Turkish Journal of Surgery最新文献

{"title":"Letter to the editor regarding \"Novel self-reversing tube ileostomy as an alternative for conventional loop ileostomy for fecal diversion\".","authors":"Emre Tunç, Onur Coşkun","doi":"10.47717/turkjsurg.2026.2026-3-38","DOIUrl":"10.47717/turkjsurg.2026.2026-3-38","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"390-391"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866368","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":"Right colic artery pseudoaneurysm in a patient with rheumatoid arthritis: A case report.","authors":"Sriparna Biswas, Bijit Saha, Rohith Kodali","doi":"10.47717/turkjsurg.2025.6793","DOIUrl":"10.47717/turkjsurg.2025.6793","url":null,"abstract":"<p><p>To describe the clinical presentation, diagnosis, and endovascular treatment of a right colic artery (RCA) pseudoaneurysm in a patient with rheumatoid arthritis, highlighting its rarity as a complication of rheumatoid vasculitis. A woman in her early 50s with rheumatoid arthritis presented with a three-day history of epigastric pain, vomiting, and melena. Examination revealed anemia, purpuric rashes, and mild abdominal tenderness. Computed tomography (CT) angiography identified an RCA pseudoaneurysm. Following resuscitation and blood transfusion, selective superior mesenteric artery angiography and transarterial coil embolization were performed. The procedure was successful, leading to symptom resolution. RCA pseudoaneurysms are rare, usually resulting from trauma or pancreatitis, but can also arise from rheumatoid vasculitis. This is the first reported case of a RCA pseudoaneurysm due to rheumatoid arthritis. CT angiography is the preferred diagnostic tool, and coil embolization is an effective treatment for hemodynamically stable patients.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"370-373"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576360","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":"Pre-procedural predictors of in-hospital mortality in ICU patients undergoing endoscopic PEG placement.","authors":"Mustafa Oruç, Eda Şahingöz, Ece Canpolat, Tezcan Akın, Serdar Gökay Terzioğlu, Erdinç Çetinkaya","doi":"10.47717/turkjsurg.2026.2025-12-39","DOIUrl":"10.47717/turkjsurg.2026.2025-12-39","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in patients unable to maintain oral intake. However, PEG placement is already considered a high-risk intervention in the intensive care unit (ICU), where short-term mortality is substantial. This study aimed to identify predictors of in-hospital mortality in ICU patients undergoing PEG.</p><p><strong>Material and methods: </strong>A retrospective cohort study was conducted at a single tertiary center from 2019 to 2024, including all consecutive adult ICU patients who underwent endoscopic PEG. Demographic, clinical, laboratory, and procedural data were analyzed. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used to identify independent predictors.</p><p><strong>Results: </strong>A total of 364 ICU patients underwent PEG, of whom 125 (34.3%) died during the index hospitalization. Among non-survivors, 56 (44.8%) died within the first 14 days after PEG placement. Non-survivors showed lower albumin levels (24.4 vs. 28.2 g/L; p<0.001), higher urea concentrations (57.1 vs. 40.6 mg/dL; p<0.001), higher neutrophil-lymphocyte ratio (6.44 vs. 4.81; p=0.002), and more frequent infection at the time of PEG (88% vs. 58.6%; p<0.001). Prolonged mechanical ventilation (>14 days) was more common among non-survivors (23.2% vs. 11.7%; p=0.005). In the multivariate model, active infection [odds ratio (OR) 3.62; p<0.001], lower albumin (OR 0.90 per g/L; p<0.001), and higher urea (OR 1.02; p=0.05) independently predicted in-hospital mortality, whereas prolonged intubation showed a strong trend but did not reach significance (OR 1.85; p=0.06).</p><p><strong>Conclusion: </strong>ICU patients with active infection, severe hypoalbuminemia, and elevated urea levels have a markedly increased risk of in-hospital mortality after PEG placement. Prolonged mechanical ventilation appears to characterize a clinically more fragile ICU population rather than serving as an independent predictor of mortality. Incorporating these objective markers into pre-procedural assessments may improve patient selection and support decision-making in the ICU.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"298-305"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843330","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":"Current status and barriers of ultrasonography utilization among general surgeons in Türkiye: Results of a nationwide survey.","authors":"Ulaş Utku Şekerci, Muhammed Çağrı Coşkun, Merve Tokocin, Berk Göktepe, Adnan Gündoğdu, Olcay Atbaş, Serhan Akalın, Kayra Cangöz","doi":"10.47717/turkjsurg.2026.2025-10-14","DOIUrl":"10.47717/turkjsurg.2026.2025-10-14","url":null,"abstract":"<p><strong>Objective: </strong>Point-of-care ultrasonography is rapidly becoming a key tool in many medical fields. Although its value in surgical practice is well established, adoption among general surgeons in Türkiye still seems quite limited.</p><p><strong>Material and methods: </strong>We conducted a nationwide cross-sectional survey of practicing general surgeons and surgery residents in Türkiye. The questionnaire covered participants' background, ultrasound training history, current usage patterns, and views on future training.</p><p><strong>Results: </strong>A total of 147 surgeons responded (44 residents, 77 specialists, and 26 academic faculty). Only 10.2% had received structured ultrasound training during residency, whereas 21.8% had attended a postgraduate course. More than three-quarters (75.5%) described their competence in ultrasound-guided procedures as low or non-existent. Self-reported competency was significantly higher among specialists and faculty than residents (p<0.001). Multivariable analysis showed that attending a postgraduate ultrasound course [adjusted odds ratio (aOR) 12.92, 95% confidence interval (CI) 4.66-35.83] and having access to a dedicated ultrasound device (aOR 4.39, 95% CI 1.36-14.16) were the strongest predictors of greater competency. Notably, more than 93% of participants reported a willingness to pay for ultrasound training courses. Our results highlight a significant gap between available training opportunities and what surgeons need. Although competency improves somewhat with experience and formal training, it remains low across all career stages.</p><p><strong>Conclusion: </strong>There is an urgent need to integrate structured, hands-on ultrasonography training into general surgery residency programs in Türkiye and to expand accessible postgraduate options.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"306-312"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866384","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":"Robotic-assisted excision of a type Ib choledochal cyst with Roux-en-Y hepaticojejunostomy in an adult with a 4-mm hepatic duct: A technical perspective.","authors":"Bijit Saha","doi":"10.47717/turkjsurg.2026.2026-2-15","DOIUrl":"https://doi.org/10.47717/turkjsurg.2026.2026-2-15","url":null,"abstract":"<p><p>Choledochal cysts are rare congenital dilatations of the biliary tree and are increasingly diagnosed in adults due to widespread use of cross-sectional imaging. Complete cyst excision with Roux-en-Y hepaticojejunostomy (RYHJ) is the standard of care to prevent long-term complications such as cholangitis and malignant transformation. Biliary reconstruction in the presence of a narrow hepatic duct remains technically challenging and is associated with a higher risk of postoperative bile leak. This video article describes a stepwise robotic technique for cyst excision and precise biliary reconstruction in an adult patient with a 4-mm common hepatic duct. A 40-year-old woman presented with recurrent right upper abdominal pain and was diagnosed on magnetic resonance cholangiopancreatography with a 3-cm saccular dilatation of the mid-common bile duct consistent with a Todani type Ib choledochal cyst. She underwent elective robotic-assisted cyst excision and RYHJ using the da Vinci Xi system. Key technical steps included standardized port placement for optimal hilar exposure, use of indocyanine green fluorescence imaging to delineate biliary anatomy, circumferential cyst dissection and transection at healthy ductal margins. A tension-free duct-to-mucosa hepaticojejunostomy was fashioned using interrupted fine absorbable sutures. The procedure was completed with minimal blood loss and no intraoperative complications. The postoperative course was uneventful, with no bile leak or infective complications, and the patient was discharged on postoperative day three. Robotic-assisted excision with RYHJ enables precise dissection and secure biliary reconstruction, even in the presence of a narrow hepatic duct, when meticulous technique is applied.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798506","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":"Predictive factors of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A single-center study.","authors":"Saadia Makni, Yosra Loukil, Rania Kharrat, Meriam Triki, Mouna Zghal, Fatma Kolsi, Naourez Gouiaa, Tahya Sellami Boudawara, Ilhem Charfeddine, Manel Mellouli","doi":"10.47717/turkjsurg.2026.2025-10-18","DOIUrl":"10.47717/turkjsurg.2026.2025-10-18","url":null,"abstract":"<p><strong>Objective: </strong>Distinguishing preoperative criteria and postoperative histological features of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from those of other thyroid tumors with follicular architecture and papillary nuclear features (non-NIFTP) is crucial to prevent overtreatment. In this study, we aim to identify the predictive factors of NIFTP.</p><p><strong>Material and methods: </strong>We conducted a retrospective study in which we collected cases of thyroid tumors with follicular architecture and papillary nuclear features diagnosed between 2012 and 2022. Clinicopathological characteristics, therapeutic modalities, and follow-up were compared between NIFTP and non-NIFTP tumors.</p><p><strong>Results: </strong>Forty cases of NIFTP and 44 cases of non-NIFTP were identified. NIFTP accounted for 8.83% of all PTCs and 33.6% of all thyroid tumors with follicular architecture and papillary nuclear features. NIFTP was associated with younger age (p=0.005), isoechoic nodules on ultrasound (US) (p=0.004), regular contours (p=0.028), absence of microcalcifications (p=0.005), and predominance in European Thyroid Imaging Reporting and Data System 2 and 3 scores (p<0.001). They predominantly exhibited a nuclear score of 2 (p<0.001), focal nuclear abnormalities (p=0.015), and a thin capsule (p=0.004). No case of NIFTP showed distant or lymph node metastases. Multivariate analysis identified a nuclear score of 2, focal nuclear abnormalities, and a thin tumor capsule as independently associated with NIFTP.</p><p><strong>Conclusion: </strong>Our findings demonstrated the indolent nature of NIFTP and the utility of cervical US in raising preoperative suspicion for this entity. Because findings regarding the Bethesda classification were not available in our study, a prospective multicenter study with a larger sample size and a longer follow-up period is warranted to address this limitation.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"196-206"},"PeriodicalIF":0.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843290","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":"Lemmel syndrome: A single-center cohort and diagnostic considerations.","authors":"Ender Ergüder, Serkan Demir, Muhammed Salih Süer, Şehnaz Evrimler, Şener Balas","doi":"10.47717/turkjsurg.2026.2025-11-25","DOIUrl":"10.47717/turkjsurg.2026.2025-11-25","url":null,"abstract":"<p><strong>Objective: </strong>Lemmel syndrome is an uncommon cause of obstructive jaundice resulting from extrinsic compression of the common bile duct by a periampullary duodenal diverticulum (PAD) in the absence of choledocholithiasis. Due to its non-specific clinical presentation, diagnosis may be delayed or misinterpreted.</p><p><strong>Material and methods: </strong>A retrospective review was conducted on 12 patients diagnosed with Lemmel syndrome at a single tertiary center between 2022 and 2024. Demographic characteristics, clinical presentation, laboratory findings, imaging modalities [ultrasonography (USG), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP)], endoscopic interventions, and outcomes were analyzed descriptively.</p><p><strong>Results: </strong>The cohort included 12 patients with a mean age of 70±9 years. All patients presented with clinical or biochemical evidence of obstructive jaundice. USG frequently failed to establish the diagnosis, whereas CT and particularly MRCP demonstrated the anatomical relationship between the PAD and the biliary tree. Endoscopic retrograde cholangiopancreatography served both diagnostic and therapeutic purposes, with biliary stenting performed when indicated. Most patients improved with conservative and/or endoscopic management.</p><p><strong>Conclusion: </strong>Lemmel syndrome should be considered in elderly patients with unexplained obstructive jaundice. Cross-sectional imaging, particularly MRCP, plays a key role in diagnosis, while endoscopic intervention remains central to management.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"214-219"},"PeriodicalIF":0.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843266","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":"How is GIST to be pronounced? Like a ginger.","authors":"Masayuki Urabe","doi":"10.47717/turkjsurg.2025.2025-5-17","DOIUrl":"10.47717/turkjsurg.2025.2025-5-17","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"279-280"},"PeriodicalIF":0.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463817","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":"Re-arming checkpoint blockade in MSS colorectal cancer: A precision-microbiome playbook from mechanisms to clinic.","authors":"Zaid Safauldeen Ali Alsheikh, Tao Qingsong, Liu Qinjie, Chen Youkun","doi":"10.47717/turkjsurg.2026.2025-8-3","DOIUrl":"10.47717/turkjsurg.2026.2025-8-3","url":null,"abstract":"<p><p>Immune checkpoint blockade transforms outcomes for the 15% of colorectal cancers (CRCs) with mismatch-repair deficiency; yet most tumours remain refractory. Beneficial gut microbes can change this. <i>Akkermansia muciniphila</i>, <i>Bacteroides fragilis</i>, and short-chain fatty acid producers prime dendritic cells to produce interleukin (IL)-12, polarise Th1 cells, and reinvigorate CD8⁺ T-cells. Antibiotics, Western-style diets, and <i>Fusobacterium nucleatum</i> foster myeloid suppression and β-catenin- or IL-17-mediated signalling, which blunt checkpoint activity. Multi-omics analyses link biosynthetic genes for inosine, riboflavin, and folate to durable clinical benefit. Faecal microbiota transplantation from responders has produced objective regressions in otherwise refractory microsatellite-stable disease. This narrative review maps CRC-microbiota-immune crosstalk, evaluates biomarkers and interventions, and proposes a CRC-specific, three-tiered clinical algorithm. We outline standards for trial design and manufacturing processes to facilitate the translation of microbiota-guided therapy into routine practice.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"267-278"},"PeriodicalIF":0.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843312","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":"Public awareness, health care-seeking behaviors, and barriers to care for acute abdominal pain in Jordan: A cross-sectional study.","authors":"Wafa Taher Abu Mahfuz, Mohammad Abusamak, Shahd Alqato, Alyaman Karajeh, Dina Emad Kilani, Suhel F Batarseh, Abdallah Bakeer, Hind Hasan, Saja Feras Banihani, Esraa A ALhomaimat","doi":"10.47717/turkjsurg.2026.2025-11-35","DOIUrl":"10.47717/turkjsurg.2026.2025-11-35","url":null,"abstract":"<p><strong>Objective: </strong>Acute abdominal pain (AAP) is a leading cause of visits to the emergency department (ED) and is often a condition requiring immediate attention and timely management to prevent potentially serious complications like sepsis. Despite the importance of this topic, public knowledge about AAP and when to seek care remains underexplored, particularly among non-medical populations. This study aimed to assess public knowledge, attitudes, and practices regarding AAP, identify their sources of health information about the condition, and pinpoint barriers to seeking medical care in Jordan.</p><p><strong>Material and methods: </strong>A cross-sectional survey was conducted among Jordanian adults using a self-administered questionnaire that was developed after a thorough literature review, tested and validated in a pilot study. Convenience and snowball sampling methods were used to collect data, which were analyzed using descriptive and inferential statistics, including linear regression analysis to identify predictors of knowledge and attitudes.</p><p><strong>Results: </strong>A total of 1.566 Jordanians participated in the study, with a median age of 26 years (interquartile range: 23-41). The most commonly perceived cause of AAP was the digestive system (86%), with changes in bowel habits (57%) and bloating (51%) being the most recognized associated symptoms. The mean knowledge score was 6.9±3.0, with most participants having fair (53.8%) or good (35.3%) knowledge scores. The vast majority (91.8%) had a positive attitude regarding the importance of raising and awarding about AAP, with a mean score of 7.89±1.66 out of 10. Age, female gender, marital status, parenthood, and prior abdominal surgery were positively associated with both better knowledge and attitude scores (p-values <0.05). However, when experiencing AAP, 35.5% reported that they would take painkillers and wait, and 30% would rest at home, while only 19.7% would seek medical help. Moreover, 4% stated that they would not seek care even in the presence of red flag symptoms. The main barriers to seeking care included long waiting times (47%) and lack of confidence in healthcare providers (31%). Regarding the sources of information about AAP, doctors and health professionals were the primary source of AAP knowledge (61%), followed by personal experiences and advice from friends and family (41%).</p><p><strong>Conclusion: </strong>Most participants had fair to good knowledge and a positive attitude toward AAP, yet a significant proportion opted for self-management over seeking medical help. The main barriers to seeking care included long waiting times, and distrust in healthcare providers. Well-coordinated education campaigns and system-level interventions are advocated to overcome the existing barriers and improve outcome for AAP in Jordan.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"42 2","pages":"156-166"},"PeriodicalIF":0.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164828","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}