Turkish Journal of Surgery最新文献

One of the factors that impair anastomosis healing in patients undergoing hepaticojejunostomy is tension of the anastomosis. There may be tension, especially in cases with a short mesojejunum. In cases where the jejunum cannot be brought higher, positioning the liver a little lower may be a solution. We placed a Bakri balloon between the liver and diaphragm to position the liver to a lower level. Here we present a successful hepaticojejunostomy case in which we placed a Bakri balloon to decrease the anastomosis tension.

Objectives: Many surgical scoring systems are used to predict operative risk but most are complicated. The aim of the study was to determine the utility of the Surgical Apgar Score (SAS) in predicting post operative mortality and morbidity in general surgical cases.

Material and methods: This was a prospective observational study. All adult patients for emergency and elective general surgical procedures were included. Intraoperative data was collected, and post operative outcomes were followed up till 30 days. SAS was calculated from intraoperative lowest heart rate, lowest MAP and blood loss.

Results: A total of 220 patients were included in the study. All consecutive general surgical procedures were included. Sixty of the 220 cases were emergency and the rest were elective. Forty-five (20.5%) of the patients developed complication. Mortality rate was 3.2% (7 out of 220). The cases were divided into high risk (0-4), moderate risk (5-8) and low risk (9-10) based on SAS. Complication and mortality rates were 50% and 8.3% in the high risk group, 23% and 3.7% in the moderate risk and 4.2% and 0 in the low risk group, respectively.

Conclusion: The surgical Apgar score is a simple and valid predictor of postoperative morbidity and 30-day mortality among patients undergoing general surgeries. It is applicable to all types of surgeries for emergency and elective cases and irrespective of the patient general condition and type of anesthesia and surgery planned.

Objectives: In this paper, it was tried to determine the incidence of COVID-19, course of the disease, and mortality rate in liver transplant patients by evaluating all patients operated on in our center. In addition, the results of liver transplantation performed in our center during the pandemic period were also presented.

Material and methods: All patients who had undergone liver transplantation in our liver transplant center were questioned about their history of COVID-19 either at their routine controls in the clinic or by phone interview.

Results: Our liver transplant unit had 195 registered liver transplantation patients (2002-2020), and 142 of these were still alive and under follow-up. During the pandemic period, 80 patients referred to our outpatient clinic for follow-up, and their records were evaluated retrospectively in January 2021. Among 142 liver transplant patients, a total of 18 (12.6%) COVID-19 patients were identified. While 13 of these patients were males, mean age of the patients at the time of interviews was 48.8 years (22-65 years). Nine of the patients had living donor liver transplant, and the rest had cadaveric liver transplant. The most common COVID-19 associated symptom in the patients was fever. During the pandemic period, 12 liver transplant operations were performed in our center. Nine of them were living donor liver transplantation and the remainder were cadaveric liver transplantations. Two of our patients got COVID-19 positive during this period. One of them who was transplanted after COVID treatment was followed-up in intesive care for a long time and was lost not related to COVID-19.

Conclusion: The incidence of COVID-19 is higher in liver transplant patients than in the general population. Nonetheless, mortality rates are low. During the pandemic period, liver transplantation can be continued by following general precautions.

Intimal angiosarcoma is a rare vascular malignancy, and diagnosis is very difficult due to nonspecific symptoms. There are controversial points regarding the diagnosis, treatment and follow-up of intimal angiosarcomas. The purpose of this case report was to evaluate the diagnosis and treatment process of a patient diagnosed with femoral artery intimal angiosarcoma. Furthermore, in line with previous studies, it was aimed to illuminate controversial points. A 33-year-old male patient, who had been operated on due to ruptured femoral artery aneurysm, was diagnosed with intimal angiosarcoma with the pathology result. Recurrence was observed during clinical follow-up, and the patient was treated with chemotherapy and radiotherapy. Since there was no response to treatment, the patient underwent aggressive surgery including the surrounding tissues. No recurrence or metastasis was observed in the patient's 10^th month follow-up. Although intimal angiosarcoma is rare, it should be considered in differential diagnosis when femoral artery aneurysm is detected. The most important step in treatment is aggressive surgery, but adding chemo-radiotherapy to the treatment should be considered.

Objectives: The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery.

Material and methods: Between March 15^th, 2020 and April 30^th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded.

Results: Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%.

Conclusion: With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.

Objectives: Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair.

Material and methods: Between 2011 and 2021, 36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0.

Results: Of the sample, 31 were females and five were males, with a mean age of 31.50 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 ± 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p <0.001; r= 0.625).

Conclusion: It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique.

Objectives: Orthotopic liver transplantation (OLT) remains the definitive treatment for patients afflicted with end-stage liver disease (ESLD). Transjugular intrahepatic portosystemic shunts (TIPS) have been adapted as a bridge to transplantation, allowing partial normalization of portal pressure and associated symptom improvement. Conflicting evidence exists on TIPS' impact on operative procedures. This study aimed to analyze available evidence on patients who underwent OLT with prior TIPS compared to OLT alone with the intent to determine TIPS' impact on surgical outcomes.

Material and methods: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing TIPS + OLT versus OLT alone in patients with ESLD. Data were analyzed using Review Manager 5.3.

Results: Thirteen studies were included. Operative time, packed red blood cells transfusions, intensive care unit admission, length of stay, dialysis, serum creatinine levels, ascites, vascular complications, bleeding revisions, reintervention, and other complications rates were similar between both groups. Fresh frozen plasma transfusion -2.88 units (-5.42, -0.35; p= 0.03), was lower in the TIPS + OLT group.

Conclusion: Our study found TIPS can be safely employed without having detrimental impacts on OLT outcomes, furthermore, these findings also suggest TIPS does not increase bleeding or complications.

Objectives: Postoperative recurrent pilonidal sinus disease is troublesome, and its treatment is a challenge. In this study, it was aimed to present the long-term efficacy of crystallized phenol treatment on postoperative recurrent pilonidal sinus disease through our results collected within the last 20 years.

Material and methods: Two hundred and twenty-seven patients who had been previously operated on and suffered from recurrent pilonidal sinus disease were enrolled. The operation was applied in our outpatient clinic under local anesthesia. Demographic data of the patients, number of crystallized phenol treatment, duration of follow-up and recurrence numbers were prospectively recorded. Treatment success and factors affecting recurrence were examined.

Results: Our success rate was found as 71.5%. This success rate belongs to the group of patients who never quit treatment and complied with the treatment. The patients were followed up for a mean 45.8 months. Of the post-crystallized phenol treatment recurrences, 72.4% took place within the first five years, while 97.4% did so within the first 10 years. Mean number of crystallized phenol applications was 2.6. The longer the duration of the disease before treatment, the more recurrence was observed after treatment (p= 0.02). There was no correlation between the number of previous operations and recurrence after treatment. As the number of sinus openings increased, so did the number of applications (p= 0.001).

Conclusion: Crystallized phenol treatment yields promising long-term results in recurrent pilonidal sinus disease as well and may be recommended as the first choice in recurrent pilonidal sinus disease treatment since it is an effective non-operative treatment modality.

Objectives: In this study, it was aimed to examine nylon burns in paediatric patients and compare the results with other causes of hot object contact burns.

Material and methods: A 10-year retrospective study was conducted on 77 paediatric patients hospitalized for hot body burns at Gazi Yaşargil Training and Research Hospital Burn Center.

Results: Of those patients with hot body burns, 72.7% (n= 56) were males and 27.3% (n= 21) were females. Male-to-female ratio was 2.67:1. Mean age of the patients was 4.79 (min= 1, max= 16) years. There were 42 patients who applied to our hospital on the day of their burn, while four patients applied one day after the burn, one patient applied two days after the burn, 13 patients applied three days after the burn and 17 patients applied five days after the burn. Most burns (79.3%) were third-degree burns, whereas 19.5% were seconddegree and 1.2% were fourth-degree burns. The most common causes of hot body burns were hot nylon and hot stoves, followed by hot ash and hot irons. The number of nylon burns was the highest in the summer and the highest number of hot stove burns occurred in the winter. Nylon burns were most common in the three to eight age group and then gradually decreased. The highest burn rate was observed in nylon burns.

Conclusion: The most common cause of all burns in the Turkish paediatric population is scalding. Although nylon burns are rare, they draw attention due to their higher burn degrees.