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Introduction Endoscopic drainage should preferably be tried unless the abscess caused by the anastomotic leak is generalized and disseminated into the abdominal cavity. The aim of this study was to evaluate the results of patients treated with EndoVac. Patient and methods The medical records of patients who underwent low anterior resection and were treated using the EndoVac therapy system due to the detection of an anastomotic leak were retrospectively evaluated. Results Thirty-three of the patients with detection of anastomotic leaks were treated using EndoVac therapy system. The mean number of application of the EndoVac therapy system was 5.8 (1 to 12) for each patient. Mean duration of hospitalization of the patients was 24.5 (9 to 92) days. Five patients underwent a second operation during the follow-up period after application of the EndoVac therapy system. In our study, the number of patients recovering without the need for additional treatment is 30 (30/33). Our success rate was 90.1%. Conclusions The EndoVac therapy system is an alternative and helpful system in the treatment of colorectal anastomotic leaks without reoperation needed. It can also prevent permanent stoma.

Background/Aim: In recent years, laparoscopic repair has become common in the treatment of peptic ulcer perforation (PUP). In this study, we aimed to compare the advantages and disadvantages of laparoscopic and conventional graham omentopexy in the treatment of peptic ulcer perforation (PUP). Methods: The files of the patients who underwent laparoscopic and conventional graham omentopexy were reviewed in this retrospective cohort study. The two groups were compared in terms of age, gender, comorbidities, ASA scores, location and diameter of perforation, Mannheim Peritonitis Index (MPI), operation times, VAS scores (4th and 24th hour), oral intake, flatus, length of hospital stay, postoperative complications, morbidity, and mortality. Results: A total of 192 cases were included in the study, with 123 patients in the Laparoscopy Group and 69 patients in the Conventional Group. In the Laparoscopy Group, earlier oral intake, earlier bowel movements, less pain, shorter length of hospitalization, less pulmonary and total complications, and fewer secondary interventions were observed (P=0.001, P=0.001, P=0.001, P=0.037, P=0.009, P=0.039, respectively). In the Conventional Group, the mean operation time was significantly shorter (P=0.002). Other findings were similar. Conclusion: We observed many advantages of laparoscopic repair in the treatment of peptic ulcer perforation. Longer operation time was the only disadvantage. Based on our results, we believe that laparoscopic approach is safe and superior to conventional surgery in the treatment of peptic ulcer perforation.

Objectives The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age. Background Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs. Method The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50. Results The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40‒49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively). Conclusion The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. Screening programs should be modified (Tab. 4, Fig. 2, Ref. 45).

Purpose: We aimed to investigate the effect of COVID-19 pandemic on general surgical emergencies. On the other hand, we analyzed the effectiveness of the measures we have taken and the incidence of COVID-19 of patients and healthcare professionals.Method: In the pandemic period between March 14 and May 15, 2020, and in the same period of the previous year, the files of patients who underwent emergency surgery and followed up nonoperatively were reviewed retrospectively. The incidence of COVID-19 was questioned in patients operated on in the pandemic period and in health professionals working in the general surgery department.Results: Demographic data were similar between the two groups. The number of patients operated on in the pandemic group (n = 103) was lower than during the control group (n = 252) (p = 0.001). In the pandemic group, there was a significant decrease in the number of surgeries of uncomplicated appendicitis, acute cholecystitis and incarcerated hernia (p=0.001, p=0.005, p=0.001, respectively). Others surgeries were similar in both groups. In the pandemic group, nonoperatively follow-up rates were significantly lower in acute mechanical intestinal obstruction and acute cholecystitis (p=0.001, p=0.011, respectively). The findings of COVID-19 were positive in 6(6/103, %5.82) patients undergoing emergency surgery. None of our doctors had COVID-19 infection (0/20). The findings were positive only in 2 nurses from the general surgery department(2/24, %8,33).Conclusion: In these and similar pandemics, we think that a new algorithm is needed to approach emergencies and the results of this study can help for that.

The optimal method for preventing abscesses in perforated appendicitis is unclear. We compared the efficacy of lavage versus aspiration for periappendicular collections/abscesses in perforated appendicitis. Our study included 286 patients. After the removal of the appendectomy material, those who underwent aspiration without prior lavage were assigned to Group I, whereas those who underwent aspiration after lavage with 500 mL physiological saline were assigned to Group II. The primary outcome measure was postoperative complications. Secondary outcome measures were intraoperative complications, morbidity, and mortality. Group I comprised 174 patients (60 female and 114 male; mean age 34.47±17.40 y), whereas Group II comprised 112 patients (39 female and 73 male; mean age 36.22±18.60 y). The 2 groups were not significantly different in age, hospitalization duration, sex, abscess formation, morbidity, or mortality. Our results demonstrate that aspiration of the surgery area without prior lavage is sufficient and can be safely applied in perforated appendicitis.

Trial design: The Sydney system for the classification of gastritis emphasized the importance of combining topographical, morphological, and etiological information from gastric biopsy materials th...

Introduction:There is no widely accepted surgical technique in intra-abdominal sepsis and there is also limited data on available surgical techniques and their outcomes. There is no significant difference between these techniques. The aim of the laparotomy, which is performed to control the source of sepsis, is to reduce mortality. This retrospective study was performed to investigate daily analysis of the effects of vacuum-assisted closure (VAC) on intra-abdominal inflammation, sepsis and mortality.Methods:The study included 159 patients who underwent VAC technique between January 2010 and April 2017. Statistical analysis of the effects of VAC technique was performed on a daily basis using APACHE IV score, Mannheim peritonitis index (MPI) and Sepsis-Related Organ Failure Assessment (SOFA) score.Results:VAC changes had a significant effect on APACHE IV score, MPI and SOFA score (p=0.0001). Although there was no significant difference in the SOFA scores between the 1st and 2nd changes or between the 3rd and 4th changes, there was a decrease in values over time.Conclusion:In the treatment of abdominal contamination with sepsis, VAC use had a positive effect on contamination by decreasing the predicted mortality rate on a daily basis. Although it had a positive effect on sepsis, the effect of VAC on sepsis alone was not significant.

Aim:Acute appendicitis is the most common surgical emergency worldwide. Laparoscopic appendectomyis widely used in acute appendicitis. In our study, we aimed to investigate the efficacy and safety of laparoscopic embedding technique.Method:Patients who underwent laparoscopic embedding technique for appendiceal stump between July 2017 and December 2018 were included in the study. Acute appendicitis was diagnosed by physical examination, laboratory tests, ultrasound and computed tomography scan. Dissection of the mesoappendix was performed with a bipolar tissue sealing system, and then the appendix radix was ligated using intracorporeal knotting technique and inverted into the cecum with a suture. The patients were evaluated in terms of age, gender, body mass index (BMI), rate of conversion, operative time, postoperative complications and length of hospital stay.Results:The mean age was 34.81±1.88 years and the mean BMI was 27.51±5.44 kg/m2. The mean operative time was 61.93±17.67 minutes. Thirtytwo patients had complicated appendicitis and 39 patients had uncomplicated appendicitis. In patients with uncomplicated appendicitis, four patients developed surgical site infection and two patients had ileus; whereas two patients developed ileus and three patients developed surgical site infection in complicated appendicitis cases. The mean length of hospital stay was 38.92±25.90 hours.Conclusion:Laparoscopic embedding technique is easy, simple, safe, fast and effective for acute appendicitis and will become the method of choice in securing the base of the appendix in complicated appendicitis.

Background The aim of this study was to investigate the importance of fibrinopeptide-A and fibrinopeptide-B, which occur during the formation of D-dimer, the most commonly used laboratory parameter, in the early diagnosis of acute mesenteric ischemia (AMI). Materials and methods This experimental study was performed in 30 male pathogen-free Wistar albino rats. The experimental animals were divided into 3 equal groups: Control group (n = 10), Sham group (n = 10) and Ischemia group (n = 10). Blood samples were taken 0, 1, 3, and 6 h after the simulation of mesenteric ischemia. Results Fibrinopeptide-A and fibrinopeptide-B levels increased significantly in the first 6 h in the ischemic group, similar to the increase in D-dimer levels. The statistical change between 0, 1, 3 and 6 h was more significant for fibrinopeptide-A and fibrinopeptide-B. Conclusion Fibrinopeptide-A and fibrinopeptide-B may be markers that can be used for early diagnosis of mesenteric ischemia, early diagnosis is highly important for decreasing mortality and morbidity.

Aim: Laparoscopic appendectomy is the gold standard treatment of acute appendicitis. However, there is no consensus about the technique to apply when closing the appendix stump. This study compares three techniques to close the appendix stump: Laparoscopic purse-string suture (LPS), metal clips, and Hem-o-lok clips. The aim is to evaluate the advantages, safety, and costs of these three methods.Methods: We conducted a retrospective cohort study which included 220 patients who underwent laparoscopic appendectomy operations for acute appendicitis between May 2017 and December 2019. The cases were divided into three groups and evaluated. Group A received LPS, group B received metal clips, and group C received Hem-o-lok clips. The demographic features of the patients, American Society of Anesthesiology (ASA) scores, duration of surgery, postoperative complications, hospital stay, and cost were evaluated retrospectively from patient files. Results: There were 79 patients in group A, 91 patients in group B, and 50 patients in group C. There was no difference between the groups with respect to demographic features, ASA physiological state scores, and laboratuary values. The operation time and postoperative complication rates did not differ between groups (P>0.05). Group C had longer hospital stays (P=0.001), and group A had lower costs (P=0.001).Conclusion: In the laparoscopic appendectomy technique, the use of LPS for appendix stump closure is safe and effective. Furthermore, technical consumables and hospital treatment costs are significantly reduced., Amaç: Laparoskopik apendektomi akut apandisit tedavisinde altın standarttır. Bununla birlikte, apendiks güdüğünü kapatırken uygulanacak teknik hakkında henüz bir fikir birliği yoktur. Bu çalışma, apendiks güdüğünü kapatmak için uygulanan teknikleri karşılaştırmaktadır: Laparoskopik sütur uygulama, metal klips uygulama ve Hem-o-lok klips uygulama. Amacımız bu üç yöntemin avantajlarını, güvenliğini ve maliyetlerini değerlendirmektir.Yöntemler: Mayıs 2017-Aralık 2019 tarihleri arasında akut apandisit nedeniyle laparoskopik apendektomi operasyonu geçiren 220 hastanın dahil edildiği retrospektif kohort çalışma planlandık. Olgular üç gruba ayrılarak değerlendirildi. A Grubunda apendiks güdüğü laparoskopik sütur yöntemi ile kapatılanlar yer aldı. B grubunda metal klips C grubunda ise Hem-o-lok klips uygulanarak apendiks güdüğü kapatılan olgular yer aldı. Hastaların demografik özellikleri, Amerikan Anesteziyoloji Derneği (ASA) skorları, ameliyat süresi, postoperatif komplikasyonlar, hastanede kalış süresi ve maliyeti değerlendirildi.Bulgular: Grup A'da 79 hasta, grup B'de 91 hasta ve grup C'de 50 hasta vardı. Demografik özellikler, ASA skorları, laboratuar değerleri açısından gruplar arasında fark yoktu. Ameliyat süresi ve ameliyat sonrası komplikasyon oranları gruplar arasında farklılık göstermedi (P>0,05). Grup C'de daha uzun hastanede kalış süresi vardı (P=0,001) ve grup A daha düşük maliyete sahipti (P=0,001).Sonuç: Laparoskopik apendektomide, apendiks güdüğünün sütur kullanılarak kapatılması tekniği güvenli ve etkilidir. Ayrıca bu tekniğin sarf malzeme kullanımını ve hastane tedavi maliyetlerini önemli ölçüde azalttığı görülmüştür.

Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations. The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients’ ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed. Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p

INTRODUCTION Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair. The present study aims to compare the advantages and disadvantages of the TEP technique under general anesthesia (GA) and epidural anesthesia (EA). MATERIALS AND METHODS The patients were divided into 2 groups as those undergoing TEP under EA (Group 1) and those undergoing TEP under GA (Group 2). The 2 patient groups were compared in terms of sex, age, body mass index data, duration of surgery, total operation time, patient satisfaction, VAS scores (1, 4, 12, and 24 h), length of hospital stay, and postoperative complications. RESULTS The number of patients operated under EA (Group 1) was 30, and the number of patients operated under GA (Group 2) was 32. Only in the postoperative first hour VAS scores was statistically significantly less and the need for analgesia evaluated in both groups was found to be statistically significantly lower in Group 1 (P

Amac: Bal antiodem etkisi, granulasyonu hizlandirici etkisi, enzimatik debridman ve immun sistemi guclendirici etkisi bilinen bir dogal gidadir. Bu deneysel calismanin amaci bir alkali ajan olan sodyum hidroksit ile olusturulan koroziv ozofajitte darlik gelisimi uzerine balin ve prednisolonun etkilerini arastirildi. Yontemler: Bu calisma, agirliklari 200-250 gram arasinda degisen Wistar tipi albino sicanlar uzerinde gerceklestirildi. Denekler, esit sayida dort gruba bolundu. Birinci, ikinci ve ucuncu gruplar ozofajit modeli gruplari olup, bu gruplardaki tum deneklerde %37,5’luk sodyum hidroksit ile koroziv ozofajit olusturuldu. Birinci gruba herhangi bir tedavi uygulanmazken, ikici gruba oral bal tedavisi ve ucuncu gruba intraperitoneal prednisolon tedavisi uygulandi. Kontrol grubunun ozofagusuna herhangi bir islem yapilmadan sam laparotomi uygulandi. Tum denekler 28. gun sakrifiye edildi ve deneklerin distal ozofaguslarindan alinan 20 mm uzunlugundaki ornekler histopatolojik incelemeye tabi tutuldu. Gruplarin doku hasari skorlari ve stenoz indeksi skorlari olculerek kiyaslandi. Bulgular: Calismaya toplam 32 denek dahil edildi ve her bir grupta sekiz denek mevcuttu. Stenoz indeksi skoru ortalama degeri ve doku hasari skoru ortalama degeri balla tedavi edilen grupta, prednisolon verilen ve tedavi verilmeyen gruplara kiyasla anlamli olarak dusuktu (P=0,001). Sonuc: Bal, prednisolona kiyasla, alkalen ajanla olusturulan deneysel koroziv ozofajit modelinde gelisen ozofagus darliklari uzerinde daha anlamli duzeyde olumlu etkiye sahiptir.

Our aim is to present our experience with laparoscopic cholecystectomy (LC) and percutaneous cholecystostomy (PC) in high-risk patients with acute cholecystitis (AC). The guidelines for AC are still debatable for high-risk patients. We aimed to emphasize the role of LC as a primary treatment method in patients with severe AC instead of a treatment after PC according to the Tokyo Guidelines (TG). AC patients with high surgical risk [American Society of Anesthesiologists (ASA) III-IV] who were admitted to our department between March 2008 and November 2014 were retrospectively evaluated. Disease severity in all patients was assessed according to the 2007 TG for AC. Patients were either treated by emergency LC (group LC) or PC (group PC). Demographic data, ASA scores, treatment methods, rates of conversion to open surgery, duration of drainage, length of hospital stay, and morbidity and mortality rates were compared among groups. Age, ASA score, and TG07 severity scores in the PC group were significantly higher than that in the LC group (P < 0.001, P < 0.001, and P < 0.001, respectively). Sex distribution (P = 0.33), follow-up periods (P = 0.33), and morbidity (P = 0.86) were similar. In the patients with early surgical intervention, mortality was significantly lower (P < 0.001). Length of hospital stay was significantly shorter in the LC group compared with the PC group (P < 0.001). In high-risk surgical patients, PC can serve as an alternative treatment method because of its efficiency in the prevention of sepsis-related complications due to AC. However, LC still should be an option for severe AC with comparable short-term results.

Robotic surgery was first introduced in 2000 especially to overcome the limitations of low rectum cancer surgery. There is still no consensus regarding the standard method for colorectal surgery. The aim of this study was to compare robotic surgery with laparoscopic colorectal surgery.This is a retrospective study. Data of patients with a diagnosis of colon or rectal cancer were analyzed for robotic colorectal surgery and laparoscopic colorectal surgery.The cost of robotic surgery group was statistically higher than the laparoscopic surgery group (p=0.032). The average operation duration was 178 minutes in the laparoscopic surgery group and 228 minutes in the robotic surgery group, and this difference was statistically significant (p=0.044). There was no statistically significant difference between the groups regarding other parameters.Disadvantages of robotic surgery seem to be its higher cost and longer operation duration as compared to laparoscopic surgery. We claim that an increase in the number of cases and experience may shorten the operation time while the increase in commercial interest may decrease the cost disadvantage of robotic surgery.

Aim: Bursectomy, mainly defined as a complete dissection of the peritoneal lining covering the anterior plane of the transverse mesocolon and the pancreas with an omentectomy during gastrectomy, has been performed for the serosa-positive gastric cancers. Recently, some researchers have interrogated whether bursectomy for gastric cancer is essential from a surgical point of view, thus, we aimed to investigate the short-term surgical and early-stage clinicopathological outcomes of bursectomy in the treatment of advanced gastric cancer patients by a single center study and retrospective controlled trial. Material and Methods: From January 2016 to December 2017, retrospective findings of selected 100 gastric cancer patients in advanced tumor stages and underwent D2 radical gastrectomy were grouped and analyzed in terms of bursectomy performed or not in Bakirkoy Dr. Sadi Konuk Training and Research Hospital.Results: In conclusion, 50 patients were in bursectomy (B) group and 50 patients in non-bursectomy (NB) group. Clinical features (age, gender, and gastrectomy pattern and tumor location) of both groups showed no statistically significant difference. Postoperative mortality rate were also similar of both groups (4%). All other post-operative complications were not significantly distinctive for two groups. Conclusions: Bursectomy may increase the surgical duration of D2 gastrectomy and but not early-stage outcomes and post-operative complications. Experienced surgeons can perform the procedure safely. However, long-term, large sample sized, and high-quality randomized controlled trials are needed for the survival benefits of bursectomy.

Background In the treatment of a subset of patients with uncomplicated appendicitis, no surgical method has been clearly established as superior. Methods The present study was a prospective randomized clinical trial. Patients diagnosed with acute appendicitis were recruited for the study. Patients with a preoperative diagnosis of complicated appendicitis were excluded. The patients were randomly divided into two groups: a laparoscopic appendectomy group and an open appendectomy group. The primary outcome measure was the rate of postoperative septic complications. Secondary outcome measures were the length of hospital stay, postoperative pain score, and quality of life score. Results Ninety-six patients were included in the study, 50 in the laparoscopic appendectomy group and 46 in the open appendectomy group. There were no significant differences between the two groups in terms of the rates of postoperative septic complications, hospital stay lengths, postoperative pain scores, or quality of life scores. Conclusion The laparoscopic approach to appendectomy in patients with uncomplicated appendicitis does not offer a significant advantage over the open approach in terms of length of hospital stay, postoperative pain score, or quality of life, which are considered the major advantages of minimally invasive surgery.

The goal of the study was to compare the efficacy of two methods--intracorporeal knotting and metal endoclip application--for closure of the appendiceal stump during laparoscopic appendectomy in a specific group of patients with uncomplicated appendicitis.The patients were randomized into two groups who had their appendiceal stump secured by intracorporeal knotting (Group 1) and metal endoclipping (Group 2). Primary outcome measure was postoperative complications, whereas secondary outcome measures were intraoperative complications, operative time, length of hospital stay, and re-admissions (including rehospitalizations and reoperations).One hundred seven patients were prospectively recruited in a randomized study between December 2010 and May 2011. Group 1 and Group 2 included 46 and 61 patients, respectively. The rate of postoperative complications in Group 1 and Group 2 was 8.7% (4/46) and 4.9% (3/61) (P.05). There were no significant differences between the groups in secondary outcome measures except the mean operative time (61.9 minutes versus 46.3 minutes, P=.0008).The closure of the appendiceal stump by either intracorporeal knotting or metal endoclipping during laparoscopic appendectomy in uncomplicated appendicitis is safe with comparable morbidity and mortality rates.

Common conflict in surgery: How to evaluate breast microcalcifications? Objective: Breast cancer is still one of the leading causes of death among women. Microcalcifications are important cues for the early diagnosis of breast cancer. Materials and Methods: Data from a total of 74 patients, who had microcalcifications in mamography and undergone wire-guided excision, was evaluated prospectively. Results: Pathologic examination showed 35% of patients (n=26) had ductal carcinoma in situ and / or invasive ductal carcinoma. 60% (n=6) of 10 lesions that were considered as benign preoperatively, diagnosed as benign in pathological evaluation whereas 65.6% (n=42) of 64 lesions that were considered as suspicious preoperatively diagnosed as benign by pathological avaluation. Conclusion: All microcalcifications in the breast should be evaluated by excisional biopsy beyond the core biopsy

Objectives: Currently, diagnostic laparoscopy (DL) is recommended for the left thoraco-abdominal region penetrating injuries (LTARP). However, organ and diaphragmatic injury may not be detected in all of these patients. Our aim is to focus on this LTARP patient group without any operative findings and to highlight the evaluation of diagnostic tools in the high-tech era for a possible selected conservative treatment. Material and methods: The patients who were admitted to ED due to LTARP, and who underwent routine DL were evaluated retrospectively in terms of demographic, clinical, radiological, and operative findings of the patients. Results: The current study included 79 patients with LTARP. In 44 of 79 patients, abdominal injury was not detected. In 30 patients an isolated diaphragmatic injury was revealed and in 4 patients a visceral injury was accompanying to diaphragmatic injury. Surgical findings revealed that the diaphragm was the organ most likely to sustain injury. In patients with more than one positive diagnostic findings need for surgery rate was 61.5%, however; in patients with one positive diagnostic finding (n = 53), positive surgical finding rate was only 35.8%, (p = 0.03). Regarding the combined use of all diagnostic tools in these patients; such as physical examination, plain chest X-ray, and computed tomography, when this method was used for pre-operative diagnosis, sensitivity was measured as 82.7%, specificity 84.1%, PPV 77.4% and NPV 88.1%. Conclusion: Although DL is reliable for diagnosis of diaphragmatic and visceral injury in patients with LTARP. However, individual decision making for laparoscopic intervention is needed to prevent morbidity of an unnecessary operation under emergent setting due to high rates of negative intraabdominal findings. Keywords: Wounds penetrating, Physical examination, Diagnostic imaging, Treatment outcome