Background The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period. Methods This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared. Results Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods. Conclusion Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.

Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients’ data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

Predictivity of aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio for detecting bowel necrosis in incarcerated inguinal hernia patients Predicción de la proporción de aspartato aminotransferasa a alanina aminotransferasa (De Ritis) para detectar necrosis intestinal

Although Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, its prevalence is approximately 2% in the general population. Most diverticula remain asymptomatic and can be diagnosed with obstruction, perforation, inflammation, and gastrointestinal hemorrhage. The treatment of complicated MD is surgery, but there is no clear treatment recommendation yet for incidentally detected cases. As in the case we present here, the development of perforation due to Giant Meckel's diverticulitis in an adult female patient is a very rare complication of a disease that can be diagnosed very rarely.

Objective: Open Common Bile Duct Exploration (OCBDE) is a critical intervention for managing complex common bile duct (CBD) stones when endoscopic retrograde-cholangiopancreatography (ERCP) is unsuccessful. The choice of technique for choledochal exploration remains debated due to variable recurrence rates and complications associated with different methods. This study evaluates the clinical outcomes: bile leakage, oncogenic transformation, and stone recurrence of Choledochoduodenostomy (CDD) versus T-tube drainage (TTD), aiming to substantiate the selection of an optimal CBD closure strategy after choledocholithotomy. Methods: We conducted a retrospective review of 138 patients who underwent OCBDE between January 1, 2016, and August 1, 2021, at our institution, following failed at least two ERCP interventions. Patients were stratified into two cohorts based on the surgical technique employed: CDD (Group-I) and TTD (Group-II). Clinical and surgical outcomes were meticulously compared between the groups. Results: Group-I (CDD) included 109 patients (79%), while Group-II (TTD) comprised 29 patients (21%). Bile leaks were identified in 8 patients (5.8%), predominantly in Group-I (p=0.871). In the section of the study encompassing the 1.5-year period of the COVD-19 pandemic, the number of OCBDE surgeries performed remained consistent with the 3.5-year period preceding the pandemic. During the pandemic period, the number of operations increased, while the frequency of TTD surgery decreased (p<0.001). Two patients from Group-I developed bile duct malignancy during follow-up period (p=0.286). Higher incidence of stone recurrence was noted in Group-II (p=0.007). Conclusion: This investigation delineates the surgical outcomes of side-to-side diamond-shaped CDD compared to TTD, incorporating critical data from approximately 1.5 years of the COVID-19 pandemic. These findings are pivotal for guiding surgical strategy in complicated CBD stone management. doi: https://doi.org/10.12669/pjms.41.6.10126 How to cite this: Ozyazici S, Dirim AB. Surgical management of common bile duct stones following repeated endoscopic failure: A retrospective cohort study covering the pandemic period. Pak J Med Sci. 2025;41(6):1579-1585. doi: https://doi.org/10.12669/pjms.41.6.10126 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose Early diagnosis of necrotic bowel segment resulting from incarcerated inguinal hernia (IIH) is crucial for reducing morbidity and mortality. The aim of this study was to investigate the efficacy of the De Ritis ratio (DRR), also known as the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), as a biomarker for intestinal necrosis. Methods This retrospective study included 132 patients who underwent emergency surgery for IIH. Patients were divided into two groups: those who underwent bowel resection for necrosis (group-1) and those who did not (group-2). Patients' demographic data, hernia type, postoperative morbidity and mortality, length of hospital stay, laboratory test results of AST, ALT, CRP (C-reactive protein), WBC (white blood cell), neutrophil, lymphocyte, platelet, monocyte counts at the time of diagnosis was recorded. Using these laboratory values, DRR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-CRP ratio (LCR) were calculated. Results Of the patients, 45 (34.1%) underwent bowel resection for necrosis. The morbidity, mortality rates and the length of stay for group 1 were statistically significantly different (p < 0.0001). The DRR, NLR, PLR, LMR, LCR values of the same group were also significantly different (p < 0.05). The receiver operating characteristic analysis of these markers showed that NLR, PLR, and DRR were the most significant markers for the diagnosis of bowel necrosis (AUC = 0.767; 0.697; 0.684 respectively). Conclusion DRR can be used as a biomarker for early diagnosis of bowel necrosis in patients with IIH.