We aimed to investigate the prevalence of postoperative hypoparathyroidism (PoH), the relevant factors, and predictors of transient or permanent hypoparathyroidism. The files of 352 patients who underwent bilateral total thyroidectomy alone or with central lymph node dissection and/or lateral neck dissection between June 1, 2019, and November 30, 2019, were retrospectively evaluated. Also, calcium and parathyroid hormone levels measured preoperatively and 4–6 h after surgery, follow-up examination results, and time to resolution of transient PoH were recorded. 16.48% (n = 58) of the surgical patients developed transient PoH and 3.98% (n = 14) developed permanent PoH. Length of hospital stay increased in patients who developed PoH (p < 0.001). Transient PoH developed less in patients who underwent parathyroid autotransplantation, while permanent PoH was not detected (p = 0.001). PoH development was not significantly correlated with nodule size as measured by preoperative thyroid ultrasonography (p = 0.944). Patients who had a serum PTH level ≤ 5.95 pmol/L 4–6 h after surgery had a greater risk of developing permanent PoH (OR 134.84, 95% CI 17.25–1053.82). PoH is more common in female gender and is not significantly correlated with nodule size. Parathyroid autotransplantation can prevent the development of PoH.

Meckel's diverticulum affects 1 - 3% of general population and is known as the most common anomaly of gastrointestinal tract. However, its estimated lifetime complication rate is approximately 4%. Intestinal obstruction is most common complication of Meckel's diverticulum in adult population. In the present study, we reported a 42-year-old female patient with a gangrenous Meckel's diverticulum in a strangulated umbilical hernia sac treated by dissection of diverticulomesenteric bands and diverticulectomy. In 36 months follow-up, there was neither any complication nor recurrence of hernia. This case represents a gangrenous Meckel's diverticulum in a strangulated umbilical hernia sac diagnosed in case of emergency. Although it is a very rare phenomenon, we should be vigilant for this entity especially in case of emergency.

This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon's learning curve on these parameters. This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21-72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3. Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

OBJECTIVE: In this retrospective study, we aimed to determine factors associated with bleeding complications in patients on long-term METHODS: Two-year hospital records yielded 44 inguinal hernia repair patients on long-term warfarin (26 men, 4 women, aged 57.4 [38-72] years). All patients were managed with LMWH bridging. Patient and operative characteristics, LMWH bridging characteristics, and international normalized ratio (INR) values were compared between patients with and without postoperative bleeding complications. RESULTS: Indication for warfarin use was heart valve disease (n=15), atrial fibrillation (n=7), deep venous thrombosis (n=3), cerebrovascular event (n=3), and pulmonary embolism (n=2). Four of the operations were urgent, while the remaining were elective. There were four ecchymosis cases and three hematoma cases in a total of seven patients. Baseline (2.94 +/- 0.26 versus 2.16 +/- 0.38, p<0.001) and preoperative INR values (1.69 +/- 0.67 versus 1.31 +/- 0.35, p=0.027) were significantly higher, while postoperative INR values (1.04 +/- 0.09 versus 1.2 +/- 0.13, p=0.004) were significantly lower in patients having bleeding complications. CONCLUSIONS: Baseline, preoperative INR, and postoperative INR were the only variables associated with postoperative bleeding complications in patients undergoing LMWH-bridged inguinal hernia repair. We suggest close monitoring of INR levels in long-term warfarin users, even for relatively low-bleeding risk operations such as inguinal hernia repair.

Background: C-reactive protein (CRP) is an acute phase reactant and its serum levels may be risen during many diseases. Hypothyroidism is a clinical disease state accompanied by mild inflammation that is known to be significantly associated with atherosclerosis. In this study, we aim to determine and compare serum CRP levels in overt and subclinical hypothyroidism subgroups and research their association with autoimmune markers.Methods: Around 79 patients who are diagnosed with overt and subclinical hypothyroidism in our polyclinic were included in this study. Patients’ morning blood samples were collected after 8hours of fast and thyroid functions, CRP, sedimentation rate, anti TG and anti TPO antibody levels were studied. Thyroid ultrasonography was planned for each patient.Results: We found significant differences regarding age, sT3, sT4, TSH, anti-TPO, anti-TG and CRP levels between overt and subclinical groups. There was no significant difference between the groups in thyroxin use, nodularity and sedimentation rate. No significant difference was found between CRP levels and autoimmunity markers anti-TPO and anti-TG among the groups as well. A significant cut-off value was determined for CRP in overt hypothyroidism by using Roc analysis and this value was also considered for being a possible cardiovascular risk marker.Conclusions: In this study, we found out that CRP levels were high in both overt and subclinical subgroups, CRP levels were increased during progression of the disease from subclinical to overt and this increase may be related with higher inflammation and tendency to cardiovascular diseases.

Aim: To compare Lichteinstein and total extraperitoneal laparoscopic hernia repair methods regarding the endocrine and inflammatory response to surgery and the results of early postoperative period. Material and Method: Between December 2013 and February 2014, patients over 18 years old who had been operated for inguinal hernia at our clinic were included in the study. Total extraperitoneal laparoscopic hernia repair was administered to the 20 patients while Lichteinstein repair was performed in another 20 patients. During the induction of anesthesia, post-operatively, and at 6th and 12th hours blood samples from the patients in both groups was obtained and serum ACTH, IL-6, WBC and CRP levels were measured. Results of early postoperative periods of operations were assessed. Results: There was no difference between the two groups in terms of surgical endocrine responses. Inflammatory response parameters varied. In patients TEP applied on WBC values ​​and average checked at 6th hours at statistically significant degree higher while average of CRP values ​​checked in 6th hours is lower at statistically significant degree in the patients with TEP than patients who underwent Lichteinstein operation. There were no significant differences detected in any period between Lichtenstein and TEP group in terms of IL-6 value that we worked as acute phase reactant. However, postoperative VAS values ​​of Lichteinstein group were statistically significantly higher than those of patients who underwent the TEP. Conclusion: In study there wasn’t difference between TEP and Lichtenstein repair in terms of inflammatory and endocrine responses. TEP repair, found to be superior than Lichtenstein repair operation; as it provide return to work early, the patients have less pain and less analgesic is needed, and less cost that promoted by the earlier return to work.