Risk assessment is difficult yet would provide valuable data for both the surgeons and the patients in major hepatobiliary surgeries. An ideal risk calculator should improve workflow through efficient, timely, and accurate risk stratification. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC) and Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) are surgical risk stratification tools used to assess postoperative morbidity. In this study, preoperative data from 300 patients undergoing major hepatobiliary surgeries performed at a single tertiary university hospital were retrospectively collected from electronic patient records and entered into the ACS-SRC and P-POSSUM systems, and the resulting risk scores were calculated and recorded accordingly. The ACS-NSQIP-M1 (C-statistics = 0.725) and M2 (C-statistics = 0.791) models showed better morbidity discrimination ability than P-POSSUM-M1 (C-statistics = 0.672) model. The P-POSSUM-M2 (C-statistics = 0.806) model showed better differentiation success in morbidity than other models. The ACS-NSQIP-M1 (C-statistics = 0.888) and M2 (C-statistics = 0.956) models showed better mortality discrimination than P-POSSUM-M1 (C-statistics = 0.776) model. The P-POSSUM-M2 (C-statistics = 0.948) model showed better mortality differentiation success than the ACS-NSQIP-M1 and P-POSSUM-M1 models. The use of ACS-SRC and P-POSSUM calculators for major hepatobiliary surgeries offers quantitative data to assess risks for both the surgeon and the patient. Integrating these calculators into preoperative evaluation practices can enhance decision-making processes for patients. The results of the statistical analyses indicated that the P-POSSUM-M2 model for morbidity and the ACS-NSQIP-M2 model for mortality exhibited superior overall performance.

Objective: This study aimed to evaluate the performance of large language models (LLMs) in answering questions from the American Board of Surgery In-Training Examination (ABSITE). Methods: Multiple choice ABSITE Quiz was entered into the most popular LLMs as prompts. ChatGPT-4 (OpenAI), Copilot (Microsoft), and Gemini (Google) were used in the study. The research comprised 170 questions from 2017 to 2022, which were divided into four subgroups: Definitions, Biochemistry/Pharmaceutical, Case Scenario, and Treatment & Surgical Procedures. All questions were queried in LLMs, between October 1, 2024, and October 5, 2024. Correct answer rates of LLMs were evaluated. Results: The correct response rates for all questions were 79.4% for ChatGPT, 77.6% for Copilot, and 52.9% for Gemini, with Gemini significantly lower than both LLMs ( P < 0.001). In the definition category, the correct response rates were 93.5% for ChatGPT, 90.3% for Copilot, and 64.5% for Gemini, with Gemini significantly lower ( P = 0.005 and P = 0.015, respectively). In the Biochemistry/Pharmaceutical question category, the correct response rates were equal in all three groups (83.3%). In the Case Scenario category, the correct response rates were 76.3% in ChatGPT, 72.8% for Copilot, and 46.5% for Gemini, with Gemini significantly lower ( P < 0.001). In the Treatment & Surgical Procedures category, the correct response rates were 69.2% for ChatGPT, 84.6% for Copilot, and 53.8% for Gemini. Although Gemini had the lowest accuracy, there was no statistically significant difference ( P = 0.236). Conclusion: In the ABSITE Quiz, ChatGPT and Copilot had similar success, whereas Gemini was significantly behind.

Background/Objectives: We compared the prognostic performance of preoperative prognostic nutritional index (PNI) and Gustave Roussy Immune Score (GRIm-s) after curative-intent gastrectomy. Methods: This retrospective cohort included 168 patients, including five postoperative in-hospital deaths. Continuous PNI and ordinal GRIm-s were compared using censoring-adjusted time-dependent AUC and concordance, with paired bootstrap confidence intervals. Preoperative prediction models underwent bootstrap internal validation; restricted mean survival time and time-varying Cox analyses addressed non-proportional hazards. Results: There were 92 deaths and 107 disease-free survival (DFS) events. At 36 months, overall survival (OS) AUC was 0.659 for PNI and 0.527 for GRIm-s (difference 0.132, 95% CI 0.039–0.226); corresponding DFS values were 0.650 and 0.516 (difference 0.134, 95% CI 0.035–0.228). After optimism correction, preoperative PNI-model AUCs were 0.610 for OS and 0.595 for DFS. PNI associations weakened over time. The cohort-derived 49.6 threshold was used only in secondary exploratory analyses. Conclusions: PNI showed better unadjusted discrimination than GRIm-s at three years, but modest internally validated model performance limits clinical interpretation. These findings do not establish clinical utility, a validated cutoff, or a substitute for pathological assessment. External validation is required.

Background and Objectives: Diverting ileostomy is frequently used after low anterior resection (LAR) for rectal cancer to mitigate the clinical consequences of anastomotic leakage. The one-stitch method (OM) has been proposed as a simplified alternative to the traditional method (TM), with potential procedural advantages. However, evidence regarding its short-term outcomes and procedural efficiency remains limited and largely context-specific. This study aimed to compare perioperative outcomes of OM and TM in a single-center cohort. Materials and Methods: This retrospective cohort study included patients who underwent LAR with diverting ileostomy for rectal cancer, between January 2022 and November 2025. A total of 67 patients were analyzed (OM: n = 31; TM: n = 36). Operative time, intraoperative blood loss, length of hospital stay, stoma-related complications, overall postoperative morbidity and anastomotic leakage were compared. Subgroup analysis was performed for laparoscopic cases. Multivariable logistic regression was used to explore factors associated with postoperative complications. Results: Baseline demographic and clinical characteristics did not differ significantly between groups. The OM was associated with shorter operative time and lower intraoperative blood loss compared with TM, both in the overall cohort and in the laparoscopic-only subgroup. No statistically significant differences were observed between OM and TM regarding stoma-related complications, overall postoperative complications or anastomotic leakage. Length of hospital stay was shorter in the TM group. In multivariable analysis, ileostomy technique was not independently associated with postoperative complications, whereas laparoscopic surgery was associated with a lower likelihood of postoperative complications. Given the limited sample size, the study was underpowered for infrequent safety endpoints. Conclusions: In this single-center retrospective analysis, the OM was associated with improved procedural efficiency but did not demonstrate a clear advantage in postoperative recovery or hospital stay. No statistically significant differences in short-term morbidity were observed; however, equivalence cannot be inferred due to limited statistical power. These findings should be interpreted as regional validation data and underscore the need for larger prospective studies incorporating longer-term and patient-centered outcomes.

Aims: There might be a potential relationship between headaches and constipation. This study aimed to observe the benefits of treating chronic constipation in disease management in patients with episodic migraine (EM). Methods: Patients diagnosed with EM according to ICHD-3 were recorded according to aura presence/absence, disease duration, frequency of attacks/day/month, severity of attacks (Visual Analog Scale (VAS) assessment) and detailed demographic information and clinical parameters. Of these patients, those with Bowel habit abnormalities (discomfort and bloating in the abdomen, abdominal pain, hard feces, excessive strain during defecation, infrequent defecation and feeling of incomplete emptying) were diagnosed with chronic constipation according to the Rome IV diagnostic criteria during the interiktal period. All participants underwent abdominal ultrasonography and assessed constipation index (CI). Daily 15 cc lactulose syrup and a nutrition program were administered to the EM group with chronic constipation, simple analgesic+prophylactic treatment was administered to EM patients without chronic constipation in severe attacks, and simple analgesic/triptan+symptomatic treatment was administered to patients with mild-moderate attacks. Results: A total of 106 patients with EM (n=54, 50.9%) chronic constipation and (n=52, 49.1%) non-chronically constipated participated in the study. The relationship between nausea and vomiting (p=0.000), vitamin D levels (p=0.036) and chronic constipation was found to be statistically significant. The difference between pre-and post-treatment USG/CI values, average VAS scores, and pain frequency (day/month) in chronically constipated patients was statistically significant (p=0.000). Conclusion: This study is important because it shows that medical treatment targeting intestinal transit in patients with EM who have chronic constipation and additional supportive supplements that change dietary habits significantly reduce intestinal volume, which in turn relieves the severity of migraine headaches and reduces their frequency.