Pilonidal sinus disease (PSD) is common in young adults, yet real-world data integrating quality of life (QoL) with surgical outcomes are limited. We aimed to describe national surgical practice for PSD in Turkey and to compare complications, recurrence, and QoL between excision-based and non-excisional (minimally invasive) procedures. This was a retrospective analysis of a prospectively maintained nationwide database including adults undergoing first surgery for PSD in 41 centers between January 2019 and January 2020. Sociodemographic and clinical data, perioperative variables, complications, and recurrence were recorded. QoL was assessed using the EQ-5D-5L (including EQ-VAS) and pain using a 10-point visual analog scale (VAS) at baseline and at postoperative day 1, day 7, 6 months, and 12 months. Patients were grouped according to surgical approach: simple excision, excision + flap and non-excisional procedures. Data from 1369 patients were analyzed (simple excision, n = 194; excision + flap, n = 983; non-excisional, n = 192). Overall, postoperative bleeding occurred in 12.3

Laparoskopik cerrahiler, minimal invaziv yaklaşımları sayesinde daha az postoperatif ağrı, düşük morbidite ve kısa hastanede kalış süresi ile hızlı iyileşme avantajı sunar. Bu durum, hastaların günlük yaşam aktivitelerine ve spor dahil fiziksel egzersizlere daha erken dönmesini mümkün kılmaktadır. Ancak spora dönüş süreci ile ilgili literatürde heterojenlik söz konusudur. Cerrahların önerilerinin büyük ölçüde kişisel deneyimlere dayandığı ve standart, evrensel protokollerin bulunmadığı görülmektedir. Güncel veriler, erken mobilizasyonun güvenli olduğunu, komplikasyon riskini artırmadığını ve aşırı kısıtlamaların kas güçsüzlüğü, kondisyonda azalma ve psikososyal sorunlara yol açabileceğini göstermektedir. Basit laparoskopik girişimlerde (kolesistektomi, apendektomi) spora dönüş daha erken gerçekleşirken, kolorektal ve obezite cerrahisi gibi büyük operasyonlarda daha temkinli yaklaşım gereklidir. Aktivite türüne göre öneriler de değişmektedir: hafif yürüyüşler ilk günlerden itibaren yapılabilirken, ağırlık kaldırma ve temaslı sporlar için 3–6 haftalık kısıtlamalar gerekebilmektedir. Özetle, laparoskopik cerrahi sonrası spora dönüş bireyselleştirilmiş olmalı, hastanın ağrı düzeyi, cerrahi türü ve risk profili dikkate alınmalıdır. Bu alanda daha güçlü kanıtlara ihtiyaç vardır.

AIM:To evaluate the incidence of catheter-related bloodstream infections and the safety characteristics of chlorhexidine gluconate (CHG)-impregnated transparent dressings compared with standard transparent dressings in patients monitored in the intensive care unit post abdominal surgery. METHODS:A total of 102 patients who had a central venous catheter inserted via the internal jugular or subclavian vein and for whom the catheters were expected to remain in place for ≥48 hours were included in the study. Patients with disrupted skin integrity, known allergies to dressing components, or pre-existing bloodstream infections prior to catheterization were excluded. Patients were randomly assigned in a 1:1 ratio to either the CHG-impregnated transparent polyurethane dressing group (n=51) or the standard transparent dressing group (n=51). According to the protocol, dressings were replaced every seven days in the CHG group and every 2-3 days in the standard group, or as clinically necessary. The primary discontinuation was defined as the development of catheter-related bloodstream infections. Categorical variables were analyzed using the chi-square/Fisher test, while independent risk factors were evaluated using logistic regression (p<0.05). RESULTS:The groups were similar in terms of age, gender, catheterization duration, and intensive care duration. The catheter-related bloodstream infection rate was 5.9% (3/51) in the CHG group and 25.5% (13/51) in the standard group, and the difference was statistically significant (p=0.014); the absolute risk reduction was 19.6%. Multivariate analysis demonstrated that standard dressing use was an independent and strong risk factor for catheter-related bloodstream infection (OR: 21.2; 95% CI: 2.5-177.1; p=0.005). Each additional day of catheterization increased the risk of infection (OR: 1.2 (1.1-1.3); p=0.002 ), and female gender showed an independent association (OR: 8.1 (1.5-44.6); p=0.016). Skin reactions were found in 5.9% (3/51) of the CHG group and 27.5% (14/51) of the standard dressing group, with a significant difference between the groups (p=0.037). Reaction severity was found to be significantly lower in the CHG group (p=0.045). Major complications and dressing intolerance were observed only in the standard dressing group (3.9%), while no such complications were observed in the CHG group (p=0.010). CONCLUSION:The routine inclusion of CHG-impregnated transparent dressings in central venous catheter care protocols in intensive care units is considered a powerful strategy that can contribute to reducing the incidence of catheter-related bloodstream infections, improving patient safety, and managing care processes more effectively.

Background Low Anterior Resection Syndrome (LARS) is a major determinant of long-term anorectal dysfunction after sphincter-preserving rectal cancer surgery. The mechanical properties of the anastomosis—including its configuration and circular stapler diameter—may influence neorectal compliance, sensory function, and postoperative evacuation dynamics. This study aimed to define the independent contributions of anastomotic configuration and stapler diameter to LARS development. Methods A retrospective cohort of 446 patients who underwent total mesorectal excision (TME) and low anterior resection between 2015 and 2023 was reviewed. A total of 309 patients who had at least 18 months of functional follow-up and validated LARS assessment were included. All anastomoses were created using double-row circular staplers, in either end-to-end or side-to-end configuration. Stapler diameter (28–29 mm vs 31–33 mm), anastomotic level, neoadjuvant treatment protocol, tumour morphology, and total dissected lymph node count were recorded systematically. Functional outcomes were assessed with the validated LARS score. Independent predictors of LARS were identified using backward stepwise multivariable logistic regression. Results The overall LARS incidence was 28.5%. In the end-to-end subgroup, age (OR 1.096) and metastatic lymph node count (OR 1.221) were independent predictors of LARS. In the side-to-end subgroup, a larger stapler diameter (31–33 mm) markedly increased LARS risk (OR 6.910), while age remained an independent determinant (OR 1.055). In the full cohort, advanced age (OR 1.063), long-course neoadjuvant radiotherapy (OR 2.248), and larger stapler diameter (OR 2.395) were independently associated with LARS. Conclusion Anastomotic configuration was not independently associated with postoperative LARS development, whereas larger stapler diameter was significantly and independently associated with an increased risk of LARS, particularly in side-to-end anastomoses. Advanced age and long-course neoadjuvant radiotherapy were also consistently associated with impaired long-term functional recovery. These findings underscore the importance of meticulous intraoperative stapler selection and individualised surgical planning, as technical decisions may have measurable long-term effects on anorectal function.

Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. This study aimed to evaluate the potential biomarker effect of ABO blood group and Rhesus factor in PTC. In this retrospective study, data from patients who underwent thyroid surgery at our center were analyzed. Patients operated for benign thyroid disease (Group I, n = 955) and those operated for PTC (Group II, n = 656) were included. Demographic data, histopathological characteristics of thyroid nodules, ABO blood group, and Rhesus factor were evaluated, and statistical analyses were performed. No significant difference was found in ABO blood group distribution between Group I and Group II (p = 0.340). Similarly, Rhesus factor showed no statistically significant association with PTC (p = 0.579). The nodule diameter was significantly smaller in the malignant group (p < 0.001). Preoperative Free T3, TSH, and thyroglobulin levels differed significantly between the two groups (p < 0.001). No statistically significant relationship was observed between ABO blood groups and histopathological characteristics, including extrathyroidal extension, lymphatic invasion, vascular invasion, and capsular invasion. ABO blood group and Rhesus factor do not appear to be independent biomarkers in papillary thyroid cancer. Our study presents findings that do not support a relationship between ABO blood group, Rhesus factor, and PTC. However, further studies with larger patient cohorts are needed to reach more definitive conclusions.

Objective:This study aimed to investigate the anti-inflammatory and antioxidant effects of ozone on liver and kidney tissues as an adjuvant therapy in the treatment of sepsis in individuals with diabetes. Materials and Methods:46 Swiss Albino mice were divided into six groups: control (C), diabetes (D), diabetes + ozone (DO), diabetes + cecal perforation (DCP), diabetes + cecal perforation + ozone (DCPO), and diabetes + ozone + cecal perforation (DOCP). The diabetes groups received 125 mg/kg intraperitoneal (i.p). Streptozotocin (STZ). The DCPO and DOCP groups received 1 mL (20 µg mL- 1 i.p.) ozone. Liver and kidney tissues were collected 24 hours later. Tissue samples were stored under appropriate conditions for histopathological and biochemical analyses. Results:Histopathological analysis of liver and kidney tissue revealed that all acute inflammatory markers were more pronounced in the DCP group compared to the C, D, and DO groups. Acute inflammatory markers were lower in the ozone-treated groups compared to the DCP group. In the diabetes and sepsis groups, malondialdehyde (MDA) levels increased in both liver and kidney tissues, while catalase (CAT) activity decreased. MDA levels were lower in the ozone-treated groups, and CAT activity was higher than in the no-ozonized groups. Blood urea nitrogen (BUN), creatinine, AST, and ALT levels were significantly higher in the DCP group compared to the C, D, and DO groups. Conversely, these values were lower in the DCPO and DOCP groups compared to the DCP group. Conclusion:Our findings suggest that ozone therapy may alleviate inflammatory and oxidative stress-related damage to the liver and kidneys caused by diabetes and sepsis. Additionally, ozone therapy appears to reduce serum markers of liver and kidney function such as AST, ALT, BUN, and creatinine.

Aim: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis. This study aimed to evaluate the AST/ALT (De Ritis) ratio as a prognostic biomarker in patients undergoing pancreaticoduodenectomy for PDAC. Material and Methods: Clinical and pathological data of 222 PDAC patients who underwent pancreaticoduodenectomy between November 2010 and December 2018 were retrospectively analyzed. The prognostic value of the De Ritis ratio was assessed using ROC curve analysis. Kaplan-Meier and Cox regression models were used to evaluate their impact on disease-free survival (DFS) and overall survival (OS). Results: 123 patients were analyzed (mean age: 63.48 +/- 10.28 years; 43.1% female). The optimal AST/ALT threshold for survival prediction was 0.66. Patients with a higher De Ritis ratio had significantly shorter median DFS and OS (p < 0.025 and p < 0.048, respectively). Multivariate analysis identified advanced age (p < 0.001), absence of chemotherapy (p < 0.001), recurrence (p = 0.003), prolonged hospital stay (p = 0.016), positive surgical margins (p = 0.012), and high metastatic lymph node count (p = 0.006) as independent risk factors for lower OS. Similar factors also predicted shorter DFS. Discussion: The De Ritis ratio may serve as a prognostic factor in operable PDAC patients. If validated, it could be a simple, cost-effective tool for guiding surgical and neoadjuvant therapy decisions.

Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10–25]) than that of preoperative patients (22, range [5–25]), p < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.

Objective: The aim of this study was to evaluate the predictive value of the first postoperative day (POD1) drain fluid amylase in predicting pancreatic fistula formation following pancreaticoduodenectomy (PD). Material and Methods: One-hundred and eighty-five prospective patients undergoing PD between April 2014 and April 2018 were studied retrospectively. Cut-off point to predict the development of POPF was determined by median values for drain fluid amylase of 1883 U/L. Patients were classified into two groups according to POD1 drain fluid amylase values: <1883 U/L (Group 1) and ≥1883 U/L (Group 2). Differences between the groups with clinically relevant POPF and without POPF were evaluated. Results: The incidence of POPF was 17.2%. POD1 amylase level was the strongest predictor of POPF, with levels of higher than 1883 U/L demonstrating the best accuracy (87.5%), sensitivity (78.1%), specificity (89.5%), positive predictive value (60.9%), and negative predictive value (95.1%). One-hundred and forty-four patients (77.8%) had a POD1 drain amylase level of less than 1883 U/L, and POPF developed in only seven (3.7%) cases, whereas in patients with POD1 drain amylase level of 1883 U/L or higher (n= 41), the POPF rate was 31.4% [OR: 22.24, 95% CI (7.930–62.396), p<0.001]. Conclusion: The cut-off point of POD1 drain fluid amylase level (1883 U/L) might predict the clinically relevant POPF with adequate sensitivity and specificity rates in patients undergoing pancreatic resection.

OBJECTIVE:Rectal cancer is an important cause of mortality and morbidity globally. The aim of this study was to investigate whether the log odds of positive nodes system is a better indicator than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis, which is an important cause of mortality and morbidity globally.METHODS:This was a single-center retrospective cross-sectional study. Data were obtained from the medical records of patients with rectum adenocarcinoma followed at Gazi University Hospital. The clinicopathological data of 128 patients with rectum adenocarcinoma who underwent low anterior resection or abdominoperineal resection between January 2010 and December 2018 was retrospectively reviewed. Patients with rectum adenocarcinoma as the first and only primary diagnosis, which was confirmed by histopathological examination, than those who had undergone complete curative resection via low anterior resection or abdominoperineal resection were included. Those with familial adenomatous polyposis or Lynch syndrome, those under 18 years of age, with a synchronous tumor, peritoneal spread, or metastatic disease at the time of diagnosis, and those with <12 lymph nodes dissected from the resection material were excluded from the study.RESULTS:In multivariate analysis, age, perineural invasion, tumor node metastasis stage, lymph node ratio stage, and log odds of positive nodes stage were found to be independent prognostic factors (p<0.05). LODDS2 patients' mortality rates were 9.495 times higher than LODDS0 patients [hazard ratio=9.495, (95%CI 4.155-21.694), p<0.001] while LNR2 stage patients' mortality rates were 7.016 times higher than LNR0 stage patients [hazard ratio=7.016, (95%CI 3.123-15.765), p<0.001] and N2 stage patients had a 5.135 times higher risk of mortality than those who were in N0 stage [hazard ratio=5.135 (95%CI 2.451-10.756), p<0.001].CONCLUSION:Log odds of positive nodes is a more valuable prognostic factor for rectal cancer patients than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis.

Travmaya Metabolik, Endokrin ve İmmün-İnflamatuar Yanıt Aydın YAVUZ Sıvı ve Elektrolit Metabolizması Ramazan KOZAN Asit- Baz Dengesi ve Bozuklukları Saygın ALTINER Şok Hakan SÖZEN Cerrahi Hastada Beslenme Kürşat DİKMEN Cerrahi Alan Enfeksiyonları Kürşat DİKMEN Cerrahi Hastanın Monitörizasyonu Murat AKIN Yara İyileşmesi Çağrı BÜYÜKKASAP Benign Tiroid Hastalıkları, Tiroid Nodüllerine Yaklaşım ve Tiroidektomi Komplikasyonları Hüseyin GÖBÜT Malign Tiroid Hastalıkları Hüseyin GÖBÜT Paratiroid Bezinin Cerrahi Hastalıkları Murat AKIN Meme Kanserı Rölatif Risk Faktörleri Osman KURUKAHVECİOĞLU Memenin Benign Hastalıkları Osman KURUKAHVECİOĞLU Memede Kitleye Yaklaşım Ekmel TEZEL Meme Kanseri Ekmel TEZEL Adrenal Bez Hastalıkları Murat AKIN Karın Duvarı Anatomisi Ziya ANADOL Fıtıklar Ziya ANADOL Karın Travmaları Osman YÜKSEL Akut Karın Sendromu Akif TÜRKOĞLU Akut Apandisit Hasan BOSTANCI Akut Pankreatit Çağrı BÜYÜKKASAP Bağırsak Obstrüksiyonu Hakan SÖZEN Gastrointestinal Kanamalar Aydın YAVUZ Mezenterik Vasküler Hastalıklar Abdülkadir BEDİRLİ Özofagus Tümörleri Aydın YAVUZ Mide Tümörleri Osman YÜKSEL Morbid Obezite Abdülkadir BEDİRLİ Kolorektal Anatomi ve Anorektal Muayene Sezai LEVENTOĞLU Kolorektal Polipler ve Prekanseröz Lezyonlar Sezai LEVENTOĞLU Benign Anorektal Hastalıklar Sezai LEVENTOĞLU Pelvik Taban Hastalıkları Sezai LEVENTOĞLU Kolorektal Tümörler Ahmet KARAMERCAN Karaciğer Tümörleri Mustafa ŞARE Karaciğer Apseleri Akif TÜRKOĞLU Kist Hidatik Hasan BOSTANCI Safra Kesesi ve Safra Yollarının Hastalıkları Aydın DALGIÇ Pankreatik Kistler ve Pankreasın Premalign Lezyonları Mustafa KEREM Pankreas Kanseri ve Periampuller Tümörler Mustafa KEREM Portal Hipertansiyon ve Cerrahi Tedavisi Aydın DALGIÇ Organ Transplantasyonu Aydın DALGIÇ Cerrahide Onkolojik Tedavi İlkeleri Ekmel TEZEL Klinikte Sık Kullanılan Ameliyat ve Girişim Adları Ekmel TEZEL Cerrahi Terimler Kılavuzu Ekmel TEZEL

OBJECTIVE General surgery is a fundamental medical discipline that requires extensive training to develop competent surgeons. This study examines the impact of the number of residents on surgical training quality in a general surgery clinic and evaluates the usability of the Surgery-to-Resident Ratio (SRR) in determining the ideal number of residents. DESIGN Retrospective analysis. SETTING General Surgery Department, Gazi University Faculty of Medicine Hospital, Ankara, Turkey. PARTICIPANTS Data from surgical residents at the General Surgery Department, collected from 2012 to 2023. METHODS The study analyzed the number of surgeries performed and the total number of residents in 3-month periods. The Surgery-Resident Ratio (SRR) was calculated by dividing the total number of surgical procedures by the total number of residents. The educational impact of the SRR was assessed to identify the optimal number of residents. RESULTS In the 48 periods analyzed, the number of residents in our clinic varied between 12 and 26, with an average of 18.69. An increase in the number of residents led to a decrease in the total number of surgical cases per resident, particularly during the COVID-19 pandemic, which caused a significant drop in elective surgeries. Excluding the COVID-19 periods, the SRR decreased significantly with more than 19 residents, suggesting that the ideal number of residents is 18 to maintain training quality. DISCUSSION The study indicates that an optimal number of residents is essential for ensuring adequate case exposure and workload distribution, which are crucial for developing surgical competence. The SRR can serve as a useful guide for clinics in determining the ideal number of residents to maintain high training standards. Our findings suggest that while the number 18 is specific to our clinic, the SRR method can be adapted to other settings to ensure effective surgical education. CONCLUSION The SRR method provides a systematic approach to determining the optimal number of residents in a surgical training program. Ensuring an adequate number of surgeries per resident is vital for their educational development and proficiency in surgical techniques.

Amaç: COVID-19 dünya çapında hızla yayılması ve pandemi haline gelmesi, cerrahi hastalarda postoperatif komplikasyonların insidansında da artışa neden oldu. Acil ameliyata alınan hastalarda COVID-19 pozitifliğinin ameliyat sonrası komplikasyonları etkileyebileceği açıktır. Bu çalışmada acil abdominal cerrahi uygulanan COVID-19 hastalarında postoperatif komplikasyonlar için öngördürücü faktörlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada acil abdominal cerrahi uygulanan ve perioperatif 72 saat içerisinde COVID-19 Polimeraz Zincir Reaksiyonu (PCR) testi pozitif sonuçlanan 52 hasta retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen hastaların medyan yaşı 50.5’di (aralık: 18-83). 30 günlük mortalite oranı %15.4 olarak saptandı. Postoperatif komplikasyon oranı %23.1’di. Postoperatif komplikasyon durumu ile yaş (p=0.003) ve preoperatif hemoglobin değeri (p=0.001) arasında anlamlı bir ilişki saptandı. Yaş ve hemoglobinin birlikte değerlendirilmesinin postoperatif komplikasyonlar için sensivitesinin %91.7, spesifitesinin %87.5 olduğu görüldü (p

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = −350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes.

Laparoscopic inguinal hernia surgery is a common procedure and pain is a common postoperative complication. Guidelines for mesh fixation vary, with no clear rule. Mesh fixation may not be necessary in total extraperitoneal approach (TEP), but more research is needed for transabdominal preperitoneal approach (TAPP). This study was conducted comparing mesh fixation methods using a suture passer and tacker, aiming to reduce pain and operation time. We used the FUÇA method for mesh fixation in TAPP. The patients were divided into two groups: Group I underwent classical tacker method while Group II used the FUÇA method. There were 52 patients in Group I and 51 patients in Group II. Polypropylene mesh was used in both groups. The surgeries were performed by four experienced surgeons. We analyzed retrospective data including age, gender, BMI, surgical approach, procedure duration, defect size, recurrence status, postoperative pain, hernia type, and complications. Pain was assessed using VAS score and McGill pain index. Recurrence was evaluated by a different surgeon. A total of 103 patients were included: 52 in Group I and 51 in Group II. Both groups had a similar median age (47 years in Group I, 45 years in Group II) and predominantly male participants (92.3

Objective: There is a continued need for biomarkers for patients with gastric cancer that can aid in diagnosis, treatment follow-up, and relapse detection. The objective of this study was to investigate the role of serum microRNA (miRNAs) in diagnosing gastric cancer and their relationship with prognostic factors that impact the choice of surgical approach. Methods: We compared the serum miRNA expression levels of 35 patients who underwent gastrectomy and D2 lymph node dissection for gastric adenocarcinoma between 2015-2018 with those of 33 controls. We also evaluated the relationship between serum miRNA expression levels and pathological prognostic factors. Results: The serum levels of miR-17-5p, miR-21-5p, miR-27a-3p, miR146a-5p, miR-148a-3p, and miR-203a-3p were significantly higher in gastric cancer patients. In early gastric cancer patients, serum levels of miR-21-5p, miR-27a-3p, miR-106b-5p, miR-146a-5p, and miR-148a3p levels were significantly higher. Furthermore, serum levels of miR106b-5p and miR-146a-5p were associated with tumor localization [area under the curve (AUC): 0.773, 0.797; p=0.049, 0.036], while serum levels of miR-27a-3p and miR-148a-5p were associated with the T-stage of the tumor (AUC: 0.748, 0.729; p=0.036, 0.049). Conclusion: Serum levels of miR-17-5p, miR-21-5p, miR-27a-3p, and miR-203a-3p were found to be diagnostic biomarkers in gastric cancers. The expression levels of serum miR-106b-5p and miR-146a-5p were found to be related to tumor location, whereas the expression levels of serum miR-27a-3p and miR-148a-5p were found to be related to the T-stage of the tumor. These findings can impact the surgical approach for gastric cancer patients.