Turkish Journal of Surgery最新文献

Objective: Ultrasound-guided core needle biopsy (CNB) is essential for diagnosing liver tumors not amenable to resection, but the outcomes of resident-performed CNB are poorly defined. We evaluated the diagnostic performance and safety of liver CNB performed by a single ultrasound-certified general surgery resident under specialist supervision.

Material and methods: In this retrospective single-center case series, 65 consecutive patients underwent ultrasound-guided liver CNB between July 2022 and January 2025. All procedures constituted the resident's entire initial experience with liver CNB. Diagnostic success was defined as obtaining sufficient tissue for definitive histopathological diagnosis. Predictors of diagnostic success were assessed using univariate analyses and logistic regression. Learning-curve effects were evaluated by comparing early and late tertiles of chronologically ordered cases and by modelling case number as a continuous predictor. The impact of lesion size was examined by subgroup analysis comparing <4 cm and ≥4 cm lesions and by treating the maximal lesion diameter as a continuous variable.

Results: Adequate tissue was obtained in 58/65 biopsies (89.2%), with malignancy confirmed in 49 patients (75.4%) and benign lesions in 9 patients (13.8%). Diagnostic success was 85.7% in the early tertile and 95.5% in the late tertile (p=0.345). Logistic regression showed a non-significant trend toward a higher diagnostic yield over time. Neither lesion size (categorized as <4 cm versus ≥4 cm) nor maximal diameter (analyzed as a continuous variable) was significantly associated with diagnostic success. No immediate or clinically overt delayed complications were observed during 24 hours of in-hospital monitoring.

Conclusion: This preliminary single-operator experience suggests that, under close supervision, an appropriately trained general surgery resident can perform ultrasound-guided liver CNB with a high diagnostic yield and a low observed complication rate. These hypothesis-generating findings support further multi-operator and comparative studies of resident-performed liver CNB.

Objective: Achieving complete total mesorectal excision (TME) is considered an important indicator of surgical quality in rectal cancer surgery. However, the impact of TME quality on overall survival (OS) remains controversial. This study aimed to evaluate the association between TME quality and OS in patients undergoing rectal cancer surgery.

Material and methods: A retrospective analysis was conducted on 171 patients who underwent elective low anterior resection or abdominoperineal resection for rectal cancer between 2021 and 2022. OS was compared between patients with incomplete TME and those with near-complete or complete TME. In addition, clinical and pathological factors associated with TME quality were assessed.

Results: Incomplete TME was independently associated with worse OS [hazard ratio (HR)=2.53, 95% confidence interval (CI) 1.15-5.59, p=0.021], while undergoing a Hartmann procedure showed the strongest negative impact on OS (HR=4.60, 95% CI 2.04-10.38, p<0.001). At 36 months, OS was 86.3% in the near-complete/complete TME group versus 68.3% in the incomplete group (log-rank p=0.008). Factors associated with incomplete TME included lower preoperative albumin levels, larger tumor size, previous abdominal surgery, tumors located closer to the anal verge, lymphovascular invasion, and positive circumferential resection margins.

Conclusion: Incomplete TME was associated with significantly worse OS in patients undergoing rectal cancer surgery. These findings highlight the importance of achieving optimal TME quality. Larger prospective studies are warranted to validate these results.

Objective: Severe chronic degenerative mitral regurgitation (MR) is characterised by altered hemodynamics and high-shear stress, which initiate left ventricular (LV) remodelling, including upregulation of various cytokines. We evaluated endothelial activation during surgical correction of chronic MR by assessing adhesion molecules ICAM-1 and VCAM-1, classic markers of inflammation, and their association with postsurgical LV dysfunction (LVD).

Material and methods: The study included asymptomatic patients with grade 3-4 degenerative MR. Transthoracic echocardiography data and blood samples were collected before and five days after surgical correction of MR. Circulating levels of adhesion molecules were measured by ELISA.

Results: Ejection fraction, end-diastolic diameter (EDD), and volume all decreased significantly after surgery. A significant decline in ICAM-1 concentration was observed between the two periods (457.11±256.12 vs. 240.29±157.14 ng/mL; p=0.031), whereas VCAM-1 levels did not change significantly. Leukocyte count and C-reactive protein were significantly higher in the postoperative period. Early postoperative LVD (in 35.7% of patients) was not correlated with adhesion molecule levels. However, we observed significant changes in ICAM-1 levels associated with postoperative EDD >5.6 cm, which indicates LV dilatation. These patients had markedly lower preoperative and postoperative ICAM-1 values than others.

Conclusion: Serum ICAM-1 levels significantly decline following surgical correction of MR and are associated with postoperative enlargement of the LV. Our study highlights dynamic changes in endothelial activity and underscores the need for a better understanding of this process in MR.

Objective: Distinguishing mild (Hinchey 1a/1b/2) from severe (Hinchey 3/4) diverticulitis is critical for appropriate management. This study evaluated the predictive value of inflammatory biomarkers and imaging features for early risk stratification.

Material and methods: We conducted a retrospective analysis of patients with acute diverticulitis between 2017 and 2024 at the hospital's general surgery department. Receiver operating characteristic analysis was used to determine optimal cut-off values for C-reactive protein (CRP) and procalcitonin, while computed tomography (CT) findings were assessed for their discriminative capacity.

Results: A total of 72 patients were included in the study. There were 59 patients in the mild diverticulitis group and 13 patients in the severe diverticulitis group. Patient demographics were similar between the groups. Procalcitonin demonstrated superior predictive performance [area under the curve (AUC) 0.795] compared to CRP (AUC 0.755). The cut-off values for procalcitonin and CRP were 0.095 and 104.5, respectively. Specific CT patterns showed high specificity for severe disease. The combination of biomarkers and imaging criteria significantly improved diagnostic accuracy, with pelvic abscess localization emerging as a key indicator of severity.

Conclusion: A biomarker-guided approach incorporating procalcitonin and targeted CT evaluation enables reliable early identification of severe diverticulitis. This strategy may enhance clinical decision-making regarding antibiotic selection and surgical consultation while reducing unnecessary interventions in mild cases.

Objective: Breast cancer accounts for 31.8% of female cancers in Saudi Arabia, with 56% of cases diagnosed before age 50, 14 years younger than in Western countries. Aggressive subtypes (TNBC: 18-24%; HER2+: 25-28%) are common, and dense breast tissue reduces the effectiveness of mammography. Currently, no age-specific screening protocols exist for this unique epidemiological profile. This study aimed to assess the age-specific diagnostic accuracy of mammography, ultrasound, and magnetic resonance imaging (MRI), and to characterize molecular subtype distribution in Saudi breast cancer patients to guide personalized screening guidelines.

Material and methods: A retrospective cohort study was conducted at a tertiary care center in Riyadh, Saudi Arabia (January 2021-December 2023). Medical records of 148 women aged 30-70 with histopathologically confirmed breast cancer (BI-RADS 4/5) were analyzed. The sensitivity and specificity of imaging modalities were assessed across age groups (30-39, 40-49, 50-59, ≥60 years). Subtype distribution and breast density (BI-RADS A-D) were correlated with imaging performance using chi-square tests and logistic regression (SPSS v28, STARD 2015 guidelines).

Results: The mean age was 48 years, with 56.4% of cases occurring in women under 50 (peak incidence: 40-49 years, 34.1%). Ultrasound sensitivity exceeded mammography in women under 50 (85.3% vs. 74.5%, p<0.01), while MRI demonstrated the highest overall accuracy (91.7%, 95% confidence interval 89.2-93.5). TNBC prevalence decreased with age (24.7% in 30-39 years to 12.0% in ≥60 years, p<0.01), while invasive lobular carcinoma incidence doubled (8.2% to 18.0%, p<0.001). Delayed diagnosis (>60 days) lowered 2-year survival by 21% (p=0.003).

Conclusion: Ultrasound is more effective than mammography for early detection in Saudi women under 50 years old, while MRI remains highly accurate across all age groups. National screening guidelines should adopt biennial ultrasound-first screening starting at age 40, with MRI reserved for high-risk cases and BI-RADS 3-4 lesions.

Although bariatric surgery is an effective intervention for morbid obesity, a significant proportion of patients referred for surgery fail to proceed to the operation. This narrative review aims to examine the rates, characteristics, and underlying reasons for preoperative attrition among bariatric surgery candidates. The literature demonstrates variability in defining pre-op attrition, with some studies adopting binary classifications and others focusing on attrition at specific stages of the preparation process. Key factors associated with attrition include socio-demographic variables (e.g., gender, age, and income), clinical and logistical issues (e.g., waiting times, insurance barriers), and psychosocial characteristics (e.g., anxiety, substance use, and motivation). Some qualitative studies have reported that patients' thoughts and feelings about the meaning of surgery-particularly their emotional readiness and identity-related concerns-can substantially influence whether they follow through with the procedure. In Türkiye, where no standardized national guidelines are in place and structured interventions are limited, there is a clear need for broader changes in how the pre-op phase is managed. Addressing this issue will likely require support systems that are flexible, multidisciplinary, and responsive to individual circumstances. This review emphasizes that personal experiences and system-level factors jointly influence whether patients complete the surgical process. Recognizing how these layers interact may help create more effective strategies for supporting those at risk of dropping out before surgery.

Objective: Anastomotic leakage following colorectal anastomosis poses substantial morbidity and mortality. Defunctioning loop ileostomy has been employed as a preventive measure, but has its own complications, including its reversal. In light of these challenges, tube ileostomy has emerged as an alternative, seeking to fulfil the same purpose as loop ileostomy while minimising complications associated with stoma creation and reversal.

Material and methods: Conducted as a cohort study, a total of 88 patients were evenly distributed into two groups. Data collection spanned six months post-surgery or until the conclusion of the study period, with monthly follow-ups. Both types of ileostomy were performed in both elective and emergency settings.

Results: In this study comparing tube and loop ileostomy, tube ileostomy showed several advantages: Lower output (218±19 mL vs. 333.33±58 mL), shorter hospital stay (8.3 vs. 11.32 days), fewer stoma bag needs, and faster closure without surgical reversal. Complications like skin excoriation, electrolyte imbalance, and hypertrophic scarring were significantly lower in tube ileostomy. Although tube-related issues like blockade (40.9%) and leakage (15.9%) occurred, overall, comorbidity handling and patient independence were better. Statistical analysis confirmed significant differences in key parameters, favouring tube ileostomy as a safer, simpler faecal diversion alternative.

Conclusion: In the early phases of this investigation, tube ileostomy demonstrated favourable outcomes. The observed reduction in complications, ease of management for tube ileostomy-related issues, and decreased hospitalisation and reversion surgery requirements highlight its potential advantages. Further exploration and long-term follow-up are warranted to validate these initial findings and ascertain the sustained efficacy and safety of tube ileostomy.

Surgical treatment of the ulcerative colitis is abdominal procto-colectomy and ileal pouch anal anastomosis. A J-shaped pouch is created from the terminal ileum to serve as a reservoir function of the rectum. Early endoscopic evaluation of the pouch can predict surgical complications and the long-term pouch outcome. The owl's eyes image in the proximal part of the pouch is an indicator that it is technically well constructed.

Minimally invasive right hemicolectomy for colon cancer has demonstrated better outcomes than those of open surgery. However, in certain patients, high body mass index, abdominal adhesions, and concomitant cardiopulmonary disease may limit the use of conventional laparoscopy. The use of the retroperitoneal approach preserves the benefits of the minimally invasive approach and expands the range of surgical options. All major steps were performed without access to the abdominal cavity: mobilization, D3 lymph node dissection and vessels ligation. Supplementary video demonstrates a retroperitoneal approach for right hemicolectomy with D3 lymph node dissection that can solve these challenges.

Objective: To evaluate the impact of blood product transfusions on clinical outcomes, including mortality, dialysis requirement, and infection, in pediatric patients with extensive burns.

Material and methods: This case-control study included pediatric patients with ≥20% total body surface area burns who were treated at a university hospital burn center between 2012 and 2022. Deceased patients were classified as cases, and discharged patients as controls. The primary outcome was mortality, and the secondary outcomes were dialysis. Multivariable logistic regression was used to assess associations between blood product usage and clinical outcomes, adjusting for burn severity, surgical duration, and infection.

Results: One hundred-thirteen patients were analyzed, with 93 discharged and 20 deceased. Platelet transfusion in the intensive care unit (ICU) was associated with lower mortality (odds ratio: 0.663, 95% confidence interval: 0.484-0.909, p=0.011) but with increased dialysis requirements. Moreover, albumin, red blood cell, and fresh frozen plasma transfusions in the ICU were correlated with an increased risk of infection. Albumin administration in the ICU was associated with decreased mortality (hazard ratio =0.848, 95% confidence interval: 0.735-0.977, p=0.023).

Conclusion: The findings suggest that burn injury severity, the amount of blood products transfused, and the timing of transfusions are critical factors in determining patient outcomes. Future research should focus on establishing evidence-based transfusion thresholds.