPARTA, TURKEY
Background&Aims:
Since the 1980s, minimally invasive surgical techniques have attracted interest in
all surgical specialties. Thyroidectomy technique mandates meticulous surgical
dissection, absolute hemostasis, en bloc tumor resection and adequate visualization
of the operative field, all of which can be accomplished with minimally invasive
techniques.
Methods:
This was a prospective study. The study group comprised all patients undergoing
MITS from its introduction in 2008 until July 2011.
Results:
There were 35 patient undergoing bilateral MITS procedures over the 2-year
period. the mean size of the thyroid lobe removed was 42.4 mm (range, 10–75
mm).The final diagnoses were: benign multinodular goitre (37%), follicular
adenoma (28%),incidental carcinoma (11%), Hashimoto’s thyroiditis (15%), Hurtle
cell adenoma (5%), subacute thyroiditis (1%), others (3%). Of the carcinomas , 80%
were papillary thyroid cancer, 20% were follicular. Four patients had temporary
recurrent laryngeal nevre paresis. One patients had a wound infection
Conclusion:
Endoscopic techniques and MIT is a debatable issue. Demonstrating the advantages

of these techniques over conventional surgery is not easy. Minimally invasive
thyroid surgery using a anterior 2.5-cm incision placed higher than the traditional
Kocher incision for the management of thyroid nodules can be performed with
an equivalent postoperative complication rate to traditional thyroidectomy while
providing excellent cosmesis
-556-
PP - 358 PANCREATICOGASTROSTOMY – AN ALTERNATE
FOR DEALING WITH PANCREATIC REMNANT AFTER
PANCREATICODUODENECTOMY
MUHAMMAD SHAHRUKH EFFENDI , TABISH CHAWLA , AYAZ AHMAD MEMON
AGA KHAN UNIVERSITY HOSPITAL. KARACHI, PAKISTAN
Background&Aims:
Whipple’s pancreaticoduodenectomy (PD) has been refined over the years to be

a safe operation. The pancreatic fistula (PF) is the single most important cause of
mortality following PD. Pancreaticogastrostomy (PG) has been recently reintroduced
as a safer procedure to reestablish pancreato-enteric anastomosis after PD.
Methods:
Retrospective review of charts was done, of the patients who underwent Whipple’s
pancreaticoduodenectomy at our institute and had pancreaticogastrostomy as a
preferred anastomosis for pancreatic stump.
Results:
23 patients underwent pancreaticoduodenectomy who had pancreaticogastrostomy

as a preferred anastomosis for the pancreatic stump. None of our patients had the
complication of post-op pancreatic fistula. Five of our patients had morbidities.
One patient had bleeding from the gastrojejunostomy site and two patients had
morbidity of delayed gastric emptying. Two of our patients had hospital acquired
pneumonia. Two patients died . One because of cardiac arrhythmias and other
because of septic shock.
Conclusion:
Pancreaticogastrostomy seems to be a safe alternative and easier anastomosis

to perform with lesser post op morbidity and mortality. As our experience and
numbers will grow, we should be able to contribute with more reliable data.
-557-
PP - 359 EFFECTIVENESS OF COLLAGENASE IN PREVENTING
POSTOPERATIVE INTRA-ABDOMINAL ADHESIONS
MURAT ÇAKIR 1, AHMET TEKİN 1, TEVFİK KÜÇÜKKARTALLAR 1, HÜSEYİN YILMAZ 2,
METİN BELVİRANLI 1, ADİL KARTAL 1, EBUBEKİR GÜNDEŞ 1, HACI HASAN ESEN 1
1
KONYA UNIVERSITY, MERAM MEDICAL FACULTY, DEPARTMENT OF GENERAL
SURGERY, KONYA, TURKEY
2
SELCUK UNIVERSITY, SELCUKLU MEDICAL FACULTY, DEPARTMENT OF GENERAL
Background&Aims:
The purpose of this study is to investigate the effectiveness of Collagenase

clastridiopeptidase A enzyme preparation used in enzymatic debridement in
preventing adhesions brought about by peritoneal damage.
Methods:
The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The
control group Group 2: Normal saline group Group 3: Sterile Novuxol® group Group
4: The group where the intraperitoneal and systemic effects of sterile Novuxol®
were investigated. Adhesion frequency and grades were scored on the post-
op 11th day according to Granat. Blood work including hemoglobin, aspartate
aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level
measurements were performed.
Results:
Adhesion frequency was found to be %80 on the right and %90 on the left for Group
1, while it was 50% on both left and right for Group 2, and 30% on the right and 10%
on the left for Group 3. Adhesion stage of the Sterile Novuxol® Group was lower
than all the other groups (p<0.05).
Conclusion:
According to the results of our study, we believe that Sterile Novuxol® can be a good
anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness.
-558-
PP - 360 PLATELET PARAMETERS IN HEPATIC CYST HYDATID
MUSTAFA ŞİT 1, GÜLALİ AKTAŞ 2, EDİP ERDAL YILMAZ 1, İSMAİL NECATİ
HAKYEMEZ 3, AYTEKİN ALÇELİK 2, ABDÜLKADİR KÜÇÜKBAYRAK 3
1
2
3
DEPARTMENT OF INFECTIOUS DISEASES, ABANT IZZET BAYSAL UNIVERSITY,
Background&Aims:
Hepatic cyst hydatid infection is caused by microorganisms named echinococcus

which belong to family Taenidae. Platelets are considered as a mediator in
inflammation because of the various proinflammatory substances that they contain.
Methods:
Thirty three patients who admitted to Doğubayazıt State Hospital’s general surgery
clinic with a diagnosis of hepatic cyst hydatid were enrolled to this retrospective
study. Laboratory data of the patients in pre- and post-operative periods were
obtained by computerized medical records database of the hospital
Results:
Pre-operative Mean platelet volume (MPV) of the patients was significantly

increased compared to postoperative MPV values
Conclusion:
We claim that MPV is a usefull follow up marker after surgery in patients with
hydatid cyst.
-559-
PP - 361 ANALYSIS OF CASES WITH PRIMARY RETROPERITONEAL
TUMORS
MUJGAN CALISKAN 1, AYLIN ACAR 1, ISMAIL EVREN 2, HASAN ERDEM 3, GURHAN
BAS 1, ORHAN ALIMOGLU 1
1
DEPARTMENT OF GENERAL SURGERY, UMRANIYE EDUCATION AND RESEARCH
2
DEPARTMENT OF UROLOGY, UMRANIYE EDUCATION AND RESEARCH HOSPITAL,
ISTANBUL, TURKEY
3
DEPARTMENT OF GENERAL SURGERY, ADANA NUMUNE EDUCATION AND
RESEARCH HOSPITAL, ADANA TURKEY
Background&Aims:
Retroperitoneal tumors are rare and most of them arise from mesodermal or
neuroectodermal tissues and residues of the embryonic urogenital body. Due to
their anatomic location and slow growth, pain and neurological symptoms do not
appear until later stages. In this article, we aim to present our experience in patients
with primary retroperitoneal tumor.
Methods:
Eight patients who underwent retroperitoneal tumor excision between April

2009 and April 2011 were included in the study. Gender, age, patients’complaints,
location, type and size of the tumor, surgical techniques, morbidity, recurrence, and
mortality rates were evaluated.
Results:
Four of the patients were females and the mean age was 48.6 years. The mass was
located in the abdomen in four patients and in the pelvis in the others. Patients
experienced abdominal pain, back/leg pain, difficult urination and constipation.
Histopathological diagnoses were determined, such as schwannoma, cystic
mesothelioma, angiomyolipoma, epidermoid cyst, liposarcoma, ganglioneuroma,
and neurofibroma. Morbidity included bleeding, deep vein thrombosis, and
pulmonary embolism. Postoperatively there were neither recurrences nor mortality.
Conclusion:
Primary retroperitoneal tumors can be located in different regions, but we did not
find any tumors in the left lumbar region. Additionaly, pathological diagnoses were
heterogeneous, including seven benign and one malignant lesion.
-560-
PP - 362 A CASE OF RECTAL MIXED ADENONEUROENDOCRINE
CARCINOMA
ERDAL POLAT 1, BAHADIR CELEP 2, ZİŞAN SAKAOĞULLARI 3, NECDET FATİH YAŞAR 1,
SİNAN YOL 1
1
KARTAL KOŞUYOLU YÜKSEK İHTİSAS EDUCATION AND RESEARCH HOSPITAL,
DEPARTMENT OF GASTROINTESTINAL SURGERY, ISTANBUL, TURKEY
2
ANKARA DIŞKAPI YILDIRIM BEYAZIT EDUCATION AND RESEARCH HOSPITAL,
3
ANKARA YÜKSEK İHTİSAS EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT
OF PATHOLOGY, ANKARA, TURKEY
Background&Aims:
World Health Organization has established a new classification system for colorectal
neuroendocrine tumors. After neuroendocrine tumors (NETs), neuroendocrine
carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs) has
been classified, past and recent cases are being reviewed in terms of diagnosis,
treatment and prognosis.
Methods:
A 83-year old women was admitted to our hospital with rectal bleeding. A hard,
mobile, fragile mass was palpated at the 4th cm from the anal verge on digital rectal
examination. Colonoscopy was performed and a unique (single) ulcerovegetative
tumor with a 3 cm diameter was seen at the anal canal and colonoscopic biopsy
yielded a diagnosis of malign epithelial tumor and small cell carcinoma. Laboratory
findings, including tumor markers CA19-9 and CEA, showed no abnormalities
except anemia. Abdominal ultrasonography showed no abnormalities. Transanal
local excision of the tumor resection was performed under regional anesthesia.
On the definitive pathological analysis of the material revealed MANEC. The tumor
was found to invade the muscular layer, surgical margins were negative and lymph
nodes were free of malignant involvement. Postoperative period was uneventful.
After the discharge, daily 50-200mg/m2 of etoposide orally was administered
for anticancer treatment and at the end of the first month, control abdominal
computed tomography scan detected a lot of metastases in the liver. Her general
condition was worsened by exacerbation of the cancer and she died 4 months after
surgery.
-561-
Results:
Discrete and conflicting information about GI NECs leads confusion. In a survival

study investigating the patients with either gastric or colonic neoplasms; the
authors find that the survival is worse in NEC patients when compared with MANEC
patients. However in an another study, no significant survival difference was shown.
Moreover, the authors stressed that the poor prognostic criteria is the presence of
G3 NEC regardless of the exocrine type – well differentiated adenocarcinoma or
squamous cell carcinoma. Our case also supports this hypothesis. The size of the
tumour correlates with prognosis and best prognosis is seen in lesions < 1 cm. For
such small lesions treatment of choice is complete resection of a localized lesion by
either endoscopically or by another surgical technique. It’s difficult to demonstrate
such well outcomes with radical surgery for more advanced disease. Lesions > 2 cm
have significantly higher risk of invasion of the muscularis propria and metastasis
and these patients are associated with worse prognosis. Most of the patients with
local advanced tumours have major surgery using ‘total mesorectal excision’to catch
the chance of cure but there is no evidence that these procedures could provide a
better survival. Locoregional resection may improve local control of symptoms and
pelvic disease without survival benefit.
Conclusion:
In the present study, we reported a case of a patient with MANEC who had a very
poor prognosis and short survival. Further studies should be carried out for a better
understanding of the nature of MANECs.
-562-
PP - 363 ESOPHAGEAL LEIOMYOMAS
NESET KOKSAL , TULAY DIKEN ALLAHVERDI , BARLAS SULU , TURGUT ANUK ,
YUSUF GUNERHAN
KAFKAS UNV, MEDICAL FACULTY, GENERAL SURGERY CLINICS, KARS, TURKEY
Background&Aims:
Leiomyomas of esophagus, although rare, are the most frequent benign tumors
of esophagus. Aim of this study is the presentation of5 patients with esophageal
leiomyomas who underwent surgical treatment during a 1-year period.
Methods:
Epidemiological data, symptoms, diagnostic examinations, location,

histopathological findings and the safety and efficacy of surgical resection are
assessed.
Results:
1men and 4women with mean age of 49years were operated. In 2 cases the tumor
was located at the lower esophagus, while in the other 3 cases, the leiomyoma
was found at the median third of esophagus. 5 patients had symptoms related to
the leiomyoma, such as dysphagia. One patients underwent a right postolateral
thoracotomy with enucleation of the lesion. One patient were treated by endoscopic
submucosal dissection(EMD). The mean diameter of the resected tumors was 4cm.
The dimensions of leiomyomas were immediately associated with the symptoms.
In no case was detected malignancy or recurrence. All patients were relieved from
their symptoms, while postoperative morbidity and mortality did not occur.
Conclusion:
Esophageal leiomyoma is a benign tumor.Surgical enucleation is considered to

be safe and effective, without complications. , EMD appears to be feasible and
minimally invasive treatment for some patients with upper gastrointestinal lesion
originating from the muscularis propria.
-563-
PP - 364 AN UNUSUAL CASE OF INTERNAL HERNIATION
COMPLICATED WITH SECONDARY JEJUNAL INTUSSUSCEPTION AND
VOLVULUS
ONUR TUTAR 1, MEHMET VELİDEDEOĞLU 2, OSMAN ŞİMŞEK 2, BİLGİ BACA 2
1
2
Background&Aims:
In adults transmesenteric hernias are most commonly acquired as a result of either

blunt abdominal travma or surgical manipulation of the bowel and mesentery.
However in the case we are reporting our patient has had no history of prior
abdominal travma or surgery.
Methods:
A 45-years-old male patient was admitted to Emergency Surgical Department with

an 6-hours history of persistent and severe abdominal pain about the umbilicus
accompanied by nausea and vomiting.Abdominal X ray imaging was requested on
suspect of intestinal obstruction.For further exploration CT scan was performed.
Results:
X ray was suggestive for intestinal obstruction.On CT invagination of jejunal

segments and volvulus of greater jejunal parts which involved invaginated segment
was revealed.On laparotomy, a small tumoral mass was detected and gathering of
the jejunal segments 140 cm apart from the treitz ligament had caused volvulus of
the small gut around a strangulated segment which further exploration revealed
this as a jejunojejunal invagination
Conclusion:
Invagination due to mass effect is common seen scenario.Although thorough scan

of medical literature showed absence of internal herniation that caused by defect
that caused by mass.In our case the mass caused invagination of intestinal segments
,these segments herniated through mesentery which further complication by
volvulus.
-564-
PP - 365 SMALL BOWEL INTUSSUSCEPTION IN A PREGNANT
WOMAN WITH PEUTZ-JEGHERS SYNDROME: A RARE CASE REPORT
ONUR TUTAR 1, MEHMET VELİDEDEOĞLU 2, OSMAN ŞİMŞEK 2, BİLGİ BACA 2, KAYA
SARIBEYOĞLU 2, SALİH PEKMEZCİ 2
1
2
Background&Aims:
Intussusception in pregnancy is a rare emergency condition associated with high

incidence of morbidity and mortality for both mother and fetus. It is very difficult to
diagnose this condition in pregnancy as in non-pregnant adult population because
of the fact that clinical presentation varies considerably in contrast to that of
children.A 19-years-old female patient who was 28 weeks pregnant was referred
to our clinic from a training hospital for further evaluation of a three-day history of
diffuse abdominal colicky pain, accompanied by severe nausea and vomiting.
Methods:
Ultrasonography (US) examination and magnetic resonance imaging (MRI) scan was
performed.
Results:
On ultrasonography (US) examination the findings were unremarkable.Magnetic

resonance imaging (MRI) revealed a sausage-shaped mass at the left upper quadrant
of abdomen,suggestive of intussusception with dilated proximal bowel loops.At
laparotomyintraluminal polypoid masses and jejunal invagination was detected.
Conclusion:
Intussusception is the most frequent complication of Peutz-Jeghers Syndrome

(PJS) but usually seen in child age.It is a predictable but infrequent complication
in adults with PJS.However, there is no report about intussusception in pregnancy
secondary to Peutz-Jeghers polyps in the literature. In this paper,we present a rare
intussusception case in a pregnant woman with PJS.
-565-
PP - 366 ILEUS SECONDARY TO RUPTURED MASSIVE LEFT
ANGIOMYOLIPOMA ASSOCIATED WITH ADVANCED TUBEROUS
SCLEROSIS
ONUR TUTAR 1, PINAR KOCAEL 2, OSMAN ŞIMŞEK 1, KAYA SARIBEYOĞLU 2, SALİH
PEKMEZCİ 2

1
MEDICINE, ISTANBUL, TURKEY 2 DEPARTMENT OF GENERAL SURGERY, İSTANBUL

UNIVERSITY CERRAHPAŞA SCHOOL OF MEDICINE, ISTANBUL, TURKEY
Background&Aims:
Angiomyolipomas associated with tuberous sclerosis are more likely to be bilateral,

multiple, and larger in size. We report the case of a 23-year-old male with tuberous
sclerosis who presented with ileus secondary to a ruptured giant AML
Methods:
A 23-year-old female with a known diagnosis of advanced tuberous sclerosis

admitted to the emergency department with an abdominal pain about the umbilicus
and and left-sided back pain , accompanied by nausea and vomiting.A computed
tomography (CT) scan of the abdomen and pelvis was performed.
Results:
CT scans revealed multiple angiomyolipomas in both kidneys and massive left renal
ruptured angiomyolipomas measuring 12x8 cm extending anteriorly and causing
ileus by compression. CT examination showed dilated jejunal and proximal ileal
segments that were measured up to 4.5 cm with air-fluid levels.
Conclusion:
Angiomyolipomas that are associated with tuberous sclerosis are more likely to be
larger and more prone to spontaneous hemorrhage. Ruptured angiomyolipomas
may be managed conservatively if the hemorrhage is self-limiting, but selective
arterial embolization and even nephrectomy may be necessary in cases of
continued hemodynamic instability. Because of this,ruptured angiomyolipomas
and its complications including ileus should be keep in mind in any patient with
tuberous sclerosis
-566-
PP - 367 ISOLATED GANGRENE OF THE LIGAMENTUM TERES
HEPATIS
ONUR TUTAR 1, PINAR KOCAEL 2

1
MEDICINE, ISTANBUL, TURKEY 2 DEPARTMENT OF GENERAL SURGERY, İSTANBUL

UNIVERSITY CERRAHPAŞA SCHOOL OF MEDICINE, ISTANBUL, TURKEY
Background&Aims:
Isolated gangrene of LTH is a rare entity and etiologic factors are unclear yet.Because
of its localization and clinic presentation,can mimic more complicated condition like
acute pancreatitis,peptic ulcer perforation and peritonitis.US and CT images enable
the definitive diagnosis.
Methods:
A 71-year-old man was referred to our clinic with abdominal pain, nausea, vomiting
and distention. He had history of diabetes mellitus, hyperlipidemia, chronic alcohol
and cigarette use.Ultrasonography and computed tomography was requested on
suspect of pancreatitis.
Results:
Abdominal US showed milimetric gallstones; heterogeneous echogenic lesion with

centrally avascular tubuler area and circumscribed inflamation,localized from free
surface of liver to the umbilicus.CT with contrast demonstrated tubuler soft tissue
lesion with heterogeneous density,which had fat density areas inside and periferal
hyperattenuating streaks.The lesion extended to umbilicus from periportal area like
falciform ligament, 8 cm in lenght.
Conclusion:
Isolated gangrene of the ligamentum teres hepatis (LTH) is an uncommon reason

of abdominal pain.The etiological reasons cannot be detected exactly.This report
describes a case of isolated gangrene of the LTH demonstrated by Ultrasonography
(US) and computed tomography (CT).Although very rare, isolated gangrene of the
LTH must be kept in mind in the differential diagnose of acute abdomen.
-567-
PP - 368 CHOLECYSTODUODENAL FISTULAE AS A CONSEQUENCE OF
CROHN DISEASE IN A FEMALE PATIENT
ONUR TUTAR 1, PINAR KOCAEL 2, OSMAN ŞİMŞEK 2, KAYA SARIBEYOĞLU 2, SALİH
PEKMEZCİ 2
1
2
Background&Aims:
Crohn disease (CD) is a progressive disease that is subdivided in three

phenotypes:inflammatory, stricturing,and penetrating.At diagnosis most CD
patients have inflammatory disease.However,the natural history of CD evolves over
time to structural digestive tract complications(strictures and fistulae) which are
associated with hospitalizations and surgeries.
Methods:
A 42 years old woman diagnosed with Crohn disease at age 25, was admitted to the
hospital with epigastric pain and fever for 2 days.Ultrasonography and for further
exploration CT scan with oral and intravenous contrast was requested on suspect of
pancreatitis or cholecystitis.
Results:
On sonographic examination pneumobilia and gallbladder wall thickening detected.

CT scan showed cholecystoduodenal fistulae with evidence of gas and oral contrast
agent in gallbladder.Also CT scans revealed gallbladder wall thickening and
pericholecystic fluid.
Conclusion:
There are several causes of bilioenteric fistulae. The vast majority of fistulas result
from chronic cholelitiasis disease.Other causes are chronic duodenal ulcer disease,
previous instrumentation to the biliary system and infections.As in our case Crohn
disease is a rare cause of of bilioenteric fistulae.
-568-
PP - 369 GASTROINTESTINAL STROMAL TUMOR FROM JEJUNUM
OZAN ANDAC ERBIL 1, ARIF EMRE 1, UMIT ABANUZ ERBIL 2
GEBZE FATIH STATE HOSPITAL, KOCAELI, TURKEY

1
DARICA FARABI STATE HOSPITAL, KOCAELI, TURKEY

2
Introduction:
Gastrointestinal Stromal Tumor (GIST) which is one of the rare tumors that origin
from digestive system; particularly mezenchimal.
Case report:
We would like to represent a 43-year-old male patient whose operation is related to

Gastrointestinal Stromal Tumor (GIST) Mentioned patient came to emergency service
who had abdominal pain, he was planned to do Laparoscopic Appendectomy with
prediagnosis of Acute Appendicitis, then he experienced Diagnostic Laparoscopy .
We saw a big mass on the jejunum. Following laparotomy we resected the mentioned
jejunal segment and Jejunojejunostomy and appendectomy were performed. As
a result of Histopathologic evaluations, jejunal GIST and acute appendicitis were
diagnosed
Conclusion:
Considering these examinations, this paper will reflect that we would like to point
out diagnostic importance of laparoscopy that is caused by Acute Appendicitis
-569-
PP - 370 ISOLATED ESOPHAGUS SQUAMOUS CELL PAPILLOMA
ARIF EMRE 1, OZAN ANDAC ERBIL 1, UMIT ABANUZ ERBIL 2
GEBZE FATIH STATE HOSPITAL, KOCAELI, TURKEY

1

2
Introduction:
Esophagus Squamous (cell) Papilloma is generally diagnosed by chance since it

does not include characteristic symptoms. It is rarely found, a kind of epithelial
tumor which has histopathologically benign character. This benign tumor is crucial
because it is precancerous.
Case report:
With this article, we represent 29-year-old male patient who has cough symptoms
(like he chokes while he eats), epilepsy and who is severely mental retarded
and autistic. We found a small mass on the esophagus middle segment upper
gastrointestinal endoscopy that we performed via fiber optic endoscopy, however
he had no lesion during indirect laringoscopy. We resected the mentioned mass
through endoscopy at the same session. After histopathological evaluations, we
determined that mass has isolated squamos papilloma.
Conclusion:
Frequency of occurrence of Esophagus Papilloma which is found at autopsy series

in general population is %0.006-0.04, however it increases to %0.01-0.45 among
patients who experienced Upper Gastrointestinal Endoscopy
-570-
PP - 371 EVALUATION OF METASTATİC LYMPH NODE RATES ON
POSTOPERATİVE GASTRİC CANCER SURVİVAL
MEHMET MIHMANLI , OZGUR BOSTANCI , GURHAN ISIL , UYGAR DEMIR , CEMAL
KAYA , HAKAN KOKSAL
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,

ISTANBUL, TURKEY
Background&Aims:
Surgical resection and lymph node dissection play an important role in curative
therapy for gastric cancer. This study is evaluating metastatic lymph node rates and
their 5 year survivals on patients we have performed lymph node dissection.
Methods:
Between January 1999 and July 2007, 90 patients with diagnosis on gastric
cancer, being performed gastrectomy and lymph node dissection were evaluated
retrospectively. Dissected lymph node count, metastatic lymph node count and
rates were studied. Metastatic lymph node rates were examined in 4 groups as 0%,
1-25%, 26-50% and ≥50% groups. The effect of metastatic lymph node rates on five
year survival were examined.
Results:
The average age of 54 men and 36 women was 61.2 (21-85) years. Five year survival
of patients was like following: 2 of 20 patients in the 0% group died and 18 (90%)
patients are still alive. In the metastatic lymph node ratio 1-25% group, 14 of 31
patients are dead and 17 (54.83%) are determined to be alive. In the 26-50% group
7 of 15 patients are dead, 8 (53.33%) of them are alive. 17 of 24 patients in the
≥50% group are identified as dead and 7 patients are alive.
Conclusion:
Determination of metastatic lymph node rates in patients with lymph node

metastasis can be evaluated as an important prognostic factor.
-571-
PP - 372 MASSIVE LOWER GASTROINTESTINAL BLEED IN SMALL
BOWEL GIST
RAJEEV PREMNATH
RAMAKRISHNA HOSPITAL, INDIA
Background&Aims:
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors
of the gastrointestinal tract occurring most commonly in the stomach and small
bowel and have remarkable cellular variability and some have malignant potential.
Clinically, GIST are associated with nonspecific symptoms, but some patients can
present gastrointestinal bleeding with shock requiring emergency surgery.
Methods:
We present two male patients aged 45 and 72 years who presented with massive
lower gastrointestinal bleeding. Both patients underwent CT scan with angiography
to identify the cause of bleeding. Both patients had jejunal tumours measuring
4x3 and 7x6 cms respectively. After preoperative evaluation and resuscitation the
patients were taken up for complete resection and anastomosis.
Results:
Post-operatively they recovered well. The histopathology revealed jejunal gist

tumours and since the CD 117 marker was negative they were advised regular
follow-up.
Conclusion:
GIST tumors manifest with acute or chronic gastrointestinal hemorrhage, especially

in the small bowel. Emergency surgery is the treatment of choice in acute cases.
Complete surgical resection of the primary tumor is the most definitive treatment
and prognosis is influenced by completeness of primary resection and tumor
malignant potential. Adjuvant treatment (imatinib) is advised for high-grade GIST
or after incomplete primary surgical treatment.
-572-
PP - 373 SPONTANEUS RUPTURE OF GASTRIC STROMAL TUMOR
KUTAY SAGLAM , SERDAR TOPALOGLU , MITHAT KERIM ARSLAN , SEVDIGUL
MUNGAN , ADNAN CALIK , SEMA KOCYIGIT
Background&Aims:
Gastrointestinal stromal tumors (GISTs) originated from stomach may present

abdominal pain, gastrointestinal bleeding or a palpable mass. Rare presentation of
stomach GISTs is extragastric growth and rupture into the peritoneum.
Methods:
We here presented a 81-years old man with spontaneus rupture of a GIST which
causes hemoperitoneum.
Results:
A 81 years old male was admitted with abdominal pain.Computed tomography

revealed free peritoneal fluid and solid mass with cystic-necrotic areas between
liver and stomach. According to rapid decrease in hemoglobin levels during follow
up, laparotomy was performed. Tumor was resected with sleeve gastrectomy and
excisional biopsy was taken from liver metastasis. Pathological examination was
revealed GIST and adjuvant imatinib mesylate therapy was started.
Conclusion:
GIST rupture is a rare cause of intraperitoneal hemorrhage. Surgical treatment

should be performed as a life saving procedure in intraabdominal rupture of these
tumors.
-573-
PP - 374 RISK FACTORS MORBIDITY AND MORTALITY IN
OBSTRUCTING COLORECTAL CANCER
SEYFİ EMİR 1, SELIM SÖZEN 2, HAKAN BURHAN KANAT 1, ZEYNEP ÖZKAN 1, FATIH
MEHMET YAZAR 1 , BURAK KAVLAKOĞLU 1
GENERAL SURGERY, ELAZIĞ TRAINING AND RESEARCH HOSPITAL, ELAZIG, TURKEY

1
GENERAL SURGERY, ADANA NUMUNE TRAINING AND RESEARCH HOSPITAL,

2
ADANA, TURKEY
Background&Aims:
Emergency surgery for obstructive colorectal cancer is associated with high

morbidity and mortality. The aim of this study was to assess the operative results,
morbidity and mortality of patients who had emergency operations for obstructing
colorectal.
Methods:
Eighteen patients who underwent emergency surgery for obstructing colorectal

cancer from January 2008 to May 2012 were retrospectively reviewed.
Results:
Sixteen patients had complete obstruction and 2 patients had perforation. Ten
patients were older than 70 years old. Fifteen patients were left-sided colon cancer
and three patients were right-sided colon cancer. Fifteen patients who were left-
sided colon cancer, 12 of them underwent left colonic resection and Hartmann
procedure, 2 patients had loop colostomy and one of them underwent total
colectomy and ileorectal anastomosis. Three patients who were right-sided colon
cancer; 2 of them underwent right colectomy and one of them underwent right
colectomy and end-ileostomy. The overall morbidity rate was 33.3 % (6 patients).
Morbidity was seen in 5 patients who were older than 70 years old.The overall
mortality rate was 11.2 % (2 patients). All of them were older than 70 years old and
had left-sided colon cancer; so that mortality rate was 20 % in patients over 70 years
old and 13.3 % in left sided colon cancer. Mortality rate was 50 % (1 patient) with
patients who had perforation.
Conclusion:
Emergency surgery for obstructing colorectal cancer carries high rates of morbidity
and mortality. Patient , colonic perforation and older age increases the morbidty
and mortality rates.
-574-
PP - 375 ABDOMINAL SURGERY IN PATIENTS ON ANTIPLATELET
THERAPY
SUPREET GREWAL , IQBAL SINGH , PREETINDER BRAR , R P DOLEY , ATUL JOSHI ,
RAJEEV KAPOOR , J D WIG
FORTIS HOSPITAL , MOHALI, INDIA
Background&Aims:
Surgeons are increasingly confronted by patients on antiplatelets and antithrombotic

therapy for therapeutic and prophylactic purposes. Aim was to evaluate the
outcome of patients on these agents in abdominal surgery.
Methods:
We reviewed the medical records of patients undergoing abdominal surgery for

both elective and emergency indications. The primary outcome was incidence of
major haemorrhagic and thromboembolic complications after surgery
Results:
We studied 14 patients with mean age of 71.14 years, 7 female, 7 male. 5 patients
were operated electively and 10 required emergency surgery. The indication of
surgery were cholelithiasis(n= 4), malignancy(n= 3), gastrointestinal bleeding(n = 2
), intestinal obstruction(n = 3), intestinal perforation(n = 2 ) and hernia(n = 1). The
antiplatelet therapy was aspirin in 6 patients, clopidogeral in 2 patients and both
drugs in 6 patients. The indication for antiplatelet medication was cereberovascular
disease(n= 2), coronary artery disease(n= 12), In 5 patients drugs were continued , all
of these patients were taken up for surgery emergently. Antiplatelets were stopped
on an average of 5.22 days before surgery in 9 patients . Bridging therpay was
given in 11 patients with enoxaparin (n = 8) and fraxiparine(n = 3). Postoperatively
1 patient had pulmonary thromboembolism. There were no bleeding episodes.
Packed red blood cells transfusion was required in 5 patients and platelets in 4.
Mortality rate was 28.6%(n = 4). Antiplatelet therapy was restarted after a mean
of 9.5 days
Conclusion:
The most important consideration in managing these patients is how to protect

the patients from the risk of discontinuing therapy. There was no increase in
thromboembolic events.
-575-
PP - 376 THE EVALUATION OF SCORRING SCALES IN ACUT
APANDISITIS: FROM SURGEONS ‘VIEW
HASAN ERDEM , KORAY DAŞ , SULEYMAN ÇETİNKÜNAR , ENVER REYHAN , SELİM
SÖZEN , CUMHUR DEGER , MEHMET AZİRET , OKTAY İRKÖRÜCÜ
ADANA NUMUNE TRAINING AND RESEARCH HOSPITAL GENERAL SURGERY

DEPARTMENT, ADANA, TURKEY
Background&Aims:
Acute appendicitis is the most common cause of acute abdomen.This study aimed
to assess reliability and practical applicability of widely used Alvarado, Eskelinen,
Ohhmann and RIPASA scoring systems
Methods:
113 Patients hospitalized due to suspicious acute appendicitis diagnosis were

assessed prospectively
Results:
Our study showed a sensitivity level of 81% for Alvarado system when cut-off value
is taken as 6.5, a sensitivity level of 83.1% for Ohmann system when cut-off value is
taken as 13.75; a sensitivity level of 80.5% for Eskelinen system when cut-off value
is taken as 63.72; and a sensitivity level of 83.1% for RİPASA system when cut-off
value is taken as 10.25
Conclusion:
For scoring systems, sensitivity and specifity values higher than 80% are acceptable.
This is why, they may prove more advantageous when cut off values are customized
to clinical populations.
-576-
PP - 377 FACTORS INFLUENCİNG RECURRENCE AND SURVIVAL IN
GASTRIC CANCER
TAYLAN ÖZGÜR SEZER , AYŞEGÜL AKTAŞ , HAYRULLAH YILDIRIM , TAYFUN YOLDAŞ ,
ÖZGÜR FIRAT , SINAN ERSIN , CÜNEYT HOŞCOŞKUN , ADEM GÜLER
EGE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF GENERAL SURGERY,

IZMIR, TURKEY
Background&Aims:
To determine the factors influencing recurrence and survival of patients in gastric

cancer.
Methods:
Between January 2009 and December 2011, 217 patients were diagnosed with
gastric cancer , in Ege University School of Medicine, Department of General Surgery.
Of these patients 134 were operated and 83 were considered inoperable. Patients
were evaluated retrospectively. Clinicopathological features of the patients, the
factors that affect the survival and recurrence were evaluated
Results:
First, 2nd, and 3rd year survival rates of 102 operated patients were 69% , 47%, and
43%, respectively. Median overall survival was 58 months for operated patients and
12 months for patients considered inoperable (P = 0.000). No difference was found
between the frequency of recurrence and tumor types set according to the WHO
and Lauren Clasification (P = 0.363, P = 0242). There was no relation between lymph
node metastasis, tumor localization and recurrence. Survival was decreased in the
presence of lymphatic, perineural and vascular invasion (P = 0.000, P = 0.002, p =
0.001). In the presence of lymphatic invasion, recurrence risk was higher than for
that vascular and perineural invasion of the tumor (P = 0.039). Higher survival rate
and lower recurrence rate was detected in the presence of intestinal metaplasia (p
= 0.015, p = 0.009). Gender has no effect on operability , recurrence and survival.
Lymph node involvement increases with higher tumor diameter (P = 0.012).
Conclusion:
While intestinal metaplasia affects the prognosis of cancer positively; vascular,

lymphatic and perineural invasion of tumor affects survival and recurrence
negatively.
-577-
PP - 378 JEJUNAL DIVERTICULITIS PERFORATION
TARKAN UNEK , TUFAN EGELI , MUCAHIT OZBILGIN , BAHA ARSLAN

Background&Aims:
Jejunal diverticula (JD) are rare and typically asymptomatic. Acute complications
include diverticulitis, perforation, bleeding, and obstruction, all leading to acute
abdomen. The most common complication is jejunal diverticulitis perforation (JDP).
Diagnosis of and differentiation other etiologies from JDP may be difficult.
Methods:
Three patients were treated in our clinic with diagnosis of jejunal diverticulitis
perforation between 2008 and 2010. All of the patients presented to emergency room
with sudden-onset abdominal pain, nausea and vomiting. On physical examination,
diffuse abdominal tenderness, rebound tenderness, and guarding were observed.
Direct chest X-Rays taken to rule out a hollow organ perforation revealed no sub-
diaphragmatic free air. Abdominal ultrasonographic and tomographic examinations
were performed, which showed findings suspected for acute abdomen but without
definite diagnosis. All three patients were taken into operation for acute abdomen.
Exploration showed perforation of jejunal diverticulitis.
Results:
All three patients underwent segmentary small intestine resection and primary
anastomosis. They were discharged with no complication postoperatively.
Conclusion:
Despite it is rare and has an innocent course, JD may cause life-threatening

complications such as perforation or diverticulitis. It is of paramount importance
for a surgeon to remember and have a suspicion for JDP in acute abdomen with an
atypical course.
-578-
PP - 379 LAPAROSCOPIC NISSEN FUNDOPLICATION: OUR INITIAL
EXPERIENCES
TUNA BILECIK , CEMAL ENSARI , RAMAZAN ERYILMAZ
ANTALYA EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL

SURGERY, ANTALYA, TURKEY
Background&Aims:
Nissen fundoplication is the most common surgical treatment used for gastro-
esophageal reflux. In this study, we report on our first experience with laparoscopic
Nissen fundoplication.
Methods:
22 patients who underwent Laparoscopic Nissen Fundoplication in Antalya

Education and Research Hospital, Department of General Surgery between January
2010 and June 2012 were enrolled in this study.
Results:
Indications were GERD symtoms,esophagitis with/without barrett, hiatal hernia.

Preoperative endoscopic examination revealed that 15 (%68.1) patient had hiatal
hernia and 10 (%45.4) patient had esophagitis. Their mean age was 42.5. Two
patients required conversion to open surgery. The average operating time was 125
mins. Median blood loss was 250 cc. Mean postsurgical stay was 4 days.
Conclusion:
Laparoscopic Nissen fundoplication is a safe and effective procedure for gastro-

oesophageal reflux disease. With experience, the duration of operation falls and
the hospital stay is shorter.
-579-
PP - 380 ESOPHAGIAL BRONCHOGENIC CYST IN ADULT
TULAY DİKEN ALLAHVERDİ , NESET KOKSAL , TURGUT ANUK
KAFKAS UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,

KARS, TURKEY
Background&Aims:
Bronchogenic cysts are congenital lesions, originating from foregut in the

intrapulmonary and mediastinal localization. Although esophagial bronchogenic
cysts are rare, they can be seen more frequently in childhood. In this study, our aim
is to report our experience with esophagial bronchogenic cyst in an adult.
Methods:
A single case was analysed in our study. Thirty-one year old male admitted to Kafkas
Unversity Hospital with dysphagia and epigastric pain. His CT scan of thorax with
contrast enhancement, showed cystic lesion of 46mmx48mm dimensions, with
intense content that cause compression and shifting of middle part of esophagus
to the left. Upper gastrointestinal endoscopy revealed a mass that extends from
35th cm to 39th cm, surrounding one third of lumen. Total removal of the cyst
was accomplished by thoracotomy. His pathological report was bronchogenic cyst.
Postoperative period was uneventful and patient was discharged from hospital
p.o.d 7.
Results:
The case report demonstrates that bronchogenic cysts may present as esophagial
mass in adults as well as in children as mentioned in several studies.
Conclusion:
Although rare in adults, it’s important to be aware of bronchogenic cysts of

esophagus. For, surgery would be needed to prevent complications.
-580-
PP - 381 PREOPERATIVE TUMOR MARKER LEVELS IN GASTRIC
CANCER
MUSTAFA DUMAN 1, ERDAL POLAT 1, KIVANC D. PEKER 1, UGUR DUMAN 2, CEBRAIL
AKYUZ 1, NECDET F. YASAR 1, ORHAN UZUN 1, SINAN YOL 1
1
KARTAL KOSUYOLU HIGH SPECIALTY TRAINING AND RESEARCH HOSPITAL,
2
BURSA SEVKET YILMAZ TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
GENERAL SURGERY, BURSA, TURKEY
Background&Aims:
To evalute the relationship between preoperative tumor marker levels and various
histopathological and clinical parameters in the patients with gastric cancer.
Methods:
One hundred and six consecutive patients with the diagnosis of gastric cancer
were included prospectively in this study. Preoperative levels of CEA, CA 19-9 and
125 were determined to examine the relationship between serum levels of these
markers with different clinical aspects of gastric cancer.
Results:
There was no significant relation between preoperative tumor marker levels and
either T or N staging. However preoperative level of CEA was significantly increased
in patient with distant metastasis (p=0.019). The preoperative levels of CA 19-9
and CA 125 were found to be significantly increased in the presence of peritoneal
carcinomatosis (p=0.007 and p=0.018 respectively).
Conclusion:
There is a wide variation for the biological properties of tumor markers especially
for gastric cancer that restricts the usage of tumor markers in the management
of gastric cancer. Determining the preoperative levels of tumor markers may
have a little benefit to have more clues about distant metastasis or peritoneal
carcinomatosis.
-581-
PP - 382 GASTRIC STROMAL TUMOR: A REPORT OF A CASE
ZATIR SOUFIANE , TOUAGH ABOUBAKER SDIK , KOUDJETI RACHID
REGIONAL MILITARY HOSPITAL UNIVERSITY OF ORAN, ALGERIA
Background&Aims:
We report the case of a gastric stromal tumor, a patient of 69 years, revealed by

epigastralgia. The diagnosis was mentioned by abdominal CT. A sleeve gastrectomy
was done taking the tumor with good postoperative course. Histological examination
confirmed the diagnosis and the patient received adjuvant treatment with imatinib.
Methods:
we operates a patient whose diagnosis of stromal tumor has been established in

pre operative we performed a sleeve gastrectomy in our patient to rule also the
problem of obesitythe resected gastric returned for a GIST low grade malignancy
with good limits of resection.
Results:
the resected gastric returned for a GIST low grade malignancy with good limits of
resection. Patient given by oncologists for adjuvant treatment with Gleevec
Conclusion:
Gastrointestinal stromal tumors are the most common mesenchymal tumors of

the digestive tract, their symptoms may be specific, dominated by gastrointestinal
bleeding and abdominal pain. CT examination is the most widely used, both for
diagnostic purposes, as for post treatment. The use of immunohistochemistry is
required to obtain a definitive diagnosis. Their prognostic evaluation is not always
easy.
-582-
PP - 383 INGESTED BONE FRAGMENT IN THE BOWEL: TWO CASES
AND A REVIEW OF THE LITERATURE
SEYFI EMIR 1, ZEYNEP OZKAN 1, HASAN BAKI ALTINSOY 2, FATIH MEHMET YAZAR 1
ELAZIĞ TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY, ELAZIG, TURKEY

1
ELAZIĞ TAINING AND RESEARCH HOSPITAL, RADIOLOGY DEPARTMENT, ELAZIG,

2
TURKEY
Background&Aims:
The majority of ingested foreign bodies are excreted from the digestive tract
without any complications or morbidity. Sharp foreign bodies like fish and chicken
bones can lead to intestinal perforation and peritonitis.
Methods:
Herein we present two patients who had intestinal tract complications caused by
ingested bone fragments; an elderly patient with ileum perforation, and another
case with severe anal pain.
Results:
The most commonly ingested foreign bodies are food products, such as fish bones,
fragments of bone or phytobezoars. Sharp foreign bodies like fish and chicken
bones can lead to intestinal perforation and peritonitis.
Conclusion:
Patient’s medical history can be misleading, and the clinical symptoms are not
specific. They can present with different clinical manifestations in the bowel. As
the whole of digestive system, any site of bowel perforation from jejunum to anal
margin, obstruction, fistula formation can be seen caused by ingested bone. A
trainee clinician may suspect that ability of predisposing factors in patient, and may
prepared various surgical option. Especially, fast-eating and elderly people with
dentures are prone to this hazardous disorder.
-583-
PP - 384 COMPARISON OF EARLY POSTOPERATIVE OUTCOMES
AFTER TOTAL GASTRECTOMY AND D2 LYMPH NODE DISSECTION
WITH AND WITHOUT SPLENECTOMY
TAHSIN DALGIC , MURAT CAYCI , MUHAMMET KADRI COLAKOGLU , OGUZHAN
OZSAY , ORHAN ELBIR , ILTER OZER , ERDAL BIROL BOSTANCI , MUSA AKOGLU

Background&Aims:
To evaluate the effects of preservation of the spleen during total gastrectomy and
D2 lymph node dissection (LND) on early postoperative results.
Methods:
Between 1998-2011, 296 patients who underwent total gastrectomy and D2 LND
were included in the study. Postoperative complications and mortality the patients
with and without splenectomy were compared. In addition, effects of potential
risk factors such as age, gender, presence of concomitant disease, stage, ASA score
and additional resection on development of postoperative complications were
evaluated.
Results:
D2 dissection was performed with splenectomy in 244 (group 1), and without
splenectomy in 52 patients (group 2). Postoperative complication rates were
34.78% and 34.6% in group 1 and 2, respectively. The difference was not statistically
significant. Mortality rates were 5,3% and 1.9%, respectively. The difference was not
statistically significant. Splenectomy, age, gender, presence of concomitant disease,
stage and additional resection were not associated with increased postoperative
complication rate significantly. ASA score was the most important factor for
development of postoperative complications.
Conclusion:
Early postoperative outcomes after total gastrectomy and D2 LND with and without
splenectomy were similar. The most important factor effecting the development of
postoperative complications is ASA score of the patients.
-584-
PP - 385 ENDOSCOPIC BALOON DILATATION FOR
GASTROINTESTINAL OBSTRUCTION: LONG-TERM AND SHORT-
TERM RESULTS
CEVHER AKARSU , AHMET CEM DURAL , OSMAN KONES , BAHA TEMIZGONUL , ALI
KOCATAS , MEHMET KARABULUT , DENIZ GUZEY , MUSTAFA U. KALAYCI, HALİL ALIŞ

Background&Aims:
In this study, we aimed to share short and long-term outcomes of the cases who
underwent an endoscopic balloon dilatation (EBD) for gastrointestinal obstruction
in our endoscopy unit.
Methods:
From January 2008 to 2012, patients who underwent an EBD procedure were
reviewed retrospectively in terms of demographics, clinical findings, etiology,
technical and clinical success rates, the number of interventions, mortality
and morbidity. Evaluation of clinical success based on the functional grading
of dysphagia. The patients were interviewed by phone to gather information
concerning the procedure.
Results:
One hundred fifty nine EBDs have been performed on 67 patients. The most
common symptoms were dysphagia, abdominal pain and weight loss. The most
common cause was postoperative anastomotic stenosis (45%). The mean number
of EBDs was 2.3±1.6. Technical success rate was 100%. Grade I-II dysphagia assessed
as full (n=37, 55.2%), Grade III-IV assessed as partial (n=14, 20.9%) and grade
V-VI assessed as non-response (n=16, 23.9%). Partial and full response accepted
as clinical success (76.1%). Perforation related to EBD occured in 2 cases (1.2%)
and have been treated endoscopically. There has not been any mortality due to
procedure. The mean follow-up time was 21.2 month (3-48).
Conclusion:
EBD is easy and safe to perform for gastrointestinal obstructions in experienced

centers and it allows surgeons to manage patients conservatively.
-585-
PP - 386 HARVESTING <15 LYMPH NODES IN CURATIVE GASTRIC
CANCER SURGERY. CAN THESE PATIENTS WITHOUT LYMPH NODE
METASTASIS BE STAGED?
ILTER OZER , ERDAL BIROL BOSTANCI , MUHAMMET KADRI COLAKOGLU , MURAT
CAYCI , TAHSIN DALGIC , MURAT ULAS , YUSUF OZOGUL , MUSA AKOGLU
TÜRKIYE YÜKSEK İHTISAS HASTANESI GASTROENTEROLOJI CERRAHISI KLINIĞI,

ANKARA, TURKEY
Background&Aims:
To investigate the factors which may effect dissection of <15 lymph nodes, and
to compare survival of N0 patients from whom < 15 lymph nodes were dissected
(Group 1: N0, <15) with those from whom ≥ 15 lymph nodes were dissected (Group
2: N0, ≥ 15).
Methods:
Between 1998 and 2011, 799 patients who underwent surgery with curative intent
were included. Age, gender, operation type, location, Borrmann classification,
T stage, differentiation, dissection type, additional organ resection, tumor size
were determined as potential factors that may affect the number of lymph nodes
removed. Also we compared the survival of patients in group 1 (N0, <15) and group
2 (N0, ≥ 15).
Results:
Advanced age, small tumor diameter and dissection type were found to be
independent factors for harvesting less than 15 lymph nodes in multivariate
analysis. The 5-year survival of N0, <15 and N0, ≥ 15 patients were %66,5 and
%62,3,respectively. The difference was not statistically significant.
Conclusion:
Small tumors, D1 LND and advanced age are associated with harvesting <15 lymph
nodes. Among N0 patients, survival of patients with <15 and ≥ 15 lymph nodes
were similar. These patients can be staged as N0.
-586-
PP - 387 SELF-EXPANDABLE BIODEGRADABLE STENTS: A FEASIBLE
ALTERNATIVE TO SURGERY FOR ANASTOMOTIC LEAKAGE, BENIGN
STRICTURES OR FISTULAS
HAKAN SEYIT , AHMET CEM DURAL , BAHA TEMIZGONUL , MEHMET KARABULUT ,
CEMAL DENIZTAS , MUSTAFA U. KALAYCI , HALIL ALIS

Background&Aims:
We aimed to share our experience with self-expandable biodegradable stents for

post operative anastomotic leak, benign stricture or tracheoesophageal fistulas
(TEF).
Methods:
From January 2012 to July 2012, patients with either an anastomotic leak, benign
stricture or TEF treated by implanting of Ella CS®-esophageal biodegradable (BD)
stents in our endoscopy unit were evaluated retrospectively.
Results:
Ten BD stents were inserted to nine patients. The mean age was 53.5 (36-82)
years. Prior operations were; sleeve gastrectomy for morbid obesity (n=4), total
gastrectomy for gastric cancer (n=3), bilateral truncal vagotomy and pyloroplasty
for recurrent gastrointestinal bleeding (n=1). Stent was placed to one patient for
benign stricture due to esophageal leiomyomatosis. Indications for stenting were
anastomotic leakage (n=5), benign stricture (n=3) and TEF (n=1). Primary technical
success was 100%, clinical success was 88.8%. In one patient with anastomotic
leakage, restenting was needed due to clinical persistance of leakage. Mean period
of stenting for stricture, leakage, and fistula were 241, 64, 38 days respectively.
There were no procedure-related complications or deaths.
Conclusion:
Treatment of anastomotic leak, stricture and TEF with BD stents is an effective

alternative to surgery and might be preferable by reason of low complication rate
due to removal-free feature in the future.
-587-
PP - 388 IS LAPAROSCOPY-ASSISTED GASTRECTOMY SAFE IN ELDERLY
GASTRIC CARCINOMA PATIENTS?
DONG YI KIM , HO GUN KİM , JAE HYUK LEE , SEONG YEOB RYU
DIVISION OF GASTROENTEROLOGIC SURGERY, DEPARTMENT OF SURGERY,

CHONNAM NATIONAL UNIVERSITY MEDICAL SCHOOL, KOREA
Background&Aims:
Background: This study compared the surgical outcomes between laparoscopy-

assisted gastrectomy (LAG) and open gastrectomy (OG) in elderly gastric carcinoma
patients.
Methods:
Methods: We selected patients whose pathological stage was IA or IB and T stage

was I. They were between 74 and 79 year old at the time of surgery. The study
enrolled 104 patients who underwent radical gastrectomy. Of these, 37 patients
underwent LAG and the remaining 67 patients underwent OG. We reviewed the
patients’ medical records retrospectively and evaluated the short-term patient
outcomes.
Results:
Results: There were no serious intraoperative complications or critical hemodynamic

changes induced by pneumoperitoneum. Intraoperative transfusion occurred all in
OG group (p=0.049). The postoperative hemoglobin level was significantly higher
in LAG group than in OG group (12.4 versus 11.5, p=0.007). The duration of NSAID
use was shorter in LAG group (3.3days versus 5.8 days, p=0.035). There was no
significant difference in complication rate (e.g.; anastomotic or duodenal stump
leakage, bleeding, intraabdominal abscess) between LAG and OG group (p < 0.05)
Conclusion:
Conclusion: Our analysis revealed that LAG can be performed safely in elderly
patients, with the known advantages of LAG. The complication rates and other
operative outcomes of LAG were similar to those of OG.
-588-
PP - 389 GASTROINTESTINAL STROMAL TUMORS PRESENTING AS
SURGICAL EMERGENCIES:
FAZİLET EROZGEN , MEHMET CELAL KIZILKAYA , RAFET KAPLAN
HASEKI TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY, ISTANBUL,

TURKEY
Background&Aims:
To evaluate surgical and oncologic outcomes of patients who underwent urgent

exploratory laparotomy, and successful surgical resection of gastrointestinal stromal
tumors.
Methods:
Medical records were retrospectively searched from January 2005 to January

2012 for cases with gastrointestinal stromal tumors, who had undergone urgent
exploratory laparotomy.
Results:
Of 51 patients operated for GISTs from January 2005 to January 2012, 6 cases had
undergone urgent exploratory laparotomy and surgical resection. Our study group
consisted of 4 female (66.6 %) and 2 male (33.4 %) patients with a median age of 60
years (range: 35-76 yrs). Their tumors were located in the stomach (n=1), jejunum
(n=2), ileum (n=2), and rectum (n=1). For these tumors, total gastrectomy (n=1),
segmental resection of the jejunum (n=2) or ileum (n=2), and left hemicolectomy
(n=1) were performed followed by an uneventful postoperative course in all patients.
According to Fletcher criteria, five tumors (83.3%) were classified as intermediate
and high risk. No postoperative morbidity and mortality were noted. All patients
received postoperative treatment with a tyrosine kinase inhibitor, imatinib. Median
length of the hospital stay was 8 (range: 6 to 12) days. With a median follow-up of
32 (range 3 to 64) months, disease-free survival rate was 100 percent.
Conclusion:
Although quite rare, patients with gastrointestinal stromal tumors may suffer
from occult gastrointestinal hemorrhage and abdominal pain as the first clinical
manifestations leading to urgent exploratory laparotomy and surgical extirpation
of the tumor.
-589-
PP - 390 DETERMINATION OF THE NATURE OF ENLARGED
REGIONAL LYMPH NODES IN GASTROESOPHAGEAL CANCER BY
USING COMPUTED TOMOGRAPHY(CT).
SULTAN MANAFOV 1, RENA GERAYZADE 1, SHAMIL ALIYEV 2, ASIF MUSTAFAYEV 1
1
SCIENTIFIC CENTER OF SURGERY NAMED AFTER M.A.TOPCHUBASHOV, BAKU,
AZERBAIJAN.
2
REPUBLİC CLİNİCAL HOSPİTAL NAMED AFTER MİR-GASİMOV, BAKU, AZERBAİJAN
Background&Aims:
The aim of the study was to determine the nature of enlarged lymph nodes in
gastroesophageal cancer by using CT
Methods:
CT images of 60 patients with gastroesophageal cancer were analyzed and

compared with results of histological studies of resected during surgery limph
nodes . Evaluation of metastases in regional lymph nodes was carried out using
the following 6 criteria for the possible presence of metastases: №1-the size of
the node over 1 cm; №2- round shape and the ratio of long to short axis <1.5 cm;
№3- indistinct rough borders ;№4- the formation of conglomerates; №5-absence
of “fatty hilum “sign; №6- node density less than 70 HU.
Results:
Enlarged nodes with criterion №1- in 52%, nodes with criterion №2 - in 73% ; nodes
with criterion №3- in 60% ; nodes with criterion №4- in 95%; nodes with criterion
- in 70% ,nodes with criterion №6 –in 81 % of cases were confirmed histologically
as metastasis.
Conclusion:
For a more accurate assessment of the presence of nodes metastases in

gastroesophageal cancer CT study of regional lymph nodes should be carried out
using 6 criteria. It attained the highest percentage of correct diagnosis of metastasis
and differentiation them from reactive enlarged nodes.
-590-
PP - 391 GASTRIC FLUID CALPROTECTIN VALUES
MURAT ÇIKOT 1, MUSTAFA UYGAR KALAYCI 1, HALIL ALIŞ 1, AHMET NURAY
TURHAN 1, ERŞAN AYGÜN 1, AHMET YILMAZ 2
1
DEPARTMENT OF SURGERY, BAKIRKOY SADI KONUK EDUCATION AND RESEARCH
2
DEPARTMENT OF GENERAL SURGERY, MEDİPOL UNIVERSITY FACULTY OF
Background&Aims:
To research the importance of Gastric fluid calprotectin value in gastric cancer.
Methods:
Between February and May 2004 ösefagogastroduodenoscopy was performed to

the cases who had GIS complaints. For the purpose of diagnosis, biopsy and gastric
fluid sample was taken from the cases. According to the biopsy results 3 different
groups was built up having 20 cases each, which were; normal (Group-1), gastrit-
ulcer (Group-2), gastric carcinoma (Group-3). Calprotectin values of Gastric fluids
were researched with Micro-Elisa method.
Results:
Avarage gastric fluid calprotection values were 73.58 mg/L for Group-1, 16.964mg/L
for Group-2 and 143.074mg/L for Group-3. After comparison, between Group-1 and
Group-2 (p= 0.043), between Group-1 and Group-3 (p= 0.010) , between Group-2
and Group-3 ( p= 0,0001) values were obtained.
Conclusion:
Calprotectin value is increasing corralated with the intensity of inflamation and it is

reaching to the highest value with gastric cancer.As a result, because of these high
values of gastric fluid calprotectin in cancer cases it will be meaningful to use this
fact as a screening test.
-591-
PP - 392 WILKIE’S SYNDROME : A RARE CAUSE OF INTESTINAL
OBSTRUCTION
ALI COSKUN , AHMET DENIZ UCAR , ERDEM CARTI , ERKAN OYMACI , MEHMET
YILDIRIM , NAZİF ERKAN
IZMIR BOZYAKA TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF SURGERY,

IZMIR, TURKEY
Background&Aims:
Superior mesenteric artery syndrome is extremely rare and characterized by

postprandial epigastric pain, nausea, vomiting and loss of appetite, with subsequent
weight loss, which aggravates the condition of the patients. The syndrome is caused
by compression of the third part of the duodenum in the angle between the aorta
and the superior mesenteric artery.
Methods:
We report a case of 16 year female who was diagnosed superior mesenteric artery
syndrome.
Results:
There was no history of recent trauma, surgery, prolonged immobilisation or

neurological illness. Her weight loss was gradual as 16 kg during 6 months period.
She was admitted to emergency department with nausea, vomiting, abdominal
pain, and weight loss.The pyhsical examination was normal and abdominal CT
revealed SMA syndrome.She was hospitilized and put on TPN treatment for
restoration of the aortomesenteric fatty tissue. Then enteral feeeding was started
and she gained approximately 6 kg .She has been following well for 11 months
without any recurrence
Conclusion:
Conservative therapy is the initial approach, and surgery is reserved for those
who do not respond to hyperalimentation. Its recognition is important because
early diagnosis of a partial obstruction may allow for medical rather than surgical
intervention, as exemplified by our case.
-592-
PP - 393 A NOVEL APPROACH FOR LAPAROSCOPIC RESECTION OF A
SUBMUCOSAL TUMOR ON UPPER PORTION OF THE STOMACH
HOGOON KİM 1, SEONGYEOB RYU 1, DONGYİ KİM 1, JAEHYUK LEE 2
1
DIVISION OF GASTOENTEROLOGIC SURGERY, CHONNAM NATIONAL UNIVERSITY
MEDICAL SCHOOL, KOREA
2
DEPARTMENT OF PATHOLOGY, CHONNAM NATIONAL UNIVERSITY MEDICAL
SCHOOL, KOREA
Background&Aims:
With the technical advances of laparoscopic surgery, various surgical approaches

are suggested. Nevertheless, laparoscopic resection for gastric SMTs are located
on the upper part of stomach, especially gastric fundus or posterior wall of upper
body, is technically difficult and time-consuming. Accordingly, we attempted a new
technique through right lateral decubitus position for laparoscopic resection.
Methods:
From January 2007 to June 2012, 307 patients with gastric SMTs were performed
laparoscopic surgery at Chonnam National University Hospital. Of these patients,
94 patients were enrolled, including 65 patients in supine position and 29 patients
in RLD position. To compare objectively, tumors located on lesser curvature, cardia,
and esophagogastric junction were excluded from these study.
Results:
Patient ages were different significantly (p=0.003). Sex, tumor size and location in
the two group were not different. Mean operative time in RLD group was shorter
than in supine group (79.65±44.33, 121.95±65.19 minutes, p=0.002). Mean
number of trocar was fewer in RLD group (3.34±0.55, 3.86±0.68, p=0.001). Mean
postoperative hospital stay was 5.31±1.41 days in RLD group and 5.06±1.72 days in
supine group (p=0.49).
Conclusion:
A novel approach through right lateral decubitus position is safe, simple and cost
effective technique for laparoscopic resection of SMTs on upper portion of the
stomach.
-593-
PP - 394 OUR EXPERIENCE IN SURGICAL TREATMENT OF PATIENTS
WITH HIATAL HERNIA AND GASTRO-ESOPHAGEAL REFLUX DISEASE
EVGHENII GUTSU , VLADIMIR IACUB , VASILE GUZUN , VLADIMIR MALINOVSCHI

Background&Aims:
Hiatal hernias in 66% of cases are associated with gastro-esophageal reflux, and
require surgical treatment. Aim of the study was to assess preliminary results of
surgical treatment for this condition.
Methods:
During three years period 145 pts with hiatal hernia and gastro-esophageal reflux
were treated surgically. The diagnosis was confirmed by physical examination,
X-ray, endoscopic and pH-metric studies. The Nissen-Rosseti fundoplication was
performed in 142 (97.9%) pts, including 138 (95.8%) cases – laparoscopically.
Results:
The complete disappearance of the pathological signs was noted in 140 pts (96.6%)
within the first 30 days after surgery. Radiological study performed on the 3-5-th
postoperative day noticed a moderated enlargement of the esophagus, but without
evident passage disorders in 108 pts (74.5%). Six (4.1%) pts required endoscopic
dilatation, and in 2 of them disturbances of esophageal passages were kept
during one year. Clinical and radiological signs of delayed gastric empting in the
postoperative period were observed in 2 pts.
Conclusion:
The analysis of early and long term results of surgical treatment for hiatal hernias
and gastro-esophageal reflux demonstrates a disappearance of symptomatology
in 96.6% of pts. In most patients the postoperative dysphagia had a transitory
character.
-594-
PP - 395 THE PRELIMINARY RESULTS OF MAGNIFYING ENDOSCOPY
WITH FLEXIBLE SPECTRAL IMAGING COLOR ENHANCEMENT
PERFORMED IN A SURGICAL ENDOSCOPY UNIT
CEVHER AKARSU 1, AHMET CEM DURAL 1, AHMET SUREK 1, MUSTAFA U. KALAYCI 1,
ALI KOCATAS 1, NURTEN SEVER 2, OSMAN KONES 1, HALIL ALIS 1
1
2
Background&Aims:
We aimed to present our preliminary experience of magnifying endoscopy with

flexible spectral imaging color enhancement (FICE) for gastrointestinal lesions.
Methods:
From February 2012 to July 2012, thirty patients with suspicious gastrointestinal
lesions detected during endoscopy were scanned with FICE. The images were
classified according to Kudo Pit Pattern Classification (KPPC). Histopathologic results
of biopsies taken from these suspicious mucosal fields were compared with KPPC.
Results:
Seventeen of 30 lesions were polypoid and evaluated as Kudo type 2. Histopathology

yielded as hyperplastic polyp. Ten lesions evaluated as Kudo type 2 or 3 were
Helicobacter Pylori associated gastritis, another two lesions which were Kudo type
5 yielded as adenocarcinoma. In a patient with prior surgery for larynx carcinoma,
cervical esophageal lesion suspected as local recurrence and evaluated as Kudo
type 5 yielded as haematoma.
Conclusion:
Magnifying endoscopy with FICE allows a better determination of mucosal

patterns and micro-vascular structures, thus help us to avoid unnecessary invasive
procedures and perform more accurate biopsies for cancer prevention and early
detection.This technique requires experience and time for visual adaptation since
this diagnosis is observer-dependent.
-595-
PP - 396 BENIGN GASTROINTESTINAL STROMAL TUMORS: FIFTEEN
CASES OPERATED ON IN 43 YEARS
MIHAI RADU DIACONESCU
SPITALUL UNIVERSITY, ROMANIA
Background&Aims:
Benign gastrointestinal stromal tumors (BGIST) are relative rare and heterogenous
tumoral lesions with impredictible clinical behaviour and prognosis. The aim of
this study was to review the clinical aspects, surgical management and outcome of
patients with BGIST in the author’s experience.
Methods:
Fifteen patients with BGIST (median age 58 years, M/F ratio: 1/1,5) representing 1,2
percent of all cases undergoing surgical treatment for GI tumors in the last more
than four decades are retrospectively reviewed.
Results:
There were 11 gastric lesions, one of the ileum and three of the colon. These
included 9 schwannomas, two leyomiomas, two lipomas and one each of fibroma
and “mixoma”. The commonest clinical manifestations were anorexia, dyspepsia and
abdominal pain (n=11), gastrointestinal bleeding (n=8), presence of a tumor (n=5),
intestinal obstruction (n=1). The diagnosis was established by clinical and imagistic
features, completed by the endoscopic studies and biopsies. The tumor’s benignity
was not allways easy to ascertain but the immunohistochemical study were useful
but not currently available for intraoperative and even postoperative diagnosis. The
surgical indication in these lesions appeared mandatory and all of them underwent
either conservative exeresis (partial gastrectomies, tumorectomies with wedge
resection) or standard gastric, enteric or colic resections. Postoperative course was
uneventful. At a median follow-up to five years all the patients were alive with no
recurrences or metastasis.
Conclusion:
A single surgeon meets (by chance) few BGIST in his professional career. In the
majority of cases the first evoked diagnosis is GI cancer. Histological diagnosis is
not always decisive and a long period of follow-up is necessary. Standard visceral
operations are preferable to the case-adapted resections. The prognosis of
these lesions was dramatically modified by the introduction of imanitib in their
management.
-596-
PP - 397 CLINICAL SIGNIFICANCE AND PROGNOSTIC VALUE OF
SERUM TUMOR MARKERS İN GASTRİC CANCER
TAYLAN ÖZGÜR SEZER , AYŞEGÜL AKTAŞ , HAYRULLAH YILDIRIM , ÖMER VEDAT
ÜNALP , ÖZGÜR FIRAT , SINAN ERSIN , CÜNEYT HOŞCOŞKUN , ADEM GÜLER

IZMIR, TURKEY
Background&Aims:
To determine the preoperative and postoperative clinical importance of serum CEA,

CA19-9, CA-125 and CA15-3 levels.
Methods:
Between January 2009 and December 2011, 217 patients were diagnosed with
gastric cancer in Ege University school of Medicine Department of General Surgery.
Of these patients,134 were operated and 83 patients were considered inoperable.
Patients were evaluated retrospectively. Clinicopathological features of the patients,
survival and serum CEA, CA19-9, CA-125 and CA15-3 levels were evaluated.
Results:
Preoperative eleveted CEA, CA19-9, CA 125 levels were statistically significant to

show operability (P=0.002, p=0.021, p=0.000). CA 125 level is more important
than others for demonstrating survival (p = 0.000). None of the markers measured
preoperatively was significant to assume postoperative recurrence, lymph node
metastasis and perineural invasion of the tumor (p> 0.05). Preoperative CA19-9
and CA15-3 levels viewed statistically significance for showing vascular invasion (p =
0.042, p = 0.016) and only CA19-9 was signifacant for showing lymph node invasion
(p=0.042). For tumor markers measured postoperative 1, 3, 6, 12, and 24 th
months; only CA19-9 and CA125 values at 24th month were statistically significant
for demostrating recurrence. .
Conclusion:
Serum CA125, CA19-9 and CA15-3 levels measured both preoperatively and
postoperatively were thought to be significant for demostrating survival, recurrence,
vascular invasion, lymphatic invasion, and inoperability criteria.
-597-
PP - 398 DOES THE NUMBER OF HARVESTED LYMPH NODES
REFLECT THE WIDTH OF LYMPHADENECTOMY IN GASTRIC
CARCINOMA? RESULTS OF A PROSPECTIVE COMPARATIVE STUDY
OKTAR ASOĞLU 1, TUBA MATLIM 1, ATİLA KURT 4, SEMEN YESİL ÖNDER 1, ENVER
KUNDUZ 1, HASAN KARANLIK 1, KURSAT RAHMİ SERİN 1, BULENT SAM 3
1
2
PATHOLOGY, ISTANBUL, TURKEY
3
JUSTİCE FORENSİC MEDİCİNE,
4
CUMHURİYET UNİVERSİTY FACULTY OF MEDİCİNE, GENERAL SURGERY, SIVAS,
TURKEY
Background&Aims:
Assess the therapeutic efficacy of extended lymph node dissection in gastric cancer.
Methods:
Total gastrectomy and extended lymphadenectomy with para-aortic lymph node

sampling was performed in 55 patients (tumor group) and 23 autopsy cases.
Number of lymph nodes stationary excised and metastatic for tumor group were
recorded. Number of lymph nodes excised (in both groups) and metastatic (for
tumor group) was recalculated, assuming D1-dissection, dissection-A (station 7 in
addition to D1) and dissection-B (stations 7 to 9 in addition to D1).
Results:
Median number of excised lymph nodes is 24 (10–57) in D1-dissection. In the

dissection-A group, average of cases with > 25 excised lymph nodes is 57% in tumor
group and 96% in control group. These are 93% and 100% in dissection-B group,
respectively. Skip metastasis was found in four patients (7%). Stage migration was
observed in 18 patients (33%). The number of metastatic lymph nodes excised from
stations 7, 8 and 9 affected stage migration significantly (p<0.05).
Conclusion:
Stationary lymph node dissections seem to be more valuable than harvested lymph
node numbers. Truncus celiacus dissection in addition to D1; may reduce possible
skip metastasis rate and also can provides radicality almost D2 disection.
-598-
PP - 399 DUODENAL GISTS
JUSTYNA DREWNIAK , JUAN EMMANUEL DANES GRASES , ROSA MARíA CUBERES
MONTSERRAT , GONZALO GARCíA-BLANCH
MóSTOLES UNIVERSITY HOSPITAL, MADRID, SPAIN
Background&Aims:
GISTs (gastrointestinal stromal tumors) are mesenchymal neoplasms of the

digestive tract which characteristically express CD117, CD34 and c-kit. They are
uncommon, (0.2-1 % of all gastrointestinal tumors), although their incidence has
increased. They usually originate in the stomach (70%). As for the small bowel, they
appear in jejunum, with duodenum being the least common site. Surgery is the
first therapeutic option. However, the technical difficulty of the approach and the
special relation to the pancreas result in a very compromising localization of the
duodenal GISTs. We studied duodenal GISTs treated in the Surgery Department of
Móstoles University Hospital in Madrid.
Methods:
We present 8 cases of duodenal GISTs, having analyzed their clinical presentation,

management and course in the last 10 years.
Results:
From the 8 patients with duodenal GISTs who underwent surgery, 3 were treated
with local resection, duodenectomy and simple duodenorrhaphy, 1 pancreas
sparing was performed and 4 segmental duodenectomies with duodeno-jejunal
anastomosis were realized. The histopathological exam showed 3 high-grade
tumors, 4 low-grade and 1 intermediate. 2 patients received imatinib neoadjuvance.
We found only one case of relapse. The operative procedure did not correlate with
long-term survival.
Conclusion:
Duodenal GISTs special feature is the technical importance of the surgery needed to
be performed in order to obtain a complete resection.
-599-
PP - 400 EFFECTS OF RAMADAN FASTING ON THE PREVALENCE OF
PATHOLOGIC FINDINGS DIAGNOSED BY UPPER GASTROINTESTINAL
ENDOSCOPY
ALI KAGAN GOKAKIN , ATILLA KURT , AYHAN KOYUNCU , MUSTAFA ATABEY ,
BORAN CIHAT KARAKUS , OMER TOPCU

Background&Aims:
The diagnostic methods such as upper gastrointestinal endoscopy (UGE) have

played an important role in the evaluation of Peptic Ulcer (PU). Every year millions
of Muslims fast in Ramadan Month. The goal of this study was to evaluate the effect
of fasting on PU via UGE.
Methods:
A total of 321 patients in the period of 2009 to 2011, who underwent UGE mostly
to clear up epigastric pain were analysed. Patients were divided into three groups:
patients who have been evaluated via UGE, in the month just before the Ramadan
(Group I, n=69), in the Ramadan month (Group II, n=132) and in the month just
after the Ramadan (Group III, n=120). Continuous data are expressed as the mean
± SD, and were compared with one-way ANOVA test among groups. Categorical
data are given as percentages and were compared with the chi-square test. Ordinal
data were tested with Kruskall-Wallis test. A p value <0.05 was considered to be
significant.
Results:
Epigastric pain was the most common indication for referral in each group.
Interestingly the indication ‘‘bleeding’’ was found to be the least of all in Group II,
but was far from statistical significance. In Group 2 was found the highest prevalence
of especially duodenal ulcers and duodenitis, the differences to the other groups
were statistically significant.
Conclusion:
Duodenal ulcers and duodenitis were found higher in Ramadan mount. We

recommend that, the patients with epigastric pain may fast by taking their
medications.
-600-
PP - 401 EVALUATION OF PERIOPERATIVE BLOOD TRANSFUSION IN
GASTRIC CANCER PATIENTS
UYGAR DEMIR 1, GURHAN ISIL 1, OZGUR BOSTANCI 1, CEMAL KAYA 1, HAKAN
KOKSAL 1, CANAN ISIL 2, MEHMET MIHMANLI 1
1
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ISTANBUL, TURKEY
2
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, ANESTHESIA AND REANIMATION
Background&Aims:
Anemia at admission and perioperative blood loss may lead to blood transfusion
in gastric cancer patients.In the literature blood tranfusion is associated with poor
prognosis.The aim of this study was to evaluate the effects of blood transfusion in
our patients.
Methods:
Data of 60 patients operated in our clinic between August 2007 and August
2012 was analyzed retrospectively.We determined patients demographics,
amount of red blood cell(RBC)transfusion, pre-post operative hemoglobin(Hb)
and hematocrit(Hct)values,morbidity,mortality and survival time of the patients
receiving transfusion(GroupA) or not(GroupB).
Results:
The mean age of the patients was 61.2years and the male:female ratio was
2:1(40:20).In Group A(n=45)mean Hb(g/dl)/Htc(%)counts were; preoperatively
10.48/33.28, postoperatively 10.05/31.43.In GroupB(n=15) mean Hb(g/dl)/Htc(%)
counts were; preoperatively 13.82/41.38, postoperatively 11.22/35.51.Mean±SD of
transfused RBC was 3.64±2.18 units. Complications occured in 7 patients in Group
A and in 1 patient in GroupB.Intensive care unit(ICU) stay was mean 1.7 days in
GroupA,0.5 days in GroupB.In GroupA 32(71.1%)patients are alive,13(28.9%)
patients are death(mean survival time was 16.4months).In GroupB 11(73.3%)
patients are alive,4(26.7%) patients are death(mean survival time was 15.3months).
Conclusion:
Although complication rate was higher and ICU stay was longer in patients receiving
RBC transfusion,overall survival time was similar with non-transfused patients.
-601-
PP - 402 EXPERIMENTAL STUDY ON WISTAR ALBINO RATS
ABOUT EFFECTIVENESS OF SODIUM HYALURONATE-
CARBOXYMETHYLCELLULOSE MEMBRANE, POLYETHYLENE-
GLYCOL-LYSINE AND HYALURONIC ACID IN POST-OPERATIVE INTRA-
ABDOMINAL ADHESIONS
ENGİN HATİPOĞLU 1, TARIK AKÇAL 2, AKİF ENES ARIKAN 2, SABRİ ERGÜNEY 2
1
REPUBLIC OF TURKEY MINISTRY OF HEALTH, SILIVRI CRIMINAL AND PENAL
INSTITUTION, STATE HOSPITAL, ISTANBUL, TURKEY
2
ISTANBUL UNIVERSITY CERRAHPASA MEDICAL FACULTY DEPARTMENT OF
Background&Aims:
To deal with post-operative adhesions several materials were tried with inconclusive
results. This study compares the effectiveness of SprayShield®, Seprafilm®,
Sepracoat® in prevention of intra-abdominal adhesions using “adhesion area
measurement” method and traditional ones.
Methods:
Sixty-four rats submitted to cecal abrasion was divided into two groups (comparison
at 5th, 14th day) each being divided into four subgroups (SprayShield®, Seprafilm®,
Sepracoat®, control). Effectiveness of each was compared with control group.
Besides macroscopical, histopathological evaluations, hematoxylin-eosin stained
slides was evaluated using x20 magnifier with Olympus BX53 light-microscope and
DP2-BSW image analysis software. Photographs including “optimized lesion area”
were taken similarly and “adhesion area measurements” were done within 10
millimeters-square zone.
Results:
In first group, no significant adhesion difference was found between subgroups
(p>0.05). SprayShield® showed significantly higher inflammation score (p=0.006)
(SprayShield®:24.63, Seprafilm®:16.50, Sepracoat®:11.50, control:13.38), adhesion
area (p=0.005) (SprayShield®:26.00, Seprafilm®:13.88, Sepracoat®:16.25, control:
9.88) in second group. There was no significant difference between groups according
to fibrosis, vascular proliferation score, and foreign body reaction (p>0.05).
Conclusion:
Effectiveness of currently used biomaterials for prevention of intra-abdominal
adhesions is not enough yet. Many researches comparing effectiveness of anti-
adhesive agents have conflicting results. For a standard approach to comparison of
effectiveness of anti-adhesive agents, much more objective methods are required.
-602-
PP - 403 FREE PERITONEAL TUMOR CELLS DETECTION IN GASTRIC
AND COLORECTAL CANCER PATIENTS
ANDREA KAZEMI NAVA 1, PAOLO MERCANTINI 1, ANDREA SAGNOTTA 1, SIMONE
ROSSI DEL MONTE 1, ALESSANDRA SPARAGNA 1, DANILO RANIERI 2, MARIA
ROSARIA TORRISI 2, VINCENZO ZIPARO 1
1
DEPARTMENT OF GENERAL SURGERY, SAPIENZA UNIVERSITY OF ROME,
SANT’ANDREA HOSPITAL, ROME, ITALY
2
DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, SAPIENZA UNIVERSITY
OF ROME, SANT’ANDREA HOSPITAL, ROME, ITALY
Background&Aims:
Free peritoneal tumor cells (FPTC) derive from the detachment of primary cancer
and may result in peritoneal carcinomatosis. Since peritoneal lavage cytology has
low sensitivity in detecting FPTC, our aim was to estimate the clinical relevance of
FPTC detected using an approach based on multiple molecular techniques.
Methods:
Samples of peritoneal lavage were collected from 27 gastric and 48 colorectal cancer
patients. FPTC recovery and detection from peritoneal washes was performed
by cytological examination and immunomagnetic enrichment for epithelial cells
followed by immunofluorescence analysis for epithelial marker EpCAM/CD326 and
carcinoembryonic antigen (CEA). CEA and CK20 mRNA levels were quantified using
a real-time qRT-PCR system.
Results:
For gastric carcinoma the FPTC positivity rate acquired by cytology,

immunofluorescence and qRT-PCR was 14.8%, 14.8%, and 78% and for colorectal
carcinoma was 0%, 17%, and 42%, respectively. qRT-PCR positivity was correlated
with a poor cancer-specific survival and time-to-recurrence rates in both gastric and
colorectal carcinoma.
Conclusion:
Epithelial immunoenrichment and immunofluorescence analysis allows unequivocal

identification of the FPTC. The real time qRT-PCR showed higher sensitivity for the
detection of CEA and CK20 mRNA levels and confirmed its prognostic value in
gastrointestinal cancers.
-603-
PP - 404 GUIDELINES FOR EXTENDED LYMPHADENECTOMY IN
GASTRIC CANCER: A PROSPECTIVE COMPARATIVE STUDY.
OKTAR ASOĞLU 1, TUBA MATLIM 1, ATİLA KURT 3, SEMEN YESİL ÖNDER 1, ENVER
KUNDUZ 1, HASAN KARANLIK 1, BULENT SAM 2, YERSU KAPRAN 4
1
2
JUSTİCE FORENSİC MEDİCİNE, ISTANBUL, TURKEY
3
CUMHURİYET UNİVERSİTY FACULTY OF MEDİCİNE, GENERAL SURGERY, SIVAS,
TURKEY
4
Background&Aims:
To assess the efficacy of extended lymph node dissection in gastric cancer and to
identify factors affecting lymph node detection.
Methods:
126 gastric cancer patients whom were eligible for curative resection received total
gastrectomy and extended lymphadenectomy (D2 group) and paraaortic lymph node
sampling (study group) were included. Supramesocolic total lymphadenectomy of
the upper gastrointestinal tract was performed on 23 autopsy cases as a control
group.
Results:
Fifty-five gastric carcinoma patients were included to the study group. The median
number of lymph nodes harvested is 47 (24–95), and the metastatic is 15 (1–71).
The median number of harvested lymph nodes was 72 (50–91) in autopsy group.
The median number of stationary lymph nodes was significantly higher in the
control group than in the study group (P<0.05). In the study group, stations 5, 12,
11, and 10 had the highest lymph node absence (LNA). In the autopsy group, no
LNA was detected.
Conclusion:
The results of this anatomical study can serve as a guideline to assess the success of
lymph node dissection during gastric cancer surgery. Note: This Trial is published in
Annals of Surgical Oncology /2012.
-604-
PP - 405 IS THERE ANY ROLE OF THROMBIN ACTIVATABLE
FIBRINOLYSIS INHIBITOR IN THE DEVELOPMENT OF
HYPERCOAGULABLE STATE IN GASTRIC CANCER.
MEHMET ESER , METIN KEMENT , SALIM BALIN , CIHAN COSKUN , UMUT KEFELI ,
MAHMUT GUMUS , YUNUS ALTUNTAS , KEMAL EYVAZ
Background&Aims:
To investigate plasma levels of thrombin activatable fibrinolysis inhibitor (TAFI) and

its relationship with coagulation markers (prothrombin fragment 1+2 ) in gastric
cancer patients.
Methods:
Thirty-three patients with gastric adenocarcinoma and twenty-nine healthy control
subjects were prospectively enrolled in the study. The patients who had a history of
secondary malignancy, thrombosis related disease, oral contraceptive use, diabetes
mellitus, chronic renal failure, or similar chronic metabolic disease were excluded
from the study. A fasting blood sample was drawn from patients to determine the
plasma levels of TAFI and Prothrombin Fragment 1 + 2 (F 1 + 2). In addition, data on
patient age, sex, body mass index (BMI), and stage of disease were recorded. The
same parameters except stage of disease were also recorded for the control group.
Subsequently, we assessed the difference in the levels of TAFI and F 1 + 2 between
the patient and control groups. Moreover, we investigated the relation of TAFI and
F 1 + 2 levels with age, sex, BMI and stage of disease in the gastric cancer group.
Results:
There were no statistical difference in any demographic variables (age, gender and
BMI) between the groups (Table 1). The mean plasma TAFI levels of gastric cancer
group (69.4 ± 33.1) and control group (73.3 ±27.5) were statistically similar (p =
0.62). The mean plasma F 1+2 level in gastric cancer group was significantly higher
than those in control group (549.7 ± 325.3 vs 151.9±67.1, respectively; p<0.001). In
gastric cancer group, none of demographic variables (age, gender and BMI) were
correlated with either TAFI or F 1 + 2 levels. Also, no significant associations were
found between the stage of the cancer and either TAFI or F 1 + 2 levels.
Conclusion:
In our study, TAFI levels of gastric cancer patients were similar to healthy subjects.
The results of our study suggest that TAFI does not play a role in pathogenesis of the
hypercoagulable state in gastric cancer patients.
-605-
PP - 406 OUTCOMES OF ESOPHAGECTOMY IN PATIENTS WITH
ESOPHAGEAL CANCER: SINGLE SURGICAL TEAM EXPERIENCE
TÜLAY MIZRAKLI 1, BILGI BACA 1, AHMET DEMIRKAYA 2, ILKNUR ERGUNER 3,
ERMAN AYTAC 1, CIGDEM BENLICE 4, ISMAIL HAMZAOGLU 1, TAYFUN
KARAHASANOGLU 1
1
2
DEPARTMENT OF THORACIC SURGERY ISTANBUL UNIVERSITY CERRAHPASA
3
4
SIXTH-YEAR STUDENT, ISTANBUL UNIVERSITY CERRAHPASA MEDICAL SCHOOL,
ISTANBUL, TURKEY
Background&Aims:
We aimed to evaluate the outcomes of esophagectomy performed by a single

surgical team.
Methods:
We have carried out a retrospective review of patients with esophageal cancer who
underwent a total esophagectomy. Preoperative, operative and postoperative data
were evaluated.
Results:
A total of 25 patients were operated between March 2004 and February 2012. Of
these, there were 10 patients who had received neoadjuvant chemoradiotherapy.
Mean age was 59 (32-80). Thoracolaparoscopic resection was performed in 8
patients. Thoracoscopy assisted resection with laparotomy was performed in 7
patients. There were two patients who underwent a transhiatal esophagectomy.
Remaining 8 patients underwent thoracotomy and laparotomy. Manual servical
anastomosis was done in all the patients. Complication rate was 32% (n=8). There
were two anastomotic leaks, two chylothoraxes, one aspiration pneumonia, one
pulmonary embolism and two recurrent laryngeal nerve palsies. The all cause
in-hospital mortality rate was 8% (n=2, pulmonary embolism and aspiration
pneumonia). Mean intensive care unit stay was 5 (0-32) days, and postoperative
hospital stay was 17 (7-57) days. Overall survival was 88% at 30 days and 64% at 2
years.
Conclusion:
Esophagectomy provides an acceptable survival time for esophageal cancer patients
with the help of concurrent treatment modalities and minimally invazive surgical
technics.
-606-
PP - 407 PREDICTIVE FACTORS FOR LONG TERM EFFECTS
OF IMATINIB THERAPY IN PATIENTS WITH INOPERABLE OR
METASTATIC GASTROINTESTINAL STROMAL TUMORS (GIST)
CZESLAW OSUCH , JAN KULIG
DEPARTMENT OF GENERAL, GASTROINTESTINAL AND ONCOLOGICAL SURGERY

JAGIELLONIAN UNIVERSITY. KRAKOW, POLAND
Background&Aims:
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors
of the gastrointestinal tract. The aim of the study was to analyze the outcomes
of treatment and factors predicting effects of imatinib therapy in inoperable or
metastatic GIST
Methods:
Between 2001 – 2011, 97 patients with GIST were treated at our Department of
Surgery. Of these, 45 (46.39 %) patients with advanced GIST received combined
treatment with imatinib (Glivec) in a dose of 400 mg/24 h increased to 800 mg/24h,
if necessary. A group consisted of 21 women (46.66 %) and 24 men (53.34 %) with
intraperitoneal spread of GIST or liver metastases. Mean age of the patients was 53
years. Mitotic activity in the analyzed group was 5-78/50 HPF.
Results:
Complete response (CR) to treatment was obtained in 4 (8.88 %) patients, partial

response (PR) in 17 (37.77 %), stable disease (SD) in 20 (44.44 %). Disease progress
(PD) was observed in 4 (8.88 %) patients. In the patients with disease progress
chemotherapy was continued with sunitinib (Sutent) in a dose of 37,5 mg/24h and
after with different inhibitors.
Conclusion:
Tumor mutational status and some biological factors (performance status and
neutrocyte count) were independent predictive factors for disease-free survival.
Only combined surgery with targeted chemotherapy with tyrosine kinase inhibitors
allows to significantly improve treatment results in the patients with advanced
gastrointestinal stromal tumors.
-607-
PP - 408 SANTULLI ENTEROSTOMY: A CONSIDERABLE ALTERNATIVE
FOR CASES WHO REQUIRES PROXİMAL ENTEROSTOMY
ERSIN ÖZTÜRK , ÖZGEN IŞIK , PINAR SARKUT , TUNCAY YILMAZLAR

BURSA, TURKEY
Background&Aims:
Santulli enterostomy is frequently prefered by pediatric surgeons but there is not

enough information about application for adult patients. We aimed to share our
experience with Santulli enterostomy by our serial which is the largest one about
adult patients in the literature.
Methods:
Patients, who were treated with this technique in Uludag University Department
of General Surgery between 01 January 2005 and 30 June 2012, included to study.
Results:
16 patients were performed Santulli enterostomy. The time for decrease of stomal
drainage and spontaneus defecation was median 20 (4-32) days. The median time
for the stoma reversal was 135 (60-220) days. 7 patients underwent stoma reversal
with sedoanalgesia and local anestehesia.
Conclusion:
Santulli enterostomy in comparison with end or loop proximal enterostomies, is

related with decreased fluid and electrolit loss, early restoration of GIS tractus
continuity, similar reversal related complication rates, and quicker reversal even
with local anesthesia.
-608-
PP - 409 THE ROLE OF “LIBIDO” IN THE DEVELOPMENT OF REFLUX-
ESOPHAGITIS
HIDAYET BILALOGLU(ISAYEV)
M.A.TOPCHUBASHOV SCIENTIFIC CENTER OF SURGERY, BAKU, AZEBAIJAN
Background&Aims:
In our study we wanted to define unsatisfied sexual energy (Libido) in etiology of

reflux-esophagitis (RE).
Methods:
94 patients of both sexes aged 18-38 years were treated and evaluated. There were
73 women and 21 men. The patients were examined according to the criteria of the
protocol generally accepted for this pathology. Moreover, the history of all patients
reflected the condition of their sexual life. The length of the disease in 13 patients
was 3 months, in 17 patients – 6 months, in 28 patients – one year, in 8 patients – 2
years, in 13 patients – it was more than 3 years.
Results:
19 of them developed erosive esophagitis, 3 patients developed superficial

esophageal ulcers. 43 out of 73 patients were married at the time of examination.
14 of them developed RE symptoms, which appeared after they had observed
a pornographic moving. 19 married women didn’t experienced orgasm during
“coitus”, 12 patients had “coitus” once a week, 5 women – twice a week, and 7
patients – once a month. 6 out of 21 men are single, 11 men have no “coitus”. Four
married men are not satisfied by their sexual life.
Conclusion:
The present study provides important information about significant disorders in

realization of sexual energy Libido in patients with RE and that this may play an
important role in the development of RE.
-609-
PP - 410 THE ROLE OF 2- [F-18] FLUORO 2- DEOXY D- GLUCOSE
POSITRON EMISSION TOMOGRAPHY IN THE PREOPERATIVE
STAGING OF GASTRIC CANCER CASES
KAZIM DUMAN 1, ABDURRAHMAN SIMSEK 2, YUSUF PEKER 2, SAADETTIN
CETINER 2
1
GUMUSSUYU MILITARY HOSPITAL DEPARTMENT OF GENERAL SURGERY,
ISTANBUL, TURKEY
2
ANKARA, TURKEY
Background&Aims:
In this study, we planned to analyze the importance and diagnostic value of FDG-
PET in the preoperative evaluation of gastric cancers by correlating its value with
computerized tomography (CT).
Methods:
A prospective study was conducted with a methodological working discipline.

Abdominal and pelvic CTs were obtained in each patient for preoperative staging.
Separate stagings were performed according to the findings of conventional
methods and PET scans, and the results were compared with operative and
histological findings.
Results:
When the patients were evaluated according to the pathological stage, eight
patients were found to be Stage 1 (26.7%), five were Stage 2 (16.7%), eight were
Stage 3 (26.7%), and nine patients were Stage 4 (30%). FDG-PET and CT down-
staged the disease in eight (26.7%) and twelve (40%) patients, respectively; FDG-
PET and CT up-staged the disease in two patients (6.7%) and five patients (16.7%),
respectively. FDG-PET accurately staged the disease in eighteen patients (60%) (p:
0.182).
Conclusion:
It is required more studies in preoperative staging of gastric cancer. FDG-PET

indicates a high specificity in staging of gastric cancer. In patients who are planned
curative surgery, it provides a beter staging when used with CT.
-610-
PP - 411 THE THERAPEUTIC RESULTS AFTER LAPAROSCOPIC
HELLERS’ MYOTOMY AND PARTIAL FUNDUPLICATION FOR
ACHALASIA: A SUBJECTIVE EVALUATION IN 40 CONSECUTIVE
PATIENTS
KAMIL GULPINAR 3, HAYDAR CELASIN 2, AHMET TURKCAPAR 1
1
ANKARA UNIVERSITY SCHOOL OF MEDICINE GENERAL SURGERY DEPARTMENT,
ANKARA, TURKEY
2
ANKARA OZEL KAVAKLIDERE UMUT HOSPITAL GENERAL SURGERY DEPARTMENT,
ANKARA, TURKEY
3
UFUK UNIVERSITY SCHOOL OF MEDICINE GENERAL SURGERY DEPARTMENT,
ANKARA, TURKEY
Background&Aims:
Achalasia is an esophageal motor disorder that results from the absence of

esophageal peristalsis combined with a defective relaxation of the lower esophageal
sphincter (LES). The aim of our study was to assess the subjective complaints or
relief of symptoms of patients’ who underwent Laparoscopic Hellers’ myotomy and
partial funduplication.
Methods:
40 patients that diagnosed of idiopathic achalasia were enrolled in our study and
underwent Laparoscopic Hellers’ myotomy and partial funduplication (toupet or
dor) between years 2002 and 2012. Postoperative follow-up was conducted at 1
st , 3 rd and 6 th months in each patient for symptoms and a complete follow-
up questionnaire was classified according to Vantrappen and Hellemans’ modified
classification.
Results:
All patients had a significant reduction in symptoms of dysphagia and regurgitation.

After 3 months 2 patients’ complaints of dysphagia was detected. In the 6 th
month three patients were presented with gastroesophagial reflux which medical
treatment was initiated.
Conclusion:
Laparoscopic Hellers’ myotomy and partial funduplication is a safe and effective

procedure in relieving symptoms of achalasia.
-611-
PP - 412 TRANSGASTRIC TUMOR-EVERTING RESECTION OF THE
GASTRIC SUBMUCOSAL TUMORS BY LAPAROSCOPIC TECHNIQUE
YAHYA EKİCİ , CEM AYDOĞAN , TUGAN TEZCANER , HÜSEYIN Y BIRCAN , MAHIR
KIRNAP , GOKHAN MORAY
BASKENT UNIVERSITY DEPARTMENT OF SURGERY, ANKARA, TURKEY
Background&Aims:
Here we want to present 2 cases who had submucosal gastric tumors which had
been treated by laparoscopic transgastric tumor everting resection technique.
Methods:
Case 1; Seventy nine years old female patient who had 3 cm submucosal mass
which was revealed by gastroscopy in the greater curvature. Case 2; Seventy two
years old female patient who had 2 cm submucosal mass which was revealed by
endosonography in the midway lesser curvature. Two 12 mm and two 5 mm ports
were inserted in abdomen after CO2 insufflations. Gastrostomy were performed
near the tumors after the determination of tumors’ site. The tumors were visualised
with scope. Tumor free surgical margins were achieved macroscopically by everting
the tumor to the outside the stomach. An endobag was used to deliver the tumor.
Gastrostomy site was closed with polyglactin sutures with two layers.
Results:
Operation times were 128 and 110 minutes and operative bleeding was negligible.
Both patients received oral intake on day 4 and both of them were discharged on
day 5 after the operation.
Conclusion:
Gastric mucosal lesions have to be removed totally with negative surgical margins.
The gastric mucosal masses must not be divided in to pieces while performing
resection. This technique provides successful laparoscopic treatment of such cases.
-612-
PP - 413 GIANT SEROUS MICROCYSTIC PANCREAS ADENOMA-CASE
REPORT
KURSAT DIKMEN 1, HASAN BOSTANCI 2, ALI CIHAT YILDIRIM 2, OMER SAKRAK 3,
MUSTAFA KEREM 3
1
TURKISH MINISTRY OF HEALTH,DR. NAFIZ KOREZ SINCAN STATE HOSPITAL
GENERAL SURGERY CLINIC, ANKARA, TURKEY
2
TURKISH MINISTRY OF HEALTH, DISKAPI TRAINING AND RESEARCH HOSPITAL 2.
GENERAL SURGERY CLINIC, ANKARA, TURKEY
3
GAZI UNIVERSITY MEDICAL FACULTY GENERAL SURGERY CLINIC, ANKARA, TURKEY
Introduction:
Serous cystadenomas are rare tumours comprising 1-2% of exocrine pancreas

tumours. Mostly they are known as benign conditions but malign transformation
as serous cystadenocarcinoma is also reported. It is usually seen on females
.Nonspecific symptoms like abdominal pain or symptoms due to mass affect are
usually seen
Case report:
64 years old female patient had investigated for her abdominal pain .Physical and
laboratory findings were normal.Abdomen Ultrasonography confirmed a 11x9,5
cm solid cystic lesion and abdomen CT confirmed a 12x11 cm lobulated cystic
solid lesion which had central cystic necrotic areas extending from liver hilus
inferiorly. Fine needle biopsy was confirmed benign cytology and tru-cut biopsy
of the pancreatic mass was reported as chronic inflamation Nevertheless this
mass could have malign contents and transformation potential. Laparatomy was
decided due to patients symptoms and mass effect. Due to vascular invasion of
the tumour Whipple procedure was performed. Pathology report was confirmed
serous microcystic adenoma.
Conclusion:
These rare tumours are usually benign but preoperative malignity criterias are not
identified.There are few differential diagnostic tools for excluding malignity.We
suggest surgical resection as best treatment approach for selected cases.
-613-
PP - 414 GALLSTONE ILEUS: CASE REPORT
TOLGA CANBAK 1, MUSTAFA HASBAHCECI 2, MUJGAN CALISKAN 1, FATIH BASAK 1,
AYLIN ACAR 1, IBRAHIM ATAK 1, GURHAN BAS 1, ORHAN ALIMOGLU 3
1
2
3
Introduction:
Gallstone ileus is a rare complication of gallstone disease occuring due to bilioenteric

fistula and cause a gastrointestinal tract obstruction. In this study, we aimed to
present a case of mechanical intestinal obstruction occured because of gallstone.
Case report:
Eighty-six-year-old male patient admitted to an emergency clinic with complaint

of abdominal pain, nausea, vomiting and constipation. Physical examination
revealed abdominal distention, hyperactive bowel sounds and right upper quadrant
tenderness. Ultrasonography (US) showed multiple stones in the gallbladder.
Abdominal computed tomography (CT) demonstrated aerobilia and small bowel
obstruction findings. Exploratory laparotomy showed cholecysto-duodenal
fistula. Impacted gallstone with size of 3x2 cm in small bowel was extracted with
enterotomy.
Conclusion:
Terminal ileum is the most common site of gallstone impaction. Preoperative

diagnosis is often difficult with nonspecific clinical findings. US and CT may detect
air in the biliary tract, impacted stone in the intestine and dilated bowel loops.
Preoperative definitive diagnosis is performed only in 50% of patients and the
surgical intervention is the preferred treatment. Gallstone ileus should be kept in
mind in elderly patients with mechanical intestinal obstruction and cholelithiasis.
-614-
PP - 415 LAPAROSCOPY FOR HEPATIC CYST HYDATID USING A NEW
ASPIRATION SYSTEM
BAHADIR CELEP 1, KEREM KARAMAN 2, AHMET ŞEKER 3, ERDAL POLAT 4, MEHMET
AKİF TÜRKOĞLU 5, SİNAN YOL 4
1
DEPARTMENT OF GENERAL SURGERY, ANKARA DIŞKAPI YILDIRIM BEYAZIT
2
DEPARTMENT OF GENERAL SURGERY, İZMIR TEPECIK EDUCATION AND RESEARCH
HOSPITAL, IZMIR, TURKEY
3
DEPARTMENT OF GENERAL SURGERY, HARRAN UNIVERSITY SCHOOL OF
MEDICINE, ŞANLIURFA, TURKEY
4
KARTAL KOŞUYOLU YÜKSEK İHTİSAS EDUCATION AND RESEARCH HOSPITAL,
ISTANBUL, TURKEY
5
DEPARTMENT OF GENERAL SURGERY, AKDENIZ UNIVERSITY SCHOOL OF
MEDICINE, ANTALYA, TURKEY
Introduction:
Hydatid cyst (HC) is a big worldwide health problem. Surgery remains the treatment
of choice but there is no consensus on the type of the operation. Laparoscopic
procedures have been drawing attention but the major problem in laparoscopic
surgery is dissemination of protoscolices-rich fluid. A safe and easy technique using
foley catheter is described which avoids spillage during laparoscopic HC surgery.
Case report:
After the aspiration of the cyst with a veress needle a triple lumen foley catheter
(TLFC) is used for a closed aspiration irrigation system. A 26 french TLFC strengthened
with a rigid stylet is then introduced the abdominal cavity through the epigastric 10
mm trocar and placed into the cyst cavity until 1 to 2 inches beyond the catheter’s
balloon. After inflation of the balloon, the catheter is gently pulled until inflated
balloon is snugged against cyst wall and the stylet is then removed. The lumens
of the catheter are connected to aspirator and irrigator forming a secure closed
system.
Conclusion:
Several methods have been described for safe evacuation of HC contents including
specially designed laparoscopic trocars. This new technique provides a cheap,
effective, safe and readily available opportunity to conduct laparoscopic HC surgery
especially in type I.
-615-
PP - 416 NON-PARASITIC SPLENIC CYST: A CASE REPORT
DOĞAN ALBAYRAK 1, ABDIL CEM İBIŞ 1, İLKAY ALBAYRAK 2, SERHAT OĞUZ 1,
HÜSEYIN AKSOY 1, CENGIZ ERENOĞLU 1, ZEKI HOŞCOŞKUN 1, AHMET RAHMI
HATIPOĞLU 1

1
EDIRNE STATE HOSPITAL THORACIC SURGERY DEPARTMENT, EDIRNE, TURKEY

2
Introduction:
Non-parasitic splenic cysts constitute a very rare clinic entity. We aimed to report a
case of splenic cyst who presented acute abdomen.
Case report:
A 46-year-old man presented to general surgery clinic complaining of abdominal

pain for approximately one month. On physical examination, there was sensitivity
in epigastric region. Chronic ethanol use noted in patient’s history and serum
biochemical parameters were normal except for an increase in amylase (280 U/L)
and lipase (140 U/L) levels. MRI showed a cystic mass with a diameter of 12 cm
which is thought to be a pancreatic pseudocyst origined from tail of pancreas (Fig.
1-2). Our patient presented to emergency department with acute abdomen in
preliminary period. There was free abdominal fluid and integrity of cystic wall was
lost in control ultrasonography and CT (Fig. 3). Emergency laparotomy was decided
and carried out. On exploration, cystic mass originated from spleen and invased to
left diaphragm was seen medial to gaster. The mass excised with splenectomy and
was not adjacent to pancreas (Fig. 4).
Conclusion:
Merely 5% of on-parasitic splenic cysts causes complications. Traumatic and rarely

spontaneous (like our case) perforation induces peritonitis. Ultimately complications
like hypertension due to hypersplenism and pressure on renal structure were
previously reported.
-616-
PP - 417 WANDERING SPLEEN: A CASE REPORT
DOĞAN ALBAYRAK 1, HÜSEYIN AKSOY 1, SERHAT OĞUZ 1, İLKAY ALBAYRAK 2, ABDIL
CEM İBIŞ 1, AHMET RAHMI HATIPOĞLU 1, İRFAN COŞKUN 1, AYDIN ALTAN 1

1

2
Introduction:
Wandering spleen is a rare clinical condition characterized by congenital

maldevelopment or acquired loss of one or more ligaments that hold spleen. We
aimed to present a case of wandering spleen who underwent surgery and review
the literature.
Case report:
An 18-year-old woman presented to general surgery clinic complaining of

intermittent abdominal pain for a long time. MRI scan of abdomen and pelvis
revealed ectopic spleen with a long pedicle in pelvis (Fig.1). Decision of operation
was taken and a midline laparotomy was performed after appropriate preparation.
On exploration, a 20 cm spleen with a long pedicle was seen in pelvis (Fig.2) and
splenectomy was carried out.
Conclusion:
The spleen can displace by its long pedicle in abdomen and acute abdomen due to
torsion of this pedicle may be occured. In adults, the condition is most commonly
seen in women aged 20–40 years and accounts only 0.25% of all indications for
splenectomy. Recently, one of the treatment options is splenopexy especially for
patients in childhood. Splenectomy is suggested for cases with splenomegaly or
hypersplenism like our case. Wandering spleen is a rare clinic entity that should
be consider in differential diagnosis of abdominal pain and splenectomy should be
performed in case of splenomegaly.
-617-
PP - 418 A RARE COMPLICATION OF MAJOR ABDOMINAL
SURGERY: CHYLOUS ASCITES AFTER RESECTION OF METASTATIC
HEMAGIOSARCOMA FROM LIVER AND OVARIES
ERDINC YENIDOGAN , HUSEYIN AYHAN KAYAOGLU , SERVET TALI , ISMAIL OKAN ,
ZEKI OZSOY , MUSTAFA SAHIN

Introduction:
Chylous ascites is a rare complication of major abdominal surgery. Injury to the

lymphatics during extensive dissection for tumors might be associated with
increased incidence of chyloperitoneum. Here, we present a case chylous ascites
developed as a complication of liver resection after metastatic hemangiosarcoma.
Case report:
33 year old female patient who underwent right mastectomy to the breast
hemangiosarcoma was diagnosed with a liver mass in her routine control.
Abdominal CT showed multiple metastatic lesions in left lobe of liver and a solitary
metastases in the right liver. Moreover, metastatic involvement of both ovaries
were noticed. The patient underwent total abdominal histerectomy, bilateral
salpingo-oophorectomy, left hepatectomy, metastasectomy from right liver, partial
omentectomy and solitary mass resection from abdomen. She recovered in three
days. However, after commencement of the oral solid feeding ended up with a
milky appearance turbulent fluid. The triglyceride level from drain effluent was
581 mg/dl. The oral feding was ceased, total parenteral nutrition and somatostatin
were started. After the drainage stopped, the oral feeding was started gradually.
The patient was discharged after 15 days without any complication.
Conclusion:
The early recognition of chylous ascites requires full awareness of this rare
complication and can be managed successfully by conservative measures.
-618-
PP - 419 LAPAROSCOPIC MANAGEMENT OF HEPATIC ABSCESS WITH
CHOLEDOCOLITHIASIS IN A SCHIZOPHRENIC PATIENT
HUSEYIN AYHAN KAYAOGLU 1, FAIK YAYLAK 2, ERDINC YENIDOGAN 1, ISMAIL
OKAN 1, SERVET TALI 1, MUSTAFA SAHIN 1
1
2
DUMLUPINAR UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, KUTAHYA, TURKEY
Introduction:
Choledocolithiazis may result with ascendant biliary enfections of the liver. These
hepatic abscess are treated with medical and surgical interventions including ERCP,
stone removal and percutaneous drainage. Here we present laparoscopic treatment
of a patient with hepatic abscess due to choledocolithiasis.
Case report:
54 year-old lady with choledocolithiasis was referred five days after laparotomy
due to incomplete dissection for cholecystectomy and dilated ductus choledocus.
Patient was treated for cholangitis with antibiotics and endoscopic stone removal
two months before the laparotomy. She was treated with ERCP two years prior the
second intervention. However, cholecystectomy was not performed and she was
absent from medical and surgical follow due to her schizophrenia. Under general
anesthesia, patient was treated with laparoscopic cholecystectomy, primary biliary
duct repair and hepatic abscess drainage. Postoperative period was favorable.
Conclusion:
Laparoscopic management may be considered in some selected patients with

complicated choledocolithiasis. However, complete preoperative and perioperative
care should be given to achieve favorable results.
-619-
PP - 420 MANAGEMENT OF PANCREATIC TRANSECTION WITH
DELAYED DIAGNOSIS AFTER BLUNT ABDOMINAL TRAUMA
ERDINC YENIDOGAN , HUSEYIN AYHAN KAYAOGLU , ISMAIL OKAN , ZEKI OZSOY ,
SERVET TALI , MUSTAFA SAHIN

Introduction:
Isolated pancreatic trauma is rare after abdominal blunt traumas. The delayed
diagnosis ends up with catastrophic results like pancreatic fistula, abscess formation
and increased morbidity and mortality. Here, we present the management of a
patient with delayed diagnosis of pancreatic transection due to the blunt abdominal
trauma.
Case report:
26 year old male patient was admitted to our clinic due to the abdominal pain and
hemodynamic instability. Medical history of patient revealed earlier hospitalization
in another center for brain injury for 15 days and discharge one week before. The
radiological methods (US, abdominal CT and subsequent MRI) showed complete
transection of pancreas at the boundry of corpus and the neck. There was a
fluid collection with 130x122x43 mm in size. The conservative management with
percutaneous drainage was not successfull. The patient underwent laparoscopic
exploration and subsequent laparoscopic distal pancreatectomy and abscess
drainage due to the distal pancreatic necrosis and abscess formation. The full
recovery was delayed to 2 months since persistent pancreatic fistula. After 15
months of follow-up, the patient is without symptoms.
Conclusion:
Delayed diagnosis of pancreatic trauma is complicated with major morbidity.

Therefore, prompt recognition is mandatory for the successfull treatment of
pancreatic trauma.
-620-
PP - 421 THE PRIMARY REPAIR OF MAIN PANCREATIC DUCT AFTER
COMPLETE TRANSECTION DURING THE RESECTION OF PANCREATIC
MUCINOUS CYSTADENOMA IN A PATIENT WITH RCC
ISMAIL OKAN 1, ERDINC YENIDOGAN 1, DOGAN ATILGAN 2, SERVET TALI 1, FATMA
MARKOC 3, HUSEYIN AYHAN KAYAOĞLU 1, ZEKI OZSOY 1, MUSTAFA SAHIN 1
1
2
UROLOGY, TOKAT, TURKEY
3
PATHOLOGY, TOKAT, TURKEY
Introduction:
The treatment of complete transection of main pancreatic duct beyond ampulla

of vater or pancreatic head is a difficult problem for surgeons. Here we present
a patient treated with primary repair of main pancreatic duct after complete
transection during the resection of pancretic mucinous cystadenoma in a patient
with RCC.
Case report:
A 65 year old woman with RCC in left kidney and a cystic lesion in the boundary of
pancreatic head and neck with the size of 15X 13 mm was referred to our clinic.
She was symptom-free for pancreatic disease. After radical nephrectomy during
concomitant surgery, the pancreatic cyst was enucleated. While dissection the
pancreatic duct was transected completely. The main pancreatic duct was repaired
with 6/0 PDS interrupted sutures and transampullary catheter stented inside the
duct. The patient discharged without any problem. The development of pancreatic
pseudocyst in the location of pancreatic head and neck boundary after two months
was managed conservatively with IV fluid resuscitation, bowel rest and antibiotics.
Pathological examination of pancreatic cyst revealed mucinous cystadenoma. She is
symptom-free during her follow-up in her 6th month after the operation.
Conclusion:
Primary repair of complete transected pancreatic duct is a safe and effective

method for the treatment.
-621-
PP - 422 CASE REPORT: GIANT CAVERNOUS HEMANGIOMA
LEADING TO VENA CAVA COMPRESSION
MEHMET YILMAZ 1, FATIH OZDEMIR 1, AYSEGUL SAGIR KAHRAMAN 2, ZEYNEP
MARAS OZDEMIR 2
1
INONU UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF SURGERY AND
ORGAN TRANSPLANTATION, MALATYA, TURKEY
2
INONU UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF RADIOLOGY,
MALATYA, TURKEY
Introduction:
Hemangioma is the most common benign tumor of the liver, and it is often
asymptomatic. We aim to present a case of giant cavernous hemangioma located
at the rigth lobe of the liver which causes bilateral lower extremity edema treated
by formal right hepatectomy.
Case report:
Forty two-year-old woman with a nonspesific bellyache was diagnosed as

hemangioma of the liver by dynamic CT scan 5 years ago. The patient was
asymptomatic until the last year. Dynamic CT scanograms showed the growth rate
of 1 cm per year for the tumor during the follow up period. The patient presented
with bilateral lower extremity edema at final physical examination which indicates
external compression of the retrohepatic vena cava because of the tumor growth.
The tumor was resected with a 1 cm clear margin by aid of CUSA. The circumference
of the leg and the thigh reduced after the operation which showed the remission
of the lower extremity edema. The external compression of the retrohepatic vena
cava dissappeared on control dynamic CT scanograms.
Conclusion:
If the hemangioma of the liver is symptomatic and causes complications like in our
case the surgical approach should be performed.
-622-
PP - 423 DIFFUSE GALLBLADDER ADENOMYOMATOSIS
HAKAN ÖZDEMIR , ZEHRA ÜNAL ÖZDEMIR , METIN ŞENOL , İBRAHIM TAYFUN
ŞAHINER

Introduction:
Gallbladder Adenomyomatosis (GAM) develops as a result of the local or diffuse

invagination of the epithelial tissue of a thinning layer of muscles. It is a benign
condition of unknown etiology. The incidence of the disease varies between 2,8–5%
after cholecystectomies. In this case, we present a GAM patient diagnosed by MRI,
was followed-up without operation.
Case report:
A 41-years-old patient applied with complaints of widespread abdominal pain. USG

revealed a diffuse thickening of the gallbladder wall by coincidence, which had
reached 1,4 cm in thickness. Upper abdomen MR and MRCP were done. Diffuse
gallbladder adenomyomatosis was identified. The patient had no further symptoms
other than nausea after the intake of fatty and was followed-up.
Conclusion:
Multiple small cystic lesions on the hypertrophic wall that surround the lumen are
typically observed during MRI. In this case, the observation of diffuse wall thickening
on the gallbladder and of Rokitansky-Aschoff sinuses have assisted in the diagnosis
of diffuse-type GAM. Despite the fact that adenomyomatosis is a benign condition,
asymmetric thickening of the gallbladder wall in the fundal and segmental types
can eventually necessitate and lead to surgery. However, as the appearance in
diffuse type GAM remains typical, follow-up for asymptomatic cases is sufficient.
-623-
PP - 424 RECURRENT GALLSTONE ILEUS : CASE REPORT AND
LITERATURE REVIEW
CHIARA MONTESANI , ANNAMARIA PRONIO , SILVIA PIRROLI , MARIAGRAZIA
COLUZZI , BERNARDO CIAMBERLANO , DANIELA CAPORILLI , ANNARITA VESTRI ,
FRANCESCA PITASI
UNIVERSITY “SAPIENZA” IN ROME – FACULTY OF PHARMACY AND MEDICINE,

ROME, ITALY
Introduction:
The gallstone ileus is a rare complication of cholelithiasis and it represents the 1-4%
of small intestine mechanical obstruction. Surgery is the treatment of choice and
it can be between : the entherolitomy alone; the one-stage surgical procedures
includes an enterolithomy, cholecistectomy and fistula repair; the two-stage surgical
procedures involves an initial enterolithomy as emergency operation followed by
colecystectomy and fistula closure in 4-6weks later. In literature there is no unique
opinion on the best choice.
Case report:
We examined a female patient of 75 years old with abdominal CT which showed

a thickened cholecyst wall with gallstones about 28 and 16,5 mm inside of the
lumen, and duodenum wall in close contact with the cholecyst. A rounded mass of
24 mm in diameter is appreciated quite after the Treitz. In the first time, trasversal
enterotomy and the extraction of the gallstone were performed. In a second time
was performed colecistectomy and fistula repair.
Conclusion:
We can state , supported by literature, that the therapeutic options for intestinal
obstruction caused by gallstone ileus, can be an one –time surgical procedure for
clinically stable patient, and the fistula repair is not indicated in the first treatment
of patiants associated with hight mortality.
-624-
PP - 425 BLEEDING IN UPPER GASTROINTESTINAL SYSTEM CAUSED
BY GALLBLADDER STONES
MEHMET CELAL KIZILKAYA , FAZILET EROZGEN , ADNAN HUT , MUZAFFER AKINCI ,
RAFET KAPLAN
HASEKI TRAINING AND RESEARCH HOSPİTAL, GENERAL SURGERY, ISTANBUL,

TURKEY
Introduction:
Haemobilia is defined as bleeding into the hepatobiliary system caused by a

pathologic connection between blood vessels and biliary ducts. A rare cause of
haemobilia is gallstone disease, with only 52 reported cases in the literature. The
haemobilia is characterised by the classical triad: jaundice, colicky pain in the right
upper quadrant and signs of gastrointestinal bleeding. Diagnosis can be made
with endoscopic procedures and with angiography of the coeliac trunk, which has
the highest sensitivity in localisation of bleeding source. The therapy of choice is
cholecystectomy. We report the case of a patient with massive gastrointestinal
haemorrhage caused by two gallstones and present the diagnostic and therapeutic
management of this disease, which is accompanied by a high mortality.
Case report:
A 55 year old male patient was admitted to emergency with complaints of weakness,
dizziness and rectal bleeding which has black colour. despite the transfusions the
general condition of the patient didn’t improve. CT showed us hematoma in inferior
of liver. so the patient were operated immediately.
Conclusion:
In conclusion, hemobilia is a rare cause of upper GI bleed. Trauma and iatrogenic

injuries are the most common causes of hemobilia. The absence of classical
symptoms is unusual. Gallstones an extremely unusual cause of hemobilia and is
due to erosions of a. gastroduodenalis which made by gallstones, which has only
been reported rarely before in the literature. To the best of our knowledge, this is
the first case of hemobilia due to gallstones. The diagnosis was made with a multi-
modality approach using EGD, ERCP, CT, pathology, and our patient’s clinical course.
-625-
PP - 426 GIANT LIVER HYDATID CYST WITHOUT BILE LEAKAGE
METIN ŞENOL , ZEHRA ÜNAL ÖZDEMIR , HAKAN ÖZDEMIR , IBRAHIM TAYFUN
ŞAHINER
MINISTRY OF HEALTH NEVŞEHIR STATE HOSPITAL, DEPARTMENT OF GENERAL

SURGERYEHIR, NEVSEHIR, TURKEY
Introduction:
Hydatid cyst is a parasitic and a zoonotic disease. It’s most commonly seen in the
liver (70%). This case is reported because of it’s giant size and conservative surgery
was performed successfully without any postoperative complications like bile
leakage.
Case report:
A 62-year-old woman was admitted to our clinic with abdominal pain at his right
side. Physical examination revealed a mass in the right upper quadrant. Abdominal
USG and CT revealed a 21x15x15 cm hydatid cyst in hepatic right lobe. Partial
cystectomy, evacuation of all the cyst contents, cholecystectomy and external
drainage was done. Although the cyst content was bilious, postoperatively there
were no bile leakage or any other complication.
Conclusion:
It’s known that the bile leakage insidance increases with the size of the cyst.
Especially after the conservative surgery more bile leakage can be seen. Doing bile
leakage test peroperatively is controversial. In this case, the hidatid cyst was too big
and the cyst content was bilious as expected, but bile leakage test wasn’t done to
search bile fistula. Interestingly there wasn’t any bile leakage after the surgery. In
conclusion, searching bile fistula is not always needed, even if the cyst content is
bilious.
-626-
PP - 427 PRIMARY SPLENIC HYDATID CYST
METİN ŞENOL , IBRAHIM TAYFUN ŞAHINER , ZEHRA ÜNAL ÖZDEMIR , HAKAN
ÖZDEMIR
MINISTRY OF HEALTH NEVSEHIR STATE HOSPITAL, DEPARTMENT OF SURGERY
Introduction:
Hydatid disease is endemic in Mediterranean countries. The major cause of the

parasitic and zoonotic disease is E.granulosus. The most common sites are liver and
lungs however it may be seen in spleen (0,5-1 %) too. Primary splenic hydatid cysts
constitute approximately of all hydatid cysts. In this case, we report a 45-year-old
male patient with a 12-cm centrally located primary splenic hydatid cyst without
any other organ involvement and total splenectomy was performed.
Case report:
A 45-year-old man was admitted to our clinic with abdominal pain at his left side.
At physical examination, a mass in the left upper quadrant of his abdomen was
palpated.. Abdominal USG and CT revealed 12 cm type 1 hydatid cyst in spleen.
Total splenectomy was performed without opening the cyst.
Conclusion:
The treatment of a splenic hydatid cyst is surgery. The type of surgery varies
according to patient’s age, his/her additional systemic diseases, localization,
number and size of the cysts. As a result, patients with centrally located, advanced
and isolated splenic hydatid cysts should be started with preoperative medical
treatment and they should be performed total splenectomy without perforating
the cyst if it’s possible. Thus, recurrence, expansion and complication risk of the
hydatid disease will disappear.
-627-
PP - 428 THE FEATURES OF SURGICAL TREATMENT OF THE
COMPLICATED FORMS OF CHRONIC PANCREATITIS TAKING INTO
ACCOUNT QUALITY OF LIFE OF PATIENTS.
КRYVORUсHKO I.A GONCHAROVA N.N.
KHARKIV NATINAL MEDICAL UNIVERSITY, UKRAINE
Introduction:
In the world prevalence the chronic pancreatitis (ChP) from 26, 5 to 50 cases on 100
thousand populations.
Case report:
Retrospective- and prospective were analyzed results of surgical treatment of 253

patients operated concerning complicated forms ChP; middle age 42,3 ± 9,3 years.
All the patients have been surveyed and operated. According of classification M.
Buchler at al. (2009) of 253 sick 136 (53,8 %) concerned stage B of current ChP
and 117 (46,2 %) – to a stage from current ChP: С1 - 23 (9,1 %); С2 – 54 (21,3 %);
С3 – 40 (15,8 %) patients. After performance pancreaticoduodenectomy at 11,1 %
of patients are received good, at 77,8 %- satisfactory and at 11,2 % - unsatisfactory
results of treatment; after duodenum- preserving operations in various modification
good results are received at 79,5 %, satisfactory - at 20,6 %, unsatisfactory- at 5,9
%; after drainage operations good results were observed at 22,2 %, satisfactory – at
44,5 %, unsatisfactory – at 33,3 %; after performance of symptomatic operations
good results are received at 8,9 %, satisfactory – at 62,2 % and unsatisfactory results
of surgical treatment.
Conclusion:
Quality of life is analyzed in terms from 1-7 years after operation with use of adapted
questionnaires SF-36 and GSRS.
-628-
PP - 429 PANCREATIC EXTRAGASTROINTESTINAL STROMAL TUMOR
INVADING DUODENUM : A CASE REPORT
SINAN YOL 1, MUSTAFA DUMAN 1, ERDAL POLAT 1, NECDET FATIH YAŞAR 1, ORHAN
UZUN 1, KIVANÇ DERYA PEKER 1, CEBRAIL AKYÜZ 1, SİBEL KAYAHAN 2
1
KARTAL KOŞUYOLU YÜKSEK İHTISAS EDUCATION AND RESEARCH HOSPITAL
2
KARTAL LÜTFİ KIRDAR EDUCATION AND RESEARCH HOSPITAL DEPARTMENT OF
Introduction:
Gastrointestinal stromal tumors (GISTs) are low grade malignancies of mesenchymal

origin in the gastrointestinal tract and these tumors arise from the intestinal cells
of Cajal. These tumors may originate from any location in the entire gastrointestinal
tract and the most susceptible sites are stomach (40-60%), small intestine (30-
40%), colon and rectum (5%) and esophagus (5%). Only 3-5% of GISTs occur in the
duodenum. There are also sporadic reports of GISTs arising from the peritoneum,
omentum, mesentery and retroperitoneum. GISTs, that originate from the soft
tissues of the abdomen and retroperitoneum are called EGISTs. EGISTs arising in the
pancreas are extremely rare and only fourteen cases are available in the previous
reports.
Case report:
A 56 year old man presented with recurrent mild right upper quadrant abdominal
pain radiating to back of torso. The patient had a history of melena requiring
blood transfusion. After his admittance with melena; a series of endoscopic and
radiologic investigations were conducted and failed to reveal the source of bleeding.
Abdominal CT scans and MRI studies also revealed a mass lesion with a diameter
of 10 cm localized head of pancreas, extending to from the right paranephritic fat
tissue. Between the duodenum and pancreas head fatty plans was obliterated by
the lesion and there was no dilatation or invasion of the common bile duct. Tumor
markers were negative for CA 19-9, CA 125 and CEA. Pancreaticoduodenectomy was
performed as the treatment of choice. The tumor was palpated as a hard mass in the
pancreatic head region. The tumor was 15 cm in diameter and extending through
the duodenum, retroperitoneum and inferior caecal region. Macroscopically
there was no metastases in the peritoneum or liver. The postoperative course was
uneventful and the patient was discharged on the postoperative 14th day. The
histopathologic examination report of the specimen confirmed the EGIST, with
predominant spindle cell and mitotic figure of fewer than 3 per 50 high power fields.
Wide necrotic areas in the tumor were noted. The surgical margins were negative
-629-
and no metastasis was noted for the 6 regional lymph nodes which were excised.
On immunohistochemistry, the tumor cells were positive for CD117 , CD34 and
vimentin, and negative for S100 and desmin. Imitanib (400mg daily) administration
was started on the 3rd postoperative week as adjuvant treatment.
Conclusion:
Preoperative diagnosis of EGIST is difficult due to the non specific signs and
symptoms. Abdominal pain, palpable mass and bleeding are the most common
presentations. Only fourteen cases have been reported in pubmed database.
Endoscopic investigations were failed to reveal the lesion. The imaging modalities
indicated that the mass was originated from the head of pancreas. There are only
fourteen cases of pancreatic EGIST reported in the literature and 6 of them were
located in the head of pancreas. Here we report the seventh case of pancreatic
EGİST arising in the head of pancreas and also the largest of these 7 tumors. Optimal
surgical treatment of GISTs entails complete removal of the tumor with clear surgical
margins and regional lymph node involvement are infrequent in GISTs, therefore
systematic lymph node dissection is not thought to be necessary. In conclusion, we
report a very rare case of a large EGIST originating from the pancreas. This report
will contribute the existing data in the literature about EGISTs with rare and unusual
locations.
-630-
PP - 430 PANCREATIC PSEUDOCYST AND PLEUROPANCREATIC
FISTULAE, AN UNFREQUENTLY ACUTE PANCREATITIS
COMPLICATION
CARLOS AUGUSTO CUTINI CINGOZOGLU , H. RODOLFO SCARAVONATI , LUCIANA
CONTINO , SANTIAGO LENZI , SILVINA LUCIA MILLETARI , NICOLAS MARTIN ORTIZ ,
RODRIGO MORAN AZZI , VICTOR HUGO SERAFINI
Introduction:
Pancreaticopleural fistulae is a rare and serious complication of acute and chronic

pancreatitis or pancreatic trauma. A case treated by endoscopic and pleural
drainage.
Case report:
A 45 -year- old masculine patient, with no medical history, diagnosed with mild
acute pancreatitis . The abdominal US and CT scan showed microlithiasis, pancreatic
edema, left peripancreatic and prerrenal collections and bilateral pleural effusion.
He was initially managed with bowel rest and enteral nutrition (nasoyeyunal feeding
tube). Despite these measures, symptoms persisted in addition to dyspnea. New CT
scan detected an increased volume of the left pleural effusion and a pancreatic
pseudocyst of 20 x 15 cm. Thoracocentesis showed pleural amilasa of 1536 IU.
Endoscopic cystogastric anastomosis and a left pleural drainage were performed.
Control CT showed downsizing of the pseudocyst (>75%) and total resolution of
pleural effusion. After 5 weeks of inpatient management, he was discharged with
no recurrence of either pancreatic pseudocyst or pleuropancreatic fistulae.
Conclusion:
Endoscopic treatment associated with pleural drainage seems to be a good option

for pancreaticpleural fistulae. Future research with controlled prospective trials to
corroborate the findings and recommendations would be helpful.
-631-
PP - 431 SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS, AN
UNUSUAL PANCREATIC TUMOR
H. RODOLFO SCARAVONATI , CARLOS AUGUSTO CUTINI CINGOZOGLU , PABLO
HERNAN VANNELLI , JUAN MANUEL SOTELO , SILVINA LUCIA MILLETARI , NICOLAS
MARTIN ORTIZ , RODRIGO MORAN AZZI , VICTOR HUGO SERAFINI
Introduction:
Solid pseudopapillary tumor of the pancreas is a rare tumor that affects young
females with low malignant potential and good prognosis with more than 90%
survival at 5 years. Metastasis is very rare. . We present a case treated in a University
Hospital, as well as a review of the literature
Case report:
A 19-year-old Caucasian female, with medical history of gallstones and cesarean,

was admitted to the hospital for recurring stomachache and food intolerance. She
denied previous history of abdominal trauma or pancreatitis. The clinical exam was
unremarkable, except for epigastric tenderness. Blood tests and tumor markers (CEA,
CA19-9, CA125) were normal. Abdominal ultrasound and CT scan were performed
and revealed a well defined 10x9 cm solid mass in the pancreatic tail, adjacent to
the spleen; predominantly cystic with multiple internal septations and enhancing
solid components. The patient underwent laparoscopic cholecistectomy and distal
pancreatectomy with splenectomy.The histological and immunohistochemical
findings were in keeping with the diagnosis of a solid-pseudopapillary tumor of
the pancreas.Five days later the patient was discharged without any postoperative
complications.
Conclusion:
Surgery represents the best treatment for this pathological entity and should be
attempted in all cases, independent of the size of the pancreatic injury
-632-
PP - 432 MANAGEMENT OF SEVERE PANCRETATICO-BILIER FISTULA
AFTER PANCREATICODUODENECTOMY: CHOOSE THE LESSER EVİL.
TARIK ZAFER NURSAL
MEDLINE ADANA HASTANESI, ADANA, TURKEY
Introduction:
Pancreatic anastomotic failure is a dreaded complication of pancreaticoduodenectomy

with a reported incidence up to 13% and mortality up to 30%. The treatment
strategy consisting of drainage and metabolic support is successful for most of the
cases. An unfortunate small minority needs more aggressive measures.
Case report:
A 54 year old man is diagnosed with a 4 cm pancreatic head mass. Whipple

procedure was done. Mainly bile stained enteric fluid with increasing amounts
through the drains and wound started on 7th postoperative day. The fistula could
not be controlled and the patient was operated on the 25th postoperative day. The
source of the leakage was the pancreaticojejunal anastomosis. The jejunal segment
after pancreatic anastomosis and just before biliary anastomosis was freed and a
linear stapler was fired across the jejunum to close this segment. The patient was
discharged at the 13th postoperative day.
Conclusion:
Completion pancreatectomy is a radical solution. However in an already deranged

patient it results in high morbidity and mortality. The principal problem of
retrograde leak of bile rich enteric fluid was solved and the enteric stream was
forced antegrade by this maneuver. A lesser evil i.e. pure pancreatic fistula was
preferred which proved to be successful.
-633-
PP - 433 ERCP IN A PREGNANT PATIENT WITH LIVER HYDATIC CYST:
REPORT OF A CASE
ASIM CINGI , M.UMIT UGURLU , WAFI ATTAALLAH , KIVILCIM UPRAK , S.CUMHUR
YEGEN

ISTANBUL, TURKEY
Introduction:
A 29-year-old, 20-week pregnant was presented to the emergency unit with acute
right upper quadrant pain and nausea of 3 days duration. She had history of treatment
for liver ecchinococcal disease and 6 months ago had undergone (PAIR) for treatment.
Case report:
On examination, the patient had fever (38.0-38.5°C) and jaundice. She had abdominal
distension with voluntary guarding of the right upper quadrant. Laboratory
investigations revealed elevated total and direct bilirubin (5.13/5,11 mg/dl) levels. CRP
value was 175 mg/L. Ultrasound of the upper abdomen showed a large heterogenous
cystic mass in the liver paranchyme of 68x54 mm diameter. She had mild intrahepatic
and extrahepatic biliary duct dilatation. USG also showed echogenities of tubular
structures in the common bile duct that give clues to the the biliary communication
of the lesion. MRCP scan showed dilatation of common bile duct filled with linear
soft tissue lesions (parasitosis). After initial treatment with antibiotics and hydration,
as the obstructive jaundice of the patient continue an ERCP procedure was planned.
Obstetric consultation was demanded and fetal monitoring was performed followed
by tocolytic treatment to prevent preterm labor.After informed consent was taken,
under conscious sedation and field protection of the uterus with proper shield papilla
and common bile duct was cannulated selectively and cholangiography revealed a
large amorphous filling defect. After sphincterotomy, structure consistent with the
detached germinative membrane was extracted with a balloon and the foreign body
forceps after partial protrusion of the material from the papilla. Common bile duct
was irrigated with sterile saline solution. In cholangiography, no further filling defect
was observed and ERCP was completed without any acute complication. During the
procedure fluoroscopy use was minimized to the shortest essential duration. Patient
was discharged from the hospital after 24 hours with improved clinical situation
without abdominal pain and able to eat without nausea. Bilirubin levels were
normalized at the end of the first week.
Conclusion:
ERCP is feasible in a pregnant woman with maximal precautions and minimal
intervention in case of necessity especially in the second trimester.
-634-
PP - 434 EXTRAHEPATIC BILIARY TRACT TRAUMA: AVULSION OF THE
LEFT HEPATIC DUCT AT BIFURCATION
VOLKAN INCE , BULENT UNAL , VURAL SOYER , MEHMET YILMAZ , SEZAI YILMAZ
INONU UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF GENERAL SURGERY,

MALATYA, TURKEY
Introduction:
Extrahepatic biliary trauma with avulsion of the left hepatic duct is less than 1 %
of all traumatic injuries. In this case, a rare condition with a rare surgical therapy is
presented.
Case report:
A 16-year-old girl with traumatic liver laceration (grade V) was referred to our centre
after primer repair to the liver and cholecystectomy were performed in another centre.
The patient re-operated due to worsening abdominal symptoms and the general
situation. There was no active bleeding but 1500cc bilious and hemorrhagic fluids
were aspirated. A complete rupture to the left bile duct at bifurcation was observed.
Primary anastomosis was chosen because of minimal tissue loss of bile duct and
hemodynamic stability of the young patient. The posterior wall of the anastomosis
was performed continue and the anterior wall was one by one technique with 6/0
poliprophilen suture over a external feeding catheter which inserted from cystic duct
to the left hepatic duct. The patient is on postoperative 4th month with uneventful.
Conclusion:
Primary end to end anastomosis over the external feeding catheter may perform
safely at the extrahepatic biliary tract injury due to blunt trauma if the patient is
young and hemodynamically stable.
-635-
PP - 435 PANCREATICODUODENECTOMY IN A PATIENT WITH
GASTROENTEROSTOMY AND BRAUN ANASTOMOSIS
NAİL ERSÖZ , İSMAIL HAKKI ÖZERHAN , YAŞAR SUBUTAY PEKER , RAMAZAN YILDIZ ,
YUSUF PEKER

ANKARA TURKEY
Introduction:
Adding Braun anastomosis (BA) between afferent and efferent loops of

gastrojejunostomy at pancreaticoduodenectomy (PD) decreases postgastrectomic
syndromes and increases postoperative quality of life. In this case, we want to
share our experiences about performing pancreatic adenocarcinom surgery
(antrectomy and PD) to a patient with history of ulcer surgery (truncal vagotomy
(TV)+gastrojejunostomy and BA).
Case report:
Antrectomy+PD was performed to a 81 years old female patient having 30 years

history of gastrojejunostomy+BA+TV, because of duodenal ulcer , with the
diagnosis of pancreatic adenocarsinoma. Previous gastrojejunostomy and BA was
kept and antrectomy + pancreaticoduodenectomy + pancreaticojejunostomy +
hepaticojejunostomy was performed. Beside keeping BA at PD, by this way two
anastomosis were performed instead of three. Oral feeding of patient was started
on postoperative 2. day and was discharged on postoperative 7. day without any
complication.
Conclusion:
We belive that, taking and evaluating madical history of patient before surgery is
important for planning present surgery. This may provide the surgeon to develop
alternative techniques resulting decreased postoperative complication and recovery
time as in our case.
-636-
PP - 436 PRIMARY SPLENIC HYDATID CYST: A CASE REPORT
YIGIT DUZKOYLU , OGUZ KOC , YAVUZ SELIM SARI , MELTEM KUCUKYILMAZ ,
MEHMET EMIN GUNES , ALI EMRE NAYCI , VAHIT TUNALI
ISTANBUL EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Introduction:
Cystic disease of the spleen is an uncommon entity with an incidence of 0.07%

in general population.The development of HD in the spleen is uncommon due to
the biological cycle of Echinococcus granulosus.In this study a case of isolated SHD
managed with open splenectomy is presented.
Case report:
A 27-year-old woman was admitted to our clinic with a 6 months of non-spesific

abdominal pain.Physical examination was unremarkable and routine laboratory
tests,including hemagglutination test for HD were normal.Abdominal ultrasound,
computed tomography and MRI examinations showed a 155x112 mm loculated cyst
with a calsified wall on the left quadrant of the abdominal cavity originating from
the spleen.The patient underwent an open splenectomy and she was discharged
home on the 4th postoperative day.Histopathologic results revealed a cystic lesion
with thick calsified wall,being consistent with hydatid cyst.Albendazol was used
postoperatively and patient remains symptom free 2 months after splenectomy.
Conclusion:
Turkey and Eastern Europe are considered endemic regions fort the E.granulosus
complex.SHD usually co-exists with liver hydatidosis, but rarely as in our case is the
spleen solely affected.SHD has no spesific clinical manifestations and the diagnosis
Diagnosis is usually established incidentally during investigation of unrelated
symptoms.
-637-
PP - 437 SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY
VERSUS SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY:
COMPARISON OF LOW COST EFFECTIVE METHODS IN THE
MANAGEMENT OF CHRONIC CALCULUS CHOLECYSTITIS
ABDELHAMID GHAZAL , MAGDY SOROUR , MOHAMED KASSEM
UNIVERSITY OF ALEXANDRIA, FACULTY OF MEDICINE, EGYPT
Background&Aims:
Recent innovators have pioneered the use of single-incision laparoscopic

cholecystectomy (SILS) which is rapidly evolving field as a bridge between traditional
laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES).
SILS has the potential of further reducing the trauma of surgical access. This may
lead to reduced postoperative pain and improved patient cosmoses
Methods:
This study was carried out on 140 patients presenting with chronic calculus
cholecystitis, patients were divided into two groups. Group I SILS using the ordinary
trocars through small supraumbilical incision. Group II SILS using the single port (Tri-
Port access) technique through vertical incision in the umbilicus.
Results:
Out of 140 cases, the operation (SILC) was completed successfully in 125 patients,
63 out of 70 patients (90%) in group I, and 62 out of 70 patients in group II (88.57%).
Conclusion:
Single-incision laparoscopic surgery is a feasible way to perform cholecystectomy,

safe, and reproducible, with better cosmoses. This procedure is a promising
alternative method, with scarless abdominal surgery for the treatment of patients
with gallbladder disease. The use of semi-flexible endoscopic camera system and
crossed-over articulating instruments are needed to overcome the difficulties in
this technique.
-638-
PP - 438 MUCINOUS CYSTADENOCARCINOMA ARISING FROM
INTRHEPATIC BILIARY DUCTS
ABDULHAKIM AL-TAMIMI 1, RAMZI NAGI 2

1
ALWALY TYPICAL HOSPITAL, YEMEN

2
Background&Aims:
The incidence of intrahepatic biliary cystadenocarcinoma is low and the first case
reported by Willes in 1943 since that time about 63 cases had been published in
different medical and surgical journals. Mucin-producing bile duct adenoarcinoma
is a rare neoplasm in the liver and such mucin secretion causes biliary dilatation,
obstructive jaundice and cholangitis.
Methods:
A 75-year –old woman was admitted to Al-wali clinic on 21/10/2007 Right upper
abdominal pain .Fever for one month , Increased in the last 3 days and associated
with chills and rigor and even disturb her sleep Severely tender and rigid abdomen,
Palpable mass She denied any other medical problem except arterial HT and repair
of paraumblical hernia before 20 years Abdominal US Thick wall GB Multiple stones
Hepatmegally with lower anterior aspect inflammtory lesion?? Abscess Trial of
triple antibiotic therapy was given for three days but there is no improvement
Patient was operated
Results:
At the gall bladder bed in the hepatic side a leak of pus was observed and collecting
amount of around 350cc of pus was evacuated During which multiple stones
had been removed from the necrotic cavity in the liver The necrotic cavity was
obliterated by omentum and drained subhepatic
Conclusion:
Mucinous cystaddenocarcinoma of the liver arising from the intrahepatic biliary

ducts is a rare type of hepatic malignancy and this was confirmed by histopathology.
-639-
PP - 439 GALLBLADDER DAUGHTER HYDATID CYST SIMULATING
GIANT GALLBLADDER POLYP
ABDULHAKIM AL-TAMIMI 1, RAMZI NAGI 2, YASSER BA ASHIN 1, MAHMOUD
MAKKI 1

1
ALWALY TYPICAL HOSPITAL, YEMEN

2
Background&Aims:
Hepatic Hyadtid disease is the commonest form of echinococcosis. The right lobe
of the liver is affected in 80% of cases and the left lobe in 20%. The incidence of
rupture into the biliary tree has been reported as 3–17% .
Methods:
A 34 years old man , farmer , healthy and well built . Present with abdominal pain
in the right hypochondrial region associated with yellowish discoloration of the
sclerae ,dark urine and intense pruritus .
Results:
The liver cyst opened and multiple daughter cyst were removed. The communication
with a major biliary duct was identified and small NG tube NO 10 was inserted
and reached to the dudenum The gall bladder was enlarged and tense Thicken wall
Cholecytectomy was done Single big daughter cyst was found ruptured during the
opening of the gall bladder Dark green color possible due to long standing
Conclusion:
Gallbladder hydatid cysts are rare and the mode of entry is via the cystic duct from
the liver where the cyst undergo maturation
-640-
PP - 440 THE EFFECT OF N-ACETYLCYSTEINE ON ANTIOXIDANT
PROTECTIVE VALUES AND ENDOGENIC INTOXICATION IN PATIENTS
WITH OBSTRUCTIVE JAUNDICE OF CHOLELITHIC ETIOLOGY
FARIZ ABDULLAYEV , HIDAYET ISAYEV
M.A. TOPCHUBASHOV RESEARCH CENTRE OF SURGERY OF BAKU, AZERBAIJAN
Background&Aims:
Experimental and clinical evidence have shown that oxidative stress is involved
in development of liver insufficiency in obstructive jaundice. Oxygen radical
production, which increases with clinical progression of obstructive jaundice,
involves increased lipid peroxidation(LP) and endogenic intoxications (EI). The aim
of this study was to assess the level of LP and EI in blood serum from patients
with obstructive jaundice and to study the dynamics of LP and EI in therapy with
5% acetylcysteine of patients with obstructive jaundice compared with another
conservative methods of therapy.
Methods:
The dynamics of LP and EI have been studied in 80 patients before and after
treatment. The patients were divided into three groups: group I comprised 20
patients and received generally accepted basic deintoxication therapy correcting
hepatic function; group II consisted of 30 patients who besides basic therapy
received 20 ml of 5% acetylcysteine; group III consisted of 30 patients and received
basic therapy + 20 ml of Hepa-mertz i.v.
Results:
Our investigation has showed, that although one day before and after the operation
the values of LP and EI in all of the patients was increased, at 7 days of postoperative
therapy the values of LP and EI were decreased relatively in all three groups, but in
patients of group II, who besides basic therapy received 20 ml of 5% acetylcysteine,
the LP and EI values were decreased significantly and in some patients the levels
were even very close to normal values.
Conclusion:
That all show, that one week after postoperative therapy the values of LP and EI
were noticeably reduced in group II as compared with that of other groups. And
we think that this allows us to recommend the use of acetylcysteine in therapy of
patients with obstructive jaundice as antioxidant and hepatoprotective drug.
-641-
PP - 441 HOW SAFE ARE COMBINED LAPAROSCOPIC OPERATIONS?
ALAATTIN ÖZTÜRK 1, HAKAN BOZKURTOĞLU 2, ORHAN ŞAHIN 3, CENGIZ KAYA 2
1
FATIH UNIVERSITY SEMA HOSPITAL, ISTANBUL, TURKEY
2
CENTRAL HOSPITAL, ISTANBUL, TURKEY
3
ERDEM HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
We aim to prove that combined laparoscopic surgeries can be done safely in a

single session.
Methods:
In our study, the medical data of 15 patients who underwent combined

laparoscopically for multiple diseases were retrospectively evaluated. Patients were
evaluated for operations, complications and the need for additional ports.
Results:
15 patients were enrolled in this study. The study included patients requiring
surgery for different organs. Combined laparoscopic surgery was performed on 7
patients according to preoperative diagnoses, and 8 patients were operated due
to additional pathology during surgery. The various surgeries included laparoscopic
cholecystectomy (LC) along with laparoscopic appendectomy (LA) in 6 patients,
LC with tubal ligation in 2 patients, LC with laparoscopic Nissen fundoplication
(LNF) in 2 patients, LA with laparoscopic appendicectomy in one patient, LA with
laparoscopic excision of Meckel diverticulitis in one patient, LC with repair of
insicional hernia in one patient, LC with overial cystotomy in one patient, LC + LNF
with partial excision of omentum in one patient. 3-5 ports were used for operations
according to the preferences of surgeons. Four patients required an additional
port for combined surgery. Wound infection appeared in only one patient and was
managed by drainage and antibiotic treatment.
Conclusion:
In conclusion, combined laparoscopic surgery can be performed safely without

complications.
-642-
PP - 442 RELAPAROSCOPY IN MINOR BILE LEAKAGE AFTER
LAPAROSCOPIC CHOLECYSTECTOMY: IS AN ALTERNATIVE
APPROACH?
ALI REZA BARBAND
TABRIZ MEDICAL UNIVERSITY, IRAN
Background&Aims:
Bile leakage is the most important complication of laparoscopic cholecystectomy

and it has been recognized as a major clinical challenge during the last two decades.
Although endoscopic intervention is widely accepted in management of the bile
leakage, relaparoscopy permits the bile drainage adequately and gives direct
control of bile leakage site in selected patients.
Methods:
Data for patients with minor bile leakage after laparoscopic cholecystectomy were
collected from January 2001 to January 2010. Patients were categorized in 2 groups,
nonoperative and relaparoscopy. Clinical presentation, kind of management, and
outcomes were evaluated in 2 groups.
Results:
After a total of 2652 laparoscopic cholecystectomies, postoperative minor bile

leakage occurred in 17 (0.64%) patients. Four patients with minimal leakage
were managed by percutaneous drainage alone. Endoscopic retrograde
cholangiopancreatography was applied to 4 patients with jaundice, high output
bile fistula, and a patient with retained CBD stone. Bile leakage was controlled in
3 of the 4 patients. There were 9 patients in the relaparoscopic group to which 1
patient was added after unsuccessful endoscopic intervention. The source of bile
leakage in the relaparoscopic cases was defined as 50%from cystic duct stump
and 50%from Luschka or accessory ducts. The success rate of bile leakage control
after relaparoscopy was 90%. The mean of hospital stay after relaparoscopy was 3
days (range, 2–10 d) and after endoscopic retrograde cholangiopancreatography
intervention or percutaneous drainage was 10 days (range, 3–28 d).
Conclusion:
Relaparoscopy is an effective procedure in the management of minor bile leakage

after laparoscopic cholecystectomy and can be an alternative approach in selected
situations.
-643-
PP - 443 TRANSDUODENAL AMPULLECTOMY FOR A VILLOUS
ADENOMA AND A PERSPECTIVE OF ITS SURGICAL TECHNIQUE
ALİ AKTEKİN 1, SELVİNAZ ÖZKARA 2, CAN GÖNEN 3
1
HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL GENERAL
2
HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL PATHOLOGY
3
HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL
GASTROENTEROLOGY DEPARTMENT, ISTANBUL, TURKEY
Background&Aims:
Ampullary adenomas are precancerous lesions. Complete resection is required

with either endoscopic or surgical techniques. Here, we described a patient with
an ampullary adenoma, which was not suitable for endoscopic resection, and we
discussed the techniques of surgical transduodenal ampullectomy.
Methods:
A 64-year-old female patient admitted with an ulcerated 16x13 mm hypoechoic

ampullary polypoid lesion with high grade dysplasia without infiltration into the
muscularis propria layer reported on endosonographic examination. During
surgery, absorbable 4-0 and 5-0 polydioxanone were used to approximate bile
and pancreatic duct to the medial duodenal wall and the common wall of the bile
and pancreatic ducts. We did not use any stents for bile and pancreatic ducts. The
defect in duodenum was bigger than the sum of bile and pancreatic duct sizes and
this defect lateral to anastomosis was closed with 4-0 polydioxanone.
Results:
Visualization of biliary and pancreatic drainages confirmed patency of both ductal

systems. They were 12 mm and 6 mm in diameters. Patient had no abnormalities
related to obstruction of biliary and pancreatic ducts and discharged at the
postoperative eight day.
Conclusion:
Transduodenal ampullectomy with a safe margin is an accurate and safe treatment

for villous adenomas of the papilla.
-644-
PP - 444 ULTRASONOGRAPHY IN STUDYING OF EFFICIENCY OF
CORRECTION CHRONIC DUODENAL IMPASSABILITY AT BILE STONE
¬ DISEASE
ANAR YUSUBOV
SCIENTIFIC CENTER OF SURGERY, AZERBAIJAN
Background&Aims:
Along with the reasons calling development in postoperative period

postcholesistektomic sindrome important value it is taken away to infringements of
a functional status of a stomach and a duodenum studying of ultrasonic research in
diagnostics chronic duodenal impassability
Methods:
In a job basis complex studying of results of treatment of 23 patients ¬ operated

apropos желчнокаменной of illness with accompanying chronic duodenal with
impassability since 2007 on 2011 years
Results:
Considering availability and high informatively of transabdomenal ultrasonic

research duodenogastral a reflux, the given method can be applied with success
to dynamic studying of efficiency of the offered methods of treatment chronic
duodenal impassability.
Conclusion:
ultrasonography as the noninvasive method is effective in diagnostics chronic

duodenal impassability
-645-
PP - 445 GASTROINTESTINAL STROMAL TUMORS IN PANCREATIC
TAIL, WITH LITERATURE REVIEW.
ASEM GHASOUP , OMAR SADIEH , AHMAD MANSOOR
AL BASHIR HOSPITAL, M.O.H, JORDAN
Background&Aims:
Gastrointestinal Stromal tumors are CD117 (C-Kit) positive mesenchymal neoplasms

originate from the interstitial cells of Cajal. Gastrointestinal Stromal T tumors
have been described outside the gastrointestinal tract however; pancreatic extra-
gastrointestinal stromal tumors are extremely rare we report a case of primary
extra-gastrointestinal stromal tumor (EGIST) in the pancreatic tail.
Methods:
A 66-year-old male patient presented with abdominal distention, mild abdominal

pain, anemia and weight loss over the last two month, Abdominal examination
reveal central large firm mass is palpable, Routine laboratory investigations were
within normal limits except for severe anemia, Ultrasonographic examination of the
abdomen showed Huge central heterogeneous abdominal mass, and Gall bladder is
absent (cholecystectomy)
Results:
Ultrasound-guided fine needle aspiration (US-FNA) was performed on the mass of

the pancreas A cytological diagnosis of pancreatic malignant mesenchymal neoplasm
was made. The final diagnosis of primary pancreatic extra-gastrointestinal stromal
tumor was confirmed by histopathological examination and immunohistochemical
findings (CD117 positivity).patient treated with distal pancreatectomy with Imatinib
protocol.
Conclusion:
We report unusual case of pancreatic extra-gastrointestinal stromal tumor which

was diagnosed by US-FNA cytology. Although it’s uncommon in the pancreas, extra-
gastrointestinal stromal tumors should be considered in the differential diagnosis of
solid and cystic pancreatic masses on cytology.
-646-
PP - 446 SINGLE-INCISION LAPAROSCOPIC CHOLECYSTECTOMY
WITH CONVENTIONAL LAPAROSCOPIC INSTRUMENTS: A
SURGEON’S INITIAL EXPERIENCE
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, ISA SOZEN 1, GULSUM
TOZLU 1, RECEP CETIN 1
1
2
ISPARTA, TURKEY
Background&Aims:
Since early nineties, laparoscopic cholecystectomy has become gold standard for
cholecystectomy. Also, a high tendency of minimizing surgical trauma encourages
the use of new approaches in laparoscopic surgery Single-incision laparoscopic
surgery (SILC) is a rapidly evolving field as a bridge between traditional laparoscopic
surgery and natural orifice transluminal endoscopic surgery
Methods:
A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.
A 12-mm trocar was placed through an open approach, and the abdominal cavity
was explored with a 10-mm laparoscope. One each 10 mm and 5-mm ports were
inserted laterally from the laparoscope port.
Results:
There were seven women and two men with a mean ge of 47 years (range: 30-60
years) BMI, 27.4 kg/m2 (22-30). Not required open cholecystectomy. Mean operative
time was 83.5 min (60-110). Length of stay was only one day. All procedures were
completed successfully without any perioperative and postoperative complications.
In all cases, there was no need to extend the skin incision
Conclusion:
Our results suggest that Single-incision laparoscopic cholecystectomy is feasible,

safe and effective and a promising alternative method to four-port and SILSport
laparoscopic cholecystectomy and as scarless abdominal surgery for the treatment
of some patients with gallbladder disease with standard laparoscopic instruments.
-647-
PP - 447 RELATION BETWEEN SEROLOGY AND GROW-UP TIME IN
ATYPICALLY LOCALIZED HYDATIC CYSTS
AHMET OKUŞ , BARIŞ SEVINÇ , SERDEN AY. , ÖMER KARAHAN , MEHMET ALI
ERYILMAZ , CEMIL ER.
KONYA TRAINING AND RESEARCH HOSPITAL, KONYA, TURKEY
Background&Aims:
Hydatic cyst is a parasitic disease caused by the larvas of ecchinococcus granulosis.

In the study, the aim is to evaluate the relation between serology and grow-up time
in atypically localized cysts.
Methods:
Retrospectively, all the patients with hydatic disease in between December 2004
and May 2012 were screened from hospital database. Hydatic cyst localization
other than liver and lungs were accepted as atypical localization.
Results:
There were 325 patients with a diagnosis hydatic disease. Most common
localizations of the cysts were liver (72.8%) and lungs (21%). Atypically localized
cyst rate was 6.4% (n: 21). Most common atypical localization was spleen (2.4%).
80.9% of atypically localized cysts were primary cases. In 3 cases with primary
intramuscular hydatic cyst and 2 cases with primary subcutaneous hydatic cysts
serology was negative.
Conclusion:
The relation between the hydatic cyst and the host is the main factor in serological
tests and grow-up time. In tissues with a weaker cellular immunity like muscle
and subcutaneous tissue, serology tends to be negative and grow-up time to be
faster. In atypically localized cysts hematogenous dissemination cannot explain the
pathogenesis fully. Therefore, lymphatic dissemination should be kept in mind.
-648-
PP - 448 A CASE OF GIANT HEMANGIOMA OF LIVER WITH
KASABACH-MERRITT SYNDROME IN THE ADULT
BYUNGGWAN CHOI , HEEJOON KIM , CHOONGYOUNG KIM , SEUNGHYUN CHO ,
YOUNHHOE HUR , CHOLKYOON CHO
CHONNAM NATIONAL UNIVERSITY HOSPITAL, KOREA
Background&Aims:
Kasabach-Merritt syndrome(KMS) is one of serious complication of giant

hemangioma. KMS is very rare and characterized by consumptive coagulopathy
with mortality rate ranges between 10 and 37%. Majority of KMS develop in
pediatric patient less than 1 year, but rarely adult KMS develop in association with
giant hemangioma.
Methods:
A 25-year-old woman was admitted to our institution because of abdominal

discomfort, and low extremity edema that have been present for 1 month. Abdominal
CT revealed a 34.2×20.7 cm sized cystic mass containing enhanced internal septa
and solid portion in right lobe of liver. The clinical impression was a malignant
liver tumor, such as embryonal sarcoma of liver or biliary cystadenocarcinoma.
Laparotomy was performed after careful preoperative preparation.
Results:
In operative findings, a huge liver tumor measuring more than 30 cm involving

segments 5~8 containing old blood and hematoma was found and right
hemihepatectomy was performed. In macroscopic findings, the specimen revealed
a huge, well-demarcated spongy tumor measured 22×12 cm with multi-septation.
The microscopic findings showed blood-filled spaces lined by a single layer of
flat endothelial cells supported by a basement membrane. The final pathologic
diagnosis was cavernous hemangioma of the liver.
Conclusion:
The present case was diagnosed that there was giant liver hemangioma which was
complicated by spontaneous bleeding due to consumptive coagulopathy associate
with KMS.
-649-
PP - 449 TREATMENT OF BUDD-CHIARI SYNDROME BY
TRANCARDIAC MEMBRANOTOMY: CASE REPORT
CIHANGIR AKYOL , AKIN FIRAT KOCAAY , EBRU ESEN , ERKIN ISMAIL , SELCUK
HAZINEDAROGLU
ANKARA UNIVERTSITY SCHOOL OF MEDICINE SURGERY DEPARTMENT, ANKARA,

TURKEY
Background&Aims:
Budd-Chiari Syndrome, is a vascular obstructive disease which ranges from small

hepatic vein branches to atriocaval junction.
Methods:
34 year old female patient has applied to our hospital with lower extremity edema
and abdominal swelling complaints. The biochemical examination revealed an
increase in liver function tests. Severe chronic liver disease was determined in liver
biopsy. In inferior vena cavagraphy chronical obstruction in the atricaval junction
and finding associated with membranous web.
Results:
After sternotomy, inferior vena cava from atrium through abdomen was explorated
and a membranous web is detected in suprahepatic inferior vena cava. After obtaining
control over intraabdominal vena cava inferior by laparotomy, membranotomy
is performed by finger fracture and dilated balloon catheter through atrium. The
patient is alive without any complaints in the 1st year.
Conclusion:
Membranous webs are considered to be congenital, recent evidence suggest that

they are sequel of thrombus. Medical treatment includes anticoagulation and
control of findings. Angiography and stenting is becoming more available technology
evolves. Although the role of the shunt surgery is currently available, the place of
surgical shunt is not clear. In case of fulminant failure and chronic cases of cirrhosis
liver transplantation should be considered.
-650-
PP - 450 MESOHEPATECTOMY : AN EMERGING TECHNIQUE
DEEVISH N D , ABHAY KATTEPUR , SHIVASWAMY B S , RAJASHEKARA BABU
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, INDIA
Background&Aims:
Mesohepatectomy is also known as Central Hepatectomy, Middle Lobectomy or

Middle Hepatic Resection. It is a rare procedure done for centrally located liver
tumors, gall bladder cancers and hilar cholangiocarcinomas. Our objective was to
review of surgical technique and post operative outcome of mesohepatectomy for
hepatocellular carcinoma.
Methods:
54 year old male came with history of pain in the right upper abdomen since 6
months. O/E: tender hepatomegaly 8 cm below the right costal margins. Liver firm
with sharp borders. CT showed large well defined heterogeneously enhancing mass
lesion occupying segments IV, V and VIII with non enhancing hypodense areas
within suggesting necrosis.
Results:
This technique was first developed by McBride and Wallace in 1972.An anatomic
mesohepatectomy is performed by en bloc resection of segments IV, V and VIII
while preserving the right posterior and left lateral sectors as well as caudate
lobe. Advantages are improved functional outcomes; oncologically equivalent to
extended resections; lower rates of complications and short post operative period.
Conclusion:
Mesohepatectomy is an emerging technique that was found to be efficacious in

well circumscribed, centrally located tumors of liver with the advantage of avoiding
unnecessary resection of functioning liver tissue.
-651-
PP - 451 APPROACH TO THE LIVER ABSCESS DUE TO ERCP:
DISCUSSION OF A CASE
DENIZ TIHAN 1, UĞUR DUMAN 1, FATIH EROL 1, NIZAMETTIN DEMIRCI 1, AHMED
TAHA 1, MURAT POLAT 1, YIĞIT MEHMET ÖZGÜN 2
1
2
YÜKSEK İHTISAS TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
Background&Aims:
Choledocholithiasis is the most common cause of obstructive jaundice. Nowadays,

considering its advantages, endoscopic retrograde cholangiopancreatography
(ERCP) is choosen as the first diagnostic and therapeutic approach in such cases.
Methods:
A 77 year-old-male was admitted to the emergency room with complaint of

jaundice. Ultrasound examination revealed choledocholithiasis. Sphincterotomy
with ERCP was performed. During his clinical follow-up, a progressive increase
in CRP and intermittent fever without leucocytosis was occured. Computerised
tomography showed a dense fluid loculation in left liver lobe with 10 cm diameter.
Percutanous drainage was performed but an adequate drainage was not achieved.
Thus, open surgical drainage and cholecystectomy was carried out.
Results:
The patient was discharged on his 6th postoperative day with oral antibiotherapy.
He has not any medical problem during his follow-up.
Conclusion:
The role of ERCP is undeniable for the diagnose and treatment of obstructive icterus.
However, the canulation of bile duct and radiocontrast agent injections may cause
ascendent bacterial infections which can lead cholangitis and even intrahepatic
abscess. An agressive antibiotherapy and percutanous and/or surgical drainage
should be required in almost every patient.
-652-
PP - 452 PRIMARY INTRA-ABDOMINAL HYDATID CYST CASES WITH
EXTRA-HEPATIC LOCALIZATION
EBUBEKIR GÜNDEŞ , TEVFİK KÜÇÜKKARTALAR , MURAT ÇAKIR , FARUK AKSOY , ALİ
BAL , ADİL KARTAL

GENERAL SURGERY, KONYA, TURKEY
Background&Aims:
We analyzed the cases of patients who had been surgically treated because of
extra-hepatic primary intra-abdominal hydatid cysts alongside with literature.
Methods:
The medical data of a total of 22 patients who had been treated at our clinic
between 2006 and 2012 because of extra-hepatic primary intra-abdominal hydatid
cyst were analyzed retrospectively.
Results:
While 16 of the patients were female, 6 were male, and their mean age was 44.5
(26-75). The cyst was most frequently seen in the spleen (n=8). Computerized
tomography (CT) assisted pre-op diagnosis in 19 patients but 3 patients were
diagnosed intra-operatively. All the patients had elective surgical procedures. The
most frequently performed surgical procedure was the total or partial resection
of the cyst with the organ it was localized in. Two patients contracted surgical site
infections. No recurrences or mortality was seen in the 36-month follow-up of the
patients.
Conclusion:
The fact that echinococcus granulosus can involve every organ should always be
remembered. Although no hydatid cysts were seen in the liver or the lungs, all the
other systems should be examined carefully according to the complaints of the
patient. Hydatid cysts should be considered, especially in endemic areas, in the
differential diagnosis of cystic masses with intra-abdominal localization.
-653-
PP - 453 LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY PATIENTS
ERDINC KAMER 1, MUSTAFA PESKERSOY 1, TURAN ACAR 1, OGUZ
HANCERLİOGULLARI 2, MEHMET HACIYANLI 1, ERCÜMENT TARCAN 1
1
2
IZMIR ARMY HOSPITAL, IZMIR, TURKEY
Background&Aims:
The use of laparoscopic cholecystectomy (LC) in older patients may pose problems
because of the comorbid conditions that are concomitant with advanced age and
may increase the postoperative LC complications and the frequency of conversion
to open surgery. The purpose of this study was to evaluate the outcome of LC in the
treatment of gallstones in the elderly (≥75 years old).
Methods:
The medical records of 1180 consecutive patients undergoing LC were reviewed.

The patients were divided into two groups based on age: group 1, patients younger
than 75 (n=1027) and group 2, patients 75 years or older (n=153).
Results:
Conversion rate to open cholecystectomy in elderly was 3.1% vs 0.1% (p<0.001).

Complication rate was 3.9% vs 1.1%. No significant difference was found in the
hospital stay of both younger and elderly patients who had underwent a successful
LC (p=0.079). The presence of inflammation was the only independent risk factors
for conversion (p=0.01) and had a marginal independent effect on the development
of complications (p=0.052) among elderly patients.
Conclusion:
This study has shown that LC can be performed safely at advanced age. However,
the presence of inflammation is the main factor which influences the adverse
outcome of LC in the elderly population.
-654-
PP - 454 LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH
PREVIOUS ABDOMINAL SURGERY
ERDINC KAMER , MUSTAFA PESKERSOY , TURAN ACAR , CENGIZ TAVUSBAY ,
MEHMET HACIYANLI

Background&Aims:
Previous abdominal surgery has been reported as a relative contraindication

to laparoscopic cholecystectomy. This study specifically examined the effect of
previous intraabdominal surgery on the feasibility and safety of laparoscopic
cholecystectomy.
Methods:
This study included 1180 patients with gallstones who underwent laparoscopic
cholecystctomy at 4. Surgical Department between 2006-2010.
Results:
Of the 1180 study patients 244 (%26.3) had undergone previous abdominal surgery
(192 women, 52 men;age,20 years to 89 years; mean age 51.2):58 (%23.8) upper
and 186(%76.2) lower abdominal operations. We compared the operative time, the
type of trocar that was used, the postoperative complications, the frequency of
open conversion and the length of the postoperative hospital stay between the
two groups. Patients with previous upper abdominal surgery had a longer operating
time (55.3±16.2 min),a conversion rate (1.6%), incidence of postoperative wound
infection (0.1%), and a postoperative stay (1.8±2.3 days).There was no significant
difference in the the major postoperative complication rate and the length of the
postoperative hospital stay.
Conclusion:
Previous abdominal operations, even in the upper abdomen, are not a

contraindication to safe laparoscopic cholecystectomy. However, previous upper
abdominal surgery is associated with an increased need for adhesiolysis, a higher
open conversion rate, a prolonged operating time, and a longer postoperative stay.
-655-
PP - 455 PANCREATIC CARCINOSARCOMA: CASE REPORT AS A RARE
TYPE OF PANCREATIC NEOPLASIA.
ERKAN OYMACI , ALI COŞKUN , DENIZ UÇAR , ERDEM CARTI , NAZIF ERKAN ,
LEVENT GENÇ , MEHMET YILDIRIM
IZMIR BOZYAKA TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY

DEPARTMENT, IZMIR, TURKEY.
Background&Aims:
Carcinosarcoma of the pancreas is a rare entity comprising a small subset of all

pancreatic neoplasms. Diagnosis is usually established by immunohistochemical
examination of the resected specimen. Prognosis is limited to several months
after resection. We review the current literature on this rare type of neoplasia,
considering histopathological and clinical features.
Methods:
A 66-year-old male was admitted to our hospital suffering from abdominal pain.
An abdominal computed tomography scan showed a cystic mass in the head of
the pancreas. An extended pancreaticoduodenectomy was performed and the
patient was discharged from hospital postoperative 12th day. The patient died
postoperative 20th day due to gastrointestinal bleeding complication.
Results:
The pathologic findings revealed areas of both adenocarcinoma and sarcoma of the
pancreas. The adenocarcinomatous areas localized to the tumor within the head of
the pancreas whereas the sarcomatous areas localized to regions of the intraductal
component.Adenocarcinomatous components infiltrated the peri pancreatic fat
and duodenal wall. Two of sixteen peri pancreatic lymph nodes showed a metastasis
of the adenoid component.
Conclusion:
Carcinosarcoma of the pancreas is a rare disease having a dismal prognosis. To our

knowledge, this carcinosarcoma is the tenth reported case of a primary pancreatic
neoplasm with mixed carcinomatous and sarcomatous components.
-656-
PP - 456 GALLBLADDER PERFORATION AFTER LIVER BIOPSY
MUSTAFA TANRISEVEN 1, ALİ KAGAN COSKUN 1, EYUP DURAN 2, ERKAN OZTURK 1,
YUSUF PEKER 1
1
TURKEY
2
ELAZIG MILITARY HOSPITAL, ELAZIG, TURKEY
Introduction:
Ultrasonography, computed tomography and magnetic resonance imaging facilities

are frequently used in diagnosis of chronic liver disease but necessity of liver biopsy
is not eliminated. We presented a case who was considered HBV enfection and was
performed liver needle biopsy for diagnosis and acute abdominal pain was occured
after biopsy.
Case report:
A 25 years old male patient had received a percutaneous liver biopsy to evaluate the
HBV enfection prediagnosis. After biopsy he suffered abdominal pain with vomiting.
Exploration revealed perforation of gallbladder. Cholesistectomy was performed.
The patient was uneventful afterward and discharged eight days after procedure.
Conclusion:
Abdominal pain is important after percutaneous liver biopsy. If pain is progressed

and physical examination and blood samples is changed, complication of procedure
must be in our mind. We mustn’t delayed treatment of these cases. Otherwise
morbidity and mortalite can increase.In conclusion patient follow outpatient
after percutaneous liver biopsy. So they can admit our emergency room with
complications. We must keep in our mind that gallbladder perforation can be
occured after biopsy and bilier peritonitis and sepsis can be occured. We must
diagnose this patients as early as we can do.
-657-
PP - 457 ULTRASOUND-GUIDED CHOLESISTOSTOMY IS A SAFE AND
EFFECTIVE ALTERNATIVE IN CRITICALLY ILL PATIENTS WITH ACUTE
CHOLECYSTITIS, CASE REPORT
MUHARREM OZTAS 1, ALI KAGAN COSKUN 2, EYUP DURAN 3, NAZIF ZEYBEK 2,
YUSUF PEKER 2
1
MEVKI MILITARY HOSPITAL GENERAL SURGERY DEPARTMENT, ANKARA, TURKEY
2
TURKEY
3
Introduction:
The standard treatment for acute cholecystitis is cholecystectomy; however,

cholecystectomy for some patients has too high-risk for emergency surgery.
Ultrasound-guided percutaneous cholecystostomy is an alternative. We report a
patient who was treated with ultrasound-guided percutaneous cholecystostomy
for treatment of acute cholecystitis.
Case report:
A 80-year-old male patient was admitted to our hospital because of an right upper
quadrant pain associated with nausea and vomiting. He was diagnosed with acute
acalculous cholecystitis with sepsis. A percutaneous cholecystostomy using a
transhepatic approach was performed. After patient recovered sepsis, laparoscopic
cholesistectomy was performed. Patient didn’t have postoperative complication
Conclusion:
Ultrasound-guided percutaneous cholecystostomy is safe and easy method for

treating acute cholecystitis in critically ill patients.
-658-
PP - 458 PREOPERATIVE CLINICAL PREDICTORS OF
CHOLEDOCHOLITHIASIS COMPARED TO RADIOLOGICAL IMAGING
FIRAT TUTAL 1, BORA KOC 1, SERVET KARAHAN 1, GOKHAN ADAS 1, HAKAN
GUVEN 2, AYHAN OZSOY 1
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY

1
BAGCILAR TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY

2
Background&Aims:
Common bile duct (CBD) stones can cause serious morbidity or mortality, and
evidence for them should be sought in all patients with symptomatic gallstones
undergoing cholecystectomy. ERCP and laparoscopic common bile duct exploration
(LCBDE) are safe and efficient methods that are recently used for the treatment of
bile duct stones
Methods:
A total of 392 consecutive patients which were treated for CBD stones from 2007
June to 2011 June were taken into analysis retrospectively in Okmeydanı Training
and Research Hospital. Previous and current clinical history and radiological indices
were used to assess the need for preoperative evaluation of the CBD.
Results:
MRC or US evaluation was normal in 36 (%9.2) patients, which had a history

of suspected choledocholithiasis and cholangiography were performed. CBD
stones were detected in 13 (%36.1) patients with cholangiography and LCBDE
was performed. There was no evidence of choledocholithiasis diagnosed by US
in 27 patients. 13 patients had a history of dark urine whose US was normal in
preoperative evaluation and CBD stones were found in 8 of these patients.
Conclusion:
Clinical history consist of fever, right upper quadrant pain, itching and dark urine
have specificities for CBD stone suspicious. When these examinations were taken
in combination, however, they were 100% specific in excluding choledocholithiasis
-659-
PP - 459 METABOLIC AND INFLAMMATORY RESPONSES AFTER ERCP
PROCEDURE AS A MINOR SURGERY
GOKHAN ADAS 1, AHU KEMIK 3, MINE ADAS 2, EMIN GURBUZ 1, BORA KOC 1, FIRAT
TUTAL 1, ADEM AKCAKAYA 4, SERVET KARAHAN 1
1
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF SURGERY,
ISTANBUL, TURKEY
2
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF
ENDOCRINOLOGY, ISTANBUL, TURKEY
3
ISTANBUL UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF BIOCHEMISTRY,
ISTANBUL, TURKEY
4
BEZMIALEM VAKIF UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF SURGERY,
ISTANBUL, TURKEY
Background&Aims:
We aim to evaluate the metabolic and inflammatory responses after ERCP procedure
in patients who have common bile duct stones
Methods:
Between September 2009 and October 2010, we studied prospectively 50 patients
who diagnosed with common bile duct stones. Our study was included patients
who had previously been suspected with common biliary duct stone via radiological
and biochemical examinations. We investigated parameters of proinflammatory
cytokines , anti inflammatory cytokines , stress hormones and acute phase reactan
. All venous blood samples were taken firstly 1hr before endoscopic intervention as
a control. After ERCP procedure, venous blood samples were taken two more times,
the first in 1hr, the second in 24 hours.
Results:
50 patients who had performed successfully ERCP procedure due to common bile
duct stones. All of them had higher serum cytokine levels (p< 0.01) after ERCP
procedure than before endoscopic intervention. Also we didn’t find any differences
IL-13 level in cytokines 24 hour after ERCP. A significiant differences (p<0,01) were
found in hormones of ACTH, cortizol, GH, aldesterone levels 1h after ERCP and 24h
after ERCP except GH level (p>0.05). There was significiant differences CRP level in
early and late time after ERCP procedure.
Conclusion:
ERCP procedure is a kind of invasive attempt as known, also causes, with its effects,
systemically inflammatory response in the body. This response, mostly not staying at
the local stage, becomes systemic inflammatory response. Therefore, before ERCP is
performed, the applications of other non-invasive methods of diagnosis are strongly
advised.
-660-
PP - 460 LIVER TRANSPLANTATION TO GIANT PRIMARY HEPATIC
NEUROENDOCRINE TUMOR
HAKAN SOZEN , UTKU YILMAZ , AYDIN DALGIC
TRANSPLANTATION CENTER, GAZI UNIVERSITY, ANKARA, TURKEY
Background&Aims:
Liver metastatic or primer hepatic Neuroendocrine tumors are amenable to various

therapeutic modalities including liver transplantation (LT).
Methods:
Case: 45 years old woman, from another country, suffers from dyspepsia, weight
loss and early satiety. She underwent blood analysis, it revealed, gamaglutamyl
transferase and alkaline phosphatase as high as 1172 and 369 respectively. She was
cachectic and gross hepatomegaly detected in physical examination. The tumor had
been accepted as unresectable from another centerand admitted to our center.
Liver biopsy was performed and sample was consisted with NET type I, Ki67 1%.
Histology revealed trabeculated pattern coexisting PGP 9.5 cytokeratin-19 and
CD56 positivity and chromografin low positivity. Also CEA, HCC, Insulin, Gastrin,
TTF-1 and CDX-2 staining were negative. The pathology yielded primary liver NET or
metastasis of pancreatic NET. PET CT was performed and no tumor other than liver
was founded. Endoscopic ultrasound did not find any pathology.
Results:
We considered her for living donor liver transplantation based on unresectable

primer liver NET, no extrahepatic disease and well-differentiated tumor (Ki67 < 10%)
reasons. After her older brother was prepared for living donor liver transplantation,
right lob liver transplantation was succesfully performed. Liver specimen revealed
same with the pre-surgical biopsy. No lymph node metastasis was found in the
hilum of the liver. She has been doing very well free of metastasis 2 years after
surgery.
Conclusion:
The use of LT for NET is controversial. As organs are in short supply, it is important
to select patients who are most likely to benefit from this demanding procedure.
Beyond the consensual criteria, i.e., it has been shown that the use of stringent
criteria to select patients for LT could achieve spectacular overall and disease-free
survival rates.
-661-
PP - 461 OUR EXPERİENCE OF LAPAROSCOPİC CHOLECYSTECTOMY
HALIL KORAY SEZER , MEHMET LEVENT CAN
BALIKESIR MILITARY COMMUNITY HOSPITAL, BALIKESIR, TURKEY
Background&Aims:
Laparoscopic cholecystectomy is a safety, efficacy, established method for the

treatment of symptomatic gallstone disease. We aim to share traditinal laparoscopic
cholesistectomy experince and complications that treated with experienced
surgeons in small community hospitals.
Methods:
This study performed during the period of January 2009 and December 2011 in
our 100 bed community hospital. We analyzed retrospectively 105 patients, who
operated elective by two surgeon whose experiences were closely. We compared
demographic data, operation time and reason of converted from laparoscopic to
open cholecystectomy and complications.
Results:
105 patients investigated retrospectively. Mean age was 42,6 (range: 24-72).
Hypertension was found in 18 patients (17.1%) , Diabetes mellitus was found in
48(54.5%), hypercholesterolemia was established in 13 (12.3%) and COPD was found
in 4 patients (3.8%). The operation was performed using 3 port in 35 patients (33.3%).
İntra-abdominal drain was placed in 22 patients (20.9%). ERCP was performed
preoperatively in 5 patients (4.7). One patient (0.9%) had undergone previously
upper abdominal surgery and 15 (14.2%) patients had undergone previosly lower
abdominal surgery. We convert open cholecystectomy in 2 (1.9%) patients, due to
bleeding. Acute pancreatitis was developed in 1 patient in postoperative 6 days and
the patient was transferred to the advanced center.
Conclusion:
Laparoscopic cholecystectomy should be performed seamlessly in small community

hospitals with patient selection. We believe that it will be benefical in terms of
patient morbidity and mortality.
-662-
PP - 462 GIANT HEPATIC AND SPLENIC HYDATID CYST AS A CAUSE
OF PARTIAL OBSTRUCTION STOMACH
H. HASAN ABUOGLU , CENGIZ ERIS , M. KAMIL YENER , EMRE GUNAY , ERKAN
OZKAN , H. MEHMET ODABASI , Z.GAMZE KILIÇOGLU
HAYDARPAŞA NUMUNE EĞITIM VE ARAŞTIRMA HASTANESI, ISTANBUL, TURKEY
Introduction:
Hydatidosis, caused by Echinococcus granulosus is still an important problem in

endemic areas as Middle and Eastern Europe including Turkey, South America,
Avustralia, New Zealand and South Africa. Giant hydatid cysts are considerably rare
even in endemic areas. We describe a case of an highly great hydatid cyst of the
liver that was causing massive compression of the adjoining organs, giving rise to a
subocclusive syndrome of the intestine.
Case report:
An 38-year-old male presented in our department with a 8 week history of a

non-specific abdominal pain, womiting and weight loss. The examination found a
epigastric mass, splenomegaly, BMI: 19.8 kg/m2, Abdominal ultrasonography and
CT-scan study showed a huge complex mass in the left hepatic lobe, splenomegaly
and upper pole of the left kidney cystic mass (6 cm). Routine laboratory tests
were within normal limits. Immunoblot assay for Echinococcus was positive. After
discussing the high risk of postoperative complications, the patient agreed to
undergo surgery. We performed a total open cyst pericystectomy; extracted the
fluid, and instilled hypertonic saline, splenectomy and partial nephrectomy.
Conclusion:
Echinococcal cysts are usually found in the liver (60%–70% of cases), lungs (10%–
25%), and less frequently involved anatomical locations such as spleen, renal, brain
and heart. Giant hydatid cysts are extremely rare. The treatment options for hydatid
cyst of the liver depend on stage, localization, size, and complications of the cysts
and include nonoperative and operative methods. In conclusion, hydatid cyst with
multiple organ involvement may cause gastric outlet obstruction symptoms like a
liver tumour. Symptomatic cases of this kind, especially in endemic areas, hydatid
cyst should be considered in the differential diagnosis.
-663-
PP - 463 SURGICAL TREATMENT OF PANCREATIC TRAUMA
IGOR KOLOSOVYCH , BORYS BEZRODNYI
NATIONAL MEDICAL UNIVERSITY NAMED AFTER O.BOGOMOLETS, UKRAINE
Background&Aims:
The main reason for the development of complication after pancreatic resection
is the traumatization of the organ after suturing the parenchyma, with the
development of pacreonecrosis.
Methods:
During surgery in cases of pancreatic trauma (34 patients) organ-saving principle of

treatment is used.
Results:
Therefore in contusions, trauma of the pancreas without lesion to the pancreatic

ducts we divide the hematoma with the removal of its contents or hemostas is
followed by the drainage of that part. The peritoneum in that area was not stitched.
The choice of the surgical method of treatment during pancreatic trauma with
lesion to the pancreatic ducts depends on the location. In cases of transerve split
of the pancreas around its tail resection of the distal part of the organ without
spleenectomy was carried out, after which the main pancreatic duct was sutured. If
the split is located in the pancreatic body the proximal part of the main pancreatic
duct is sutured blindly, and on the distal part a pancreatoenteroanastomosis was
fashioned. In cases of pancreatic head trauma drainage of the lesion area and
peripancreatic cellular tissue was used. If a pancreatic fistula developed, the latter
closed after another operative intervention.
Conclusion:
Postoperative mortality was 18%.
-664-
PP - 464 ROLE OF INTRA-OPERATIVE CHOLANGIOGRAPHY
DURING LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENT WITH
CHOLEDOHOLITHIASIS
OLEG KANIKOVSKY , IGOR PAVLYK , OLEKSIY HARCHUK
Background&Aims:
To quantify the frequency of the incidental finding of residual stones in common

bile duct (CBD) after endoscopic intervention on papilla Vateri.
Methods:
A cohort of patients with acute calculi’s destructive cholecystitis and CBD stones
between July 2011 and July 2012 were studied. Before surgery all patient had
endoscopic papillosphyncterotomy (PST) with stones extraction and cholangiography,
after that for a several day underwent laparoscopic cholecystectomy (LC). During
surgery we used ultrasonic dissector to avoid damage of extra hepatic ductal
system. For all patient intra-operative cholangiogram (IOC) were indicated. Residual
stones were extracted through cystic duct (CD).
Results:
The study included 45 patient [median age 51 (36 –75), male : female 17 : 28]. In 21
(46,7%) patients detected 1 stone in CBD, and 24 (53,3%) – more than one (max –
4). All patients at the moment of presentation had a jaundice with average level of
bilirubin 135 mkmoll/l. During LC in 9 (20%) patient in IOC we detect residual stones
of CBD that were extracted with Dormia basket.
Conclusion:
There was no confidence, even after successful adequate PST and endoscopic stone
extraction, in presence of residual stones in CBD. So, all patient after PST indicated
IOC during LC.
-665-
PP - 465 THE EFFECT OF ERCP ON THE RECRRENCE RATE IN ELDERLY
PATIENTS WITH ACUTE BILIARY PANCREATITIS
GURHAN BAS , IBRAHIM ATAK , FATIH BASAK , TOLGA CANBAK , METIN YUCEL ,
ADNAN OZPEK , ISMAIL KABAK , ORHAN ALIMOGLU

Background&Aims:
ABP constitutes the important part of emergency presentations to the surgery

clinics. It was aimed to demonstrate the effect of ERCP on the recurrence rate in
patients over 70 years admitted to our clinic due to ABP.
Methods:
ERCP sphincterotomy was performed in the same admission to the patients over
70 years admitted to our clinic due to ABP between July 2009 and June 2012. The
demographic characteristics and recurrence rates of the patients performed ERCP
and the patients discharged without performing ERCP due to any reason were
compared.
Results:
59 patients over 70 years were admitted to our clinic due to ABP. 42 patients were
female and 17 patients were male. Mean age was 79,78 years. ERCP sphincterotomy
was performed in 22 patients. ERCP could not be performed in 37 patients. While
recurrence was not seen in the patients performed ERCP during average 13.1
months of follow-up, recurrence was seen in 9 patients (24,3%) ERCP not performed
during average 9.7 months of follow-up. The difference was statistically significant
(p<0.05).
Conclusion:
Cholecystectomy and ERCP can be performed to reduce recurrent ABP. ERCP

sfincterotomy might be an effective method to reduce the recurrent biliary
pancreatic events in patients with high risk for general anesthesia
-666-
PP - 466 TWO-PORT LAPAROSCOPIC SURGERY THROUGH A SINGLE
INCISION; 61 CASES
CELALETTIN VATANSEV 1, ILHAN ECE 2, TEVFIK KÜÇÜKKARTALLAR 1, HUSEYIN
YILMAZ 3, MEHMET ERIKOGLU 1
1
NECMETTIN ERBAKAN UNIVERCITY, MERAM FACULTY OF MEDICINE,
DEPARTMENT OF GENERAL SURGERY, KONYA, TURKEY
2
KONYA ANIT HOSPITAL, GENERAL SURGERY, KONYA, TURKEY
3
SELCUK UNIVERCITY, SELCUKLU FACULTY OF MEDICINE, DEPARTMENT OF
GENERAL SURGERY, KONYA, TURKEY
Background&Aims:
This clinical trial was aimed to present the laparoscopic interventions that were
performed for various intra-abdominal organs using two ports through a single
incision.
Methods:
The present study consisted of 61 patients who underwent surgery in the Department
of Surgery. All of the operations were performed using two ports through a single
umbilical incision and suspension-traction suture technique. Cholecystectomies
were performed similar to the standard technique and the gallbladder was removed
through the umbilicus.Splenectomy was performed on three patients with the
assistance of a vascular sealing device. Similarly, appendectomy was performed on
six patients diagnosed with acute appendicitis.
Results:
The operative time was 56 min (Range 35- 90 min) blood loss was negligible. The
mean age of the patients was 44 years. None of patients required a conventional
laparoscopy. Most patients were discharged on the first operative day on oral diet. A
bile leakage and a wound infection were noted at short time follow-up. The surgical
wound healed in all patients with an inconspicuous scar. The main follow-up time
was 12 months, and no hernias developed.
Conclusion:
In this study, the operation duration and the complication rates were similar to
standard laparoscopy, whereas more satisfactory outcomes were obtained with
respect to esthetics and achieved a significant cost advantage with this technique.
-667-
PP - 467 A SUGGESTIBLE TECHNIQUE FOR LAPAROSCOPIC DISTAL
PANCREATECTOMY INVOLVING A LARGE CYSTIC TUMOR
KORAY TOPGÜL 1, S.SAVAŞ YÜRÜKER 2, BÜLENT KOCA 2
1
MEDICAL PARK SAMSUN HOSPITAL, DEPARMENT OF GENERAL SURGERY,
SAMSUN, TURKEY
2
ONDOKUZ MAYIS UNIVERSITY, MEDICAL FACULTY, DEPATMENT OF SURGERY,
SAMSUN, TURKEY
Background&Aims:
The laparsocopic approach is a safe method for the teratment distal pancreatic
tumors. However, large masses may be problemetic in terms of removing of the
tumour from intraabdominal cavity via small incision. In our patient, we determined
a simple solution for extraction of large cystic pancreatic tumour in laparoscopic
technique.
Methods:
A large cystic tumour (size 78x82 mm) was confirmed in CT scan of fifty-year-
old woman patient. We performed laparoscopic spleen-preserving distal
pancreatectomy. After the resection, the mass was placed into the endobag. The
endobag was drawn towards to the abdominal wall. The incision size was not
enlarged. The cyst was cleaned out by an injection syringe when the cyst inside
the endobag. We reduced the tumour size. In this way, we removed the endobag
with diminised cystic mass from small incision easily without additional incision.
Postoperative period was unproblematic.
Results:
Conclusion:
A small abdominal incision for removing the resected tissues can be used by way
of aspirate of cystic content. As a result, laparoscopic distal pancreatectomy can be
performed safely, even for large cystic pancreatic tumors.
-668-
PP - 468 MULTIPLE EPITHELOID HEMANGIOENDOTHELIOMA OF
LIVER: TWO DIFFICULT CASES
KORAY TOPGÜL 1, İLHAN KARABIÇAK 2, MURAT ÇAN 1, MAHMUT FIKRET GÜRSEL 1,
TUĞRUL KESICIOĞLU 2, MURAT DANACI 3
1
MEDICAL PARK SAMSUN HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
SAMSUN, TURKEY
2
ONDOKUZ MAYIS UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGERY,
SAMSUN, TURKEY.
3
ONDOKUZ MAYIS UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF
RADIOLOGY, SAMSUN, TURKEY
Background&Aims:
Hepatic epitheliod hemangioendothelioma (HEHE) is a rare tumor of vascular

origin with unpredictable malignant potential. We present two patients with HEHE,
confirmed histologically, and had disease confined to the liver were treated with
liver resection. HEHEs are rare, with an incidence of one per million population.
There are no clear risk factors for the development of HEHE, although liver trauma,
hormones, vinyl chloride, asbestos may be implicated.
Methods:
Case 1: 62 year-old man diagnosed with HEHE. MRI showed 5 tumors in the
right lobe. Patient was offered both OLT and resection. He preferred resection.
Intraoperative USG showed a total of 11 lesions, size ranging 0.6 to 2.4 cm, which
all were enucleated. Case 2: 52 year-old woman diagnosed with HEHE. MRI showed
6 masses in both lobes. We performed non-anatomic resection for the lesions in
segement 2, 3 and 8 and segmentectomy for segment 1, 6 and 7.
Results:
Conclusion:
Resection or orthotopic liver transplantation are the choice of treatment since the
tumor has malignant potential. Resection can be considered in patients with limited
disease or where liver donor is not available as in our patients. Intraoperative USG
is mandatory in these cases since MRI may not show all tumors.
-669-
PP - 469 A CASE OF GIANT GASTROINTESTINAL STROMAL TUMOR
(GIST) WITH MULTIPLE RELAPSE AND DRUG UNRESPONSIVE
KORAY TOPGÜL , ZAFER MALAZGIRT , MURAT ÇAN , MAHMUT FIKRET GÜRSEL
MEDICAL PARK SAMSUN HOSPITAL, DEPATMENT OF GENERAL SURGERY, SAMSUN,

TURKEY
Background&Aims:
Herein we presented a GIST case that he was operated fourth times because of
recurrence of the disease under high dose imatinib theraphy.
Methods:
Case Thirty-four-year-old man patient was operated for small bowel GIST (7x8
cm) and segmental small bowel resection was carried out in 2007. High risk GIST
(mitosis: 12/50) was reported. He could not received imatinib therapy because of
health insurance did not pay. Two years later he came because of 15x15 cm size
of liver metastasis at the rigth lobe. We performed non-anatomic resection for it.
The oncology department started imatinib therapy. During the follow up period
we determined a new mass (5x6 cm) over the pancreas in 2011. We reoperated
the patient and removed the mass without any organ resection. The oncology
department increased dose of imatinib. The patient came again because of a giant
recurrent (16x16 cm) GIST in 2012. We removed the mass and we had to implement
subtotal gastrectomy, transvers colectomy, distal pancreatectomy and splenectomy.
He was referred to oncology department to regulate new treatment modality. They
changed the patient’s medication and they started sunitinib therapy.
Results:
Conclusion:
The changes in GIST therapy have to known and surgical and medical therapies
should be considered together with in high grade GISTs.
-670-
PP - 470 DIFFERENTIAL DIAGNOSTIC BETWEEN RETROPERITONEAL
HIDATIC CYST AND CEFALO- PANCREATIC PSEUDOCYST
MANEA CRISTINA ALEXANDRA , RADU VIOLETA ELENA , BADIU CRISTIAN , NACEV
TUDOR VLAD , NECOARA COSTEL , VICOL DRAGOS IONUT , GRIGOREAN VALENTIN
TITUS
BAGDASAR-ARSENI EMERGENCY HOSPITAL BUCHAREST, ROMANIA
Background&Aims:
We present a case of a 49 year old male, who underwent, 5 years ago, a surgical
intervention for hepatic hidatic cyst, which presented now for pain in the upper
abdominal quadrant, nausea and early gastric plenitude.
Methods:
Clinical and imagistic examination revealed a tumoral mass in the upper abdominal
quadrant, with liquid content, which came in close contact with the head of the
pancreas and another two cystic masses in the right hepatic lobe.
Results:
Intraoperatory we discovered a cystic mass in the small peritoneal cavity, which

had close contact with the head of the pancreas suggestive for a pancreactic
pseudocyst, and another cystic tumour in the right hepatic lobe. At the punctioning
of the both small peritoneal cavity and hepatic cystic masses we extracted clear
“stone water”-like liquid.
Conclusion:
The hidatic cyst can reappear anywhere, leading to rough differential diagnostic
in preoperatory imagistic examinations and intraoperatory unforeseen situations.
The punction of the cystic mass, the appearance of the evacuated liquid and of the
cystic wall merged into the diagnosis of hidatic cyst of the small peritoneal cavity.
-671-
PP - 471 AN AUDIT IN THE MANAGEMENT OF ACUTE PANCREATITIS
MATTHEW SAMMUT , CLIFFORD CARUANA , LUKE SAMMUT
GENERAL SURGICAL DEPARTMENT, MATER DEI HOSPITAL, MALTA
Background&Aims:
Although international guidelines are available for the management of acute

pancreatitis, at present there are no guidelines for acute pancreatitis locally. The
aim was to audit and review the local management of acute pancreatitis.
Methods:
Patients with elevated amylase >300iu/l (1st September 2009 to 31st August 2010)
were retrospectively identified. Medical notes and hospital electronic software
were used for data collection.
Results:
144 episodes (128 patients) of acute pancreatitis (16 - readmission episodes) were
included (116 mild vs 28 severe episodes). There were 82 males and 62 females
(age range - 17 years to 89 years (mean – 60.3 years) with an average hospital stay
of 11 days. The complication rate was 15.25% (mortality rate - 6.94%). Gallstone
disease was the most common aetiology (71 episodes (49%)). The cause for
pancreatitis was not identified in 32 episodes (22%). 139 cases had conservative
management. Antibiotics were prescribed in 58.6% for mild acute pancreatitis and
100% for severe acute pancreatitis. Cholecystectomy for gallstone pancreatitis was
done as a delayed procedure in 31 patients.
Conclusion:
There is a high rate of patients with unidentified aetiology when compared

to international recommendations. Only a few patients had early ERCP/
cholecystectomy for gallstone pancreatitis. Inappropriate prescription of antibiotics
was also noted. A management protocol guideline was recommended for the local
management of patients with acute pancreatitis.
-672-
PP - 472 ROLE OF ENDOSONOGRAPHY IN DIAGNOSIS OF FASCIOLA
HEPATICA: A CASE REPORT.
MEHMET KAMIL YILDIZ 1, MEHMET ODABAŞI 1, CENGIZ ERIŞ 1, HASAN ABUOĞLU 1,
EMRE GÜNAY 1, ERKAN ÖZKAN 1, M.A.TOLGA MÜFTÜOĞLU 1, SAMI AKBULUT 2
1
HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL, ISTANBUL,
TURKEY
2
DIYARBAKIR EDUCATION AND RESEARCH HOSPITAL, DIYARBAKIR, TURKEY
Background&Aims:
Fasciola hepatica is a liver fluke that is flat, brownish and leaf-shaped. The adult
flukes can obstruct the common bile duct (CBD) and difficult to diagnose. Endoscopic
ultrasonography (EUS) emerged as a novel modality for diagnosis of biliary stage.
Methods:
A 43 year-old female with jaundice and abdominal pain was admitted to hospital.
Minimal dilatation in CBD was seen on abdominal ultrasography (US). Magnetic
resonance cholangiopancreatography (MRCP) revealed same findings and in the
distal portion there was a tumefaction. The patient underwent EUS. There was a
living worm that was thought to be fasciola hepatica.
Results:
ERCP was performed for diagnosis and therapeutic intervention. After selective
cannulation, contrast agent was filled CBD and floating filling defect was observed.
One fasciola hepatica was removed by baloon catheter. Patient’s symptoms
improved slowly. Medical treatment with triclabendazole was ordered.
Conclusion:
It should be emphasized that EUS as a noninvasive modality in equivocal MRCP has

an excellent accuracy. It was recommended the use of ERCP only for probability of
choledocholithiasis is high. CT and US may also be used in follow-up to evaluate the
medical therapy . Sometimes, the diagnosis of fascioliasis is difficult, as seen in the
present case. EUS defined the lesion clearly, advising ERCP.
-673-
PP - 473 ENZYMATIC DEBRIDEMENT IN NECROTIZING PANCREATITIS
MURAT ÇAKIR 1, AHMET TEKİN 1, TEVFİK KÜÇÜKKARTALLAR 1, HÜSEYİN YILMAZ 2,
METİN BELVİRANLI 1, ADİL KARTAL 1, EBUBEKİR GÜNDEŞ 1, HACI HASAN ESEN 1
1
2
Background&Aims:
Multiple organ failure and pancreatic necrosis are the factors that determine
prognosis in acute pancreatitis attacks. We investigated the effects of collagenase
on the debridement of experimental pancreatic necrosis.
Methods:
The study covered 4 groups; each group had 10 rats. Group I: Necrotizing pancreatitis
group. Group II: The collagenase group with pancreatic loge by isotonic irrigation
following necrotizing pancreatitis. Group III: The collagenase group with pancreatic
loge following necrotizing pancreatitis. Group IV: The intraperitoneal collagenase
group following necrotizing pancreatitis. The progress of the groups was compared
hematologically and histopathologically.
Results:
Biochemical and Hematologic parameters: The differences in AST levels between

Group I and II; differences in glucose, calcium, LDH, AST, and amylase between
Group II and III; between Group II and IV; between Group I and III; and between
Group I and IV were statistically significant (p<0.05). There were no differences in
all the parameters between Group III and IV (p<0.05). Histopathological analysis:
There were statistically significant differences between Group II and III; and Group
II and IV (p<0.05).
Conclusion:
In conclusion, the collagenase preparation used in this experimental pancreatitis

model was found to be effective in the debridement of pancreatic necrosis.
-674-
PP - 474 DOES ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREOTOGRAPHY HAVE A NEGATIVE EFFECT ON
LAPAROSCOPIC CHOLECYSTECTOMY?
MURAT ÇAKIR 1, TEVFİK KÜÇÜKKARTALLAR 1, AHMET TEKİN 1, HÜSEYİN YILMAZ 2,
MEHMET AYKUT YILDIRIM 1, MEHMET ERİKOĞLU 1, ADİL KARTAL 1, EBUBEKİR
GÜNDEŞ 1
1
2
Background&Aims:
We have observed that patients who had undergone ERCP had some difficulties
with laparoscopic cholecystectomy procedures. We planned to compare the
surgical procedures of patients who had undergone ERCP and those who had not
through a retrospective study in order to clarify the situation.
Methods:
The values of 122 patients who had undergone ERCP because of choledocholithiasis
before having laparoscopic cholecystectomy procedures between 2008-2011 were
compared to the values of 2140 patients operated because of cholelithiasis only
within the same period.
Results:
Among the patients who underwent surgical procedures following ERCP, 80(65%)
were female while 42(35%) were male. The average age of the patients was
51.9 (20-83). Operation period after the procedure was 30.14(1-93) days. While
hospitalization period was 4.67(1-22) days, postoperative hospitalization period
was 2.68(1-15) days. Regarding the difficulty of operation, in 58(47.5%) patients
adhesion, in 2(1.6%) patients bleeding, and in 12(9.8) patients conversion to open
procedure was seen. In 2(1.6%) patients bleeding and billiary fistula were the
reasons for re-operation. The findings of patients (including adhesion, bleeding
conversion rate and soon) done laparoscopic cholecystectomy without ERCP were
better than patients done ERCP before laparoscopic cholecystectomy (p<0,05).
Conclusion:
Laparoscopic cholecystectomy is more complicated in patients who underwent

ERCP.
-675-
PP - 475 THE RESULTS OF VESSEL SEALING SYSTEM USED SURGICAL
TREATMENT OF HEPATIC HYDATID CYST
NAZIF ZEYBEK , YAŞAR SUBUTAY PEKER , MEHMET FATIH CAN , MURAT URKAN ,
İSMAIL HAKKI ÖZERHAN , YUSUF PEKER

ANKARA, TURKEY
Background&Aims:
Hepatic hydatid cyst is an important public health problem in endemic areas of

the eastern countries. In this case, we aimed to analyze the outcomes of hepatic
hydatid cyst patients who were treated surgically and harmonic scalpel was used.
Methods:
37 of 131 hepatic hydatid cyst patients between 2006 and 2011 who were surgically
with partial cystectomy by using vessel sealing system was retrospectively evaluated.
Results:
The mean operation time was 79,4 (min 47, max 137) minutes and mean blood
loss was 24,8 (min 6, max 140) cc. The mean postoperative hospital stay was 9,6
days (min 5, max 42). Postoperative complications occurred in 5 patients. The
only major complication was biliary leakage in four patients, which were treated
by percutaneous drainage. All the patients were followed up by ultrasound and
if necessary by computerized tomography at 3, 6 and 12 months, and yearly
thereafter. No recurrence and mortality was noted.
Conclusion:
It is concluded that partial cystectomy with harmonic scalpel is a safe and effective
method for the treatment of hepatic hydatid disease.
-676-
PP - 476 THE EFFECT OF LIVING DONOR HEPATECTOMY
PROCEDURES ON POSTOPERATIVE BILIARY COMPLICATION
ABUZER DIRICAN , MUSTAFA ATES , BURAK ISIK , KORAY KUTLUTURK , SEZAI
YILMAZ
INONU UNIVERSTY SCHOOL OF MEDICINE, MALATYA, TURKEY
Background&Aims:
Biliary complication(BC) is a common postoperative complication after living

donor hepatectomy(LDH). The aim of this study was to evaluate effect of LDH
procedures(right, left hepatectomy, left lateral segmentectomy) on postoperative
BC.
Methods:
Data of living donors underwent hepatectomy for liver transplantation between April
2006 and May 2012 was evaluated and graded by modified Clavien Classification
retrospectively.
Results:
The mean age of 593 living liver donors was 31.±9.9 (men/women: 341/252).
Of 533 donors underwent hepatectomy, 45 left lateral segmentectomy, 15 left
hepatectomy. BC developed in 60 (10.1%) donors were evaluated: 19 were Grade I,
30 Grade IIIa, 11 Grade IIIb. Postoperative complications recorded in 53(9.9%) donors
underwent right hepatectomy, 3(6.6%) left lateral segmentectomy and 4 (26.2%) left
hepatectomy. There is no statically difference between right hepatectomy and left
hepatectomy(p=0.06), and left lateral segmentectomy(p=0.06), left hepatectomy
and left lateral segmentectomy(p=0.058). Likewise when we compared Grade
IIIb complication which necessity to interventional procedures or surgery no
statistically significant differences were observed between groups(p=0.83, p=0.13,
p=75). No donor mortality occurred. All complications were treated conservatively,
by interventional procedures or surgery.
Conclusion:
Although the percentage of postoperative BC after left hepatectomy is more than

left lateral segmentectomy and right hepatectomy, there were no statistically
significant differences between surgical procedures regarding to postoperative BC
frequency.
-677-
PP - 477 OUTCOMES OF LEFT LOBE DONOR HEPATECTOMY FOR
LIVING DONOR LIVER TRANSPLANTATION: A SINGLE CENTER
EXPERIENCE
SERTAC USTA , MUSTAFA ATES , ABUZER DIRICAN , BURAK ISIK , SEZAI YILMAZ
DEPARTMENT OF GENERAL SURGERY, INONU UNIVERSITY, SCHOOL OF MEDICINE,

MALATYA, TURKEY
Background&Aims:
The study aim was to evaluate our experience of left lobe donor hepatectomy
operation and to grade the severity of postoperative complications according to
5-tier Clavien classification system for living donor liver transplantation.
Methods:
Between November 2006 and April 2012, data from medical records of living liver
donors underwent left lobe hepatectomy for LDLT were revived for study.
Results:
Sixty adult patients underwent left lobe donor hepatectomy for LDLT were enrolled
for the study. Of 60 patients (30 men/ 30 women) median age was 31.7±8.9
(range, 19-63) years. Totally, 15 complications were observed in 12 of the 60 (5 %)
donors. Although complications developed in 6/15 (40%) donors underwent left
hepatectomy and in 6/ 45 (13.3%) donors underwent left lateral segmentectomy,
there was not statically significant differences between both surgical procedures
(p=0.056). Seven of 16 complications were grade 1 (43.7%), and 2 complications
were grade 2 (12.5%). Major complications consisted of 4 grade 3a (25%), 3
grade 3b (18.7%). Grade 4 and grade 5 complications were not shown. The most-
common complication was biliary, which had seen in 7 donors (11.6%) of total
16 complications (43.7%). The mean follow-up times were 30± 7.1 (range, 2-58
months). There was no donor mortality.
Conclusion:
In experienced centers, proper living liver donor selection and postoperative

intensive care follow-up of healthy subjects with controllable low morbidity can be
safely performed left lobe donor hepatectomy for living donor liver transplantation.
-678-
PP - 478 COMBINATION OF LASER THERAPY AND REGIONAL
LYMPHOTROPIC ANTIBACTERIAL THERAPY IN MANAGEMENT OF
ACUTE DESTRUCTIVE CHOLECYSTITIS
RUSTAM MAMMADOV 1, KAMRAN MAMMADOV 2, ELNUR GASIMOV 1, NADIR
ZEYNALOV 1
AZERBAIJAN MEDICAL UNIVERSITY, AZERBAIJAN

1
CENTRAL HOSPITAL OF GOYCHAY CITY, AZERBAIJAN

2
Background&Aims:
The role of lymphatic system in pathogenesis of purulent inflammatory diseases

of hepato-biliary zone is very important. There is information in literature about
separate application of laser therapy and introduction of antibiotics into lymphatic
pathways in treatment of acute destructive cholecystitis, however no information
about their combination.
Methods:
We have proposed a method of combination of laser and antibiotic therapy. In

the end of operation we insert a catheter into the round ligament of liver to inject
antibiotic in twice reduced doze than in intramuscular introduction. Together
with catheter we insert a light guide for intravenous laser irradiation of blood.
We applied this method in 28 patients with acute destructive cholecystitis (main
group). We compared the results with 25 patients treated by standard approach
(control group).
Results:
In 5 patients of control group there were postoperative infiltrates managed

conservatively, in 1 patient a subhepatic abscess managed by puncture. There were
no complications in patients of main group and hospital stay period significantly
reduced.
Conclusion:
Combination of laser and regional antibiotic therapy via round ligament of liver in
management of acute destructive cholecystitis reduces postoperative complication
rate and hospital stay.
-679-
PP - 479 ROLE OF LAPAROSCOPIC FLEXIBLE CHOLEDOCHOSCOPY IN
CHOLEDOCHOLITHIASIS
NURU BAYRAMOV , NAMIQ NOVRUZOV , AYNUR SEFIYEVA , AYGUN QADIROVA ,
VEFA PASHAZADE , RUHENGIZ AHMEDOVA , KONUL ASLANOVA
CENTRAL CUSTOMS HOSPITAL, AZERBAIJAN
Background&Aims:
The purpose of this study was to share our experience of laparoscopic CBD
exploration.
Methods:
A total of 22 patients had undergone removal of the CBD stones in a single-stage

procedure simultaneously with LC. The 3 mm or 5 mm choledochoscope were
used. In 8 cases choledochoscopy was performed transcystically and 14 patients
underwent CBD exploration through choledocothomy incision.
Results:
The average operative time was 120 min and the mean duration of choledochoscopy
was 18 min. Conversion to open surgery was not required. During transcystic
maneuvers visualization of intrahepatic bile ducts was achieved in 7 cases. In 5
cases papilla was passed during the procedure and in one patient calculi less than 3
mm was pushed into duodenum transpapillary. In all cases under visual endoscopic
control stones were removed by using baskets. In 1 patient a residual stone
have been observed, which was required ERCP. External T-tube was placed after
choledocothomy procedure and extracted at 12-18 postoperative days following
negative radiologic findings during cholangiography. After transcystic stone removal
cystic duct was clipped. The mean hospital stay was 2 days and postoperative
complications such as high level of amylases or papilla injuries were not observed.
Conclusion:
Clearance of the CBD stones by laparoscopic single-stage approach is a safe and

effective procedure with very good results.
-680-
PP - 480 DAY CASE AND READMISSION RATE OF ELECTIVE
LAPAROSCOPIC CHOLECYSTECTOMY IN DISTRICT GENERAL
HOSPITAL
NGIE CHANG LAW
WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST, UK
Background&Aims:
Laparoscopic cholecystectomy is the gold standard for treating gallbladder disease.

The study aims to analyse day case and readmission rate of elective laparoscopic
cholecystectomy service provided by a district general hospital and compare
outcomes with other hospitals.
Methods:
Audit proformas were used to analyse all patients who underwent laparoscopic
cholecystectomy from October 2010 to September 2011 retrospectively. Total
number of procedures, length of stay, conversion rate and reason for readmission
were identified.
Results:
A total of 303 laparoscopic cholecystectomies were performed during study period

(273 elective cases, 30 emergency cases). Of the 273 elective cases performed, 21
cases(7.7%) were converted to open surgery. Only 59 patients(21.6%) qualified as
day case patients (discharged within 24 hours of admission for elective surgery); 138
patients (50.5%) were discharged within 24-36 hours and the rest (27.9%) stayed
beyond 36 hours. 12 patients were readmitted within 90 days of their surgery, of
whom only 10 had complications related to the surgery. Non specific abdominal
pain was the most common reason for readmission. There was 1 case of bile leak
and retained CBD stone each. Overall readmission rate is 3.7%.
Conclusion:
Day case rate at our hospital is satisfactory when compared to national average
of 6.4% but lagged behind high performing trusts who are achieving day case rate
between 40 to 50%. Measures such as nurse-led discharge, better patient selection,
reduce usage of drains and arranging earlier time slots for operation to improve day
case rates. Readmission rate are low and comparable with other published reports.
-681-
PP - 481 MINI-INVASIVE SURGERY OF PANCREATITIS THAT
COMPLICATED ENDOSCOPIC INTERVENTIONS ON THE DISTAL PART
OF COMMON BILE DUCT
ALEKSANDR VLAKHOV , SERGEY LEONENKO , OLEXANDR BUTYRSKY , VIKTOR
STAROSEK
CRIMEAN MEDICAL UNIVERSITY, UKRAINE
Background&Aims:
Endoscopic papillosphincterotomy is a common method of treatment for

choledocholithiasis and diseases of distal part of common bile duct. It may be
complicated with pancreas damage.
Methods:
We treated 775 patients (m:f=189:586, age 19-95); in 67 of them (8,6%) pancreatic

reaction was observed.
Results:
We distinguish 3 degrees of pancreatic post-surgery reaction: i) transitory

hyperamylasemia (without any clinical/ultrasonic (US)/laparoscopic manifestations)
– 38; ii) reactive pancreatitis (mild epigastric pain, single vomiting/US – moderate
pancreas enlargement, hypoechoid parenchyma/laparoscopy – insignificant serous
exudation under liver) – 20; iii) pancreatonecrosis (strong stable pain, multiple
vomiting/US – pancreas enlargement, heteroechoid parenchyma, duodenostasis,
parapancreatic liquid masses, pleuritis/laparoscopy – exudation around liver,
in bursa omentalis, distension of transverse colon, steatonecrosis patches on
omentum) – 9. We use following laparoscopic interventions. For i) – laparoscopic
cholecystectomy (LCE) without bile ducts draining; all patient survived. For ii) –
LCE with extrahepatic bile ducts draining, draining subhepatic excavation, post-
surgery comprehensive medication therapy in ICU; all patients survived. For iii) –
LCE with extrahepatic bile ducts draining, draining abdominal excavations, bursa
omentalis and parapancreatic liquid foci under US control, post-surgery therapy
with extracorporeal detoxification and selective drugs delivery to pancreas by
celiac trunk catheterizing, sequesterectomy for postponed pancreatonecrosis
complications (3); 1 patient died.
Conclusion:
Our algorithm provides good results of post-surgery complication management.
-682-
PP - 482 VASCULAR COMPLICATIONS ASSOCIATED WITH
LAPAROSCOPIC SURGERY OF CHOLEDOCHOLITHIASIS
OZLEM UYANIK , JESUS BOLLO RODRIGUEZ , RAQUEL DOMINGUEZ CARO , JOSE
LUIS PALLARES SEGURA , JOSE ANTONIO GONZALEZ LOPEZ , MANUEL RODRIGUEZ
BLANCO , VICENS ARTIGAS REVENTOS , MANUEL TRIAS FOLCH

Background&Aims:
Treatment of choledocholithiasis can be realized by endoscopic retrograde

cholangiopancreatography or by the surgical approach. Laparoscopic surgical
treatment of choledocholithiasis has the advantage of allowing cholecystectomy
in the same surgery, meanwhile carries the risk of complications. Vascular lesion
of celiac trunk branches is a rare complication but with a high rate of morbidity
and mortality. We present two cases with postoperative hemorrhage through
pseudoaneurysm.
Methods:
Case 1 with chronic cholecystitis and choledocholithiasis and Case 2 with acute
cholecystitis and choledocholithiasis, both underwent laparoscopic cholecystectomy
and choledochotomy for stone extraction and choledochorrhaphy.
Results:
The case 1 in her forth and the case 2 in his first postoperative day presented
hemorrhage through the pseudoaneurysm of the gastroduodenal artery diagnosed
by urgent computed tomography. Both patients had a sudden clinical worsening
reaching a state of hypovolemic shock. We realized urgent reoperation where we
observed rupture of pesudoaneurysm resulting in massive hemoperitoneum, we
ligated gastroduodenal artery and resected the aneurysmal segment.
Conclusion:
Although vascular complications after choledocholithiasis surgery are uncommon,

they should be considered in all postoperative patients where there has been
manipulation of the hepatic hilum presenting hemoperitoneum or signs of active
bleeding. The survival of these patients depends on early diagnosis and treatment.
-683-
PP - 483 HEPATOCELULER CARCINOMA OF PROGNOSTIC FACTORS
RASİM FARAJOV , ÖMER VEDAT ÜNALP , LEVENT YENİAY , ALPER UĞUZ , TAYFUN
YOLDAŞ , TAYLAN ÖZGÜR SEZER , E.MURAT SÖZBİLEN , AHMET ÇOKER
DEPARTMENT OF GENERAL SURGERY, EGE UNIVERSITY, SCHOOL OF MEDICINE,

IZMIR, TURKEY
Background&Aims:
The aim of this study was to identify the factors effecting survival of the patients
who underwent surgical treatment (either liver resection or liver transplantation)
owing to Hepatocellulary carcinoma (HCC) in Ege Univesity Faculty of Medicine
Department of General Surgery Division of Organ Transplantation; and yet to share
our experience.
Methods:
In this study we retrospectively analyzed patients who underwent liver

transplantation (n=115) between 1997 and 2009 or who underwent liver resection
(n=47) between 2000 and 2009 owing to a diagnosis of HCC in Ege Univesity Faculty
of Medicine Department of General Surgery Division of Organ Transplantation. For
the patients who underwent liver transplantation, clinical data such as age, sex,
diagnosis, type of the liver transplantation (cadaveric or living related), tumor size
( T1, T2, T3, T4), tumor differentiation (well, mild, poor), Child - Pugh score, model
for end stage liver disease (MELD) score, alpha feto protein (AFP) level, length of
survival (months) and final status of the patient (alive or exitus) was collected.
Similarly for the patients who underwent liver resection; clinics data such as
age, sex, diagnosis, type of the liver resection, tumor size ( T1, T2, T3, T4), tumor
differentiation (well, mild, poor), status of the surgical borders (R0 or R1), presence
of chirrosis, Child - Pugh score, MELD score, alpha feto protein (AFP) level, length
of survival (months) and final status of the patient (alive or exitus) was collected.
Statistical analyses was done utilizing Statistical Package for Social Sciences (SPSS)
program’s version 16. Statistical relations between clinical data and survival was
analyzed using Kaplan - Meier, Log - Rank and Chi square tests. P values under 0.05
were accepted statistically significant.
-684-
Results:
For the patients who underwent liver transplantation owing to HCC and liver
cirrhosis, hepatitis B and C infection ( p=0,005), presence of T3 and T4 tumors (
p<0,05), presence of poorly differentiated tumors ( p<0,05), and AFP values higher
than 200 ng/ml (p<0,05) were found to be bad prognostic factors. For the patients
who underwent liver transplantation owing to HCC and liver cirrhosis, presence
of T1 and T2 tumors ( p<0,05) and AFP values lower than 200 ng/ml ( p<0,05)
were found to be good prognostic factors. For the patients who underwent liver
transplantation owing to HCC and liver cirrhosis, type of the transplantation, Child-
Pugh and MELD score, had no statistically significant effect on the overall survival
of these patients (p<0,05). For the patients who underwent liver resection owing to
HCC, presence of well differentiated tumors (p<0,05), and “A” Child score (p<0,05)
resection owing to HCC, primary diagnosis, resection type, tumor size, presence of
cirrhosis, surgical margins and AFP values had no statistically significant effect on
the overall survival of the patients (p<0,05).
Conclusion:
For the patients who underwent liver transplantation owing to HCC and liver
cirrhosis, hepatitis B and C infection ( p=0,005), presence of T3 and T4 tumors (
p<0,05), presence of poorly differentiated tumors ( p<0,05), and AFP values higher
than 200 ng/ml (p<0,05) were found to be bad prognostic factors. For the patients
who underwent liver transplantation owing to HCC and liver cirrhosis, presence
of T1 and T2 tumors ( p<0,05) and AFP values lower than 200 ng/ml ( p<0,05)
transplantation owing to HCC and liver cirrhosis, type of the transplantation, Child-
Pugh and MELD score, had no statistically significant effect on the overall survival
of these patients (p<0,05). For the patients who underwent liver resection owing to
HCC, presence of well differentiated tumors (p<0,05), and “A” Child score (p<0,05)
resection owing to HCC, primary diagnosis, resection type, tumor size, presence of
cirrhosis, surgical margins and AFP values had no statistically significant effect on
the overall survival of the patients (p<0,05).
-685-
PP - 484 LAPAROSCOPIC CHOLECYSTECTOMY: THE PROPHYLAXIS OF
SURGICAL SITE INFECTION
RASIM JAFARLI , ELKHAN JAFAROV
Background&Aims:
The median rate of surgical site infections (SSIs) following laparoscopic

cholecystectomy is reported 1.1% which is 4 time lower compare to open
cholecystectomy. Aim of this study was to estimate the effectiveness of prophylaxis
measures which reduce a rate of SSIs.
Methods:
292 laparoscopic cholecystectomies were performed during 2006-2012 years.
Results:
The SSis was occurred in 13 (0.44%) patients after the surgery. 9 of them have
a suppuration of umbilical wound in postoperative period, 4 patients have
inflammatory conglomerate in operation field. The highest rate of SSIs was in
patients with perforate cholecystitis (7.1%), local peritonitis (4%), diabetes (2.2%),
obesity (1.06%). Antibiotics injected selectively, a simple dose (1mg ceftriaxone)
to patients with high risk of SSIs. For wound infection prophylaxis, first troacar
was inserted 1cm upper or lower the umbilicus, longitudinal section was made.
Drainage is left for 24hours in wound at patients with high risk of SSIs. To prevent a
perforation an aspiration of acute gallbladder is performing during the operation.
Dissection of tissues with minimal damage, careful hemostasis and sanation of an
operative field is the main method of SSIs prophylaxis.
Conclusion:
Carrying out an operation laparoscopically, which provides the minimal damage of

tissues, careful sanation of an operative area is important preventive maintenance
of SSIs. Antibiotics should be spent selectively. Drainage of abdominal cavity is not
preventive action.
-686-
PP - 485 SINGLE-INCISION LAPAROSCOPIC CHOLECYSTECTOMY
RASIM JAFARLI
Background&Aims:
Findings have shown that single-incision laparoscopic cholecystectomy (SILC) is

feasible and reproducible.
Methods:
Their results for 15 patients are presented. The gallbladder was retracted; the SILC
procedure was performed using standard technique with 5-mm reticulating or
conventional laparoscopic instruments.
Results:
In this series, with an average age of 36.8 years (range, 17-61 years) underwent
SILC. Their mean BMI was 32.8 kg/m(2) (range, 17-42.5 kg/m(2)), and 2 patients
had undergone previous abdominal surgery. The mean operative time was 53.8
min (range, 23-110 min). The mean estimated blood loss was 25.3 ml (range,
5-125 ml), and the patients had’nt an intraoperative cholangiography. There were
no conversions of the SILC technique. A SILC technique was feasible for all of the
patients. For the remaining patients, either a three-channel port or three individual
trocars were required.
Conclusion:
The SILC technique with a S-port technique is safe, feasible, and reproducible. The
operating times are reasonable and can be lessened with experience. Excellent
exposure of the critical view was obtained in all cases. The SILC procedure is
becoming the standard of care for most of the authors’ elective patients with
gallbladder disease.
-687-
PP - 486 SURGICAL MANAGEMENT OF BILE DUCT INJURY
BOYUKKISHI AGAYEV , ALINIYAZ MAMEDOV , RASIM JAFARLI
SCIENTIFIC CENTER OF SURGERY, AZERBAIJAN MEDICAL UNIVERCITY, AZERBAIJAN
Background&Aims:
The purpose of this research was carrying out of the analysis of the rea-sons of
unsuccessful outcomes of primary regenerative and reconstructive opera-tions
after damage of bilious canals and definition of optimum surgical tactics de-pending
on complications and terms of diagnostics of damage.
Methods:
The present research is based on studying of results of surgical treatment yatrogen

injury of bilious channels at 37 patients.
Results:
Repeated reconstructive interventions at yatrogen injury of bilious trakts differ

considerable complexity as practically in all supervision reveal high level of damage.
Conclusion:
Than above damage level, use of frame drainages in various updatings is especially
expedient. At operations concerning cicatricial strictur of bilio-biliar and biliodigestiv
anostomozis also it is necessary to apply replaceable transhepatic drainages.
-688-
PP - 487 CHOLECYSTOSTOMY IN ACUTE CHOLECYSTITIS: AN AUDIT
SANA NASIM
THE AGA KHAN UNIVERSITY HOSPITAL, PAKISTAN
Background&Aims:
Standard treatment for acute cholecystitis is cholecystostomy,but some patients

are at high risk for immediate surgery.Percutaneous cholecystostomy might be the
procedure of choice in this group.We reviewed the experience of cholecystostomy
in a large tertiary centre population.
Methods:
All Retrospective review of patients who underwent cholecystostomy tube

placement from January 1988 to December 2008. Data was analyzed using SPSS
version 16.
Results:
62 patients (mean age 63 yrs) had cholecystostomy tubes placed from January 1988
to Dec 2008.All had confirmed or presumed acute cholecystitis.54(95%) of them
had image-guided placement of cholecystostomy tube.One had post-procedural
bleeding.Nine patients(16%) expired during the hospital stay,none was procedure-
related.Around 66% of them had drain in place for >4 weeks.21 subsequently had
elective cholecystectomy while 2 underwent emergency cholecystectomy.Bile
aspirated at cholecystostomy was culture positive in 38 (66%) patients.
Conclusion:
Tube cholecystostomy with delayed laparoscopic cholecystectomy has been

proposed for the management of citically ill/high risk patients with acute cholecystitis
as an alternative treatment.In experienced hands,percutaneous cholecystostomy is
easy to perform,with low complication and high success rates.
-689-
PP - 488 PREVENTIVE MEASURES OF ORGAN HEMODYNAMIC
DISORDERS IN CASE OF PROGRESSIVE ACUTE PANCREATITIS
ALEX SKOROMNY , SERGIY KHILKO , IVAN FOMOCHKIN
Background&Aims:
In patients suffering from acute pancreatitis the progression of central and

regional hemodynamic disorders is accompanied by high incidence of lethal cases.
Improvement of treatment results in patients suffering from acute pancreatitis
adjusted for organ hemodynamic disorders.
Methods:
All the patients were divided into 2 groups. Patients from the 2nd group together
with basic therapy were injected with 10% submicron perfluoro-carbon emulsion
every 48 hours and ozonous isotonic solution NaCl 5 ml/kg once a day.
Results:
The clinical studies have shown that the use of the proposed treatment regimen
in the complex therapy resulted in normalization on 5th - 7th day of volumetric
blood flow in the veins and arteries under consideration, a faster normalization
of biochemical measurements and restoration of activity levels of dehydrogenases
in peripheral blood neutrophiles on 5th day. The evident effect was observed on
3rd day of the clinical observation against the background of perfluoro-carbon
introduction. The proposed treatment regimen allowed to reduce postoperative
mortality by 7% and total mortality by 10,3%.
Conclusion:
The studies results make possible to recommend oxygen-carrying solutions as

pathogenetic therapy agents for preventive measures and treatment of acute
pancreatitis progressive forms.
-690-
PP - 489 THE USE OF STREPTOKINASE AND ARTERIAL PERFUSION
ON DEVELOPMENT BILIARY COMPLICATIONS AFTER ORTOTOPIC
LIVER TRANSPLANTATION
SHOHRAT SHARIPOV 2, OLEG RUMMO 1, IVAN PİKİRENYA 2, ALEKSEİ SCHERBA 1
ORGANS AND TISSUES TRANSPLANTATION CENTER, MINSK, BELAUS

1
DEPARTMENT OF CARDIAC SURGERY WITH A COURSE OF TRANSPLANTOLOGY,

2
BELARUSIAN MEDICAL ACADEMY OF POST-GRADUATE EDUCATION, BELARUS
Background&Aims:
After orthotopic liver transplantation (OLT), biliary complications occur from 10 to

35% of cases. Reduce the number of biliary complications after OLT.
Methods:
In a randomized prospective study included 49 recipients after OLT from 2009 to

2011 were treated in the Centre of organ and tissue transplantation. A study group
consisted of 22 recipients (mean age - 39.9 years), including 12 men and 10 women.
On the donor phase for 15 min. before reperfusion, a solution is a donor with brain
death were administered intravenous fluids 1500000 IU streptokinase and heparin
25,000 units, during the preparation of the graft was performed by arterial perfusion
pressure of 120 mm Hg. The control group consisted of 27 subjects (mean age -
41.7 years), including 16 men and 11 women who were not given streptokinase,
and arterial perfusion during the preparation of the graft was performed under the
gravitational pressure.
Results:
In 2 of the 22 recipients of the main group (9%) developed postoperative biliary

complications in the control group - in 9 of 27 patients (33,3%), χ2 = 4,09, p <0.043.
Conclusion:
In order to prevent the development of biliary complications should be used for the
donor streptokinase during surgery and arterial graft perfusion pressure on back-
table.
-691-
PP - 490 RISK FACTORS FOR DEVELOPMENT OF PANCREATIC
FISTULA FOLLOWING DISTAL PANCREATECTOMIES CARRIED OUT
AGAINST PANCREAS PATHOLOGIES
TARKAN UNEK , MUCAHIT OZBILGIN , CIGDEM ARSLAN , GULSEN ATASOY , SEDAT
KARADEMIR , TUFAN EGELI , IBRAHIM ASTARCIOĞLU

Background&Aims:
Rate of pancreatic fistula (PF) following distal pancreatectomy (DP) ranges between
0-64 percent. PF considerably increases mortality and morbidity. This study aimed
to investigate factors effective on PF development in patients undergoing DP.
Methods:
Data of 51 patients were retrospectively assessed, who underwent DP in Dokuz

Eylül University Department of General Surgery between January 1997 and January
2011. PF classification was made according to The International Study Group on
Pancreatic Fistula (ISGPF) criteria.
Results:
According to ISGPF, 3 (37.5%) of 8 patients had Grade A, 3 (37.5%) had Grade B,

and 2 (25%) had Grade C attack PF. PF was present in one (1.9%) patient with in-
hospital mortality. Multivariate analysis revealed that a soft pattern of pancreas
parenchyma (p=0.048, OR: 12.420) and an intraoperative blood loss greater than
150 mL (p=0.043, OR: 1.003) were risk factors for development of PF.
Conclusion:
In our series which included a limited number of patients with lower PF ratios
compared to average PF ratios in literature, a soft texture of pancreas and an
intraoperative blood loss greater than 150 cc were risk factors for development of
PF.
-692-
PP - 491 AN ORTHOTOPIC LIVER TRANSPLANTATION FROM A
CADAVERIC DONOR WITH SITUS INVERSUS TOTALIS TO A RECIPIENT
WITH NORMAL ANATOMY
TARKAN UNEK , MUCAHIT OZBILGIN , SEDAT KARADEMIR , TUFAN EGELI , IBRAHIM
ASTARCIOĞLU

Background&Aims:
Situs inversus totalis (SIT) is seen with a prevalence of 0.005%. Anatomic discordance
may take place during transplantation of liver grafts from donors with this anomaly
to recipients with normal anatomy; thus, such livers generally could not be utilized.
We report herein a case of LT from SIT donor to normal recipient, which was
performed using classical LT techniques.
Methods:
The donor was a male with brain death due to ischemic encephalopathy. During
harvesting, he was noted to have SIT; liver and both kidneys were excised with
classical harvest method. Recipient underwent a total hepatectomy by excising
retrohepatic vena cava inferior (VCI). Voluminous left lobe (approximately 30-35%)
was noted to be able to fill right diaphragmatic space by folding unto itself and to
keep the graft placed orthotopically in a stable position.
Results:
Classical orthotopic LT under total clamping was carried out in conjunction with
VCI resection LT was completed in 330 minutes and 10 Urinary system infection
erythrocyte suspensions were consumed.
Conclusion:
If appropriately placed, SIT livers can be successfully transplanted in our country

where cadaveric organ resources are limited.
-693-
PP - 492 COMPARISON OF MILAN AND UCSF CRITERIA FOR LIVER
TRANSPLANTATION TO TREAT HEPATOCELULAR CARCINOMA
TARKAN UNEK 1, SEDAT KARADEMIR 1, CIGDEM ARSLAN 1, TUFAN EGELI 1, GÜLSEN
ATASOY 1, FUNDA OBUZ 2, MESUT AKARSU 3, IBRAHIM ASTARCIOĞLU 1
1
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF
RADIODIAGNOSTIC, IZMIR, TURKEY
3
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF
GASTROENTEROLOGY, IZMIR, TURKEY
Background&Aims:
Liver transplantation (LT) is one of the most important treatment methods used in
the treatment of patients with hepatocellular carcinoma (HCC). Milan and University
of California San Francisco (UCSF) criteria are most widely accepted criteria used in
selection of patients for LT. These criteria were assessed in this single-center study.
Methods:
Using Milan and UCSF criteria radiologically before LT and pathologically after LT,
56 patients were assessed, who underwent LT at Dokuz Eylül University Faculty of
Medicine Department of General Surgery between the years 1998 and 2009. 31
(55.3%) patients underwent living-donor LT and 25 (44.7%) patients underwent
cadaveric LT.
Results:
Five-year survival rates in patients complying with the Milan criteria in assessments
prior to and after LT were significantly higher compared to patients excluded from
UCSF criteria (p=0.000). Average survival rates in Milan (+), Milan(-)/UCSF(+), and
UCSF(-) patients were 105.8±7.4, 31.1±6.6, and 26.3±6.5 months, respectively.
Conclusion:
Given the limited number of cadavers, Milan criteria are the best criteria for
improved survival in selecting HCC patients for LT. UCSF criteria may benefit patients
in cases where living-donors are used.
-694-
PP - 493 A RARE CAUSE OF LIVER MASS: ADULT TYPE WILM’S
TUMOR
MAHIR KIRNAP , AYDINCAN AKDUR , TUGAN TEZCANER , FEZA KARAKAYALI , İLKER
ARER , GÖKHAN MORAY
BASKENT UNIVERSITY, DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY
Introduction:
Wilm’s tumor is a rare entity in adults. Its incidence is less than 0.2/1.000.000 per
year. Liver invasion of adult Wilm’s tumor is rarely seen.
Case report:
Thirty three years old male presented with right liver mass, invading right kidney.
Preoperative clinical and radiological findings together with liver biopsy result were
concomitant with carcinoma. The patient underwent right hepatectomy and right
nephrectomy. Pathology was reported as giant adult type Wilm’s tumor.
Conclusion:
This case is an example of a rare type of live tumor diagnosed giant adult type Wilm’s
tumor. This is an important diagnosis should keep in mind during management of
liver masses.
-695-
PP - 494 SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY:
RESULTS OF OUR FIRST
RAMAZAN ERYILMAZ , TUNA BILECIK , CEMAL ENSARI
THE ANTALYA EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL

Background&Aims:
Laparoscopic surgery has become the standart method for the most of the
intraabdominal organs. Port numbers have been diminished to reduce incisional
morbidity and improve cosmetic outcomes. In this study , we present our first
experiences in cholecystectomy cases which were performed via Single Incision
Laparoscopic Surgery.
Methods:
Ten patients who underwent cholecystectomy with the method of single

intraumbilical incision at the Antalya Education and Research Hospital, Department
of General Surgery between January 2012 and June 2012 were evaluated regarding
age, gender, body mass index, amount of hemorrhage, rate of conversion to
conventional laparoscopic surgery, duration of operation, duration of hospitalization
and complications.
Results:
There were no intraoperative or early postoperative complications and no

conversion to conventional laparoscopic surgery. Mean amount of hemorrhage was
less than 100 cc, mean duration of operation was 88.4 minutes, and mean duration
of hospitalization was 1.3 day.
Conclusion:
The preliminary results of our experience about single incision laparoscopic

surgery show this method is a good alternative in selected patients to conventional
laparoscopic surgery with better cosmetic results.
-696-
PP - 495 DO SURGEONS PROFIT FROM VIRTUAL LIVER PLANNING
SYSTEMS?
WERKGARTNER GEORG 1, WAGNER DORIS 2, SORANTIN ERICH 3, MISCHINGER
HANS JÖRG 1
1
GENERAL SURGERY, AUSTRIA
2
TRANSPLANTATION, AUSTRIA
3
MEDICAL UNIVERSITY OF GRAZ, DEPARTMENT FOR RADIOLOGY, AUSTRIA
Background&Aims:
In order to facilitate planning of liver resections radiologic liver planning systems

have been proposed. The aim of the presented study was to investigate if surgeons
profit from the virtual planning mode.
Methods:
Twenty clinicians (10 surgeons (SRG) and 10 radiologists (RAD)) had to do surgical
planning in 15 scenes in 2D, 3D and virtual reality (VR). Standardized tasks and
measurements had to be performed in each scene in a defined time span of 5
minutes. Every participant was only allowed to do 5 scenes daily with a time span
of 1 day in between.
Results:
SRG needed less time to perform tasks in VR as compared to 2D and 3D imaging (2D:
1.9 ± 0.4 min (RAD) vs. 4.0 ± 0.9 min (SRG), p=0.001; 3D: 2.5 ± 1.6 min (RAD) vs. 3.2
± 0.5 min (SRG), p=0.05; VR: 4.5 ± 0.9 min (RAD) vs. 2.5 ± 1.2 (SRG), p=0.001). The
time span SRG needed to perform the given tasks decreased significantly (p=0.03)
throughout the study period and increased for radiologists.
Conclusion:
Surgeons seem to profit from virtual planning and have a high training curve
considering virtual imaging.
-697-
PP - 496 BILIARY COMPLICATIONS AFTER TREATMENT FOR HYDATID
CYST OF THE LIVER: FACTORS ASSOCIATED WITH SPONTANEOUS
CLOSURE OF POSTOPERATIVE BILIARY FISTULA
NAZIF ZEYBEK 1, HAKAN DEDE 1, DENIZ BALCI 2, ALI KAĞAN COŞKUN 1, İSMAIL
HAKKI ÖZERHAN 1, YAŞAR SUBUTAY PEKER 1, YUSUF PEKER 1
1
ANKARA TURKEY
2
DEPARTMENT OF GENERAL SURGERY, ANKARA UNIVERSITY SCHOOL OF
Background&Aims:
Hydatid cyst of liver (HCoL) is a worldwide distributed disease which minor and
major complications after surgery-percutaneous drainage (PD) are 33.0% and
25.1%. Postoperative biliary fistula (PBF) is one of the common complications of
HCoL surgery.
Methods:
We reviewed retrospective data of 282 patients who underwent surgery or PD for

HCoL from January 01.01.2000 to 31.12.2010. We searched for predictive factors
for spontaneous closure of the fistula.
Results:
Among 282 patients, two groups were settled. Group 1 was patients with PBF
(n=46, %16.3) and group 2 was patients without PBF (n=236). All PBF occured in
postoperative five days and only in surgically treated (n=243, %86.2) patients.
Output of fistula, time till closure, preoperative immunologic, biochemical and
microbiological parameters and type of treatment were analysed for association
with spontaneous closure. Fistula output was found to be statically significant
predictor for spontaneous closure of PBF. It was found that fistulas with >102.5ml/
day output were 121.5 times more manipulated for closure instead of spontaneous
closure when compared to ones with <102.5ml/day (p<0.01).
Conclusion:
In conclusion, spontaneous closure of fistula should not be expected when fistula

output is more tahn 102.5 ml/day and surgical treatment should be planned in
order to decrease the time of hospital stay.
-698-
PP - 497 LEIOMYOSARCOMA OF THE RETROHEPATIC VENA CAVA:
REPORT OF A CASE TREATED BY RESECTION AND RECONSTRUCTION
WITH POLYTETRAFLUOROETHYLENE VASCULAR GRAFT
YUCEL YANKOL , NESIMI MECIT , TURAN KANMAZ , KORAY S ACARLI

ISTANBUL SISLI MEMORIAL HOSPITAL, ISTANBUL, TURKEY
Introduction:
Leiomyosarcoma of vena cava is a rare malignant tumor. We present a case with

leiomyosarcoma located at retrohepatic vena cava which was treated by resection
and reconstruction.
Case report:
Our patient was 61 years old woman who was admitted to our hospital with pain on
the right upper abdomen quadrant. Computed tomography showed the retrohepatic
vena cava tumor which seems like a leiomyosarcoma measuring 3x3,5x4 cm. The
tumor was located at 2 cm below the confluence of the hepaic veins and ending
2 cm above the renal veins. The caudate lobe of the liver was displaced anteriorly
by the tumor. There was no metastasis. Tumor was resected with 1-1,5 cm clear
surgical margins. No liver resection needed. Polytetrafluoroethylene vascular graft
(Gore-tex) with 24 mm diameter and 7 cm length used for the reconstruction of the
vena cava. She discharged from the hospital 9 days after the operation. Patological
findings showed leiomyosarcoma originating from retrohepatic vena cava. There
has been no recurrence or metastasis after 8 months from the surgery.
Conclusion:
Radical resection of the tumor is the best curative therapy for leiomyosarcoma.
Polytetrafluoroethylene vascular graft can be used in extensive tumors located at
vena cava.
-699-
PP - 498 THE FIRST CASE OF ACCESSORY LIVER WITH ITS OWN
GALLBLADDER
YUCEL YANKOL , NESIMI MECIT , TURAN KANMAZ , KORAY S ACARLI , MUNCI
KALAYOGLU

ISTANBUL SISLI MEMORIAL HOSPITAL, ISTANBUL, TURKEY
Introduction:
The published anatomic variations of hepatobiliary system were usually about

biliary tract and vascular supply of the liver. We present the first case of accessory
liver with its own gallbladder in English literature.
Case report:
Our case was a 32 years old man who was a candidate of liver donor. During the
operation, an accessory liver tissue two cm in diameter was found two cm below
the left lobe of the liver. There was also a gallbladder two cm in diameter attached
to the accessory liver with a cystic duct. The bile duct of the accessory liver was
connected to the left bile duct of the main liver. Arterial and portal supply of
accessory liver were originated from the left artery and portal vein of the liver. The
hepatic vein of the accessory liver was directly connected to the left lobe of the
liver.
Conclusion:
Hepatobiliary system has a lot of anatomic variations. Our case is the first case of
accessory liver with its own gallbladder in the english literature.
-700-
PP - 499 CONTINUING DIAGNOSTIC AND THERAPEUTIC
CHALLENGES IN GALLBLADDER POLYPS
ZULFU ARIKANOGLU 1, FATIH TASKESEN 1, IBRAHIM ALIOSMANOGLU 1, MESUT
GUL 1, HATICE GUMUS 2, YUSUF CELIK 3, AYSENUR KELES 4, SADULLAH GIRGIN 1
1
DIYARBAKIR, TURKEY
2
DEPARTMENT OF RADIOLOGY, DICLE UNIVERSITY FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
3
DEPARTMENT OF THE DEPT OF BIOSTATISTICS AND MEDICAL INFORMATICS,
DIYARBAKIR, TURKEY
4
DEPARTMENT OF PATHOLOGY, DICLE UNIVERSITY FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
Background&Aims:
Polypoid gallbladder lesions are difficult to specify preoperatively and the surgical
indications still remain controversial. The aim of this study is to compare the
pathological diagnoses with the results of the ultrasonographic examination and
to assess the criteria for surgery in patients who have undergone surgery with the
diagnosis of gallbladder polyp.
Methods:
Thirty-five patients preoperatively diagnosed with gallbladder polyps between

January 2000 and December 2010 were retrospectively reviewed.
Results:
The sample comprised 11 males (31.4%) and 24 females (68.6%), with a mean
age of 42.91±14.19 (range 27-79) years. Among the patients, 71.4% were
symptomatic and the most frequently observed symptom was abdominal pain.
While ultrasonography was the imaging method routinely used in all the patients,
both ultrasonography and computed tomography were employed in 7 patients.
Histopathological examination confirmed the polyp in 19 patients (54.3%), 2 of
these polyps were observed to be adenocarcinomas. The forward stepwise binary
logistic regression analysis of the results revealed the risk variables as the polyp size
and the presence of gallstones. The odds ratios and confidence intervals for the two
variables were 2.27 (1.53-3.37) and 2.64 (1.62-3.90).
Conclusion:
We identified the risk factors for false-positive ultrasound results in gallbladder
polyps using a binary logistic model. Surgery should be the chosen method
of treatment in all symptomatic polyps larger than 10 mm in diameter and
accompanied by gall stones.
-701-
PP - 500 EMERGENCY CHOLECYSTECTOMY VS. PERCUTANEOUS
CHOLECYSTOSTOMY IN HIGH-RISK PATIENTS WITH ACUTE
CHOLECYSTITIS: A HIGH VOLUME INSTITUTION’S FIVE YEAR
EXPERIENCE
CEVHER AKARSU 1, FILIZ ISLIM 2, AHMET CEM DURAL 1, MURAT GONENC 1, AHMET
SUREK 1, AYSUN ERBAHCECI SALIK 2, OSMAN KONES 1, HALIL ALIS 1
1
2
BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL,
INTERVENTIONAL RADIOLOGY DEPARTMENT, ISTANBUL, TURKEY
Background&Aims:
We aimed to present the results of high risk patients with acute cholecystitis who
underwent an emergency laparoscopic cholecystectomy or/and cholecystostomy
in our institution.
Methods:
High-risk patients (ASA III-IV) with acute cholecystitis who were admitted from
March 2008 to February 2012 have been evaluated in 3 groups due to the procedure
retrospectively; group 1: Emergency laparoscopic cholecystectomy (LC) (n=55),
group 2: Percutaneous cholecystostomy (PC) followed by interval LC (n=30) and
group 3: PC without interval LC (n=26).
Results:
The technical success rate of PC was 98.2%. Mean operative time was 88.6±37.1
and 104.4±49.4 min. in group 1 and 2 respectively (p=0.19). Conversion to open
surgery, morbidity and mortality rates were not significantly different between
group 1 and 2 (p=0.53, p=0.97, p=0.66 respectively). Mean length of hospital stay
was shorter in group 1 (p=0.04). Interval period for LC in group 2 was 92 days (12-
230). Length of hospital stay was longer in group 3 than group 1 and 2 (p=0.01).
Morbidity and mortality rates were not significantly different between group 2 and
3 (p=0.88, p=0.12 respectively).
Conclusion:
Emergency LC results were better than interval LC following PC. However when
surgery is not a reasonable option, PC can be performed with or without interval LC.
-702-
PP - 501 THE EFFECT OF SILDENAFIL CITRATE ON LIVER STRUCTURE
AND FUNCTIONS IN OBSTRUCTIVE JAUNDICE: AN EXPERIMENTAL
STUDY
TAMER SIMSEK , OMER FAIK ERSOY , ERDINC YENIDOGAN , HUSEYIN AYHAN
KAYAOGLU , NAMIK OZKAN , MUSTAFA SAHIN

Background&Aims:
We aimed to investigate the effect of 10 mg/kg sildenafil citrate on the structure

and function of liver in a rat model of obstructive jaundice.
Methods:
62 male Wistar albino rats were distributed into 6 different groups. Obstructive
jaundice was performed by ligating the common bile duct. 10 mg/kg sildefanil
citrate in drinking water was delivered through mouth after the operation until
sacrification.
Results:
At 10th day, there was no difference between sildenafil-treated and control groups
with regard to AST and ALT levels (p=0.423, p=0.661). ALP ve total bilirubin levels
among groups were statistically different (p<0.0001). At 28th day, liver function
tests except ALT showed significant differences among groups (p<0.0001). Liver
function tests were not changed significantly between 10th and 28th days in
sildenafil-treated rats (p>0.05). Significant differences were observed among
groups with regard to cholestasis, fibrosis, inflammation and necrosis (p<0.0001).
However, edema increased in sildenafil-treated group (p<0.0001). At 28th day,
the severity of structurel changes in liver after obstructive jaundice except edema
reduced significantly (p<0.0001). Sildenafil-treated groups at different time points
didnt show any statistical difference in histopathological changes (p>0.05).
Conclusion:
Oral administration of 10 mg/kg sildenafil citrate drammatically reverses the

biochemical and histopathological changes induced by obstructive jaundice in rats.
-703-
PP - 502 THE USE OF NIFEDIPINE FOR THE PREVENTION OF POST-
ERCP PANCREATITIS
MEHMET YASAR 1, BULENT KAYA 2, ALI KEMAL TASKIN 1, METIN AYDIN 1
1
DÜZCE UNIVERSITY MEDICAL FACULTY-DEPARTMENT OF GENERAL SURGERY,
DUZCA, TURKEY
2
FATIH SULTAN MEHMET TRAINING AND RESEARCH HOSPITAL-DEPARTMENT OF
GENERAL SURGERY, ISTANBUL TURKEY
Background&Aims:
Pancreatitis after ERCP is still an important problem. The aim of this prospective
study was to analyse the effect of oral Nifedipine for the prevention of post-ERCP
pancreatitis.
Methods:
A total of 42 patients were undergone ERCP in Duzce University Medical Faculty-
Department of General Surgery.The patients were divided into two groups. In
Group I, the diagnostic or therapeutic ERCP was performed without giving any
post-ERCP medication beside routine analgesics.Nifedipine 30 mgr once a day was
given after ERCP to patients in Group II. Preoperative and postoperative values of
leucocyte, amylase and other biochemical parameters were measured. Patients with
pancreatitis were diagnosed with criterias of Cotton ( presence of new pancreatic
type of abdominal pain within 24 hours of ERCP and three fold increase in serum
amylase level).SPSS 18 statistical program was used to analyse data.
Results:
There were 22 men and 20 women in this study. The average age was 61.4 ± 13.8
(Range:34-83). There were 16 patients in Group I and 26 patients in Group II.
Preoperative leucocyte count was 8.205 ±2.498 K/UL (Range:3200-13300) in Group I
and 10.302 ±4447 K/UL (Range:5130-18200) in Group II. Preoperative amylase level
was 163.7 ±225.3 IU/L (Range26-779) in Group I and 260.2 ±458.5 IU/L (25-664)
in Group II. Post-ERCP leucocyte count was 9.001±3.089 K/UL (Range:2970-14000)
in Group I and 9053 ± 4.124 K/UL (Range:3660-18200) in Group II. Postoperative
amylase level was 314.4±469.5 IU/L (Range:17-1435) in Group I and 183.6±228.6 IU/L
in Group II. There were three post-ERCP pancreatitis in Group I (18.7%), and three
post-ERCP pancreatitis in Group II( 11.1%).
Conclusion:
Pancreatitis is most common complication of ERCP. Several agents had been used for
the prevention of post-ERCP pancreatitis. Our clinical trial showed that Nifedipine was
not favorably changed the leucocyte count and amylase levels after ERCP. But the rate
of clinically determined pancreatitis was lower in patients treated with Nifedipine.
Further studies about Nifedipine with larger sample size for the prevention of post-
ERCP pancreatitis can be advised.
-704-
PP - 503 A SITUATION THAT LEAVES SURGEONS IN A
DIFFUCULT CONDITION DURING SURGICAL PROCEDURE:
XANTHOGRANULOMATOUS CHOLECYSTITIS
FATIH TASKESEN 1, ZULFU ARIKANOGLU 1, OMER USLUKAYA 1, IBRAHIM
ALIOSMANOGLU 1, ABDULLAH OGUZ 1, ABDURRAHIM DUSAK 2, GUL TURKCU 3,
HEKIM KUZU 1
1
DEPARTMENT OF SURGERY, DICLE UNIVERSITY HOSPITAL, FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
2
DEPARTMENT OF RADIOLOGY, DICLE UNIVERSITY HOSPITAL, FACULTY OF
MEDICINE, DIYARBAKIR, TURKEY
3
DEPARTMENT OF PATHOLOGY, DICLE UNIVERSITY HOSPITAL, FACULTY OF
MEDICINE, DIYARBAKIR, TURKEY
Background&Aims:
Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis
characterized by severe proliferative fibrosis and accumulation of lipid-laden
macrophages in regions of destructive inflammation. XGC clinically and radiologically
mimics early-stage gallbladder cancer, with wall thickening on computed tomography.
Methods:
The study included 14 XGC patients that were identified following retrospective
analysis of the records of 1248 patients that underwent cholecystectomy between
2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years.
Results:
All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had
cholangitis, and 2 presented with obstructive jaundice. A right upper quadrant mass
was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery
was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy
was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1
patient developed wound infection, 1 patient had post-operative pneumonia, and
1 patient developed intraabdominal hematoma. None of the patients in the series
died.
Conclusion:
XGC is difficult to diagnose, both preoperatively and intraoperatively, and definitive
diagnosis depends exclusively on pathological examination. XGC should be a
consideration in all difficult cholecystectomy cases.
-705-
PP - 504 PANCREATODUODENECTOMY FOR PANCREATIC HEAD AND
PERIAMPULLAR CANCER
BORYS BEZRODNYI , IGOR KOLOSOVICH
O.O. BOGOMOLETZ NATIONAL MEDICAL UNIVERSITY, UKRAINE
Background&Aims:
After pancreatoduodenectomy postoperative complications reach 10-12%,

mortality rate 5-8%. Therefore it is necessary to improve the technique of
pancreatoduodenectomy to have better results.
Methods:
For the reconstruction phase of pancreatoduodenectomy we propose

two original methods of pancreatodigestive anastomosis and a method of
antireflux hepaticojejunostomy. This methods were performed in the course of
pancreatoduodenectomy for 123 patients suffering from pancreatic head cancer
(89 patients) and major duodenal papilla (32 patients). The peculiarity of the
surgical technique is to removal of the pancreatic uncinate processus, using of
pylorus preserving operations and implementation of regional lymphadenectomy.
In cases of dilatation of the pancreatic duct, hepaticojejunostomy is formed with the
proximal end of the intestine looppassed through the mesentery of the transversal
colon, distally – terminolateral pancreatojejunostomy and duodenojejunostomy are
fashioned. When the pancreatic duct is not dilated, the intestine loop was isolated
according to Roux. On the lateral end of the “Y”-like construction performed a
hepaticojejunoctomy, on the medial end - a pancreatojejunostomy, distally - a
duodenojejunoanastomosis.
Results:
Postoperative complications developed in 9 (7,4%) patients, 5 (4,1%) of which died.
Conclusion:
The proposed options for the reconstruction phase of pancreatoduodenectomy

provide satisfactory immediate results.
-706-
PP - 505 VILLOUS ADENOMA IN GALLBLADDER VOLVULUS: A RARE
COINCIDENCE
ZEYNEP ÖZKAN 1, AYSE NUR GÖNEN 1, SEYFI EMIR 1, BEKIR SARICIK 1, FATIH
MEHMET YAZAR 1, GULÇIN CIHANGIROĞLU 2, BURHAN HAKAN KANAT 1 , BURAK
KAVLAKOĞLU 1
1
ELAZIG TRAINING AND RESARCH HOSPITAL, GENERAL SURGERY DEPARTMENT,
ELAZIG, TURKEY
2
ELAZIG TRAINING AND RESARCH HOSPITAL,PATOLOGY DEPARTMENT, ELAZIG,
TURKEY
Background&Aims:
Gallbladder volvulus and gallbladder adenoma, especially villous adenoma are rare
clinical conditions. They are more common in elderly female patients. We reported
in this case an 80 -year-old female patient with gallbladder adenoma and volvulus
Methods:
An 80-year- old female admitted to our hospital with a sudden onset of right
upper quadrant abdominal pain and vomiting that had worsened in hours. She
had no abnormality in her medical history. Clinical signs are similiar to acute
cholecystitis. She had neither leucocytosis nor other pathologies in labarotory
results. Abdominal ultrasonography revealed hydropic gallbladder with a size of
37x99 mm.,concentrated bile sludge and multiple milimetric calculi in the lumen.
We performed urgent laparotomy. A floating gangrenous gallbladder due to torsion
was seen on laparatomy. It was detorsioned and resected. There was a 2.5x2x1
cm villous adenoma at the cervical region of gallbladder without any calculi on
histopathological evaluation
Results:
Gallbladder villous adenoma and volvulus are rare entities and their coincidence
is extremely rare. Both of these pathologies are more common in elderly female
patients.
Conclusion:
The patients especially older female patients with acute abdomen should be also
evaluated for acute cholecystitis, even for rare causes such as gallbladder adenomas
and/or gallbladder volvulus.
-707-
PP - 506 PATHAGENETIC MECHANISMS OF STRUCTURE DAMAGING
OF MYOCARDIUM DURING EXPERIMENTAL ACUTE PANCREATITIS
FIKRET ALIYEV
Background&Aims:
Now there is a direct relationship of development of concomitant insuffi ciency
syndrome with the subsequent endotoxicosis in patoand tanathogenesis acute
pancreatitis where great significance is taken away to disorder of functioning of
cardiovascular systems. Studying of morphofunctional condition of myocardium of
white rats in different terms of acute experimental pancreatitis (AEP) became the
purpose of the present research.
Methods:
Object of research were 45 white nonlinear male-rats - (by 195-220 gr. weight).
Acute experimental pancreatitis was modelledafter application tyopental narcosis.
By way of laparomyomectomythere was conducted opening abdominal cavity with
the subsequentmobilisation of a duodenum and pancreas. By tapping there has been
made collection of bile of 0,15 milliliters for one kg of weight (ml/kg) and entered
into a pancreas. Animals were taken out from the experiment after 1, 3, 6, 24 hours
by way of decapitation under tyopenthal narcosis.
Results:
At histologic research swelling of acinar cells and partial noncontiguousness of some
acinuses is observed. There is taken place an increase of quantity of functioning
capillaries, disclosing of intercapillary anastomoses in a myocardium. The B.Schick-
reaction specifies slight increase of speed of recycling glycogen in cardiac hystiocytes
(myocytes) in comparison with the test. At this time some vessels are spasmed. In
some myofibrillas banding it is clearly visible. There are found slightly deformed
lymphatic lacunas with the expanded gleams and wrong contours. Starting from 3
hours of the experiment the picture of diffusive serous pancreatitis with hyperemia
of pancreas and individual form elements of blood for limits of capillaries is marked.
In interlobar spaces the structure of a fibrous fabric has bulked up and there is
marked weak cellular infiltration.
Conclusion:
Histologic research shows development of the expressed hypostasis of stroma and
considerable changes of rheological blood characteristics in microcyrculatory vessels
in a kind of stasis. Contractural damages have focal character having localized mainly
perivascularly in subendocardiac and intramular sections of ventricles. Increase
in pericapillary quantity zones of neutrophilic leukocytesm which in conditions of
endotoxemia has the important factor of damage cardiac myocytes and endothelia
of vessels, draws attention.
-708-
PP - 507 A CASE OF SCLEROSING ANGIOMATOID NODULAR
TRANSFORMATION OF SPLEEN RELATED TO IGG4-RELATED
SCLEROSING DISEASE
CHOONG YOUNG KIM , SEUNG HYUN CHO , BYUNG GWAN CHOI , HEE JOON KIM ,
YOUNG HOE HUR , CHOL KYOON CHO
CHONNAM NATIONAL UNIVERSITY MEDICAL SCHOOL, KOREA
Background&Aims:
Sclerosing angiomatoid nodular transformation of spleen(SANT) is a very rare

inflammatory tumor-like vascular lesion comprising of angiomatoid nodules in a
fibrosclerotic background. The pathogenesis of SANT still remains unclear and many
authors have proposed various hypotheses about pathogenesis.
Methods:
A 51-year-old woman visited our hospital complaining of intermittent abdominal

pain. In clinical review of the patients there was non-specific past or recent history of
systemic infectious disease, tumorous condition or drug abuse. Abdominal computed
tomography revealed a 5.1×4.6 cm sized well-defined heterogenously enhanced
nodular mass in the spleen. The routine laboratory data including tumor markers
were all within normal limits. Laparoscopic splenectomy was performed under the
impression of splenic tumor.
Results:
In macroscopic examination, there was 4×4 cm in sized tumor with red-brown multi-
nodular surface. Microscopically, the tumor was composed of multiple vascular
structures separated by fibrous connective tissue. An immunohistochemical
examination showed positive staining for CD31, CD34, factor VIII, and IgG4. The tumor
of our case was diagnosed as SANT and which was thought to be related with IgG4-
related sclerosing disease.
Conclusion:
In our case, immunohistochemical staining for IgG4 was positive. Thus, our data
support the possibility that SANT is connected to IgG4-related sclerosing disease.
-709-
PP - 508 EFFECTS OF PANCREATICOJEJUNOSTOMY AND
WIRSUNGOJEJUNOSTOMY ON PANCREATIC ANASTOMOTIC
LEAKAGE IN PATIENTS WITH MAIN PANCREATIC DUCT DIAMETER 5
MM OR LESS
ERDAL BİROL BOSTANCI , RAMAZAN SAYGIN KERİMOĞLU , İLTER ÖZER , TAHSİN
DALGIÇ , EROL AKSOY , MURAT ULAŞ , METİN ERCAN , MUSA AKOĞLU
TÜRKİYE YÜKSEK IHTİSAS HOSPİTAL, ANKARA, TURKEY
Background&Aims:
This study aims to present the effects of pancreaticojejunostomy (PJ) and

wirsungojejunostomy (WJ) on pancreatic anastomotic leakage in patients with
pancreatic duct diameter 5 mm or less.
Methods:
The records of the 284 patients with pancreatic duct diameter 5 mm or less who
were treated by pancreaticoduodenectomy between April 1999-January 2012
were investigated. Pancreatic leakage was identified in three groups as grade
a,b,c according to International Study Group for Pancreatic Fistula. Effects of age,
gender, preoperative drainage, postoperative bilirubin levels, pancreatic texture,
type of anastomosis, and intraoperative stent usage on anastomotic leakage were
investigated.
Results:
PJ and WJ were performed for pancreatic anastomosis in 182 (53%) and 102 (47%)
patients, respectively. Pancreatic anastomotic leakage was detected in 86 (30%)
patients. The leakage was identified as grade a in 37 (13%), grade b in 30 (10.6%),
grade c in 19 (6.7%) patients. Grade b and c anastomosis leakage was detected in 36
(74%) patients who were treated with PJ and in 13 (26%) patients who were treated
with WJ (p=0.132). The risk factors were distrubuted homogenously in groups.
Conclusion:
There is no significant difference of anastomotic leakage in groups of PJ and WJ in

patients with pancreatic duct diameter 5 mm or less.
-710-
PP - 509 ANTIMICROBIAL PROPHYLAXIS PRIOR TO PANCREATICO-
DUODENECTOMY
PETER THOMSON , SIMON BRAMHALL , JOHN ISAAC , RAVI MARUDANAYAGAM ,
DARIUS MIRZA , PAOLO MUIESAN , ROBERT SUTCLIFFE
THE LIVER UNIT, QUEEN ELIZABETH HOSPITAL, BIRMINGHAM, UK
Background&Aims:
At our unit, antimicrobial prophylaxis prior to pancreatico-duodenectomy (PD)

consists of piperacillin/fluconazole in patients who had preoperative biliary
drainage (PBD), or co-amoxiclav in patients without PBD. The primary objective of
this study was to determine the appropriateness of these regimens by analysis of
intraoperative bile samples.
Methods:
Retrospective analysis of 60 consecutive patients who underwent PD (May 2011 -

April 2012). Data regarding intraoperative bile cultures/sensitivities were recorded.
Results:
Intraoperative bile samples were available in 33/36 patients who underwent PBD,
and were positive in 30 (91%): bacteria in 26 (single 17, multiple 9) and fungi in
17 (all candida). Bile samples were available in 16/24 patients in the non-PBD
group, of which 5 were positive (31%) for bacterial infection (single in all cases).
In the PBD group, bacterial sensitivities were co-amoxiclav 7/26, piperacillin
10/26, meropenem/vancomycin 8/26 and ciprofloxacin/gentamicin/metronidazole
18/26. In the non-PBD group, sensitivities were co-amoxiclav 2/5, piperacillin 4/5,
meropenem/vancomycin 0/5 and ciprofloxacin/gentamicin/metronidazole 4/5.
Surgical site infections occurred in 8% of the PBD group and 29% of the non-PBD
group.
Conclusion:
Anti-fungal prophylaxis is essential prior to pancreatico-duodenectomy in patients

who have undergone preoperative biliary drainage. Regular review of intraoperative
bile cultures and tailoring of prophylactic antibiotic regimens is recommended.
-711-
PP - 510 COMMON BILE DUCT – DOES SIZE MATTER?
ANNA KAMOCKA , NIGEL D›SOUZA , ANDREW CHARLES GORDON
HEATHERWOOD AND WEXHAM PARK HOSPITALS, UK
Background&Aims:
To evaluate correlation between pre- and intraoperative common bile duct

(CBD) measurements and incidence of CBD stones at the routine intraoperative
cholangiogram (IOC).
Methods:
Retrospective review of laparoscopic cholecystectomies with routine IOC at

Heatherwood&Wexham Park Hospitals, UK, between Jan2007 and Jan2010. CBD
size at pre-operative imaging and IOC were analysed alongside with incidence of
CBD calculi.
Results:
78 patients underwent IOC. In 21(Group1), preoperative CBD size ranged 4-15mm

(mean 8mm, median 7mm) and CBD calculi were seen in 7 cases(CBD 4-15mm,
mean 10mm, median 11mm). Intraoperative CBD size was 6-23mm (mean 11mm,
median 9mm). 1 patient whose CBD was measured preoperatively at 6mm had a
6mm stone present at IOC. 2 patients with CBD of 11 and 14mm pre-operatively
had intraoperative CBD measurements of 20mm and 18mm respectively with no
calculi. In 57 patients(Group 2), preoperative CBD was reported as normal but
the size was not specified. CBD measured 3-14mm intraoperatively(mean 6.8mm,
median 7mm) and abnormalities were found in 4 cases: 1 CBD stone, 1 stricture, no
flow to duodenum in 2 cases.
Conclusion:
There is poor correlation between CBD size measured pre- and intraoperatively. It
is difficult to predict presence of CBD calculi at the time of operation based on pre-
operative imaging.
-712-
PP - 511 A PROPOSED NEW CLASSIFICATION SYSTEM FOR
INTRAOPERATIVE COMPLICATIONS OF LIVING-DONOR LIVER
TRANSPLANTATION WITH OUTCOMES OF 550 RIGHT-LOBE LIVING-
DONOR HEPATECTOMIES
MUSTAFA ATES , ABUZER DIRICAN , DINCER OZGOR , BURAK ISIK , KAYAALP
CUNEYT , SEZAI YILMAZ
DEPARTMENT OF GENERAL SURGERY, INONU UNIVERSITY, SCHOOL OF MEDICINE,

MALATYA, TURKEY
Background&Aims:
The modified Clavien classification system for liver transplantation (LT) does not
include intraoperative complications. We describe a new classification system for
intraoperative complications of LT using the outcomes of 550 consecutive living-
donor right-lobe hepatectomies (LDRLHs).
Methods:
Data from medical records of living donors (LDs) who underwent RLH for adult LT
between 2006-2012 were reviewed. A new classification system for intraoperative
complications consisting of five major grades with subdivisions for intraoperative
complications (iGrade) was used. iGrade I–II were recognized as minor and iGrade
III–Va/b as major. Postoperative complications were stratified using Clavien’s
classification.
Results:
Consecutive 550 living LDs were enrolled, but only 533 donors underwent complete
RLH and 17(3%) donor operations were aborted. Intraoperative complications
iGrade I were recorded in 3(3.5%), iGrade II in 56(65.8%), and iGrade III in 26(30.1%)
LDs. The most common intraoperative complication was vascular trauma, in
53(9.9%) donors. 196 postoperative complications occurred in 137/533(25.7%)
donors: 113(57.6%) had minor (Grades I–II) and 83(42.4%) had major (Grades III–
IVa) complications.The most common postoperative complications involved the
abdominal wall incision in 59 (11%) and the biliary tract in 53 (9.9%) donors.
Conclusion:
A classification system for intraoperative complications of LT is necessary to
uniformly assess LT results. The proposed new classification system, based on
Clavien system principles, is easily applied and enables the uniform assessment of
intraoperative complications of LT.
-713-
PP - 512 COMPARING AVERAGE HOSPITAL COST AND
REIMBURSEMENT PAYMENT OF CHOLECYSTECTOMY OPERATIONS
IN TERTIARY HOSPITALS: UNIVERSITY, RESEARCH AND TEACHING
PELIN TANYERI 1, ORHAN VELI OZKAN 1, GUVENC KOCKAYA 2, MEHMET EMIN
BÜYÜKOKUROĞLU 1, OMER YALKIN 1, OSMAN NURI DILEK 1
SAKARYA UNIVERSITY, SAKARYA, TURKEY

1
HEALTH ECONOMICS AND POLICY ASSOCIATION, TURKEY

2
Background&Aims:
Social security Institution(SGK) pays, on average, 792 TL for conventional(CC)

and 1045TL for laparoscopic(LC) cholecystectomy. However true costs may vary
depending on number of days in hospital and complications arising. The figures
indicate average of all costs, but do not reflect the costs of complicated cases,
which are usually treated in university hospital or ministry of health research
and teaching hospitals. The aim of this research is to estimate the average cost of
cholecystectomy carried out in tertiary hospitals and compare per case cost with
reimbursement amount.
Methods:
Computer base searches for costs of cholecystectomy were conducted and

calculated in Sakarya University, research and teaching hospital General Surgery
Department.
Results:
259 cholecystectomy operations were performed in 2011. The average costs of CC

and LC operations carried out in the hospital were calculated as 2799 TL and 2004
TL, respectively. It was calculated that SGK paid an average of 1239 TL and 1022 TL
for CC and LC operations, respectively.
Conclusion:
Hospital cost for LC is lower than CC at same outcome. SGK payment however is not
covering cost of both procedures in tertiary hospitals. Package payment from SGK
needs to be increased to guarantee the outcome in the future.
-714-
PP - 513 THE ROLE OF PROBIOTICS AND ENEMA IN REDUCING
SEPTIC COMPLICATIONS IN EXPERIMENTAL ACUTE PANCREATITIS IN
RATS
BAHADIR OSMAN BOZKIRLI 1, AHMET ZİYA ANADOL 2, AYŞE KALKANCI 3, GÜLDAL
YILMAZ 4, BANU ÇAYCI 5
1
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
2
GAZI UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,
ANKARA, TURKEY
3
GAZI UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF MICROBIOLOGY, ANKARA,
TURKEY
4
GAZI UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF PATHOLOGY, ANKARA,
TURKEY
5
GAZI UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF BIOCHEMISTRY, ANKARA,
TURKEY
Background&Aims:
The purpose of this study is to investigate the effects of two previously suggested
treatment modalities,enema and probiotics, on bacterial translocation(BT), TNF-
alpha serum levels, and the tissue expression of TNF-alpha in pancreas in Severe
Acute Pancreatitis(SAP).
Methods:
We used 4 groups, containing 8 rats each. In Sham Group a sham laparotomy was made.
SAP was induced by laparotomy and taurocholate infusion into the biliopanceatic
duct in all the groups except Sham Group. Control Group received no treatment.
Enema Group received enema and Probiotic Group received a probiotic agent. 48
hours after induction of SAP, tissue and blood samples were taken for bacterial
cultures, TNF-alpha serum levels and TNF-alpha pancreatic tissue expressions .
Results:
In Enema Group, there was more bacterial proliferation in tissue cultures then all
the other groups(p<0,05). In Probiotic Group, there was no proliferation in the
pancreatic samples(p<0,05). There was no significant difference between TNF-alpha
serum levels between the control group and the treatment groups(p>0,05). TNF-
alpha tissue expressions were higher in Control group when compared to all the
other groups(p<0,05).
Conclusion:
Enema increases BT in SAP. Probiotic treatment decreases BT but does not change
systemic inflammation. The mechanism by which both treatments decrease TNF-
alpha tissue expressions remains to be explained.
-715-
PP - 514 A NEW MODEL OF REVERSIBLE OBSTRUCTIVE JAUNDICE
WITH FAST ABSORBABLE SUTURE MATERIALS
NURETTİN KAHRAMANSOY 1, HAYRİ ERKOL 1, EDİP ERDAL YILMAZ 1, MUSTAFA ŞİT 1,
FAHRİ YILMAZ 2, MEHMET TOSUN 3, CAVİT ÇÖL 1
1
2
DEPARTMENT OF PATHOLOGY, ABANT IZZET BAYSAL UNIVERSITY, SCHOOL OF
3
DEPARTMENT OF BIOCHEMISTRY, ABANT IZZET BAYSAL UNIVERSITY, SCHOOL OF
Background&Aims:
Reversible obstructive jaundice models have some restricting features like a second
anaesthesia, relaparotomy and surgical intervention after common bile duct ligation.
The present study investigates the feasibility of a new application which can eliminate
these restricting features. Fast absorbable suture materials were used for ligation.
Therefore, spontaneous biliary decompression was anticipated by the self release of
these fast degrading materials.
Methods:
This is an experimental study containing 7 Wistar Albino rats in each group. Common
bile ducts were ligated with silk, polyglytone 6211, and irradiated polyglactine 910.
Rats were grouped due to the suture materials and the experiments termination date,
on the 5th day (Sham, Silk5, Polyglytone5, Polyglactine5) and on the 21st day (Silk21,
Polyglytone21, Polyglactine21) after the ligation. Biochemical and morphologic
changes of liver were assessed.
Results:
The group Polyglactine21 showed significantly low means of ALT, AST, GGT, total and
direct bilirubin values when compared with the group Polyglactine5 (p=0.004-0.037).
However, morphologic changes did not correlate with the biochemical amelioration.
In the group Polyglytone21, not only the biochemical but also the morphologic
changes significantly ameliorated when compared with the group Polyglytone5
(p=0.003-0.043). No mortality was obtained due to the procedure.
Conclusion:
Common bile duct ligation with polyglytone offers a new reversible model for
prolonged obstructive jaundice which abolishes the need for relaparotomy and a
second surgical intervention and significantly reduces mortality.
-716-
PP - 515 PROSPECTIVE RANDOMIZED TRIAL FOR EARLY VS DELAYED
LAPAROSCOPIC CHOLESYSTECTOMY FOR ACUTE CHOLESYSTITIS
ALPER BİLAL OZKARDES , MEHMET TOKAC , FAHRİ YETİSİR , GURKAN ERSİN
DUMLU , AHMET GURER , MURAT BAKİ YILDIRIM , MEHMET KİLİC
Background&Aims:
Elective laparoscopic cholesystectomy has become the gold standard for

symptomatic gallstones. With the increased experience in laparoscopy, surgeons
started to attempt this approach for acute cholesystitis. The aim of this study was
to compare the results of early versus delayed laparoscopic cholesystectomy for
acute cholesystitis.
Methods:
Between January 2011 and March 2012, 60 patients whose physical, laboratory
and ultrasound findings suggested acute cholesystitis were randomly operated by
laparoscopy, either within 24 hours of admission (30 patients) or after 6-8 weeks
later following the initial treatment (30 patients).
Results:
There was no difference between groups regarding demographic, clinical and

laboratory parameters. There was no significant difference in operation time,
intraoperative and postoperative complication rates and conversion rates (one in
each group). On the other hand, total hospital stay was longer (5.2 vs. 7.8 days) and
total costs were higher in the delayed group (2500,967tl. vs. 3713,467tl.).
Conclusion:
With the advantage of shorter hospital stay and cost effectivity, early laparoscopic
cholesystectomy for acute cholesystitis is a safe and feasible technique.
-717-
PP - 516 TREATMENT OF PANCREATIC PSEUDOCYSTS UNDER EUS
GUIDANCE
GOKHAN ADAS 1, KEMAL DOLAY 2, BORA KOC 1, FIRAT TUTAL 1, ADEM AKCAKAYA 3,
TUNA GELDIGITTI 1, SERVET KARAHAN 1, NAMIGAR TURGUT 4
1
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF SURGERY,
ISTANBUL, TURKEY
2
AKDENIZ UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF SURGERY,
ANTALYA, TURKEY
3
4
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF ANESTHESIA,
ISTANBUL, TURKEY
Background&Aims:
We aimed to evaluate the technical feasibility, efficacy and complications of EUS
guided transmural drainage of pancreatic pseudocyst and to discuss our results
with recent literatures.
Methods:
Endoscopic treatment of pancreatic pseudocyst was performed in 12 patients
by using linear echoendoscope. All patients were screened by transabdominal
ultrasound and a computed tomography scan before the procedure to assess
accessibility of the pancreatic pseudocyst from the stomach or duodenum. We
determined etiology, technical and clinical success rate, follow-up time after the
procedure, cyst location, cyst features, complications, recurrence rate and need for
surgery.
Results:
During the study period, 12 patients (7 male, 5 female) with a median age of 48
years (range, 17 to 73) underwent EUS-guided transmural drainage of pancreatic
pseudocysts. The causes of pancreatic pseudocyst respectively were biliary (n:10),
alcohol (n:1) and idiopathic (n:1). The drainage was performed transgastric in 11
cases and transduodenal in 1 case. We encountured 2 major complications in our
study as a percentage of 16% and there was no death. The procedure was found to
be technically successful in 100% of patients and clinical success was achived in 92%
of patients. The median follow-up time was 9.5 months.
Conclusion:
EUS-guided transmural drainage of pancreatic pseudocysts showed a high technical
and clinical success rate. These findings suggest that this procedure should be first
line treatment for pancreatic pseudocyst.
-718-
PP - 517 INTRAVENOUS VERSUS ORAL ANTIBIOTIC PROPHYLAXIS
EFFICACY FOR ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMIES: A
PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
AHMET SERDAR KARACA 1, KORAY DAS 2, FARUK KARATEKE 2, EBRU MENEKSE 2,
ERSOY ARSLAN 2, EREN ERSOY 1, MEHMET OZDOGAN 2, HALDUN GUNDOGDU 1
ANKARA ATATURK TEACHING AND RESEARCH HOSPITAL, ANKARA, TURKEY

1
ADANA NUMUNE TEACHING AND RESEARCH HOSPITAL, ADANA, TURKEY

2
Background&Aims:
The aim of the present prospective randomized controlled trial is to compare the
effectiveness of intravenous and oral antibiotic prophylaxis in elective laparoscopic
cholecystectomy.
Methods:
500 patients were split into 2 groups as to include 250 patients in each and they were
evaluated in a prospective and randomized fashion. While Group 1 was subjected
to 1g cephazolin via IV route during anesthesia induction, Group 2 received 1g
cephalexin monohydrate via oral route 1 hour prior to the operation. Demographic
findings and operation results of the patients were compared by analysis.
Results:
Forty-one patients were lost in following period and excluded from the study.
Four hundred and fifty-nine patient (237 patients in Group 1, 222 patients in
Group 2) were included. Both groups were similar with regard to demographic
characteristics and inclusion criteria. Among all, only 10 (2,2%) cases demonstrated
postoperative surgical site infection. Surgical site infection at postoperative period
was determined in 6 (2,7%) cases of Group 1 and 4 (1,7%) cases of Group 2. There
was no statistically significant difference between the groups in terms of surgical
site infection (P=0,533).
Conclusion:
Oral antibiotic prophylaxis can be used in elective laparoscopic cholecystectomy

prophylaxis due to its cost-effective and reliable nature.
-719-
PP - 518 COMPARISON OF THE VALUES OF CD10, CYTOKERATIN19
AND AVAILABLE GRADING SYSTEMS IN PREDICTING THE
PROGNOSIS OF PANCREATIC NEUROENDOCRINE TUMORS
ALPER UGUZ 1, OMER UNALP 1, TAYFUN YOLDAS 1, RASİM FARACOV 1, ELA
EKMEKCİGİL 1, FATMA NUR YURUM 2, FUNDA YİLMAZ 2, AHMET COKER 1
1
IZMIR, TURKEY
2
EGE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PATHOLOGY, IZMIR,
TURKEY
Background&Aims:
This study was undertaken to examine prognostic factors in patients with pancreatic
neuroendocrine tumors (PNET) undergoing surgical treatment.
Methods:
Tumors were classified on the basis of 2004 WHO Classification Guidelines

and European Neuroendocrine Tumor Society (ENETS) grading system.
Immunohistochemical staining with Ki-67, CD10 and cytokeratin 19 was performed.
Results:
A total of 36 patients were included. Overall, 33 patients had a long-term follow-up.

Ten patients (30.3%) experiencing recurrence. Seven patients (21.1%) died. Five-
year survival rate was 75.6%. Positive surgical margins, extra-pancreatic invasion,
and multi-focal disease were associated with reduced survival (p < 0.05). CD10 and
cytokeratin 19 positivity had no association with recurrence and other pathological
findings (p > 0.05). In addition, there was an association between survival and WHO
2004 classification (p < 0.05).
Conclusion:
Although vascular and peripancreatic invasion showed increased risk of recurrence,

they were unrelated to survival. Of the histopathological examinations, Ki-67
and mitotic activity showed correlation with both recurrence and survival, while
immunohistochemical staining with cytokeratin 19 and CD 10 did not provide
adequate prognostic information. WHO classification system is more effective than
ENETS grading system. Even in patients with metastatic liver disease and positive
surgical margins, surgery may be effective.
-720-
PP - 519 MINIMIZING THE SHOULDER PAIN AFTER LAPAROSCOPIC
CHOLECYSTECTOMY: A PROSPECTIVE, RANDOMISED, CONTROLLED
TRIAL.
KORAY DAS , FARUK KARATEKE , EBRU MENEKSE , MEHMET AZIRET , MEHMET
OZDOGAN , HASAN ERDEM , SULEYMAN CETINKUNAR , SELİM SOZEN
Background&Aims:
Early postoperative pain is the most common complaint and the primary reason
for prolonged convalescence after elective Laparoscopic Cholecystectomy (LC).
It has been also reported that there is a strong correlation between the residual
gas volume and the severity of pain after various laparoscopic procedures. In
the present study, we aimed to investigate the effects of active gas aspiration on
postoperative outcomes and pain following elective LC.
Methods:
Adult patients with symptomatic cholelithiasis who were eligible for LC were
included in the study. Patients were randomly assigned to either active gas
reduction group (Group 1) or control group (Group 2). The demographic data, Body
Mass Index (BMI), educational status, operation time, volume of CO2 insufflated
during the operation, hospital stay, and return to daily activity were recorded.
Postoperative shoulder and abdominal pain assessment was performed using a
visual analog scale (VAS). After surgery the VAS scores noted at 1th , 24th hours,
3th and 7th days, respectively.
Results:
A total of 200 patients (47 male and 153 female) were included for the statistical
analysis. The mean age was 48 years (range of 21-70). In group 1, 105 patients
were enrolled, and group 2 included 95 patients. The demographic data, operative
findings and clinical outcomes were similar in both groups. VAS scores for shoulder
pain at 1th and 24th hours were significantly lower in group 1 (P=0,001 and P=0,021,
respectively). However, there were not any significant differences in the VAS scores
for shoulder and abdominal pain following the 24th hours. No differences were
found in the hospital stays and returns to the daily activity (P>0,05) .
Conclusion:
The postoperative shoulder pain was significantly lower in the aspirated patient
group in first 24 hours. Active aspiration of the residual gas just before the removal
of the trochars is a simple procedure and leads to a more comfortable hospital stay
for patients.
-721-
PP - 520 EFFECTS OF EXTERNAL PANCREATIC STENTS ON
PANCREATIC ANASTOMOTIC LEAKAGE FOR PATIENTS WITH
WIRSUNG CANAL SIZE ≤ 5 MM
EROL AKSOY , ERDAL BIROL BOSTANCI , İLTER ÖZER , TAHSIN DALGIÇ , MEHMET
AKIF TÜRKOĞLU , MURAT ULAŞ, YUSUF BAYRAM ÖZOĞUL , MUSA AKOĞLU
TURKIYE YUKSEK IHTISAS TEACHING AND RESEARCH HOSPITAL, DEPARTMENT OF

GASTROINTESTINAL SURGERY, ANKARA, TURKEY
Background&Aims:
Pancreatic anastomotic leakage (PAL) is the most common complication after

pancreaticoduodenectomy (PD). Effects of using pancreatic stents on PAL has been
controversial. The aim of this study is to assess effects of external pancreatic stents
on pancreatic anastomotic leakage.
Methods:
Between 2009 and 2012, 50 patients with Wirsung canal size ≤ 5 mm underwent PD.
In Group 1, external stent was inserted to the Wirsung canal while pancreaticojejunal
anastomosis was performed without a stent in group 2. The groups were compared
with regard to anastomotic leakage, postoperative complications, hospital stay
and mortality. In addition, risk factors for PAL (age, gender, ASA, BMI, comorbidity,
laboratory tests, preoperative biliary drainage, operation time, blood loss, blood
transfusion, Wirsung canal size, texture of pancreatic tissue and using external
pancreatic stent) were evaluated by univariate and multivariate analysis.
Results:
Hospital stay was longer in group 1 (p<0.05). There were 17 and 13 PAL in group 1
and 2, respectively. The difference was not significant. Postoperative complications
and mortality (2 patients in group 1 and 1 patient in group 2) were similar. Presence
of comorbid conditions and obesity was found to increase the risk of PAL by
univariate and multivariate analysis.
Conclusion:
Using external stent in pancreaticoduodenectomy did not decrease PAL. Comorbid

conditions and obesity were found to be independent risk factors for PAL.
-722-
PP - 521 EFFICACY OF CHLORHEXIDINE GLUCONATE DURING
SURGERY FOR HYDATID CYST: FIVE YEARS OUTCOME OF
PROSPECTIVE STUDY
OMER TOPCU , ALI KAGAN GOKAKIN , MUSTAFA ATABEY , BORAN CIHAT KARAKUS
, AYHAN KOYUNCU

Background&Aims:
Avoiding spillage of the cyst contents and the use of effective scolicidal agents are
essential to lower the recurrence rate. Aim of this study was to evaluate the efficacy
of chlorhexidine gluconate in hydatid surgery via analyzing five years results of our
cases.
Methods:
Sixty consecutive patients with 87 liver cysts were studied. Only type I and type II
cysts were included. In all, 37 women and 23 men with a mean age of 46.2 years
(19–80 years) were included. The mean cyst size was 8 cm (4–20 cm). The mean
follow-up time was 68.86 (36–102) months. The patients were followed up by
ultrasonography at 6 month intervals for the first two year and yearly the rest for
detection of a recurrence.
Results:
Twenty four of 87 cysts (27.6%) were in communication with the biliary tract.
Biliary leakage or fistulawere developed in four patients. None of the patients
demonstrated findings of sclerosing cholangitis. There was no recurrence and
mortality. There were three cavity related complications (two bile collection, one
infection).
Conclusion:
Intracystic injection of 0.04% Chlorhexidine Gluconate is an effective measure

against the dissemination of viable protoscolices and can be used during hydatid
cyst surgery.
-723-
PP - 522 ENDOSCOPIC MANAGEMENT OF DIFfiCULT PIGMENTED
COMMON BILE DUCT STONES FOR PATIENTS CONTRAINDICATED
FOR SURGERY
ARUNKUMAR KRISHNAN , RAVI RAMAKRISHNAN , JAYANTHI VENKATARAMAN
Background&Aims:
Endoscopic sphincterotomy and stone extraction is widely performed as a primary

method for patients with CBD stones. However, there is no clear consensus on the
better therapeutic approach. Aim of the present was to analyze the effectiveness of
‘interim’ plastic biliary stent deployment in difficult pigment stones.
Methods:
35 Patients who had co-morbid illness and elderly patients who are not fit for
surgery were included. Bile duct drainage and endoscopic placement of 7 Fr plastic
biliary stents were established. The diameters of the CBD stones were measured on
the radiographs.
Results:
In this 11 patients has multiple CBD stones and 26 patients had large stones. Stone
retrieval was possible, after a median of 24 days. All patients had reductions in the
stone number and/or stone size. In 6 patients there was spontaneous clearance of
the stones from the CBD. The median number and size of stones per patient was
significantly reduced after biliary stenting compared with before {5 vs 2 P <0.0001}
and {2.8 to 2.0 P< 0.001}. All the stones were black and amorphous in consistency.
Conclusion:
Plastic biliary stenting may fragment common bile duct stones and decrease stone
sizes. Shorter period of deployment is sufficient for pigment stones unlike the hard
cholesterol stones.
-724-
PP - 523 ERRORS AND COMPLICATIONS IN LAPAROSCOPIC
SURGERY - HOW TO DEAL WITH THEM OR HOW TO PREVENT THEM
ANEL OKIC , IBRAHIM CERO , HASIB MUJIC , HARUN SESTIC , ANHEL KOLUH
CANTONAL HOSPITAL ZENICA, BOSNIA AND HERZEGOVINA
Background&Aims:
A better understanding of anatomy and variations of hepato-biliary (HB) systems
for more efficient diagnosis, surgical treatment and to avoid possible mistakes in
practice. Pointing on the common mistakes at work and technical deficiencies that
lead to mistakes in laparoscopic surgery.
Methods:
We used the experiences and research works of colleagues and experts from the
region as well as with those from prestigious centers around the world. We compare
some results that we get the statistical processing and analysis of complications
that occurred in KB Zenica and compared with research papers with more recent
date. Original photographs and sketches were used to show hepatobiliary system,
and statistically represented anomalies and variations that occur in practice and
theory. Special emphasis is on the extrahepatic bile ducts and vascularization tract,
because the greatest number of errors and injuries during the operation happens in
these elements. We analyzed the most common risk factors and uncertainty factors
that are reported during laparoscopic surgery. It is compared the use of different
versions of certain surgical instruments and the reliability of certain techniques and
the most common complications / errors that occur.
Results:
Significant correlation with parameters such as: insufficient knowledge of anatomy,
variations and anomalies with frequent mistakes during surgery, while significantly
reducing their influence ongoing training, exchange of experience and proper patient
preparation and processing. A special importance is the technical preparation and
selection techniques used in surgery. Routines and practices as a parameter are
significantly behind the above.
Conclusion:
We have come to the conclusion that good preoperative preparation, good
knowledge and continuous training can significantly affect the reduction of errors
and violations in the course of surgery hepatobiliary system. Technical preparedness
of doctors, choosing the right techniques and approaches can affect the outcome
of the operation. Exchanging ideas and knowledge with colleagues, monitoring and
research papers and sharing personal experiences and the recipe for a successful
and complete operating procedures.
-725-
PP - 524 HARMONIZATION WITH OPEN SURGERY IN THE ERA OF
LAPAROSCOPY.
SHAHRAM NAZARI , SEMİRA MOUSAVİ KHOSROSHAHİ
ERFAN HOSPITAL, IRAN
Background&Aims:
Laparoscopic cholecystectomy (LC) has become the standard procedure for gall
bladder surgery. Isolation of the cystic duct is the first dangerous part. Despite
increasing experience of surgeons, bile duct injuries are still greater than open
surgery. In conventional open cholecystectomy, the fundus-down approach (FDA),
partial cholecystectomy (PC), cholecystostomy, primary evacuation of liquids
or entrapped stones, pushing up the entrapped stone in Hartman`s pouch and
subtotal cholecystectomy are well recognized safe procedures that minimize the
risk of damage to the structures in or around Calot’s triangle. In spite of this, such
maneuvers are not widely practiced in LCs.
Methods:
The purpose of this study was to evaluate the feasibility of such maneuvers,
especially PC and FDA in difficult cholecystectomies (DCs). The study included 540
patients treated over 36 months.
Results:
FDA was started in 45 patients. Five cases converted to open surgery. PC was done
in 24 patients. Operative time was 95-130 minutes (mean 112.5).
Conclusion:
FDA and PC could be started in DCs. They are safe procedures, and have the
potentials to reduce the conversion rate and decrease the risk of injury to bile
ducts. The surgeon should have adequate laparoscopic experience and must be
familiar with intraoperative cholangiography and intracorporeal suturing.
-726-
PP - 525 INITIAL POSTOPERATIVE DEATHS IN DDLT LIVER
TRANSPLANT RECIPIENTS: A PRELIMINARY REPORT
Background&Aims:
Liver transplant often results in hemodynamic and biochemical changes in the

immediate postoperative period, often causing concern to the treating physician.
Aim of the study to determine the preoperative clinical profile, the laboratory
changes in the immediate postoperative period up to 7 days following DDLT patients.
Methods:
A detailed assessment of the patients preoperative clinical diagnosis, presence of

comorbid illness and postoperative hematological, biochemical, was made between
survivors and those who died. Parameters were compared between two groups to
determine early postoperative outcome in DDLT patients.
Results:
34 patients categorized into group I-26 patients (Survivors) and group II-8(mortality).
There was no difference in the fluctuation of haemoglobin levels in two groups.
Early leucocytosis and persistent azotemia predicted early morbidity and mortality.
A significant fall of platelet count predicted mortality. Transaminases showed a
significant rise between the 2nd and 3rd postoperative days and stabilized and
showed a onwards trends by the 7th-9th postoperative days in both group. Cause of
death was intra-operative events like cardiac arrhythmias, and in ischemic cardiac
events(2),pulmonary thromboembolosm(1),and hepatic artery thrombosis(1),
multiorgan failure(4).
Conclusion:
Pre-operative co-morbid illness, postoperative worsening azotemia, persistent

leukocytosis, and sepsis and cardiac events in the immediate postoperative period
predicts an outcome post DDLT
-727-
PP - 526 LAPAROSCOPIC CHOLECYSTECTOMY: COMPLICATIONS AND
CONVERSIONS
DEEVISH N D , SHIVASWAMY B S , RAJASHEKARA BABU , SANTHOSH C S
Background&Aims:
Laparoscopic cholecystectomy has become standard method for treating gallstone.

However, different centres have reported different complications and conversion
rate. The objective of this study was to evaluate complications and conversion
of laparoscopic cholecystectomy into open cholecystectomy in Victoria Hospital
(tertiary level hospital), Bangalore, India.
Methods:
Files of all patients who had laparoscopic cholecystectomy from January 2001 to
December 2011 were reviewed. Out of 1450 laparoscopic cholecystectomy cases,
1189 were included in the study as complete information was lacking in the rest.
Results:
Out of 1189 cases, 942 were female. Symptomatic cholelithiasis were 76.47%. The
mean hospital stay was 6.48 days. Post-operative complications occured in 5.88%
patients. Conversion rate to open cholecystectomy was 5.92%.
Conclusion:
Laparoscopic cholecystectomy is a reliable and safe surgery. With growing experience

in laparoscopic technique, it is possible to bring complications and conversion rate
to minimum. Our study emphasizes that although the rate of conversion to open
surgery and complication rate are low in experienced hands. The surgeon should
keep a low threshold for conversion to open surgery and it should be taken as a step
in the interest of the patient rather than be looked upon as an insult to the surgeon.
-728-
PP - 527 LAPAROSCOPIC DISTAL PANCREATECTOMY WITH
PRESERVATION OF SPLEEN
SAHIN

Background&Aims:
Laparoscopic approach is becoming favored for pancreatic disorders localized to

body or tail of the organ. Here we report our experience with the distal pancreas.
Methods:
From 2009, 7 patients underwent a laparoscopic procedure for pathologies of the

distal pancreas. The indication was cystic neoplasia for 4 patients, neuroendocrin
tumor for 2 patients and solid lesion for one patient. Laparoscopic distal
pancreatectomy (DP) with spleen preservation was performed to 6 patients and
enucleation to one. Splenic artery and vein was preserved in all DP cases except one
whose artery was clipped for bleeding.
Results:
Four of the patients was male and mean age of the patients was 54 (27-76).
Enucleation procedure was converted to open surgery because of bleeding during
dissection of gastrocolic ligament. Mean operation time was 85.14 min (62-125) and
mean postoperative stay was 3.42 days (2-8). Two low output pancreatic fistulas,
one of them was in enucleation procedure, were seen and managed conservatively.
One incisional hernia occurred in the patient who underwent conversion to an
open procedure. Partial splenic infarct was detected during the computerized
tomography examination for left upper quadrant pain in the patient whose splenic
artery was clipped. No intervention was required in the patient.
Conclusion:
Laparoscopy for the distal pancreas seems a safe procedure with low morbidity rate
and early discharge from the hospital.
-729-
PP - 528 LAPAROSCOPIC SINGLE INCISION CHOLECYSTECTOMY
WITHOUT GAS; KEYLESS ABDOMINAL ROPE-LIFTING SURGERY
(KARS)
BARLAS SULU 1, ELIF DEMIR ILINGI 1, HASAN ALTUN 1, YUSUF GUNERHAN 1, NESET
KOKSAL 1, KAHRAMAN ULKER 2
1
KAFKAS UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, KARS, TURKEY
2
KAFKAS UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF OBSTETRICS AND
GYNECOLOGY, KARS, TURKEY
Background&Aims:
In single port laparoscopic surgery the complications from pneumoperitoneum

and difficulty of use of devices are known. We presented the first cholecystectomy
without gas by Keyless Abdominal Rope-Lifting Surgery(KARS).
Methods:
Through transumbilical transverse incision by 2cm length, abdominal cavity was

entered. Umbilical fascia was hanged in alignment with 6 and 12 o’clock with
sutures. Polypropylene suture was placed inside Veress cannula and cannula was
pushed forward through incision in 1 and 11 o’clock direction between fascia and
peritoneum. Suture was taken out from skin, 5- 7cm away from the incision than
again 5-7cm away from the last point. The abdominal wall hanged vertically.To
distance the abdominal wall from liver in subcostal area, a third hanger suture was
used. Cholecystectomy was done from single incision without using trocar and with
laparoscopic devices.
Results:
Surgery durations of two patients aged 63 and 40 with gallstone were 42 and 110
minutes, VAS(visual analog score) values on postoperative days 1 and 7 were 3, 1
and 2, 1 respectively.No pain was detected except from incision area. There was no
need for additional analgesic.
Conclusion:
There may be some advantages with KARS technique in laparoscopic cholecystectomy

in terms of complications related to pneumoperitoneum, postoperative pain and
cost effective.
-730-
PP - 529 NUTRITIONAL STRATEGY IN PATIENTS WITH SEVERE
ACUTE PANCREATITIS - RELATION AND IMPORTANCE TO CYTOKINE
CONCENTRATION
MINKOV GEORGI 1, YOVTCHEV YOVCHO 1, PETROV ALEN 1, NIKOLOV STOYAN 1,
VLAYKOVA TATYANA 2

1
DEPARTMENT OF CHEMISTRY AND BIOCHEMISTRY, UNIVERSITY HOSPITAL,

2
BULGARIA
Background&Aims:
Inability to use gastrointestinal tract in patients with severe acute pancreatitis

(SAP) may lead to exacerbation of the stress response and severity. Therefore the
establishment of proper nutrition strategy determines individualized therapeutic
approach.
Methods:
This study investigated and analyzed all available medical information related to
strategies for nutritional support (NS) in patients with SAP. The evidences about
statements, optimal way of delivery of nutritients, time and effect of nutritional
strategy in these patients were systematicly examined.
Results:
We analyzed the available literature published in PUBMED and MEDLAIN systems in

period from January 1986 to March 2012. So we concluded that only SAP requires
creation of individual NS. Enteral nutrition(EN) is a new „gold standard” in NS of SAP.
Examination of cytokines serum concentration in the course of EN may evaluate
and prove the impact on immunoinflamatory response.
Conclusion:
Efforts of several teams in recent years were directed to prove and enforce the
strategy for EN in daily practice. Implement standards allowed the creation of
strategies for NS in condition of SAP. Despite all the advantages of EN - reduction
of infected complications, need of surgical intervention - implementation of
therapeutic effect remains unclear. Nevertheless the EN in patients with SAP isn’t
just a formula for NS, but also a major part in the complex therapeutic strategy.
-731-
PP - 530 PERSISTENT BILE LEAKS AFTER SURGERY OF LIVER
HYDATID CYST
Background&Aims:
Hydatid cyst of the liver is a well-recognized parasitic disease since the days
of Hippocrates >2000 years ago. It is caused by the larval form of echinococcus
granulosus. It is endemic in Mediterranean countries, Middle East and South
America. The liver is the most common organ involved with the disease 70-75%
followed by the lung around 15-17% .Post operative bile leaks may follow many types
of surgical techniques,, for that reasons many different options has been used to
decrease this complication this study aims to identify the possible predictive factors
associated with cysto-biliary communications To evaluate the effect of surgical
type of intervention in decreasing the incidence of bile leakage To determine the
minimum and maximum time of persistent bile leaks
Methods:
This is prospective experimental study performed in the period between January

2006 and March 2009. 28 patients (8males and 20 females) Presenting to Al-Wali
typical hospital and Al-Gamhoriah teaching hospital, Aden city All of them diagnosed
as symptomatic liver hydatid cyst All of them operated by conservative surgical
approach – 1.Omentoplasty ± Gelatin spong ( obliterative ) – 2.Marsupialization +
External drainage( non oblit) Any patient found to have leakage of bile more than
20-30ml /day lasting more than 3-4 days through the drain in the post operative
period was consider to have a bile leak
-732-
Results:
Mean age 32.2 years with SD ± 6, Youngest age 8 , Oldest patient 65, female 20
( 71%), males 8(29%), right upper abdominal pain is the mail complaint seen in
26 patients, abdominal mass in 13, fever in 3 and four patients presented with
jaundice. Abdominal US done for all patients25 single cyst ( 23 right lobe, 2 left
lobe) Gharbi type I and II , 3 multiple cysts all of them in the right lobe( Gharbi
Type III and one type IV Mean diameter of the cyst 10.2cm echinococcuc antigen
positive in 27(95.5%) Omentoplasty ± Gelatin spong ( obliterative surgery ) done
in 15(53.6%) , Marsupialization + External drainage( non oblit) done in 13(46.4%)
Bile leaks had been observed in 6 cases Four cases stop within four weeks all of
them were low out put fistula One case stop within 3 months and later needed
percutanous drainage (due to biloma) under guided US which continues for other
three months The sixth case stopped spontaneously after 107 days
Conclusion:
Bile leakage is a morbid complication in conservative surgery especially non

oblitrative type while adoption of the oblitration for the residual cavity can decrease
such problem markedly. Bile leaks it seem to be more common in right lobe liver
cyst and in those tend to have multiple cyst and of a size more than 10 cm. Primary
suturing of the cysto-biliary communication can prevent the leakage in most of the
cases Long time persistent of bile leak can lead to some psychological upset
-733-
PP - 531 PRE-OPERATIVE ARTERIAL EMBOLIZATION OF
SYMPTOMATIC LIVER HEMANGIOMAS. IS EMBOLIZATION USEFUL
TOOL FOR THE CONTROL OF OPERATIVE BLOOD LOSS.
SERDAR TOPALOGLU , ADNAN CALIK , ORHAN KALAYCI , HALIL OZTURK , MITHAT
KERIM ARSLAN , IRFAN INCI , HASAN DINC
Background&Aims:
The present study was designed to investigate the efficacy and safety of preoperative
selective intraarterial embolization (IAE) for reduction of blood loss during surgical
resection of giant liver hemangiomas.
Methods:
A retrospective study was performed on 23 patients who underwent resection of

giant liver hemangiomas with (n=11) or without preoperative selective IAE (n=12).
Preoperative selective IAE was preferred for giant liver hemangiomas in difficult
locations.
Results:
A total of 16 enucleations and 8 anatomic resections were performed for treatment
of giant hemangiomas. The Pringle maneuver was routinely used in cycles of
10/5 min of clamp/reperfusion times. Patient demographics were comparable
between the two groups. Operative time, bleeding amount and Pringle period were
significantly higher in the preoperative selective IAE group compared to control
group (P=0.005, P=0.03 and, P=0.04 respectively). Intraoperative blood loss and
blood transfusion in the preoperative IAE group were comparable between two
groups (p>0.05). There was no complication occurred depend on IAE procedure. In a
comparison of the two groups, there was no significant difference in the changes of
the perioperative serum aspartate transaminase levels (p=0.086). Slight increment
in the perioperative total bilirubin levels was observed in the preoperative selective
IAE group compared to control group (P = 0.06). The postoperative hospital stay
and surgical complications according to Dindo’s classification were comparable
between two groups (P = 0.378, P = 0.227, respectively).
Conclusion:
Selective IAE was performed with a low morbidity and slight increase in hospital
stay secondary to the technique. It could be used for the control of intraoperative
blood loss in selected cases.
-734-
PP - 532 RISK FACTORS FOR DEVELOPMENT OF COMPLICATIONS
AFTER ERCP
MUSTAFA HASBAHCECI 1, FATIH BASAK 2, TOLGA CANBAK 2, MUJGAN
CALISKAN 2, AYLIN ACAR 2, KAMIL OZDIL 3, GURHAN BAS 2, ORHAN ALIMOGLU 4
1
2
3
UMRANIYE EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF
GASTROENTEROLOGY, ISTANBUL, TURKEY
4
Background&Aims:
Endoscopic retrograde choleangiopancreatography (ERCP) is commonly used

invasive technique in diagnosis and treatment of biliary and pancreatic diseases.
But there are several important complications releated to ERCP. In this study, we
evaluated ERCP related complications and the risk factors affecting this issue.
Methods:
A total of 81 patients underwent ERCP between January 2010- November 2011

during hospitalization in surgical wards. Demographic data, indication for ERCP,
findings and complications of ERCP were investigated retrospectively. Statical
evaluation and comparisons between groups with and without complications were
made with “chi-square” test. p <0.05 was accepted as significant.
Results:
Complications developed in 28 (34%) patients after ERCP. The number of 15 (53.5%)
patients were female and 13 (46.5%) patients were male. Avarage age was 65.5
years (range: 44-84) and 10 patients were over 70 years old. The complications were
pancreatitis (n=7), hyperamylasemia (n=14) hemorrhage (n=5), cholangitis (n=1)
and hemobilia (n=1). There was no mortality. Complications were treated medically.
Seven of patients (25%) were underwent difficult canulation. Complications were
detected in 7 (67%) of 11 malignancy (p<0.05).
Conclusion:
Patients with difficult cannulation during ERCP and suspicion of malignancy are
especially observed due the risk of post-ERCP complications.
-735-
PP - 533 STENT PLACEMENT MAY BE A DEFINITIVE TREATMENT
PROCEDURE FOR PATIENTS WITH UNEXTRACTABLE COMMON BILE
DUCTSTONES.
WAFI ATAALLAH , ÖMER GÜNAL , ASIM CINGI , TOLGA DEMIRBAŞ
MARMARA UNIVERSITY, MEDICAL FACULTY, ISTANBUL, TURKEY
Background&Aims:
Common bile duct stones sometimes may be a dilemma for the surgeon especially
in patients that their stones are unextractable . We investigated the spontaneous
stone and/or stent removal rate in those patients with unextractable common bile
ductstones on ERCP as a definitive treatment.
Methods:
We have retrospectively analysed patients with common bile duct stone/s those
have undergone ERCP. Only the patients stented with common bile duct stone/s
due to unyielding stone extraction included the study. Major outcome measures
were the stented patient number due to unextractable bile ductstone, number of
subjects that spontaneous stone and/or stent removal, number of patients that has
undergone surgical common bile duct exploration.
Results:
275 ERCPs were performed for bile duct stone removal between 2010-2012. 39
Patients had an unsuccesful stone extraction and were stented as a temporary
measure. Six (15%) spontaneous stone and/or stent diappearance in their last ERCP
sessions. Eight (21%)patients needed to undergone surgical common bile duct stone
removal. Mean follow period was 1.8 month. 18 stayed stented under follow-up.
Seven(18%) patients have successful stone removal during the subsequent ERCP
sessions. There were no significant correlation between the stent and/or stone
diasappearance and recorded parameters.
Conclusion:
Our findigs made us promulgate the stent application and expect to spontaneous
stone removal as a definitive procedure in especially the challenging bile duct stone
patients.
-736-
PP - 534 THE ANALYSIS OF ELECTIVE LAPAROSCOPIC
CHOLECYSTECTOMY CASES
TOLGA CANBAK 1, FATIH BASAK 1, KEMAL TEKESIN 1, MUSTAFA OZBAGRIACIK 1,
SULEYMAN KALCAN 1, AYLIN ACAR 1, GURHAN BAS 1, MUSTAFA HASBAHCECI 2
1
2
BEZMIALEM FOUNDATION UNIVERCITY, GENERAL SURGERY DEPARTMENT,
ISTANBUL, TURKEY
Background&Aims:
The purpose of this research was to evaluate our experience with laparoscopic
cholecystectomies.
Methods:
In this study we prospectively investigated patients whom underwent elective

cholecystectomy between January 2009 – June 2010 in a single department of
surgery. The patients were evaluated as five groups which were asymptomatic
cholelithiasis (group I), chronic cholecystitis (group II), interval cholecystectomy for
acute cholecystitis (group III), acute biliary pancreatitis (group IV) and obstructive
jaundice (group V). The patient’s demographic status, rate of conversion, morbidity
and mortality, hospitalization time , complications and pathology results were
evaluated.
Results:
Of the 1002 patients, 780 patients (78%) were women and 222 (%22) were men.
The average age was 48,7 (range 17-83) and hospitalization time was 1.2 days
(range 1-12). While the total conversion rate was 3.2%, the highest conversion
rate (16%) was saw in group III. Postoperative ERCP was performed in 5 patients
(0.5%). Reoperation wasn’t necessary in any case. The cancer of gallbladder was
observed in 3 patients (0.3%). The lowest complication rate was observed in group
I. Perioperative mortality wasn’t observed.
Conclusion:
It’s observed that rate of conversion in interval acute cholecystitis group was higher
than the other groups although we didn’t perform any statistical analysis.
-737-
PP - 535 THE COMPARISON OF POSTOPERATIVE PAIN IN PATIENTS
CHOLECYSTECTOMY
BARLAS SULU , ELIF DEMIR ILINGI , MUSA SINAN EREN , TULAY DIKEN , YUSUF
GUNERHAN , NESET KOKSAL
KAFKAS UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,

KARS, TURKEY
Background&Aims:
To understand the postoperative pain if the wideness of incision in single port

laparoscopic cholecystectomy(SC) is problematic or not.
Methods:
In our study with prospective planning, patients were included in both groups
respectively. The patients were evaluated with visual analog scale(VAS) and pain
levels on postoperative days 1 and 7.
Results:
Inboth groups there were 30 patients each. The patients, in-group standard
laparoscopic cholecystectomy(LC) were 12 male(40%), 18 female(60%), mean age
was 45.76±11.18, BMI was 28.54±5.5 kg/m2. The patients, in-group SC were 9
male(30%), 21 female(70%), mean age was 47.53±9.16, BMI was 30.3±4.29kg/m2.
No significant differences were found between groups in terms of age, gender, ASA
and BMI. In-group LC the average VAS scores on postoperative 1st day was 3.9±1.1
and on 7thday was 1.9±1.1. In-group SC the average VAS scores on postoperative 1st
day was 4.1±1.0 and on 7th day was 2.1±1.1. In both groups, the VAS score values on
postoperative day 7 were significantly decreased with respect to postoperative day
1(p<0,05). No significant differences were found between groups on postoperative
days 1 and 7 due to pain levels.
Conclusion:
No significant differences were found in patients who had SC and LC in terms of pain
during postoperative duration.
-738-
PP - 536 THE EFFECT OF SURGICAL PROCEDURES ON MORBIDITY,
SURGERY DURATION AND HOSPITALIZATION FOR PATIENTS
CHOLECYSTECTOMY
BARLAS SULU , ELIF DEMIR ILINGI , HASAN ALTUN , BULENT ÇAĞLAR BILGIN ,
YUSUF GUNERHAN , NESET KOKSAL
KAFKAS UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,

KARS, TURKEY
Background&Aims:
The comparison of the single port laparoscopic cholecystectomy(SC) and standard

laparoscopic cholecystectomy(LC) in terms of safety of patients, duration of surgery
and hospitalization.
Methods:
In our study with prospective planning, patients were included in both groups
respectively. Duration of surgery, early and late postoperative morbidity and
hospitalization periods were recorded.
Results:
In both groups there were 30 patients each. Follow-up was 16 months. The patients,
in-group LC were 12 male(40%), 18 female(60%), mean age was 45.76±11.18, BMI
was 28.54±5.5 kg/m2. The patients, in-group SC were 9 male(30%), 21 female(70%),
mean age was 47.53±9.16, BMI was 30.3±4.29kg/m2. No significant differences
were found between groups in terms of age, gender, ASA and BMI. The average
duration of surgery in-group LC was 65.8 minutes, whereas in-group SC it was 83
minutes(p<0.05).The average duration for hospitalization in-group LC 1.56±0.8
days and in-group SC it was 1.96 ±1.0 days(p>0.05).Wound infection was seen in
2 patients in-group LC, and in 4 patients in-group SC.In-group SC, incisional hernia
was detected in 2 patients.
Conclusion:
The duration of surgery is longer in SC. No differences were detected in terms of

hospitalization in both groups.The risk of wound infection and incisional hernia
increases for the patients who have SC patients.
-739-
PP - 537 THE VALUE OF MINIMALLY INVASIVE SURGERY FOR THE
TREATMENT OF HEPATOCELLULAR CARCINOMA
HALIT TOPAL , JOYCE TIEK , STEFFEN FIEUWS , JACQUES PIRENNE , FREDERIK
NEVENS , BAKI TOPAL
UNIVERSITY HOSPITALS LEUVEN, BELGIUM
Background&Aims:
Little is known about the oncologic outcome and prognostic indicators of patients
with hepatocellular carcinoma (HCC) who undergo minimally invasive liver surgery
(MILS).
Methods:
Between 2004 and 2009, 119 consecutive patients with HCC underwent surgery,
i.e. MILS (resection 13; RFA 54; resection + RFA 5) in 72 and open liver surgery (OLS;
resection 40; RFA 4; resection + RFA 3) in 47 patients. Eighteen potential predictive
factors were assessed for their prognostic value.
Results:
The rate of surgical site complications was similar in both groups while more non-
surgical site complications were observed in the OLS vs. MILS-group (25.5% vs.
2.8%; p=0.0002). Patients who underwent OLS had a longer hospital stay (median
10 days vs. 3 days after MILS; p<0.0001). Survival rates were comparable in the 2
groups. In cirrhotic patients with HCC, postoperative liver transplantation (LTx) was
found to be the only independent predictor of both OS and DFS.
Conclusion:
MILS seems to result in better postoperative outcomes and similar survival rates as
compared to OLS. Following surgery for HCC, LTx seems to be the only independent
factor having a beneficial impact on survival of cirrhotic patients with HCC.
-740-
PP - 538 USE OF ANTIBIOTICS IN ACUTE CALCULOUS CHOLECYSTITIS
– AN AUDIT OF OUR PRACTICES
HASSAAN BARI , RIZWAN KHAN
AGA KHAN UNIVERSITY HOSPITAL, PAKISTAN
Background&Aims:
To audit our practices of antibiotic usage in patients with acute calculous cholecystitis
and compare them with international guidelines.
Methods:
A retrospective study was performed by reviewing the medical records of all patients
with the diagnosis of acute calculous cholecystitis, admitted at Aga Khan University
Hospital, from January to December 2009. Data was recorded regarding patient’s
demographics, clinical features, hematological & radiological investigations &
empiric antibiotics used (monotherapy –single antibiotic, combination therapy –
more than one antibiotic).
Results:
A total of 96 patients admitted with diagnosis of acute calculous cholecystitis met

the inclusion criteria. The patients were classified into garde I (n=50), grade II (n=40)
and grade III (n=6). The combination therapy was used in 65 % of grade I patients
where a monotherapy is recommended. Flagyl was concomitantly used in 67 % &
61% patients in grade I and II, respectively, where it is not recommended. Early
cholecystectomy was performed in 97%, 95% & 100% of patients with grade I, II
and III respectively.
Conclusion:
Grading of acute cholecystitis is helpful for guiding management strategies. Empiric

antibiotics should be used according to disease severity. Monotherapy should be
the first priority for mild & moderate cases and combination therapy for severe
cases. Use of Flagyl should be more selective.
-741-
PP - 539 VISCERAL ARTERY PSEUDOANEURYSMS
ÖMER ÜNALP , ELA EKMEKCİGİL , TAYFUN YOLDAŞ , TAYLAN SEZER , HALİL
BOZKAYA , CELAL ÇINAR , MURAT SÖZBİLEN , AHMET ÇOKER
EGE UNIVERSITY, GENERAL SURGERY DEPARTMENT, IZMIR, TURKEY
Background&Aims:
To evaluate the hepatopancreaticobiliary system cases complicated with

hemorrhage caused by visceral artery pseudoaneurysms
Methods:
We searched the computer based databases and entries of cases between June
2006-June 2012 and identified the cases of visceral artery pseudoaneuryms to
review in details about the etiologies,therapeutic interventions, materials used to
anastomosis,symptoms to find the dıagnosis, to evaluate the treatment alternatives
and outcomes.
Results:
We experienced 27 cases for pseudoaneurysmal bleeding, 19 cases were male and

8cases were female,average age found 50.07.
Conclusion:
: Pseudoaneurysms are rarely seen but most dangerous complications caused

by surgical or endovascular percutan interventions.Early diagnoses and acute
treatment will be life-saver.Beware of increasing morbidity and mortality rates,at
first we must control the bleeding sourche with embolization by the interventional
radiology.But in approprıate patients for persistant hemorrhagies don’t avoid
surgical approaches with acute interventions,they will be result with excellent long-
term outcomes.
-742-
PP - 540 A CASE OF RENAL TUMOR MIMICKING AN INCARCERATED
ABDOMINAL HERNIA
EMRE GUNAY 1, BULENT KAYA 3, MEHMET KAMIL YILDIZ 1, ERKAN OZKAN 1, CENGIZ
ERIS 1, HACI HASAN ABUOGLU 1, HACI MEHMET ODABASI 1, OZCAN CAKIR 2
1
2
OF RADIOLOGY, ISTANBUL, TURKEY
3
S.B. FATIH SULTAN MEHMET RESEARCH AND TRAINING HOSPITAL DEPARTMENT
Introduction:
There is not many of incarcerated or strangulated hernia is shared with the

literature, involved within cases of tumor. However, cases of renal tumor involved
with incarcerated abdominal hernia has not been submitted previously. We shared
a case which ultrasonography reported as an incarcerated abdominal hernia , but
during the operation, we understood that a tumor arising from the kidney was
protruding from the abdominal wall.
Case report:
54-year-old male patient with chronic renal failure, admitted to the emergency
department with a complaint of shortness of breath has been internalized to do
hemodialysis with the diagnosis of ARF on CRF. An abdominal ultrasonography was
planned for the patient with abdominal swelling and pain in the left upper quadrant
which was reported as incarcerated abdominal hernia. There was an approximately
15 cm of diameter painful swelling revealed by palpation assessed by examination.
Patient underwent to surgery and a tumor originating from left kidney was found
and left nephrectomy was performed.
Conclusion:
Sometimes some tumors mimic incarcerated or not incarcerated hernias. Our

surveys present that there is no cases of renal tumor mimicking an incarcerated
abdominal hernia in the literature. In most cases, ultrasound is sufficient to identify
whether or not incarcerated hernias. However, the incomplete imaging evaluation
leads to wrong assumptions in diagnosis. This case is a condition that must be kept
in mind.
-743-
PP - 541 A RARE PRESENTATION OF CYSTIC HYDATID DISEASE IN
ENDEMIC REGION: ISOLATED SUBCUTANEOUS HYDATID DISEASE
ERDINC YENIDOGAN , ISMAIL OKAN , HUSEYIN AYHAN KAYAOGLU , SERVET TALI ,
ZEKI OZSOY , MUSTAFA SAHIN

Introduction:
Hydatid disease is endemic in some regions of the world where agriculture and
livestock farming. Although the most common presentation is the involvement of
liver, lung, spleen, brain, kidney, muscle and bone are also involved albeit rare. Here,
we present an isolated subcutaneous hydatid disease in a woman from endemic
region.
Case report:
A 53 year old woman applied to the hospital with a complaint of swelling in her
umbilical region. Her medical history revealed prior cholecystectomy and umbilical
mesh herniorraphy. Physical examination showed nothing abnormal but a well-
delineated nodular lesion of 10 cm diameter under the scar of umblical hernioraphy.
The lesion was thought as recurrence or a secondary cyst formation due to the
mesh reaction. Abdominal CT showed high intensity cystic lesion with the size of
103x81x109 mm between subcutaneous tissue and muscle planes in the umbilical
region. Chest X-ray and CT showed that there was no involvement of intrabdominal
organs and lungs. The patient was operated and the cystic lesion was delivered
without perforation. The pathological examination put the diagnosis of hydatid
disease.
Conclusion:
Presentation with cystic lesion in any part of the body should raise the suspicion
of hydatid disease in an endemic region. Awareness and preoperative prompt
diagnosis might prevent the spillage of cystic contents during operation.
-744-
PP - 542 SCAR ENDOMETRIOMA FOLLOWING CESARIAN SECTION :
CASE REPORT
FATIH TASKESEN 1, SUHHA BOSTANCI 2, ZULFU ARIKANOGLU 1, OMER USLUKAYA 1,
ABDULLAH OGUZ 1
1
DEPARTMENT OF SURGERY, DICLE UNIVERSITY HOSPITAL, FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
2
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, SAKARYA EDUCATION AND
RESEARCH HOSPITAL, SAKARYA, TURKEY
Introduction:
Term of endometriosis is growth of ectopic endometrial tissue outside of the

uterine cavity while extrapelvic endometriosis refers to endometriosis found at
body sites other than the pelvis. All scar endometriosis is not characterized by
endometrioma. When there are no palpable nodules it is hard to diagnose the
disease. The treatment for scar endometrioma is surgical removal of the lesion.
Case report:
A 37-year-old woman was presented with a 10-month history of pain during her
menstruation at her abdominal scar from a cesarean section three years earlier. On
local examination was noticed a painful lump on the lateral aspect of a pfannensteil
incision. Patient was treated surgically, with removal of the endometrioma with
a safety margin, with the aiming of achieving a cure and avoiding locoregional
recurrence. Histopathology showed presence of endometrial glands and stromal
cells in the connective tissue which confirmed diagnosis of endometriosis abdominal
wall scar.
Conclusion:
A thorough history and physical examination should always be performed, and

surgeons should consider this entity in their differential diagnosis when their
patients have symptoms of cyclical pain at the site of incision of abdominal
gynecologic surgery procedures especially after cesarean section.
-745-
PP - 543 EMERGENCY LAPAROTOMY FOR IATROGENIC
DIAPHRAGMATIC HERNIA
FRANCESCO FARELLI , MICHELE BENEDETTI , ROBERTO CARONNA , LUCA SACCO ,
ALESSANDRA PULVIRENTI , GABRIELE RUSSILLO , PIERO CHIRLETTI
SAPIENZA UNIVERSITY OF ROME – DEPARTMENT OF SURGICAL SCIENCES –

GENERAL SURGERY, ITALY
Introduction:
Iatrogenic diaphragmatic perforation is a possible intraoperative complication that,

if undetected, could be responsable of late diaphrammatic hernia.
Case report:
Case I. 54 year old woman was hospedalized in ICU for a thoracic pain. She
underwent left VLS adenalectomy for Cushing’s disease two years before. At
admission she had precordial pain and vomit but no signs of cardiac ischemia. A CT
scan demonstrated a diaphragmatic hernia with rotation and intrathoracic stomach
herniation. She underwent emergency laparotomy with reduction of the stomach
in the peritoneal cavity and diaphragmatic suture. Case II. 51 year old woman
was admitted for abdominal pain and intestinal occlusion. Four months before
she underwent isteroannessectomy, peritonectomy and HIPEC for sierous ovarian
carcinoma. A CT scan showed a gastric intrathoracic volvulus with severe dilatation
of right colon. An emergency laparotomy was performed, the stomach was replaced
into the abdomen and diaphrammatic hernia repaired. The postopertaive outcome
of both patients was without complications.
Conclusion:
Due to the absence of previous abdominal trauma, the diaphragmatic lesions can be
referred to an unidentified iatrogenic injury. Even if full-thicknes injuries can be easily
detected during previous laparotomy/laparoscopy, in these patients there were
probably only a partial diaphragmatic laceration that led to a transdiaphragmatic
visceral herniation
-746-
PP - 544 OPTIMIZING THE TREATMENT OF PATIENTS WITH
POSTOPERATIVE VENTRAL HERNIAS.
ALEXANDR KOSTIRNOY , IGOR KAMINSKY , OKSANA GERBALI
DEPARTMENT OF SURGERY № 1 (HEAD, PROFESSOR A.V. KOSTYRNOY), UKRAINE
Introduction:
Treatment of postoperative ventral hernias (PVG) - the actual problem of modern
abdominal surgery. PVG comprise 20-26% of all external abdominal hernias, ranking
second in frequency after inguinal hernia (Feleshtinsky Y.P., 2009; Zhebrovsky V.V.,
2010). A common limitation of disability and disability patients with hernias makes
it possible to consider the approach to the treatment of patients with postoperative
ventral hernia (PVG) as one of the most important problems in theoretical and
practical medicine.
Case report:
The aim of the study. To improve the results of surgical treatment of patients with
PVG through the development and implementation of efficient measures stabilize
the immune system. Material and methods. The study included 71 patients with PVG
and concomitant obesity: women - 53 (74.6%), men - 18 (25.4%). Overweight were 56
(78.9%) patients. Discussion of the results. Studies in the preoperative period showed
that PVG cause an imbalance in patients with phagocytic activity of neutrophils and
levels of anti-LPS. Before the operation, after the introduction in the preoperative
preparation cycloferon showed marked imbalance of the studied parameters
associated with the severity of obesity. At the time of discharge of patients from the
hospital after hernioplasty indicators of general Ig differed from preoperative levels
and indicators of healthy adults only in a subgroup of obese I, for which the figures in
this period the total IgM levels were higher than preoperative values and normative,
and IgG - below the level at the time admission to the hospital. Only in the subgroup
of obese II Ig levels of all classes of performance achieved prior to surgery, whereas
no different from normal levels of total Ig of all classes in the main sub-groups of
obese I and II. The most pronounced dynamics of the overall Ig was detected in a
subgroup of obese III.
Conclusion:
We believe that comprehensive measures to prevent the persistence of inflammation,
activation of pathogenic flora, improvement of reparative processes should include
measures aimed at stimulation of sanitizing functions of phagocytes. A fundamentally
new approach to integrated management of PVG, the modulation of wound healing
process is the appointment of cycloferon. Found that in patients with immune there
has been local and systemic complications in the early postoperative period. In
conjunction with UV irradiation space operations, conventional antibiotic therapy
periods of hospital treatment after surgery on average decreased by 1.5 times, which
has a significant socio-economic impact.
-747-
PP - 545 AMYAND’S HERNIA: A CASE REPORT
MEHMET SAYDAM 1, HUSEYIN SINAN 1, MUHARREM OZTAS 1, AHMET ZIYA BALTA 2,
MEHMET YILDIZ 1
1
ANKARA, TURKEY
2
ISTANBUL HAYDARPASA GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT
Introduction:
Amyand hernia is described presence of appendices vermiformis in inguinal hernia

sac. The incidence of Amyand hernia is approximately 1% of all hernias. There are
many treatment procedures of Amyand’s hernia. Since Amyand hernia is extremely
rare and there are many controversial surgical managements, we wanted to share
our case. We have encountered a Amyand hernia case during right inguinal hernia
repair surgery. Treatment method and outcome were evaluated.
Case report:
Twentyone-year-old male patient was suffering from right groin pain and swelling
for almost one year. He was operated with the diagnosis of right inguinal hernia,
electively. Intraoperative exploration revealed Amyand hernia, appendectomy and
hernia repair were performed using polypropylene patch with same incision..The
patient’s postoperative course remained without complication and after 3 days he
was discharged.
Conclusion:
Amyand hernia which especially difficult to diagnose preoperatively, particularly

in terms of therapeutic approach, the debate continues, is extremely rare entity.
There is no current consensus about appendectomy and using patch. We think that;
regardless of the appendix is inflamed or noninflamed, appendectomy should be
done. If the appendix is inflamed or perforated, prosthetic materials shouldn’t be
used and while repairing hernia, anatomic repair or biological materials resistant to
infection should be used.
-748-
PP - 546 RICHTER’S HERNIA: A CASE REPORT
MEHMET SAYDAM 1, HUSEYIN SINAN 1, MUHARREM OZTAS 1, AHMET ZIYA BALTA 2,
MEHMET YILDIZ 1
1
ANKARA, TURKEY
2
ISTANBUL HAYDARPASA GULHANE MILITARY MEDICAL ACADEMY, DEPARTMENT OF
Introduction:
Richter hernia is described presence of antimesenteric wall of the intestine in inguinal

hernia sac. Since Richter hernia is extremely rare and there are many controversial
surgical managements, we wanted to share our case. We have encountered a Richter
hernia case during right inguinal hernia repair surgery. Treatment method and
outcome were evaluated.
Case report:
Twenty-year-old male patient was suffering from right groin pain. He was operated
with the diagnosis of right inguinal hernia, electively. Intraoperative exploration
revealed Richter hernia, intestinal segment imported into the peritoneal cavity and
hernia repair were performed using polypropylene patch with same incision.The
patient’s postoperative course remained without complication and after 2 days he
was discharged.
Conclusion:
Richter hernia which especially difficult to diagnose preoperatively, particularly

in terms of therapeutic approach, the debate continues, is extremely rare entity.
If such a herniation becomes necrotic and is subsequently reduced during hernia
repair, perforation and peritonitis may result.These hernias progress more rapidly to
gangrene than other strangulated hernias, and obstruction is less frequent. The gold
standard technique for repair is the preperitoneal approach, followed by laparotomy
and resection if perforation is suspected
-749-
PP - 547 A RARE TYPE OF INGUINAL HERNIA
MURAT FERHAT FERHATOGLU , EMRE BOZDAG , CIHAT ATILLA KARAKELLEOGLU
Introduction:
Amyand’s hernia(AH) is first described by a French surgeon named Claus Amyand

, in this rare kind of hernia(less than %1) appendix occurs in hernia sac with or
without incarceration or inflammation. Preoperative diagnosis is difficult in this kind
of hernia and usually misdiagnosed as an ordinary incarcerated hernia. In this case
we aimed to present an 82 year-old man with AH which diagnosed per-operatively.
Case report:
82 year-old man is refers to the emergency clinic with a right inguinal and hypo-
gastric pain, in examination he has a palpable ,non-reductable mass in right hemi-
scrotum ; he explains that swelling occurs in 24 hours. In his CBC leukocyte and
CRP is elevated, USG reports as incarcerated right inguinal hernia. Patient is taken
emergency operation based on the diagnosis of incarcerated right inguinal hernia.
Per-operatively , appendix with inflammation found in hernia sac, appendectomy
performed with hernia repair using mesh from the same incision. Patient was
discharged with any complication on his 5th day of hospitalization.
Conclusion:
AH treatment changes according to the varies of appendix and presence of

additional pathologies. If appendix is inflamed or perforated in hernia sac most
acceptable procedure to perform an appendectomy with a hernia repair using the
same incision.
-750-
PP - 548 SYNCHRONOUS IN SURGERY OF ABDOMINAL CAVITY
A.V.SIVOZHELEZOV, V.V.CHUGAJ, R.S.SHEVCHTNKO, A.TONKOGLAS
THE KHARKOV NATIONAL MEDICAL UNIVERSITY, UKRAINE
Introduction:
By data of WHO, combined surgical diseases reveal at 20 - 30 % of patients.

Approximately at 13 % of patients are necessary synchronous operations. Studying
of this question will allow to optimise criteria of surgical tactics. Aims: substantiation
of optimum surgical tactics.
Case report:
From 2002 till 2012 year in surgery clinic of KNMU, at 936 patients herniaalloplastic
have been perform (including 370 (39,5 %) postoperative hernias). At 124 (13,2 %)
patients were required elimination of accompanying diseases of abdominal cavity:
removal of adhesions 49 (5,3 %), cholecystectomy - 40 (4,3 %), resection of a small
bowel - 4 (0,4 %), hemicolectomy - 3 (0,3 %), operations on a stomach - 9 (1,0 %),
uterus amputation - 8 (0,8 %), tumours of abdominal cavity - 8 (0,8 %), hernias of
other localisation - 3 (0,3 %).
Conclusion:
At incisional hernias, after the basic stage carried out, implantation of artificial mesh
have been done by “on lay”, “in lay” and “sub lay” techniques. At patients with
huge hernias made not tension herniaalloplastic (“Prolen”). In cases when the basic
stage was carried out by laparoscopic method, the ventral hernias have executed
by laparoscopic herniaalloplastic (“Proceed” 10х20 sm. mesh), with its fixing by
transaponeurosis stitches and a “Protak” stapler. Duration of the postoperative
period made till 6 days. Conclusion: Performance of synchronous herniaalloplastic,
by laparoscopic methods, is a method of a choice for patients with two-three
accompanying diseases.
-751-
PP - 549 LAPAROSCOPIC UMBILICAL HERNIA REPAIR IN
CONJUNCTION WITH FULL ABDOMINOPLASTY
VAN CAUWENBERGE SEBASTIAAN , DILLEMANS BRUNO , VERCAUTEREN
CHARLOTTE , AKIN FAKI
AZ SINT-JAN HOSPITAL BRUGGE, BELGIUM
Introduction:
When both traditional abdominoplasty with umbilical transposition and umbilical

hernia repair are performed simultaneously, the umbilicus may be prone to
tissue necrosis. Our aim was to evaluate the surgical feasibility of simultaneously
combining a standard abdominoplasty with a laparoscopic umbilical hernia mesh
repair in order to preserve the umbilical blood supply.
Case report:
A 36-year old multiparous female patient with considerable skin and fascial laxity in
combination with a significant umbilical hernia was seen in our outpatient clinic. She
underwent a standard abdominoplasty with umbilical transposition in combination
with umbilical hernia repair. The umbilical hernia was first repaired laparoscopically
with intra-peritoneal placement of a lightweight monofilament polypropylene
mesh. Trocar incisions were placed in the preoperative marked abdominal flap.
This flap was then resected during the full abdominoplasty leaving no scars of the
trocars used. There were no intra- or post-operative complications.
Conclusion:
To our knowledge this is the first report in medical literature describing a

laparoscopic umbilical hernia repair in conjunction with a full abdominoplasty.
This surgical approach may offer a valid alternative over the standard techniques
without the risk of compromising blood supply to the umbilicus in patients with an
umbilical hernia that are candidate for an abdominoplasty.
-752-
PP - 550 ONE TROCAR MESH-FREE LAPAROSCOPIC SPIGELIAN
HERNAI REPAIR
YAHYA EKICI , CEM AYDOĞAN , TUGAN TEZCANER , HÜSEYİN Y BİRCAN , GÖKHAN
MORAY
BASKENT UNIVERSITY, ANKARA, TURKEY
Introduction:
Spigelian hernia is a rare abdominal wall hernia type which is encountered

approximately 0.4% of all hernias. Various repair techniques like open
transabdominal, laparoscopic repair with mesh or mesh-free have been used in the
treatment of this disorder. Recent evidence has been showed that the outcomes of
laparoscopic procedures are much better than the outcomes of open procedures.
Laparoscopic transabdominal suture repair procedure has been reported as a
successful technique in the treatment of this rare hernia type.
Case report:
Forty nine years old female patient who had left lower abdominal pain and mass
approximately 1 year period was admitted to our center. Reductable hernia in
left semisircular line was detected by physical examination. The abdomen was
insuflated by a veress needle. The needle inserted in abdomen at the point of
midclavicular line at the level of umblicus. Ten mm trochar and camera inserted in
abdomen. Intraabdominal pressure was maintained 12 mmHg. Transabdominal full
thickness 0 polpypropylene suture was placed perpendicular to hernia defect by
using a suture-passer tree under the vision of 30 degree camera . Sutures were tied
out of abdomen and the repaired defect was confirmed by laparoscopy.
Conclusion:
Open repair with mesh was the common surgical choice before laparoscopic
techniques in the treatment of Spigelian hernia.Increasing number of reports
have been encountered about laparoscopic repair with mesh in recent years. One
trocar laparoscopic suture repair without mesh is feasible and safe method with
the advantage of successful laparoscopic localization in small Spigelian hernias. This
technique needs no special laparoscopic tool. It has lower costs when compared
with mesh free repair.
-753-
PP - 551 ANTEROLATERAL HERNIA OF ABDOMEN: SPIGELIAN
HERNIA, A RARE CASE
ILGAR İSMAYİLOV , YAŞAR SUBUTAY PEKER , AYTEKIN ÜNLÜ , RAMAZAN YILDIZ ,
ÖNER MENTEŞ , YUSUF PEKER

ANKARA, TURKEY
Introduction:
Hernias of abdomen are common where as Spigelian hernia (SH) is a rare case
which about 1000 cases have been reported worldwide up to 2010. The defect of
abdominal wall is at Spigelian fascia (located between semilunar line and rectus
muscle) usually at lower abdomen. Patient is most frequently presented with
abdominal pain as a result of strangulation.
Case report:
72-years-old patient with acute starting abdominal pain with mass located at
lower abdomen, lateral of right rectus muscle for 7 hours, was evaluated. She had
WBC:9700/mikroL with neutrophilia without any other laboratory findings. Dilated
edematous small intestinal loops were examined with USG which hernia sac with
small intestinal loops inside was also confirmed by abdominal CT. Operation was
planned for patient. Necrotic intestinal loops were found durning urgent herniotomy
and resection was performed with side to side anastomosis. Hernia orifice was
primarily sutured without mesh. Patient was discharged on postoperative seventh
day.
Conclusion:
SH is a rare case which is hard to diagnose and where CT is the most valuable
technique. Surgery is primary treatment (whether laparoscopic or open) because
SH is usually strangulated. Thus, every surgeon must keep SH in mind at anterior
abdominal wall masses.
-754-
PP - 552 URINARY BLADDER HERNIATION FOLLOWING CESAREAN
SECTION
ZEHRA UNAL OZDEMIR , HAKAN OZDEMIR , IBRAHIM TAYFUN SAHINER , METIN
SENOL
MINISTRY OF HEALTH NEVSEHIR STATE HOSPITAL,DEPARTMENT OF GENERAL

Introduction:
Incisional hernias may be observed following abdominal surgeries. Such hernias

are characterized by a change in the location and position of abdominal organs
and tissues. Incisional hernias observed following cesarean sections generally
result from the herniation of fat tissues or intestines. We are presenting a case in
which urinary bladder herniation was observed within the fascia defect developed
following cesarean section.
Case report:
A 40-years-old woman; underwent cesarean section delivery 1 year ago, applied

with complaints of pain on the midsection of the incisional line. During physical
examination, a 3 cm mass was identified in this region. At abdomen CT, the fascia
defect was identified as herniation of the urinary bladder. The patient was operated
accordingly and discharged without any complications.
Conclusion:
In distinct hernias, USG is usually enough before surgery. Although a fascia defect
was initially observed via USG evaluation, a CT should be done for hernias that
develop in association with cesarean section incisions, too. Performing surgeries
with prior knowledge of urinary bladder herniation will assist in preventing possible
complications. When the anatomical location of cesarean section incisions are
considered, it should be taken into account that the urinary bladder might also
become herniated instead of the intestinal loops.
-755-
PP - 553 TROCAR SİTE HERNİATİON FOLLOWİNG LAPAROSCOPİC
CHOLECYSTECTOMY
METİN ESER 1, AHMET GURER 1, MESUT ÖZDEDEOĞLU 1, GULTEN KIYAK 1, GURKAN
DUMLU 1, ALPER BILAL OZKARDES 1, MEHMET KILIÇ 2
1
2
Background&Aims:
We here present a case with an early trocar site herniation after laparoscopic
cholecystectomy.
Methods:
A 66 year old woman diagnosed as cholelithiasis underwent a laparoscopic

cholecystectomy. Postoperatively patient had persistent nausea, hence oral feeding
was stopped.
Results:
Still her complains like nausea and vomiting continued. An intestinal loop was
observed at trocar site in abdominal CT scan. She was urgently operated. An
intestinal segment was reduced and the fascial defect was primary sutured.
Conclusion:
Trocar site hernias are important since they need surgical interventions. Assuming
that asymptomatic patients don’t admit to hospital, prevalence must be higher
than known. Diameter and design of the trocar, previous fascial defects and site
of trocar insertion, also patient-related risk factors It is advised to close the fascial
defects that are formed by the 10 mm trocars in patients who are above 60 years
old and who have additional risk factors like obesity, especially if the operation lasts
long. In 85% of cases with trocar site herniation, diameter of trocar was larger than
10 mm. Computed tomography might be useful for diagnosis. Some studies advise
surgical intervention for early signs of intestinal obstruction.
-756-
PP - 554 INCISIONAL HERNIA REPAIR: SIMPLE SUTURIZATION
VERSUS SUBLAY-ONLAY MESH TECHNIQUE
CEM DONMEZ 1, GULTEN KIYAK 1, GURKAN DUMLU 1, EMIN CELIK 1, ALPER BILAL
OZKARDES 1, AHMET GURER 1, MEHMET KILIÇ 2
1
2
Background&Aims:
In this study,complications and recurrence rates of primary suturization and

different prosthetic mesh techniques are compared.
Methods:
Patients who were operated due to incisional hernia between 2003-2008 were
divided into 3 groups such as;primary sutured,onlay-technique and sublay-
technique.
Results:
In this study, 14patients were treated with primary suturization. The rest were
treated with onlay(24patients) or sublay(37patients) prosthetic mesh techniques.
There were no significant differences between three groups for recurrences in
the three years follow up. As total follow-up period was considered, recurrence
rates were significantly lower in sublay group than onlay group. It is found that
many factors like age,gender,size of fascial defect, wound site infection and seroma
formation didn’t affect hernia recurrence.
Conclusion:
Patients with incisional hernia compose a wide range of heterogeneous population.

It is still uncertain how to treat small incisional hernias. On the other hand,
all prospective and retrospective studies advocate that even the small fascial
defects(<5cm) should be treated with prosthetic mesh. Some studies claim that
sublay-technique decreases recurrence rates with a ratio of %2-4. In our study, after
43 months follow-up, recurrence rates for sublay and onlay mesh technique were
13% and 33% respectively. As a conclusion, treatment of incisional hernias is not
standardized yet.
-757-
PP - 555 THE EFFECT OF INGUINAL HERNIA REPAIR ON SEXUAL
FUNCTIONS: A PRELIMINARY STUDY
ALAATTIN ÖZTÜRK 1, CENGIZ KAYA 2, HAKAN BOZKURTOĞLU 3, ZUHAL YANANLI 1,
ÖMER FARUK AKINCI 1
1
FATIH UNIVERSITY SEMA HOSPITAL, ISTANBUL, TURKEY
2
PENDIK STATE HOSPITAL, ISTANBUL, TURKEY
3
CENTRAL HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Inguinal hernia repair is frequently performed. However, the impact of surgery on

sexual function has not been sufficiently investigated. We aimed to evaluate the
effect of inguinal hernia repair on sexual functions in this study.
Methods:
In this study, a total of 85 male patients who underwent inguinal hernia surgery
were enrolled. Patients were operated in three different hospitals. A questionnaire
designed to assess sexual functions was given to patients in preoperative and
postoperative three months. Conditions of sexual functions were compared
between the preoperative and postoperative periods.
Results:
The mean age was 48 (20-80) years. Result of questionnaire was received
preoperative and three months after surgery. The difference between them was
evaluated. A significant decrease was observed in sexual desire and erectile function
after surgery. The pain during sexual intercourse was found in 14 patients (16.4%),
and the loss of feeling over the penis in 11 patients (12.4%) in postoperative period.
There was no change in the satisfaction of orgasm and morning erection. When the
postoperative period was evaluated as a whole, the nine patients (10.5%) expressed
that there was a change in their sexual relations and the operation was blamed.
Conclusion:
It was observed that significant negative changes on the sexual functions occurred
three months after inguinal hernia repair.
-758-
PP - 556 PRIMARY INGUINAL HERNIA REPAIR IN ELECTIVE SURGERY
FOR WOMEN. MESH OR NON MESH REPAIR?
ALBANA ÇELA , ALMA LLUKAÇI , ETMONT ÇELIKU
FIRST CLINIC OF SURGERY, UNIVERSITY HOSPITAL CENTER “MOTHER THERESA” –

TIRANA, ALBANIA
Background&Aims:
Inguinal hernia is rare to females. Sometimes mesh or non mesh repair is a dilemma
for women’s surgery considering: females’ anatomy of inguinal canal, long term
complications and cost effectivity. The aim of this study was to investigate the
benefits of mesh or non mesh repair of women’s primary inguinal hernia in elective
surgery
Methods:
This is a prospective study. 1474 patients operated for primary inguinal hernia repair
in elective surgery in First Clinic of Surgery in University Hospital Center “Mother
Theresa” in Albania were investigated from January 2000 – December 2008.
Results:
172 patients(11.7%) were women, and had performed 181 (11.6%) primary inguinal
hernia repair. All data: age, BMI, type of hernia, co-morbidity, type and duration of
operation, type of anesthesia, early and late complications were registered. Patients
were followed 3, 5, 7 days after surgery, one, three months and every year after
operation. In total 109 (60.2%) of operations were without mesh (Group A- Bassini
repair) and 72 (39.8%) with mesh (Group B - Lichtenstein repair). We analysed
results of each group and compared them. None died from surgery. In total there
were 7 recidives (3.8% of all female patiens), all were non mesh repairs (6.4%)
Conclusion:
Based in our study mesh is a good choice in primary inguinal hernia repair for
women in elective surgery.
-759-
PP - 557 HERNIA UTERI INGUINALIS IN A CASE OF TRUE
HERMAPHRODITISM
ANIKETH VENKATARAM , RAJASHEKARA BABU , SHIVASHANKAR SANTHOSH ,
SADASHIVAIAH SHIVASWAMY
Background&Aims:
True hermaphroditism, now known as ovotesticular disorder of sexual differentiation

(OT-DSD) is a rare condition diagnosed by the presence of both ovarian and
testicular tissue. The presence of uterus and structures in an inguinal hernia sac of
a male patient is known as hernia uteri inguinalis. This finding is rarely seen in OT-
DSD with only two cases being reported worldwide. We report a case of hernia uteri
inguinalis in OT-DSD, in view of its extreme rarity
Methods:
An eighteen year old male presented with a reducible mass in left groin for past
four years. He was a short statured phenotypic male with gynaecomastia and
ambiguous genitalia. Diagnostic laparascopy confirmed the a nonfunctional uterus
with ipsilateral ovary in left inguinal canal for which excision with hernioplasty was
performed.
Results:
Histopathology confirmed the presence of uterus with ipsilateral ovary. Karyotype

revealed the genotype as 46 XX. Ultrasound guided cytology revealed the
contralateral gonad as a testis, confirming the diagnosis of OT-DSD. Subcutaneous
mastectomy for gynaecomastia was performed and hypospadias was corrected by
creation of a neo urethra using full thickness skin graft.
Conclusion:
We report the third documented case of hernia uteri inguinalis in a patient with
ovotesticular disorder of sexual differentiation.
-760-
PP - 558 A GIANT INGUINOSCROTAL HERNIA PRESENTED WITH
ERECTILE DYSFUNCTION
AYBALA AGAC AY 1, AHMET AY 2, KUZEY AYDINURAZ 1, SEDAT DOM 1, ORAL
SAYGUN 1, VURAL SOZEN 1, CAGATAY ERDEN DAPHAN 1
1
KIRIKKALE UNIVERSITY FACULTY OF MEDICINE, GENERAL SURGERY DEPARTMENT,
KIRIKKALE, TURKEY
2
VIRANSEHIR STATE HOSPITAL GENERAL SURGERY CLINIC, SANLIURFA, TURKEY
Introduction:
Giant inguinal hernias are extremely rarely seen today and in fact never seen in
developed countries. Accurate diagnostic and interventional approaches are of vital
importance, given the significant morbidity and discomfort they cause.
Case report:
A 74-year-old male patient admitted to urology polyclinic with the complaint of

erectile dysfunction. The patient with no symptoms of ileus had the preliminary
diagnosis of strangulated inguinal hernia and was recommended to be hospitalized
for examination and treatment. The patient stated that he had no hernia, was
satisfied with the size of testicles, and that he and his family would not tolerate
the downsizing of his testicles. The patient was informed that problems related
to micturition and coitus were caused by inguinal hernia and that other problems
could not be corrected unless the hernia was repaired. After these explanations,
the patient left the hospital refusing any further examination and treatment.
Conclusion:
Patients with giant inguinoscrotal hernia can present with symptoms such as urinary
retention and testicular pain as in our case and testicular tumors, acute epididymitis,
epididymal cyst or rarely hematocele should be included in differential diagnosis.
Therefore, inguinoscrotal hernias, as well as urological pathologies should be kept
in mind in such cases.
-761-
PP - 559 INTRAABDOMINAL HERNIA AS A RARE CAUSE OF ILEUS
SEDAT DOM , AYBALA AGAC AY , KUZEY AYDINURAZ , HUSEYIN OZDEN , ORAL
SAYGUN , CAGATAY ERDEN DAPHAN

KIRIKKALE, TURKEY
Introduction:
İntraabdominal hernia is a rare cause of ileus. In this case we aimed to remind the
entity of torsion and strangulation of ileum due to an intraabdominal hernia.
Case report:
A 82 year old woman admitted to the hospital with complaints of abdominal pain,
vomiting and abdominal distension. On physical examination, abdomen was found
to be distended. Increased sensitivity and muscular defense all over the abdomen
were noted. There was a dense bubble of gas and air–fluid level on direct abdominal
X-ray film obtained in the standing position. With respect to blood biochemistry,
the white blood cell count was 23,000/lL and the neutrophil ratio was 89%. During
laparotomy, a layer-by-layer exploration of abdomen was performed and small
intestines were found to be tortioned and strangulated around herniated omentum
(Figure 1-2).Ileal resection was performed.
Conclusion:
Here, in the light of the presented case caused by a complete torsion of the ileum
around omentum , we emphasize that intraabdominal hernia should be kept in
mind in the differential diagnosis of acute abdominal pain.
-762-
PP - 560 TRAUMATIC PILONIDAL SINUS CAUSED BY COCYGEAL
FRACTURE
KUZEY AYDINURAZ , AYBALA AGAC AY , SEDAT DOM , MAHMUT AKARSU , CAGATAY
ERDEN DAPHAN , ORAL SAYGUN

KIRIKKALE, TURKEY
Introduction:
While traumatic pilonidal sinus is a rare entity, pilonidal sinus caused by cocygeal
fracture is an exceptional diagnosis. Hereby we present a case with pilonidal sinus
with cocygeal fracture with the aim of assisting to optimise the diagnostic procedure
of disease.
Case report:
A 32 year-old woman admitted to the hospital with the complaint of sacral pain.On
physical examination,there was an orifice on mid-sacral area which was thought to
belong to sinus pilonidalis. During operation, exploration of sacral region revealed
misunion of broken coccyx, and with half of the broken bone inside the cavity with
hair (Figure 1). Resection was completed, and histopathological examination of the
specimen revealed pilonidal sinus including the broken half of the coccyx.
Conclusion:
In this case, a rare etiology for sinus pilonidalis caused by travma is discussed.
The importance of preoperative optimal study on differential diagnosis and
management, also pertaining the complications of traumatic pilonidal sinus is
stressed.
-763-
PP - 561 A RARE DISEASE: MORGAGNI HERNIA RESULTS IN 15
PATIENTS
SOYKAN ARIKAN 1, EMRE OZORAN 1, SERKAN SARI 1, MEHMET BAKI DOGAN 1,
FEYZULLAH ERSOZ 1, EMINE OZYUVACI 3, AHMET KOCAKUSAK 2, TURKAN DUBUS 4
1
ISTANBUL EDUCATION AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ISTANBUL, TURKEY
2
HASEKI EDUCATION AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ISTANBUL, TURKEY
3
ISTANBUL EDUCATION AND RESEARCH HOSPITAL, ANESTHESIOLOGY AND
REANIMATION CLINIC, ISTANBUL, TURKEY
4
ISTANBUL EDUCATION AND RESEARCH HOSPITAL, THORACIC SURGERY CLINIC,
ISTANBUL, TURKEY
Background&Aims:
Morgagni Hernia is a rare disease and mostly diagnosed incidentally. We treated 15

patients in 10 years period and we presented our results with review of literature.
Methods:
Patients who were operated for Morgagni Hernia between 2002-2012 were
retrospectively reviewed from the hospital archives. Patients were called by the
telephone on the review date. We looked for operative technique, hospital stay,
complications, demographic properties, symptoms at diagnosis, method of
diagnosis and comorbidities.
Results:
A total of 16 patients were operated. 9 were female and 7 were male. Average age
was 64.94 years. 8 patients were operated laparoscopically and 8 had open surgery.
2 patients had the need for emergency surgery. Mesh was used in 11 patients, 9
were dual mesh and 2 were polypropylene. Average hospital stay was 11.25 days.
2 patients had complications after surgery and there was no mortality after the
surgery. Location of the hernia sac were mostly located on the right side.
Conclusion:
Morgagni Hernia are mostly located on the right side and laparoscopic repair of the
disease in elective cases are associated with less hospital stay and has no differences
concerning complications. Although it is a congenital disease it is mostly diagnosed
in the advanced ages incidentally.
-764-
PP - 562 INGUINAL LIPOSARCOMA PRESENTING A INCARCERATED
INGUINAL HERNIA: A CASE REPORT
FATİN R. POLAT
TOYOTA ACİL YARDIM VE TRAVMA HASTANESİ GENEL CERRAHİ BLM, SAKARYA,

TURKEY
Background&Aims:
The liposarcoma is a malignant tumour of the adipose tissue that arises from
the primitive mesenchymal cells. These neoplasms have been usually found in
the soft tissues of limbs, trunk, mediastinum, retroperitoneum and occasionally
in the spermatic cord. The clinical aspect is frequently a complaint of scrotal or
inguinal painless mass, mimicking to an inguinal hernia and the diagnosis of tumor
is performed mainly during surgery.(1) Herein, we report a case of liposarcoma,
mimicking Incarcerated inguinal hernia and successfully treated.
Methods:
case: Our case was a 81-year-old man admitted to our hospital with left inguinal
mass. There were no specific abnormalities in the laboratory data, and the tumor
markers were within normal limits. He was diagnosed with non reducible inguinal
hernia for the first time and received a hernia repair. The mass(10x5 cm), however,
was found to be a tumor it situated along the spermatic cord and testicular
vessels. The tumor was resected near part of the internal inguinal ring, sparing the
elements of cord(figure 1). The transversalis fascia was repaired by direct suture
and a polypropylene mesh was located above(figure 2). Histopathological diagnosis
showed well-differentiated liposarcoma of the sclerosing type. Postoperative
computed tomography (CT) revealed a minimal residual edema and fluid in the
internal ring. The patient was sent to oncology hospital during postoperative 3th
days due to marginal biopsies were positive for tumour.
Results:
Inguinal liposarcomas are relatively rare and in most cases these tumors are thought
to originate in the spermatic cord. The origin of the tumor is believed to be the
retroperitoneum.(1,2) These neoplasms have been usually found in the soft tissues of
limbs, trunk, mediastinum, retroperitoneum and occasionally in the spermatic cord.
(1,3) Incarcerated inguinal hernia is a common surgical indication in the emergency
room. Delayed diagnosis can result in ischemic bowel or bowel perforation. The
reported incarcerated contents include bowel loop, mesentery, omentum and,
rarely, malignant lesions, such as lymphoma, liposarcomas, metastatic tumors etc.
-765-
(4) The clinical aspect is frequently a complaint of scrotal or inguinal painless mass,
mimicking to an inguinal hernia and the diagnosis of tumor is performed mainly
during surgery, as in our patient. In the case of a firm not reducible painless inguinal
mass without signs and symptoms of bowel obstruction, an abdominal tumor with
inguinal or scrotal extension should be suspected and preoperatively excluded.
The US and CT scan may be helpful to plane a correct therapeutic strategy before
intervention.(1) Essential components of treatment include early diagnosis and
resection. Early diagnosis and prompt surgical intervention provide the only chance
of a successful outcome.
Conclusion:
REFERENCES 1.Baldassarre E, Santacroce C, Barone M, Torino G, Siani A, Valenti

G.Retroperitoneal well-differentiated liposarcoma presenting as an incarcerated
inguinal hernia.G Chir. 2007 Aug-Sep;28(8-9):315-7. 2.Noguchi H, Naomoto Y, Haisa
M, Yamatsuji T, Shigemitsu K, Uetsuka H, Hamasaki S, Tanaka N. Retroperitoneal
liposarcoma presenting a indirect inguinal hernia.Acta Med Okayama. 2001
Feb;55(1):51-4. 3.Ghimire P, Wu GY, Zhu L. Rare synchronous primary large B-cell
gastric lymphoma and huge retroperitoneal liposarcoma with inguinal hernia
in chronic hepatitis B patient.Curr Oncol. 2011 Apr;18(2):e103-8. 4.Hsu YF, Chou
YY, Cheng YH.Spermatic cord myxoid liposarcoma presenting as an incarcerated
inguinal hernia: report of a case and review of literatures. Hernia. 2011 Mar 9.
[Epub ahead of print].
-766-
PP - 563 EXPERIENCE OF ONLAY MESH VENTRAL HERNIA REPAIR IN
A UNIVERSITY HOSPITAL
H. RODOLFO SCARAVONATI , SILVINA LUCIA MILLETARI , CARLOS AUGUSTO CUTINI
CINGOZOGLU , PABLO HERNAN VANNELLI , JUAN MANUEL SOTELO , GERARDO
NICOLAS REYNAUD , RODRIGO MORAN AZZI , VICTOR HUGO SERAFINI
Background&Aims:
Incisional hernias occur frequently after abdominal surgery and can cause serious
complications. The relevance of different factors such as surgical technique, mesh
material, and patient-related parameters concerning the outcome following mesh
repair is still under debate.
Methods:
Retrospective analysis from a prospectively collected database. We include all

patients with diagnosis of incisional hernia who were repaired by on-lay technique
Results:
Between January 2008 and December 2009, a total of 108 patients underwent plasty
of anterior abdominal wall by on-lay disposition of synthetic implant (69 Females;
39 Males). The average age was 51 years old. We divided the patients into 3 groups
according to Chevrel classification: Small 12% (n = 13), Medium 60% (n = 65), Big
28% (n = 30). Mean operative time was 78 min (r: 20-180). The average hospital stay
was 1.55 days (r: 1-10). The mesh was rejected in 2 patients. The recurrence rate
was 5.5% (n = 6). There was no mortality and the morbidity was 18,5% (seroma,
wound infection). Mean follow-up was 41 months (r: 31-53).
Conclusion:
Onlay mesh ventral hernia repair seems to be a safe procedure, with low index
of morbidity and recurrence rates are similar to other techniques according to
worldwide publications.
-767-
PP - 564 THE INFLUENCE OF CONCOMITANT DISEASES ON
INTRAABDOMINAL PRESSURE AT PATIENTS WITH INGUINAL
HERNIAS AT ELDERLY AND SENILE AGE.
NESIB SERHETOV , HIDAYET BILALOGLU
Background&Aims:
Objectives: In our study we wanted to determine the influence of concomitant

chronic diseases at the level of intraabdominal pressure at patients with inguinal
hernias at elderly and senile age.
Methods:
Material and Methods: There were 154 patients with inguinal hernia of senile and
elderly age examined in our clinic. There were 29 women and 125 men. 64 patients
were at the age of 61-70 years, 45 patients – 71- 75 years, 42 patients – 80-86 years,
3 patients - 81-90 years.
Results:
Results: 76% patients had the following concomitant diseases: diabetes mellitus
in 20.7% of patients, hypertension – 17.5%, chronic spastic colitis – 15%, colonic
diverticulosis – 9%, chronic bronchitis – 13%, ischemic heart disease – 11.7%,
cholelithis – 7.2%, lower extremity varicose – 7.1%, nephrolithiasis – 6.5% and
postmyocardial infarction cardiosclerosis – in 5.8% of patients.
Conclusion:
Conclusions: It was stated, that the patients suffering from chronic constipation
developed intraabdominal pressure more frequently different from those patients-
smokers, the patients after adenectomy and the patients with ischemic heart
disease. In the patients with inguinal hernia the presence of diabetes mellitus,
hypertension and nephrolithiasis does not effect on the values of intraabdominal
pressure .
-768-
PP - 565 DARN PROCEDURE IN INGUINAL HERNIA REPAIR
KORAY TOPGÜL 1, AYTEK ÇAKMAK 2, GÜLTEKIN OZAN KÜÇÜK 3
1
MEDICAL PARK SAMSUN HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
SAMSUN, TURKERY
2
MEDIVA HOSPITAL, DEPARTMENT OF GENERAL SURGERY, SAMSUN, TURKEY
3
GAZI STATE HOSPITAL, DEPARTMENT OF GENERAL SURGERY, SAMSUN, TURKEY
Background&Aims:
The aim of this study was to assess the outcome of patients with inguinal hernia
where the Moloney darn.
Methods:
Darn procedure was performed in a total of 331 patients by one surgeon (A.Ç.)
between January 2000 and January 2011. We evaluated the patients retrospectively
via telephone interviews. We reached 229 patients. We recorded complications and
recurrences. We questioned whether it is pain. Also we researched all patient files
and recorded hernia types, anaesteshia types.
Results:
There were 275 indirect, 46 direct, 6 femoral and 4 pantaloon hernias. Spinal was
the most commonly performed (76%). General anaesthesia was performed in all
incarserated cases. Median follow-up time was six years. Recurrence rate was 1.4%,
chronic pain rate was 2.5% in 275 patients.
Conclusion:
The darn repair method is simple, safe and cheap. Also, it has similar recurrence
and complication rates when compared to the all hernia repair methods including
the Lichtenstein method in English litrature. The darn method is logical surgical
alternative of inguinal hernia repair.
-769-
PP - 566 ABDOMINOPLASTY AND NON-SUTURE IMPLANTATION
TECHNIQUE BY TRABUCCO IN SURGERY FOR INCISIONAL HERNIA
OF FRONT ABDOMINAL WALL
ELNUR GASIMOV 1, NADIR ZEYNALOV 1, KAMIL HAJIYEV 2, ADIL MAMMADOV 1

1
CLINICAL MEDICAL CENTER OF BAKU CITY, AZERBAIJAN

2
Background&Aims:
Abdominoplasty is applied mainly according to esthetic indications. However

remaining skin and fat apron after hernioplasty predisposes the recurrence of the
disease. Non-suture plasty technique by Trabucco is a new direction in surgery of
incisional herniae.
Methods:
We have managed 17 patients with big incisional herniae and pendulous abdomen
in 2011-2012. 5 patients were included into control group with tension-free
hernioplasty by ordinary polypropylene mesh in onlay variant without excision of
skin and fat apron. Main group included 12 patients with tension-free hernioplasty
by non-suture sublay technique of Trabucco and abdominoplasty. All operations
were finalized by drainage of subcutaneous fat. All patients got prophylactic
antibiotic therapy.
Results:
In the main group seroma was noted in 3 patients. It was evacuated by drainage
tube and punctures. We got perfect esthetic effect. In all patients from control
group long lasting seromas were noted, in one patient a suture sinus developed.
In 2 patients on 4-5 postoperative day wound suppurated and later resulted in
recurrence of hernia.
Conclusion:
Combination of non-suture technique by Trabucco with abdominoplasty helps to

reduce the recurrence rate due to excision of excessive fat as well as save the time
of hernioplasty.
-770-
PP - 567 ARE FIBRINOGEN AND COMPLETE BLOOD COUNT
PARAMETERS PREDICTIVE IN EXTERNAL HERNIAS FOR REDUCING
COST BURDEN?
SAHIN KAHRAMANCA , OSKAY KAYA , HAKAN GUZEL , CEM AZILI , EMRE GOKCE ,
TEVFIK KUCUKPINAR
DISKAPI YILDIRIM BEYAZIT TEACHING AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
If there is a delay greater than 48 hours in external strangulated hernias, requiring

of bowel resection and mortality rate will increase. It causes to extend hospital stay
and to need intensive care and as a result causes more health expenditures. Mean
platelet volume (MPV), platelet distribution width (PDW), and fibrinogen (F) level
in blood were shown as valuable parameters to predict ischemic events in different
parts of the body in the literature. We aimed to investigate these parameters in
external hernia patients and to choose candidates for early operation.
Methods:
Two groups were studied. Each group contained 100 patients. In group A: elective
external hernia repairing. In group B: incarcerated and urgent external hernia
repairing. Blood F level, WBC, MPV, PDW and operation type, duration of hospital
stay, need for intensive care unit, and total cost of each patient were enrolled.
Results:
We found high F and WBC levels but low MPV-PDW values in group B. Bowel
resection rate, duration of hospital stay, need for ICU and cost burden were high
in group B.
Conclusion:
Considering external hernia, waiting is risky which will increase the costs. Early
operation will be recommended for these patients if F and WBC levels are high.
-771-
PP - 568 PARADUODENAL HERNIA
UMIT ABANUZ ERBIL 1, OZAN ANDAC ERBIL 2, ARIF EMRE 2

1
GEBZE FATIH STATE HOSPITAL, GEBZE, TURKEY

2
Introduction:
The most common cause of internal hernia is Paraduodenal hernias that are
relatively rare congenital malformations
Case report:
The most common cause of internal hernia is Paraduodenal hernias that are relatively
rare congenital malformations and occur as a consequence of rotation error of
midgut during fatal period. Patients may consult a doctor with symptoms ranging
from repeated abdominal pain to bowel obstruction. Diagnosis generally occurs
during laparotomy. In this article, we aim to discuss two cases of paraduodenal
hernia including right and left-lying ones in accordance with literature.
Conclusion:
In this article, we aim to discuss two cases of paraduodenal hernia including right
and left-lying ones in accordance with literature.
-772-
PP - 569 A RARE COMPLICATION AFTER INGUINAL HERNIA REPAIR:
INTRACRANIAL SUBDURAL HEMORRHAGE
ÖZGÜR DANDİN 1, HASAN BAĞKESEN 1, CENGİZ KAPLAN 1, ERKAN KAYA 1, CAN
BAŞARAN 2, FERHAT CÜCE 3
1
BURSA MILITARY HOSPITAL BURSA TURKEY
2
3
VAN MILITARY HOSPITAL, VAN, TURKEY
Introduction:
A lot of complications can occur after inguinal hernıa repair for many reasons.
Postdural puncture headaches represent one of the principal complications of
spinal anesthesia but intracranial subdural hemorrhage caused by spinal anesthesia
after this type of surgery is extremely rare.
Case report:
We report the case of a 21-year-old man who had intracranial subdural hemorrhage
five days after inguinal herniorrhaphy and orchiectomy. The operation was
performed under spinal anesthesia. On the second postoperative day, our patient
started to have a headache with nausea. The severe headache persisted even in the
supine position and his vital signs and neurological examination were normal. On
the fifth postoperative day his headache was improved in the supine position but
continued standing. Cranial MRI showed a bilateral subdural hematoma from his
frontal to temporal region. The oral analgesic and intravenous hydration therapy
was given to patient for two weeks. After two weeks the patient declining signs in
cranial tomography and complaints ending was discharged with no problem.
Conclusion:
Persistent, non postural and more severe headache may be due to subdural
hematoma formation. Intracranial subdural hematoma is rare but a potentially
lethal complication that can occur after surgery under spinal anesthesia.
-773-
PP - 570 THE FREQUENCY OF SIMULTANEOUS UMBLICAL HERNIA
REPAIRS DURING LAPAROSCOPIC CHOLECYSTECTOMY IS GREATER
THAN IN OPEN CHOLECYSTECTOMY
TURKAY KIRDAK , PINAR SARKUT , ERDAL UYSAL , EKREM KAYA , NUSRET KORUN
ULUDAG UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT, BURSA,

TURKEY
Background&Aims:
In the present study, it has been investigated that if there is any difference between
simultaneous umbilical hernia repairing rate which is done during laparoscopic or
open cholecystectomy.
Methods:
Medical records of the patients between January 1993 and June 2005 were analyzed
retrospectively. In addition, we analyzed the patients who had only the umbilical
hernia repairing in the same period and we compered the hernia repairing methods
between these patients and the patients who has also laparascopic cholecystectomy.
Results:
During this period, 3028 cholecystectomy has been performed. 2281 of them
underwent laparoscopic surgery. Total number of patients who has both
cholecystectomy and umbilical hernia repairing is 46. Number of patients who had
laparascopic cholecytectomy and simultaneous umbilical hemia repairing was 44
(p<0.001) and only 2 of them was repaired with mesh. During same the period,
number of patients who have had only umbilical herni repairing was 284 and 156
primary repairing was applied.
Conclusion:
Simultaneous umbilical hernia repairing rate, which is done during laparoscopic

cholecystectomy, is higher than it is done during open cholecytectomy. Most of
these repairings have been done without mesh. Yet, there is no enough data for
examining long term results of these repairings.
-774-
PP - 571 IMPROVED PATIENT SATISFACTION AND COMFORT
WITH CYANOACRYLATE GLUE SKIN CLOSURE FOR HERNIOPLASTY
PATIENTS
RAJEEV PREMNATH
RAMAKRISHNA HOSPITAL, INDIA
Background&Aims:
Patient satisfaction and results for skin closure with cyanoacrylate based glue were
studied in hernioplasty patients.
Methods:
114 patients who underwent both laparoscopic and open hernioplasty were
recruited for wound closure with 2-octyl cyanoacrylate (Dermabond®). 104 patients
underwent open surgery and 10 patients underwent laparoscopic surgery. Wounds
were closed with subcuticular undyed poliglecaprone (monocryl®). Inguinal wounds
were closed with 4/0 monocryl® and open abdominal wounds with 3/0 monocryl®.
Wounds were closed with either Dermabond® Mini or Dermabond®. No dressing
was used in any patient and all patients were advised to have a normal bath from
post-operative day one. Patients were examined on the post-operative day 1, 7 and
day 14 to assess for infection or adverse reaction.
Results:
The incidence of infection was less than 2%. Two patients both in the open
hernioplasty group had collection that required draining and antibiotics. No patient
in the laparoscopic group had any infection.
Conclusion:
Dermabond® skin adhesive is an effective method to close hernioplasty wounds.

Hernioplasty is a clean surgery and wound closure with skin glues help prevent
infection. Patients were more comfortable and satisfied as there was no dressing or
suture removal and could have bath the day after surgery.
-775-
PP - 572 INTESTINAL OBSTRUCTION DUE TO A DEFECT IN THE
MIDDLE OF THE POLYESTER MESH
S. SAVAŞ YÜRÜKER 1, İLHAN KARABIÇAK 1, SEDA HANÇERLI 1, KORAY TOPGÜL 2,
ZAFER MALAZGIRT 2
1
2
MEDICAL PARK HOSPITAL, DEPARTMANT OF GENERAL SURGERY, ISTANBUL,
TURKEY
Background&Aims:
In this paper, we present a patient intestinal obstruction after ventral hernia repair.
Methods:
41-year-old female patient with a hernia defect of 20x30 cm underwent open

posterior hernia repair with a parietex composite mesh. Patient had early
postoperative ileus and did not respond to medical treatment. We performed
repalarotomy.
Results:
We found a 1 cm defect in the middle of the mesh and a small bowel loop herniating
from the defect. The defect was enlarged and the bowel loop replaced to the
abdomen. The defect was repaired. The edges of the defect on the mesh was sharp
which may be secondary to either iatrogenic during surgery or factory error. The
patient was dischared 6 days after the second operation.
Conclusion:
Ileus after hernia repair with mesh is a well known postoperative complication.
Defect on the mesh must be kept in mind for potential cause of this problem.
-776-
PP - 573 EFFICACY OF HEMOVAC DRAIN IN PILONIDAL DISEASE
SURGERY: RANDOMIZED CONTROLLED TRIAL
SEYFİ EMİR 1, BURHAN HAKAN KANAT 1, SELİM SÖZEN 2, FATİH MEHMET YAZAR 1 ,
BURAK KAVLAKOĞLU 1
ELAZIĞ TRAINING AND RESEARCH HOSPITAL, ELAZIG, TURKEY

1

2
Background&Aims:
In this study our aim was to evaluate the effects of drainage after Karydakis flap
reconstruction in patients with pilonidal disease.
Methods:
A prospective, randomized and controlled clinical trial was held. Eighty four patients
undergoing the Karydakis procedure and they were assigned randomly into two
groups-with and without hemovac drainage of the cavity. Forty-two patients had
drain (Group I) and 42 patients hadn’t (Group II). Age, gender, Body-mass index,
coexisting diseases, duration of symptoms , occurrence of preoperative infection,
antibiotic need, number of sinuses and length of hospital stay were study’s
variables. Complication rates and time to recover normal daily activities were
primary outcomes of the study
Results:
Mean age of patients was 23.97±13.38 (16-47) years in group-I and 24.17±12.31
(15-43) years in group-II (p>0.05). There were 33 males and 9 females in group-I
with; 34 males and 8 females (p>0.05). The average length of hospital stay was
1.8 ± 0.6 in the group-I and 1.6 ± 0.5 days in the group-II (p>0.05). There were 1
seroma, 1 wound dehiscence in the group-I, while 3 seromas, 2 wound dehiscence
and 2 hematoma developed in the Group-II (p<0.05). Time to recover normal daily
activities was shorter in group-I but there was no statistically significant difference
between the two groups.
Conclusion:
Hemovac drains are effective in preventing complications of Karydakis flep

reconstruction.
-777-
PP - 574 EPIDERMOID CYST OF ROUND LIGAMENT: A CASE REPORT
ŞAHİN KAHRAMANCA , CEM AZILI , DURAY ŞEKER , EMRE GÖKCE , TEVFİK
KÜÇÜKPINAR
DISKAPI YILDIRIM BEYAZIT RESEARCH AND TRAINING HOSPITAL GENERAL SURGERY

Background&Aims:
Epidermoid cysts are the most common benign cutaneous cysts. They can be
present anywhere in the body lined by squamous epithelium, mostly on face,
trunk, back, neck, extremities and scalp. Epidermoid cysts of spermatic cord area
and round ligament are extremely rare; only two cases of epidermoid cyst of round
ligament are reported in the literature. We discuss a case of an epidermoid cyst of
the round ligament presented as inguinal mass.
Methods:
A 22 years old female patient who admitted to our hospital with left inguinal
swelling occured in postpartum period is reported.
Results:
A firm, semi mobile mass was present on physical examination. Ultrasonography

showed a heterogeneous, cystic mass with dense solid component of 9x4 cm in
size; whereas computed tomography scan suggested a large cystic mass between
internal oblique and transvers abdominal muscles. During exploration of left
inguinal area, a round ligament cyst was found. The round ligament was resected
and pathologic examination revealed epidermal cyst of the round ligament.
Conclusion:
Cysts of the inguinal cord can mimic inguinal hernias and manifest as inguinal masses
with pain in some cases. Epidermoid cysts are extremely rare in round ligament and
complete surgical excision is suggested to prevent recurrence and infection.
-778-
PP - 575 LAPAROSCOPIC INGUINAL HERNIA REPAIR; OUR
EXPERIENCES IN 20 CASES
TUNA BILECIK , RAMAZAN ERYILMAZ , CEMAL ENSARI

Background&Aims:
Inguinal hernia repair is the most frequently performed elective general surgical
procedure in the Turkey. The two most common laparoscopic techniques for
inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and
totally extraperitoneal (TEP) repair. The aim of this study were to assess our first
experiences of laparoscopic inguinal hernia repair.
Methods:
All consecutive patients with uncomplicated symptomatic inguinal hernia diagnosed

clinically, attending the surgery out patient department at Antalya Education and
Research Hospital was included and were operated by a single surgeon. 20 patients
who underwent inguinal hernia repair with the method of laparoscopic at the
Antalya Education and Research Hospital, Department of General Surgery between
January 2011 and June 2012 were enrolled in this study. Patient demographic data,
operative and postoperative courses, complications and outpatient follow-ups were
recorded and analyzed.
Results:
A total of 20 hernia repairs were included in the study. 12 of them were repaired
by TAPP technique. The mean operative time was 55 minutes. Most of the patients
were discharged at the second day of the surgery. The incidence of intraoperative
complications was 10%. The incidence of postoperative complications was 15% and
the incidence of early recurrence rate was 5%.
Conclusion:
Laparoscopic hernia repair is technically difficult,but in the hands of a well-trained

surgeon, it is safe and effective with a high degree of patient satisfaction. Morbidity
in the learning period of laparoscopic inguinal hernia repair can be accepted.
-779-
PP - 576 LICHTENSTEIN HERNIOPLASTY WITHOUT ANTIBIOTIC
PROPHYLAXIS: A 2-YEAR STUDY
VLADIMIR CIJAN , MILENA ŠćEPANOVIć , PREDRAG BOJOVIć , MILOš BRANKOVIć ,
DUBRAVKA STEPANOVIć
CLINICAL HOSPITAL CENTER ’’ZVEZDARA’’, DEPARTMENT OF SURGERY, BELGRADE,

SERBIA
Background&Aims:
Inguinal hernioplasty is one of the most frequent general surgery operations

worldwide and Lichtenstein procedure constitutes the current gold standard for the
elective repair. There is ambiguity about the usefulness of antibiotic prophylaxis in
inguinal mesh hernioplasty and the evidence for its value is still a matter of debate.
The aim of this study was to determine if antibiotic prophylaxis prevents wound
infection in Lichtenstein hernioplasty.
Methods:
A prospective two-year database of patients categorized in antibiotic (received

antibiotics) and placebo (received placebo) group who underwent Lichtenstein
hernioplasty was established. Demography, hernia type and anaesthesia,
complications and hospitalisation were recorded. Infections were evaluated 1
week, 2 weeks and 1 month postoperatively according to Center for Disease Control
criteria.
Results:
A total of 200 patients were operated, between 2010.-2012., including 100 patients
in each group. Groups were comparable regarding demography, hernia type,
hospitalisation and recurrence. Superficial surgical site infection developed in 3
patients from the antibiotic and in 4 patients from the placebo group. One patient
from each group developed deep surgical site infection.
Conclusion:
Based on our results, we conclude that prophylactic antibiotics did not decreased
risk of wound infection in Lichtenstein hernioplasty and hence routine use of
prophylactic antibiotics cannot be recommended for the same.
-780-
PP - 577 OPTIMIZATION OF SURGICAL TREATMENT OF RECURRENT
INGUINAL HERNIA AFTER OPERATION BY LICHTENSTEIN
YAROSLAV FELESHTYNSKY , SERGEY SVYRYDOVSKY , VOLODYMYR VATAMANUK ,
VYACHESLAV PREPODOBNY , VITALIY SMISHCHUK
P. L. SHUPIK NATIONAL MEDICAL ACADEMY OF POST-GRADUATE EDUCATION,

UKRAINE
Background&Aims:
Surgical treatment of recurrent inguinal hernia after operation by Lichtenstein

is associated with technical difficulties. This requires to use other methods
allohernioplasty. To improve results of surgical treatment of recurrent inguinal
hernia after operation by Lichtenstein.
Methods:
The treatment of male with recurrent inguinal hernia after operation by Lichtenstein
was analyzed. The average age of patients was 54,3±4,2 years. In the first group (32
patients) – open preperitoneal alloplasty by Rives. In the second group (32 patients)
– laparoscopic transabdominal preperitoneal alloplasty (TAPP).
Results:
Postoperative pain (VAS≥6) was observed in 3 (9,4%) patients of the first group,
in the second group wasn’t observed. Hematoma of scrotum in 3 (9,4%) patients
of the first group, seroma – in 2 (6,3%). In the second group These complications
weren’t observed in the second group. Chronic pain was observed in 2 (9,5%),
recurrences – in 1 (4,8%) among 21 patients of first group. There were no such
complications in the second group.
Conclusion:
TAPP is an optimal variant of allohernioplasty after operation by Lichtenstein in case

of recurrent inguinal hernias, that reduces the frequency of early postoperative
complications, chronic pain and recurrences compared with operation by Rives.
-781-
PP - 578 ABDOMINAL ACTINOMYCOSIS
YAVUZ PIRHAN 1, ÇAĞLAR ÖZÇELİK 2, SEVİM TURANLI 2
T.C.S.B. SUNGURLU DEVLET HASTANESİ, ÇORUM, TURKEY

1
T.C.S.B. ANKARA ONKOLOJİ EĞİTİM VE ARAŞTIRMA HASTANESİ, ANKARA, TURKEY

2
Background&Aims:
This case study is introduced because the anatomic localization of lesion is out of
type for actynomycosis.
Methods:
A 46 year old woman complaining of abdominal pain and having approximately

15 cm mass under the skin was admitted to the hospital. The patient had no
history of abdominal surgery and chronic disease. In screening strangulated-
incarcerated umbilical hernia was determined and the patient was taken into
operation immediately. During the operation, approximately 10*10*10 cm mass
participating in abdomen and including fascia, muscle, omentum and urinary
bladder was observed under umbilicus. With the early diagnosis of malignancy,
mass was resected en bloc in such a way that including urinary bladder and
other constructions with strong surgical margin. Other abdominal organs were
normal. Postoperative pathology reports was reported as “actynomycos’’. Oral
and intravenous antifungal treatments were given. No pathologic appearance and
recurrence has been observed during the follow-up of 6 months.
Results:
It is a yeast infection that soft tissue actynomycosis is seen rarely and mostly occurs
after a surgery and a chronic disease. Our patient has no chronic disease and
surgical history. It can be confused with malignancy on CT scan. Malignancy cannot
be discriminate from strangulated-incarcerated umbilical hernia in our case.
Conclusion:
For treatment, firstly surgical then antifungal treatment should be applied.
-782-
PP - 579 STRANGULATED INTERPARIETAL HERNIA ORIGINATED
FROM APPENDECTOMY INCISION: A CASE REPORT
ZEYNEP OZKAN 1, BEKIR SARICIK 1, SEYFI EMIR 1, FATIH MEHMET YAZAR 1, BURHAN
HAKAN KANAT 1, EVRIM GUL 2
ELAZIG TRAINING AND RESARCH HOSPITAL, GENERAL SURGERY, ELAZIG, TURKEY

1
ELAZIG TRAINING AND RESARCH HOSPITAL, EMERGENCY DEPARTMENT, ELAZIG,

2
TURKEY
Background&Aims:
Interparietal hernias are rare clinical condition especially in adults. Preoperative

and intraoperative diagnosis are difficult. We presented in this case strangulated
incisional interstitiel hernia.
Methods:
A 65 year old female patient admitted emergency room with sudden onset abdominal
pain. She declared that five years ago appendectomy was performed. Abdominal
examination concist of localised right abdominal tenderness on appendctomy scars.
Abdominal ultrasonography showed that there was a strangulated hernia under
appendectomy incision. During operation there was detected any defect eksternal
or internal oblique fascias but a mass palpated upper transvers fascia. Strangulated
omentum and bowel was reducted to abdomen. This defect was repaired with
primary suturation and prolen mesh was applied on the obliqius eksternus fascia
Results:
Three subtypes interparietal hernias have been described. These are preperitoneal,
interstitial and superficial. Our case was interstitiel type. Interparietal hernias have
been repaired conventional or laparoscopic approach. We preferred conventional
approach and after primary closure of defect, a prolene mesh placed above the
fascia. Interparietal hernias should be considered by surgeon that patient with
previous abdominal surgery.
Conclusion:
Interparietal hernias should be considered by surgeon that patient with previous

abdominal surgery.
-783-
PP - 580 DEDIFFERENTIATED RETROPERITONEAL LIPOSARCOMA
PRESENTING AS AN INCARCERATED INGUNAL HERNIA: A CASE
REPORT
ZÜLFIKAR KARABULUT , PAŞA DOĞAN , GÖKHAN MORAY
BAŞKENT UNIVERSITY, ANKARA, TURKEY
Background&Aims:
Dedifferentiated retroperitoneal liposarcoma is an extremely rare tumor, accounting

for less than 15 % of all soft tissue sarcomas. Only a few cases with retroperitoneal
liposarcomas within an inguinal hernia sac.
Methods:
A 63-year-old female patient presented with complaints of pain and swelling of the
left groin for the previous 2 months. Physical examination showed, a 15 cm, solid,
fixed mass on the left inguinal area. CT examination showed an 18 x 18x 9cm lobular
mass with fat density from the midline of the left kidney to the uterus. At operation,
a 15 cm, hard, encapsulated lipomatous mass was detected in the left inguinal area
within a hernia sac. A complete mass excision and hernia repair was performed
with polypropilene mesh.
Results:
Pathological examination showed dedifferentiated retroperitoneal liposarcoma
Conclusion:
Retroperitoneal tumours have often reached large dimensions at the time of

diagnosis due to the fact that they are late to produce symptoms. CT and MR
imaging is very important in ascertaining the size and location of the mass and
identifying the presence of any metastatic lesions. Radical complete resection
should be performed due to its positive effect on the rate of survival.
-784-
PP - 581 ASSESMENT OF SEXUAL FUNCTIONS AFTER INGUINAL
HERNIA REPAIR
GURKAN DUMLU 1, GULTEN KIYAK 1, HAYDAR OCAL 1, METIN ESER 1, ALPER BILAL
OZKARDES 1, AHMET GURER 1, MEHMET KILIÇ 2
1
2
MEDICINE, ANKARA,TURKEY
Background&Aims:
We aimed to prospectively assess sexual functions after inguinal hernia repair using
prosthetic mesh.
Methods:
Erectile function is assessed with face to face interview by a single clinician by using
International Scoring Questionnaire for Erectile Function at first and sixth months
after surgery.
Results:
Forty male patients are treated with prosthetic mesh for inguinal hernia. 19 of them
had left, 17 of them had right and 4 of them had bilateral inguinal hernia. As a
result, a significant increase in erectile function and sexual desire was recorded. On
the other hand, there were no statistically significant difference for sexual pleasure,
orgasmic function and general satisfaction.
Conclusion:
For the last two decades, usage of prosthetic meshes in clinical practice became
common around the world. Although recurrence rates are decreased, new
complications like tissue enduration and foreign body reactions came forward.
Natural outcomes of operations and complications could easily affect patients’
sexual functions and so their quality of life. It is thought that pain-related decreased
motion capacity and beliefs about early recurrence following hard work are main
causes for sexual impairment. It would be a wise approach to inform patients for
sexual difficulties after surgery and convince them about their temporality.
-785-
PP - 582 SURGERY OF THE ABDOMINAL WALL TUMORS AND
RECONSTRUCTION
ACAR AREN 1, MEHMET EMİN GÜNEŞ 1, GÜRHAN ÇELIK 1, ŞEFİKA AKSOY 1, DİDEM
CAN TRABLUS 1, BİNNUR KARAGÖZ DOBRA 1, ERDEM KINACI 1, EROL BOZKURT 2
1
ISTANBUL TRAINING AND RESEARCH HOSPITAL CLINIC OF GENERAL SURGERY,
ISTANBUL, TURKEY
2
ISTANBUL TRAINING AND RESARCH HOSPITAL DEPARTMENT OF PATHOLOGY,
ISTANBUL, TURKEY
Background&Aims:
The abdominal wall has a wide variety of neoplasms. Most of them are soft tissue
tumors. The resection of these tumors with negative margins could cause large
defects. The repair of the abdominal wall by the surgeon could be difficult. In this
study we discussed the problems the surgeons faced during reconstructing or
repairing the abdominal defects.
Methods:
Between 2005-2012 all patients who underwent abdominal wall tumor resection
were included in the study. Data queried included patient demographics, indications,
tumor defect, risk factors, type of repair, complications.
Results:
A total of 31 patients underwent reconstruction after total resection of abdominal
wall tumors. The indications included desmoid tumors (n = 10); Dermatofibrosarcoma
(n = 1); Liposarcom (n = 1); Endometriozis (n =19 ). The type of repair included
fascial cutaneous Limberg flap (n=1), dual mesh repair (n=5), primary mesh-
assisted closure (n=19).All other cases were repaired with primary fascial closure.
The average follow-up period was 24 months. There was no reccurens and hernia
observed during this period. Only 1 case was operated several times because of
a desmoid tumor located in different parts of the abdominal wall. Postoperative
complications were seroma (n=6), hematoma (n=1), small bowel injury (n=1) with
no mortality.
Conclusion:
Abdominal wall reconstruction after total tumor resection with tumor free surgical
margins is challenging. Because of expandable character of the abdominal wall,
with proper planning the reconstruction can be simplified and the patient outcome
improved
-786-
PP - 583 THE EFFECT OF TOPICAL TETRACYCLINE APPLICATION
ON SEROMA FORMATION IN LICHTENSTEIN TECHNIQUE: A
PROSPECTIVE RANDOMIZED STUDY
EMİN TURK 1, ERDAL KARAGULLE 1, GOKCEN COBAN 2, ERKAN YİLDİRİM 2, GOKHAN
MORAY 1
BASKENT UNIVERSITY DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY

1
BASKENT UNIVERSITY DEPARTMENT OF RADIOLOGY, ANKARA, TURKEY

2
Background&Aims:
This study aimed to investigate whether topical tetracycline application has a

limiting effect on seroma formation in patients undergoing hernia repair using
polypropylene mesh (Lichtenstein Technique).
Methods:
This study was conducted in 96 patients undergoing elective inguinal hernia repair.
The inclusion criteria were being in ASA I and II categories and having unilateral
hernia. Patients were randomized and divided into 2 groups. After the graft was
placed and before external oblique muscle aponeurosis was closed, 5 ml (100
mg) tetracycline was administered on the graft in tetracycline group (tetra group,
n=50 ml) and 5 ml isotonic saline was administered in the other group (control
group, n=46) without putting a drain. Patient characteristics and general operative
outcomes were compared and analyzed. Seroma checks via surface ultrasonography
were done at 1st and 7th days, and 1st month; ultrasonography was repeated at
2nd and 3rd months if a seroma was observed at first checks.
Results:
There were no statistically significant differences between the two groups in

terms of patient characteristics and general operative outcomes. There were no
significant differences in terms of seroma measurements at 1st day, 1st week, 1st
month, and 2nd month (P=0.35, 0.94, 0.11, and 0.74, respectively). At 2nd month,
seroma formation was observed in 3 patients in control group and 2 patients in
tetra group. No seroma was observed in these patients at 3rd month.
Conclusion:
Topical tetracycline application had no limiting effect on seroma formation following

inguinal hernia operation.
-787-
PP - 584 AN EXTRAPERITONEAL MINIINVASIVE METHOD FOR
UMBILICAL HERNIA REPAIR
ANDRIY KUDRYAVTSEV , VALERY KRYSHEN , VOLODYMYR MUSCHININ
DNIPROPETROVSK MEDICAL ACADEMY, UKRAINE
Background&Aims:
The prevalence of abdominal wall hernias, including umbilical, and popularity

of miniinvasive surgical treatment methods forces surgeons to search for more
modern operative techniques.
Methods:
In 2008 authors developed and implemented method of umbilical hernia repair.

It consists of skin incision through the navel, hernial sac detachment without
abdominal cavity disclosure. Then sac is placed into the abdominal cavity,
aponeurosis is exfoliated from the peritoneum for 2-3 cm away from the hernial
ring. Hernial defect closed by mesh implant having radius by 2-3 cm more than
the hernia defect which is placed preperitoneally and sutured with aponeurosis
by encircling stitch. Then incision defect is stitched by intradermal suture which is
hided in navel.
Results:
There were operated 81 patients during the period of 2008-2012. Intermediate time
the patients spent in clinic after surgery was 9±1 hours. There were no significant
nearest complications. There were no relapses during observation period. Level of
life’ quality was rated by the patients by modified SF-36 scale and there was 63
excellent and good results, 18 acceptable results, with no unacceptable/bad results.
Conclusion:
Thus, proposed methodic can be used for umbilical hernia surgery. The results
are acceptable. Used technique improves cosmetic effect and reduces the time of
rehabilitation.
-788-
PP - 585 COMPARISON OF COSKUN AND LICHTEINSTEIN HERNIA
REPAIR METHODS FOR GROIN HERNIA. LONG TERM RESULTS
FARUK COŞKUN 1, TOLGA DINÇ 2
ANKARA NUMUNE HASTANESI, ANKARA, TURKEY

1
SAMI ULUS EĞT VE ARŞ HST, ANKARA, TURKEY

2
Background&Aims:
Coskun hernia repair technique has been reported to be an effective new fascia
transversalis repair with its short term follow up results. Our aim is to determine
the long term results of Coskun’s hernia repair technique and to compare it with
Lichtenstein technique
Methods:
A total of 493 patients, had groin hernia repair procedure via Coskun’s or Lichtenstein
technique at Ankara Numune Education and Research Hospital 3rd General Surgical
Department between January 1999 and March 2010 were were reached via phone
call and one’s having complains invited for physical examination. P <0.05 was
considered statistically significant.
Results:
The patients included to study were 443 (%89) male and 50 (%10.2) female. follow-
up period was ranging 12 to 108 months. Of the operations, 436 (89.1%) were
carried out by registrars and 57 (10.9%) were by specialists. There were 8 (3.1%)
recurrences in Coskun hernia repair group and 7 (2.9%) in Lichtenstein group .
Conclusion:
Long term results of our study showed similar efficacy of the Coskun hernia repair
technique with Lichtenstein repair at also long term follow up. As Coskun hernia
repair technique is easy to learn and perform in educational center, it will add to
lowering the recurrence rates that is well known directly effecting the recurrences.
-789-
PP - 586 GROIN PAIN IN YOUNG MALE ADULTS: RETROSPECTIVE
EVALUATION OF 446 PATIENTS
DURSUN ÖZGÜR KARAKAŞ 1, IBRAHIM YILMAZ 2, AYKUT AYTEKIN 3
1
2
GELIBOLU MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
CANAKKALE, TURKEY
3
AĞRI MILITARY HOSPITAL, DEPARTMENT OF RADIOLOGY, AGRI, TURKEY
Background&Aims:
In young male adults; groin pain is evaluated as an inguinal hernia and usually
referred to general surgeons. Less frequently; urological, internal and orthopedical
diseases can cause to groin pain.
Methods:
The side of groin pain, whether or not surgery, physical examination, and
ultrasonographic (USG) results were analysed from the soldier patients who
applied to department of General Surgery of Ağrı Military Hospital with groin pain
complaint from 01 January 2011 to 31 December 2011.
Results:
446 (14%) of the 3196 patients were applied with groin pain complaint (58,3%
right, 39,5% left, and 2,2% bilateral). Inguinal hernia was detected 43,8% at right,
28,1% at left, and 0,6% at bilateral with physical examination. Inguinal hernia
was not detected 10,3% at right, 9% at left, and 1,6% at bilateral with physical
examination and USG. At right 28,5% normal, 5,7% inguinal lymphadenomegaly,
and 3,2% urological pathology was found in the evaluation of USG results. At left
13,1% normal, 8,1% inguinal lymphadenomegaly, and 11,4% urological pathology
was found. No pathology was found with USG in bilateral groin pain.
Conclusion:
Urological, orthopedical pathology, and lymphadenopathy should be considered in

the differential diagnosis of groin pain except inguinal hernia in young male adults.
USG is a non-invasive, easy, cheap method with high degree of accuracy properties
and should be first alternative imaging at the differential diagnosis of undetermined
inguinal hernia on physical examination in the patients with groin pain.
-790-
PP - 587 LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIAS
SAHIN

Background&Aims:
Laparoscopy is increasingly the access of choice for the repair of diaphragmatic

hernias, primarily because it has less morbidity and requires shorter hospitalization
than open abdominal and thoracic approaches. Here we present 10 cases of
diaphragmatic hernias treated with laparoscopic approach.
Methods:
From June 2006, 10 patients underwent a laparoscopic procedure for diaphragmatic

hernias. The indication was posttraumatic hernias for 5 patients, Bochdalek hernia
for 4 patients and Morgagni hernia for one patient. After reduction of the hernia
contents, the defect was closed primarily in 7 patients, than mesh replacement was
done. The defects were closed directly with mesh replacement in 3 patients, which
were not suitable for primer closure.
Results:
Seven of the patients was female and mean age of the patients was 40.7 (24-65).
One procedure, which was left sided traumatic hernia, was converted to open
surgery because of bleeding from left liver lobe during dissection of triangular
ligament. Mean operation time was 107.9 min (65-175) and mean postoperative
stay was 3.1 days (2-7). No significant morbidity was happened except atelectasis
in 2 patients. Mean follow-up period was 29.9 (6-72) months. No recurrence was
detected.
Conclusion:
Operative interventions for diaphragm pathology are considered among the most
difficult reconstructive surgeries. Although the laparoscopic treatment of hiatal
hernia is a standard operation in daily surgical practice, the use of laparoscopic
techniques for diaphragmatic hernias is still rare. Our experience shows that
laparoscopy is a safe and effective in the treatment of diaphragmatic hernias.
-791-
PP - 588 MODIFIED THREE-DIMENSIONAL ANTERIOR
POLYPROPYLENE MESH TEHNIQUE FOR FEMORAL HERNIAS
FIKRET AKSOY 2, OKTAY YENER 1
GÖZTEPE TRAINING AND RESEARCH HOSPITAL, İSTANBUL, TURKEY

1
İSTANBUL BÖLGE HOSPITAL, ISTANBUL, TURKEY

2
Background&Aims:
The objective of this article is to investigate the outcome of modified three-

dimensional anterior polypropylene mesh tehnique for femoral hernias
Methods:
This study was performed as a prospective clinical trial in 45 patients between

2005-2010. Patients operated via modified three-dimensional anterior
polypropylene mesh tehnique. In this technique polypropylene mesh designed as
three-dimensionally (Figure 2). This mesh can be stiched both inguinal and Cooper
ligament (Figure 3).
Results:
In this study, 45 patients with inguinal hernias were operated via modified three-
dimensional anterior polypropylene mesh tehnique between 2005-2010 years.
Short and long term results were reported. There were 24 men and 21 women. The
mean age of the patients was 43.6 years (range 22–78). Patient characteristics and
physical status are shown in Table 1. Of the 45 inguinal repairs, 33 was femoral, 2
was combined direct and indirect and 10 (%) had been operated once previously.
14 of femoral hernias were operated emergently and 1 has undergone small bowell
resection. The recurrent hernias were direct in 4, indirect in 3 and unnoticed
femoral in 3 patients. The mean operation time was 50 (30-120) minutes. There
were no major intraoperative complications. Minor complications were seromas 4
(%), hematomas 2 (%), urinary retention 1 (%) and wound infection 2(%). The mean
hospital stay was 1.5 (1-3) days. Patients completed a 45 (10-60) months follow-up.
No chronic pain or testicular atrophy was detected during the follow-up period.
Recurrent hernia was not detected along follow up time.
Conclusion:
In conclusion, modified three-dimensional anterior polypropylene mesh tehnique

can confidently be appliable and allows anatomic support for the potential hernia
area with a low morbidty and rerecurrence rate. This technique should It is easy to
learn, cheap and should be the general surgeons’ procedure of choice.
-792-
PP - 589 PROPOSAL FOR LEARNING CURVE OF TEP HERNIA REPAIR:
ABILITY TO COMPLETE OPERATION LAPAROSCOPICALLY AS A FIRST
PHASE OF LEARNING CURVE
MUSTAFA HASBAHCECI 1, FATIH BASAK 2, AYLIN ACAR 2, ORHAN ALIMOGLU 2
1
BEZMIALEM VAKIF UNIVERSITY FACULTY OF MEDICINE DEPT OF GENERAL
2
UMRANIYE EDUCATION AND RESEARCH HOSPITAL DEPT OF GENERAL SURGERY,
ISTANBUL, TURKEY
Background&Aims:
Learning curve of totally extraperitoneal hernia (TEP) repair is still continuing

debate.
Methods:
A single surgeon experience of TEP repair was analyzed prospectively with regard to
number of the cases and ability to complete the operation laparoscopically. Study
group included one female and 38 male patient with 42 hernias with a mean age
of 48 years.
Results:
There were 22 left and 20 right sided hernias. Indirect, direct and combined hernias
were present in 18, 12 and 12 cases, respectively. Recurrences were detected
only in 4 cases. Peritoneal injury was occurred in 9 cases (21.4%). Conversion to
open surgery was necessitated in 7 cases (16.7%). The mean operative time was
55 minutes (range 20-110 minutes) excluding patients in which operation was
converted to open surgery. The causes for conversion were peritoneal injury
causing loss of exposure in 2, difficulty to determine the anatomy in 2, adhesions
in 2 recurrent cases and sliding hernia in one case. With an analysis of the cases
to time period, it was shown that all conversions (p=0.009) and seven out of nine
peritoneal injuries (p=0.130) were occurred during the first 21 cases. Right-sided
hernia (p=0.041) and recurrence (p=0.011) were the other significant factors for
conversion.
Conclusion:
It should be considered that at least 20 cases of TEP repair is required to complete

the operation laparoscopically.
-793-
PP - 590 RECYCLING THE BAND : CONVERSION OF A FAILED
LAPAROSCOPIC ADJUSTABLE BANDING TO AN ADJUSTABLE
BANDED ROUX-EN-Y GASTRIC BYPASS
DONALD VAN DER FRAENEN , FRANCİS GOUDSMİDT , HANNE VANOMMESLAEGHE
, SEBASTİAAN VAN CAUWENBERGE , BRUNO DİLLEMANS
AZ SINT JAN HOSPITAL, BRUGES, BELGIUM
Introduction:
Failure of laparoscopic adjustable gastric banding (LAGB) is defined as inadequate

weight-loss, band intolerance or band-related complications. Revisional surgery
after failed LAGB in the super-obese (body mass index > 50 kg/m²) poses multiple
problems. Primarily, conversion to a laparoscopic Roux-en-Y gastric bypass
(RYGB) might not always produce sufficient weight-loss, keeping in mind the 15%
failure-rate after primary RYGB. Secondly, revisional surgery in the super-obese is
technically challenging on itself.
Case report:
Our patient underwent a LAGB in the past for a BMI of 66,9 kg/m². Because of
insufficient weight-loss a laparoscopic adjustable banded gastric bypass was
performed. First, the band was carefully lifted from its tunnel, then a RYGB was
performed and finally the band was repositioned and fixed by suturing the gastric
remnant to the gastric pouch. The procedure and postoperative course were
uneventfull and patient was discharged on the fourth postoperative day. Operative
time was 110 minutes.
Conclusion:
After failed LAGB, preserving the band and performing a laparoscopic adjustable
banded RYGB is a possible solution in selected cases. Repositioning the band can
add restriction in a latter phase, when weight has reached a plateau. Evidently
this technique can only be performed if the stomach is not damaged by band
complications. In these cases we would opt for a two-stage procedure.
-794-
PP - 591 OUR EXPERIENCE IN LAPAROSCOPIC SLEEVE
GASTRECTOMY FOR MORBID OBESITY SURGERY: 44 PATIENTS
HASAN ALTUN 1, AZIZ BORA KARIP 1, OKTAY BANLI 2, UMIT AKYUZ 1, HAMIT KAFKAS
CELIK 1, FATIH KILIC 1, MEHMET OKUDUCU 1, KEMAL MEMISOGLU 1
1
SB FATIH SULTAN MEHMET EDUCATION AND RESEARCH HOSPITAL, ISTANBUL,
TURKEY
2
ANKARA CAG HOSPITAL, ANKARA, TURKEY
Background&Aims:
Laparoscopic Sleeve Gastrectomy (LSG) has become very popular among bariatric
surgeons. When compared to other methods, LSG procedure is simpler and the
results are sufficient. In this study, we would like to present our experience in LSG
for morbid obesity surgery.
Methods:
Between January 2009 and July 2012, a total of 44 patients underwent LSG
for morbid obesity. All operations were performed by the same surgical team.
Postoperative morbidities, mortalities and excess weight loss of the patients were
collected prospectively.
Results:
The mean age of patients was 35.45 years (range, 21-56 years), 14 were male and
30 were female. Preoperative mean body mass index was 45.2 kg/m2 (range, 36-
55.2 kg/m2). There was no conversion to laparotomy. One patient underwent
relaparoscopy due to a leakage from esophagogastric junction at the 4th
postoperative day. He was treated by irrigation and drainage successfully. Three
patients had postoperative intra-abdominal bleeding. All three bleeding stopped
spontaneously with conservative treatment. Two patients developed wound
infection at the trocar site where the stomach had been removed at the first week.
One patient developed pulmonary embolism at 5th postoperative day and improved
with medical treatment. Calculated EWL were 19.4%, 26.9%, 49.6% and 73.5% at 1
month, 3 months, 6 months and 1 year, respectively. There was no mortality.
Conclusion:
LSG has become an important surgical option for the treatment of the ever growing
morbidly obese population. Its postoperative complications are verly low and EWL
is satisfactory when compared to other bariatric procedures.
-795-
PP - 592 HIGH PREVALENCE OF VITAMINE D DEFICIENCY IN MORBID
OBESE PATIENTS CANDIDATES OF BARIATRIC SURGERY
ABDOLREZA PAZOUKI , MEDI RESHADI , ZEINAB TAMANNAIE , MOHADESE
PISHGAHROUDSARI , SOMAYYEH MOKHBER

Background&Aims:
Obesity is a growing public health problem all over the world.The prevalence of
vitamin D, calcium and phosphore insufficiency is high among morbidly obese after
surgery. However its prevalence isn’t clear before surgery among obese patients.
We aimed to explore serum level of vitamin D, calcium and phosphore among
obese patients.
Methods:
during this analytic cross-setional study from January 2010 to January 2011, 335
patients with morbidly obese who were reffered to Rasoul Akram, Moheb and
Milad r hospital (Tehran, Iran) were enrolled.
Results:
Mean age of patients were 39±10 years and 286 individuals were female and other
49 patients were male. Mean value of calcium, phosphore, parathormone and
vitamin D was 9.7±5.2, 3.8±0.6, 69±48 and 21±27 respectively.
Conclusion:
Present study showed that mean value of above hormones are different from
normal population, and there is a very high prevalence of vitamin D deficiency
among this patient before obesity surgery so it seems evaluation of this hormones
in obese patients may be helpful.
-796-
PP - 593 OUTCOMES OF 153 PATIENTS WITH A LAPAROSCOPIC
CONVERSION OF A VERTICAL-BANDED GASTROPLASTY TO ROUX-
EN-Y GASTRIC BYPASS
AKIN FAKI 1, VERCAUTEREN CHARLOTTE 1, VASAS PETER 2, VAN CAUWENBERGE
SEBASTIAAN 1, DILLEMANS BRUNO 1
AZ SINT JAN BRUGGE, BELGIUM

1
COLCHESTER HOSPITAL UNIVERSITY, UK

2
Background&Aims:
Vertical banded gastroplasty (VBG) is often associated with complications such

as gastric outlet obstruction, reflux, unsatisfactory weight loss and occasionally
requires revisional surgery to a Roux-en-Y Gastric Bypass (RYGB). However, revisional
bariatric surgery is associated with relatively higher rates of complications. The
objective of the study is to review our single centre results of patients undergoing
revisional RYGB following primary VBG.
Methods:
Retrospective review of prospective collected data of 153 patients who underwent

a laparoscopic RYGB as a revisional procedure following a VBG between 2004-2011.
Short and longterm complications were determined.
Results:
One hundred and fifty three patients underwent revisional RYGB post VBG. Mean
age was 44.4 (15-74) years with a mean pre-operative BMI of 34.2 (23.5-65.5)
kg/m2. Mean hospital stay was 4.3 days. Early complication rate was 3.9% while
late complications developed in 11 (7.7%) of the patients. No leaks or mortality
has been reported. Mean BMI decreased significantly to 28.8 kg/m² after a mean
follow-up of 48 months.
Conclusion:
Revisional RYGB following VBG is a safe procedure with outcomes comparable to

primary RYGB in terms of low rates of morbidity and mortality. We recommend
RYGB as the procedure of choice in patients requiring revisional surgery following
VBG.
-797-
PP - 594 MENSTRUAL IRREGULARITY AMONG MORBID OBESE
WOMEN CANDIDATE FOR LAPAROSCOPIC BARIATRIC SURGERY, A
MULTICENTER CROSS-SECTIONAL STUDY
ZEINAB TAMANNAIE , ABDOLREZA PAZOUKI , SHAHLA CHAICHIAN

Background&Aims:
The incidence of obesity in this century is increasing very rapidly. Obesity and
especially morbid obesity affects a greater proportion of women than men .Previous
studies have shown that obese women are more likely to experience menstrual
cycle irregularity but most of these studies have been limited by small sample
size and none of them had focused on morbid obese women and candidates for
bariatric surgery. Unfortunately, Menstrual Irregularity has a negative impact on
women’s reproductive system and health.
Methods:
In this observational study, women whom were 15_50 years old, non-pregnant, with
BMI over 40 were included and their menstrual cycle characteristics were asked by
a General Practitioner with precision. From 524 patients with morbid obesity who
underwent laparoscopic bariatric surgery in Hazrat Rasul Hospital, Milad Hospital,
Parsian Hospital and Moheb Hospital during the year of 2007 to 2011 who were
evaluated before surgery, 234 patients were participated in our study.
Results:
The mean age of the patients was 38.3 (±10.52). From all patients 111 patients or
47.4% had irregular menstruation, it was very higher than normal population and
the incidence of hypermenhorea, dysmenhorea, oligomenhorea, poly menhorea,
and amenorerrho were 16.7, 5.1, 5.1, 3.8, and 16.7 respectively. And about 3.8% of
married women had infertility that was 3 times more than normal weight women.
Conclusion:
morbid obese women should be treated by recommended methods of laparoscopic

bariatric surgery as the gold standard because of its major effect on reproductive
health and fertility.
-798-
PP - 595 MERALGIA PARESTHETICA AFTER LAPAROSCOPIC
BARIATRIC SURGERY
ABDOLREZA PAZOUKI , MOHAMMADALI PAKANEH , ZEINAB TAMANNAIE , SHAHLA
CHAICHIAN

Background&Aims:
Meralgia Paresthetica (MP) is a benign clinical syndrome of entrapment of the

lateral cutaneous nerve of thigh. Among the complications of bariatric surgery,
neurologic complications are not uncommon and of these complications. knowing
the clinical risk factors of MP is of great importance as they help the diagnosis of MP
among the serious differential diagnoses.To study prevalence of MP and its clinical
risk factors after bariatric surgery in a sample of Iranian morbid obese patients
undergoing surgery for obesity.
Methods:
: In a cross-sectional study, 163 patients (146 females and 17 males) who underwent
laparoscopic bariatric surgery were interviewed to complete the questionnaire of
the study containing history and presention of MP neuropathy
Results:
One month after surgery, 32 patients (19.5 percent) had a neurologic sign or
symptom at location of lateral thigh. Diagnosis was MP in 21 (17 women and 4 men)
patients (12.8 percent of all patients), subacute polyneuropathy in 7 patients (4.3
percent), and acute polyneuropathy in the other 4 patients (2.4 percent). No specific
treatments were done for patients with MP. Symptoms of MP were resolved within
6 months in 15 patients (71.4 percent). In univariate analysis of MP, only history
of a neuropathy was significantly correlated with occurrence of MP after surgery
(Pvalue = 0.004) with an odds ratio of 4.2 (95% confidence interval: 1.4 to 12.2).
Conclusion:
Although MP is not a common complication after briatric laparoscopic surgery,

Presence of history of neuropathy and diabetes should be mentioned by surgeons
as risk factors for MP.
-799-
PP - 596 LIVER ABSCESS, A RARE COMPLICATION OF SLEEVE
GASTRECTOMY
ALFALAH HAITHAM , D’SOUZA JOVIAL , ABBAS GHANEM
KING SAUD MEDICAL CITY, RIYADH, SAUDI ARABIA
Background&Aims:
Laparoscopic Sleeve Gastrectomy (LSG) is classified as a clean contaminated surgery

based on the degree of microbial contamination and carries its own risk of surgical
site infection including deep organ abscess.
Methods:
We are reporting a case of a thirty-two year old morbidly obese diabetic woman
underwent Laparoscopic Sleeve Gastrectomy (LSG). Then she developed a liver
abscess in the short post operative phase.
Results:
Immediate perioperative period was uneventful. Forty four days post-operatively

the patient complains of upper abdominal pain, vomiting, fever and chills. The
computerized tomography (CT) scan showed an abscess in segment VI and VII of the
liver which was treated with intravenous antibiotics and (CT) guided drainage. She
responded well to the treatment, draining 1600 ml of pus over a period of eighteen
days. Her abdominal ultrasound Two months later shows evidence of collapse and
organization of the abscess cavity.
Conclusion:
(LSG) is a new modality of surgical treatment of obesity and surgical site infection is
a part of the related complication including the rare incidence of liver abscess, and
it response to the same principles used when dealing with deep organ infection.
-800-
PP - 597 OBESE PATIENTS AFTER LAPAROSCOPIC ADJUSTABLE
GASTRIC BANDING- COMPLICATIONS AND THE INFLUENCE ON BMI
AND COMORBIDITIES.
BORA KOC , SERVET KARAHAN , GOKHAN ADAS , FIRAT TUTAL , AYHAN OZSOY ,
TUNA GELDIGITTI
OKMEYDANI TRAINING AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Laparoscopic adjustable gastric banding is one of the several weight loss

procedures in the bariatric surgeon’s for morbid obesity treatment. Laparoscopic
gastric banding has the lowest perioperative risk and operative time compared
to laparoscopic gastric bypass, sleeve gastrectomy and duodenal switch. The
adjustable gastric band treatment results in approximately 50% weight loss in five
years. In the long-term, reoperation rates can have high incidence; although with
changes in the operation tecnique, reoperation rates can be decreased after gastric
banding.Also these procedure is reversible compare to the others. In this study, we
want to present the standardized laparoscopic adjustable gastric banding technique
and early postoperative results in 3 and 6 months, 1 and 2 years of our first 30
consecutive patients who underwent LAGB from October 2007 to April 2010. We
wished to evaluate whether this method proved to be efficacious and caused with
few complications for the middle-aged obesis less than 50 kg/m² BMI.
Methods:
The data for 30 consecutive middle-aged (20-40 y.) patients that BMIs are between
35-50 kg/m² undergoing LAGB between October 2007 and April 2010 were evaluated
prospectively. All patients were analysed at the General Surgery Department of
Okmeydanı Training and Research Hospital. Each LAGB was performed by the same
surgeon assistanced by the same resident. Each patient underwent a standardized
work up including medical clearance, psychiatric and nutritional evaluation,
preoperative imaging, standard laboratory examinations and also consultations.
These patients had previous attempts for weight loss using other non-operative
modalities with no success. Patients scheduled postoperative office visits in week
1 and week 4, then in 3,6,9,12 ve 24 months. Data collected included patients’
demographics, comorbidities, preoperative weight and BMI, preoperative HbA1c
levels, operating times, complications and morbidity/mortality rates. Postoperative
data analysis include 3,6,12,24 months BMI and percentage of excess weight loss,
HbA1c levels and changes in comorbidity status.
-801-
Results:
A total of 30 patients’ LAGB were completed laparoscopically with an average

operative time of 64,6 minutes [range 48-83 minutes]. There were not any iatrogenic
injuries or surgical bleeding or leaks within the peritoneal cavity. The early results
of excess weight loss percentage were 16.7±8.18% and 22.3±9.27%, in 3 and 6
months, respectively. The long-term evaluation of excess weight loss percentage
were 40.9±18.56% and 55.6±17.23% at first and second years, respectively. Average
BMI in 3, 6, 12 and 24 months were 9.85%, 14.8%, 25.8% and 32.9%. Comorbidity
situations were assessed at each 3,6,12,24 month follow-up visit. Improvement in
comorbidities were observed if the patients required lower dosage of medicine for
their comorbidities. To discontinue the medical teraphy was defined as resolution
of the comorbidity. At the 12-month period hypertension improved in 14 (77.7%)
patients, hyperlipidemia improved in 22 (84,6%) patients, HbA1c levels decreased
in 6.24 (14.75%) and diabetes improved in 18 (78.2%) patients. The changes in the
HbA1c leves were not statistically significant enough to be observed in every office
visit. Pre-operative levels of HbA1c decreased after 90 days to 7.13. After 6 months,
it reached values closed to 7.02 and after 12 months, it was 6.24. And finally the
HbA1c leves reached 5.86 at the end of 24 months. In all cases no per-operative
complications were observed. Minor complications like nausea, vomiting, wound
infection and gastroesophageal reflux did not require hospital admission and they
were managed in outpatient conditions. The overall minor complication rate was
13.3% with no mortalities in our first 30 cases. 2 patients who had nause with
intermittant vomiting underwent an upper gastrointestinal endoscopy with normal
results. These two patients had a preoperative history of gastroesophageal reflux
and were treated by a proton pump inhibitor which alleviated the patients’ nausea.
One patient developed superficial wound infection at the port site. This patient
was treated with a course of oral antibiotics for wound infection and displayed
no evidence of infection at the 3-week follow-up. At one patient symptomatic
cholelithiasis was diagnosed after 9 months from LAGB and this patient underwent
successful laparoscopic cholecystectomy leading to resolution of the symptoms
without any complications. Pouch dilation and intragastric band migration or
band erosion which are major complications along with band slippage; occured
in 3 patients. Pouch dilatation occured in 2 patients, we prefered non-operative
treatment including complete band deflation, diet and follow-up contrast study in
4-6 weeks for both of them. One of them could be treated non-operatively and
after 18 weeks pouch size return to normal. The other patient’s band was displaced
laparoscopically and sleeve gastrectomy was performed at the same time (Picture
1,2). The other major complication was intragastric band erosion and migration.
This patient came to office visit with an epigastric stabbing pain for 20 days. Also
the patient reported that she had regained weight in the last two months. Upper
gastrointestinal endoscopy was performed for the diagnosis, and suprisingly we
saw the gastring band was placed to intragastric position utterly.
-802-
The interesting point is the treatment of this complication, we could displace the
gastric band balloon by using an endoscopic grasper and dislocate the inflation
port by local anesthesia. She required only 1 day hospital admission and due to
resolution of the symptoms without any complications, she was discharged.
Conclusion:
Laparoscopic Adjustable Gastric Band (LAGB) has got a world-wide popularity for
a bariatric surgery procedure as a primary operation. The potential advantages of
the LAGB are that it confers immediate restriction of caloric intake, can generally be
performed in less time than the other procedures require , reversibility and lower
operative risk compared to other restrictive procedures. The possible disadvantages
of the LAGB include placement of a foreign body or usual requirement of
adjustments at the office visits, proved undurability of more than five yeas and less
weight loss range. This is a safe and durably effective procedure, however, optimal
results depend upon the patient’s participation in a lifelong process of care. It is
hoped that by optimising this care process late complications will be avoided. Our
results show that LAGB can be performed with acceptable mortality and low short-
term complication rates.
-803-
PP - 598 ENDOSCOPIC INTRAGASTRIC BALLOON CAN BE INSTALLED
WITHOUT ANESTHESIA?
FEVZI CELAYIR 1, GÜRKAN YETKIN 1, FERDA AYBEY 2, EBRU ŞEN ORAN 1, MEHMET
ULUDAĞ 1, EVREN PEKER 1
1
ISTANBUL SISLI ETFAL TEACHING AND TRAINING HOSPITAL GENERAL SURGERY
2
ISTANBUL SISLI ETFAL TEACHING AND TRAINING HOSPITAL ANESTHESIA CLINIC,
ISTANBUL, TURKEY
Background&Aims:
In this study,we tried to prove that endoscopic intra gastric balloon can also be
easily done without anesthesia in obese patients
Methods:
Between 2007-2010 , we performed intragastric balloon without any anesthesia in

20 patients with BMI 35 and above who admitted to our hospital’s endoscopy unit
for obesity. 20 patients did not applied for anesthesia especially. These patients
were compared with other 20 patients undergoing endoscopy for intragastric ballon
with anesthesia Time, difficulty, patient tolerance, and return to daily activities and
comfort after the procedure were compared.
Results:
Processing time is about 10 minutes of without anesthesia in the group and 20

minutes anesthesia in the group. Patient tolerance of anesthesia in the group was
not difficult to insertion of a nasogastric catheter. However, in terms of doctor and
patient comfort and working conditions were better than in the group receiving
anesthesia. Patients who do not want anesthesia had quicker return to normal
activities after the procedure, Patients without anesthetisia said that appliying
an endoscopic intragastric balloon is not too difficult for them, and they could
recommend this method to others
Conclusion:
An endoscopic intragastric baloon can be applied as comfortable as a nasogastic

tube.But maximum comfort is only possible with anesthesia for the patient and
doctor.
-804-
PP - 599 A 6-YEAR EXPERIENCE WITH LAPAROSCOPIC ADJUSTABLE
GASTRIC BANDING: 285 PATIENTS
OKTAY BANLI 2, HASAN ALTUN 1, ROJBIN KARAKOYUN 3, AZIZ BORA KARIP 1,
MEHMET OKUDUCU 1, BULENT KAYA 1, KEMAL MEMISOGLU 1
1
FATIH SULTAN MEHMET EDUCATION AND RESEARCH HOSPITAL, ISTANBUL,
TURKEY
2
ANKARA CAG HOSPITAL, ANKARA, TURKEY
3
ANTALYA EDUCATION AND RESEARCH HOSPITAL, ANTALYA, TURKEY
Background&Aims:
Obesity is an increasing health problem worldwide and it is a preventable cause

of death. There a lot of procedures for weight loss designated as restrictive,
malabsorbtive and restrictive/malabsorbtive. Laparoscopic adjustable gastric
banding (LAGB) is the most popular restrictive procedure for morbid obesity in
Europe.
Methods:
A total of 285 patients underwent LABG at our center between February 2006 and
July 2012. There were 223 women (78.2 %) and 62 men (21.8 %). Median age was
38.5 years and ranged between 18 and 60 years. Mean preoperative BMI was 43.5
kg/m2 (range, 35-58 kg/m2). Generally, patients were discharged from hospital on
the first postoperative day.
Results:
The mean operative time was 50 min (range 35-215 min). Mean hospital stay was
1.2 days ( range 1-12 days). The mean excess weight loss (EWL) was 46.1%, 69.1%
and 65% at 1 year, 2 years and 3 years follow up, respectively. EWL was 63% at
≥5 years follow up. Early complications (up to 30 days after surgery) occurred in 7
patients (2.5%), while late complications occurred in 16 patients (5.6%). There was
one mortality (0.35%) following LAGB in one patient due to pulmonary embolism.
Conclusion:
LABG has gained a lot of popularity, since Kuzmak introduced silicone band with an
inflatable balloon. LABG is associated with decreased postoperative complications
and a shorter learning curve compared to other bariatric procedures. In our study,
patients achieved satisfactory EWL and low complication rate at 5 years.
-805-
PP - 600 EARLY RESULTS OF OBESITY SURGERY IN OUR PATIENTS
OVER AND UNDER 40 YEARS
SÜLEYMAN BOZKURT , HALIL COŞKUN , HÜSEYIN KADIOĞLU , YELIZ EMINE
ERSOY , NAIM MEMMI , GÖKHAN ÇİPE , MUSTAFA HASBAHÇECİ , MAHMUT
MÜSLÜMANOĞLU
BEZMIALEM VAKIF UNIVERSITY, GENERAL SURGERY DEPARTMENT, ISTANBUL,

TURKEY
Background&Aims:
Recently obesity surgery is being performed frequently and becoming more

popular. Generally young patients prefer obesity surgery and our aim is to evaluate
early results of our patients having obesity surgery <40 and >40 years.
Methods:
Results of 36 patients having laparoscopic sleeve gastrectomy or mini gastric bypass

in Bezmialem Vakif University Obesity Surgery Unit were evaluated retrospectively.
Results:
: Mean age of 36 patients (13 male, 23 female) were 34,2±10,1 years. 24 patients
were <40 and 12 were >40 years old. Sleeve gastrectomy was performed in 23,
and minigastric bypass in 13 patients. No postoperative complications were
encountered. No statistically significance was found between patients in terms of
surgical technique under and over 40 years(p=0,056), between male and female
ratios (p=0,273), initial weight and initial BMI(p=0,258 and p=0,222, respectively).
When the excess weight losses of groups in the third and sixth months were
evaluated, mean losses were 36,5±10,7 and 65,4±23,5 percent respectively (p=0,45
and p=0,974, respectively).
Conclusion:
Obesity surgery is generally being preferred by younger patients. however, our

study showed that, complication rates and success in weight and excess weight loss
were similar in patients over 40.
-806-
PP - 601 A RARE SITE OF MALIGNANT MELANOMA: THE UMBILICUS
A CASE REPORT
BAHADIR CELEP 1, AHMET OĞUZ HASDEMİR 1, SALİH SİNAN GÜLTEKİN 2, CEM
AZILI 1, SÜLEYMAN ÇETİNKÜNAR 3, İBRAHİM ÇOLHAN 4, YASİN UÇAR 5, TEVFİK
KÜÇÜKPINAR 1
1
DEPARTMENT OF GENERAL SURGERY, DIŞKAPI YILDIRIM BEYAZIT TRAINING AND
RESEARCH HOSPITAL, ANKARA, TURKEY
2
DIVISION OF NUCLEAR MEDICINE, DIŞKAPI YILDIRIM BEYAZIT TRAINING AND
3
DEPARTMENT OF GENERAL SURGERY, ADANA NUMUNE TRAINING AND
RESEARCH HOSPITAL, ADANA, TURKEY
4
DEPARTMENT OF GENERAL SURGERY, KURTALAN STATE HOSPİTAL, SİİRT, TURKEY
5
DEPARTMENT OF GENERAL SURGERY, ŞEREFLİKOÇHİSAR STATE HOSPİTAL,
ANKARA, TURKEY
Introduction:
Umbilical malignant melanoma (MM) is extremely rare. Up to date only 11 papers

including 23 cases have been reported in the English literature. The aim of this
report is to emphasize important surgical issues in a primary umbilical MM.
Case report:
A 55-year-old man was presented with umbilical swelling. He had an umbilical nevus
which increased rapidly in size recently. Diagnosis was made by an excisional biopsy.
Chest radiography, surface ultrasonography and abdominal tomography revealed no
evidence of metastatic spread through embryonic ligaments or distant metastasis.
Technetium-99m (Tc-99m) labelled nanocolloid was used intraoperatively for
detection of sentinel lymph nodes and no nodal activity was found in bilateral
axiller and inguinal regions. An excisional biopsy was taken with 2 cm wide margins
including anterior abdominal wall down to the peritoneum with a part of ligament
falciforme. The fascial defect was closed primarily and the skin was repaired with
rhomboid flap. The Breslow’s invasion depth was 4.5 mm corresponding to a Clark’s
level IV.
Conclusion:
The surgery should be carried with regard to the complex lymphatic drainage of the
umbilicus and also the surgeon should know that the tumor can be spread through
the embryogenic ligaments. Aesthetic concerns and patient satisfaction are other
problematic aspects.
-807-
PP - 602 RIGHT ILIAC FOSSA PAIN - IT’S NOT ALWAYS APPENDICITIS
(PART I)
CHRIS NEOPHYTOU , ALI QUREISHI , IFIGENIA MANTRALI
Introduction:
We report a case of suspected appendicitis which turned out to be a tubo-ovarian

abscess
Case report:
A 24-year-old female otherwise fit and well presented to our emergency department
complaining of sudden onset right lower abdominal pain for the last two days.
This was associated with loss of appetite, multiple episodes of vomiting and fever.
She did not complained of any other GI, urinary or gynaecological symptoms. On
examination, she had low grade pyrexia 37.8 and right iliac fossa tenderness, with
localised peritonism but otherwise soft abdomen. Inflammatory markers were
raised (WBC 18.9 – CRP 197). Urine dipstick was negative. A working diagnosis of
acute appendicitis was made and she underwent diagnostic laparoscopy. Intra-
operatively, the appendix was found to be normal, however a large right tubo-
ovarian abscess (TOA) was found. Following advice from the gynaecology team, it
was aspirated and the patient was sent home 2 days later on antibiotics.
Conclusion:
TOAs are usually found in sexually experienced, menstruating women who have
been exposed to STDs and who may have developed salpingitis in the absence of
a contraceptive method that prevents ovulation. They constitute approximately
2% of gynecology admissions to urban hospitals and should be considered in the
differential diagnosis of RIF pain.
-808-
PP - 603 RIGHT ILIAC FOSSA PAIN - IT’S NOT ALWAYS APPENDICITIS
(PART II)
CHRIS NEOPHYTOU , IFİGENİA MANTRALİ , ALİ QUREİSHİ , SURESH PİLLAİ
Introduction:
We report a case of suspected appendicitis which turned out to be a haemorrhagic

ovarian cyst.
Case report:
A 16-year-old female otherwise fit and well presented to our emergency department
complaining of gradual onset right lower abdominal pain for the last four days.
This was associated with an episode of collapse. She did not complain of any other
GI, urinary or gynaecological symptoms. On examination, she had right iliac fossa
tenderness, with localised peritonism but otherwise soft abdomen. Observations
and blood tests were normal. The likelihood of appendicitis was low an US scan
was requested to exclude gynaecological pathology. Due to limited cover over the
weekend, the scan did not happen. The patient was complaining of increasing pain,
she underwent a laparoscopy the next day. Intra-operatively, the appendix was
found to be normal, however the abdomen was filled with blood. A large ruptured
right haemorrhagic ovarian cyst was found, which was cauterised.
Conclusion:
The irritation of the peritoneum from a bleeding ovarian cyst can often be
misinterpreted as peritonism due to appendicitis. A pelvic ultrasound scan is not
always useful as the results are variable. However, if a bleeding ovarian cyst is
proven during a US scans, this can be potentially treated conservatively.
-809-
PP - 604 CASTLEMAN’S DISEASE: A CASE REPORT
DOĞAN ALBAYRAK 1, SERHAT OĞUZ 1, İLKAY ALBAYRAK 2, HÜSEYIN AKSOY 1, ABDIL
CEM İBIŞ 1, AHMET RAHMİ HATİPOĞLU 1, İRFAN COŞKUN 1, AYDIN ALTAN 1

1

2
Introduction:
Castleman’s disease, its etiology is poorly defined, often placed in the thorax, is
a very rare benig disease. In this article, It is aimed the presetation of literature
information of our patien who underwent surgical excision, in her histopathological
examination, it was reported that she had hyaline vascular type Castleman’s disease.
Case report:
46-year-old female patient with a complaint of intermittent abdominal pain was

evaluated in general surgery clinic. In MR and CT, in the duodenum posterior,
retroperitoneal area, at the adjacant of head of the pancreas and porttal vein, it was
reported that there was a mass about 4 cm in diameter(Fig1-2). Then laparotomy
was performed for diagnostic purposes and in committed exploration, 4 cm
diameter mass was totally excise from described area(Fig3). In her histopathologic
examination, it was reported as Castleman’s disease.
Conclusion:
Castleman’s disease is a very rare disorder. In 70% of cases of mediastinal disease

is located in the thorax but it can be rarely seen localized in the neck, pelvis,
pleura and muscle. Retroperitoneal is a very rare residential area for Castleman’s
disease. Castleman’s disease should be considered in the differential diagnosis of
retroperitoneal masses. Surgical intervention is often required due to the difficulties
in the differential diagnosis.
-810-
PP - 605 A RARE LOCATION OF SECONDARY HYDATID CYST DISEASE
SOYKAN ARIKAN , EMRE OZORAN
ISTANBUL EDUCATION AND RESEARCH HOSPITAL GENERAL SURGERY CLINIC,

ISTANBUL, TURKEY
Introduction:
Hydatid disease is formed by the lavral form of Echinococcus granulosus. Liver is

the most commonly affected organ in the body. Other organs can be affected with
lower incidence. After treatment for the primary disease reccurences can be seen.
Case report:
74 years old male patient was operated for cyst hydatic disease of the liver 40
years ago. Since 25 years he suffered from pain and swelling on the left side of the
abdominal wall. With these complaints he was admitted to our clinic and a mass
was palpable on the left abdominal wall. In the abdominal CT a cystic mass was
seen on the left abdominal wall with the dimensions of 10x4cm. After preparation
for surgery, the patient was operated under general anesthesia and the cystic mass
was removed from the abdominal wall. Germinative membrane of Echinococcus
granulosus was observed in the mass. Postoperative period was uneventful and the
patient was discharged without complications after 3 days.
Conclusion:
As the parasite located in a very rare site and it was secondary disease which is
separated from the first disease location.There was no connection between the two
incisions and locations. We would like to present this late reccurence other than the
primary location.
-811-
PP - 606 MALIGN CYLINDROMA OF THE SCALP WITH MULTIPLE
CERVICAL LYMPH NODE METASTASIS: A CASE REPORT
GOKHAN GIRAY AKGUL 1, ERDINC YENIDOGAN 2, SOYKAN DINC 1, ISIN PAK 3,
MUHAMMET KADRI COLAKOGLU 1, MEHMET ALI GULCELIK 1
1
2
3
Introduction:
Cylindromas are usually benign tumours as small, solitary, slow-growing nodules of

the scalp, face and trunk. Malignant dermal cylindromas are very rare. We present
an unusual case of malign cylindroma of the scalp with multiple metastasis to
cervical lymph nodules and also this case is the only case that has the most lymph
node metastasis.
Case report:
Patient presented to our clinic with hyperemic plaque located on his scalp with
bilateral, multipl palpable submandibulary lymph nodes. Entire scalp was removed
reaching in depth the periostal level and bilateral modified radical neck dissection
was performed. The histopathological examination of the scalp specimen was
malignant skin ecrine tumour, cylindroma and on the neck dissection specimen,
55 lymph nodes were reported as metastatic out of 79. The patient was treated
with chemotherapy and radiotheraphy. No recurrence or metastasis was observed
during a 5 year follow-up period.
Conclusion:
Malign cylindroma of the scalp rarely presents with multipl cervical lymph node
metastasis, however it is important to be aware of this possibility. The case reported
below is outstanding in literature for being the only case that has the most lymph
node metastasis. Although malign transformation of dermal cylindromas is rare,
aggresive surgery should be considered with locoregional metastasis of the tumour.
-812-
PP - 607 NON-TRAUMATIC PSEUDOCYST OF THE SPLEEN
HAKAN ÖZDEMİR , METİN ŞENOL , ZEHRA ÜNAL ÖZDEMİR , İBRAHİM TAYFUN
ŞAHİNER

Introduction:
Most of splenic cysts are parasitic (hydatid cyst). Nonparasitic cysts are classified
in two catagories; true cysts with epithelial lining and false cysts (pseudocyst).
Pseudocysts are usually secondary to trauma or hemorrahage. In this case, a
32-year-old male with a 12 cm pseudocyst in the spleen and hasn’t trauma history
is reported.
Case report:
A 32-year-old man was admitted with abdominal pain at his left side. Physical
examination revealed a mass in the left upper quadrant. In radiological
examination, a 12 cm cystic mass in spleen with peripheral calsification is defined.
Total splenectomy was done. The patient was discharged on postoperative day 3.
Surprisingly pseudocyst was reported after pathological examination.
Conclusion:
It is difficult to diagnose pseudocyst preoperatively. Hydatid disease takes the

first place in differential diagnosis espesially in endemic regions. In this case,
preoperatively the cyst was thougth as hydatid cyst because it’s endemic in Turkey
and the cyst had peripheric calsification, so that total splenectomy was preferred.
The patient was questioned retrospectively but there wasn’t any trauma history. In
conclution, if hydatid disease cannot be definitely ruled out preoperatively, total
splenectomy would be the safer approach and pseudocyst should be kept in mind
even without trauma history.
-813-
PP - 608 RIB HAEMANGIOMA
JOSIP BUBNJAR
GENERAL HOSPITAL ZABOK, CROATIA
Introduction:
We present a case of a female patient with an accidentally discovered rib mass on

a routine chest x-ray.
Case report:
CT scan and bone scitigraphy were undertaken but the diagnosis could not be
established. An en-bloc resection of the rib with surrounding two ribs and soft
tissues was performed. Histopathologic examination revealed the tumor to be a
hemangioma. The patient recovered completely.
Conclusion:
Rib hemangiomas are very rare tumors, and are usually discovered accidentally.
Preoperative diagnosis is very hard to establish, as only histopathological
examination is specific enough.
-814-
PP - 609 A RARE CAUSE OF LUNG EMPYEMA: INTRAPLEURAL
RUPTURE OF PRIMARY SPLENIC HYDATID CYST
NESIMI GÜNAL 1, SEDAT DOM 2, AYBALA AGAC AY 2, KUZEY AYDINURAZ 2, BERKANT
OZPOLAT 1
1
KIRIKKALE UNIVERSITY MEDICAL FACULTY,DEPARTMENT OF THORACIC SURGERY,
KIRIKKALE, TURKIYE
2
KIRIKKALE UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,
KIRIKKALE, TURKIYE
Introduction:
There are various causes of lung empyema. Primary hydatid cyst of the spleen
with intrapleural rupture presenting with empyema is rarely reported. Herein, we
present an elderly woman who admitted with empyema due to intrapleural rupture
of primary hydatid cyst.
Case report:
A 68 years old woman with left sided chest pain, fever and fatigue admitted to the
Department of Thoracic Surgery. Chest x-ray revealed fluid in the left hemithorax
which was diagnosed as empyema and tube drainage was performed. Fever and
chest pain diminished as soon as the patient was put on sulbactam ampicilline.
Further microbiologic examination of the empyema fluid revealed hydatid cyst
vesicules. On CT scan, a semi-calcified cyst in the spleen which was continous with
the diaphragm and an abscess within the spleen were discovered. The abdomen and
thorax were entered simultaneously via a thoracoabdominal incision. Splenectomy
was performed and a passage to the intrapelural space through the diaphragm was
discovered. The hemithorax was entered and hydatid vesicules were cleared from
the intrapleural space extending as far as the cardiac apex. The patient recovered
uneventfully.
Conclusion:
In endemic areas, primary splenic hydatid cysts rupturing into pleural space should
be kept in differential diagnosis of lung empyema.
-815-
PP - 610 A RARE ENTITY: AGGRESSIVE ANGIOMIXOMA
NAIL ERSÖZ 1, YAŞAR SUBUTAY PEKER 1, MURAT URKAN 1, ÖNDER ÖNGÜRÜ 2,
YUSUF PEKER 1
1
ANKARA, TURKEY
2
TURKEY
Introduction:
Aggressive angiomixoma is an uncommon, (106 cases since 1983) local aggressive,

and extremely rare metastatic (3 cases) entity which is usually seen on external
genital organs and pelvis of adult female. In this case, we want to share our
experiences about treatment and evaluation of aggressive angiomixoma. Data of a
patient with pelvic aggressive angiomixoma, who was surgically treated is examined
retrospectivly and presented in this study.
Case report:
38 years old asymptomatic female patient, had pelvic mass with size of 95x48x50
mm, diagnosed during check-up. Further radiologic and pathologic evoluation of
mass resulted the prediagnosis of spindle cell mesenchimal tumour which is located
from lateral of vagina, up to superolateral of urinary bladder. Surgical excision of
tumour was performed. Patient was discharged without any complication.
Conclusion:
Aggressive angiomixoma is an uncommon, not invasive but local infiltrative entity

with rich vascular tissue. Treatment of angiomixoma is surgical resection, however
estrogen and progesteron reseptor positive cases may be treated with GnRH
analogues and aromatase inhibitors in addition to surgery as well as radiotherapy
may also be added. Relaps may be seen up to %30-40 of cases independant from
margin free resection.
-816-
PP - 611 SQUAMOUS CELL CARCINOMA ARISING IN A RECURRENT
PILONIDAL DISEASE AND ILIOINGUINAL LYMPH NODE METASTASIS
NIYAZI KARAMAN , LUTFI DOGAN , CAN ATALAY , CIHANGIR OZASLAN , MEHMET
ALTINOK
DEPARTMENT OF GENERAL SURGERY, ANKARA ONCOLOGY TRAINING AND

Introduction:
The malignancy arising in pilonidal disease is very rare. The most frequent
malignancy is squamous cell carcinoma. In this paper, a patient presented with
squamous cell carcinoma arising in pilonidal disease and progressed with bilateral
inguinal and iliac lymph node metastasis is presented.
Case report:
The patient had been given adjuvant radiotherapy at the cumulative dose of 5100
cGy due to the close resection margins (0.5cm). The patient was presented to our
clinic with a complaint of bilateral inguinal nodularities. The patient was treated
with neoadjuvant chemotherapy (cysplatinum, methotrexate and bleomycine)
and operated with bilateral inguinal dissection. Six months after the completion of
chemothearpy, the patient was presented with the complaint of abdominal pain.
At radiological evaluation, the metastatic involvement of iliac lymph nodes with
severe invasion to the adjacent structures was observed and the patient was died
from disease progression in short period of time.
Conclusion:
Squamous cell carcinoma. arising in chronic pilonidal disease should be kept in

mind for its possible early diagnosis and treatment. Optimal treatment should be
planned for each patient to decrease local recurrence and prolong survival. In case
of recurrent disease, survival can be prolonged with extended resections.
-817-
PP - 612 ASYMPTOMATIC HETEROTOPIC OSSIFICATION ON
ABDOMINAL SCAR AND ILEOSTOMY
ÖZGÜN AKGÜL , EMIR ÇAPKINOĞLU , MURAT KEMAL ATAHAN
IZMIR KATIP ÇELEBI UNIVERSITY ATATÜRK EDUCATION AND RESEARCH HOSPITAL,

IZMIR, TURKEY
Introduction:
Heterotopic ossification is a rare, benign condition which occurs when bone

develops in tissues that do not normally ossify.
Case report:
We herein report the case of a 78-year-old gentleman who underwent a laparotomy

for a ascendant colon tumour and after surgery while the second operation for
closing ileostomy there has been detected an asymptomatic heterotopic ossification
around of ileostomy and on the abdominal midline incision scar.
Conclusion:
Heterotopic ossification may occur at various sites and is a recognised but

exceedingly infrequent sequela of abdominal surgery. This case is submission for
to attract attention on a topic which have an exactly unknown etiology and limited
information in the literature.
-818-
PP - 613 DERMATOFIBROSARCOMA IN THE RIGHT UPPER
QUADRANT: A RARE TUMOR OF SOFT TISSUE
H. RODOLFO SCARAVONATI , CARLOS AUGUSTO CUTINI CINGOZOGLU , SILVINA
LUCIA MILLETARI , VALERIA EVANGELISTA IGLESIAS , MANUEL TORRES , ANDRES
KAPLAN , RODRIGO MORAN AZZI , VICTOR HUGO SERAFINI
Introduction:
Dermatofibrosarcoma protuberans is relatively uncommon soft tissue neoplasm

with low to intermediate grade malignancy. Although metastasis rarely occurs, is
a locally aggressive tumor with a high recurrence rate. We report a case treated
surgically
Case report:
A 28 years old male, with no medical history, was admitted with a 6 cm sized,
well-circumscribed, skincolored maculopapular lesion of 14 years duration in right
upper quadrant. Lesion was progressive and increased gradually in size since its
appearance but was completely asymptomatic. On palpation it was not indurated
and freely mobile over the underlying tissues. Routine laboratory investigations
revealed no abnormality. Ultrasound exploration demonstrated a patchy, solid
tumefaction. Nuclear magnetic resonance showed a bulky mass occupying the soft
tissue area without infiltration of the underlying structures. The patient underwent
2 cm-wide surgical resection. The histological report described a mesenchymal
neoplasm with spindle cells and storiform pattern. No early or late complications
were observed, with any local recurrence after 24 months of follow-up
Conclusion:
The recurrence potential of DFSP is directly related to the extent of resection.

Surgery with histological margin control allows low recurrence rates and is the first-
line treatment modality for this condition
-819-
PP - 614 PRIMARY VERTEBRAL CYST HYDATID
SÜLEYMAN ÇETİNKÜNAR 1, AHMET OĞUZ HASDEMİR 2, MERT TÜZÜNER 3,
BAHADIR CELEP 2, TEVFİK KÜÇÜKPINAR 2
1
ADANA NUMUNE EĞİTİM ARAŞTIRMA HASTANESİ GENEL CERRAHİ KLİNİĞİ,
ADANA, TURKEY
2
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM ARAŞTIRMA HASTANESİ GENEL
CERRAHİ KLİNİĞİ, ANKARA, TURKEY
3
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM ARAŞTIRMA HASTANESİ ORTOPEDİ
KLİNİĞİ, ANKARA, TURKEY
Introduction:
Hydatid cyst disease is caused by infection with Echinococcus granulosus. The

locations are most frequently in the liver (60—70%) and lungs (10—15%). Bone
involvement remains rare (0.5—2%), vertebral locations observed in half of these
cases, 50% of spinal involvement was seen in thoracal region, 10% in cervical region,
20% in lumbar region and 20% in sacral region
Case report:
A 57-year-old male patient was admitted with back pain and numbness at toes of
left foot. In physical examination, parestesia was detected and SLR test was pozitive
in left leg. Serological test (IHAT) were positive. MRI of the lumbar region shows
that a cystic mass begins from the left psoas muscle and collapsing the L4 vertebrae.
Totally cyst excision, L4 corpectomy and vertebral stabilisation was performed in
anterior approach. The antihelmintic drugs was given for 6 months
Conclusion:
Vertebral cyst hydatid has a poor prognosis. The only curative treatment option
for hydatid disease is radical surgery with drug therapy.The surgical goal must be
removal of the cyst totally. we think that anterior approach is a safe and better
procedure for exploring the involved vertebral section and totally excision of the
cysts and prevention of the relapses
-820-
PP - 615 DIABETIC FOOT MANAGEMENT IN TURKEY
ANKARA NUMUNE EDUCATION AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
Applications of new technologies to the medicine with better understanding of

pathophysiology of the diseases help longer life times. This consequently increased
the incidences of geriatric problems and chronic diseases. Diabetic patients
with longer life times are more prone to diabetic foot complications. Aim: In our
prospective study, we aimed to evaluate current status in diabetic foot in our
patient population and to gather data for the construction of national diabetic foot
treatment algorithms.
Methods:
Patients admitted to our outpatient clinic between June and December 2011 were
included the study. A total of 93 patients were reviewed and data analyzed.
Results:
The mean age was 63.3 years and 65,6% was male. Type 2 diabetes was the most
frequent. While 55.7% of the patients had hypertension, 19.3% had cardiac and
16.1% had renal complications. Diabetes was diagnosed by its complications in six
patients. At the course, 36.6% required surgical intervention and %73.3 of them
underwent amputations. Average healing time was seventy days.
Conclusion:
Diabetic foot is an increasing complication of diabetes. It is difficult to manage and

also takes long time to treat which in turn results with psychological and economic
costs. Preventive measurements should be seriously taken into consideration in this
patient population
-821-
PP - 616 SPLEEN ABSCESS CAUSED BY AMILOIDOSIS: CASE REPORT
SAMET YALÇIN 1, İBRAHİM KILINÇ 2, GÜLTEN KIYAK 2, GÜRKAN DUMLU 2, AHMET
GURER 2, MEHMET KILIÇ 1
1
2
Background&Aims:
We present a case with spleen abscess because of amiloidosis which is a rare cause
of this disease.
Methods:
68 year old male admitted to ER with abdominal pain that exists for 10 days,loss of
appetite and continuos fever for last 2 days.
Results:
An abdominal CT scan performed. An approximately 6 cm cystic lesion with air-liquid

levels is visualised at spleen. He had taken to surgery emergently. A splenectomy
is performed. There was no postoperative complications. Pathological examination
indicated thick walled hyalinised vessel are seen in capsule and paranchyme of
spleen that it is compatible with amiloidosis.
Conclusion:
Amiloide could deposit many organs like spleen and rarely it is presented with
abscess. Splenectomy for splenic amiliodosis is for symptomatic relief either than
eradication of primary disease. However, it could be life-saving for splenic abscess
caused by amiolidosis. Computed tomography scan is most sensitive and spesific
diagnostic method for spleen abscess. Medical treatment only is usually not
enough and have high mortality rates. Percutaneous drainage could be considered
for uniloculated abscess. On the other hand, because of higher rates of failure and
long hospitality periods, splenectomy is still gold standard therapy. As a conclusion,
splenic abscess should be considered for primary or secondary amiloidosis.
-822-
PP - 617 GOSSYPIBOMA MISTAKEN FOR A HYDATID CYST : CASE
REPORT
BAHADIR OSMAN BOZKIRLI , RIZA HALDUN GÜNDOĞDU , PAMIR EREN ERSOY ,
SONER AKBABA , MEHMET ODUNCU
ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
Gossypiboma is the term for a mass of cotton matrix accidentally retained in the
body after surgery. Gossypibomas are rarely mistaken for abdominal hydatid cysts.
Methods:
Here we present a case of gossypiboma that was mistaken for an abdominal hydatid
cyst in the preoperative evaluation.
Results:
A 34 year old male patient was admitted to our clinic for the complaints of nausea
and vomiting after the meals and abdominal distention that was apperent for 5
months. He had a history of open Nissen fundoplication 10 years ago. On physical
examination there was a median laparotomy incision. A large mass was palpable in
the epigastrium. Abdominal CT revealed a 20x18 cm calcified cystic mass originating
from the left lobe of the liver with a collapsed germinative membrane inside it. The
patient was operated with a suggested diagnosis of type 3 hydatid cyst. Laparotomy
revealed a large mass with a pseudocapsule, filling the epigastrium. When the
pseudocapsule was opened, 3 liters of brown-black liquid discharged. In the cystic
cavity there was a 30x30 cm surgical compress near the esophageal hiatus.
Conclusion:
We believe gossypiboma should be kept in mind in the differential diagnosis of

abdominal hydatid cysts in the presence of a former abdominal operation.
-823-
PP - 618 APOCRINE HIDROCYSTOMA ON THE FINGER
EMIR EROLER 1, DENIZ TIHAN 1, UĞUR DUMAN 1, YIĞIT MEHMET ÖZGÜN 2
ŞEVKET YILMAZ TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF

1
GENERAL SURGERY, BURSA, TURKEY

YÜKSEK İHTISAS TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF GENERAL
2
Background&Aims:
Apocrine hidrocystomas are benign cutaneous tumoral lesions arising from the
apocrine secretory glands. Its most common presentation is a superficial solitary
cutaneous nodule which is frequently located on the face, near the eye. Here we
share an apocrine hidrocystoma case on the finger; an extremely rare localisation.
Methods:
A 50-year-old woman admitted to the general surgery clinic with complaint of a

2-cm-nodular mass on his heft hand’s fifth finger. The lesion was totally excised
under locoregional anesthesia. Histopathological analysis was concordant with
apocrine hidrocystoma.
Results:
The patient is free of recurrence and has not any medical problem or reccurduring
his follow-up.
Conclusion:
Apocrine hidrocystoma is believed to be mostly benign, it could slowly enlarge.

Generally, the lesion is presented as a solitary superficial nodule smaller than 1
cm. The exact incidence may not be known, but it is estimated that it may be one
per thousand of submitted cutaneous biopsies. The proper treatment is surgical
excision.
-824-
PP - 619 INTRAABDOMINAL GOSSYPIBOMA: REPORT OF TWO
CASES
EBRU ORAN 1, GÜRKAN YETKIN 1, FEVZI CELAYIR 1, NURCIHAN AYGÜN 1,
ABDÜLCABBAR KARTAL 1, FEVZIYE KABUKÇUOĞLU 2, MEHMET ULUDAĞ 1
1
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, 1ST GENERAL SURGERY UNIT,
SISLI, ISTANBUL, TURKEY
2
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL, PATHOLOGY UNIT, SISLI,
ISTANBUL, TURKEY
Background&Aims:
Gossypiboma is a heritage of previous surgery causing medicolegal issue.
Methods:
We present two cases of gossypiboma mimicking intraabdominal malignancy.
Results:
Case 1: A 28 year old woman presented with a history of open cholecystectomy

was admitted to our clinic. On physical examination mass lesion was found at
the epigastric region. Abdominal CT and MRI revealed a cystic mass measuring
77x65x108 mm in diamater at the lesser sac with contiguity of left hepatic lobe,
gastric antrum and jejunal loops, with high-density enhanced wall, suggestive of
serous cystadenocarcinoma. At laparotomy, wall of the lesion was inadvertently
opened. Retained surgical sponges were detected after running out of serous fluid.
Mass was completely retrieved. Case 2: A 36 year old female patient was admitted
with the complaint of mass in the left lower quadrant. There were two caesarean
sections in her background. A 10x10 cm mass was palpated on the left lower
abdomen. Ultrasonography and abdominal tomography showed tumoral mass
near the left ovary. In the laparotomy, the mass was encapsulated and resembling
a stromal tumor. It was completely removed. Pathological examination revealed
gossypiboma.
Conclusion:
Gossypiboma should be considered in the differential diagnosis of intraabdominal

masses in patients experienced surgery
-825-
PP - 620 THE LAPAROSCOPIC DRAINAGE OF INTRAABDOMINAL
ABSCESS AFTER LAPAROSCOPIC APPENDECTOMY.
MEHMET ULUDAĞ , EBRU ORAN , BÜLENT CITGEZ , FEVZI CELAYIR , NURCIHAN
AYGÜN , GÜRKAN YETKIN
SISLI ETFAL TRAINING AND RESEARCH HOSPITAL 1ST GENERAL SURGERY UNIT,
SISLI, ISTANBUL, TURKEY
Background&Aims:
Laparoscopic drainage can be performed via small incision and accomplished under
direct vision.
Methods:
We introduce a case with intraabdominal abscess following laparoscopic

appendectomy performed for gangrenous appendicitis, treated with laparoscopic
drainage.
Results:
Case: The patient with fever and leucocytosis postoperatively showed free fluid
with intense content at subhepatic region and right inferior quadrant and abscess
formation of 45 cm³ in rectovesical area in USG. Because they might have required
multiple percutaneous drainage and there were intestinal loops adjacent to the
abscess, laparoscopic drainage was preferred in stead of percutaneous approach.
At laparoscopy, the small intestinal segments which were forming the ceiling of
the abscess pouch in rectovesical region was dissected and we entered into the
pouch. The abscess was drained and the content was sent for culture. The cavity
and free fluid were irrigated and aspirated and silicone drain was placed in the
cavity under direct vision. The control USG on 7th day postoperatively revealed no
signs of residual abscess. The clinical course postoperatively was uneventful, and
the patient was discharged on day 9.
Conclusion:
Laparoscopic drainage should be considered as an alternative procedure when it is

not safe to perform percutaneous drainage or there are multiple abscesses.
-826-
PP - 621 EFFECT OF POLYETHYLENE GLYCOL GEL ON INTRA-
ABDOMINAL ADHESION FORMATION
EREN ERSOY , HALDUN GUNDOGDU , HANDE TEMEL , AYLIN YAZGAN , EMRE
ERGUL
ATATURK RESEACH AND TRAINING HOSPITAL, ANKARA, TURKEY
Background&Aims:
Postoperative adhesions are one of the major complications following laparatomy

in general and they may occur after all laparatomies The aim of this study was to
evaluate the efficacy of polyethylene glycol gel on preventing postoperative intra-
abdominal adhesion, inflammation and fibrosis in an experimental model.
Methods:
Twenty-two Wistar Albino rats were randomized as treated and control. All rats
underwent laparotomy with subsequent cecal wall abrasion and abdominal wall
injury. Polyethylene glycol gel was placed to each treated rat between the injured
surfaces while the control group received nothing. The animals were sacrificed
on postoperative day twenty-one. Three observers graded the intra-abdominal
adhesions and resected specimens for the histological examination by means of
fibrosis and inflammation. Fibrosis, inflammation and adhesions were graded by
using quantitative scoring systems.
Results:
The treated group showed significantly lower values for the adhesion and
inflammation scores. On the other hand fibrosis scores showed no significant
difference. All scores in two groups were statistically correlated.
Conclusion:
The placement of polyethylene glycol gel between the injured surfaces is associated
with a significantly reduced rate of postoperative adhesions and inflammation. This
may be a promising result for reducing the morbidity, caused by postoperative
adhesions.
-827-
PP - 622 A CASE OF RETROPERITONEAL TERATOMA DIFFICULT TO
DISTINGUISH FROM HIDATID CYST
EYUP DURAN 1, ZAFER KILBAS 2, NAIL ERSOZ 2, NAZIF ZEYBEK 2, YUSUF PEKER 2

1

2
TURKEY
Introduction:
To describe a case of retroperitoneal mature teratoma presenting as hidatid cyst

in a twentyone years old man who had abdominal pain and mass sensation in the
right hemiabdomen.
Case report:
Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were

performed. Imaging studies showed a big cystic lesion in the right retroperitoneal
space, 90*73*42 mm, well defined, with thin septa. It is localizated near the aorta
and inferior right kidney. The diagnosis was hidatid cyst. and Surgical treatment was
performed. retroperitoneal lesion was resected. Microscopic evaluation revealed a
benign mature cystic teratoma characterized by cystic spaces lined by respiratory
epithelium and intestinal columnar epithelium.
Conclusion:
Although retroperitoneal teratoma contains fat, cyst, soft tissue and calcification, In
our case, the tumor contained more cystic structure than the ‘typical’ retroperitoneal
teratoma, which led to the misdiagnosis.
-828-
PP - 623 ULTRASONOGRAPHIC EVALUATION OF POST-OPERATIVE
FLAP THICKNESS IN PATIENTS WITH PILONIDAL SINUS
FATIH ALTINTOPRAK 1, YUSUF ARSLAN 2, GIYASETTIN ASIL 3, OMER YALKIN 2,
GOKHAN AKBULUT 1, OSMAN NURI DILEK 1
1
2
3
RADIOLOGY, SAKARYA, TURKEY
Background&Aims:
In this study, we investigated that relationship between post-operative flap thickness

and recurrence in patients with pilonidal sinus disease.
Methods:
Ninety-eight patients who had been operated with pilonidal sinüs were evaluated
retrospectively. in Sakarya University Faculty of Medicine between 2008-2012. In
evaluation of the flap thickness, the nearest and farthest margins were measured
by ultrasonograpy between skin and sacrum at the operation site.
Results:
Resection and primary repair was performed in 46 patients (46.9%), Limberg flap
transposition was performed in 52 patients (53.1%). Mean flap thickness was found
17.2 mm (range: 3.9 - 36.4) in primary repair group, 20.5 mm (range: 4.0 - 42.3)
in Limberg group. Recurrence rate was found 8.6% (4 patients) in primary repair
group, 1.9% (1 patient) in Limberg group in avarage of 27.1 months (range: 12-54
months) follow-up.
Conclusion:
In literature, it is defined that flap repair methods have less recurrence rate than
primary repair method. In this study, it is concluded that the length between skin
and sacrum may be influence on recurrence rate. On the basis of this result, we
want to emphasize that each patient may be in need of different flap techniques.
-829-
PP - 624 THE USE OF A DIFFERENT TULLE GRAS CONTAINING SILVER
NITRATE AND BORIC ACID SOLUTION FOR TOPICAL TREATMENT OF
THE WOUNDS
İBRAHIM ETEM ÖKCESIZ 1, NIMET EMEL LÜLECI 2, ÖZGE ÜLKER 3
1
HAND AND MICROSURGERY DEPARTMENT OF DELTA HOSPITAL, ISTANBUL,
TURKEY.
2
DEPARTMENT OF PUBLIC HEALTH MARMARA UNIVERSITY MEDICAL FACULTY,
ISTANBUL, TURKEY
3
DEPARTMENT OF TOXICOLOGY, FACULTY OF PHARMACY,ANKARA UNIVERSITY,
TURKEY
Background&Aims:
Background: Combination of silver nitrate and boric acid in a solution provides us

some advantages in addition to their antimicrobial activities. And it is also possible
to use this solution in form of a tulle gras which was prepared by the senior author
at 1980, and presented at some national surgical congresses of 1988 and 1990s Each
of the ions in this solution has different function in addition to their antimicrobial
effect.. For example silver has an anti tumour activity and suppresses granulation,
nitrate-nitrite is a “NO” producer with relaxing smooth muscle, boric acid has also
anti tumour and astringent effect.
Methods:
It is necessary to carry out some basic requirements of a wound, such as, to avoid
infection, to eliminate necrotic tissues without exposing critical tissues, to provocate
granulation, to stimulate epithelialisation in every epithelial island with suppressing
neighbouring granulation tissue, and finally to eliminate tumour cells remnants if
a palliative excision of an exulcerated neoplasm had been done previously. Very
small amounts(0.3-0.7 %, 1-3% respectively) of the salts, according to their toxic
levels, have been used in the solution. Some medicaments such as balsam of Peru
or honey and some antibiotics deeply penetrated have been easily added according
to requirements of the wounds during dressing. This tulle gras has been used in a
wide spectrum which includes many cases such as replantations of major or minor
amputations totally or subtotally, large crush lacerations, burns, large decubital
ulcers, unhealing wounds after the palliative tumour excisions, anorectal lesions,
oral lesions, diabetic food lesions…
-830-
Results:
The requirements of the wounds have been carried out efectively by this tulle gras,
beyond inevitable blood leakage which has been avoided by this direct cauterisation
of silver nitrate especially in large wounds. So anemia problem especially in
children has been excluded. In this presentation, the cases which are easy to
explain the mechanism of this topical treatment above mentioned is presented.
No complication was seen except mild methemoglobinemia in a new born, and
teratogenic effect must be in mind for pregnants
Conclusion:
Because of this topical treatment is safe, cheap and easy to use, it has an importance
for public health
-831-
PP - 625 CAN C-REACTIVE PROTEIN REVOLUTIONISE DIAGNOSING
APPENDICITIS?
JAMIE KELLY , NIKUL AMIN
ROYAL SUSSEX COUNTY HOSPITAL, BRIGHTON, UK
Background&Aims:
Studies have considered the role of CRP and IL-6 in the diagnosis of appendicitis
but little in the literature discusses its role in ruling out appendicitis. Our study
contrasted the sensitivity of CRP against other routine investigations.
Methods:
All patients undergoing appendectomy during one year were included (n=83).
Serum CRP taken twenty-four hours after the onset of the patient’s symptoms
was recorded, as was the white cell count and ultrasound findings. These were
retrospectively contrasted against the histology of the appendix.
Results:
CRP was elevated in 51 of the 83 patients and acute appendicitis histologically

proven in 46 patients (90.2%). All but one of the false positives had other intra-
abdominal pathology found at surgery. Of the 22 that did not have an elevated CRP,
1 (4.5%) did have acute appendicitis. CRP taken at least twenty-four hours after the
onset of symptoms was significantly more accurate at predicting the histology, be
that a normal or inflamed appendix, than the white cell count or ultrasound (p=
<0.01, 0.03 respectively).
Conclusion:
If taken at least twenty hour hours after the onset of symptoms, CRP is a valuable
cost-effective tool to the clinician in both diagnosing and ruling out acute
appendicitis.
-832-
PP - 626 PRIMARY CUTANEOUS MELANOMA AND SENTINEL LYMPH
NODE BIOPSY: LONG-TERM OUTCOMES
KAPTAN GÜLBEN , UĞUR BERBEROĞLU , HÜSEYIN ALTINYOLLAR , VOLKAN KINAŞ
ANKARA ONCOLOGY TRAINING AND RESEARCH HOSPITAL, ANKARA, TURKEY
Background&Aims:
To assess the role of sentinel lymph node biopsy (SLNB) on long-term disease
outcome in patients with primary cutaneous melanoma.
Methods:
Thirty-eight melanoma patients underwent SLNB between 1998-2010 in a single

center. Disease-free survival (DFS), overall survival (OS) and prognostic factors were
analyzed.
Results:
Median age was 53 years (range 24-74). Median Breslow thickness was 3 mm
(range 1-18) and 28.9% were ulcerated melanomas. Median follow-up time was 62
(range 13-204) months. The number of patients with SLN-positive was 13 (%34,2)
and completion lymph node dissection was performed in all of 13 patients. Fifteen
patients (39,5%) developed recurrence; 10 in the SLN-positive group (67%) and 5
in the SLN-negative group (33%; p<0.001). In the SLN-negative group two patients
developed regional node recurrence; false-negative rate was 13.3%. SLN positivity,
tumor localization and ulceration were independent prognostic factors for DFS in
multivariate analysis. For OS SLN positivity, localization and Breslow thickness were
found to be the strongest prognostic factors. 10-year DFS was 73% for SLN-negative
patients compared to 22% for SLN-positive patients (p<0.001). 10-year OS was 82%
and 23%, respectively (p<0.001).
Conclusion:
The results of this study in a single center show that long-term survival rates are
worse in the SLN-positive patients.
-833-
PP - 627 ARTIFICIAL ANAL BAND IMPLANTATION FOR TREATMENT
OF SEVERE FECAL INCONTINENCE
EBRU ASMAZ , M. UMIT UGURLU , ASIM CINGI , CUMHUR YEGEN

ISTANBUL, TURKEY
Background&Aims:
Fecal incontinence is a debilitating problem in which affected individuals often

suffer in silence.This study aims to report early outcomes of artificial anal band
implantation for treatment of severe fecal incontinence.
Methods:
Eight patients (4 women, 4 men), mean age of 53 (21-72) with severe fecal
incontinence was reviewed after surgical implantation with A.M.I soft anal band
system, AAB 300.
Results:
The soft anal band system is successfully implanted in eight patients. One patient
(12,5 %) required device explantation due to postoperative infection. One patient
(12,5 %) with BMI of 36 was not be able to use the activator and the valve of the
system effectively that were placed subcutaneously. One patient (12,5 %) with fecal
incontinence due to congenital coloanal atresia could not have a functional system.
Five of eight patients (62,5%) had properly functioning artificial anal band systems.
The comparative preoperative and post-activation fecal incontinence, quality of life
scores are found to be improved from a mean of 45,13 ± 3,61 to 102,2 ± 3,68 p<
0,0001; CI 95% [(-)69,06-(-)45,09].
Conclusion:
Artificial anal band implant is effective in restoring quality of life in carefully selected
patients.
-834-
PP - 628 INCIDENCE OF PATHOLOGIES DETECTED BY ABDOMINAL
ULTRASONOGRAPHY IN KONYA (EARLY RESULTS)
MEHMET ALI ERYILMAZ 1, SÜLEYMAN BAKDIK 2, SERDEN AY. 1, ÖMER KARAHAN 1,
ISMET TOLU 2, AHMET OKUŞ 1, HAKAN YILMAZ 2, SELMAN CEVHEROĞLU 2
1
KONYA, TURKEY.
2
KONYA, EDUCATION AND RESEARCH HOSPITAL, CLINIC OF RADIOLOGY, KONYA,
TURKEY
Background&Aims:
The aim of the study is to determine the incidence of pathologies detected by

abdominal ultrasonography in Konya.
Methods:
Screening has begun in 2011 after the necessary permissions from local ethical
committee. Participators’ identity, age, gender, history and family history has been
recorded. Abdominal ultrasonography has been performed in supine position.
Hepatobiliary, genitourinary systems, spleen, midline structures and anterior
abdominal wall has been evaluated.
Results:
The mean age of 2010 participants was 46 (18-94). There were 1071 (53.3%)
female and 939 (46.7%) male. In abdominal ultrasonography; hepatosteatosis
in 371 (18.5%), liver hemangioma in 14 (0.7%), hidatic cyst of liver in 11 (0.5%),
cholelithiasis in 60 (3%), splenomegaly in 13 (0.6%), simple cyst of spleen in 3
(0.1%), aortic aneurism in 4 (0.2%) participants were detected. In renal evaluation;
nephrolithiasis in 34 (1.7%) and simple cyst in 145 (7.2%) participants were
detected. In pelvic evaluation; prostatic hypertrophy in 4 (0.4%) males and myoma
uteri in 8 (0.7%) females were detected.
Conclusion:
In Konya population most common pathologies at abdominal ultrasonography were

hepatosteatosis, renal cyst, cholelithiasis and nephrolithiasis.
-835-
PP - 629 INCIDENCE OF CHRONIC ILLNESSES AND PREVIOUS
SURGERY; KONYA SAMPLE
MEHMET ALI ERYILMAZ 1, ÖMER KARAHAN 1, AHMET OKUŞ 1, SERDEN AY. 1, BARIŞ
SEVINÇ 1, NERGIZ AKSOY 1, RECEP DEMIRGÜL 1, SAIT BODUR 2
1
KONYA, TURKEY
2
LECTURER, NECMETTIN ERBAKAN, SCHOOL OF MEDICINE, DEPARTMENT OF
PUBLIC HEALTH, KONYA, TURKEY
Background&Aims:
The aim of this study is to determine the incidence of chronic illnesses and previous
surgery.
Methods:
This screening study has been performed in 20 randomly determined regions on

2010 participants. Their sociodemographics, chronic illnesses and previous surgery
has been recorded.
Results:
The mean age of 2010 participants was 46 (18-94). There were 1071 (53.3%) female
and 939 (46.7%) male. 85.5% (1719) of participants’ were living in urban and 9.7%
(194) were living in rural areas. 50.7% (1029) of participants were housewife,
16.9% (339) were retired and 20.9% (420) were actively working. 28.1% (564) of
participants were smokers and 1% (22) were drinking alcohol. There was no chronic
illness in 85.5% (1718) of participants. However, there were chronic heart disease
in 65 (3.23%), chronic pulmonary disease in 65 (3.23%), diabetes mellitus in 53
(2.63%), goiter in 21 (6.01%) participants. 144 (7.16%) of participants had previous
appendectomy, 121 (6.01%) had cholecystectomy, 109 (5.42%) had hernia surgery
and 27 (1.34%) had heart surgery previously. 121 (11.2%) of females had c-section
before.
Conclusion:
In Konya population most common chronic illnesses were heart diseases,

pulmonary diseases and diabetes mellitus. Most common surgical procedures were
appendectomy and cholecystectomy, c-section and hernia surgery.
-836-
PP - 630 DERMATOFIBROSARCOMA PROTUBERANS ON THE
SHOULDER
MEHMET FATIH EROL , KAAN AKAN , NECDET DENIZ TIHAN , UĞUR DUMAN ,
ERDINÇ MERCAN , MURAT POLAT
BURSA ŞEVKET YILMAZ EĞITIM VE ARAŞTIRMA HASTANESI, BURSA, TURKEY
Introduction:
Dermatofibrosarcoma protuberans (DP) is a rare malignant mesenchymal tumor

that arises in the dermis. DP is a slow growing tumor that rarely metastases to
regional lymph nodes or distant sites but shows high rate of local recurrence if not
excised properly. DP comprises less than 0,1% of all cutaneous malignencies and 6%
of all soft tissue sarcomas. The tumor most frequently involves the trunk, followed
by proximal extremities and the head and the neck. DP most commonly occurs in
early to middle adult life between 20 and 50 years of age.
Case report:
A 51-year-old man admitted with painless and rapidly growing lesion on his left
shoulder which appeared two years ago. Our clinical examination revealed a single
firm, fibrous nodule (sized 5x3 cm) in skin which is freely mobile. Histopathological
and immunohistochemical findings revealed the lesion to be DP. We performed a
wide excision with 3 cm free skin margins. The patient is stil under follow up.
Conclusion:
While DP is a highly recurrent tumor, our case confirms that wide excision prevents
recurrence. Long term follow up is necessary to detect recurrence.
-837-
PP - 631 MODIFIED LP IN TREATMENT OF PSD WITH EYE DROP
EXCISION
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, GULSUM TOZLU 1,
GIRAYHAN CELIK 1, RECEP CETIN 1
1
2
ISPARTA, TURKEY
Background&Aims:
Pilonidal sinus disease (PSD) is an inflammatory disease seen in the intergluteal

region and commonn problem in surgical practice that mostly affects young people
. Different non-surgical and surgical methods have been used for treating PSD but
the best surgical technique for treating pilonidal sinus disease is controversial.
Methods:
110 patients with pilonidal disease in the sacrococcygeal region were operated
between June 2008 and 2011. All of them underwent eye-drop sheap excision and
modified Limberg flap reconstruction. And we do not use drain.The patients were
followed up by physical examination at 1th, 3th 5th , 10 th day after the operation
and at 1, 3, 6, and 12 months following surgery by phone.
Results:
There were 110 patients. The mean operative time was 40 min (range 35–67
min). All patients were followed up longer than 12 months, There were 3 wound
dehiscences because of riding cycle in postoperative 5. day(one patient) and fecal
contamination (two patients). We did not detect any case of flap necrosis. Two
cases of seroma and three cases of flab echimosis were observed.Maceration of the
surgical incision site was detected in 3 patients who were all successfully treated
with conservative measures. There were 3 patients with recurrence in this series.
Conclusion:
The results of the present study suggest that use of the modified Limberg flap with
eye drop excision is associated with a lower maceration and recurrence rate when
compared with the available data on use of the Limberg flap. Flab necrosis and
wound healing is beter. And Routine usage of drains did not affect wound-related
complications and recurrence rates.
-838-
PP - 632 FIRST TURKISH EXPERIMENTAL TEXTBOOK IN 15 TH
CENTRY
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, ISA SOZEN 1, MEHMET
FATIH BENZIN 1, RECEP CETIN 1
1
2
ISPARTA, TURKEY
Background&Aims:
Although Turks have created one of the world’s first written history texts – namely
Orhun Inscriptions - in Central Asia at 8th century, it was not before the 14th century
that written scientific material was produced in Turkish
Methods:
Şerefeddin Sabuncuoğlu (AD 1385–1468) lived in the city of Amasya in central

Anatolia during the early period of the Ottoman Empire. This Turkish surgeon had
worked in Amasya hospital as a chief surgeon, when only the masters would reach
such a position. In 1465, at the age of 83, he wrote a book entitled Cerrahiyyetü’l-
Haniyye (meaning Imperial Surgery). It was the first illustrated textbook in the
Turkish medical literature, containing color illustrations and descriptions of new
surgical techniques, incisions, and instruments.So he wrote Mucerreb-name that
first Turkish experiment book after 2 years.
Results:
Sabuncuoğlu performed innovate procedures first on animals and then on himself

and finally on his patients, as he had written in his other book Mucerrebname (The
Book of Experiences).When application of the drugs was discussed, he used the
scientific language that contemporary medical literature employs when presenting
case studies.
Conclusion:
He not only preserved, but also added to, earlier achievements in medicine and was
a pioneer surgeon and medical writer still remembered 600 years later.
-839-
PP - 633 SURGERY IS STILL AN OPTION IN RECURRENT
RETROPERITONEAL GAINT LIPOSARCOMAS
OSMAN BOZBIYIK , SERDAR KUCUKALIOGLU , SAFAK OZTURK , BARIS TURKER ,
UMIT BAYOL , CENGİZ AYDIN
TEPECIK RESEARCH AND EDUCATION HOSPITAL, IZMIR, TURKEY
Introduction:
Retroperitoneal liposarcoma is relatively rare, locally aggressive malignancy.

Despite an agressive resection, local recurrence is a major problem. We would like
to accentuate the possibility of reresection in these tumors.
Case report:
A 53 year old female patient, who underwent surgery of retroperitoneal liposarcoma

5 years ago, presented with abdominal mass. Computed tomography imaging
showed a huge left retroperitoneal tumor. The patient underwent laparotomy
and complete resection of the recurrent tumor was achieved.Histopathologic
examination revealed a dediferantiated, grade 3 liposarcoma.
Conclusion:
Surgical resection with an adequate margin of normal tissue remains the dominant
therapeutic modality. The most important prognostic factors for survival in
retroperitoneal sarcomas are completeness of resection, histologic subtype and
grade. Local recurrence is commen. Patients with isolated local recurrence should
be evaluated for a chance to reresection.
-840-
PP - 634 UTILITY OF NEUROMONITORING IN THE CERVICAL LYMPH
NODE DISSECTION
ANTONIO MORAL DUARTE , OZLEM UYANIK , JOSE IGNACIO PEREZ GARCIA ,
MONTSERRAT CLOS ENRRIQUEZ , JAVIER ANGELO ALANEZ SAAVEDRA , ANA BELEN
MARTIN ARNAU , MANUEL TRIAS FOLCH

Background&Aims:
Neck dissection requires the identification and preservation of various cervical

branches of the cranial nerves. Surgical experience in this type of dissection is the
main guarantee of the success. Our goal is to show the neuromonitoring techniques
that help us make these interventions safer.
Methods:
In the last two years we have used the monitoring technique with the NIM-Response
2.0 (Medtronic, USA) localizing the electrodes in the intubation tube, trapezius and
orbicularis oris muscles in patients undergoing cervical dissection. This allowed the
identification and dissection of the laryngeal, spinal and the mandibular branch of
facial nerves with the signal emitted by the corresponding channel of the monitor
and an audio signal. Not monitored phrenic nerve is identified by diaphragmatic
contractions.
Results:
We performed 12 dissections in 10 patients with advanced differentiated thyroid

carcinoma or cervical recurrence of differentiated or medullary carcinoma.
The neurostimulator facilitated the surgery in all cases without producing any
neurological lesion.
Conclusion:
The neuromonitoring facilitates identification and dissection of the nerves involved

in the cervical lymph node dissection. As in other specialties such as neurosurgery
and ENT it should be incorporated in the technological resources of the general
surgeon dedicated to cervical interventions.
-841-
PP - 635 PROTECTION OF MELATONIN ON TISSUE DAMAGE DURING
MESENTERIC ISCHEMIA – REPERFUSION IN RAT
PARICHEHR PASBAKHSH , FARID ABOLHASANI , SARA SAEEDNIA
TEHRAN UNIVERSITY OF MEDICAL SCIENCES, ANATOMY DEPARTMENT,IRAN
Background&Aims:
A mean effect of the I/R damage is formed at the reperfusion phase, and free
oxygen radicals that appear in the reoxygenized tissue are held responsible for this
mechanism. Melatonin was found to be a potent free radical scavenger antioxidant.
Methods:
A total of 42 young male were divided equally in to 6 groups with different

concentration of melatonin (10, 20, 30 mg/Kg) .Group 1 was control,group 2 sham
. Group 3 was I/R, group 4 was I/R plus melatonin 10 mg/Kg, group 5 was I/R plus
melatonin 20 mg/Kg, group 6 was I/R plus melatonin 30 mg/Kg.After laparatomy,
a microvascular traumatic clip was placed across IMA under general anesthesia,
and it was removed after ischemia for 30 minutes.The first dose of melatonin was
applied before reperfusion, the second dose was applied just after reperfusion, and
the third dose was applied on the second day all by intramuscular route.On the
third day of the experiment
Results:
The levels of tissue MDA were found to be significantly lower in group I/R +
Melatonin(10 mg/Kg) compare to group I/R (P≤ 0.05). MDA level in groups I/R
+Melatonin (20 mg/Kg) and I/R + Melatonin (30 mg/Kg) are lower than I/R group,
but there is no significant difference between them
Conclusion:
These results suggest that Melatonin in dose of 10 mg/Kg has antioxidant effect in
preventing intestinal ischemia – reperfusion (I/R) damage
-842-
PP - 636 SHORT-TERM RESULTS OF KARYDAKIS FLAP FOR PILONIDAL
SINUS DISEASE: 164 PATIENTS
SEYFİ EMİR , BURHAN HAKAN KANAT , ZEYNEP ÖZKAN, BURAK KAVLAKOĞLU
GENERAL SURGERY, ELAZIĞ TRAINING AND RESEARCH HOSPITAL, ELAZIG, TURKEY
Background&Aims:
The management of pilonidal sinus disease is frequently unsatisfactory.The aim of

this study was to determine the advantages and the short term results of Karydakis
Flap techniques.
Methods:
One hundred sixty four patients were operated for primary pilonidal sinus disease.
An eccentric vertical elliptical skin incision is made encompassing the pilonidal
complex; the mid-axis of this incision should lie about 2 cm lateral to the midline.
The incision is deepened down to the sacral periosteum and the sinus complex
excised.A suction drain is placed, and the wound closed using two layers of
interrupted 2/0 and 3/0 Vicryl’ sutures,
Results:
One hundred forty two patients were male and 22 were female. Mean age was
28.42 years.The mean duration of symptomps was 18.12 months.The median time
for removal of drains was 3 days and the median length of admission was 4 days.
Ten patients could not be traced. At the end of the follow up period; the recurrence
rate was 1.21%.
Conclusion:
The ideal operation for pilonidal sinus disease should be simple, require a short
hospitalization, if any is required, and have a low recurrence rate. of Karydakis
Flap techniques may be considered as an alternative operation for pilonidal sinus
resulting in alow recurrence rate.
-843-
PP - 637 UNUSUALLY LARGE EXTRAGASTROINTESTINAL STROMAL
TUMOR PRESENTING AS AN ABDOMINAL WALL MUSCLE SOFT
TISSUE TUMOR
AYDINCAN AKDUR 1, MAHIR KIRNAP 1, TUGAN TEZCANER 1, HANDAN ÖZDEMIR 2,
NEFISE ÇAĞLA TARHAN 3, SEDAT YILDIRIM 1, GÖKHAN MORAY 1
1
BAŞKENT UNIVERSITY, DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY
2
BAŞKENT UNIVERSITY, DEPARTMENT OF PATHOLOGY, ANKARA, TURKEY
3
BAŞKENT UNIVERSITY, DEPARTMENT OF RADIOLOGY, ANKARA, TURKEY
Introduction:
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors
of the gastrointestinal (GI) tract. Most GISTs arise in the stomach and small bowel,
whereas a small number occur elsewhere in the GI tract. Rare cases are identified
outside the GI tract and are collectively known as extragastrointestinal stromal
tumors (EGISTs). In this study, we reviewed the clinical and pathologic characteristics
of a case of EGIST presenting as a lateral abdominal wall soft tissue tumor.
Case report:
The patient was 35 years old, female. Patient was admitted to the hospital with
complain of abdominal pain. Physical examination revealed abdominal mass left
lumbal region. Computerized tomography and magnetic resonance revealed the
tumor was located between internal and external oblique muscles measured
104x102x77 mm and were well circumscribed. The tumor was excised and the
margins were free of malignancy. Histological examination showed epithelioid cell
morphology. The mitotic count was 5/50 HPFs. Immunohistochemistry showed
focal positivity for CD117, diffuse positivity for CD34, positivity for vimentine.
Conclusion:
This case consolidates the possibility that this rare tumor can involve the abdominal
wall as a primary site and should be included in the differential diagnosis of mass
in this site.
-844-
PP - 638 LAPAROSCOPIC SPLENECTOMY; OUR EXPERIENCE
TUNA BILECIK , RAMAZAN ERYILMAZ , CEMAL ENSARI

Background&Aims:
Splenectomy is a standart treatment of various hematological disorders. It can be

performed laparoscopically as safe as open conventional surgery.In this study, we
report on our first experience with laparoscopic splenectomy.
Methods:
Eight patients underwent LS between January 2010 and January 2012. Data were
collected retrospectively on all patients.
Results:
Indications were idiopathic thrombocytopenic purpura (ITP), hereditary

spherocytosis, autoimmune hemolytic anemia, and others. Mean spleen size was
13 cm and mean weight was 261 g.There was one patient of colon injury and two
procedures were converted to open splenectomy because of bleeding. Mean
surgical time was 125 minutes and was greater in the first 3 cases than the last 5.
Mean postsurgical stay was 2.87 days. Thrombocytopenia resolved after surgery in
87.5% of patients, and hematocrit levels increased.
Conclusion:
Laparoscopic splenectomy for benign hemotologic disorder is safe and associated

with low morbidity and a short hospital stay.
-845-
PP - 639 THE ROLE OF CURCUMIN ON BACTERIAL TRANSLOCATION
AND INFLAMMATORY RESPONSE IN AN EXPERIMENTAL INTESTINAL
OBSTRUCTION MODELS OF RATS
ZULFU ARIKANOGLU 1, AHMET TURKOGLU 1, BURAK VELI ULGER 1, OMER
USLUKAYA 1, HATICE YUKSEL 2, RECEP TEKIN 3, AYSENUR KELES 4
1
DIYARBAKIR, TURKEY
2
DEPARTMENT OF BIOCHEMISTRY, DICLE UNIVERSITY FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
3
DEPARTMENT OF INFECTIOUS DISEASES AND CLINICAL MICROBIOLOGY,
DIYARBAKIR, TURKEY
4
DEPARTMENT OF PATHOLOGY, DICLE UNIVERSITY FACULTY OF MEDICINE,
DIYARBAKIR, TURKEY
Background&Aims:
Intestinal obstruction is associated with impaired intestinal barrier function and
the translocation of the enteric bacteria to the systemic circulation. The aim of
this study is to evaluate the effects of curcumin on the bacterial translocation and
inflammatory response induced by a mechanical bowel obstruction in a rat model.
Methods:
Thirty Wistar albino rats weighing 200–250 g were randomized in three groups,
with 10 rats in each group. Group 1 (Sham) had only ileocaecal junction dissections;
Group 2 (Intestinal obstruction) had complete ileal ligations; and Group 3 (Intestinal
obstruction + curcumin) had complete ileal ligations and was intraperitoneally
administered curcumin at a dose of 100 mg/kg. Twenty-four hours later, the rats
were sacrificed by drawing blood from the heart for the biochemical analyses.
The peritoneal swab culture, liver, MLNs, spleen and ileum were collected for the
microbiological and histopathological analyses.
Results:
Curcumin reduced the secretion of the inflammatory cytokines, the damage and
bacterial translocation; prevented the formation of inflammatory changes in
intestine, liver, spleen and mesenteric lymph nodes; and also significantly prevented
the formation of intestinal damage subsequent to the intestinal obstruction
(p<0.05).
Conclusion:
This experimental study shows that curcumin may have protective effects against
bacterial translocation and intestinal oxidative damage in mechanical intestinal
obstructions. Further experimental studies are needed to explain the exact
mechanism of this beneficial effect.
-846-
PP - 640 SURGICAL EXCISION OF INJECTION SITE SIGNIFICANTLY
REDUCED SERUM INSULIN CONCENTRATIONS IN A POTENTIALLY
LIFE-THREATENING ANALOGUE INSULIN OVERDOSE
JAN DROSTE , ANDREW PETTIT , VIKRAM HUNDIA , NITHIN NARAYAN , ALI NEJIM
AIREDALE NHS FOUNDATION TRUST, UK
Background&Aims:
Several case reports of overdoses with the new long-acting insulin analogues
have recently been published. Severe hypoglycaemia with serious neurological
sequelae including death can follow. Thirty years ago, surgical authors were able to
demonstrate that, in insulin overdoses with short acting and depot insulin, excision
of the soft tissue at the injection site lowered plasma insulin levels. A young diabetic
man arrived in hospital 30 minutes after injecting himself with a large insulin
analogue dose (glargine 1200 Units, aspart 600 Units). Abdominal wall examination
revealed a swollen subcutaneous area. The aim was to show a reduction of serum
insulin concentrations after excision of the injection site.
Methods:
The injection site was surgically excised 5 ¼ hours after the injection, under local
anaesthetic, removing the skin and subcutaneous tissue until reaching the muscle
layer. The skin was sutured. Serial blood samples were taken and serum insulin
concentrations were measured.
Results:
Wound healing was uneventful. Excision of the insulin injection site reduced serum
insulin concentrations from 4220 to 88 pmol/l within 2.5 hours.
Conclusion:
This is the first case report describing the successful reduction in serum insulin
concentrations using surgical excision, after a severe, potentially life-threatening
overdose with the new analogue insulin.
-847-
PP - 641 CYTOREDUCTIVE SURGERY FOLLOWED BY HYPERTHERMIC
INTRAPERITONEAL CHEMOTHERAPY: MORBIDITY AND MORTALITY
ANALYSIS OF OUR PATIENTS
KURSAT KARADAYI 1, MUSTAFA TURAN 1, HAKAN ALAGOZLU 2, ALI YANIK 3, METIN
SEN 1
1
CUMHURIYET UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
2
CUMHURIYET UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF
GASTROENTEROLOGY, SIVAS, TURKEY
3
CUMHURIYET UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF
GYNECOLOGIC ONCOLOGY, SIVAS, TURKEY
Background&Aims:
The purpose of this study was to analyze the morbidity and mortality of cytoreductive
surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and early
postoperative intraperitoneal chemotherapy (EPIC) with closed abdomen technique
in the treatment of peritoneal surface malignancies.
Methods:
Forty-four patients (17 with ovarian cancer, 12 peritoneal mesothelioma, 8 colorectal

cancer, 3 uterine sarcoma, 3 gastric carcinoma and with 1 peritoneal cancer)
underwent 52 procedures. Peritonectomy was performed with complete removal
of all the involved visceral and parietal peritoneum. HIPEC was performed using
preheated (42.5°C) perfusate for 60 minutes. EPIC was continued for postoperative
5 days.
Results:
All patients underwent resection of the lesions. Total peritonectomy was performed
in 30 patients, while partial peritonectomy was carried out in 14 according to the
spread of carcinomatosis. Completeness of cytoreduction score of our patients was
0 in 34 patients, 1 in 8 patients and 2 in 2 patients. Major morbidity developed in 9
patients. Of the 44 patients, 32 were alive without evidence of disease with a mean
follow-up period of 18 ± 6 months. Overall 1 year survival was 60%.
Conclusion:
Cytoreductive approach combined with intraperitoneal chemotherapy prolongs

survival in selected patients with peritoneal carcinomatosis with acceptable
morbidity and mortality
-848-
PP - 642 DOES HYDATID DISEASE HAVE PROTECTIVE EFFECTS
AGAINST LUNG CANCER ?
SULE KARADAYI 1, SULHATTIN ARSLAN 2, ZEYNEP SUMER 3, MUSTAFA TURAN 4,
HALDUN SUMER 5 , KÜRŞAT KARADAYI 4
1
CUMHURIYET UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF EMERGENCY
MEDICINE, SIVAS, TURKEY
2
CUMHURIYET UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF CHEST
DISEASE, SIVAS, TURKEY
3
CUMHURIYET UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF
MICROBIOLOGY, SIVAS, TURKEY
4
5
CUMHURIYET UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PUBLIC
HEALTH, SIVAS, TURKEY
Background&Aims:
We hypothesized that solid tumors rarely occur in patients with hydatid disease.
Methods:
We obtained the serum of 14 patients diagnosed with hydatid disease, the serum
of 10 patients who did not have a history of hydatid disease, and the hydatid
cyst fluid from six patients. These sera and fluid samples were added at different
concentrations to NCI-H209/An1 human lung small cell carcinoma cells and L929
mouse fibroblasts as a control group
Results:
Sera of patients with hydatid diseases had cytotoxic effects on NCI-H209/An1 cells,
but they did not have cytotoxic effects on fibroblast cells. Sera from healthy subjects
did not have a cytotoxic effect on the tumor cell line or control fibroblasts. Cyst
fluid, also, did not have toxic effects on the NCI-H209/An1 cell line, but was toxic to
fibroblasts up to a 1:32 dilution.
Conclusion:
Sera from patients with hydatid disease had cytotoxic effects on human small cell
lung cancer cells in vitro.
-849-
PP - 643 MESENCHYMAL STEM CELL (MSCS) THERAPY IN PATIENTS
WITH SMALL BOWEL TRANSPLANTATION: SINGLE CENTER
EXPERIENCE
SAİT MURAT DOĞAN , EYÜP KEBAPCI , CEM TUĞMEN , SELÇUK KILINÇ , MAŞALLAH
BARAN , MUSTAFA ÖLMEZ , CEZMİ KARACA
IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL TRANSPLANTATION UNIT,

IZMIR, TURKEY
Background&Aims:
Acute cellular rejection (ACR) of the small intestinal graft occurs more frequently and
severely than in any other abdominal organ.Mesenchymal Stem Cells have ability to
inhibit T cell proliferation in vitro and in vivo and exert similar inhibitory effects on
B, dendritic, and natural killer cells as a new stem cell therapy class for autoimmune
disease, solid organ transplantation and treatment of graft-versus-host disease
(GVHD). Severe liver dysfunction and fibrosis is another problem.Mesenchymal
Stem Cells can produce a series of growth factors, enhance hepatocyte functionality
and stimulate endogenous hepatocyte proliferation. Aim: We describe six patients
with intestinal failure treated by small bowel (SB) tx and MCSs and analyze these
patients’ prognosis and follow-up.
Methods:
We made small bowel transplantation to six patients having short bowel syndrome.
All the patients had standart immunesuppressive treathment and Mesenchymal
Stem Cell therapy.In this way, we intend to prevent acute rejection and GVHD
reactions, that cannot be overcome with immunosuppressive agents.
Results:
Three of our patients died 2 months after transplantation because of sepsis. Other
3 patients have good qulity of life and have no problems in their routine controls.
Conclusion:
It is our opinion that in patients with good liver reserve, an isolated small bowel
transplantation is an effective treatment for intestinal failure and Mesenchymal
Stem Cell (MSCs) Therapy will help to prevent acute rejection and GVHD reactions.
-850-
PP - 644 THE EFFECTS OF SULPHORAPHANE IN THE RAT MODEL OF
EXPERIMENTAL INTESTINAL ISCHEMIA REPERFUSION
TUTKUN TALİH , ERDOGAN SOZUER , MUHAMMET AKYUZ

KAYSERI, TURKEY
Background&Aims:
To investigate the effects of sulphoraphane (SFN), which was shown to protect

such organs as the brain, kidneys, liver and the heart against the injury of ischemia
reperfusion (I-R), on the injury of reperfusion in the experimental intestinal I-R
model.
Methods:
The study employed 30 Wistar-Albino rats and there were three main groups:
control group (n=10), I-R group (n=10) and SFN + I-R group (n=10). The rats in the
control group were sacrificed after a 3 hour-follow-up subsequent to the laparotomy.
The Ischemia-Reperfusion group was given an hour of ischemia and a two-hour
of reperfusion afterwards. The Sulphoraphane+Ischemia-Reperfusion group was
administered a dose of 3mg/kg SFN intraperitoneal. The rats were sacrificed after
the ileum resection for a measurement of tissue malondialdehit (MDA), superoksid
dismutaz (SOD) and glutatyon peroksidaz (GSH-Px) activity and histopathological
analysis.
Results:
The IR and SFN+I-R groups were histopatologically shown to have similar cell
injuries. In the SFN+I-R group, the increase in the GSH-Px activity was higher than
the SOD activity and both of the increases were statistically significant compared
to the control group (p<0,001). The SFN application did not yield a significant
difference in the tissue MDA level compared to the control group.
Conclusion:
The effect of the use of SFN on the I-R injury in the intestine did not show an
apparent effect.
-851-
PP - 645 TREATMENT OF LIVER ECHINOCOCCOSIS OF
SUBDIAPHRAGMAL LOCALIZATION
MKRTICH MKRTCHYAN 2, HOVHANNES SARKAVAGYAN 1, ARMEN KHANOYAN 1,
TIGRAN KHACHATRYAN 1, ARTAK MANUKYAN 1, ARTUR SARDARYAN 1, HAYK
KIKOYAN 1
ST. GRIGOR LUSAVORICH MC, DEP.-T OF THORACIC SURGERY, ARMENIA

1
YEREVAN STATE MEDICAL UNIVERSITY N.A. MKH. HERATSI, FACULTY OF GENERAL

2
AND THORACIC SURGERY, ARMENIA
Background&Aims:
Echinococcosis is a severe parasitic disease which remains a serious medical and

socioeconomic problem worldwide including Armenia. The study aims at improving
outcomes of surgery of hidated cysts of subdiaphragmatic segments (SDS) of liver.
Methods:
123 patients aged 13-74 (68 men, 55 women) underwent SDS cysts surgery in
1996-2011. In 104 cases, cysts were localized only in SDS of liver and the remaining
19 cases, cysts had SDS and other localizations. Transthoracic-trasdiaphragmatic
echinococcectomy (right lateral thoracotomy on 6-7th intercostal space) used in
112 and transabdominal echinococcectomy (upper medial laparotomy) – in 11
cases.
Results:
123 patients underwent 130 operations (111 transthoracic-trasdiaphragmatic

echinococcectomies of SDS cysts; 5 single-stage echinococcectomies of right
lung and SDS cysts, 3 laparotomies, 2 splenectomies and echinococcectomies of
4,5,7 segments, 5 echinococcectomies of 4-8th segments, 3 left thorcotomies and
transthoracic-trasdiaphragmatic echinococcectomies of SDS cysts, 1 single-stage
echinococcectomy of right lung, SDS and left thoracotomy and laparotomy of 3-6th
segments). Draining of cavities were made in 14 cases (10.8%) of infected cysts,
otherwise we performed partial pericystecromy and oversewing. Residual cavities
were washed with 30% NaCl as antiparasitic mean and 10% betadine to prevent
infection complications. Postoperative complications occurred in 11 cases (8.3%)
with no lethal outcomes.
Conclusion:
Transthoracic-trasdiaphragmatic echinococcectomy at 6-7th intercostal space is an

optimal surgical access to SDS cysts with lower rate of postoperative complications.
-852-
PP - 646 COMPARISION OF MODIFIED PRIMARY REPAIR,
MARSUPIALISATION AND LIMBERG FLAP TECHNIQUES FOR
PILONIDAL DISEASE: A PROSPECTIVE RANDOMIZED STUDY
MEHMET TOKAÇ , FAHRI YETIŞIR , AKGÜN EBRU SALMAN , ALPER BILAL ÖZKARDEŞ
, MESUT ÖZDEDEOĞLU , DOĞUKAN DURAK , MEHMET KILIÇ
Background&Aims:
There is still no agreement on best surgical modality for sacrococcygeal pilonidal

disease (SPD). In this study, we aimed to compare early and late results of tension-
free primary repair, marsupialisation and Limberg flap techniques for SPD.
Methods:
In this study, 91 patients with SPD were randomly divided into three groups as
total excision + tension free primary repair (group 1, 30 patients) ,total excision +
marsupialisation ( group 2, 31 patients) and total excision + Limberg flap ( group 3,
30 patients). Early complications,postoperative patient comfort, cosmetic results
and recurrence rates were compared between these groups.
Results:
There was no significant difference between groups about preoperative clinical

findings and demographic status. Mean follow-up period was 21,5 months. Time to
walk without pain, time to sitting on toilet without pain, time to drive without pain
and time to return work are longer group 3 than group 1,2. It was found that VAS
scores about wound site cosmetic status of group 1 was higher than other groups .
While patients involved in first and second groups proposed surgery to others, this
ratio was very low in third group.
Conclusion:
Tension-free primary repair is seemed to be an alternative method to commonly

used Limberg flap technique with similar postoperative benefits and better cosmetic
results for SPD patients.
-853-
PP - 647 A MODIFIED METHOD IN LAPAROSCOPIC PERITONEAL
CATHETER IMPLANTATION: THE COMBINATION OF PREPERITONEAL
TUNNELING AND PELVIC FIXATION
OGUZ KOC , GUNGOR UZUM , MEHMET EMIN GUNES , YIGIT DUZKOYLU , MELTEM
KUCUKYILMAZ , YAVUZ SELIM SARI , VAHIT TUNALI
ISTANBUL EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY
Background&Aims:
Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the

management of end-stage renal disease (ESRD).In this study, we aimed to evaluate
our results obtained with peritoneal dialysis catheter placement by combination of
pelvic fixation plus preperitoneal tunneling.
Methods:
Laparoscopic peritoneal catheter implantation by combining preperitoneal

tunneling and pelvic fixation methods was performed in 82 consecutive patients.
Sex,age,primary disease etiology,complications,mean duration of surgery,mean
duration of hospital stay, morbidity,mortality and catheter survival rates and
surgical technique used were assessed. Analysis of catheter survival was performed
using the Kaplan–Meier method.
Results:
Mean follow-up period was 28.35±14.5 months. Mean operative time was
28±6 minutes and mean duration of hospital stay was 3±1 days. There were no
conversions from laparoscopy to other insertion methods.No infections of the exit
site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias,
or extrusion of the superficial catheter cuff were detected. No mortality occurred in
this series of patients. Catheter survival was found 92% at 3 years follow up.
Conclusion:
Although laparoscopic placement of PD catheters avoids many perioperative and

early complications, as well as increasing catheter free survival period, and quality
of life, our results indicate that different laparoscopic placement methods yields no
superior results from one another.
-854-
PP - 648 ADHESION PREVENTING PROPERTIES OF 4% ICODEXTRIN
AND CANOLA OIL: A COMPARATIVE EXPERIMENTAL STUDY
CENGIZHAN YIĞITLER 1, DURSUN ÖZGÜR KARAKAŞ 2, BÜLENT GÜLEÇ 1, ZAFER
KÜÇÜKODACI 3, ALPASLAN COŞAR 4, MEHMET LEVHI AKIN 1
1
2
3
4
GIRNE MILITARY HOSPITAL, DEPARTMENT OF BIOCHEMISTRY, KKTC
Background&Aims:
Postsurgical abdominal adhesions pose a significant problem. In this study, the

effects of 4% icodextrin and canola oil on prevention of postoperative peritoneal
adhesions were compared.
Methods:
24 Wistar albino rats were divided into 3 groups. After laparotomy, serosal abrasion
was made by brushing at cecum. 3 mL of NaCl %0.9, icodextrin 4%, and 3 mL of
canola oil were given intraperitoneally for control, icodextrin, and canola oil groups,
consecutively. Then the abdomen was closed. All subjects were sacrificed at day 10.
Macroscopic, histopathological and biochemical evaluations were done.
Results:
Macroscopically, both canola oil and icodextrin 4% reduced adhesion formation

but the difference was not statistically significant (p=0,17). Histopathological
examination revealed that there was no statistical significance in terms of giant cell,
lymphocyte/plasmocyte, neutrophil, ICAM1, and PECAM1 scores. However, both
canola oil and 4% icodextrin were significantly prone to reduce fibrosis (p=0,025).
Histiocytic reaction was significantly higher in canola oil group (p=0,001), in which
hydroxyproline levels were significantly lower than other groups (p=0,034).
Conclusion:
In this study, canola oil was found to be superior to 4% icodextrin with its lower
hydroxyproline level and greater histiocytic reaction. Considering these results,
we assume that canola oil can be a promising agent in the prevention of adhesion
formation.
-855-
PP - 649 COMPARISON OF THE MINI NUTRITIONAL ASSESSMENT,
SUBJECTIVE GLOBAL ASSESSMENT, AND NUTRITIONAL RISK
SCREENING (NRS2002) FOR NUTRITIONAL SCREENING IN ELDERLY
PATIENTS
ERKAN ÖZTÜRK , MURAT URKAN , AYTEKİN ÜNLÜ , MEHMET FATİH CAN , BİRGÜL
DAĞ , HÜLYA ŞAFAK , GÖKHAN YAĞCI

ANKARA, TURKEY
Background&Aims:
Subjective global assessment (SGA), Malnutrition Universal Screening Tool, Mini

Nutritional Assessment(MNA), and Nutritional Risk screening(NRS2002) have been
developed to identify the risk for malnutrition. MNA is first choice for geriatric
patients.We aimed that to compared prospectively SGA and/or NRS with MNA
results.
Methods:
The study consisted of all patients who were above 60. Patients examined
prospectively with MNA, SGA and NRS-2002. Examinations were administered by
two physicians without knowledge of the MNA result. The first mesure was.maden
first day, second one was after fifteen days.
Results:
114 patients were admitted to the study. The mean age was 70.5 years.61(53.3%)
were females 53(46.7%) were males. All of patients were living in their home.
Nobody was not living in a nursing home. 73(65%)patients well nourished,
30(27.3%) patients under risk, and 11(9,65) malnourished according to the MNA
score. 78(68.4%) patiens as well (SGA A), 29(25.4%) patients as mild(SGA B) and
7(6.2%) patients malnourished(SGA C).NRS-2002 results’; 88(77.2%) patients
without risk,14(12.3%) patients becoming malnourished and 12(10.5%) patients
high risk for malnutrition.
Conclusion:
Three score systems has got the same result. The NRS2002 and SGA are
simple,quick,valid and reliabe tool which can be used to identify older patients at
risk of malnutrition. But another randomised controlled trials have to do.
-856-
PP - 650 COMPARISON OF 4% ICODEXTRIN AND OMEGA 3 FATTY
ACIDS IN PREVENTION OF PERITONEAL ADHESIONS
DURSUN ÖZGÜR KARAKAŞ 1, CENGIZHAN YIĞITLER 2, BÜLENT GÜLEÇ 2, ZAFER
KÜÇÜKODACI 3, OSMAN METIN IPÇIOĞLU 4, MEHMET LEVHI AKIN 2
1
2
3
4
DEPARTMENT OF BIOCHEMISTRY, ISTANBUL, TURKEY
Background&Aims:
Postoperative peritoneal adhesions are one of the major concerns in abdominal

surgery.
Methods:
24 Wistar albino rats were divided into three groups. After laparotomy, serosal
abrasion was carried out by cecal brushing. 3 cc 0,9% NaCl, 3 cc 4% icodextrin
and 200 mg/kg ω-3 FAs for each group were applied intraperitoneally, then the
abdomen was closed. All subjects sacrificed 10 days postoperatively. Macroscopic
and histopathological cellular reactions as a function of giant cell, lymphocyte/
plasmocyte, neutrophil, histiocyte, intracellular adhesion molecule-1 (ICAM-1),
and platelet endothelial cell adhesion molecule-1 (PECAM-1) were assessed and
hydroxyproline levels were measured in all three groups.
Results:
Macroscopically, both ω-3 FAs and 4% icodextrin reduced adhesion formation

but the difference was not statistically significant (p=0,253). Histopathological
examination revealed that there was no statistical significance in terms of giant cell,
lymphocyte/plasmocyte, neutrophil, ICAM1, and PECAM1 scores, however, both
ω-3 FAs and 4% icodextrin were found to be prone to reduce fibrosis (p=0,047),
whereas in ω-3 FA group, hystiocytic reaction was significantly increased (p=0,001),
and hydroxiproline levels were significantly lower than other groups (p=0,044).
Conclusion:
In this study, ω-3 FAs were found to be superior to 4% icodextrin with lower
hydroxiproline level and greater hystiocitic reaction. Considering these results, ω-3
FAs can be a promising agent in the prevention of adhesion formation.
-857-
PP - 651 INFECTED SACROCOCCYGEAL PILONIDAL SINUS DISEASE
TREATMENT WITH PHENOL APPLICATION
EMRAH OTAN , CEMALETTIN AYDIN , AYDEMIR OLMEZ , BULENT UNAL , HUSEYIN
YONDER , CUNEYT KAYAALP
INONU UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF GENERAL SURGERY,

MALATYA, TURKEY
Background&Aims:
Sacrococcygeal pilonial sinus disease (SPSD) may result in infection, abscess

formation, carcinoma. Ideal treatment for infected SPSD would be simple, cheap,
applicable outpatiently under local anesthesia. This study evaluates the results of
infected SPSD patients treated with topical polyphenol application.
Methods:
29 patients diagnosed infected SPSD and treated with triple polyphenol application
on day first, second and seventh days of admission between May 2007 and October
2009 were followed up prospectively. Anatomic healig was described as closure of
the orifices and no residual complaint. Symptomatic healing consisted no residual
complaint with persistent orifices.
Results:
Healing was observed anatomically in 65,5% and symptomatically in 79,3% of the

patients. Mean age of the patients was 27,8 ± 7,4, with a significant male dominence
( 96,6%, n=28). Mean orifice count was 1,9 ± 1,8 and orifices were located centrally
in 65,5% (n=19), laterally in 20,7 (n=6), both centrally and laterally in 13,4 % (n=4)
of the patients. 65,5% of the patients had abundant body hair, 10,3% (n=3) had
previous SPSD treatment. 89,7% (n=26) of the sinus cavities contained hair. Mean
wound healing time was 27,8 ± 12,3 days.
Conclusion:
Triple polyphenol application is an alternative, feasible treatment for infected SPSD

with satisfactory symptomatic and anatomic healing rates.
-858-
PP - 652 OUTCOMES IN TREATMENT OF SACROCOCCYGEAL
PILONIDAL DISEASE: MODIFIED LIMBERG TRANSPOSITION FLAP
VERSUS CRYSTALLIZED PHENOL APPLICATION
SAİD KÖKÇAM , KEMAL ARSLAN , ARİF ATAY , ERSİN TURAN , HANDE KÖKSAL ,
OSMAN DOĞRU

KONYA, TURKEY
Background&Aims:
Although many kinds of medical and surgical methods have been used in the
treatment of pilonidal disease, high recurrence rates are still being a problem. In
this study our aim is to compare the results of a surgical procedure with medical
phenol application.
Methods:
The study includes the data of patients with chronic pilonidal disease who were
admitted to our hospital between 2009 and 2011. Group 1 includes 150 patients
who were performed crystallized phenol and Group 2 includes 150 patients who
underwent surgery. The groups were compared according to demographic data and
outcomes.
Results:
The mean follow-up period was 28.49±5.11 months. In Group 1, 134 patients; in
Group 2, 126 patients accepted to involve in the study. There were no difference
between the two groups by means of demographic data, body mass index, follow-
up times, recurrence rates, patient satisfaction and recommandation rates (p>0.05).
In Group 1, wound complication rates were significantly lower and recovery times
and time to return to work were significantly shorter (p<0.001, p=0.001, p<0.001
respectively).
Conclusion:
Crystallized phenol application can be the first choice in treatment of sacrococcygeal

pilonidal disease in terms of outpatient application without anesthesia, no need to
hospitalisation, lower wound complication rates and shorter recovery time.
-859-
PP - 653 TACTICAL EVACUATION OF CASUALTIES BY MILITARY
HELICOPTERS: PRESENT AND FUTURE ASPECTS
AYTEKİN ÜNLÜ , MURAT URKAN , ÜMİT ALAKUŞ , İSMAİL HAKKI ÖZERHAN ,
RAMAZAN YILDIZ , ERKAN ÖZTÜRK , GÖKHAN YAĞCI , YUSUF PEKER

ANKARA, TURKEY
Background&Aims:
Injury is a surgical disease and survival is inversely proportionate to elapsed time

to treatment. As the routine use of helicopters started during the Vietnam War, it
has been well established that rapid transport was associated with unprecedented
survival of critically injured patients.
Methods:
Currently, helicopters are used for tactical and medical evacuation purposes both
in the Turkish Military and civilian health care system. Despite the rapid transport
advantages, these flying ambulances are austere environments in terms of limited
space and medical resources. Accordingly, a study group consisting of experienced
military trauma surgeons has analyzed the data related with the present and future
aspects of casualty evacuation missions with military helicopters.
Results:
The main focus of this study was to increase the Turkish Trauma Society awareness,
improve en route care quality, identify new research topics and increase military
medical readiness for the ensuing conflicts and disaster situations.
Conclusion:
Helicopter tactical evacuation is not merely a rapid transport of trauma victims

but an essential part of prehospital care. However, care is notoriously suboptimal
especially when compared with medical evacuation. Upon analysis of available
data, further prospective studies and additional funds are required to improve care
given to both civilian and military trauma victims.
-860-
PP - 654 THE EFFECTS OF DIFFERENT CONCENTRATIONS OF
EPINEPHRINE ADJUVANT TO LEVOBUPIVACAINE ON WOUND
HEALING
SÜLEYMAN YEYEN 1, DURSUN ÖZGÜR KARAKAŞ 2, ERSEL TAN BUDAK 3, IBRAHIM
YILMAZ 4
1
ÇANAKKALE MILITARY HOSPITAL, DEPARTMENT OF ANESTHESIOLOGY,
ÇANAKKALE, TURKEY
2
3
AĞRI MILITARY HOSPITAL, DEPARTMENT OF ANESTHESIOLOGY, AGRI, TURKEY
4
GELIBOLU MILITARY HOSPITAL, DEPARTMENT OF GENERAL SURGERY,
ÇANAKKALE, TURKEY
Background&Aims:
Local anesthetics (LAs) and epinephrine are often combined for infiltration of
surgical sites for their wide range effects.
Methods:
Fourty female Albino-wistar rats were divided into four groups. 3 ml of 3,75 mg/
ml levobupivacaine was aplicated for all groups. In control group (C) (n=10); 1ml
isotonic saline, in group A10 (n=10); 1ml 1/100.000 adrenaline, in group A5 (n=10);
1ml 1/200.000 adrenaline, and in group A2,5 (n=10); 1ml 1/400.000 adrenaline
were added. Two minutes after the infiltration of the drug combination into
subcutaneous tissue, 3 cm longitudinal cutaneous-subcutaneous incisions were
performed on mid-dorsal line under sterile conditions. Incisions were sutured
with 4/0 sharp prolen with six sutures. Postoperative 8th days rats were sacrified
to evaluate wound healing. Tissue burst pressures (TBP), tissue hydroxyproline
levels (THP) were measured and hystopathological evaluation for fibrotic index was
performed.
Results:
There was no statistically significant difference between groups according to TBP
and THP levels (p=0.4, p=0.201 respectively). Fibrotic index values were significantly
higher in epinephrine groups (p=0,001) and was highest in A2,5.
Conclusion:
Epinephrine added to levobupivacaine in low concentrations accelerates wound

healing in the early phase by stimulating fibrosis and has no adverse effects on
surgical sites. Long term studies is needed for late effect of epinephrine adjuvant
levobupivacaine.
-861-
PP - 655 VIDEOPOSTER HAS A SPECIAL SCREEN AND IT CAN DISPLAY
THE VIDEO OF THE STUDY CONTINUOUSLY DURING THE CONGRESS
ALI DOĞAN BOZDAĞ 1, KÜBRA EREN BOZDAĞ 2, AYKUT SOYDER 1, MURAT AKSU 3
1
ADNAN MENDERES UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF
GENERAL SURGERY, AYDIN TURKEY
2
ADNAN MENDERES UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF
DERMATOLOGY, AYDIN TURKEY
3
IZMIR UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF MEDICAL HISTORY
AND ETHICS, IZMIR TURKEY
Background&Aims:
Since 2007, videoposter presentation technique is used in many national and

international presentations. The important feature of this technique is that it has a
screen on the poster, and display operation videos, slide show, video-animation of
the study continuously during the congress. Recently video sessions and e-posters
are seen in the congress, but it is expensive to obtain a special screen for each video
or e-poster. The aim of study is to evaluate the interest about the presentation
techniques.
Methods:
There will be a videoposter and a poster in the opposite corners of the poster hall,
and they will present the same study. One camera will record the participants who
interest the poster and the other camera will record the participants who interest
the videoposter. So it will be possible to evaluate the interest to the videoposter
and classic poster objectively.
Results:
The records will be evaluated and the duration of the participants on the poster and
the videoposter will be analyzed.
Conclusion:
Videoposter presentation is the only technique capable of continuous video

playback throughout the congress, thus enables sharing and spreading information
continuously in a practical and economical way. This study is supported by Adnan
Menderes University Scientific Research Funding
-862-
PP - 656 CYCLOPS: CAMERA ON THE FOREHEAD OF THE SURGEON
ALI DOĞAN BOZDAĞ 1, ŞÜKRÜ BOYLU 1, TÜRKER KARABUĞA 2
1
ADNAN MENDERES UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF
2
IZMIR UNIVERSITY; FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY,
IZMIR, TURKEY
Background&Aims:
Currently, video record of an operation is more important for surgical education.

Poor location, view, and to obstruct the view of the camera impair the quality.
It is also important not to break the surgeon’s concentration, and not to try his
patience during the video recording. A camera on the eyeglasses of the surgeon
may overcome these difficulties and obtain a good quality video recording.
Methods:
The camera built in the eyeglasses was used. The half of the front of the eyeglasses
was closed, and collinear view point with the camera and the eyes of the surgeon
was obtained. Then the operation was recorded.
Results:
The surgical procedure was recorded successfully. There was nothing to obstruct
the view, and no need for any other staff for recording. During the video recording
there was no need to stop the procedure for a good viewpoint or the surgeon did
not move aside. The operation time was not prolonged unnecessarily.
Conclusion:
Currently, the quality and the capability of the surgical video recordings are
increased. It is possible to achieve a good quality video recording by using the
camera built in the eyeglasses without any waste of time, and any effort of an
another staff.
-863-
PP - 657 SETTING UP A SURGICAL TEACHING PROGRAMME
FOR MEDICAL STUDENTS AND FOUNDATION DOCTORS - AN
EXPERIENCE FROM OXFORD MEDICAL SCHOOL
MATEE ULLAH, ALİ QUREISHI, STEPHANIE ELTZ, HANNAH KING, ZABEEH ULLAH,
ASIF KHAN, ELIZE RICHARDS
JOHN RADCLIFFE HOSPITAL, UK

Background&Aims:
We report our experience of setting up and running a clinical and surgical skills
course for final year medical students and foundation doctors within the Oxford
Deanery.
Methods:
A course was designed to cover the basic practical skills needed by junior doctors in
their foundation years, skills included were suturing, catheterization, examination,
cannulation, arterial blood gas and many others. Teaching was standardised in
accordance with the Medical School Curriculum. Educational handouts, practical
demonstrations and observation of skills by tutors were the primary interventions.
Using Trust and Medical school guidelines relating to practical procedures
a questionnaire was designed to assess the competence and confidence of
participants prior to and upon completion of the course.
Results:
There were 70 participants over 10 weeks; outcome assessments demonstrated an

average improvement in scores by 50% upon course completion.
Conclusion:
We constructed a clinical skills course relating to the Oxford medical school

curriculum, students worked in small groups of 6 with access to relevant practical
models and equipment. Feedback was collected each session to allow for continual
improvement. The course was so successful that it has now been incorporated into
the Oxford medical school curriculum.
-864-
PP - 658 NANOTECHNOLOGY RELATED ADVANCES IN SURGERY
HASAN HAKAN EREM 1, ERMAN AYTAC 2, AYSİN DURAL EREM 3
1
GUMUSSUYU MILITARY HOSPITAL, DEPARTMENT OF BALMUMCU GENERAL
2
CLEVELAND CLINIC OHIO, DEPARTMENT OF COLORECTAL SURGERY, USA
3
ISTANBUL TECHNICAL UNIVERSITY, DEPARTMENT OF TEXTILE ENGINEERING,
ISTANBUL, TURKEY
Background&Aims:
The aim of this study was to investigate the applications and new application
opportunities of nanotechnology in surgery.
Methods:
Nanotechnology related articles with references to the literature using Medline

were examined in detail.
Results:
Nanotechnology is an interdisciplinary field based on physics, chemistry, biology,

engineering and medicine. It has applications in all branches of science. In
nanotechnology, at least one dimension of the particles should be less than 100
nanometers(nm). Inorganic and organic nanoparticle production can be classified
as top-down and bottom-up approaches. Chemical and physical properties of
materials in nano size are quite different from the macro. A nanocomposite is as a
multiphase solid material where one of the phases has one, two or three dimensions
of less than 100 nm, or structures having nano-scale repeat distances between
the different phases that make up the functional materials. Nanocomposites
are found in nature for example in the structure of the abalone shell and bone.
Nanotechnology will create new opportunities in the prevention, detection and
treatment of some pathologies in surgery which are difficult to manage. Their
possibility in clinical, diagnostic and therapeutic uses is really high. Some of the
important nanotechnology products are: (Nanocomposites, nanoemulsions, drug
delivery systems, femtosecond laser, nanoshells, smart sensors, artificial cells and
organs, nanorobotics.)
Conclusion:
More research is needed to understand potential benefits of nanotechnology and

prevent nanotoxicity and nanoethic problems
-865-
PP - 659 MODIFIED MILLER PYRAMID IN SURGICAL EDUCATION
MEHMET ZAFER SABUNCUOGLU 1, AYLIN SABUNCUOGLU 2, ESIN KULAC 3, ISA
SOZEN 1, GIRAY AYNALI 4, RECEP CETIN 1
1
2
ISPARTA, TURKEY
3
SULEYMAN DEMIREL UNIVERSITY DEPARTMENT OF MEDICAL EDUCATION AND
INFORMATICS, ISPARTA, TURKEY
4
SULEYMAN DEMIREL UNIVERSITY DEPARTMENT OF DEPARTMENT OF
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, ISPARTA, TURKEY
Background&Aims:
Miller’s pyramid has been used over the last twenty years as a framework for
assessing clinical competence.
Methods:
Miller’s pyramid traditionally only has 4 stages. The first two stages that ‘knows’
and ‘knows how’ is cognitive and upper two levels are behavioural levels. But
during recent our discussions there have been suggestions that we should include
authenticity levels at the top of pyramid.
Results:
Summit surgical training is not only ‘shows how’ and ‘does’ but also experienced
surgeon have entrant surgeon do operation and cogitate the supplemetary
resolution while realize the intstrumental and surgical insufficiency by using
knowledge and experience.
Conclusion:
If we accept that surgical education is continued unceasingly, it’s more integral

shape as a result of place of reverse pyramid on the top of Miller Pyramid. Because
profesional authenticity in surgery will progres everytime.
-866-
PP - 660 SEVERITY RATING SURGEONS PERFORMING
LAPAROSCOPIC CHOLECYSTECTOMY BASED ON TELEMETRIC HEART
RATE MEASUREMENT
MIROSLAW SZURA 1, JAN M. KRZAK 2
JAGIELLONIAN UNIVERSITY, IST DEPARTMENT OF SURGERY, KRAKOW, POLAND

1
SYGEHUS LILLEBAELT, KOLDING, DENMARK

2
Background&Aims:
The method of evaluating the strain by using the heart rate measurement can be
applied in easy tasks or moderately difficult ones, on the basis of oxygen consumption
and energy expenditure, but at the same time in those requiring considerable static
power or those involving limited, well-defined group of muscles. The aim of this
study is to evaluate the energy expenditure of an experienced surgeon during the
basic laparoscopic procedure.
Methods:
100 cholecystectomies were analyzed, in which the experienced surgeon was

randomized into one of the two roles – as the operator (I) or as the assistant (II).
Telemetric pulse rate was monitored continuously during the surgery, and all
variations, mean pulse rate values and energy expenditure were recorded. Out of
these data metabolic equivalent was calculated in kcal/kg/h.
Results:
The average pulse rate in group I was 83/min and 88/min. in group II. The highest
pulse rate in group I was 110/min. and 120 in group II (p=0,001). Energy expenditure
calculated out of the metabolic equivalent was on average 3,17 kcal/kg/h in group I,
and 3.32 kcal/kg/h in group II (p=0,005).
Conclusion:
Pulse rate is higher and pulse rate variations are more frequently observed in the
experienced surgeons assisting during the laparoscopic cholecystectomies. Also,
energy expenditure of the experience surgeon is higher when assisting the resident
surgeon.
-867-
PP - 661 AUGMENTATION REALITY; A POTENTIAL TOOL FOR
SURGICAL EDUCATION
STEVE ATHERTON , MUHAMMAD JAVED , JEREMY YARROW , S.V WEBSTER , SARAH
HEMINGTON GORSE
WELSH CENTRE FOR BURNS AND PLASTIC SURGERY, UK
Background&Aims:
Poster presentations are an important medium of presenting scientific techniques

and represent an integral part of conferences & meetings. We describe and
demonstrate an innovative use of an augmented reality application Aurasma© for
smartphones and tablets, to present surgical techniques as 3D animation and video
alongside paper poster format.
Methods:
We used the free Aurasma© application available on both iOS and Android 2.2
and higher platforms from iTunes App Store and Google Play.Once installed, any
user with a 3G or WiFi connection on any smart phone or tablet can subscribe to
the Medical Illustration channel for free. The user can then scan the trigger image
placed on a poster with a smart phone to view videos or 3D data.Further interaction
can direct the user to a website for more content.
Results:
We have successfully trialled this method at a regional burns and plastic surgery
centre’s and found it to be highly effective.
Conclusion:
This technique maintains the essence of a poster and yet blends it with qualities of
oral presentation permitting audience to see the surgical technique as a video or 3D
animation.This novel method will allow authors to present their scientific work in a
more interactive environment.
-868-
PP - 662 ATTRITION IN SURGICAL RESIDENCY---THE REAL FACE OF A
HIDDEN PROBLEM
MEHWASH NADEEM , MUHAMMAD SHAHRUKH EFFENDI , MOHAMMAD
HAMMAD ATHER
Background&Aims:
Attrition in surgical residency is of continued concern for surgical educators globally.

It results in loss of morale and resources. Aim of this study was to determine the
rate and trend of attrition at our institute, and to identify its reason/s.
Methods:
This was a questionnaire based survey conducted at university hospital. Residents

who left voluntarily from one of the five surgical residency programs i.e., General
surgery, Orthopedics, neurosurgery, ENT or Urology during academic year 2005 to
2011 were identified from department database and were contacted.
Results:
During last six years total of 106 residents were recruited. 84 (78%) were male, of
them 34.5% left the program voluntarily. Of 22% females, 54% left the program
voluntarily but this gender related attrition was not statistically significant (p=0.07).
The overall 6 years attrition rate was 39%. The reasons identified for attrition in
descending order are personal, attitude of senior residents or faculty and change of
specialty. None of the resident left due to work load. Approximately 40% rejoined
same specialty after leaving while 35% chose different specialty.
Conclusion:
Although attrition in surgical residency is not unique to our program but the
recent rise in attrition is a major concern. It is the responsibility of our institute to
analyze the important issues regarding attrition and to optimize the career paths of
residents.
-869-
PP - 663 PECULIARITIES OF POST-DIPLOMA SURGICAL EDUCATION
IN UKRAINE
OLEXANDR BUTYRSKY , VIKTOR STAROSEK , ALEKSANDR GRINCHESKU ,
ALEKSANDR VLAKHOV
Background&Aims:
The main feature of post-diploma education in Ukraine – continuity.
Methods:
It includes thematic refresher courses on actual surgical problems (Surgical infection,

Hepatopancreobiliary pathology etc), distant conferences, pre-certification courses
provided by Faculties of post-diploma education at medical universities.
Results:
Educational process is carried out with: i) lectures – necessary for correct orientation
in already acquired knowledge and obtaining new information about achievements
of medical science; taking into account methods of audiovisual presentation lectures
efficacy reaches 100%; ii) practical classes – foresee work near patient’s bed,
participation in professor’s rounds, clinical discussions, operations; iii) workshops –
foresee theoretical discussion of certain surgical problem (sepsis, gastro-intestinal
bleeding etc). Methods of knowledge control are PC testing and oral discussion.
Once per 5 years after pre-certification course, passing exam at the Faculty and
obtaining recommendation for medical category the surgeons are certified under
guidance of regional medical administration with awarding/confirmation of medical
category (II/I/higher). To obtain the category a doctor must have certain number of
points for different types of activity defined by Health Care Ministry (NB! No points
are given for number and quality of surgical activity). Expelling doctor from the
certification causes his disqualification.
Conclusion:
We consider our system may be useful but it requires improvement.
-870-
PP - 664 CHEMOPORT FRACTURE - A REPORT OF TWO CASES
PREETINDER BRAR , ATUL SHARMA JOSHI , IQBAL SINGH , ABHISHEK VYAS , RAJEEV
BEDI , RUDRA PRASAD DOLEY , G. S KALRA , JAI DEV WIG
FORTIS HOSPITAL, INDIA
Background&Aims:
Central Venous access devices play an important role in the management of cancer
patients. Several long term complications exist. However, spontaneous fracture and
migration of the catheter is uncommon.
Methods:
Two patients with spontaneous fracture of chemoport catheter are presented

here. The migrated fragment was successfully retrieved by open and endovascular
approach.
Results:
– We describe two patients who experienced complications of the intravenous port

system. Both of them showed fracture and migration of the port catheter. The port
system was placed under image guidance. They were receiving chemotherapy for
Ewing’s sarcoma (n=1) and carcinoma breast (n=1). The port was in place for one
year (n=1) and one and half years in the other. Presentation was pain in the neck
(n =1) and pain in the shoulder (n=1). Chest x ray revealed complete fracture of the
catheter with migration of the fragment in internal jugular vein in one and right
ventricle in the other. Migrated catheter fragments were removed surgically in one
and in the other the dislodged catheter was successfully retrieved by percutaneous
endovascular technique.
Conclusion:
Catheter fracture remains a potential complication. This must be recognized and

treated promptly. Periodic chest imaging is recommended for detection and timely
removal of the catheter.
-871-
PP - 665 A GUIDE FOR PATENT APPLICATION IN TURKEY
ALİ DOĞAN BOZDAĞ 1, İSMAİL YAMAN 2, HAYRULLAH DERİCİ 2, ŞÜKRÜ BOYLU 1,
TUĞRUL TANSUĞ 3, KÜBRA EREN BOZDAĞ 4
1
ADNAN MENDERES UNİVERSİTY, MEDİCAL SCHOOL, DEPT. OF GENERAL SURGERY,
AYDIN, TURKEY
2
BALIKESİR UNİVERSİTY, MEDİCAL SCHOOL, DEPT. OF GENERAL SURGERY,
BALIKESİR, TURKEY
3
ANADOLU MEDİCAL CENTER, DEPT. OF GENERAL SURGERY, KOCAELİ, TURKEY
4
ADNAN MENDERES UNİVERSİTY, MEDİCAL SCHOOL, DEPT. OF DERMATOLOGY,
AYDIN, TURKEY
Background&Aims:
The nature of surgery provokes the surgeons to develop new methods and devices.
Facing several difficulties that necessitate immediate solutions during the practice
of surgery, surgeons gain an ability to deal with challenges in a creative manner. If
the solution is an invention, the process of filing patent application can be started.
Methods:
If a device is being produced, a search for existing patents of similar devices should
be conducted on search engines. EBİLTEM (Science and Technology Center of
Ege University) is authorized to perform a search for patents in Europe. A patent
specification document should be prepared. Then the inventor applies to the
Turkish Patent Institute (TPI) for the grant of a patent. Protection is established as
the application is filed by TPI.
Results:
Preparing invention specification costs about 2500 – 3000 TL. After the application is
filed the inventor may apply to TÜBİTAK (The Scientific and Technological Research
Council of Turkey) for financial support. Scientific publications about the invention
can be made after patent application had been filed.
Conclusion:
Surgeons who are armed with thorough knowledge of patenting process can help
surgical technology to be developed by easily transferring their new ideas into
technology.
-872-
PP - 666 EDUCATION ON SURGERY WITH USE OF MEDICAL
SIMULATORS
BEREZNYTS`KYY YAKIV , SULYMA VOLODYMYR
STATE ORGANIZATION “DNIPROPETROVS’K MEDICAL ACADEMY MINISTRY OF

HEALTH”, DNIPROPETROVSK, UKRAINE
Background&Aims:
The doctor’s of the general medical practice and surgeons tasks determinates basic
requirements: goal-directed methodic algorithm of questioning of the patient
(getting anamnesis), physical examination, substantiation of provisional diagnosis,
determinate algorithm of additional methods of investigations with analysis of
received results, differential diagnosis, forming clinical diagnosis, substantiation of
treatment program and it’s implementation.
Methods:
For the practical training used division’s computer class - for computer testing
of students and interns, two classes of medical simulators (products firm “3B
Scientific”) - for acquiring and mastering practical skills. For the interns-surgeons
to mastery of the operational equipment in operation and manipulation rooms,
as well as mastering of mini invasive surgery technology in the learning center
“Endoscopic technologies in medicine”.
Results:
Received results underscore the increased objectivity in the control of knowledge

on the part of teachers’ interest and increasing of foreign students and of foreign
medical interns’ interest to master a subject, that allowed to prepare a general
practitioner in surgery and surgeons, and integrate in the future in practical public
health in worldwide.
Conclusion:
Use of medical simulators and training mannequins for acquiring practical skills and
new technologies of operative interventions using modern endoscope equipment,
tools, and simulators allows to imitate the real clinical situation during operative
interventions and learn steps to resolve it.
-873-
PP - 667 CAN WIKIPEDIA REPLACE THE TRADITIONAL SURGICAL
TEXTBOOK?
ALI QUREISHI 1, AMIT SHARMA 2 , CHRIS NEOPHYTOU 1

1

2
Background&Aims:
86% of doctors have used the internet to gather health, medical or drug information,
its use far exceeds that of peer review journals (77%) and books (56%). Of those
searching the internet 92% select the top ‘non-sponsored’ website and nearly 100%
atleast one of the top four. Given wikipedia is almost always in the top four websites
during internet searches, we aimed to assess the quality of information it provided
and compared it to a traditional surgical textbook.
Methods:
The six commonest emergency surgical conditions were searched using wikipedia
and in an internationally renowned surgical text book. The quality of information
and its resources were assessed and tabulated.
Results:
Although the quality of information provided in the surgical textbook was high,
wikipedia was superior in terms of access and imaging. There was a significant
variability in the reliability of information with numerous unvalidated or missing
resources.
Conclusion:
Wikipedia is a useful tool for surgeons and medical students. As we continue to seek
information we should be aware of the potential pitfalls and benefits to Wikipedia
so that we make best use of this valuable, free and rapidly accessible resource.
-874-
PP - 668 EVALUATION OF FIVE YEARS OF “BASIC SURGICAL
TRAINING COURSE” ORGANIZED BY TURKISH SURGICAL
ASSOCIATION
RAMAZAN YILDIZ 1, NİYAZİ KARAMAN 2, SERAP EREL 3, KUZEY AYDINURAZ 4,
MURAT AKIN 5, BETÜL BOZKURT 6, MUTLU DOĞANAY 1, SEHER DEMİRER 7
1
GÜLHANE MILITARY MEDICAL ACADEMY,DEPARTMENT OF GENERAL
SURGERY,ANKARA,TURKEY
2
DR. ABDURRAHMAN YURTASLAN ANKARA ONCOLOGY TRAINING AND RESEARCH
HOSPITAL,GENERAL SURGERY CLINIC, ANKARA,TURKEY
3
ANKARA TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ANKARA,TURKEY
4
KIRIKKALE UNIVERSITY,FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, KIRIKKALE,TURKEY
5
GAZİ UNIVERSITY FACULTY OF MEDICINE,DEPARTMENT OF GENERAL SURGERY,
ANKARA,TURKEY
6
ANKARA NUMUNE TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY
7
ANKARA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, ANKARA,TURKEY
Background&Aims:
Aim is to determine the distribution of participants and training centers according

to divisions and to evaluate participant’s satisfaction rates of trainees of Basic
Surgical Training Course (BSTC). BSTC was first organized in 2007, currently being
held under the certitication of the Turkish Surgical Association.
Methods:
BSTC was designed for the first year surgery residents and intended to give
knowledge and skills in dealing with issues such as, safety rules in surgery, techniques
of knot tying, surgical wound, wound closure techniques, sutures, operating room
rules, surgical hand washing, wearing gowns and gloves and assistance during
surgery. The distribution of course centers and participating trainees were analyzed
retrospectively from registration lists. Participant evaluation forms and pre-test/
post test results of trainees were evaluated.
-875-
Results:
BSTC was carried out nine times under the certification of Ankara Surgical Association
between 2007 and 2008 and 150 residents were attended during this period..
Between 2009 and 2012, under the certification of Turkish Surgical Association,
our course were held 26 times and 528 residents were attended. Nine instructors
from different institutions are involved in the course program. When we evaluated
the distribution of divisions, 54 % of participants were found to be general surgery
residents. There were total 14 different disciplines other than general surgery .
The first three were with the rates of 17.4% obstetrics and gynecology, 6 % with
orthopedics and 4.4 % with the ear, nose and throat. The courses were held at
total eleven centers at Ankara (TSA and ZTB Women’s Hospital), Istanbul (İstanbul
and Cerrahpasa Faculty of Medicine), Izmir, Bursa, Adana, Kocaeli, Istanbul, Trabzon
and Malatya. According to interpretations of post-course evaluation forms new
topics were added. The comments were adressed to increase the time reserved for
practice (knot tying, wound closure etc).
Conclusion:
Between the years of 2007 and 2012 total of 678 residents at their first training year
were participated and extremely positive feedbacks were received about these
courses. Our course program is dynamic and being updated for periods of 6 months
according to comments from participant evaluation forms. It is honorary for us that
some of the medical faculties were approved our course as a part of their formal
surgical training program.
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PP - 669 EVALUATION OF TWO YEARS OF “EDUCATION AND
USE OF STAPLER COURSE” ORGANIZED BY TURKISH SURGICAL
ASSOCIATION
NİYAZİ KARAMAN 1, RAMAZAN YILDIZ 2, SERAP EREL 3, KUZEY AYDINURAZ 4,
MURAT AKIN 5, FEZA KARAKAYALI 6, MUTLU DOĞANAY 7, SEHER DEMİRER 8
1
DR. ABDURRAHMAN YURTASLAN ANKARA ONCOLOGY TRAINING AND RESEARCH
HOSPITAL,GENERAL SURGERY CLINIC, ANKARA,TURKEY
2
GÜLHANE MILITARY MEDICAL ACADEMY; DEPARTMENT OF GENERAL
SURGERY,ANKARA;TURKEY
3
ANKARA TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY CLINIC,
ANKARA,TURKEY
4
KIRIKKALE UNIVERSITY,FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, KIRIKKALE,TURKEY
5
GAZİ UNIVERSITY FACULTY OF MEDICINE,DEPARTMENT OF GENERAL SURGERY,
ANKARA,TURKEY
6
BAŞKENT UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
7
ANKARA NUMUNE TRAINING AND RESEARCH HOSPITAL, GENERAL SURGERY
8
ANKARA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
Background&Aims:
Surgical stapling is one of the most common operative techniques in surgery.

However, courses for using of staplers given to doctors by doctors other than the
company staff are not available. There is no real standardized education for using
a surgical stapler. After realising this fact, Turkish Surgical Association(TSA), Basic
Surgical Education Comission started to work in order to create one day course. The
first “Education and Use of Stapler Course” (EUSC) was performed at October 09th
of 2010 under the certification of TSA. Our aim is to define distribution of course
participants and centers and to evaluate course participant evaluation forms and
pre and post-course tests.
Methods:
The course is intended for surgeons and general surgery residences who completed
third years of training. The course program includes principles of anastomotic
healing, technical principles of anastomosis, stapler history, terminology of stapler,
types of staplers, open surgery and laparoscopic surgical stapler types and their
uses, mesh fixative staplers, skin staplers and possible complications associated with
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surgical stapling. The informations for stapling techniques and hands-on training
were given. All of the participants have the opportunity for stapler applications and
anastomosis for each type of stapler on gastrointestinal system models made from
sponge. Distribution of course centers and trainees participating in the course were
reviewed retrospectively from the course registration lists. The course participant
evaluation forms and pre and post-course tests were evaluated for feedbacks.
Results:
EUSC was performed 15 times under the certification of the TSA and 285
participants were attended between the years 2009-2012 . Eight instructors from
different institutions were involved in this course project. Most of the trainess were
residents: 84% (174) , remaining were 16% (32) postgraduate surgeons. There is
an attendance from different surgical specializations (Urology,Thorax surgery etc)
. The courses were held at total of eight different centers at Ankara, Istanbul (
Cerrahpasa and Istanbul Faculty of Medicine), Izmir, Antalya, Istanbul and Trabzon.
Three courses were held within the program of three different national congresses,
from which one was organized by different association.
Conclusion:
We provide surgeons standardized stapler education including stapler technique,

coupled with an understanding of basic wound healing and anastomosis. Between
the years 2009-2012 a total of 285 residents and surgeons had an extremely positive
feedbacks about the courses. The course participant evaluation forms are dynamic
and updated by the six-month periods. Participation of the different surgical
specializations and increasing number of trainees are encouraging and pleasing us.
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PP - 670 THE ANALYSİS OF MALPRACTİCE LİTİGATİON İNVOLVİNG
RETAİNED İNTRAABDOMİNAL FOREİGN BODİES
ARİF KARAKAYA 1, AHMET FERAN AĞAÇHAN 2, HABİB BOSTAN 1, EYÜP KANDEMİR 1,
FEZA EKİZ 3, ÖMER TOPUZ 4, ERGÜN YÜKSEL 2
1
ADLİ TIP KURUMU, ISTANBUL, TURKEY
2
ERZURUM BÖLGE EĞİTİM VE ARAŞTIRMA HASTANESİ, ERZURUM, TURKEY
3
DİYARBAKIR EĞİTİM VE ARAŞTIRMA HASTANESİ, DIYARBAKIR, TURKEY
4
KAYSERİ EĞİTİM VE ARAŞTIRMA HASTANESİ, KAYSERİ, TURKEY
Background&Aims:
Retained intraabdominal foreign body is an absolute iatrogenic surgical
complication. The aim of this study was to assess the medico-legal implications of
this complication and to analyze preventive measures.
Methods:
Survey of 39 patients with gossypyboma who were studied between 2008 and 2012
in İstanbul Forensic Medicine İnstitution jury for fault of treatment investigated
retrospectively according to age, gender, risk factors, status of co-workers, type of
surgical procedure, preventive measures, presentation, investigation and principles
of treatment.
Results:
Out of 39 surgeons, 27 were males and 12 were females with a mean age of 42. 40%
of retained sponge occurred after an emergency procedure and only 18 % were
gynecological or obstetrical procedures. 35% was operated in state hospital, 27% in
the university hospital,25% in private hospitals and 13% in army hospitals. Clinical
presentations were intestinal obstruction, intraabdominal abscess , localized
persistent pain or abdominal mass, enterocutaneous fistula and peritonitis.
Regarding the type of initial surgical procedure; most commonly resections
for gastrointestinal malignancies, cholecystectomies and appendectomies are
associated with sponges. A falsely correct sponge count was reported in 40%
of cases and in 45% of operations radiopaque sponges were used. Preoperative
diagnosis could be done only in 24% of cases. All patients were reoperated to
remove the foreign body.
Conclusion:
The incidence of retained sponge decrease with medico-legal threat and most of
them end in claim. Human errors are still primary reason and the incidence will
be reduced with awareness about condition. It is an avoidable iatrogenic surgical
complication.
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PP - 671 THE EFFECTS OF CARBONMONOXIDE(CO) AND
CARBOXYHEMOGLOBIN(COHB) LEVELS IN SYSTEMIC CIRCULATION
ON PATIENT, RELEATED WITH MONOPOLAR ELECTROCAUTERY
MANIPULATION DURING LAPAROSCOPIC CHOLECYSTECTOMY.
İSMAİL HAKKI ÖZERHAN , YÜKSEL BALDAN , MURAT URKAN , TANER YİĞİT ,
AYTEKİN ÜNLÜ , ORHAN KOZAK

ANKARA, TURKEY
Background&Aims:
The aim of study is effects of carbonmonoxide (CO) and systemic carboxyhemoglobin

(COHb) levels on patient, releated with monopolar electrocautery manipulation
during laparoscopic cholecystectomy.
Methods:
35 laparoscopic cholecystectomy who was diagnosed of benign gall bladder disease

between January-July 2012 was accepted. Intraoperative monopolar electrocautery
manipulation was measured with sensitive chronometer. Arterial COHb levels was
measured during postoperative 30. min, 1., 2., 4. And 6. hrs. Intraperitoneal CO
was measured with detector. before and after the manipulation of intraoperative
electrocautery and after the gas discharge.
Results:
Electrocautery manipulation duration was measured 122,69±52,33 seconds

mean CO levels measured after intraoperative electrocautery manipulation was
535,97±227,98 parts per million (ppm).The level of CO after the manipulation of
electrocautery and the level of arterial COHb postoperative 30. minute, 1. and 2.
hour has statisticaly difference. The measurements determined that the mean
level of COHb was 0,61±0,20%and 0,61±0,20%respectively. None of the CO toxicity
semptoms were detected from the patients who was accepted for the study.
Increase of intraperitoneal CO levels was detected releated with electrocautery
manipulation significantly.
Conclusion:
To prevent CO toxicity and other biologic-chemical toxins surgent, patient and staff
in operation room have to use electrocautery more carefully and shorter.
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PP - 672 THE PROBLEM OF RECRUITMENT, APPOINTMENT AND
TRAINING OF GENERAL SURGEONS IN UKRAINE
PETRO FOMIN , RAISA BOGATYREVA , RAISA MOISEENKO , ALEXANDR TOLSTANOV
, NIKOLAY HOBZEY
NATIONAL MEDICAL UNIVERSITY NAMED AFTER A.A. BOGOMOLETZ, UKRAINE
Background&Aims:
The recruitment, appointment and training of general surgeons (GS) is very actual
problem in Europe which continue to discuss at many meetings.
Methods:
We analyzed the age, professional skills, training, special competence of GS in

Ukraine on the levels of surgical service: district (DH), municipal and regional (MH,
RH) hospitals.
Results:
In Ukrainian system of Public Health there are more then 14000 GS (1,92 on 10 000)
, who did annually more then 2000000 general surgical operations and procedures.
According the staff posts there is total deficit - 19,6% (range from 5,0 to 31,0%) of
physical persons: on the level DH - 22,6% (range from 8,0 to 38,0%) and MH, RH –
29,0% (range from 4,0 to 33,0%). In the level of DH work 42,0% of GS, who did near
73,3% and in the MH, RH are 58,0% of GS who did 26,7% of all general surgery. The
serious problem is the age of GS, 23,0% of individuals are in retirement and 12,0%
- in pre-retirement age. According our system we delegated list of general surgery
procedures for DH and MH,RH.
Conclusion:
The time has come to redefine and to optimize graduate training in general surgery.
General surgery should continue to be the core of medical education.The resident
training program should be structured and organized to provide focused training in
abdominal surgery.
-881-
PP - 673 DOUBLE THROMBOSIS OF THE PORTAL SYSTEM DUE TO
ACUTE APPENDICITIS
ANDER BENGOECHEA , DANIEL PEREZ , MARCOS ALBA , MARIA DEL CARMEN
BAZAN , MARIA DE LOS ANGELES MAYO , MANUEL LOPEZ , JOSE MANUEL
PACHECO , JOSE LUIS FERNANDEZ
HOSPITAL UNIVERSITARIO, PUERTA DEL MAR, CADIZ, SPAIN
Introduction:
The infectious thrombosis of the portal system drainage area is called pylephlebitis.
Pylephlebitis associated with acute appendicitis is a rare complication with a high
mortality. We present the case of a fourteen years old male with this complication.
Case report:
Fourteen-years old patient admitted to hospital with abdominal pain and fever,
presenting painful abdomen together with leucocytosis but no peritonism.
No further evidence in ultrasound exploration. Due to clinical worsening CT is
prescribed showing appendicitis and partial thrombosis of mesenteric superior and
portal vein. Urgent surgery was decided performing an appendectomy. After four
days the patient was discharged patterning LMWH.
Conclusion:
Pylephlebitis is caused by the moving up of the infection trough the portal vein
system. A double implication is very rare presenting a low incidence associated
with appendicitis 0,05% to 3% but, on the contrary, up to a 30% mortality rate
when they come along together. It appears with abdominal pain together with
nausea, temperature, jaundice, leucocytosis and signs of peritoneal irritation. The
diagnostic technique of choice is Angio-CT. Thrombophilia should also be dismissed
as a primary cause. The treatment is the exeresis of the center of infection along
with an antibiotic coverage and early anticoagulation with Heparine during four-to-
six months.
-882-
PP - 674 FUNGAL INFECTION OF PROLENE MESH SUCCESSFULLY
TREATED WITH LOCAL AMPHOTERICIN B IRRIGATION
MEHWASH NADEEM , HASNAIN ZAFAR , MUHAMMAD SHAHRUKH EFFENDI
Introduction:
Mesh hernioplasty is the preferred surgical procedure for large abdominal wall
hernias. Fungal mesh infection has not been reported in literature yet. Use of
topical antifungal (like Amphotericin B) for irrigation in fungal mesh infection can
be a preferred way of treatment in selected group of patients.
Case report:
A 28 years old male came for reversal of ileostomy and incisional hernia repair in
a single setting. He underwent stoma reversal along with incisional hernia repair
with prolene mesh application and the wound was left open considering the nature
of surgery as clean contaminated. His daily dressings were started from second
postoperative day. On fifth postoperative day mould like growth was noted over the
mesh. Decision was made to treat it conservatively with local wound care although
scrapping was sent for culture and he was discharged home. Culture showed
heavy growth of aspergillus flavus. Wound management using amphotericin B for
irrigation as well as for wound packing was started. On follow up after a month’s
time his wound was found to be granulating well with no overlying fungal growth.
Conclusion:
We advocate conservative management of fungal mesh infection with local

amphotericin B irrigation as a safe alternate in selected group of patients.
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PP - 675 VAC APPLICATION IN ABDOMINAL CATASTROPHE
DENIZ GUZEY , SULEYMAN BUYUKASIK , MUSTAFA U. KALAYCI , MEHMET
KARABULUT , GULAY SAHIN , AHMET CEM DURAL , M. ECE DILEGE , HALIL ALIS

Background&Aims:
Vacuum assisted closure (VAC) facilitating management of abdominal catastrophe

is used widely to drain septic material and to close abdomen in reoperations.
Methods:
From January 2011 to July 2012 the cases treated by VAC were evaluated
retrospectively in terms of demographics, primary diseases, time of treatment,
number of VAC application and mortality.
Results:
Mean age of 40 cases was 56 (29-86) years. VAC was used in 26 cases after emergency
procedures (65%) and malignancy rate was 40% (n=16). Mean cost of treatment
was 27,696TLs (1125-84,911 TLs). Mean time of treatment was 47.8±43.8 days
and mean number of VAC application was 7.3±6.5 in 23 cases who discharged with
closed skin/dressings (n=14, n=9 respectively). In 10 cases who had anastomotic
leakage, mean time of treatment was 71.9±58.1 days and mean number of VAC
application 6.7±6.1 VAC (p=0.007). Malignancy rate of these ten cases was 60%, and
mortality rate was 30% (n=3). Total mortality rate was 40% (n=16).
Conclusion:
In the cases with open abdomen, VAC is a good but expensive alternative. To
evaluate of its effectiveness is difficult because of its application in heterogeneous
patient groups with different co-morbidities. Our results concluded that VAC is used
for longer time in the cases with anastomotic leakage.
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PP - 676 LAPAROSCOPIC SLEEVE GASTRECTOMY AND THREE LEVELS
OF SURGICAL SITE INFECTION
ALFALAH HAITHAM , D’SOUZA JOVIAL , ABBAS GHANEM
KING SAUD MEDICAL CITY, RIYADH, SAUDI ARABIA
Background&Aims:
Laparoscopic sleeve gastrectomy (LSG) becomes a popular standalone procedure for

weight loss in morbid obese patient, and the results seen in short and intermediate
terms are encouraging. (LSG) is classified as a clean contaminated surgery based
on the degree of microbial contamination and it carries its own risk of surgical site
infection (SSI). This study aims to present the cases of (LSG) who develops (SSI) at
different levels.
Methods:
From March 2008 to December 2011, 217 morbidly obese patients (160 women
(74%)) underwent (LSG) in our hospital. The mean age+SD was 32+8.7 years. The
pre-operative weight+SD was 123+21 Kg (range 85-180) and the body mass index
was 47.1+7 Kg/m2 (range 35-70). The data was analyzed retrospectively.
Results:
Three patients (1.3%) had primary (SSI) which were a spectrum of superficial
surgical site infections (wound infections), space infections (peritonitis) and organ
infection (liver abscess). Each of those patients underwent secondary intervention
to treat that infection.
Conclusion:
The incidence of (SSI) were <2% which is in the accepted international range of (SSI)
for clean contaminated surgeries proposed as 4% and up to 6 to 9%. (LSG) is a good
choice for treatment of morbid obesity with low risk of (SSI).
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PP - 677 PERIOPERATIVE BODY TEMPERATURE: ONE-DAY
PREVALENCE STUDY IN ONE HOSPITAL
NACIYE CIGDEM ARSLAN 1, CEM TERZI 1, OZLEM KAYA 1, ARAS EMRE CANDA 1,
SULE OZBILGIN 2, SEVDA OZKARDESLER 2
1
2
DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF ANESTHESIA
AND REANIMATION, IZMIR, TURKEY
Background&Aims:
As the monitorization of body temperature has been a standard procedure of

surgery it is well known that hypothermia is a common effect of anesthesia. Aim of
this study is to assess the effectivity of perioperative patient warming systems on
providing normothermia in our operation rooms.
Methods:
Fifty one patients were recruited to the study in the study day. Twenty nine adult
patients were eligible for the study (6 patients did not meet the inclusion criteria,
11 patients or surgeons declined to participate, 5 other reasons) who underwent
elective surgery longer than 2 hours on the same day in Dokuz Eylul University School
of Medicine. Twenty patients were taken into analysis (9 patients were excluded
due to study protocol violence). Preoperative, and postoperative body temperature
of patients and the operation rooms, patient warming methods, duration and type
of the operations were recorded. Blanket, warmed infusion solutions, forced air
system and lavation with warm serum was used to maintain normothermia.
Results:
All the patients have been administered one or more warming methods. Room
temperatures were stabile during the operations. Preoperative and postoperative
normothermia was achieved in only 6 (30%) patients.
Conclusion:
Although this is a study with very limited number of patients, results showed that
despite different patient warming methods, normal ranges of body temperature
couldn’t be reached without a standard normothermy procedure and close
monitorization. Every centre should have a standard normothermia policy
to maintain preoperative, intraoperative and postoperative normothermia.
Normothermia policy should be monitorized for every patient.
-886-
PP - 678 VACUUM-ASSISTED CLOSURE RESULTS AT WOUND
INFECTIONS DEVELOPING AFTER ABDOMINAL SURGERY
FATIH ALTINTOPRAK 1, YENER UZUNOGLU 2, OMER YALKIN 2, MEHMET
YAHYAOGLU 3, ENIS DIKICIER 2, GUNER CAKMAK 2, FEYYAZ ONURAY 2, OSMAN NURI
DILEK 1
1
2
3
INFECTION DISEASES AND CLINICAL MICROBIOLOGY, SAKARYA, TURKEY
Background&Aims:
The evaluation of the results are obtained by the vacuum-assisted closure (VAC)
system in the localized treatment of wound infections developing after abdominal
surgery.
Methods:
The records of 41 patients who were used on VAC for wound infections developing
after abdominal surgery between 2010-2012 were retrospectively evaluated.
Results:
Twenty-two patients (53.6%) were male, nineteen (46.4%) were female, and the
average age was 55.3 (23-84 years). The VAC system was applied on the abdominal
incisions in all patients. Sixteen patients (39%) had been operated due to various
gastrointestinal malignancies. Gram (-) microorganisms were the most common
reasons for infections (25 patients, 60.9%). The VAC system was applied for an
average period of 10.4 days (3-52 days). The wound area was sutured upon
obtaining a clean and dry wound region for 33 patients (80.4%), whereas it was
left for secondary healing for eight patients (19.5%). The VAC-application-related
complications that would require the termination of treatment was not observed in
any patients, whereas superficial bleeding occurred in three patients (7.1%).
Conclusion:
The contribution of VAC treatment to the systemic control of the infection, as well
as its positive local effects is known. While VAC is already commonly used in wound
infections in the extraabdominal regions, it may be regarded as a reliable alternative
to the conventional wound care methods also in wound infections developing after
abdominal surgeries.
-887-
PP - 679 COMPLICATIONS AT TREATMENT OF POSTOPERATIVE
PERITONITIS BY METHOD¬ OF LAPAROSTOMY.
NATALIYA STATSENKO , ALEXENDR KOSTIRNOY , ELDAR USEINOV
CRIMEAN STATE UNIVERSITY, UKRAINE
Background&Aims:
COMPLICATIONS AT TREATMENT OF POSTOPERATIVE PERITONITIS BY METHOD¬

OF LAPAROSTOMY. Background&Aims : to study intra-abdominal¬ and ulcers
complications arisingup¬ for¬ patients- with postoperative peritonitis treated by
themethod of laparostomy.
Methods:
Methods: At timely diagnostics of perforation of nestis, we are inclined to produce

her- taking in, ¬fixing to the line of guysutures intestinal loop or peritoneum to
the front wallof stomach. At the belated diagnostics the leadingout ofzone of
perforation is expedient on a front abdominal wall assuspended single-barrelled or
double-barrelled. For the prophylaxis- of suppuration at imposition of laparostomy
it is expedient to sew ¬together aperitoneum -and skin separate guysutures. At
suppuration of such wounds and subsequent secondary -cicatrization it isnecessary
to apply autoskinplastiks.
Results:
Results: postoperative lethality of these patients made 37,5% (15persons). Reasons

of fatal outcomes it was been: in one case endotoxic shock, arising up for a patient
with a perforetive pyosalpinx, heavy diabetes mellitus,universal angiopathy; two
patients died of recrudes centintestinal fistulas and 12 from making progress
peritonitis with a hemorrhagic- syndrome at one.
Conclusion:
Conclusion: in spite of complications, method of laparostomy with programmatic

sanations of abdominal region, executableon concrete testimonies, is effective
in treatment of heavy forms of peritonitis, allowing to labour for the substantial
increase of survivability of patients.
-888-
PP - 680 EARLY INTERVENTION IS IMPORTANT FOR THE SUCCESS IF
THE FEEDING TUBE COMES OUT
S. SAVAŞ YÜRÜKER 1, İLHAN KARABIÇAK 1, SEDA HANÇERLI 1, KORAY TOPGÜL 2,
NECATİ ÖZEN 1
1
ONDOKUZ MAYIS UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL
2
MEDICAL PARK HOSPITAL, DEPARTMENT OF GENERAL SURGERY, ISTANBUL,
TURKEY
Background&Aims:
Percutaneous feeding methods carry some complications. In case of the feeding

tube comes out accidently , any kind of catheter must be inserted within the few
hours after removal to prevent tube tracts closure. In this repot we present how we
are treating these problem.
Methods:
Fourteen patients was admitted to our clinic with the complaints of feeding tube
removal between 2011 and 2012. We used temporary feeding tube, gastrostomy
tube, central venouse catheter, suction tube or foley catheter to prevent closure of
the tract.
Results:
Nine out of 14 patients could be treated (% 64) through the local skin incision. All
patients (n=7) admitted within the 24 hours and half of the patients (n=2) admitted
within the 48 hours after tube removal could be treated locally with permanent or
temporary catheter. None of the patients admitted after 48 hours tube removal
could be treated locally.
Conclusion:
The success of the locally treatment of the feeding tube removal depends on the
time of the admission after the tube comes out. The first 24 hour is the threshold
for the success.
-889-
PP - 681 TRANSMEMBRANE DIALYSIS IN TREATMENT OF SURGICAL
PERITONITIS
VALERY KRYSHEN , PAVEL LYASHCHENKO , ANATOLIY VLASENKO
Background&Aims:
Reducing endotoxicosis is the direct impact towards improving peritonitis treatment

results, which is important in the prevention and elimination of MOFS intensity.
In our data, we used the intra-abdominal application of tubular semi permeable
membranes of cellulose viscose.
Methods:
Observed group (OG) - 11 patients with peritonitis, to whom transmembrane

dialysis was done in postoperative period. Clinical comparison group (CCG) - 12
patients with peritonitis, where the transmembrane dialysis was not used. The
postoperative dialysis was carried out permanently and stopped when there was
objective evidence that the elimination of peritonitis was observed.
Results:
Most of OG patients starting from third day after the surgery noted to be improved
in common condition, restoration of intestine peristalsis, decrease of intoxication
severity, normalization of laboratory parameters. In comparison with CCG patients,
the above mention changes were observed later- on 5th-7th day.
Conclusion:
The peritoneal dialysis with using tubular semi permeable membranes of cellulose
viscose provides good irrigation and diffusion of toxins from the peritoneal fluid to
drain, followed by elimination of abdominal bypassing into blood flow, resulting in
reduction of postoperative complication rate.
-890-
PP - 682 ABOUT SYSTEMIC ANTIBIOTICOTHERAPY FOR LEG
TROPHIC ULCERS
OLEXANDR BUTYRSKY
Background&Aims:
Oregon protocol and Alexander House Group recommend systemic

antibioticotherapy (SAT) for venous trophic ulcers (TU) treatment. Aim - proving
efficiency of semipermeable biogenic membranes (SBM) impregnated with Dimexid
to avoid SAT.
Methods:
33 pts with leg posthtrombotic TU were undergone for topical treatment with SBM.
Results were confirmed with quantity and content of microbes in TU tissues.
Results:
We consider that microbes and TU healing are associated; despite decrease

of microbial concentration healing was extremely inhibited even if microbial
concentration downs to 105/g but pathogens (St. aureus, Pr. vulgaris) are obtained,
epitelization and granulation growth were very poor/not observed. If saprophytic
microflora was smeared, and concentration decreased, regeneration was very
intensive. Early appearing granulations form the reliable barrier preventing active
wound infection. The final SBM impact on TU is reduced number of microbes and
prevalence of saprophytic microflora (54%)/sterile epithelizing surface (35%) by the
30-th day of treatment. Microflora changes correlate with clinical manifestations.
Bactericidal impaction is explained with SBM property to promote tissue lysis
products removal, and impregnation of subjacent tissues with Dimexid.
Conclusion:
change of TU microbial content and maximal sanitation enable successful healing

without SAT. SAT is indicated for secondary infection/systemic reactions (fever,
lymphangitis).
-891-
PP - 683 THE EFFECT OF CEFAZOLIN PROPHYLAXIS ON
POSTOPERATIVE INFECTIOUS COMPLICATION IN ELECTIVE
LAPAROSCOPIC CHOLECYSTECTOMY
EMIN TURK 1, ERDAL KARAGULLE 1, KIVANC SEREFHANOGLU 2, HALE TURAN 2,
GOKHAN MORAY 1
BASKENT UNIVERSITY DEPARTMENT OF GENERAL SURGERY, ANKARA, TURKEY

1
BASKENT UNIVERSITY DEPARTMENT OF INFECTIOUS DISEASES AND CLINICAL

2
MICROBIOLOGY, ANKARA, TURKEY
Background&Aims:
This study assessed the effect of cefazolin prophylaxis on postoperative infection
in patients undergoing elective laparoscopic cholecystectomy. Additionally, we
determined risk factors in cases with postoperative infection.
Methods:
Five hundred eighteen patients with symptomatic cholelithiasis who underwent
elective laparoscopic cholecystectomy were selected for this prospective study.
Patients were randomized consecutively and divided into 2 groups: the cefazolin
(CEF) group patients (n=278) received 1 g cefazolin, and the control group (n=240)
received 10 mL isotonic sodium chloride solution. Cultures of gallbladder mucosa
and stones were obtained from all patients. Patient characteristics and general
operative outcomes were compared and analyzed. All patients were followed
regarding postoperative infections.
Results:
Postoperative infections occurred in 4 patients in CEF group and in 2 patients in
the control group; no significant difference existed regarding this (P = .52). Risk
of infection increased in patients with previous cholecystitis and/or endoscopic
retrograde cholangiopancreatography (P = .004), patients with ruptured
gallbladders, and patients in whom a suction drain was used (P = .002 and .04).
Patients with positive gallstone and gallbladder mucosa cultures were significantly
older and had a significantly higher rates of previous cholecystitis attack and/or
previous endoscopic retrograde cholangiopancreatography (P = .03 and P < .001).
Conclusion:
No correlation existed between cefazolin prophylaxis and postoperative infections

in elective laparoscopic cholecystectomy patients. There may be an increased
risk of infection in patients with previous cholecystitis or endoscopic retrograde
cholangiopancreatography. In addition, there is an increased risk of postoperative
infection in patients with gallbladder rupture and suction drain use.
-892-
PP - 684 BURIED BUMPER SYNDROME TREATED WITH GASTRIC
WEDGE RESECTION
S. SAVAŞ YÜRÜKER , İLHAN KARABIÇAK , BÜLENT KOCA , HAMZA ÇINAR , NECATİ
ÖZEN

Background&Aims:
Percutane endoscopic gastrostomy (PEG) is a preferred feeding way if the patient is

unable to receive per-oral for 4 weeks. In this report, we present a rare complication
of PEG tube.
Methods:
52 year-old man admitted to our clinic with the complain of gastrostomy tube
obstruction. The patient has inserted PEG two years ago after a trauma. Gastroscopy
showed PEG tube has buried into the gastrtic mucousa, folded and formed a mass.
CT scan showed the same findings and he was diagnosed with Buried Bumper
Syndrome.
Results:
Tube could not be exctracted by traction and we decided to perform laparatomy.

A wedge resection of the stomach including the tube was performed and a new
balooned gastrostomy tube was placed.
Conclusion:
Surgical resection is required as in this case if the tube is buried into the mucosa and
makes a mass. Otherwise if the bumper is out from the stomach local treatment is
possible.
-893-
PP - 685 THE EFFECTS OF VARDENAFIL ON LUNG INJURY IN A RAT
MODEL OF ABDOMINAL SEPSIS
SEDAT DOM 1, FATİH AGALAR 2, CANAN AGALAR 3, UCLER KİSA 4, PİNAR ATASOY 5,
TAYFUN SAHİNER 6, CAGATAY DAPHAN 1, EMİNE EGEMİS 7
1
KIRIKKALE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF GENERAL
SURGERY, KIRIKKALE, TURKEY
2
FORMERLY KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF
GENERAL SURGERY, KIRIKKALE, TURKEY NOW ANADOLU MEDICAL CENTER,
ISTANBUL, TURKEY
3
KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF INFECTIOUS
DISEASES AND CLINICAL MICROBIOLOGY, KIRIKKALE, TURKEY AFFILIATED FATIH
SULTAN MEHMET TRAINING RESEARCH HOSPITAL, ISTANBUL ,TURKEY
4
KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF BIOCHEMISTRY,
KIRIKKALE, TURKEY
5
KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PATHOLOGY,
KIRIKKALE, TURKEY
6
FORMERLY KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF
GENERAL SURGERY, KIRIKKALE, TURKEY NOW NEVSEHIR CITY HOSPITAL, NEVSEHIR,
TURKEY
7
KIRIKKALE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF INFECTIOUS
DISEASES AND CLINICAL MICROBIOLOGY, KIRIKKALE, TURKEY
Background&Aims:
Several studies had shown benefical effects of Vardenafil on lung tissue via nitric
oxide synthesis especially in ARDS and pulmonary hypertension. Our aim was to
evaluate its possible protective effects on lung tissue in a rat sepsis model.
Methods:
40 Wistar-Albino rats were divided into four groups. Intraperitoneal saline was given
to sham and sepsis groups while vardenafil and vardenafil-sepsis groups received
10 mg/kg of vardenafil pretreatment. Sepsis was induced by cecal ligation-puncture
model. On 72nd hour lungs were excised for wet-to-dry weight ratio, microscopic
evaluation, and stored for malondialdehyde and nitric oxide measurement. CRP
and leucocyte levels were also measured.
-894-
Results:
There was no difference in malondialdehyde and nitric oxide levels between the
groups and vardenafil didn’t alter acute phase reactant status. However vardenafil
pretreatment reduced wet-to-dry weight ratio (6.38±2.50 to 4.88±,1.93, p<0.05),
alveolary haemorrhage (2±0.25 to 1±0, p<0.05), and positive cultures of lung tissue
(90% to 20%, p<0.05) compared to sepsis group but had no protective effect on
pathological lesions of lung tissue.
Conclusion:
Vardenefil administration seem to have positive effects on lung tissue reducing

tissue edema and alveolary haemorrhage in sepsis model. Further studies are
needed to determine its outcome more accurately.
-895-
PP - 686 THYMOQUINONE COATED POLYPROPYLENE MESH:
COMPARISON OF INTRAABDOMINAL ADHESIONS
OKTAY AYDİN1, KUZEY AYDINURAZ1, FATİH AĞALAR2, İBRAHİM TAYFUN ŞAHİNER3,
CANAN AĞALAR4, CEM BAYRAM5, EMİR BAKİ DENKBAŞ6, PINAR ATASOY7
1
DEPARTMENT OF GENERAL SURGERY, KIRIKKALE UNIVERSITY MEDICAL FACULTY,
KIRIKKALE, TURKİYE
2
DEPARTMENT OF GENERAL SURGERY, ANADOLU MEDICAL CENTER IN
AFFILIATION WITH JOHNS HOPKINS MEDICINE, GEBZE, İZMİT, TURKİYE
(FORMERLY DEPARTMENT OF GENERAL SURGERY, KİRİKKALE UNIVERSITY
MEDICAL FACULTY, KIRIKKALE, TURKİYE )
3
İ.ŞEVKİ ATASAGUN STATE HOSPITAL, NEVSEHİR, TURKİYE ( FORMERLY
DEPARTMENT OF GENERAL SURGERY, KIRIKKALE UNIVERSITY MEDICAL FACULTY,
KIRIKKALE, TURKİYE )
4
DEPARTMENT OF INFECTIOUS DISEASES AND CLINICAL MICROBIOLOGY,
KIRIKKALE UNIVERSITY MEDICAL FACULTY, KİRİKKALE, TURKİYE ) AND FATİH
SULTAN MEHMET RESEARCH AND TRAINING HOSPITAL, İSTANBUL, TURKİYE
5
NANOTECHNOLOGY AND NANOMEDICINE DIVISION, INSTITUTE OF SCIENCE
AND TECHNOLOGY, HACETTEPE UNIVERSITY, BEYTEPE, ANKARA, TURKİYE
6
CHEMISTRY DEPARTMENT, FACULTY OF SCIENCE, HACETTEPE UNIVERSITY,
BEYTEPE, ANKARA, TURKİYE
7
DEPARTMENT OF PATHOLOGY, KIRIKKALE UNIVERSITY MEDICAL FACULTY,
KIRIKKALE, TURKİYE
Background&Aims:
Visceral adhesion to polypropylene mesh is a major problem. Mesh surface

modifications have been a means of changing adhesive properties of the mesh.
Thymoquinone, extracted from Nigella Sativa has antiinflammatory and antioxidant
properties. Thymoquinone coated polypropylene mesh is hypothesized to reduce
intraabdominal adhesions.
Methods:
Thymoquinone coated polypropylene mesh material was tested for cytotoxicity,

contact angle, surface spectroscopy, thymoquinone content, sterility, electon
microscopic surface properties. Experimental incisional hernia model was created
in study groups each consistig of 12 wistar rats. The defect was closed with naive
mesh in control group, with polilactic acid ( carrier for thymoquinone ) coated
mesh and polilactic acid-thymoquinone coated mesh in study gorups. Adhesion
scores and histopathologic properties were evaluated after sacrification on
postoperative 21th day.
-896-
Results:
Granuloma formation, lymphocyte infiltration, polymorphonuclear leukocyte

infiltration, histiocyte and giant cell formation, capillary infiltration, collagen content,
fibroblast formation were significantly reduced in polilactic acid thymoquinone
coated mesh group (p<0,05). Though not statistically significant probably due to the
limited number of study animals, adhesion formation was also reduced in polilactic
acid thymoquinone coated mesh group (p:0.067).
Conclusion:
Thymoquinone coated mesh is shown to reduce adhesion formation and

thymoquinone is a promising coating material for mesh surface modification.
-897-
PP - 687 COMPARISON OF VERESS NEEDLE VERSUS OPEN
APPROACH FOR LAPARASCOPIC ACCESS
PEKER K.1 , INAL A. 1, DEMİRYILMAZ I.2 , EMİROGLU M.3
1
UNIVERSITY OF ERZİNCAN, MENGUCEK GAZİ TRAINING AND RESEARCH HOSPITAL,
ERZİNCAN, TURKEY
2
İBNİ SİNA HOSPİTAL, KAYSERİ,TURKEY
3
İZMİR TEPECİK TRAINING AND RESEARCH HOSPITAL, İZMİR, TURKEY
Background&Aims:
We tried to compare open approach with Veress needle technique for laparascopic
operations in terms of patient safety.
Methods:
437 patients who were underwent laparascopic cholecystectomy between

January 2007 and December 2011, were enrolled in the study. In 239 of patients
intraperitoneal access was obtained by Veress needle technique. In 198 patients
pneumoperitoneum was created by open acccess tecnique, through an infraumblical
eliptical incision, where abdominal fascia was seen, suspended by two clamps and
pneumoperitoneum was created via an peritoneal incision.
Results:
There were no bowel or vascular injury in both of two groups. On follow-up, one
patient in open access group and four patients in needle approach group were
developed incisional port-site hernia.
Conclusion:
Access to the peritoneal cavity is the one of most hazardous step in every
laparascopic surgical procedure. Many research suggest higher incidences of serios
vascular and visceral injuries than reported rates. Needle approach for laparascopic
access or sharp trocar placement was accused for most of these complications.
On the other hand open technique provides an easier access to abdominal fascia
especially in obese patients, yields better cosmetic results and warrants lower rates
of port-site hernia by permitting to define incisional margins during fascial closure.
-898-
PP - 688 COMPARISON OF VESSEL SEALING SYSTEMS AND
CONVENTIONAL TECHNIQUE FOR HAEMORRHOIDECTOMY: A
PROSPECTIVE CLINICAL STUDY OF SAFETY AND EFFICACY
PEKER K.1 , INAL A.1 , EMİROGLU M.2
1
UNIVERSITY OF ERZİNCAN, MENGUCEK GAZİ TRAINING AND RESEARCH HOSPITAL,
ERZİNCAN, TURKEY
2
İZMİR TEPECİK TRAINING AND RESEARCH HOSPITAL, İZMİR, TURKEY
Background&Aims:
The aim of this study was to assess the effectiveness of the LigaSure and Harmonic
Scalpel tissue sealing devices for haemorrhoidectomy in comparison with
conventional haemorrhoidectomy.
Methods:
69 patients were assigned to LigaSure, Harmonic Scalpel or conventional

haemorrhoidectomy between September 2010 and December 2011 prospectively.
All patients were underwent proctoscopic examination to exclude other
proctologic diseases preoperatively. Patients underwent Milligan-Morgan open
haemorrhoidectomy using either LigaSure, Harmonic Scalpel or conventional
haemorrhoidectomy.
Results:
Postoperative wound healing rates, pain levels acoording to VAS(Visual analogue

scale) and need for analgesic medication in first 48 hours were compared. While
there were no significant difference between Harmonic Scalpel and conventional
group in terms of wound healing and need for analgesic medication, both two
groups were significantly better than Ligasure group in terms of wound healing
and need for analgesic medication (p< 0.001). Pain levels according to VAS were
significantly higher in Ligasure group than other both two groups (p< 0.001).
Conclusion:
Results of this study revealed poorer surgical outcomes for Ligasure

haemorrhoidectomy and no superior results for Harmonic Scapel in terms of
postoperative wound healing, need for analgesic medication and postoperative
pain levels than conventional technique.
-899-
-900-
We thank all the sponsors for their supporting contributions.
3M
ABDICA
BIOLITEC
CONVATEC
COOK MEDİKAL
COVIDIEN
DOGSAN
ETHICON
HARTMANN
HITIT MEDICAL
INTRA MEDİKAL
KCI
MEDURA
PUSULA MEDICAL
ROCHE
STRYKER
SYSTAGENIX
TUTKU
*Names are sorted in alphabetical order by the lastname.
-901-
-902-
INDEX
-903-
A AKGÜL, ÖMER LÜTFI 380
ER, AHMET 271, 544 AKGÜL, ÖZGÜN 818
AATBEY, MUSTAFA 434 AKGUN, ERHAN 163, 322
ABAMBOR, EVRIM 236 AKGUNER, TANER 356, 508
ABBASOV, VUGAR 522, 523 AKGÜN, ISMAIL ETHEM 203, 477, 490, 529, 530
ABDULLAYEV, FARIZ 641 AKINCI, MUZAFFER 625
ABOLHASANI, FARID 842 AKINCI, ÖMER FARUK 758
ABUOGLU, HACI HASAN 353, 354, 355, 743 AKİN, FAKİ 520
ABUOĞLU, HASAN 15, 136, 363, 514, 673 AKIN, LEVHI 300
ABUOGLU, H. HASAN 398, 663 AKIN, MEHMET LEVHI 120, 198, 241, 327, 525,
ACAR, AYLIN 197, 235, 240, 247, 344, 348, 408, 855, 857
485, 560, 614, 735, 737, 793 AKIN, MEHMET LEVHİ 432
ACAR, AYLİN 349, 469 AKIN, MURAT 875, 877
AÇAR, H. ZAFER 472 AKKUCUK, SECKIN 422
ACARLI, KORAY S 23, 111, 699, 700 AKOGLU, MUSA 50, 105, 584, 586
ACAR, TURAN 271, 356, 544, 654, 655 AKOĞLU, MUSA 52, 140, 325, 710, 722
ACIKGOZ, SEREFDEN 346 AKSEL, BÜLENT 229, 258
ADAS, GOKHAN 659, 660, 718, 801 AKSOY, EROL 140, 710, 722
ADAS, MINE 660 AKSOY, FARUK 470, 471, 653
AERTS, RAYMOND 16 AKSOY, FIKRET 792
AĞAÇHAN, AHMET FERAN 83, 879 AKSOY, HÜSEYIN 507, 616, 617, 810
AGALAR, CANAN 894 AKSOY, MURAT 439
AĞALAR, CANAN 896 AKSOY, NERGIS 125, 423
AGALAR, FATIH 362 AKSOY, NERGIZ 555, 836
AGALAR, FATİH 894 AKSOY, ŞEFİKA 786
AĞALAR, FATİH 896 AKSU, MURAT 862
AGAYEV, BOYUKKISHI 421, 688 AKTAN, A.OZDEMIR 39
AGCAOGLU, ORHAN 439 AKTAŞ, AYŞEGÜL 577, 597
AGHAYEVA, AFAG 339, 340 AKTAŞ, GÜLALİ 312, 313, 559
AGUSTíN, MARTA CARMEN CLIMENT 27, 155 AKTAS, HIKMET 22
AHMED, IBRAHIM 92 AKTAS, SUAT 348, 458
AHMEDOVA, RUHENGIZ 680 AKTEKIN, ALI 15, 514
A, INAL 898 AKTEKİN, ALİ 644
A., INAL 899 AKTER, FARHANA 21, 510
AKAN, KAAN 837 AKYAĞCI, SERPIL BILGIN 210
AKAR, İLKER 369 AKYILDIZ, HIZIR 147, 283, 476
AKARSU, CEVHER 64, 135, 371, 431, 465, 495, AKYILDIZ, HIZIR YAKUP 183, 459
496, 585, 595, 702 AKYILDIZ, MAHIR 80
AKARSU, MAHMUT 763 AKYOL, CIHANGIR 129, 164, 296, 650
AKARSU, MESUT 694 AKYOL, CİHANGIR 367
AKAY, GÜVEM GÜMÜŞ 229 AKYOL, CİHANGİR 366, 518
AKBABA, SONER 33, 153, 206, 338, 823 AKYUZ, ALI 166
AKBULUT, GOKHAN 231, 829 AKYUZ, CEBRAIL 581
AKBULUT, GÖKHAN 397 AKYÜZ, CEBRAIL 99, 629
AKBULUT, SAMI 15, 136, 363, 673 AKYUZ, MUHAMMET 147, 183, 283, 476, 851
AKCAKAYA, ADEM 202, 203, 477, 490, 536, AKYÜZ, MUHAMMET 459
660, 718 AKYUZ, UMIT 795
AKÇAKAYA, ADEM 250, 529, 530 ALAGOZLU, HAKAN 848
AKÇAL, TARIK 602 ALAKUŞ, ÜMİT 204, 428, 860
AKCAN, ALPER 88, 147, 183, 283, 459, 476 ALANEZ, JAVIER 467
AKDUR, AYDINCAN 46, 332, 695, 844 ALBAITY, TALAAT 26
AKGUL, GOKHAN GIRAY 89, 200, 486, 812 ALBA, MARCOS 882
AKGÜL, HIKMET 229 ALBAYRAK, DOĞAN 507, 616, 617, 810
-904-
ALBAYRAK, İLKAY 616, 617, 810 ANDRIY, ZHIGULIN 107
ALBUZ, OZGUR 62, 176, 450 ANILIR, ENDER 399
ALÇELIK, AYTEKIN 312 ANTOLINO, LAURA 124
ALÇELİK, AYTEKİN 559 ANTONIO, PINNA 28
ALCI, ERMAN 519 ANUK, TURGUT 115, 306, 563, 580
ALDEMIR, MUSTAFA 430 ARAS, ABBAS 372, 449
ALDEMİR, MUSTAFA 268 ARAS, OZGEN 118
ALEN, PETROV 66, 222, 299, 731 ARAVOSITA, PARASKEVI 113
ALEXANDRA, MANEA CRISTINA 671 ARDIC, SUKRU 400
ALHAJRI, KHALID MAJED 38, 239 ARDUÇOĞLU, AYŞE MERTER 351
ALHARTHI, BANDAR 141, 215 AREN, ACAR 245, 318, 502, 543, 786
ALIJANI, AFSHIN 85 ARER, İLKER 695
ALIMOGLU, ORHAN 197, 235, 240, 247, 326, ARICA, SECIL 422
402, 408, 451, 462, 485, 552, 560, 614, 666, ARIKAN, AKİF ENES 504, 602
735, 793 ARIKANOGLU, ZULFU 430, 701, 705, 745, 846
ALIMOĞLU, ORHAN 134, 344, 348, 456 ARIKAN, SOYKAN 764, 811
ALİMOĞLU, ORHAN 81, 349, 442, 469 ARIKAN, YÜKSEL 507
ALIOSMANOGLU, IBRAHIM 701, 705 ARIKÖK, ATA TÜRKER 295
ALI, RIDVAN 466 ARISOY, KORAY 482
ALIS, HALIL 64, 135, 205, 371, 372, 373, 431, ARNAU, ANA BELEN MARTIN 234, 841
447, 449, 465, 495, 496, 531, 587, 595, 702, ARPA, MEDENI 39
884 ARSLAN, BAHA 578
ALIŞ, HALIL 591 ARSLAN, CIGDEM 177, 692, 694
ALIŞ, HALİL 585 ARSLAN, ERSOY 719
ALIYEV, FIKRET 708 ARSLAN, ISMAIL 483
ALIYEV, SHAMIL 590 ARSLAN, KEMAL 190, 512, 513, 859
ALLAHVERDI, TULAY DIKEN 563 ARSLAN, MITHAT KERIM 118, 573, 734
ALLAHVERDİ, TULAY DİKEN 580 ARSLAN, NACIYE CIGDEM 101, 122, 248, 319,
ALOIZOS, STAVROS 113, 452 320, 321, 886
ALOTAIBI, FAISAL 239 ARSLAN, SULHATTIN 849
ALPER, AYDİN 368 ARSLAN, YUSUF 829
AL-TAMIMI, ABDULHAKIM 26, 175, 244, 262, ARZIMAN, IBRAHIM 400
323, 342, 639, 640, 732 ASHIN, YASSER BA 262, 342, 640
ALTAN, AYDIN 617, 810 ASHLEY, CHRIS 385
ALTINOK, DUYGU 39 ASIL, GIYASETTIN 829
ALTINOK, MEHMET 817 ASLANER, ARİF 538
ALTINSOY, HASAN BAKI 583 ASLAN, FATIH 548
ALTINTAŞ, HÜSNIYE 220 ASLANOVA, KONUL 680
ALTINTOPRAK, FATIH 211, 231, 359, 396, 397, ASLAN, SINAN 399
829, 887 ASMAZ, EBRU 834
ALTINYOLLAR, HÜSEYIN 833 ASOĞLU, OKTAR 131, 166, 253, 324, 598, 604
ALTUN, HASAN 115, 730, 739, 795, 805 ASTARCIOĞLU, IBRAHIM 692, 693, 694
ALTUNTAS, YUNUS 605 ATAALLAH, WAFI 14, 736
ALTUNTAS, YUNUS EMRE 130, 335 ATABEY, MUSTAFA 189, 381, 382, 383, 600,
AMBARCIOGLU, PINAR 159 723
AMIN, NIKUL 832 ATAHAN, MURAT KEMAL 818
AMMENDOLA, MICHELE 103 ATAK, IBRAHIM 402, 552, 614, 666
ANADOL, AHMET ZİYA 715 ATAK, IBRAHİM 462
ANANIA, MARCO 170 ATAK, İBRAHIM 326, 456
ANDREEV, PAVEL 289 ATAK, İBRAHİM 442
ANDRIIETS, VOLODYMYR 298 ATALAY, CAN 817
ANDRIIETS, YULIYA 298 ATALAY, SULEYMAN 354, 355
ANDRIKOPOULOU, MARIA 385 ATAMANALP, S. SELCUK 287
-905-
ATASOY, GULSEN 319, 692 AZZI, RODRIGO MORAN 546, 631, 632, 767,
ATASOY, GÜLSEN 694 819
ATASOY, PINAR 896
ATASOY, PİNAR 894 B
ATAY, ARİF 190, 512, 513, 859 BABU, RAJASHEKARA 172, 651, 728, 760
ATES, MUSTAFA 677, 678, 713 BACA, BILGI 159, 339, 340, 345, 413, 606
ATHANASIOU, CHRISTOS 169 BACA, BİLGİ 564, 565
ATHER, MOHAMMAD HAMMAD 82, 869 BAEZ, ALEXANDER JOSé SALAZAR 27, 155
ATHERTON, STEVE 868 BAGHAKI, SEMIH 159
ATICI, ALI E. 165 BAĞKESEN, HASAN 773
ATILA, KORAY 101 BAHADIR, BURAK 19
ATILGAN, DOGAN 621 BAIDO, SERGEY 107
ATİLLA, HALİS ATİL 407 BAKDIK, SÜLEYMAN 835
A.TONKOGLAS 751 BAKIR, BARIS 131, 253
ATTAALLAH, WAFI 634 BAKIR, BARIŞ 166
ATZENI, JENNY 161 BAL, ALİ 653
AVCI, CAVİT 185 BALCI, CAN 315
AVCI, COSKUN 189 BALCI, DENIZ 698
A.V.SIVOZHELEZOV 751 BALDAN, YÜKSEL 524, 880
AVTAN, LEVENT 185 BALDUCCI, GENOVEFFA 341
AY, AHMET 761 BALIK, EMRE 166
AY, AYBALA AGAC 362, 761, 762, 763, 815 BALIN, SALIM 75, 236, 605
AY, AYBALA AĞAÇ 517 BALTA, AHMET ZIYA 120, 198, 221, 241, 249,
AYBEY, FERDA 804 327, 525, 748, 749
AYDIN, BERRIN 386 BALTA, AHMET ZİYA 257, 414, 416, 464
AYDIN, BERRİN 387 BANLI, OKTAY 795, 805
AYDIN, CAGATAY 386, 387 BARAN, MAŞALLAH 850
AYDIN, CEMALETTIN 31, 457, 460, 540, 858 BARBAND, ALI REZA 643
AYDIN, CENGİZ 840 BARDAKCI, OSMAN 533
AYDIN, FERİT 366 BARI, HASSAAN 127, 741
AYDIN, HALIME 130 BARRETT, MICHAEL PAUL 92, 455
AYDINLI, BULENT 287 BASAK, FATIH 197, 235, 240, 247, 348, 451,
AYDIN, METIN 704 485, 614, 666, 735, 737, 793
AYDIN, OKTAY 517 BAŞAK, FATIH 344
AYDİN, OKTAY 896 BAŞAK, FATİH 349, 469
AYDIN, ÖVGÜ 226 BAŞARAN, CAN 218, 220, 243, 257, 414, 416,
AYDINURAZ, KUZEY 362, 517, 761, 762, 763, 773
815, 875, 877, 896 BAŞARAN, EBRU 218
AYDOGAN, AKIN 422 BAŞÇEKEN, SALİM İLKSEN 258, 366, 367
AYDOĞAN, BAKİ 263 BAS, GURHAN 197, 235, 240, 247, 326, 344,
AYDOĞAN, CEM 612, 753 348, 402, 408, 451, 485, 536, 552, 560, 614,
AYDOĞAN, FATIH 226 666, 735, 737
AYGÜN, ERŞAN 591 BAS, GÜRHAN 458, 462
AYGUN, NURCIHAN 41, 474, 475 BAŞ, GÜRHAN 81, 134, 349, 442, 456, 469
AYGÜN, NURCIHAN 273, 825, 826 BASNAEV, USEIN 410
AYNALI, GIRAY 866 BASOGLU, IRFAN 495, 496
AY, SERDEN 125, 423, 555, 648, 835, 836 BASOL, OMER 430
AYTAÇ, BÜLENT 168 BATMAN, BURÇİN 42, 74, 493
AYTAC, ERMAN 126, 154, 345, 606, 865 BATTAL, MUHARREM 490, 529
AYTEKIN, AYKUT 790 BATUR, SEBNEM 159
AZILI, CEM 350, 771, 778, 807 BATUR, ŞEBNEM 226
AZIRET, MEHMET 721 BAYAR, SANCAR 229
AZİRET, MEHMET 576 BAYDO, SERGEY 269, 302
-906-
BAYKAN, MEHMET 459 BOSTANCI, ERDAL BIROL 50, 105, 140, 584,
BAYKAN, OZGUR 39 586, 722
BAYOL, UMIT 840 BOSTANCI, ERDAL BİROL 52, 325, 710
BAYRAKTAR, BARIŞ 399 BOSTANCI, HASAN 196, 505, 613
BAYRAM, CEM 896 BOSTANCI, OZGUR 571, 601
BAYRAMOV, NURU 680 BOSTANCI, ÖZGÜR 55
BAYTEKIN, HALIL FIRAT 495 BOSTANCI, SUHHA 745
BAZAN, MARIA DEL CARMEN 882 BOSTAN, HABİB 83, 879
BEDI, RAJEEV 871 BOWLING, KIRK 304
BEDIR, ORHAN 30 BOYACIOGLU, ZEHRA 270
BEKİN, AHMET 437 BOYLU, ŞÜKRÜ 863, 872
BEKTAS, HASAN 318 BOZBIYIK, OSMAN 840
BEKTAŞ, HASAN 502 BOZDAĞ, ALI DOĞAN 862, 863
BEKTAŞOĞLU, HÜSEYİN 250 BOZDAĞ, ALİ DOĞAN 872
BELVİRANLI, METİN 558, 674 BOZDAG, EMRE 750
BENEDETTI, MICHELE 746 BOZDAĞ, KÜBRA EREN 862, 872
BENGOECHEA, ANDER 882 BOZDOGAN, ATİLLA 93
BENLICE, CIGDEM 159, 345, 606 BOZKAYA, HALİL 742
BENLICE, ÇIGDEM 339 BOZKIRLI, BAHADIR OSMAN 33, 153, 537,
BENZIN, MEHMET FATIH 404, 405, 556, 839 715, 823
BERARDI, GIAMMAURO 114 BOZKURT, BETÜL 875
BERBER, IBRAHİM 387 BOZKURT, BIRKAN 534
BERBEROĞLU, UĞUR 833 BOZKURT, EROL 245, 786
BERBER, UFUK 198 BOZKURT, M. ABDUSSAMET 371, 373
BERNSTEIN, ZVI 107 BOZKURTOĞLU, HAKAN 642, 758
BEŞTEMİR, ATTİLA 403 BOZKURT, SULEYMAN 184
BEYAZ, SERBULENT GOKHAN 211, 359, 396 BOZKURT, SÜLEYMAN 162, 275, 314, 437, 806
BEZRODNYI, BORYS 664, 706 BRAMHALL, SIMON 711
BILALOGLU, HIDAYET 768 BRANKOVIć, MILOš 780
BILALOGLU(ISAYEV), HIDAYET 609 BRAR, PREETINDER 426, 575, 871
BILECIK, TUNA 311, 579, 696, 779, 845 BRAUNGART, SARAH 330
BILGIC, BILGE 531 BREUS, ARTEM 32
BİLGİÇ, ÇAĞRI 399 BRUNO, DILLEMANS 180, 181, 182, 752, 797
BILGIN, BULENT ÇAĞLAR 739 BUBNJAR, JOSIP 814
BILGIN, ISMAIL AHMET 436 BUCI, SKENDER 409, 425
BILGIN, İSMAIL AHMET 340 BUDAK, ERSEL TAN 861
BILIR, GULAY 486 BUGRA, DURSUN 316
BINBOĞA, SINAN 214 BUĞRA, DURSUN 166
BINGUL, MUSTAFA 122 BÜLBÜLLER, NURULLAH 351
BIRCAN, HÜSEYIN Y 612 BULBUL, TEVFIK 405, 406
BİRCAN, HÜSEYİN Y 753 BULBUL, YILMAZ 118
BİROL, SELİM 437 BULUŞ, HAKAN 264, 535
BISGIN, TAYFUN 101 BURNE, RICHARD 463
BLANCO, MANUEL RODRIGUEZ 683 BUTYRSKY, OLEXANDR 682, 870, 891
BLYTH, ANDREW 309 BUYUKASIK, SULEYMAN 205, 465, 884
BOCCHETTI, TOMMASO 114 BÜYÜKOKUROĞLU, MEHMET EMIN 714
BODUR, SAIT 836
BOGATYREVA, RAISA 881 C-Ç
BOJOVIć, PREDRAG 780 CABIOGLU, NESLIHAN 91
BÖLER, DENIZ EREN 91 CABRERA, MONTSERRAT ESTORCH 478
BOLUKBASI, KUBILAY 292 ÇAKABAY, BAHRI 229
BORA, SEYMEN 101 ÇAKIR, COŞKUN 134
BOSTANCI, ERDAL B. 165 ÇAKIR, MURAT 390, 558, 653, 674, 675
-907-
CAKIR, OZCAN 743 CELASIN, HAYDAR 100, 611
ÇAKMAK, ATIL 366, 367 CELAYIR, FEVZI 41, 273, 474, 475, 804, 825,
ÇAKMAK, AYTEK 769 826
CAKMAK, GULDENIZ KARADENIZ 17 ÇELEBİ, AYSE ESRA 191
CAKMAK, GUNER 397, 887 CELEP, BAHADIR 295, 350, 561, 615, 807, 820
CALAY, ZERRIN 226 CELİK, AKGUN 437
CALDARALO, FRANCESCO 137 CELIK, ATILLA 214, 547
CALIK, ADNAN 118, 573, 734 CELIK, AYKUT FERHAT 339, 340
ÇALIKAPAN, MURAT 218, 220, 243 CELİK, AYSUN SİMSEK 437
CALIN, TIU 188 CELIK, EMIN 532, 757
CALISKAN, CEMIL 163, 322 ÇELIK, EMIN 554
CALISKAN, MUJGAN 197, 235, 240, 247, 348, CELIK, GIRAYHAN 255, 405, 406, 556, 838
408, 451, 485, 560, 614, 735 ÇELIK, GÜRHAN 786
CALISKAN, MÜJGAN 462 ÇELİK, GÜRHAN 502
ÇALIŞKAN, MÜJGAN 81, 349, 442, 456, 469 ÇELİK, HAKİM 533
CAMLIBEL, AHMET MITHAT 200 CELIK, HAMIT KAFKAS 795
CAMLIBEL, MITHAT 230 CELIK, M. FERHAT 205, 372, 449
CANADELL, JUAN CARLOS PERNAS 286 CELIK, SERKAN YASAR 297
CANAN, FATIH 308, 312 ÇELIKU, ETMONT 759
CANBAK, TOLGA 197, 235, 240, 247, 344, 348, CELIK, YUSUF 701
349, 402, 469, 485, 614, 666, 735, 737 ÇERMIK, FIKRET 245
CANBAY, EMEL 270, 316 CERO, IBRAHIM 70, 725
CANDA, ARAS EMRE 122, 177, 248, 263, 266, ÇETİNAYAK, OĞUZ 263
319, 320, 321, 886 CETINER, SAADETTIN 610
CANDEMIR, GULTEKIN 292 CETINKUNAR, SULEYMAN 721
CANKAYA, ATILLA 372 ÇETİNKÜNAR, SULEYMAN 576
CAN, MEHMET FATIH 148, 395, 487, 676 ÇETİNKÜNAR, SÜLEYMAN 807, 820
CAN, MEHMET FATİH 464, 856 ÇETİN, MEHMET MUSTAFA 308
CAN, MEHMET LEVENT 662 CETIN, RECEP 255, 404, 405, 406, 556, 647,
ÇAN, MURAT 669, 670 838, 839, 866
CANTÜRK, NUH ZAFER 88, 233 CETİNTAS, DEMİR 407
ÇAPAR, MUZAFFER 466 CEVAHİR, NURAL 387
ÇAPKINOĞLU, EMIR 818 CEVHEROĞLU, SELMAN 835
CAPORILLI, DANIELA 624 CHAICHIAN, SHAHLA 798, 799
CARİLLİ, SENOL 368 CHAN, SHIRLEY 455
CARONNA, ROBERTO 746 CHARLOTTE, VERCAUTEREN 180, 752, 797
CARO, RAQUEL DOMINGUEZ 94, 683 CHATTERJEE, ABHISEK 444
CARTI, ERDEM 592, 656 CHAWLA, TABISH 557
CARTI, ERDEM BARIŞ 246, 374, 375, 376 CHENG, YUHMİN 419
CARUANA, CLIFFORD 672 CHERNOV, ANDREY 289
CASIAN, DUMITRU 358 CHIRLETTI, PIERO 746
CASSAR, KEVIN 68 CHIVATE, SHANTIKUMAR 291
CASSAR, NOEL 90 CHKHAIDZE, ZURAB 150, 429, 444
CASSIMAN, DAVID 16 CHO, CHOL KYOON 709
CATALANO, SILVIA 492 CHO, CHOLKYOON 649
CATANHO, CAROLİNA 411 CHOI, BYUNG GWAN 709
CATANIA, ANTONIO 43 CHOI, BYUNGGWAN 649
CAUWENBERGE, SEBASTIAAN VAN 520, 521 CHO, SEUNG HYUN 709
CAUWENBERGE, SEBASTİAAN VAN 794 CHO, SEUNGHYUN 649
ÇAYCI, BANU 715 CIAMBERLANO, BERNARDO 624
CAYCI, MURAT 50, 105, 584, 586 CIAMPORCERO, TERESA 492
ÇEKMEN, MUSTAFA 233 CICEK, ALI FUAT 151
ÇELA, ALBANA 759 ÇİÇEK, YUSUF 504
-908-
CIFTCI, ALI 270 CULIUC, VASILE 358
CIHANGIROĞLU, GULÇIN 707 CULPIN, ELIZABETH 461
CIJAN, VLADIMIR 780 CUNEYT, KAYAALP 713
ÇIKOT, MURAT 591
ÇINAR, CELAL 742 D
ÇINAR, HAMZA 893 DADA, H. GÖZDE MUHAFIZ 370
CINGI, ASIM 634, 736, 834 DAĞ, BİRGÜL 856
CINGOZOGLU, CARLOS AUGUSTO CUTINI 546, DALGIC, AYDIN 661
631, 632, 767, 819 DALGIC, TAHSIN 50, 105, 165, 584, 586
CIN, NECAT 317, 548 DALGIÇ, TAHSIN 140, 722
CIPE, GOKHAN 184 DALGIÇ, TAHSİN 52, 325, 710
ÇİPE, GÖKHAN 162, 250, 275, 314, 806 DÁLMEİDA, JOãO RAPOSO 411
CITGEZ, BULENT 203, 477, 490 D’AMBROSİO, ERASMİNA 117
CITGEZ, BÜLENT 201, 826 DANACI, MURAT 669
ÇITGEZ, BÜLENT 530 DANDIN, ÖZGÜR 210, 249, 525
CLARKE, LEWIS 385 DANDİN, ÖZGÜR 218, 220, 243, 257, 414, 415,
CLOS, MONTSERRAT 207, 467 416, 417, 773
COBAN, GOKCEN 787 DANIELA, KNIEPEISS 20
COKER, AHMET 720 DAPHAN, CAGATAY 894
ÇOKER, AHMET 684, 742 DAPHAN, ÇAĞATAY 517
ÇOLAK, M.HALDUN 471 DAPHAN, CAGATAY ERDEN 362, 761, 762, 763
COLAKOGLU, MUHAMMET KADRI 50, 89, 105, DAS, KORAY 199, 719, 721
200, 486, 584, 586, 812 DAŞ, KORAY 511, 576
COLAK, TAHSIN 301 D, DEEVISH N 651, 728
ÇÖL, CAVİT 716 DEBONO, JOSEPH 90, 95
ÇOLHAN, IBRAHIM 350 DEDE, HAKAN 698
ÇOLHAN, İBRAHİM 427, 807 DEGER, CUMHUR 576
COLINA, ALBERTO 279, 280 DEMETRIADES, DEMETRIOS 61, 62, 176, 443,
COLUZZI, MARIAGRAZIA 624 450
COMERT, MUSTAFA 17, 346 DEMİRBAĞ, SUZİ 67
CONSTATINO, JúLIO 440 DEMIRBAS, BULENT 377, 378, 532
CONTE, ANNALISA LO 124 DEMIRBAS, SEZAI 254, 395
CONTINO, LUCIANA 546, 631 DEMIRBAŞ, SEZAI 30
COŞAR, ALPASLAN 855 DEMİRBAŞ, SEZAİ 369
COSKUN, ALI 592 DEMIRBAŞ, TOLGA 736
COŞKUN, ALI 656 DEMIRCAN, FIRAT 110
COŞKUN, ALİ 246, 264, 374, 375, 376, 535 DEMİRCİ, ERKAN 538
COSKUN, ALI KAGAN 278, 658 DEMIRCI, NIZAMETTIN 652
COSKUN, ALİ KAGAN 657 DEMIRCI, ROJBIN KARAKOYUN 351
COŞKUN, ALI KAĞAN 698 DEMIRCI, SALIM 229
COSKUN, CIHAN 605 DEMIR, EBRU OFLUOGLU 17
COŞKUN, FARUK 789 DEMİRER, SEHER 875, 877
COŞKUN, HALIL 806 DEMIRGÜL, RECEP 125, 555, 836
COŞKUN, HALİL 162, 275 DEMIR, HAKAN 233
COŞKUN, İRFAN 617, 810 DEMIR, HALE 226
COSKUN, KAGAN 30 DEMIRKAYA, AHMET 606
COŞKUN, MÜMIN 14 DEMİR, MUSTAFA 399
COSKUNPİNAR, ENDER 316 DEMİRTURK, PELİN 199
COSTANTINI, RAFFAELE 137 DEMIR, UYGAR 55, 571, 601
COSTEL, NECOARA 671 DEMİRYAS, SÜLEYMAN 504
CRISTIAN, BADIU 671 DE, MRIGANKA 45
CÜCE, FERHAT 249, 773 DENIZTAS, CEMAL 373, 587
CULCU, DENIZ 386 DENIZ, VEDAT 297
-909-
DENKBAŞ, EMİR BAKİ 896 DUMAN, MUSTAFA 99, 165, 581, 629
DERİCİ, HAYRULLAH 872 DUMAN, UGUR 165, 581
DERICI, SERHAT TOLGA 120, 327 DUMAN, UĞUR 210, 541, 652, 824, 837
DETTORI, GIUSEPPE 28, 274 DUMLU, GURKAN 378, 532, 756, 757, 785
DEVECI, KOKSAL 65, 383, 434 DUMLU, GÜRKAN 206, 473, 488, 822
DEVECI, SALIH 487 DUMLU, GURKAN ERSİN 717
DEYLGAT, BERT 520 DURAK, DOĞUKAN 853
DIACONESCU, MIHAI RADU 78, 596 DURAL, AHMET CEM 64, 135, 205, 370, 371,
DIKEN, TULAY 738 372, 373, 431, 447, 449, 465, 495, 496, 531,
DIKICIER, ENIS 231, 397, 887 585, 587, 595, 702, 884
DIKMEN, KURSAT 613 DURAL, CEM 306
DILEGE, M. ECE 205, 372, 884 DURAL, ÖZLEM 370
DILEK, OSMAN NURI 231, 359, 396, 397, 714, DURAN, EYUP 193, 292, 293, 364, 395, 484,
829, 887 487, 657, 658, 828
DİLEK, OSMAN NURİ 403 DURUSU, MURAT 400
DILLEMANS, BRUNO 520, 521 DUSAK, ABDURRAHIM 705
DİLLEMANS, BRUNO 794 DUZKOYLU, YIGIT 637, 854
DINC, HASAN 734
DINC, SOYKAN 89, 812 E
DINÇ, TOLGA 789 EARDLEY, NICOLA 307
DIRICAN, ABUZER 677, 678, 713 ECE, ILHAN 435, 667
DOBRA, BİNNUR KARAGÖZ 786 EFFENDI, MUHAMMAD SHAHRUKH 82, 557,
DOĞANAY, MUTLU 875, 877 869, 883
DOĞAN, HALDUN 164 EFSTATHIOU, ELIAS 121, 169, 328
DOGAN, LUTFI 230, 817 EGE, BAHADIR 168, 331
DOGAN, MAHMUT 64, 449 EGELI, TUFAN 297, 578, 692, 693, 694
DOGAN, MEHMET BAKI 764 EGEMİS, EMİNE 894
DOĞAN, PAŞA 784 EKER, TEVFIK 296
DOĞAN, SAİT MURAT 850 EKER, TEVFİK 367
DOĞAN, SERHAT 388 EKICI, YAHYA 332, 753
DOĞRUL, AHMET BÜLENT 191 EKİCİ, YAHYA 612
DOĞRU, OSMAN 190, 512, 513, 859 EKINCI, NESE 356, 508
DOLAY, KEMAL 718 EKİZ, FEZA 83, 879
DOLEY, R P 426, 575 EKMEKCIGIL, ELA 163
DOLEY, RUDRA PRASAD 871 EKMEKCİGİL, ELA 720, 742
DOM, SEDAT 362, 761, 762, 763, 815, 894 EKMEKÇIGIL, ELA 80
DÖM, SEDAT 517 ELBIR, ORHAN 584
DONMEZ, CEM 757 ELENA, RADU VIOLETA 671
DONNELLY, PATRICIO E. 546 ELPEK, ÖZLEM 290
DORIS, WAGNER 20, 29, 145, 697 ELS, VAN DESSEL 181
DRAKOPOULOS, SPYROS 452 ELTZ, STEPHANIE 864
DREWNIAK, JUSTYNA 599 EMER, ÖZDEŞ 79
DROSTE, JAN 847 EMİRKADİ, HAKAN 407
D›SOUZA, NIGEL 712 EMIROĞLU, GÜLRUH 80
DUARTE, ANTONIO MORAL 94, 219, 234, 242, EMIR, SEYFI 583, 707, 783
478, 498, 841 EMİR, SEYFİ 424, 574, 777, 843
DUBUS, TURKAN 764 EMRE, ALİ 368
DUCH, JOAN 207 EMRE, ALI UGUR 17, 19, 346
DUGER, CEVDET 65 EMRE, ARIF 569, 570, 772
DÜLGER, MUSTAFA 233 ENHOS, SULTAN AKAYKUCUK 214, 547
DULGEROGLU, ONUR 548 ENRIQUEZ, MONTSERRAT CLOS 94
DULUNDU, ENDER 14 ENRRIQUEZ, MONTSERRAT CLOS 219, 234,
DUMAN, KAZIM 277, 432, 610 242, 498, 841
-910-
ENSARI, CEMAL 579, 696, 779, 845 ERSOZ, NAIL 151, 224, 293, 828
ENSARI, CEMAL OZBEN 311 ERSÖZ, NAIL 260, 816
ERBAŞ, İBRAHIM 273 ERSÖZ, NAİL 636
ERBIL, OZAN ANDAC 569, 570, 772 ERTAN, YEŞIM 80
ERBIL, UMIT ABANUZ 569, 570, 772 ERYILMAZ, MEHMET 67, 400
ERCAN, GULCIN 214 ERYILMAZ, MEHMET ALI 125, 423, 555, 648,
ERCAN, İLKER 152 835, 836
ERCAN, K. DENİZ 390 ERYILMAZ, RAMAZAN 311, 579, 696, 779, 845
ERCAN, METIN 50 ERZIN, YUSUF 339
ERCAN, METİN 52, 325, 710 ESEN, EBRU 366, 650
ER, CEMIL 648 ESEN, HACI HASAN 558, 674
ERÇETIN, CANDAŞ 306 ESER, MEHMET 75, 96, 236, 238, 605
ERÇETİN, CANDAŞ 370 ESER, METIN 554, 785
ERÇIN, CENGIZ 233 ESER, METİN 377, 553, 756
ERDAMAR, SIBEL 345 ESTORCH, MONTSERRAT 207
ERDEM, ALI FUAT 211 ETÖZ, ABDULLAH 243
ERDEM, HASAN 560, 576, 721 EVREN, ISMAIL 560
ERDOĞAN, GÜLGÜN 290 EYI, YUSUF EMRAH 400
ERDOGAN, OKAN 290 EYVAZ, KEMAL 75, 96, 236, 238, 605
EREL, SERAP 875, 877
EREM, AYSİN DURAL 154, 865 F
EREM, HASAN HAKAN 154, 251, 865 FABER, EDMOND 409, 425
EREN, MUSA SINAN 738 FABİANİ, ELİSABETTA 43
ERENOĞLU, CENGIZ 616 FAKI, AKIN 180, 181, 182, 752, 797
ERGONENC, TOLGA 211 FARACOV, RASİM 720
ERGUL, EMRE 827 FARAJOV, RASIM 519
ERGUNER, ILKNUR 339, 340, 606 FARAJOV, RASİM 684
ERGUNER, İLKNUR 159 FARELLI, FRANCESCO 746
ERGÜNEY, SABRİ 602 FARRUGIA, JAMES 95
ERICH, SORANTIN 697 FELESHTYNSKY, YAROSLAV 149, 781
ERIKOGLU, MEHMET 667 FERHATOGLU, MURAT FERHAT 201, 202, 203,
ERİKOĞLU, MEHMET 675 477, 490, 491, 750
ERIS, CENGIZ 353, 354, 355, 398, 663, 743 FERHATOĞLU, MURAT FERHAT 530
ERIŞ, CENGIZ 15, 136, 363, 514, 673 FERLENGEZ, EKREM 437
ERKAN, NAZIF 656 FERNáNDEZ, ESTELA MEMBRILLA 27, 155
ERKAN, NAZİF 246, 374, 375, 376, 592 FERNANDEZ, JOSE LUIS 882
ERKEK, A.BULENT 296 FERRANDO, VALTER 158, 343
ERKEK, AYHAN BULENT 129 FERRARO, VALENTINA 489
ERKOL, HAYRİ 716 FERRARO, VALENTİNA 117
EROLER, EMIR 210, 824 FIEUWS, STEFFEN 116, 740
EROL, FATIH 541, 652 FILIZ, ALI ILKER 198
EROL, MEHMET FATIH 837 FILIZ, ALI İLKER 221, 241, 327
EROZGEN, FAZILET 625 FIORDALISO, MICHELE 137
EROZGEN, FAZİLET 589 FIRAT, DENIZ 314
ERSIN, SINAN 577, 597 FIRAT, ÖZGÜR 577, 597
ERSOY, BURAK 448, 453 FIRAT, PINAR 37
ERSOY, EREN 719, 827 FIRIDIN, SADIYE NUR 345
ERSOY, OMER FAIK 703 FLORIAN, IBERER 20
ERSOY, PAMIR EREN 33, 153, 338, 823 FOLCH, MANEL TRIAS 94
ERSOY, PAMİR EREN 537 FOLCH, MANUEL TRIAS 128, 219, 234, 242,
ERSOY, YELIZ EMINE 184, 314, 806 285, 286, 418, 478, 498, 683, 841
ERSOY, YELİZ EMİNE 250 FOMIN, PETER 107
ERSOZ, FEYZULLAH 764 FOMIN, PETRO 54, 881
-911-
FOMOCHKIN, IVAN 690 GÖNEN, AYSE NUR 707
FRAENEN, DONALD VAN DER 520, 521, 794 GÖNEN, CAN 644
FRAGASSI, FRANCESCO 489 GONENC, MURAT 135, 371, 431, 447, 449,
FRAGASSİ, FRANCESCO 117 465, 531, 702
FRAGERO, MARíA JOSé PONS 27, 155 GONULLU, DOGAN 315, 482
FRANÇA, NUNO 411 GORANOV, NIKOLAY 217
FRANCIS, GOUDSMEDT 180, 181, 182 GORDON, ALEXANDRA 304
FRONZO, PASQUALE DI 489 GORDON, ANDREW CHARLES 712
FUZUN, MEHMET 177, 266, 320 GORGULU, SEMIH 40, 47, 223, 224, 225, 237,
FÜZÜN, MEHMET 263 484
GORGULU, SEMİH 501
G GÖRGÜLÜ, SEMİH 79
GALLO, GAETANO 103 GORKEN, ILKNUR 122
GAMSIZKAN, MEHMET 223, 365, 524 GORSE, SARAH HEMINGTON 868
GARAS, GEORGE 45, 86 GORYELOV, ILYA 410
GARCíA-BLANCH, GONZALO 599 GOUDSMIDT, FRANCIS 521
GARCIA, JOSE IGNACIO PEREZ 94, 219, 234, GOUDSMİDT, FRANCİS 794
242, 478, 498, 841 GOURGIOTIS, STAVROS 113, 452
GASIMOV, ELNUR 679, 770 GÖZALAN, UĞUR 479, 480
GASPARRI, GUIDO 492 GRASES, JUAN EMMANUEL DANES 599
GAVELLO, GIORGIA 492 GRECO, ROBERTO 43
GECER, MELIN 236, 238 GREGORY, SIMPSON 307
GECIM, ETHEM 296 GREWAL, SUPREET 426, 575
GEDIK, MEHMET LARI 315 GRIMA, MATTHEW JOE 68
GELDIGITTI, TUNA 718, 801 GRINCHESKU, ALEKSANDR 870
GEMENETZIS, GEORGE 452 GUAITOLI, ELEONORA 43
GEMICI, EYUP 373, 465 GUEDES, VİTOR MOURA 411
GENÇ, ECE 99 GULAY, HUSEYIN 101
GENÇ, LEVENT 656 GÜLBEN, KAPTAN 833
GEORGI, MINKOV 66, 222, 299, 731 GULCELIK, M.ALI 230
GEORG, WERKGARTNER 20, 29, 145, 697 GULCELIK, MEHMET ALI 89, 200, 486, 812
GERAYZADE, RENA 294, 590 GULCELIK, NESE ERSOZ 486
GERBALI, OKSANA 747 GÜLCÜ, BARIŞ 123, 329
GEZEN, FAZLI CEM 130, 335 GÜLEÇ, BÜLENT 221, 855, 857
GHANEM, ABBAS 800, 885 GÜLER, ADEM 577, 597
GHASOUP, ASEM 208, 646 GULER, S.ATA 216
GHAZAL, ABDELHAMID 232, 261, 638 GUL, EVRIM 783
GHIGLIONE, FRANCESCO 492 GULLUOGLU, BAHADIR M. 216
GIACCAGLIA, VALENTINA 124, 341 GUL, MESUT 701
GIORGOBIANI, GIORGI 144 GÜL, NURDAN 42
GIRGIN, SADULLAH 701 GULOTTA, GASPARE 161
GJATA, ARBEN 409 GULPINAR, KAMIL 100, 611
GOKAKIN, ALI KAGAN 65, 189, 381, 382, 383, GULTEKIN, FATMA AYCA 17, 19, 346
434, 600, 723 GÜLTEKİN, SALİH SİNAN 807
GOKCE, EMRE 771 GULUMSER, FARUK 270
GÖKCE, EMRE 778 GUMRUKCU, GULİSTAN 387
GOKCEIMAM, MEHMET 96 GUMUS, HATICE 701
GOK, ILHAN 205, 431 GUMUS, MAHMUT 605
GOKLER, CİHAN 199 GÜMÜŞ, TÜLIN 488
GÖKLER, CIHAN 511 GUNAL, ARMAGAN 364
GOLUB, DMITRIY 107 GÜNAL, NESIMI 815
GOLUB, DMYTRO 269, 302 GÜNAL, ÖMER 14, 736
GOMES, ALINE 440 GUNAY, EMRE 353, 354, 355, 398, 663, 743
-912-
GÜNAY, EMRE 15, 136, 363, 514, 673 HARLAK, ALİ 428
GUN, BANU DOGAN 346 HARRIES, RHIANNON 304
GÜNDEŞ, EBUBEKIR 390, 470, 653 HASBAHCECI, MUSTAFA 184, 235, 240, 344,
GÜNDEŞ, EBUBEKİR 388, 389, 471, 558, 674, 614, 735, 737, 793
675 HASBAHÇECI, MUSTAFA 314
GUNDOGDU, HALDUN 719, 827 HASBAHÇECİ, MUSTAFA 162, 275, 349, 806
GÜNDOĞDU, KEMAL 403 HASDEMİR, AHMET OĞUZ 807, 820
GUNDOGDU, RAMAZAN 301 HASDEMIR, OĞUZ 350
GÜNDOĞDU, RIZA HALDUN 33, 153, 338, 823 HASHAD, DOAA 232
GUNDUGDU, KEMAL 396 HASLAK, ADNAN 543
GÜNDÜZ, UMUT 538 HATEMI, İBRAHIM 340
GUNDUZ, YASEMIN 396, 397 HATIPOĞLU, AHMET RAHMI 616, 617
GUNERHAN, YUSUF 115, 563, 730, 738, 739 HATİPOĞLU, AHMET RAHMİ 810
GÜNER, YUSUF 331 HATİPOĞLU, ENGİN 602
GUNES, MEHMET EMIN 318, 543, 637, 854 HAVVA, ÜLKER 220
GÜNEŞ, MEHMET EMİN 502, 786 HAZER, BATUHAN 415, 417
GUNGOR, FIRAT 284 HAZINEDAROGLU, SELCUK 650
GUNYELI, ILKER 404 HELMUT, MÜLLER 20
GÜRBULAK, ESIN KABUL 529, 530 HOBZEY, NIKOLAY 881
GÜRBULAK, ESN KABUL 203 HONNANI, SHARATH S 106
GURBUZ, EMIN 660 HOŞCOŞKUN, CÜNEYT 577, 597
GÜREL, DUYGU 263 HOŞCOŞKUN, ZEKI 616
GÜREL, MEHMET 258 HUANG, PENGJU 419
GURER, AHMET 377, 378, 532, 534, 717, 756, HUNDIA, VIKRAM 847
757, 785, 822 HUR, YOUNG HOE 709
GÜRER, AHMET 206 HUR, YOUNHHOE 649
GÜRER, SEZER 290 HUT, ADNAN 625
GURRADO, ANGELA 117, 489
GÜRSEL, MAHMUT FIKRET 669, 670 I-İ
GURSOY, GOKTURK 505 IACUB, VLADIMIR 594
GUR, UFUK 276 IARYNKO, DARIIA 146
GUTSU, EVGHENII 358, 394, 594 IBERER, FLORIAN 145
GUVEN, HAKAN 214, 547, 659 İBIŞ, ABDIL CEM 616, 617, 810
GUZEL, HAKAN 771 IBUKIC, AMIR 167, 265
GÜZEL, HAKAN 427 İÇÖZ, GÖKHAN 80
GUZEY, DENIZ 205, 372, 585, 884 I., DEMİRYILMAZ 898
GUZUN, VASILE 394, 594 IDIZ, OĞUZ 275
GVENETADZE, TAMAZ 144, 150, 429, 444 İGCİ, ABDULLAH 93
IGDEM, AYSENUR 482
H IGLESIAS, VALERIA EVANGELISTA 819
HACIYANLI, MEHMET 271, 508, 544, 654, 655 ILHAN, MEHMET 371
HAITHAM, ALFALAH 800, 885 ILINGI, ELIF DEMIR 115, 730, 738, 739
HAJIYEV, KAMIL 770 İLVAN, ŞENNUR 226
HAKYEMEZ, İSMAİL NECATİ 559 INABA, KENJI 61, 62, 443, 450
HALKIA, EVGENIA 121, 169, 328 INCE, MEHMET 300
HAMADE, AYMAN 21 INCE, VOLKAN 635
HAMZAOGLU, HULYA OVER 339 INCI, ERCAN 495
HAMZAOGLU, ISMAIL 339, 340, 606 INCI, IRFAN 118, 734
HANCERLİOGULLARI, OGUZ 271, 654 INNOCENTI, PAOLO 137
HANÇERLI, SEDA 776, 889 INSENSER, JUAN J. SANCHO 27, 155
HARCHUK, OLEKSIY 665 IONUT, VICOL DRAGOS 671
HARILINGAM, MOHANRAJ 510 IPÇIOĞLU, OSMAN METIN 857
HARLAK, ALI 278 IQBAL, JAVERIA 141, 215
-913-
İREM, BURAK 427 KALEMOGLU, MURAT 284
İRGİL, CEYHUN 218, 220, 243 KALKANCI, AYŞE 715
İRGİL, SEDAT 220 KALRA, G. S 871
IRKKAN, SULTAN CIGDEM 200 KAMA, NURI AYDIN 479
İRKÖRÜCÜ, OKTAY 576 KAMA, NURİ AYDIN 480
ISAAC, JOHN 711 KAMER, ERDINC 271, 356, 508, 544, 654, 655
ISAYEV, HIDAYET 641 KAMINSKY, IGOR 747
ISCAN, YALIN 131, 253 KAMOCKA, ANNA 712
İŞCAN, YALIN 37, 42, 53, 74, 493 KANAT, BURHAN HAKAN 424, 707, 777, 783,
İŞÇİ, AHSEN 312 843
ISGOR, ADNAN 41, 474, 475 KANAT, HAKAN BURHAN 574
ISIK, ARDA 536 KANDEMİR, EYÜP 83, 879
ISIK, BURAK 677, 678, 713 KANIKOVSKY, OLEG 550, 551, 665
IŞIK, ÖZGEN 608 KANKAYA, BURAK 372, 531
ISIL, CANAN 601 KANMAZ, TURAN 23, 111, 699, 700
ISIL, GURHAN 571, 601 KANNA, EFTHYMIA 113
ISLIM, FILIZ 702 KAPLAN, ANDRES 819
ISMAIL, ERKIN 650 KAPLAN, CENGİZ 773
İSMAİLOV, ILGAR 79 KAPLAN, İ. RAFET 437
İSMAYİLOV, ILGAR 754 KAPLAN, RAFET 589, 625
KAPOOR, RAJEEV 426, 575
J KAPRAN, YERSU 131, 166, 370, 604
JAFARLI, RASIM 421, 686, 687, 688 KAPTANOGLU, LEVENT 96
JAFAROV, ELKHAN 686 KARABIÇAK, İLHAN 288, 669, 776, 889, 893
JAMALİ, SHAHBANO 503 KARABUĞA, TÜRKER 863
JAN-PAUL, MULIER 181 KARABULUT, MEHMET 371, 373, 431, 447,
JAVED, IMRAN 71 585, 587, 884
JAVED, MUHAMMAD 868 KARABULUT, ZÜLFIKAR 227, 784
JÖRG, MISCHINGER HANS 29, 697 KARACA, AHMET SERDAR 466, 719
JOSHI, ATUL 426, 575 KARACA, CAN 163, 322
JOSHI, ATUL SHARMA 871 KARACA, CEZMİ 850
JOVIAL, D’SOUZA 800, 885 KARAÇETIN, DIDEM 245
KARADAYI, KURSAT 433, 848
K
KARADAYI, KÜRŞAT 849
KABAK, ISMAIL 247, 344, 402, 666
KARADAYI, SULE 849
KABUKÇUOĞLU, FEVZIYE 825
KARADEMIR, SEDAT 692, 693, 694
KADIOGLU, HUSEYIN 184
KARAGÖZ, ALI 423
KADIOĞLU, HÜSEYIN 88, 806
KARAGULLE, ERDAL 787, 892
KADIOĞLU, HÜSEYİN 250, 275
KARA, HALIL 91
KAHRAMAN, AYSEGUL SAGIR 622
KARAHAN, ÖMER 125, 423, 555, 648, 835, 836
KAHRAMANCA, SAHIN 542, 771
KARAHAN, SERVET 659, 660, 718, 801
KAHRAMANCA, ŞAHIN 350
KARAHASANOGLU, RİDVAN 515
KAHRAMANCA, ŞAHİN 295, 427, 778
KARAHASANOGLU, TAYFUN 340, 345, 606
KAHRAMANSOY, NURETTİN 716
KARAKAŞ, BARIŞ 192, 351, 538
KAHYAOGLU, ZEYNEP 231
KARAKAŞ, DURSUN ÖZGÜR 198, 221, 249, 415,
KALAIDOPOULOU, OURANIA 169
417, 790, 855, 857, 861
KALAYCI, MUSTAFA U. 64, 135, 373, 431, 447,
KARAKAS, SERDAR 31
585, 587, 595, 884
KARAKAYA, ARİF 83, 879
KALAYCI, MUSTAFA UYGAR 591
KARAKAYALI, FEZA 332, 695, 877
KALAYCI, ORHAN 734
KARAKAYA, M.ARIF 496
KALAYOGLU, MUNCI 23, 111, 700
KARAKELLEOGLU, CIHAT ATILLA 750
KALCAN, SULEYMAN 402, 552, 737
KARAKELLIOĞLU, ATILLA 134
KALCAN, SÜLEYMAN 442
KARAKOYUN, MUSTAFA 538
KALDIRIM, UMIT 400
-914-
KARAKOYUN, ROJBIN 805 KEBAPCI, EYÜP 850
KARAKOYUN, ROJBİN 538 KEFELI, UMUT 605
KARAKURSAKOV, NARIMAN 410 KEH, CHRIS 309
KARAKUS, ALI 422 KELES, AYSENUR 701, 846
KARAKUS, BORAN CIHAT 65, 189, 381, 600, KELLY, JAMIE 832
723 KEMENT, METIN 96, 130, 236, 238, 335, 605
KARAMAN, KEREM 615 KEMIK, AHU 660
KARAMAN, NIYAZI 44, 76, 256, 817 KENDIRCI, MURAT 60, 347, 821
KARAMAN, NİYAZİ 875, 877 KEREM, MUSTAFA 613
KARAMANOS, EFSTATHIOS 61, 62, 176, 450 KERIMOĞLU, RAMAZAN SAYGIN 140, 479
KARANLIK, HASAN 131, 324, 598, 604 KERİMOĞLU, RAMAZAN SAYGIN 480, 710
KARATEKE, FARUK 199, 511, 719, 721 KESICIOĞLU, TUĞRUL 669
KARATEPE, OGUZHAN 490 KESICI, SEVGI 259
KARATEPE, OĞUZHAN 162, 250, 275, 314 KESICI, UGUR 259
KARGICI, HULAGU 505 KESMER, SADIK 337
KARGI, ERTUĞRUL 233 KHACHATRYAN, TIGRAN 852
KAR, HALDUN 317, 548 KHAN, AFAQ ZAMAN 503
KARIP, AZIZ BORA 795, 805 KHAN, ASIF 864
KARSIDAG, TAMER 515 KHAN, IQBAL 503
KARSLIOGLU, YILDIRIM 293 KHAN, MAJOR ASAD ZAMAN 503
KARTAL, ABDULCABBAR 529, 530 KHANOYAN, ARMEN 852
KARTAL, ABDÜLCABBAR 825 KHAN, RIZWAN 741
KARTAL, A CABBAR 474 KHAN, USMAN 385
KARTAL, ADIL 435 KHILKO, SERGIY 690
KARTAL, ADİL 558, 653, 674, 675 KHOLEIF, YASSER 506
KASSEM, MOHAMED 261, 638 KHOSROSHAHİ, SEMİRA MOUSAVİ 138, 726
KASTRINAKI, KALIOPI 121 KIKOYAN, HAYK 852
KATEV, NIKOLAY 217 KILAVUZ, OGUZHAN 448
KATORKIN, SERGEY 289 KILBAS, ZAFER 223, 224, 225, 228, 237, 483,
KATTEPUR, ABHAY 651 484, 501, 828
KAUR, GEETINDER 174, 330, 333, 446, 461, KILBAŞ, ZAFER 79, 204
463 KILIÇ, ABDULLAH 30
KAVLAKOĞLU, BURAK 424, 574, 707, 777, 843 KILIC, ALI 247, 326, 344, 402, 485
KAYAALP, CUNEYT 31, 457, 460, 858 KILIÇ, ALİ 469
KAYAALP, CÜNEYT 540 KILIC, FATIH 795
KAYA, BULENT 354, 704, 743, 805 KILIC, MEHMET 534, 542
KAYA, CEMAL 55, 571, 601 KILIÇ, MEHMET 206, 378, 472, 473, 488, 532,
KAYA, CENGIZ 642, 758 553, 554, 756, 757, 785, 822, 853
KAYA, EKREM 22, 774 KİLİC, MEHMET 717
KAYA, ERKAN 773 KILIÇOGLU, Z.GAMZE 663
KAYA, HANDAN 216 KILICTURGAY, SADIK 22
KAYAHAN, SİBEL 629 KILINÇ, IBRAHIM 377, 378
KAYA, MUSTAFA 81, 402 KILINÇ, İBRAHIM 488, 554
KAYAOGLU, HUSEYIN AYHAN 36, 58, 89, 98, KILINÇ, İBRAHİM 206, 553, 822
334, 357, 497, 509, 618, 619, 620, 703, 729, KILINÇ, SELÇUK 850
744, 791 KIM, CHOONG YOUNG 709
KAYAOĞLU, HUSEYIN AYHAN 621 KIM, CHOONGYOUNG 649
KAYA, OSKAY 771 KIM, DONG YI 588
KAYA, OZLEM 886 KIM, DONGYI 549
KAYAPINAR, ALİ KEMAL 52, 325 KİM, DONGYİ 593
KAYILIOĞLU, SELAMİ ILGAZ 518 KIM, HEE JOON 709
KAYMAK, SAHIN 224 KIM, HEEJOON 649
KAYNAK, ADNAN 470 KIM, HOGOON 549
-915-
KİM, HOGOON 593 KOVACEVIC, DUJO 167, 265
KİM, HO GUN 588 KOYUNCU, AYHAN 381, 382, 383, 600, 723
KIMILOGLU, ELIFE 315 KOZAK, ORHAN 483, 880
KINACI, ERDEM 318, 543, 786 K., PEKER 898, 899
KINAŞ, VOLKAN 833 KRAND, OSMAN 272
KING, HANNAH 864 KRISHNAN, ARUNKUMAR 112, 454, 724, 727
KIRDAK, TURKAY 77, 774 KRYSHEN, VALERY 32, 146, 788, 890
KIRDAK, TÜRKAY 500 KRZAK, JAN M. 867
KIREMITÇI, SABA 229 KUCUKALIOGLU, SERDAR 840
KIR, GÖZDE 81 KÜÇÜKBAYRAK, ABDÜLKADİR 559
KIRNAP, MAHIR 46, 306, 612, 695, 844 KUCUKERDONMEZ, OZGE 300
KISAOGLU, ABDULLAH 287 KUCUK, GULTEKIN OZAN 212
KİSA, UCLER 894 KÜÇÜK, GÜLTEKIN OZAN 769
KIVILCIM, TANER 231, 359, 397 KÜÇÜKKARTALAR, TEVFİK 653
KIYAK, GULTEN 377, 378, 534, 756, 757, 785 KÜÇÜKKARTALLAR, TEVFIK 390, 435, 667
KIYAK, GÜLTEN 206, 822 KÜÇÜKKARTALLAR, TEVFİK 388, 389, 470, 471,
KIZILKAYA, MEHMET CELAL 589, 625 558, 674, 675
KLYUZKO, IVAN 298 KÜÇÜKODACI, ZAFER 855, 857
KNIEPEISS, DANIELA 145 KUCUKPINAR, TEVFIK 771
KOCAAY, AKIN FIRAT 650 KÜÇÜKPINAR, TEVFIK 350
KOCA, BÜLENT 288, 668, 893 KÜÇÜKPINAR, TEVFİK 295, 427, 778, 807, 820
KOCAEL, PINAR 412, 436, 566, 567, 568 KUCUKYILMAZ, MELTEM 637, 854
KOCAK, SAVAS 468 KUDRYAVTSEV, ANDRIY 146, 788
KOÇAK, SAVAŞ 88 KULAC, ESIN 866
KOCAKUSAK, AHMET 764 KULACOGLU, HAKAN 542
KOCATAS, ALI 64, 135, 447, 495, 496, 531, KUL, FATIH 77
585, 595 KULIG, JAN 57, 607
KOC, BORA 659, 660, 718, 801 KULIG, PIOTR 57
KOC, DURUCAN AYDIN 129 KULU, RIDVAN 476
KOCKAYA, GUVENC 714 KUMAR, YOGESH 106
KOÇ, MEHMET ALI 367 KUNDUZ, ENVER 131, 166, 253, 324, 598, 604
KOC, OGUZ 637, 854 KURBANOV, ANTON 54
KOCYIGIT, SEMA 573 KURT, ATİLA 598, 604
KÖKÇAM, SAİD 190, 859 KURT, ATILLA 65, 434, 600
KOKSAL, HAKAN 571, 601 KURTOGLU, MEHMET 439
KÖKSAL, HAKAN M. 55 KURT, YAVUZ 221, 241, 327
KÖKSAL, HANDE 190, 512, 513, 859 KUTERDEM, ERCÜMENT 518
KOKSAL, NESET 115, 563, 580, 730, 738, 739 KUTLAY, NÜKHET 164
KOKSOY, FERDA NIHAT 315, 482 KUTLUTURK, KORAY 457, 677
KOLODZIEJCZYK, PIOTR 57 KUZUCUOGLU, TAMER 361, 445, 448, 453
KOLOSOVICH, IGOR 706 KUZU, HEKIM 705
KOLOSOVYCH, IGOR 664 KUZU, IŞINSU 164
KOLSARICI, ELIFCAN 332 KUZU, MEHMET AYHAN 129, 164
KOLUH, ANHEL 70, 725
KONCA, CAN 258, 366 L
KONES, OSMAN 64, 135, 371, 373, 447, 449, LADUKAR, LAXMIKANT 291
585, 595, 702 LALEMAN, WIM 16
KORKUT, MUSTAFA 163, 322 LAM, LYDIA 443
KORUN, NUSRET 77, 500, 774 LANGIU, SERENA 170
KOSMAZ, KORAY 326 LAPORTE, MARIANO 310
KOSTIRNOY, ALEXANDR 410, 747 LARZABAL, ANDONI 279
KOSTIRNOY, ALEXENDR 888 LAW, NGIE CHANG 681
KOSTYRNOY, ALEXANDER 420 LEE, JAE HYUK 588
-916-
LEE, JAEHYUK 593 MARTINS, VERA 92
LENZI, SANTIAGO 546, 631 MARUDANAYAGAM, RAVI 711
LEONENKO, SERGEY 682 MASó, XèNIA CROUS I 27, 155
LEVENTOGLU, SEZAI 168 MASSIMINI, FRANCESCA 137
LEVENTOĞLU, SEZAİ 331 MASSOBRIO, ANDREA 158, 343
LIAKOS, NIKOLAOS 452 MATARACI, EMINE 259
LICARI, LEO 161 MATLIM, TUBA 598, 604
LILA, ALI 425 MATYJA, ANDRZEJ 305
LITTLE, ZOE 21 MAYO, MARIA DE LOS ANGELES 882
LLUKAÇI, ALMA 759 MCNICOL, FRANCES 307
LOCHE, GIOVANNI 28, 170, 274 MECIT, NESIMI 23, 111, 699, 700
LOCHMAN, PETR 282 MEKHAIL, PETER 385
LOMINADZE, NIKOLOZ 539 M., EMİROGLU 898, 899
LOPES, DAVİD 411 MEMISOGLU, KEMAL 795, 805
LOPEZ, ANTONIO GONZALEZ 683 MEMMI, NAIM 184, 806
LOPEZ, MANUEL 882 MEMMİ, NAİM 162, 250, 314
LOSADA, JOAQUIN 279, 280 MEMON, AYAZ AHMAD 557
LÜLECI, NIMET EMEL 830 MENEKSE, EBRU 199, 719, 721
LUPOSELLA, MARIA 103 MENEKŞE, EBRU 338
LUPPI, CARLOS EDUARDO RODRIGUEZ 286, MENKE, HENRIK 391, 392, 393
418 MENKSE, EBRU 511
LUPU, ION 285, 286, 418 MENTES, B.BULENT 168
LYASHCHENKO, PAVEL 32, 890 MENTEŞ, B.BÜLENT 331
MENTES, ONER 40, 47, 223, 225, 237, 484
M MENTEŞ, ÖNER 369, 754
MAGALTADZE, VAKTTANG 539 MEO, GIOVANNA DI 489
MAGRINI, LAURA 173 MEO, GİOVANNA Dİ 117
MAKAY, ÖZER 80 MERAL, ULVI MEHMET 151
MAKKI, MAHMOUD 262, 342, 640 MERCAN, ERDINÇ 837
MALAZGIRT, ZAFER 670, 776 MERCANTINI, PAOLO 124, 173, 603
MALINOVSCHI, VLADIMIR 594 MERCIMEK, HACI YAVUZ 400
MALYA, FATMA UMİT 441 MERIC, KAAN 353
MAMEDOV, ALINIYAZ 688 MERİÇ, SERHAT 74
MAMMADOV, ADIL 770 MERT, MERAL 495
MAMMADOV, ALINIYAZ 421 MESCİ, AYHAN 67
MAMMADOV, KAMRAN 679 MESTRES, FERRAN CABELLERO 128
MAMMADOV, RUSTAM 679 MIHMANLI, MEHMET 55, 571, 601
MANAFOV, SULTAN 294, 590 MILLETARI, SILVINA LUCIA 310, 546, 631, 632,
MANOLIZI, JUAN MANUEL 310 767, 819
MANSOOR, AHMAD 208, 646 MIRZA, DARIUS 711
MANTRALI, IFIGENIA 808 MISCHINGER, HANS JÖRG 145
MANTRALİ, IFİGENİA 809 MISIRLIOĞLU, SELIM 541
MANUKYAN, ARTAK 852 MIZRAKLI, TÜLAY 606
MARCHUK, SERGIY 298 MKRTCHYAN, MKRTICH 852
MARCO, CARLO Dİ 43 MOISEENKO, RAISA 881
MARIEKE, DE VISSCHERE 180 MOKHBER, SOMAYYEH 796
MARIO, SCANU ANTONIO 28 MONBALIU, DIETHARD 16
MARKOC, FATMA 509, 621 MONTEMURRO, SEVERINO 103
MAROGNA, PIETRO 274 MONTESANI, CHIARA 624
MARQUES, CONCEIÇãO 440 MONTE, SIMONE ROSSI DEL 603
MARQUES, PEDRO PESTANA 411 MONTSERRAT, ROSA MARíA CUBERES 599
MARTIN, ANA BELEN 467 MORAL, ANTONIO 207, 467
MARTINEZ, CLARA ELENA AGUIRRE 310 MORAY, GOKHAN 612, 787, 892
-917-
MORAY, GÖKHAN 46, 332, 695, 753, 784, 844 OJKTAY, GÜLGÜN 263
MOTOR, SEDAT 422 OKAN, ISMAIL 36, 98, 311, 334, 357, 497, 509,
MUFTUOGLU, M.A. TOLGA 353 536, 618, 619, 620, 621, 729, 744, 791
MÜFTÜOĞLU, M.A.TOLGA 15, 136, 363, 514, OKAN, İSMAIL 134
673 ÖKCESIZ, İBRAHIM ETEM 830
MúGICA, FERNANDO 279, 280 OKIC, ANEL 70, 725
MUIESAN, PAOLO 711 OKKABAZ, NURI 130, 335
MUJIC, HASIB 70, 725 OKKA, MEHMET 435
MUNGAN, SEVDIGUL 573 OKK, ENGIN 476
MUSCHININ, VOLODYMYR 788 OKOYE, OBI 62, 176
MUSLUMANOGLU, MAHMUT 93, 184 OKUDAN, MURAT 297
MÜSLÜMANOĞLU, MAHMUT 88, 162, 250, OKUDUCU, MEHMET 795, 805
275, 314, 806 OKUMUŞ, AYHAN 243
MUSTAFAYEV, ASIF 590 OKUŞ, AHMET 125, 423, 555, 648, 835, 836
MUTI, AYBUKE 345 OLGUN, DENIZ CEBI 159
MUTLU, AYTUL 515 OLMEZ, AYDEMIR 858
MUTLUOĞLU, MESUT 260 ÖLMEZ, AYDEMIR 540
MYSTAKELLI, CHRISTINA 113 ÖLMEZ, MUSTAFA 850
OLTULU, YASEMİN 316
N ONCEL, MUSTAFA 75, 130, 335
NADEEM, MEHWASH 869, 883 ÖNDER, SEMEN YESİL 598, 604
NADIRADZE, EMZAR 539 ÖNEL, SAFA 199
NADOLSKY, VALERIY 551 ONGORU, ONDER 293
NAGI, RAMZI 639, 640 ÖNGÜRÜ, ÖNDER 816
NARAYAN, NITHIN 847 ONURAY, FEYYAZ 359, 403, 887
NARDI, MATTEO 43 ORAL, ETHEM NEZIH 166
NASH, NICK 176 ORAL, ETHEM NEZİH 131
NASIM, SANA 63, 689 ORAN, EBRU 825, 826
NASTRO, PIERRO 21 ORAN, EBRU SEN 41, 474, 475
NAVA, ANDREA KAZEMI 114, 173, 603 ORAN, EBRU ŞEN 273, 804
NAYCI, ALI EMRE 637 ORHAN, BÜLENT 243
NAZARI, SHAHRAM 138, 726 ORHUN, SİBEL 537
NEJIM, ALI 847 OROZAKUNOV, ERKİNBEK 518
NEOPHYTOU, CHRIS 86, 352, 506, 808, 809, ORTIZ, NICOLAS MARTIN 631, 632
874 OSUCH, CZESLAW 607
NEOPHYTOU, CHRISTODOULOS 384 OTAN, EMRAH 31, 457, 460, 540, 858
NEVENS, FREDERIK 16, 116, 740 OYMACI, ERKAN 246, 374, 375, 376, 592, 656
N.N., КRYVORUсHKO I.A GONCHAROVA 628 OZARDALİ, ILYAS 533
NOVRUZOV, NAMIQ 680 OZASLAN, CIHANGIR 230, 817
NUNES, JOSé LUíS 411 OZBAGRIACIK, MUSTAFA 197, 485, 737
NURSAL, TARIK ZAFER 178, 633 ÖZBAĞRIAÇIK, MUSTAFA 81
OZBAN, MURAT 387
O-Ö
OZBAS, SERDAR 209, 468
OBUZ, FUNDA 122, 321, 694
ÖZBAŞ, SERDAR 88
OCAL, HAYDAR 785
OZBILGIN, MUCAHIT 319, 578, 692, 693
ODABASI, HACI MEHMET 353, 354, 355, 743
OZBILGIN, SULE 886
ODABASI, H. MEHMET 398, 663
OZCAN, AYHAN 293
ODABAŞI, MEHMET 15, 136, 363, 514, 673
ÖZCAN, EMRAH 524
ODARCHENKO, SERGIY 550
ÖZÇELİK, ÇAĞLAR 782
ODUNCU, MEHMET 153, 823
OZCELIK, KAZIM CAGLAR 44, 76, 256, 481, 499
ODUOZA, UCHE 174
ÖZÇELİK, MUHİTTİN 277
OGUZ, ABDULLAH 379, 380, 705, 745
ÖZDAĞ, HILAL 164
OĞUZ, ABDULLAH 268
ÖZDEDEOĞLU, MESUT 532, 553, 756, 853
OĞUZ, SERHAT 616, 617, 810
-918-
OZDEMIR, BEKIR 483 OZOGUL, YUSUF 105, 586
OZDEMIR, EBRU 355 ÖZOĞUL, YUSUF 52, 140, 325
OZDEMIR, FATIH 460, 622 ÖZOĞUL, YUSUF BAYRAM 722
OZDEMIR, HAKAN 252, 360, 527, 755 OZORAN, EMRE 764, 811
ÖZDEMIR, HAKAN 623, 626, 627 OZPEK, ADNAN 326, 408, 451, 462, 552, 666
ÖZDEMİR, HAKAN 526, 813 ÖZPEK, ADNAN 81, 442, 456, 469
ÖZDEMIR, HANDAN 844 OZPOLAT, BERKANT 815
OZDEMIR, YAVUZ 277, 300 OZSAHIN, HAMDI 203
ÖZDEMIR, YAVUZ 120, 198, 221, 241, 327, 525 OZSAY, OGUZHAN 584
OZDEMIR, YILMAZ 200, 486 OZSOY, AYHAN 659, 801
OZDEMIR, ZEHRA UNAL 252, 360, 527, 755 OZSOY, ZEKI 357, 509, 618, 620, 621, 744
ÖZDEMIR, ZEHRA ÜNAL 623, 626, 627 OZTAS, MUHARREM 193, 254, 292, 364, 395,
ÖZDEMİR, ZEHRA ÜNAL 526, 813 407, 658, 748, 749
OZDEMIR, ZEYNEP MARAS 622 ÖZTAŞ, MUHARREM 260
OZDEN, HUSEYIN 762 OZTOP, ILHAN 122, 321
ÖZDENKAYA, YAŞAR 370 OZTUNA, DERYA GOKMEN 129
OZDIL, KAMIL 735 OZTUNA, FUNDA 118
OZDOGAN, MEHMET 199, 719, 721 ÖZTÜRK, ALAATTIN 642, 758
ÖZDOĞAN, MEHMET 511 OZTURK, ALPER 93
ÖZEMİR, İBRAHIM ALI 399 OZTURK, ERKAN 40, 47, 223, 225, 228, 237,
ÖZEN, NECATİ 288, 889, 893 484, 487, 501, 657
OZEN, YILMAZ 22 ÖZTÜRK, ERKAN 79, 204, 365, 856, 860
ÖZER, ALI 152 ÖZTÜRK, ERSIN 123, 152, 329, 608
OZERHAN, ISMAIL HAKKI 278, 293 OZTURK, GURKAN 287
ÖZERHAN, İSMAIL HAKKI 369, 636, 676, 698 OZTURK, HALIL 734
ÖZERHAN, İSMAİL HAKKI 365, 860, 880 OZTURK, MUSTAFA 293
OZER, ILTER 50, 105, 584, 586 OZTURK, SAFAK 840
ÖZER, İLTER 52, 140, 325, 710, 722 ÖZTÜRK, TÜLIN 226
ÖZER, MAHMUT 99 OZUNER, GOKHAN 126
OZER, MUSTAFA 30, 254 OZYAZİCİ, SEFA 199
ÖZGAN, EDİZ TEVFİK 416 ÖZYAZICI, SEFA 511
ÖZGEHAN, GÜLAY 295 OZYILDIZ, MEHMET 270
OZGOR, DINCER 713 OZYUVACI, EMINE 764
OZGUN, HEDEF 267
ÖZGÜN, YIĞIT MEHMET 652, 824 P
ÖZGÜR, İLKER 37, 53, 493 PACHECO, JOSE MANUEL 882
OZKAN, ERKAN 353, 354, 355, 398, 663, 743 PACH, RADOSLAW 57, 305
ÖZKAN, ERKAN 136, 673 PAGOULATOU, ALEXANDRA 328
OZKAN, NAMIK 36, 703 PAKANEH, MOHAMMADALI 799
OZKAN, ORHAN VELI 714 PAK, ISIN 812
OZKAN, ZEYNEP 583, 783 PALOMARES, IBONE 279, 280
ÖZKAN, ZEYNEP 574, 707, 843 PAPATSAKONAS, ANASTASIOS 169
ÖZKARA, SELVİNAZ 644 PARAL, JIRI 282
OZKARDES, ALPER 542 PARAMPALLI, UMESH 92
OZKARDES, ALPER BILAL 377, 378, 532, 534, PASAOGLU, ESRA 318, 543
756, 757, 785 PASBAKHSH, PARICHEHR 842
OZKARDES, ALPER BİLAL 717 PASCULLI, ALESSANDRO 489
ÖZKARDEŞ, ALPER BILAL 206, 853 PASCULLİ, ALESSANDRO 117
OZKARDESLER, SEVDA 886 PASHAZADE, VEFA 680
OZKURT, ENVER 439 PATMANO, MEHMET 147, 283
OZLEM, NURAYDIN 337 PAVLIS, THEODOROS 113
OZMEN, VAHİT 93 PAVLYK, IGOR 550, 551, 665
OZOGUL, BUNYAMI 287 PAZOUKI, ABDOLREZA 494, 528, 796, 798, 799
-919-
PEACOCK, MARK 69 Q
PEHLIVANLI, FARUK 362 QADIROVA, AYGUN 680
PEKER, EVREN 273, 804 QUREISHI, ALI 384, 506, 808, 874
PEKER, KIVANC D. 581 QUREISHI, ALİ 45, 864
PEKER, KIVANÇ DERYA 99, 629 QUREİSHİ, ALİ 86, 809
PEKER, SUBUTAY 151, 228
PEKER, YAŞAR SUBUTAY 148, 260, 369, 524, R
636, 676, 698, 754, 816 RACHID, KOUDJETI 582
PEKER, YASIN 317, 548 RAIMONDI, PAOLO 137
PEKER, YUSUF 47, 67, 79, 148, 151, 224, 225, RAJU, TIRAMULARAJU 69
228, 260, 278, 365, 369, 395, 524, 610, 636, RAMAKRISHNAN, RAVI 724
657, 658, 676, 698, 754, 816, 828, 860 RAMSANAHIE, ANTHONY 506
PEKMEZCI, SALIH 413, 436 RANIERI, DANILO 603
PEKMEZCİ, SALİH 412, 565, 566, 568 RANIERI, GIROLAMO 103
PEREZ, BEATRIZ ESPINA 94, 219, 242, 498 RAZA, SYED JOHAR 82
PEREZ, DANIEL 882 REES, BEN 352
PEREZ, JOSE IGNACIO 207, 467 REIS, ERHAN 230, 256
PESKERSOY, MUSTAFA 271, 356, 508, 544, RENOM, JOAN DUCH 219, 478, 498
654, 655 RESHADI, MEDI 796
PETER, VASAS 797 REVAZISHVILI, BESARION 539
PETRONE, PATRIZIO 464 REVENTOS, VICENS ARTIGAS 683
PETTIT, ANDREW 847 REYHAN, ENVER 165, 576
PİCCİNNİ, GİUSEPPE 117 REYNAUD, GERARDO NICOLAS 767
PIETRUSZKA, SZYMON 57 RIAZ, MOHAMMAD 85
PİKİRENYA, IVAN 691 RICHARDS, ELIZE 864
PİLLAİ, SURESH 809 RIMINI, EDOARDO 158, 343
PINDOZZI, FIORALBA 124 RIZZO, GIOVANNI 28, 170, 274
PINEDO, RAFAEL 279, 280 ROCCA, PAOLO COSSU 170
PINHEIRO, LUIS FILIPE 440 RODRIGUEZ, JESUS BOLLO 128, 285, 286, 418,
PINNA, ANTONIO 274 683
PIRENNE, JACQUES 16, 116, 740 RODRIGUEZ, VICTOR TURRADO 94
PIRHAN, YAVUZ 481, 499, 782 ROMAIRONE, EMANUELE 158, 343
PIRROLI, SILVIA 624 RONCHETTA, CLEMENTE 492
PISHGAHROUDSARI, MOHADESE 796 ROONEY, PAUL 307
PITASI, FRANCESCA 624 R.S.SHEVCHTNKO 751
POLAT, ERDAL 99, 165, 561, 581, 615, 629 RUBIO, PAULA 279, 280
POLAT, FATİN R. 765 RUMMO, OLEG 691
POLAT, MURAT 210, 541, 652, 837 RUSSILLO, GABRIELE 746
POLAT, ŞEFIKA BURÇAK 488 RYU, SEONG YEOB 549, 588
POLENOK, PETRO 420 RYU, SEONGYEOB 593
PONZ, CARMEN BALAGUE 128, 285
S-Ş
POSA, LUIS GRANDE 27, 155
SAA, RAUL 279, 280
POYRAZOGLU, O. BILGEHAN 183
SAAVEDRA, JAVIER ANGELO ALANEZ 234, 841
POYRAZOGLU, ORHAN K. 183
SABUNCUOGLU, AYLIN 255, 556, 647, 838,
PREMNATH, RAJEEV 572, 775
839, 866
PRENEN, HANS 51
SABUNCUOGLU, MEHMET ZAFER 255, 404,
PREPODOBNY, VYACHESLAV 781
405, 406, 556, 647, 838, 839, 866
PRONIO, ANNAMARIA 624
SACCO, LUCA 746
PROVENZA, GIUSEPPE 124
SACCO, ROSARIO 103
PROWDE, CHARLES 446
SADIEH, OMAR 208, 646
PRYNDYUK, SERGEY 107, 269, 302
SAEEDNIA, SARA 842
PULLICINO, VERONICA SAID 95
ŞAFAK, HÜLYA 856
PULVIRENTI, ALESSANDRA 746
SAFAMANESH, SINA 494
-920-
SAFAROV, ABBAS 522, 523 SARSENOV, DAUREN 191
SAĞLAM, ABDULLAH 363 SAVAS, OSMAN ANİL 515
SAGLAM, FAZIL 547 SAVİNO, GRAZİA 43
SAGLAM, KUTAY 573 SAXENA, SANDEEP 174, 446, 461, 463
SAGNOTTA, ANDREA 114, 173, 603 SAYDAM, MEHMET 30, 193, 254, 292, 364,
SAGOL, OZGUL 101, 321 748, 749
SAHINER, IBRAHIM TAYFUN 252, 360, 527, 755 SAYGUN, ORAL 362, 517, 761, 762, 763
ŞAHINER, IBRAHIM TAYFUN 626, 627 SAYIN, TURGAY 33, 153, 537
ŞAHINER, İBRAHIM TAYFUN 623 SCABINI, STEFANO 158, 343
ŞAHİNER, İBRAHİM TAYFUN 526, 813, 896 SCANU, ANTONIO MARIO 170, 274
SAHİNER, TAYFUN 894 SCARAVONATI, H. RODOLFO 310, 546, 631,
SAHIN, FATMA 130 632, 767, 819
SAHIN, GULAY 884 ŠćEPANOVIć, MILENA 780
SAHIN, MUSTAFA 98, 311, 334, 497, 509, 536, SCHERBA, ALEKSEİ 691
618, 619, 620, 621, 703, 729, 744, 791 SDIK, TOUAGH ABOUBAKER 582
ŞAHIN, MUSTAFA 134 SEBASTIAAN, VAN CAUWENBERGE 180, 181,
SAHIN, NURETTIN 431, 449 182, 752, 797
ŞAHIN, ORHAN 642 SECKİN, GOKSEL 368
SAKAOĞULLARI, ZİŞAN 561 SEFIYEVA, AYNUR 680
SAKRAK, OMER 613 SEGURA, JOSE LUIS PALLARES 128, 285, 286,
SALAMONE, GIUSEPPE 161 418, 683
SALIK, AYSUN ERBAHCECI 702 ŞEKER, AHMET 615
SALMAN, A.EBRU 472, 473 SEKER, DURAY 542
SALMAN, AKGÜN EBRU 853 ŞEKER, DURAY 778
SALMAN, TANSU 368 SEKER, GAYE 542
SALVI, PIER FEDERICO 341 ŞEKER, GAYE 295, 427
SAM, BULENT 598, 604 SELAMOGLU, DERYA 93
SAMMARCO, GIUSEPPE 103 SEN, BULENT 432
SAMMUT, LUKE 672 ŞENER, ZEYNEP 538
SAMMUT, MATTHEW 672 SEN, METIN 433, 848
SANCHEZ, M. CARMEN MARTINEZ 128, 285, SENOCAK, MUSTAFA 345
418 SENOL, METIN 252, 360, 527, 755
SANMUGALINGAM, NIMALAN 333 ŞENOL, METIN 623, 626
SANTHOSH, SHIVASHANKAR 172, 760 ŞENOL, METİN 526, 627, 813
SAPİEZKO, JAN 281 SENTURK, TOLGA 293
SARACOGLU, AYTEN 445, 448, 453 ŞENYÜREK, GÖKHAN 288
SARACOGLU, KEMAL TOLGA 361 ŞENYÜREK, YASEMIN GILES 37
SARACOGLU, TOLGA 39 ŞENYÜREK, YASEMİN GİLES 42, 53, 74, 493
SARAGNA, ALESANDRA 173 SERAFINI, VICTOR HUGO 310, 546, 631, 632,
SARAH, VANDENHAUTE 180 767, 819
SARANTITIS, IOANNIS 304 SEREFHANOGLU, KIVANC 892
SARANTOPOULOS, EVANGELOS 391, 392, 393 SERETIS, CHARALAMPOS 452
SARDARYAN, ARTUR 852 SERHETOV, NESIB 768
SARIBEYOGLU, KAYA 413 SERİNDERE, MEHMET 428
SARIBEYOĞLU, KAYA 412, 436, 565, 566, 568 SERİN, KURSAT RAHMİ 131, 253, 324, 598
SARICI, I. SAMIL 439 SERİNSOZ, EBRU 301
SARICIK, BEKIR 707, 783 SESTIC, HARUN 70, 725
SARI, SERKAN 764 SEVER, NURTEN 465, 496, 531, 595
SARI, TOYGAR 296 SEVGEL, ÖZLEM 220
SARI, YAVUZ SELIM 637, 854 SEVİNÇ, ALİ İBRAHİM 263
SARKAVAGYAN, HOVHANNES 852 SEVINÇ, BARIŞ 125, 555, 648, 836
SARKUT, PINAR 22, 77, 123, 152, 608, 774 SEYIT, HAKAN 587
SARRIUGARTE, AINGERU 280 SEZAK, MURAT 519
-921-
SEZER, HALIL KORAY 193, 662 SOZBILEN, MURAT 519
SEZER, TAYLAN 742 SÖZBİLEN, MURAT 742
SEZER, TAYLAN OZGUR 163 SOZEN, HAKAN 661
SEZER, TAYLAN ÖZGÜR 577, 597, 684 SOZEN, ISA 255, 556, 647, 839, 866
SHAMA, AMIT 384 SOZEN, SELİM 721
SHAMIM, MUHAMMAD SHAHZAD 82 SÖZEN, SELIM 574
SHARIPOV, SHOHRAT 691 SÖZEN, SELİM 424, 576, 777
SHARMA, AMIT 45, 874 SOZEN, VURAL 761
SHARMA, AMİT 86 SOZUER, ERDOGAN 147, 183, 283, 459, 476,
SHEKOUH, ALI 276 851
SHIVASWAMY, SADASHIVAIAH 172, 760 SOZUTEK, ALPER 301
SILVESTROV, MAKSYM 107 SPARAGNA, ALESSANDRA 114, 603
SILVESTROV, MAXIM 269, 302 SPILIOTIS, JOHN 121, 169, 328
SİMEK, JAN 282 SRIDHAR, ASHWIN 385
SIMPSON, GREGORY 276 S, SANTHOSH C 728
SIMSEK, ABDURRAHMAN 610 S, SHIVASWAMY B 651, 728
ŞIMŞEK, OSMAN 413, 436, 566 STAROSEK, VIKTOR 682, 870
ŞİMŞEK, OSMAN 412, 564, 565, 568 STATSENKO, NATALIYA 888
SIMSEK, TAMER 703 STEENBERGEN, WERNER VAN 16
ŞIMŞEK, TURGAY 233 STEPANOVIć, DUBRAVKA 780
SINAN, HUSEYIN 30, 193, 254, 278, 364, 748, STOCCHI, LUCA 126
749 STONELAKE, STEPHEN 303
SINAN, HÜSEYIN 292 STOYAN, NIKOLOV 66, 222, 299, 731
SİNAN, HÜSEYİN 414 SUBASHI, KASTRIOT 409, 425
SINGH, IQBAL 426, 575, 871 SUBASI, ISMAIL EGE 408, 451
SINHA, ASH 455 SUBASI, İSMAİL EGE 462
SISIK, ABDULLAH 408, 451, 458, 462 SUBRT, ZDENEK 282
ŞIŞIK, ABDULLAH 456 SÜCÜLLÜ, İLKER 120, 241, 257, 327, 414, 416,
ŞİŞİK, ABDULLAH 442 525
ŞİT, MUSTAFA 308, 312, 313, 559, 716 SUGGETT, NIGEL 303
SIVRIKOZ, EMRE 61, 439, 443, 450 SULU, BARLAS 115, 563, 730, 738, 739
SKIADA, DIMITRA 62 SUMER, DEMET 19
SKOROMNY, ALEX 690 SUMER, FATIH 460
SLUTZKY, MAURICIO GABRIEL 310 SÜMER, FATIH 540
SMISHCHUK, VITALIY 149, 781 SUMER, HALDUN 849
SOHEILIPOUR, FAHIME 528 SUMER, ZEYNEP 189, 849
SOKMEN, SELMAN 177, 321 SUREK, AHMET 595, 702
SOLER, EDUARDO M. TARGARONA 128, 285, SUTCLIFFE, ROBERT 711
286, 418 SVYRYDOVSKY, SERGEY 149, 781
SOMMA, CARMINE DI 139 SZURA, MIROSLAW 305, 867
SOMMA, SALVATORE DI 173
SORMAZ, İSMAİL CEM 42, 53, 74, 493 T
SOROUR, AMANY 232 TAHA, AHMED 652
SOROUR, MAGDY 261, 638 TALAAT, IMAN 232
SORRENTI, SALVATORE 43 TALİH, TUTKUN 851
SOTELO, JOSE CARLOS 310 TALI, SERVET 357, 509, 618, 619, 620, 621, 744
SOTELO, JUAN MANUEL 632, 767 TALI, UFUK 346
SOUFIANE, ZATIR 582 TALVING, PEEP 61, 443
SOYDAN, SECIL 168 TAMANNAIE, ZEINAB 494, 528, 796, 798, 799
SOYDER, AYKUT 88, 209, 267, 468, 862 TANG, MANHON 85
SOYER, VURAL 635 TANIK, CANAN 203
SOYLU, LUTFI 88, 468 TANRISEVEN, MUSTAFA 40, 47, 228, 237, 501,
SÖZBİLEN, E.MURAT 684 657
-922-
TANSUĞ, TUĞRUL 872 TOPAL, HALIT 16, 51, 116, 740
TANTOĞLU, UTKU 164 TOPALOGLU, SERDAR 111, 118, 573, 734
TANYERI, PELIN 714 TOPCU, OMER 65, 189, 434, 600, 723
TARCAN, ERCÜMENT 654 TOPGÜL, KORAY 668, 669, 670, 769, 776, 889
TARHAN, NEFISE ÇAĞLA 844 TOPHURIA, DAVID 429, 444
TAŞCI, H.İBRAHİM 470 TOPUZ, ÖMER 83, 879
TAŞÇI, H. İBRAHİM 471 TORBA, MYFTAR 409, 425
TAŞÇI, İHSAN 504 TORRES, MANUEL 819
TASDEMIR, NIHAT 297 TORRISI, MARIA ROSARIA 603
TASDOVEN, ILHAN 17 TOSUN, MEHMET 716
TAŞ, HÜSEYIN 148 TOZLU, GULSUM 404, 406, 647, 838
TAŞ, HÜSEYİN 67 TRABLUS, DİDEM CAN 786
TAŞ, İLHAN 268 TRIAS, MANUEL 207, 467
TASKESEN, FATIH 297, 430, 701, 705, 745 TROFIMOV, MYKOLA 56, 102
TASKIN, ALI KEMAL 704 TROISI, ROBERTO 114
TAŞKIN, FÜSUN 209 TSKHVEDADZE, ARCHIL 429, 444
TATAR, FATMA 317, 548 TUFAN, TURGUT 487
TATYANA, VLAYKOVA 66, 222, 299, 731 TUĞMEN, CEM 850
TAVLI, ŞAKİR 390 TÜKÜN, AJLAN 229
TAVUSBAY, CENGIZ 271, 317, 544, 548, 655 TUMERDEM, SAHAP 326
TEIXEIRA, PEDRO 443, 450 TUNALI, VAHIT 637, 854
TEKE, MEMIK 379 TUNCA, FATIH 37
TEKESIN, KEMAL 737 TUNCA, FATİH 42, 53, 74, 493
TEKIN, AHMET 435 TUNCAY, ERHAN 453
TEKİN, AHMET 388, 389, 558, 674, 675 TUNCER, SALIM KEMAL 400
TEKIN, RECEP 846 TUNCER, YILDIRAY 75
TEMEL, HANDE 537, 827 TURAN, ERSİN 190, 859
TEMIZGONUL, BAHA 447, 585, 587 TURAN, HALE 892
TEMIZ, MUHIYITTIN 422 TURANLI, SEVIM 44, 76, 256, 481, 499
TERZI, CEM 122, 177, 266, 320, 321, 886 TURANLI, SEVİM 782
TERZİ, CEM 263 TURAN, MUSTAFA 433, 848, 849
TERZIOĞLU, TARIK 37 TURGUT, HURRIYET 205
TERZİOĞLU, TARIK 42, 53, 74, 493 TURGUT, NAMIGAR 718
TESTINI, MARIO 489 TURGUT, TANER 270
TESTİNİ, MARİO 117 TURHAN, AHMET NURAY 591
TEZCANER, TUGAN 46, 306, 332, 612, 695, TURKCAPAR, AHMET 100, 611
753, 844 TURKCU, GUL 705
TEZCAN, LEVENT 249 TURKCU, UMMUHANI OZEL 17, 19
TEZELMAN, SERDAR 37, 42, 74, 493 TURK, EMIN 892
THOMSON, PETER 303, 309, 711 TURK, EMİN 787
TIBAU, ARIADNA 207 TURKER, BARIS 840
TIEK, JOYCE 116, 740 TÜRK, H.ŞEBNEM 55
TIHAN, DENIZ 210, 541, 652, 824 TURKKAN, SELİM 407
TİHAN, DENİZ 257 TURKMENOGLU, OZGUR 301
TIHAN, NECDET DENIZ 837 TURKOGLU, AHMET 379, 380, 430, 846
TIRNAKSIZ, MEHMET BÜLENT 191 TÜRKOĞLU, AHMET 268
TITUS, GRIGOREAN VALENTIN 671 TÜRKOĞLU, MEHMET AKIF 722
TOKAC, MEHMET 534, 717 TÜRKOĞLU, MEHMET AKİF 615
TOKAÇ, MEHMET 473, 488, 853 TUTAL, FIRAT 236, 238, 659, 660, 718, 801
TOLSTANOV, ALEXANDR 881 TUTAR, ONUR 412, 436, 564, 565, 566, 567,
TOLU, ISMET 835 568
TOMASSINI, FEDERICO 124 TUTCHENKO, MYKOLA 298
TOPAL, BAKI 51, 116, 740 TUZBAIA, ZURAB 429
-923-
TUZCU, MEHMET 65, 434 UZUN, ORHAN 581, 629
TÜZÜNER, MERT 820
TUZUN, ISHAK SEFA 515 V
VALENTE, SOFIA 411
U VALERY, KRYSHEN 56, 102
UCAR, AHMET DENIZ 592 VANDECAVEYE, VINCENT 51
VANNELLI, PABLO HERNAN 632, 767
UÇAR, AHMET DENİZ 246, 374, 375, 376
VANOMMESLAEGHE, HANNE 794
UÇAR, DENIZ 656
VARMA, AARTI 352
UÇAR, YASİN 350, 807
VATAMANUK, VOLODYMYR 149, 781
UGURLU, M. UMIT 834
VATANSEV, CELALETTIN 435, 667
UGURLU, M.UMIT 216, 634
VATANSEV, CELALETTİN 388
UĞURLU, ÜMIT 14
VEERAPUR, BASAVARAJ 106
UGUZ, ALPER 322, 720
VELáZQUEZ, PATRICIA SáNCHEZ 27, 155
UĞUZ, ALPER 684
VELET, RÜMEYSA SELVINAZ 477
ULAS, MURAT 50, 586
VELİDEDEOĞLU, MEHMET 564, 565
ULAŞ, MURAT 52, 140, 325, 338, 710, 722
VENKATARAM, ANIKETH 172, 760
ULGER, BURAK VELI 379, 380, 430, 846
VENKATARAMAN, JAYANTHI 112, 454, 724, 727
ÜLGER, BURAK VELİ 268
VERSLYPE, CHRIS 51
ÜLKE, ERDOĞAN 277
VESCIO, GIUSEPPINA 103
ULKER, KAHRAMAN 730
VESTRI, ANNARITA 624
ÜLKER, ÖZGE 830
VINNITSKA, ALLA 269, 302
ULLAH, MATEE 864
VINNITSKAYA, ALLA 107
ULLAH, ZABEEH 864
VITTORE, FRANCESCO 489
ULUDAG, MEHMET 41, 273, 474, 475
VLAD, NACEV TUDOR 671
ULUDAĞ, MEHMET 804, 825, 826
VLAKHOV, ALEKSANDR 682, 870
UNAL, BULENT 31, 457, 635, 858
VLASENKO, ANATOLIY 890
ÜNAL, BÜLENT 540
VOLODYMYR, SULYMA 873
UNAL, ETHEM 272
VOSSLER, TIMOTHY 450
ÜNAL, MUSTAFA 472
VOUGAS, VASILIS 452
UNALP, OMER 322, 720
V.V.CHUGAJ 751
ÜNALP, ÖMER 742
VYAS, ABHISHEK 871
ÜNALP, ÖMER VEDAT 597, 684
UNEK, TARKAN 578, 692, 693, 694 W
ÜNLÜ, AYTEKIN 120, 369, 524, 754 WEBB, A 384
ÜNLÜ, AYTEKİN 365, 428, 464, 856, 860, 880
WEBB, PETER 455
UNLU, MEHTAT 122
UPRAK, KIVILCIM 634 WEBSTER, S.V 868
URAS, CIHAN 91 WHITELEY, GRAHAM 304
URKAN, MURAT 79, 365, 428, 464, 676, 816, WIG, JAI DEV 871
856, 860, 880 WIG, J D 426, 575
USEINOV, ELDAR 888 WILSON, IAIN 92, 455
USLUKAYA, OMER 379, 430, 705, 745, 846
USLUKAYA, ÖMER 268, 380 X
USTA, SERTAC 31, 678 XYNOS, APOSTOLOS 121
UYANIK, OZLEM 94, 128, 207, 219, 234, 242,
285, 286, 418, 467, 478, 498, 683, 841 Y
UYSAL, ERDAL 500, 774 YAGCİ, GOKHAN 407
UZER, HASAN 459 YAĞCI, GÖKHAN 365, 856, 860
UZUM, GUNGOR 854 YAHYAOGLU, MEHMET 887
UZUNER, MURAT 541 YAKIV, BEREZNYTS`KYY 873
UZUN, HUSEYIN 75, 236, 238 YAKOVENKO, ANATOLIY 298
UZUNKOY, ALİ 533 YAKUPOGLU, SEZER 361, 445, 448, 453
UZUNOGLU, YENER 887 YALÇIN, ABDULLAH 312
-924-
YALCIN, SAMET 532 YIGIT, TANER 483
YALÇIN, SAMET 553, 554, 822 YİĞİT, TANER 67, 880
YALKIN, OMER 396, 397, 714, 829, 887 YILDIRGAN, M. ILHAN 287
YALMAN, HAYDAR 399 YILDIRIM, ALI CIHAT 196, 505, 613
YALTI, TUNC 272 YİLDİRİM, ERKAN 787
YAMAK, SEDA 105 YILDIRIM, HAYRULLAH 577, 597
YAMAN, İSMAİL 872 YILDIRIM, KADIR 337
YANANLI, ZUHAL 758 YILDIRIM, M.BAKI 472
YANAR, FATIH 439 YILDIRIM, MEHMET 246, 374, 375, 376, 592,
YANAR, HAKAN 439, 450 656
YANIK, ALI 848 YILDIRIM, MEHMET AYKUT 675
YANKOL, YUCEL 23, 111, 699, 700 YILDIRIM, MURAT BAKI 473, 488
YARDIMCI, ERKAN 162, 184 YILDIRIM, MURAT BAKİ 717
YARDIMCI, SAMET 14 YILDIRIM, MUZAFFER 359
YARROW, JEREMY 868 YILDIRIM, OSMAN 308, 312
YASAR, MEHMET 704 YILDIRIM, SEDAT 46, 844
YASAR, NECDET F. 581 YILDIRIM, ŞÜKRÜ 218, 243, 257, 414, 416
YAŞAR, NECDET FATIH 99, 629 YILDIRIM, UTKU MAHIR 350
YAŞAR, NECDET FATİH 561 YILDIZ, BARIS DOGU 115
YASTI, AHMET CINAR 60, 347, 821 YILDIZ, MEHMET 193, 292, 748, 749
YAVUZ, ALPER 264, 535 YILDIZ, MEHMET KAMIL 15, 136, 353, 354,
YAVUZ, RIDVAN 110 355, 363, 514, 673, 743
YAYLAK, FAIK 619 YILDIZ, MERVE 159
YAZAR, FATIH MEHMET 574, 583, 707, 783 YILDIZ, M. KAMIL 398
YAZAR, FATİH MEHMET 424, 777 YILDIZ, MUSTAFA 196
YAZAR, SUKRU 91 YILDIZ, PINAR 196
YAZGAN, AYLIN 827 YILDIZ, RAMAZAN 40, 47, 79, 204, 223, 225,
YEGEN, CUMHUR 834 228, 237, 395, 464, 484, 487, 501, 636, 754,
YEGEN, GULCIN 531 860, 875, 877
YEĞEN, GÜLÇİN 370 YILDIZ, SELIM YIGIT 270
YEGEN, S.CUMHUR 216, 634 YILDIZ, ŞENOL 260
YEKELER, ENSAR 37 YILMAZ, AHMET 465, 496, 591
YEMEZ, KURSAT 317 YILMAZ, BAHRI 536
YENER, M. KAMIL 663 YILMAZ, EDIP ERDAL 308
YENER, OKTAY 398, 792 YILMAZ, EDİP ERDAL 312, 313, 559, 716
YENİAY, LEVENT 684 YILMAZ, FAHRİ 716
YENIDOGAN, ERDINC 36, 89, 98, 200, 334, YİLMAZ, FUNDA 720
357, 486, 497, 509, 618, 619, 620, 621, 703, YILMAZ, GÜLDAL 715
729, 744, 791, 812 YILMAZ, HAKAN 835
YENİSEY, CİGDEM 387 YILMAZ, HUSEYIN 667
YETIM, IBRAHIM 422 YILMAZ, HÜSEYİN 558, 674, 675
YETISIR, FAHRI 472, 473, 488, 534 YILMAZ, IBRAHIM 790, 861
YETIŞIR, FAHRI 853 YILMAZLAR, TUNCAY 152, 329, 608
YETİSİR, FAHRİ 717 YILMAZ, MEHMET 460, 622, 635
YETKIN, ENIS 80 YILMAZ, MUSTAFA 80
YETKIN, GURKAN 41, 474, 475 YILMAZ, SEZAI 31, 457, 635, 677, 678, 713
YETKIN, GÜRKAN 273, 804, 825, 826 YILMAZ, SEZGIN 507
YEYEN, SÜLEYMAN 861 YILMAZ, UTKU 331, 661
YIĞITBAŞ, HAKAN 214, 547 YILMAZ, ZEKI 476
YİĞİTBAŞI, RAFET 399 YIRGIN, HAKAN 64, 135
YİĞİT, GÜVEN 277, 432 YOLDAS, TAYFUN 163, 322, 519, 720
YIĞITLER, CENGIZHAN 855, 857 YOLDAŞ, TAYFUN 577, 684, 742
YİĞİT, NURİ 204 YOL, SINAN 99, 165, 581, 629
-925-
YOL, SİNAN 561, 615
YONDER, HUSEYIN 858
YORUBULUT, MEHMET 168
YOSYPENKO, MYXAILO 149
YOVCHO, YOVTCHEV 66, 222, 299, 731
YÜCEL, ERGUN 257, 414
YÜCEL, ERGÜN 120, 198, 221, 241, 327, 525
YUCEL, METIN 197, 326, 348, 408, 451, 458, 462, 552, 666
YÜCEL, METIN 456
YÜCEL, METİN 81, 442
YUKSEKDAG, SEMA 240
YÜKSEKDAG, SEMA 134
YÜKSEL, ERGÜN 83, 879
YUKSEL, HATICE 846
YUKSEL, MURAT 230
YÜKSEL, SEHER 164
YURDAKAN, GAMZE 17
YÜREKLI, BANU 472
YÜRÜKER, S. SAVAŞ 288, 776, 889, 893
YÜRÜKER, S.SAVAŞ 668
YURUM, FATMA NUR 720
YUSAF, MAMOON 333
YUSUBOV, ANAR 645
Z
ZAFAR, HASNAIN 883
ZAFAR, SYED NABEEL 82
ZEREN, SEZGIN 259
ZEYBEK, NAZIF 148, 151, 278, 524, 658, 676, 698, 828
ZEYNALOV, NADIR 679, 770
ZHYGULIN, ANDREY 269, 302
ZIPARO, VINCENZO 114, 124, 173, 341, 603
ZUHUR, SAYID S. 477, 490
-926-
We would like to express our sincere gratitude and appreciation to
the Republic of Turkey Promotion Fund of the Prime Ministry.

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ABSTRACT BOOK

SUPPORTING COMPANIES 901

Address to the Opening Ceremony of the XVI. Annual Meeting of

The West and The Rest

Let’s look at the west and the rest!

Let’s start with the rest:

Now let’s look at the west (2-4).

In each case, however, some common elements can be found.

XVI. ANNUAL MEETING OF EUROPEAN SOCIETY OF SURGERY

Secretary - Haldun Gündoğdu

Secretary General - Jan Kulig (Poland)

Treasurer - Andrew Kingsnorth (UK)

Frantisek Antos (Czech Republic)

*Names are sorted in alphabetical order by the lastname.

MARMARA UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY,

We intend to investigate the pancreatico-duodenectomy operations retrospectively

We have scanned all pancreaticoduodenectomies performed in our clinic during

Between 2010-2012 Seventy six pancreaticoduodenectomies were reached out for

Anastomosis type, suture material used in construction of pancreatic-enteric

HAYDARPAŞA NUMUNE EDUCATION AND RESEARCH HOSPITAL, ISTANBUL, TURKEY

The laparoscopic cholecystectomy (LC) was considered to be a contraindication for

UNIVERSITY HOSPITALS LEUVEN

Liver transplantation is being increasingly performed for oncologic and metabolic

We describe a series of 9 patients (5 men and 4 women) who received a combined

En bloc liver and pancreas transplantation is a feasible technique. Compared to

Similar protective effect of ischemic and ozone oxidative preconditioning (OzoneOP)

OzoneOP reduced liver injury determined by liver histology and serum

Resolvin D1 (RvD1), an endogenous lipid molecule derived from docosahexaenoic

Cerulein injection caused AP, confirmed by an increase in serum amylase, lipase

Treatment with RvD1 reduced cerulein-induced AP and associated lung injury in

QEQM HOSPITAL, MARGATE, UK

Background: Acute pancreatitis accounts for approximately 3% of all cases of

Compliance with guidelines for investigating and managing pancreatitis is essential

ULUDAG UNIVERSITY MEDICAL FACULTY GENERAL SURGERY DEPARTMENT

Prophylactic antibiotics have been used widely for at the laparoscopic

The data of 570 patients (group-1:193; group-2:191; group-3:186) were analyzed.

Based on our data, prophylactic antibiotic is not necessary in patients undergoing

HEPATO-PANCREATO-BILIARY SURGERY AND ORGAN TRANSPLANTATION CENTER,

Liver transplantation is the only treatment of the end-stage liver disease.

We present the outcomes of our 445 liver transplant cases.

This is a prospective study performed in the period between September 2004

HOSPITAL UNIVERSITARIO DEL MAR

An unicentric prospective observational study was conducted of 152 consecutive

II° SURGICAL CLINIC, UNIVERSITY HOSPITAL OF SASSARI, ITALY

Despite new technologies have been developed in surgical bleeding control,

Complicated appendicitis (CA) is a frequent problem in adults. Laparoscopic surgery

LS is definitely feasible in patients with CA and it only seems to cause a mild

There was a statistically significant difference between the median number of

INONU UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF GENERAL SURGERY

Infectious complications following liver transplantation are among the most

Results of 30 consecutive patients with a primary liver transplantation history

DNEPROPETROVSK MEDICAL ACADEMY, UKRAINE

Observed group (OG) - 11 patients with peritonitis, to whom the transmembrane

ANKARA ATATÜRK TRAINING AND RESEARCH HOSPITAL, CLINIC OF GENERAL

An online questionnaire was undertaken to assess, the awareness of malnutrition

GAZIOSMANPASA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF GENERAL

The sensitivity of thyroid FNAB is significantly lower in nodules ≥3cm, whereas US

PRINCE SULTAN RIYADH MILITARY MEDICAL CITY

MARMARA UNIVERSITY SCHOOL OF MEDICINE