OBJECTIVE: An inguinal hernia may transform to an incarcerated hernia, which would require emergency surgery with increased morbidity and mortality. This study aims to analyze whether it is possible to predict intestinal ischemia in incarcerated hernia using complete blood count parameters and serum C-reactive protein (CRP). METHODS: Medical records of 129 patients were used to analyze whether there is a correlation between intestinal ischemia and laboratory parameters. Receiver operating characteristics analysis and Youden index were used to determine cutoff values, sensitivity, and specificity. RESULTS: Female patients, those with a femoral type hernia, and patients with additional diseases were found to be more prone to bowel resection. CRP, lymphocyte to CRP ratio (LCR), and neutrophil to CRP ratio (NCR) parameters were significant (AUC=0.914, p<0.001; AUC=0.901, p<0.001; and AUC=0.908, p<0.001, respectively). A value 19 in CRP has a 90% sensitivity and 88.9% specificity. CONCLUSION: Decreased pre-operative NCR and LCR, and increased CRP levels can be used as a predictor for estimating intestinal ischemia.

Malignant melanoma (MM) is a tumor with high metastatic potential. The small intestine is the third most common metastasis area for MM. Intestinal obstruction, intussusception, hemorrhage, and perforation have been determined as the clinical presentation in patients who were admitted to the hospital because of abdominal pain, weakness, constipation, weight loss, and palpable abdominal mass. Presentation as perforation is rarer than the other clinical presentations. We report the case of a patient with metastatic MM, who attended the emergency department because of acute abdomen. Perforation and invagination due to metastatic lesions were cured by surgical intervention. Possible metastasis should be considered in patients with active complaints or in patients scheduled for emergency intervention, as in our case, if there is a history of MM. Possible metastasis should be considered in preoperative planning, information, and anticipation of the operative procedure.

Aims: Acute appendicitis (AA) is the most common cause of acute abdomen requiring surgical intervention. This study aimed to compare the diagnostic accuracy and consistency of the classic Alvarado score, which is widely used worldwide in the diagnosis of AA, with the more recently introduced Karaman score.Methods: A retrospective analysis was conducted on 101 patients who underwent appendectomy with a preliminary diagnosis of AA in a tertiary hospital between December 2020 and December 2021. Demographic data, clinical findings, laboratory parameters, preoperative Alvarado and Karaman scores, and histopathological results of the patients were analyzed. The diagnostic performance of the scores was evaluated using ROC analysis (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results: The mean age of the study group was 35.8 ± 13.8 years, with 61.4% males and 38.6% females. Histopathologically, the rate of AA was 92.1%, and the negative appendectomy rate was 7.9%. In the ROC analysis, while the Alvarado score (AUC: 0.657) showed slightly higher discriminative power compared to the Karaman score (AUC: 0.651), both systems demonstrated "moderate" performance. At the Alvarado score threshold, 100% specificity and 100% PPV were achieved; however, sensitivity was found to be 28.0% at this threshold. In logistic regression analysis, both Alvarado (OR: 1.48, p=0.024) and Karaman (OR: 1.18, p=0.031) scores were determined to be independent predictors for predicting AA. A strong positive correlation (r=0.773, p<0.001) was detected between the two scoring systems.Conclusion: Alvarado and Karaman scoring systems are reliable auxiliary tools that support the surgeon in the diagnosis of AA. The full specificity provided by the Alvarado score at its threshold supports the conclusion that these patients can be directed to surgery without the need for advanced imaging. However, the moderate overall accuracy rates of the scores indicate that an approach based solely on scoring may be insufficient; a comprehensive strategy integrating clinical examination, biochemical markers, and imaging methods (USG/CT) should be implemented for definitive diagnosis.

Purpose: Since laparoscopic surgery is performed with carbon dioxide (CO ₂ ) insufflation, it is known to have some metabolic consequences. Due to these metabolic changes, some clinicians may prefer open surgery for inguinal hernia in patients with pulmonary comorbidities. Our study aimed to compare the metabolic and systemic perioperative effects of preperitoneal insufflation with those of intraperitoneal insufflation. Methods: This prospective controlled study included 20 patients who underwent totally extraperitoneal (TEP) inguinal hernia repair and 20 patients who underwent laparoscopic cholecystectomy. End-tidal carbon dioxide (ETCO ₂ ), peak inspiratory pressure (PIP), vital parameters, and arterial blood gas analysis results [pH, bicarbonate (HCO ₃ ⁻ ), partial pressure of carbon dioxide (PCO ₂ ), and lactate] were recorded before insufflation and at 10 and 20 minutes after insufflation. These parameters were compared between the 2 groups. Results: In comparison between groups, no statistically significant differences were found in terms of age, gender, ASA score, or BMI ( P >0.05). In both groups, within-group analyses of HCO ₃ , ETCO ₂ , and PCO ₂ showed that 10-minute measurements were significantly higher than preinsufflation and 20-minute measurements ( P 0.05). No statistically significant difference was observed between the groups when preinsufflation 10-minute and 20-minute analyses were evaluated for all parameters ( P <0.05). Conclusion: On the basis of the standardized intergroup analyses of pulmonary and metabolic parameters, preperitoneal and intraperitoneal CO ₂ insufflation demonstrated similar perioperative respiratory and metabolic effects. Laparoscopic inguinal hernia repair, which offers rapid postoperative recovery, does not appear to impose a greater metabolic burden than laparoscopic cholecystectomy. Therefore, laparoscopy may be considered a primary surgical approach for inguinal hernia repair, similar to cholecystectomy.

Aims: Surgical complications play a major role in the etiology of hypoparathyroidism. Calcium and phosphorus metabolisms are disrupted by hypoparathyroidism. As a result, bone mineralization is impaired and may cause many pathologies. In clinical practice, parathyroid transplantation is not possible in every patient. In this study, we aimed to evaluate whether it would be possible to prevent the complications caused by hypoparathyroidism with mineral-supplemented medical therapy, even if we could not replace the lost parathyroid tissue. Methods: A total of 79 individuals with hypoparathyroidism (parathormone levels below the reference range for more than one year) secondary to thyroidectomy admitted to our hospital were included in the study. Calcium, phosphorus, alkaline phosphatase (ALP), vitamin D, and creatinine levels were recorded in the last three controls. The relationship between parathormone levels, mineral levels, and ALP, which is an indicator of bone turnover, was analyzed. Results: The mean calcium value was 8.57±0.90 and the mean phosphorus value was 4.46±0.99 in individuals diagnosed as hypoparathyroid with biochemical data. When the relationship between parathormone and the average of the last three calcium values, the relationship between the average phosphorus value, and the relationship between ALP and vitamin D were examined, no significant difference was found (p<0.05). When the relationship between the calcium phosphorus product and its effect on bone mineralization was examined, the mean calcium phosphorus product was 37.64±7.37, and no statistically significant difference was found with parathormone level (p<0.05). Conclusion: Preservation of parathyroid tissue is important for calcium-phosphorus metabolism. Although loss of parathyroid tissue is irreversible, it may be possible to prevent complications with mineral supplementation. As long as calcium and phosphorus balance are maintained externally, bone turnover will be preserved, along with many pathologies caused by hypocalcemia. No matter how low the parathormone level is, the bone mineralization problem caused by hypoparathyroidism can be reduced or even eliminated with mineral levels normalized with medical treatment.

The role of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. While fixation may increase postopera