Background: Cardiopulmonary complications and liver dysfunction are also specific complications and problems associated with laparoscopic surgery. The main causes of postoperative liver dysfunction, which may often occur after laparoscopic surgery, include carbon dioxide pneumoperitoneum and ligation of the aberrant left hepatic artery. Hepatic steatosis may develop as a natural consequence of neoadjuvant therapy, although rarely, owing to chemotherapy. Nathanson retractor may cause a prolonged elevation in liver enzymes of these patients compared with those who do not receive neoadjuvant therapy. Materials and Methods: The data of 151 patients who underwent laparoscopic radical gastrectomy between January 2017 and January 2022 for histologically proven primary gastric cancer in our clinic were retrospectively reviewed. Results: The mean length of hospital stay was 6.21 days. The mean time normalization of the aspartate aminotransferase (AST) value was 2.45 ± 1.83 (range, 0–12) days postoperatively. The analysis of the correlation between the preoperative and postoperative 1-day values of alanine aminotransferase (ALT) and AST revealed a significant difference between the preoperative and postoperative 1-day median values of both parameters ( P < .001). Each one unit increase in ALT led to an increase of 0.338 days in the length of intensive care stay and an increase of 0.345 days in the overall length of hospital stay. As the time to normalization of the AST value increased, the length of both intensive care stay and hospital stay increased. Each one unit increase in AST resulted in an increase of 0.316 days in the length of intensive care stay and an increase of 0.376 days in the overall length of hospital stay. Conclusion: Alternative retraction methods can be used safely in laparoscopic surgery for gastric cancer patients receiving neoadjuvant therapy. We are of the opinion that the Nathanson retractor should be used only during dissection of the relevant regions to shorten the intraoperative intermittent release or the time of use.

BACKGROUND: This study aimed to evaluate the effect of Dermalix (R) (Dx) on wound healing and anastomotic leakage in a rat model of end-to-end colon anastomosis.METHODS: The study was carried out on 40 rats, as divided into three groups, including a negative control group (n=10, laparotomy only) control group (n=15, colon anastomosis), and the experimental group (n=15, colon anastomosis plus Dx applied to anastomosis site). The rats were sacrificed on the 3rd post-operative day, and resected colon segments were evaluated for bursting pressure (mmHg) using an infusion pump set-up and for pathological parameters of wound healing including neutrophil infiltration, epithelial regeneration, granulation tissue formation, local inflammatory response, neovascularization, and foreign body reaction.RESULTS: Anastomotic leakage rate was significantly lower (1 rat vs. 6 rats, P=0.040). Moreover, mean bursting pressure was significantly (2.95 times) higher (mean 121 vs. 41 mmHg, respectively, P<0.05) in the Dx experimental group than in the control group. Dx was considered to significantly accelerate wound healing by increasing neovascularization (P<0.001). Control and experimental groups were similar in terms of other pathological parameters.CONCLUSION: Based on significantly lower rate of anastomotic leakage and its positive effects especially on the bursting pressure and neovascularization, Dx seems to be considered as a promising technology in preventing anastomotic leakage.

Background and Objectives: The aim of the present study was to calculate HALP and modified HALP scores for patients diagnosed with acute cholecystitis (AC) and to determine the predictive utility of these scores for surgical timing and morbidity in patients who underwent surgery for AC. Materials and Methods: This study included data from 641 patients who underwent surgery for AC between January 2010 and May 2023. The HALP score was calculated using the formula hemoglobin (g/L) × albumin (g/L) × lymphocyte (10⁹/L)/platelets (10⁹/L). The modified HALP score was calculated using the formula hemoglobin (g/L) × albumin (g/L) × lymphocyte (10⁹/L) × platelets (10⁹/L). Results: The mean HALP score was 46.81, and the mean modified HALP score was 2,758,401.21. Laparoscopic cholecystectomy (LC) was successfully completed in 582 (90.8%) patients. When examining the relationship between HALP and modified HALP scores and the procedure type, a statistically significant difference was found in the distribution of median HALP and modified HALP scores between the LC and laparoscopic and open cholecystectomy (LTOC) groups. For patients with a HALP score < 34.43 and modified HALP score < 2,077,019, the likelihood of conversion to open surgery increased, with a sensitivity of 65.5% vs. 58.8% and a specificity of 66.1% vs. 59.3%. In patients who underwent surgery, there was a significant difference in the LTOC between the HALP score and modified HALP score cut-off groups (p < 0.001 and, p = 0.007). Conclusions: Evaluation of the HALP score is a promising and valuable assessment method for designing appropriate treatment and management strategies for patients with AC.

Purpose Perianal fistula is a common disease that significantly affects the quality of life of patients. Several treatment options are available; loose seton is one of the most popular options. Aim of this study was to evaluate the relationships between quality of life and different types of knots used during the application of anal fistula. Methods Patients who presented with anal fistulas between 2021 and 2024 were included in this study. Patients were divided into 3 groups on the basis of the type of knot used for treatment. In group A, the seton ends were tied in the alpha configuration. In group B, a ring-like seton with overlapping ends was used. In group C, a knotless seton was applied. All patients completed the quality of life assessment with the Anal Fistula Questionnaire at 15, 30, and 90 days after surgery. Results Sixty-three patients were randomized. A total of 52 men were included. Median age was 43 years. Three patients in group C and five patients in group B experienced complications, including abscess, anal pain, loss of seton, and second fistula. Physical and mental component scores revealed that postoperative quality of life was similar among the three groups. Conclusion No differences in postoperative quality of life among groups were observed at 15, 30, or 90 days after surgery. Physical and mental component scores of quality of life in patients in Anal Fistula Questionnaire revealed that quality of life improved over time in all three groups. Clinical trial registration The study was registered at ClinicalTrials.gov (Study ID: NCT05348473, date: 04/29/2022).