Objective: Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). Material and Methods: A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Results: Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Conclusion: Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.
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Objective: Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. Material and Methods: In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. Results: Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. Conclusion: This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
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Objective: Anorectal malignant melanoma is a rare tumor with poor prognosis. In this study, it was aimed to present our surgical results by reviewing the literature retrospectively in 11 patients who underwent surgery for ARMM in our clinic. Material and Methods: The patients who underwent surgery for anorectal malignant melanoma in Yuksek İhtisas Training and Research Hospital between 2007-2018 were included in the study. Results: Four patients were males and seven were females. Mean age was 54.18. The tumor was in the rectum in 4 cases, in the anorectal region in 3 cases and in the anal canal in 4 cases. Wide local excision was performed in 3 cases and APR was performed in 8 cases. Four of the cases were stage I, 6 were stage II and 1 was stage III. Mean tumor size was 4.73 cm, and mean tumor depth was 13.6 mm. Mean number of metastatic lymph nodes was 10.37. Median survival was 12 months. Conclusion: Anorectal malignant melanoma is a type of tumor diagnosed in late and advanced stages due to lack of specific findings. Although ARMM is rare, when rectal bleeding, pain, hemorrhoids and changes in bowel habits are observed, ARMM should be kept in mind.
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Objective: COVID-19 disease, which rapidly became a pandemic, led to significant changes in the provision of health services. This included radical
changes to the supply and delivery of routine services to release resources for emergency care. During this process, a range of restrictions were imposed
including the recommended rules to be followed before, during and after surgery. Health services provided for breast cancer diagnosis, treatment and
follow-up have also undergone enforced changes meaning the diagnosis, treatment, and follow-up of patients with priority has come to the fore. In this
study, the effect of the COVID-19 pandemic in Turkey, between March 11, 2020 and May 31, 2020 was assessed in comparison to pre-pandemic practice
in terms of divided into two periods, and breast cancer diagnosis, treatment, and follow-up.
Material and Methods: Surgeons dealing with breast cancer treatment and registered to SENATURK (Turkish Senology Academy) were contacted on-
line. The period was divided into two, between March 11th and April 30th and May 1st to May 31st
, 2020. Surgeons were requested to complete two elec-
tronic evaluation forms, one for each period, investigating change in practice. Only complete responses for both periods were included in the analysis.
Results: There were 93 respondents. Except for less multidisciplinary breast councils, there was no delay in radiological and pathological diagnoses. The
number of breast cancer surgeries increased in Period 2, and more COVID-19 positive breast cancer patients were operated in Period 2. Benign breast
patients were delayed less frequently in Period 2. In the statistical analysis performed between the two groups, it was found that only a significant dif-
ference was in the number of outpatients with benign breasts.
Conclusion: With sufficient awareness of the risks of COVID-19 and with individual protection, breast cancer treatment was not affected during the
assessed period of active pandemic in Turkey.
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Objective: This study aimed to compare the efficacy and the safety of ultrasound-guided continuous thoracic paravertebral block (CTPB) to the con-
tinuous thoracic epidural block (CTEB) for pain relief in patients undergoing lung surgery.
Material and Methods: Our study included 102 patients after lung surgery at the 74 Central Hospital from 9/2013 to 12/2017. Patients were divided
into 2 groups: CTPB group (n= 51) and CTEB group (n= 51). The primary outcomes were the Visual Analogue Scale (VAS) scores when patients were at
rest (VR
) and movement (VM
), the total used dosage of bupivacaine - fentanyl after surgery, plasma glucose, and cortisol levels, additional doses of mor-
phine. Adverse reactions were recorded during the study. The study was approved by the Ethics Committee of the 74 Central Hospital. All participants
provided their informed consent.
Results: There were no significant differences between CTPB and CTEB groups in terms of the V R and the V M
, total used doses of bupivacaine - fentanyl
after 72-hours of surgery (p> 0.05), the increased plasma glucose, and plasma cortisol (p> 0.05), and the additional doses of morphine. The percent of
patients in the CTPB group undergoing adverse reactions in the circular system and the respiratory system was lower than in the CTEB group. Adverse
reactions included vascular puncture, urinary retention, and itch.
Conclusion: Ultrasound-guided CTPB is an effective intervention of pain relief after lung surgery. Its analgesic efficacy is comparable to CTEB. Also, this
method had fewer adverse reactions in circulation and respiration compared to the CTEB.
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Objective: Sacrococcygeal pilonidal sinus disease is common in children. The disease reduces the quality of life of patients with symptoms such as pain
and chronic discharge. Variable surgical techniques have been described for the treatment of pilonidal sinus disease. This study aims to evaluate clinical
approach of Turkish pediatric surgeons to children with pilonidal sinus disease.
Material and Methods: Survey questions were prepared through a literature review for controversial issues. The participants were asked pre-selected
and checkbox questions. The survey was sent to 450 pediatric surgeons, members of the Association of Turkey Pediatric Surgery via a link to Google
Forms.
Results: Nineteen percent (88) of the members responded. Seventy five (85.2%) of the pediatric surgeons stated that they did not perform additional
preoperative imaging. Surgical excision methods were preferred more than minimally invasive procedures (102 to 46). Sixty (68.2%) of the participants
preferred preoperative prophylactic single dose intravenous antibiotics and postoperative oral antibiotics. Regarding the participants’ practices, poor
local hygiene, overweight, wide or deep sinus pit were stated as the most common causes of recurrence. Vast majority of the pediatric surgeons recom-
mended laser epilation (%85.2) and slimming (59.1%) to patients.
Conclusion: Various studies have been published from Turkey for pilonidal sinus disease. As seen in the current study, Turkish pediatric surgeons do not
have a common opinion in pilonidal sinus disease and prefer surgical excision methods more frequently. Prospective randomized studies with bigger
number of patients are required to establish common guidelines in disease management
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Vivek GUPTA, Vikram Singh SODHA, Nitin KUMAR, Vishal GUPTA, Ravi PATE, Abhijit Chandra
Vivek GUPTA, Vikram Singh SODHA, Nitin KUMAR, Vishal GUPTA, Ravi PATE, Abhijit Chandra
Objective: Pancreas is a less commonly injured organ in blunt abdominal trauma. This study aimed to analyze the management and outcomes of
patients in whom the pancreatic injury was missed during the initial evaluation of blunt abdominal trauma.
Material and Methods: We retrospectively (2009-2019) analyzed the details and outcome of patients who underwent conservative management of
blunt abdominal trauma, where the diagnosis of pancreatic injury was missed for at least 72 hours following trauma.
Results: A total of 31 patients with missed pancreatic injury were identified. All patients were hemodynamically stable following trauma and most
(21) were initially assessed only by an ultrasound. A delayed diagnosis of pancreatic injury was made at a mean of 28 (4 to 60) days after trauma when
patients developed abdominal pain (31), distension (18), fever (10) or vomiting (8). On repeat imaging, 18 (58.1%) patients had high grade pancreatic
injuries including complete transection or pancreatic duct injury. Seven (22.5%) patients were managed conservatively, seventeen (54.8%) underwent
percutaneous drainage of intra-abdominal collections, seven (22.5%) underwent endoscopic or surgical drainage procedure for symptomatic pseu-
docyst. Eleven (35.4%) patients needed readmissions to manage recurrent pancreatitis, intra-abdominal abscess and pancreatic fistula. Three patients
required pancreatic duct stenting for pancreatic fistula. There was no mortality.
Conclusion: Pancreatic injury may be missed in patients who remain hemodynamically stable with minimal clinical symptoms after abdominal trauma,
especially if screened only by an ultrasound. In our series, there was significant morbidity of missed pancreatic injury.
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Objective: Obesity is a global health epidemic with considerable co-morbidities. The increasing demand for bariatric surgery has led to the emergence
of new techniques. We modified previously described Mini Gastric By-pass(MGB) technique via leaving a bridge at the most cranial 2 cm of the fundus
of the human stomach to the follow-up and treatment of the remnant stomach and duodenum. We would like to entitle this new technique as Bridged
MGB and aimed to apply on rabbits as an experimental study.
Material and Methods: The study was performed in the experimental animal laboratory of university after ethical approval was taken from the local
ethics committee. Described new technique was applied to 2.1 and 3.2 kg 2 New Zealand rabbits.
Results: As a result of the operations, one of the rabbits died on the day of the operation; the other rabbit was exitus postoperatively on the third day.
In autopsies, although no problem was detected at the anastomoses, necrosis was detected in the large curvature of both rabbits.
Conclusion: Rabbit, one of the popular experimental animals, has been shown to be different from the human gastrointestinal system in both arterial
and topographic aspects and it has been emphasized that it varies according to the species and even the diet and the climate. We believe that our study
failed as a result of these differences and that animals more similar to humans should be used in gastrointestinal experimental studies.
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Neoplasms of the appendix are very rare. They usually show glandular or neuroendocrine differentiation, and when they both occur in the same area,
it is called a “collision tumor.” Low-grade mucinous neoplasms associated with appendiceal diverticula are also uncommon. The appendectomy speci-
men of a 60-year-old man contained dense and mucoid luminal content on the distal tip, and similarly a solid, yellow, lumen-obscuring tumor with a
diameter of 1.5 cm at the base of the appendix was detected. Microscopically, there were three diverticula that comprised herniation of the mucosal
layer through the appendiceal wall. Interestingly, all of the diverticula and the normal-appearing appendiceal wall were lined by adenomatous epithe-
lium. The luminal portion had pools of mucin-containing, rare clusters of low-grade epithelium that gave rise to the diagnosis of a“low-grade mucinous
neoplasm.” The solid-appearing tumor was diagnosed as a “neuroendocrine neoplasm,” and there was no transition zone between these two types of
tumors. There are some cases that have been reported as low-grade mucinous neoplasms associated with appendicular diverticula and collision tumors
consisting both mucinous neoplasms and carcinoid tumors in the literature; our case has a unique appearance with two different types of tumors both
in the appendix wall and within multiple diverticula
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Objective: Laparoscopic adrenalectomy is the gold standard for the resection of adrenal tumors. However, there are some technical difficulties, which may be due to the fact that adrenalectomy is rarely encountered in general surgery practice and has a high learning curve. In addition to these, obesity is another problem in laparoscopic adrenalectomies. In the present study, it was aimed to evaluate whether obesity affects perioperative and postoperative complications after laparoscopic adrenalectomy.
Material and Methods: This is a retrospective comparative study carried out between December 2008 and June 2018. A total of 65 patients who un- derwent laparoscopic transperitoneal adrenalectomy were divided into two groups according to their Body Mass Index (BMI). Patients’ demographic data, perioperative and postoperative results were analyzed from hospital medical records.
Results: There were 30 non-obese and 35 obese patients. There was no significant difference between obese and non-obese patients in terms of operation time, peroperative complications and length of hospital stay. However, there was a statistically significant difference between the two groups for postoperative complications (p< 0.031). There was conversion to open surgery in four obese patients and in one patient in the non-obese group.
Conclusion: In obese patients, technical difficulties may be encountered during surgery due to increased adipose tissue, and postoperative complication rates may increase. Nevertheless, laparoscopic transperitoneal adrenalectomy can be performed safely paying attention to the management of obesity-related complications.
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