Sangar Abdullah

Aims: Partial matricectomy by the Winograd technique is a common surgical treatment for ingrown toenail, and several modifications have been described. This study compared the classic Winograd technique with primary suture against a modified technique in which the wound is left open to heal by secondary intention.Methods: The records of patients who underwent surgery for Heifetz stage 2 or 3 ingrown toenail of the great toe between February 2021 and November 2023 at a tertiary training and research hospital were reviewed retrospectively, with follow-up completed in November 2024. Patients with diabetes mellitus, previous surgery for recurrent disease, or total nail excision were excluded. A single index nail was analysed per patient. The primary outcome was time to return to work or usual daily activities; secondary outcomes were recurrence, surgical site infection, and patient satisfaction. Recurrence was analysed using Kaplan-Meier and Cox proportional hazards methods. Results: Of 171 patients screened, 131 were analysed (66 classic Winograd, 65 modified). Median follow-up was 24.8 months. Return to work or usual daily activities was one day earlier after the classic technique (median 9 versus 10 days; p=0.011; Hodges–Lehmann median difference 1 day, 95% CI 0 to 2). Recurrence occurred in 12.1% and 10.8% respectively, with no difference in recurrence-free survival (log-rank p=0.95; HR 0.97, 95% CI 0.35–2.67). Surgical site infection (9.1% versus 12.3%, p=0.585) and satisfaction (92.4% versus 89.2% satisfied or very satisfied, p=0.561) did not differ significantly.Conclusion: No statistically significant differences in recurrence, infection, or satisfaction were observed between the techniques, with a clinically small difference in return to work.

Background: The C-reactive protein–albumin–lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune function. This study evaluated changes in the CALLY index after sleeve gastrectomy and their associations with weight loss and cardiometabolic changes in women. Methods: This retrospective, observational, single-center study included 72 women who underwent sleeve gastrectomy and had complete preoperative and 12-month postoperative data. The CALLY index was calculated preoperatively and at 12 months. ΔCALLY was defined as the 12-month value minus the preoperative value. Weight-loss outcomes were assessed using total weight loss (TWL) and excess weight loss (EWL). Associations were evaluated using Spearman’s rank correlation analysis and multivariable linear regression. Results: The CALLY index increased from 1.70 [0.87–2.56] preoperatively to 6.94 [2.72–15.54] at 12 months (p < 0.001). Mean TWL and EWL were 31.43 ± 7.83% and 73.30 ± 20.12%, respectively. ΔCALLY correlated positively with TWL (r = 0.303, p = 0.010) and EWL (r = 0.312, p = 0.008) and negatively with ΔBMI (r = −0.250, p = 0.035), Δfasting insulin (r = −0.234, p = 0.046), ΔHOMA-IR (r = −0.243, p = 0.040), and Δtriglycerides (r = −0.254, p = 0.031). After adjustment for age, preoperative BMI, and diabetes mellitus, ΔCALLY remained positively associated with TWL (B = 0.342, 95% CI 0.172–0.513; p < 0.001). Conclusions: The CALLY index increased significantly during the first year after sleeve gastrectomy in women. Changes in the CALLY index were associated with weight loss and changes in selected metabolic parameters. ΔCALLY may reflect inflammatory and immunonutritional changes accompanying postoperative weight loss.

Background/Objectives: Although current guidelines (European Society of Gastrointestinal Endoscopy [ESGE] 2024, U.S. Multi-Society Task Force [USMSTF] 2020) recommend cold snare polypectomy (CSP) over cold forceps polypectomy (CFP) for small colorectal polyps, CFP remains widely used. Comparative economic data using real institutional pricing are scarce, limiting evidence for guideline-concordant resource allocation. We evaluated the healthcare economics and procedural outcomes of CSP versus CFP to assess their institutional resource implications. Methods: This prospective cohort study analyzed 153 consecutive patients (181 polyps ≤ 9 mm) at a single tertiary care center (June–October 2025). Technique allocation was based on endoscopist preference. The primary outcome was histopathologically confirmed complete resection; secondary outcomes were one-piece resection rate, procedure time, and cost outcomes based on institutional pricing. Firth penalized logistic regression, propensity score matching, and a neoplastic-restricted sensitivity analysis were performed. Results: Complete resection rates did not differ significantly (CSP 97.4% vs. CFP 94.2%, p = 0.29). CSP achieved higher one-piece resection rates (96.2% vs. 84.5%, p = 0.011) and shorter procedure time (median 3.2 vs. 5.1 min, p < 0.001). For 6–9 mm polyps, piecemeal resection was reduced with CSP (6.8% vs. 28.6%, p = 0.010). Despite higher device costs ($6 vs. $3), direct device-plus-labor cost was lower for CSP ($18.06 vs. $22.24, p < 0.001), with no statistically significant difference in complete resection. High-grade dysplasia was the only variable independently associated with incomplete resection. Findings were consistent in propensity score-matched (n = 61 pairs) and neoplastic-restricted (n = 134) analyses. Conclusions: By reducing direct device-plus-labor costs by 19% while improving one-piece resection, and remaining consistent across multivariable, propensity score-matched, and sensitivity analyses, these findings indicate that, within a cost-minimization framework, CSP is a cost-saving, guideline-concordant technique with no statistically significant difference in complete resection or observed adverse events.

Aims: Distinguishing complicated from uncomplicated acute appendicitis before surgery has important implications for surgical planning and patient counseling. This study aims to evaluate and compare the diagnostic value of inflammatory biomarkers and liver function tests in differentiating complicated from uncomplicated acute appendicitis, and to determine whether their combined use improves predictive performance over inflammatory markers alone.Methods: A total of 722 appendectomy patients from a single institution were retrospectively analyzed. Based on operative findings and histopathological reports, patients were classified as complicated (gangrenous, perforated, abscess) or uncomplicated. Preoperative white blood cell count (WBC), neutrophil, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analyzed. Diagnostic performance was evaluated using ROC analysis, logistic regression, and DeLong test model comparison.Results: Of 722 patients, 637 (88.2%) had uncomplicated and 85 (11.8%) had complicated appendicitis. CRP (p

Purpose: No consensus exists on the optimal method of appendiceal stump closure during laparoscopic appendectomy. This study aimed to compare the safety and clinical outcomes of three stump closure methods: loop, Hem-o-lok clip, andendostapler.Methods: Medical records of patients who underwent laparoscopic appendectomy for acute appendicitis between May 2023 and March 2025 at a single institution were retrospectively reviewed. Patients were grouped according to the stump closure method. Demographic data, operative parameters, histopathological findings, 30-day complications (Clavien-Dindo classification), and late complications were compared among the three groups.Results: A total of 368 patients were analyzed: loop (n=201), Hem-o-lok clip (n=100), and endostapler (n=67). The three groups were comparable in terms of demographics and comorbidities. The endostapler group had significantly larger appendix diameter on computed tomography and more intraoperative abscess findings (p

The clinical significance of gastric histopathological findings in laparoscopic sleeve gastrectomy (LSG) specimens remains debated. This study investigated whether gastric histopathology is associated with postoperative weight loss and metabolic outcomes following LSG, and whether any observed association is mediated through differences in postoperative weight loss. This retrospective cohort study included 181 adult patients who underwent LSG between January 2022 and December 2024. Patients were classified into Group A (normal mucosa or inactive gastritis, n = 48) and Group B (pathological findings, n = 133). Weight loss, metabolic parameters, inflammatory markers, liver enzymes, and remission of associated medical problems were assessed at baseline, 6, and 12 months. Causal mediation analyses were performed to decompose the total effect of the pathology group into direct effects and indirect effects mediated through percentage total weight loss (%TWL). Group B achieved significantly lower %TWL at 12 months compared to Group A (31.8 ± 7.6% vs. 34.1 ± 5.8%, p = 0.030). Despite this difference, both groups demonstrated comparable improvements in all metabolic, inflammatory, and hepatic parameters, with no significant between-group differences. Causal mediation analysis revealed no clinically meaningful total or direct effects of gastric histopathology on any outcome at either time point. Subgroup analyses of H. pylori-positive and active gastritis patients separately confirmed no significant differences. Remission rates of associated medical problems for diabetes and hypertension were similar between groups. Although patients with pathological gastric findings achieved modestly lower weight loss, this was not associated with differential metabolic, inflammatory, or hepatic outcomes following LSG, whether analyzed as a total effect or through causal mediation via weight loss.

Background: Intraoperative ultrasound (IO-USG) may optimize axillary management in breast cancer surgery. This study evaluated IO-USG’s dual role in preventing unnecessary axillary lymph node dissection (ALND) and identifying additional nodal metastases missed by sentinel lymph node biopsy (SLNB). Methods: This retrospective cohort study included 314 consecutive patients with invasive breast cancer who underwent SLNB with IO-USG evaluation between January 2019 and December 2023. IO-USG was performed after SLNB to identify suspicious non-sentinel nodes. Patients were categorized into SLNB-only, targeted axillary dissection (TAD), or ALND based on combined SLNB and IO-USG findings. Results: Of 314 patients, 113 (36%) received neoadjuvant chemotherapy and 201 (64%) underwent upfront surgery. Final surgical management comprised SLNB-only in 244 (77.7%), TAD in 46 (14.7%), and ALND in 24 (7.6%) patients. Among 89 SLNB-positive patients, 68 (76.4%) avoided ALND through IO-USG guidance. IO-USG identified additional axillary metastases in 4 of 225 SLNB-negative patients (1.8%). Molecular subtype analysis revealed no IO-USG positivity in triple-negative cases (0/25), while HR+/HER2- tumors comprised 82.6% of IO-USG-positive cases. At a median follow-up of 33.2 months, no axillary recurrences occurred. Conclusion: IO-USG may support personalized axillary management, helping avoid ALND in 76.4% of node-positive patients while identifying additional axillary metastases in 1.8% of SLNB-negative cases. As a complementary technique to standard SLNB, it appears to provide selective utility based on tumor biology. Trial registration: Not applicable.

Background and Objectives: Gallstone ileus (GI) is a rare mechanical intestinal obstruction resulting from gallstone impaction through a bilioenteric fistula, accounting for 1–4% of mechanical intestinal obstructions. This study aimed to evaluate the clinical approach, surgical management, and outcomes in a cohort of surgically treated GI patients. Materials and Methods: A retrospective cohort analysis of 12 patients diagnosed with GI and treated surgically between January 2018 and December 2024 was conducted. Data collected included demographics, clinical presentation, imaging findings, surgical approach, and postoperative outcomes. Descriptive statistics were used due to small sample size. Results: All patients presented with abdominal pain and vomiting, with delayed admission (mean 3.83 ± 2.08 days). Rigler’s triad was identified on CT in 91.7% of cases. The distal ileum (66.7%) was the most common site of obstruction, with a mean stone size of 3.19 ± 0.6 cm. Surgical management included enterolithotomy alone (66.7%, n = 8) and one-stage procedures (33.3%, n = 4). Laparoscopic approaches were employed successfully in 41.7% of cases (n = 5) without the need for conversion. Postoperative complications occurred in 41.7% of patients, with 8.3% mortality (n = 1). One recurrence was observed during a median (IQR) follow-up period of 33.00 (7.00–66.00) months. Conclusions: GI management should be individualized based on patient risk factors. In our cohort, enterolithotomy alone was the most common approach for high-risk elderly patients, while one-stage procedures were performed in stable patients with residual gallstones. Laparoscopic approaches were utilized in selected hemodynamically stable patients with appropriate surgical expertise. Our experience suggests that minimally invasive techniques can be successfully achieved in this traditionally challenging condition with careful patient selection.