The impact of comorbidities on mortality in patients with non-traumatic major lower extremity amputation.

OBJECTIVE: Major lower limb amputation is generally associated with a high risk of early and late-term mortality. In this study, 30-day, one-year and three-year mortality of non-traumatic major lower extremity amputations and comorbidities affecting the mortality rate were investigated. METHOD: Patients who underwent a major lower limb amputation secondary to diabetes or peripheral artery disease between the years 2010-2015 were retrospectively evaluated. Additional to patient demographic data and comorbidities, amputation level, survival and mortality time were extracted. Mortality rates after 30 days, one year and three years were analysed. The associations of the survival to different parameters were evaluated with Kaplan-Meier analysis and log rank test, while the impact of the risk factors on mortality was evaluated with the Cox regression test. RESULTS: A total of 193 patients were enrolled in the study. Approximately 60% of patients were aged ≥65 years, and 65.8% were male. Below-knee amputation was performed in 64.8% of patients and above-knee amputation in 35.2% of patients. The mean follow-up of patients was 29.48 months (range: 0-101 months). After non-traumatic major lower extremity amputation, 30-day, one-year and three-year mortality were 16.6%, 38.3% and 60.1%, respectively. On Cox regression analysis, age ≥65 years was the only variable that had significant impact on the 30-day mortality (hazard ratio (HR): 3.4; p=0.012), while age ≥65 years (HR: 2.5, p=0.000), diabetes (HR: 2, p=0.006) and renal failure (HR: 2, p=0.001) were found to have significant impacts on three-year mortality. CONCLUSION: The findings of this study showed that >50% of patients with non-traumatic major lower limb amputations died within three years. Advanced age, diabetes and renal failure were the risk factors that increased the mortality. The high mortality rates revealed the importance of employing all hard-to-heal wound treatment options before making an amputation decision. Further, prospective studies are needed to determine the effects of primary disease status and timing of amputation on mortality.

Comparison of intraoperative biliary anastomosis stenting technique in living-donor liver transplantation: Review of 41 patients.

BACKGROUND: Biliary fistula is one of the most important complications in liver transplantation. Complications can vary from simple local peritonitis to death, and various techniques have been described to prevent them. In this study, we compared two different stenting methods used in biliary tract anastomosis in living-donor liver transplantation. METHODS: We retrospectively analyzed data from 41 living-donor liver transplantations that were performed due to endstage liver failure between August 2019 and November 2020. Patients were grouped according to the stenting technique used in biliary anastomosis. Postoperative biliary tract complications were investigated. RESULTS: Biliary fistulas were observed in 2 (7.4%) patients in the internal stent group, while 4 (28.5) fistulas were observed in the external stent group. Biliary tract stricture was observed in 2 (7.4%) patients in the internal stent group, but there was no statistical difference in complications. The preoperative MELD score (p = 0.038*) was found to be statistically significant in regard to developing complications. DISCUSSION: Our study did not show the effect of stenting methods used during biliary anastomosis on the development of complications. However, larger randomized controlled studies are needed.

Outcomes of Surgical Strategies for Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Cohort Study.

BACKGROUND: Adequate portal flow to the liver graft is the requirement of a successful liver transplant (LT). Historically, portal vein thrombosis (PVT) was a contraindication for LT, especially for living donor LT (LDLT), demanding technically more difficult operations and advanced technique. In this study, the outcomes of patients with and without PVT after LDLT were compared. METHODS: Adult LDLTs performed by 2 centers (n = 335) between 2013 and 2020 were included into this large cohort study. PVT was classified based on Yerdel classification grade 1 to 4. RESULTS: Sixty-two patients with PVT constituted 19% of the study cohort of 335 recipients. While mean platelet count was found to be lower (P = .011) in the PVT group, patient age (P = .035), operation duration (P = .001), and amount of intraoperative blood transfusion (P = .010) were found to be higher. Incidence of PVT was higher in female patients than males (22.7% vs 16.1%, P = .037). There was no significant difference in survival between patients with and without PVT on 30-day (P = .285), 90-day (P = .565), 1-year (P = .777), and overall survival (P = .917). Early thrombosis did not show a better survival rate than Grades 2, 3, or 4 PVT. Thrombosis limited to portal vein was not found to bring a survival advantage compared with Grade 3 and 4 thromboses. Eversion thrombectomy was the most common procedure (66%) to overcome PVT intraoperatively. CONCLUSION: Although technically more challenging, PVT is not a contraindication of LDLT. Similar outcomes can be achieved in LDLT in patients with PVT after proper restoration of portal flow, which eliminates the default survival disadvantage of patients with PVT.

Factors affecting mortality in elderly patients who underwent surgery for gastric cancer.

AIM: The aim of this study was to determine factors affecting overall mortality in patients over 60 years of age who underwent surgery for gastric cancer in our clinic. MATERIAL AND METHODS: Data on histopathological diagnosis (tumor size, lymph node status, and number), pathological stage, serum albumin level, tumor markers, complete blood count, and demographic information of 109 patients over 60 years of age who had surgery for gastric cancer between January 2011 and July 2016 were obtained retrospectively from the patient files. In addition, the survival status of all patients were examined and recorded. Metastatic lymph node ratio (MLR), red cell distribution width platelet ratio (RPR), neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), and prognostic nutritional index (PNI) were calculated. RESULTS: On univariate analysis of independent parameters, pathological LN number (p = 0.001), MLR (p <0.001), T3 (p = 0.001) or T4 (p = 0,006) tumor stage according to TNM system, the presence of metastasis (p = 0.063), and male gender (p = 0.066) were found to affect overall mortality (OM). On multivariable Cox regression analysis of these results, MLR (p = 0.005) and T stage (p = 0.006) was determined to be a statistically significant and independent prognostic value. CONCLUSION: In patients over 60 years of age who underwent surgery for gastric cancer, the factors affecting mortality were determined to be the presence of metastases, number of pathological lymph nodes, and male gender. Metastatic lymph node ratio and T1&T2 stage were determined to be independent prognostic factors. KEY WORDS: Elderly, Gastric cancer, Mortality, Prognostic factor.

Questions from and answers to a patient with groin hernia.

Inguinal hernia surgical treatment are the most commonly performed operations in general surgery practice. There is a need for detailed anatomical knowledge and surgical skills to satisfactorily treat this disease. In this review, we aimed to present up-to-date information and approaches on basic diagnosis, treatment, complications and management of inguinal hernias in our institution. KEY WORDS: Chronic pain, Groin hernia, Inguinal hernia, Recurrence, Surgery.

Video-assisted treatment of pilonidal disease, using a combination of diathermy ablation and phenol application.

Video-assisted diathermy ablation (VADA) and crystallised phenol application (CPA) have been independently suggested as minimally invasive treatment options for sacrococcygeal pilonidal disease (SPD). The failure rates may be 5-33% with either method, and these methods have a longer healing time when used alone. Thus, we combined the two methods to fulgurate the infected inner lining of the sinus after cleaning up the hair and debris, and to identify the anatomy of the pilonidal cavity in its entirety, including its branches and cavities, by video assistance; the ultimate aim was to disperse sclerosing phenol crystals for faster healing and potentially less or no recurrence. This is the first case in the literature that has been treated by combining CPA and VADA. The patient healed within less than a month, with no need for professional wound care, and was free of recurrence at 2-year follow-up.