Aim: There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and its clinical significance. The present study investigated the changes made by the Nathanson retractor used during LG on LFT and its clinical significance. Material and Method: The data of 236 patients, who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospective studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients who have undergone cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, who have preoperative high ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL). Results: ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of the patients in the LG group were found to be significantly higher (P 0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients' clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P = 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P = 0.019). Conclusion: Although the use of the Nathanson retractor during LG causes an increase in liver function tests, this does not cause major clinical problems in patients. Key Words: Gastrectomy; gastric cancer; laparoscopy; liver enzymes; liver dysfunciton

ÖZ Amaç Stoma yapımı kolorektal cerrahi prosedürlerin vazgeçilmez parçasıdır. Cerrahlar stoma ile yapmış oldukları anastomozun morbiditesinden kurtulmayı ummaktadırlar. Stomalar hem oluşturulma hem de kapanmaları esnasında yüksek morbidite kaynağıdırlar. Sorunsuz stomalar hem sağlık maliyetlerini azaltır, hemde hasta yaşam kalitesini desteklerler. Bu çalışmamızda stoma ve yara bakımı hemşiresi tarafından ameliyat öncesi yapılan işaretlemenin stoma kalitesi ile ilişkisini ortaya koymayı amaçladık. Gereç ve Yöntemler Çalışmaya onkoloji kliniğimizde malign tanılarla opere edilip stoma oluşturma ihtiyacı duyulan 150 hasta dahil edildi. Hastaların WOC hemşiresince tutulan tıbbi kayıtları ve veri tabanı geriye dönük olarak incelendi. Demografik ve klinikopatolojik veriler kaydedilip, gruplandırıldı. Hem acil hem de elektif prosedürler geçiren hastalar çalışmaya dahil edildi. İstatistiksel analizler yüzde 95 güven aralığında yapıldı. P değerinin 0,05'ten küçük olması istatistiksel olarak anlamlı kabul edildi. Bulgular Stoma bölgesinin işaretlenme durumu ve VKİ ile, komplikasyonlar arasında anlamlı bir ilişki izlendi, (p=0.03, p=0,01). İleostomili hastalar kolostomili hastalardan anlamlı derecede fazla peristomal cilt komplikasyonlarıyla ( PSC) ilişkiliydi, (p=0.02).Yine yapılan fark analizinde de stoma işaretleme durumu ile stoma çapları arasında anlamlı bir farklılaşma izlendi, büyük stoma çapları WOC hemşiresince konsulte edilmeyen hastalarla ilişkiliydi, (p=0,001). Sonuç Bulgular WOC hemşiresi tarafından operasyon öncesi yapılacak olan konsültasyonun stoma kalitesini etkileyen komplikasyonlar ve stoma çapı ile ilişkili olduğunu göstermiştir.

Aim: Volvulus is a disease characterized by the abnormal twisting of a gaseous distension of the loop of the intestine around itself. Colonic volvulus is the third common cause of colonic obstruction. The study aimed to determine whether the percentage of immature granulocytes is a marker of early necrosis in the volvulus. Methods: Demographic characteristics of the cases were collected in the study. In addition, age, gender, white blood cell count, immature granulocyte count, immature granulocyte percentage, platelet lymphocyte ratio, and neutrophil-lymphocyte ratio were compared between groups with and without necrosis in terms of treatment. Results: The effectiveness of immature granulocyte percentage (IG%) and IG markers were statistically significant in predicting necrosis. The AUC was the highest for IG (0.820, 95% CI: 0.586–1), followed by IG% (0.820, 95% CI: 0.617–1). The optimal cut-off value for the IG was 0.65, with a sensitivity of 76.2% and specificity of 85.7% (P = 0.013). The optimal cut-off value for the IG% was 0.065, with a sensitivity of 85.7% and specificity of 71.4% (0.018). Conclusion: IG% and IG count were found to be useful for predicting necrosis in patients with volvulus.

Objectives: This retrospective study aimed to compare loop ileostomy (LI) with loop transverse colostomy (LTC) as covering stoma regarding the perioperative outcomes in patients who underwent low anterior resection for rectal cancer between 2015 and 2020. Methods: Data were collected from patient files and the hospital's electronic database. The primary outcome measure was complications related to stoma formation, stoma reversal, and overall complications. Secondary outcome measures were hospital discharge time and readmission rate after discharge. Results: A total of 90 patients (38 female, 52 male; 56.6 ± 6.8 years) were included in the study. There were two groups considering the technique for covering stoma: Group LI (n = 50) and Group LTC (n = 40). Demographic and perioperative characteristics were similar. Primary outcome measure: Postoperative course was complicated in 49 (54.4%) patients. The complication rate was higher in the group LI than the group LTC (62% vs 45%; p = 0.03). Among them, 29 (59.2%) complications were related to the stoma formation related, and 14 (28.6 %) complications were related to the stoma reversal related, and 6 (12.2%) were overall complications. The rate of complications related to the stoma formation was higher in the group LI compared to the group LTC (20 [40%] vs. 9 [22.5%]; p = 0.01). The most common complication was periostomal skin irritation (48.3%) followed by dehydration (13.8%), stoma retraction (10.3%) patients, parastomal hernia (10.3%), bleeding (6.9%), anastomotic leak (3.4%), incisional hernia (3.4%), and high-output stoma (3.4%). Complications including incisional hernia, high output stoma, and anastomotic leakage (Grade C; requiring laparotomy) were observed only in the group LI. The morbidity rate in 30 days after the surgery was higher in the group LI compared to the group LTC (16 [32%] vs. 8 [20%]; p = 0.02). A total of 14 stoma reversal complications included incisional hernia in 7 (14.3%) patients, wound infection in 5 (10.2%) patients, and rectal bleeding in 2 (4.1%) patients. The rate of complications was not different between groups (16% vs. 15%; p = 0.41). Overall complications were similar between study groups (3 complications in each group; p = 0.73). Secondary outcome measure: The group LTC patients were discharged earlier compared to the group LI (7.1 ± 2.0 days vs. 9.4 ± 2.5 days; p = 0.03). The readmission rate after hospital discharge was higher in the LI group than the group LTC (18% vs. 12.5%; p = 0.02). Conclusions: It was concluded that LTC was superior compared to LI concerning complications after low anterior resection for rectum cancer.

Background and Aims: This study aimed to investigate the importance of immunohistochemical (IHC) markers and other prognostic variables in the definition of breast cancer. Patients and Methods: Two hundred female patients who underwent breast cancer surgery were classified into two groups according to age: young women (≤45 years; n = 104) and older women (≥65 years; n = 96). Molecular subtypes and local stages were determined. The Kaplan–Meier method was used to estimate the survival curves. The relationships among categorical variables were analyzed using the Chi-square test. Results: The difference between the tumor diameter and distribution of Ki-67 levels was significant (P = 0.001, P < 0.05). T stage, local stage, histological grade, estrogen receptor status, lymphovascular invasion status, axillary nodal state, human epidermal growth factor receptor 2 status, and distribution of molecular subtypes were correlated (P < 0.05). The mean disease-free survival rates (DFS) at 1, 2, and 5 years were found 92.9%, 86.5%, and 70.1%, respectively, in the young female group. The DFS rates of older patients were 96.7%, 95.4%, and 84.6%, respectively. Conclusion: This study showed that young age was associated with poor prognostic features at the IHC marker level.