Turkish Journal of Surgery最新文献

Objective: The controlling nutritional status (CONUT) score, calculated using serum albumin, total cholesterol, and lymphocyte count, is an effective predictor of post-operative complications (PC) following oncologic resections in gastrointestinal system cancers. This retrospective study aimed to investigate the impact of pre-operative CONUT scores on overall post-operative complications (OPC) in patients with stage I-III gastric cancer (GC) who underwent gastrectomy.

Material and methods: Patients who underwent curative gastric resection for GC between January 2013 and December 2024 were retrospectively analyzed. Patients with a preoperative CONUT score of 0-1 were classified as the normal CONUT group. In contrast, those with a score of 2 or higher were classified as the high CONUT group. Preoperative, intraoperative, and postoperative data were reviewed. Risk factors for the development of OPC were evaluated using univariate and multivariate analyses.

Results: In the high CONUT group, American Society of Anesthesiologists scores, neutrophil/lymphocyte ratio, lymphatic invasion rates, TNM stages, duration of intensive care unit stay, OPC rates, and comprehensive complication index values were significantly higher (p<0.05). Multivariate analysis revealed that advanced TNM stage [odds ratio (OR): 5.8, 95% confidence interval (CI): 1.4-24.6, p=0.016] and a high CONUT score (OR: 4.1, 95% CI: 1.3-13.0, p=0.014) were independent risk factors for the development of PC.

Conclusion: Pre-operative CONUT score may serve as a predictor of OPC following curative GC resections.

Objective: Postoperative respiratory complications (PRCs) are a significant concern after cardiac surgery, contributing to increased morbidity and mortality. This study aimed to analyze the incidence and risk factors for PRCs in a tertiary center in Bosnia and Herzegovina and compare findings with data from developed countries.

Material and methods: This prospective cohort study included 300 adult patients who underwent open-heart surgery with cardiopulmonary bypass at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, between January 2020 and October 2023. Preoperative, intraoperative, and postoperative variables were analyzed, including comorbidities, surgical procedures, mechanical ventilation duration, and intensive care unit stay. PRCs were defined based on standardized clinical and radiological criteria. Multivariate logistic regression identified independent risk factors.

Results: The most common PRCs were pneumonia (37.3%), atelectasis (29.3%), pleural effusion (22.0%), and respiratory failure (10.7%). Key independent risk factors included oxygen saturation <94%, ejection fraction <45%, diabetes mellitus, anemia, and red blood cell transfusion >500 mL. In contrast to studies from developed countries, intraoperative variables were not significant predictors.

Conclusion: Our findings suggest that preoperative comorbidities play a more dominant role in PRC development in our setting compared to developed nations. The high incidence of pneumonia may reflect delayed postoperative mobilization and limited access to respiratory therapy. These results underscore the need for optimized preoperative patient management and improved postoperative respiratory care protocols in resource-limited healthcare settings.

Objective: Chronic pancreatitis (CP) leads to enduring abdominal pain and functional insufficiency, alongside notable risks posed by vascular complications. Pseudoaneurysms (PSA) are common in CP, necessitate careful management due to potential life-threatening hemorrhage. Literature suggests a 5-10% incidence of gastrointestinal bleeding in CP, often related to PSA affecting nearby arteries. Our study aims to evaluate the prevalence and outcomes of vascular complications in CP, aiding in improved management strategies.

Material and methods: This retrospective observational study was conducted on the patients diagnosed with CP at a tertiary care center in Northeast India from April 2018 to December 2023. Demographic data and risk factors such as smoking and alcohol use were collected from medical records. The diagnosis and etiological assessment followed the M-ANNHEIM criteria, employing contrast-enhanced computed tomography.

Results: In our study of 86 patients with CP, predominantly male (68.6%), the median age at presentation was 37.4 years. Arterial PSAs were identified in 11 patients (12.79%), with a median onset of 18.2 months from symptom onset. Univariate analysis revealed that male sex (p=0.015), alcohol abuse (p=0.001), smoking (p=0.035), pseudocyst formation (p=0.008), and absence of parenchymal calcification (p=0.002) were significantly associated with PSA development. Interestingly, inflammatory head mass was more prevalent in patients without PSA (49.3% vs. 9.1%, p=0.02), suggesting a potential protective effect. On multivariate analysis, independent predictors of PSA formation included an alcohol abuse [odds ratio (OR): 10.75, 95% confidence interval (CI): 0.967-119.53, p=0.05], a pseudocyst presence (OR: 27.41, 95% CI: 1.591-472.39, p=0.02), and a bulky pancreatic head (OR: 12.72, 95% CI: 2.97-54.51, p=0.0006), while parenchymal calcification remained inversely associated (OR: 0.1279, 95% CI: 0.016-1.02, p=0.05).

Conclusion: Arterial PSA formation in CP is independently associated with alcohol abuse, pseudocysts, and inflammatory head mass, while parenchymal calcification appears protective. Endovascular coiling has emerged as a promising intervention, demonstrating effective management of PSA and successful prevention of hemorrhagic complications.

Objective: Loss of muscle mass (sarcopenia) and impaired muscle quality (myosteatosis) associated with poor surgical outcomes. This study aimed to evaluate the impact of sarcopenia and myosteatosis on postoperative short-term outcomes and prognosis in patients with gastric cancer.

Material and methods: Patients who underwent gastric cancer surgery and had abdominal computed tomography (CT) imaging were included in the study. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were calculated using CT images. Patients were divided into groups based on previously established threshold values: Those with low SMI (indicating sarcopenia) versus those with normal SMI, and those with low SMD (indicating myosteatosis) versus those with normal SMD. Demographics, clinicopathologic characteristics, postoperative outcomes, and survival data were extracted from prospective database.

Results: Among the 237 patients, 87 patients (36.7%) had sarcopenia and 139 patients (58.6%) had myosteatosis. Patients with myosteatosis were characterized by older age, poorer preoperative nutritional status, inferior performance status, and extended hospital stays. Higher severe complication incidence was observed among patients with myosteatosis (18% vs. 10.2%, p=0.09). Overall survival of patients with sarcopenia or myosteatosis was significantly lower than that of patients with a normal SMI or SMD (p=0.03, p<0.001 respectively). Myosteatosis was identified as an independent risk factor for overall survival in multivariate analysis (hazard ratio: 2.20, 95% confidence interval: 1.26-3.86, p=0.006).

Conclusion: This study indicated sarcopenia or myosteatosis is associated with reduced overall survival. Although there were no significant difference severe complication rates are higher in patients with low SMD than in patients with normal SMD, and reporting of SMD from preoperative CT should be considered in preoperative evaluation.

Obesity is highly prevalent among individuals with cognitive impairments, yet bariatric surgery is often underutilized in this population due to concerns regarding adherence and safety. The aim of this review is to evaluate the outcomes of bariatric surgery in obese adults with cognitive impairments, focusing on weight loss, cognitive function, general health, and postoperative risks. A systematic review of 11 studies was conducted, including case reports, cohort studies, and pilot trials that investigated bariatric surgery outcomes in adults with intellectual disabilities, neurodevelopmental disorders, or acquired cognitive dysfunction. Outcomes included excess weight loss (EWL), cognitive changes, comorbidity resolution, and postoperative complications. Most studies reported significant weight loss, although slightly lower than in neurotypical populations (EWL ranging from 31.1% to 90%). Cognitive improvements were observed in domains such as memory and executive function within weeks after surgery. Bariatric surgery also led to notable improvements in comorbidities such as diabetes and hypertension. However, risks included nutritional deficiencies and poor adherence, particularly in patients with low preoperative cognitive function. Strong caregiver support and structured follow-up programs were key predictors of long-term success. Bariatric surgery can be a safe and effective intervention for adults with cognitive impairments when tailored support systems are implemented. Cognitive screening and personalized postoperative care are essential to optimize outcomes.

Embryonal rhabdomyosarcoma (ERMS) is a highly aggressive pediatric malignancy that can develop in various anatomical locations. This case series presents four pediatric patients diagnosed with ERMS, including one with the uncommon presentation of prostatic rhabdomyosarcoma. By analyzing clinical features, treatment strategies, and outcomes, this study aims to provide insights into the challenges of managing this malignancy in different anatomical sites.

Gastrointestinal schwannomas are benign, slow-growing, rare tumors comprising 2-6% of all mesenchymal tumors of the gastrointestinal tract and 0.2% of all gastric neoplasms. In the gastrointestinal system, schwannomas are mostly observed in the stomach, followed by the colon and rectum. In this case series, we present the clinicopathological results of 9 cases, along with a literature review. A retrospective analysis was conducted on nine patients diagnosed with gastrointestinal schwannoma in a single institution. Tumors were located in the small intestine and stomach, with an average tumor size of 4.6 cm (range: 1.8-8.5 cm). Diagnoses were incidental in most cases, with only four patients presenting symptoms such as epigastric pain and changes in bowel habits. Histopathological characteristics of tumors were studied. Surgical resection with negative margins was performed in 8 cases. Histopathological analysis confirmed schwannomas characterized by solid, homogeneous, spindle-cell structures without cystic changes or necrosis. Immunohistochemically, all tumors were S-100 positive, with variable expression of other markers. Desmin was negative in seven samples. One gastric schwannoma showed focal smooth muscle actin positivity, while others were negative. The Ki-67 index ranged from 0% to 6%, and c-Kit was negative in all cases. DOG-1 expression was examined in four cases, showing focal positivity in small bowel schwannoma and negativity in three gastric schwannomas. Gastrointestinal schwannomas are predominantly benign tumors, more common in women, and typically occur in the sixth decade of life. While imaging and endoscopic techniques help in diagnosis, definitive diagnosis relies on histopathological analysis. Surgical resection remains the gold standard for treatment.

Objective: Pyonephrosis is defined as accumulation of purulent debris in the renal pelvis and urinary collecting system. Urinary diversion through percutaneous nephrostomy (PCN) is the first choice of treatment for pyonephrosis. Even after PCN insertion some patients end up with complete loss of renal function. We aim to determine the proportion of patients undergoing complete loss of renal function after PCN insertion, the factors facilitating renal function recoverability and the complications of the procedure.

Material and methods: In this prospective observational study, 100 patients with pyonephrosis were consecutively included over a period of one year. Pre-PCN and post-PCN creatinine clearance (CrCL) were analysed. Associated clinical factors were collected on a data sheet proforma. Data were analysed using Stata 12.1.

Results: Mean age of study participants was 44.4 years (standard deviation: 11.8) where majority (69%) were males. Rate of nephrectomy after pyonephrosis was 15.6%. Among the participants, 77% patients did not have any complications after PCN insertion while 18% had dislodgement and 5% had bleeding. Significant improvement was found in post-PCN CrCL compared to pre-PCN CrCL (p-value: 0.001). Persons having severe hydronephrosis had lower odds of having improved glomerular filtration rate after PCN insertion (adjusted odd's ratio 0.3, p-value: 0.005, 95% confidence interval: 0.1-0.7) compared to those having moderate hydronephrosis.

Conclusion: Early PCN insertion is imperative for salvaging a pyonephrotic kidney. It is cost-effective and allows the patient to undergo definitive endourologic surgery for underlying pathology, thus avoiding a potential nephrectomy.

Gastric volvulus is a rare cause of acute abdomen, and its complexity increases when associated with congenital anomalies. We report an exceptional case of gastric volvulus with perforation in a female patient, which was accompanied by asplenia, jejunal diverticulosis, and absent colonic attachments. To our knowledge, this combination has not been previously documented. This case highlights the need for further research into the mechanisms behind such rare anatomical associations.

To describe the clinical presentation, diagnosis, and endovascular treatment of a right colic artery (RCA) pseudoaneurysm in a patient with rheumatoid arthritis, highlighting its rarity as a complication of rheumatoid vasculitis. A woman in her early 50s with rheumatoid arthritis presented with a three-day history of epigastric pain, vomiting, and melena. Examination revealed anemia, purpuric rashes, and mild abdominal tenderness. Computed tomography (CT) angiography identified an RCA pseudoaneurysm. Following resuscitation and blood transfusion, selective superior mesenteric artery angiography and transarterial coil embolization were performed. The procedure was successful, leading to symptom resolution. RCA pseudoaneurysms are rare, usually resulting from trauma or pancreatitis, but can also arise from rheumatoid vasculitis. This is the first reported case of a RCA pseudoaneurysm due to rheumatoid arthritis. CT angiography is the preferred diagnostic tool, and coil embolization is an effective treatment for hemodynamically stable patients.