The importance of predictive markers in incarcerated abdominal wall hernia.

PURPOSE: Emergency abdominal wall hernia repairs play a significant role in general surgical emergencies. In such cases, the time taken to decide on surgery is crucial, as the situation may progress to necrosis, perforation, and organ resection due to strangulation following incarceration. To facilitate the early detection of this condition, studies have been conducted on various predictive markers, most of which are related to similar markers used in acute mesenteric ischemia. This study aims to assess the predictive significance of preoperative laboratory and imaging findings in incarcerated abdominal wall hernia with strangulation. METHODS: Retrospectively, 122 patients who underwent emergency surgery for incarcerated abdominal wall hernias with a preoperative diagnosis between January 1, 2018, and September 1, 2023, at the General Surgery Clinic of Samsun University Education and Research Hospital were included in the study. According to the examination of the operation notes, Group I was designated for patients who underwent bowel resection, Group II for those who underwent omental resection, and Group III for those without resection. The study investigated the association between patients 'age, gender, hernia type and side, preoperative laboratory parameters (pH, Base Excess (BE), Lactate, White Blood Cell Count (WBC), Neutrophil (N), Lymphocyte (L), Monocyte (M), Platelet (P), C-Reactive Protein (CRP), and pH/BE, pH/Lactate, Lactate/BE, N/L, N/M, L/M, N/CRP, M/P, P/CRP ratios), physical examination (PE), and imaging findings among the resection groups. RESULTS: Out of the 122 patients operated with a preliminary diagnosis of acute incarcerated abdominal wall hernia, 68 were female, 34 were male, and the median age was found to be 67.16 (30-99). In the conducted statistical analysis, mean values of Lactate (p = 0.007), WBC (White Blood Cell) (p = 0.001), Neutrophil (p < 0.001), and NLR (Neutrophil-to-Lymphocyte Ratio) (p = 0.003) were significantly different based on resection groups. Subsequent pairwise comparisons indicated that these differences were attributed to variations in mean values of Lactate, WBC, Neutrophil, and NLR between the Bowel Resection and Resectionless groups. Mean values of Monocytes were also significantly different among resection groups (p = 0.049), and pairwise comparisons revealed that this difference was due to variations in mean values of Monocytes between the Omental Resection and Resectionless groups. The cut-off values were determined as follows in the ROC analysis: 1.2 mmol/L for Lactate, 18.5 (10^9/L) for WBC, 8.1 (10^9/L) for Neutrophil and 10 mg/L for CRP concerning bowel resection. CONCLUSION: In cases of abdominal wall hernia operations due to incarceration, bowel and/or intra-abdominal organ resections related to strangulation can lead to significant morbidity and mortality. Beyond the imaging methods available for preoperative assessment, high levels of laboratory parameters, including Lactate, WBC, Neutrophil, and NLR ratio, may primarily indicate the need for bowel resection, considering that omental resection is associated with lower morbidity and mortality compared to bowel resection, elevated levels of monocytes may primarily indicate the requirement for omental resection in emergency abdominal wall hernia surgery. We recommend that this be prioritized in emergency surgery to prevent complications such as bowel perforation and sepsis and improve clinical outcomes. The surgeon is advised to keep this in mind.

A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey.

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

Comparison of the analgesic efficacy of the ultrasound-guided transversalis fascia plane block and erector spinae plane block in patients undergoing open inguinal hernia repair under spinal anesthesia.

BACKGROUND: Open inguinal hernia repair (OIHR) surgery is a common surgical procedure, and ultrasound guided interfascial plane blocks can also be included in current approaches to postoperative multimodal analgesia regimens. This study aimed to compare the postoperative analgesic efficacy of the erector spinae plane block (ESPB) and transversalis fascia plane block (TFPB) in patients undergoing OIHR. METHODS: This prospective, randomized, assessor-blinded comparative study was conducted in the postoperative recovery room and ward of a tertiary hospital. A total of 80 patients with American Society of Anesthesiologists physical status I-III were enrolled and allocated equally to either the ESPB or TFPB group. The patients received standard multimodal analgesia in addition to an ultrasound-guided ESPB or TFPB. During the first 24 h postoperatively, tramadol consumption was assessed and pain levels at rest and during movement were compared using numeric rating scale (NRS) scores at 1, 3, 6, 9, 12, 18, and 24 h postoperatively. RESULTS: The results showed no difference in NRS scores at any time point between the groups, except for NRS at rest in the third hour. However, tramadol consumption was lower in the TFPB group than in the ESPB group overall (88 ± 75.2 vs. 131 ± 93.7 mg, respectively; P = 0.027, mean difference: -43, 95% CI [-80.82, -5.18]). CONCLUSIONS: The TFPB leads to lower tramadol requirements in the first 24 h postoperatively than the ESPB in patients undergoing OIHR.

Laparoscopic Sleeve Gastrectomy: Impact on Body Mass Index and Thyroid Hormones in Euthyroid Obese Patients.

BACKGROUND Obesity is still a major global public health problem and its incidence is increasing. Obesity leads to deterioration in thyroid functions. Even when they are within normal ranges, high normal levels of thyroid-stimulating hormone (TSH) increase morbidity and mortality. This study aimed to evaluate the body mass index (BMI) and TSH levels in 300 euthyroid patients with obesity before and after laparoscopic sleeve gastrectomy (LSG). MATERIAL AND METHODS A total of 300 euthyroid patients who underwent LSG between 2019 and 2021 were included in the study. Body mass index (BMI), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT) 3 and tetraiodothyronine (FT4) levels were recorded before surgery and at 6 and 12 months after surgery and subsequently analyzed. RESULTS Mean BMI values were significantly lower at 6 and 12 months after surgery (P<0.001). There was a significant difference between mean TSH and FT4 levels before surgery and those at 6 and 12 months after surgery (P<0.001). However, mean FT3 levels remained unchanged 1 year after surgery (P=0.005). CONCLUSIONS LSG is not only effective in terms of weight loss, but also exhibits improving effects on thyroid hormone homeostasis in obese patients and provides protection against further adverse effects of TSH.

COVID-19 outbreak and acute appendicitis: Does the lockdown has a influence on appendectomies?-A single center retrospective cohort study.

Objectives: Healthcare systems have been negatively affected from COVID-19 pandemic worldwide. Elective surgical procedures were postponed and conservative treatment options were considered even in urgent conditions. This study aimed to explore the influence of the COVID-19 pandemic on urgent appendectomy in a pandemic hospital. Material and Methods: Patients on whom appendectomy was performed between March 2020- June 2020 were included into the study (pandemic group). For comparison, control group patients were selected in the same period of 2019 (control group). Patients' demographics, laboratory and radiological findings, length of hospital stay, complications and histopathological findings of the groups were compared. Results: Forty-six patients were included in pandemic group and and one hundred-one in the control group. Patient characteristics were similar in both groups. There were no significant differences in type of surgery, complications, laboratory and histopathological findings. In the control group, length of hospital stay was longer when compared with the pandemic group. Conclusion: Although the number of appendectomies performed decreased significantly during the COVID-19 pandemic, perioperative parameters were similar in both groups.

Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis.

Background: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with a high recurrence rate. The serum albumin to globulin ratio (AGR) is a relatively novel biomarker in inflammatory diseases, and one whose role in the recurrence of IGM remains unknown. This study primarily investigated the potential risk factors for IGM recurrence and whether AGR can be used as a predictive factor. Methods: Patients diagnosed with IGM from pathology reports between 2016 and 2021 were enrolled in the study, and their medical records were analyzed retrospectively. The patients were divided into two groups - recurrence and non-recurrence. Clinical, demographic characteristics, and laboratory parameters were compared. Results: Eighty-five patients were included in the study, recurrence being detected in 16 (18.8%) of these, with a median follow-up time of 39.99±18.93 months. No relationship was determined between childbearing, breastfeeding, disease severity, or therapeutic approaches and IGM recurrence. While AGR was significantly lower in the recurrence group (p < 0.001), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) results were comparable in the two groups (p = 0.472 and p = 0.421, respectively). Multivariate analysis identified low AGR (odds ratio (OR): 50.7, 95% CI 5.93-434.1 P < 0.001) and smoking (OR: 4.45, 95% CI 1.04-18.9 P = 0.044) as independent risk factors for IGM recurrence. Conclusion: The study findings indicated that AGR at a cut-off value of ≤1.179 at diagnosis and smoking exhibited a remarkable performance in predicting the recurrence of IGM. Developing new risk stratification systems for IGM recurrences and using AGR in these classifications may increase the success of treatment. Trial Registration: This study was registered with ClinicalTrials.gov, NCT05409586.

Is platelet-rich plasma improves the anastomotic healing in hyperthermic intraperitoneal chemotherapy with oxaliplatin: an experimental rat study.

PURPOSE: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a novel treatment option for peritoneal surface malignancies. Due to cytotoxic effects of chemotherapeutic agents, anastomosis healing can be impaired and lead to leakage rates higher than conventional intestinal surgery. In this experimental study, we aimed to investigate the effects of platelet-rich plasma (PRP) on colonic anastomosis in rats that received HIPEC with oxaliplatin. METHODS: Thirty rats were divided into 3 groups. Group 1 was determined as control group and hyperthermic saline perfusion was performed after colon anastomosis. In group 2, colon anastomosis then hyperthermic oxaliplatin perfusion was performed. In the last group, the colonic anastomosis was enhanced by PRP gel and then hyperthermic oxaliplatin perfusion was performed. All the rats were reoperated on postoperative day 7 and anastomotic bursting pressure values were recorded. Tissue samples were taken for hydroxyproline assay and histopathological examination. RESULTS: Control group had higher anastomotic bursting pressure value than group 2 and group 3 (P < 0.001). There were significant differences in anastomotic bursting pressure between groups 2 and 3 (P < 0.001). Group 2 had significantly lower hydroxyproline levels than group 3 and control group (P < 0.001). Histopathological examination revealed that PRP application reduced inflammatory response. CONCLUSION: PRP application on colonic anastomosis improves anastomotic healing and can reduce anastomosis related complications and stoma creation; though further clinical studies are needed.