Effect of Early Versus Delayed Laparoscopic Cholecystectomy on Postoperative Morbidity and Difficult Cholecystectomy in Patients With Grade II Cholecystitis According to Tokyo 2018 Guidelines: A Prospective Study.

BACKGROUND: The timing of the cholecystectomy in patients with acute cholecystitis is still controversial. In our study, we aimed to investigate the effect of early and delayed cholecystectomy on difficult cholecystectomy, morbidity and mortality in patients diagnosed with Grade II acute cholecystitis according to Tokyo 2018 guidelines. METHODS: Patients who presented to the emergency department and diagnosed with Grade II acute cholecystitis between December 2019 and June 2021 were included in this study. Cholecystectomy was performed within 7 days and 6 weeks after symptom onset. The effect of early and delayed cholecystectomy was observed. RESULTS: A total of 92 patients were included in the study. The timing of cholecystectomy was not a risk factor for mortality, morbidity and difficult cholecystectomy. The conversion rate was higher in delayed group (P = .007). The bleeding was significantly higher in early group (P = .033). Total hospital stay was higher in delayed group (P < .001). CRP was a predictive parameter for increased Parkland score in early group (P < .001). CONCLUSIONS: Delayed cholecystectomy does not facilitate cholecystectomy in patients with Grade II acute cholecystitis. Early cholecystectomy can be performed safely and high CRP levels can be used to determine difficult cholecystectomy in early period.

Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy.

BACKGROUND: The aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence. METHODS: Patients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence. RESULTS: 36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors. CONCLUSIONS: Percutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence.

Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease.

INTRODUCTION: Minimally invasive techniques still continue to maintain their popularity in hemorrhoidal disease. In this study, we aimed to present the symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates of patients treated with the laser hemorrhoidoplasty (LHP) method in our clinic. METHODS: The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively. The patients enrolled in the study were followed for at least 6 months (6 months, 1 year, and 2 years) and their results were analyzed. RESULTS: A total of 103 patients were included in the study. Seventy-five (72.8%) of them were male and the mean age was 41.6 ± 13.6 years. The mean operation time was 17.9 ± 5.2 min and minor complications developed in 3 (2.9%) patients postoperatively. Mean time to return to normal daily life was 2.17 (1-11) days. Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019). CONCLUSION: LHP is a popular procedure which is effective in selected patient groups with acceptable recurrence rates.

OBJETIVO: Presentar las tasas de recurrencia y recuperación sintomática, los niveles de dolor posoperatorio y las tasas de complicaciones de los pacientes tratados con hemorroidoplastia láser en nuestra clínica. MÉTODO: Los datos de los pacientes que se sometieron a hemorroidoplastia láser debido a enfermedad hemorroidal interna de grados 2, 3 y 4 en nuestra clínica se revisaron retrospectivamente. Los pacientes incluidos en el estudio fueron seguidos durante al menos 6 meses (6 meses, 1 año y 2 años) y se analizaron sus desenlaces. RESULTADOS: Se incluyeron en el estudio 103 pacientes, de los cuales 75 (72.8%) eran de sexo masculino. La edad media fue de 41.6 ± 13.6 años. El tiempo operatorio medio fue de 17.9 ± 5.2 minutos. Se desarrollaron complicaciones menores en 3 (2.9%) pacientes en el posoperatorio. El tiempo medio de reincorporación a la vida diaria normal fue de 2.17 (1-11) días. La recurrencia se observó en 16 (17.6 %) pacientes con enfermedad de grados 2 y 3, y en 6 (50%) de 12 pacientes con enfermedad de grado 4 (p = 0.019). CONCLUSIONES: La hemorroidoplastia láser es un procedimiento popular que es efectivo en grupos de pacientes seleccionados, con tasas de recurrencia aceptables.

Effect of skeletal muscle area and prognostic nutritional index in periampullary tumors.

INTRODUCTION: The skeletal muscle area (SMA) and prognostic nutritional index (PNI) are both considered as predictive parameters for mortality and morbidity for various type of cancer. In this study, we aimed to identify the effects of pre-operative SMA and PNI values on post-operative mortality and morbidity in patients with periampullary region tumors (PRT). METHODS: Patients between 2010 and 2020 were retrospectively analyzed and divided into two groups according to SMA and PNI cutoff values. Univariate and multivariate analysis was performed to find potential risk factors. RESULTS: The mean age was 65.94 ± 11.242 and 54 (60.6%) of the patients were male. Hypertension was found a reducing factor for morbidity in both univariate and multivariate analysis (p = 0.039; p = 0.045). Chronic obstructive pulmonary disease and low PNI were found as factors affecting mortality in univariate analysis (p = 0.046; p = 0.014). However, only low PNI was found as an enhancing factor for mortality in multivariate analysis. CONCLUSION: Although SMA is not a risk factor for post-operative morbidity and mortality, PNI can be considered as a risk factor for mortality in patients with PRT.

INTRODUCCIÓN: El área del músculo esquelético (SMA) y el índice nutricional pronóstico (PNI) se consideran parámetros predictivos de mortalidad y morbilidad para varios tipos de cáncer. En este estudio, nuestro objetivo fue identificar los efectos de los valores preoperatorios de SMA y PNI sobre la mortalidad postoperatoria. y morbilidad en pacientes con tumores de la región periampular (PRT). MÉTODOS: Los pacientes entre 2010-2020 fueron analizados retrospectivamente y divididos en dos grupos según los valores de corte de SMA y PNI. Se realizaron análisis univariados y multivariados para encontrar posibles factores de riesgo. RESULTADOS: La edad media fue de 65.94 ± 11.242 y 54 (60.6%) de los pacientes eran varones. Se encontró que la hipertensión es un factor reductor de la morbilidad tanto en el análisis univariado como en el multivariado (p = 0.039; p = 0.045). La EPOC y el PNI bajo se encontraron como factores que influyen en la mortalidad en el análisis univariante (p = 0.046; p = 0.014). Sin embargo, solo el PNI bajo se encontró como un factor potenciador de la mortalidad en el análisis multivariado. CONCLUSIÓN: Aunque la SMA no se consideró un factor de riesgo de morbilidad y mortalidad posoperatorias; La PNI puede considerarse un factor de riesgo de mortalidad en pacientes con PRT.

Do Stoma Formation and Use of Vacuum Assisted Closure System Affect Mortality in Perineal Fournier's Gangrene?

OBJECTIVE: The aim of this study was to identify the effects of creation of stoma and the use of vacuum-assisted closure systems on postoperative mortality and hospital stay in patients with Fournier's gangrene involving anorectal region. STUDY DESIGN: A retrospective study. PLACE AND DURATION OF STUDY: Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey, from January 2010 to September 2021. METHODOLOGY: A total of 66 patients with Fournier's gangrene with anorectal involvement were selected from hospital records and divided into two groups as alive and exitus. Differences between these two groups and the factors affecting mortality were analysed with the SPSS statistics software, version 25.0. The value of p<0.05 was considered statistically significant. RESULTS: The mean age of the patients was 57.9±12.9 years, however, age was higher in exitus group (p=0.013). Debridement count was significantly raised in patients with vacuum assisted closure system (p<0.001). The use of vacuum-assisted closure system was associated with a longer hospital stay (p=0.042). Both stoma creation and the use of vacuum-assisted closure system were not found as risk factors for higher mortality. CONCLUSION: Stoma creation and the use of vacuum-assisted closure systems have no effect on mortality in patients of Fournier's gangrene with anorectal involvement. Urogenital involvement may be considered as a risk factors for mortality. KEY WORDS: Fournier's gangrene, Vacuum-assisted closure system, Stoma, Anorectal region, Perineum, Mortality.

Effect of preoperative skeletal muscle area and prognostic nutritional index values on postoperative morbidity and mortality in patients with gastric cancer: a single-center retrospective analysis.

INTRODUCTION: The aim of this study was to determine the impact of preoperative prognostic nutritional index (PNI) value and skeletal muscle area (SMA) on short-term outcomes of patients with gastric cancer. PATIENTS AND METHODS: A total of 107 patients underwent gastrectomy due to gastric cancer between January 2016 and December 2019 were retrospectively analyzed. The patients were divided into groups according to the determined PNI and SMA cutoff values. Clinicopathological features and short-term results were compared. RESULTS: Overall morbidity was 29% (n = 31) in patients who underwent gastrectomy. Preoperative PNI value was ranged from 24.5 to 61.5 (median, 49.5). Preoperative SMA values were ranged respectively from 55.7 to 142 (median, 98.9) in women and 77.5 to 203.3 (median, 129.3) in men. It was observed that the risk of postoperative complications increased in patients with low PNI (OR 0.270, p = .003). The average postoperative length of hospital stay was 12.1 days. The longer postoperative hospital stay was seen in lower PNI group (PNI ≤ 48, 15.1 days vs. PNI> 48, 10 days; p = .033). Clavien-Dindo classification was high in patients with low PNI and sarcopenia (PNI ≤ 48, p = .004 and Sarcopenia, p = .006). Likewise, mortality was significantly increased in patients with low PNI and sarcopenia (PNI ≤ 48, 20% vs. PNI > 48, 0%; p < .001 and Sarcopenia, 13.7% vs. Nonsarcopenia, 3.6%; OR 0.233, p = .053). CONCLUSIONS: As a result, preoperative SMA and PNI values were found closely related to the postoperative hospital stay, morbidity and mortality results of patients with gastric cancer. Preoperative nutritional support may help to overcome longer hospital stay, higher mortality and morbidity rates in patients with gastric cancer.

Evaluation of the Increase in Serum Calcium Levels After Unilateral Adrenalectomy.

Introduction This study aims to investigate the prevalence and characteristics of patients with elevated serum calcium due to adrenal insufficiency after unilateral adrenalectomy. Methods The study included 76 patients who underwent unilateral adrenalectomy from January 2012 to November 2021 and did not have an additional etiologic factor for hypercalcemia, During the postoperative period, the highest calcium value in six months was taken into account as the postoperative value. Calcium values were corrected according to the albumin value. Results Of the 76 patients included in the study, serum calcium levels were higher in six patients (7.9%) after adrenalectomy. Unlike the others, a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine values were detected in the postoperative period in this patient group. In this patient group, the corrected calcium level detected an average increase of 1.3 mg/dL. Conclusion After unilateral adrenalectomy, hypercalcemia may occur due to adrenal insufficiency. It should also be considered that there may be a decrease in GFR and increased creatinine in these patients.

A new prognostic marker in patients undergoing Hartmann's procedure for acute tumoral obstruction of the left colon.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade

Risk Factors for the Morbidity and Mortality of Stoma Closure.

OBJECTIVE: To identify the risk factors for postoperative complications of stoma closures. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Izmir University of Health Sciences, Tepecik Training and Research Hospital, Izmir Turkey from October 2008 to December 2018. METHODOLOGY: A total of 179 patients were divided into two groups according to presence or absence of postoperative complications. Differences between these two groups were analysed with tests of proportion; p <0.05 value was considered statistically significant. The results are reported as odds ratios (ORs) with 95% confidence interval (CI). RESULTS: The median age of the patients with postoperative complications was 57.00 (40.00-67.00) and 30/55 (54.5%) of them were males. American Society of Anesthesiology (ASA) score and coronary artery disease had significant association with postoperative complications of stoma closure (p=0.033, p=0.024). Although colostomy was not associated with presence of postoperative complications, but when the authors analysed correlations of colostomy with postoperative complications separately, it was found that colostomy was a risk factor for postoperative ileus (OR 0.257, 95% CI 0.081-0.821; p= 0.026). CONCLUSION: ASA score and coronary artery disease should be considered as risk factors for complications of stoma closure. Colostomy should be considered as a risk factor for postoperative ileus. Key Words: Colostomy, Ileostomy, Stoma closure, Risk factors.

Ectopic ureter associated with Zinner's syndrome in a kidney recipient: case report and literature review.

INTRODUCTION Zinner's Syndrome is a triad of mesonephric duct anomalies comprising unilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. In this study, we present a kidney recipient with ectopic ureter associated with Zinner's syndrome and a literature review. CASE PRESENTATION A 59-year-old male with a history of chronic kidney disease and left renal agenesis underwent deceased donor kidney transplantation. After securing optimal renal functions, the patient underwent abdominal computed tomography (CT) scan for the seroma that occurred under the incision. The final diagnosis was an ectopic distal ureter ending in the seminal vesicle cyst's wall and ipsilateral renal agenesis. The patient was discharged without any complications and the clinical follow up was uneventful. DISCUSSION AND CONCLUSION Congenital seminal vesicle disorders are usually associated with ipsilateral urinary duct anomalies stemming from the same embryonic structure. To our knowledge, this is the first case report that describes kidney transplantation in a patient with ipsilateral renal agenesis and ectopic ureter ending in the seminal vesicle cyst. In patients with renal agenesis, during the ipsilateral urinary tract anastomosis, the possibility of ectopic ureter should be kept in mind otherwise graft loss can occur with a high morbidity rate.

Ectopic ureter associated with Zinners syndrome in a kidney recipient: case report and literature review

SUMMARY INTRODUCTION Zinner's Syndrome is a triad of mesonephric duct anomalies comprising unilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. In this study, we present a kidney recipient with ectopic ureter associated with Zinner's syndrome and a literature review. CASE PRESENTATION A 59-year-old male with a history of chronic kidney disease and left renal agenesis underwent deceased donor kidney transplantation. After securing optimal renal functions, the patient underwent abdominal computed tomography (CT) scan for the seroma that occurred under the incision. The final diagnosis was an ectopic distal ureter ending in the seminal vesicle cyst's wall and ipsilateral renal agenesis. The patient was discharged without any complications and the clinical follow up was uneventful. DISCUSSION AND CONCLUSION Congenital seminal vesicle disorders are usually associated with ipsilateral urinary duct anomalies stemming from the same embryonic structure. To our knowledge, this is the first case report that describes kidney transplantation in a patient with ipsilateral renal agenesis and ectopic ureter ending in the seminal vesicle cyst. In patients with renal agenesis, during the ipsilateral urinary tract anastomosis, the possibility of ectopic ureter should be kept in mind otherwise graft loss can occur with a high morbidity rate.

RESUMO INTRODUÇÃO A Síndrome de Zinner é uma tríade de anomalias do ducto mesonéfrico que compreende agenesia renal unilateral, cisto da vesícula seminal e obstrução do ducto ejaculatório. Neste estudo, apresentamos um receptor de rim com ureter ectópico associado à Síndrome de Zinner e revisão da literatura. APRESENTAÇÃO DO CASO Homem de 59 anos com história de doença renal crônica e agenesia renal esquerda foi submetido a transplante de rim de doador falecido. Após função renal ideal, foi realizada tomografia computadorizada do abdome (TC) devido ao seroma sob incisão. O diagnóstico final foi um ureter distal ectópico que termina na parede do cisto da vesícula seminal e agenesia renal ipsilateral. O paciente recebeu alta sem complicações e o acompanhamento clínico ocorreu sem intercorrências. DISCUSSÃO E CONCLUSÃO Os distúrbios congênitos da vesícula seminal geralmente estão associados às anomalias do ducto urinário ipsilateral devido a uma mesma estrutura embrionária. Até onde sabemos, é o primeiro relato de caso que descreve o transplante renal em um paciente com agenesia renal ipsilateral e ureter ectópico terminado no cisto da vesícula seminal. Em pacientes com agenesia renal, durante a anastomose do trato urinário ipsilateral, deve-se ter em mente a possibilidade do ureter ectópico, caso contrário, poderá ocorrer perda do enxerto com alta taxa de morbidade.

Impact of Subclinical Rejection on Kidney Graft Function.

BACKGROUND: In kidney transplant recipients with borderline infiltration, protocol biopsy results demonstrated the relationship with chronic injury. The purpose of this study was to evaluate the effect of subclinical rejection (SCR) on 6-month protocol biopsy results in long-term renal function in renal transplant recipients with stable graft function. MATERIAL AND METHODS: Transplant protocol biopsies performed in 45 patients with stable renal function were included in this study at 6 months. Biopsy specimens were evaluated for SCR. Study groups were divided into patients with and without SCR. Renal functions were compared with pathologic evaluation. The effect of immunosuppressive regimens on renal function were evaluated in patients with SCR RESULT: The median age of patients was 32 years (range, 18-64 years). The median follow-up was 56 months (range, 24-84 months). According to the 6-month protocol biopsy results, 20 of 45 patients (44.4%) met SCR criteria based on Banff 07 parameters. There was not a statistically significant difference in renal function with SCR. CONCLUSION: The presence of SCR on the 6-month protocol biopsy results in renal transplant recipients with a stable graft function does not cause deterioration in the long-term graft function.