Investigation of postoperative erectile dysfunction in colorectal surgery patients and comparison of results.

BACKGROUND: Although surgical treatment is curative for colorectal cancers, erectile dysfunction (ED) is one of the complications that affect the patient quality of life. The present study aimed to evaluate sexual dysfunction in patients who underwent anterior resection (AR) and low AR (LAR) surgery secondary to rectosigmoid pathologies in our clinic, to analyze the effective variables, and to compare the results. METHODS: In the retrospectively designed study, male patients who underwent surgery for malignancy or other surgical pathologies in the General Surgery Clinic between January 2017 and December 2022 were examined. Female gender, patients under 18 years of age, and patients who refused to participate in the study were excluded. RESULTS: The high age of the patient increased the risk of severe ED in the postoperative period. However, surgical technique, alcohol use, American Society of Anesthesiologists (ASA) score, and Clavien-Dindo class were not determinants in the presence of severe ED. CONCLUSION: ED is an emerging medical problem that affects patients who undergo colorectal surgery adversely both in social and psychological aspects. Discussions on the issue are still ongoing. Clinicians' concerns can be addressed in the future as the number of prospectively designed studies involving more homogeneous and larger populations increases.

Investigation of factors that may potentially affect anxiety in patients undergoing esophagogastroduodenoscopy and evaluation of sedation effect.

BACKGROUND: As with any other invasive procedure, esophagogastroduodenoscopy (EGD) may lead to considerable anxiety in patients. This study aimed to investigate and compare the effects of sedated and non-sedated procedures on anxiety in patients undergoing EGD and to better recognize patient groups at risk for anxiety. METHODS: In this prospective and 2-armed designed study, demographic data, including age, gender, comorbidities, height, weight, body mass index (BMI), and educational background, were collected. In this study, the Beck Anxiety Inventory (BAI) was administered to each patient before they were brought to the endoscopy unit. Subsequently, each patient who underwent EGD was telephoned on the seventh day after the procedure and the BAI was administered a second time. RESULTS: Women population had higher pre-EGD and post-EGD BAI scores compared to men. No significant correlation was observed between educational background and BAI scores. Possible correlations between age, BMI, Charlson comorbidity index (CCI), and BAI scores were examined. There was a weak correlation between BMI and pre-EGD and post-EGD BAI scores. A strong and positive correlation was observed between the pre-EGD BAI score and post-EGD BAI and difference in BAI scores between groups (ΔBAI). CONCLUSION: Endoscopic procedures may cause anxiety in patients as with all other invasive procedures. Patients' compliance with the procedure and having a lower level of anxiety are very significant for diagnostic and, if necessary, therapeutic success. In this study, the patient gender was evaluated as a predictor of anxiety level, whereas educational background was not a predictor.

Non-malignant left colon emergency surgery: evaluation of factors affecting clinical outcomes and complications.

BACKGROUND: Emergency colorectal resections hold a significant position in general surgical practice, and pathologies of the left colon are relatively common. This study was conducted to assess the outcomes of isolated left colon surgeries with benign etiologies, drawing on clinicopathological and biochemical data. METHODS: We carried out a retrospective review and statistical analysis of demographic, clinical, and laboratory data of patients who underwent left colon surgery at the general surgery clinic of a tertiary care hospital, excluding those with malignancy-related emergencies, from January 2017 to January 2022. RESULTS: The average age of the 48 patients in the study was 56.9±16.4 years. Complicated acute diverticulitis was the most frequent indication for emergency surgery (n=19, 39.6%). The Hartmann procedure was the surgical technique most often employed (n=30, 62.5%). The rates of postoperative morbidity and mortality within 30 days were 27.1% and 8.3%, respectively. Increased postoperative morbidity was linked to advanced age (mean 65.4±15.8 vs. 53.8±15.7, p=0.028), the preoperative administration of vasopressors, lower platelet counts, hypoalbuminemia (<3 mg/dl), and azotemia (blood urea nitrogen >20 mg/dl). There was no statistically significant correlation between comorbidities, American Society of Anesthesiologists (ASA) scores, surgical methods, or other clinical data and postoperative outcomes. CONCLUSION: For emergency colorectal surgery pertaining to left colon pathologies, it is critical to conduct a comprehensive evaluation in the perioperative period, especially for elderly and hypotensive patients with renal function abnormalities and for those requiring vasopressors.

Fournier's Gangrene: Evaluation of Patient Outcomes Using Clinical Data and Prognostic Biomarkers.

OBJECTIVE: To find out the outcomes of Fournier's gangrene (FG) patients using clinical data and prognostic biomarkers based on the current literature. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey, from January 2018, to January 2022. METHODOLOGY: Patients who were diagnosed with and treated for FG were included in the study. Patients younger than 18 years of age, those with missing hospital records and postoperative follow-up data, those with benign diseases related to the perianal or anal region, and those with other malignant diseases were excluded from the study. Patients' demographic, clinical, and laboratory data, including the calculated systemic immune-inflammation index (SII) and pan-immune-inflammation values (PIV) were obtained retrospectively from the medical records. Variables were analysed using SPSS statistics software, version 25.0. The value of p <0.05 was considered statistically significant. RESULTS: A total of twenty-four patients, 14 (58.3%) males and 10 (41.7%) females, were included in this study. No statistically significant correlations were found between the calculated indices and patients' clinical outcomes. The length of intensive care unit stay was strongly and positively correlated with age (r = 0.672 and p <0.001), and the length of hospital stay was moderately and inversely correlated with preoperative albumin levels (r = -0.584 and p = 0.003). CONCLUSION: SII and PIV had no statistically significant interactions with FG. KEY WORDS: Fournier's gangrene, Systemic immune-inflammation index, Pan-immune-inflammation value, Colostomy, Albumin.

A rare case of pantaloon hernia accompanied by strangulated ileal segment: Inguinal herniation of the bladder.

Mesanenin inguinal kanal içine herniasyonu nadir görülen bir klinik antitedir ve tüm inguinal hernilerin yaklasik %1-4'ünü olusturmaktadir. Genellikle yasli erkek hastalarda ve sag tarafta sik görülmektedir. Hastalar çogunlukla asemptomatik oldugundan, intraoperatif olarak tani almaktadir. Preoperatif süreçte taninin dogrulanmasi, olasi mesane yaralanmalarinin önüne geçebilmek adina önem teskil etmektedir. Biz de bu çalismamizda; akut mekanik intestinal obstrüksiyon ve strangülasyon semptomlariyla acil servise basvuran hastada, mesane herniasyonunun eslik ettigi nadir bir pantolon herni olgusunu literatür esliginde sunmayi amaçladik.

Acute appendicitis over the age of 50: The evaluation of the impact of clinical variables on operative and post-operative outcomes.

BACKGROUND: Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis. METHODS: Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail. RESULTS: A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively). CONCLUSION: The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.