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Objective: Perianal abscesses occur as a result of an infection in the anal gland due to the obstruction of the anal gland ducts opening to the anal crypts. Preoperative use of MRI reduces the risk of recurrence, fistula formation, and postoperative fecal incontinence as it allows detailed anatomical imaging. The aim of this study is to investigate the contribution of preoperative MRI to reducing recurrence and surgical complications in patients who underwent emergency surgery for perianal abscess. Material and Methods: A total of 206 patients with perianal abscess evaluated and not evaluated with MRI between January 2016 and 2021 were included in this retrospective study. The patients had no history of surgery or local drainage applied to the perianal region. In addition to demographic data of patients, postoperative complications, hospitalization duration, recurrence ratio, and MRI findings are evaluated. Results: In the preoperative period, recurrence was found in 16 (%13.2) of 121 cases evaluated with MRI, while the disease recurred in 24 (%28.2) of 85 cases who were operated without MRI evaluation. The presence of a fistula was significantly higher while the presence of recurrence was significantly lower in the group that underwent MRI in the preoperative period (p=0.033, p=0.012 respectively). Conclusion: Contrary to popular belief, surgical treatment of abscesses is not that easy due to the high risk of recurrence, the high rate of association with perianal fistula, and the different types and spreads of abscesses. Therefore, preoperative MRI is the most useful diagnostic method for detecting perianal abscesses and additional pathologies.

Background/Aim: Percutaneous cholecystostomy (PC) is an alternative procedure to surgery in selected patients with acute cholecystitis (AC). This study aimed to review the clinical and surgical results of patients who underwent percutaneous cholecystostomy. Methods: The records of patients who underwent PC for AC were evaluated for age, gender, comorbidities, survey, catheterization timing, complications, control, removal timing, operation type, interval time, pathology, C-reactive protein (CRP) level and white blood cell count (WBC), ultrasonography (USG) and computed tomography (CT) results. Results: One hundred and thirty-six AC patients who underwent PC were included in the study. The median age was 73 (32-96) years and 57.3% of the patients were male. Out of the 136, 106 (78%) had an American Society of Anesthesiologists (ASA) classification score of 3 or 4. The median Charlson’s comorbidity index (CCI) score was 5 (0-13). The median timing of catheterization was 23 (20-144) hours and length of hospital stay (LOS) was 3 (1-25) days. Dislocation was the most common complication of PC, and 7.4% (n=10) had recurrent AC. The median time until tube removal was 26.5 (1-238) days. Among all, 41.2% (n=56) of the patients underwent interval cholecystectomy, which equates to 76.8% of the those performed laparoscopically. The median time until the operation was 100 (1-264) days. Chronic cholecystitis was the most common pathology of cholecystectomy after PC. Bacterial bile cultures were analyzed in 36 of the patients and showed positive results in 66.7%, with no overall effect on the outcome. Nine patients (6.6%) died.Conclusion: The importance of PC in AC increased with the Covid19 pandemic. PC was performed especially for old patients with ASA ≥3, and CCI ≥5 due to lower complication and recurrence rates. PC could be the final treatment for selected AC patients. Interval cholecystectomies performed after 8 weeks had a shorter LOS and a lower rate of complication.

IntroductionThe aim of this randomized controlled experimental study was to evaluate the efficacy of potassium, pH and D-dimer levels in blood, as well as potassium and pH levels in peritoneal lavage fluid, in the early diagnosis of acute mesenteric ischemia.Material and methodsThis study was conducted at the Istanbul University Center of Experimental Medicine after having received approval from the Istanbul University animal testing ethics committee. Male albino Wistar rats (n = 24; 250 to 350 g) were divided into two control groups and two ischemic groups. Levels of potassium, pH, and D-dimer in blood and levels of potassium and pH in peritoneal lavage fluid were analyzed for 1 h and 2 h after the induced acute mesenteric ischemia procedure. The degree of ischemic injury was determined using the histopathological damage score in tissue samples taken from the terminal ileum.ResultsIschemic groups had statistically significant differences in potassium and pH in blood and peritoneal lavage fluid compared to non-ischemic groups (p < 0.05). There was no significant difference between control and ischemic groups in terms of D-dimer and histologic grading results after 1 h (p = 0.132, p = 0.475 respectively), while there was a significant difference between control and ischemic groups after 2 h (p < 0.05).ConclusionsThe levels of potassium, pH, and D-dimer could be useful in daily practice for the early diagnosis of acute mesenteric ischemia.

Aim:Periappendicular inflammatory mass (PIM) defined as a mass located at the right lower quadrant of the abdomen due to inflammation, and can not clearly distinguish from borders of appendix. The aim of this study is evaluating the PIM.Method:The patients who hospitalized for PIM evaluated retrospectively. Patient’s age, gender, length of hospital stay (LOS), performing colonoscopy, comorbidity, etiology, and treatment evaluated. Also, etiology elaborated with age, gender, LOS, treatment, levels of C-reactive protein (CRP), white blood cells, neutrophil % (Neu%), and performing colonoscopy.Results:One hundred fourty four patients were included to study. The mean age was 41.35±17.9 years, and 54.2% of the patients were male. The mean LOS was 4.2±2.6 days. Colonoscopy performed only 28.5% of the patients. The most common etiology was plastron appendicitis (PA) (75%), and 32.4% of the PA was with abscess. 67.3% of the patients were treated conservatively (medical treatment or percutaneous drainage), and the rest treated surgically. The most common surgical approach was diagnostic laparoscopy and drainage. Malignancy reported at two right at age, LOS, treatment, CRP, Neu%, and colonoscopy between etiologies were statistically hemicolectomy patients. The most common comorbidities were hypertension and diabetes (12.5%, and 8.3%, respectively). 44.4% of PIM had negative ultrasonography, 71.5% had positive CT imaging. The differences significant (p

Aim: There is still a need for an ideal laboratory test that can determine the type of disease, the degree of its activity, predict its course, and monitor treatment response in patients with inflammatory bowel disease (IBD). This study aims to investigate the relationship between disease types and activity with Adenosine deaminase (ADA) levels in patients with IBD. Methods: A total of 92 patients with IBD [43 with Crohn’s disease (CD) and 49 with ulcerative colitis (UC)] and 31 healthy control (HC) volunteers were included in this case-control study. Patients’ age, gender, body mass index, location and severity of the disease, medication, endoscopic examination, hemogram, C-reactive Protein (CRP), and ADA results were evaluated. Results: The mean ADA level was 24.87 (9.6 - 74.9) IU/L in the IBD group and 20.8 (13.7 - 38.9) IU/L in the HC group. The difference between the IBD and HC groups was statistically significant (P

The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier's gangrene (FG) and develop methods to increase the survival rate.We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taşçıoğlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species.The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively.Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

Spontaneous spleen rupture (SSR) is a fatal and rare pathology causing acute abdomen. SSR secondary to infectious mononucleosis (IM) is quite rare (0.06-0.5%), and it is the most common cause of IM associated death. A 43 years old male patient, who had no previous severe disease history, chronic drug use, or previous operation applied to our emergency outpatient clinic of general surgery. The patient had complaints of severe abdominal pain, nausea, vomiting, and diarrhea. In abdominal computerized tomography, diffuse free fluid with respectively increased in density (hemorrhage?) was observed. Emergency operation was decided, because patient developed acute peritonitis signs. During exploration in the operation, it was observed that spleen was ruptured at multiple sites, and bleeding was ongoing, and splenectomy was performed. Serology was consistent with the previous EBV infection. It was mentioned in the pathology report that there was no neoplastic infiltration, and infectious causes should be investigated. No problem has been encountered during approximately two years’ follow-up. SSR secondary to EMN is a rare, fatal, and very severe pathology. Diagnosis is delayed, or it is not even diagnosed because there is no trauma. Correct diagnosis on time, and decision of emergency surgical intervention can be life-saving.

This case report presents three consecutive patients who developed esophageal anastomotic leak after gastric cancer surgery and were treated by the two-way vacuum-assisted closure with open abdomen technique in addition to endoscopic stent application (ESA). Esophageal anastomotic leak follow-up was performed by fluoroscopic fistulography. Total parenteral nutrition was given until cessation of leak. All applications of the two-way vacuum-assisted closure were carried out with a vacuum-assisted closure management system. In case of the improvement of the esophageal anastomotic leak detected by fluoroscopy, the two-way vacuum-assisted closure application was terminated. The subcutaneous layer was bilaterally dissected from the fascial layer of the anterior wall of the abdomen, and the abdominal skin was closed without tension. The combination of ESA and the two-way vacuum-assisted closure technique should be suggested in case of severe abdominal sepsis in patients with an esophageal anastomotic leak.

Aim: Acute appendicitis is the most common emergent surgical disease and complicated appendicitis is an indicator of disrupted access to healthcare. Language disability has become more important in the healthcare sector with increasing migration in the last decade. We aimed to evaluate language disability as a risk factor for complicated appendicitis.Methods: From January 2014 to December 2018, patients who were operated for acute appendicitis were evaluated retrospectively. Patients’ age, gender, language disability (LD) (no (C) or yes (F)), whether surgical drainage was required, pathological findings (appendix diameter, severity as uncomplicated (UCA) or complicated (CA), and presence of local peritonitis), levels of C-Reactive Protein (CRP), White Blood Cells (Wbc), Neutrophil% (Neu%), and ultrasonography (USG) and computed tomography (CT) results were noted and compared.Results: Six hundered twenty-eight patients were included in the study, among which 15.1% (n=95) were considered F, and 12% (n=74) were CA. Age and gender did not significantly differ in terms of LD and severity (P=0.15, P=0.24 and P=0.2, P=0.21, respectively). Drainage requirement, local peritonitis, levels of CRP, Wbc, and Neu% were significantly higher in the CA group (P, Amaç: Akut apandisit en sık acil cerrahi hastalık ve komplike apandisit sağlık kuruluşlarına erişebilme göstergesidir. Son on yılda göçlerin artması ile dil engeli sağlık için önemli hale gelmiştir. Dil engelinin komplike apandisit için risk faktörü olarak değerlendirmeyi amaçladık.Yöntemler: Ocak 2014’den Aralık 2018 tarihleri arasında akut apandisit nedeni ile opere edilen hastalar geriye dönük değerlendirildi. Hastaların yaş, cinsiyet, dil engeli (DE) (var (Y) yok (V)), drenaj uygulanması, patolojisi (apandiks çapı, şiddeti komplike olan (KA), komplike olmayan (KOA), ve lokal peritonit varlığı), C-Reaktif Proteini (CRP), beyaz küre (BK), nötrofil yüzdesi (Nöt%), ultrasonografi (US) ve bilgisayarlı tomografi (BT) sonuçları istatistiksel olarak değerlendirildi. Bulgular: Altı yüz yirmi sekiz hasta çalışmaya dahil edildi. %15,1’i (n=95) Y, ve %12’si (n=74) KA idi. DE ve şiddet açısından yaş ve cinsiyet farkı istatistiksel olarak anlamlı saptanmadı (sırasıyla P=0,15, P=0,24 ve P=0,2, P=0,21). Drenaj, lokal peritonit, CRP, BK ve Nöt% KA grubunda anlamlı olarak yüksek saptandı (sırasıyla P

WOS: 000452510300005 PubMed: 30251732 Objectives: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. Methods: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyil University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. Results: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.

Objective This study was performed to determine the healing effects of pentoxifylline on molecular responses and protection against severe ischemic damage in the small intestine. Methods Thirty-six Wistar albino rats were divided into six groups. The superior mesenteric artery was clamped for 120 minutes, and reperfusion was performed for 60 minutes. Saline (0.4 mL), pentoxifylline (1 mg/kg), and pentoxifylline (10 mg/kg) were intraperitoneally administered to the rats in the C1, P1, and P3 groups, respectively, 60 minutes before ischemia and to the rats in the C2, P2, and P4 groups, respectively, during reperfusion onset. Malondialdehyde, myeloperoxidase, tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 in serum and tissue were measured by enzyme-linked immunosorbent assay. Intestinal ischemic injury was histopathologically evaluated by the Chiu score and immunohistochemical staining. Results All serum and tissue molecular responses were significantly blunted in the pentoxifylline-treated groups compared with the controls. Significant improvement in ischemic damage was demonstrated in the pentoxifylline-treated groups by histological grading and immunohistochemical scoring. Conclusions The protective effects of pentoxifylline were confirmed by molecular responses and histopathological examination.

Aim: Lymph node metastasis is one of the most important prognostic factors in colorectal cancer. We investigated the prognostic value of lymph node ratio (LNR); (the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) in node-positive colorectal cancer patients. Method: We assessed 321 node-positive colorectal cancer patients. To determine the LNR threshold value that will separate patients in two prognostic groups with significantly different cancer-specific survival (CSS) rates, survival analyses were conducted with LNR threshold values between 0.05 and 0.95, at increments of 0.05. Results: In the whole series, the most significant LNR threshold value separating patients in low-risk (213 patients) and high-risk (108 patients) groups in terms of CSS was 0.40 (p

Background Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival. Methods Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail. Results A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9+-16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO. Conclusion Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause.

Objective We compared the breast cancer patients with invasive lobular carcinoma (ILC), invasive ductal carcinoma (IDC) and mixed invasive ductal and lobular carcinoma (IDLC) in terms of clinicopathological and treatment features, metastatic patterns and long-term survival. Materials and methods In a 10 years patient cohort, 3412 patients with unilateral breast carcinoma were enrolled in the study. Tumors were classified histologically according to criteria described by World Health Organization classification. Results The highest rate of T3 tumors were found in IDLC patients, the lowest in IDC patients, and the difference between groups was significant only in comparison of IDC vs IDLC. Axillary positivity rate was highest in IDLC, lowest in ILC; differences were significant in comparisons of IDLC vs ILC and IDLC vs IDC. There was no significant difference between the patient groups in terms of surgical treatment, mastectomy and breast conserving surgery. Rate of bone metastasis was highest in IDLC, lowest in IDC, with significant difference between IDLC and IDC. Locoregional recurrence-free survival (LRFS) rate was 90.9% in ILC patients, 92.5% in IDC patients, 92.9% in IDLC patients, with no significant difference between the groups; in multivariate Cox analysis, histological type had no prognostic significance (p=0.599). Distant metastasis-free survival (DMFS) rate was 66.2% in ILC patients, 66.7% in IDC patients, 57.1% in IDLC patients; in multivariate Cox analysis, histological type had no prognostic significance (p=0.392). Conclusion Although these results suggest that IDLC may have a worse prognosis than IDC and ILC, in multivariate analysis LRFS and DMFS were not significantly different among the histological type groups.

The aim of this study was to investigate the incidence of appendiceal neuroendocrine tumors (NET) in an acute appendicitis cohort, as well as to investigate the behavioral form of the tumor. Our secondary aim was to investigate survival in patients with appendiceal NET.Between February 2006 and June 2018, 6518 appendectomies were performed for acute appendicitis in the department of surgery, University of Health Sciences, Okmeydanı Education and Research Hospital, İstanbul, Turkey. The medical records of these consecutive 6518 appendectomy patients were evaluated retrospectively. After the histopathological analysis, a total of 22 patients were identified as cases of appendiceal NET. These patients were included in the study. A retrospective analysis of data including gender, age, intraoperative surgical findings, duration of postoperative follow-up and survival, tumor localization, the diameter of the tumor, tumor grade, invasion, surgical margin, and stage of the tumor was performed.The incidence of appendiceal NET was 0.33%. Eleven patients were diagnosed as primary pathological stage pT1aN0M0 according to the European Neuroendocrine Tumor Society guidelines. One patient was diagnosed as primary pathological stage pT1bN0M0, and 10 patients were diagnosed as primary pathological stage pT2N0M0. The median tumor diameter was 7.6 mm. There was no patient with a tumor diameter greater than 20 mm.The incidence of appendiceal NET in our study is consistent with that stated in the literature. The results of our research suggest that further surgical procedures for NETs that occur coincidentally in patients of the AA cohort are often unnecessary. In addition, the study revealed that disease-free survival (100%) was good over a mean follow-up of 59.2 months.

Objective To determine the factors associated with mortality in Fournier's gangrene (FG) toward informing the development of effective treatment strategies. Study design A descriptive study. Place and duration of study Department of Surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey, from February 2012 to September 2017. Methodology Informations of 30 patients treated for FG were examined retrospectively. The deceased patients (Group 1, n = 8) were analysed separately from the living ones (Group 2, n = 22). Informations in this analysis contained gender, age score, dissemination score, Uludag Fournier's Gangrene Severity Index (UFGSI) and Fournier's Gangrene Severity Index (FGSI) scores, serum levels of urea, infection source, the presence of diabetes, obesity, and other comorbidities, the presence of stoma for diversion, duration of the vacuum-assisted closure treatment, hospitalisation time, intensive care period, and species of bacteria isolated. Results The overall mortality rate was detected as 26%. A significant difference between the two groups concerning age score of UFGSI parameters was found. The dissemination score of the infection, which is one of the UFGSI parameters, was significantly higher in Group 1 than in Group 2. According to UFGSI and FGSI scores, the scores of group 1 patients were significantly higher. To determine the incidence of mortality, the UFGSI and FGSI had 87.5% sensitivity and had 96% and 91% specificity, respectively. The cut-off values for UFGSI and FGSI were 10 and seven, respectively. Conclusion Based on the findings described in this study, age and dissemination scores from the UFGSI can be used to predict patient outcome. Patients with a UFGSI score greater than 10 have a higher mortality rate.

A 55-year-old male patient developed a duodenal re-leak, which caused severe peritonitis, on the second postoperative day after surgery to treat an acutely perforated duodenal ulcer. Relaparotomy was performed 2 days after surgery for the re-leak after omentoplasty. The necrotic omentum was dissociated from the bulbus duodeni. Viable omentum for reinsertion of the omental patch was not found. The turned-outward duodenal mucosa was excised and the duodenal perforation was sutured. Two-way vacuum-assisted closure (VAC) was carried out by taking a liquid culture of the abdomen and washing the abdomen. The two-way VAC exchange procedures were continued every 3 days until the re-leak was terminated. The whole treatment process occurred in the intensive care unit. The duodenal leak was completely stopped by 41 days after surgery. The subcutaneous layer was dissected from the fascial layer of the anterior wall of the abdomen; thus, the abdominal skin was closed without tension and the patient was subsequently discharged. In conclusion, since primary source control is often difficult when treating duodenal leaks, the two-way VAC system is a convenient solution for localizing the source of the peritonitis and removing toxic peritoneal material.

Sleeve gastrectomy(SG) is a popular bariatric surgery procedure with rare but dreaded complications. Although drain amylase levels are a reliable early predictor of anastomosis leakage in oesophagectomy and pancreaticoduodenectomy, for SG have not yet been studied. We aimed to monitor drain amylase levels to ascertain their applicability for early diagnosis of gastric leakage in SG.Twenty-four rats were randomly divided into three groups: Group A: only laparotomy and abdominal drain; Group B: laparotomy, SG, and drain; Group C: laparotomy, SG with fistula,and drain. On postoperative days 0,1,2,3, and 4, drain lavage samples were collected to measure amylase.Groups were compared in pairs. Preoperative weights were not significantly different in any comparison. On postoperative days 0,1,2,3, and 4, drain amylase levels were found to be significantly lower in Group A than in Group B as well as in Group A than in Group C but were significantly higher in Group C than in Group B. For postoperative day 1, a receiver operating characteristic curve was done. Drain amylase levels over 1514 IU were statistically significant for leakage.Drain amylase levels were significantly high in sleeve gastrectomy with fistula. This indicates that drain amylase level monitoring might be an easy and cheap alternative for determining staple-line leakage for high risk patients with Body Mass Index(BMI)50kg/m2 in whom we cannot use radiological imaging.Animal Experimental Study, Bariatric Surgery, Drain amylase, Sleeve gastrectomy, Staple-line leakage.La sleeve gastrectomy (SG) è una procedura di chirurgia bariatrica molto diffusa, gravata con rare ma pericolore complicazioni. Sebbene i livelli di amilasi dal drenaggio rappresentano un affidabile undicatore precoce di deiscenza dell’anastomosi nell’esofagectomia e nella pancreaticoduodenectomia, ciò non è stato studiato nella SG. Ci siamo proposti di monitorare sperimentalmente il livello dell’amilasi dal drenaggio per accertare l’utilizzazione nella diagnosi precoce di deiscenza nella SG. 24 ratti sono stati divisi a random in tre gruppi. GruppoA: ratti sottoposti a semplice laparotomia e drenaggio. Gruppo B: laparotomia, SG e drenaggio. Gruppo C: laparotomia, SG con fistola e drenaggio. Nei giorni postintervento 0, 1, 2, 3 e 4 sono stati effettuati con lavaggio prelievi dai drenaggio per la misurazione dell’amilasi. I gruppi sono stati paragonati a coppia. Il peso preoperatorio dei ratti non ha presentato differenzxe significative in tutti i confronti. I livelli di amilasi dai drenaggio nei giorni postopeatori 0, 1,2,3,4 sono risultati significativamente inferiori nel Gruppo A rispetto al Gruppo B, ad analogamente nel Gruppo A rispetto al Gruppo C, ma sono risultati più elevati nel Gruppo C rispetto al Gruppo B. Nel primo giorno postoperatorio è stata eseguita una curva di caratteristica operativa (ROC). I livelli di amilasi superiori alle 1514 IU sono stati statisticamente indicatori significativi della deiscenza. In conclusionne i livelli di amilasi dai drenaggi risultano più elevati nella SG con fistola, indicando che il loro monitoraggio può rappresentare una facile ed economica alternativa per individuare una deiscenza della linea anastomotica in pazienti ad alto rischio, con BMI50 kg m2 in cui non è realizzabile l’imaging radiologica.

Background Acute pancreatitis has an incidence of approximately 1 in 1000 to 5000 pregnancies, and is most often seen in the third trimester or the postpartum period. The most common cause of pregnancy-related acute pancreatitis is cholelithiasis, which accounts for more than 65% of cases. The aim of this study was to present a detailed analysis of 4 years of experience with cases of acute biliary pancreatitis related to pregnancy from a single center. Methods The medical records of 55 consecutive patients who were hospitalized in the emergency surgery clinic for acute biliary pancreatitis related to pregnancy between January 1, 2014 and January 1, 2018 were examined in this single-center, retrospective study. Results Fifty-five patients with acute biliary pancreatitis related to pregnancy were included in the study. Of the 55 women, 13 (24%) were in the pregnant group, 28 (51%) in the postpartum (6 weeks) group, and 14 (25%) were in the 1-year (6 weeks-1 year) group. There was no statistically significant difference between the 3 groups. The most appropriate treatment for each patient was targeted. Six (10%) patients had recurrent acute pancreatitis. There was no maternal or fetal mortality or morbidity. Conclusion Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester.

BACKGROUND The aim of this study was to investigate the incidence of appendiceal neuroendocrine tumors (NET) in an acute appendicitis cohort, as well as to investigate the behavioral form of the tumor. Our secondary aim was to investigate survival in patients with appendiceal NET. METHODS Between February 2006 and June 2018, 6518 appendectomies were performed for acute appendicitis in the department of surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey. The medical records of these consecutive 6518 appendectomy patients were evaluated retrospectively. After the histopathological analysis, a total of 22 patients were identified as cases of appendiceal NET. These patients were included in the study. A retrospective analysis of data including gender, age, intraoperative surgical findings, duration of postoperative follow-up and survival, tumor localization, the diameter of the tumor, tumor grade, invasion, surgical margin, and stage of the tumor was performed. RESULTS The incidence of appendiceal NET was 0.33%. Eleven patients were diagnosed as primary pathological stage pT1aN0M0 according to the European Neuroendocrine Tumor Society guidelines. One patient was diagnosed as primary pathological stage pT1bN0M0, and 10 patients were diagnosed as primary pathological stage pT2N0M0. The median tumor diameter was 7.6 mm. There was no patient with a tumor diameter greater than 20 mm. CONCLUSION The incidence of appendiceal NET in our study is consistent with that stated in the literature. The results of our research suggest that further surgical procedures for NETs that occur coincidentally in patients of the AA cohort are often unnecessary. In addition, the study revealed that disease-free survival (100%) was good over a mean follow-up of 59.2 months.

Objective: Breast pain is a very common condition among young women. The aim of this study is to provide supplementary and specific data especially in addition to available literature informa-tion about the ultrasonographic findings and breast cancer risk in women younger than 40 years who applied to the breast outpatient clinic with isolated mastalgia, and had no breast cancer risk factor.Method: Ultrasonograpic examination results of women between dates 01/01/2011 and 01/01/2015, and contribution of ultrasonography to diagnostic procedure of breast cancer were retrospectively evaluated.Results: A total of 1066 patients were included in the study. There were 555 (52%) women with focal and 511 (48%) women with diffuse mastalgia. US examination revealed only 7 suspicious cases, all of whom were over 30 years of age. Of women with suspicious masses, 6 had focal mastalgia, and invasive cancer was diagnosed in 3 of cases after core biopsy. In only one patient in the diffuse mastalgia group a suspect mass was detected which revealed to be a benign lesion on histopathological examination of core biopsy specimenConclusion: Careful clinical examination may be adequate especially in women younger than 30 years of age who have no breast cancer risk factor, and only diffuse mastalgia complaint. However, possibility of breast cancer should be considered in women older than 30 years even they have no breast cancer risk factor, and no complaint other than focal mastalgia. Amaç: Meme ağrısı genç kadınlar arasında çok yaygın bir durumdur. Bu çalışmanın amacı, meme hastalıkları polikliniğine izole mastalji ile başvuran ve meme kanseri risk faktörü olmayan 40 yaşından küçük kadınlarda özellikle ultrasonografik bulgular ve meme kanseri riski hakkında mevcut literatür bilgilerinin yanı sıra ek ve spesifik veriler sağlamaktır.Yöntem: 01/01/2011 ve 01/01/2015 tarihleri arasında kadınların ultrasonografik inceleme sonuç-ları ve meme kanseri tanısında ultrasonografinin katkısı retrospektif olarak değerlendirildi. Bulgular: Çalışmaya toplam 1.066 hasta dâhil edildi. Fokal mastaljisi olan 555 (%52) kadın ve yaygın mastaljisi olan 511 (%48) kadın vardı. Ultrasonogafi muayenesinde, her biri 30 yaşın üze-rinde olan yalnızca 7 şüpheli olgu ortaya çıktı. Şüpheli kitleleri olan kadınların 6’sında fokal mas-talji vardı ve kor biyopsiden sonra 3 olguya invaziv kanser teşhisi konuldu. Yaygın mastalji grubun-da yalnızca 1 hastada şüpheli kitle vardı ve kor biyopside benign bir lezyon saptandı.Sonuç: Özellikle meme kanseri risk faktörü olmayan ve yalnızca yaygın mastalji yakınması olan 30 yaşından küçük kadınlarda dikkatli klinik muayene yeterli olabilir. Bununla birlikte, meme kanseri risk faktörü olmayan ve fokal mastalji dışında hiçbir şikayeti olmayan 30 yaşından büyük kadın-larda meme kanseri olasılığı göz önünde bulundurulmalıdır.

BACKGROUND The Alvarado score (AS) and the Appendicitis Inflammatory Response score (AIRS) were developed to diagnose acute appendicitis (AA). The aim of this study was to evaluate the severity of AA using the AS and the AIRS tools. METHODS Patients who presented between January 2016 and December 2017 and underwent surgery for AA and who had a preoperative AS and AIRS value were evaluated retrospectively. The details of age, sex, pathological severity, the presence of local peritonitis or fecaloid, drainage, appendix diameter, and operation type were evaluated according to the AS and the AIRS. RESULTS A total of 578 patients were included in the study. Appendicitis was the most common pathological severity classification (44.4%). The most common appendix diameter group was 7-10 mm (59.2%). The difference observed in the AS and AIRS results for all of the pathological severity categories was statistically significant (p

Highlights • Painful, discolored umbilical swelling in women may be primary endometriosis. • Abdominal tomography must be carried out to exclude concomitant pelvic endometriosis. • To avoid recurrens of primary umbilical endometriosis: Total umbilical resection., Background Primary umblikal endometriosis is a rare illness. In this report we aimed to discuss the management of this rare condition. Case summary A 28-year-old nulliparous woman was present at our clinic who was suffering from painful swelling in the umbilicus during her menstruation for the last 3 months. Her examination showed a dark-color sensitive nodule of 20 × 15 mm in size in the umbilicus. A lower abdominal tomography was performed to exclude the presence of a concomitant pelvic endometriosis, and it showed increased density consistent with subcutaneous inflammation in the umbilicus. Her medical history and physical examination suggested primary umbilical endometriosis. A total resection including umbilicus was performed. Discussion Primary umbilical endometriosis is a rare benign disease and clinically difficult to differentiate from other diseases that cause umbilical nodule. Imaging modalities have no pathognomonic findings for diagnosis. Surgical exploration and excision are the definitive and safe treatment of primary umbilical endometriosis. Conclusion Total umbilical resection should be preferred to avoid local recurrent.

Summary Purpose In this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease. Methods Ninety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH ( n = 48) or SH ( n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6–36) months. Results The patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group. Conclusion HSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method.

Objective: The development and extensive use of methods of breast imaging has increased the diagnosis of non-palpable breast lesions (NPBL). Although several methods have been applied in the localization of NPBL throughout the world, the technique of wire-guided localization is used as a standard. The aim of this study is to present the results of ROLL (Radioguided occult lesion localization), which is a new technique in our clinic for localization of NPBL. Materials and Methods: We included 44 patients who had NPBL in the study. The lesions were localized preoperatively with TC-99m labelled human serum albumin. A gamma probe was used to determine the place of lesion and to guide the excisional biopsy. We assessed the duration of the localization, the excisional biopsy and hospital stay, the volume of the excised piece, the surgical margin in the malign facts, complication, cost calculation, and the comfort of the procedure from the points of view of the surgeon, radiologist and patient for every case. Results: We successfully localized and excised all lesions with ROLL. As a result of the pathologic evaluation, 54.4% of the lesions were reported as benign, 45.6% as malign. An adequate surgical margin was obtained in 71.4% of the malignant lesions. Conclusion: ROLL is an alternative method to wire-guided localization for NPBL.

Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

Objective: Because of its poor prognosis and high mortality rate, early diagnosis of acute mesenteric ischemia (AMI) is a challenge. The value of serum markers in the diagnosis of AMI is limited and the studies related with the D-dimer test carried out in recent years. In this prospective study we investigated the value of the level of plasma D-dimer in the diagnosis of AMI and the differential diagnosis from acute pancreatitis and acute cholecystitis. Methods: We included 89 patients who admitted to our emergency department with abdominal pain. The number and the diagnosis of the patients were 17 AMI, 42 acute pancreatitis and 30 acute cholecystitis, respectively. We measured the levels of plasma D-dimer of all patients by using a latex agglutination ‘immunoassay’ method. Eventually we calculated the sensitivity and specificity of D-dimer test in the diagnosis of AMI. Results: We determined the specificity of the D-dimer test in the differential diagnosis of AMI as 50% from acute pancreatitis, 70% from acute cholecystitis, 58.3% from all the control group and the sensitivity was 100%. Conclusion: The measurement of plasma D-dimer concentration may be useful in the differential diagnosis of AMI from acute pancreatitis and acute cholecystitis. However, to reveal the diagnostic value of D-dimer test more clearly, further studies with larger series are needed, where cut-off value is highly defined, and other patients with acute abdominal pain are added into the control group. Key words: Acute mesenteric ischemia, diagnosis, D-dimer

Highlights • Hepatocellular carcinoma (HCC), which constitutes more than 90% of primary liver cancers, is a major global health problem. • In HCC, 30% of cancer related deaths is due to hepatic failure, and 10% is due to gastrointestinal (GI) bleeding. GI metastasis is reported as 0.4-2%. GI bleeding frequency due to HCC direct invasion is 0.05-2%, and may be fatal. • Besides, the repetition of TAE, intra-arterial chemotherapy, radiotherapy, and individualized treatment plans have recently increased survival in unresectable HCC patients, and thus it is expected that GI involvement will be more commonly encountered in HCC patients in the near future., Background The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal. Case presentation We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13 cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure. Discussion Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding. Conclusions The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.

Background and Objectives In this study, the value of the serum tumor markers carcinoembryonic antigen (CEA), CA 19-9, and CA 125 was assessed in the differential diagnosis of benign and malignant pancreatic diseases with and without obstructive jaundice. Methods Serum levels of CEA, CA 19-9, and CA 125 were measured by immunoradiometric assay before the treatment in 123 patients with pancreatic carcinoma and 58 patients with a benign pancreatic disease. Results The sensitivity of CEA, CA 19-9, and CA 125 in the diagnosis of pancreatic carcinoma was 39.0%, 81.3%, and 56.9%; and specificity was 91.4%, 75.9%, and 77.6%, respectively. Although there was no significant difference between the CA 19-9 positivity ratios of the jaundiced (84.3%) and nonjaundiced (73.5%) patient subgroups of the pancreatic carcinoma, this ratio was significantly higher in the jaundiced subgroup (64.7%) than the nonjaundiced subgroup (7.3%) of the benign pancreatic diseases (P

BackgroundTo compare the patients with primary colorectal carcinoma (CRC) and non-resectable distant metastases with or without primary colorectal tumor resection as a primary treatment in terms of postoperative mortality and overall survival (OS).Patients and methodsThe clinicopathological data of 188 CRC patients with non-resectable distant metastases was analyzed. All patient data were collected prospectively. Colorectal tumor was resected in 121 patients (64.3%). Kaplan–Meier method was used for calculation and plotting of the OS curves of the patient groups, and log-rank test was used for the comparison of the survival curves. The relative importance of the prognostic features was investigated using the Cox proportional hazards model.ResultsIn the whole series and in the patient group undergoing emergency surgical intervention, mortality rate was lower in patients having colorectal tumor resection compared with non-resected patients, with differences approaching the significance level (p = 0.072 and p = 0.076, respectively). Median OS time was significantly longer in resection group (11.0 months), compared with non-resection group (5.5 months) (p

Background : To investigate the prognostic significance of the number of lymph nodes removed in colorectal cancer (CRC) patients with no metastatic lymph node. Patients and methods : The clinicopathological data of 461 CRC patients was analyzed. In order to compare the survival of patients who had fewer lymph nodes removed versus the survival of patients who had 1–3 metastatic lymph node(s), a separate group of 74 N1 disease patients were also included in the study. All patient data were collected prospectively. Kaplan–Meier method was used for calculation and plotting of the survival curves of the patient groups, and log-rank test was used for the comparison of the survival curves. Results : Cancer-specific survival (CSS) rates of patients who had 1–7 lymph node(s) and 8–11 lymph nodes removed were significantly worse than those who had 12 or more lymph nodes removed ( p = 0.006 and p = 0.037, respectively), while CSS was not significantly different between those who had 1–7 versus 8–11 lymph node(s) removed ( p = 0.647); this grouping had independent prognostic significance in Cox analysis ( p = 0.006). CSS of patients with N1 disease was not significantly different from those who had 1–7 and 8–11 lymph node(s) removed ( p = 0.312 and p = 0.165, respectively), while it was significantly worse than CSS of patients who had 12 or more lymph nodes removed ( p = 0.001). Conclusion : In colorectal cancer patients whose removed lymph nodes are non-metastatic, removal of at least 12 lymph nodes will determine the lymph node status reliably.