Since December 2019, the world has been battling the COVID-19 pandemic, and health workers are at the forefront of the fight. Surgeons also fulfill their duty; however, elective cases had to be postponed in order to use resources appropriately in the fight against coronavirus. Although benign elective surgical procedures can be postponed to a distant time during this pandemic, surgical interventions for urgent and life-threatening situations are mandatory to perform but the main uncertainty among surgeons is about cancer patients. In this paper, we aimed to present a suggestion to the surgeon about how to manage digestive system cancers during pandemic in the light of the published articles and guidelines.
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Objective: The whole world is dealing with the COVID-19 pandemic, and healthcare professionals are the most affected group. The aim of this study was to evaluate the knowledge of general surgeons about COVID-19 and understand the attitude and current situation of our colleagues.Material and Methods: This descriptive study comprised general surgeons working in different parts of Turkey. A survey with 23 questions was pre-pared to determine the demographic characteristics of the participants, workplace characteristics, change in daily work practices and their attitudes in the pandemic process.Results: A total of 332 forms were evaluated. Survey results show that the majority of surgeons have changed their daily surgical practices. Many surgeons take part in the treatment of COVID-19. While most benign cases are delayed, the managemet of malignant cases differs. There are also differences in the evaluation of patients preoperatively and the type of operation. Personal protective measures are followed. While the rate of infected surgeons is low, the majority of surgeons have concerns about infection.Conclusion: Turkish surgeons have managed to get a quick reaction from the start of the pandemic. However, there are still differences in preopera-tive patient evaluation and operation selection and precautions during the operation. Surgeons also should be informed about the management of malignant patients.
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Objective: The aim of the present study was to search the most-cited articles from Turkey on abdominal wall hernias and analyze their characteristics with several parameters.Material and Methods: In March 2019, a search was conducted through all databases in the Web of Science (WoS) to determine the most-cited articles on abdominal wall hernias. Each article was evaluated in regard to host journal, year of publication, the complete list of authors, the type of article, main subject of the study, institution of the study group. Citation counts in Google Scholar (GSch) were also obtained.Results: Mean number of citations of the top 100 articles in herniology was 30.50. Articles were published in 38 journals; Hernia is the leading host. No cor-relation was observed between the journal impact factors and the number of the citations. Two thirds of the articles were clinical studies. Article types had no significant effect on the citation counts. Inguinal hernia was the most frequent topic by taking place in 58 papers. Articles related to incisional hernias had a higher mean number of citations in comparison with other topics. Ankara University School of Medicine had most cited articles, the highest number of total citations, and the highest citation per articles. Ankara Numune Training and Research Hospital and Istanbul University School of Medicine had the highest number of the articles in the list.Conclusion: Citation counts of hernia related articles from Turkey are relatively low. Hernia is the leading journal for Turkish studies. Inguinal hernia is the most frequent topic whereas papers about incisional hernias receive more citations than others.
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Objective: The aim of this study was to evaluate the prognostic factors effecting recurrence risk and disease-free survival of the patients who were diagnosed as gastrointestinal stromal tumor after complete resection of the tumor with or without adjuvant therapy.Material and Methods: Between the years 2005 and 2013, data of 71 patients including clinical and demographic features, tumor localizations, patho-logic examinations, survival and recurrence rates were enrolled into this retrospective study.Results: Male/female ratio was 1.71, and mean age was 60.27 ± 14.65 years. Forty-two (59.2%) patients had tumor in stomach, 16 (22.5%) in small bowel, whereas 12 (16.9%) had extra-gastrointestinal system and one patient (%1.4) had rectal localization. Modified NIH risk stratification scheme categorized 9 (12.68%) patients in very low-, 12 (16.90%) in low-, 21 (29.58%) patients in moderate-and 29 (40.85%) patients in high-risk group. Twenty-four (33.8%) patients had a metastatic disease at follow-up while 13 (18.3%) patients were metastatic at admission. R0 resection was successfully performed in 51 (71.8%) patients, while R1 resection in 9 (12.7%) and R2 resection in 11 (15.5%) were achieved. Mean follow-up time was 47.12 ± 33.52 months (range, 1-171 months). Nineteen (26.8%) patients demonstrated recurrence with a mean time of 22.16 ± 15.89 months (range, 3-57 months). During follow-up 17 (23.9%) patients were deceased. In univariate analysis, high-risk group, small bowel and extra-gastrointestinal system localization, R1-2 resection, necrosis, positive resection margin and invasion of surrounding tissues, metastatic disease and adjuvant therapy were statistically significant in terms of recurrence. Multivariate analysis presented small bowel and extra-gastrointestinal system localization, R2 resection, mitoses count, invasion and adjuvant therapy as independent prognostic risk factors affecting disease-free survival rates. The 1, 3 and 5 years of disease-free survival rates of the patients were 89.6%, 75.4%, 64.3%, respectively.Conclusion: As mentioned in the literature, the mainstay of curative therapy of gastrointestinal stromal tumor is surgery. In our study, not only small bowel, extra-gastrointestinal system localization and invasion of surrounding tissues by tumor, but also R2 resection that complicate the local control of the disease were represented as independent adverse prognostic factors for disease-free survival. Unfavourable clinical outcomes of adjuvant therapy over the disease-free survival was linked to higher tumor stage with metastatic disease and emphasized that prospective trials with more cases should be practiced.
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Objective: Frostbite injuries are important causes of morbidity and mortality after trauma. Epidemiology, injury patterns, and outcomes after frostbite among patients presenting to trauma centers are incompletely defined. The purpose of this study was to delineate patient demographics, clinical char-acteristics, and independent predictors of outcomes after frostbite.Material and Methods: Patients with frostbite injury were identified from the National Trauma Data Bank (NTDB) (2007-2014). Demographics, clinical/injury data, and outcomes were collected. Patients were dichotomized into study groups based on intensive care unit (ICU) admission. Univariate analy-sis was performed with the Mann-Whitney U, Fisher’s exact, or Chi-Square test as appropriate. Multivariate analysis using logistic regression determined independent predictors of outcomes.Results: Over the study period, 241 patients were identified. Median body temperature on admission was 36.3⁰C (IQR 33.4-36.7). Mortality was 3% (n= 7). ICU admission was required in 101 (42%) patients and 48 (20%) underwent surgical intervention. On multivariate analyses, mortality was predicted by lower admission GCS (p= 0.027) and amputation by higher HR (p= 0.013). Need for ICU admission was predicted by older age (p= 0.010), male gender (p= 0.040), higher HR (p= 0.031) and ISS (p< 0.001), and lower GCS (p= 0.001). Prolonged hospital LOS was predicted by higher heart rate (p< 0.001) and ISS (p< 0.001). Conclusion: Frostbite injuries are uncommon but can necessitate surgical intervention and cause mortality. Lower GCS and higher heart rate, but not body temperature, portend poor outcomes. These findings can be used to triage patients appropriately upon admission and to better inform prognosis after frostbite injuries.
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Objective: This study aimed to investigate the efficacy of intralesional epidermal growth factor (EGF) in preventing the extremity from a major amputation and its effects on wound healing in chronic diabetic foot ulcers (DFUs).
Material and Methods: Thirty-three patients with DFUs were treated with intralesional EGF application between January 2013 and January 2017.
The first endpoint was to determine the prevention rate of major amputation within 12 months following treatment. The second endpoints were the
recovery of ulcer surface area with ≥ 50% granulation following two months and the healing of ulcer surface area with ≥ 75% granulation following six
months after the first application of EGF.
Results: After three patients were excluded because of major side effects in the remaining 30 patients (48 DFUs), granulation rate of ≥ 50% was achieved
in 24 (37 DFUs) patients, and not achieved in 6 (11 DFUs) patients eight weeks following the EGF application. A granulation rate of ≥ 75% was achieved in
21 (31 DFUs) patients after six months. At 12 months following the treatment, one major and seven minor amputations were performed, a total of 10 DFUs
in five patients were not healed, and the DFUs in 17 patients completely recovered.
Conclusion: Intralesional EGF application has positive results in addition to good foot care in DFUs, and promising results can be obtained by protecting the extremity from amputation by using it in patients whose vascular intervention methods are not appropriate and have DFUs that do not heal
with conventional wound care treatments.
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Objective: Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient
loss. The effect of peritoneal dialysis on post-kidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown.
In this study, it was aimed to analyze factors effecting major ureteral complications after living donor kidney transplantation and impact of peritoneal
dialysis and double J-stents (JJ stents).
Material and Methods: This study included 116 adult to adult living donor kidney transplant patients. Factors effecting major urologic complications
after living donor kidney transplantation were analyzed. The donors were primary relatives of the recipients.
Results: Major urologic complications after living donor kidney transplantation was 8/116 (6.9%). Urinary leak was present in 2 (1.7%) patients. Ureteral
stenosis was encountered in 6 (5.2%) patients. Double J stents were used in 84 (72.4%) of the cases. The effect of JJ ureteral stent was not statistically significant for urinary leak, ureteral stenosis (p= 0.074, p= 0.470, respectively). A total of 29 (25%) patients had peritoneal dialysis before kidney transplantation.
Preoperative peritoneal dialyses and bacteriuria after kidney transplantation were independent risk factors for ureteral stenosis in multivariate analysis (p=
0.013, and p= 0.010 respectively).
Conclusion: In the guidance of the results of the present study, peritoneal dialysis prior to kidney transplantation and bacteriuria are independent
risk factors for ureteral stenosis after living donor kidney transplantation. JJ stents have no effect on urologic complications after living donor kidney
transplantation.
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Objective: The study aimed to compare the techniques applying prolene mesh and progrip-self fixating mesh in terms of post-operative pain, limitation of movement and quality of life.
Material and Methods: The study was conducted from November 2014 to January 2016 in Department of Surgery, Manisa Celal Bayar University Hospital. The study recruited 50 male patients, aged 18 and over and was carried out as a double blinded procedure. Twenty-five patients were randomly
selected to receive hernia repair by progrip self-fixating mesh and 25 patients were treated with hernia repair with suture fixation method by using
prolene grafts, and patients’ pain follow-up was performed with face-to-face or telephone interviews with VAS (Visual Analogue Scale) and return to
daily routine activities were evaluated with SF-36 (Short Form-36) quality of life scale. Recurrent hernias and emergency cases were excluded.
Results: The pain scores were lower and a statistically significant difference was achieved in patients in whom progrip self-fixating mesh was used in the
early postoperative period. Both methods gave statistically similar results in terms of pain and quality of life.
Conclusion: In the literature, there are some evidence that the repair applied with progrip self-fixating graft has more positive outcomes compared to
the repairs applied with suture fixation. It is concluded that there is a need for longer follow-ups and larger series of cases in order to achieve a definite
result.
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Objective: The clinical results of obese patients who have undergone open or laparoscopic appendectomy, whether one technique is superior to the
other is still not clearly known.In our study, we compared the clinical results of obese patients operated with laparoscopic or open technique for acute
appendicitis.
Material and Methods: We performed retrospective analyses of patients operated for acute appendicitis between the dates of July 2016 and July 2019
at Istinye University Faculty of Medicine Bahcesehir Liv Training and Research Hospital and Liv Hospital Ankara. Of the 241 patients whose height and
weight information was accessible, 57 had a body mass index of 30 kg/m2
or higher. Eighteen of these patients underwent open surgery while the
other 39 underwent laparoscopic surgery. The primary result criterion was complication ratio. Secondary criteria were operation time and length of
hospital stay.
Results: Upon comparison of laparoscopic and open techniques in terms of intraoperative-postoperative complications (p= 0.01), operation time (p=
0.02) statistically significant differences were found between the groups. However the mean length of hospital stay (p= 0.181) was similar in both groups.
Conclusion: In obese appendicitis patients, the laparoscopic technique proved to be superior to the open technique in criteria such as perioperativepostoperative complications, operation time, and etc. Length of hospital stay was determined to be similar between the groups.
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Mehmet Ali KOÇDOR ,
Erbil DOĞAN ,
IŞIL KASAPOĞLU ,
Bahadır GÜLLÜOĞLU ,
Davut GÜVEN ,
Nuh Zafer CANTÜRK ,
Ahmet Zeki IŞIK ,
Sevilay ALTINTAŞ ,
Mustafa EMİROĞLU ,
Murat Kemal ATAHAN ,
Funda GÖDE ,
Cemal POSACI ,
Öner MENTEŞ ,
Bahadır SAATLİ ,
Muzaffer SANCI ,
Sefa KURT ,
Mehmet ÖZEREN ,
Abut KEBUDİ ,
Gürkan UNCU ,
Murat CELİLOĞLU
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