Turkish Journal of Surgery最新文献

Objective: Medical visual documentation is an important part of medical education. It provides numerous benefits to both. This article argues for the integration of medical photography into medical education.

Material and methods: A medical visualization and documentation elective course was offered to second-year students at the Kocaeli University Faculty of Medicine. At the end of the 14-week program, a questionnaire was administered to students who participated in the course. The survey results were analyzed using data analysis programs.

Results: According to the survey results, the students stated that the elective course positively impacted their education and experience as future doctors.

Discussion: In many medical schools, both in Turkey and around the world, medical photography training is not integrated into medical education. This presents challenges for medical education and physicians. However, these difficulties can be overcome by providing integrated training and courses for doctors.

High-grade serous ovarian cancer (HGSOC) is the most lethal gynecologic malignancy, typically affecting postmenopausal women. BRCA1 mutation carriers are at increased risk of developing early-onset disease. While bariatric surgery reduces the incidence of several obesity-related cancers, its potential impact on hormonally driven malignancies in genetically predisposed individuals remains unclear. We report a rare case of early-onset HGSOC in a 21-year-old woman with morbid obesity and type 2 diabetes who underwent Roux-en-Y gastric bypass in 2010. Following significant weight loss, she regained regular menstruation and discontinued insulin therapy. After progressive weight regain, she underwent revisional bariatric surgery in 2020. Three years later, she presented with an ovarian cyst and elevated tumor markers. Imaging suggested malignancy, and biopsy confirmed HGSOC with a BRCA1 mutation. The patient underwent optimal cytoreductive surgery followed by chemotherapy and commenced olaparib maintenance therapy. As of September 2024, she remains disease-free. This case raises the concern that bariatric surgery, by restoring ovulatory function and altering metabolic and hormonal balance, may unmask a latent susceptibility to cancer in genetically predisposed patients. The temporal association between metabolic surgery and early-onset ovarian cancer warrants further investigation into postoperative hormonal shifts and cancer surveillance strategies. Bariatric surgery in women with hereditary cancer syndromes should be approached with caution. Preoperative genetic counseling, multidisciplinary assessment, and long-term oncologic surveillance are essential to ensure patient safety.

We present a rare case of co-occurrence of Strongyloides stercoralis (S. stercoralis) infection and newly diagnosed pancreatic adenocarcinoma in a 71-year-old female who presented with new-onset jaundice and right upper quadrant abdominal pain. The patient had eosinophilia, recurrent Escherichia coli cholangitis, and a strong family history of jaundice in an endemic region. S. stercoralis larvae were identified on histopathological examination following pancreaticoduodenectomy. Notably, ivermectin treatment attenuated the delayed postoperative gastric emptying that had not responded to conventional management, including nasogastric decompression or drainage of a perigastric collection. While S. stercoralis can cause obstructive jaundice and pancreatic masses, this case highlights the importance of considering parasitic infections in patients from endemic areas or with immunosuppressive conditions who present with abdominal symptoms, particularly to avoid unnecessary interventions and prevent clinical deterioration.

Isolated common bile duct (CBD) injuries following blunt abdominal trauma are exceptionally rare in infants and often present a diagnostic challenge. Due to the retroperitoneal location of the CBD and the potentially mild peritoneal response to bile leakage, early symptoms may be subtle or absent. As a result, diagnosis is frequently delayed. We present a case of a 2-year-old child who was diagnosed on the 14th day after blunt trauma caused by a falling television unit. Imaging and surgical findings confirmed an isolated CBD injury. The patient was treated with the two-stage surgical approach using transcystic duct catheter drainage followed by delayed reconstruction. The initial procedure involved damage control surgery, including biliary drainage via a transcystic duct catheter and thorough peritoneal irrigation. Four months later, the definitive reconstruction was performed with a Roux-en-Y hepaticojejunostomy. This case emphasizes that isolated CBD injuries, though rare in infants, can follow blunt abdominal trauma and may present with delayed symptoms due to bile's low peritoneal irritancy. This case underscores the rarity and novelty of the transcystic duct catheter approach when managing bile leakage in an infant prior to definitive surgical reconstruction.

Objective: Hip fractures are common in older adults and are associated with increased morbidity and mortality. Although multimodal anesthesia with peripheral nerve blocks is recommended, the superiority of specific block methods remains unclear. This study compared the postoperative analgesic efficacy of the suprainguinal fascia iliaca block (SFIB) and lumbar erector spinae plane block (LESPB) in patients who underwent hip fracture surgery.

Material and methods: This single-center, single-blind, randomized controlled trial was conducted at a university hospital (Marmara University Faculty of Medicine, İstanbul, Türkiye) between August 2022 and May 2023. Patients received SFIB, LESPB, or no block before spinal anesthesia. No block-related complications were observed. Postoperative analgesia was provided using patient-controlled intravenous morphine, with tramadol administered as rescue analgesia for NRS pain scores above 4. The primary outcome was 24-hour total opioid consumption. Secondary outcomes included opioid consumption at 6 and 48 hours, pain scores, rescue analgesia requirements, and time to discharge from the intensive care unit and hospital.

Results: A total of 63 patients (mean age 78.5±14.0 years; 46 females and 17 males) with American Society of Anesthesiologists I-III undergoing hip fracture surgery were randomized to SFIB (n=23), LESPB (n=22), or control (n=22). During the first 24 hours, opioid consumption were higher in the control group [18 (9-24.5); p=0.002]. Post-hoc analysis showed a significant difference between the control and SFIB groups [6 (4-9); p<0.001]. The LESPB [13 (5-22)] and control groups were comparable (p>0.016).

Conclusion: SFIB provided the greatest reduction in postoperative opioid use during the first 24 hours after hip fracture surgery. While LESPB appears to be an alternative to SFIB, it produced a reduction in opioid consumption similar to that observed in the control group. Suprainguinal FIB should be prioritized as a component of multimodal analgesia for these surgeries.

Objective: Evaluating the diagnostic accuracy of extended focused assessment with sonography for trauma (E-FAST) for detecting pneumothorax, hemothorax, and pulmonary contusions using thoracic computed tomography (CT) as the reference standard.

Material and methods: Retrospective analysis of 202 adult thoracic trauma patients (2016-2021). E-FAST diagnostic accuracy was calculated using CT as reference standard.

Results: E-FAST was performed in 149 patients (74%), who presented with significantly higher injury severity (injury severity score: 25 vs. 17; p=0.018) and hemodynamic instability. E-FAST demonstrated 90% sensitivity for pneumothorax, 86% for hemothorax, and 95% specificity for both conditions. Positive predictive values were 92% for pneumothorax and 89% for hemothorax. E-FAST was superior to chest radiography for detecting pleural complications and facilitated immediate thoracic drainage in 39.1% of cases. Cost analysis revealed four-fold reduction compared to CT.

Conclusion: E-FAST demonstrated high diagnostic accuracy for pneumothorax and hemothorax compared to CT, while also showing superior performance to conventional radiography. E-FAST facilitates rapid bedside assessment and immediate surgical decision-making in critically injured patients. However, the significant selection bias toward critically injured patients limits the conclusions regarding the independent impact on clinical outcomes.

Objective: Bioresorbable poly-D-L-lactic acid (PDLLA) plates are increasingly used in rhinoseptoplasty due to their biocompatibility, adequate initial mechanical strength, and complete resorption over time. These properties may offer advantages over permanent implants, particularly in complex cases involving post-traumatic nasal deformity. To evaluate the clinical efficacy and safety of PDLLA plates in achieving functional and aesthetic outcomes in primary and reconstructive rhinoseptoplasty.

Material and methods: A retrospective cohort study was conducted on 37 consecutive patients [23 men, 14 women; median age 37 years, interquartile range (IQR) 30-44] who underwent rhinoseptoplasty between January 2022 and December 2024. The minimum follow-up was 3 months. Primary endpoints included septal stability, complication profile (e.g., infection, extrusion, resorption issues), and patient-reported outcomes. Subjective nasal appearance and symptom burden were assessed using the validated Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). In select cases requiring revision, histopathological evaluation of implantation sites was performed at 12 and 24 months.

Results: He use of pure PDLLA plates provided reliable septal stabilization and facilitated precise dorsal alignment, eliminating the need for autologous graft harvesting in 83.8% of cases. No plate-related infections, extrusions, or delayed resorption events were observed. Patient-reported symptom burden, as measured by the SCHNOS score, improved markedly from a median of 21 (IQR: 15-26) preoperatively to 1 (IQR: 0-1) postoperatively. Histology confirmed complete material resorption by 24 months, with mature collagenous remodeling and an absence of chronic inflammatory infiltrate.

Conclusion: In carefully selected patients, PDLLA plates appear to be a biocompatible and technically feasible adjunct in rhinoseptoplasty, facilitating septal reconstruction, eliminating donor-site morbidity, and yielding improvements in both patient-reported nasal function and aesthetic outcomes. These preliminary findings support further investigation in larger, controlled studies.

Objective: Bladder carcinoma represents a significant challenge in oncology due to its heterogeneous molecular nature. This study aimed to identify key genetic factors and molecular pathways involved in bladder carcinoma pathogenesis to facilitate the development of targeted therapies.

Material and methods: The top 30 genes associated with bladder carcinoma were retrieved from the disease gene network database. Comprehensive bioinformatic analysis was performed using various enrichment tools, including gene ontology biological process, cellular component, molecular function analyses, and pathway mapping through WikiPathways and metabolite associations through human metabolome database. Drug interactions were evaluated using DrugMatrix data.

Results: Gene ontology analysis revealed significant enrichment of cancer-related biological processes, cellular components, and molecular functions. Pathway analysis identified strong associations with head and neck squamous cell carcinoma, cancer pathways, pleural mesothelioma, endometrial cancer, and bladder cancer pathways. Key genes including CDKN2A, PTEN, EGFR, PIK3CA, HRAS, FGFR3, and TP53 were implicated across multiple pathways. Metabolite analysis showed significant associations with phosphatidylinositol derivatives, highlighting the importance of the PI3K pathway. Drug interaction analysis revealed potential modulatory effects of several compounds including sertraline, valproic acid, and hydroxyurea on gene expression patterns in bladder carcinoma.

Conclusion: This study provides comprehensive insights into the molecular underpinnings of bladder carcinoma, highlighting interconnected pathways and potential therapeutic targets. The significant overlap with other cancer types suggests common oncogenic mechanisms that could be exploited for therapeutic intervention. Further validation of these findings in clinical samples may facilitate the development of personalized treatment approaches for bladder carcinoma patients.

Objective: De novo malignancy is a significant complication following kidney transplantation, attributed to prolonged immunosuppression. This study evaluates the incidence, risk factors, and clinical outcomes of de novo malignancies in kidney transplant recipients.

Material and methods: A retrospective cohort analysis was conducted on 1200 kidney transplant recipients between 2016 and 2023. Patients were categorized based on the presence or absence of de novo malignancies. Statistical analyses were performed to identify risk factors, including age, sex, comorbidities, and immunosuppressive regimens. Patient and graft survival were assessed using Kaplan-Meier analysis and the log-rank test.

Results: Among the study population, 43 patients (3.6%) developed de novo malignancies. The most frequent malignancy types were non-melanoma skin cancers (27.9%) and post-transplant lymphoproliferative disorders (18.6%). Patients with malignancies exhibited a lower three-year survival rate (83.7%) compared to those without malignancies (91.4%), though the difference was not statistically significant (p=0.067). Graft survival at three years was slightly lower in the malignancy group (84.0% vs. 88.7%, p=0.146). Older recipient age was identified as a significant risk factor (hazard ratio=1.03 per year, p=0.025).

Conclusion: De novo malignancy remains a concern in kidney transplant recipients, particularly among older patients. Regular screening protocols, lifestyle interventions, and individualized immunosuppressive regimens are essential to mitigate risk and improve outcomes.

Objective: This study aimed to evaluate the effects of the coronavirus disease-2019 (COVID-19) pandemic on the diagnostic and surgical treatment processes of gastric cancer. Three-year periods before and after the pandemic were compared to examine differences in the diagnostic process, disease stage, surgical extent, and survival.

Material and methods: A retrospective analysis was conducted on 395 patients who underwent resection surgery for gastric cancer between March 11, 2017, and March 11, 2023. Patients with incomplete data regarding the diagnostic and treatment processes, those deemed inoperable following exploratory surgery and subsequently referred for alternative treatment, and patients operated on at external centers were excluded. A total of 197 patients were analyzed and divided into two groups: pre-pandemic (PP, n=137) and post-pandemic (PS, n=60).

Results: A significant decrease in the number of surgeries was observed in the PS group compared to the PP group. Significant differences were found between the two groups regarding locally advanced disease at diagnosis (T4/N+), the application rate of cytoreductive surgery+hyperthermic intraperitoneal chemotherapy, and follow-up mortality (p=0.031, p=0.028, and p=0.005). The overall mean survival was 50.02±2.78 months in the PP group and 32.52±2.24 months in the PS group (p=0.765). No significant differences were observed between the groups regarding the diagnostic process and pathological stages.

Conclusion: The COVID-19 pandemic may have reduced both the referral rates for surgery and the extent of surgical interventions for advanced-stage gastric cancer. It is believed that both surgeons and patients adopted more conservative approaches during the pandemic.