Turkish Journal of Surgery最新文献

Park's method of submucosal hemorrhoidectomy has not gained widespread clinical use despite its minimally invasive nature. However, combining this technique with modern bipolar technology LigaSure™ offers a promising approach to surgical treatment of hemorrhoidal disease. A patient with stage III hemorrhoidal disease underwent surgery under subarachnoid anesthesia in the Lloyd Davis position. The procedure involved lifting external hemorrhoids with an Allis clamp to expose internal hemorrhoids. Using monopolar coagulation, a linear incision was made in the distal skin covering left lateral external hemorrhoids. The surgeon carefully separated varicose veins from sphincter fibers. The LigaSure™ device was then used to dissect hemorrhoidal tissue in the submucosal layer toward the hemorrhoidal artery origin. The artery was ligated 1 cm above the dentate line using bipolar technology while preserving the mucosa. Similar techniques were applied to remove right posterior and anterior hemorrhoidal tissue. The result showed three small incisions on the anoderm with complete preservation of the anal canal mucosa. The modified technique allows excision of hemorrhoidal tissue and ligation of arteries without sutures, preserving the lining of the anal canal. This approach potentially results in shorter hospital stays, less postoperative pain, and promotes rapid recovery.

Objective: The deltopectoral (DP) flap was and still is a workhorse flap in the reconstruction of head and neck defects following tumor resection, even in the current era of free microvascular flaps.

Material and methods: We retrospectively recruited, from a prospectively maintained database, all patients with a history of defect reconstruction using one-stage tunneled de-epithelialized fasciocutaneous DP flap following resection of head and neck cancer between June 2020 and June 2023. Patient and disease characteristics, surgery parameters, flap specifics, oncological outcomes, and follow-up data were analyzed and reported.

Results: Eleven patients were recruited; 6 of them were females (54.54%). Head and neck squamous cell carcinoma is the most common pathology (54.5%), followed by papillary carcinoma of the thyroid gland (27.3%). Six patients were operated upon for recurrences, and tumor fungation and/or ulceration was reported in 81.8%. The median age at the time of flap reconstruction was 71 years (range: 46.5-77). Wound complications were reported in 36.4% of patients, with the overall rate of flap necrosis being 27.3%, including 3 patients who suffered from major necrosis at the distal 1/3 of the flap. No delay in receiving adjuvant therapies, according to treatment protocols, was reported for any of the surviving patients.

Conclusion: The one-stage tunneled de-epithelialized fasciocutaneous DP flap is an effective choice with acceptable outcomes for defect reconstruction following resection of locally advanced head and neck cancer, whether on a curative or palliative basis, in relatively old patients with different comorbidities who require rapid treatment sequencing.

Objective: Preoperative anaemia is a risk factor for an increased requirement for blood and blood-product transfusions in patients undergoing thoracic surgery. Our aim was to study the association between preoperative anaemia and adverse outcomes in patients undergoing thoracic surgery.

Material and methods: This was a prospective descriptive study of adult patients undergoing thoracic surgery. Patients were classified into preoperative anaemia (Group A: Hb <13 g/dL in males, <12 g/dL in females) and non-anaemia (Group B). Collected data included demographics, intraoperative parameters, laboratory values, and postoperative outcomes, including complications, transfusion requirements, intensive care unit stay, and length of hospital stay. Statistical analyses were conducted to assess differences between the groups.

Results: A total of 104 patients were included: 29 with preoperative anaemia (Group A) and 75 with normal haemoglobin levels (Group B). Both groups were predominantly male. Patients with preoperative anaemia experienced significantly higher rates of intraoperative bleeding and perioperative crystalloid use, greater chest tube drainage volumes and longer durations, and increased postoperative pRBC transfusion requirements. Complications were more frequent in Group A than in Group B (31% vs. 8%, p=0.005) and hospital stays were longer (9.6±5.5 days vs. 7.7±4.7 days, p=0.014).

Conclusion: This study highlights the significant impact of preoperative anaemia on patients undergoing thoracic surgery. Preoperative anaemia was associated with increased intraoperative bleeding, higher complication rates, and longer hospital stays. These findings emphasise the need for thorough preoperative evaluation and optimisation of anaemia to improve surgical outcomes.

Objective: Türkiye has the highest obesity prevalence in Europe, contributing to significant health and economic burdens. Metabolic bariatric surgery (MBS) is the most effective intervention for achieving sustained weight loss and improving obesity-related conditions. This study aimed to assess short-term remission rates in six obesity-related conditions and quantify changes in direct medical costs from the patient's perspective at 3 and 6 months following MBS.

Material and methods: This prospective multicentre cohort study included 179 patients aged 18-65 with Class II or higher obesity who underwent MBS between July 2017 and November 2018. Clinical parameters and self-reported direct medical expenditures were evaluated preoperatively and at 3 and 6 months post-operatively. Outcomes included remission or improvement in diabetes, hypercholesterolemia, hypertension, joint diseases, obstructive sleep apnea syndrome (OSAS), and depression, as well as cost reductions.

Results: Mean age was 38.8±11.7 years; 57.5% had been living with obesity for over 25 years. Preoperatively, 82.1% had obesity-related conditions. At 6 months, excess weight loss reached 68.3%. Remission rates were 89.5% for diabetes, 94.6% for hypertension, 85.7% for hypercholesterolemia, and 100% for joint diseases and OSAS. Depression remission was 95.7%. Medication/device use declined by 96%. Total direct medical costs decreased by 13.95%, and by 88.53% excluding surgery.

Conclusion: In a country with high obesity and diabetes rates, MBS offers rapid clinical improvements and substantial cost reductions. Notably, 57% of patients had used non-prescriptive supplements preoperatively, highlighting the need for better health literacy. These findings reinforce the need to prioritize early surgical intervention within national obesity care frameworks.

Objective: There are limited data on the long-term outcomes after surgery for chronic pancreatitis. The aim of the current study was to assess the long-term pain relief and survival outcomes following surgical intervention for chronic pancreatitis.

Material and methods: This was a single-center retrospective cohort study that included 36 patients who underwent surgery for chronic pancreatitis. The study analyzed 30-day morbidity and mortality rates, long-term pain relief, and endocrine and exocrine insufficiency. Additionally, 10-year overall survival rates were assessed.

Results: The 30-day morbidity rate was 12/36 (33.4%), with no reported mortality. The median preoperative and postoperative visual analog scale scores were 9 (8-9) and 1 (1-2), respectively (p<0.001). Among 34 patients with severe pain, 33 (97%) reported substantial improvement. Long-term mortality was 6/36 (16.7%), and the 1-year, 5-year, and 10-year overall survival rates were 97%, 90%, and 85%, respectively. Factors associated with inferior survival included preoperative diabetes mellitus (p<0.001), hospital admissions after surgery (p=0.002), failure to gain weight after surgery (p=0.001), post-operative body mass index <18.5 kg/m² (p=0.029), and poor pain control after surgery (p=0.004). Conversely, preoperative endoscopic stent placement (p=0.031) was linked to improved 10-year overall survival.

Conclusion: Surgery offers long-term pain relief for chronic pancreatitis, and outcomes can be optimized through early identification and management of high-risk factors.

Objective: Acute mesenteric ischemia (AMI) is a rare but highly fatal vascular emergency. Due to its non-specific clinical presentation, early diagnosis remains a major challenge. This study aimed to evaluate the diagnostic utility of selected inflammatory ratios and nutritional scores in differentiating AMI from other causes of acute abdominal pain.

Material and methods: This retrospective, single-center study included 40 patients diagnosed with AMI and 40 control patients who presented with non-specific abdominal pain and had no definitive diagnosis. Preoperative laboratory parameters obtained upon emergency admission were analyzed. Calculated indices included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), C-reactive protein (CRP)-to-albumin ratio (CAR), and CRP-to-LDH ratio (CLDR), among others. Group comparisons, Pearson correlation analyses, and receiver operating characteristic (ROC) curve analyses were performed.

Results: Compared to controls, AMI patients showed significantly elevated levels of NLR, PLR, SII, CAR, and CLDR, and significantly lower levels of PNI (p<0.05). ROC analysis revealed that SII [area under the curve (AUC) =0.89], NLR (AUC =0.86), and PNI (AUC =0.81) demonstrated the strongest diagnostic performance. Several indices were found to be strongly correlated, Including NLR with SII and CAR with CLDR. The observed mortality rate in the AMI group was 52.5%.

Conclusion: Inflammatory and nutritional markers, particularly SII, NLR, and PNI, appear to offer valuable diagnostic support in identifying AMI. These indices may help prioritize patients for advanced imaging and early intervention, especially in resource-limited emergency settings. Further prospective multicenter studies are needed to confirm their clinical utility.

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.