Turkish Journal of Surgery最新文献

Objective: 2-15% of laparoscopic cholecystectomy gets converted to an open procedure due to various factors. The aim of this study was to identify pre-operative risk factors that could predict the conversion of laparoscopic cholecystectomy to open surgery. Pre-operative prediction would help in reducing the morbidity.

Material and methods: Adult patients undergoing elective laparoscopic cholecystectomy at a tertiary institute were included in the study. The parameters analysed were age, gender, body mass index, total count, liver function test, gall bladder size and wall thickness, impacted stone in Hartmann's pouch and common bile duct (CBD) diameter on ultrasonography. Intra-operative findings and the total number of conversions to open surgery were documented. Statistical analysis was done using SPSS 16.0 Inc., IBM system. A univariate regression analysis was used to find the significant risk factors followed by multivariate linear regression.

Results: Twenty-one of the 222 (9.5%) patients who underwent laparoscopic cholecystectomy, were converted to open cholecystectomy. Six variables were found significant on univariate analysis: Age, sex, total count, gallbladder wall thickness and size and diameter of the CBD. On logistic regression analysis, gall bladder wall thickness and size were found to be significant, and were used in the scoring system, wherein 1 point was given to each variable. The predicted risk of conversion was 0.5%, 1.8% and 7.2% for a score of zero, one and two respectively.

Conclusion: The most significant factors predicting conversion of laparoscopic cholecystectomy to open surgery were gall bladder size and wall thickness. This prediction can be used to minimize the time to conversion and reduce the morbidity.

Objective: This study investigates the effects of adipose tissue-derived mesenchymal stem cell (MSC), human recombinant epidermal growth factor (EGF) and silver sulfadiazine (SSD) on wound healing in the burn stasis zone by applying the comb burn model in rats.

Material and methods: A comb burn model was used for the burns and 32 Wistar albino female rats were randomly divided into four groups (control, SSD, SSD+MSC, SSD+EGF). On the 1^st day and the 21^st day, the total burn area on the 1^st day and the healed, healing, and non-healing burn area on the 21^st day were calculated with the Image-J program. At the end of the 21^st day, the pathology samples taken after euthanasia were scored semiquantitatively in terms of epithelization, inflammatory cell density, fibroblast density, collagen amount, and angiogenesis after hematoxylin-eosin staining.

Results: Histopathological analysis demonstrated that epithelialization scores were highest in the MSC (3.88±0.35, p<0.001) and EGF (3.63±0.52) groups, while the control group had the lowest values (1.50±0.53). Inflammatory cell density was significantly lower in the MSC (1.50±0.53, p<0.001) and EGF (1.88±0.64) groups than in the control group (3.75±0.46). Similarly, fibroblast density was lowest in the MSC (1.38±0.52, p<0.001) and EGF (1.75±0.71) groups, while the control group had the highest values (3.63±0.52). Collagen fibril density was significantly increased in the MSC (3.88±0.35, p<0.001) and EGF (3.50±0.53) groups compared to the control (1.63±0.74). Angiogenesis was highest in the EGF group (3.75±0.46, p<0.001), followed by the MSC group (3.00±0.53), while the control group had the lowest values (1.25±0.46). These results suggest that MSC and EGF play a significant role in wound healing, with MSC demonstrating superior epithelialization and EGF exhibiting the greatest angiogenic effect. Photo-analytical measurements showed that on day 1, burn area sizes were similar among all groups (p>0.05). By day 21, the healing burn area was significantly smaller in the MSC (3.19±0.98 cm², p<0.001) and EGF (4.33±0.48 cm²) groups compared to the control (8.43±2.35 cm²). The non-healing area was smallest in the EGF group (0.67±0.49 cm²), followed by the MSC (1.06±0.49 cm², p<0.001) and SSD (1.91±0.75 cm²) groups, whereas the control group had the largest non-healing area (7.29±2.20 cm²). These findings suggest that MSC was the most effective treatment for promoting wound healing, followed by EGF and SSD.

Conclusion: We determined that both histologically and photo analytically, MSC and EGF provided faster wound healing in the burn stasis zone EGF gave better results than all groups in preventing necrosis.

Objective: This study aimed to assess the perspectives of general surgery residents in Türkiye regarding the conditions and methods of their training, as well as the methods and circumstances under which their training is conducted.

Material and methods: The study involved 426 resident physicians undergoing training in general surgery at various institutions, including university hospitals, education and research hospitals, and foundation university hospitals, from January to March 2024. A web-based survey was distributed to the residents via email, containing 18 multiple-choice questions. The results were analyzed using the SPSS statistical software.

Results: The study revealed that 21.36% of the resident physicians had been in training for 0 to 1 year, while 20.19% had been in training for 2 to 3 years. A significant portion, 62.44%, was receiving their training in education and research hospitals, 36.38% in university hospitals, and only 1.17% in foundation university hospitals. In terms of training adequacy, 48.36% of the residents felt they did not receive enough practical training, and 81.22% believed they lacked sufficient theoretical training. Furthermore, 66.10% reported insufficient support for conducting academic research, and only 47.65% were aware of the core training program. Regarding work hours, 35.45% of residents were on duty every other day, 7.28% worked more than eight shifts per month, and 68.08% reported working 60 hours or more per week. Additionally, 91.31% of the residents deemed their salaries inadequate, and 71.36% experienced delays in receiving their on-call pay. Notably, only 55.63% expressed satisfaction with their experience as general surgery residents.

Conclusion: The findings of this research indicate that there is a lack of standardization in general surgery specialization training in Türkiye. The report reveals that both theoretical and practical training are insufficiently provided and not delivered in a systematic manner. Additionally, general surgery residents expressed low levels of satisfaction with the training they receive. It is evident that improvements are necessary in several areas concerning the training and working conditions of resident physicians.

Objective: The study aim was to determine our results of minimally invasive technique without aortic cross clamping for mitral valve surgery after previous cardiac surgery.

Material and methods: We performed 24 consecutive mitral valve surgeries between January 2015 and December 2018 in patients with a history of previous cardiac surgery. The procedure was performed using video-assisted right minithoracotomy, femoro-femoral bypass, a temperature of 26 °C, and cardiopulmonary bypass without aortic cross-clamping.

Results: Mitral valve replacement was performed in 12 (50%) of these patients, and mitral valve repair was performed in the same number (50%). The mean ejection fraction was 46.08±6.52% and the mean age was 61.52±11.48 years. Eighteen patients (75%) had previous coronary artery bypass graft surgery, and six patients (25%) had previous mitral valve surgery. In terms of postoperative complication frequencies that patients have experienced, one of the patients (4.1%) had postoperative low cardiac output syndrome. Two patients (8.3%) had renal failure; 2 patients (8.3%) had pneumonia, and stroke was seen in one patient (4.1%) postoperatively, whereas 2 patients (8.3%) had reoperation for bleeding. The mean postoperative packed red blood cell transfusion requirement at 48 hours was 1.00±1.10 units. The mean length of hospital stay was 10.54±4.37 days.

Conclusion: Minimally invasive port access procedure via right thoracotomy may be a safe and effective option in selected patients who need mitral surgery and have a history of prior sternotomy.

Objective: The objective is to assess the clinical efficacy of erector spinae plane block (ESPB) for post-operative analgesia in patients undergoing laparoscopic cholecystectomies.

Material and methods: This prospective, interventional, quasi-randomized single-blind study was approved by institutional ethical committee. Total 82 patients undergoing laparoscopic cholecystectomy were allocated into two groups, ESPB and control group. Postoperatively, the total tramadol consumption in 24 hours, the visual analogue scale (VAS) at various time intervals and time to rescue analgesia in both groups were monitored.

Results: The requirement of tramadol in first 24 hours was significantly more in controls as compared to cases (p=0.005). The mean VAS at rest, coughing and at movement was significantly lower in the immediate period, at 2^nd hour and 4^th hour after being shifted to post-operative area, in case group as compared to control. The time to rescue analgesia was statistically significantly more in ESPB group (p=0.002).

Conclusion: ESPB for laparoscopic cholecystectomy is a safe and effective technique of multimodal analgesia which provides better pain relief, reduced opioid requirement, lower post-operative pain scores, reduced total post-operative analgesic consumption along with prolonged time to rescue analgesia.

Objective: The etiology of primary pilonidal sinus disease (PSD) remains unclear. Prior investigations suggest that sharp fragments from the occiput contribute to the formation of PSD. In 2009 a correlation between PSD and a deeper natal cleft was reported. We investigated the association between intergluteal fold (IGF) depth and PSD risk using a standardized five-step measuring protocol.

Material and methods: Our clinical prospective study included 95 PSD patients and 105 non-PSD individuals, and measurements were taken from the glabella sacralis to the anus in a northern German population.

Results: The mean (± standard deviation) intergluteal depth progressively increased from the intergluteal opening from the sacral glabella at 9.1 (±3.4) mm to a maximum of 62.6 (±10.4) mm. Notably, the deepest point was consistently observed at the anus, where PSD occurrence is rare. No significant difference in IGF depth between PSD and non-PSD patients was found. Additionally, PSD predominantly developed in the proximal (cranial) third of the IGF, despite the maximum depth being in the distal region.

Conclusion: These findings suggest that IGF depth is not a risk factor for PSD.