Turkish Journal of Surgery最新文献

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.

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.