Turkish Journal of Surgery最新文献

{"title":"Unveiling the secrets of the profunda femoris artery: A cadaveric journey with morphometric insights.","authors":"Athikayala Gopikrisshna Dhaminirithika, Hannahsugirthabai Rajilarajendran, Gowthaman Kavinnilavan, P Indra","doi":"10.47717/turkjsurg.2025.6571","DOIUrl":"https://doi.org/10.47717/turkjsurg.2025.6571","url":null,"abstract":"<p><strong>Objective: </strong>Profunda femoris artery (PFA), a branch of femoral artery primarily supplies blood to skin, muscles of the inner thigh and proximal femur and plays a significant role in collateral blood supply. This study aimed to investigate the origin, branching pattern and morphometries of PFA in cadavers.</p><p><strong>Material and methods: </strong>Lower limbs of male and female cadavers (n=41) were analyzed for origin of PFA, lateral circumflex artery (LCFA) and medial circumflex artery (MCFA), distance from mid-inguinal point, course, branching pattern and their external calibers. Data were tabulated and analyzed using SPSS.</p><p><strong>Results: </strong>The PFA showed origins that are posterolateral, posteromedial, and posterior. The distance between PFA and the midpoint of the inguinal ligament was (L=3.7-6.2; mean =5.19±0.7 cm; R=3.2-6.2 cm, mean =4.74±0.9 cm). The origin of MCFA was medial (R=61%, L=52%) and posteromedial (R=39%, L=48%); LCFA was lateral (R=100%, L=78%) and posterolateral (R=0%, L=22%). The average diameter of PFA, MCFA, & LCFA was (L=5.04, 2.9, 2.8 cm and R=5.4, 3.09, 3.71 cm). The paired t-test with a significant p-value (95% confidence) demonstrated that differences in the diameters of the arteries at the specified levels between the left and right limbs could have clinical implications, such as differences in blood flow or susceptibility to vascular conditions.</p><p><strong>Conclusion: </strong>To reduce intra-operative and post-operative complications in the femoral region branches during diagnostic and surgical procedures, it is essential to comprehend the normal and variant positions and distances of the PFA's origin and its circumflex branches.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholecystectomy associated vasculobiliary injuries: Incidence and impact on surgical repair outcomes.","authors":"Saurabh Singla, Rakesh Kumar Singh, Saket Kumar, Umakant Prasad, Manish Mandal, Sanjay Kumar","doi":"10.47717/turkjsurg.2025.6577","DOIUrl":"10.47717/turkjsurg.2025.6577","url":null,"abstract":"<p><strong>Objective: </strong>Bile duct injury with concomitant vascular injury is a common complication of cholecystectomy. The influence of concomitant vascular injury on the presentation and management of bile duct injury remains debatable. This study aimed to determine the incidence of concomitant vascular injury in patients with post-cholecystectomy bile duct injury and its impact on presentation and short-term outcomes following biliary repair.</p><p><strong>Material and methods: </strong>This prospective study was done between November 2019 and December 2022. Patients presenting with post-cholecystectomy bile duct injury were investigated to detect vascular injury using computed tomography angiography. A comparative analysis of clinical presentation, and results of biliary reconstruction was performed on patients with and without concomitant vascular injury. McDonald criteria were used to grade the outcome of biliary reconstruction in these patients.</p><p><strong>Results: </strong>We studied 48 patients with bile duct injury of which 19 (39%) patients had concomitant vascular injury on imaging. Concomitant vascular injury was found in 87% and 42% of patients with Strasberg type 4 and type 3 injury, respectively. At presentation, the incidence of liver abscesses was significantly higher in patients with concomitant vascular injury. After two years of biliary repair, 75% of patients had McDonald Grade A status, irrespective of whether vascular injury was present.</p><p><strong>Conclusion: </strong>Approximately 39% of patients with biliary injury had concomitant vascular injury. A higher grade of biliary injury was associated with increased chances of concomitant vascular injury. The presence of vascular injury did not correlate with increased operative morbidity, prolonged hospital stay, or inferior outcomes of delayed biliary repair.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"24-30"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of early and delayed cholecystectomy for acute gallstone-related disease.","authors":"Mathew Vithayathil, Cissy Yong, Khaled Dawas","doi":"10.47717/turkjsurg.2025.6568","DOIUrl":"10.47717/turkjsurg.2025.6568","url":null,"abstract":"<p><strong>Objective: </strong>Laparoscopic cholecystectomy is the definitive treatment for gallstone-related disease. Early laparoscopic cholecystectomy (ELC) is recommended for management of acute gallstone-related disease, as delayed laparoscopic cholecystectomy (DLC) is associated with recurrent presentations and complications. This series evaluated the outcomes of ELC and DLC in patients presenting acutely to secondary care.</p><p><strong>Material and methods: </strong>All cholecystectomies performed for patients presenting with acute gallstone-related disease including biliary colic, acute cholecystitis, gallstone pancreatitis and obstructive jaundice over a 24-month period were included. Clinical outcomes including hospital stay, peri-operative complications, re-presentation of gallstone-related disease, and repeat hospital admissions and imaging were recorded for ELC and DLC cases.</p><p><strong>Results: </strong>Of 105 cholecystectomies performed, only 6.7% were ELC. The mean time from index presentation to cholecystectomy was 3.4 days and 119.6 days for ELC and DLC, respectively. Over one-third of patients (38.8%) undergoing DLC experienced recurrent gallstone-related disease between index presentation and surgery. Re-admission to hospital for gallstone-related symptoms was seen in 25.5% of patients. The mean additional inpatient stay for readmission for gallstone-related disease in the DLC group was 3.3 days, with 30.6% requiring repeat imaging.</p><p><strong>Conclusion: </strong>DLC is associated with significant recurrence of gallstone-related complications. Re-admission to hospital incurs additional inpatient stay, and investigation, leading to a negative impact on patients' health and additional financial burden.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"19-23"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance of para-aortic lymph node metastasis for prognosis in patients with pancreaticobiliary cancer who underwent radical surgical resections.","authors":"Atsushi Nanashima, Junichi Arai, Masahide Hiyoshi, Naoya Imamura, Takeomi Hamada, Yuki Tsuchimochi, Ikko Shimizu, Takahiro Ochiai, Hiroshi Kawakami, Yuichiro Sato, Wada Takashi","doi":"10.47717/turkjsurg.2025.6587","DOIUrl":"10.47717/turkjsurg.2025.6587","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate surgical strategies for patients undergoing radical resection, in cases where solitary distant lymph node metastasis is identified intraoperatively, we investigated the prognostic significance of para-aortic lymph node (PALN) metastases and other regional lymph node (RLN) metastases in pancreatic carcinomas (PC) and biliary duct cancers (BDC).</p><p><strong>Material and methods: </strong>This study retrospectively analyzed data from 181 PC patients and 116 BDC patients who underwent radical resections at two institutions between 1994 and 2021.</p><p><strong>Results: </strong>Among PC patients, metastases were observed in RLN and PALN in 54% and 9% of cases, respectively. Similarly, RLN and PALN metastases were present among BDC patients in 39% and 9% of cases, respectively. Survival analysis revealed that patients with BDC and PALN metastases exhibited significantly reduced disease-free (DFS) and overall survival (OS) compared to those without PALN involvement. Multivariate analysis identified PALN metastasis as an independent predictor of OS in BDC patients (p<0.05), while RLN metastasis was independently associated with DFS (p<0.05). Additional clinicopathological factors associated with PALN and RLN metastases were also identified. Preoperative serum levels of Duke Pancreas II monoclonal antibody were significantly elevated in patients with PALN metastases. Histological findings of lymphatic or perineural infiltration and hepatic or pancreatic invasion were independently associated with RLN metastases.</p><p><strong>Conclusion: </strong>Based on these findings, radical resection may be considered for PC patients with isolated PALN metastases only in the absence of additional adverse prognostic factors. Prospective clinical trials are warranted to further refine the criteria for surgical intervention when solitary PALN metastases are detected intraoperatively.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"5-18"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A questionnaire on the perception of social and academic discrimination against female general surgeons in Türkiye.","authors":"Hilmi Bozkurt, Tahsin Çolak, Simge Tuna, Cumhur Özcan, Enver Reyhan","doi":"10.47717/turkjsurg.2025.6578","DOIUrl":"10.47717/turkjsurg.2025.6578","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this research was to identify the specific prejudices that women in general surgery in Türkiye have to face in their workplace and academic careers. This was achieved by gathering the opinions of both genders on these issues and raising awareness of gender bias to promote a more inclusive environment for future generations of surgeons.</p><p><strong>Material and methods: </strong>A total of 202 people, 99 male and 103 female surgeons, participated in the survey. The questionnaire was distributed to people working in general surgery clinics via e-mail and WhatsApp groups of the Turkish Surgical Association and the Turkish Colorectal Association.</p><p><strong>Results: </strong>The mean age of the participants was 37.65±11.55 years (ranging from 24 to 74 years). Among the partipiciants, 40.4% agreed that surgery is more suitable for males, while 89.3% of women disagreed (p<0.001). 88.3% of the women stated that women are negatively influenced in choosing general surgery because of the male-dominated environment, and 52.5% of men agreed, while 40.4% of men disagreed (p<0.001). 66.7% of men and 65% of women believed that women do not prefer to work in general surgery because it is difficult to balance with family responsibilities (p=0.890). Women are more subjected to humiliating behaviors, while 53.4% of women agree. 85.4% of the women stated that it is important to have a female lecturer as a role model in the institution where they work.</p><p><strong>Conclusion: </strong>This study shows different views on gender prejudice among male and female surgeons in general surgery. Female respondents, including male and female surgeons, indicated experiencing bias and underrepresentation in academic disciplines, although they had differing perspectives on discrimination. Both genders agreed on the difficulty of work-life balance, with a similar percentage of individuals identifying family responsibilities as an obstacle.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"69-77"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trastuzumab significantly improves survival in resectable HER-2 positive gastric cancer: A retrospective study.","authors":"Olgun Erdem, Tolga Canbak, Mehmet Erman Bacaksız, Suat Aktaş, Kemal Tekeşin, Fatih Başak","doi":"10.47717/turkjsurg.2025.6687","DOIUrl":"10.47717/turkjsurg.2025.6687","url":null,"abstract":"<p><strong>Objective: </strong>Gastric cancer (GC), with a five-year survival rate of approximately 20%, frequently displays aggressive behavior when HER-2 is overexpressed. While trastuzumab, a monoclonal antibody against human epidermal growth factor receptor-2 (HER-2), has improved outcomes in advanced GC, its effect in resectable disease is less studied.</p><p><strong>Material and methods: </strong>This retrospective study included patients who underwent total gastrectomy with D2 lymph node dissection between 2016 and 2021. Among 180 patients, HER-2 status was determined for 97 cases. Of these, 20 HER-2 positive patients received trastuzumab-containing therapies. A control group of 40 HER-2 negative patients was randomly selected. Overall survival (OS) was compared between groups. Univariate and multivariate analyses were used to identify prognostic factors.</p><p><strong>Results: </strong>Sixty patients with a median follow-up of 29.5 months were analyzed. HER-2 positivity was associated with significantly improved OS (p=0.038). Univariate analyses revealed that HER-2 positivity (p=0.047), younger age (p=0.001), advanced tumor stage (p<0.001), and larger tumor size (p=0.010) were significantly related to OS. In the multivariate model, advanced tumor stage [hazard ratio (HR)=3.634, p=0.001] and younger age (HR=0.213, p<0.001) remained independent predictors of worse survival, while HER-2 positivity and tumor size lost their significance. Tumor subtype and location did not significantly influence OS.</p><p><strong>Conclusion: </strong>The findings suggest that trastuzumab-containing treatment strategies can markedly improve survival in resectable HER-2 positive GC. Routine assessment of HER-2 status and integration of targeted therapies may enhance patient outcomes. In addition, advanced stage and younger age emerged as key prognostic factors.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"85-91"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the disenchantment with tranexamic acid in liver surgery: A hopeful outlook for future developments.","authors":"Ahmet Serdar Karaca","doi":"10.47717/turkjsurg.2025.6798","DOIUrl":"10.47717/turkjsurg.2025.6798","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"1-4"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to: The use of Bakri balloon to reduce the anastomosis tension in hepaticojejunostomy: An exchange between surgery and obstetrics/gynecology.","authors":"Shigeki Matsubara, Alan Lefor","doi":"10.47717/turkjsurg.2023.6093","DOIUrl":"10.47717/turkjsurg.2023.6093","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"112-113"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous and uneventful anal expulsion of expanded polytetrafluoroethylene (e-PTFE) vascular graft after living donor liver transplantation.","authors":"Tufan Egeli, Tarkan Ünek, Cihan Ağalar, Muhammet Berkay Sakaoğlu, Mücahit Özbilgin, Funda Obuz, Canan Altay, Mesut Akarsu, İbrahim Astarcıoğlu","doi":"10.47717/turkjsurg.2022.5567","DOIUrl":"10.47717/turkjsurg.2022.5567","url":null,"abstract":"<p><p>Living donor liver transplantation (LDLT) is a useful therapeutic option for end-stage liver disease due to the shortage of deceased donor liver grafts, particularly in Asia and Türkiye. Right liver LDLT is frequently performed in adults and some cases require anterior section venous drainage. Synthetic grafts, particularly expanded polytetrafluoroethylene (e-PTFE), are often preferred for venoplasties. Despite its many advantages, some complications associated with these grafts have been reported, such as gastrointestinal tract migration, perforation, and bleeding. Here we present an extremely rare case about an e-PTFE graft.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"102-104"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of P-POSSUM and NELA scores in predicting 30-day mortality following emergency laparotomy: A prospective observational study.","authors":"Mahendra Lodha, Abhijeet Khoth, Karthik N, Mayank Badkur, Satya Prakash Meena, Niladri Banerjee, Swathi M","doi":"10.47717/turkjsurg.2025.6645","DOIUrl":"10.47717/turkjsurg.2025.6645","url":null,"abstract":"<p><strong>Objective: </strong>Emergency laparotomy carries a 10-18% mortality risk, influenced by factors such as age, medical conditions, and sarcopenia. Scoring models like the Portsmouth physiological and operative severity score (P-POSSUM) and the National Emergency Laparotomy Audit (NELA) have been developed to predict outcomes and assist decision-making. Both models are widely used, but their effectiveness in predicting outcomes, particularly in the Indian context, requires further evaluation. This study aimed to compare the P-POSSUM and NELA scores in predicting 30-day mortality for patients undergoing emergency laparotomy.</p><p><strong>Material and methods: </strong>This single-institution prospective observational study included 238 adult patients of age ≥18 years undergoing emergency laparotomy for acute abdominal conditions, following ethical approval. P-POSSUM and NELA scores were calculated preoperatively, and their predictive accuracy was evaluated by comparing predicted versus observed mortality using sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>The NELA area under the curve was 0.699, while the P-POSSUM area under the curve was 0.687. NELA demonstrated higher sensitivity (73.9%) and specificity (45.6%) than P-POSSUM, which had a sensitivity of 52.2% and specificity of 27.4%. P-POSSUM and NELA scores were significantly higher in patients requiring intensive care unit admission than in those who did not.</p><p><strong>Conclusion: </strong>Our study found that the NELA score outperforms the P-POSSUM score in predicting 30-day mortality in emergency laparotomy patients, indicating that NELA is a more reliable tool for preoperative risk stratification and clinical decision-making.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 1","pages":"56-60"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}