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Objective:This study aimed to investigate the factors associated with pancreatic fistula (PF) development after pancreaticoduodenectomy (PD) at our clinic.Methods:Patients who underwent PD for periampullary tumours between 2010 and 2019 were included in the study and categorised into Group I (with PF) and Group II (without PF). The demographic and clinical characteristics, laboratory parameters, tumour characteristics and post-operative results were compared between the groups. Risk factors for PF were analysed by univariate analysis and multivariate logistic regression analysis.Results:In total, 155 patients participated in the study (Group I: n=31; Group II: n=124). The rate of PF was 20%. The two groups were comparable with regard to sex (p=0.348) and age (64.8 vs 66.9 years, p=0.916). Compared with Group II, Group I had a higher number of metastatic lymph nodes (1.61 vs 0.87, p=0.041), a higher number of post-operative complications (58.1% vs 21.8%, p=0.000) and a longer duration of post-operative hospital stay (25.25 vs 16.43 days, p=0.000). Haemoglobin (p=0.493) and albumin (p=0.698) levels were similar between the groups. Total survival duration was shorter in Group I (23.9 vs 38.18 months, p=0.024). In multivariate analyses, being ≥65 years (p=0.040), tumour localisation (p=0.021), lymph node stage (p=0.008) and performedtumour diameter ≥2 (p=0.021) were the independent risk factors for developing pancreatic fistula.Conclusion:In our study, tumour diameter, patient age and lymph node status were associated with PF development. The development of PF reduced expected survival. We believe that identifying the preoperative, intraoperative and post-operative factors related to PF formation may help decrease its development.

Aim:We aimed to determine the clinical value of erythrocyte distribution width (RDW) and mean platelet volume (MPV) in the diagnosis of acute appendicitis (AA) and in determining the severity of the disease.Method:Patients who were operated between January 2013 and January 2020 with a preliminary diagnosis of AA were included in the study. The patients were divided into two groups as Group 1 negative appendectomy and Group 2 acute appendicitis. In addition, Group 2 is divided into subgroups as a:perforated and b: non-perforated. RDW and MPV were compared between the groups and subgroups.Results:A total of 861 patients participated in our study. Group 1 consisted of 144 patients and Group 2 consisted of 717 patients. The mean age was similar in both groups (33.02 vs 35.34, p=0.088), female sex was higher in Group 1 (52.8% vs 42.9, p=0.019), RDW was higher in Group 1 (14.03 vs 13.67, p=0.007), MPV was similar between the groups (8.81 vs 8.95, p=0.363). RDW was an independent risk factor in the diagnosis of AA in multivariate analysis (odds ratio 0.604, 95% confidence interval (minimum-maximum) 0.420-0.868, p=0.006). RDW and MPV were independent variables in the diagnosis of perforated appendicitis in multivariate logistic regression analysis.Conclusion:RDW is a useful parameter in the diagnosis of AA and in determining the severity of the disease. However, MPV value does not have sufficient diagnostic value.

Aim:In the present study, we aimed to investigate the seasonal characteristics of presentations to the hospital due to diverticular disease.Method:The patients who were admitted to the hospital between January 1st, 2015 and January 1st, 2020 due to diverticular disease were included in the study. The study was designed retrospectively. The patients were divided into groups according to the treatment method, namely Group 1: patients who received surgical treatment, and Group 2: patients who received medical treatment. Age, sex and seasonal periods were compared. Also, the patients were separated into three groups according to age: those between 18 and 40 years of age, those between 40 and 60 of age and those over 60 years of age. The sex and the treatment methods of the patients were also examined in the season groupsResults:One hundred fifty seven patients participated in our study. Group 1 consisted of 39 patients and Group2 consisted of 118 patients. Presentations to the hospital with acute diverticulitis occurred most frequently in the winter (39.5%). The average age was higher in Group 1 (60.61 vs 54.42, p=0.030). The sex distribution was similar in the groups (p=0.152). Winter was dominant in treatment groups (30.8% vs 42.4% p=0.060). In winter, the average age of the patients who received surgical treatment was higher than those who received medical treatment (68 vs 50 p=0.001). In winter, all patients who received surgical treatment were over 60 years of age. In summer, the ratio of patients who received medical treatment was highest for the group over 60 years of age (p=0.040).Conclusion:In our study, we displayed the seasonal change in hospital admissions due to diverticular disease. We detected an increased rate of presentations to the hospital in winter. Selection of the treatment method did not display a seasonal variation. However, when we made an additional evaluation according to the age groups, it was seen that greater number of patients who were older than 60 years received surgical treatment in winter whereas the greater number of them received medical treatment in summer. Pathophysiological mechanism of this change could not be fully revealed.

Aim:In this study, we aimed to share our surgical experiences and clinical results in non-traumatic small bowel perforations.Method:Patients who underwent surgical treatment for non-traumatic small bowel perforation between 2009-2019 were included in the study. Patients were divided into two groups according to postoperative 90-day mortality status: Group 1 (no mortality), Group 2 (mortality). The demographic, clinical features, treatment methods and results of the patients were compared between the groups.Results:Forty-two patients participated in our study. Group 1 consisted of 25, and Group 2 consisted of 17 patients. Male sex was dominant in Group 2 (48% vs 76.5%, p=0.062). Mean age was higher in Group 2 (54 vs 61, p=0.218). American Anesthesiology Association score (ASA) was statistically significantly higher in Group 2 (12% vs 58.8%). Forty-two percent of patients had abdominal surgery and 30% had a history of malignancy. The presence of electrolyte imbalance was similar in the groups (56% vs 76.5%, p=0.049). The days between the first complaint and laparotomy were similar between the groups (6.40 vs. 5.70 p=0.699). In perforated areas, jejunum was dominant in Group 2 with 64.7%, and ileum in Group 1 with 68%. The multiple perforation rate was higher in Group 2, but was not statistically significant (12% vs 23.5%, p=0.284). From postoperative complications, anastomosis leakage was higher in Group 1, but it was not statistically significant (12% vs 5.9%, p=0.501).Conclusion:Morbidity and mortality of non-traumatic small bowel perforations is high. While the ASA score and hypoalbuminemia were associated with postoperative mortality in non-traumatic small bowel perforations, we did not find the localization of the perforation and the time between the first complaint and laparotomy to be related to mortality.

Gallstone ileus occurs when a gallstone passes into the intestinal system through a fistula between the gallbladder or biliary tract, and the duodenum, stomach or colon, and causes an obstruction. Although it is usually seen in advanced ages, it has rarely been reported in patients who are 100 years old. A 100-year-old female patient, without significant medical or surgical history, was admitted to the emergency department for diffuse abdominal pain, nausea, vomiting, and constipation. Abdominal computed tomography showed air in the biliary tract and obstruction in the small intestine. Patient was operated under emergency conditions. Enterolithotomy was performed and the stone was extracted. Postoperative recovery was uneventful. Bilioenteric fistulas, a major complication of chronic gallbladder diseases, usually develop secondary to intense inflammation. Patients’ age, concomitant disease, clinical condition and intraoperative findings should be taken into consideration while planning the treatment. The data in the literature generally supports the employment of enterolithotomy in high-risk patients and reserves cholecystectomy and resection of the fistula for less comorbid patients with feasible anatomy.

Aim:Acute appendicitis (AA) is one of the most common emergency surgical pathologies. The tests used in the differential diagnosis of these patients need to be quick, easy to access and cheap. Discussions continue about the value of laboratory tests in the diagnosis of AA. In this study, we aimed to determine the diagnostic value of platelet/lymphocyte ratio (PLR) in the diagnosis of AA and to determine its diagnostic value in different age groups.Method:Patients who underwent appendectomy after a preliminary diagnosis of AA between January 2015 and January 2020 were enrolled. Patients were divided into two groups, according to the postoperative pathology finding: group 1 (negative appendectomy) and group 2 (AA). In addition, groups were divided into subgroups based on age: 18-39 years, 40-59 years and 60 years and older. Platelet and lymphocyte counts and PLR were compared between groups and subgroups. In diagnostic accuracy evaluation ROC curve analysis was used; p

Objective: There are multiple subtypes of breast cancer with different biological and pathological features and accordingly exhibit different clinical behaviors. The aim of this study was to compare the treatment modalities, clinical features and prognostic characteristics of Mix Mucinous Carcinomas (MMBC) and other rare tumors of the breast.Materials and Method: A total of 2152 patients who were operated on for breast cancer in our clinic between 2010-2019, with pathological diagnoses of tubular, pure mucinous, mix mucinous or papillary carcinoma were enrolled in the study. Patients were divided into two groups as mix mucinous patients (Group1) and other rare tumors (Group2). The demographic, clinical and prognostic characteristics and treatment approaches were compared between Groups, and additionally between the subtypes of Group 2.Results: 42 patients participated in our study. Group 1 consisted of 7 patients, and Group2 consisted of 35 patients. The subtypes in Group2 were papillary (n=21), pure mucinous (n=10) and tubular (n=4). Progesterone Receptor Positivity was found to be significantly higher in Group 2 patients than in Group1 patients (p=0.005, p0.05). Mean survival was 19.5+5.6 (8.5-30.5) months in Group 1 and 46.3+5.2 (36.1-56.6) months, in Group2 when evaluated separately (p:0.002).Conclusion: The prognosis of pure mucinosis (PMBC) and other atypical cancers of the breast compared to the (MMBC) is quite good. Rare pathological types of breast cancer can have favorable outcomes when treated with necessary oncological principles.

Acute appendicitis is the most common non-traumatic emergency surgical pathology, and duplication of the appendix is a rare congenital anomaly usually detected incidentally during laparotomy. Since Picoli first described appendix duplex in a female patient who presented with associated anomalies, few other cases have been reported. In this study, we aimed to present a case of appendix duplication detected in a 56-year-old female renal transplant patient undergoing surgery for acute appendicitis. Surgical management of double appendix is of practical importance to avoid serious medical and legal consequences.

Background: Breast cancer is the most commonly seen and cause of cancer deaths in women in most of the developed and developing countries. Breast cancer awareness and organized population based screening programmes have resulted in early diagnosis, reduction in mortality, and breastconserving surgery. Therefore, body image of women suff ered from breast cancer has been protected, and overall survival rate has increased. Eighty-four KETEM’s (Cancer Early Detection and Screening Center) in 81 provinces in Turkey has been founded by Cancer Control Department of The Ministry of Health of Turkey. Opportunistic screening has been performed in these centers; however there are no available data regarding the eff ect of opportunistic screening on breast cancer mortality. Population based organized screening programmes should be implemented to reach this aim.Aim: The aim is to organize national early diagnosis and screening programs consistent with the conditions of country, that are necessary for early diagnosis and treatment of breast cancer which is the most frequently seen female cancer with gradually increasing incidence in our country.Methods: National Cancer Advisory Board, Breast Cancer Early Detection and Screening Sub-Committee organized three meetings in Ankara in 2008. In addition to those three-day workshops, a fourth one was performed in January 22-24, 2009 to provide reports from those studies. In these meetings, expert panelists selected by The Ministry of Health, National Cancer Advisory Board, and National Federation of Breast Societies shared their experiences and knowledge on early detection and screening of breast cancer in Turkey. Two representatives from the World Health Organization also attended to the third meeting. During those meetings, targets and strategies for early detection and screening for breast cancer had been evaluated. Possible barriers to screening, their eliminations, methods of follow up the prepared programme step by step had also been discussed.Results: To reach the success with early detection and screening programs is not possible without community awareness about the importance of early detection and especially high-level awareness of the target population. For this reason, education of women and increasing breast cancer awareness should be the fi rst step. Health care providers (physicians, nurses, midwives etc.) and their administrators (health administrators, chief of staff in hospital etc.) should also be trained and included in those programs. A realistic budget for screening projects should be prepared and carried out. There should be a high-level coordination and a comprehensive organization among study groups, screening centers, and institutions. Social, cultural, and other possible regional barriers against the implementation of projects should be explored and eliminated. Activities, performance status and available data should be controlled, evaluated and published periodically. Targets, strategies, activities, criteria relationships with other related organizations should be re-evaluated, and performance should be monitored regularly.Conclusions: Organizing and implementing breast cancer early detection and screening programmes could be possible only with comprehensive, planned in details, and well determined studies. Resources should be used carefully and timely whenever necessary. As a result of this, downstaging of breast cancer and reduction in mortality rate in community could be possible.