Exploring the perspectives and challenges of general surgery residents in Türkiye: Insights from a survey on surgical training - Turkish Journal of Surgery

Amaç: Bu sistematik derleme ve meta-analizin amacı, erişkin kadınlarda rektocele bağlı semptomların cerrahi tedavisinde kullanılan başlıca yöntemleri karşılaştırmak ve güncel literatür doğrultusunda etkinlik–güvenlik profillerini değerlendirmektir.Yöntem: PRISMA 2020 kılavuzuna uygun olarak 1998–2025 yılları arasında yayımlanmış çalışmalar tarandı. Dahil etme kriterleri erişkin kadın popülasyonu, rektocele için uygulanan cerrahi girişim, ≥12 ay takip ve ≥10 hasta içeren çalışma tasarımları idi. Toplam 45 çalışma (12 RCT, 33 gözlemsel) analiz edildi; 20 çalışma meta-analize dahil edildi. Temel sonuçlar anatomik başarı, obstrüktif defekasyon sendromu (ODS) düzelmesi, rekürrens ve reoperasyon oranları; ikincil sonuçlar ise meş komplikasyonları, disparoni, fekal inkontinans ve de novo konstipasyondu.Bulgular: Meta-analiz, transvajinal posterior kolporafinin transanal onarıma göre anlamlı derecede daha düşük rekürrens oranı sunduğunu göstermiştir (RR ≈ 0.25). Meş ile güçlendirilmiş posterior onarım, yerli doku tamirine göre belirgin bir avantaj sağlamamış; buna karşın meş erozyonu ve ağrı gibi komplikasyonlar %5–10 oranlarında görülmüştür. STARR, kısa dönemde ODS semptomlarını belirgin biçimde azaltmasına rağmen, uzun dönemde rekürrens ve yeniden müdahale gereksinimi %20–30 düzeyine ulaşmıştır. Laparoskopik ventral meş rektopeksi; ODS, intussusepsiyon ve çoklu kompartman prolapsusu olan hastalarda %80–95 iyileşme oranları ve düşük komplikasyon profili ile en güçlü seçeneklerden biri olarak öne çıkmıştır.Sonuç: Erişkin kadınlarda rektocele tedavisinde yerli doku posterior kolporafi çoğu hasta için birinci basamak cerrahi olmaya devam etmektedir. STARR seçilmiş ODS-dominant hastalarda etkili olmakla birlikte, uzun dönem başarısı sınırlıdır. Posterior kompartmanda meş kullanımı anlamlı fayda sağlamadığından önerilmemektedir. Ventral meş rektopeksi, karmaşık veya çoklu prolapsuslu hastalarda üstün fonksiyonel sonuçlar sunmaktadır. Tedavi kararı mutlaka bireyselleştirilmeli, anatomi–fonksiyon ilişkisi bütüncül olarak değerlendirilmelidir.

Background/Objectives: Posterior vaginal wall prolapse (rectocele) significantly im-pairs bowel function and quality of life (QoL). This study evaluated the short-term functional, QoL, and safety outcomes of transvaginal Prolene mesh–augmented recto-cele repair and examined predictors of recurrence. Methods: A retrospective cohort of 120 women (mean age 49.5 ± 11.0 years) who underwent transvaginal mesh-augmented rectocele repair between January 2020 and July 2023 was analysed. Functional and QoL outcomes were assessed using the Constipation Scoring System (CSS), Obstructed Defecation Syndrome (ODS) score, Patient Assessment of Constipa-tion Quality of Life (PAC-QOL), and Visual Analogue Scale (VAS) for pelvic/rectal pain. Results All functional and QoL scores improved significantly at 12 months (all p < 0.001): CSS decreased from 9.5 ± 2.8 to 6.0 ± 3.1 (−36.8%), ODS from 22.3 ± 7.5 to 15.4 ± 5.2 (−30.9%), PAC-QOL from 58.6 ± 15.5 to 39.1 ± 18.2 (−33.3%), and VAS pain from 7.38 ± 1.73 to 4.61 ± 1.67 (−37.5%). The overall complication rate was 11.7%, with mesh exposure (5.0%), retraction (4.2%), and infection (1.7%). Multiparity (p = 0.004) and higher BMI (p = 0.011) were independently associated with recurrence. Conclusions: Transvaginal mesh–augmented rectocele repair provides substantial short-term im-provements in bowel function, pain, and QoL with an acceptable safety profile. Multi-parity and obesity are important predictors of recurrence, underscoring the need for individualized risk assessment and long-term follow-up.

Post-hepatectomy liver failure is a serious complication following liver resection and is associated with high morbidity and mortality. Platelets play a crucial role in liver regeneration due to their rich content of growth factors. However, the comparative effects of platelet-rich plasma (PRP) and concentrated growth factor (CGF) on liver regeneration remain unclear. This study aimed to evaluate and compare the effects of splenectomy (SPx), PRP, and CGF on liver regeneration and function following 70% hepatectomy in rats. Male Wistar rats were randomly divided into six groups: Control, Sham, Hepatectomy (PHx), Hepatectomy + SPx, Hepatectomy + PRP, and PHx + CGF. PRP and CGF were prepared using differential centrifugation and administered via the portal vein after hepatectomy. Liver regeneration was assessed histopathologically, immunohistochemically and biochemically on postoperative day (POD) 5. PRP treatment significantly increased Ki-67 expression, indicating enhanced hepatocyte proliferation. CGF promoted neovascularization and improved hepatocyte morphology but showed lower Ki-67 expression than PRP. SPx did not significantly enhance regeneration compared to PHx alone. Signal Transducer and Activator of Transcription 3 (STAT3) expression was highest in the PHx group, whereas the PRP and CGF groups exhibited moderate levels. PRP and CGF improved liver function biochemically, reducing bilirubin levels. Both PRP and CGF promote liver regeneration, albeit through distinct mechanisms: PRP primarily enhances cellular proliferation, whereas CGF facilitates vascularization and modulates the immune response. SPx did not confer additional benefits in this model. These findings suggest that PRP and CGF may have potential therapeutic applications in preventing post-hepatectomy liver failure.

Human papillomavirus (HPV)-associated cancers have traditionally been viewed as focal diseases arising from localized malignant transformation. However, growing molecular evidence suggests that HPV-associated molecular alterations may extend beyond visible lesions into histologically normal epithelium, raising the possibility of a virus-associated field effect. In this review, HPV-induced field cancerization is distinguished from HPV infection alone and is used to describe spatially extended molecular abnormalities demonstrated in histologically normal HPV-positive or tumor-adjacent tissue, whereas findings from premalignant lesions, established tumors, and experimental models are considered supportive evidence of progression or mechanism. This emerging concept challenges conventional models of HPV-driven carcinogenesis and carries important implications for early detection and cancer prevention. Evidence relevant to HPV-associated field effects includes spatially distributed viral, epigenetic, transcriptomic, and immune alterations in selected histologically normal tissues, while findings related to viral integration, metabolic reprogramming, premalignant lesions, tumors, and experimental models provide complementary progression or mechanistic evidence. Such molecular abnormalities have been reported most consistently in cervical disease, with supportive but more limited evidence in the oropharynx and anal canal, whereas the relevance of HPV-associated field effects in the urinary bladder remains controversial. In this review, we aim to synthesize current molecular evidence supporting HPV-induced field cancerization, discuss potential underlying mechanisms, and evaluate emerging methodological approaches for detecting field effects in normal tissues. We further highlight the translational relevance of this phenomenon for molecular-based screening, risk stratification, and preventive strategies aimed at intercepting HPV-associated cancers at their earliest stages.