Turkish Journal of Surgery最新文献

{"title":"One-stage tunneled de-epithelialized deltopectoral flap for huge head and neck cancer defects in the era of free flaps.","authors":"Shadi Awny, Mohammad Zuhdy, Ibrahim Nazif, Ahmed M Abdellatif, Khalid Atallah, Ahmed Fareed, Ahmed Abdallah","doi":"10.47717/turkjsurg.2025.2025-3-32","DOIUrl":"10.47717/turkjsurg.2025.2025-3-32","url":null,"abstract":"<p><strong>Objective: </strong>The deltopectoral (DP) flap was and still is a workhorse flap in the reconstruction of head and neck defects following tumor resection, even in the current era of free microvascular flaps.</p><p><strong>Material and methods: </strong>We retrospectively recruited, from a prospectively maintained database, all patients with a history of defect reconstruction using one-stage tunneled de-epithelialized fasciocutaneous DP flap following resection of head and neck cancer between June 2020 and June 2023. Patient and disease characteristics, surgery parameters, flap specifics, oncological outcomes, and follow-up data were analyzed and reported.</p><p><strong>Results: </strong>Eleven patients were recruited; 6 of them were females (54.54%). Head and neck squamous cell carcinoma is the most common pathology (54.5%), followed by papillary carcinoma of the thyroid gland (27.3%). Six patients were operated upon for recurrences, and tumor fungation and/or ulceration was reported in 81.8%. The median age at the time of flap reconstruction was 71 years (range: 46.5-77). Wound complications were reported in 36.4% of patients, with the overall rate of flap necrosis being 27.3%, including 3 patients who suffered from major necrosis at the distal 1/3 of the flap. No delay in receiving adjuvant therapies, according to treatment protocols, was reported for any of the surviving patients.</p><p><strong>Conclusion: </strong>The one-stage tunneled de-epithelialized fasciocutaneous DP flap is an effective choice with acceptable outcomes for defect reconstruction following resection of locally advanced head and neck cancer, whether on a curative or palliative basis, in relatively old patients with different comorbidities who require rapid treatment sequencing.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"418-427"},"PeriodicalIF":0.6,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970408","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":"Health and economic outcomes of metabolic bariatric surgery: A patient perspective.","authors":"Yonca Özatkan, İsmail Ağırbaş","doi":"10.47717/turkjsurg.2025.2025-5-3","DOIUrl":"10.47717/turkjsurg.2025.2025-5-3","url":null,"abstract":"<p><strong>Objective: </strong>Türkiye has the highest obesity prevalence in Europe, contributing to significant health and economic burdens. Metabolic bariatric surgery (MBS) is the most effective intervention for achieving sustained weight loss and improving obesity-related conditions. This study aimed to assess short-term remission rates in six obesity-related conditions and quantify changes in direct medical costs from the patient's perspective at 3 and 6 months following MBS.</p><p><strong>Material and methods: </strong>This prospective multicentre cohort study included 179 patients aged 18-65 with Class II or higher obesity who underwent MBS between July 2017 and November 2018. Clinical parameters and self-reported direct medical expenditures were evaluated preoperatively and at 3 and 6 months post-operatively. Outcomes included remission or improvement in diabetes, hypercholesterolemia, hypertension, joint diseases, obstructive sleep apnea syndrome (OSAS), and depression, as well as cost reductions.</p><p><strong>Results: </strong>Mean age was 38.8±11.7 years; 57.5% had been living with obesity for over 25 years. Preoperatively, 82.1% had obesity-related conditions. At 6 months, excess weight loss reached 68.3%. Remission rates were 89.5% for diabetes, 94.6% for hypertension, 85.7% for hypercholesterolemia, and 100% for joint diseases and OSAS. Depression remission was 95.7%. Medication/device use declined by 96%. Total direct medical costs decreased by 13.95%, and by 88.53% excluding surgery.</p><p><strong>Conclusion: </strong>In a country with high obesity and diabetes rates, MBS offers rapid clinical improvements and substantial cost reductions. Notably, 57% of patients had used non-prescriptive supplements preoperatively, highlighting the need for better health literacy. These findings reinforce the need to prioritize early surgical intervention within national obesity care frameworks.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"41 4","pages":"398-410"},"PeriodicalIF":0.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702012","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":"Children are not just small adults: Comment on \"Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for pediatric mesenchymal hamartoma: A case report\" by Caballes et De Lara.","authors":"Juri Fuchs","doi":"10.47717/turkjsurg.2025.2025-3-17","DOIUrl":"10.47717/turkjsurg.2025.2025-3-17","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"345-346"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576353","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":"Microbiome, mechanics, and morphology: Rethinking the etiopathogenesis of pilonidal sinus disease.","authors":"Semra Demirli Atıcı","doi":"10.47717/turkjsurg.2025.2025-5-2","DOIUrl":"10.47717/turkjsurg.2025.2025-5-2","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"343-344"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576356","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":"Pilonidal disease: Gaps in the guidelines and future perspectives.","authors":"Çiğdem Arslan","doi":"10.47717/turkjsurg.2025.2025-5-19","DOIUrl":"10.47717/turkjsurg.2025.2025-5-19","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"216-218"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576358","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":"Long-term outcomes of surgery for chronic pancreatitis: A single-center experience.","authors":"Abdullah Altaf, Syed Tatheer Abbas, Nusrat Yar Khan, Abu Bakar Hafeez Bhatti","doi":"10.47717/turkjsurg.2025.6656","DOIUrl":"10.47717/turkjsurg.2025.6656","url":null,"abstract":"<p><strong>Objective: </strong>There are limited data on the long-term outcomes after surgery for chronic pancreatitis. The aim of the current study was to assess the long-term pain relief and survival outcomes following surgical intervention for chronic pancreatitis.</p><p><strong>Material and methods: </strong>This was a single-center retrospective cohort study that included 36 patients who underwent surgery for chronic pancreatitis. The study analyzed 30-day morbidity and mortality rates, long-term pain relief, and endocrine and exocrine insufficiency. Additionally, 10-year overall survival rates were assessed.</p><p><strong>Results: </strong>The 30-day morbidity rate was 12/36 (33.4%), with no reported mortality. The median preoperative and postoperative visual analog scale scores were 9 (8-9) and 1 (1-2), respectively (p<0.001). Among 34 patients with severe pain, 33 (97%) reported substantial improvement. Long-term mortality was 6/36 (16.7%), and the 1-year, 5-year, and 10-year overall survival rates were 97%, 90%, and 85%, respectively. Factors associated with inferior survival included preoperative diabetes mellitus (p<0.001), hospital admissions after surgery (p=0.002), failure to gain weight after surgery (p=0.001), post-operative body mass index <18.5 kg/m² (p=0.029), and poor pain control after surgery (p=0.004). Conversely, preoperative endoscopic stent placement (p=0.031) was linked to improved 10-year overall survival.</p><p><strong>Conclusion: </strong>Surgery offers long-term pain relief for chronic pancreatitis, and outcomes can be optimized through early identification and management of high-risk factors.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"277-282"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601664","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":"Diagnostic utility of inflammatory ratios and nutritional scores in acute mesenteric ischemia: A retrospective single-center study.","authors":"Ferdi Bolat, Muhammet Fatih Keyif, Mustafa Şit, Bahri Özer, Oğuz Çatal, Songül Peltek Özer","doi":"10.47717/turkjsurg.2025.2025-4-7","DOIUrl":"10.47717/turkjsurg.2025.2025-4-7","url":null,"abstract":"<p><strong>Objective: </strong>Acute mesenteric ischemia (AMI) is a rare but highly fatal vascular emergency. Due to its non-specific clinical presentation, early diagnosis remains a major challenge. This study aimed to evaluate the diagnostic utility of selected inflammatory ratios and nutritional scores in differentiating AMI from other causes of acute abdominal pain.</p><p><strong>Material and methods: </strong>This retrospective, single-center study included 40 patients diagnosed with AMI and 40 control patients who presented with non-specific abdominal pain and had no definitive diagnosis. Preoperative laboratory parameters obtained upon emergency admission were analyzed. Calculated indices included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), C-reactive protein (CRP)-to-albumin ratio (CAR), and CRP-to-LDH ratio (CLDR), among others. Group comparisons, Pearson correlation analyses, and receiver operating characteristic (ROC) curve analyses were performed.</p><p><strong>Results: </strong>Compared to controls, AMI patients showed significantly elevated levels of NLR, PLR, SII, CAR, and CLDR, and significantly lower levels of PNI (p<0.05). ROC analysis revealed that SII [area under the curve (AUC) =0.89], NLR (AUC =0.86), and PNI (AUC =0.81) demonstrated the strongest diagnostic performance. Several indices were found to be strongly correlated, Including NLR with SII and CAR with CLDR. The observed mortality rate in the AMI group was 52.5%.</p><p><strong>Conclusion: </strong>Inflammatory and nutritional markers, particularly SII, NLR, and PNI, appear to offer valuable diagnostic support in identifying AMI. These indices may help prioritize patients for advanced imaging and early intervention, especially in resource-limited emergency settings. Further prospective multicenter studies are needed to confirm their clinical utility.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"283-288"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691661","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":"Retroperitoneal duodenal perforation following biliary stent migration: A case report and review of conservative management.","authors":"Recep Erçin Sönmez, Tuğrul Özdemir, Fatih Büyüker, Orhan Alimoğlu","doi":"10.47717/turkjsurg.2025.2025-3-6","DOIUrl":"10.47717/turkjsurg.2025.2025-3-6","url":null,"abstract":"<p><p>Endoscopic biliary stenting is a widely adopted technique for managing bile duct injuries post-cholecystectomy. However, its complications can have severe consequences. Although rare compared to other endoscopic retrograde cholangiopancreatography-related complications, duodenal perforation due to stent migration carries a significant risk of morbidity and mortality. While biliary stenting is often considered a less invasive alternative to surgery, timely recognition and management of potential complications remain crucial. We present a case of duodenal perforation due to biliary stent migration in a 49-year-old woman following laparoscopic cholecystectomy, emphasizing the effectiveness of conservative management, including the key role of interventional radiology, in selected patients.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"338-342"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576359","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":"Non-standardized surgery lateral internal sphincterotomy: Is there a consensus?","authors":"Neriman Şengül, Buse Balcı, Hatice Maras, Cihangir Akyol","doi":"10.47717/turkjsurg.2025.2025-4-18","DOIUrl":"10.47717/turkjsurg.2025.2025-4-18","url":null,"abstract":"<p><strong>Objective: </strong>Lateral internal sphincterotomy (LIS) is considered the gold standard surgical treatment for chronic anal fissures. However, substantial variation exists in the surgical techniques applied. This study aims to evaluate practice differences among surgeons performing LIS and to assess whether a consensus has been established.</p><p><strong>Material and methods: </strong>An anonymous online survey was conducted to assess surgeons' technical approaches to LIS. Data were collected using a 24-question survey targeting surgeons from various countries.</p><p><strong>Results: </strong>A total of 207 surgeons (131 from Türkiye, 76 from other countries) responded. The majority were male (73.3%) and between 40 and 64 years of age (64.7%). Most participants (70%) had more than 10 years of surgical experience, and 55% were affiliated with academic centers. The open technique was preferred by 73.6% of respondents, while 21.4% opted for the closed method. Partial sphincterotomy was favored by 66%, followed by complete (21%) and tailored (12%) approaches. Substantial heterogeneity was noted in bowel preparation, patient positioning, incision type, and management of skin tags or hypertrophied papillae. Only 6% reported routine use of anorectal manometry. Variations were more prominent across countries than between demographic groups. The principal finding of the study is the lack of a standardized approach to LIS across international surgical communities.</p><p><strong>Conclusion: </strong>There is no standardized approach to LIS among surgeons. Surgical technique preferences vary significantly and appear to be influenced more by geographic practice location than by individual surgeon characteristics such as age, gender, or experience.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"289-293"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576357","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 predictive tool for postoperative ileus after ileostomy closure: Model development and validation.","authors":"Atul Khare, Reena Kothari, Dinesh Kateha, Amrendra Verma, Pawan Agarwal, Dhananjaya Sharma","doi":"10.47717/turkjsurg.2025.2025-3-5","DOIUrl":"10.47717/turkjsurg.2025.2025-3-5","url":null,"abstract":"<p><strong>Objecitve: </strong>Postoperative ileus (POI) is a significant complication after ileostomy closure, which results in recurrent vomiting, dehydration, delay in starting enteral feeding, and even anastomotic breakdown. We aimed to develop a prediction model for POI occurrence after ileostomy closure.</p><p><strong>Material and methods: </strong>One hundred consecutive patients undergoing ileostomy closure were studied prospectively and data of various demographic and clinical variables were recorded in a predesigned proforma. The final prediction model was developed using logistic regression and internally validated in the next 50 patients.</p><p><strong>Results: </strong>Factors associated with POI were age, body mass index, tobacco or alcohol addiction, comorbidity, anemia, thrombocytopenia, renal dysfunction, as shown by creatinine level, hypoproteinemia, hypernatremia, and hypokalemia. The mean score of those who developed POI was higher (p=0.002) than those who did not. A cut-off at score 8 had a sensitivity of 85.71%, specificity of 73.12%, and area under the curve was 0.8241 (SE 0.1123). The predictive model was validated in the next 50 consecutive patients and showed good sensitivity (80%) and specificity (93.3%).</p><p><strong>Conclusion: </strong>Our predictive model can determine the occurrence of POI with accuracy.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":" ","pages":"241-247"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609707","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}