Turkish Journal of Surgery最新文献

Objective: Although blood transfusion is necessary for addressing anemia, coagulopathy, and systemic inflammation, transfusions also carry risks that may influence morbidity and mortality. This study, of patients with burns treated at a tertiary care centre, was conducted from October 2024 to May 2025. It aimed to investigate the association between blood and blood product transfusion requirements and clinical outcomes in adult patients with severe burns. Additionally, the study identified other predictors of mortality, and examined the prognostic role of common biochemical markers and complications in determining patient outcomes.

Material and methods: This retrospective cohort study analyzed 82 eligible adult patients with burns. Patients were considered eligible if they were 18 years of age or older, were admitted for acute burn injury and had complete clinical and laboratory data. Demographic, clinical, laboratory, and transfusion data were retrieved from electronic medical records. Cox proportional hazards regression was used to identify independent predictors of mortality, while Kaplan-Meier analysis assessed survival trends.

Results: Participants were grouped into survivors (n=33) and non-survivors (n=49). Non-survivors required higher total volume of red blood cells (11 vs. 6 units), fresh frozen plasma (11 vs. 5 units), and platelets (4 vs. 0 units), particularly in the intensive care unit (ICU) setting. Compared to survivors, non-survivors also had elevated creatinine levels, lower platelet counts, and higher rates of complications such as pneumonia and dialysis. Cox regression confirmed total body surface area burned as the strongest independent predictor of mortality.

Conclusion: High transfusion requirements in the ICU are associated with increased mortality in patients with severe burns and may serve as a surrogate marker for disease severity. These findings support the need for restrictive, individualized transfusion strategies and underscore the importance of integrating transfusion parameters into early risk assessment and prognostic models in burn care.

The collection fluid of negative pressure wound therapy (NPWT) is a promising material for diagnostic and research of the wound. However, a standardized method for wound fluid collection has not yet been established. Only a few techniques have been described as drilling the canister or disrupting the suction port system. A simple and sterile method for collecting wound bed fluid directly after NPWT is demonstrated.

Objective: Obesity presents challenges in airway management due to physiological and anatomical changes, increasing the risk of difficult mask ventilation and tracheal intubation. This study aimed to determine the frequency and types of airway complications and identify risk factors for difficult intubation and extubation in pediatric patients undergoing bariatric surgery.

Material and methods: This retrospective cohort included 269 patients aged 12-17 years with body mass index ≥30 undergoing bariatric surgery under general anesthesia in Hamad Medical Corporation operating rooms between January 1, 2014, and January 1, 2024. We collected demographic data, preoperative airway assessment values; postoperative airway complications, and vital parameters. Multivariable logistic regressions were performed to assess variables associated with difficult intubation or extubation.

Results: Of the 269 patients, one developed cardiovascular instability post-operatively and one experienced bronchospasm after intubation. None of the patients experienced laryngospasm, vomiting, or airway edema. Desaturation occurred in 10 (3.6%) patients during intubation and 14 (5.1%) during extubation. Male sex was associated with a higher odd of difficult intubation [odds ratio (OR) 2.28, 95% confidence interval (CI): 0.95-5.49, p=0.065] and extubation (OR 3.83, 95% CI: 0.85-17.35, p=0.082). More than one intubation attempt increased the odds of difficult extubation 15.52- fold (95% CI: 1.83-131.37, p=0.012).

Conclusion: Male pediatric patients with obesity, especially with a history of snoring, are at higher risk for difficult intubation. Multiple intubations attempts strongly predict difficult extubation.

Objective: Timely identification of the risk of bowel resection is crucial for improving surgical outcomes in incarcerated hernias. Preoperative recognition of risk factors can improve postoperative recovery and patient safety. This study aims to investigate the predictors of bowel resection and postoperative complications in patients undergoing surgery for incarcerated abdominal wall hernias.

Material and methods: A single-center retrospective analysis was performed on patients who underwent surgery for incarcerated abdominal wall hernia between January 2017 and January 2022. Multivariate logistic regression was performed to determine risk factors for bowel resection, postoperative complications, and mortality. A p-value of <0.05 was considered statistically significant.

Results: A total of ninety-two patients were detected. Mean age was 66.1±14.5 years and the 76 (82.6%) of the patients were male. Bowel resection was associated with symptom duration, higher platelet count, higher neutrophil to lymphocyte and platelet to lymphocyte ratio (p=0.014, p=0.040, p=0.042, p=0.015). Postoperative hospital stay was longer and postoperative mortality was higher in patients who underwent bowel resection (p<0.001, p=0.013). No risk factors for bowel resection or mortality were identified. Symptom duration and bowel resection were found to be risk factors for postoperative complications [odds ratio (OR): 1.713, 95% confidence interval (CI): 1.093-2.686; p=0.019] (OR: 4.655, 95% CI: 1.230-17.613; p=0.023).

Conclusion: Although no specific risk factors for bowel resection or mortality have been identified, symptom duration and bowel resection may be considered risk factors for postoperative complications in these patients. Furthermore, hernia sac fluid is not a risk factor for bowel resection.

Objective: To investigate long-term cancer-specific outcomes associated with extended versus segmental colectomy (SC) in patients with stage I-III transverse colon adenocarcinoma using a large, population-based cohort.

Material and methods: Patients who diagnosed with transverse colon cancer undergoing curative-intent colectomy were identified from the surveillance, epidemiology, and end results database (2013-2019). Surgical procedures were categorized as extended colectomy (EC) or SC based on standardized procedural coding. 1:1 propensity score matching was performed to reduce selection bias and balance baseline characteristics. Cancer-specific survival (CSS) was analyzed using multivariable Cox proportional hazards regression.

Results: Among 18,799 eligible patients, 58% underwent EC. EC was more frequently performed in individuals with higher tumor stage (p<0.01) and those receiving adjuvant chemotherapy (26% vs. 23%, p<0.01). After matching (n=7.904 in each group), EC was associated with a higher rate of adequate lymphadenectomy (>12 lymph nodes retrieved: 94% vs. 89%, p<0.01). Five-year overall survival did not differ significantly between groups (65.6% for EC vs. 66.9% for SC, p=0.074). However, SC was associated with a modest but statistically significant improvement in CSS (84.3% vs. 81.7%, p<0.01). In adjusted analysis, surgical extent (HR=0.8376, p<0.001), along with age, sex, tumor grade, stage, and lymph node yield, were independently associated with CSS.

Conclusion: While EC is more commonly utilized in advanced-stage disease and facilitates higher lymph node retrieval, SC offers comparable-and potentially superior-CSS in selected patients. These findings support the consideration of a tailored surgical strategy based on tumor biology and individual patient characteristics.

Objective: Robot-assisted (RA) surgeries are a major advancement in the medical field, allowing surgeons to operate remotely with minimal direct involvement. Over the past decade, robotic systems have been increasingly used in many areas, including orthopedic procedures. This systematic review and meta-analysis aimed to evaluate the effectiveness of RA-total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (RA-UKA).

Material and methods: A systematic review and meta-analysis of 12 randomized controlled trials was conducted to compare total and unicompartmental RA-TKA with each other and with the conventional method. A total of 1.538 participants were included in the studies, which were published between January 2014 and November 2024. The main outcomes of interest were range of motion (ROM) and pain measured by the visual analogue scale (VAS). The Cochrane RoB2 tool was used to assess the risk of bias. Subgroup analyses were carried out for RA-TKA and RA-UKA outcomes. Prospero Registration: CRD42024627463.

Results: RA knee arthroplasty and conventional knee arthroplasty showed no significant differences in either outcome ROM or VAS score for pain with results of [MD =2.30, 95% CI: -1.56 to 6.16] and (MD =0.05, 95% CI: -0.14 to 0.23), respectively. Similarly, the comparison between RA-TKA and RA-UKA in the subgroup analysis also showed no significant difference, with combined results of (MD =2.30, 95% CI: -1.56 to 6.16) and (MD =0.05, 95% CI: -0.14 to 0.23), respectively.

Conclusion: RA knee arthroplasties (RA-TKA and RA-UKA) show similar outcomes to each other and to conventional methods in terms of ROM and pain reduction (VAS), with both robotic techniques showing comparable alternatives to traditional methods. These techniques also offer advantages such as greater precision and less direct involvement from the surgeon, which may help reduce human error. RA-TKA and RA-UKA produce similar results, and either can be used depending on the patient's knee condition and availability of experienced surgeons in robotics. Future studies with standardized protocols, larger sample sizes, and longer follow-up periods are needed to better understand and confirm the long-term benefits and differences between RA-TKA and RA-UKA techniques.

Objective: Contour irregularities are among the most significant complications that may occur after gynecomastia surgery and they can adversely affect aesthetic outcomes. This study evaluated the use of proactively harvested autologous fat grafts from the same surgical field prior to gynecomastia surgery for the treatment of intraoperative contour deformities, as well as the impact of this approach on patient satisfaction.

Material and methods: A retrospective evaluation was conducted on 24 male patients who were diagnosed with gynecomastia between April 2023 and March 2025 through physical examination, endocrinology consultation, and breast ultrasonography, who subsequently underwent surgical treatment. Prior to surgery, autologous fat grafts were harvested from the breast area in all patients. Intraoperatively identified contour irregularities were treated with same-session fat injection using the previously harvested grafts. All patients were followed up with ultrasonography and digital photography. Additionally, patient satisfaction was assessed using BODY-Q chest module and the chest satisfaction questionnaire.

Results: Of the 24 patients, 83% (n=20) presented with pseudogynecomastia and were treated with liposuction alone, while 17% (n=4) had gynecomastia and underwent liposuction combined with gland excision. Intraoperative contour irregularities were detected in 9 patients (37.5%), in whom an average of 8 cc (interquartile range 7-10) of fat was injected. Over a mean follow-up of 12.4 months, no statistically significant difference in aesthetic satisfaction was observed between patients with and without fat grafting (p>0.05). Both groups reported high satisfaction, and intraoperative contour deformities were successfully corrected.

Conclusion: Proactively harvesting autologous fat from the breast tissue during gynecomastia surgery may be a safe and practical method for immediate correction of intraoperative contour irregularities. This approach avoids additional donor site morbidity and provides a readily available graft source. While satisfaction outcomes were high in all patients, larger prospective studies are needed to confirm the long-term efficacy and broader applicability of this technique.

With this review, we aimed to contribute to the literature by reviewing the studies on nipple adenoma and presenting a novel study regarding its occurrence in a male case, for which we have not found any publications worldwide. We have reviewed studies on nipple adenoma, which we rarely encounter in the literature. We also present a 41-year-old male patient, whom we operated on with a diagnosis of nipple adenoma. His postoperative histopathological examination revealed invasive breast carcinoma, a unique case in the literature, together with this review study. Nipple adenoma, which is extremely rare in male patients, is rare in the literature and clinical practice. In light of the data, this case is the second instance of a male patient with nipple adenoma presented in the literature after many years. The fact that it is the only male patient associated with invasive carcinoma makes the case unique. Nipple adenomas require careful examination because they are rare and can be confused with malignancy. Moreover, although its association with malignancy is exceptionally rare, it should still be included in the differential diagnosis for male breast lesions. Safe surgery and postoperative follow-up are recommended.