Surgeons, Hernia Surgery and Informed Consent in the Seventeenth Century Ottoman Istanbul.

BACKGROUND: In the seventeenth century Ottoman Istanbul, especially Greek surgeons specialized in hernia surgery. Both Muslim and non-Muslim patients had signed contracts with surgeons in sharia courts before undergoing a surgery. In this study, we analyze these documents, which serve as informed consent in the Ottoman period, in detail. METHODS: We used Istanbul Sharia Court Registers (Istanbul Sicils) as the primary information source. We scanned a total of twenty nine registers dating back to the seventeenth century. In six of these registers, we determined a total of twenty one informed consents (known as riza senedi in Turkish literature) regarding hernia surgery and surgeons. Based on these data, we examined the surgeons and hernia surgeries, the fees received by surgeons, and the informed consent documents of the seventeenth-century Istanbul. RESULTS: In the scanned informed consents, we identified five male surgeons and twenty one patients. While four of the surgeons were Greek, one of them was Muslim. The contracts show that the patients were informed about possible complications before operations, and their permissions were obtained accordingly. The contracts also clearly state that a blood-money from the surgeons would not be requested if a patient dies during or after an operation. The cost of operations ranged between 500 and 2100 akce. CONCLUSIONS: The patient-physician relationship in Ottomans was seen as a business relationship. Medical processes were recorded in courts before treatment fees were paid. These court records had been a practice that protected the patients and the physicians in terms of criminal liability.

Changing the Surgical Approach to Breast Diseases During the COVID-19 Pandemic Period.

Background Postponing elective surgeries during the COVID-19 pandemic has also affected the approach to both malignant and benign breast diseases. This paper aims to share how the COVID-19 pandemic affects our approach to breast cancer, benign breast cases, and the procedures' results. Methodology A cross-sectional study was conducted in a tertiary-level public hospital in Istanbul, Turkey. We retrospectively analyzed our treatment options for patients diagnosed with breast cancer and benign breast disease in the general surgery clinic of a tertiary hospital that declared a pandemic status between March 11, 2020, and June 1, 2020. Results The number of patients who visited the breast outpatient clinic and received a diagnosis of breast cancer was 23. Among the benign diseases, no intervention was made except for abscess (eight patients, 40%) and mastitis (12 patients, 60%). Conclusions Patients with acute abscesses and mastitis were treated for both diagnostic and therapeutic purposes. Chemotherapy and hormone therapy were chosen for those diagnosed with cancer. Priority was given to oncology protocols rather than surgical approaches during the pandemic. We think that different approaches will be defined as the pandemic continues.

Repair of diaphragmatic hernias: Retrospective analysis of 70 cases.

BACKGROUND: Congenital and traumatic diaphragmatic hernias (DH) can lead to respiratory and gastrointestinal complications that can be the cause of serious morbidity and mortality. In this study, we aimed to share our experience with the surgical repair of complicated or non-complicated DH. METHODS: Patients who were operated on under emergency or elective conditions with the diagnosis of DH between 2009 and 2023 were analyzed retrospectively. Demographic characteristics, histories, symptoms, etiology of DH, computed tomography find-ings, surgical techniques, and postoperative outcomes of the patients were recorded. RESULTS: The mean age of the cases was 51.5±18.5, and 29 were female and 41 were male. Hernia etiology was found to be con-genital (40%), traumatic (32.8%), spontaneous (14.3%), and iatrogenic (12.8%), respectively. The mean diameter of the defects was 7.3±2.76 cm (range: 3-15 cm), and 84% of the defects were on the left side. Sixty percent of the cases were treated by laparoscopic surgery and 11.4% by laparotomy. The conversion rate from laparoscopic to open was 24.3%. Dual mesh was used in 48% of the pa-tients, and primary suturing was applied in 34%. The postoperative mortality rate was 7.1%. CONCLUSION: DH is an important cause of morbidity and mortality due to abdominal organ strangulation and pulmonary and cardiac complications. When a DH is diagnosed, laparoscopic or open surgery is the treatment that should be preferred.

The role of serum nesfatin-1 in a rat model of acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a disease that can still be fatal despite rapid advances in medicine. The relationship between serum nesfatin-1 levels and AP is still to be fully resolved. OBJECTIVES: To investigate the utility of serum nesfatin-1 levels in the diagnosis of AP. MATERIAL AND METHODS: Twenty-four male Sprague Dawley rats were divided into control, mild pancreatitis and severe pancreatitis groups (n = 8/group). Acute pancreatitis was induced by cerulein injection and the control group received saline injections. Then, the serum nesfatin-1, amylase, lipase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were determined. A pathologist blinded to the study scored the severity of pancreatitis. RESULTS: There was a considerable decrease in serum nesfatin-1 levels in parallel to the severity of pancreatitis, though there was no statistically significant relationship observed between pancreatitis and nesfatin-1. In addition, there was no significant difference in AST or ALT levels among the groups. However, a strong positive correlation between amylase and lipase levels was observed (p < 0.05). The severe pancreatitis group (group 3) had a higher lipase level and pathology score than mild pancreatitis group (group 2), and this difference was statistically significant. CONCLUSIONS: Serum nesfatin-1 may be used as a diagnostic and severity marker in pancreatitis in the future.

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

Objective: In laparoscopic cholecystectomy, partial cholecystectomy is usually preferred when the anatomic exploration is not enough to prevent bile duct injury and other complications. Some surgeons choose laparoscopically to perform partial cholecystectomy, whereas others convert to open surgery. In this study, we aim to discuss and compare the effectiveness of laparoscopic partial cholecystectomy (LPC) and open partial cholecystectomy (OPC). Materials and Methods: The data of 4712 patients who underwent laparoscopic cholecystectomy between 2012 and 2020 were reviewed. A total of 98 patients who had partial cholecystectomy were included in the study. Patients were examined in two groups according to whether the procedure was open or laparoscopic. The first group of patients was named the OPC group (n = 52), and the second group of patients was the LPC group (n = 46). The data of the two groups were comparatively analyzed. Results: The mean operative time and the postoperative hospital stay, respectively, were 118.2 minutes and 4.8 days in the OPC group, and 87.3 minutes and 2.55 days in the LPC group (P < .005 and P = .005). It was found that wound infection decreased by 83.1% (P = .026; odds ratio [OR] = 0.169) in the LPC group compared with the OPC group, and the probability of developing incisional hernia decreased by 81.1% (P = .014; OR = 0.189). At least one complication was observed in 17 patients in the OPC group and in 7 patients in the LPC group (P = .045). The probability of developing complications in any patient was 63% lower in the LPC group (P = .049; OR = 0.370). Conclusions: The indications that cause the surgeon to perform partial cholecystectomy are inherently open to complications, regardless of the surgical technique used. However, the laparoscopic operation has advantages such as shorter operation time, shorter postoperative hospital stay, lower risk of wound infection and incisional hernia rate, and lower complication rate than the open procedure. However, if the team performing the surgery does not have enough experience, they should never hesitate to switch to open cholecystectomy.

Extended View Totally Extraperitoneal Technique and Its Advantages in Laparoscopic Inguinal Hernia Repair.

Objective: Endoscopic total extraperitoneal (TEP) is used increasingly in inguinal hernias. Perhaps the most fundamental difficulty of the classical TEP method is that the dissection plan it offers is overly limited, which is among the reasons why techniques other than TEP are preferred in large scrotal hernias. This study discusses our experience with the extended view totally extraperitoneal (e-TEP) method, which significantly expands the dissection plan compared to the classical method. Methods: Patients who had inguinal hernia surgery in 2018 and 2019 were retrospectively analyzed, and 21 male patients with L3 inguinal hernia by European Hernia Society classification, who underwent laparoscopic e-TEP surgery, were included in the study. Patient data were obtained from the hospital's electronic database and patient files. One year after the surgery, the patients were invited to the hospital by telephone and re-examined. Results: The median patient age was 47 years. The mean duration of surgery was 43.6 minutes, and the median postoperatively pain score in the first 24 hours was 1.975. Zig maneuver was performed in 85.7%, and drains were placed in 33.4% of patients. In 28.6% of patients, the peritoneal violation occurred. However, there was no conversion to another surgical technique. The mean length of stay was 1.33 days. Two patients had seroma, one had scrotal edema, and one had urinary retention. No recurrence was observed in any patient during the 1-year follow-up. Conclusions: According to our experience, the e-TEP technique can be safely performed in scrotal hernias as it offers a larger dissection plane. It also allows patients with large scrotal hernias to benefit from all the advantages of the TEP technique.

Reliability of Hem-o-Lok clip in laparoscopic appendectomy is an uncharted territory.

AIM: Laparoscopic appendectomy is increasingly used in the treatment of acute appendicitis. We aimed in the present report to evaluate the reliability of the Hem-o-Lok clip used in appendix stump capping for occluding orifice . MATERIAL AND METHODS: In this study, sequential laparoscopic appendectomy cases, in whom Hem-o-Lok clips was employed, in a single center between January 2017 and June 2020 because of acute appendicitis were retrospectively analyzed. RESULTS: The study was completed with a total of 305 cases who underwent laparoscopic appendectomy with hem-o-lok clips within the specified date range. There were no intraoperative complications in any of the cases. The number of women was 94 (30.8%) and the number of men was 211 (69.2%). The average age was 32.7 years. There were 275 (90.2%) patients without appendix perforations and 30 (9.8%) patients with perforations.Postoperative complications occurred in 13 patients. Surgical site infection in five patients, mechanical intestinal in two patients, intraabdominal abscess in five patients, and hematoma at the trocar entry site in one patient were observed. There were no intraoperative complications in any of the patients. CONCLUSIONS: Hem-o-Lok clip can be applied safely in laparoscopic appendectomy for the capping of the appendix stump, with its easy-to-use and low-cost features. KEY WORDS: Acute appendicitis, Laparoscopic appendectomy, Hem-o-lok clip.

Systematic assessment of complications after laparoscopic colorectal surgery for advanced colorectal cancer: A retrospective study using Clavien-Dindo classification, 5-year experience.

Aim: The presence and frequency of surgical complications indicate the quality of the surgery performed. However, a standard classification system should specify, describe, and compare complications. Clavien Dindo classification is an easily applicable classification in the evaluation of complications. Our study aimed to reveal the severity of complications and the factors affecting them by using the Clavien Dindo classification in patients undergoing laparoscopic colorectal surgery. Methods: Between January 2015 and December 2020, we retrospectively collected the laparoscopic colorectal surgery complications using Clavien Dindo grading in patients in our colorectal surgery unit in the database. The outcome variables studied were age, gender, BMI, ASA score, postoperative length of hospital stay, operation procedure, cancer size, postoperative mortality. Results: There were 53 males and 17 female patients, with a mean age of 56,9±13,4.(19-81). Seventy patients, 32 (45%), had at least one postoperative complication. About complications; 58.6% were rated as Clavien I, 22.9% as Clavien II, 8.6% as Clavien IIIa, 4.3% as Clavien IIIb, 2.9% as Clavien IVa, and 2.9% as Clavien V. There was no Clavien grade IVb complication in any of the patients. Length of hospital stays was significantly higher in patients with had major complex surgery and had higher scores. Clavien Dindo classification was positively statistically significantly related to the day of hospitalization in male and female sex (p<0.001 for all). In addition, positively significantly related to Clavien Dindo classation and tumor diameter in the female sex (p=0.014) detected. Conclusions: In laparoscopic colorectal surgery, the Clavien-Dindo classification can be easily applied and used safely to determine complication rates. The reason for this statistical difference that we detected in our study and that occurs in women may be due to anatomical differences or the surgeon's experience.

Rat Model Investigation on the Role of Biomarkers in Hepatic Ischemia-Reperfusion Injury.

OBJECTIVES: Liver function is affected by ischemiareperfusion. Ischemia-reperfusion injury to the liver often follows hepatobiliary surgery. Here, we investigated biomarkers of liver ischemia-reperfusion injury using an animal model. MATERIALS AND METHODS: For this study, 24 male Sprague Dawley rats (146-188 g) were divided into 4 groups: group A was the control group, group B was the partial hepatic ischemia-reperfusion group, group C was the total hepatic ischemia-reperfusion group, and group D was the intermittent total hepatic ischemiareperfusion group. Laboratory liver function levels were measured before ischemia, after ischemia, and after reperfusion. We used liver and renal biopsies for histopathological examination at the end of the study. RESULTS: After clamping and reperfusion, alanine aminotransferase and cystatin C levels in groups B, C, and D were significantly higher than levels in group A. In group B, after clamping, neutrophil gelatinaseassociated lipocalin levels were higher than in groups A and D, with significantly higher level than in group D after reperfusion. Neutrophil gelatinase-associated lipocalin levels decreased significantly in groups B, C, and D after reperfusion. There was significantly greater hepatic damage in groups B, C, and D compared with group A but no significant differences in renal injury scores among the groups. There was a significant positive correlation between hepatic damage and renal injury. With regard to histopathological examination versus laboratory results, a statistically significant positive correlation was shown between grade of hepatic damage and serum alanine aminotransferase and cystatin C levels. Similarly, there was a positive correlation between renal damage score and alanine aminotransferase level. CONCLUSIONS: In our animal model, alanine amino - transferase and cystatin C levels tended to increase with ischemia-reperfusion injury levels but neutrophil gelatinase-associated lipocalin decreased during reperfusion. In liver ischemia, we suggest that neutrophil gelatinase-associated lipocalin may be an important biomarker for distinguishing the reperfusion phase.

The Effect of Prognostic Factors on Long-Term Protection in Breast Cancer.

Objectives Axillary lymph node involvement is considered to be one of the most important factors in the staging and survival of breast cancer. Recurrences in women with a negative axillary condition detected as a result of long patient follow-up have revealed the importance of other prognostic factors and many studies have begun. The aim of this study is to evaluate breast cancer patients and to investigate other factors affecting breast cancer. Materials and methods Patients with breast cancer who were operated in our clinic between January 2005 and June 2007 were included in the study. Demographic characteristics, tumor size, lymph node involvement, grade, histological type, the status of estrogen and progesterone receptors (ER and PR), type of surgery performed, and cerb-B2 receptor status were recorded retrospectively. Results The mortality rate of the ER (+) PR (+) group was significantly lower than that of the ER (-) PR (-) group (p<0.05). There was no statistically significant difference between the ER (+) PR (+) cases and the mortality rates of any positive cases (p>0.05). There was a statistically significant difference between survival rates according to cerb-B2 status (p<0.01); cerb-B2 was positive in all patients who died. In cerb-B2 positive cases, there was a statistically significant difference between survival rates according to the tumor stages (p <0.05). Conclusion As a result; preoperative and postoperative staging of all breast cancer patients who applied to surgery clinics should be performed. Prognostic factors should be determined and patients should be directed to post-surgical treatment according to this information. Axillary lymph involvement, number, tumor size, estrogen receptor, progesterone receptor, and cerb-B2 status are safe markers that can be used to determine prognosis in our series.