It is difficult to differentiate between non-complicated acute cholecystitis (NCAC) and complicated acute cholecystitis (CAC) preoperatively, which are two separate pathologies with different management. The aim of this study was to create an algorithm that distinguishes between CAC and NCAC using the decision tree method, which includes simple examinations. In this retrospective study, the patients were divided into 2 groups: CAC (149 patients) and NCAC (885 patients). Parameters such as patient demographic data, American Society of Anesthesiologists (ASA) score, Tokyo grade, comorbidity findings, white blood cell (WBC) count, neutrophil/lymphocyte ratio, C-reactive protein (CRP) level, albumin level, CRP/albumin ratio (CAR), and gallbladder wall thickness (GBWT) were evaluated. In this algorithm, the CRP value became a very important parameter in the distinction between NCAC and CAC. Age was an important predictive factor in patients with CRP levels >57 mg/L, and the critical value for age was 42. After the age factor, the important parameters in the decision tree were WBC and GBWT. In patients with a CRP value of ≤57 mg/L, GBWT is decisive and the critical value is 4.85 mm. Age, neutrophil/lymphocyte ratio, and WBC count were among the other important factors after GBWT. Sex, ASA score, Tokyo grade, comorbidity, CAR, and albumin value did not have an effect on the distinction between NCAC and CAC. In statistical analysis, significant differences were found groups in terms of gender (34.8% vs 51.7% male), ASA score (P < .001), Tokyo grade (P < .001), comorbidity (P < .001), albumin (4 vs 3.4 g/dL), and CAR (2.4 vs 38.4). By means of this algorithm, which includes low-cost examinations, NCAC and CAC distinction can be made easily and quickly within limited possibilities. Preoperative prediction of pathologies that are difficult to manage, such as CAC, can minimize patient morbidity and mortality.

BACKGROUND Pilonidal sinus is a chronic or acute infectious disease in the intergluteal cleft. Various surgical treatments exist, but optimal management remains debated. This study compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease. MATERIAL AND METHODS The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated. After 54 patients were excluded, the remaining patients were divided into 4 groups: PMC (n=228), LF (n=82), KF (n=53), and LP (n=59). Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups. RESULTS The operation time was significantly shorter in the LP group (P<0.001). Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group. Hospital stay was significantly shorter in the LP group (mean, 8 h; P<0.001). Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001). According to the Likert scale, the satisfaction rate of the LP group was significantly higher (P<0.001). CONCLUSIONS The PMC method has a higher postoperative complication rate and a slower return to normal physical activity. The KF method appears to be more advantageous in terms of postoperative recurrence rate. Although the LP method seems to be more advantageous in terms of quality of life in selected patients, studies with larger samples and longer follow-up periods are needed.

Although the classical surgical treatment of adhesive ileus is performed using the open method, laparoscopic surgery has recently been performed in some centers. This study aimed to discuss the feasibility and role of laparoscopic surgery in the treatment of adhesive small bowel obstruction. In this retrospective study, the data of 830 patients who were operated for ileus in Başkent University Faculty of Medicine, Ankara Hospital, Department of General Surgery between January 2011 and September 2022 were analyzed. Missing data and intraabdominal cancer-related ileus were accepted as exclusion criteria and 648 patients were excluded from the study. The development of adhesion-related ileus and completeness of the data were accepted as inclusion criteria. Data were compared between the 2 groups [open group (OG; 152 cases) and laparoscopic group (LG; 30 cases]). When the patient characteristics were evaluated, it was found that the history of previous abdominal surgery (P < .001) and the number of previous abdominal surgery (P < .001) were statistically significantly higher in OG. Operation time was significantly longer in the LG (P = .022). There were no statistically significant differences between the groups in terms of intraoperative bowel injury (P = .216), bowel resection (P = .284), and stoma creation (P = .331). OG had a significantly higher rate of Clavien-Dindo grade ≥ 3 serious complications (P < .001) and mortality rate (P = .045). The first gas out occurred significantly earlier in the LG (P = .014). Oral intake was initiated earlier in the LG (P = .004). The length of hospital stay was significantly shorter in the LG (P < .001). There was no significant difference between the groups in terms of postoperative ileus, readmission, and reoperation. Laparoscopic surgery can be safely performed for the treatment of selected patients with adhesive small bowel obstruction. In addition, it is advantageous in terms of postoperative recovery.

This single-center study conducted in Turkey aims to assess the impact of preoperative nutritional status based on global leadership initiative on malnutrition criteria on 30-day postoperative surgical outcomes in patients undergoing pancreaticoduodenectomy (PD) for pancreatic head adenocarcinoma. A retrospective analysis was conducted on patients who underwent PD. Patients were classified into 2 groups based on preoperative nutritional assessments of global leadership initiative on malnutrition criteria: malnourished (n = 23; 46%) and nonmalnourished (n = 27; 54%). Preoperative data, including demographics, comorbidities, intraoperative data, final pathological results, and postoperative 30-day outcomes, including overall and major (Clavien-Dindo > II) complications, length of hospital stay (LOS), and 30-day mortality rates, were recorded and compared. A total of 50 patients were included in the study. Demographics, American Society of Anesthesiologists scores, and comorbidities were similar between the groups (P > .05). The mean Clavien-Dindo grade was 3 in the malnourished group and 2 in the nonmalnourished group (P = .001). Malnourished patients had a significantly higher rate of major complications (73.9%) compared to nonmalnourished patients (14.8%)(P = .001). The median LOS was similar between the 2 groups. The rate of postoperative transfusions was higher in the malnourished group (P = .033). Postoperative 30-day mortality was significantly higher in the malnourished group (26.1%) compared to the nonmalnourished group (0%) (P = .006). Multivariate logistic regression analysis confirmed that malnutrition was an independent predictor of postoperative major complications (OR: 16.3, 95% CI: 3.9–66.8, P = .001). Preoperative malnutrition is a strong predictor of 30-day postoperative major complications and mortality following PD in patients with pancreatic head adenocarcinoma.

Ultrasound-guided fine-needle aspiration biopsy (FNAB) is an essential diagnostic tool for detecting malignancy in thyroid nodules. The objective of this study was to evaluate the necessity of FNAB in the treatment decision-making process for thyroid nodules exceeding 3 cm in size. The records of patients who underwent thyroidectomy in our center between 2018 and 2023 were retrospectively reviewed. The study included patients with an index nodule size exceeding 3 cm. Exclusion criteria were missing data, treatment for a different oncological condition, recurrent disease, and purely cystic nodule. Patients were categorized into 2 groups based on the size of the index nodule: Group 1 included nodules measuring between 3 to 4 cm, and Group 2 included nodules 4 cm and larger. Demographic data, FNAB results, and histopathological findings were recorded. The specificity, sensitivity, false negative, and false positive rates of FNAB were calculated. There were 1935 patients who underwent thyroidectomy within the specified date range. In 359 of these patients, the index nodule size was 3 cm or more. There were 188 patients with nodule size between 3 and 4 cm. The mean age was 50.42 ± 13.34 years, and 257 patients were female (F/M ratio = 2.5/1). Fine needle aspiration biopsy was performed on 237 patients, resulting in 65 false negatives. Both the incidence of malignancy and the rate of FNAB false negatives were higher in nodules measuring 4 cm or larger. This study identified a high malignancy rate and a significant rate of false negatives in FNAB of thyroid nodules larger than 3 cm. These findings highlight the importance of carefully considering these factors in the surgical planning of such nodules.

Objective: To evaluate the risk factors for developing rectus sheath hematoma (RSH). Study Design: An observational study. Place and Duration of Study: Department of General Surgery, Hitit University School of Medicine, Erol Olcok Training and Research Hospital, Turkey; from January 2018 to April 2020. Methodology: Patients with RSH were studied. Those with other pathologies in rectus sheath, and repeat studies, were excluded. Demographic data, presenting symptoms, comorbidities, medications administered containing anticoagulant drugs, imaging results, laboratory findings, coagulation parameters, length of hospital stay, treatments administered, type of RSH, morbidity, mortality and risk factors of increased bleeding diathesis, were recorded. Results: Of the 61 studied patients, 56 (91.8%) had at least one chronic disease, and 77% were receiving anticoagulation therapy. RSH size was significantly larger for patients taking acetylsalicylic acid than for patients taking other anticoagulants, and an RSH area less than 1,924 mm2 was associated with increased length of hospital stay. Binary logistic regression analysis showed that a unit increase in gender was associated with a 1.5-fold increase in the risk of greater RSH size, and that female gender was associated with a 45.3-fold risk of increase in the risk of RSH. Notably, if up to 4 units of erythrocyte suspension replacement is not applied for conservative treatment of RSH, RSH size may increase by 23.5 times. Conclusion: Risk factors of RSH include chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, asthma, hypertension, diabetes mellitus, chronic renal failure, prior abdominal surgery, female sex, older age, anticoagulant drug use and cancer-related immunosuppression.