Turkish Journal of Surgery最新文献

Endoscopic biliary stenting is a widely adopted technique for managing bile duct injuries post-cholecystectomy. However, its complications can have severe consequences. Although rare compared to other endoscopic retrograde cholangiopancreatography-related complications, duodenal perforation due to stent migration carries a significant risk of morbidity and mortality. While biliary stenting is often considered a less invasive alternative to surgery, timely recognition and management of potential complications remain crucial. We present a case of duodenal perforation due to biliary stent migration in a 49-year-old woman following laparoscopic cholecystectomy, emphasizing the effectiveness of conservative management, including the key role of interventional radiology, in selected patients.

Objective: Lateral internal sphincterotomy (LIS) is considered the gold standard surgical treatment for chronic anal fissures. However, substantial variation exists in the surgical techniques applied. This study aims to evaluate practice differences among surgeons performing LIS and to assess whether a consensus has been established.

Material and methods: An anonymous online survey was conducted to assess surgeons' technical approaches to LIS. Data were collected using a 24-question survey targeting surgeons from various countries.

Results: A total of 207 surgeons (131 from Türkiye, 76 from other countries) responded. The majority were male (73.3%) and between 40 and 64 years of age (64.7%). Most participants (70%) had more than 10 years of surgical experience, and 55% were affiliated with academic centers. The open technique was preferred by 73.6% of respondents, while 21.4% opted for the closed method. Partial sphincterotomy was favored by 66%, followed by complete (21%) and tailored (12%) approaches. Substantial heterogeneity was noted in bowel preparation, patient positioning, incision type, and management of skin tags or hypertrophied papillae. Only 6% reported routine use of anorectal manometry. Variations were more prominent across countries than between demographic groups. The principal finding of the study is the lack of a standardized approach to LIS across international surgical communities.

Conclusion: There is no standardized approach to LIS among surgeons. Surgical technique preferences vary significantly and appear to be influenced more by geographic practice location than by individual surgeon characteristics such as age, gender, or experience.

Objecitve: Postoperative ileus (POI) is a significant complication after ileostomy closure, which results in recurrent vomiting, dehydration, delay in starting enteral feeding, and even anastomotic breakdown. We aimed to develop a prediction model for POI occurrence after ileostomy closure.

Material and methods: One hundred consecutive patients undergoing ileostomy closure were studied prospectively and data of various demographic and clinical variables were recorded in a predesigned proforma. The final prediction model was developed using logistic regression and internally validated in the next 50 patients.

Results: Factors associated with POI were age, body mass index, tobacco or alcohol addiction, comorbidity, anemia, thrombocytopenia, renal dysfunction, as shown by creatinine level, hypoproteinemia, hypernatremia, and hypokalemia. The mean score of those who developed POI was higher (p=0.002) than those who did not. A cut-off at score 8 had a sensitivity of 85.71%, specificity of 73.12%, and area under the curve was 0.8241 (SE 0.1123). The predictive model was validated in the next 50 consecutive patients and showed good sensitivity (80%) and specificity (93.3%).

Conclusion: Our predictive model can determine the occurrence of POI with accuracy.

Objective: This study aimed to evaluate the local and systemic risk factors associated with breast cancer-related lymphedema (BCRL), with a focus on whether primary systemic treatment (PST), particularly taxane-based chemotherapy, is an independent risk factor.

Material and methods: A prospective clinical study was conducted on 80 breast cancer patients discussed at our institution's weekly breast cancer council. Patients were grouped based on PST status. Clinical examinations and measurements were performed preoperatively and postoperatively at 1, 6, 12, 18, and 24 months. Only the operated arm was assessed using tape measurements and the truncated cone formula. Arm volumes were calculated, and lymphedema (LE) was diagnosed based on a volume difference (≥200 mL or ≥2 cm circumference).

Results: No statistically significant differences were found between PST and non-PST groups regarding age, body mass index, menopausal status, smoking, or tumor characteristics. LE was detected in 7 (8.8%) patients, all Stage 1. PST and taxane-based chemotherapy were not significantly associated with LE development. However, seroma presence (p=0.038) and axillary radiotherapy (p=0.043) were significantly associated with LE. Arm volume increase was most significant at 1 and 18 months postoperatively (p=0.055 and p=0.044, respectively).

Conclusion: PST, including taxane-based chemotherapy, does not appear to be an independent risk factor for BCRL. In contrast, postoperative seroma and axillary radiotherapy are significantly associated with LE development. Early identification and management strategies should target these modifiable factors to reduce the risk of LE.

Objective: Primary hyperparathyroidism (PHPT) is a common endocrine condition that causes hypercalcemia and other symptoms due to improper parathyroid hormone (PTH) secretion. With fatigue, bone pain, and neuropsychiatric difficulties, the disorder drastically lowers quality of life (QoL). This study uses Pasieka's parathyroid symptoms score to evaluate parathyroidectomy's impact on Indian PHPT patients' QoL.

Material and methods: This 18-month prospective observational study was conducted at an Indian academic tertiary care facility. Parathyroidectomy was performed on 42 PHPT patients. Pasieka's parathyroid symptoms questionnaire and baseline clinical and biochemical parameters were completed preoperatively and three months postoperatively. The questionnaire uses a linear analog scale to assess 13 symptoms, including weariness, bone pain, mood issues, and cognitive issues.

Results: Preoperatively, patients demonstrated markedly increased calcium and PTH levels. Post-parathyroidectomy, notable enhancements were noted across various QoL dimensions. Significant reductions in bone pain, joint pain, weariness, and muscle weakness were seen (p<0.001). Neuropsychiatric symptoms, such as irritability and mood fluctuations, shown considerable improvement (p<0.001). Cognitive symptoms, including amnesia, exhibited some improvement, although dermatological symptoms such as itching and polydipsia were mitigated.

Conclusion: PHPT patients benefit greatly after parathyroidectomy in both physical and mental ways. In order to reduce the systemic effects of PHPT, surgery must be performed quickly. Parathyroidectomy improves patient well-being.

Objective: The coronavirus disease-2019 (COVID-19) pandemic led to widespread public health measures that reduced human-to-human contact. This study investigates the pandemic's effect on the clinical and pathological outcomes of Helicobacter pylori (HP) infection in patients with dyspeptic complaints.

Material and methods: We retrospectively analyzed data from patients presenting with dyspepsia before the pandemic (January-December 2019) and during the pandemic (April-December 2020). Gastric biopsies were evaluated for HP infection and inflammation severity according to the Sydney classification. Statistical analyses compared the incidence and clinical characteristics of HP infection between the two periods.

Results: Among 788 patients, there was no significant difference in HP infection incidence or severity between the pre-pandemic and pandemic periods (p=0.51). However, more symptomatic patients presented during the pandemic, including increased cases of epigastric pain (p<0.01) and gastroesophageal reflux (p<0.001).

Conclusion: Despite social distancing measures, the incidence of HP infection remained unchanged. Our findings suggest that COVID-19 restrictions did not significantly impact HP transmission but may have influenced symptom presentation and patient healthcare-seeking behavior.

Objective: To evaluate the morphological and metabolic characteristics of incidentally detected elastofibroma dorsi (EFD) on F-18 florodeoksiglukoz (FDG) positron emission tomography/computed tomography (PET/CT) and their longitudinal changes in oncologic patients.

Material and methods: We retrospectively reviewed 42 197 PET/CT scans performed at our institution between January 2019 and September 2023. EFD was incidentally identified in 20 patients (0.05%). Patient demographics, primary malignancy, lesion localization, dimensions, and maximum standardized uptake values (SUV_max) were recorded. Measurements were obtained before treatment and at the next 3‑month follow‑up. Statistical analyses included Mann‑Whitney U, Shapiro-Wilk and Spearman correlation tests; significance was set at p<0.05.

Results: The cohort comprised 17 females (85%) and 3 males (15%) with a median age of 67 years (range, 47-83). Primary diagnoses were breast cancer (n=8, 40%) and various other malignancies (n=12, 60%). Lesions were bilateral in 75% of cases. Pre‑treatment lesion size ranged from 10 to 55 mm; median SUV_max was 2.4 (right) and 2.5 (left). No significant differences in baseline size or SUV_max were observed between breast and other cancers. A moderate correlation existed between right and left SUV_max (r=0.641; p=0.010). After 3 months, only the left longest diameter showed a statistically significant decrease (median, 45.0 mm vs. 43.0 mm; p=0.034), which may reflect measurement variability or positional factors rather than true biological change. SUV_max values remained stable.

Conclusion: Incidentally detected EFD on PET/CT exhibits low to moderate and stable FDG uptake and predominantly bilateral localization. Recognition of its characteristic features can prevent unnecessary interventions.

Objective: Profunda femoris artery (PFA), a branch of femoral artery primarily supplies blood to skin, muscles of the inner thigh and proximal femur and plays a significant role in collateral blood supply. This study aimed to investigate the origin, branching pattern and morphometries of PFA in cadavers.

Material and methods: Lower limbs of male and female cadavers (n=41) were analyzed for origin of PFA, lateral circumflex artery (LCFA) and medial circumflex artery (MCFA), distance from mid-inguinal point, course, branching pattern and their external calibers. Data were tabulated and analyzed using SPSS.

Results: The PFA showed origins that are posterolateral, posteromedial, and posterior. The distance between PFA and the midpoint of the inguinal ligament was (L=3.7-6.2; mean =5.19±0.7 cm; R=3.2-6.2 cm, mean =4.74±0.9 cm). The origin of MCFA was medial (R=61%, L=52%) and posteromedial (R=39%, L=48%); LCFA was lateral (R=100%, L=78%) and posterolateral (R=0%, L=22%). The average diameter of PFA, MCFA, & LCFA was (L=5.04, 2.9, 2.8 cm and R=5.4, 3.09, 3.71 cm). The paired t-test with a significant p-value (95% confidence) demonstrated that differences in the diameters of the arteries at the specified levels between the left and right limbs could have clinical implications, such as differences in blood flow or susceptibility to vascular conditions.

Conclusion: To reduce intra-operative and post-operative complications in the femoral region branches during diagnostic and surgical procedures, it is essential to comprehend the normal and variant positions and distances of the PFA's origin and its circumflex branches.

Objective: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. Identifying the critical view of safety (CVS) is crucial in this procedure to prevent complications, but achieving CVS can be challenging, necessitating bailout procedures. This study analyzes factors influencing CVS identification and describes bailout procedures used when CVS identification fails.

Material and methods: We collected data from symptomatic cholelithiasis patients undergoing LC at Cipto Mangunkusumo Hospital from January to October 2023. Factors contributing to CVS identification failure were analyzed, and bailout procedures were described.

Results: Among 107 symptomatic cholelithiasis patients, the mean age was 50.38 years, with the majority being female (55.14% of whom were female). CVS was identified in 88 patients (82.24%). Univariate analysis showed that history of endoscopic retrograde cholangiopancreatography (ERCP) [odds ratio (OR) 5.46], Bile duct (BD) stent (OR 16.53), and diagnosis of cholecystitis (acute, OR 6.17; chronic; OR 4.00) significantly increased CVS identification failure risk. Multivariate analysis identified BD stent as the only significant risk factor (OR 7.41). Higher failure rates were associated with Parkland scores of 4-5, Nassar scores of 4, and G10 scores of 4-5. Among those with CVS identification failure, 5 completed cholecystectomy via top-down approach, 6 underwent subtotal fenestrating cholecystectomy, 6 underwent subtotal reconstituting cholecystectomy, and 2 converted to open cholecystectomy.

Conclusion: Predicting CVS identification failure using preoperative parameters and intraoperative scoring systems is crucial for anticipating surgical complexity and ensuring timely intervention. History of ERCP, BD stent presence, and cholecystitis diagnosis were significant predictors of CVS identification failure. Intraoperative scoring systems reliably predicted CVS identification failure.

Objective: This study aimed to evaluate the functional status of the urethra using uroflowmetry before surgery, as well as three and six months postoperatively in cases of distal hypospadias.

Material and methods: Thirty-nine consecutive patients who underwent surgery for distal hypospadias (hypospadias group) between 2016 and 2019 were prospectively included as part of this study. The control group consisted of 40 patients with a normal urethra who underwent surgery due to conditions other than hypospadias (phimosis, undescended testis, hernia). Uroflowmetry was performed preoperatively in these patients. Postoperative uroflowmetry was performed at three and six months following hypospadias surgery. Uroflowmetric results [maximum flow rate (Q_max), average flow rate (Q_ave), voided volume, void duration, flow start time, time to maximum urine flow rate, post-void residual urine, flow curve] were compared between the groups.

Results: The mean age for the patients with distal hypospadias was 35.9±29.6 months and 40.8±26.1 months for the control group. Pre- and postoperative Q_max values (three and six months after surgery) were 6.9 mL/s (0.1-15), 6.4 (0.2-14), and 7.5 (2.5-15). Qave values were preoperatively 4.0 (0.1-12.1), 3.8 (0.3-8.1), and 4.7 (1.0-11.1) mL/s three and six months after surgery, respectively. Bell-type flow was the most frequent uroflow flow curve in the preoperative hypospadias and control groups (95% and 66.6%, respectively). Postoperatively, bell-type flow remained the most common pattern, while a significant reduction in plateau-type flow was observed. Four boys (10.3%) had symptoms of obstruction.

Conclusion: Surgery improved urination dynamics and partial urethral obstruction of hypospadias cases that were present from the baseline. The urinary flow rates improve over time as the reconstructed neourethra regains functionality six months after the tubularized incised plate procedure.