Analysis of general surgery outpatient clinic admissions and operations during COVID-19 pandemic in Turkey: Reactions of 12728 patients.

Covid-19 pandemic is spreading rapidly in Turkey. We aimed to examine the numbers and demographic data of patients who applied to the general surgery outpatient clinics and operated in this process. Our primary outcome is to reveal the response of general surgery patients to the Covid-19 pandemic.The first Covid-19 case in Turkey has appeared in March 11, 2020. Patients who were operated on due to a surgical emergency or trauma were evaluated separately. Patients in 3 periods were compared with each other. A total of 12728 patients were examined in general surgery outpatient clinics in 26 working days. It is seen that patients come to the outpatient clinic after the first time the Covid-19 patient is seen. All patients reduced hospitalization after the first death due to Covid-19. Women had reduced going to the hospital earlier than men. There was no change in the number of emergency surgeries. Rapid decrease was observed in the number of elective surgeries.It is not easy to control the entrance and exit of these busy hospitals. The remote diagnosis (mail, phone or video-call) and treatment methods that can be expected in the near future may be even closer with the Corona virus (Tab. 3, Fig. 4, Ref. 15). Keywords: general surgery, Covid-19, outpatient clinics, operation, reaction of patients.

Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie's syndrome.

BACKGROUND: Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome. METHODS: This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management. RESULTS: In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease. CONCLUSIONS: Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.

Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off?

PURPOSE: The aim of this study was to compare early and delayed cholecystectomy for the treatment of acute calculous cholecystitis (ACC). MATERIALS AND METHODS: The medical records of patients who were diagnosed to have ACC by combined clinical and radiological examination were evaluated retrospectively. The patients were divided into two non-randomized groups according to the duration between the onset of symptoms and cholecystectomy. Group 1 included the patients who underwent cholecystectomy within the first 72 h after the onset of symptoms and Group 2 those who underwent beyond the 72nd hour after the onset of symptoms. RESULTS: We reviewed records for 203 patients. There were 109 patients in Group 1 and 74 patients in Group 2. Access-related complications occurred in four patients. One patient in Group 1 and two patients in Group 2 had trocar site bleeding. In one patient in Group 1, liver trauma occurred. Two patients had bile duct injury in Group 1 as Type D injury according to the Strasberg classification in one patient and E2 injury in other. CONCLUSION: Early cholecystectomy in acute cholecystitis with biliary stones could be performed regardless of time with similar complication, mortality and conversion rates.