Ductal carcinoma in situ (DCIS) is a heterogeneous precursor lesion with variable invasive potential. Current predictive parameters for invasion risk offer limited utility for personalized assessment. This study aims to evaluate artificial intelligence (AI)-assisted mammography analysis as a tool for predicting invasion risk in DCIS patients. In this retrospective cohort study, 74 patients with pathologically proven DCIS by preoperative biopsy were analyzed using a deep learning-based AI system (Transpara version 1.7.4). The AI system classified patients into low-risk and high-risk groups, which were validated against postoperative histopathological findings. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations. Invasion was detected in 19 (25.7%) patients, with 18 (94.7%) classified as high-risk by the AI system. The model demonstrated 94.7% sensitivity, 45.5% specificity, 37.5% PPV, and 96.2% NPV. In patients aged ≥ 50 years and those with lesions ≥ 3 cm, the NPV reached 100%. A significant relationship was found between necrosis and invasion (p = 0.004). The high NPV suggests AI-assisted mammography analysis could serve as an effective rule-out tool for invasion in DCIS patients, potentially identifying candidates for less aggressive surgical treatment. Further validation in larger, multi-center studies is necessary to confirm these findings.

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.

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: Preoperative evaluation in bariatric surgery aims to minimize perioperative risks and identify comorbid abdominal pathologies that may influence surgical planning. The role of routine abdominal ultrasonography (USG) remains debatable. Methods: This retrospective study included 1119 consecutive candidates for bariatric surgery who underwent routine preoperative ultrasonography (USG) between January 2022 and October 2024. Patients were stratified by BMI and categorized according to USG findings as normal, incidental, requiring follow-up/concomitant procedures, or necessitating cancellation. Baseline characteristics, USG findings, surgical outcomes, and predictors of cancellation were analyzed using univariate, multivariate, and Firth’s penalized logistic regression analyses. Ultrasonographic findings were further stratified as clinically significant (requiring intervention) or non-clinically significant (not requiring intervention) to standardize interpretation. Results: Abnormal USG findings were present in 77.5% of patients, with hepatic steatosis (60.8% [n = 680]), hepatomegaly (21.5%), and gallstones (13.9%) being the most frequent. Higher BMI was significantly associated with hepatomegaly, steatosis, and gallstones (all p < 0.05), but not with surgical cancellation. Bariatric surgery was cancelled in 11 patients (1.0%) due to critical findings exclusively identified on USG, including large ovarian/uterine masses, choledochal cysts, and suspected malignancies. In multivariate and Firth-adjusted regression, large ovarian/uterine masses (adjusted OR 12.9, 95% CI 3.0–55.2, p = 0.001; Firth OR 11.4, 95% CI 2.5–51.4, p = 0.002) and choledochal cysts (Firth OR 29.7, 95% CI 1.8–489.5, p = 0.048) emerged as independent predictors of cancellation. Conclusions: Although the overall cancellation rate was low, the detection of critical USG findings in 1.0% of patients had major clinical implications, preventing inappropriate or unsafe surgery and enabling timely referral for specialist management. Routine preoperative ultrasonography thus offers a clinically meaningful safeguard in bariatric surgery, supporting its inclusion in preoperative assessment algorithms.

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