Fatih Şahin

Anal stenosis, characterized by fibrotic narrowing of the anal canal, commonly arises as a postoperative complication, particularly following hemorrhoidectomy. It significantly impairs quality of life, manifesting with symptoms such as pain, straining, and incomplete evacuation. The diamond flap procedure is a reconstructive surgical technique aimed at restoring the anatomical and functional integrity of the anal canal by excising scar tissue and transposing well-vascularized tissue to the stenotic area. This study presents two cases of post-hemorrhoidectomy anal stenosis treated with the diamond flap technique. Both patients exhibited marked improvement in symptoms and anal canal diameter postoperatively, with no complications or recurrence at 6-8 weeks of follow-up. Flap viability, symptom resolution, and patient satisfaction were satisfactory in the short term. These cases are consistent with published reports of the diamond flap as a surgical option in the management of anal stenosis; longer follow-up and larger series are needed.

Aims: Emergency surgery encompasses a broad spectrum of clinical presentations, often characterized by acute physiological derangement and limited opportunities for preoperative optimization. Reliable preoperative tools that anticipate postoperative deterioration are therefore essential, particularly for planning intensive care unit (ICU) utilization. Although the Emergency Surgery Score (ESS) has been validated for outcome prediction, its role in forecasting postoperative ICU admission and length of hospital stay warrants further clarification.Methods: This retrospective observational study evaluated adult patients who underwent emergency surgery for acute abdominal conditions at a tertiary care center. Preoperative ESS was calculated for each patient using established variables. Postoperative ICU admission constituted the primary outcome, while length of hospital stay was defined as the secondary outcome. Comparative analyses were performed between patients requiring ICU care and those managed on the surgical ward. The independent predictive value of ESS was assessed using binary logistic regression, and its relationship with length of hospital stay was examined through regression modeling.Results: Among 88 patients included in the analysis, 8 (9.1%) required postoperative ICU admission. ESS values were significantly higher in patients admitted to the ICU compared with those treated on the general ward. Logistic regression demonstrated that ESS independently predicted postoperative ICU admission, with each one-point increase in ESS being associated with a significantly higher likelihood of ICU admission (OR 5.02, 95% CI 1.79-14.07). Model calibration and discrimination were both strong. In parallel, higher ESS values were associated with a marked prolongation of hospital stay. Conclusion: ESS is a robust preoperative predictor of postoperative ICU admission and hospital length of stay in emergency surgical patients. Its simplicity and reliance on routinely available data support its use as a practical tool for perioperative risk stratification and critical care planning.

Aims: Acute diverticulitis (AD) and primary epiploic appendagitis (EA) are two distinct pathological entities that often present with similar clinical features, complicating the process of differential diagnosis. While AD is an inflammatory condition of the diverticula that may progress to significant complications, EA represents a self-limiting inflammatory process originating from ischemic infarction of an epiploic appendage. Accurate differentiation between these two conditions is crucial, as management strategies differ significantly: AD may require hospitalization and antibiotic therapy, while EA is typically managed conservatively. Laboratory parameters have been increasingly investigated to assist in the early and accurate diagnosis of these conditions. This study aims to evaluate the diagnostic value of routine laboratory parameters and to develop a novel scoring system to help clinicians distinguish between AD and EA. Methods: A retrospective analysis was conducted on 184 patients diagnosed with either EA or AD at Hitit University Medical Faculty Erol Olçok Training and Research Hospital between January 1, 2013, and January 1, 2022. Demographic data, laboratory values, including white blood cell count (WBC), neutrophil (NE), lymphocyte (LY), hemoglobin (Hb), platelet (Plt), mean platelet volume (MPV), albumin (Alb), creatine kinase (CK), and C-reactive protein (CRP), lesion localization, comorbidities, hospitalization status, length of stay, complications, interventions, recurrence, and colonoscopy findings were recorded. Comparative analyses between the EA and AD groups were performed. Multivariate analysis identified significant predictors for developing the Ramcho Index (RI) and the Ramcho Score (RS), which integrate laboratory and clinical parameters to create an objective, numeric index and a 0–9 point scale. Results: Among the 184 patients, 109 were diagnosed with AD and 75 with EA. CRP, neutrophil-lymphocyte ratio (NLR), and CRP-albumin ratio (CAR) were significantly elevated in AD (all p

Boerhaave syndrome remains a life-threatening condition due to rapid mediastinal contamination and sepsis, prompting growing interest in minimally invasive alternatives to surgery. Alongside surgery and endoscopic stenting, endoscopic vacuum therapy (EVT) has emerged over the past decade as an organ-preserving treatment option that combines defect closure with continuous internal drainage—an advantage over conventional stents, which often migrate and fail to control underlying contamination. This narrative review synthesizes current evidence on the role of EVT and hybrid vacuum–stent technologies in the management of spontaneous esophageal rupture. Across recent multicenter cohorts, observational studies, and case series, EVT demonstrates high defect closure rates (80–90%), particularly when applied early in contained perforations and in patients at increased operative risk. Comparative data suggest that, while stents provide effective luminal sealing, EVT offers a distinct advantage in controlling sepsis through active drainage, thereby reducing the need for adjunctive interventions in selected cases. Hybrid systems such as the VACStent further integrate luminal patency, sealing, and negative pressure, allowing nutritional intake while maintaining effective drainage. However, the available evidence remains heterogeneous and largely non-randomized, and EVT appears less effective in the presence of extensive contamination, large chronic cavities, or advanced sepsis. Current data support EVT as a central component of individualized, multimodal management strategies for Boerhaave syndrome, complementing rather than replacing surgical and stent-based approaches. Further prospective and comparative studies are required to refine patient selection and optimize treatment algorithms.

Background and Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery (CRS), increasing morbidity, mortality, and healthcare costs. While several AL risk factors have been identified, the role of aortic calcification (AC) remains unclear. As a marker of systemic atherosclerosis, AC may impair tissue perfusion and anastomotic healing. Additionally, tumor factors (TNM stage, histology, and localization) and patient comorbidities (hypertension, cardiovascular disease, and neoadjuvant therapy) may contribute to AL risk. This study evaluates the association between preoperative AC and AL incidence while considering additional risk factors. Materials and Methods: This retrospective cohort study included 151 patients undergoing CRS from January 2020 to October 2023. Preoperative CT scans classified AC into Stage 0 (none), Stage 1 (50%) of the aortic circumference. Data on demographics, tumor characteristics, neoadjuvant therapy, and comorbidities were collected. AL risk factors were analyzed using univariate and multivariate logistic regression. Results: AL occurred in 5.96% (9/151) of patients. AL incidence was significantly higher in patients with >50% AC (44.47% vs. 11.27%, p = 0.012). Multivariate analysis confirmed AC as an independent AL predictor (OR = 10.38, 95% CI: 1.243–92.118, p = 0.032). Rectal tumor localization (p = 0.038), hypertension (p = 0.027), cardiovascular disease (p = 0.014), and neoadjuvant therapy (p = 0.045) were also associated with increased AL risk. Conclusions: Severe AC is an independent predictor of AL in CRS. Additionally, rectal tumors, hypertension, cardiovascular disease, and neoadjuvant therapy contribute to AL risk. Preoperative vascular assessments and comprehensive risk stratification models may help identify high-risk patients and guide perioperative management strategies to reduce AL incidence.

Background and Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery (CRS), increasing morbidity, mortality, and healthcare costs. While several AL risk factors have been identified, the role of aortic calcification (AC) remains unclear. As a marker of systemic atherosclerosis, AC may impair tissue perfusion and anastomotic healing. Additionally, tumor factors (TNM stage, histology, localization) and patient comorbidities (hypertension, cardiovascular disease, neoadjuvant therapy) may contribute to AL risk. This study evaluates the association between preoperative AC and AL incidence while considering additional risk factors. Materials and Methods: This retrospective cohort study included 151 patients undergoing CRS from January 2020 to October 2023. Preoperative CT scans classified AC into Stage 0 (none), Stage 1 (< 50%), and Stage 2 (>50%) of the aortic circumference. Data on demographics, tumor characteristics, neoadjuvant therapy, and comorbidities were collected. AL risk factors were analyzed using univariate and multivariate logistic regression. Results: AL occurred in 5.96% (9/151) of patients. AL incidence was significantly higher in patients with >50% AC (44.47% vs. 11.27%, p=0.012). Multivariate analysis confirmed AC as an independent AL predictor (OR = 10.38, 95% CI: 1.243–92.118, p=0.032). Rectal tumor localization (p=0.038), hypertension (p=0.027), cardiovascular disease (p=0.014), and neoadjuvant therapy (p=0.045) were also associated with increased AL risk. Conclusions: Severe AC is an independent predictor of AL in CRS. Additionally, rectal tumors, hypertension, cardiovascular disease, and neoadjuvant therapy contribute to AL risk. Preoperative vascular assessments and comprehensive risk stratification models may help identify high-risk patients and guide perioperative management strategies to reduce AL incidence.

Objective: Gastric cancer surgery, including curative and palliative procedures, is crucial for managing gastric cancer. Accurate assessment of nutritional status is essential for risk stratification and improving patient outcomes. This retrospective study aims to identify the most reliable predictors of postoperative mortality by investigating the correlation between four nutritional scores and the mortality rate following gastric cancer surgery. Material and Method: This retrospective study evaluated 50 patients diagnosed with gastric adenocarcinoma and operated on at Hitit University Department of General Surgery between April 2021 and September 2023. Nutritional scores were calculated using albumin, cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio, along with mortality rates. Data collected included age, gender, operation type, laparoscopy usage, albumin, cholesterol, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, mortality rates, and TNM stages. Nutritional scores were calculated, and their predictive accuracy for mortality was assessed using time-dependent Receiver Operating Characteristic curve analysis. Results: Significant differences in albumin levels, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and nutritional scores were found between deceased and surviving patients. Specifically, albumin levels were significantly lower in deceased patients (median = 3.5 mg/dL) compared to surviving patients (median = 4.1 mg/ dL, p=0.001). The median neutrophil-to-lymphocyte ratio was higher in deceased patients (p=0.005), and the median lymphocyte-to-monocyte ratio was lower in deceased patients (p=0.009). Among the scores, the Naples Prognostic Score was significantly associated with mortality but was outperformed by the Prognostic Nutritional Index. The Prognostic Nutritional Index had the highest predictive accuracy with an Area Under the curve of 0.792, a sensitivity of 76%, and a specificity of 86.2%, outperforming the others. Conclusion: Among the evaluated scores, the Prognostic Nutritional Index is the most effective predictor of prognosis. Its superior predictive accuracy suggests that the PNI can be utilized to enhance risk assessment and guide nutritional interventions in gastric cancer patients undergoing surgery.

Aim: In primary hyperparathyroidism patients, avoiding hypoparathyroidism and hypocalcemia after surgery is essential. We aimed to evaluate if the delta parathormone percent value (ΔPTH%) can identify patients with an increased risk of developing hypocalcemia after parathyroid surgery for primary hyperparathyroidism. Material and methods: Eighty patients with parathyroid adenomas who underwent single parathyroidectomy were analyzed, and demographical data, preoperative, and postoperative laboratory data were collected were included in the study. Postoperative hypocalcemia was defined as a corrected calcium value below 8.5 mg/dL calculated from the blood values taken on the first postoperative day. The ΔPTH value was calculated by finding the difference between the preoperative PTH value and the postoperative PTH value, and the percentage of ΔPTH was calculated by dividing the ΔPTH value by the preoperative PTH (ΔPTH = Preoperative PTH – Postoperative PTH, and ΔPTH% = ΔPTH / Preoperative PTH). Results: Postoperative hypocalcemia developed in 7.5% of the patients. Hypocalcemic patients had higher ΔPTH and ΔPTH% values. The selection of 130.95 ng/L as ΔPTH level cutoff level divided patients with and without postoperative hypocalcemia with 83.3% sensitivity and 62.2% specificity. As for ΔPTH%, a cut-off value of 71.4% had 100.0% sensitivity, 56.8% specificity, and a 16-fold increase in odds of postoperative hypocalcemia. Conclusion: ΔPTH and ΔPTH% values are helpful predictors of postoperative hypocalcemia after parathyroidectomy and can be used as a guiding tool.

Amaç Papillertiroid kanserinde santral lenf nodlarının metastazının cerrahi öncesi saptanması zordur. Papiller tiroid kanserinin tedavisinde santral lenf nodu diseksiyonunun rolü belirsizliğini koruyor. Bu çalışma, papiller tiroid kanserli hastalarda preoperatif santral lenf nodu metastazı oluşumunu öngörmek için hazır preoperatif klinik özelliklere dayalı bir nomogram oluşturmayı amaçladı Gereç ve Yöntemler 2013-2022 tarihleri arasında bilateral total tiroidektomi yapılmış papillertiroid karsinomu tanılı hastalar tarandı ve 314 hasta çalışmaya dahil edildi. Hastaların demografik verileri, operasyon süresi, TSH, T3, T4 düzeyleri, glukoz/lenfosit oranları (GLR), patoloji raporlarındaki lenfovasküler invazyon, kapsül invazyonu ve boyun metastazı durumu retrospektif olarak taranarak not edildi. Tüm istatistiksel analizler için IBM SPSS 26.0 kullanılarak değerlendirildi. p

Introduction: One of the most important causes of morbidity in pancreaticoduodenectomy (PD) surgery is pancreatic anastomosis leakage. There is a possibility of pancreatic fistula even in the most experienced hands. After PD, pancreatic fistula occurs between 10% and 20% in various series. This study aims to evaluate the effects of pancreatic duct size and pancreatic tissue on the development of pancreatic fistula after PD is performed in our center. Material and Method: Pancreatic duct size was categorized as small 3 mm. Pancreatic gland tissue was categorized as a soft, medium, and hard. These variables were calculated preoperatively with the help of computed tomography (CT), ultrasonography(USG), and Endoscopic ultrasound (EUS), and postoperative pathology results. It was accepted that the 24-hour flow rate of the drain behind the pancreatic anastomosis was more than 50 ml during 3 days after PD and/or the amylase concentration of the drain content measured at 3 different times was 3 times higher than the serum amylase concentration. Results: A total of 90 patients were included in the study, anastomotic leakage was not observed in 63 (70%) of 90 patients, and leakage was observed in 27 (30%) patients. The mean age was 71.22±10.78 years (p=0.615). There was no statistically significant difference between the ductus diameters between the two groups (p=0.240). There was no statistical difference between the groups formed according to pancreatic duct width. (p=0.059). It was observed that 60.3% of the patients in the non-leakage group had a hard appearance, and this rate was statistically significantly reduced to 29.6% in the patients with leakage (p=0.008). Conclusion: In summary, our study showed that pancreatic fistula after PD is associated with soft pancreatic parenchyma. The surgeon should consider this risk factor when performing a PD and be more careful to reduce the rate of pancreatic fistula.