Objective:Trauma remains a leading cause of death and disability worldwide, with hemorrhage and traumatic brain injury being major contributors. The reverse shock index (SI) multiplied by Glasgow Coma scale (rSIG) is a novel scoring tool with potential for early identification of high-risk trauma patients. This study, the largest and first of its kind in India, aimed to assess the predictive value of rSIG for in-hospital mortality and early transfusion requirements in trauma patients. Material and Methods:This was a prospective, hospital-based study conducted at Government Medical College, Kozhikode, Kerala, from December 2022 to December 2023. A total of 536 trauma patients admitted under the department of general surgery were enrolled. Data on demographics, mechanism of injury, vital signs, GCS score, transfusion requirements, and outcomes were collected. rSIG, SI, and revised trauma score (RTS) were calculated. Receiver operating characteristic analysis was used to assess predictive performance. Results:A total of 536 trauma patients were analyzed (mean age 44.49±15.81 years; 80% males), with road traffic accidents (RTAs) accounting for 68% of cases. RTAs were significantly linked to head and multisystem injuries and contributed to 94% of deaths. Overall mortality was 11.9% (64 patients), exclusively among those with head injury. RTS showed marginally better mortality prediction than rSIG [area under the curve (AUC) 96% vs. 92%; p<0.001], while rSIG best predicted early transfusion need (AUC 91.8%; p<0.01). Conclusion:This study demonstrates that RTAs are the predominant cause of trauma, with head injury as the principal determinant of mortality. While rSIG effectively predicted early transfusion requirements, RTS showed slightly higher accuracy than rSIG in predicting mortality. rSIG remains a practical and reliable triage tool in resource-limited settings.
Objective:Mesh-based inguinal hernia repair has reduced recurrence rates; however, long-term postoperative symptoms remain clinically relevant. The Carolinas comfort scale (CCS) is a disease-specific tool developed to assess these outcomes. This study aimed to validate the Turkish version of the CCS and evaluate long-term quality of life. Material and Methods:The CCS was translated and culturally adapted using standardized procedures. A retrospective cohort of patients who underwent elective inguinal hernia repair with mesh between 2018 and 2020 was analyzed. Reliability, validity, and factor structure were evaluated using established statistical methods. Results:A total of 85 patients were included, with a median follow-up of 79 months. The Turkish CCS demonstrated excellent internal consistency (Cronbach's α=0.952), strong convergent validity with VAS (ρ=0.952, p<0.001), and significant discriminative validity for chronic pain (p<0.001). The recurrence and chronic pain rates were 10.6% and 35.3%, respectively. Conclusion:The Turkish version of the CCS is a valid and reliable instrument for assessing long-term outcomes after mesh-based inguinal hernia repair and can be used in both clinical practice and research.
Obesity is a major risk factor for cancer. While bariatric surgery reduces obesity-related risks, it may introduce challenges in surgical oncology. We report a case of esophageal carcinoma in a patient with a history of laparoscopic sleeve gastrectomy (LSG), successfully managed with a completely laparoscopic-thoracoscopic Ivor-Lewis esophagectomy using the remnant stomach for reconstruction. Despite LSG-related vascular alterations, collateral circulation appeared sufficient to support conduit perfusion, suggesting that this approach is feasible in selected patients.
Objective:Anastomotic leakage remains a major complication following colorectal surgery. This study aimed to evaluate the association between the preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score and postoperative anastomotic leakage in patients undergoing colorectal cancer resection. Material and Methods:This single-center retrospective cohort study included 505 patients who underwent colorectal resection with primary anastomosis for stage II-III colorectal cancer. The association between preoperative HALP score and anastomotic leakage was evaluated using univariable analyses and receiver operating characteristic (ROC) analysis. A multivariable logistic regression model adjusted for age and tumor location was fitted, and Firth's penalized likelihood estimation was used for the adjusted analysis because of the limited number of events. The study is reported in accordance with the strengthening the reporting of observational studies in epidemiology statement. Results:Anastomotic leakage occurred in 18 patients (3.6%). Patients who developed leakage had significantly lower preoperative HALP scores than those without leakage [median 18.0 (10.8-33.3) vs. 34.5 (16.6-90.4); p<0.001]. ROC analysis demonstrated good discriminative ability (area under the curve =0.877; 95% confidence interval, 0.802-0.951; p<0.001). The Youden-derived cut-off value of 22.1 yielded a sensitivity of 72.2% and a specificity of 85.0%. In the Firth penalized multivariable logistic regression model, a higher HALP score remained independently associated with lower odds of anastomotic leakage after adjustment for age and tumor location (adjusted odds ratio, 0.83 per 1-unit increase; 95% confidence interval, 0.76-0.91; p<0.001). Given the limited number of leakage events, these findings should be interpreted as exploratory. Conclusion:Lower preoperative HALP scores were associated with postoperative anastomotic leakage. Because of the retrospective study design, these findings should be interpreted as exploratory and require confirmation in larger prospective multicenter studies.
Objective:Point-of-care ultrasonography is rapidly becoming a key tool in many medical fields. Although its value in surgical practice is well established, adoption among general surgeons in Türkiye still seems quite limited. Material and Methods:We conducted a nationwide cross-sectional survey of practicing general surgeons and surgery residents in Türkiye. The questionnaire covered participants' background, ultrasound training history, current usage patterns, and views on future training. Results:A total of 147 surgeons responded (44 residents, 77 specialists, and 26 academic faculty). Only 10.2% had received structured ultrasound training during residency, whereas 21.8% had attended a postgraduate course. More than three-quarters (75.5%) described their competence in ultrasound-guided procedures as low or non-existent. Self-reported competency was significantly higher among specialists and faculty than residents (p<0.001). Multivariable analysis showed that attending a postgraduate ultrasound course [adjusted odds ratio (aOR) 12.92, 95% confidence interval (CI) 4.66-35.83] and having access to a dedicated ultrasound device (aOR 4.39, 95% CI 1.36-14.16) were the strongest predictors of greater competency. Notably, more than 93% of participants reported a willingness to pay for ultrasound training courses. Our results highlight a significant gap between available training opportunities and what surgeons need. Although competency improves somewhat with experience and formal training, it remains low across all career stages. Conclusion:There is an urgent need to integrate structured, hands-on ultrasonography training into general surgery residency programs in Türkiye and to expand accessible postgraduate options.
Objective:Electrical burns are associated with deep tissue damage and a high risk of limb loss. Early identification of patients at risk for amputation remains challenging, as traditional predictors such as voltage level and total body surface area (TBSA) may not adequately reflect tissue injury. This study aimed to evaluate clinical, laboratory, and treatment-related factors associated with amputation in adult patients with electrical burns, with a focus on biomarker-based risk prediction. Material and Methods:This single-center retrospective cohort study included adult patients hospitalized for electrical burns between February 2019 and October 2025. Patients with incomplete records or hospital stays <7 days were excluded. Demographic data, burn characteristics, electrocardiographic findings, surgical interventions, and laboratory parameters at admission and day 7 were recorded. Univariate and multivariate logistic regression analyses were performed to identify factors associated with amputation. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis. Results:A total of 83 patients were included (91.6% male; median age 32 years), with 75.9% exposed to high voltage. Amputation was required in 22.9%, and mortality was 2.4%. Compared with patients who did not undergo amputation, those requiring amputation had significantly higher admission levels of creatine kinase (CK), CK-MB, aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), C-reactive protein, neutrophils, and neutrophil/lymphocyte ratio, whereas albumin, lymphocyte count, and HALP score were significantly lower. No significant differences were observed between the amputation and non-amputation groups with respect to voltage level or TBSA. In multivariable analysis, none of the evaluated variables remained independently associated with amputation; however, LDH (odds ratio=1.001, p=0.074) and HALP score (odds ratio=0.683, p=0.056) showed borderline associations. ROC analysis showed good performance for HALP, ALT, and LDH (area under the curve: 0.76-0.77). Conclusion:Amputation risk in electrical burns is more closely related to biomarkers of muscle injury and inflammation than to voltage or TBSA. Although no independent predictors were identified in multivariable analysis, admission LDH and HALP score showed borderline associations with amputation risk, and several laboratory biomarkers demonstrated meaningful discriminatory performance. Early laboratory assessment may therefore contribute to risk stratification and support limb-preserving strategies. Prospective multicenter studies are needed for validation.
Objective:To evaluate the clinical impact of orally administered iohexol on the restoration of bowel passage and surgical outcomes in patients with adhesive small bowel obstruction. Material and Methods:This retrospective study included 120 adult patients diagnosed with adhesive small bowel obstruction between August 2021 and January 2024. Patients were categorized according to the treatment strategy used in routine clinical practice: Conservative management with oral iohexol or standard conservative management alone. Demographic data, laboratory parameters, time to restoration of bowel passage, length of hospital stay, need for surgery, readmission, recurrence, morbidity, and mortality were analyzed and compared between groups. Restoration of bowel passage was defined by both radiological and clinical criteria and was assessed using abdominal radiographs obtained at 24-hour intervals and clinical improvement. Results:Bowel passage was successfully restored with conservative treatment in 109 patients (90.8%), while 11 patients (9.2%) required surgical intervention. No statistically significant difference was observed between the groups regarding surgical requirement (p=0.755). However, patients who received oral iohexol achieved bowel passage significantly earlier than those managed without contrast [median 1 day [interquartile range (IQR) 1-2] vs. 4 days (IQR 3-5); p<0.001]. The corresponding mean times to bowel passage were 1.35 and 4.10 days, respectively. Mortality occurred only in surgically treated patients. Conclusion:Oral iohexol appears to be a safe adjunct to conservative management in patients with adhesive small bowel obstruction and is associated with earlier restoration of bowel passage. Failure of bowel passage to resolve in the early period remains an important indicator for operative management. Although no statistically significant difference in surgical requirement was observed in this cohort, larger prospective randomized controlled studies are needed to further clarify the impact of oral iohexol on clinical outcomes in adhesive small bowel obstruction.
Objective:This study aims to retrospectively examine the relationship between graft bile duct number (single or multiple) and biliary anastomosis technique (duct-to-duct or Roux-en-Y hepaticojejunostomy) with postoperative morbidity and mortality in living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) patients. Material and Methods:A retrospective cohort study was conducted on 244 patients who underwent LDLT and DDLT at Ankara Güven Hospital Liver Transplantation Center between January 2013 and January 2025. Patient data including demographic characteristics, preoperative parameters (MELD score, underlying liver disease), surgical variables (bile duct number, anastomosis type, graft type, operation time), and postoperative outcomes were collected systematically. Bile duct anatomy was classified as single or multiple ducts, and anastomosis techniques were categorized as duct-to-duct or Roux-en-Y. Biliary complications were graded according to the International Liver Transplant Society consensus classification and Clavien-Dindo system. Statistical analyses were performed using SPSS 27.0, employing independent-samples t-tests, Mann-Whitney U tests, and chi-square tests. Results:The mean patient age was 57.8±11.5 years with mean body mass index (BMI) of 27.62±5.67 kg/m². The cohort comprised 70.49% males and 29.51% females. Significant gender distribution differences were observed between groups, with higher male ratio in the duct-to-duct group (75.94%) compared to Roux-en-Y group (63.96%; p=0.041). Diabetes mellitus prevalence was notably higher in the Roux-en-Y group (46.85%) versus duct-to-duct group (34.59%; p=0.052). No significant differences were found in age, BMI, or blood group distribution between anastomosis techniques. Conclusion:Preliminary findings suggest demographic and comorbidity variations between anastomosis technique groups, indicating the need for individualized surgical planning in LDLT and DDLT based on bile duct anatomy and patient characteristics.
Objective:Hypocalcemia (HC) is a common complication after thyroid surgery. This retrospective case-control study aimed to evaluate the efficacy of postoperative betamethasone infusion in reducing the incidence of HC following thyroid surgery, with recurrent laryngeal nerve palsy and other complications as secondary outcomes. Material and Methods:A total of 196 patients who underwent total or completion thyroidectomy were retrospectively analyzed. Patients were divided into groups receiving postoperative betamethasone infusion or no glucocorticoid treatment. Postoperative data on HC incidence (at least one serum calcium measurement below 8.0 mg/dL), symptomatic HC (HC associate with numbness of the extremities, facial paresthesia, muscular spasms, and Chvostek's or Trousseau's signs), pain, recurrent laryngeal nerve palsy, voice dysfunction, sore-throat and dysphagia were collected and analyzed. Additionally, demographic and clinical characteristics were assessed, including preoperative assessments, intraoperative techniques, and postoperative recovery parameters. Results:The study found a significantly lower incidence of HC and symptomatic HC in the betamethasone group compared to the control (32.0% vs. 49.5%, p=0.013; 11.3% vs. 25.3%, p=0.012, respectively). Betamethasone-treated patients also reported lower postoperative pain scores (p=0.002). Conclusion:Betamethasone infusion post-thyroidectomy demonstrated efficacy in reducing HC and symptomatic hypoparathyroidism, with minimal impact on other complications. The findings suggest the potential of glucocorticoids as a therapeutic option in thyroid surgery to enhance postoperative outcomes and patient recovery.
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.
Pilonidal sinus disease (PSD) is one of the most common benign surgical conditions affecting adolescents and young adults worldwide—yet its management remains surprisingly fragmented. Despite increasing scientific activity across Europe and beyond, surgical techniques, outcome definitions, and follow-up standards still vary widely, limiting meaningful comparison and slowing progress. For a condition of such prevalence and socio-economic relevance, this lack of coordination represents a missed opportunity. PiloNERDs International (Pilonidal Network for Expertise, Research and Development) was founded to change this. As a clinician-led global initiative dedicated exclusively to pilonidal disease, PiloNERDs provides a structured platform for harmonised definitions, robust long-term outcome assessment, shared registries, multicentre collaboration, and open methodological exchange. By uniting surgeons and researchers across borders, the network transforms individual expertise into collective scientific strength. This project marks a decisive step from isolated excellence toward coordinated advancement. Through enthusiastic international cooperation, PiloNERDs aims to elevate research quality, accelerate innovation, and establish reproducible standards—ultimately delivering better, evidence-based surgical care for the predominantly young patients entrusted to us.
Thiersch's operation is a kind of suture technique to narrow the patulous anus for the treatment of rectal prolapse. It can be applied under local anaesthesia to elderly patients who can not tolerate major surgery. It also can be used as a temporary treatment untill the definitive treatment is planned. We demonstrated a simple way of the Thiersch operation with a video presentation. We also report the follow-up results of the patients who were operated on with this technique.
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.
