Botulinum toxin injection in outpatients for chronic anal fissure.

OBJECTIVES: The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications. METHODS: Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting. RESULTS: Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3. CONCLUSION: Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.

A new circumareolar approach combined with power assisted liposuction in the management of advanced gynecomastia.

AIM: Gynecomastia is a benign proliferation of the glandular tissue of the male breast that causes considerable emotional distress due to restriction of daily activity, especially in young men. In patients with severe gynecomastia, a new approach is described with liposuction combined with circumareolar subcutaneous mastectomy with minimal periareolar scarring, including the elimination of the excess skin. Prospectively recorded data in a period of fifteen-month were evaluated retrospectively for aesthetic outcomes and early and late complications. MATERIAL-METHOD: A total of 18 patients (36 breasts) were treated between September 2021 and December 2022. The patient was marked preoperatively while standing up. Under general anesthesia, power assisted liposuction and deepithelialization of excess skin were performed. A superiorly based nipple areola complex (NAC) flap was created with attention to blood supply intact. The excess fibroglandular tissue was resected. The wound was approximated with pursestring suture and the NAC was positioned in its new location. The wound was closed after the insertion of a hemovac drain into the liposuction port. RESULTS: The ages of patients with bilateral grade 3 gynecomastia ranged from 17 to 34. Follow-ups ranged from 5 months to 1 year. The prophylactic antibiotic treatment administered to all patients. Liposuction was performed again on one patient due to an aesthetic problem. Minimal areola enlargement was observed in 2 patients. CONCLUSIONS: This new circumareolar approach with liposuction is a good method for wide excision of breast tissue in the surgical management of severe gynecomastia with minimal scarring and very good cosmetic results. KEY WORDS: Breast, Gynecomastia, Periareolar incision, Power assisted liposuction, Surgical Technique, Subcutaneous mastectomy.

Prognostic value of KI-67 proliferation index in luminal breast cancers.

AIM: This study aimed to examine the prognostic significance of the KI-67 proliferation index, especially in breast cancer (BC) patients without HER-2 expression and no nodal involvement. MATERIAL AND METHODS: The database of hormone-receptor-positive patients who underwent surgery for BC in our Surgical Oncology Clinic between 2008 and 2020 was retrospectively reviewed and recorded. Patients were categorized based on their KI-67 level, considering the cutoff value of 20%. RESULTS: Our study revealed that tumors with high KI-67 levels were more likely to have a more advanced histological grade (p = 0.00) and size (p = 0.038). In the univariant analysis, KI-67 level was effective on overall survival (p = 0.044) and disease-free survival (p = 0.048). However, we found that there was no independent prognostic factor in the multivariant analysis. CONCLUSION: Although the Ki-67 proliferation index does not yet have an agreed threshold value and scoring methodology, it can also be used to determine prognosis and evaluate treatment response in some patients.

OBJETIVO: Este estudio tuvo como objetivo examinar la importancia pronóstica del índice de proliferación KI-67, especialmente en pacientes con cáncer de mama sin expresión de HER-2 y sin compromiso ganglionar. MATERIAL Y MÉTODOS: Se revisó y registró retrospectivamente la base de datos de pacientes con receptores hormonales positivos intervenidas de cáncer de mama en nuestra Clínica de Oncología Quirúrgica entre 2008 y 2020. Las pacientes fueron categorizadas de acuerdo con su nivel de KI-67, considerando el valor de corte del 20%. RESULTADOS: Nuestro estudio reveló que los tumores con valores elevados de KI-67 eran más propensos a tener un grado histológico (p = 0.00) y un tamaño (p = 0.038) más avanzados. En el análisis univariado, el nivel de KI-67 fue efectivo sobre la supervivencia global (p = 0.044) y la supervivencia libre de enfermedad (p = 0.048). Sin embargo, encontramos que no había ningún factor pronóstico independiente en el análisis multivariante. CONCLUSIONES: Aunque el índice de proliferación Ki-67 aún no tiene un valor de umbral acordado ni una metodología de puntuación, también se puede utilizar para determinar el pronóstico y evaluar la respuesta al tratamiento en algunas pacientes.

Plastic and reconstructive breast surgery techniques in the surgical treatment of idiopathic granulomatous mastitis: a single-center experience.

Purpose: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease with unknown cause and undefined treatment. Since it has a high recurrence rate, wide excisions are recommended for surgical treatment. This study aims to discuss the selection and outcomes of plastic and reconstructive breast surgery techniques following wide excision. Methods: This study examines the prospectively recorded surgical outcomes of 18 patients who were diagnosed with IGM between 2020 and 2022. Following histopathological confirmation of all patients' diagnoses, the most appropriate technique was used in conjunction with wide surgical excision. Preoperative standing drawings were made for all patients and operations were performed by the same surgical team under general anesthesia. All patients were monitored for 6 months for postoperative complications, recurrence, and aesthetic outcomes. Results: The patients underwent surgery for recurrence (n = 8), recurrent abscess (n = 4), and persistent disease (n = 6), in that order. Patients were treated with dermoglandular flap transposition (n = 6), Wise pattern reduction mammoplasty (n = 3), vertical reduction skin incision (n = 3), inferior pedicle with Wise pattern reduction mammoplasty (n = 4), and free nipple reduction mammoplasty (n = 2) techniques following partial mastectomy. No major complications developed postoperatively. Two patients with recurrence benefited from topical steroid injections. Conclusion: A wide excision is required to prevent IGM recurrence during surgery. After wide excision, the simplest and most easily applicable plastic and reconstructive breast surgery techniques can yield successful results with acceptable complication and recurrence rates. In technique selection, we recommend an individualized surgical approach for effective patient management.

Management of Aberrant Left Hepatic Artery During Laparoscopic Gastrectomy and Consequences.

Introduction: Aberrant left hepatic artery (ALHA) can exist in up to 25% of the population. The presence of ALHA during lymph node (LN) dissection in gastric cancer may complicate the process. In this study, we aimed to evaluate the existence rate, management, and consequences of ALHA in our laparoscopic gastrectomy series. Patients and Methods: Demographical and clinical data of laparoscopically operated 158 consecutive gastric cancer patients were collected retrospectively. Study patients were divided into three groups according to absence, existence and preservation, and existence and sacrification of ALHA. Harvested LN numbers, operation time, and postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase values on consecutive days were analyzed using Kruskal-Wallis and Mann-Whitney U tests. P < .05 is accepted as significant. Results: The median AST and ALT values of the ALHA-sacrificed group were higher than those of the group without ALHA and the ALHA-preserved group on the 1st, 3rd, and 5th postoperative days (P < .05). On the 10th day, liver enzymes returned to normal values. Conclusion: Adequate and appropriate dissection of LNs while preserving ALHA can be performed without prolonging the operation time. Sacrification of ALHA causes an increase in liver enzymes, with spontaneous recovery in most cases.