Comparison of Early Postoperative Outcomes Between Totally Extraperitoneal and Lichtenstein Repair of Inguinal Hernia: A Prospective Randomized Study.

Background: Surgical repair of inguinal hernia is among the most commonly performed surgical interventions in general surgery clinics, with minimal postoperative complications, less pain, and maximum cosmetic results. The aim of this study is to compare the outcomes of patients who underwent Lichtenstein repair (LR), which is currently the most commonly used open surgical procedure to repair inguinal hernias, and laparoscopic totally extraperitoneal (TEP) repair with regard to postoperative cosmesis, patient satisfaction, pain, and inflammatory response. Patients and Methods: The study consisted of male patients 18-65 years of age, who were operated for inguinal hernia with two different methods between February 2022 and January 2023 in the general surgery clinic of Elazig Fethi Sekin City Hospital. C-reactive protein (CRP), white blood cell, and interleukin 6 (IL-6) levels were observed to evaluate the inflammatory response in all patients. Visual Analog Scale and Verbal Rating Score systems were used to monitor the response to pain in the postoperative period. In addition, both groups were evaluated for patient satisfaction in cosmetic terms using the Vancouver Scar Scale and the Modified Stony Brook Scar Evaluation Scale. Results: Postoperative pain sensation in the TEP group was found to be significantly lower compared to the LR group. In terms of inflammatory response, IL-6 and CRP levels were found to be significantly higher in the LR group on postoperative day 1 and 2. Satisfaction with the cosmetic appearance of the surgical scar was significantly higher in the TEP group. Conclusion: TEP, which is a laparoscopic hernia repair method, is a safe surgical technique that can be preferred, especially in patients with less postoperative pain and higher cosmetic expectations. In terms of inflammatory response, significant difference is also in favor of TEP repair.

Analysis of blood parameters and clinical features in women with pilonidal sinus disease: Is there a link between the disease and polycystic ovary syndrome?

OBJECTIVE: Pilonidal sinus disease (PSD) is a common disorder in the sacrococcygeal region and has a lower incidence in female as compared with male patients. The aim of this study is to evaluate clinical, hematological, biochemical, and hormonal parameters in women with PSD, and to determine whether the disease plays a major role in abnormalities of clinical and laboratory findings. This study also brings to the forefront the issue of the association between PSD and polycystic ovary syndrome (PCOS). METHODS: The prospective single-center study included women with PSD, and an equal number of healthy women enrolled in the control group (50 women in each arm of the study). Medical history was taken from every patient, and blood tests were performed on all participants. Ultrasound imaging was performed to evaluate the ovaries. RESULTS: Both groups were matched for age (p=0.124). The prevalence of obesity and dyslipidemia was significantly higher in women with PSD compared to controls (p=0.046, p=0.008, respectively). The right ovary volume was significantly higher in the study group than the control group (p=0.028). The study group had also significantly higher mean levels of neutrophil, C-peptide, and thyroid stimulating hormone (p=0.047, p=0.031, and p=0.048, respectively). The prevalence of PCOS was higher in patients with PSD, but the difference failed to reach statistical significance (32 vs. 22%, p=0.26). CONCLUSION: Based on the findings of our study, some clinical and blood parameters differed significantly between women with and without PSD. Although the present study revealed that the prevalence of PCOS was not significantly different in women with or without PSD, more comprehensive and prospective studies are required.

Identification of Risk Factors for Mastalgia and Its Relationship with Benign or Malignant Breast Diseases.

Objectives: Mastalgia is a medical condition that primarily affects women of all age groups. Affected individuals experience excruciating pain, tightness, or a burning sensation in the breast tissue. The aim of this study is to observe the clinicopathologic features of women with mastalgia and compare these features with asymptomatic cases. Methods: A total of 524 female patients who applied to the general surgery outpatient clinic were prospectively evaluated. The patients were divided into two groups. Group 1 (G1) included patients with mastalgia, while Group 2 (G2) included asymptomatic patients. The two groups were compared in terms of clinical, radiological, and pathological features. Results: This study was conducted on 524 women, among whom the prevalence of mastalgia was found to be 61.45%. There were 322 patients in G1 and 202 patients in G2. The mean age was significantly higher in G2 compared to G1 (46.33±10.33 vs. 43.58±10.33, respectively; p=0.001). Premenopausal women rates for G1 and G2 were 73.91% and 59.4%, respectively (p=0.001). The regular exercise rate in G1 was 18.01%, while it was 25.74% in G2 (p=0.034). The past history of breast cancer rate was significantly higher in G2 than in G1 (p=0.015). The consumption of analgesics was significantly lower in G2 compared to G1 (p=0.05). Non-steroidal anti-inflammatory drugs were the most commonly used analgesic drug class in both groups, with significant intergroup differences (G1: 27.63%, G2: 19.8%, p=0.043). Screening mammography with or without ultrasound examination was performed significantly more often in G2 compared to G1 (66.33% vs. 55.27% and 82.17% vs. 72.98%, p=0.012 and p=0.016, respectively). No significant difference was found concerning the frequency of benign or malignant pathologies between the groups. Conclusion: Breast pain is common and should be considered physiological without other breast symptoms and after excluding non-breast causes. It is safe to provide symptom control advice and reassurance to patients who have breast pain but do not have signs or symptoms indicating a possible serious underlying condition requiring further medical intervention.

Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review.

Most of the approaches that were valid until recently in breast cancer surgery have undergone significant changes with rising awareness, increasing number of patients, and knowledge. It is important to repair the damage caused by surgical treatment performed in accordance with oncological principles and to obtain good cosmetic results. The quality-of-life indexes increase and body image is positively affected by the development of oncoplastic surgery and reconstruction techniques. The oncoplastic techniques are commonly used for the closure of glandular defects. Surgeons must pay attention to the breast volume, tumor location, the amount of breast tissue that would be removed, and the oncoplastic technique that may be required. Oncoplastic breast surgery allows wide local excision of the mass with good cosmetic results. In addition, a contralateral breast lift, breast augmentation or breast reduction may be required to accommodate the conceptually reconstructed breast. The use of oncoplastic breast surgery techniques results in lower mastectomy rates with equivalent local and long-term survival rates as compared with mastectomy and offers women the option of plastic and reconstructive interventions performed at the time of initial surgery. Mastectomy may be needed for large tumors, as breast-conserving surgery may not be possible or may not produce satisfactory cosmetic results. Breast reconstruction methods after mastectomy include autologous or implant-based breast reconstructions, which can be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction). Oncoplastic and reconstructive breast surgery minimizes the impact of breast cancer surgery and yields equivalent survival outcomes without psychological morbidity. With advanced techniques, better breast image than before can also be achieved. In this review, the technical details of oncoplastic breast surgery, surgical margin positivity management, reconstruction methods, radiation therapy given after reconstruction surgery, radiologic imaging modalities, and management of complications are discussed.

Comparison of Online Learning Video Platforms Regarding Laparoscopic Adrenalectomy: YouTube and WebSurg.

Background: The internet is a widely used source for receiving medical information. Nevertheless, the quality of data on online platforms is still questioned. Our aim was to compare the laparoscopic adrenalectomy videos published on the two online platforms, WebSurg® (WS) and YouTube® (YTb) regarding the quality of data, educational power, and accuracy of the sources. Materials and Methods: Most viewed popular visual content returned by YTb in reply to the keyword "laparoscopic adrenalectomy" were involved in the research protocol. The quality of the data, educational power, and the accuracy and reliability of the sources were assessed by applying new scoring systems. A novel scoring method estimated technical quality. The 10 most viewed videos in the WS were compared with 10 YTb videos with the highest technical scores. Results: Scoring systems measuring the quality of data and educational power of the mostly viewed WS visual content revealed higher scores than those of the most technically qualified 10 YTb videos (10 videos having the highest laparoscopic adrenalectomy scoring system scores [LASS-S]; P = .021; P = .003; P = .025, respectively). Also, there was no significant difference between the top 10 most viewed WS videos and 10 YTb videos having the highest LASS-S in terms of LASS-S (P = .34). Conclusions: Although WS videos were passed through a professional reviewing process, and were mostly provided by academicians, they remained below the expected quality. The presented research showed that attentively chosen YTb content on laparoscopic adrenalectomy is almost as accurate as WS content. Notwithstanding all its limitations, the informative power or potential of YTb should not be neglected.

Simple Blood Tests May Be Used to Predict the Increased Risk of Conversion in Elective Laparoscopic Cholecystectomy Surgery.

Background: In this study, we aimed to evaluate the possibility if simple blood tests that can be made in majority of hospitals may be used predict to risk of conversion to laparoscopic surgery to an open approach. Patients and Methods: The hospital records of 636 patients who underwent elective laparoscopic cholecystectomy (L-C) were retrospectively reviewed, and 583 patients included in the study protocol. Preoperative laboratory tests of all patients and data of patients who underwent conversion from laparoscopic surgery to open surgery were examined. Results: Of the 583 patients who were included in the study, 404 (69.29%) were female and the mean age was 50.02 ± 12.84 (19-89) years. The cholecystectomy was completed laparoscopically in 559 (89.5%) patients. The most common symptoms seen in the patients were epigastric discomfort and right upper quadrant pain. The high level of white blood cell (WBC) count and c-reactive protein (CRP) were found to be statistically significant before surgery in patients who had a conversion to open cholecystectomy (P < .001). Conclusion: Elevation of WBC count and CRP value before elective L-C may be useful in the prediction of a high risk of conversion from laparoscopic to open approach. This finding will help the surgeon to plan the treatment and inform the patient of the possibility before surgery.

Usefulness of Endoscopic Tattooing Before Neoadjuvant Therapy in Patients with Clinical Complete Response in Locally Advanced Rectal Cancer for Providing a Safe Distal Surgical Margin.

Background: Endoscopic tattooing of colorectal tumors enables tumor localization and determination of appropriate surgical margins. It becomes very difficult to detect the distal surgical margins (DSMs) of rectal tumors in patients who obtain clinical complete response (cCR) after neoadjuvant therapy. In this study, our aim is to examine the benefits of endoscopic tattooing of the tumor before neoadjuvant therapy in patients with locally advanced rectal cancer in accurate localization of the previous tumor and in providing appropriate DSMs in cases with cCR. Patients and Methods: The patients who were diagnosed with locally advanced rectal cancer, received neoadjuvant therapy and subsequently achieved cCR, and underwent surgery between January 2015 and October 2020 were included in the study. The patients were divided into two groups according to whether they were endoscopically tattooed before neoadjuvant chemoradiotherapy. Results: A total of 49 cases were included in the study. Significantly better DSMs were observed especially in female gender in the tattooed group. DSMs were found to be closer to the resection margins in the nontattooed group. It was found that endoscopic tattooing had a significant effect on the DSM in the regression analysis (P = .06, R2 = 0.47). It was determined that laparoscopy or open surgery alone did not differ in terms of DSMs but open surgery together with tattooing was found to be strongly effective in providing larger DSMs. Conclusion: In locally advanced rectal cancer, endoscopic tattooing of the distal margin of the tumor before neoadjuvant therapy is a reliable and effective method for obtaining a safe DSM and not leaving the residual tumor at the lower end of anastomosis, especially in cases of cCR.

Assessment of the Educational Quality, Accuracy, and Transparency of WebSurg Videos on Minimally Invasive Video-Assisted Parathyroidectomy.

Background The internet has changed the way both physicians and patients search for health information. WebSurg® is a valuable source of information that informs surgeons about new technologies and techniques and aims to promote quality, safety, and patient-centered care. In this study, our aim is to evaluate the popularity, quality, transparency, and accuracy of videos about minimally invasive video-assisted parathyroidectomy (MIVAP). Materials and methods A total of 31 videos related to MIVAP returned by the WebSurg® search engine in response to the keywords "MIVAP", "video assisted parathyroidectomy'', and "minimally invasive parathyroidectomy'' were included in this study. Videos were evaluated in terms of time since upload, run time, country, academic degree, and the number of views and likes. The popularity of videos was determined by the video power index (VPI) formula. The DISCERN questionnaire score (DISCERNqs), global quality score (GQSc), and Journal of American Medical Association benchmark criteria (JAMABC) scoring systems were used to analyze WebSurg® videos for reliability and quality. Results The academic degree of the members was MD in 90.32% of uploaded videos. Forty-eight point thirty-eight percent (48.38%) of the videos were uploaded by members from France. There was no significant difference between the DISCERNqs, JAMABC, GQSc, and MIVAP scoring system (MIVAP-SS) scores in terms of academic degree and country. A statistically significant negative correlation was found between the time since upload and the VPI score (r=-0.683, p<0.001). The run time was positively correlated with the DISCERNqs, JAMABC, GQSc, and MIVAP-SS scores (p=0.003, p=0.002, p=0.003, p<0.001, respectively). For the MIVAP-SS score, the Spearman correlation analysis demonstrated a statistically significant positive correlation with VPI, DISCERNqs, JAMABC, and GQSc (p<0.05). Conclusion Videos about MIVAP are helpful for surgeons to learn the procedure step-by-step before the surgery they will be performing but still below the expected quality. It is recommended to use MIVAP-SS points, which is a novel scoring system, to ensure standardization and improve quality.

The change in incidence of breast cancer by stage: how is it changed after the COVID-19 pandemic? A single-center retrospective study.

AIM: The impact of COVID-19 pandemic is pronounced in each healthcare process, including the management of breast cancer. The anxiety of COVID-19 changes patient preferences and some delay in routine controls and surgical managements occur. Some disintegration in medical care is to be expected during the pandemic, but the new coping strategies are needed in order to avoid delayed diagnosis of breast cancer. METHODS: A total number of 140 patients assigned for biopsy and diagnosed with breast cancer in our tertiary clinic between December 1st and August 31st were classified into 3 groups; A (December-February), B (March-May) and C (June-August) in order to compare the stage of breast cancer at the time of diagnosis before, during and after the peak period of pandemic. Clinical stage and age at presentation, family history of breast, ovarian and other types of cancer, BRCA (genetic testing), menopausal status, side of involvement (uni- or bilateral), histopathologic subtype, receptor positivity and molecular subtype were recorded for each patient. RESULTS: Group A included 20 stage I (27.77 %), 32 stage II (44.44 %), 16 stage III (22.22 %) and 4 stage IV (5.55 %) breast cancer patients. Group B had 5 stage I (22.72 %), 8 stage II (36.36 %), 7 stage III (31.81 %) and 2 stage IV (9.09 %) breast cancer patients. Whereas in group C there were 4 stage I (8.69 %), 21 stage II (45.65 %), 16 stage III (34.78 %) and 5 stage IV (10.86 %) patients with breast cancer. The number of late-stage cancer patients in group C was significantly higher in comparison with the other groups (p<0.05). CONCLUSION: We speculate that the change in incidence of breast cancer by stage is attributable to a delay in the diagnosis of breast cancer due to COVID-19 related restrictions and presentation of new cases at more advanced stages once the restrictions were eased. KEY WORDS: Biopsy, Breast cancer, COVID-19, PandemicStage.

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery.

Background In this study, we identified preoperative risk factors, including imaging features and blood tests, to predict conversion from laparoscopic appendectomy to open appendectomy. Thus, we aimed to prevent patients from being exposed to the risks of laparoscopy by choosing patients for whom proceeding directly to an open surgery as an initial approach was appropriate. Patients and methods The cohort of 632 patients who underwent laparoscopic appendectomy due to acute appendicitis in our center between January 2017 and March 2021 were analyzed, and 521 of these patients comprised the study population. Baseline characteristics, medical history, preoperative laboratory tests, imaging features, and postoperative pathologic findings of all patients according to groups who underwent laparoscopic appendectomy or conversion to open appendectomy were examined. Results Among 521 patients, the appendectomy procedure was completed laparoscopically in 498 (95.6%) patients, and conversion to open appendectomy was occurred in 23 (4.4%) patients. 223 (42.8%) patients were female, and 298 (57.2%) patients were male. The mean age of all patients was 35.17±12.61 years (range, 16-80 years). Preoperative ultrasonography feature associated with a higher rate of conversion was free fluid collection (p=0.001). The levels of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio on admission were found to be significantly higher in the conversion group compared to the laparoscopy group (p=0.001, p=0.027, p=0.02, respectively).  Conclusions Free fluid collection detected by ultrasonography, and elevation of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio may be useful in the prediction of a high risk of conversion appendectomy. Despite the unquestionable advantages of laparoscopic surgery, there are still substantial conversion rates. Within this framework, our study will help the surgeons to choose the most appropriate surgical methods for patients by evaluating them individually, and to inform them of the possibility of conversion to the open approach, and other risks before surgery.

Management of the Axilla and the Breast After Neoadjuvant Chemotherapy in Patients with Breast Cancer: A Systematic Review.

Breast cancer is the most common cancer in women worldwide. Breast cancer is traditionally treated with surgery, plus adjuvant systemic therapy and radiotherapy as required. Neoadjuvant chemotherapy (NACT) for the treatment of breast cancer is used for locally advanced operable breast cancer to reduce the tumor size, to perform breast conserving surgery, and to perform a limited axillary approach. Adjuvant chemotherapy for the treatment of inflammatory breast cancer and even in inoperable breast cancer is used to increase overall survival time and to delay disease progression while relieving symptoms. NACT for breast cancer is a new strategy that was introduced toward the end of the 20th century and is increasingly used in the treatment of breast cancer. At present, NACT is increasingly being used to reduce the need for axillary dissection and to convert patients with large tumors to candidates for breast conservation therapy in both locally advanced and operable breast cancers. Breast conserving procedures are currently more preferred by surgeons and axillary dissection is being replaced by sentinel lymph node biopsy after chemotherapy. One of the targets of neoadjuvant systemic therapy is to try to perform a less aggressive surgery by breast conservation, mainly for cosmetic reasons and avoiding axillary dissection mainly for arm mobility, pain, and lymphedema risk. The other target of neoadjuvant systemic therapy is to see the response of the tumor to chemotherapy and determine the treatment accordingly. Neoadjuvant systemic therapy increases the rate of complete pathological response by clearing the breast and axilla from tumor cells before surgery. In this review, we examine the key points of using the NACT in breast cancer, considering radiological imaging methods, surgical management, and reconstruction after NACT.

Giant parathyroid adenoma diagnosed by brown tumour, a clinical manifestation of primary hyperparathyroidism: A case report.

Brown tumour (BT) is the pathological expression of osteitis fibrosa cystica which is caused due to primary and secondary hyperparathyroidism (HPT). It is a rare benign lesion of skeletal system that usually affects the facial bones, clavicles, ribs, pelvis and extremities. The purpose of this case report is to present the clinical, pathological and radiological findings of BT - rarely seen in adults - originating from the giant parathyroid adenoma and emerging as the first clinical sign of HPT. The patient underwent a successful parathyroidectomy and was discharged on the first postoperative day without any complications. Histopathologically, it was confirmed as parathyroid adenoma. With the increased use of biochemical tests, HPT is diagnosed and treated early and so the frequency of symptomatic HPT due to parathyroid adenoma has decreased in developed countries, but we still sometimes encounter cases of primary hyperparathyroidism (PHPT) occurring as BT. With multidisciplinary preoperative evaluation, surgical resection of bones is refrained from in order to prevent unnecessary morbidity and mortality, unless these osteolytic bone lesions cause a pathological fracture.

Evaluation of the Reliability, Utility, and Quality of the Information in Transoral Endoscopic Thyroidectomy Vestibular Approach Videos Shared on Open Access Video Sharing Platform YouTube.

Background: The internet is a broadly preferred source of information both by patients and medical professionals. YouTube™ is a significant information source that may be a useful tool to inform the public, medical students, and residents, and may improve the learning experience if used adequately. In this study, we aimed to estimate the quality and accuracy of videos regarding Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) aired on YouTube, which is the most popular video platform of the online world. Materials and Methods: We evaluated the first 50 videos, returned by the YouTube research engine, in reply to the "TOETVA" keyword. The popularity of the videos was assessed using the video power index (VPI). The educational quality, accuracy, and transparency of the content regarding TOETVA were estimated by using the DISCERN questionnaire score (DISCERNqs), Journal of American Medical Association benchmark criteria (JAMABC), and global quality score (GQSc). The technical quality was ranked through TOETVA Scoring System (TOETVA-SS) by a TOETVA practicioning endocrine surgeon. Results: The content of the videos were about surgical technique with a rate of 68%. According to sources, videos uploaded by physicians had significantly higher DISCERNqs, JAMABC, GQSc, and TOETVA-SS scores. Unlike, videos uploaded by physicians had a lower VPI than videos uploaded by nonmedical sources. The videos of surgical technique had significantly higher DISCERNqs, JAMABC, GQSc, and TOETVA-SS scores. Surgical technique videos also had higher VPI scores than "information about disease or surgery" videos. Also, negative correlations were found between the VPI (popularity index) and educational value (GQSc), transparency (JAMABC), and technical quality (TOETVA-SS) scores. Conclusions: The data acquired from YouTube videos regarding TOETVA is of below expected quality and reliability. Nevertheless, the educative potential of the online video platform, YouTube, cannot be underestimated.

Comparison of the management of emergency and oncological surgeries during the COVID-19 pandemic with the previous experience. A single-center retrospective study.

AIM: The aim of this study is to point out the changes and possible delay in diagnosis or treatment of malignancies and an added risk of COVID-19 exposure emerging from these interventions, as well as to underline the increase of surgical demand once the pandemic measures are eased. METHODS: This study is a retrospective review of the patients operated between 11.03.2020 and 31.05.2020 in a center with a high incidence of COVID-19 infection during the pandemic. The numbers of emergency, elective and oncological surgeries as well as the increasing or decreasing trends of these interventions between March 11 and May 31 of previous years were compared with the corresponding period of 2020 or in other words the pandemic period. RESULTS: From March 11 to May 31, 2020 there was a progressive reduction in surgical activity, with only 195 operations: 61(31,28%) on a scheduled basis for tumor pathology, 59(30,25%) for benign pathology and 75(38,46%) for emergency indications. When the surgical trends of previous years are considered, all types of oncological surgeries decreased significantly in pandemic period March 11 to May 31, 2020. CONCLUSION: One of the most striking changes in medical care settings during the COVID-19 pandemic was observed in surgical management strategies. The most significant among these were the limitation of elective surgical procedures and the prioritization of emergency or non-delayed oncological operations. One may speculate that the standstill of elective surgeries including the oncological surgeries might have long term impacts on the clinical outcomes of patients as well as the healthcare workers and organizations. KEY WORDS: COVID-19, Emergency, Oncology, Pathology, SARS-CoV-2, Surgery.

Pseudoangiomatous stromal hyperplasia causing severe breast enlargement in a 15-year-old girl: A case report.

Pseudoangiomatous stromal hyperplasia (PASH), composed of proliferated stromal mesenchymal cells of myofibroblastic origin, is a benign lesion of the breast. A few cases associated with pseudoangiomatous stromal hyperplasia of the breast have been reported. We report this case of a 15-year-old girl with PASH accompanied by severe enlargement and painful mass in the right breast. There were no other palpable masses or lymph nodes. Biopsy of the mass showed histopathologic features characteristic of fibroadenoma. The palpable mass was around 6x5cm in diameter, while clinical manifestations aroused suspicion of malignancy mimicking sarcoma of the breast. Although, biopsy of the mass showed benign histopathologic features; surgical excision was performed because of the damage caused by enlarging breast tissue and clinical suspicion of malignancy.

Management of Breast Cancer during the COVID-19 Pandemic.

The novel coronavirus disease (COVID-19) arises from the virus SARS-CoV-2 which is similar to the original SARS virus. The most common symptoms of the COVID-19 infection are fever, coughing and shortness of breath. According to the current data, the primary mode of transmission for the COVID-19 virus is between people through respiratory droplets and contact routes. The virus may lead to worse respiratory complications, including pneumonia, especially in older patients and patients with pre-existing illnesses, such as cancer. Cancer patients are at a significantly higher risk of getting infected with COVID-19 since their immune system can be compromised and that reality has to do with both that they have cancer and that they are on therapy for their cancer. COVID-19 crisis has impacted every aspect of the practice, including outpatient, elective, wards, emergency care, conferences, teaching and research. We should make sure cancer patients on active treatment are treated appropriately. In this review, we tried to explain how to prevent the negative effects of the COVID-19 pandemic on the diagnosis and treatment of breast cancer patients.