Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique used in the diagnosis and treatment of pancreaticobiliary system. ERCP is used less frequently in children than in adults due to the rarity of pancreaticobiliary diseases and technical difficulties. However, ERCP is a safe, effective diagnosis and treatment tool for children. Methods: All patients within the age range of 1–19 years, who underwent ERCP between 2010 and 2021 at our endoscopy unit, were retrospectively examined. Patient demographics, use of imaging methods, indications, type of sedation, interventions, success of ERCP, findings, and complications were evaluated. Results: Overall, 105 ERCPs were performed in 66 children (29 male and 37 female). The indications were choledocholithiasis, cyst hydatic, choledochal cyst, biliary atresia or anomaly, liver transplantation-related disorders, and pancreatic disorders, respectively. ERCP was finished as diagnostic ERCP in 20% and as therapeutic in 80%. Therapeutic procedures were sphincterotomy, stent placement or removal, stone or debris extraction, and balloon sweep or dilatation, respectively. The success rate in the procedures was 75.23%. The overall complication rate was 15.23%. Postprocedure pancreatitis occurred in 11.42%, hemorrhage occurred in 2.85%, and aggravation of cholangitis in 0.95%. All complications were managed conservatively. Conclusion: ERCP in pediatric patients is a safe procedure that can be performed by adult endoscopists with high success rates. Since our region is an endemic region for hydatid cyst disease, the most common ERCP indication after choledocholithiasis is procedures related to liver hydatid cyst disease. The most common complication was pancreatitis, and complications were treated medically.

Objective: With the developments in patient management and the increase in surgical experience, the use of laparoscopy in liver resections has become widespread. However, with the consensus meetings and international recommendations, laparoscopic liver resections have been tried to be standardized. We aimed to present this laparoscopic liver resection experience by comparing open and laparoscopic techniques. Materials and Methods: Patients who underwent liver resections between 2015 and 2022 were retrospectively screened and divided into 2 groups as laparoscopic liver resections and patients who underwent liver resection with open surgery. Indications, resection techniques, operative times, length of hospital stay, early hospital mortality, and complications were compared between both groups using statistical methods. Results: Laparoscopic surgery was performed in 31 (14%) patients, and open surgery was performed in 189 (86%). The mean operation time was 316 ± 168.2 minutes in patients who underwent laparoscopic liver resection. It was 329.4 ± 123.6 in the open surgery group. The length of hospital stay was 11.6 ± 4.9 days in patients who underwent laparoscopic liver resection, while it was 19.7 ± 12.1 days in patients who underwent open surgery. The difference between the length of hospital stay was statistically significant (Mann–Whitney U-test, P=.00). There was no difference between the 2 groups in terms of complications and early mortality. Conclusion: Laparoscopic liver resections are a safe method that can be applied in 3 or less segment resections. As the experience of the surgical team increases, it can be safely applied for major hepatectomies. Cite this article as: Kara S, Korkut E, Aksungur N, et al. A comparison of laparoscopic surgery and open surgery in liver resections: A single-center experience. Eurasian J Med., 2023;55(3):234-238.

Background/Objectives: Residual cavity complications contribute to morbidity after conservative surgery for hepatic cystic echinococcosis (HCE). We compared omentoplasty and tube drainage in patients with HCE at high risk of biliary complications. Methods: This prospective, single-center, nonrandomized study included 60 patients allocated alternately to omentoplasty or tube drainage (30 per group). The primary outcome was bile leakage and/or residual cavity complications within 30 days after surgery. Exploratory Firth logistic regression adjusted for cyst diameter and preoperative cholangitis. Holm correction was applied to five secondary outcomes. Results: The primary outcome occurred in 6/30 (20.0%) versus 16/30 (53.3%) patients (risk ratio 0.375; 95% confidence interval [CI] 0.170–0.826; p = 0.015). Adjusted odds were higher with tube drainage (odds ratio 5.25; 95% CI 1.51–22.72; p = 0.008). This association persisted after additional adjustment for preoperative endoscopic retrograde cholangiopancreatography. Surgical site infection (3.3% vs. 30.0%) and percutaneous intervention (0% vs. 26.7%) were less frequent with omentoplasty (Holm-adjusted p = 0.049 and 0.023, respectively). The operative-time difference was not significant after Holm adjustment. Bile leakage occurred in 20.0% versus 36.7% (p = 0.252). Mean follow-up was 68.8 ± 5.8 months; all patients completed at least 60 months, with no loss to follow-up. Recurrence occurred in 3.3% versus 13.3% (p = 0.353). Conclusions: Omentoplasty was associated with a lower incidence of the composite outcome, including after adjustment. These findings support its use in suitable patients and warrant confirmation in larger randomized studies.

Background and Objectives: Mortality following percutaneous endoscopic gastrostomy (PEG) may reflect illness severity, nutritional impairment, systemic inflammation, and patient selection. The prognostic value of routinely available indices, including the Prognostic Nutritional Index (PNI) and C-reactive protein-to-albumin ratio (CAR), remains uncertain in critically ill patients undergoing PEG. Materials and Methods: This retrospective cohort analyzed 93 adult intensive care patients who underwent PEG, with one index PEG retained per patient. Pre-PEG feeding and swallowing context, functional dependence, clinical-procedure consent documentation, and the availability of decision-relevant fields were described from retrospective hospital records. The primary outcome was date-defined 90-day all-cause mortality, calculated from the calendar-day difference between recorded PEG and death dates, with PEG placement defined as day 0; 30-day mortality was secondary. Separate multivariable logistic models included age, sex, APACHE II, and either PNI or log2-transformed CAR. Results: Date-derived death occurred within 30 days in 25/93 patients (26.9%; 95% CI, 18.9–36.7). Among 92 patients classifiable at 90 days from the available date fields, 45 deaths occurred by day 90 (48.9%; 95% CI, 38.9–59.0), and 47 patients had no recorded death through day 90; one patient with a last-known-alive date at day 81 and no recorded death was not classifiable for the 90-day endpoint. APACHE II was associated with 90-day death in both models (PNI model OR per 5 points, 1.95; 95% CI, 1.17–3.26; p = 0.011; CAR model OR, 1.96; 95% CI, 1.17–3.27; p = 0.011), whereas PNI and CAR were not statistically significantly associated. In the CAR model, age was also associated with 90-day death (OR per 10 years, 1.36; 95% CI, 1.02–1.81; p = 0.039). Primary PEG indications were predominantly acute or chronic neurological dysphagia (73.1%) and prolonged mechanical ventilation or ICU stay (18.3%), with dysphagia due to dementia recorded as the primary indication in only one patient (1.1%, alive at 90 days); all 93 patients had documented swallowing assessments and signed procedure consent after a median of 23 days of nasogastric/nasojejunal feeding. Among the 45 deaths by day 90, recorded causes were sepsis, septic shock, or multiorgan dysfunction in 32 (71.1%), acute respiratory failure in 6 (13.3%), cardiovascular/cardiorenal causes in 4 (8.9%), and cerebrovascular causes in 3 (6.7%), with no recorded deaths directly attributed to the PEG procedure (0/93) and four acute or subacute post-PEG events descriptively noted. Conclusions: In this retrospective intensive care cohort, higher APACHE II scores were associated with date-defined 90-day all-cause mortality. PNI and CAR were not statistically significantly associated with 90-day mortality in separate adjusted models. These findings describe all-cause outcomes following PEG and do not establish mortality attributable to PEG or the appropriateness of individual PEG decisions.

Bu kitap bölümü, rekombinant DNA teknolojisinin temel prensiplerini, kullanılan başlıca mikroorganizmaların avantajları ve dezavantajları, bu teknolojinin çeşitli sektörlerdeki güncel uygulamalarını kapsamlı bir şekilde ele almayı amaçlamaktadır. Ayrıca, teknolojideki son gelişmeler, özellikle CRISPR-Cas9 gibi gen düzenleme araçları ve sentetik biyolojinin rolü üzerinde durulacak, etik ve güvenlik konularına değinilerek gelecekteki potansiyel uygulamalar ve zorluklar değerlendirilecektir. Mikroorganizmaların rekombinant DNA teknolojisindeki merkezi rolü, bu bölümün ana odak noktalarından biri olacaktır, zira bakteriler ve mayalar gibi mikroorganizmalar, genetik mühendisliği uygulamaları için vazgeçilmez konak sistemleri sunmaktadır. Bu bölüm, okuyuculara rekombinant DNA teknolojisinin karmaşık dünyasına dair derinlemesine bir bakış sunarak, bu alandaki güncel bilgi birikimini ve gelecekteki yönelimleri anlamalarına yardımcı olmayı hedeflemektedir. Ayrıca yeteri miktarda üretilemeyen bileşiklerin yüksek miktarda üretimine yönelik alternatif çalışma modelleri hakkında literatürde yapılan bazı çalışmaları (Albümin ve İnsülin gibi hayati öneme sahip proteinler ve günlük hayatımızda’da kullanabileceğimiz hidrofobin proteinler) değerlendireceğiz.