General Surgery Clinic Research Articles

The effect of cyberchondria on anxiety and surgical fear levels in surgical oncology patients

Abstract This study was conducted to examine the relationship between cyberchondria, surgical fear and anxiety in patients undergoing oncological surgery. This descriptive study was conducted with 163 patients in the general surgery clinics of a university hospital in Türkiye between January and December 2023. The study revealed that mean total scores of cyberchondria, surgical fear and anxiety scales were moderate with values of 39.87 ± 12.66, 45.84 ± 19.80, and 28.83 ± 11.76, respectively. A moderately significant positive correlation was observed between cyberchondria and surgical fear and anxiety levels (r:0.688, and r:0.684; p = 0.000, respectively), while a strongly significant positive relationship was found between surgical fear and anxiety levels (r: 0.759, p = 0.000). The results also demonstrated that 47% of patients’ fear of surgery could be attributed to the independent variable of cyberchondria (R2: 0.470). The results demonstrated that 46% of the variance in anxiety levels could be attributed to the cyberchondria independent variable (R2: 0.468). The pervasive use of the internet has given rise to a growing tendency among individuals to seek disease-related information online. The study found that the patients exhibited moderate levels of cyberchondria, with an increase in the tendency corresponding to an increase in surgical fear and anxiety. It is recommended that healthcare professionals share detailed information with patients in a way that does not encourage them to engage in excessive online medical research and allocate sufficient time to patients to alleviate their surgical anxiety and fear.

Relationship Between Preoperative Surgical Fear, Anxiety, and Satisfaction Levels in Individuals Choosing Bariatric Surgery Tourism: A Descriptive, Cross-Sectional Study.

Bariatric surgical tourism is a rapidly growing sector. The aim of this study was to evaluate the preoperative surgical fear, anxiety, and satisfaction levels regarding bariatric surgery tourism processes and to examine the relationships between these variables. This descriptive, cross-sectional study was conducted between July and November 2024 with foreign patients who visited the general surgery clinic of a healthcare institution for bariatric surgery within the scope of health tourism. Data were collected through face-to-face interviews using the Patient Information Form, Surgical Fear Scale, and Surgical Anxiety Scale. All results were evaluated within a 95% confidence interval, with statistical significance set at p < 0.05. The mean age of the patients was 39.39 ± 9.35years, and 88.5% were from the UK. Additionally, 88.5% reported choosing bariatric surgery tourism due to high surgical costs in their home country. The mean score for surgical fear was 37.68 ± 20.58, while the mean score for surgical anxiety was 19.53 ± 12.90. Patients who lacked prior knowledge about bariatric surgery tourism had significantly higher surgical fear and anxiety scores (p < 0.05). Age, fear and anxiety associated with undergoing surgery in a foreign country, and total surgical anxiety scale score were identified as independent predictors of patients' satisfaction with their bariatric surgery tourism experience (R2 = 0.130; p < 0.01). Preoperative knowledge levels and satisfaction with the information provided significantly impacted surgical fear and anxiety levels among bariatric surgery tourism patients.

Evaluation of the necessity of simultaneous cholecystectomy in patients undergoing liver hydatid cyst surgery.

Liver hydatid cysts remain a significant public health issue in Turkey, the Middle East, East Asia, and Russia. Surgical treatments are often employed for certain stages of this disease. However, the necessity of simultaneous cholecystectomy during these procedures remains unclear. Treating symptoms related to subsequent cholelithiasis can become more challenging. This study investigates the necessity of simultaneous cholecystectomy by following patients who underwent hydatid cyst surgery with or without concurrent cholecystectomy. Patients who underwent surgery for hydatid cysts between 2019 and 2024 at the General Surgery Clinic of Ankara Bilkent City Hospital were retrospectively reviewed. A total of 97 patients were included, with 56 (54.32%) undergoing cholecystectomy along with hydatid cyst surgery (Group 1) and 41 (45.68%) not undergoing cholecystectomy (Group 2).Preoperative clinical, laboratory, and radiological findings, as well as intraoperative data, morbidity, mortality, and postoperative symptoms, were analyzed. Patients in Group 1 had longer hospital stays, higher blood loss, and significantly higher Clavien-Dindo complication scores. In the postoperative follow-up of Group 2, 8 patients (19.51%) developed stones or sludge, and 1 patient (2.4%) developed polyps. Four patients (9.75%) presented to the emergency department with cholecystitis symptoms. A total of 5 patients (12.19%), including 4 with symptomatic cholelithiasis (9.7%) and 1 with gallbladder polyps (2.4%), underwent elective cholecystectomy. Two (40%) of these cholecystectomies were performed laparoscopically, while three (60%) were converted to open cholecystectomy. Simultaneous cholecystectomy during liver hydatid cyst surgery may prevent difficulties associated with treating symptoms related to subsequent cholelithiasis.

A questionnaire on the perception of social and academic discrimination against female general surgeons in Türkiye.

The purpose of this research was to identify the specific prejudices that women in general surgery in Türkiye have to face in their workplace and academic careers. This was achieved by gathering the opinions of both genders on these issues and raising awareness of gender bias to promote a more inclusive environment for future generations of surgeons. A total of 202 people, 99 male and 103 female surgeons, participated in the survey. The questionnaire was distributed to people working in general surgery clinics via e-mail and WhatsApp groups of the Turkish Surgical Association and the Turkish Colorectal Association. The mean age of the participants was 37.65±11.55 years (ranging from 24 to 74 years). Among the partipiciants, 40.4% agreed that surgery is more suitable for males, while 89.3% of women disagreed (p<0.001). 88.3% of the women stated that women are negatively influenced in choosing general surgery because of the male-dominated environment, and 52.5% of men agreed, while 40.4% of men disagreed (p<0.001). 66.7% of men and 65% of women believed that women do not prefer to work in general surgery because it is difficult to balance with family responsibilities (p=0.890). Women are more subjected to humiliating behaviors, while 53.4% of women agree. 85.4% of the women stated that it is important to have a female lecturer as a role model in the institution where they work. This study shows different views on gender prejudice among male and female surgeons in general surgery. Female respondents, including male and female surgeons, indicated experiencing bias and underrepresentation in academic disciplines, although they had differing perspectives on discrimination. Both genders agreed on the difficulty of work-life balance, with a similar percentage of individuals identifying family responsibilities as an obstacle.

Does intraoperative neuromonitoring during thyroidectomy reduce the risk of hypoparathyroidism?

Objectives: To evaluate the effect of intraoperative neuromonitoring on postoperative hypoparathyroidism after bilateral total thyroidectomy. Method: The prospective study was conducted at the General Surgery Clinic of the University of Health Sciences Haseki Training and Research Hospital, Turkiye, from February 2016 to December 2020, and comprised patients who had undergone bilateral total thyroidectomy. They were evaluated for recurrent laryngeal nerve damage, hypocalcaemia and hypoparathyroidism. Further, it was explored whether the use of intraoperative neuromonitoring had an effect on postoperative complications between experienced surgeons with &gt;5 years of experience and less-experienced surgeons with &lt;5 years of experience. Data was analysed using SPSS 15. Results: Of the 64 patients 59(92.2%) were females and 5(7.8%) were males. The overall mean age was 47.7±10.8 years. Experienced surgeons operated 38(59.4%) patients, while the less experienced operated 26(40.6%). The most common complications were transient hypocalcaemia 38(59.3%) and transient unilateral vocal cord paralysis 9(14%). There was no significant difference between experienced surgeons and less experienced surgeons in terms of postoperative complications (p&gt;0.05). Conclusion: The use of intraoperative neuromonitoring during bilateral total thyroidectomy reduced the risk of hypoparathyroidism regardless of the surgeon's experience. Key Words: Thyroidectomy, Vocal cord paralysis, Hypocalcaemia, Recurrent laryngeal nerve, Postoperative complications, Hypoparathyroidism.

Diagnosis of Acute Appendicitis with Machine Learning-Based Computer Tomography: Diagnostic Reliability and Role in Clinical Management.

Purpose: Acute appendicitis (AA) is a common surgical emergency affecting 7-8% of the population. Timely diagnosis and treatment are crucial for preventing serious morbidity and mortality. Diagnosis typically involves physical examination, laboratory tests, ultrasonography, and computed tomography (CT). This study aimed to evaluate the effectiveness of artificial intelligence (AI) in analyzing CT images for the early diagnosis of AA and prevention of complications. Methods: CT images of patients who underwent surgery for AA at the General Surgery Clinic of Kanuni Sultan Suleyman Health Application and Research Center between January 1, 2019, and June 31, 2023, were analyzed. A total of 1200 CT images were evaluated using four different AI models. The model performance was assessed using a confusion matrix. Results: The median age of the patients was 28 years, with a similar sex distribution. No significant differences were observed in terms of age or sex (P = .168 and P = .881, respectively). Among the AI models, MobileNet v2 showed the highest accuracy (0.7908) and precision (0.8203), whereas Inception v3 had the highest F-score (0.7928). In the receiver operating characteristic analysis, MobileNet v2 achieved an area under the curve (AUC) of 0.8767. Conclusion: AI's role in daily life is expanding. In the present study, the highest sensitivity and specificity were 77% and 86%, respectively. Supporting CT imaging with AI systems can enhance the accuracy of AA diagnoses.

IWOUND telemedicine application in the practice of the surgical department – who uses it?

iWOUND telemedicine application in the practice of the surgical department – who uses it?

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

Medication use and potential drug-drug interactions in a general surgery clinic: A descriptive study.

Medication use and potential drug-drug interactions in a general surgery clinic: A descriptive study.

Are the systemic immune-inflammation index and panimmune-inflammation value predictive indicators for the decision of operative treatment in adhesive small bowel obstruction?

Emergency surgical pathologies constitute a significant portion of general surgery practice. Small bowel obstructions are a common cause of surgical emergencies in general surgical practice. This study aimed to investigate the predictive role of the Systemic Immune-Inflammation Index and Pan-Immune-Inflammation Value in determining the need for operative treatment in adhesive small bowel obstructions. These obstructions are significant in general surgery, yet clinicians lack consensus on treatment selection and clinical follow-up. This study also seeks to address controversial questions surrounding this topic. The study included patients with small bowel obstruction caused by adhesions during the postoperative period who were treated and followed up in our General Surgery Clinic. Patients' age, demographic information, and clinical data from January 2017 to January 2024 were retrospectively reviewed and recorded using the hospital information management system (HIMS) and patient records. Statistical analyses were performed using SPSS version 22.0. A total of 341 patients with postoperative adhesive small bowel obstruction were included in the study. The mean age was 59.6+-17.4 years (range: 18-93 years), with a male-to-female ratio of 1.4: 1. The median duration of symptoms was 2 days (range: 1-30 days). Operative treatment was performed in 19.6% of cases. The most frequently used operative technique was explorative laparotomy and bridectomy (70.1%). Intensive care unit (ICU) admission was required for 16.1% of patients, and the in-hospital mortality rate was 4.1%. The predictive roles of the Systemic Immune-Inflammation Index (SII), Pan-Immune-Inflammation Value (PIV), and other markers for operative treatment were evaluated. Receiver operating characteristic (ROC) analysis revealed that SII (area under the curve [AUC]=0.601, p=0.009) and PIV (AUC=0.596, p=0.010) were determinants for operative treatment. SII and PIV values may assist in determining the need for operative treatment or non-operative follow-up in patients with adhesive small bowel obstruction (ASBO). By utilizing these markers, unnecessary operative interventions may be avoided. The management strategies for ASBO, a significant component of general surgical emergency practice, remain to be fully clarified. There are ongoing debates in the literature on this subject. We believe further studies with prospective, homogeneous, and broader populations should be conducted to address this issue.

Analysis of Mammography BI-RADS Distribution and Follow-up Ultrasound Assessment: A Single-Center Study.

Our study has three main aims: 1) to assess the distribution of Breast Imaging Reporting and Data System (BI-RADS) classifications in a cohort of Turkish women undergoing screening mammography, 2) to analyze the frequency and non-completion rates of recommended follow-up ultrasound (US) examinations, and 3) to examine the outcomes of completed follow-up US examinations. Our goal was to evaluate potential gaps in the current breast cancer screening process by analyzing BI-RADS classifications, follow-up completion rates, and outcomes of completed ultrasound examinations. This retrospective study analyzed 1761 Turkish women who underwent screening mammography from 2020-2022 at the Istanbul Aydin University General Surgery Clinic, Istanbul, Turkey. We assessed the distribution of BI-RADS classifications, analyzed the frequency and non-completion rates of recommended follow-up US, and examined the outcomes of completed follow-up US examinations. Chi-square tests of independence and Spearman's rank correlation test were used to analyze the data. Our study revealed three key findings: 1) Over half of mammograms (55.9%) were classified as BI-RADS 0, requiring further imaging. 2) Nearly one-third of patients who recommended US examinations (31.91%) did not complete recommended follow-up ultrasound appointments. 3) Among those who completed follow-up ultrasonography, almost one-third (29.7%) were reclassified as BI-RADS 3 or higher. Notably, 2.3% (n=18) were classified as BI-RADS 4 or 5, suggesting findings suspicious for malignancy. Our findings highlight the crucial role of follow-up US in breast cancer screening. The high rate of initial BI-RADS 0 classifications using mammography, coupled with the significant non-completion rate for follow-up US examinations, particularly among older age groups, highlights potential gaps in the current screening process.

The Effects of Pranayama and Deep Breathing Exercises on Pain and Sleep Quality After Laparoscopic Cholecystectomy.

The purpose of the present research is to determine the effects of pranayama and deep breathing exercises applied to patients after laparoscopic cholecystectomy on shoulder pain and sleep quality. The research was conducted at the General Surgery Clinics of the University of Health Sciences, Van Training and Research Hospital between March 2023 and June 2024. The study was carried out using a pretest-posttest control group randomized controlled experimental trial design. A total of 66 patients (22 in the pranayama group, 22 in the deep breathing group, and 22 in the control group) were included in the study. The research data were collected using the "Patient Descriptive Form," "Visual Analog Scale," and "Richard-Campbell Sleep Scale." The three groups had similar mean preoperative pain and sleep scores (p > 0.05). Mean pain scores were lower in the pranayama and deep breathing groups than in the control group after the exercise at the 6th, 12th, and 24th postoperative hours and discharge (p < 0.05). Deep breathing exercises were revealed to decrease postoperative pain more effectively than pranayama breathing exercises. Considering sleep scores, the pranayama and deep breathing groups had higher mean sleep scores in comparison with the control group (p < 0.05). Trail Registration: This study was registered in the ClinicalTrials.gov database as (NCT06495411) Protocol Registration and Result System. This study was conducted as a master thesis.

Testing Machine Learning-Based Pain Assessment for Postoperative Geriatric Patients

The global population is aging, and there is a concomitant increase in surgery for the elderly. In geriatric patients, where postoperative pain assessment is difficult, technological tools that perform automatic pain assessment are needed to alleviate the workload of nurses and to accurately assess patients' pain. This study offers a more reliable and rapid assessment tool for assessing the pain of elderly patients undergoing surgery. The study aimed to develop a machine learning–based pain assessment application for postoperative geriatric patients. A methodological study was conducted with 68 patients in the general surgery clinic of a hospital between October 2022 and June 2024. Data were collected using a Sociodemographic Data Collection Form, the Numeric Rating Scale, and the Wong-Baker FACES Pain Scale. Then, machine learning was used. Data are summarized using descriptive statistics and presented using narrations, tables, and graphs. The study reveals that nurses assigned lower scores to patients' pain levels. In the categorical classification, a high level of agreement was observed between the patient and the machine learning for each measurement. A machine learning–based pain assessment application is an efficacious method for assessing pain following geriatric surgery. It facilitates nursing care and supports the advancement of geriatric nursing.

Gastroenteropancreatic Neuroendocrine Tumors: Does Tumor Location Affect Prognosis?

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare entities. Generally, they can be localized anywhere in the gastrointestinal or hepatobiliary tract. The purpose of our study is to evaluate the effect of tumor location on prognosis in patients with GEP-NET undergoing surgery. Our secondary objective is to examine other factors affecting the prognosis of patients with GEP-NET. We retrospectively analyzed data from 30 patients with GEP-NET who underwent surgery in the General Surgery Clinic between 2012 and 2022. The gNET group (n=18) included tumors located in the gastrointestinal tract, while the pNET group (n=12) included tumors located in the hepatopancreatobiliary system. Surgical, laboratory, radiological, and pathological findings of the patients, as well as follow-up outcomes were recorded and statistically analyzed. In subgroup comparison, tumor size was found to be larger in the pNET group (P=0.002). The statistical analysis of recurrence (16.7% versus 33.3%) and mortality rates (16.7% versus 41.7%) between the subgroups (P=0.329 and P=0.210, respectively) did not reveal a significant difference. When all patients were evaluated, it was observed that advanced age, presence of carcinoma diagnosis, higher tumor grade, advanced TNM stage, larger tumor size, presence of lymphovascular or perineural invasion, elevated mitotic index, higher Ki-67 index, and having received adjuvant therapy increased the rates of recurrence and mortality. There was no statistically significant difference in survival outcomes between the GEP-NET groups located in the gastrointestinal tract and the hepatopancreatobiliary system.

Turkish validity and reliability study of the Feeling Safe During Surgery Scale.

This study was conducted methodologically to evaluate the Turkish validity and reliability of the Feeling Safe During Surgery Scale and to assess its suitability for the Turkish population. This methodological validity and reliability study collected data from 148 patients who underwent elective surgery with regional anesthesia in the general surgery clinics of a university hospital in Istanbul between December 1, 2021 and June 30, 2022. Data were obtained through face-to-face interviews with patients using the Patient Information Form, developed by the researchers based on the literature, and the Turkish version of the Feeling Safe During Surgery Scale, originally created in Swedish. The Statistical Package for the Social Sciences (SPSS) Amos 26 was used for data analysis. The content validity index of the scale was determined to be 0.96. Confirmatory factor analysis indicated that the Turkish version of the Feeling Safe During Surgery Scale was acceptably compatible with the original scale. The adapted Turkish version was found to have a comprehensible language structure and appropriate content. Cronbach's alpha coefficient for the total score was α=0.839, indicating a high level of reliability. Consequently, the Turkish version of the Feeling Safe During Surgery Scale was determined to be valid, reliable, and stable over time. The Turkish version of the Feeling Safe During Surgery Scale is a valid and reliable instrument that can be used in the Turkish population for assessing the sense of safety in patients undergoing elective surgery with regional anesthesia in surgical units.

Timing of Anticoagulation Resumption After Spontaneous Rectus Hematoma

Objective:Rectus sheath hematoma (RSH) is a rare condition characterized by acute abdominal pain and development of a mass on the abdominal wall. It is caused by bleeding resulting from the rupture of one of the inferior epigastric arteries or a tear in the rectus muscle. It is associated with trauma and anticoagulant usage. Although there have been no substantial advancements in the diagnosis and treatment of RSH in recent years, it is anticipated that the incidences of RSH will increase with the rising use of anticoagulants. Surgery is rarely performed, but patients are monitored in general surgery departments. Treatment requires maintaining a delicate balance between the risks of bleeding and thrombosis. This study aims to present nontraumatic RSH cases treated in our clinic, supported by a review of the literature. Methods: This retrospective multicenter study included patients over 18 years of age who were admitted with a diagnosis of nontraumatic RSH between 2020 and 2021 at the Department of General Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, and the General Surgery Clinic of Kayseri City Hospital. Patients diagnosed with RSH were identified by reviewing clinical protocol records and digital databases. The demographic data of the patients, such as age and gender, physical examination findings at admission, medications used, comorbidities, complete blood count, international normalized ratio and other laboratory information, imaging methods used for diagnosis, and receipt and quantity of blood products, were recorded. Following diagnosis, patients were monitored for one month for bleeding (recurrent bleeding, gastrointestinal bleeding, and intracranial bleeding) and thrombotic complications (heart valve thrombosis, cerebrovascular events, and pulmonary embolism). Results: Of the 32 patients included in the study, 24 were men (75%) and eight were women (25%). Abdominal pain and palpable swelling were common complaints in all patients. Patient age ranged between 27 and 92 years with a mean age of 70.6 ± 12.9 years. Mean length of hospital stay was 12.6 ± 12.0 days, and 28% of the patients stayed in the intensive care unit for a mean duration of 2.8 ± 6.3 days. Correlation analysis revealed a weak positive correlation between the size of the hematoma on imaging and length of hospital stay and a weak negative correlation between Hb value at diagnosis and length of hospital stay (p = 0.017 and r = 0.426). Conclusion: Nontraumatic RSH is a potentially fatal condition that requires hospitalization and intensive care unit admission as well as substantial amounts of blood transfusion. There is a relationship between the imaging method used at admission and the length of hospital stay as well as the hemoglobin level of the patient.

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients.

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom-Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

The Effect of Two Types of Subcutaneous Heparin Injections on Pain, Ecchymosis, Hematoma and Drug Absorption: A Quasi-Experimental Study.

Subcutaneous heparin injections sometimes cause pain, ecchymosis, and hematoma. The prevalence of complications depends on the injection site, technique, and drug absorption. This study investigated the effect of two types of subcutaneous heparin injections on pain, ecchymosis, and hematoma as well as drug absorption rates. The study is a quasi-experimental. The research was conducted between September 2021 and May 2022. The sample consisted of 122 patients treated in the general surgery clinic of a university hospital in the Black Sea region of Türkiye. We used ultrasonography (USG) to measure the subcutaneous tissue thicknesses of the sites before heparin injections. We used the tissue-releasing technique (TRT) to administer heparin injections to 68 participants (Group TRT). We used the tissue-pinching technique (TPT) to administer heparin injections to 54 participants (Group TPT). We administered all injections into the arm or abdomen. We used a "Subcutaneous Injection Form" to collect data. We monitored all participants for the injection site, drug absorption after 1 day, pain, ecchymosis, and hematoma for 3 days. There was no significant difference in the prevalence of pain, ecchymosis, and hematoma between the groups (p > 0.05). Most injections into the arm and abdomen resulted in drug absorption. However, one in ten injections into the arm resulted in the needle reaching the muscle rather than the subcutaneous tissue (11.7%). Abdominal injections caused no complications. The drug was administered in the right place in abdominal injections. The tissue-releasing and TPTs are not superior to each other as far as drug absorption, pain, ecchymosis, and hematoma are concerned. In this study recommend pinching the tissue or using the abdominal region in cases where the subcutaneous tissue thickness is less than 15.96 mm. The nurse should consider Body Mass Index before choosing the right subcutaneous heparin injection site and the correct injection technique.

Fournier's Gangrene Mortality Index (FGMI): A New Scoring System for Predicting Fournier's Gangrene Mortality.

Fournier's gangrene is an aggressive, rapidly progressing, and life-threatening necrotizing fasciitis of the perineal and genital regions. Various scoring systems have been developed for predicting survival and prognosis in Fournier's gangrene. This retrospective study aimed to evaluate the effectiveness of the newly developed Fournier's gangrene mortality index (FGMI) in predicting mortality associated with Fournier's gangrene. The study included patients over the age of 18 years who were followed-up with a diagnosis of Fournier's gangrene in the general surgery clinics of three different hospitals in Şanlıurfa province between 2014 and 2024. The patients included in this study were divided into two groups: deceased (n = 20) and surviving (n = 149). In FGMI, the parameters used were age, creatinine level, albumin level, lymphocyte percentage, and neutrophil-to-lymphocyte ratio. Based on the total score and risk assessment, <5 points were categorized as low-to-moderate mortality risk and ≥5 points as high mortality risk. A total of 169 patients with a diagnosis of Fournier's gangrene were included in the study; 87 were men (51.48%). The median age of all patients was 53 (40-63) years; 20 patients (11.8%) died. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score did not show a statistically significant difference between the deceased and surviving groups (p = 0.5). Compared to the survivors, the deceased had higher neutrophil counts, neutrophil percentages, neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, and C-reactive protein-to-albumin ratios, whereas lymphocyte counts, lymphocyte percentages, eosinophil counts, eosinophil percentages, monocyte counts, and monocyte percentages were lower, and these differences were statistically significant. According to receiver operating characteristic (ROC) analysis, the ROC-area under the curve for predicting mortality based on an FGMI score of ≥5 was 0.88 (95% CI: 0.80-0.95) with a sensitivity of 90% and a specificity of 70% (p < 0.001). Univariate risk analysis was performed, and the odds ratio revealed that mortality risk in patients followed-up for Fournier's gangrene with a FGMI score of ≥5 was 20 times higher (4.48-90.91) (p < 0.001). The results reveal that the FGMI score is a scoring system that can predict mortality at the initial clinical presentation of patients with Fournier's gangrene. Another important finding of the present study is that the LRINEC score was not sufficiently effective in predicting mortality.

Comparison of early and late term results of onlay and sublay mesh approaches in open incisional hernia surgery

Aims: Despite the increase in minimally invasive techniques, open techniques continue to be frequently used in incisional hernia repairs. In open incisional hernia surgeries, onlay and sublay techniques are the most frequently preferred depending on the area where the mesh is placed. In this study, we aimed to compare these two techniques by analyzing perioperative findings. Methods: Data from elective open incisional hernia surgeries (onlay and sublay) performed by the same surgical team in the general surgery clinic between 01.01.2023 and 31.12.2023 were retrospectively reviewed. Emergency surgeries, laparoscopic or combined surgeries, patients who did not undergo mesh repair, patients who received preoperative botulinum toxin due to “loss of domain”, patients with missing data, and patients who did not continue their follow-up were excluded from the study. Results: The data of a total of 74 patients who met the inclusion criteria were analyzed in the study. Onlay procedure was performed in 53 (71%) patients and sublay procedure was performed in 21 (19%) patients with a retromuscular approach. No intraoperative complications were detected in any of the patients. There were statistically significant differences between the groups in terms of female gender (p: 0.007), duration of surgery (p&lt;0.001) and duration of hospital stay (p&lt;0.001). There were no statistically significant differences between the groups in terms of complications (p:0.42), unexpected re-admission (p:0.779) and six-month recurrence (p: 0.779). Conclusion: Onlay or sublay techniques can be safely applied in open incisional hernia surgery because they have acceptable complication and recurrence rates. Surgical experience and patient factors are the main determinants of which technique to apply.