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Objectives: Nodular goiter is the most common disease of the thyroid gland. Thyroid nodules are malignant in 3-5% cases. To determine the incidence of malignancy in patients defined as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) as a result of fine needle aspiration biopsy (FNAB) and evaluate the clinical, biochemical and sonographic features as possible predictors of malignancy. Methods: Patients who had undergone at least one FNAB and diagnosed as AUS/FLUS from January 2011 to December 2015 were included in the study. Age, gender, benign disease, thyroid stimulating hormone (TSH) level, size, localization, number, time of FNAB, ultrasonography (USG) characteristics, follow-up data on repeated FNAB results and, if surgical excision was performed, final pathological results were analyzed. Results: A total of 5181 thyroid nodules were biopsied in 4089 patients, and the biopsy specimen taken from 611 nodules was diagnosed histopathologically as AUS/FLUS (11.79%). After FNAB, 167 of 611 patients diagnosed with AUS/FLUS were operated. While 65.9% (n = 110) of 167 patients who underwent surgery were made a benign diagnosis; malign diagnosis was made to 34.1% (n = 57). Conclusions: The rate of malignancy in surgically confirmed nodules was 34.1% in this study, which is higher than the Bethesda classification. Due to the high malignancy rate which determined in cytologically diagnosed AUS/FLUS, we think that the repeat decision of the FNAB should be reconsidered and the surgical plan after the first FNAB should be considered more seriously.

The extended-view totally extraperitoneal (eTEP) approach is a promising technique for abdominal wall hernias and has increased in popularity among hernia surgeons in recent years. This study aims to present the results of applying the laparoscopic eTEP approach for incisional abdominal wall hernias (IAWHs).This study is a retrospective analysis of a prospectively collected dataset of 30 patients who underwent laparoscopic eTEP for IAWHs between October 2018 and March 2021 (median follow-up of 15 months).Thirty patients (8 male, 22 female) with a mean age, mean body mass index, and median ASA score of 53.5, 30.8, and 2, respectively, underwent the eTEP procedure for incisional abdominal wall hernias. In total, 11 (36.7%) patients had a recurrent IAWH. Seventeen (56.7%) patients were treated with eTEP RivesStoppa (eTEP-RS), whereas 10 (33.3%) patients needed the eTEP transversus abdominis release (eTEP-TAR) procedure. In three patients, conversions to other procedures (laparoscopic intraperitoneal onlay mesh-plus (IPOM-Plus) and open RivesStoppa) were needed due to intraoperative complications: iatrogenic perforation to the intestine and large peritoneal tear causing loss of the working space. The mean operative time and mean length of stay (LOS) were 203.5 min and 1.5 days for eTEP-RS and 291.5 min and 1.6 days for eTEP-TAR, respectively. Two patients developed asymptomatic seromas, and one patient developed an asymptomatic hematoma; all were treated conservatively. Only one recurrence was observed over the course of the follow-up period.The eTEP approach is a safe and feasible option for IAWH repair and a valuable addition to the armamentarium of hernia surgeons.

Transversus abdominis release (TAR) is the newest approach that allows effective myofascial mobilization, creating a large retromuscular space and wide mesh overlap to repair complex and large incisional ventral hernias. This article narrates the technical details and results of the TAR technique performed in a single center. The present study is a retrospective analysis of a prospective dataset from 25 patients who underwent posterior component separation (PCS) with TAR procedure for large incisional ventral hernias between October 2017 and July 2021. The minimum follow-up period was ten months. Twenty-five patients (five male, 20 female) with a mean age of 61.2 years, a mean BMI of 32.2 kg/m2, and a median ASA score of 2.0 underwent the TAR procedure. Fifteen (60%) patients had a history of incisional hernia surgery. The mean surgical time was 248 minutes. The mean total defect and mesh areas were 187.4 (90-500) cm2 and 1141.8 (750-2250) cm2, respectively. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.5 and the median hospital length of stay (LOS) was 5 days. There were three (12%) surgical site infections (SSIs), two of which were deep infections that needed debridement. During the follow-up period (median of 26 months), two (8%) recurrences were recorded. The TAR technique represents an effective and safe repair modality of large and complex incisional hernias. TAR is an essential addition to the repertoire of the surgical community.