A novel index to predict postoperative hypocalcemia in primary hyperparathyroidism.

BAKGROUND: Vitamin D (Vit D) deficiency is common in patients with hyperparathyroidism, but the importance of replacement before surgery is controversial. It can be predicted that hypocalcemia risk will be higher in patients with high bone turnover. AIM: In this study, the effect of preoperative ALP/Vit D ratio on postoperative hypocalcemia was investigated. METHODS: Among the primary hyperparathyroidism cases who were operated between 2015 and 2022, 158 patients with complete data were included in the study. Preoperative laboratory results, radiological images, and pathology reports of the patients were evaluated retrospectively. The cross-sectional value of the ALP/Vit D value predicting hypocalcemia was calculated. The effect of these parameters on postoperative hypocalcemia was investigated. RESULTS: The mean age of our patients was 54 (21-81 years). When factors affecting postoperative hypocalcemia were evaluated by univariable analysis, Vit D deficiency and insufficiency (p < 0.001), ALP (p < 0.001), ALP/Vit D ratio (p < 0.001), and T score (p = 0.026) found to be factors affecting postoperative hypocalcemia. In multivariate analysis, the ALP/Vit D ratio was found to be an independent variable in predicting hypocalcemia. It was found that hypocalcemia was 45 times more common in patients with ALP/Vit D > 6.34 (p < 0.001). ALP/Vit D ratio predicts patients who will develop postoperative hypocalcemia with 87.2% sensitivity and 87.1% specificity. CONCLUSIONS: Vit D deficiency increases the risk of postoperative hypocalcemia, but it is not sufficient alone to predict it. The risk increases more in patients with high bone turnover. The preoperative ALP/Vit D ratio is the strongest predictor of postoperative hypocalcemia risk.

Comparison of Balloon Trocar versus Telescopic Dissection Method for TEP Inguinal Hernia Repair.

OBJECTIVE: To compare the outcomes between two methods of dissection (balloon trocar vs. telescopic dissection) used in total extra-peritoneal (TEP) inguinal hernia repair. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of General Surgery, Faculty of Medicine, Sakarya University, conducted between January 2018 and January 2020. METHODOLOGY: The study included patients who underwent elective TEP inguinal hernia repair. Preoperative and early postoperative results were compared, after the patients had been divided into a balloon trocar group (Group 1) and telescopic dissection group (Group 2). The technique performed depended on equipment availability. Permission was obtained from the Institutional Review Board. The study data are presented as descriptive statistics (mean, standard deviation, median, first quartile, third quartile, frequency and percentage); p-value <0.05 was considered significant. RESULTS: A total of 189 patients were included; 95 patients in Group 1 and 94 patients in Group 2. No significant differences in age, gender, body mass index, body weight, ASA performance status, operating time, duration of hospitalisation or postoperative bleeding values were observed between the groups (p >0.05). European Hernia Society Quality of Life pain score values ​​ were higher in Group 2 than Group 1 (p = 0.016). CONCLUSION: Telescopic dissection was cheaper than balloon dissection. The bleeding values and operating time were similar between the two methods, but telescopic dissection caused more postoperative pain. Key Words: Inguinal hernia, Telescopic dissection, Balloon dissection, Total extra-peritoneal (TEP) surgery.

WHY DIAGNOSTIC LAPAROSCOPY.

INTRODUCTION: Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with laboratory and imaging methods, and an invasive procedure such as diagnostic laparoscopy may be required to obtain a diagnosis. Diagnostic laparoscopy is also performed therapeutically, but laparotomy is inevitable in some cases. The aim of the study is to evaluate the role of diagnostic laparoscopy in diagnosis and treatment and to retrospectively examine the factors that force the surgeon to perform a laparotomy. MATERIAL AND METHODS: Patients over the age of 18 who underwent diagnostic laparoscopy in the general surgery clinic of Sakarya University Training and Research Hospital between January 2013 and December 2019 were retrospectively evaluated. Patients under 18 years of age and patients diagnosed before surgery were excluded. Demographic data of the patients, whether there was a conversion from laparoscopy to laparotomy, postoperative morbidity, and mortality were recorded. RESULTS: The data of 347 patients in total were evaluated retrospectively between the specified dates. 216 of the patients were previously diagnosed, laparoscopic procedures performed for staging purposes and they were not included in the study. The remaining 131 patients were included in the study. 68 of the patients were women and 63 were men. 79.4% of the patients were diagnostic laparoscopies performed due to emergency circumstances, and 20.6% for abdominal pain evaluation. While the procedure was concluded laparoscopically in 64.9% of the patients, the operation was continued by performing laparotomy in 35.1%. CONCLUSION: Despite the increase in the variety and frequency of use of imaging modalities, a laparoscopic intervention is an essential approach in both diagnosis and treatment when the diagnosis is doubtful, especially in emergency cases in appropriate cases.