IntroductionThe mortality rate of perforated peptic ulcer is still high particularly for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients. This study’s aim was to develop an easy and applicable scoring system to predict mortality based on hospital admission data.MethodsTotal 227 patients operated for perforated peptic ulcer in two centers were included. All data that may be potential predictors with respect to hospital mortality were retrospectively analyzed.ResultsThe mortality and morbidity rates were 10.1% and 24.2%, respectively. Multivariated analysis pointed out three parameters corresponding 1 point for each which were age >65 years, albumin ≤1,5 g/dl and BUN >45 mg/dl. Its prediction rate was high with 0,931 (95% CI, 0,890 to 0,961) value of AUC. The hospital mortality rates for none, one, two and three positive results were zero, 7.1%, 34.4% and 88.9%, respectively.ConclusionBecause the new system consists only age and routinely measured two simple laboratory tests (albumin and BUN), its application is easy and prediction power is satisfactory. Verification of this new scoring system is required by large scale multicenter studies.

BackgroundPilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF).Material/MethodsThe data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined.ResultsThe mean age was 28.4 years (14–77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01).ConclusionsAccording to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Objectives: To investigate the influence of the metastatic lymph node/total lymph node ratio (N-ratio) on survival and prognosis in surgically treated gastric carcinomas. Methods:A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). Original ArticleResults: Group 2 patients had a total lymph node mean of 25.10±13.64 while Group 1 patients had a total lymph node mean of 18.77±9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97±10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). Conclusion:The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.

ÖZAmaç: Tiroid nodülleri tiroid glandının en önemli patolojilerindendir. Tiroid nodüllerinde, bazı özel-liklerin bulunması nodülün malign olma olasılığını artırmaktadır. Çalışmamızda, bu parametrelerden özellikle nodül çapının malignite ile olan ilişkisini ve ek olarak bunun yanında ultrasonografi de karşılaş-tığımız diğer risk faktörlerinin malignite açısından destekleyici özelliklerini incelemeyi amaçladık. Gereç ve Yöntemler: Çalışma Ankara Numune Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği'nde 2006-2012 yılları arasında opere edilen toplam 271 olgu üzerinde yapılmıştır. Olgular; yaş, cinsiyet, USG ( nodül boyutu, yapısı, sayısı, ekojenitesi, kontur özellikleri, kalsifikasyon durumu) bulgularına ve İİAB sonuçlarına göre değerlendirildi. Bulgular: Çalışmaya dahil edilen 271 hastanın, 227'si(%83,8) kadın, 44'ü(%16) erkekti. Hastaların yaş ortalaması 49,2 ± 13 idi. Tek nodül çapı ile malignite arası değerlendirme yapıldığında; hastaların nodül çapı ile postoperatif sonuç arasında anlamlı bir ilişki olduğu görüldü (p=0,001). Benign nodüller içerisinde çapı 1 cm'den az olanların oranı daha az iken, malign nodüller içerisinde ise çapı 1 cm'den az olanların oranı daha fazla tespit edildi. Multinodüler grupta ise malignite ve çap arasındaki ilişki anlamlı bulunmadı (p=0,679). Sonuç: Nodül çapı ile malignite arasında anlamlı bir ilişki mevcut olup, bu ilişki soliter nodüllerde daha anlamlı olmakla beraber, küçük çaplı nodüller daha malign bulunmuştur. Nodül çapı tiroid nodül takibinde önemlidir ancak, benign-malign ayrımında tek başına çok anlam ifade etmemektedir. Anahtar Sözcükler: Tiroid nodülü, Tiroid kanseri, Nodül çapı-malignite ilişkisi ABSTRACT Objective: Thyroid nodules are the most important pathologies of the thyroid gland. The presence of certain features in thyroid nodules increases the likelihood that the nodule is malignant. In our study, we aimed to investigate the relationship between malignancy and nodule diameter, and other risk factors that we encountered on ultrasonography (USG) in terms of malignancy. Material and Methods: This study was carried out on 271 cases operated between 2006 and 2012 at the Clinic of General Surgery, Ankara Numune Training and Research Hospital. Features such as age, gender, USG (nodule size, structure, number, echogenicity, contour features, calcification status) were evaluated according to the findings and the results of fine needle aspiration biopsy (FNAB). Results: Of the 271 patients included in the study, 227 (83.8%) were female and 44 (16%) were male. The mean age for all groups was 49.2 ± 13. When single nodule diameter and malignancy were evaluated, there was a significant correlation between nodule diameter and post-operative outcome of the patients (p = 0.001). The proportion of nodules with a diameter less than 1 cm was lower in benign nodules while nodules with a diameter less than 1 cm were more common among malignant nodules. In the multinodular group, the relationship between malignancy and diameter was not significant (p = 0.679). Conclusion: The...

Introduction: COVID-19 has spread all over the world and caused significant changes in healthcare practices. This is why many expert associations have published new guidelines on COVID-19 management. This study aims to investigate whether the COVID-19 pandemic has an effect on Inguinal hernia (IH) emergencies. Material and Method: A total of 63 patients diagnosed with strangulated/incarcerated inguinal hernia who presented to the emergency surgery department of our hospital between April 2020 and January 2021 during the pandemic (DP) and between April 2019 and January 2020 before the pandemic (BP) were retrospectively analyzed and compared. Results:There was no statistically significant difference between both groups in terms of demographic characteristics. The comparison of the number of admissions, admission time, anesthesia type, hospital stay, postoperative complications, ASA score, hernia, WBC, and CRP averages showed no statistically significant difference between the groups. Moreover, there was no statistically significant difference between the two groups in terms of distributions of hernia types, hernia repair types, mesh use, and additional resection requirement. The comparison of the patients who underwent organ resection by admission time in both groups showed no statistically significant difference. It was observed that the number of patients who required small bowel resection were especially high on the 4th day. In DP, small bowel resection was performed on 4 (66.7%) patients and omentectomy was performed in 2 (33.3%) patients. In BP, only one right hemicolectomy was performed. The comparison of the patients with an admission time of 4th day revealed a statistically significant difference (p=0.03). Conclusion: We observed that morbidity increased as the admission time was delayed. Anticipating that the fear of COVID-19 infection will hold back the emergency response during the pandemic period, patients should be informed not to delay early diagnosis and treatment.