Background/Objectives: Postoperative early hypocalcemia (PEH) is a key postoperative issue after parathyroidectomy in primary hyperparathyroidism. It often leads to long-lasting hypocalcemia, requiring more calcium and active vitamin D supplements. This study aimed to determine whether the extent of intraoperative parathyroid hormone (PTH) decline, measured 15 min after parathyroid tumor excision, could serve as a reliable intraoperative rule-out marker for PEH. Methods: We conducted a retrospective review of 88 adult patients who underwent surgical intervention for a solitary parathyroid tumor at a single institution. Postoperative early hypocalcemia (PEH) was defined as a total serum calcium level <8.5 mg/dL within the postoperative 6th hour or on postoperative day 1, requiring clinical calcium supplementation (oral and/or intravenous), with active vitamin D when appropriate. The percentage decrease in PTH at 15 min post-excision was calculated using morning-of-surgery preoperative PTH values alongside the 15-min post-excision levels. Additional variables assessed included preoperative alkaline phosphatase (ALP), parathyroid tumor weight, and serum concentrations of calcium, phosphate, magnesium, and 25-hydroxyvitamin D. Predictive factors were identified by logistic regression, and the diagnostic accuracy of the 15-min PTH decline was evaluated using receiver operating characteristic (ROC) curve analysis, optimizing cutoff selection with Youden’s index. Odds ratios were standardized per 10-unit increments for ALP and parathyroid tumor weight for interpretability. Results: Of the studied cohort, 10 patients (11.4%) developed PEH. The intraoperative 15-min PTH decline was notably greater in those who developed PEH compared to those who did not (81.2 ± 4.4% vs. 69.9 ± 8.3%; p < 0.001). Univariate logistic regression showed a significant association between the 15-min PTH decline and PEH (OR 1.22 per 1% increment; 95% CI 1.08–1.38). That said, when we added ALP and parathyroid tumor weight to the multivariate models, PTH decline no longer predicted independently. In contrast, ALP (OR 3.11 per 10 U/L; 95% CI 1.34–7.93; p = 0.011) and parathyroid tumor weight (OR 1.22 per 10 mg; 95% CI 1.10–1.48; p = 0.004) stayed significant. Thus, the incremental prognostic contribution of the 15-min PTH decline beyond ALP and parathyroid tumor weight appears limited. The ROC curve for the 15-min PTH decline produced an AUC of 0.883, with an optimal cutoff of 75% providing 100% sensitivity and 74.4% specificity. No patients with a PTH decline below 75% developed PEH. Conclusions: Preoperative ALP and parathyroid tumor weight showed the strongest independent associations with PEH following parathyroid tumor surgery. An intraoperative PTH decline of less than 75% at 15 min may serve as a practical rule-out tool for PEH, although further validation in larger patient populations is warranted.

Aim: This study aimed to evaluate the predictive value of the C-reactive protein to albumin ratio (CAR), measured on postoperative day 7, for identifying surgical complications following elective colorectal cancer surgery. Materials and Methods: A retrospective analysis was conducted on 200 patients who underwent curative colorectal resections between January 2017 and December 2023. Demographic and perioperative data, as well as 30-day postoperative complications, were reviewed. CRP and albumin levels were assessed preoperatively and on postoperative day 7. CAR was calculated as CRP (mg/dL) divided by albumin (g/dL). Complications were classified according to the Clavien–Dindo system. Results: Postoperative complications occurred in 40% of patients. On day 7, those with complications had significantly higher CRP levels, lower albumin levels, and elevated CAR values (mean CAR: 5.07 ± 2.05 vs. 2.31 ± 1.12; p

Background: This study aims to evaluate the efficacy and safety of a minimally invasive technique (pit excision with a punch biopsy needle) using a 1470 nm diode laser in the treatment of pilonidal sinus disease. Methods: A prospective study conducted included 187 patients who underwent laser treatment for pilonidal sinus. Patients were divided into two groups based on the severity of the disease: Group 1 (simple group) included patients who had no prior abscess formation and had one or two sinus openings, while Group 2 (complicated group) comprised patients with a history of abscess drainage and more two extensive sinus openings. The surgical procedure was performed under local anesthesia. The sinus openings were excised using a punch biopsy needle and subsequently closed with a diode laser probe. Patients were followed up at regular intervals during the postoperative period. Results: The findings revealed that the operative time (12.22 ± 1.72 min), postoperative pain scores and wound-healing duration were significantly lower in the simple group compared to the complicated group (p < 0.001). The recurrence rates were 3.7% in the simple group and 14.1% in the complicated group. The return-to-work time was 1.06 ± 0.32 days in the simple group and 1.32 ± 0.90 days in the complicated group. Conclusions: In conclusion, the combination of punch biopsy and diode laser is considered a safe and effective method, particularly for simple pilonidal sinus cases, due to its low complication rates, short recovery time, and early return-to-work advantages. However, more advanced treatment approaches are required for complicated cases.

Background/Objectives: This study aimed to evaluate the prognostic significance of preoperative inflammatory biomarkers—C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)—in predicting early postoperative complications (within 30 days) in patients undergoing percutaneous endoscopic gastrostomy (PEG). Methods: Data from 184 patients who underwent PEG placement at our institution between January 2021 and May 2022 were retrospectively analyzed. Demographic characteristics, PEG indications, and preoperative laboratory parameters (CRP, albumin, neutrophils, lymphocytes, and platelets) were recorded. CAR was calculated as the ratio of CRP (mg/L) to albumin (g/dL). Complications occurring within 30 days post-procedure were defined as early postoperative complications. Patients with and without complications were compared, and logistic regression analysis was used to identify potential risk factors. Results: The mean age of the patients was 71.5 ± 5.9 years, and 58.7% were male. PEG indications included neurological dysphagia (54.3%), head and neck malignancies (21.7%), and other causes (23.9%). At least one early complication occurred in 26 patients (14.1%). There were no significant differences in age, sex, body mass index, or Charlson Comorbidity Index between patients with and without complications (p > 0.05). Logistic regression revealed that elevated CAR was an independent predictor of postoperative complications (OR = 2.88; 95% CI: 1.62–5.13; p < 0.001). Although NLR (OR = 1.34) and PLR (OR = 1.02) were also associated with increased risk, they were less predictive than CAR in multivariate analysis. Conclusions: Preoperative CAR, NLR, and PLR levels are valuable biomarkers for predicting early complications following PEG. Notably, higher CAR levels are significantly associated with increased complication risk. Incorporating these indicators into clinical decision-making could facilitate early identification of high-risk patients and implementation of preventive strategies.

The extension of the digestive tract in the form of a blunt sac that is lined with mucosa and connected to the lumen is called a diverticulum. Diverticula can be divided into two groups as congenital (true) and acquired (pseudo) diverticula. Most of the diverticula are seen in the descending colon and sigmoid colon, and in 65% of the cases, the disease is only in the sigmoid colon. Diverticula are usually 0.5 - 1 cm in size and are numerous. İt can rarely be single and giant in size. In this presentation, we present a case of a giant sigmoid diverticulum originating from the sigmoid colon fixed to the bladder and uterocervical junction with radiological and surgical images in the light of the literature.

Aims: Laser hemorrhoidoplasty (LHP) is a minimally invasive surgical procedure gaining popularity due to its low complication rate and rapid recovery. However, issues such as postoperative pain and urinary retention continue to adversely affect patient comfort. This study aimed to evaluate the effects of ultrasound-guided pudendal nerve block (PNB) under propofol sedation, compared to spinal anesthesia (SA), on postoperative pain control, analgesic requirement, urinary retention incidence, and patient satisfaction. Methods: A prospective, randomized, controlled trial was conducted at Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital. Ninety-six patients diagnosed with grade 2–3 hemorrhoidal disease and scheduled for elective LHP were enrolled. Patients were divided into two groups: the PNB group (n=48) received PNB under propofol sedation, and the SA group (n=48) received SA. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 2, 4, 8, 16, 48, and 72 hours. Secondary outcomes included total analgesic consumption, urinary retention incidence, and patient satisfaction. Results: At all time points, VAS scores were significantly lower in the PNB group compared to the SA group (p