General Surgery

Bezoar is de�ned as the accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract. ese foreign bodies can be hair (trichobezoar), �bers or seeds of vegetables and fruits (phytobezoar), or remnants of milk (lactobezoar) and stones (lithobezoar). Lithobezoar, the accumulation of stones in the digestive tract, is commonly seen in stomach. In this paper, a 7-yearold girl with colonic lithobezoar who presented with constipation, abdominal pain, and the history of pica was successfully treated by the extraction of the stones under general anesthesia.

The objective of the present study was to compare different off-midline techniques in terms of their advantages and disadvantages. Methods: A total of 81 patients were included in this prospective, controlled, randomized study. Patients in group 1 were treated with the Limberg flap, and patients in group 2 were treated with Mutaf technique. Patients were followed up for 9 months postsurgically and assessed at regular intervals. Results: A total of 41 and 40 patients received surgical treatment with Limberg or Mutaf techniques, respectively. The 2 groups were similar in terms of age, gender, body mass index, and Tezel pilonidal sinus classification. Also, the 2 groups were comparable with regard to the frequency of preoperative discharge from the wound site, history of abscess formation, and the resultant antibiotic use. Early results showed similar recurrence rates and surgical-site complications between the 2 groups. Although a lower visual analogue scale score was found in group 2 at postoperative day 1, seroma persistence, time to withdrawal of surgical drains, and wound healing were more prolonged. Conclusion: In this study, Mutaf technique was comparable to Limberg flap in the treatment of pilonidal sinus. Therefore, Mutaf technique may be offered as a viable surgical therapeutic option among off-midline closure approaches.

Objectives.Rates of negative laparotomy (NL) for acute appendicitis have been reported as 15% and parasitosis contributed to 2%. This study was planned to reduce the rates of NL by preoperative determination of parasitosis.Methods.In retrospective examination of 2730 appendectomy specimens in Hitit University Department of General Surgery between 2008 and 2012, 55 patients were determined with parasitosis and compared with 102 age-matched randomly selected patients with lymphoid hyperplasia.Results.The parasite group comprised 63.6% females with a mean age of 15.1 years. The number of patients in the parasitosis group increased from city centre to rural areas of towns and villages (p<0.001). While a lower rate of sonographic findings was found in the parasitosis group, the findings of inflammation in the histopathological evaluation were significantly low (p=0.014,p=0.0011, resp.). A significant difference was determined between groups in respect of the eosinophil and haematocrit...

Pilonidal sinüs (PS) sakrokoksigeal bölgenin sık karşılaşılan benign seyirli kronik bir hastalığıdır. Hastalığın etiyolojisinde kıl foliküllerinin oluşturduğu yabancı cisim reaksiyonu en çok kabul gören teoridir. Günümüzde çeşitli cerrahi yöntemler uygulanmasına rağmen halen ideal bir tedavi yöntemi yoktur. Bu çalışmada PS eksizyonu sonrası primer ve limberg flep ile yapılan onarım karşılaştırılmıştır. Conclusion: Many methods have been defined for repair of the pilonidal disease. However, none of these treatments can not prevent recurrence and fully cure. Primary repair method is still can be preferred because of its cosmetic results, minimally invasive procedure.

Departmental sources Background: The primary aim of this study was to evaluate the effectiveness of patient positioning prior to trocar entry in laparoscopic sleeve gastrectomy. Material/Methods: The records of 300 patients that had a laparoscopic sleeve gastrectomy surgery at Aydin State Hospital from January 2015 until January 2017 were analyzed retrospectively. First, 140 patients who had been placed in the surgical position after the entry of trocars (PAET) were included as the first group, and 160 patients who had been placed in the surgical position before entry of trocars (PBET) were included as the second group. A comprehensive analysis based on the comparison of age, gender, body mass index (BMI), duration of total anesthesia, and incompleteness rate of operations between the two groups was performed. Results: The PAET group was composed of 111 females (79.3%) and 29 males (20.7%). The averages of age, BMI, and duration of anesthesia for this group were 36.84, 46.3 kg/m 2 , and 161.56 minutes, respectively. The PBET group was composed of 123 females (76.9%) and 37 males (23.1%). The averages of age, BMI, and duration of anesthesia of this second group were 38.8, 47.4 kg/m 2 , and 120.8 minutes, respectively. In the PAET group, the operations for four patients (2.9%) were never completed; in the PBET group, there was no uncompleted operations (p=0.046). Conclusions: PBET is an effective method which both shortens the operation time and decreases the rate of uncompleted operations.

Departmental sources Background: T-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement. Material/Methods: Retrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis. Results: Of the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4-21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found. Conclusions: A retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications.

BACKGROUND The study evaluated reliability and outcomes of percutaneous dilatational tracheostomy (PDT) performed via Griggs' method in the intensive care unit. MATERIAL AND METHODS We examined 78 patients who underwent bedside PDT in the intensive care unit (ICU). Demographic characteristics were recorded. In addition, ventilator-related pneumonia, duration of performing PDT, and rates of complications, mortality, and morbidity were assessed. RESULTS The mean age of patients was 68.7 years, and 56.4% were females (n=44). The most common indication for ICU was pneumonia (44.9%, n=35), followed by trauma (24.8%, n=13). Mean opening of PDT was 21 minutes. Mean duration of intubation prior to PDT was 21±6 days. Mean FiO2 before and after PDT was 58.7% and 49.1%, respectively. PEEP ratios before and after PDT were 5 and 3, respectively. Seventy-one patients (91%) needed no sedation after PDT. Mechanical ventilator-induced pneumonia was observed in 32.1% (n=25) of patients. The overa...

BACKGROUND We sought to investigate subgroup distribution using Bethesda classification and risks for malignancy. We also compared the malignancy risk of cases that were denoted as non-diagnostic due to cystic contents, with cases that were denoted as non-diagnostic due to presence of other features. MATERIAL AND METHODS The study included pathology test results of 1,440 thyroid nodule samples diagnosed using Bethesda classification. Results of 305 thyroidectomy excision specimens from these patients were also compared with cytology results to determine the frequency of malignancy. The non-diagnostic group was divided into two categories: those with cystic contents, and others. Malignancy rates were separately calculated for the two groups, and compared with the other classification groups. RESULTS Distribution of malignancy rates by Bethesda classification were as follows: non-diagnostic 12.5% (6/48), benign 1.5% (3/198), atypia of undetermined significance/follicular lesion of und...

The present study investigated the effectiveness of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) in wound healing suppressed by corticosteroid in rats. Forty rats were separated into four groups. To disrupt the wound-healing processes, intraperitoneal single dose 10 mg/kg methylprednisolone was administered to all rats with the exception of Sham-S group. Then, full-thickness incision was performed to the abdominal skin of all animals, and PRP or MSCs were applied to the incision line except the Sham-S and Sham-M group animals. Ten days later, all animals were sacrificed to investigate: tissue collagenization, inflammation, and re-epithelialization grades histopathologically; and tissue hydroxyproline (HP), interleukin-1β (IL-1β), tumor necrosis factor-α levels biochemically. Collagenization ( = 0.003) and inflammation grade ( = 0.002) values were higher in PR group. Tissue HP level value was found to be high in MC group ( < 0.001). Tissue IL-1&beta...

BACKGROUND The aim of this study was to investigate the early and late results of use of LigaSure, Harmonic Scalpel, and conventional hemorrhoidectomy in hemorrhoidectomy, to determine the least painful method, and to investigate the relationship between pain perception and personal differences in hemorrhoid bundles. MATERIAL AND METHODS Ninety patients undergoing hemorrhoidectomy between 2014 and 2017 were retrospectively evaluated. We investigated the duration of hospitalization and the presence of bleeding, incontinence, perianal wetness, urinary retention, stenosis, and recurrence during follow-up after surgery. Analgesic requirement was determined by Patient-Controlled Analgesia, as well as pain score by use of the Visual Analog Score and patient satisfaction by Short Form-36. We also assessed the relationship between pain and lateral thermal damage, the number of peripheral nerves, number of excised bundles, and the number of thrombosed vessels, as determined by histopathologi...

Departmental sources Background: Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). Material/Methods: The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. Results: The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). Conclusions: According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Amaç: İnguinal herni kesesi içinde apendiks vermiformis varlığı ile tanımlanan Amyand herni inguinal hernilerin yaklaşık %1ini oluşturur. Bu durum akut apandisit tablosu ile acil servise başvuruya neden olabileceği gibi, perioperatif insidental olarak da tespit edilebilir. Amyand herni tespit edilen hastalarda apendektominin yapılıp yapılmaması, apendektomi yapılınca fıtık onarımında sentetik greft kullanımının güvenirliği halen tartışma konusudur. Bu çalışmada kliniğimizde Amyand herni tanısı konulan ve cerrahi tedavisi yapılan hastaların sonuçları bildirilmiştir.

Bu çalışmada, cerrahi alanında kohort çalışmalarının raporlama kalitesini iyileştirmek ve bir standart oluşturmak amacıyla uzmanlardan oluşan bir grup tarafından 2017 yılında yayınlanan 17 maddelik (37 alt madde) STROCSS (Cerrahide Kohort Çalışmaların Raporlanmasının Güçlendirilmesi) kriterlerinin Türkçeye uyarlanmasının yapılması amaçlanmıştır. Gereç ve Yöntem: STROCSS kriterleri, üç yazar (E.D., C.A., M.A.T.) tarafından birbirlerinden ayrı olarak Türkçeye çevrilmiş ve Y.Y. 'nin liderliğinde son taslak olarak belirlenmiştir. Türkçeye uyarlanmış kontrol listesi kullanılarak 2010-2018 yılları arasında TR dizinde yayınlanan 10 cerrahi kohort araştırmasının raporlanma kalitesi beş farklı cerrahi branştaki akademisyen hekim (İ.Ş.T., G.D., Ü.M., G.D., M.E.) tarafından değerlendirilmiştir. İstatistiksel değerlendirmelerde sınıf içi korelasyon katsayısı ve Bland-Altman grafikleri kullanılmıştır. Bulgular: Cerrahi branşlardaki ikili değerlendirmeler arasında anlamlı uyum olduğu görülmüştür (p<0,001; p<0,001; p=0,007; p=0,001). En yüksek uyum iki farklı Genel Cerrah arasında bulunmuştur; 0,963 (0,857-0,991). Tüm Akademisyen Hekimler arasında ise 0,947 (0,858-0,985) uyum düzeyi bulunmuştur (p<0,001). Bland-Altman grafiklerine göre genel olarak tüm gözlemciler arasında uyuşma bulunmuştur. Sonuç: Birçok uluslararası yayıncı tarafından cerrahi alanındaki makalelerin incelemeye alınması için zorunlu hale gelen bu kılavuzun çevirilmesi ile ülkemizdeki araştırmacılara çalışmalarının raporlanmasında kolaylık sağlayacağı ve ulusal yayınlarda bir standart oluşturulacağı düşünülmektedir.

Background. This study was performed to better understand the best surgery timing for gallbladder polyps (GP). Objectives. The objective was to determine the potential for malignant transformation and the best timing for surgery in GP, based on an assessment of the clinical symptomatology and on the results of the imaging and histopathological examinations. Material and methods. Age, gender, clinical symptoms, preoperative ultrasound findings, and the results of the postoperative histopathological examination were retrospectively assessed in a total of 2,656 patients undergoing cholecystectomy in

The accumulation of undigested foreign bodies or nutrients in gastrointestinal tract is named as bezoar. These foreign bodies can be hair (trichobezoar), fibers or seeds of vegetables and fruits (pythobezoar), remnants of milk (lactobezoar) and stones (lithobezoar). Lithobezoar is mostly seen in the stomach and rarely in the colon. Colonic lithobezoar is usually seen in iron deficiency anaemia, pica or psychologically ill patients. It can be the reason for mechanical intestinal obstruction and ileus at these patients. In this case, we present a 35-year-old schizophrene patient with colonic lithobezoar who presented by ileus.

Paratubal cysts (PTCs) are generally incidentally detected in pregnancy. However, paratubal cystadenomas in pregnant women are very rare cases who are reported individually. An unusually giant case of paratubal cystadenoma in a pregnant woman is presented here. A 27-year-old woman presented to our department for a routine pregnancy checkup. A giant cystic mass accompanying a 17-week gestation was detected on examination. During laparotomy, a huge right-sided PTC was resected. Histopathological evaluation revealed a benign cystadenoma originating in the ipsilateral paratubal space. PTCs are often denoted as being benign. Neoplastic transformation or malign potential will change the course of follow-up and the patients' prognosis. Treatment with surgical excision in the second trimester can safely prevent such associated adverse conditions. In conclusion, gynecologists should be careful for causes of adnexal masses in a woman with an intrauterine pregnancy. PTCs also tend to show accelerated growth patterns during pregnancy.

Splenectomised patients are associated with lifelong risk of fatal overwhelming post-splenectomy infection (OPSI), which is mostly caused by Streptococcus pneumoniae. Today OPSI cases can still be reported even in patients with appropriate vaccination. In our study, the levels of vaccine-specific memory B- and T cells were compared between control and splenectomised patients to enlighten the underlying reason. Five healthy and 14 post-traumatic splenectomised individuals were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV-13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV-23). The levels of memory B- and T cells were compared by ELISPOT analysis. Splenectomised patients generated reduced levels of memory IgG B cells in response to PCV-13 vaccination, while the memory IFN-γ T-cell levels were undetectable in asplenic patients. This was despite the detection of vaccine-induced memory T-cell levels in control patients, which were analysed simultaneously f...

Backgrounds: Abdominal traumas have an important place in the emergency room. Historically, surgical intervention was adopted as a treatment method for liver and spleen traumas. However, with the development of imaging methods, the possibility of non-surgical follow-up was obtained. In this study, the advantages and disadvantages of conservative treatment for surgical intervention were investigated. Material and Method: The patients with complaints of blunt abdominal trauma, who were admitted to the third step research center emergency service during the 27-month period and were referred to general surgery, were retrospectively examined. Results: Of patients, 58.2% (n=53) was monitored conservatively, 34.1% (n=31) had splenectomy and 4.4% (n=4) underwent the primary repair due to isolated liver injury, and both splenectomy and liver primary repair were performed in 3.3% (n=3) because of multiple solid organ injury. We observed that the injuries of non-surgical spleen trauma patients changed between grade I and III. All patients with grade IV-V injuries underwent splenectomy. Patients with decreased hematocrit and whose hematocrit did not increase despite erythrocyte replacement were operated on. Conclusion: In this study, it was explained that patients who were followed up without surgery did not need surgery and that both liver trauma and spleen trauma should be given the chance to follow up without surgery.

Yabancı cisimlerin farkında olmadan yutulması, klinik pratikte sık rastlanılan bir durum olmasına rağmen; bunların ince bağırsak perforasyonuna neden olması nadiren görülür. Bu yazıda, kemikli-kırmızı etli bir yemek yenmesi sonrası gelişen, ince bağırsak perforasyon olgusu sunuldu. 63 yaşında erkek hasta, akut karın bulguları ile kırsal bölgeden acil servisimize sevk edilmişti. Acil serviste görülen hasta, şiddetli karın ağrısı, bulantı ve kusmadan şikayetçi idi. Karın periumblikal bölge ve sağ paraumblikal bölgede ve sağ inguinal bölgede hiperemi hassasiyet, defans saptanmış olup bağırsak sesleri hipoaktif idi. Hasta yakın zamanda parça etli bir yemek yeme öyküsü olduğunu ancak herhangi bir yabancı cisim yuttuğunun farkında olmadığını söyledi. Acil olarak ameliyata alındı. Hastada ne olduğu net anlaşılamayan bir yabancı cisime bağlı terminal ileumda perforasyon saptandı. Hastaya yabancı cisim çıkarılması ve primer ince barsak onarımı yapıldı. Aynı zamanda sağ inguinal bölgeden ağrılı yaklaşık 3 cm'lik LAP eksizyonu yapıldı. Postoperatif altıncı günde hasta şifa ile taburcu edildi.

The case reported here describes primary appendiceal adenocarcinoma(AACa) mimicking manifestations of ovarian malignancies. A 55-year-old woman with clinical findings of ovarian cancer underwent laparatomy in which an appendiceal tumor was encountered. Total abdominal hysterectomy, bilateral salpingo-oopherectomy, appendectomy, right hemicolectomy and omentectomy were performed. Final histopathological result demonstrated mucinous adenocarcinoma with signet ring epithelial cells.Therefore, AACa should be kept in mind by gynecological surgeons for diffential diagnosis of ovarian malignancies, since therapautic approaches differ from each other