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Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients. [ABSTRACT FROM AUTHOR]

Background/aim: Despite advancements in surgical methodologies and the extensive perioperative and postoperative care administered to recipients, the prevalence of complications requiring early relaparotomy following living donor liver transplantation (LDLT) remains persistent. This study sought to analyze the determinants influencing relaparotomy occurrences in the initial 30 days following LDLT. Additionally, it was aimed to evaluate the impact of early laparotomy on both graft and patient survival within this distinct patient cohort. Materials and methods: The study encompassed recipients (n = 535) aged 18 years and older who underwent primary LDLT at our institution from January 2019 to December 2021. Exclusion criteria involved patients necessitating early retransplantation. Early relaparotomy was specified as surgical intervention within the initial 30 days following LDLT. Results: The study enrolled a total of 535 patients, among whom 85 (15.9%) underwent early relaparotomy. The median age of the patients was 54 (range: 41-60) years, with a predominant male representation (66.2%). Univariate analysis comparing the laparotomy and nonrelaparotomy groups revealed statistically significant differences in the creatinine (p = 0.043) and sodium (p = 0.025) levels, graft side (p < 0.001), etiology (p = 0.005), and blood loss (p = 0.012). In the multivariate analysis, creatinine (p = 0.039; OR = 1.668; 95% CI = 1.027-2.709) and left lobe graft (p < 0.0001; OR = 3.611; 95% CI = 1.960-6.652) emerged as independent risk factors for relaparotomy. Conclusion: The primary causes of early relaparotomy following LDLT include postoperative bleeding, biliary leakage, and vascular complications. Preoperative elevation in creatinine and sodium levels, the presence of Budd-Chiari syndrome, utilization of a left lobe graft, and intraoperative blood loss are identified as risk factors associated with early relaparotomy after LDLT. Patients undergoing early relaparotomy exhibit inferior survival rates compared to those who do not. [ABSTRACT FROM AUTHOR]

Gallbladder cancers are relatively rare malignancies. While early-stage cases can achieve good outcomes with cholecystectomy, the 5-year survival rate in advanced stages is extremely low. Primary sclerosing cholangitis is a progressive liver disease characterized by inflammation of the bile ducts and is associated with an increased risk of gallbladder cancers. A 32-year-old male patient with primary sclerosing cholangitis was referred for liver transplantation. Imaging revealed a suspicious polypoid lesion, 2.5 cm in diameter, in the gallbladder. With a Meld score of 30, the patient was placed on the transplant waiting list. After waiting period of one month a deceased donor liver transplant was performed. The hepatectomy specimen revealed T2 gallbladder cancer. No recurrence or metastasis was detected during 1 year of follow-up. There is no consensus on the management of suspicious gallbladder lesions in patients with primary sclerosing cholangitis. Cholecystectomy in these patients carries a risk of decompensation in cirrhosis. Considering the decompensated liver cirrhosis and high Meld score, we preferred transplantation over cholecystectomy. Therefore, liver transplantation can be considered as primary treatment option instead of cholecystectomy. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. [ABSTRACT FROM AUTHOR]

Introduction: Minimally invasive treatment approaches for pilonidal disease comprise controlling tissue damage of the sinus cavity via chemical agents or lasers. Although silver is a widely used chemical for healing wounds, there are limited studies about pilonidal disease management. We aimed to evaluate the efficacy of silver nitrate on pilonidal disease. Methods: Patients who were diagnosed with pilonidal disease and were treated with silver nitrate application in Malatya, Turkey in 2018-2020 were evaluated. Silver nitrate was applied in the sinus tract following the excision of the sinus orifice with a small incision and debridement of the sinus cavity. Silver nitrate sticks were used to obtain controlled damage in the tissue of the sinus cavity for three sessions at baseline and on days one and seven. The obtained results were evaluated with the Mann Whitney U and chi-square tests. Results: 42 patients with the pilonidal disease were included in this study, and silver nitrate treatment was applied in our institute. The median age of the patients was 24 (range: 16-56) years, and all of the treatment procedures were applied in the operating room. Thirthy-three of the patients (78.6%) were accepted as treated at the end of the 12-month follow-up duration. Conclusion: Silver nitrate treatment is a simple, safe, and inexpensive minimally invasive treatment technique for pilonidal disease. This treatment can be an alternative treatment choice to other minimally invasive techniques. It is easy to perform in outpatient clinics, and the results of this study might be promising. A preprint version of this manuscript is available with DOI:10.21203/rs.3.rs-3612439/v1. [ABSTRACT FROM AUTHOR]

This article from the Turkish Journal of Surgery discusses a study that examined the potential use of fatty acid binding proteins (FABPs) as biomarkers for complications in living donor liver transplantation. The study found that FABP levels were significantly higher in patients who experienced complications, suggesting that they could be useful in predicting these complications. The article includes tables that provide data on various laboratory parameters in recipients of liver transplants, both with and without complications, at different time periods. Further research is needed to determine the effectiveness of these biomarkers. [Extracted from the article]

Objectives: Liver transplantation is the only treatment option for patients with end-stage liver disease. Hemodynamic, respiratory, and metabolic monitoring in the intensive care unit (ICU) is a vital step after the transplant procedure. While most recipients are discharged from the hospital within postoperative two weeks, some patients stay longer, which increases both morbidity and the costs of liver transplantation. We aimed to explore the implications of ICU stay for post-transplant early mortality. Methods: This is a retrospective analysis of the liver transplant recipients with Hepatitis B virus (HBV)-related cirrhosis between January 2017 and June 2022. Patients =18 years with HBV-related cirrhosis were included in the study. The patients were analyzed in two groups: patients who survived (n=167) and patients with early mortality (n=11) defined as mortality within postoperative 90 days. Various operative and clinical data were compared among the groups. Results: Post-transplant ICU stay was significantly longer in patients with mortality (11 (7-21) versus 5 (4-7), p<0.001). Although it was not statistically significant, the MELD score (20 (17-25) versus 17 (14-22), p=0.051) and postoperative severe complication rate (63.6% to 34.1%, p=0.058) tended to be higher in the mortality group. We performed a ROC curve analysis and showed that cut-off value for the length of ICU stay was 10.5 days in terms of 90-day mortality. The sensitivity was 64% and the specificity was 94% (the area under the curve = 0.820, 95% CI = 0.651-0.990, p<0.001). In univariate analyses, duration of operation (HR = 1.005, 95% CI = 1.002-1.009, p=0.002) and ICU stay =10.5 days (HR = 19.855, 95% CI = 5.796-68.011, p<0.001) were found as significant variables, but in multivariate analyses, only the ICU stay =10.5 days (HR = 17.204, 95% CI = 3.881-76.265, p<0.001) was found as an independent predictor of early post-transplant mortality. Conclusion: The prolonged ICU stay is an independent predictor of postoperative 90-day mortality in living donor liver transplantation for HBV-related cirrhosis. By using length of ICU stay, high risk patients can be determined and closely monitored for early detection and management of serious complications that may lead to early post-transplant mortality. [ABSTRACT FROM AUTHOR]

A 53-year-old male patient who underwent a rectal cancer operation nine years ago was evaluated with complaints of pain and swelling in the lateral thigh. Radiological imaging revealed abscess foci in the right thigh muscles. Surgical drainage and debridement were performed but developed recurrence. Contrast-enhanced abdominal tomography was performed due to a positive medical history and it was seen that an enterocutaneous fistula was formed from the anastomosis site of previous cancer surgery to both sides of the thigh. Bilateral thigh abscesses were drained and radical debridement was performed in the same session with surgery for the fistula. Pathological examination of the surgical specimens showed no evidence of cancer and the patient was discharged on the 14th postoperative day with complete resolution of the infection. Hip abscesses are rare, delays in the diagnosis and treatment of the underlying cause in cases of abscess secondary to abdominal or pelvic pathologies lead to an increase in mortality. Therefore, it should be kept in mind that thigh abscesses may be another side of the coin besides being seen as an isolated infection. [ABSTRACT FROM AUTHOR]

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Hydatid cyst is a parasitic infection most commonly localized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis. In the present case, echinococcal cysts originating from segments 5, 6, and 7 in the right lobe of the liver, reaching 35 cm in diameter, caused compression symptoms. The diagnosis was made by abdominal tomography showing characteristic daughter vesicles and calcified cystic wall. The patient underwent pericystectomy and had an uneventful postoperative course with no recurrence in the 5-year follow-up. [ABSTRACT FROM AUTHOR]

Background and Aim: Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main purpose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria. Materials and Methods: The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A criteria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria. Results: Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001). Conclusion: LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of early mortality and OS. [ABSTRACT FROM AUTHOR]

Appendicitis is the most common emergency abdominal surgery today. Although its common complications are well-known, retroperi-toneal abscess and scrotal abscess are rare and less known complications. In this study, we presented our patient who presented with appendicitis complicated with retroperitoneal abscess and scrotal fistula after appendectomy, and the literature review we conducted through PubMed. A 69-year-old man was admitted to the emergency department with complaints of abdominal pain, nausea-vomiting continuing for about 7 days, and fever and mental status change in the last 24 h. He was taken to emergency surgery with the pre-liminary diagnosis of perforation and retroperitoneal abscess. At laparotomy, perforated appendicitis and associated retroperitoneal abscess were seen. An appendectomy was performed, and the abscess was drained. The patient, who stayed in the intensive care unit for 4 days due to sepsis, was discharged on the 15th postoperative day with full recovery. He was admitted 15 days after his discharge because of an abscess from the scrotum. Percutaneous drainage was performed in the patient, whose tomography revealed an abscess extending from the retroperitoneal area to the left scrotum. The patient, whose abscess regressed, was discharged with recovery 17 days after hospitalization. These rare complications associated with appendicitis should be on the minds of surgeons to make an early diagnosis. Delay in treatment may lead to increased morbidity and mortality.