Inguinal hernia repair is one of the most common surgical procedures worldwide. There is still controversy over which method has the best postoperative results. The aim of this study was to compare early and late postoperative results of laparoscopic totally extraperitoneal herniorrhaphy (TEP) and open Lichtenstein herniorrhaphy (OLR). The study was conducted in a randomized prospective manner and it was concluded with 302 patients (147 cases in TEP group and 155 cases in OLR group). All procedures were performed by two experienced surgeons in both open and laparoscopic inguinal hernia repair. The groups were similar in terms of age, sex, and types of inguinal hernia according to Nyhuss classification. The mean operation time was shorter in TEP group with 49.2 ± 15.5 min vs 54.3 ± 14.6 min in OLR group (P = 0.004). The mean length of hospital stay was significantly shorter in TEP group (P = 0.001). The mean postoperative visual analogue scale score was significantly lower in TEP group. With a mean follow-up of 40.95 months, the recurrence rates were similar in both groups with a rate of 4.3%. In terms of chronic pain, TEP group has better results than OLR with 3.4% vs 25.2%, respectively (P = 0.001). In experienced hands, TEP procedure has better early and late postoperative results than OLR, whereas recurrence rates are similar.

Background: Low-grade appendiceal mucinous neoplasm (LAMN) is an uncommon tumor of the appendix that is usually diagnosed incidentally after surgery. Although LAMN may be asymptomatic, it can rupture and seed mucin and neoplastic epithelium into the peritoneum, causing pseudomyxoma peritonei (PMP). Materials and methods: Data from 53 patients were retrospectively analyzed. Age, sex, tumor size, margin status, peritoneal carcinomatosis index, surgical procedures, postoperative results with histologic diagnosis, T stage, recurrence, and mortality of the patients were evaluated. Results: Appendectomy was performed in 37 patients, right hemicolectomy in nine patients, cytoreductive surgery in one patient, and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in six patients. Recurrence occurred in four patients. Of the patients who developed recurrence, one patient had stage T4a disease, and the other three patients had T4b disease (p<0.001). Eighteen patients had acellular mucin in the serosa and four of these patients developed recurrence (p=0.004). Twelve patients had appendix perforation, and three of these patients had PMP on exploration (p<0.001). The mean survival time was 93.3 months in patients without recurrence and 32 months in patients with recurrence (p=0.021). Conclusions: Low-grade appendiceal mucinous neoplasms are rare appendiceal tumors. The appropriate management of this tumor is controversial. T stage, appendix perforation, presence of acellular mucin on the serosa, and surgical margins are risk factors for the development of PMP. Appendectomy is considered sufficient when there are no risk factors for Tis (LAMN) and T3 disease. Right hemicolectomy may be sufficient if there are no risk factors for T4a disease, but cytoreductive surgery and hyperthermic intraperitoneal chemotherapy seem to be the most appropriate treatments in the presence of the stated risk factors for T4b disease.

Background: Urinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure. Methods: A total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications. Results: The mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208). Conclusions: Ureteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

Background Gallbladder cancer is a rare cancer with a poor prognosis despite all the advances in treatment options and is mostly detected incidentally. In the current literature, re-excision is performed on patients with stage T1b and above, but high mortality rates are still observed. In this study, we aimed to investigate the reasons affecting the prognosis of incidental gallbladder cancer. Methodology Data from 33 patients were retrospectively analyzed. Patient age, sex, preoperative radiologic findings, surgical procedures, margin status, postoperative results with histologic diagnosis, T stage, complications, and mortality were evaluated. Results Of the 33 patients included in the study, 24 (72.7%) were female, nine (27.3%) were male, and the mean age was 66.4 ± 13.4 years. Seventeen (51.5%) patients in our study were aged over 65 years. Age over 65 years was found to have a significant effect on mortality (p = 0.018). In the preoperative ultrasound imaging, 27 (81.8%) patients had gallstones, two (6.1%) patients had gallbladder polyps, 31 (93.9%) had focal or diffuse thickness increases in the gallbladder wall, and nine (27.3%) patients had pericholecystic fluid. The presence of pericholecystic fluid (p = 0.039) and wall thickness (p = 0.006) were found to be associated with mortality. There was perineural invasion and lymphovascular in 17 patients each. Both perineural invasion (p = 0.016) and lymphovascular invasion (p = 0.007) were associated with mortality. Tumor grade was also associated with mortality (p = 0.001). When the prognosis of the patients was evaluated according to the T stage, the increase in the T stage negatively affected the prognosis (p < 0.001). Overall survival was a median of 17 months (95% confidence interval = 10.6-23.3). Conclusions Incidental gallbladder cancer is detected on routine histologic examination of gallbladder specimens after cholecystectomy. Most patients may require re-excision, but the prognosis is still poor in patients who have undergone re-excision. Age >65 years, pericholecystic fluid, T stage, grade, lymphovascular invasion, and perineural invasion had a significant effect on mortality, the presence of which should trigger the option of re-excision to be examined more carefully.

Fournier gangrene is described as necrotizing fasciitis involving the genital, perineal, and perianal area. Early surgical debridement of necrotic tissues, topical therapy, and antibiotics are fundamental in the treatment of Fournier gangrene. We aimed to compare the effects of Dakin solution and povidone iodine solution on patient outcomes by using the Fournier gangrene severity index (FGSI). The demographic data, comorbid diseases, local therapeutic interventions, FGSI, necessity of diverting colostomy or orchiectomy, hospitalization time, number of debridements, complications, and outcomes of 57 patients with Fournier gangrene were retrospectively analyzed. A total of 47 of 57 patients (82.5%) were male, and 10 patients (17.5%) were female, with a mean age of 62.3 ± 13.8 years (range, 27–85 years). The survivors were significantly younger than the nonsurvivors. The mean FGSI score was 4 (range, 1–9) in survivors, and mean FGSI score was 9 (range, 6–10) in nonsurvivors. FGSI score was significantly higher in the mortality group. The median hospital stay was 13 days (range, 3–34 days) in the Dakin solution group and 20 days (range, 1–41 days) in the povidone iodine group. Overall mortality rate was 17.5%. Advanced age had a statistically significant effect on mortality. The hospitalization time was significantly shorter in the Dakin solution group, and use of Dakin solution decreased the number of debridements. Dakin solution has favorable effects on hospital stay and the necessity of multiple debridements. Dakin solution seems to be a good and cost-effective choice for treatment in local wound healing.