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Background Previous studies have shown that pelvimetry can be valuable in predicting surgical difficulties in rectal cancer operations. However, its usability in predicting circumferential resection margin (CRM) involvement remains debatable. This study investigated the factors affecting CRM status and the importance of computed tomography (CT) pelvimetry in predicting CRM involvement in laparoscopic resection of middle and lower rectal cancer. Methodology In this study, we retrospectively investigated the data of 111 patients who underwent a laparoscopic operation for middle and lower rectum cancer at Ankara University Faculty of Medicine, Department of Surgical Oncology between January 2014 and January 2020. The predictive value of CT pelvimetry and other variables on the CRM status was analyzed. Results The following four pelvic parameters differed significantly between the genders: transverse diameter of the pelvic inlet (p = 0.024), anteroposterior diameter of the pelvic outlet (p = 0.003), transverse diameter of the pelvic outlet (p0.001), and pelvic depth (p0.001). The effect of pelvic anatomic parameters on CRM involvement was not found to be significant. It was found that tumor height from the anal verge (p = 0.004), tumor size (p0.001), and gender (p = 0.033) were significant risk factors for CRM involvement. Survival was poor in patients with male gender (p = 0.032), perineural invasion (p0.001), and grade 3 tumor. Conclusions In this study, no benefit was found in predicting CRM positivity from CT pelvimetry in the laparoscopic resection of middle and lower rectal cancer. Besides, tumor height from the anal verge, tumor size, and gender were important factors for CRM positivity. Although our study sheds light on this issue, prospective randomized studies with larger sample sizes are needed.

Background: Different attitudes are followed in the literature regarding the treatment of postoperative fistulas. We have concluded that the drain can be safely removed in appropriate patients after the fistula tract has matured. Methods: In patients with fistula, drain flow was monitored until the fistula tract developed. In general, we waited until the fifteenth day for safety to ensure that the fistula tract matured. The drain was removed unchanged and unshortened all at once. The patients were followed up with clinical and imaging methods in the next days, weeks, and months. Results: We had a total of 15 patients with fistula. The mean age of the patients was 44.6 (10-81) years. 9 of the 15 patients were male and 6 were female (60%, 40%). Eleven patients developed pancreaticobiliary fistulas, one had a tracheoesophageal fistula, and three had chylous fistulas. Conclusions: In the 15 patients we presented, drains were a mechanical obstacle to the closure of fistulas. After the drain removed patients stasis,leakage or spread did not occur. We think that our experience based on a limited number of patients will bring our thesis that the drain itself prevents fistula closure in some patients to the literature.

Introduction: In this study, it was aimed to examine the relationship between procalcitonin (PCT) values and complications, age, mortality, survival and to evaluate the correlation of procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) values in patients operated for gastric cancer. Methods: File records of 50 patients who were operated on for gastric cancer between 2015 and 2018 and whose procalcitonin levels were obtained were retrospectively reviewed. Results: Eighteen (36%) of the study participants in the study were female, and 32 (64%) were male. Mortality rates were found to be significantly higher in those with PCT values of 2 and above on PO 1st and 3rd days. It was observed that the development of respiratory complications was significantly higher in patients with a PCT value of 2 and above on PO 5th and 7th days. Conclusions: Post-operative high values in gastric cancer patients are significant in terms of mortality and survival in the follow-up. In gastric cancer and other malignant diseases, it is necessary to determine cut-off values, to conduct specificity and sensitivity studies by making detailed examinations for respiratory complications, mortality, and survival times during treatment.

Introduction: Coronavirus disease 2019 (COVID-19) was declared to be a global pandemic by the World Health Organization on March 11, 2020. The impact on gastric cancer (GC) surgery is unknown. Various reports have shown data indicating that cancer patients with COVID-19 have high morbidity and mortality rates. The choice of surgical procedures and perioperative management of the patients with malignancy has become even more impor¬tant in the COVID-19 pandemic. In this study, we aimed to evaluate the effects of the COVID-19 pandemic on the preopartive, intraoperative, and postoperative findings of patients operated for gastric cancer in our clinic. Materials and Methods: We defined the ‘COVID-19’ period as occurring between 12-03-2020 and 31-08-2020. All the enrolled patients were divided into two groups, pre-COVID-19 group (Pre-CG; 64 cases) and COVID-19 group (CG; 39 cases). A total of 103 patients with gastric cancer were included in this study. Patient characteristics, preoperative, intraoperative, and postoperative clinicopathological findings were compared between groups. Results: The waiting times before admission increased in CG (Pre-CG [6.73±2.85] vs CG [20.61±5.16] ; p

Introduction: Benign anastomosis strictures are frequently seen in anastomoses performed after upper gastrointestinal system resections. Although the first step in treatment is the preferred endoscopic procedures, surgical treatment is also an option. Mortality and morbidity of surgical treatment is at a very high rate compared to endoscopic approaches. Materials Methods: 523 surgical operations, which underwent UGI resection and anastomosis between 31 December 2014 and 31 December 2019 at the surgical oncology clinic, were retrospectively scanned from the hospital database. All patients were those who had surgery for malignancy. Results: The median age of the patients was 55 ± 12 (32-78) and 55% (n = 10) patients were male and 44% (n = 8) patients were female. When the patients were evaluated in terms of their current symptoms at the time of admission, the most common symptom was reported as dysphagia with 83% (n = 15) of the patients. 66% (n = 12) nausea was present. Discussion: Indication should be selected by considering the indications in stent and balloon dilatation in anastomosis strictures. Balloon dilation can be considered as the main procedure. Stricturotomy, cauterization are also among the options of treatment. Endoscopic treatment can be done safely in qualified hands

AİM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSİONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.

Introduction: The study aims to evaluate the long-term results of patients who underwent laparoscopic gastrectomy for gastric cancer in Ankara University Medical Faculty, Surgical Oncology Clinic, within 5 years. Materials and Methods: We retrospectively reviewed the data of patients who underwent laparoscopic gastrectomy for gastric cancer at the Surgical Oncology Clinic of Ankara University Medical Faculty between January 2014 and September 2019. One hundred forty-six patients were included in the study. Results: Fifty-one (34.9%) of the patients were female; 95 (65.1%) were male. The mean ± standard deviation and median (minimum–maximum) values of the patients were 60.92 ± 14.13 and 64.00 (22.00–93.00), respectively (Table 1). Eighty-seven (59.6%) cases were located in the antrum, 29 (19.9%) were in the cardia region, and 30 (20.5%) were in the corpus region. Overall, 106 (72.6%) of 146 patients were alive, while 40 (27.4%) were ex. The mean survival was 21.8 months (0–69). Postoperative mortality was seen in 9 patients (6.2%) and our disease-free survival rate was 70.5%. Recurrence occurred in 14 (9.6%) of all patients. Table 1. Patient Characteristics Variables Age Mean ± SD 60.92 ± 14.13 Median (min.–max.) 64.00 (22.00–93.00) Albumin Mean ± SD 3.90 ± 0.51 Median (min.–max.) 4.00 (2.50–5.01) Met lymph count Mean ± SD 8.41 ± 7.05 Median (min.–max.) 6.00 (1.00–40.00) Total lymph count Mean ± SD 23.09 ± 8.97 Median (min.–max.) 22.00 (4.00–52.00) Survival Mean ± SD 21.83 ± 17.40 Median (min.–max.) 17.50 (0.10–69.00) Gender, n (%) Man 95 (65.1) Woman 51 (34.9) Morbidity, n (%) No 117 (80.1) Yes 29 (19.9) TM location, n (%) Antrum 87 (59.6) Cardia 39 (19.9) Corpus 30 (20.5) Operation, n (%) Subtotal 103 (70.5) Total 43 (29.5) Anastomosis, n (%) Open 6 (4.1) Intracorporeal 54 (37.0) Mini-laparotomy 86 (58.9) Sur comp, n (%) No 131 (89.7) Yes 15 (10.3) T, n (%) 1 32 (21.9) 2 18 (12.3) 3 55 (37.7) 4 41 (28.1) N, n (%) Negative 68 (46.6) Positive 78 (53.4) Mortality, n (%) No 106 (72.6) Yes 40 (27.4) Recurrence, n (%) No 132 (90.4) Yes 14 (9.6) Conclusion: In conclusion, although laparoscopic gastrectomy is a reliable and feasible method for gastric cancer, the standardization of laparoscopic surgery is required in clinics.

Urinary system resections due to rectosigmoid cancers are an issue where the number of experienced surgeons is low because they are not performed frequently.The selection and application of the type of reconstruction after resection are technical procedures that should be performed by experienced cancer surgeons and urologists. Aims: It was aimed to present the urine reconstruction methods and results applied in local advanced rectal and sigmoid colon cancer surgeries performed by the same team for many years. Study Design: Patients who were operated for rectosigmoid region tumor and had urinary resection-reconstruction between 2016-2020 were reviewed. The demographic data of the patients, clinicopathological notes, reconstruction types, postoperative urinary leakage and fistula rates were examined and noted. Methodology: Retrospective patient document analysis using electronic hospital file system and clinical notes. Results: 37 patients were included in the study within the criteria. 17 (46%) of the patients were male and 20 (54%) were female. The mean age of the patients was 58.6 ± 16 years. The most common reconstruction procedures were Ureteroneocystostomy and bladder reconstruction. The least used method was ureteroureterostomy uteretostomy. It was observed that urine leakage / fistula developed in 11 (29.7%) of 37 patients included in the study. Conclusion: Although the rate of urological complications is also affected by the chosen technique, it may also be affected by factors such as the presence of preoperative hydronephrosis, multiorgan resections, and age.

It is reported that 0.5-13 % of all colorectal cancers are hereditary. Many mutations that cause genomic instability have been described lately in this cancers; the most famous one is yet microsatellite instability pathway. Investigating the presence of these mutations is important in tailoring patients' treatment and predicting prognosis. Aims: We evaluated the association between micro satellite status and other pathologic prognostic factors like grade, tumor size, lymph node metastasis, lymphovascular invasion and perineural invasion in patients who underwent curative colon resection for colorectal cancers (CRC) in our clinic in the past five years. Study Design: A total of 205 sequential patients who were older than 18 and had curative colon resection for CRC in Ankara University Surgical Oncology Unit and been tested for microsatellite instability (MSI) were analyzed on behalf of the facultys’ database. Methodology: Pathology results had been determined and tumor localizations, lymph node metastasis status, grade, lymphovascular and perineural invasion status were evaluated. Information about MSI status and defected genes were obtained from detailed pathology reports. Patients were divided into two groups as MSI and MSS. Results: No significant difference was found between two the groups in the context of microsatellite instability status. Lymphovascular invasion had been seen higher in high frequency microsatellite instability (MSH-H) compared to low frequency microsatellite instability (MSH-L) group (76.4% vs 53.1%, P =.02). There was no statistical difference in perineural invasion between the two groups (P = 0.102). Signet ring cell status between the groups we found a higher rate of signet ring cells and consequently a higher grade in MSH-H group (17.6% vs 10.6%, P = 0.042). Conclusion: In conclusion, although many important points have been identified in our study, more studies are needed to compare the evaluation of MSI in colon cancer with other prognostic factors and to investigate its effect on the course of the disease.

Introduction: In cancer patients, wound healing is seriously impaired due to cachexia and tumour-related catabolism. Therefore, several surgical complications may develop in patients with malignant diagnosis. Parastomal wounds are also among the most frequent surgical complications in this patient group which causes serious deterioration of the patients’ quality of life. Various factors influence the duration of parastomal wound healing and multiple methods are used in its treatment. Among them, new method is the treatment with the Vacuum-Assisted Closure (VAC) system. Aim: To examine the effect of VAC system on the duration of wound healing in parastomal wounds. Materials and Methods: A retrospective study was conducted in which the data of 31 patients who underwent surgery with a diagnosis of intra-abdominal malignancy at the surgical oncology clinic between January 2010 to January 2018, and who developed a parastomal wound were evaluated retrospectively, through the hospital database. The patients’ clinical and demographic data, peristomal skin complications and the applied treatment methods were determined from the hospital database. The effect of the patient-related factors and the VAC treatment on the duration of wound healing was analysed. The patients whose data could not be accessed and had no stoma complications were excluded from the study. In this study, analyses were performed using IBM SPSS statistical version 23.0. Results: A total of 38 patients developed parastomal wounds. The seven patients whose data could not be accessed were excluded from the study, so 31 patients who developed parastomal wounds, participated and out of them 10 (32.2%) were men and the mean age was found as 51.77±15.23. There were 20 patients with ileostomy and 11 patients with colostomy. The most frequent diagnosis in the patient population was colorectal cancer. The VAC treatment was applied to 14 (45.2%) of the patients, the others were applied conventional wound care methods. When the relationship between clinical, demographic data, parastomal wound treatment methods and the durations of wound healing were viewed, the effect of being above 65 years of age (p=0.044), presence of Diabetes mellitus (DM) (p=0.012), and having a Body Mass Index (BMI) value of 25 or above (p=0.046) on parastomal wound healing was found to be statistically significant. Parastomal wound healing took a longer time in these patients. When the VAC treatment and other conventional wound treatment methods were compared, the duration of hospital stay was found to be short, statistically and significantly, in the VAC group (p=0.016). Conclusion: In malignant patients, being above the age of 65, the presence of DM and having a BMI value of 25 and above lengthen the duration of parastomal wound healing. The healing duration in parastomal wounds treated with VAC is shorter than other conventional methods. Thus, VAC is a successful and feasible method in parastomal wound treatment. Although, the results of this retrospective study are helpful in predicting and managing parastomal wounds, but prospective, randomised and large-scale studies are needed.

Introduction: Benign anastomosis stenosis may develop in postoperative or long term period due to many reasons such as anastomosis leakage and anastomosis ischemia after colorectal surgery. While surgical treatment was commonly used in benign anastomosis stenosis in the past, surgery has left its place to more minimally invasive methods such as endoscopic treatments. There is no gold standard treatment method in the management of benign anastomosis strictures in the literature. In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Material and Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Discussion and Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented. Keywords: Rectal Neoplasms, Stenosis, Laparoscopy, Anastomostic stenosis

Objectives: There is no consensus on the duration of antimicrobial prophylaxis (AMP) for prevention of surgical site infections (SSI) after curative gastrectomy for gastric adenocarcinoma and the data is limited. In this study, we aimed to compare the effect of single-dose and extended-dose AMP on SSI prevention. Methods: A total of 210 patients who underwent curative gastrectomy for gastric cancer included in the study. Patients who received a single dose of 1 g cefazolin 30 minutes before the surgical incision were determined as single-dose group and the patients who received 1 g cefazolin one time 30 minutes before the surgical incision and every 12 hours until the first postoperative day were determined as extended-dose group. Demographic characteristics, postoperative outcomes and the types and incidence of SSI were compared in two groups and risk factors for SSI development were analyzed. Results: There was no significant difference in the demographic characteristics and postoperative outcomes in both AMP groups in the general patient population and in the subgroups formed based on different clinicopathological and operative factors. There was no significant difference in the incidence of SSI between the two groups (23,4% and 26,7% p = 0,346). Age, diabetes mellitus, chronic obstructive pulmonary disease (COPD), operation time and operative approach were found to be independent risk factors for SSI development. Conclusion: In patients undergoing curative gastrectomy for gastric adenocarcinoma, it has been found that the use of extended-dose AMP has no effect on reducing the incidence of SSI and single-dose AMP is sufficient and safe.

Amac: Calismamiz, kanser hastalarinin koronavirus hastaligi2019 [coronavirus disease-2019 (COVID-19)] ile ilgili farkindaliklari, tedbirlere uyumlari ve saglik hizmetlerine erisimlerini hastalardan alinan bilgiler dogrultusunda irdelemeyi amaclamistir Gerec ve Yontemler: 1 Aralik 2019-31 Mart 2020 arasindaki 4 aylik periyotta Ankara Universitesi Cerrahi Onkoloji Kliniginde kanser nedeni ile ilk kez opere edilen hastalar bulunarak telefonla iletisim saglandi On uc soruluk kisa bir anket uygulanmasi icin telefonlarina, yakinlarinin telefonlarina veya mail adreslerine Google Formlar (Google Inc, California, ABD) kullanilarak yapilan anket linki gonderildi Bulgular: Populasyon, %58,4 (n=83) kadin, %41,5 (59) erkek hastalardan olusmakta idi Ortalama yas 55,97±18,8 olarak tespit edildi Hastalar maske, mesafe ve hijyen kurallarina %73 (n=104) oranla tamamen uydugunu, %20 (n=29) hasta ise kurallara siklikla uydugunu belirtmistir %40,1 hasta ise bu surec icerisinde acil bir durum gelismedikce hastaneye basvurmadigini beyan etti Hastalarin %40,8’i COVID-19 ve salgin hastaliklardan korktuklari yanitini verirken, %59,2’lik hasta grubu ise kanser hastaligim sikkini secmistir Sonuc: Calismamiz, kanser hastalarinin cogunun pandemiden oncesinde dahi maske, mesafe ve hijyen kurallarini kismen uygulamakla birlikte, pandemi surecinde bu tedbirlere daha fazla onem gostermis oldugu gorulmustur Ancak kanser hastalarindaki bu hassasiyetin, hastane basvurularinda gecikme ve ozellikle tani asamasinda gecikmelere yol acabilecegi asikârdir Alternate abstract:Objective: Our study aimed to examine the awareness of cancer patients about coronavirus disease-2019 (COVID-19), their compliance with the measures and their access to health services in line with the information received from the patients Material and Methods: In the 4-month period between December 1, 2019 and March 31, 2020, patients who were operated for the first time due to cancer were found in Ankara University Surgical Oncology Clinic and communication was established by phone In order to apply a short questionnaire with 13 questions, a questionnaire link made using Google forms (Google Inc, California, USA) was sent to their phones, their relatives' phones or e-mail addresses Results: The population consisted of 58 4% (n=83) female and 41 5% (59) male patients The mean age was 55 97±18 8 years The patients stated that 73% (n=104) completely complied with the mask distance and hygiene rules, 20% (n=29) of them stated that they followed the rules frequently 40 1% of the patients stated that they did not apply to the hospital unless an emergency occurred during this period While 40 8% of the patients answered that they feared COVID-19 and epidemic diseases, 59 2% of the patients chose the option of cancer Conclusion: Although most of the cancer patients in our study partially applied the mask distance and hygiene rules even before the pandemic, it was observed that these measures were more important during the pandemic process However, it is obvious that this sensitivity in cancer patients may cause delays in hospital admissions and especially in the diagnosis stage

Objective To investigate the effect of sarcopenia on surgical outcomes in patients with primary high-grade serous ovarian cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC). Study design Descriptive study. Place and duration of study Department of Surgical Oncology, Faculty of Medicine, Ankara University Ankara, Turkey, from January 2013 to January 2020. Methodology Forty patients, who underwent CRS and HIPEC with the diagnosis of primary high-grade serous ovarian cancer and peritoneal carcinomatosis were included in the study. Preoperative staging CT images were used to determine total psoas index values by measuring psoas muscle area at the level of L3 vertebra. Patients with total psoas index values below the cut-off levels were considered sarcopenic. Demographic, clinicopathological and perioperative results were compared between sarcopenic and non-sarcopenic patients. Results Serious postoperative complications (36.4% vs. 6.9%, p=0.039) and infective (54.5% vs. 17.2%, p=0.042) and pulmonary (72.7% vs. 34.5%, p=0.040 complications were significantly higher in sarcopenic patients. Hospital stay [20(12-25) vs. 12(9-16.5) days, p=0.017] and ICU stay [4(2-6) vs. 2(1-2.5) days, p=0.013)] were found to be longer in sarcopenic patients. In univariate analysis, advanced age (OR: 1.40 95% CI: 1.07-1.84; p=0.021) and sarcopenia (OR: 7.71% 95 CI: 1.17-51.06; p=0.039) were significantly associated with serious postoperative complications. The presence of sarcopenia (OR: 0.050 95% CI: 0.004-0.675; p=0.024) was found to be independent predictor of serious postoperative complications. Conclusion Sarcopenia can easily be diagnosed without additional cost or radiation exposure with routine preoperative staging CT images. Identification of sarcopenic ovarian cancer patients in preoperative period may affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy, thus postoperative complication rates may be reduced and short-term results may be improved. Key Words: Cytoreductive surgery, Ovarian cancer, Sarcopenia.

Aim: Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor. The diagnosis is challenging because it is usually hard to differ DFSP from other skin lesions. Distant metastasis is rare, but local recurrence is common.The aim of this study is to review the treatment algorithms in DFSPs that are detected incidentally and to increase awareness about this rare tumor. Material and Methods: 17 patients who underwent excision of epidermal lesions which were considered to be benign and were diagnosed with DFSP, at departmant of general surgery between 2012 and 2017, were analyzed. Result: A total of 17 patients were analyzed retrospectively. No recurrence was detected in any of ourpatients. Conclusion: Awareness of this rare entity is important for diagnosis and management of the disease.

OBJECTIVE To investigate the prognostic effect of red distribution width (RDW) in patients with gastric cancer. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Department of Surgical Oncology, Ankara University School of Medicine, between November 2010 and January 2020. METHODOLOGY Patients diagnosed with adenocarcinoma by biopsy, who underwent radical surgery and lymph node dissection, and had preoperative RDW value, were inducted. Patients who had history of active inflammation in the past three months, received treatment for hematology disorder, blood transfusion, malignancy other than gastric cancer, autoimmune disease, venous thrombosis, or under 18 years of age, and those having cardiac and cerebrovascular diseases and distant metastases were excluded from the study. Apart from diagnosis, preoperative blood values, clinicopathologial, demographic features, and follow-up data were included in the study. RESULTS RDW average value was 15.11 ± 2.87 and median value was 14.3%. For RDW cut off value, 13.4% was accepted as reference from previous studies was divided into two groups as

Introduction: The CRP/Albumin Ratio (CAR) which has been shown to be closely related to the results in septic patients has been found to be also associated with postoperative and long-term outcomes in patients with malignant diagnosis. Although the prognostic value of CAR in many gastrointestinal cancers has been determined, studies on pancreatic cancer are limited. Aim: To evaluate the predictive value of CAR on serious postoperative complications after curative pancreaticoduodenectomy for pancreatic cancer. Materials and Methods: One hundred eighty seven patients that underwent curative resection for pancreatic cancer between January 2010 and January 2020 were included in the study. The optimal cut-off level of the CAR was calculated as 0.22. Patients were divided into two groups as below and above this value. Clinicopathological and postoperative variables were compared between the groups. Results: In univariate and multivariate analysis, modified Glasgow Prognostic Score (mGPS) (OR: 3.67. %95 CI: 2.31~5.82. p=0.028), CAR (OR: 8.02 %95 CI: 3.45~21.62. p>0.001), lymph node status (OR: 1.54. %95 CI: 0.41~3.39. p=0.042) and TNM stage (OR: 3.92. %95 CI: 1.56~10.08. p= 0.005) were found to be independent risk factors for serious postoperative complications. Conclusion: Based on these data, CAR, which can be easily measured from preoperative biochemical results in each patient, may be an independent and significant predictor of postoperative serious complications and poor outcomes after pancreaticoduodenectomy in patients with pancreatic cancer.

Objective: In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented.

Objective: The aim of our study was to compare the success rates of suture selection, recovery times and pain associated with local wound infection and seton placement in patients undergoing cutting seton placement for complex anal fistula. Methods: The study included a total of 90 patients who were admitted with the diagnosis of complex anal fistula between January 2015 and July 2018. Results: The first session and other revision appointments demonstrated that the number of patients who required fistulotomy was significantly higher in group-1 as the seton failed to complete the transection (p = 0.001). When the patients were asked to rate pain for 3 different conditions according to numeric rating scale (NRS), the patients in group-2 had significantly higher pain in all 3 cases compared to the patients in group-1 (p = 0.001). The impact of the suture material on local infection was examined and it was determined that the results of cultures for seton material were significantly more positive in group-1 (p = 0.001). Conclusions: We conclude that a multi-stage tight seton placement with silk material can lead to satisfactory results by aiming to shorten the cutting time of silk seton. doi: https://doi.org/10.12669/pjms.36.4.1920 How to cite this:Akici M, Ersen O. The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort. Pak J Med Sci. 2020;36(4):816-820. doi: https://doi.org/10.12669/pjms.36.4.1920 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.

Endoskopik retrograd kolanjiopankreatografi (ERCP) profesyonelleşmek için uzun bir öğrenme eğrisi bulunan ileri endoskopik tekniktir. ERCP işleminde standart endoskopik tekniklere göre ciddi komplikasyonlar gelişme riski daha yüksektir. Perforasyon ERCP’nin nadir ancak en korkulan ve en fazla mortalite ile ilişkili olan komplikasyonlarından birisidir. Endoskopik sfinkterotomi (ES) prosedüre eklendiğinde %0.3’ten %1’e varan oranlarda perforasyon gelişmektedir ve bu hastalar da %16-18 oranla mortal seyretmektedir. Perforasyon ile operasyon arasında ge- çen süre mortalite ile ilişkili önemli bir faktördür. Geciken cerrahilerde mortalite önemli ölçüde artmaktadır. ERCP’ye bağlı perforasyonlarda standart bir cerrahi yaklaşım bulunmamaktadır. Bu çalışmada ERCP nedenli periampullar retroperitoneal perforasyon gelişen hastalardaki deneyimimiz nedeniyle ERCP perforasyonlarına cerrahi yaklaşımımızı aktarmayı amaçladık. Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique which has a long learning curve to develop proficiency and higher potential for serious complications than any other standard endoscopic technique. Perforation is a rare but one of the most feared complications complication of (ERCP), but it is surely associated with mortality. When endoscopic sphincterotomy (ES) added to procedure perforation occurs in 0.3% to 1% of patients, and that carries a mortality rate of 16% to 18%. The interval between the perforation and the operation is of great significance. The mortality rate increases dramatically with late surgical management. There is no standard surgical approach to perforations related with ERCP. In this study we present our experience for surgical management of ERCP-related periampullary retroperitoneal perforations.

Amaç: Anal fistüller sık görülen anorektal problemlerden olup cerrahi olarak tedavi edilebilen bir hastalıktır. Buna rağmen nükslerde ciddi bir oranda görülmektedir. Bu çalışmada retrospektif olarak basit perianal fistül nedeniyle opere edilmiş hastalarda nüks üzerine etkili olan faktörleri incelemeyi amaçladık. Gereç ve Yöntem: Bu çalışmada Afyon Sağlık Bilimleri Üniversitesinde Ocak 2008-Aralık 2017 arasında basit perianal fistül tanısıyla fistülotomi uygulanan 269 hasta incelenmiştir. Çalışmaya alınan olgular yaş, cinsiyet, hastanede yatış süresi, fistül traktının uzunluğu, komplikasyon ve nüks görülme oranları yönünden değerlendirilmiştir. Bulgular: Olguların 59'u kadın (% 21,9), 210'u erkek (%78) olup, yaş ortalamaları 49,4 idi. Acil ve elektif olarak opere edilen hastalarda nüks açısından anlamlı fark yoktu (p=0,594). Toplamda 28(%17,8) hastada nüks görüldü. Kadın ve erkek hastalarda nüks açısından anlamlı fark gözlenmedi (p=0,584). Tüm hastalardaki ortalama fistül traktı uzunluğu 1,8 cm olarak tespit edildi. Nüks olan hastalardaki fistül traktı uzunluğu diğer hastalara oranla istatistiksel olarak anlamlı şekilde uzun olduğu tespit edildi (p=0,042). Hastaların hastanede yatış yaptıkları gün sayısı ortalama 1,3 gündü. 16(%5,9) hastada postoperatif üriner inkontinans gözlendi. Toplamda 12(%4,4) hastada lokal enfeksiyon tablosu tespit edildi. Taburculuk sonrası ortalama pansuman/küretaj sayısının 3 olduğu görüldü. Hiçbir hastamızda fekal inkontinans görülmedi. Ortalama takip zamanı 45,2 ay olarak saptandı. Sonuç: Anal fistül cerrahi olarak tedavi edilebilen ancak basit tiplerinde bile nükslerle seyredebilen bir hastalıktır. Basit perianal fistüllerde fistülotomi seçilecek en iyi yöntemdir. Ancak seçilen cerrahi yöntemin yanı sıra, ameliyat sonrası yara bakımı ve yakın takibin hastalığın nüksü açısından seyri konusunda belirleyici olduğu kanaatindeyiz.

Aim: In our study, we aimed to present the results of our experiences and the results we detected in the retrospective examination of patients undergoing percutaneous endoscopic gastrostomy. Material and Method: 378 patients in whom percutaneous endoscopic gastrostomy tube were placed at the patient's bedside in Afyon Kocatepe University of Health Sciences, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 1, 2008 and December 31, 2017 were included in the study. Patient records were examined by the file scanning methods. The records were evaluated in terms of demographic information, technical information, indications, complications and results. Results: Of a total of 378 patients in whom PEG catheter was placed, 230 (60.9%) were male and 148 (39.1%) were female. The mean age of all patients was 73.4 ± 2 (20-93). While 244 (64.5%) of the patients had swallowing disorder due to neurological causes, PEG procedure was performed in 98 (26%) due to swallowing disorder caused by mechanical reasons. In 36 patients (9.5%) PEG catheter was opened for diversion due to surgical reasons. No procedure-related mortality or major complication was observed in any patient after the procedure. The rate of wound infection was determined to be significantly higher in patients with high subcutaneous adipose tissue when compared to the level at which the gastrostomy catheter was detected. The risk of complication development was detected higher in patients over the age of sixty (p = 0.038). Conclusion: In a general surgical clinic, peg catheter placement procedure is performed in patients with surgical or medical diseases in accordance with the complication and success rates in the literature.

Background: Rectal cancer ranks 3rd among the most common malignancies in both sexes. Abdominal infections that can be seen after rectal cancer surgery are the most feared postoperative complications, as they can also be the harbinger of anastomotic leakage. According to its localization, the rate of anastomotic leak varies between 4% and 29.5%. Procalcitonin (PCT) is an increasing parameter in bacterial infections and sepsis. Therefore, it is used to monitor the infection and the effectiveness of the treatment. Our study we aimed to evaluate the effect of PCT on early diagnosis of anastomotic leakage in rectal surgery and the correlation between PCT and CRP and WBC levels.Methods: File records of 50 patients who were operated on for rectal cancer and had anastomosis between 2016 and 2019 were retrospectively analyzed. Demographic features, operation information, preoperative and postoperative clinical features of the patients were recorded. The WBC, CRP and procalcitonin values of the patients were measured on the preoperative and postoperative 1st and 5th days. Patients were divided into two groups as PC values

Background: In this study, the effect of perioperative blood transfusion on infectious complications in patients undergoing curative surgery for gastric adenocarcinoma was investigated.Methods: The clinicopathological results of 312 patients who underwent curative gastrectomy were retrospectively analyzed. The effect of blood transfusion on the development of postoperative infectious complications were statistically analyzed.Results: In the subgroup of patients with intraoperative transfusion, surgical site infection incidence was found to be significantly higher in patient with 2U above ES transfusions. (p=0.014). In the subgroup of patients with postoperative transfusion, hospital stay (p

Highlights • Developmental abnormalities of liver including ectopic liver are rare conditions. • Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. • Ectopic liver has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. • The vascular anatomy of ectopic liver should be identified before the dissection of gallbladder in order to prevent hemorrhage from the liver parenchyma., Introduction Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. Presentation of case A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. Discussion Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. Conclusion Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation.

Objective Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management of biliary system parasites. Material and methods Investigators retrospectively evaluated patients with biliary system parasites who underwent endoscopic retrograde cholangiopancreatography procedures over an eight-year period. We collected data regarding patient demographics, clinical features, and parasite type. We aimed to determine the utility of endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary system parasites. Results We identified 22 patients with biliary system parasites from a total of 3,450 endoscopic retrograde cholangiopancreatography procedures performed during an eight-year period. Parasite types included Echinococcus granulosus (n=19), Fasciola hepatica (n=2), and Ascaris lumbricoides (n=1). Fifteen patients with liver hydatid cysts underwent endoscopic retrograde cholangiopancreatography prior to surgery due to obstructive jaundice. The endoscopic retrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in the remaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatography due to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosis of cholangiocarcinoma. However, the final diagnosis was made using endoscopic retrograde cholangiopancreatography following inspection of flat, leaf-shaped, motile flukes extracted from the bile duct. In one patient with ascariasis, a longitudinal tubular structure was identified in the bile duct; emergency surgery was required. Conclusion The diagnosis of parasitic diseases is clinically challenging, and definitive diagnosis requires endoscopic retrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatography provides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use of endoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategies for biliary system parasite infections.

Highlights • Class E injuries are the most common major bile duct injuries and can cause serious clinical condition including bile leak. • Iatrogenic operative injuries may be a cause of spontaneous postoperative choledochoduodenal fistula even in transaction type complete injuries. • Spontaneous closure of a postoperative bile fistula doesn’t guarantee that it is not a transaction type injury., Introduction Bile leak after cholecystectomy which is the frequency less than 2% is an important problem for patients. Some bile duct injuries occuring after laparoscopic cholecystectomy are the complex bile duct injuries and can cause bile leak and fistula. Presentation of case A 74-year-old woman has high output bile drainage from abdominal drain after laparoscopic cholecystectomy so an ERCP was performed. It was clear that there was a complete transaction of bile ducts, however this finding was inconsistent with the patient’s clinical situation. The bile drainage of the patient was ceased and she was discharged to home without any problem. Four months later the patient was admitted again for recurrent cholangitis episodes. Patient was operated to perform a biliary-enteric diversion for the suspicion of biliary stricture. There was a thin fistula tract over the duodenum that was previously seperated from the proximal choledochus. The distal part of the bile duct was ended blindly. A hepaticojejunostomy anastomosis over a transhepatic stenting was performed. Discussion The circumferential injuries are the most common and devastating injuries leading to bile leak, peritonitis and varying degrees of sepsis. The probability of a bile fistula to close spontaneously is almost impossible in cases of iatrogenic circumferential full thickness injuries. Conclusion In the present case we have reported a case of Bismuth type 2 (Strasberg type E2) injury in which the biliary drainage was closed spontaneously with the formation of spontaneous biliary-duodenal fistula. It is an extremely interesting case that has not been reported in the literature previously.

Fournier gangreni, agirlikli olarak erkeklerde gorulen, hizli ilerleyen, mortalite orani yuksek bir nekrotizan fasiittir. Yumusak doku enfeksiyonlari ile benzer etiyoloji gosterme- sine karsin ozellikle immunsupressif ve diabetli hastalarda hastalik cok daha hizli seyir gostererek mortal seyreder. Hastaligin tedavisinde ana unsurlar erken tani, erken cerra- hi debritman ve uygun antibiyoterapidir. Bu calisma predis- pozan faktor olarak insan immun yetmezlik virusu (HIV) pozitifligi olan bir hastada iskiorektal apse drenaji sonrasin- da Fournier gangreni gelisimini aktarmak ve bu hastalarda erken cerrahi debritmanin gerekliligini vurgulamak amac- lanmistir. Fournier's gangrene mainly seen in men is rapidly progressi- ve necrotizing fasciitis and has a high mortality rate. Altho- ugh the etiology of Fournier's gangrene is similar to the show soft tissue infections, the disease especially could be morta- lity in patients with immunosuppressive and diabetes. The main factors in treatment of the disease are early diagnosis, surgical debridement and appropriate antibiotics. In this article we aimed to present developing Fournier's gangrene in a patient with human immunedeficiency virus (HIV) positi- ve after iskiorectal abscess drainage and intended to high- light the need for early surgical debridement.

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

Objective: Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. Material and Methods: Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. Results: Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. Conclusion: In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy unit’s being young and the low patient volume.