Background and Objectives: Ingrown toenail frequently causes pain and infection and may recur following surgical treatment. This study compared a nail-preserving strategy, minimal matricectomy combined with lateral longitudinal excision, against total nail avulsion for recurrence and clinical outcomes, using propensity-score analysis to address non-randomized treatment allocation. Materials and Methods: In this two-center retrospective cohort study, 412 patients treated between January 2020 and December 2024 were classified according to the surgical procedure received: minimal matricectomy with lateral longitudinal excision (n = 233) or total nail avulsion (n = 179). The primary endpoint was recurrence; secondary outcomes included postoperative pain, healing time, infection, reintervention, return to activity, and patient satisfaction. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis, and recurrence-free survival was assessed using the Kaplan–Meier method with the log-rank test. Results: Over a mean follow-up of 18 months, recurrence occurred in 1.7% (n = 4) of the minimal matricectomy group versus 12.3% (n = 22) of the avulsion group (p < 0.001; crude OR 8.0, 95% CI 2.7–23.7). After IPTW adjustment, the association remained consistent (adjusted OR 7.4, 95% CI 2.6–21.3; standardized mean differences <0.10 for all covariates). Kaplan–Meier analysis confirmed significantly higher recurrence-free survival with minimal matricectomy (log-rank p < 0.001). Reintervention (1.3% vs. 9.5%) and return to normal activity (5 vs. 9 days) also favored minimal matricectomy, with lower pain scores, shorter healing, fewer infections, and higher satisfaction. Conclusions: Minimal matricectomy combined with lateral longitudinal excision was associated with lower recurrence and improved clinical outcomes compared with total nail avulsion. This association remained statistically significant after propensity score adjustment for measured baseline covariates. Prospective randomized studies are warranted to confirm these findings.

Background and objectives: The optimal surgical approach for incarcerated or strangulated abdominal wall hernias remains debated. While laparoscopic techniques are well established electively, evidence on their emergency-setting role is limited. This study compared open and laparoscopic repair in patients undergoing emergency surgery for incarcerated or strangulated abdominal wall hernias, focusing on postoperative morbidity, mortality, operative time, and hospital stay. Materials and methods: This retrospective single-center cohort study included 180 consecutive patients treated between January 2023 and June 2025, analyzed by initially intended approach (open, n = 90; laparoscopic, n = 90; converted patients retained in their original group). Demographics, hernia type, intraoperative findings, complications, mortality, and length of stay were compared using Fisher's exact and Mann–Whitney U tests. Wound-related morbidity (surgical site infection and/or seroma) was analyzed as a composite outcome via multivariate logistic regression adjusted for age, sex, BMI, ASA class, hernia type, smoking, symptom duration, contamination, and bowel resection, with a reduced four-covariate sensitivity model. Propensity-score matching, subgroup analyses by hernia type, and mesh-use/no-bowel-resection sensitivity analyses were also performed; all were prespecified but exploratory, without correction for multiple testing. Results: Groups were comparable in baseline characteristics (all p > 0.05), with no postoperative deaths. Operative time was longer with laparoscopy (82.0 ± 16.7 vs. 76.0 ± 13.5 min, p = 0.025), while hospital stay was shorter (3.9 ± 1.0 vs. 5.2 ± 0.9 days, p < 0.001) and postoperative ileus less frequent (1.1% vs. 8.9%, p = 0.034). Wound complications were numerically lower after laparoscopy (13.3% vs. 22.2%) but not statistically significant ( p = 0.172). No covariate independently predicted wound morbidity on multivariate analysis (technique OR 0.59, 95% CI 0.26–1.33, p = 0.203). Propensity-matched analysis (68 pairs) confirmed the operative-time and length-of-stay findings; the length-of-stay benefit was consistent across all hernia-type subgroups and sensitivity analyses. Conclusions: Laparoscopic repair of strangulated abdominal wall hernias was associated with shorter hospital stay and lower ileus rates, but longer operative time, than open repair, with no significant difference in wound morbidity or mortality. Given the non-randomized design and limited power for the wound-complication comparison (∼35%), these findings—particularly regarding wound morbidity—should be considered hypothesis-generating. Laparoscopic repair may be a reasonable option in carefully selected, hemodynamically stable patients, pending confirmation by adequately powered multicenter trials.

Background/Objectives: Surgical site infection (SSI) remains a common complication after ileostomy closure. Mechanical bowel preparation (MBP) and oral antibiotic preparation are often bundled together, so their independent contributions to SSI risk are unclear. We evaluated the adjusted associations of oral antibiotic preparation and MBP with SSI after ileostomy closure, a setting in which these two components have rarely been examined separately. Methods: We retrospectively reviewed 432 consecutive patients undergoing loop or end ileostomy closure at a single center between January 2022 and December 2025. SSI was defined per Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) criteria. Multivariable logistic regression was used to assess adjusted associations with SSI, with MBP and oral antibiotic preparation included as the exposures of primary interest, adjusting for adjuvant oncologic therapy and closed suction drain use—the covariates associated with SSI on univariate analysis. Results: SSI occurred in 35 patients (8.1%). Oral antibiotic preparation was associated with a lower SSI rate (2.9% vs. 11.5% without; absolute risk reduction 8.5 percentage points, unadjusted descriptive number needed to treat 12; p = 0.003), while no statistically significant unadjusted association was detected for MBP (p = 1.000). After adjustment, oral antibiotic preparation was associated with lower odds of SSI (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.08–0.56; p = 0.002), whereas no statistically significant adjusted association was observed for MBP (OR, 1.21; 95% CI, 0.58–2.53; p = 0.610); this confidence interval is compatible with both a clinically meaningful benefit and a clinically meaningful harm of MBP, and the study is not powered to exclude either. Adjuvant oncologic therapy (OR 2.53, 95% CI 1.23–5.20) and closed suction drain use (OR 2.33, 95% CI 1.14–4.77) were associated with higher adjusted odds of SSI. The model showed acceptable discrimination (area under the receiver operating characteristic curve [AUC] = 0.745), with no evidence of poor fit on a covariate-pattern-based goodness-of-fit assessment (χ² = 11.37, df = 14, p = 0.657). A Firth penalized-likelihood model, used because of the limited number of events in the antibiotic-exposed group, gave materially unchanged estimates (OR 0.23, 95% CI 0.09–0.58). Conclusions: Oral antibiotic preparation was associated with lower adjusted odds of SSI after ileostomy closure, whereas the association with MBP remained inconclusive. This observational association should not be interpreted as evidence of causality, because residual confounding—particularly by surgeon-level practice—cannot be excluded. These findings should be considered hypothesis-generating and require confirmation in prospective studies using standardized preparation protocols.

AIM: Anastomotic leakage (AL) is a life-threatening complication of colorectal surgery carrying significant risks of postoperative morbidity and mortality. Timely identification of patients at elevated risk for AL is critical for optimizing surgical outcomes. This study aimed to evaluate factors associated with AL and to assess the predictive utility of the postoperative day 3 C-reactive protein-to-albumin ratio (CAR) in patients undergoing elective right hemicolectomy for colon cancer.METHODS: This retrospective observational cohort study included patients who underwent elective right hemicolectomy with primary ileocolic anastomosis for colon cancer at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital (January 2020 to January 2025). Patients undergoing emergency surgery, multivisceral resection, diverting stoma formation, or with incomplete data were excluded. ROC curve analysis and limited univariable logistic regression were used to evaluate the predictive performance of postoperative day 3 CAR.RESULTS: A total of 194 patients were included, and AL developed in 14 patients (7.2%). No significant differences were observed between groups regarding age, body mass index, operative duration, surgical technique, or comorbidities, confirming the homogeneity of the study population. Early enteral feeding was initiated significantly later in patients with AL (3.36 ± 0.74 vs. 2.83 ± 0.76 days, p = 0.021). Postoperative day 3 C-reactive protein (CRP) levels were significantly higher in the AL group (451.3 [398.7–534.2] mg/L vs. 98.4 [71.2–138.6] mg/L, p < 0.001), whereas serum albumin levels were significantly lower (2.30 ± 0.16 g/dL vs. 3.09 ± 0.34 g/dL, p < 0.001). The postoperative day 3 CAR was markedly elevated in patients with AL compared with those without leakage (196.4 [168.2–248.7] vs. 32.1 [22.4–45.8], p < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated strong predictive performance for CAR, with an area under the curve (AUC) of 0.91 (95% CI: 0.84–0.98, p < 0.001). The optimal cutoff value was 148.7, yielding a sensitivity of 85.7% and specificity of 88.3%. In limited univariable logistic regression analysis, postoperative day 3 CAR remained significantly associated with AL (odds ratio [OR]: 6.84, 95% CI: 3.11–11.52, p < 0.001).CONCLUSIONS: On postoperative day 3, CAR demonstrated strong discriminatory performance for anastomotic leakage after elective right hemicolectomy in this retrospective cohort. The high negative predictive value (98.8%) suggests potential utility as a rule-out tool for early postoperative risk stratification; however, these findings require prospective multicenter validation before any clinical implementation can be considered.

Background: Difficult laparoscopic cholecystectomy (LC) is associated with prolonged operative times, bile duct injuries, and increased postoperative morbidity. Reliable preoperative prediction could optimize surgical planning and patient consent, but the incremental value of adding laboratory and ultrasonographic (USG) data to routinely available clinical variables has rarely been quantified. Materials and methods: We conducted a retrospective cohort study of 648 consecutive patients undergoing LC for symptomatic gallstone disease, reported in accordance with the STROCSS 2021 guidelines and relevant TRIPOD recommendations. Difficult LC was defined a priori as a composite outcome (operative time ≥90 min, subtotal cholecystectomy, conversion to open surgery, fundus-first dissection, or additional ports), capturing distinct but overlapping dimensions of operative difficulty ranging from prolonged dissection to surgeon-driven bailout strategies. Independent predictors were identified by multivariable logistic regression, and discriminative performance of clinical, clinical + laboratory, and combined (clinical + laboratory + USG) models was assessed using fivefold cross-validated receiver operating characteristic analysis, with bootstrap-derived 95% confidence intervals (CIs), calibration, and bootstrap optimism correction. Results: Difficult LC occurred in 125 patients (19.3%). Impacted stone [adjusted odds ratio (OR) 2.86, 95% CI 1.66–4.92], previous cholecystitis attack (OR 1.87, 95% CI 1.15–3.02), gallbladder wall thickness (OR 1.74 per mm, 95% CI 1.36–2.21), body mass index (OR 1.05 per kg/m ² , 95% CI 1.00–1.11), and C-reactive protein (OR 1.02 per mg/L, 95% CI 1.01–1.04) were independent predictors (all p < 0.05). Cross-validated areas under the receiver operating characteristic curve (AUC) values increased progressively from 0.723 (95% CI 0.687–0.786) (clinical) to 0.734 (95% CI 0.700–0.796) (clinical + laboratory) to 0.768 (95% CI 0.742–0.831) (combined + USG), a pattern preserved after excluding operative time from the outcome definition [0.705 (95% CI 0.635–0.801) → 0.716 (95% CI 0.641–0.808) → 0.739 (95% CI 0.675–0.832)]. The paired-bootstrap increment in AUC was +0.011 (95% CI −0.007 to +0.040) for laboratory variables and +0.034 (95% CI +0.010 to +0.071) for ultrasonographic variables, indicating that the laboratory increment alone was not statistically distinguishable from zero, whereas the ultrasonographic increment was. The combined model showed acceptable calibration (slope 0.76, intercept 0.03, Brier score 0.134) and an optimism-corrected AUC of 0.783. Difficult LC was associated with more postoperative bile leaks, 30-day readmissions, and longer hospital stays (all p < 0.001). Conclusion: Sequentially adding laboratory and then ultrasonographic data to a clinical-only model produced modest, calibration-confirmed improvements in cross-validated discrimination of difficult LC. This increment was statistically robust for ultrasonographic variables (95% CI excluding zero) but not for laboratory variables alone, indicating a modest incremental improvement in discrimination rather than a clinically transformative gain. External, prospective validation is warranted before routine clinical implementation.