Background: Patient deaths are an unavoidable occurrence in surgical practice. Although these events have negative effects on patients and their families, they can also have a profound adverse impact on surgeons who are unprepared for these deep emotional experiences. This study aims to investigate the impact of patient deaths on general surgeons’ psychosocial well-being and surgical practices.Methods: A national cross-sectional survey of a 30-item questionnaire was conducted. The survey evaluated the surgeons’ demographics, professional and practice characteristics, and the impact of patient deaths on their emotional well-being, professional career, and social life.Results: Four hundred eighty participants completed the survey. One-third of the participants reported that patient deaths affected their emotional well-being, 23.3% reported that patient deaths affected their social life, and 34.2% reported that patient deaths affected their professional career. Surgeons who reported suffering from the emotional impact of death exhibited no differences in terms of place of practice, academic title, surgical experience, work hours, or annual surgical volume. Middle-aged surgeons (p = 0.004), females (p = 0.041), and surgeons who reported feeling burned out (p < 0.001) were more likely to be affected by patient loss. Feelings of sadness, worry, and stress were most reported. A total of 18.1% of the participants indicated that they considered taking a break after patient death, and 11.9% thought they would abandon their surgical career.Conclusions: The findings of this study suggest that patient death affects surgeons’ psychosocial well-being and surgical practices. Greater awareness and effort are required at the personal, institutional, and organizational level to provide effective support, helping surgeons to cope with the emotional burden of patient deaths.

BACKGROUND: Tumoral lesions are a relatively rare cause of acute appendicitis. Accurate pre-operative diagnosis is essential to provide appropriate treatment. The aim of this study was to evaluate factors that may increase diagnostic rate of appendiceal tumoral lesions in patients undergoing appendectomy. METHODS: A retrospective review of a large cohort of patients who underwent appendectomy for acute appendicitis from 2011 to 2020 was undertaken. Demographics, clinicopathologic findings, and pre-operative laboratory values were recorded. Univariate and multivariate logistic regression and receiver-operating characteristic curve analysis were performed to identify the factors that predict appendiceal tumoral lesions. RESULTS: A total of 1400 patients were included in the study, with median age of 32 (range, 18-88) years, and of whom 54.4% were male. Overall, 2.9% (n=40) of patients had appendiceal tumoral lesions. Multivariate analysis revealed that age (Odds Radio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08) and WBC count (OR 0.84, 95% CI 0.76-0.93) were independent predictors of appendiceal tumoral lesions. The optimal cutoff age was 37 years old (AUC: 0.79; sensitivity: 82.0%; specificity: 62.0%). WBC count <10x109/L was another independent predictive factor (AUC: 0.69, sensitivity: 74%; specificity: 60%). CONCLUSION: Predicting an appendiceal tumoral lesion preoperatively is critical to ensure a favorable post-operative outcome. Higher age and low WBC counts appear to be independent risk factors for an appendiceal tumoral lesion. In case of doubt and in the presence of these factors, wider resection should be favored over appendectomy only to provide a clear surgical margin.

Purpose: Every procedure, no matter how difficult, has a learning curve. However, no one discusses the learning curve for simple operations. This idea constantly comes up when there is a demanding surgical method that challenges habits. The aim of this study is to use cumulative sum analysis to estimate the learning curve of the demanding laparoscopic complete mesocolic excision+central vascular ligation technique for right sided colon cancer. Materials and Methods: This retrospective study involved patients older than 18 years and with right-sided colon cancer admitted to Ankara University School of Medicine, Department of General Surgery between January 2015 and June 2022. The cumulative sum (CUSUM) chart based on operation duration and quantity of lymph nodes harvested was utilized to determine the learning curve. Results: 53 patients included in this study. CUSUM analysis based on operation duration showed that Surgeon had passed the learning phase and was considered proficient after 21 cases. And the CUSUM analysis based on the lymph nodes harvested revealed that surgeon gained proficiency in 25th case. In terms of demographic, oncological, and operative data, there was no difference between the the groups defined by the phases according to the CUSUM analysis based on both operation duration and lymph node count. Conclusion: Surgeons can become familiar with laparoscopic complete mesocolic excision for right sided colon cancer and perform it after approximately 21 to 25 operations.

BACKGROUND: This study aims to evaluate the prevalence of abdominal aortic aneurysm (AAA) in Turkish men aged 60 years and older and the factors associated with AAA. METHODS: Through sixty-two family health centers located in the Kecioren district of Ankara, 239 male volunteers of the target age were recruited for this pilot study. The volunteers were scanned using B-mode ultrasonography. An aorta of 3 cm or larger in outer to outer diameter was accepted as having AAA. The participants were screened for age, height, weight, known diseases and risk factors. RESULTS: AAA was detected in 11 volunteers (4.6%). A history of smoking increased the risk of AAA (Odds ratio: 12.75; CI 95%, 1.2-134.3). The presence of an aneurysm with a history of myocardial infarction (MI) was statistically significant when compared to volunteers without a history of MI (p=0.007). Similarly, volunteers with a history of coronary angiography had a greater risk of an aneurysm than volunteers without (9.5% and 1.9%, respectively). Also, there was a negative correlation between diabetes, peripheral arterial disease, and aortic diameters. CONCLUSION: Although AAA has high mortality rates when ruptured, it is a preventable disease. Therefore, it is necessary to know the prevalence of AAA in Turkey. Our findings were compatible with the literature. However, our study was performed as a pilot study, and there is a need for larger studies in our country.

Laparoscopic total gastrectomy (LTG) is increasingly performed for gastric cancer, yet concerns remain regarding its oncologic adequacy compared to open total gastrectomy (OTG), especially outside of randomized clinical trials. Real-world data comparing both techniques are still limited. This retrospective cohort study included patients who underwent total gastrectomy with D2 lymphadenectomy for gastric cancer between January 2016 and December 2021 at a single tertiary center. Patients were grouped as LTG or OTG. Propensity score matching (1:1) was used to adjust for baseline variables. Long-term clinical outcomes and survival data were compared. Complications were graded using the Clavien-Dindo classification. Kaplan–Meier analysis was used to evaluate disease-free survival (DFS) and overall survival (OS). After propensity score matching (24 LTG vs. 24 OTG), the LTG group demonstrated a significantly shorter hospital stay (6.79 ± 0.66 vs. 7.33 ± 0.64 days; p = 0.006), with comparable operative times (3.5 ± 0.42 vs. 3.5 ± 0.49 h; p = 1.000) and complication rates (16.7% vs. 20.8%; p = 0.71), all classified as Clavien-Dindo Grade I-II. Oncologic outcomes showed equivalent lymph node yield. Oncologic outcomes were equivalent, including lymph node yield (35.12 ± 9.32 vs. 36.46 ± 10.19; p = 0.639). Survival analysis revealed no significant differences: median overall survival was 6 years (95% CI: 3.87–8.12) for LTG vs. 4 years (2.16–5.83) for OTG (p = 0.541), and disease-free survival was 6 years (4.53–7.46) vs. 4 years (1.72–6.27) (p = 0.443), with a median follow-up of 28.4 months. Laparoscopic total gastrectomy is a safe and effective alternative to open surgery when performed by experienced surgeons. These findings support the feasibility of LTG in real-life clinical settings and complement existing evidence from randomized trials. retrospectively registered.