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Introduction: Colorectal anastomosis using circular stapler has a lot of advantages. However, some technical problems may be encountered during the use of the device such as firing system disorders, incomplete anastomosis and formation of stapler defects. In this study, our clinical experience in 'the missing doughnut' problem will be evaluated with the literature. Methods: The patients who were operated with colorectal tumor between 2012-2017 was entered the study. In which we have researched and evaluated the operation reports. Case series: We detected a missing doughnut in 7 cases. The condition of the anastomosis was checked by intra-abdominal palpation, endoscopy, and "air leak test". We did not detect any leakage with the air test. Conclusion: Missing doughnuts is a condition that disturbs the surgeon, makes them think that the anastomosis is insufficient and insecure at first and evokes the idea that the anastomosis should be remade. However, a condition like this in difficult areas may jeopardize the safety of the anastomosis and cause the patient to have a permanent colostomy. In such conditions, at first one must be calm, test the strength and leak of the anastomosis line and then decide what to do. [ABSTRACT FROM AUTHOR]

Aim: Pain control is an important issue in patients with inoperable cancers of upper abdominal organs. Although various pharmacological drugs are adequate for this, more invasive and interventional methods such as celiac plexus block (CPB) come forward for the cases which are unresponsive to conventional medical treatments. In this study our aim was to evaluate the contribution of CPB to patient comfort in patients with inoperable cancer. Material and Methods: Thirty-four patients who were diagnosed with inoperable malignant and underwent CPB during five years period were included. All procedures were performed with the guidance of endoscopic ultrasonography (EUS) and ethanol was used as the neurolytic agent. Results: Majority of the cases were female (%55.9, n:19) and the median age was 66 years (range: 56-78 years). Most of the patients had pancreatic cancer (38.3%, n:13), and the remaining patients had gastric cancer, Klatskin tumor, gallbladder cancer and hepatocellular carcinoma. Pain resolved completely in 16 patients (47.2%) and was controlled with non-narcotic analgesics in six patients (17.6%) after the procedure. None of the patients developed any major complication or paraplegia. Conclusion: It was observed that pain control was not sufficiently achieved in the advanced grade of invasion. For this reason, patient selection should be done meticulously and CPB should be performed in the early period of pain in order to obtain an effective response. [ABSTRACT FROM AUTHOR]

Chronic visceral ischemia is described as postprandial abdominal pain caused by intestinal hypoperfusion. Chronic visceral ischemia arising from the stenosis of major mesenteric arteries can cause death. Chronic abdominal pain, weight loss, and sitophobia are the major symptoms. The main cause of chronic visceral ischemia is atherosclerosis; Doppler ultrasonography, tomographic angiography, and magnetic resonance angiography can be used for diagnosis. The gold standard method is mesenteric catheterized angiography. Surgical bypass or endovascular balloon angioplasty and stent replacement can also be performed to prevent serious complications and death. A total of three patients, two male and one female, applied to emergency services with blunt abdominal pain lasting a few hours that started after meals and was located in the epigastric and periumblical regions. The patients were diagnosed with chronic visceral ischemia after screening tests and physical examination. Mesenteric catheterized angiography was performed immediately in all the cases. Balloon angioplasty and stent replacement were performed on the stenoses, and occlusions were detected. Mesenteric catheterized angiography may be preferred in cases with strong clinical suspicion; balloon angioplasty and stent replacement can also be used as treatments with lower rates of complications. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy has become the routine procedure in axilla-negative breast cancer patients at most medical centers for axillary staging and local control in the recent years. Sentinel lymph node is the only focus in axillary lymph metastasis in a large portion of patients. In our trial, we investigated the clinical and pathological factors that affect the positive status of sentinel lymph node. We included 89 patients, who underwent sentinel lymph node biopsy (SLNB) with methylene blue and/or technetium-99 m Sulphur Colloid due to early-stage breast cancer. Five patients, in whom SLN was not detected and who underwent axillary dissection, were excluded from the trial. The patient age, location of the tumor, the type of the tumor, the T stage by the TNM staging system, the histological grade and type of the tumor, the status of multifocality, the lymphovascular invasion status of the tumor, and the ER, PR, and HER-neu2 status were recorded. The median age of the 89 patients was 52, 9 (±10) years. Fifty-seven (64 %) and 32 (36 %) of the 89 patients were detected to have positive and negative SLN, respectively. Assessing the SLNB positivity and the patient age, tumor size, tumor grade, multifocality, tumor localization, the T stage by the TNM staging, the ER/PR positivity/negativity, and the HER/neu2 and p53 status, the data revealed no statistically significant results with respect to SLN metastasis. The lymphovascular invasion status (LVI) was observed to statistically affect the SLN positivity ( p < 0.016). We showed that LVI could be an important marker in predicting the SLN positivity in patients with axilla-negative early-stage breast cancer. In the future, upon introduction of new biomarkers and with relevant studies, it may be possible to predict the SLNB status of patients at an adequately high accuracy and a low risk. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6-8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. Methods: We aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. Results: We retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. Conclusion: Early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation. [ABSTRACT FROM AUTHOR]

Hepatodiaphragmatic interposition of the small or large intestine is known as Chilaiditi syndrome, whichis a rare disease diagnosedincidentally. Chilaiditi syndrome is typically asymptomatic, but it can be associated with symptoms ranging from intermittent, mild abdominalpain to acute intestinal obstruction, constipation, chest pain and breathlessness. A 54-year-old male patient was admitted to thehospital with a history of abdominal pain, nausea and vomiting. Chest X-ray revealed an elevation of the right hemidiaphragma caused bythe presence of a dilated colonic loop below. The patient underwent urgent surgery with perforation as preliminary diagnosis. The patientunderwent right hemicolectomy and ileocolic anastomosis because of the intestinal obstruction related to Chilaiditi's Syndrome.Due to the rarity of this syndrome and typical radiological findings, this case was aimed to be presented. [ABSTRACT FROM AUTHOR]

Objective: Axillary lymph node (ALN) metastasis is the most significant prognostic factor for predicting overall survival in breast cancer patients. Ultrasonography (US) and magnetic resonance imaging (MRI) are commonly used imaging methods in the detection of breast cancer lymph node metastasis (1, 2). The accurate assessment of ALN at preoperative period will guide the choice of appropriate surgical approach to the axillary and prevent potential surgery-related complications such as lymphedema, seroma and nerve injury. In this study, we aimed to compare effectiveness of MRI and US in the assessment of axillary. Materials and Methods: We retrospectively screened 1004 patients, who underwent US and MRI between 2016 and 2019. There were 257 patients with category 4, 5 or 6 according to Breast Imaging Reported Data System classification. Patients with received neo-adjuvant therapy excluded from the study. The MRI and US results were compared with histopathologic results of sentinel lymph node biopsy or axillary lymph node dissection. Results: The lesion was identified as malignant in 209 patients. Patients with received neo-adjuvant therapy (n=48; 23%). The remaining 161 patients underwent surgery. Of these, histopathological examination of ALNs was reported as positive in 73 patients and negative in 88 patients. The sensitivity, specificity values were 94.81%, 88% according to US and 89.02%, 73.95% according to MRI for the detection of metastatic ALNs, respectively. Conclusion: Dynamic-enhancement breast MRI is highly effective in detection of multi-focal, multi-centric lesion, invasion of skin and pectoral muscle. But, the result is not the same in the assessment of metastatic ALN. Ultrasonography is readily available, inexpensive, practical and successful imaging modality in the assessment of ALN. Major disadvantage of US is highly dependent to experience of radiologist. In our study, we observed that both sensitivity and specificity of US was statistically superior than MRI for the detection of metastatic ALNs. [ABSTRACT FROM AUTHOR]

Parathyroid adenoma is the most common cause of primary hyperparathyroidism and rarely reaches huge sizes. As the gland enlarges it may exhibit atypical morphology and extension to the mediastinum which may complicate the excision of the tumor while preserving the capsular integrity. We present a 35-year-old male patient who was referred to our department with a complaint of severe hypercalcemia. Neck ultrasound and parathyroid scintigraphy revealed an adenoma of 45x25 mm in size in the left parathyroid lobe extending to the retrosternal area. The patient underwent an uneventful parathyroidectomy. The patient remained well with no evidence of biochemical recurrence during the 4-year follow-up. Here, we presented a very original case of one of the largest parathyroid adenomas (8 cm) with atypical configuration (having multiple spicular extensions from the main body) ever reported in the literature which was completely retrieved from the posterior mediastinum via cervical route., Competing Interests: The authors declared that there are no conflicts of interest in connection with this paper., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Idiopathic omental infarction (IOI) is challenging to diagnose due to its low incidence and vague symptoms. Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies. Although hypercoagulability and thrombosis are among the causes of omental infarction, venous thromboembolism scanning is rarely performed as an etiological investigation., Case Summary: The medical records of the 5 cases, who had the diagnosis of IOI by computed tomography, were examined. The majority of the patients were male ( n = 4, 80%) and the mean age was 31 years (range: 21-38). The patients had no previous abdominal surgery or a history of any chronic disease. The main complaint of all patients was persistent abdominal pain. Omental infarction was detected in all patients with contrast-enhanced computed tomography. Conservative treatment was initially preferred in all patients, but it failed in 1 patient (20%). After discharge, all patients were referred to the hematology department for thrombophilia screening. Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase (A1298C mutation) and heterozygous for a factor V Leiden mutation., Conclusion: IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain. Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to report., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome and affects many organs. We aim to report an adult patient with VHL disease having bilateral adrenal pheochromocytoma and multiple neuroendocrine tumors of the pancreas who was successfully treated with simultaneous function-preserving adrenalectomy and pancreatectomy. A 27-year-old woman was admitted to hospital with hypertension. The computed tomography of the abdomen revealed a solid tumor in both adrenal glands with the sizes of 12x7 cm on the right and 4x4 cm on the left. She also had two pancreatic solid masses in the head and three in the tail with varying sizes. The laboratory tests are all within normal limits except elevated 24-hour urinary metanephrine and normetanephrine. I-123 MIBG scanning showed increased uptake in both adrenal glands. Fine needle aspiration biopsy of the tumor on head of pancreas via endoscopic ultrasonography showed neuroendocrine tumor. Those findings were compatible with bilateral pheochromocytoma and multiple pancreatic neuroendocrine tumors and genetic tests revealed the mutation which confirmed the diagnosis of VHL disease. After suppression with alpha-1 inhibitor, right total, left cortical-sparing adrenalectomy, Whipple procedure for the pancreatic head lesions and spleen-preserving distal pancreatectomy were performed and pancreatic corpus was preserved. This case showed that multiple function-preserving procedures can be safely performed with oncological principles in patients with VHL disease., Competing Interests: The authors declare no conflict of interest and no financial issues to disclose., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesencyhmal tumors of the gastrointestinal tract. Today surgical resection is still the treatment of choice for primary gastric GISTs. This study compares the laparoscopic versus open surgical resection approaches of gastric GISTs., Methods: A retrospective chart review was conducted from our database, and 68 primary gastric GIST resections were found to be performed in our center between 2008- 2020. Of these 68 patients, 57 were included for the study. Open resection was performed in 32 patients, and laparoscopic resection was performed in 25 patients. The medical records were examined and compared for clinical, pathologic and surgical results according to preferred surgical method of choice., Results: Fifty-seven patients were qualified for the study. The average diameter of the tumor was 4.8 ± 1.91 cm in the laparoscopic group, and 6,8 ± 4,27 cm in open group. Estimated blood loss during the surgery was significantly lower in laparoscopic group patients (100.7 ml vs 287.5 ml) (p< 0.001) and also length of stay was shorter compared with open at 4.4 versus 11.9 days (p < 0.001). Laparoscopic group patients needed less pain medication, and they had quicker return to daily life., Conclusions: Laparoscopic approach is safe and feasible with acceptable oncologic outcomes and certain benefits like decreased length of stay, less complication rates and better comfort. The preference of laparoscopic resection should be decided not only on tumor location or diameter but also surgeon’s laparoscopic surgical experience., Key Words: Laparoscopic, Gastric resection, GISTs

Objectives: Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated., Methods: The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated., Results: Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44-83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients., Conclusion: Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2021 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak., Methods: Fifty-seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed., Results: Thirty-three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29-86). All patients had at least one episode of cholecystitis. Forty-seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow-up of 49 months (range: 13-98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively., Conclusions: Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases., (© 2020 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal pain or intraabdominal mass. Since clinical diagnosis is usually difficult, radiological examinations play a very important role in diagnosis. A 37-year-old multiparous woman was admitted to the emergency room with a complaint of abdominal pain. The patient stated that she underwent an operation due to gastric volvulus nine years ago. Preoperative diagnosis was made by ultrasonography and computed tomography. Splenectomy was performed because of the irreversible infarction. Wandering spleen torsion is a rare clinical condition that may cause an acute abdomen. Computerized tomography is the gold standard for preoperative diagnosis. Gastric volvulus and wandering spleen have similar etiologies. In the literature, the coexistence of these two diseases in adulthood is rarely reported. However, to our knowledge, this case is the first report to describe the emergence of these two pathologies at different times in adulthood.

Objectives: The selection of incision type, closure type of incision and the suture material are some of the important factors to prevent hernia development. We should aim to perform the best procedure with the best technique to reduce the risk of recurrence. Surgical options include primary repair and open or laparoscopic repair with mesh. Mesh repairs can be performed as onlay, sublay or inlay according to the area where the mesh is to be laid. In this retrospective study, our main goal was to compare the recurrence rates in patients who underwent incisional hernia repair with onlay and inlay mesh techniques., Methods: This retrospective study included 185 patients who underwent surgery due to incisional hernia in our clinic between January 2012 and October 2017. Patients were divided into two groups according to the technique as Group 1 with onlay mesh repair and Group 2 with inlay mesh repair. The same type of mesh (prolen) was applied to all patients., Results: There were 121 patients in Group 1 and 64 patients in Group 2. According to data we obtained, 64.3% of the patients were women and the mean age of all patients was 58.4±16.4 years. Postoperative complications (such as seroma-hematoma, surgical site infection, mesh rejection, postoperative ileus) developed in 29.2% (n=54) of the patients. The length of hospital stay was 4.2±3 days in Group 1 and 5.6±5 days in Group 2. The mean follow-up period was 48.6 months (24-93 months), with the recurrence rates of 5.8% (n=7) in Group 1 and 10.9% (n=7) in Group 2, respectively. There was a statistically significant difference between the groups concerning comorbidity, postoperative complications, the length of hospitalization stay and recurrence., Conclusion: We believe that the onlay technique will be more appropriate than the inlay technique when only prolen mesh is preferred because the recurrence rates are higher in the inlay technique., Competing Interests: Conflict of Interest: The authors have no conflict of interest., (Copyright: © 2020 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature., Methods: The medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage., Results: Among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2±16.26 years (range, 21-93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery., Conclusion: In all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes.

Background: In recent years, the importance of oncologic principles in colorectal cancer (CRC) surgery has been emphasized in many studies. Although emergency surgery is related to high morbidity and mortality rates, their adequacy and prognosis in maintaining oncologic principles are still controversial. This study aims to compare the clinicopathological features of CRC patients who underwent emergency and elective surgical resection and also to evaluate their compatibility with oncologic principles and to evaluate their short/long term results., Methods: Of the patients who underwent surgery for CRC, 564 were included in this study. The patients were divided into two groups according to their surgical conditions as an emergency (Group 1) and elective (Group 2). Demographics, clinicopathological features, prognostic factors and survival rates of the patients were evaluated retrospectively., Results: There were 104 (18.4%) patients in group 1 and 460 (81.6%) patients in group 2. 61.2% of the patients were male and the mean age was 64.27. There were statistically significant differences between the groups in age distribution, tumor localization, surgical procedures, T- N classification, AJCC stage, presence of mucinous subtype, lymphovascular and perineural invasion. The mean tumor diameter was 5.23±3.48 cm. There was no difference between the groups concerning the adequacy of lymph node harvest, except in patients who underwent low anterior resection. The mean survival time was 475.212 days, and the median survival time was 376 days. The disease-free and overall survival rates were higher in group 2., Conclusion: Despite the appropriate oncologic resection, CRC patients operated under emergency conditions had worse short-term and long-term results than the CRC patients operated under elective conditions. Thus, we believe that the prevalence of colorectal cancer screening programs should be increased to reduce the rate of emergency surgery.

Metaplastic breast carcinoma (MBC) is a general term defining a heterogeneous group that includes biphasic lesions, with both malignant epithelial and mesenchymal tissue components. Although its clinical findings are similar to those present in invasive ductal carcinoma, it rarely presents with the findings of inflammatory breast cancer. It is generally seen in the fifth decade. MBC spreads via lymph and blood circulation. Most common distant metastasis areas include lungs and the bone. Although the treatment generally relies on the same principles applied in invasive ductal carcinoma, a more aggressive treatment should be employed in at-risk groups due to higher rates of local recurrence. In this study, we aimed to discuss clinicopathological features and treatment approach in 5 women with MBC., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Hepatodiaphragmatic interposition of the small or large intestine is known as Chilaiditi syndrome, whichis a rare disease diagnosed incidentally. Chilaiditi syndrome is typically asymptomatic, but it can be associated with symptoms ranging from intermittent, mild abdominal pain to acute intestinal obstruction, constipation, chest pain and breathlessness. A 54-year-old male patient was admitted to the hospital with a history of abdominal pain, nausea and vomiting. Chest X-ray revealed an elevation of the right hemidiaphragma caused by the presence of a dilated colonic loop below. The patient underwent urgent surgery with perforation as preliminary diagnosis. The patient underwent right hemicolectomy and ileocolic anastomosis because of the intestinal obstruction related to Chilaiditi's Syndrome. Due to the rarity of this syndrome and typical radiological findings, this case was aimed to be presented.