Turkish Journal of Surgery最新文献

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.

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.