Does Neutrophil-Lymphocyte Ratio Correlate with the Improvement of Hepatosteatosis after Laparoscopic Sleeve Gastrectomy?

INTRODUCTION: Obesity is a disease that shortens life expectancy and predisposes to many diseases such as severe hepatosteatosis. Hepatosteatosis is characterized by inflammatory infiltration of the portal space. Bariatric surgery has improvement effect on hepatosteatosis and degree of inflammation. Laparoscopic sleeve gastrectomy is an effective and most common therapeutic option for obesity. Neutrophil-lymphocyte ratio is a parameter associated with inflammatory disease. This study aimed to investigate if there is any correlation between improvements in hepatosteatosis and biochemical parameters especially neutrophil-lymphocyte ratio and ultrasonographic findings 1 year after the laparoscopic sleeve gastrectomy. METHODS: The files of 66 patients who underwent laparoscopic sleeve gastrectomy between May 2017 and April 2020 were retrospectively reviewed. Preoperative and postoperative 1-year demographic data, biochemical and inflammatory parameters, and ultrasonographic reports of the liver were reviewed. RESULTS: A statistically significant improvement in hepatosteatosis was demonstrated by ultrasonography 1 year after laparoscopic sleeve gastrectomy. A significant decrease was also observed in neutrophil-lymphocyte ratio. No correlation was found between the decrease of neutrophil-lymphocyte ratio and improvement in hepatosteatosis. There was also significant difference between the preoperative and postoperative BMI, biochemical and inflammatory parameters. CONCLUSION: However, we found laparoscopic sleeve gastrectomy is associated with significant improvement in hepatosteatosis and inflammatory parameters; no correlation between the improvement in hepatosteatosis and NLR was seen at 1 year.

Recommendations for bariatric and metabolic surgical operations during the COVID-19 pandemic in Turkey.

The world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic.

Enhanced recovery after surgery (ERAS) in one-anastomosis gastric bypass surgery: a matched-cohort study.

BACKGROUND: One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint. OBJECTIVES: To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients. SETTING: Turkey. METHODS: The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions. RESULTS: Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P = 1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001). CONCLUSION: The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization.

Clinical Value of CXCL5 for Determining of Colorectal Cancer

Background: Several studies indicate that chemokines play important roles in colorectal mucosal immunity. The chemokine CXCL5 which is expressed by epithelial cells within colorectal mucosa is a promoter of cell proliferation, migration and invasion, is a novel serum prognostic marker in patients with colorectal cancer. The purpose of this study was to investigate whether serum and tissue CXCL5 levels is altered in colorectal carcinomas (CRC) compared to colonic adenoma and normal mucosa.It also aimed to compare colon adenoma and colorectal cancer for blood CXCL5 and CEA levels, their sensitivity, and specificity. Methods: CXCL5 expression was assessed with immunohistochemistry staining in biopsy samples taken during colonoscopy in 22 colonic adenomas, 23 colorectal carcinomas and 23 normal colonic tissue samples. Also all patients' serum CXCL5 and CEA levels were measured. This stduy was prospective observational study. Results: The number of cases who were stained positive with immunohistochemistry was found to be higher in the group with CRC. When compared with the other groups, both levels of serum CXCL5 and CEA were significantly high in the group CRC. Sensitivity and specificity of serum CXCL5 were found to be low as a result of the ROC analysis. Conclusion: Although the level of CXCL5 is high in CRC, its level in serum is not significant enough to support the early diagnosis of the disease.

Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios are Not Different among Breast Cancer Subtypes

Background: Breast cancer is a heterogeneous complex of diseases comprising different subtypes that have different treatment responses and clinical outcomes. Systemic inflammation is known to be associated with poor prognosis in many types of cancer. The neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) are factors used as indicators of inflammation. In this study, we evaluated NLR and PLR ratios in breast cancer subtypes. Methods: A total of 255 breast cancer patients were evaluated retrospectively. Patients were classified into three subtypes: estrogen receptor (ER)- or progesterone receptor (PR)-positive tumors were classified as luminal tumors; human epidermal growth factor receptor-2 (HER2)-overexpressed and ER-negative tumors were classified as HER2-positive tumors; and ER, PR, and HER2-negative tumors were classified as triple-negative tumors. The NLR and PLR were calculated. Results: The median NLR and PLR were 3 (0.37­37,1) and 137 (37.1­421.3), respectively. 66.7% of the patients were luminal type, 19.2% were HER2 positive, and 14.1% were triple negative. NLR was not associated with grade (p: 0.412), lymphovascular invasion (p: 0.326), tumor size (p: 0.232) and metastatic lymph node involvement (p: 0.406). PLR was higher in the patients with lymph node metastasis than in those without lymph node metastasis (p: 0.03). The NLR was 2 in the luminal group, 1.8 in the HER2-positive group, and 1.9 in the triple-negative group, but the differences were not significant(p: 0.051). PLR was 141 in the luminal group, 136 in the HER2-positive group, and 130 in the triple-negative group, but the differences were not significant. Conclusion: We could not find any significant differences for NLR and PLR according to breast cancer subtypes.

Extremely rare presentation of an omphalomesenteric cyst in a 61-year-old patient.

The umbilicus is remaining scar tissue from the umbilical cord in the fetus. If the omphalomesenteric duct in the umbilicus is not properly closed, an ileal-umbilical fistula, sinus formation, cysts, or, most commonly, Meckel's diverticulum can develop. The others are very rare and mostly occur in the pediatric population. We describe herein a 61-year-old female with a giant omphalomesenteric cyst presented as an asymptomatic infraumbilical mass. To our knowledge, this is the oldest patient reported and the largest cyst described in the literature. The diagnosis of a painless abdominal mass frequently suggests malignancy in older patients. But, extremely rare conditions can be detected, such as an omphalomesenteric cyst.

Turkish surgeons' experiences and perception about single-incision laparoscopic surgery.

OBJECTIVE: We aimed to show Turkish surgeons' current status of experience and perception about single-incision laparoscopic surgery. MATERIAL AND METHODS: The experience and perception of general surgeons, who were members of the Turkish Surgical Association (3.5%, 116/3312), about single-incision laparoscopic surgery were analyzed according to demographic characteristics and a self-report questionnaire with the following four domains: surgeons' perception regarding the performance of single-incision laparoscopic surgery in their clinical practice; their experience of laparoscopic surgery; education, experience, and attitude for single-incision laparoscopic surgery; and the reason for performing/not performing single-incision laparoscopic surgery in their practice. RESULTS: There were no significant factors affecting Turkish surgeons' preference of surgical approach. Although, most surgeons performing single-incision laparoscopic surgery were educated (72.2%), the dominant factor driven them to perform this surgery seemed to be personal achievement and satisfaction (57%). Most surgeons who did not perform single-incision laparoscopic surgery were not interested to do so and considered it unnecessary (62.1%). In addition, the need for special equipment and training were dominant barriers (61%). CONCLUSION: It seems that Turkish surgeons' perception to perform single-incision laparoscopic surgery was more related to their personal achievement and satisfaction.

Oxidative stress markers in laparoscopic vs. open appendectomy for acute appendicitis: A double-blind randomized study.

BACKGROUND: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. PATIENTS AND METHODS: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBC's) were collected just before the surgery and 24 h after surgery. RESULTS: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24(th) h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24(th) h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24(th) h (P = 0.172). CONCLUSIONS: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Prospective randomized comparison of single-incision laparoscopic cholecystectomy with new facilitating maneuver vs. conventional four-port laparoscopic cholecystectomy.

OBJECTIVE: We aimed to investigate the technical feasibility of single-incision laparoscopic cholecystectomy (SILC) with our new facilitative maneuver and to compare it with the gold standard four-port laparoscopic cholecystectomy (LC). MATERIAL AND METHODS: Operation time, cosmetic score and incisional hernia rates between LC (n=20) and SILC-1 (first 20 consecutive operations with the new technique) and 2 (subsequent 20 operations with the new technique) were compared. RESULTS: The median operation time for LC, SILC-1 and SILC-2 were; 35 min (12-75), 47.5 min (30-70), and 30 min (12-80), respectively (p=0.005). The operation duration was similar in LC and SILC-2 (p=0.277) groups. Wound seroma rate was higher in SILC-1 (45%) and SILC-2 (30%) groups than LC (5%) group (p=0.010). Cosmetic score was similar between all the groups. Hernia rates were 15.8% and 5.3% in the SILC-1 and SILC-2 groups, respectively, while there was no hernia in the LC group. CONCLUSION: SILC with new facilitating maneuver is comparable with classical four-port laparoscopic cholecystectomy in terms of ease, operation time, reproducibility and safety. Besides these advantages, the single-incision access technique must be optimized to provide comparable wound complication and postoperative hernia rates before being recommended to patients.

Experience and knowledge level of female health care professionals in Samsun province regarding puerperal mastitis.

OBJECTIVE: Inappropriate or insufficient knowledge of health care professionals about puerperal mastitis can lead mothers to premature weaning, as well as the lack of education on proper breastfeeding. However, the importance of education regarding puerperal mastitis seems to be underestimated. MATERIAL AND METHODS: From July to August 2014, 317 female health care professionals were surveyed in Samsun, Turkey. Participants were classified into three groups; nurses, maternity care nurses (obstetrics and gynecology nurses and pediatrics clinic nurses), and midwives. A specifically prepared questionnaire was used to collect data. RESULTS: 69.1% (n=219) of female health care professionals had one or more child/ren. The median length of breastfeeding duration was 11 months (0-36) while the overall puerperal mastitis rate was 13.3% (n=29). Puerperal mastitis related cessation of breastfeeding was similar between the groups, with an overall rate of 3.1%. 61.1% of the participants stated that they had one or more hours of education regarding puerperal mastitis while 5.4% indicated that they learned about the pathology from their experiences. Midwives and maternity care nurses were found to be more knowledgeable than nurses regarding the reasons, risk factors, prevention, symptoms, and treatment of puerperal mastitis. CONCLUSION: As a result, the current level of education regarding breastfeeding and puerperal mastitis and daily practice in female health care professionals in Turkey is far from desired levels. The breastfeeding education of health care professionals must be adapted to an effective program, such as UNICEF/WHO 20-hour breastfeeding training course, and puerperal mastitis should be accepted as a public health care issue.

The effect of laparoscopic sleeve gastrectomy on morbid obesity and obesity-related comorbidities: A cohort study.

OBJECTIVE: Bariatric surgery with multidisciplinary management is a more effective method to treat morbid obesity and obesity-related comorbidities compared with nonsurgical treatments. Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch in the super-obese population. In the past few years, however, LSG has been performed as a definitive procedure because of its promising early and midterm results. The aim of this study is to evaluate the efficacy of our initial LSG series of 73 patients on excess weight loss (EWL) and resolution of obesity-related comorbidities in short-term follow-up. MATERIAL AND METHODS: From March 2013 to May 2014, 78 morbid obese patients with an average body mass index (BMI) of 46.3 kg/m(2) underwent LSG. There is a 9-month follow-up period on average. Five patients were excluded from the study, because they could not be contacted. Comorbidities, preintervention BMI, glucose, HbA1c, and lipid profiles were recorded at 1, 6, and 12 months postintervention. RESULTS: After the surgery, the percent EWL was 58%. The mean serum glucose level, HbA1c level, LDL-cholesterol level, triglyceride level, insulin, and insulin resistance decreased significantly and the mean HDL-cholesterol level increased. CONCLUSION: For the resolution of comorbidities, LSG may be used as an effective bariatric and metabolic surgery.

Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works.

Obesity and diabetes is a co-pandemic and a major health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.

Old-scar mass and changing surgical perspective: Sarcoidosis.

Sarcoidosis is a systemic inflammatory disease of an unknown etiology. Skin is involved in 25% of all cases, and 29% of them present as a scar sarcoidosis. Asymptomatic old-scar masses are generally regarded as a foreign body reaction by surgeons and often result in excisional biopsy. We describe a case of a patient who developed sarcoidosis in a 34-year-old appendectomy scar and adjacent inguinal lymph nodes without any local or systemic symptom and radiologic finding. Surgeons should not underestimate the importance of such lesions as a simple condition. Scar sarcoidosis may resolve spontaneously, or the treatment with some topical agents is effective. Furthermore, scar sarcoidosis may be the initial manifestation of systemic sarcoidosis.

The effect of silymarin on hepatic regeneration after partial hepatectomy: is silymarin effective in hepatic regeneration?

AIM: Silymarin from Silybum marianum was found to reduce liver injury. The aim of the present study was to investigate the effects of silymarin on hepatic regeneration in partially hepatectomized rats. METHODS: Thirty Wistar-Albino rats were divided into 3 groups of 10 animals as sham, control and experimental groups. In the sham group (n=10) abdominal incision was closed after laparotomy. In the control group (n=10), the rats underwent 70% hepatectomy after laparotomy. In the experimental group (n=10) after partial 70% hepatectomy, silymarin (200 mg/kg/d) were given to rats for 10 days. Rats in three groups were sacrificed on 10 days. Aspartate (AST) and alanine transaminase (ALT), gamma glutamyl transferase (GGT), ALP, LDH and total bilirubin levels were measured using intracardiac blood samples. Tissue malondialdehyde (MDA) and tissue glutathion (GSH) and Superoxide dismutase (SOD) levels were measured. To reveal the increase in the mass of the remnant liver tissue in the control and experimental groups relative weight of the liver was calculated. Histopathological analysis of the liver was performed using a semi-quantitative scoring system. RESULTS: A statistically significant difference among three groups was not shown for AST and ALT levels. A statistically significant difference was found between the groups as for total bilirubin and gamma glutamyl transferase levels. Increases in relative liver weights were seen with time in Groups 2 and 3. A statistically significant difference was not found for tissue malondialdehyde, Glutathion and Superoxide dismutase levels between hepatectomy and hepatectomy + silymarin groups. On liver tissue sections of the rats in the hepatectomy + silymarin group, increased regeneration and lipid peroxidation were observed accompanied by decreased antioxidant response. CONCLUSION: It has been observed that silymarin with many established functions such as antiproliferative, anti-inflammatory and energy antioxidant effects, does not contributed to proliferative regeneration of the liver-which has very important metabolic functions -after partial hepatectomy; instead it will decrease serum levels of transaminases.

The effect of polymorphism in DNA repair genes RAD51 and XRCC2 in colorectal cancer in Turkish population.

The genes RAD51 and XRCC2 encode proteins that are important for the repair of double-strand DNA breaks by recombination. Therefore, genetic variability in these genes may contribute to the occurrence and progression of carcinoma. We investigated the association of polymorphisms in the DNA repair genes XRCC2-A/G and RAD51-135G/C with the colorectal cancer risk. Genotypes were determined by PCR-RFLP assays in 71 patients with colorectal cancer and 86 age-matched healthy controls. After amplification, we used a restriction enzyme (RAD51; MvaI and XRCC2; HphI) and digested the PCR product. Then, this DNA fragments were passed through gel electrophoresis. By examining these images, we identified changes in the nucleotides in these specific regions. To clarify fragments polymorphisms, the PCR products were sequenced with an Applied Biosystems Automated Sequencer. We observed the Arg188His polymorphism of XRCC2 genes in 42.2%, as shown in 30 of the 71 cancer patients. Only 21 out of 86 controls showed this polymorphism (24.2%). We also observed that 21 of the 71 patients (29.5%) carried the RAD51135G/C polymorphism of this gene. The same polymorphism was observed in 11 of the 86 controls (12.7 %; p < 0.05). The obtained results indicate that the polymorphism of RAD51 and XRCC2 genes may be associated with the incidence of colon cancer in the Turkish population. Further studies, including those on a larger group of patients, are required to further clarify this point.

Expression of FHIT, p16, p53 and EGFR as prognostic markers in thyroid tumors of uncertain malignant potential.

PURPOSE: Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. METHODS: Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). RESULTS: Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, in Group II a moderate positive correlation was detected between MACIS and EGFR. CONCLUSION: According to our findings p53 was not important in tumor genesis at early stages in well-differentiated thyroid carcinomas and p16 loss of expression could be used as a finding to help in difficult microscopic diagnosis. TT-UMP is a gray zone of lesions requiring specific therapeutic procedures and postoperative follow-up. A positive correlation was detected between EGFR and TT-UMP, leading to assume that this situation could be used as a new tool in the follow-up of these patients in the future.

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: a prospective clinical study.

BACKGROUND: This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively. METHODS: Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947). RESULTS: Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%. CONCLUSION: Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.

High levels of platelet/lymphocyte ratio are associated with metastatic gastric cancer.

PURPOSE: The predictive and prognostic value of cheap, easily accessible and commonly available complete blood count parameters has already been studied in a variety of cancers. In the present study, we aimed to investigate the association between pretreatment platelet/lymphocyte ratio (PLR) and metastatic gastric cancer. METHODS: The records of 228 patients dating from January 2010 to June 2014 were retrospectively evaluated. Patients who had undergone radical (N=157) or palliative gastrectomy (N=71) for metastatic gastric cancer were included and divided into two groups according to stage (early-advanced) and metastasis (absence-presence) status, and PLR values were compared. RESULTS: 38 (16.6%) of 228 patients had early gastric cancer (non metastatic cases). PLR values of advanced gastric cancer (not including metastatic cases) were significantly higher compared to early gastric cancer (231.6±107.45 and 160.3±71.5, respectively; p<0.001). Seventy one (31.1%) of 228 patients had distant metastasis. PLR values of metastatic gastric cancer were significantly higher than in non-metastatic gastric cancer (251.0±94.8 and 192.7±88.8, respectively; p<0.001). Logistic regression analysis showed that PLR was an independent predictive factor for tumor burden in both stage and metastasis groups (p<0.001 and p=0.003, respectively). Also, in correlation analysis, PLR showed mild correlation with stage and metastasis groups (r=0.291 and r=0.299, respectively). CONCLUSIONS: Pretreatment PLR values were correlated with tumor burden, and most higher values were detected in metastatic disease. Our findings may be useful, especially in the decision-making for laparoscopic staging in patients who have no radiological evidence of metastatic disease.

Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis.

BACKGROUND: Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. PATIENTS AND METHODS: A retrospective case-controlled study was designed in two groups, both containing 100 patients, acute appendicitis and control. Leukocyte count, neutrophil percentage, platelet count and meal platelet volume (MPV) were compared. RESULTS: MPV values for acute appendicitis and control groups were 7.4 ± 0.9 fL (5.6-10.6) and 9.1 ± 1.6 fL (5.1-13.1). For the diagnosis of acute appendicitis, ROC analysis revealed 74% sensitivity and 75% specificity for a cut-off value of 7.95 fL of MPV, however, the diagnostic value of leukocyte count and/or neutrophil ratio was superior. CONCLUSION: Our results suggest that, MPV value is an important parameter in the diagnosis of acute appendicitis, but in terms of sensitivity and specificity, leukocyte count and/or neutrophil percentage is superior.