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Background: Several studies on the reduction of pain with the use of local anesthetics after laparoscopic hernia surgeries have been published. We aimed to analyze the results of local anesthesia applied to the patients by retrospectively scanning the files of patients who underwent total extraperitoneal laparoscopic hernioplasty for inguinal hernias. Methods: The files of patients who underwent TEP laparoscopic hernioplasty for inguinal hernias between March 2019 and November 2022 in Ankara Bilkent city hospital general surgery clinic were retrospectively scanned. The pain scoring records in the observation forms of these patients and the analgesics administered were recorded. Results: A total of 374 and 210 patients underwent unilateral and bilateral TEP laparoscopic hernioplasty, respectively. All of the patients, 232 were not administered any local anesthesia, 186 were administered bupivacaine, and 166 were administered bupivacaine+dexamethasone. When the VAS scores of the patients in both main groups were compared, significant differences were found in VAS scores between patients who received bupivacaine and bupivacaine+dexamethasone and those who did not (p

Aim: Systemic immune-inflammation (SII) index may provide more promising prognostic information in patients with cancer surgery. However, to the best of our knowledge, the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy has not been studied. Thus, this study aimed to evaluate and compare the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy.Materials and Methods: All patients over 18 years-old that underwent successful pancreaticoduodenectomy due to pancreatic cancer between February 20, 2019 and June 30, 2021 at Ankara City Hospital Department of General Surgery were included. The main predictor of interest was SII index which was measured by neutrophil*platelet / lymphocyte count. The main outcome of the study was long-term all-cause mortality.Results: A total of 223 patients were included in the current study. Multivariable cox regression analysis revealed that history of congestive heart failure [HR (95%CI): 3.682 (1.140-11.892)], and SII index [HR (95%CI): 1.001 (1.001-1.001)] were independently associated with all cause long-term mortality. The accuracy of predicting mortality for SII index was assessed by the area under the ROC curve which was = 0.77. A higher value of 1305 of SII index was found with 76% sensitivity and 67% specificity for predicting all-cause long-term mortality.Conclusions: The results of the study suggest that measurement of the SII index, an easily available and relatively cheap marker, is an independent predictor of long-term survival after pancreaticoduodenectomy in patients with pancreatic cancer., Amaç: Sistemik immün inflamasyon (Sİİ) indeksi, kanser cerrahisi geçiren hastalarda umut verici prognostik bilgiler sağlayabilir. Pankreatikoduodenektomi yapılan pankreas kanseri tanılı hastalarda Sİİ indeksinin prognostik değeri daha önce araştırılmamıştır. Bu nedenle, bu çalışmada pankreatikoduodenektomi yapılan pankreas kanserli hastalarda Sİİ indeksinin prognostik değerini değerlendirmeyi amaçladık.Gereç ve Yöntem: 20 Şubat 2019 - 30 Haziran 2021 tarihleri ​​arasında Ankara Şehir Hastanesi Genel Cerrahi Kliniği'nde pankreas kanseri nedeniyle pankreatikoduodenektomi yapılan 18 yaş üstü tüm hastalar çalışmaya dahil edildi. İlgilenilen ana belirteç, nötrofil*trombosit/lenfosit sayısı ile ölçülen Sİİ indeksiydi. Çalışmanın ana sonlanım noktası, tüm nedenlere bağlı uzun dönem mortaliteydi.Bulgular: Çalışmaya toplam 223 hasta dahil edildi. Çok değişkenli Cox regresyon analizi, konjestif kalp yetmezliği öyküsü [HR (%95 GA): 3.682 (1.140-11.892)] ve Sİİ indeksinin [HR (%95 GA): 1.001 (1.001-1.001)] uzun dönem mortalite ile bağımsız olarak ilişkili olduğunu gösterdi. Sİİ indeksinin mortalite öngörü doğruluğunu değerlendirmek için yapılan ROC analizinde eğri altında kalan alan 0.77 olarak belirlendi. Sİİ indeksinin 1305 ve üzerinde olmasının uzun dönem mortaliteyi öngörü duyarlılığı %76, özgüllüğü %67 olarak hesaplandı.Sonuçlar: Çalışmanın sonuçları, kolay elde edilebilen ve nispeten ucuz bir belirteç olan Sİİ indeksinin, pankreas kanseri tanılı hastalarda pankreatikoduodenektomi sonrası uzun dönem sağkalımı bağımsız olarak öngördürebilecek bir parametre olduğunu göstermektedir.

Hospitalizations in emergency general surgery (EGS) cases in the USA have increased by 28% since 2001. The costs of these cases are estimated to increase by 45% annually until 2060, reaching 41.20 billion dollars. According to the literature, the general surgery clinic team allocates an average of 5.5 hours a day for emergency room consultations. The aim of this study is to determine the effects of consultations from the emergency room in our country on the EGS approach and to create appropriate solution proposals with the data obtained from the regional hospitals.The source of the data in our study is the number of EGS cases presented by 10 regional hospitals at the Central Anatolia regional meetings of The Turkish Association of Trauma and Emergency Surgery between 2017 and 2020. MATLAB R2021b (The MathWorks, Inc., Natick, Massachusetts, USA) and SPSS (IBM SPSS Statistics for Windows, version 22.0, IBM Corp., Armonk, NY, USA) programs were used for data analysis and graphics creation.The hospitalization/consultation rate was evaluated as the success of the doctors working at the emergency department in recognizing EGS cases; the average value was 20.15% across all hospitals. The surgery/emergency hospitalization rate, which shows rate of the hospitalized patients underwent surgery, is 59.17% when all centers are taken into account. The rate of surgery/admission in acute cholecystitis cases is 31.49% for all centers. It is seen that the hospitalization/consultation rate decreases with the increase in hospital workload. The rate of laparoscopic/total appendectomy is 22.78% across all centers. There is a correlation between acute appendicitis cases and EGS consultation numbers, but there is no correlation between laparoscopic appendectomy and consultation numbers. In addition, it is seen that medical follow-up is preferred in acute cholecystitis cases in centers where the consultation burden is increased; cholecystectomy is preferred at a higher rate in centers where the consultation burden is less. National EGS systems are needed and tried to be developed in order to improve the approach and outcomes of EGS patients worldwide. It is considered essential to establish a national EGS maintenance system that coordinates country resources and optimizes outcomes.

Amac: Bu calismada inguinal herni nedeni ile yapilan Lichtenstein ve TEP yontemleri, cerrahiye endokrin ve inflamatuvar yanit ve postoperatif erken donem sonuclari acisindan karsilastirildi. Gerec ve Yontem: Klinigimizde inguinal herni tanisi ile opere edilen 40 hasta calismaya dâhil edildi. Hastalarin 20’sine TEP, 20’sine Lichtenstein onarimi yapildi. Her iki gruptaki hastalardan anestezi induksiyonu sirasinda, postoperatif 6. ve 12. saatte kan alinarak serum ACTH, IL-6, WBC ve CRP duzeyleri bakildi. Operasyonlarin postoperatif erken donem sonuclari degerlendirildi. Bulgular: Her iki grup arasinda cerrahiye endokrin yanit acisindan fark bulunmadi. Inflamatuvar yanitta parametreler degiskenlik gostermekte idi. TEP yapilan hastalarin 6. saatte bakilan WBC degerleri ve ortalamasi Lichtenstein yapilan hastalardan istatistiksel olarak anlamli derecede daha yuksekken, yine 6. saatte bakilan CRP degerinin TEP yapilan hastalardaki ortalamasi Lichtenstein yapilan hastalarin ortalamasindan istatistiksel olarak anlamli derecede daha dusuk bulundu. IL-6 degerleri acisindan TEP yapilan grup ile Lichtenstein yapilan grup arasinda hicbir donemde anlamli farklilik saptanmadi. Lichtenstein yapilan grubun postoperatif VAS degerleri, TEP yapilan hastalardaki degerlerden istatistiksel olarak anlamli derecede daha yuksek bulundu. Sonuc: Calismamizda TEP fitik onarimi ile Lichtenstein fitik onarimi arasinda inflamatuvar ve endokrin yanit acisindan anlamli fark bulunmamistir. TEP, hastalarin erken ise donmesi, daha az agri olmasi ve daha az analjezige ihtiyac duyulmasi ve ise erken donusun de yarattigi daha az maliyet ile Lichtenstein fitik onarimina gore daha ustun bulunmustur.

Background In the presence of advanced age and comorbidities, patients with gallstones may face gangrenous and perforated cholecystitis during their follow-up. In the literature, dynamic thiol/disulfide homeostasis has been shown to play an important role in detoxification, antioxidant protection, regulation of enzymatic reactions, and apoptosis and cellular signaling mechanisms. In this study, we aimed to evaluate the efficacy of IMA and thiol/disulfide homeostasis in the preoperative diagnosis of patients with cholelithiasis, acute/chronic cholecystitis, and perforated gallbladder. Methods Sixty-six patients that presented to the General Surgery Clinic of Ankara City Hospital for a cholecystectomy operation between February 2019 and May 2020 were included in this study. The patients were divided into three groups depending on the condition for which they were scheduled for surgery: cholelithiasis, cholecystitis, and perforated gallbladder. The demographic data, history of cholecystitis, chronic disease, white blood cell (WBC), amylase, lipase and liver function tests (AST and ALT) were recorded before the operation. Gallbladder appearance was evaluated using hepatobiliary ultrasonography. The duration of surgery, pericholecystic adhesions, hospital stay, body mass index (BMI), postoperative complications, and pathology results of specimens were recorded. In addition, thiol/disulfide and IMA values were analyzed in the blood samples taken from the patients preoperatively. Results The mean native thiol and total thiol values of the patients with an adhesion score of 0 were significantly higher than those with an adhesion score value of 1, 2 or 3. In addition, the disulfide, disulfide/native thiol, native thiol/total thiol and IMA values of the cases with an adhesion score of 2 or 3 were significantly higher than those with an adhesion score of 0. The native thiol and total thiol averages of the patients with normal cholecystectomy were higher than the others. The disulfide, native thiol/total thiol and IMA averages of those who underwent cholecystectomy due to a perforated gallbladder were also higher than the other groups. The mean preoperative WBC of the patients who underwent cholecystectomy due to a perforated gallbladder was also significantly higher than the other groups. Lastly, the native thiol and total thiol values had a statistically significant negative correlation with age, operation time, and hospital stay, and a statistically significant positive relationship with BMI. Conclusion We consider that in the preoperative diagnosis of the perforated gallbladder, the evaluation of thiol/disulfide hemostasis and IMA parameters can be used as an effective and reliable method to predict intraoperative difficulties.

Background We aimed to compare the cytology and histopathology results of hot, cold, and warm nodules in patients who had thyroidectomy due to toxic multinodular goiter (TMNG). Methods Five hundred and nine thyroid nodules from 413 patients who had operation with TMNG were included in this retrospective study. The nodules were categorized as hot, cold, and warm groups. The cytology and histopathology results were compared. Results The 509 thyroid nodules were grouped as hot (n = 364 [71.5%]), cold (n = 122 [24.0%]), and warm (n = 23 [4.5%]) according to scintigraphy. Cytological evaluations of 364 hot nodules were as follows: 80 (22%) nondiagnostic (ND), 259 (71.2%) benign, 17 (3.6%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), 2 (0.5%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 2 (0.5%) suspicious for malignancy (SM), and 4 (1.1%) malignant. The cytology of 122 cold nodules were ND in 25 (20.5%), benign in 86 (70.5%), AUS/FLUS in 8 (6.6%), FN/SFN in 1 (0.8%), and finally SM in 2 (1.6%). The 23 warm nodules were determined as ND, benign, and FN/SFN in 7 (30.4%), 15 (65.2%) and 1 (4.3%), respectively. There were no differences according to cytological results between groups (P = .616). However, malignancy rate was 3.8% in hot nodules, it was found as 6.6% in cold nodules. The malignancy was detected in 4.3% of warm nodules. There were no differences in malignancy rates between groups (P = .459). Conclusion We demonstrated similar malignancy rates in hot nodules when compared with cold and warm nodules.

WOS: 000483427400017 PubMed: 31233903 Background Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for reporting thyroid cytopathology. Cytological features described as atypia are not always observed in every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer variability considering these cell types, even though the cytological criteria are well defined. Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis of AUS. Methods: Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each case was calculated. Statistical analysis of the association between each nuclear feature and the presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points from the total score of these nuclear features were also calculated. Results: Nuclear grooves and overlapping were more common in malignant cases (p < 0.001 and p = 0.048, respectively). A cut-off point of >= 5.5 for the total score was sensitive and specific for defining malignancy. Conclusion: The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can be helpful for thyroid FNA samples.

AMAÇ: Bu çalışmada10 yılda gerçekleşen kolesistektomi olguları içerisinde raporlanmış Safra Kesesi Poliplerinin (SKP) klinik ve histopatolojik olarak değerlendirilmesi amaçlanmıştır. GEREÇ ve YÖNTEM: Kliniğimizde 2007-2016 yılları arasında yapılmış olan 5212 kolesistektomi vakası retrospektif olarak incelendi. Hastalar preoperatif ultrasonografi ve postoperatif patoloji sonuçlarına göre değerlendirildi. 241 hasta preoperatif ultrasonografilerinde multiple veya tek sayıda polipoid lezyon olması nedeni ile opere edilmişti. BULGULAR: Hastaların ortalama yaşı 44,65 yıl olup en genç hasta 21 en yaşlı hasta 84 yaşındaydı.145 hasta kadın, 96 hasta erkek idi. 157 hastanın semptomatik şikayetleri var iken, 84 hastada herhangi bir semptom yoktu. Kolesistektomi sonrası patolojik incelemelerde 58 ve 57 yaşlarında olan 2 kadın hastada safra kesesi karsinomu saptandı. (% 0,83) 66 yaşındaki bir diğer kadın hastada da düşük dereceli displazi mevcuttu. Opere edilen diğer hastalarda malign veya premalign lezyon saptanmadı. En çok rastlanan patolojik sonuç 149 vaka ile kolesterol polibi idi. Bunun dışında, başka bir patoloji olmaksızın olan kolelitiazis, koleterolozis, kronik kolesistit, fibroepitelyal polip, hamartamoz polip, inflamatuar polip ve adenomyoma görülmüştür. SONUÇ: Safra kesesi kanserleri yaşla birlikte artmakta ve kadınlarda daha sık görülmektedir. Bizim çalışmamızda görülmüş olan 2 kanser vakası da 50 yaşın üstünde olan kadın hastalardır. Safra kesesinin polipoid lezyonları değerlendirilirken hastanın semptomatik olup olmaması, yaşı, cinsiyeti, ultrasonografik olarak polibin boyutu, çap artışı, çok sayıda olup olmaması göz önünde bulundurulmalıdır. Bu sonuçlar sağlık eğitimi, sağlık politikası ve gelecekteki araştırmalar için değerli bir kaynak olabilir. Daha ileri özelliklerini tanımlamak için daha geniş çapta çalışmalara ihtiyaç vardır.

We aimed to investigate the relation between preoperative serum thyrotrophin (TSH) and clinicopathological features in patients with papillary thyroid carcinoma (PTC) and microcarcinoma (PTMC). Patients who underwent thyroidectomy and diagnosed to have benign nodular disease or PTC/PTMC in our clinic were evaluated retrospectively. Patients with a previous history of thyroid surgery, patients using antithyroid medications or thyroid hormone and patients with tumors known to be unresponsive to TSH were excluded. Data of 1632 patients were analyzed. Histopathological diagnosis was benign in 969 (59.4%) and malignant in 663 (40.6%) patients. Preoperative median serum TSH was significantly higher in malignant compared to benign group (1.41 IU/dL vs. 0.98 IU/dL, p

Omer Parlak Department of General Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey. e-mail: oparlak@hotmail.com INTRODUCTION Lipomas are benign soft tissue tumors. They are the most common soft tissue tumors of adult age. They are commonly solitary, mobile, painless, and slow-growing lesions. They are usually located on the extremities but rarely can be intraabdominal. Total surgical excision is usually curative if the lesion is symptomatic. The differential diagnosis of lipomas and other soft tissue tumors is very important to prevent possible complications and metastasis. CT and MRI are often used for this purpose, but pathological examination must be done for exact diagnosis.

Background: The aim of this study is to compare the results of patients who were treated with two groups (under 65 years and over 65 years) of thyroid cancer.Methods: A retrospective review of 1176 patients undergoing thyroid cancer surgery between January 2007 and December 2016 was performed. Patients were grouped as ≥65 (geriatric group) and