Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
The Effect of Postoperative Nutrition Initiation Time on the Development of Complications and Duration of Hospital Stay in Patients with Liver Transplantation: Retrospective Study
Karaciğer Transplantasyonlu Hastalarda Postoperatif Beslenmeye Başlama Zamanının Komplikasyon Gelişimi ve Hastanede Kalış Süresi Üzerine Etkisi: Retrospektif Araştırma
Kübra YILMAZa , Gülay YAZICIa , Volkan ÖTERb , Osman AYDINb , Erdal Birol BOSTANCIb
aAnkara Yıldırım Beyazıt University Faculty of Health Sciences, Department of Nursing, Division of Surgical Diseases Nursing, Ankara, Türkiye
bAnkara Bilkent City Hospital, Clinic of Gastroenterology Surgery, Ankara, Türkiye
Turkiye Klinikleri J Health Sci. 2024;9(3):418-26
doi: 10.5336/healthsci.2023-100486
Article Language: EN
Full Text
ABSTRACT
 Objective: Nutrition is crucial during the late stages of liver failure and throughout the transplantation process. Current guidelines recommend feeding 12-24 hours after liver transplantation unless a complication that affects nutritional status has developed. However, there are limited studies in the literature showing the effects of the transition to nutrition after liver transplantation on patients. The aim of this study is to determine the effect of transition to postoperative nutrition on complication development and hospital stay in liver transplant patients. Material and Methods: Between 2017 and 2022, 69 patients who underwent liver transplantation were included in the study. The 18-question data form prepared by the researchers was filled in retrospectively. Results: As a result of the study, gas output was detected on the first day in 92.5% of the patients fed at the postoperative 24th hour and in 93.5% of the patients fed at the 48th hour. Complications were seen in 80% of the patients fed at 96th hour. The hospital stay was found to be higher in patients fed at the 96th hour compared to the other groups (p<0.05). When compared with the postoperative nutrition time, a significant difference was found between feeding hours and the incidence of complications, postoperative hospital stay, gas removal time and the type of complication (p<0.05). Conclusion: As a result of this research, it was determined that early postoperative nutrition in patients who underwent liver transplantation shortened the duration of hospital stay, provided early gas release and reduced the incidence of complications.

Keywords: Liver transplantation; hospital stay; postoperative complications; postoperative nutrition
ÖZET
 Amaç: Karaciğer yetersizliğinin son döneminde ve nakil sürecinde beslenme konusu oldukça önemlidir. Mevcut kılavuzlar, beslenme durumunu etkileyecek bir komplikasyon gelişmediyse karaciğer naklinden 12-24 saat sonra beslenmeyi önermektedir. Ancak literatürde karaciğer nakli sonrası beslenmeye geçişin hastalar üzerindeki etkilerini gösteren sınırlı sayıda çalışma bulunmaktadır. Bu çalışmanın amacı, karaciğer nakli yapılan hastalarda postoperatif beslenmeye geçişin komplikasyon gelişimi ve hastanede kalış süresine etkisini belirlemektir. Gereç ve Yöntemler: Araştırmaya 2017-2022 yılları arasında karaciğer nakli olan 69 hasta dahil edildi. Araştırmacılar tarafından hazırlanan 18 soruluk veri formu geriye dönük olarak dolduruldu. Bulgular: Araştırma sonucunda postoperatif 24. saatte beslenen hastaların %92,5'inde, 48. saatte beslenen hastaların %93,5'inde ilk gün gaz çıkışı tespit edildi. 96. saatte beslenen hastaların %80'inde komplikasyon görüldü. 96. saatte beslenen hastaların hastanede kalış süresi diğer gruplara göre daha yüksek bulundu (p<0,05). Ameliyat sonrası beslenme süresi ile karşılaştırıldığında beslenme saatleri ile komplikasyon görülme sıklığı, ameliyat sonrası hastanede kalış süresi, gaz çıkarma süresi ve komplikasyon türü arasında anlamlı fark bulundu (p<0,05). Sonuç: Bu araştırma sonucunda, karaciğer transplantasyonu yapılan hastalarda postoperatif erken beslenmenin hastanede kalış süresini kısalttığı, erken gaz çıkışı sağladığı ve komplikasyon görülme sıklığını azalttığı belirlendi.

Anahtar Kelimeler: Karaciğer nakli; hastanede kalış; ameliyat sonrası komplikasyonlar; postoperatif beslenme
REFERENCES:
  1. El-Gamal S, Morsy WYM, Ismail MS, El-Shazly MAR. Impact of a designed nursing intervention protocol about preoperative liver transplantation care on patients' outcomes at a university hospital in Egypt. Journal of Education and Practice. 2013;4(19):105-16. [Link] 
  2. Sayın Y. Current practices in surgical nursing. In: Çelik S, ed. Surgical Diseases of the Hepatopancreatobiliary System. 1st ed. Antalya: Çukurova Nobel Medicine Publisher; 2021. p.515-9.
  3. Genç R. Türkiye'de ve dünyada organ transplantasyon cerrahisi: transplantasyon lojistiğinin yönetimi [Organ transplantation surgery in Turkey and in the world: the management of transplantation logistics]. Turkish Journal of Surgery. 2009;25(1):40-4. [Link] 
  4. Esquivel CO. Liver transplantation: where we are and where we are heading. Transplant Proc. 2010;42(2):610-2. [Crossref]  [PubMed] 
  5. Kasapoğlu B, Yalçın KS, Türkay C. Canlı donörden karaciğer transplantasyonu [Liver transplantation from a living donor]. Current Gastroenterology. 2010;14(2):96-102. [Link] 
  6. Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Ann Transl Med. 2018;6(20):409. [Crossref]  [PubMed]  [PMC] 
  7. Türkiye Organ Nakli Vakfı [İnternet]. [Erişim tarihi: 5 Ocak 2023]. İstatistikler. Erişim linki: [Link] 
  8. Sanchez AJ, Aranda-Michel J. Nutrition for the liver transplant patient. Liver Transpl. 2006;12(9):1310-6. [Crossref]  [PubMed] 
  9. Çelebi D, Yılmaz E. Cerrahi hastalarda enteral ve parenteral beslenmede kanıta dayalı uygulamalar ve hemşirelik bakımı [Enteral and parenteral nutrition in surgical patients evidence-based practices and nursing care]. Istanbul Gelisim University Journal of Health Sciences. 2019;7:714-31. [Crossref] 
  10. Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5(2):608-23. [Crossref]  [PubMed]  [PMC] 
  11. Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am. 2011;91(3):565-78. [Crossref]  [PubMed] 
  12. British Transplantation Society. Living Donor Liver Transplantation. 2015. Cited: January 6, 2023. Available from: [Link] 
  13. European Association fort he Study of the Liver (EASL). EASL Clinical practice guidelines: liver transplantation. 2015. Cited: January 6, 2023. Available from: [Link] 
  14. European Comittee (Partial Agreement) on Organ Transplantation, Guide to the quality and safety of organs for transplantation 7th Edition, 2018. Accessed July 14, 2024. Available at: [Link] 
  15. ERAS Türkiye Derneği [İnternet]. [Erişim tarihi: 29 Mart 2023]. ERAS protokollerinin temel ögeleri. Erişim linki: [Link] 
  16. Brustia R, Monsel A, Skurzak S, Schiffer E, Carrier FM, Patrono D, et al. Guidelines for perioperative care for liver transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations. Transplantation. 2022;106(3):552-61. [Crossref]  [PubMed] 
  17. Feltracco P, Barbieri S, Galligioni H, Michieletto E, Carollo C, Ori C. Intensive care management of liver transplanted patients. World J Hepatol. 2011;3(3):61-71. [Crossref]  [PubMed]  [PMC] 
  18. Yirui L, Yin W, Juan L, Yanpei C. The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2021;45(3):101594. [Crossref]  [PubMed] 
  19. Fuentes Padilla P, Martínez G, Vernooij RW, Urrútia G, Roqué I Figuls M, Bonfill Cosp X. Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst Rev. 2019;2019(10):CD012340. [Crossref]  [PubMed]  [PMC] 
  20. Kim JM, Joh JW, Kim HJ, Kim SH, Rha M, Sinn DH, et al. Early enteral feeding after living donor liver transplantation prevents infectious complications: a prospective pilot study. Medicine (Baltimore). 2015;94(44):e1771. [Crossref]  [PubMed]  [PMC] 
  21. Ikegami T, Shirabe K, Yoshiya S, Yoshizumi T, Ninomiya M, Uchiyama H, et al. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition. J Am Coll Surg. 2012;214(3):288-95. [Crossref]  [PubMed] 
  22. Rayes N, Seehofer D, Hansen S, Boucsein K, Müller AR, Serke S, et al. Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation. 2002;74(1):123-7. [Crossref]  [PubMed] 
  23. Usui M, Hayasaki A, Fujii T, Iizawa Y, Kato H, Tanemura A, et al. Early enteral feeding of daikenchuto stimulates early bowel movement with increased portal venous blood flow after living donor liver transplantation. Transplant Proc. 2018;50(9):2690-4. [Crossref]  [PubMed] 
  24. Herbert G, Perry R, Andersen HK, Atkinson C, Penfold C, Lewis SJ, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2018;10(10):CD004080. Update in: Cochrane Database Syst Rev. 2019;7:CD004080. [Crossref]  [PubMed]  [PMC] 
  25. Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. 2023 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. [PubMed] 
  26. Türk Karaciğer Araştırmaları Derneği [İnternet]. [Erişim linki: 31 Mart 2024]. MELD Hesapla. Erişim linki: [Link] 
  27. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-61. [Crossref]  [PubMed] 
  28. Mahmoodzadeh H, Shoar S, Sirati F, Khorgami Z. Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial. Surg Today. 2015;45(2):203-8. [Crossref]  [PubMed] 
  29. Fanning J, Hojat R. Safety and efficacy of immediate postoperative feeding and bowel stimulation to prevent ileus after major gynecologic surgical procedures. J Am Osteopath Assoc. 2011;111(8):469-72. [Crossref]  [PubMed] 
  30. Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy. World J Gastroenterol. 2006;12(15):2459-63. [Crossref]  [PubMed]  [PMC] 
  31. Terzioglu F, Şimsek S, Karaca K, Sariince N, Altunsoy P, Salman MC. Multimodal interventions (chewing gum, early oral hydration and early mobilisation) on the intestinal motility following abdominal gynaecologic surgery. J Clin Nurs. 2013;22(13-14):1917-25. [Crossref]  [PubMed] 
  32. Heitkemper MM, Chang L. Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gender Medicine. 2009;6:152-67. [Crossref]  [PubMed]  [PMC] 
  33. Lobato Dias Consoli M, Maciel Fonseca L, Gomes da Silva R, Toulson Davisson Correia MI. Early postoperative oral feeding impacts positively in patients undergoing colonic resection: results of a pilot study. Nutr Hosp. 2010;25(5):806-9. [PubMed] 
  34. Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics (Sao Paulo). 2011;66(12):2001-5. [Crossref]  [PubMed]  [PMC] 
  35. Li B, Liu HY, Guo SH, Sun P, Gong FM, Jia BQ. The postoperative clinical outcomes and safety of early enteral nutrition in operated gastric cancer patients. J BUON. 2015;20(2):468-72. [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com