Anatomical variations of the recurrent laryngeal nerve (RLN), such as an extralaryngeal terminal bifurcation (ETB), threaten the safety of thyroid surgery. Besides the morphology of the nerve branches, intraoperative evaluation of their functional anatomy may be useful to preserve motor activity. We exposed 67 RLNs in 36 patients. The main trunk, bifurcation point, and terminal branches of bifid nerves were macroscopically determined and exposed during thyroid surgery. The functional anatomy of the nerve branches was evaluated by intraoperative nerve monitoring (IONM). Forty-six RLNs with an ETB were intraoperatively exposed. The bifurcation point was located along the prearterial, arterial, and postarterial segments in 11%, 39%, and 50% of bifid RLNs, respectively. Motor activity was determined in all anterior branches. The functional anatomy of terminal branches detected motor activity in 4 (8.7%) posterior branches of 46 bifid RLNs. The motor activity in posterior branches created a wave amplitude at 25–69% of that in the corresponding anterior branches. The functional anatomy of bifid RLNs demonstrated that anterior branches always contained motor fibres while posterior branches seldom contained motor fibres. The motor activity of the posterior branch was weaker than that of the anterior branch. IONM may help to differentiate between motor and sensory functions of nerve branches. The morphology and functional anatomy of all nerve branches must be preserved to ensure a safer surgery.

Objective: We aimed to evaluate and compare the effects of anti-adhesion materials, Seprafilm, Suprofilm, olive oil, and olive oil containing Vitamin E by measuring tension forces. Methods: 60 male Wistar-Albino rats were divided into six groups. The front side of the cecum and right abdominal parietal peritoneal wall were abrased. The rats were euthanized on the 14th postoperative day. Adhesions between intestines, omentum, other abdominal organs, cecum, incisionsites, and abdominal anterior wall peritoneum were all evaluated. Adhesion strength was measured with dynamometer. Histopathological evaluations of the adhesion area was performed. Results: Stage-I (0.43Newton) in Group-I, stage-IV (1.0540N) in Group-II, stage-II (0.6370N) in Group-III, stage-II in Group-IV (0, 5230N), stage-III (0.7620N) in Group-V, stage-IV (1.3560N) in Group-VI, were detected. A significant difference was found between these findings. P = 0.001, (p<0.05). Histopathological examination: It was found that GroupV-VI reduced inflammation, increased collagen production, fibroblastic activity and vascular proliferation. Conclusions: More objective evaluation can be made by measuring the tension force of the adhesions. Suprafilm can also be effectively used as an antiadhesive, such as Seprafilm. Olive oil and vitamin E require more studies to be used as antiadhesives.

A 33-year-old female patient was admitted to our clinic with complaints of nausea and vomiting for two days and the inability to tolerate food. The patient had a Nissen fundoplication three years ago. Computed tomography (CT) showed a bezoar image in the distal esophagus. The patient stated that the symptoms began after he ate a persimmon two days ago. The patient underwent esophagogastroduodenoscopy. A bezoar was observed in the distal esophagus at the esophagogastric junction. No pathology was observed in the stomach and duodenum. After the bezoar was shredded with a snare and removed with a retrieval snare. Here, we further describe this case of a bezoar that caused ileus in the distal esophagus after a fundoplication operation. '+st+' Mohammadi A, Mojtahedzadeh M, Ahmadi A, Imanipour MH, Saghafi F, Soltaninejad S, et al. Bowel Obstruction by Persimmon Phytobezoar. IJMTFM. 2021; 11(3):32507. doi: 10.32598/ijmtfm.v11i3.32507. DOI: https://doi.org/10.32598/ijmtfm.v11i3.32507 Gökbulut V, Kaplan M, Kaçar S, Akdoğan Kayhan M, Coşkun O, Kayaçetin E. Bezoar in upper gastrointestinal endoscopy: A single center experience. Turk J Gastroenterol. 2020 Feb;31(2):85-90. doi: 10.5152/tjg.2020.18890. DOI: https://doi.org/10.5152/tjg.2020.18890 Georgiev YP, Karashmalakov AG, Zafirov GK. Esophageal bezoar after repeated fundoplications. Quant Imaging Med Surg. 2018 Mar;8(2):257-8. doi: 10.21037/qims.2017.06.07. DOI: https://doi.org/10.21037/qims.2017.06.07 Ustaoğlu M, Paköz ZB. Üst Endoskopide Yabancı Cisim Saptanan Hastaların Analizi: Doğu Karadenizde Tek Merkezli Retrospektif Çalışma. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2020;22(1):1-6. doi: 10.24938/kutfd.586116 DOI: https://doi.org/10.24938/kutfd.586116 Altintoprak F, Dikicier E, Deveci U, Cakmak G, Yalkin O, Yucel M, Akbulut G, Dilek ON. Intestinal obstruction due to bezoars: a retrospective clinical study. Eur J Trauma Emerg Surg. 2012 Oct;38(5):569-75. doi: 10.1007/s00068-012-0203-0. DOI: https://doi.org/10.1007/s00068-012-0203-0 Khalil H, Parmar C, Sufi P. Conservative Managing of Bezoar in Giant Hiatus Hernia Causing Gastric Outlet Obstruction During the COVID-19 Pandemic. Obes Surg. 2021 Jun;31(6):2780-2. doi: 10.1007/s11695-021-05250-y. DOI: https://doi.org/10.1007/s11695-021-05250-y Padhya K, Dhamija A, Carlson C, Farivar A. Post-Fundoplication Esophageal Bezoar Resolved With Endoscopic Instillation and Oral Ingestion of Cola. The American Journal of Gastroenterology. October 2019;114:S1022-3. doi: 10.14309/01.ajg.0000596816.59903.5b. DOI: https://doi.org/10.14309/01.ajg.0000596816.59903.5b Copyright (c) 2023 Mehmet Emin Gönüllü , Mevlüt Pehlivan , Mehmet Fuat Çetin , Erman Yekenkurul This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Objective Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Identifying simple and accessible biomarkers to predict PEP risk may enhance patient safety and guide clinical decisions. Material and Methods This retrospective, single-center study included 613 adult patients who underwent ERCP between January 2017 and December 2024. Demographic data, comorbidities, procedural details, and preoperative laboratory parameters were collected from institutional electronic health records. The primary outcome was the development of PEP, defined by standard diagnostic criteria. Results Post-ERCP pancreatitis occurred in 52 patients (8.5%). Demographic characteristics and comorbidities, including age, sex, body mass index, diabetes mellitus, and hypertension, were not significantly associated with PEP. Pancreatic duct cannulation was significantly more frequent among patients with PEP (53.8% vs. 24.8%, p < 0.001) and remained an independent risk factor in multivariable analysis (aOR: 3.05, 95% CI: 1.65–5.64, p < 0.001). Patients who developed PEP had higher preoperative neutrophil-to-lymphocyte ratio (NLR) (3.7 ± 1.9 vs. 2.9 ± 1.5, p = 0.001) and C-reactive protein (CRP) levels (18.5 ± 11.2 vs. 11.4 ± 8.3 mg/L, p = 0.001). In adjusted analysis, both NLR (aOR: 1.14, 95% CI: 1.02–1.28, p = 0.02) and CRP (aOR: 1.04, 95% CI: 1.01–1.08, p = 0.008) remained statistically significant but modest independent predictors of PEP. ROC analysis demonstrated limited discriminative ability for both NLR (AUC: 0.64) and CRP (AUC: 0.66), with moderate sensitivity and specificity. Conclusion Elevated preoperative NLR and CRP levels, together with pancreatic duct cannulation, were independently associated with an increased risk of post-ERCP pancreatitis. Although these inflammatory markers demonstrated statistically significant associations, their predictive strength was modest. Therefore, NLR and CRP should be interpreted as supportive parameters rather than standalone predictors and may contribute to pre-procedural risk stratification when integrated with established clinical and procedural risk factors. Further prospective, multicenter studies are warranted to validate these findings and clarify their role in clinical practice.