Oğuzhan Fatih Ay

Background: This study aimed to evaluate the clinical characteristics, imaging accuracy, and postoperative outcomes of acute appendicitis before and after a major earthquake. Methods: We retrospectively analyzed 810 appendectomies performed between August 2021 and August 2024, stratified into pre- (n = 436) and post-earthquake (n = 374) groups based on the February 6, 2023, earthquake. The study population was restricted to patients who underwent appendectomy, reflecting the clinical outcomes of an operatively managed cohort. Complicated appendicitis was defined based on the postoperative histopathological examination. Pre- and post-earthquake groups were compared using appropriate statistical tests, and logistic regression analysis was performed to identify the factors associated with complicated appendicitis. Results: The incidence of complicated appendicitis did not differ significantly between the pre- and post-earthquake groups (9.1% vs 10.8%, P = .429). Postoperative complications were significantly more frequent in the post-earthquake cohort ( P < .001), with a notable increase in Clavien-Dindo Grade II events (19.0% vs 5.3%) despite a higher proportion of ASA I individuals. Regarding laboratory parameters, platelet counts were higher in the post-earthquake group (263.5 vs 247.6 × 10 ³ /µL, P = .001), while elevated C-reactive protein levels were the sole independent predictor of complicated appendicitis (OR: 3.98, P = .025). Conclusion: The rates of complicated appendicitis remained stable following the earthquake, confirming the preservation of emergency surgical capacity. However, systemic strain was associated with increased minor postoperative morbidity. In an institution maintaining a primary operative approach, these findings demonstrate that sustaining emergency surgical throughput under disaster conditions entails subtle operational frictions, even when surgical access is fully maintained.

This study aimed to identify independent predictors of sentinel lymph node (SLN) metastasis in clinically node-negative (cN0) breast cancer and evaluate the diagnostic accuracy of intraoperative frozen section (FS). A retrospective analysis was conducted on 72 female patients with early-stage (cT1-2 cN0) invasive breast cancer who underwent SLN biopsy. Clinical, pathological, and radiological parameters were evaluated. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of metastasis. Intraoperative FS results were compared with definitive paraffin pathology. Definitive permanent paraffin section analysis confirmed SLN metastasis in 41.7% (n = 30) of patients. The false negative rate for intraoperative FS was 23.3%. Multivariate analysis identified lymphovascular invasion (LVI; OR = 8.22, P = .001) and elevated continuous progesterone receptor expression (OR = 1.02, P = .008) as significant independent predictors of initial SLN metastasis. Conversely, human epidermal growth factor receptor 2 positivity demonstrated a significant inverse relationship with nodal involvement (OR = 0.20, P = .010). Other clinicopathological parameters, including Ki-67, were not significantly associated. Our findings suggest that initial SLN metastasis may be primarily associated with the presence of LVI, elevated progesterone receptor expression, and human epidermal growth factor receptor 2 status. Preoperative identification of these specific markers could optimize risk stratification and support the strategic consideration of neoadjuvant systemic therapy to mitigate the diagnostic limitations of intraoperative staging.

Introduction: This study aimed to evaluate the diagnostic yield and surgical morbidity of isolated axillary surgery in non-breast pathologies, specifically comparing the safety profiles of excisional biopsy and axillary dissection.Methods: A retrospective review was conducted on patients who underwent isolated axillary surgery at a secondary-level center between 2018 and 2024. Data on demographics, surgical parameters, and pathology were analyzed. Comparative statistical analyses were performed using Fisher's exact and Mann-Whitney U tests.Results: A total of 42 patients were included (mean age: 58.1±14.4 years). Excisional biopsy was the most common procedure (71.4%), followed by axillary dissection (23.8%). Patients with malignancy were significantly older than those with benign pathologies (65.3 vs. 54.9 years; p=0.026). While the overall morbidity was 16.7%, a significant disparity was observed based on the surgical approach: morbidity was 70% in the axillary dissection group compared to 0% in the excisional biopsy group (p

Background: Achalasia is a rare esophageal motility disorder that causes dysphagia owing to impaired lower esophageal sphincter (LES) relaxation. This study aimed to evaluate a modified dissection and radial myotomy technique during peroral endoscopic myotomy (POEM) and to compare its outcomes with those of the standard approach. Methods: This prospective, single-center study was conducted between February 2022 and December 2022. Eighty total with 80 achalasia patients undergoing POEM were divided into 2 groups: Group A (n=40), treated with the novel technique, and Group B (n=40), treated with the standard approach. Demographics, Eckardt score (ES), submucosal tunnel (ST), myotomy length, intervention duration, and adverse events were recorded. The follow-up period ranged from 3 to 20 months. Results: Patients who underwent the novel radial myotomy technique (Group A) had significantly longer myotomy lengths (11.8±2.4 vs. 8.1±2.0 cm, P P 1–3 P =0.006) compared with the conventional POEM group (Group B). Subgroup analysis revealed that in Type III achalasia patients, the novel approach yielded longer submucosal tunnel lengths (15.6±0.8 cm, P =0.038) and favorable symptom relief. Despite extended dissection, there was no increase in gastroesophageal reflux disease (GERD)-related symptoms. Conclusion: The novel dissection and radial myotomy technique demonstrated superior outcomes in reducing dysphagia symptoms and LES resistance compared with the standard approach. Tailoring ST and myotomy lengths based on the achalasia type and EGJ involvement may optimize outcomes without increasing the risk of GERD.

Purpose: Glaucocalyxin A (GLA), a diterpenoid with antioxidative and anti-inflammatory properties, has shown vascular protective effects in preclinical models. This study aimed to evaluate whether GLA improves colonic anastomotic integrity following ischemia–reperfusion (I/R) injury. Methods: Twenty-four female Sprague Dawley rats were randomized into three groups (n = 8): control + GLA, I/R, and I/R + GLA. I/R was induced by 60-minute superior mesenteric artery occlusion and 60-minute reperfusion before end-to-end colonic anastomosis. GLA (10 mg/kg) was administered intraperitoneally. On postoperative day 7, anastomotic bursting pressure, adhesion scores, hydroxyproline, oxidative stress markers (total oxidative status, total antioxidant capacity, ischemia-modified albumin), and histopathology were evaluated. Results: The I/R + GLA group demonstrated significantly higher bursting pressure compared with the I/R group (126 versus 40 mmHg; p < 0.005). Tissue TOS levels were significantly lower in the I/R + GLA group compared with both other groups (p < 0.005). No significant differences were found in hydroxyproline levels, IMA values, or histopathological healing scores. Conclusion: GLA may support colonic anastomotic healing after I/R injury by reducing oxidative stress and could serve as a potential protective agent against anastomotic compromise.

Many organs can be associated with inguinal herniation, but bladder herniation is rare and occurs in only 1-4% of cases. A 48-year-old male patient attended the emergency department with a complaint of painful swelling in the left inguinal region that started during the day. In the patient whose vitals were stable, a decision was made for diagnostic laparoscopy due to significant tenderness in the left lower quadrant and suspicion of intestinal strangulation on Computed Tomography. On examination, the intestinal loops were intact, and a direct hernia was observed; then, open surgery was performed for hernia repair. Upon examination, it was observed that the blood supply to the herniated structure was impaired bladder tissue. The ischemic tissue wedge was resected and primary repaired. Mesh was utilized in the operation area. The patient, who was followed up with the postoperative urology clinic, was discharged on the 3rd postoperative day uneventfully. In patients presenting with strangulated recurrent herniation, it is crucial to consider the possibility of encountering retroperitoneal organs such as the bladder within the hernia sac. Additionally, in laparoscopic examination, if no intraperitoneal organ herniation is found, bladder herniation should be kept in mind.

AIM: Differentiating complicated appendicitis (CA) from uncomplicated appendicitis (UA) is a critical aspect of preoperative evaluation that influences surgical planning and patient outcomes. This study explored the role of the immature granulocyte count (IG#) and percentage (IG%) as accessible and reliable biomarkers to enhance the diagnostic precision of CA. METHODS: This retrospective observational study analyzed 482 emergency appendectomies performed at a single tertiary hospital between January 2020 and June 2023. After excluding 23 cases due to haematological disorders, malignancies, additional procedures, or incomplete data, 459 patients were included in the final analysis. Patients were categorized into the UA and CA groups based on histopathological examination. CA was defined as a perforation or gangrene. Laboratory parameters, including IG#, IG%, and inflammatory markers, were compared between groups. RESULTS: Among the 459 patients, 386 (84.1%) had UA and 73 (15.9%) had CA. The median age of CA patients was significantly higher than that of UA patients (36 vs. 33 years, p = 0.016). CA patients also demonstrated significantly elevated levels of C-reactive protein (CRP), direct bilirubin, white blood cell count (WBC), IG#, IG%, and neutrophil-to-lymphocyte ratio (NLR) compared to UA patients (p < 0.001). Receiver operating characteristic (ROC) analysis identified an IG# cut-off of 0.06 (area under the ROC curve [AUROC] = 0.699, sensitivity = 68.5%, specificity = 65.2%) and an IG% cut-off of 0.35 (AUROC = 0.663, sensitivity = 75.3%, specificity = 49.6%). In the multivariable logistic regression analysis, none of the evaluated laboratory parameters, including WBC count (Odds ratio (OR): 1.133, 95% Confidence interval (CI): 0.979–1.313, p = 0.095), IG# (OR: 0.000, 95% CI: 0.000–1.595, p = 0.056), IG% (OR: 6.740, 95% CI: 0.873–52.064, p = 0.067), and NLR (OR: 1.070, 95% CI: 0.980–1.169, p = 0.131), remained significant independent predictors of CA. CONCLUSIONS: Elevated IG# and IG% levels were associated with CA in univariate analysis; however, they did not remain significant independent predictors in the multivariable model. Although the potential of these markers may still provide complementary information in certain clinical scenarios, further large-scale prospective studies are needed to better define their role in clinical practice.

Objective: Our study aims to explore the predictive value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, calculated from routine blood te...

Background: The integration of artificial intelligence (AI) into clinical workflows holds promise for enhancing outpatient decision-making and patient education. ChatGPT, a large language model developed by OpenAI, has gained attention for its potential to support both clinicians and patients. However, its performance in the outpatient setting of general surgery remains underexplored. Objective: This study aimed to evaluate whether ChatGPT-4 can function as a virtual outpatient assistant in the management of puerperal mastitis by assessing the accuracy, clarity, and clinical safety of its responses to frequently asked patient questions in Turkish. Methods: Fifteen questions about puerperal mastitis were sourced from public health care websites and online forums. These questions were categorized into general information (n=2), symptoms and diagnosis (n=6), treatment (n=2), and prognosis (n=5). Each question was entered into ChatGPT-4 (September 3, 2024), and a single Turkish-language response was obtained. The responses were evaluated by a panel consisting of 3 board-certified general surgeons and 2 general surgery residents, using five criteria: sufficient length, patient-understandable language, accuracy, adherence to current guidelines, and patient safety. Quantitative metrics included the DISCERN score, Flesch-Kincaid readability score, and inter-rater reliability assessed using the intraclass correlation coefficient (ICC). Results: A total of 15 questions were evaluated. ChatGPT’s responses were rated as “excellent” overall by the evaluators, with higher scores observed for treatment- and prognosis-related questions. A statistically significant difference was found in DISCERN scores across question types (P=.01), with treatment and prognosis questions receiving higher ratings. In contrast, no significant differences were detected in evaluator-based ratings (sufficient length, understandability, accuracy, guideline compliance, and patient safety), JAMA benchmark scores, or Flesch-Kincaid readability levels (P>.05 for all). Interrater agreement was good across all evaluation parameters (ICC=0.772); however, agreement varied when assessed by individual criteria. Correlation analyses revealed no significant overall associations between subjective ratings and objective quality measures, although a strong positive correlation between literature compliance and patient safety was identified for one question (r=0.968, P<.001). Conclusions: ChatGPT demonstrated adequate capability in providing information on puerperal mastitis, particularly for treatment and prognosis. However, evaluator variability and the subjective nature of assessments highlight the need for further optimization of AI tools. Future research should emphasize iterative questioning and dynamic updates to AI knowledge bases to enhance reliability and accessibility.

Breast abscesses are common in surgical practice, with significant recurrence rates. Identifying factors associated with recurrence is crucial for guiding management and improving outcomes. This study aimed to evaluate the clinical, pathological, radiological, and laboratory factors associated with recurrence in patients who underwent surgical treatment for breast abscesses. This retrospective observational study included female patients who were managed surgically for breast abscesses between January 2018 and June 2024. The data included demographic, surgical, pathological, and laboratory parameters. Statistical analyses were performed to compare the recurrence and non-recurrence groups and identify significant predictors of recurrence. Logistic regression analysis was applied to determine independent predictors of recurrence. A total of 55 patients who underwent surgical treatment for breast abscesses were included in the study. Recurrence was observed in 30.9% of the patients (n = 17). In intergroup comparisons, lower hemoglobin levels were associated with recurrence (mean: 12.1 vs 13.09 g/dL; P = .057; mean difference: −0.994; 95% CI: −2.018 to 0.030), and recurrence was more frequent among Syrian-immigrant patients (17.6% vs 2.6%; χ² = 3.927; P = .048). Logistic regression identified granulomatous mastitis as a significant predictor, increasing the risk of recurrence (OR: 62.7; 95% CI: 1.98–1981.4; P = .031). This study highlights the high recurrence rate of surgically treated breast abscesses and the heterogeneity of the condition, which includes diverse etiologies. Preoperative patient counseling regarding recurrence risk is essential to strengthen the patient–physician relationship.