General Surgical Clinic Research Articles

Development and evaluation of a one-stop surgical outpatient clinic to tackle waiting lists

Background/Aims The COVID-19 pandemic caused substantial disruption to elective surgery, with NHS trusts still trying to work through their backlogs and reduce waiting lists. This study aimed to design, implement and evaluate a novel one-stop general surgical outpatient clinic to tackle long waiting lists post COVID-19. Methods General surgical outpatient clinics were held on 6 days between April and October 2021. The impact of these clinics was retrospectively measured using data collected from the trust's electronic database on the length of waiting lists, number of weeks before appointment and financial expenditure associated with the project. Results There were 1440 fewer patients on the outpatient waiting list after the clinics were implemented compared to before, with a 100% reduction in the number of patients waiting longer than 52 weeks for an appointment. Across the six clinic days, 93.7% of available slots were booked and patients attended 90.5% of booked slots. A net financial benefit of £128 700 was calculated. Conclusions Lessons from this project could be applied in other specialties and NHS trusts to tackle waiting lists and outpatient clinic backlog post COVID-19.

Determining the role of remote consultations in general surgical practice in Scotland: a qualitative questionnaire-based study

INTRODUCTION Telemedicine consultations became widespread during the COVID-19 pandemic to deliver healthcare while minimising viral transmission. Research around establishing the role of remote appointments in general surgery outpatient clinics after the pandemic has not been undertaken. The aim of this study was to investigate views on remote consultations to determine this. METHODS Patients attending the adult general surgical outpatient clinic at Aberdeen Royal Infirmary between August 2021 and January 2022 as well as general surgeons from three neighbouring hospitals were invited to complete an anonymous questionnaire on the acceptability of remote and face-to-face (F2F) appointments in pre and postoperative scenarios. Differences in patients’ preferences between demographic groups, and between patients’ and surgeons’ views were analysed. RESULTS A total of 51 patients and 26 surgeons responded. Patients’ views differed depending on demographic parameters and the scenario. Patients and surgeons had similar views on preoperative consultations. Given the choice of telephone, video or F2F appointments, the F2F option was overall most popular. Patients and surgeons differed in their views on remote consultations following surgery and acute admissions. In some scenarios, young patients, those who lived in remote regions and those in employment/education preferred remote appointments. CONCLUSIONS While telemedicine is feasible and acceptable in general surgery clinics, there are differences in preferences between surgeons and patients. Patients’ preferences varied depending on their background, home circumstances and clinical context. Service provision should ensure that when remote consultations are available, patient preference is prioritised rather than surgeon ease.

The effect of bed exercises following major abdominal surgery on early ambulation, mobilization, pain and anxiety: A randomized-controlled trial.

This randomized-controlled trial aimed to investigate the effect of bed exercises on postoperative anxiety, pain, early ambulation and mobilization. This study was conducted with a randomized-controlled trial design and in the general surgical clinic of a research and training hospital. A total of 120 patients (60 in the experimental group and 60 in the control group) scheduled for major abdominal surgery took part in the study. The data were collected using a patient information form, the Anxiety Specific to Surgery Questionnaire and the Visual Analog Scale through face-to-face interviews. The patients in the experimental group performed 15-min bed exercises on the day of their operation, as well as on the postoperative first and second days, and the control group underwent only the routinely performed procedures in the clinic. The data were analysed using descriptive statistics, analysis of variance and t-tests. The sample of our study included major abdominal surgery patients. Ambulation was achieved at a mean time of 4 h earlier in the experimental group. On the postoperative first and second days, the patients in the experimental group had mean mobilization durations that were approximately 2 h longer compared with the patients in the control group. Moreover, the postoperative pain and anxiety levels of the patients in the experimental group were significantly lower than those of the patients in the control group (p < 0.05). We recommend that bed exercises be performed to lower anxiety and pain severity, achieve early ambulation and increase the duration of mobilization among patients following major abdominal surgery.

Acute surgical abdomen during the COVID-19 pandemic: a retrospective study on clinical and therapeutic challenges

Background As with other medical specialties throughout the epidemic, general surgical clinics’ treatment protocols have changed because of the COVID-19 pandemic, which has become a serious danger to healthcare systems. The presence of severe COVID-19 in young individuals and among medical workers has exacerbated the psychological burden on clinicians treating patients suspected of having or being infected with SARS-CoV-2, even if comorbidities and older age are statistically linked to higher death rates. Patients and methods A retrospective comparative study included patients who were admitted to the emergency room (ER), surgical, or managing conservatory for acute surgical abdomen. All subjects were divided into three groups. 1186 patients; out of them, 490 cases were examined before the pandemic, 334 cases were examined during the pandemic, and 362 cases were examined after vaccination. Results Before the pandemic, the commonest cause of acute abdomen was appendicitis (21.8%), strangulated hernia (21%), and cholecystectomy (17.8%). During the pandemic, the commonest cause of acute abdomen was appendicitis (21.8%), cholecystectomy (16.8%), and Mesenteric venous occlusion (MVO)/Mesenteric Artial occlusion (MAO) (13.8%). After the pandemic, the commonest causes of acute abdomen were cholecystectomy (25.4%), appendicitis (24.6%), and exploration abdomen (11.9%). The time of management differed significantly among the studied groups. The highest requirement for immediate intervention was attributed to the before pandemic group, while during the pandemic group was associated with conservative management, and after conservative management. Conclusion The Sars-Cov-2 pandemic highly affected the clinical presentation, aetiology, diagnostic and paraclinical investigations, and therapeutic management, as well as the changes in emergency practice procedures.

Malignancy risk in Bethesda class IV thyroid nodules in an iodine deficient region.

According to the latest guidelines, in patients with high-risk nodules with indeterminate cytology, diagnostic lobectomy should be the preferable surgical approach in the absence of factors that suggest a total thyroidectomy. This retrospective observational study has as its main aim the evaluation of the cases that underwent surgery, for Bethesda class IV nodules in our iodocarent geographical area. Particular attention was paid to carcinoma incidence, preoperative nodule size, histological characteristics of the neoplasm, surgical approach and eventual need of radiometabolic treatment. A total of 320 patients were included that underwent surgery for Bethesda IV nodules, between January 2010 and December 2020, at the General Surgical Clinic of the University Hospital of Parma, Italy. A total of 230 total thyroidectomies (71.9%) and 90 lobectomies (28.1%) were performed. Our data showed a strong impact of the 2015 ATA Guidelines on the surgical approach choice, with a progressive propensity towards a conservative approach and an increase of lobectomies from 7.2% to 41.5% after the new guidelines introduction. However, in our sample the percentage of lobectomies remains below 50%; this data is certainly influenced by the number of cases of multinodular pathology, often bilateral, in our geographical area. The nodules malignancy rate resulted 28.8%. Our data showed that increasing size correlated with an increasing malignancy rate (P<0.01), and follicular carcinomas were found to be larger than papillary carcinomas (P<0.001). A statistically significant correlation also emerged between nodule size increase and local/lymphovascular invasion (P<0.05). On the other hand, there was no statistically significant correlation between nodule size and multifocality, and between nodule size and presence of lymph node metastases. Out of the patients where it was possible to find this data, 66% underwent radioiodiometabolic treatment: 59% with papillary carcinoma, and 85% with follicular carcinoma. In patients with Bethesda IV thyroid nodules, diagnostic lobectomy should be the preferable surgical approach in absence of factors that suggest total thyroidectomy. In our opinion, total thyroidectomy remains the first choice in large nodules (≥4 cm) as these nodules have a high malignancy rate, greater local/lymphovascular invasion and a consequent frequent indication for post-operative radiometabolic treatment.

Exploring the educational value of the general surgical outpatient clinic: a systematic review.

Optimising opportunities for exposure and learning in the clinical environment is a priority for surgical education. The surgical outpatient clinic provides a setting for engaging with the patient journey while gaining essential surgical knowledge and skills. This systematic review seeks to determine the role of the outpatient clinic in current surgical education for multiple levels of learners and identify strategies to improve educational utility. A systematic search strategy was conducted across Medline (OVID), Embase, PubMed, and Web of Science databases according to PRISMA guidelines. A comprehensive grey literature search for evaluation of international postgraduate surgical curricula was also performed. Publications were included if they discussed or utilised the general surgical outpatient clinic in an educational context. Nine publications were included in this review. Educational interventions in a surgical outpatient clinic setting were discussed in three publications and two publications presented observational data relating to educational opportunities in the surgical outpatient clinic. Four postgraduate surgical curricula outlined the current approaches to surgical education in the outpatient clinic setting. Assessment of included studies by Kirkpatrick level of evidence highlighted that included studies did not investigate high-order educational outcomes. Thematic analysis of curricula was utilised to build a common set of learning outcomes. Educational interventions were found to improve learning outcomes, particularly those that facilitated active student participation. Postgraduate surgical curricula utilise the surgical outpatient clinic and recognise its importance in surgical training through the implementation of outpatient-based learning objectives which serve as fundamental components of training. Common learning objectives can be used to direct further research into the efficacy of this educational context. The online version contains supplementary material available at 10.1007/s44186-023-00106-8.

Determinants of Quality of Life in Women living with Breast Cancer in Southwest Nigeria

Background: The quality of life (QOL) among women with breast cancer is hampered in areas of social, emotional, and sexual functioning and this could persist even years after treatment. It is an important parameter for monitoring disease progression at the early stage. Hence, this study aimed to determine the factors associated with the overall quality of life among subjects living with breast cancer.&#x0D; Methods: The study was a comparative cross-sectional design conducted among women with breast cancer attending the General Surgical Outpatient clinic of LAUTECH Teaching Hospital Ogbomoso and a comparison group of age-matched control. The instrument used include the World Health Organization Quality of Life-BREF and socio-demographic and clinical variable questionnaire in 240 interviewer-administered questionnaires. Data were analyzed using SPSS version 21. A P-value of less than 0.05 was taken as statistically significant. The predictors of overall QOL were analyzed using a binary logistic regression.&#x0D; Results: All QOL domain scores were significantly higher among controls than in subjects with breast cancer. ρ-value = 0.001. Level of education and duration of diagnosis had a statistically significant association with the overall quality of life, P-value&lt; 0.05. Respondents who attained a tertiary level of education were 0.040 times less likely to have a poor quality of life compared to respondents that were not educated (P-value= 0.038) and the odds of having a poor overall quality of life decreased with duration since diagnosis P-value= 0.049.&#x0D; Conclusion: Our study shows that women with breast cancer experience a lower QOL, especially in the physical, psychological and social domains than women without the disease. Also, the level of education, employment and marital status, and duration since diagnosis were major factors influencing QOL. Assessment of QOL is an important metric that should be incorporated into the breast cancer treatment program.

Clinical behavior of appendiceal mucinous neoplasia: 9 years of experience

Appendiceal mucocele is known a mucinous neoplasia of the appendix. It’s etiology is not clear. For last 30 years it’s incidence has increased to 2,8 cases/million person from 0,6 cases per million. Even if different classification has been made over the years, WHO and AJCC classifications are frequently used. Objective: The aim of this study was to find the pathologically performing the discrimination between LAMN and HAMN in the extracted specimen and how much the scattering mucin influenced the surgery and patients’ follow-up. Material and Methods: Patients and Centers: In two different hospitals between 2012-2020, the patients admitted to the emergency department and diagnosed as acute abdomen were evaluated retrospectively. All patients were accepted in the emergency clinic and operated then followed in the general surgical clinic. The appendiceal mucocele diagnosis was based on perioperative observation of mucinous distention or mucin dissemination. After obtaining specimens, the type of the mucinous neoplasm of appendix diagnosis and assessment was made by histopathological investigation. Results: Appendix mucocele was detected in 19 of 2974 patients included in the study. Two additional patients had advanced pseudomyxoma peritonei (PMP) after previous appendectomy. 11 of the patients (52.4%) were female. The mean age was 63.8 years. The appendix was evaluated preoperatively as enlarged in fourteen patients. In 1 patient, this condition was belonging to the ovary. Adeno cancer in one patient and PMP in 2 patients were clinically detected. Histopathologically, the appendix size was 37.1x71.9 mm. Sixteen of the patients were reported as LAMN, 2 as HAMN, 1 as adenocarcinoma and 2 as PMP. The leukocyte, carcinoembryonic antigen (CEA) and CA 19-9 levels of the patients were found to be significantly higher than normal. The patients were followed up for an average of 30.2 months. Early postoperative complications were seen in 5 patients. Complications evaluated late were seen in 8 patients. Recurrence was detected in one of the patients during the follow-up. The average survival rate was 36.7 months, although it was slightly higher in women. While the effect of leukocytosis, CEA, CA 19-9 on mortality was not significant, but tumor size was (p&lt;0.05). This study has a few limitations. These are the small number of patients, the retrospective evaluation of the patients, and the relatively short follow-up time. Conclusion: In this study, we found mucocele more frequently than seen in the literature. Histopathologically, low grade mucinous neoplasia (LAMN) was often encountered. Mucocele with acellular mucin scattering were also seen in approximately 20% of the patients. After simple appendectomy, no recurrence was observed during the follow-up. The leukocyte count, tumor markers, and tumor size were evaluated in terms of their effects on postoperative morbidity and mortality. The tumor size had a negative effect on survival only. Finally, the simple appendectomy operation was considered suitable for the treatment.

Patient satisfaction with general surgery telephone consultations during the COVID-19 pandemic: a single surgeon experience.

COVID-19 pandemic accelerated the development and use of telemedicine in surgical practice. Here we set out to understand patient satisfaction with the use of telephone consultation in the general surgical clinic and preference over face-to-face consultation. A prospective cohort study was carried out for consecutive patients seen in a general surgery telephone clinic by a single surgeon in a district general hospital in the UK from 1st September 2021 to 10th March 2022. Demographic data was collected from electronic patient records. At the end of the consultation patients were asked to: 1) score their satisfaction with the telephone consultation on a 5-point Likert Scale; and 2) whether they preferred telephone consultations to face-to-face appointments. It was noted if a patient required a further face-to-face consultation in addition to the telephone consultation. The study included 245 patients who were reviewed by telephone consultation. Most patients (59.6%; N.=146) gave the telephone consultation the highest satisfaction score with a further 31% (N.=76) scoring it as a 4 out of 5. Only 2.8% of patients said they would have preferred a face-to-face consultation and gave a median satisfaction score of 2 (IQR 2-3) compared to 5 (IQR 4-5) in those who preferred telephone consultations (P<0.001). Telemedicine is associated with high levels of patient satisfaction regardless of patient age or gender. Lower rates of satisfaction are associated with the need for further face-to-face follow-up. If telemedicine is to remain a permanent part of surgical practice, disease specific protocols for its use are required.

Subcutaneous nodules following vaccination.

Five patients presented to surgical clinics at our institution with subcutaneous nodules of the upper arm or thigh present for 6-18 months. Excisional or fine-needle biopsy was performed due to diagnostic uncertainty and parental concern. Histopathological examination revealed these to be cutaneous lymphoid hyperplasia in reaction to vaccine components. Nodular reactions with this histopathological pattern are well recognised within vaccine-related literature, but less commonly recognised in patients presenting to general paediatric or surgical clinics. This article reviews literature on delayed-onset nodule formation after vaccination and recommends observation and reassurance as mainstays of management of this largely benign entity.

Awareness, perception, knowledge and attitude towards robotic surgery in a general surgical outpatient clinic in Singapore, Asia

Awareness, perception, knowledge and attitude towards robotic surgery in a general surgical outpatient clinic in Singapore, Asia

Comparison of rarely seen tumors of the colorectal region clinicopathologically

Background: Majority of colorectal neoplasms are adenocarcinomas but there is a small percentage of tumors from other histological cell lines Method: One thousand one hundred patients who were applied surgical treatment due to colorectal cancer at general surgical clinic between years of 2010-2020 were examined. Patients have been grouped as Diffuse large b cell lymphoma (DLBCL) (group1), Malignant melanoma (group2), Medullary carcinoma (group3), Neuroendocrine tumor (group4) and they were included in the study in this way. In the groups,clinicopathological data of patients and their survival periods have been compared. Results: Twenty patients are included in our study: Group 1 was composed of 5, Group 2 was composed of 4, Group 3 was composed of 3, and Group 4 was composed of 8 patients. Emergency application rate (60%) was higher in Group 1 (p: 0.004). A verage age was above 50 in 4 groups and there was no difference between groups (p:0,966).Tumor diameter was on average (cm)(8 vs 6,55 vs 5,4 vs 3,75 p:0,073) in the groups, The number of lymph nodes dissected were (13 vs 14.5 vs 19 vs 19 p:0.373) The number of metastatic lymph nodes were ( 0 vs 1.5 vs 0 vs 0.5 p:0.188). Survival was significantly shorter in the malignant melanoma group, the longest survival was in the neuroendocrine tumor group (15.625vs8.5vs20 vs 40.857 p:0.001) Conclusions: Although clinicopathological features and postoperative follow-up results were similar, there were differences in survival among patients. Maligant melanoma histopathological type had a worse prognosis than other tumors

Aspirin Use, Compliance, and Knowledge of Anticancer Effect in the Community.

Millions of adults worldwide use low-dose aspirin for secondary prevention of heart disease. Results of randomized trials indicate that regular use of low-dose aspirin may reduce the risk of colorectal cancer by more than 20%, leading to speculation of its chemoprevention role for high-risk groups. Little is known, however, about the use of aspirin in our community. To determine aspirin use and therapy compliance (never or rarely missing a dose) and to assess whether patients in our community are aware of its anticancer effect. Observational study. Prospective data were collected during a 1-year period from patients in our general surgical clinic regarding aspirin use, comorbidities, adverse effects, and awareness of anticancer effect. Statistical analysis was performed. Among aspirin users (n = 137), the mean age was 65.8 years. Most (76.6%) received an 81-mg daily dose of aspirin. Compliance was 25.6% and was significantly associated with diabetes mellitus (p = 0.0028). Only 9.5% were aware of the medication's anticancer effect. Among nonusers (n = 383), the mean age was 53.3 years, a significant difference vs that of aspirin users (p < 0.001). Only 4.7% of nonusers knew of the anticancer effect. Nonusers were more likely to be women (p = 0.0005), younger than age 40 years (p < 0.0001), and have comorbidities or polypharmacy (p = 0.002). No significant difference was found between groups in anticoagulants use, nonsteroidal anti-inflammatory drug use, and smoking. Knowledge of aspirin's anticancer effect is low. More research is required to understand why aspirin compliance is also low.

Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias

Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.

An Analysis of the Quality Of Life among Diabetic Foot Ulcer Patients in Kuantan, Pahang

Introduction: Foot ulcer is one of the most serious complications associated with diabetes mellitus that mat resulted in a disability and impairment of health related quality of life. Materials and Methods: The main objective of this cross-sectional study was to determine the factors adversely associated with quality of life among diabetic foot ulcer patients. Diabetic patients with evidence of diabetic foot ulcer attending outpatient orthopaedics and general surgical clinic of Hospital Tengku Ampuan Afzan were recruited into this study. A set of validated SF-36 questionnaire was employed to evaluate the health-related quality of life for each patient. This study was registered with the National Medical Research Register (NMRR registration no. 17-1520-36332). Results: There is a slightly higher proportion of female among the 104 respondents. Its prevalence is most pronounces in the lower income group. Majority presented with Wagner stage 2 and 3. Amputation has been performed in 54% of these patients. Physical health score fair worse than mental health. Age, low socioeconomic status, presence of comorbidities, major amputation, ulcer at the forefoot and wheelchair usage associated with an adverse effect on the physical health aspect in these patients. Interestingly, smoker seems to score better on the mental health aspect of the quality of life. Conclusion: Diabetic foot ulcer affected physical health aspect much more than mental health aspect within the context of the quality of life.

Pain resolution in non-operatively managed ultrasound-only groin hernias: 3-year follow-up.

General surgeons frequently see patients with groin lumps and pain. However, in the absence of a lump, an ultrasound scan identified groin hernia is a diagnostic and management challenge. Some surgeons recommend inguinal hernia surgery while others do not. The outcome of non-operative management is uncertain. This study represents a minimum 3-year follow-up of all non-operatively managed patients seen in general surgical outpatient clinic over a 12-month period. To be included, patients needed to meet all four criteria: groin pain, no clinical hernia, groin hernia identified on ultrasound scan requested by the general practitioner and non-operative management. Patients were interviewed via a standardised telephone survey. Primary outcome measure was groin pain which was assessed with the Sheffield Pain score. From July 2014 to June 2015, 67 patients met the inclusion criteria. 42 participated (37 men and 5 women). Two-thirds were pain free (68%). Only 2 patients underwent hernia surgery. Women were more likely to describe developing a lump (60% vs 14%; p = 0.013), to see a surgeon (40% vs 8%; p = 0.039) and undergo hernia surgery (20% vs 3% p = 0.088). At least in the medium term, non-operative management of men who present with groin pain (with an ultrasound scan reporting a hernia but no lump) is reasonable.

The effective factors on our early and late results, recurrence and survival in differential thyroid cancers: “An analysis of 184 patients”

Aim: The purpose of the study was to investigate the effective prognostic factors on recurrence and mortality in patients with differential thyroid cancer. Material and Methods: The effects of various parameters of demographic characteristics, the admission symptoms, physical examination, laboratory findings, pathological examination, and surgical method of 184 patients, who underwent surgery due to differential thyroid cancer between January 1986 and December 2009 in 4th General Surgical Clinic of Ankara Numune Training and Research Hospital, on prognosis were examined. The information of the patients was obtained from automation system of the hospital and Thyroid Cancer Information and Follow-Up Form of 4th General Surgical Clinic of Ankara Numune Training and Research Hospital.Results: The sample group consisted of 172 papillary cancer patients and 12 follicular cancer patients. The mean age of the patients was 45.4 years (15-78). There were 159 (86.4%) female patients and 25 (13.6%) male patients. The mean follow-up period of 161 (87.5%) patients, who were followed up regularly, was 73.26 months (1-231). The mean recurrence period was 77.66 months (1-150). Mortality was observed in eight (4.3%) patients during their follow-up period. The mean life expectancy of those who died was 66.87 months (1-150 months).* Single variable analysis revealed that the T stage and pathologic final stage were effective on recurrence. Painful nodules and palpable lymph nodes in the neck and the papillary histological malignant subtype variant, as well as the presence of vascular and adjacent organ invasion, multicentricity, T stage, the lymph nodes, distant metastasis, and the clinical stage during the admission were identified to be effective on mortality.Conclusion: The risk of recurrence is high in DTC patients with high T stage and advanced pathologic stage. The rate of survival of those with multicentric tumors and advanced pathologic stage is low. Therefore, it is important for patients to be followed up closely within a postoperative multidisciplinary context.Keywords: Differential; thyroid; cancer; recurrence; mortality.

Clinicopathological characteristics and prognosis of gastric adenocarcinoma patients

Aim: The purpose of the study was to investigate the effective prognostic factors on recurrence and mortality in patients with differential thyroid cancer. Material and Methods: The effects of various parameters of demographic characteristics, the admission symptoms, physical examination, laboratory findings, pathological examination, and surgical method of 184 patients, who underwent surgery due to differential thyroid cancer between January 1986 and December 2009 in 4th General Surgical Clinic of Ankara Numune Training and Research Hospital, on prognosis were examined. The information of the patients was obtained from automation system of the hospital and Thyroid Cancer Information and Follow-Up Form of 4th General Surgical Clinic of Ankara Numune Training and Research Hospital.Results: The sample group consisted of 172 papillary cancer patients and 12 follicular cancer patients. The mean age of the patients was 45.4 years (15-78). There were 159 (86.4%) female patients and 25 (13.6%) male patients. The mean follow-up period of 161 (87.5%) patients, who were followed up regularly, was 73.26 months (1-231). The mean recurrence period was 77.66 months (1-150). Mortality was observed in eight (4.3%) patients during their follow-up period. The mean life expectancy of those who died was 66.87 months (1-150 months).* Single variable analysis revealed that the T stage and pathologic final stage were effective on recurrence. Painful nodules and palpable lymph nodes in the neck and the papillary histological malignant subtype variant, as well as the presence of vascular and adjacent organ invasion, multicentricity, T stage, the lymph nodes, distant metastasis, and the clinical stage during the admission were identified to be effective on mortality.Conclusion: The risk of recurrence is high in DTC patients with high T stage and advanced pathologic stage. The rate of survival of those with multicentric tumors and advanced pathologic stage is low. Therefore, it is important for patients to be followed up closely within a postoperative multidisciplinary context.Keywords: Differential; thyroid; cancer; recurrence; mortality.

Laparoscopic total extraperitoneal inguinal hernia repair: Retrospective study on prosthetic materials, postoperative management, and quality of life.

Laparoscopic inguinal hernia repair is one of the most frequently performed operations. However, the search for the most appropriate prosthetic materials continues to occupy the surgical community. The purpose of this study was to evaluate the postoperative short- and mid-term effects (like duration of stay, number and type of complications, and inguinal pain) of laparoscopic inguinal hernia repair using the total extraperitoneal (TEP) approach. The evaluation encompassed different types of mesh and fixation devices, as well as medications prescribed during hospitalization.This retrospective study was conducted at the General, Laparoendoscopic, Bariatric, and Robotic Surgical Clinic of the Athens Medical Center. Clinical data from 524 patients were evaluated. The answers from an appropriately designed questionnaire completed from each individual were used to obtain information about their postoperative course. The statistical analysis was implemented in SPSS v 23.Analysis revealed that pain sensation on discharge decreased with increasing age (P < .05). No clear relationship was found between surgical clips and pain (P = .292), as well as mesh absorbability and chronic pain (P = .539). The major postoperative complications were annoyance and discomfort (15.9%). The recurrence rate was 1.7%.Postoperative complications following the TEP approach were mostly found to be minor; chronic pain, as an aspect of impaired quality of life, was not experienced in the majority (89.08%). The properties of prosthetic materials used and the type of medications prescribed were not found to exert a significant role in satisfactory postoperative outcomes.

TREATMENT OF PATIENTS WITH EXTERNAL PANCREATIC FISTULAS AFTER PERCUTANEOUS DRAINAGE INTERVENTIONS OF PANCREATIC PSEUDOCYSTS

Introduction. External pancreatic fistulas are developed up to 45 % during the postoperative period after the percutaneous drainage of pancreatic pseudocysts. According to some authors this fact is the main contraindication for using of transcutaneous method in treatment of these patients. The objective is to optimize the tactics of treatment for minimizing the possible development of external pancreatic fistulas Materials and methods. Puncture-draining operations were performed in 164 patients with chronic pancreatic pseudocysts. Puncture operations with ultrasound control were primarily performed in 54 patients (32.9 %), they were effective for 29 patients (53.7 %). Traditional surgical interventions were performed in 7 patients (12.9 %) from this group. Percutaneous drainage of pseudocyst was secondary used in 18 patients (33.4 %). Percutaneous drainage of pseudocysts was primarily used in other group consisting of 110 (67.1 %) patients. During the postoperative period, external pancreatic fistula formed in 36 (32.7 %) patients from this group. The fistulas were eliminated by supplementing the transcutaneous interventions with endoscopic methods. Results. Endoscopic papillosphincterotomy was performed in 36 patients. Pancreatic fistulas were closed after the operation in 12 patients (33.3 %). Endoscopic formation cystogastro-, cystoduodenoanastomosis on «lost drainage» were performed in 9 patients (25 %). Temporary decompression transpapillary stenting of the MPD was performed in 15 patients (41.7 %), endoscopic retrograde stenting was performed in 5 of them. Antegrade stenting of the MPD was transcutaneously performed in 10 patients. There were no lethal outcomes. Fistulas regressed in all patients. Recurrence of cyst formation, pancreatic hypertension were not be to dynamic examinations. Algorithm of treatment was formed and based on the results of a retrospective analysis to treatment of pancreatic cysts in general surgical clinic of «Pavlov First Saint Petersburg State Medical University». Conclusions. Coherent combining of minimally invasive technologies in the treatment of patients with chronic pancreatic pseudocysts leads to good results: absolute cystic regression and elimination of pancreatic fistulas as appropriate.