Objectives: To investigate the influence of the metastatic lymph node/total lymph node ratio (N-ratio) on survival and prognosis in surgically treated gastric carcinomas. Methods: A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). Results: Group 2 patients had a total lymph node mean of 25.10±13.64 while Group 1 patients had a total lymph node mean of 18.77±9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97±10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). Conclusion: The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.

Acute appendicitis is one of the most common non-gynecological and non-obstetric causes of acute abdominal conditions requiring urgent surgery during pregnancy. Due to the similarity between the symptoms of the disease and those of pregnancy, laboratory findings become particularly important in diagnosis. This study aimed to evaluate these parameters for the first time using a new index definition. Between 2015 and 2021, a total of 120 patients were included in the study, divided into the four groups: healthy pregnant woman (HPW), healthy woman (HW), unhealthy pregnant woman (UPW, pregnant patient with acute appendicitis), and unhealthy woman (UW, non-pregnant patient with acute appendicitis). Laboratory parameters, including white blood cell count (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), ischemia-modified albumin (iMA), and platelet-lymphocyte ratio (PLR), were assessed. In this study, significant differences were observed in various laboratory parameters between groups, such as WBC, CRP, NLR, and PLR, indicating potential markers for differentiating between pregnant women with and without appendicitis. An index was created for the diagnosis of acute appendicitis in pregnant women and was named the Pregnant Index. The Pregnant Index (PGIndex) values of pregnant women without appendicitis were compared with those of pregnant women with appendicitis. It was found that the PGIndex value was significantly higher in pregnant women with appendicitis (p < 0.001). Using the ROC curve and Youden index, the PGIndex cut-off value to best differentiate between the two groups was 10.62. This value provided a sensitivity of 73.3%, specificity of 96.7%, positive predictive value of 95.7%, negative predictive value of 78.7%, and test accuracy of 85% for identifying pregnant women with appendicitis. Compared to other markers, the PGIndex had the highest accuracy value, and it was observed that patients with a PGIndex value above 10.62 had a significantly increased likelihood of having appendicitis. These results indicate that the PGIndex is a significant marker for detecting appendicitis in pregnant women. Laboratory parameters, particularly NLR and PLR, show promise as diagnostic tools for appendicitis in pregnant women. Incorporating these markers, the Pregnant Index (PGIndex) demonstrated high sensitivity and specificity in distinguishing between pregnant women with and without appendicitis. This is the first study using the Pregnant Index in pregnant women to diagnose appendicitis. Early diagnosis is crucial for preventing maternal and fetal morbidity and mortality associated with appendicitis during pregnancy.

This study aims to evaluate the surgical outcomes and complications of completion thyroidectomy (CT) in patients who previously underwent lobectomy with istmhectomy (LI) or subtotal thyroidectomy (ST). The study also seeks to identify patient groups that benefit from CT and examine the risks associated with this procedure. A retrospective analysis was conducted on 70 patients who underwent completion thyroidectomy in our General Surgery Clinic between January 2015 and July 2023. Patients who had previously undergone thyroid surgery due to thyroid malignancy or benign goiter were included in the study. Demographic data, initial pathology, surgical procedures, postoperative complications, and histopathological findings were analyzed. Postoperative complications, including hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, and the need for tracheostomy, were recorded and compared between groups. Based on prior surgical history, 18 patients (25.7%) had previously undergone LI, while 52 patients (74.3%) had undergone subtotal thyroidectomy (ST). The overall complication rate was significantly higher in the ST group (36.5%) compared to the LI group (11%) (p = 0.04). A significant association was found between larger nodule size and higher complication rates (p = 0.03). Postoperative histopathological examination revealed malignancy in 18.5% of patients, with no significant difference between the groups in terms of histopathological findings. This study highlights the increased risk of complications, particularly hypoparathyroidism and recurrent laryngeal nerve injury, in patients undergoing completion thyroidectomy after subtotal thyroidectomy. However, no significant differences were found between the groups regarding malignancy rates and histopathological findings. Further studies with larger patient populations and long-term follow-ups are needed to better understand the clinical benefits and risks of CT.

Introduction: The metastatic lymph node ratio (MLNR) has been proposed as a meaningful prognostic indicator in colon cancer (CC). This study aimed to assess the prognostic relevance of MLNR by investigating its association with disease-free survival (DFS), overall survival (OS), and recurrence, and to compare its predictive value with traditional parameters, including the TNM classification and total lymph node count (TNLC).Materials and methods: This retrospective, single-center study included patients who underwent surgical resection for colon cancer. Survival outcomes were analyzed using Kaplan-Meier survival curves and multivariate logistic regression. MLNR was evaluated in relation to demographic and clinical factors, including age, tumor location, surgical type, and the administration of adjuvant chemotherapy. The optimal MLNR cut-off value for predicting recurrence was determined via receiver operating characteristic (ROC) curve analysis.Results: A total of 122 patients were analyzed. MLNR >0.125 was significantly associated with increased recurrence risk (adjusted HR: 7.0, p<0.001) and reduced DFS. Patients with an MLNR ≤0.125 demonstrated significantly longer DFS (p<0.001). MLNR emerged as an independent prognostic factor, offering potential prognostic benefit compared to TNLC in predicting both DFS and OS. Additionally, adjuvant chemotherapy was independently associated with a lower recurrence risk (Exp(B):0.234, p=0.038). Emergency surgery was found to be significantly correlated with poorer survival outcomes (p=0.023).Conclusion: MLNR contributes additional prognostic information to the TNM staging system and may support more individualized risk stratification and decision-making regarding adjuvant therapy in colon cancer. Further large-scale prospective studies are warranted to validate these findings and to establish a clinically applicable MLNR threshold.

Surgical site infections (SSIs) are a significant cause of morbidity in colorectal surgeries, mainly due to the contaminated nature of these procedures. Traditional wound management techniques have limitations, leading to prolonged hospital stays and increased healthcare costs. Negative pressure wound therapy (NPWT) has emerged as an advanced method for managing surgical wounds, promoting faster healing by enhancing tissue perfusion, reducing edema, and managing wound exudate. This retrospective cohort study aims to compare the outcomes of NPWT with those of conventional wound care in patients undergoing high-risk gastrointestinal surgeries. A total of 141 patients classified as having contaminated or dirty wounds were divided into two groups: the NPWT group (47 patients) and the conventional wound care group (94 patients). Postoperative outcomes, including SSIs, wound healing, dehiscence, and incisional hernia development, were monitored at 1 month and 1 year. The results revealed a significant reduction in superficial SSIs in the NPWT group (6.4% vs. 18.1%, p = 0.04), along with shorter hospital stays (8.9 vs. 11.2 days, p = 0.01). Incisional hernia rates were also significantly lower in the NPWT group at both 1 month (6.4% vs. 12.8%, p = 0.05) and 1 year (6.4% vs. 16.0%, p = 0.03). While the reduction in deep SSIs did not reach statistical significance (2.1% vs. 9.6%, p = 0.08), the observed trend suggests further investigation. This study demonstrated that NPWT not only reduces the incidence of SSIs and hospital stays but also decreases the long-term incidence of incisional hernias. These findings suggest that NPWT should be considered a standard approach for managing high-risk surgical wounds, especially in gastrointestinal procedures, where infection risks are inherently greater.

Aim: Postoperative wound infection is still the most developing complication after surgery and globally responsible for almost %25 hospitalizations requiring complications after surgery. Several significant parameters to minimize Surgical Site Infection (SSI) evaluated and published in many articles, reviews, and guidelines. We aim to investigate the SSI outcomes of 3 different hair removal procedures before surgery, including skin preparation, in this original research article. Material and Method: 314 patients enrolled in this study were males aged 18 and 65, admitted to the outpatient clinic with unilateral inguinal hernia, and were eligible for Lichtenstein tension-free open hernia repair using mesh. Results: Wound infection has occurred in 6 patients from Group-1 (4.83%), 8 patients on Group-2 (7.92%), 4 patients on Group-3 (4.49%). There are no statistically significant between Group1 and Group-3 (p>0.05) when the wound infection rates of Group-2 statistically significantly higher than Group-1 and Group-3 (p