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Background. Renal transplantation is the main treatment for end-stage renal disease and has rapidly increased in number over the past 3 decades, leading to an increasing need for organs. The disparity between organ access and the number of patients on the waiting list has led transplant surgeons to use marginal cadaveric donors. As a consequence, the concept of “marginal cadaveric kidney donor” has been developed. Methods. We retrospectively evaluated 120 patients who received kidneys from cadaveric donors between September 2009 and August 2021. The donors were divided into standard and marginal cadaveric donors, and their age, sex, cause of death, criteria of acceptance as marginal donors, and Kidney Donor Profile Index (KDPI) were recorded Results. The donors included 69 men and 51 women, with a mean age of 52.9 § 16.8 years. There were 52 standard donors and 68 marginal donors. Graft and donor survival were compared based on the KDPI values of the donors, and were respectively found to be higher in those with a KDPI of 0 to 60 than in those with a KDPI of 81 to 100 (P = .011 and .039, respectively). There was no significant difference between those with a KDPI of 61 to 80 and the other groups. Conclusions. Expanded criteria donor organs, which offer greater survival benefits than hemodialysis, can be used safely to meet the increasing need for donors. Expanded criteria donor organs should thus be considered a valuable alternative in this patient group.

Genistein is a natural isoflavonoid and has several pharmacological effects, such as antioxidant, antitumor activity, and improvement of glucose metabolism. The safety of intestinal anastomosis after ischemia-reperfusion (I/R) injury is a critical issue for surgeons. This experimental study aimed to investigate the effects of genistein on anastomotic healing after intestinal I/R injury.A total of 36 male Wistar Albino rats were divided into four groups: control, I/R, genistein, and genistein + I/R. The control group received segmental ileal resection and ileoileal anastomosis. The I/R group received resection + anastomosis after intestinal I/R. The genistein group was administered subcutaneous injection of 1 mg/kg genistein 12 h and 1 h before the procedure and received ileal resection + anastomosis. The genistein + I/R group received I/R + ileal resection + anastomosis after genistein injection. Anastomotic bursting pressure, hydroxyproline, superoxide dismutase, and glutathione peroxidase levels and histopathological wound healing scores of all rats were measured on postoperative day 5.The anastomotic bursting pressure was significantly higher in the genistein and genistein + I/R groups (P 0.001). Genistein increased the hydroxyproline concentration and the superoxide dismutase and glutathione peroxidase levels in the intestinal anastomosis (P 0.001). In histopathological assessment, the mean wound healing score was significantly higher in the genistein group than in the other groups (P 0.001).Genistein, with its anti-inflammatory and antioxidant properties, shows protective effects against increased oxidative stress after intestinal I/R injury and contributes positively to intestinal anastomotic healing.

Objective: The aim of this study was to determine the DNA and genotypes of Echinococcus granulosus in liver cyst hydatids isolated in humans. Material and Methods: This study was conducted prospectively at the Department of General Surgery of the Cerrahpaşa School of Medicine, University of İstanbul-Cerrahpaşa, between January 2015 and June 2016 in 30 patients who were operated on for cystic Echinococcosis. E. granulosus DNA was analyzed using the Polymerase Chain Reaction (PCR) method in the cyst samples (protoscolex and/or germinative membrane) obtained during the operation, and genotype was determined in the PCR positive samples by sequence analysis. At the same time, indirect hemagglutination (IHA) was used to test for the presence of antibodies in the patients’ blood. Results: E. granulosus DNA was found in 29 out of 30 cystic Echinococcosis of the liver samples. All of the 29 cystic Echinococcosis samples were found to be G1 (sheep) species. Also, IHA was positive in 22 patients and negative in eight patients. Conclusion: In the present study, G1 species was the most commonly seen liver cystic Echinococcosis species. We suggest that a vaccine, which could be developed against prevalent regional genotypes, would be efficacious in the prevention of the disease with a cause of mortality and morbidity.

Early prediction and diagnosis of perforation in acute appendicitis allow surgeons to choose the most appropriate treatment. The purpose of this study is to evaluate whether pre-operative routine laboratory examinations have a role in predicting complicated acute appendicitis.In the study, 783 patients operated with the diagnosis of acute appendicitis between the years 2014 and 2019 were analyzed retrospectively. Among the patients with non-perforated and perforated acute appendicitis, pre-operative laboratory tests include leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) parameters were compared.Appendicitis was not detected histopathologically in 81 cases. In the study, 89.9% (n=631) of the 702 patients were non-perforated and 10.1% (n=71) were perforated acute appendicitis cases. Perforation rate was higher in elderly patients (p0.01). It was seen that lymphocyte count was significantly lower in the perforated group, and CRP and NLR were significantly higher (p=0.048, p=0.001, p=0.028, respectively). In the diagnosis of perforated acute appendicitis, cutoff values were 44.0 mg/dL for CRP, 7.65 for NLR and 1.7/mm3 for lymphocytes. There was no statistical difference between the groups in terms of WBC, neutrophil, PLT, MPV, and PDW values.Low lymphocyte count, high CRP, and high NLR were found to be reliable and strong predictive parameters in the diagnosis of complicated acute appendicitis.

In the present study, we aimed to determine the risk factors for mortality in Fournier's gangrene (FG), which has a high morbidity and mortality rate and requires urgent surgical intervention.A retrospective analysis was made of 150 patients who were operated on in our clinic due to FG of anorectal origin be-tween 2010 and 2020. The cases were divided into survival and non-survival groups. Demographic, clinical, laboratory, and treatment data, FG Severity Index (FGSI), and simplified FGSI (SFGSI) scores were analyzed.Thirty-day mortality rate was 15.3%. In the non-survival group, rate of smoking, diabetes mellitus, malignancy and other chronic diseases, and mean age, duration of symptoms at admission, number of debridements, SFGSI, FGSI, white blood cells, and creatinine were significantly higher, while hematocrit, serum potassium, and albumin levels were significantly lower (p0.05). Among these factors, age (OR=1.147, CI=1.019-1.291; p=0.023), smoking (OR=0.09, CI=0.023-0.418; p=0.002), malignancy (OR=0.038, CI=0.008-0.186; p=0.001), and serum potassium level (OR=0.141, CI=0.022-0.910; p=0.04) were identified as risk factors associated with mortality in FG.FG is a fatal fasciitis still associated with high mortality. Advanced age, smoking, malignancy, and hypopotassemia are independent predictive risk factors for mortality in FG.

Objective: Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair. Material and Methods: Between 2011 and 2021, 36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0. Results: Of the sample, 31 were females and five were males, with a mean age of 31.50 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 ± 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p< 0.001; r= 0.625). Conclusion: It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique.

Gallbladder gangrene and perforation are an important complication of acute calculous cholecystitis and are dif-ficult to detect preoperatively. Therefore, in this study, we aimed to evaluate whether serum inflammatory parameters are predictive factors for complicated cholecystitis (CC).In the present study, histopathological findings of 250 patients who were operated on with the diagnosis of acute chole-cystitis (AC) in the emergency department between 2014 and 2019 were evaluated and the cases were divided into two groups as AC and CC. Parameters, including age, gender, body mass index, white blood cell (WBC) count, C-reactive protein (CRP), neutrophil-to-lym-phocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW), were examined for their ability to predict CC.The findings obtained in this study showed that WBC, CRP, and NLR were significantly higher in the CC group (p0.05). WBC9.000 cells/ml, CRP29.0, and NLR4.3 were the factors that could predict CC. There was no significant difference between the two groups concerning MPV and PDW (p0.05). CC was observed more frequently in patients over 65 years of age, but there was not a statistically significant difference (p=0468).WBC, CRP, and NLR are valuable biochemical markers in predicting complicated AC. Advanced age may be a help-ful predictive factor for CC. These factors may be helpful in making an early cholecystectomy decision.

Background: The safety and effectiveness of laparoscopic mini-gastric bypass (MGB) versus laparoscopic sleeve gastrectomy (LSG) remain unclear. In this study, we aimed to compare the postoperative outcomes of MGB and LSG procedures performed in bariatric surgery. Methods: A total of 363 patients who underwent MGB and LSG surgery between 2016 and 2018 at a single metabolic surgery center were analyzed retrospectively. Two surgical procedures were compared in terms of the perioperative, early and late postoperative outcomes. Results: There were 225 patients in the MGB group and 138 patients in the LSG group. No significant difference was found between the groups regarding the operating time, the conversion to open surgery and the early postoperative complications (p>0.05). The length of hospital stay was significantly shorter in the MGB group (p:0.001). The excess weight loss (EWL) was significantly higher in the MGB group (90.3 ± 13 vs. 79.2 ± 16). No significant difference was found between the two groups in terms of the remission rates of comorbidities. The symptoms of gastroesophageal reflux disease were observed in a significantly fewer number of the patients in the MGB group (6 patients 4.9% vs. 10 patients 18.5%). Conclusions: The MGB procedure is superior to the LSG in terms of the length of hospital stay, EWL, and the postoperative gastroesophageal reflux parameters.

This study aimed to determine whether the use of i-scan endoscopy provides additional benefits to conventional endoscopy in the diagnosis of gastric precancerous lesions.A total of 120 patients with histologically-verified intestinal metaplasia (IM) or atrophic gastritis (AG) were prospectively evaluated by esophagogastroduodenoscopy. Endoscopic examinations were performed using i-scan and high-definition white-light endoscopy (HD-WLE). The diagnostic yields of both techniques and the number of targeted biopsies per patient were compared.A total of 318 suspicious lesions were detected in 108 patients with i-scan (n = 186) and 81 patients with HD-WLE (n = 132). The diagnostic yields of i-scan and HD-WLE were 81.6% (98/120) versus 77.5% (93/120), respectively (p 0.05). When only targeted biopsies were taken into account, the diagnostic yields of i-scan and HD-WLE were 89.8% versus 65.4%, respectively (p 0.05). The mean number of biopsies per patient for i-scan and HD-WLE were 3.27 (393/120) and 7.3 (882/120), respectively (p 0.05). The mean endoscopic procedure times were 16 and 17 min for i-scan and HD-WLE, respectively (p 0.05).Although targeted biopsies with i-scan were not found to be significantly superior to either targeted or random biopsies with HD-WLE, the number of biopsies required to confirm these lesions was much lower.

BACKGROUND: There is still no consensus about whether laparoscopic appendectomy should be performed in selected cases or routinely in all cases for treatment of acute appendicitis. Especially for rural hospitals with laparoscopic equipment shortages, it is critical to develop surgical methods alternative to LA. This prospective study aimed to compare mini-incision open appendectomy (MOA) and laparoscopic appendectomy (LA) procedures. METHODS: A total of 102 patients who had been operated on by a single surgeon for acute appendicitis between July 2018 and February 2020 and whose body mass index (BMI) was 0.999, respectively). CONCLUSION: Mini-incision open appendectomy is a reliable method in patients with acute appendicitis who have a BMI of

turgut, basar can/0000-0001-9591-4697; Yurdacan, Muge/0000-0002-8653-1309 WOS:000528165700015 PubMed ID: 32185770 BACKGROUND: This study evaluated the outcome of the reversal of Hartmann's procedure based on preoperative and intraoperative risk factors. METHODS: We retrospectively reviewed 78 cases, whom we applied the Hartmann's procedure either electively or under emergency conditions in our clinic between the years 2010 and 2016. RESULTS: Of the cases reviewed in this study, 45 patients were males, and 33 patients were females. Of all cases included in this study, 32 cases were operated due to malignancies, 15 cases were operated due to a perforated diverticulum, and 11 cases were operated due to sigmoid volvulus. Reversal of Hartmann's was performed in 32 cases. The morbidity and mortality rates for the reversal of Hartmann's procedure were 37.5% and 0.0%, respectively. CONCLUSION: The reversal of Hartmann's procedure appears to be a safe operation with acceptable morbidity rates. If the correct patient selection, correct operation timing and meticulous surgical preparation are performed, the risk of morbidity and mortality of the reversal of Hartmann's procedure can be minimized.