Turkish Journal of Surgery最新文献

{"title":"Factors associated with anastomotic leak following gastrectomy for gastric adenocarcinoma and its effect on long-term outcomes.","authors":"Rakesh Shaganti, Sunil Kumar Godara, Rajneesh Kumar Singh, Rahul R, Shagun Misra, Shaleen Kumar","doi":"10.47717/turkjsurg.2024.6351","DOIUrl":"10.47717/turkjsurg.2024.6351","url":null,"abstract":"<p><strong>Objectives: </strong>Gastrectomy for cancer is a technically demanding surgery and anastomotic leak is an important complication of this surgery. This study aimed to identify the factors associated with anastomotic leak following gastrectomy in gastric cancer patients and its long-term effect on outcomes.</p><p><strong>Material and methods: </strong>This is an ambispective study of 181 patients who underwent curative gastrectomy for gastric adenocarcinoma over 13 years, at our institution. Groups with and without anastomotic leak were compared using the Mann-Whitney U test (continuous variables) and Chi-square test (categorical variables). A multivariable analysis was performed to determine the factors associated with anastomotic leak.</p><p><strong>Results: </strong>Out of the 181 patients who underwent curative gastrectomy, 12 (6.6%) patients experienced anastomotic leak. A multivariable analysis revealed that younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associating factors for anastomotic leak. During a median follow-up of 34 months (ranging from 12 to 130), it was observed that 25 (18.3%) patients developed anastomotic stenosis, but it was not related to anastomotic leak. The incidence of post-operative pulmonary complications, administration of adjuvant therapy, recurrence rates, and mortality due to anastomotic leak did not significantly change. Moreover, neoadjuvant therapy did not increase the incidence of anastomotic leaks.</p><p><strong>Conclusion: </strong>Factors like younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associated with increased risk of anastomotic leak, which needs further studies to validate the findings. Thus, preoperative optimization and resection with adequate margins may be of utmost importance in preventing anastomotic leaks.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"111-118"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772673","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":"Laparoscopic-assisted pancreaticoduodenectomy for periampullary carcinoma: An experience of 50 cases from a single tertiary care center.","authors":"Basant Narayan Singh, Rohith Kodali, Utpal Anand, Kunal Parasar, Kislay Kant, Saad Anwar, Bijit Saha, Siddhali Wadaskar","doi":"10.47717/turkjsurg.2024.6419","DOIUrl":"10.47717/turkjsurg.2024.6419","url":null,"abstract":"<p><strong>Objectives: </strong>Laparoscopic-assisted pancreaticoduodenectomy (LAPD) is being performed in several centers worldwide. The proportion of minimally invasive pancreaticoduodenectomy for periampullary carcinoma (PAC) has recently increased, owing to its potential benefits. However, the safety and feasibility of LAPD have not yet been standardized. In this study, it was aimed to report our experience with LAPD in 50 patients.</p><p><strong>Material and methods: </strong>Fifty patients with resectable PAC who underwent LAPD between June 2021 and August 2023 were retrospectively analyzed.</p><p><strong>Results: </strong>Mean age of the study group was 49.9 ± 12 years, and most were females (54%). Ampullary carcinoma was the most common type (58%). Mean operative time and estimated blood loss were 460 ± 40 minutes and 426 ± 156 mL, respectively. Four patients had suspected portal vein involvement, and two patients had hemorrhage during uncinate process dissection, resulting in conversion to open surgery. Severe post-operative morbidity was noted in 13 (26%) patients. Following surgery, Grade B post-operative pancreatic fistula was present in 26% of patients, whereas Grade B and C delayed gastric emptying was present in 18% and 2% of patients, respectively. Mean hospital stay was 9.4 ± 2.8 days. Mean number of lymph nodes harvested was 13.4 ± 4. All patients underwent R0 resection, and no mortality was noted during the 30-day follow-up period.</p><p><strong>Conclusion: </strong>LAPD is a feasible procedure for resectable PAC offering good oncological outcomes and minimal complications. It can be performed effectively by experienced surgeons in specialized centers.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"126-135"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772549","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":"Pancreatic fistula and bleeding following choledochal cyst excision: Experience of two decades.","authors":"Sai Krishna Katakam, Supriya Sharma, Anu Behari, Rahul R, Ashok Kumar Ii, Ashish Singh, Rajneesh Singh, Ashok Kumar, Rajan Saxena","doi":"10.47717/turkjsurg.2024.6354","DOIUrl":"10.47717/turkjsurg.2024.6354","url":null,"abstract":"<p><strong>Objectives: </strong>Choledochal cyst excision (CDCE) with hepaticojejunostomy is standard of care in choledochal cysts. Complications related to inadequate healing of distal stump like post-operative pancreatic fistula (POPF) and bleeds have not been addressed in literature. We report two decade experience with these complications following CDCE.</p><p><strong>Material and methods: </strong>Retrospective analysis of demographics, operative details and post-operative course of patients who developed POPF (according to International Study group of Pancreas surgery classification) and bleeds following CDCE were compared with those who did not develop these complications.</p><p><strong>Results: </strong>POPF was seen in in 34 out of 377 operated patients (incidence of 9%). In those with POPF, 24/34 (70%) had biochemical leak and 10/34 (30%) had clinically relevant POPF (B and C). All grade B POPF 6/34, required additional percutaneous drains while all grade C 4/34 required operative intervention to control sepsis. There was no mortality in the POPF group while two patients in control died from non-surgical causes. A difficult distal stump precluding closure was the only factor found associated with subsequent development of POPF (5.9% in POPF group vs. 0.5% in control group, p= 0.03). Post-operative bleeding was seen in 2 (6%) patients with POPF and in 5/343 (1.4%) in control group.</p><p><strong>Conclusion: </strong>It is possible to anticipate development of POPF intraoperatively, during CDCE. Most of these POPFs can be managed conservatively with adequate drainage. Surgery is required only in grade C fistula and bleeds. Since these are isolated pancreatic fistulas, unlike those seen after pancreaticoduodenectomy, they are associated with more favourable outcomes.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"104-110"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772554","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":"Hepato-pancreato-biliary tuberculosis: A review.","authors":"Peeyush Varshney, Vinay Kumar Kapoor","doi":"10.47717/turkjsurg.2024.6338","DOIUrl":"10.47717/turkjsurg.2024.6338","url":null,"abstract":"<p><p>Hepato-pancreato-biliary (HPB) tuberculosis (TB) is a rare form of extra-pulmonary TB that poses a diagnostic dilemma and is a great masquerader of malignancy. It is almost always curable but requires a high degree of suspicion and corroboratory evidence to document its existence. Medline/PubMed was searched with keywords \"hepatic\", \"liver\", \"biliary\" and \"pancreatic\" with \"tuberculosis\". Data were gathered and analyzed. Common symptoms of HPB TB include jaundice, weight loss, abdominal pain and other constitutional symptoms that make it indistinguishable from malignancy. Imaging modalities such as ultrasonography, computed tomography, magnetic resonance imaging may reveal dilated intrahepatic biliary radicles, mass lesion, and biliary stricture or enlarged necrotic lymph nodes. Fine-needle aspiration cytology/biopsy, brush biopsy, acid-fast bacilli (AFB) staining and molecular testing may help clinch the diagnosis. Most cases require biliary drainage and initiation of anti-tubercular therapy (ATT) whereas surgery is reserved for medically refractory cases or fibrotic strictures. However, most cases are diagnosed post-operatively on histopathology where pre-operative diagnosis is malignancy. A high index of suspicion, coupled with streamlined investigations, may help identify patients pre-operatively to be managed with ATT as TB is completely curable with medical management in most of the cases.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"95-103"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772679","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":"FROM THE EDITOR'S DESK.","authors":"Kaya Sarıbeyoğlu","doi":"10.47717/turkjsurg.2024.20240101","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.20240101","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 1","pages":"ix"},"PeriodicalIF":0.5,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735116","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":"Repair of stoma prolapse with the \"peristomal cerclage\" method using vessel tape.","authors":"Arif Hakan Demirel, İbrahim Kurtoğlu, Saygın Altıner, Recep Aydın","doi":"10.47717/turkjsurg.2023.6154","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6154","url":null,"abstract":"<p><p>Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called <i>peristomal cerclage</i> applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26^th month and terminal period, and his colostomy is working normally. The present report aimed to describe the <i>peristomal cerclage</i> method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"39 4","pages":"373-376"},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870103","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":"Zinc supports liver regeneration after partial resection.","authors":"Yuki Takahashi, Hideyuki Oyama, Akihiro Nakamura, Yuzo Minegishi, Kuniya Tanaka","doi":"10.47717/turkjsurg.2023.6260","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6260","url":null,"abstract":"<p><strong>Objectives: </strong>Safe removal of extensive liver tumor burdens depends on regeneration of the remnant liver, which requires a large amount of zinc over a short period of time. We studied how zinc influences regeneration.</p><p><strong>Material and methods: </strong>We measured perioperative serum zinc concentrations after liver cancer diagnosis in 77 patients undergoing hepatectomy to determine how serum zinc affected short-term outcomes and remnant liver regeneration.</p><p><strong>Results: </strong>Serum zinc concentration at diagnosis showed no correlation with inflammatory or nutritional parameters except for a weak correlation with the lymphocyte-to-monocyte ratio. When patients were divided into a high pre-hepatectomy zinc group (≥75 µg/dL, n= 39, H group) and a low zinc group (<75 µg/dL, n= 38, L group), short-term results such as mortality (p> 0.999), morbidity (p= 0.490), and hospital stay (p= 0.591) did not differ between groups. However, hypertrophy in the future liver remnant after hepatectomy in the H group (127.7 ± 24.7% of original volume) was greater than in the L group (115.9 ± 16.7%, p= 0.024). In a subgroup of patients with extended hepatectomy, hypertrophy was 130.9 ± 26.8% in the H group vs. 116.4 ± 16.5% in the L group (p= 0.037).</p><p><strong>Conclusion: </strong>Greater serum zinc at diagnosis was associated with greater hypertrophy in the future liver remnant.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"39 4","pages":"344-353"},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870175","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":"Laparoscopic gastrectomy for gastric cancer: A single cancer center experience.","authors":"Amr Abouzid, Ahmed Setit, Ahmed Abdallah, Mohamed Abd Elghaffar, Mosab Shetiwy, Islam A Elzahaby","doi":"10.47717/turkjsurg.2023.6158","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6158","url":null,"abstract":"<p><strong>Objectives: </strong>Laparoscopic gastrectomy (LG) was challenging to most surgeons due to the two-dimensional view, difficult manipulations of the instruments, ergonomic discomfort, and the associated muscular spasm and effort. Technological advances with improved surgical experience, have made LG a more feasible and favorable approach for gastric cancer (GC) patients.</p><p><strong>Material and methods: </strong>LG was performed in 44 patients with GC between July 2015 to June 2022, in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt, and we assessed the surgical outcomes of this approach as an initial experience of a single cancer center.</p><p><strong>Results: </strong>Twenty-seven patients underwent laparoscopic distal gastrectomy, and seventeen underwent laparoscopic total gastrectomy. Two cases had combined resection. Operative time was 339.2 ± 76.73 min, while blood loss was 153.86 ± 57.51 mL. The patients were ambulant on postoperative day 0, oral intake was started within three days (range 1-5 days) and the hospital stay was six days (range 3-9 days).</p><p><strong>Conclusion: </strong>LG for GC is a feasible approach for both early and advanced GC patients as it allows for adequate diagnosis of the peritoneal disease, meticulous dissection, and identification of the lymph nodes with minimal blood loss and decrease surgery-related problems and encourage the early patients' discharge from hospital and return to daily life activities.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"39 4","pages":"354-364"},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872039","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 comparative analytical study on outcome of secondary peritonitis using Mannheim's peritonitis index in geographically diverse Indian patients.","authors":"Ankan Ghosh, Anindya Halder, Nirmalya Sen, Aiindrila Dhara, Sourav Ghosh, Khulem Stellone Singh","doi":"10.47717/turkjsurg.2023.6043","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6043","url":null,"abstract":"<p><strong>Objectives: </strong>Secondary peritonitis is caused by infection of the peritoneal cavity due to perforation of the alimentary tract. Mannheim's peritonitis ındex (MPI) is a prognostic scoring system that predicts outcomes in peritonitis. Increasing MPI scores correlate with poor outcomes and mortality. The objective of this study is to evaluate the effectiveness of MPI-based prognosis and its impact on Indian patients with secondary peritonitis.</p><p><strong>Material and methods: </strong>For understanding the effectiveness of the MPI scoring system, a cross-sectional data analysis of published studies on secondary peritonitis from 10 geographical locations in India was performed. The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population. Patients were divided into risk groups on the basis of MPI scores: <21 mild, MPI= 21-29 moderate, MPI> 29 severe risk.</p><p><strong>Results: </strong>We observed a significant correlation between mortality with age and gender as reported worldwide. Site of perforations were prevalent in the upper alimentary tract with the majority being gastro-duodenal for the Indian population as opposed to distal parts in the western population. Higher lethality in India is often associated with evolution time, organ failure, and sepsis due to delayed presentation and poor management.</p><p><strong>Conclusion: </strong>MPI scoring is effective in predicting risk across geographically diverse Indian populations. The sensitivity and specificity of MPI scores are more reliable and a score >29 specifically recommends aggressive resuscitation & monitoring of patients, initiation of broad-spectrum antibiotics, and intensive care support to reduce mortality and morbidity.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"39 4","pages":"300-309"},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858124","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":"Histopathological evaluation after pancreatic surgery: Comparison of the results of HPB-specific pathologists and non-specific pathologists.","authors":"Ahmet Cihangir Emral, Kürşat Dikmen, Maryam Tahernejad, Khotan Sardari, Ali Rahman Pour, Özgür Ekinci, Mustafa Kerem","doi":"10.47717/turkjsurg.2023.6286","DOIUrl":"https://doi.org/10.47717/turkjsurg.2023.6286","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare the results of the evaluation of HPB-specific pathologists and general pathologists on the specimens of patients who underwent pancreaticoduodenectomy by the same surgical team.</p><p><strong>Material and methods: </strong>The pathological results of 159 patients who underwent pancreaticoduodenectomy (PD) in the periampullary region was retrospectively examined. Histopathological evaluation results of HPB-specific pathologist (S group) and other pathologists (NS group) were compared. Tumor size (mm), total lymph nodes, metastatic lymph nodes, surgical margin positive/negative (RO/R1/R2 resection) and data of patients who underwent vascular resection were evaluated.</p><p><strong>Results: </strong>The specimens of 91 patients were examined by a HPB-specific pathologist (S group), and the specimens of 68 patients were examined by non-specific pathologists (NS group). When compared in terms of the average total number of lymph nodes and metastatic lymph nodes dissected, a statistically significant result was observed (p= 0.04, p <0.01 respectively). Additionally, surgical margin positivity (R1) was found to be statistically higher in the S group (p= 0.02).</p><p><strong>Conclusion: </strong>In order for the success of HPB surgery to be reflected in the clinic, it is of great importance that the specimens are examined by HPBspecific pathologists.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"39 4","pages":"310-314"},"PeriodicalIF":0.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859045","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}