Objective:Surgical site infections (SSIs) are among the most common postoperative complications, contributing to morbidity, prolonged hospital stays, and healthcare costs. Prophylactic antibiotics are widely used, but the optimal regimen for clean elective surgeries remains debated. Material and Methods:A hospital-based analytical cross-sectional study was conducted over a six-month period (March-August 2025) in the department of general surgery of a tertiary-care teaching hospital. Ninety-four consecutive patients undergoing clean elective surgeries were enrolled and allocated to two groups: Group A (n=52) received a single intravenous (IV) dose of cefotaxime 30 minutes prior to incision, and Group B (n=42) received postoperative multidose oral antibiotics according to institutional protocol. Baseline demographic and clinical data were recorded, and patients were monitored for signs of SSI, including fever, tachycardia, redness, and wound discharge. Results:The mean age of Group A participants was 28.3±5.9 years compared to 36.4±7.3 years in Group B (p=0.042), though other socio-demographic variables were comparable. The overall incidence of SSI signs was low in both groups. Fever occurred in 13.4% of Group A and 14.2% of Group B; tachycardia occurred in 9.6% and 7.1%; redness in 1.9% and 7.1%; and wound discharge in 3.8% and 2.3% in Groups A and B, respectively; none of these differences were statistically significant (p>0.05 for all). Conclusion:Single-dose IV prophylaxis was as effective as postoperative multi-dose oral antibiotics in preventing SSIs in clean elective surgeries. Short-course prophylaxis is sufficient in this setting and supports rational antibiotic stewardship.
Objective:Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by rapid deterioration, yet it is often identified late owing to vague and non-specific clinical findings. Identifying laboratory markers that can assist in early mortality prediction remains essential for improving outcomes. This study aimed to determine whether the bicarbonate-to-lactate ratio (HCO₃/lactate) and the albumin-to-creatinine ratio could serve as reliable predictors of early mortality in patients with AMI. Material and Methods:This retrospective case-control study included 87 patients who underwent surgical treatment for acute arterial mesenteric ischemia caused by superior mesenteric artery embolism between 2015 and 2025. Demographic characteristics, comorbidities, laboratory findings, and mortality outcomes were evaluated. The predictive performance of the bicarbonate-to-lactate and albumin-to-creatinine ratios was assessed using receiver operating characteristic (ROC) analysis; independent predictors of mortality were identified through multivariate logistic regression. Results:The 28-day mortality rate was 62.1%. In univariate analysis, lower bicarbonate and albumin levels, reduced HCO₃/lactate and albumin/creatinine ratios, and higher lactate, creatinine, and C-reactive protein values were significantly associated with mortality (p<0.05). ROC analysis identified values of <6 for the HCO₃/lactate ratio and <2.6 for the albumin/creatinine ratio as the best cut-off values. In the multivariate model, a HCO₃/lactate ratio <6 increased the risk of death by more than 13-fold, while an albumin/creatinine ratio <2.6 increased mortality risk by approximately 4.5-fold. Conclusion:Both the HCO₃/lactate and albumin/creatinine ratios are simple, inexpensive, and easily obtainable biochemical markers that may assist clinicians in predicting early mortality in AMI. Their incorporation into early evaluation algorithms could enhance risk stratification, although validation through prospective studies is warranted.
Objective:Acute abdominal pain (AAP) is a leading cause of visits to the emergency department (ED) and is often a condition requiring immediate attention and timely management to prevent potentially serious complications like sepsis. Despite the importance of this topic, public knowledge about AAP and when to seek care remains underexplored, particularly among non-medical populations. This study aimed to assess public knowledge, attitudes, and practices regarding AAP, identify their sources of health information about the condition, and pinpoint barriers to seeking medical care in Jordan. Material and Methods:A cross-sectional survey was conducted among Jordanian adults using a self-administered questionnaire that was developed after a thorough literature review, tested and validated in a pilot study. Convenience and snowball sampling methods were used to collect data, which were analyzed using descriptive and inferential statistics, including linear regression analysis to identify predictors of knowledge and attitudes. Results:A total of 1.566 Jordanians participated in the study, with a median age of 26 years (interquartile range: 23-41). The most commonly perceived cause of AAP was the digestive system (86%), with changes in bowel habits (57%) and bloating (51%) being the most recognized associated symptoms. The mean knowledge score was 6.9±3.0, with most participants having fair (53.8%) or good (35.3%) knowledge scores. The vast majority (91.8%) had a positive attitude regarding the importance of raising and awarding about AAP, with a mean score of 7.89±1.66 out of 10. Age, female gender, marital status, parenthood, and prior abdominal surgery were positively associated with both better knowledge and attitude scores (p-values <0.05). However, when experiencing AAP, 35.5% reported that they would take painkillers and wait, and 30% would rest at home, while only 19.7% would seek medical help. Moreover, 4% stated that they would not seek care even in the presence of red flag symptoms. The main barriers to seeking care included long waiting times (47%) and lack of confidence in healthcare providers (31%). Regarding the sources of information about AAP, doctors and health professionals were the primary source of AAP knowledge (61%), followed by personal experiences and advice from friends and family (41%). Conclusion:Most participants had fair to good knowledge and a positive attitude toward AAP, yet a significant proportion opted for self-management over seeking medical help. The main barriers to seeking care included long waiting times, and distrust in healthcare providers. Well-coordinated education campaigns and system-level interventions are advocated to overcome the existing barriers and improve outcome for AAP in Jordan.
Objective: Distinguishing preoperative criteria and postoperative histological features of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from those of other thyroid tumors with follicular architecture and papillary nuclear features (non-NIFTP) is crucial to prevent overtreatment. In this study, we aim to identify the predictive factors of NIFTP. Material and Methods: We conducted a retrospective study in which we collected cases of thyroid tumors with follicular architecture and papillary nuclear features diagnosed between 2012 and 2022. Clinicopathological characteristics, therapeutic modalities, and follow-up were compared between NIFTP and non-NIFTP tumors. Results: Forty cases of NIFTP and 44 cases of non-NIFTP were identified. NIFTP accounted for 8.83% of all PTCs and 33.6% of all thyroid tumors with follicular architecture and papillary nuclear features. NIFTP was associated with younger age (p=0.005), isoechoic nodules on ultrasound (US) (p=0.004), regular contours (p=0.028), absence of microcalcifications (p=0.005), and predominance in European Thyroid Imaging Reporting and Data System 2 and 3 scores (p<0.001).They predominantly exhibited a nuclear score of 2 (p<0.001), focal nuclear abnormalities (p=0.015), and a thin capsule (p=0.004). No case of NIFTP showed distant or lymph node metastases. Multivariate analysis identified a nuclear score of 2, focal nuclear abnormalities, and a thin tumor capsule as independently associated with NIFTP. Conclusion: Our findings demonstrated the indolent nature of NIFTP and the utility of cervical US in raising preoperative suspicion for this entity. Because findings regarding the Bethesda classification were not available in our study, a prospective multicenter study with a larger sample size and a longer follow-up period is warranted to address this limitation.
Objective:This study aimed to evaluate contemporary surgical approaches and decision-making patterns of general surgeons in the management of recurrent inguinal hernia following laparoscopic inguinal hernia repair (LIHR), with particular emphasis on recurrence timing, surgeon experience, and annual laparoscopic case volume. Material and Methods:The questionnaire consisted of 26 items, including both multiple-choice and short-answer questions, and was designed to assess demographic characteristics, surgical experience, preferred surgical techniques, preoperative evaluation strategies, and management approaches for recurrent inguinal hernia following LIHR. Recurrences were classified as early (≤2 years) or late (>2 years) based on the postoperative time interval. Results:A total of 179 surgeons participated in the survey. Most respondents were male and had ≤10 years of surgical experience. Surgeons with higher annual laparoscopic hernia repair volumes were significantly more likely to prefer re-laparoscopic posterior approaches for both early and late recurrences, whereas surgeons with lower case volumes predominantly favored open anterior repair techniques (p<0.05). Surgical preferences also varied in female patients and according to the initial repair technique (transabdominal preperitoneal or total extraperitoneal). Nearly two-thirds of participants reported insufficient or only partially sufficient training in recurrent hernia repair, while the majority strongly agreed on the need for national or international clinical guidelines. Conclusion:Surgeon experience and annual laparoscopic case volume significantly influence the management of recurrent inguinal hernia following LIHR. As laparoscopic expertise increases, re-laparoscopic approaches are more frequently adopted. These findings highlight the need for standardized training programs and evidence-based guidelines to optimize the management of recurrent inguinal hernia after laparoscopic repair.
Objective:Lemmel syndrome is an uncommon cause of obstructive jaundice resulting from extrinsic compression of the common bile duct by a periampullary duodenal diverticulum (PAD) in the absence of choledocholithiasis. Due to its non-specific clinical presentation, diagnosis may be delayed or misinterpreted. Material and Methods:A retrospective review was conducted on 12 patients diagnosed with Lemmel syndrome at a single tertiary center between 2022 and 2024. Demographic characteristics, clinical presentation, laboratory findings, imaging modalities [ultrasonography (USG), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP)], endoscopic interventions, and outcomes were analyzed descriptively. Results:The cohort included 12 patients with a mean age of 70±9 years. All patients presented with clinical or biochemical evidence of obstructive jaundice. USG frequently failed to establish the diagnosis, whereas CT and particularly MRCP demonstrated the anatomical relationship between the PAD and the biliary tree. Endoscopic retrograde cholangiopancreatography served both diagnostic and therapeutic purposes, with biliary stenting performed when indicated. Most patients improved with conservative and/or endoscopic management. Conclusion:Lemmel syndrome should be considered in elderly patients with unexplained obstructive jaundice. Cross-sectional imaging, particularly MRCP, plays a key role in diagnosis, while endoscopic intervention remains central to management.
Objective: Robotic surgery is increasingly used across specialties, yet its ergonomic impact on operating room nurses remains underexplored. This multicenter study aimed to evaluate the ergonomic challenges and musculoskeletal discomfort among scrub nurses during robotic surgery and to compare these outcomes with laparoscopic procedures, with additional analysis based on years of robotic surgery experience. Material and Methods: This cross-sectional, multicenter, questionnaire-based study was conducted between January and February 2025, among scrub nurses with experience in robotic surgery from multiple centers. Ergonomic perceptions, physical strain, musculoskeletal discomfort, and comparisons between robotic and laparoscopic surgery were assessed. Nurses were stratified into less than and more than 5 years of robotic surgery experience, and comparative statistical analyses were performed. Results: Most nurses rated the robotic operating environment as comfortable (69.6%), and 56.4% reported reduced workload compared with laparoscopy. Physical strain was reported by 30.9%, most commonly during instrument exchange. Musculoskeletal discomfort predominantly affected the neck, back, and shoulders. Shoulder pain was significantly more common among nurses with >5 years of experience (70% vs. 33.3%, p=0.008). Although 71.4% reported ergonomic support from robotic systems, 85.7% had not received ergonomic training. Conclusion: Robotic surgery is perceived by scrub nurses as ergonomically more favorable than laparoscopic surgery; however, substantial musculoskeletal discomfort persists, particularly among more experienced nurses and in the absence of ergonomic training. These findings suggest a potential cumulative ergonomic burden and highlight the need for structured ergonomic education and system-level interventions.
Objective: Description of the clinical presentation and tumor behavior, its general and pathological characteristics, diagnostic and therapeutic approaches, as well as treatment outcomes in children with neuroblastoma (NB) at a single-center. Special focus was placed on the duration of the diagnostic process and the correlation between disease stage, presence of metastases, and treatment outcomes. Given the small cohort, this report is presented as a descriptive case series complemented by a focused review of the literature NB. Material and Methods: A retrospective study was conducted for the time period from January 1st, 2010, to December 31st, 2024. The study included 13 patients (7 males, 6 females; median age: 44 months; range, 0-114) diagnosed with NB who underwent surgery and were hospitalized at the Department of Pediatric Surgery, Clinical Center of the University of Sarajevo. Demographic, clinical, biochemical, radiological, and treatment data were extracted from medical records. A narrative review of major published NB cohorts was conducted to compare our observations with existing evidence. Results: The median age at diagnosis was 44 months. The largest number of patients were in the age group of 2-4 years, and most presented with stage four disease (according to International Neuroblastoma Staging System classification). The tumor was located in the adrenal gland in 92.3% of cases. The median survival time was 36 months. Patients had elevated serum neuron-specific enolase, urinary vanillylmandelic acid, as well as blood ferritin and lactate dehydrogenase levels. The most common symptoms were loss of appetite, presence of a palpable mass, and abdominal pain. Metastases were present in 76.9% of patients, and stage four was associated with aggressive metastatic dissemination. A multimodal approach was used in treatment. The median time from symptom onset to primary care physician consultation was 12 days, and the median time from physician consultation to diagnosis was 14 days. Relapse occurred in 46.2% of cases, most frequently in patients with stage four disease. Atotal of7 patients (46.2%) survived. Conclusion: Advanced-stage disease at diagnosis, metastatic burden, and unfavorable outcomes, are dominating factors in our single-center experience. When compared with larger published cohorts, our findings align with global patterns. Due to inherent sample size limitations, these observations are hypothesis-generating and the need for larger, multicenter studies remains.
Alport syndrome (AS) is a hereditary nephropathy caused by pathogenic variants in COL4A3, COL4A4, or COL4A5, leading to type IV collagen defects and progressive glomerular basement membrane dysfunction. Kidney transplantation provides excellent long-term outcomes; however, donor eligibility, genotype-specific prognosis, and post-transplant complications continue to raise important clinical considerations in the era of precision medicine. We present a comparative case series of three genetically confirmed patients with AS who underwent kidney transplantation: Two with X-linked disease and one with autosomal-dominant inheritance. Genetic, clinical, and immunologic findings were analyzed and contextualized within current literature and recommendations. All patients initially achieved functioning grafts.The autosomal-dominant case demonstrated stable long-term function under cyclosporinebased immunosuppression. Among the X-linked cases, one experienced coronavirus diease-2019-associated arterial thrombosis requiring graft nephrectomy and subsequently underwent successful deceased-donor transplantation one year later; the other developed late antibody-mediated rejection six years post-transplant, with partial recovery following corticosteroid therapy. Kidney transplantation is an effective treatment for AS when guided by molecular confirmation and careful donor evaluation. In this national case series of three patients, outcomes were generally favorable across inheritance types; however, vascular events and late humoral immune complications affected the long-term course of the graft and underscored the need for individualized surveillance.
Objective: Breast cancer is the most common type of cancer in women. Identifying women at risk of breast cancer and ensuring their participation in cancer screening programs have been shown to reduce mortality rates. Therefore, it is important to identify the determinants of attitudes toward breast cancer screening, among which anxiety may play a significant role. This study aimed to explore the screening attitudes and anxiety levels of women with breast cancer and those of their female first-degree relatives within a patient-relative dyadic framework. Material and Methods: Breast cancer patients and their female first-degree relatives between the ages of 18-65 were included in this cross-sectional study as a patient-relative dyad. The patients were administered a socio-demographic questionnaire, the breast cancer worry scale, and the attitude towards cancer screening scale. Results: A total of 37 dyads participated in the study. The median age of the entire cohort was 47. Screening participation was reported in 37.1% (13/35) of patients pre-diagnosis and in 29.1% (7/24) of eligible relatives. A negative correlation was found between patients'anxiety and their relatives'screening attitudes (r=-0.395, p=0.016 Spearman's correlation), whereas a positive correlation was found between patients'attitudes and their relatives'attitudes (r=0.501, p=0.002 Spearman's correlation). Conclusion: Higher levels of anxiety in breast cancer patients were associated with less favorable screening attitudes among their relatives, whereas screening attitudes were positively correlated within patient-relative dyads. These findings suggest that anxiety and screening attitudes may cluster within patient-relative dyads. Further research is required to determine the clinical implications.
Objective:Colorectal cancer (CRC) screening uptake in Türkiye remains suboptimal, despite the presence of a national screening program. Understanding whether barriers arise primarily from patient-related factors or system-level constraints is essential for effective policy planning. This study aimed to evaluate barriers to CRC screening across the screening pathway using patient, procedural, and provider perspectives. Material and Methods:A descriptive cross-sectional study was conducted between January and June 2025 at a tertiary training and research hospital. Three distinct groups were surveyed: 100 screening-naïve outpatients aged 50-70 years, 100 patients undergoing diagnostic or screening colonoscopy, and 50 general surgeons performing or referring for colonoscopy. Study-specific questionnaires, pilot-tested for clarity but not formally validated, were used to assess screening awareness, attitudes, perceived barriers, and strategies for improvement. The data were analyzed descriptively. Results:Among screening-naïve outpatients, 54% had no prior awareness of CRC screening, and only 28% had received a physician recommendation for screening. Fear of a serious diagnosis (45%) and pain or discomfort (40%) were commonly reported concerns; however, most respondents indicated that these would not deter screening. Among patients undergoing colonoscopy, 77% underwent the procedure for symptoms rather than preventive screening, while post-procedure satisfaction was high. Surgeons predominantly identified system-level barriers, particularly long waiting times (90%) and an insufficient number of trained endoscopists (92%), as major limitations in effective screening delivery. Conclusion:The primary perceived barrier to CRC screening in Türkiye appears to be limited system capacity rather than patient reluctance. Improving screening uptake will likely require coordinated public awareness efforts, structured national reminder systems, and expansion of the number of adequately trained endoscopists, alongside endoscopy infrastructure.
Objective:To examine the effects of virtual reality glasses and stress-ball use on pain, vital signs, anxiety, fear, satisfaction, and comfort during dressing changes in patients undergoing abdominal surgery. Material and Methods:This research is a randomized experimental study with pretest-posttest control group design. The study was conducted from 8 August to 20 November 2024 in general surgery unit 1 of a city hospital in the Mediterranean Region of Türkiye. A total of 156 patients who underwent abdominal surgery and met the sampling criteria were included in the study: 52 in the virtual reality group, 52 in the stress ball group, and 52 in the control group. Data were collected using the socio-demographic and clinical characteristics form, state-trait anxiety inventory, and visual analog scale. Results:Patients who were given virtual reality glasses and a stress ball during dressing changes reported higher levels of comfort and relaxation than those in the control group. Fear levels during dressing changes were also higher in the virtual reality group than in the other groups. Anxiety levels were lower in the intervention groups (virtual reality and stress ball) compared to the control group. No statistically significant differences were found among the groups with respect to pain, vital signs, or satisfaction. Conclusion:The use of virtual reality glasses and stress balls during dressing changes in patients appears to be effective in enhancing comfort and reducing anxiety.
Objective:To describe the clinical, radiological, and surgical characteristics of primary hydatid cysts arising in uncommon anatomical locations other than the liver and lungs. Material and Methods:This single-center retrospective observational study included 523 patients who underwent surgical treatment for hydatid disease at Servergazi State Hospital, Denizli, Türkiye, between January 2009 and June 2024. Patients with hepatic or pulmonary involvement, a history of previous hydatid surgery, or multi-organ disease were excluded. Demographic characteristics, clinical presentations, cyst localizations, diagnostic modalities, and treatment approaches were systematically recorded. Diagnostic evaluation was based on serological assays and imaging techniques, including ultrasonography, computed tomography, and magnetic resonance imaging. Results:Of the 523 patients evaluated, 29 (5.5%) were identified as having primary hydatid cysts in atypical anatomical locations. The spleen was the most frequently involved site, followed by musculoskeletal structures, the central nervous system, and various soft tissue localizations. Serological tests were positive in 82.7% of cases. All patients underwent surgical management tailored to cyst location, and postoperative albendazole therapy was administered. Postoperative complications were limited, and no procedure-related mortality was observed. Conclusion:Primary hydatid cysts may present in a wide spectrum of uncommon anatomical locations and often manifest with non-specific clinical features. Awareness of these atypical presentations is essential for accurate diagnosis and appropriate surgical management, particularly in endemic regions.
Advances in surgical techniques, together with the widespread use of neoadjuvant and adjuvant therapies, have markedly improved disease-free and overall survival in patients with rectal cancer. Nevertheless, urogenital dysfunction remains a significant source of postoperative morbidity, primarily due to the anatomical location of the rectum and its close relationship with the autonomic pelvic nerves. Although the incidence of urological complications has declined to below 10%, sexual dysfunction continues to affect approximately one-quarter of patients. Nerve-sparing total mesorectal excision, performed without compromising oncological principles, has therefore become a critical component of contemporary rectal cancer surgery. Minimally invasive videoassisted techniques, offering magnified visualization and enhanced precision during pelvic dissection, facilitate the accurate identification and preservation of autonomic nerve structures. However, current evidence indicates that awareness and consistent application of nerve-sparing principles remain suboptimal, even among experienced colorectal surgeons. This video systematically demonstrates the key anatomical landmarks and stepwise surgical maneuvers required for effective nerve preservation during total mesorectal excision, aiming to reduce urogenital functional morbidity.
Objective: Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy and is associated with increased maternal morbidity and risk of preterm delivery. Diagnostic difficulty rises with advancing gestation, contributing to delayed diagnosis and higher negative appendectomy rates. This retrospective study compared surgical outcomes between laparoscopic and open appendectomy in pregnant patients and assessed trimester-specific trends. Material and Methods: This retrospective single-center cohort study included pregnant patients who underwent appendectomy between June 2020 and December 2023. The final cohort of 50 cases met the inclusion criteria. Primary outcomes were maternal postoperative complications and preterm birth; secondary outcomes included operative time and length of stay (LOS). Continuous variables were non-normally distributed and are summarized as median (range). Group comparisons were performed using the Mann-Whitney U and Fisher's exact tests. Results: Appendectomies were performed during the first (26%), second (60%), and third trimesters (14%). Laparoscopic appendectomy accounted for 48% of cases. Operative time was significantly shorter in the laparoscopic group compared with the open approach (47 vs. 58 minutes, p=0.044). No significant differences were observed in postoperative complications, LOS, or preterm birth.The overall negative appendectomy rate was 8%, increasing to 28.6% in the third trimester, consistent with greater diagnostic difficulty in late gestation. Conclusion: Laparoscopic appendectomy is a safe and feasible option during pregnancy, providing comparable maternal and obstetric outcomes to open surgery while offering shorter operative times. Larger prospective studies are needed to clarify trimester-specific management, particularly in late gestation.
Objective:Severe chronic degenerative mitral regurgitation (MR) is characterised by altered hemodynamics and high-shear stress, which initiate left ventricular (LV) remodelling, including upregulation of various cytokines. We evaluated endothelial activation during surgical correction of chronic MR by assessing adhesion molecules ICAM-1 and VCAM-1, classic markers of inflammation, and their association with postsurgical LV dysfunction (LVD). Material and Methods:The study included asymptomatic patients with grade 3-4 degenerative MR. Transthoracic echocardiography data and blood samples were collected before and five days after surgical correction of MR. Circulating levels of adhesion molecules were measured by ELISA. Results:Ejection fraction, end-diastolic diameter (EDD), and volume all decreased significantly after surgery. A significant decline in ICAM-1 concentration was observed between the two periods (457.11±256.12 vs. 240.29±157.14 ng/mL; p=0.031), whereas VCAM-1 levels did not change significantly. Leukocyte count and C-reactive protein were significantly higher in the postoperative period. Early postoperative LVD (in 35.7% of patients) was not correlated with adhesion molecule levels. However, we observed significant changes in ICAM-1 levels associated with postoperative EDD >5.6 cm, which indicates LV dilatation. These patients had markedly lower preoperative and postoperative ICAM-1 values than others. Conclusion:Serum ICAM-1 levels significantly decline following surgical correction of MR and are associated with postoperative enlargement of the LV. Our study highlights dynamic changes in endothelial activity and underscores the need for a better understanding of this process in MR.
Objective:Ultrasound-guided core needle biopsy (CNB) is essential for diagnosing liver tumors not amenable to resection, but the outcomes of resident-performed CNB are poorly defined. We evaluated the diagnostic performance and safety of liver CNB performed by a single ultrasound-certified general surgery resident under specialist supervision. Material and Methods:In this retrospective single-center case series, 65 consecutive patients underwent ultrasound-guided liver CNB between July 2022 and January 2025. All procedures constituted the resident's entire initial experience with liver CNB. Diagnostic success was defined as obtaining sufficient tissue for definitive histopathological diagnosis. Predictors of diagnostic success were assessed using univariate analyses and logistic regression. Learning-curve effects were evaluated by comparing early and late tertiles of chronologically ordered cases and by modelling case number as a continuous predictor. The impact of lesion size was examined by subgroup analysis comparing <4 cm and ≥4 cm lesions and by treating the maximal lesion diameter as a continuous variable. Results:Adequate tissue was obtained in 58/65 biopsies (89.2%), with malignancy confirmed in 49 patients (75.4%) and benign lesions in 9 patients (13.8%). Diagnostic success was 85.7% in the early tertile and 95.5% in the late tertile (p=0.345). Logistic regression showed a non-significant trend toward a higher diagnostic yield over time. Neither lesion size (categorized as <4 cm versus ≥4 cm) nor maximal diameter (analyzed as a continuous variable) was significantly associated with diagnostic success. No immediate or clinically overt delayed complications were observed during 24 hours of in-hospital monitoring. Conclusion:This preliminary single-operator experience suggests that, under close supervision, an appropriately trained general surgery resident can perform ultrasound-guided liver CNB with a high diagnostic yield and a low observed complication rate. These hypothesis-generating findings support further multi-operator and comparative studies of resident-performed liver CNB.
Objective:Achieving complete total mesorectal excision (TME) is considered an important indicator of surgical quality in rectal cancer surgery. However, the impact of TME quality on overall survival (OS) remains controversial. This study aimed to evaluate the association between TME quality and OS in patients undergoing rectal cancer surgery. Material and Methods:A retrospective analysis was conducted on 171 patients who underwent elective low anterior resection or abdominoperineal resection for rectal cancer between 2021 and 2022. OS was compared between patients with incomplete TME and those with near-complete or complete TME. In addition, clinical and pathological factors associated with TME quality were assessed. Results:Incomplete TME was independently associated with worse OS [hazard ratio (HR)=2.53, 95% confidence interval (CI) 1.15-5.59, p=0.021], while undergoing a Hartmann procedure showed the strongest negative impact on OS (HR=4.60, 95% CI 2.04-10.38, p<0.001). At 36 months, OS was 86.3% in the near-complete/complete TME group versus 68.3% in the incomplete group (log-rank p=0.008). Factors associated with incomplete TME included lower preoperative albumin levels, larger tumor size, previous abdominal surgery, tumors located closer to the anal verge, lymphovascular invasion, and positive circumferential resection margins. Conclusion:Incomplete TME was associated with significantly worse OS in patients undergoing rectal cancer surgery. These findings highlight the importance of achieving optimal TME quality. Larger prospective studies are warranted to validate these results.
Objective:Distinguishing mild (Hinchey 1a/1b/2) from severe (Hinchey 3/4) diverticulitis is critical for appropriate management. This study evaluated the predictive value of inflammatory biomarkers and imaging features for early risk stratification. Material and Methods:We conducted a retrospective analysis of patients with acute diverticulitis between 2017 and 2024 at the hospital's general surgery department. Receiver operating characteristic analysis was used to determine optimal cut-off values for C-reactive protein (CRP) and procalcitonin, while computed tomography (CT) findings were assessed for their discriminative capacity. Results:A total of 72 patients were included in the study. There were 59 patients in the mild diverticulitis group and 13 patients in the severe diverticulitis group. Patient demographics were similar between the groups. Procalcitonin demonstrated superior predictive performance [area under the curve (AUC) 0.795] compared to CRP (AUC 0.755). The cut-off values for procalcitonin and CRP were 0.095 and 104.5, respectively. Specific CT patterns showed high specificity for severe disease. The combination of biomarkers and imaging criteria significantly improved diagnostic accuracy, with pelvic abscess localization emerging as a key indicator of severity. Conclusion:A biomarker-guided approach incorporating procalcitonin and targeted CT evaluation enables reliable early identification of severe diverticulitis. This strategy may enhance clinical decision-making regarding antibiotic selection and surgical consultation while reducing unnecessary interventions in mild cases.
Minimally invasive right hemicolectomy for colon cancer has demonstrated better outcomes than those of open surgery. However, in certain patients, high body mass index, abdominal adhesions, and concomitant cardiopulmonary disease may limit the use of conventional laparoscopy. The use of the retroperitoneal approach preserves the benefits of the minimally invasive approach and expands the range of surgical options. All major steps were performed without access to the abdominal cavity: mobilization, D3 lymph node dissection and vessels ligation. Supplementary video demonstrates a retroperitoneal approach for right hemicolectomy with D3 lymph node dissection that can solve these challenges.
