Aim: This study aimed to investigate the effect of preoperative thrombocytopenia and other risk factors on the need for emergency surgery due to complications following living donor liver transplantation (LDLT), and to evaluate the impact of emergency surgery on patient survival.Materials and Methods: The data of 270 patients who underwent LDLT for end-stage liver disease between July 2021 and October 2023 were analyzed retrospectively. Patients were divided into two groups: those requiring postoperative emergency surgery and those who did not. Preoperative demographic findings, etiology, comorbidities, Model for End-Stage Liver Disease (MELD) scores, and laboratory parameters (including platelet counts and INR) were compared between the groups.Results: Postoperative emergency surgery was required in 31 (11%) patients. The most common indications were portal vein thrombosis, intra-abdominal bleeding, and hepatic vein thrombosis. The mean preoperative platelet count was significantly lower (p=0.027) and INR was significantly higher (p=0.047) in the emergency surgery group compared to the non-emergency group. A platelet cut-off value of 81,000/mm³ was identified for predicting reoperation. There was no statistically significant difference between the groups regarding comorbidities or decompensation findings. Emergency surgical intervention significantly shortened patient survival (p

Background: Serologic compatibility, particularly ABO and Rh blood group matching, has long been considered a potential determinant of early outcomes in pediatric liver transplantation. Although the liver possesses unique tolerogenic properties that reduce susceptibility to antibody-mediated injury, the clinical significance of ABO and Rh mismatch in children remains insufficiently defined. Existing literature focuses predominantly on ABO incompatibility, while the impact of Rh disparity—despite its frequent occurrence—has never been systematically examined in a pediatric cohort. Objectives: This study aimed to evaluate the influence of ABO and Rh mismatches on early postoperative outcomes, including biliary complications, EBV seroconversion, and CMV infection, in a contemporary pediatric liver transplant population. Methods: A retrospective single-center cohort of 99 pediatric liver transplant recipients between 2022 and 2025 was analyzed. ABO and Rh compatibility were assessed using standard serologic methods. Early postoperative outcomes—biliary complications, CMV infection, EBV seroconversion, early graft dysfunction, vascular events, and acute rejection—were systematically recorded. Comparative analyses were performed between matched and mismatched groups; Rh mismatch was further evaluated through multivariable logistic regression. Results: Major ABO incompatibility was present in only 1 patient (1.0%), while 11 patients (11.1%) had Rh mismatch. Across all primary and secondary outcomes, neither ABO nor Rh mismatch was associated with increased early postoperative morbidity. Biliary complications occurred in 13 patients (13.1%), but none in the ABO-incompatible or Rh-mismatched groups. EBV seroconversion developed in 14 patients (14.1%); rates were similar between Rh-compatible (68.2%) and Rh-mismatched recipients (72.7%; p = 1.00). CMV infection occurred in 5 patients (5.1%), with no significant difference between groups (p = 1.00). All vascular complications and biopsy-proven rejection episodes occurred exclusively in serologically compatible pairs. Multivariable analysis showed no independent association between Rh mismatch and biliary morbidity, EBV seroconversion, or CMV infection. Early graft and patient survival were 100% in both ABO- and Rh-mismatched recipients. Conclusions: In this pediatric cohort, Rh mismatch demonstrated no adverse clinical impact, and the single ABO-incompatible graft did not experience early complications. These findings support the concept that pediatric liver recipients—owing to developmental immunologic tolerance—may be uniquely resilient to serologic disparities. While ABO incompatibility remains too rare for firm conclusions, Rh incompatibility appears clinically inconsequential and should not limit donor availability in pediatric transplantation. Larger multicenter studies are warranted to confirm these observations and refine allocation strategies.

Background: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes-ODS, Wexner incontinence score (WIS), and LARS-in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse-Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme's procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months.

OBJECTIVES:The influence of obesity on postoperative outcomes remains controversial. We evaluated the relationship between preoperative body mass index and perioperative and postoperative outcomes in adult recipients of living donor liver transplant. MATERIALS AND METHODS:We retrospectively studied 225 adult patients who underwent living donor liver transplant between November 2019 and June 2024 and grouped patients by preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) into 4 groups. Demographic data, comorbidities, operative parameters, complication rates, and survival outcomes were analyzed across groups. We used multivariable Cox regression analysis to assess independent predictors of mortality. RESULTS:Although Model for End-Stage Liver Disease scores, operative time, and hospital stay did not differ significantly among groups, higher body mass index was associated with significantly increased early postoperative complications (P = .018). Logistic regression revealed early complications as an independent predictor of mortality (odds ratio of ≈9, P < .001). Overall survival differed significantly across body mass index categories (P = .007), with poorest outcomes in morbidly obese patients (body mass index ≥ 40). Cox regression confirmed that obesity (body mass index 35-39.9) was an independent predictor of reduced long-term survival (hazard ratio = 1.65; 95% CI, 1.01-2.70; P = .045), whereas morbid obesity showed a nonsignificant trend toward higher risk. Diabetes, cardiovascular disease, and low graft-to-recipient body weight ratio were also more common in higher body mass index groups and contributed to increased mortality risk. CONCLUSIONS:Elevated body mass index was associated with increased early postoperative risk, particularly in the obese group, with reduced long-term survival posttransplant. These associations remained significant after adjustment for major clinical covariates. Presence of comorbidities and reduced graft-to-recipient weight ratio further compounded risk. Comprehensive preoperative evaluation and individualized management, including metabolic optimization and prehabilitation, may help improve outcomes in this high-risk population.

Background Advanced age has traditionally been considered a relative contraindication for liver transplantation (LT) owing to increased perioperative risk and comorbid burden. However, recent evidence suggests that appropriately selected elderly patients can achieve comparable outcomes to younger recipients. Objective To evaluate and compare perioperative outcomes, comorbidities, and survival in live donor liver transplantation (LDLT) recipients aged ≥65 years versus <65 years Methods This retrospective observational study analyzed adult LDLT recipients at a high-volume transplant center between November 2019 and June 2024. Patients were divided into 2 groups based on age at transplantation: <65 years (n = 182) and ≥65 years (n = 43). Demographic data, MELD scores, comorbidities, perioperative complications, and survival rates were compared. Cox regression analysis was used to identify independent predictors of mortality. Results The elderly group had significantly lower MELD scores (15.1 vs. 17.2, p = .02) but higher rates of cardiovascular comorbidity (39.5% vs. 26.4%, p = .018). No significant differences were observed in diabetes prevalence, pulmonary disease, length of hospital stay, or early and late complication rates. One-year survival rates were 83.7% for elderly and 88.7% for younger recipients. Although the mortality risk was higher in the elderly group (HR = 2.13, p = .064), the difference was not statistically significant. Conclusion Advanced age alone should not be considered a contraindication for LDLT. With appropriate candidate selection and individualized perioperative management, elderly recipients can achieve favorable outcomes comparable to younger patients.

Background/Objectives: Small intestine and vermiform appendix lengths are critical anatomical parameters with significant implications for bariatric surgery, transplantation, and the management of short bowel syndrome. However, reliable normative data derived from direct in vivo measurements in healthy individuals remain limited. This study aimed to establish reference values in a homogeneous cohort of healthy living liver donors and to investigate the potential anatomical and functional correlation between these two structures based on their shared embryological origin and immunological roles. Methods: Data from 99 healthy living liver donors representing a multi-ethnic population were analyzed. Intraoperative measurements were performed using a standardized surgical technique: small intestine length was measured from the ligament of Treitz to the ileocecal valve, and appendix length from the base to the tip. Relationships between morphometric measurements and anthropometric variables were evaluated. Results: The mean small intestine length was 630 ± 104.7 cm, and the mean appendix length was 84.8 ± 21.1 mm. Small intestine length was significantly greater in males (p = 0.011), while appendix length showed no sex-based difference. A weak but statistically significant positive correlation was found between small intestine length and appendix length (r = 0.237; p = 0.021). Furthermore, an appendix length ≥8 cm was associated with a higher probability of having a small intestine length >600 cm. Notably, the retrocecal appendix position was observed in only 4.0% of donors, a prevalence substantially lower than that reported in appendicitis series, suggesting it may be a risk factor for inflammation. Conclusions: This study provides normative reference values derived from healthy individuals, free from the bias of cadaveric changes or inflammation. The novel finding of a correlation between small intestine and appendix lengths supports the hypothesis of a functional "anatomical continuum" within the gut-associated lymphoid tissue (GALT) system. These data may offer practical guidance for surgical planning in procedures requiring precise bowel length estimation.

BACKGROUND Knowledge of the concordance between portal vein (PV) and bile duct (BD) anatomy is essential for planning living donor liver transplantation (LDLT) and hepatobiliary surgery. Unrecognized variants can result in bile leakage, vascular injury, or graft-related complications; therefore, accurate preoperative mapping is mandatory. Because the PV and BD systems develop in parallel during embryogenesis, an anatomical relationship between them has been proposed, but available data remain limited and inconsistent. This retrospective study of 423 living liver donors aimed to evaluate the association between PV and BD types and to determine whether biliary anatomy can be anticipated from preoperative vascular imaging. MATERIAL AND METHODS Donor grafts were categorized as right or left lobe. Portal vein anatomy was assessed with triphasic CT angiography. Intraoperative cholangiography (IOC) was routinely performed for every donor to define BD anatomy. RESULTS A statistically significant association was found between PV and BD types (P=0.0028). BD variations were more frequent in donors with PV Type 2 and Type 3. Notably, 21% of donors with PV Type 1 had BD Type 3. In right-lobe donors, "classical concordance" (PV1-BD1) was observed in 57.7% (n=222), whereas in left-lobe donors it was 34.2% (n=13). Overall "anatomical concordance" (direct PV-BD type match) was 64.9% in right-lobe and 52.6% in left-lobe donors. CONCLUSIONS PV and BD anatomies are significantly related, supporting the concept of parallel embryological development. However, relevant biliary variants can occur even in donors with normal PV anatomy, particularly in left-lobe grafts. Thus, PV type alone is not sufficient to predict biliary complexity, and IOC together with meticulous preoperative evaluation remains essential in LDLT.

Aim: Perianal condyloma acuminata (CA) is a common sexually transmitted disease caused by human papillomavirus (HPV), characterized by high recurrence rates following monotherapies. While surgical modalities provide rapid clearance, they often fail to eliminate subclinical viral reservoirs in surrounding tissue. This study evaluates the long-term efficacy and recurrence outcomes of a combined therapeutic protocol involving surgical excision followed by delayed adjuvant topical imiquimod. Materials and Methods: In this single-center retrospective cohort study, 31 patients treated for perianal CA between 2014 and 2022 were analyzed. The treatment protocol consisted of surgical excision and electrocauterization of all macroscopic lesions, with wounds left for healing by secondary intention. Delayed adjuvant 5% imiquimod cream was initiated on postoperative day 15 and applied once daily for 16 weeks. Recurrence was assessed at two levels: clinical recurrence (new visible lesions on examination) and virological recurrence (positive HPV DNA detection). Results: Thirty-one patients (24 males, 7 females; mean age 38.5±17.7 years) were included. Lesions were confined to the perianal region in 80.6%. The mean follow-up duration was 29.4 months (range: 12–72 months). All patients completed the protocol without major complications or treatment discontinuation. Among 20 patients (64.5%) with regular clinical follow-up, no clinical recurrence was observed (0/20). Among 10 patients with complete follow-up including HPV DNA screening, virological recurrence was detected in 2 patients (20%). Conclusion: Surgical excision followed by delayed adjuvant imiquimod therapy appears to be a safe and effective strategy for the management of perianal CA, yielding 0% clinical recurrence and 20% virological recurrence over a median follow-up of 22 months. These findings should be confirmed by prospective studies with larger cohorts.

Background and Objectives: Living donor hepatectomy is an essential component of liver transplantation programs, with donor safety representing the foremost priority. This study aimed to evaluate early postoperative complications in living liver donors and to identify clinical and demographic factors associated with complication risk using the Clavien–Dindo classification. Materials and Methods: A retrospective analysis was conducted on 502 consecutive living liver donors who underwent hepatectomy between August 2021 and May 2025. Donors received standardized preoperative evaluation, surgical management, and postoperative follow-up. Demographic characteristics, graft-related variables, remnant liver ratio, and clinical outcomes were recorded. Postoperative complications were graded using the Clavien–Dindo classification, with Grade ≥ IIIa defined as major complications. Univariable and multivariable logistic regression analyses were performed. Results: Postoperative complications occurred in 58 donors (11.6%; 95% CI: 9.0–14.6%), the majority of which were mild to moderate (Grades I and II). Biliary complications were the most frequent cause of morbidity. Major complications (≥Grade IIIa) were observed in 17 donors, while no Grade IV and V complications or mortalities were recorded. Donors with complications had significantly longer hospital stays (p = 0.0002). Although crude complication rates were higher among Turkish donors than foreign donors (13.9% vs. 7.5%, p = 0.043), this association did not remain statistically significant after multivariable adjustment. No independent associations were identified between complication risk and graft type, remnant liver ratio, graft volume, or BMI. Conclusions: Living donor hepatectomy was associated with a low rate of severe early postoperative complications under standardized protocols. However, given the retrospective design and limited structured long-term follow-up, these findings primarily reflect early postoperative safety. Biliary complications remain the most common postoperative issue. Further multicenter prospective studies with extended follow-up are needed to comprehensively assess long-term donor outcomes.

Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approach is universally required, or whether selective ligation guided by intraoperative findings is acceptable in lower-risk recipients, remains unresolved. This single-centre retrospective cohort study included adult recipients who underwent right lobe LDLT without inclusion of the middle hepatic vein at a high-volume transplant centre (approximately 150 adult LDLTs per year) between November 2021 and May 2025. Eligible patients had intraoperatively measured segment 5 and/or segment 8 veins ≥ 5 mm. Venous management was determined intraoperatively and was not randomized: reconstruction was preferred in recipients judged at higher risk of congestion, and all recipients with graft-to-recipient weight ratio (GRWR) < 0.8 were managed in the reconstruction group. The primary endpoints were postoperative day 7 (POD7) international normalized ratio (INR), total bilirubin, and ascites volume. Multivariable adjustment was prespecified for postoperative ascites only, adjusting for ligation status, MELD score, and GRWR. Prespecified sensitivity analysis restricted to GRWR ≥ 0.8 was performed. Partial Olthoff early allograft dysfunction (EAD) and approximate ILTS–iLDLT small-for-size syndrome (SFSS) were assessed as secondary analyses. A total of 170 recipients were included (16 selective ligation; 154 reconstruction). Baseline variables did not differ statistically, but all 20 recipients with GRWR < 0.8 were in the reconstruction group. POD7 outcomes were comparable: INR 1.24 vs. 1.27 (p = 0.80), bilirubin 1.46 vs. 1.70 mg/dL (p = 0.35), ascites 1100 vs. 1250 mL (p = 0.89). In multivariable analysis (n = 91), selective ligation was not independently associated with ascites (β = 0.202; 95

OBJECTIVE:Liver transplantation is currently the most treatment for fulminant hepatitis, end-stage liver failure, hepatocellular carcinoma, and liver-originated metabolic diseases in children. With technological advances, improvements in surgical techniques and immunosuppressive therapy protocols have increased 1-year survival rates to 80%-90%. Our center successfully performs both living donor and cadaveric liver transplants in children. This study retrospectively analyzed the preoperative and postoperative data of 72 pediatric patients who underwent liver transplantation between July 2022 and July 2024. METHODS:We included 72 patients who underwent liver transplantation between July 1, 2022, and July 1, 2024. Cases were evaluated based on demographic data, liver failure etiology, and postoperative complications. RESULTS:Of the cases, 37 were female (58%) and 35 male (42%), with a mean age of 6.6 years (ranging from 5 months to 17 years and 11 months). Indications included biliary atresia (25), autoimmune hepatitis (9), cryptogenic cirrhosis (7), PFIC (7), congenital hepatic fibrosis (1), Caroli disease (2), Wilson's disease (4), Alagille syndrome (3), hepatocellular carcinoma (2), primary hyperoxaluria type 1 (2), Crigler Najjar syndrome type 1 (3), Budd-Chiari syndrome (1), glycogen storage disease type 3 (1), portal vein thrombosis (1), and acute fulminant hepatitis (4). Mean PELD score for patients under 12 years was 18 (range 0-37), and MELD score for patients over 12 years was 19.3 (range 11-40). A total of 69 patients received orthotopic liver transplantation from living donors. Two patients received combined liver and kidney transplants, and 1 received a cadaveric liver transplant. Donors included 40 females and 32 males. Left lobe transplants were performed in 58 patients, and right lobe in 14. Immunosuppression included Tacrolimus + MMF in 70 patients and Cyclosporine in 2. Postoperative complications included biliary anastomosis stenosis (3), bile leakage (2), hepatic vein thrombosis (1), portal vein thrombosis (4), intestinal perforation secondary to Bogota syndrome (5), PRES syndrome due to Tacrolimus toxicity (1), primary graft dysfunction (1), and postoperative bleeding (2). Within the first month, 12 patients (16.6%) died, and 3 (4%) died between 1 month and 1 year postoperatively. The most common early cause of death was sepsis and multiorgan failure. One patient developed chronic rejection but recovered with steroid immunosuppression without the need for re-transplantation. CONCLUSION:Liver transplantation is a high-risk procedure requiring lifelong medication and follow-up. It is, however, the most effective treatment method for several severe pediatric liver conditions.

OBJECTIVE:Despite advancements in surgical techniques, biliary complications remain a significant concern in liver transplantation. This study evaluated the effectiveness of applying a variceal band to the cystic duct stump in preventing bile leakage in patients with a trans-cystic feeding catheter. METHODS:The medical records of 328 liver transplant recipients between April 2022 and June 2024 were retrospectively reviewed. A total of 170 patients with trans-cystic external catheters were included in the study. Of these, 116 patients underwent variceal band application to the cystic duct stump, while 54 did not. The 2 groups were compared regarding demographic characteristics, graft weight, number of bile ducts, presence of bile leakage, and MELD scores. RESULTS:Among the 170 patients who underwent living-donor liver transplantation (LDLT), 58.8% were male, and 41.2% were female. Graft weight was significantly higher in the group with the variceal band application (p < .05). Bile leakage from the cystic duct stump occurred in 2 patients in the group without variceal banding, whereas no bile leakage was observed in the variceal band group. These 2 cases were successfully treated with percutaneous catheter placement under radiologic guidance. CONCLUSION:The variceal band application is an effective and promising method for reducing bile leakage in LDLT patients utilizing a trans-cystic feeding catheter. However, multicenter studies with larger patient cohorts are necessary to more definitively assess the safety and efficacy of this technique.

BACKGROUND:Selecting the appropriate graft for living donor liver transplantation requires accurate calculation of estimated graft volume. PURPOSE:To investigate the error rate in graft volume calculation in the preoperative evaluation of donor liver and the contribution of donor portal vein type to the error margin. MATERIAL AND METHODS:The study included 197 right lobe liver donors. Estimated graft volume calculations based on preoperative radiological images of donors were retrospectively reviewed. Demographic data of the donors and liver portal vein type were recorded. The proportional differences between the weight of the right lobe graft removed during transplantation and the estimated volume were calculated separately according to the portal vein groups. The margin of error in the estimated graft volume measurement and the effect of portal vein type were statistically evaluated. RESULTS:Considering all donors, estimated preoperative volume was calculated to be 6.877% higher than actual graft weight on average. Preoperative estimated graft volume was on average 5.746% higher for Type 1, 8.311% higher for Type 2, and finally 17.883% higher for Type 3 portal vein variant. It was shown that, as the portal vein anatomy in the donor becomes more complex, the negatively proportional difference in preoperative volume estimation increases. CONCLUSION:Volume estimation showed a negative proportional difference for all three variants of the portal vein. Especially, the presence of a Type 3 portal vein in the liver graft may cause more errors in preoperative graft volume calculation.

Background: This systematic review aimed to comprehensively evaluate the clinical, diagnostic, and therapeutic features of synchronous acute cholecystitis (AC) and acute appendicitis (AAP). Methods: The review protocol was prospectively registered in PROSPERO (CRD420251086131) and conducted in accordance with PRISMA 2020 guidelines. A systematic search was performed across PubMed, MEDLINE, Web of Science, Scopus, Google Scholar, and Google databases for studies published from January 1975 to May 2025. Search terms included variations of “synchronous,” “simultaneous,” “concurrent,” and “coexistence” combined with “appendicitis,” “appendectomy,” “cholecystitis,” and “cholecystectomy.” Reference lists of included studies were screened. Studies reporting human cases with sufficient patient-level clinical data were included. Data extraction and quality assessment were performed independently by pairs of reviewers, with discrepancies resolved through consensus. No meta-analysis was conducted due to the descriptive nature of the data. Results: A total of 44 articles were included in this review. Of these, thirty-four were available in full text, one was accessible only as an abstract, and one was a literature review, while eight articles were inaccessible. Clinical data from forty patients, including two from our own cases, were evaluated, with a median age of 41 years. The gender distribution was equal, with a median age of 50 years among male patients and 36 years among female patients. Leukocytosis was observed in 25 of 33 patients with available laboratory data. Among 37 patients with documented diagnostic methods, ultrasonography and computed tomography were the most frequently utilized modalities, followed by physical examination. Twenty-seven patients underwent laparoscopic cholecystectomy and appendectomy. The remaining patients were managed with open surgery or conservative treatment. Postoperative complications occurred in five patients, including sepsis, perforation, leakage, diarrhea, and wound infections. Histopathological analysis revealed AAP in 25 cases and AC in 14. Additional findings included gangrenous inflammation and neoplastic lesions. Conclusions: Synchronous AC and AAP are rare and diagnostically challenging conditions. Early recognition via imaging and clinical evaluation is critical. Laparoscopic management remains the preferred approach. Histopathological examination of surgical specimens is essential for identifying unexpected pathology, thereby guiding appropriate patient management.

Acute liver failure (ALF) caused by hepatic vascular injury during cholecystectomy is a rare but serious indication of liver transplantation (LT). We present a case of acute liver failure secondary to portal vein, hepatic artery, and common bile duct injury during laparoscopic cholecystectomy, requiring a same-day emergency living donor liver transplantation (LDLT). A 57-year-old man underwent elective laparoscopic cholecystectomy at an external facility. During the operation, uncontrolled bleeding from the liver hilum led to conversion to open surgery. Despite attempts to control the bleeding with sutures, the patient developed abnormal liver enzymes postoperatively. A computed tomography scan revealed necrosis of the right liver lobe and hypoplasia of the left lobe, leading to the patient to be transferred to our center. Upon admission, the patient was found to have encephalopathy, coagulopathy, hypotension, and oliguria, with elevated transaminase levels. Based on these findings, an emergency LT was deemed necessary. Due to the unavailability of a cadaveric organ, the patient's daughter was prepared as a living donor. Exploratory laparotomy revealed a necrotic right liver lobe, atrophic left lobe, transection of the right hepatic artery and common bile duct, and a thrombosed right portal vein. The patient successfully underwent LDLT from his daughter within 24 hours. At the seventh-month follow-up, he had no complications. Hepatic vascular injury during laparoscopic cholecystectomy can lead to ALF, which carries a high mortality risk. In such cases, LDLT may be a life-saving strategy. Early referral of a patient with ALF to a transplant center is life-saving.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delays in CRC diagnosis and treatment, and their potential negative effects on surgical outcomes. However, the extent of this impact remains uncertain. Aim: To compare the clinical characteristics, treatment strategies, and outcomes of CRC patients between the Pre-COVID-19 and COVID-19 Era groups, and to identify independent predictors of metastasis and mortality. Methods: This retrospective multicenter study included 397 CRC patients who underwent surgical treatment between 1 July 2018, and 1 August 2021, at three tertiary medical centers. Patients were divided into two groups: Pre-COVID-19 (n = 213) and COVID-19 Era (n = 184). Demographic data, tumor characteristics, surgical approach, postoperative complications, and survival outcomes were analyzed. Logistic regression analysis was conducted to identify independent predictors of metastasis and mortality. Results: The median age was 64 years (95% CI: 63-66), with 59.2% being male. Compared to the Pre-COVID-19 group, patients in the COVID-19 Era had significantly larger tumors (p < 0.001), with a significantly higher total LN retrieved (p = 0.006), more advanced T-stage (p = 0.007), higher N2 lymph node involvement (p = 0.027), and poorer tumor differentiation (p = 0.030). Intestinal perforation was more frequent in the Pre-COVID-19 group (p = 0.042). Multivariate analysis revealed increased odds of mortality associated with the positive LN retrieved (OR: 1.14; p = 0.001), moderate tumor differentiation (OR: 2.99; p = 0.043), poor differentiation (OR: 4.57; p = 0.023), undifferentiated histology (OR: 6.95; p = 0.028), intestinal obstruction (OR: 2.67; p = 0.007), intestinal perforation (OR: 11.76; p < 0.001), and distant metastasis (OR: 2.86; p = 0.008). Regarding metastasis, elevated preoperative CEA (OR: 1.02; p = 0.002), lymph node involvement (OR: 4.87; p = 0.002), and perineural invasion (OR: 2.17; p = 0.033) were independently associated with increased odds of metastasis. Conclusions: Although overall survival did not differ significantly between groups, patients treated during the COVID-19 Era exhibited more advanced histopathological characteristics, including a higher proportion of T4 tumors, increased N2 lymph node involvement, and poorer differentiation grades. Despite no significant differences in postoperative complications between groups, it is noteworthy that preoperative intestinal perforation was less frequent in the COVID-19 Era cohort.

BACKGROUND:Portal vein thrombosis (PVT) is a significant vascular complication in liver transplant candidates, necessitating modifications in surgical techniques and increasing the risk of postoperative complications. This study aimed to evaluate postoperative thrombotic complications, the need for reoperation, survival, and mortality rates after living donor liver transplantation (LDLT) in patients with preoperative PVT. METHODS:Forty-nine patients diagnosed with preoperative PVT undergoing LDLT between July 2021 and August 2024 at our center were retrospectively reviewed. Patients were classified according to the Yerdel classification. Surgical techniques, portal vein reconstruction, associated diseases, MELD/PELD scores, postoperative PVT occurrence, the need for reoperation, and survival data were analyzed. RESULTS:Postoperative PVT developed in 6 patients (12.2%); 3 of these patients (6.1%) required reoperation. Overall, mortality occurred in 13 patients (26.5%); 3 cases were due to non-PVT-related reasons (sepsis following ERCP/PTC or sudden cardiac arrest). The PVT-related mortality rate was 20.4% (10 patients). Mortality was observed in 4 (66.7%) patients with postoperative PVT. Among 8 patients with Yerdel Grade 3-4 PVT, postoperative PVT occurred in 2 patients (25%). Thrombosis occurred in 2 of 6 patients (33.3%) who underwent graft reconstruction; 1 required reoperation. Portal flow was successfully restored in 83.3% of reconstructed cases. Patients developing postoperative PVT had a higher mean MELD/PELD score (22.5 vs. 19.2), an average age of 48.8 years, and equal gender distribution. The mean follow-up period was 14.2 months overall and 7.7 months in patients with postoperative PVT. Comorbidities (diabetes, hypertension, cardiac, or pulmonary pathology) were present in approximately 50% of patients with postoperative PVT and 62% of those who died. The most common preoperative diagnoses were cryptogenic cirrhosis (22.4%), NASH (18.3%), and HBV infection (16.3%). CONCLUSION:Preoperative PVT significantly correlates with postoperative PVT development and mortality following LDLT. Advanced Yerdel stages, high MELD/PELD scores, and the necessity for portal vein reconstruction increase this risk. Early diagnosis, close imaging follow-up, and proper anticoagulation management postoperatively are crucial. Our findings highlight the importance of a multidisciplinary approach in surgical planning and lay the groundwork for prospective, multi-center studies.

BACKGROUND: Symptomatic pleural effusion in patients with decompensated cirrhosis—often termed hepatic hydrothorax—is thought to reflect advanced disease and may carry poor prognosis. However, its impact on outcomes after liver transplantation remains uncertain. METHODS: In this retrospective cohort study, we evaluated all adult patients who underwent their first liver transplantation at a single tertiary centre between 2015 and 2022. Baseline demographics, clinical characteristics and disease severity scores were extracted from institutional databases. The presence of symptomatic pleural effusion requiring therapeutic intervention was determined from imaging reports and clinical records. Multivariable logistic regression was used to assess associations between pleural effusion and mortality at 30 days, 90 days and overall, adjusting for age, sex, Model for End-Stage Liver Disease (MELD) score and ascites. RESULTS: Of 459 transplant candidates, 59 (12.8%) had symptomatic pleural effusion. These patients displayed higher MELD scores and a greater prevalence of ascites compared with those without effusion, though age and sex distributions were similar. Unadjusted mortality rates were higher in the effusion group (20.3%, 28.8% and 33.9% at 30 days, 90 days and overall, respectively), but in multivariable analyses pleural effusion was not an independent predictor of mortality at any time point. MELD score showed a borderline association with early mortality. CONCLUSIONS: Symptomatic pleural effusion is common among liver transplant candidates and is associated with more advanced liver disease, yet it does not independently increase post-transplant mortality. These findings suggest that pleural effusion should prompt careful optimisation of ascites and early transplant evaluation but need not preclude transplantation. Future studies should explore effusion characteristics and management strategies to better stratify risk.

Background/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness—specifically advanced stage, lymphovascular invasion, and total gastrectomy—remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes.