Surgeons In Turkey Research Articles

Primary Arthroplasty or Internal Fixation in Intertrochanteric Femur Fractures: A Survey of Surgical Attitudes of Orthopedic Surgeons in Turkey.

This study aimed to examine the primary arthroplasty attitudes of Turkish orthopedics and traumatology specialists and residents to patients with intertrochanteric fractures, of various ages, comorbidity situations and fracture types, using an internet-based questionnaire. Between March and April 2021, a cross-sectional survey was conducted with a total of 159 orthopedics and traumatology specialists and residents in Turkey, using an online questionnaire that consisted of 16 different patient scenarios of varying intertrochanteric fracture types, ages, and comorbidity conditions. Respondents’ preference ratio for primary arthroplasty was 24.1% in the scenarios with patients over the age of 71, while it was 8.4% in the scenarios with patients aged between 50 and 70. The ratios of primary arthroplasty preference were 12.4%, 21% and 27.3% in 2-part, 3-part and 4-part fracture scenarios, respectively. The primary arthroplasty preferences of respondents with 10 years or more of professional experience were observed to be statistically significantly different to those of the respondents with 1 to 10 years of experience in the 4-part fracture scenario where the patient was aged 71 years and above with an ASA (American Society of Anesthesiologists) score of 3–4 (p < 0.05). Despite varying opinions in the literature in recent years, primary arthroplasty can be considered a valuable alternative approach for Turkish surgeons, and in older adult patients with unstable intertrochanteric fractures, particularly those who need early mobilization and have high ASA scores.

Women in surgery: Analysis of female surgeons in Turkey

Women in surgery: Analysis of female surgeons in Turkey

Burnout Among General Surgeons in Turkey

Burnout Among General Surgeons in Turkey

The investigation survey of inguinal hernia operation techniques preferred by pediatric surgeons in Turkey

In inguinal hernia, standard procedure has been considered open repair for a long time, the number of pediatric surgeons who prefer laparoscopic techniques is increasing day by day. In this study, it was aimed to determine how pediatric surgeons in our country approach patients with inguinal hernia and manage the treatment process. Controversial issues on inguinal hernia repair were identified and a questionnaire was prepared to reveal the current situation. The questionnaire was delivered to members of Turkish Association of Pediatric Surgery on the official website of the association. The survey was directed to 420 people, 92 people returned with the answers to the questionnaire. Thirty-six of the surgeons prefer the laparoscopic method for inguinal hernia repair. The reason for choosing open surgery was questioned, the most frequent answer was to be more experienced and to have more cumulative knowledge on open repair method. According to survey, the greatest advantage of laparoscopy was stated to be the better evaluation of the contralateral inguinal canal (n=16, %44.4). Twelve of surgeons who performed laparoscopic treatment in the selection of patients stated that gender is important and prefer laparoscopic surgery for female patients. Thirty percent (n = 11) of the participants stated that they prefer laparoscopy in patients between 3 months and 13 years old, while the rest prefer laparoscopy at all ages. In conclusion thirty nine percent of surgeons in Turkey prefer laparoscopic repair. Open repair is still preferred in our country. There is still no consensus on perfect method and patient selection yet.

Video-Based Learning Habits of General Surgeons in Turkey: A Survey Study

Video-Based Learning Habits of General Surgeons in Turkey: A Survey Study

Violence in emergency service: The situation of general surgeons in Turkey.

Violence in healthcare in public health is a problem about socio-economic and personal development that is un-fortunately seen in every service but more frequently in emergency departments. In our study, we aimed to determine the violence experiences of general surgeons in the emergency room and their perceptions about it. The study is designed in a cross-sectional type. We sent a survey containing 11 questions to the e-mails of 941 general surgeons registered in the National Trauma and Emergency Surgery Association in August-September 2019. The rate of participation to the online survey was 9.98%. The participants who have been subjected to violence in anyway and who have never encountered violence were 64.9% and 16.0%, respectively. Female surgeons composed 10.6% of the participants and their rate of exposure to violence was 90.0%. When the number of patients accepted by the surgeon increased, the rate of being exposed to violence rose (p=0.014). Those who're ex-posed to verbal violence applied to courts less frequently (p=0.046). The surgeons whose had to applied to courts could not receive remarkable support from their institutions. The participants stated that who're source of violence should get effective punishments and victims should be strongly supported. The specialists exposed to violence in the emergency room include general surgeons. Increase of the risk of ex-posure to violence for surgeons correlates workload. Verbal violence moved to the court stage has observed less frequently than the physical. It would be appropriate to take serious sanctions strengthened by legal regulations as the first step toward a solution.

Türkiye'de Ağız ve Çene Cerrahlarının Defansif Diş Hekimliği Konusundaki Bilgi, Tutum ve Davranışlarının Değerlendirilmesi

Objective: The aim of the study is to explain the concept of defensive dentistry and to investigate the knowledge, attitudes and behaviors of oral and maxillofacial surgeons in Turkey regarding defensive dentistry. Material and Methods: In this cross-sectional descriptive study, a defensive dentistry behavior scale was used. One hundred and two oral and maxillofacial surgeons were included in the study. Results: In this study, it was found that 43.2% of oral and maxillofacial surgeons practiced 'high', 37.3% of 'moderate' and 19.6% of 'low' level defensive dentistry. Positive defensive dentistry scores of oral and maxillofacial surgeons were found to be higher than negative dentistry scores. There was no significant difference in positive and negative dentistry practices according to the demographic characteristics of the participants (age, gender, marital status, working experiences, working place). Of oral and maxillofacial surgeons, 80.4% stated that they never heard about the concept of defensive dentistry and 91.2% stated that they did not know the content of this concept. Conclusion: This study revealed that in Turkey, oral and maxillofacial surgeons performed a moderate level of defensive dentistry. In order to reduce defensive dentistry practices, oral and maxillofacial surgeons should be provided with a suitable and safe working environment in which they can practice effectively on the basis of law and ethical principles.

Turkey is leading in the 21st century pilonidal sinus disease research.

Pilonidal sinus disease (PSD) has been a recognized pathology for the past 188 years. We studied whether scientific interest in this common disease has grown or declined over time. Our investigation included analysis of the world literature between 1833 and 2018. A PubMed search was conducted to identify all publications on pilonidal sinus disease, broken down by country, year of publication and number of patients included or described. The number of patients studied has been increasing, with date of more than 10,000 patients published per decade since 1970, and the total number of affected patients exceeding n=40,000 in 2010 and Turkey leads the research, contributing 39% of the Mediterranean patients and 18% of the patients globally, while Italy provides 26% of the Mediterranean patients and 12% of the global total. Flap studies have increased, whereas primary open treatment studies have decreased from 40% in 1940 to less than 10% at present. Twenty percent of the studies performed today report primary median approaches, and the number of randomized controlled trials has increased. Surgeons in Turkey currently publish the lion´s share of the pilonidal sinus literature.

National Consensus on Oncoplastic Breast Conserving Surgery in Turkey: Position Paper for the Standardization of Surgical Practice.

The algorithms that define most of the application of oncoplastic breast conserving surgery (OBCS) in breast cancer patients are not clearly defined. Therefore, a consensus survey was conducted between the leading and experienced breast surgeons and oncoplastic breast surgeons in Turkey on the controversial areas of oncoplastic breast surgery. This consensus survey was carried out on-line through the Consensus software program (www.consensuss.com) under the roof of Turkish Federation of National Societies for Breast Diseases (TFNSBD). After finalizing each proposition, web-based remote access consensus process was performed on the Likert scale using Delphi method with the Consensus (www.consensuss.com) software program. Through the related software, an invitation was sent to 111 people who had at least 5 years of general surgery expertise in Turkey, and who devoted more than 50% of their daily clinical practice to the treatment and surgery of breast diseases. Sixty-two out of 111 people accepted to participate in the panel and made an on-line evaluation. According to the consensus results; Lumpectomy area should be done by placing the clips on at least four walls of the cavity, if the margin of the tumor is clear in central tumors, the distance between the tumor and the nipple is not significantly important, oncoplastic techniques may be used in patients with locally advanced breast cancer after neoadjuvant chemotherapy, in patients who have macromastia with ductal carcinoma in situ or breast cancer, OBCS techniques can be performed, and OBCS should be evaluated in terms of breast aesthetics. After OBCS, re-excision can be performed at a re-do setting in cases with involved surgical margins. Our consensus results may provide a basis for the development of some standards in OBCS.

Dysphagia in Children with EA-TEF From the Perspective of Pediatric Surgeons in Clinical Settings.

The current study was aimed to define clinical practice, knowledge and awareness, and best practice regarding dysphagia in children with esophageal atresia with/without tracheoesophageal fistula (EA-TEF) from the perspective of pediatric surgeons in Turkey. Pediatric surgeons practice EA repair were included. A survey related to clinical practice, knowledge and awareness, and best practice regarding dysphagia in EA-TEF was used. The survey was electronically sent to potential participants. Seventy-two pediatric surgeons with a mean professional experience of 14.73 ± 9.66years (min = 1, max = 41) completed the survey. 19.4% (n = 14) had a standardized protocol for dysphagia screening and %51.4 (n = 37) provided swallowing rehabilitation to their patients. Most of the participants (80.6%) reported that they do not have an appropriate team approach for dysphagia management. The mean knowledge and awareness score was 11.04 ± 1.27 (min = 7, max = 12). The mean VAS score related to the need for standardized protocol in dysphagia management was 9.23 ± 1.44 (min = 3, max = 10). The mean VAS score related to the need for routine screening for dysphagia after surgery was 8.67 ± 2.17 (min = 1, max = 10). The mean score for the degree of the contribution of diagnosis and management of dysphagia to the surgical treatment in children operated for EA-TEF was 7.98 ± 2.08 (min = 3, max = 10). The participants mostly suggested the necessity of a standardized protocol in dysphagia and routine dysphagia screening in children with EA-TEF. Knowledge and awareness is found to be high among pediatric surgeons in Turkey. However, their clinical practice does not include a standardized protocol regarding dysphagia screening and management.

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey.

One of the most important aspects of inappropriate antibiotic use among general surgeons in Turkey is the use of surgical antibiotic prophylaxis (SP). In order to shed light on the current situation, we conducted a survey of general surgeons in our country. Our aim was to evaluate the approach taken by our general surgeons in prescribing SP, while providing data pertinent to the effectiveness of the 'Rational Drug Use' (AIK) national action plan. A questionnaire on the subject of personal SP usage and compliance with guidelines was distributed amongst general surgeons between 2018-2019. The questions related to individual approaches taken by surgeons when treating patients with either clean or clean-contaminated wounds. Results of the questionnaires were collated and compliance with ASHP guidelines was evaluated. A total of 317 completed questionnaires were evaluated. According to the questionnaire results, the rate of total compliance with ASHP guidelines was 26.8%. The compliance rate for preoperative SP was 69.7% in the clean wound group and 54.6% in the clean-contaminated wound group. Although 96.5% of the participants reported correct timing for the first dose of SP, this number dropped to 79.5% apropos the adminstration of further doses of prophylaxis. The percentage of surgeons prescribing continued antibiotics at discharge for clean and clean-contaminated cases was 22.7% and 38.5%, respectively. The results of this study indicate that inappropriate use of SP is widespread in our country, and that antibiotics continue to be prescribed at discharge.

Assessment of periprosthetic joint infection prevention methods amongst Turkish orthopedic surgeons in total joint replacement: A survey.

Objectives This study aims to assess the methods employed by Turkish orthopedic surgeons to prevent periprosthetic joint infection (PJI) in total joint arthroplasty (TJA).Patients and methods The data obtained for this study, conducted between January 2019 and February 2019, were gathered by sending out an online survey to Turkish Society of Orthopedics and Traumatology members (n=2,267). A total of 354 orthopedic surgeons responded and completed survey. The survey had 23 questions which include the experience, academic position, hospital where the physician works, monthly arthroplasty numbers, and infection prevention methods employed before, during, and after surgery.Results The period for antibiotics prophylaxis showed variability, with about 63% of surgeons using prophylaxis longer than 24 hours. In terms of academic position, 52.4% of professors and 52.8% of associate professors used prophylaxis for the first 24 hours whereas this rate was 31.3% in operators (p=0.01). Of surgeons, 50.7% who perform more than 10 arthroplasties per month and 33.6% of surgeons who perform less than 11 arthroplasties per month used 24-hour antibiotic prophylaxis (p=0.006). Blood glucose level assessment prior to surgery was performed by the majority of surgeons (94%). A total of 118 orthopedic surgeons (33.3%) performed methicillin- resistant Staphylococcus aureus (MRSA) decolonization with 54.7% of associate professors, 59.5% of professors, and 24.7% of operators (p=0.001). Only 60 surgeons (16.9%) checked vitamin D levels.ConclusionOur study results demonstrated that the majority of orthopedic surgeons in Turkey do not follow the antibiotic prophylaxis recommendations and they use antibiotic prophylaxis for longer periods. Professors and associate professors, and surgeons with higher monthly arthroplasty numbers than surgeons with lower monthly arthroplasty numbers follow the recommended periods more than their counterparts. Most surgeons assess blood glucose levels whereas a small number of surgeons perform MRSA decolonization and check vitamin D levels.

Ağız ve Çene-Yüz Cerrahlarının Dental Malpraktis ile İlgili Görüşleri

The aim of this study is to explain the concept of dental malpractice, to reveal the knowledge and opinions of oral and maxillofacial surgery specialists about dental malpractice and to investigate whether these opinions differ according to demographic characteristics. This is a descriptive, cross-sectional survey conducted from January to December 2019 in Turkey. In order to measure and evaluate the views of oral and maxillofacial surgeons on dental malpractice, a questionnaire consisting of 22 questions was prepared after the literature review. One hundred and twenty four oral and maxillofacial surgeons working in public and private sectors were included in the study. 6.5% of the participants stated that judicial and administrative investigations and/or lawsuits have been filed against them due to dental malpractice. While 12.9% of the participants stated that they had sufficient knowledge about the concept of dental malpractice, only 6.5% stated that they had knowledge about the legal regulations related to malpractice. While 93.5% of the participants found their profession risky in terms of dental malpractice, the rate of those who had occupational liability insurance was found to be 80.6%. Of participants 87.1% think that the distinction of malpractice-complication is not made clearly. This study reveals that although oral and maxillofacial surgeons in Turkey have serious concerns about dental malpractice, they do not have sufficient knowledge about dental malpractice and the current legal regulations. So, oral and maxillofacial surgeons should strengthen their professional education and update their knowledge of medical ethics and health law-related issues.

National questionnaire on skills and techniques in pediatric tracheotomy surgery in Turkey

ObjectiveThe aim of the study was to determine the differences in surgical preferences of ENT Surgeons in Turkey with regard to pediatric tracheotomy. DesignQuestionnaire study. ParticipantsENT Surgeons. Materials and methodsThe national multiple-choice questionnaire study included a total of 16 questions about physicians technical preferences, different methods and complications in pediatric tracheotomy surgery. It was planned and implemented with the support of a professional survey company (www.surveymonkey.com). ResultsThe questionnaire was answered by 591 ENT Surgeons; the percentage of the physicians performing pediatric tracheotomies in the previous year was 59.6%. Forty point four percent (40.4%) of the physicians had not performed tracheotomies in the pediatric age group and 57.9% had not performed tracheotomies in patients under one year old. Seventy point six percent (70.6%) of the physicians who had performed tracheotomies had made vertical skin incisions, 69.5% of them had removed subcutaneous adipose tissue, 81.4% of them had retraction the thyroid isthmus area from their field of view; 83.9% of them had made a vertical incision to the trachea, 82.5% of them had applied a stay suture to the trachea and 4.7% of them had used additional techniques for stoma maturation. The intraoperative mortality, early complication, late complication, and total complication rates were 3.9%, 32.7%, 21.2% and 53.9 respectively. ConclusionsThis is the first large-scale questionnaire study with data on pediatric tracheotomy techniques and the practices of ENT Surgeons at a national level. Common approaches were observed among the.

An Evaluation of the Approach of Orthopaedic Surgeons to Local Anaesthetic Toxicity

Aim: To review the knowledge of orthopaedic surgeons related to the diagnosis, treatment and prevention of local anaesthetic systemic toxicity (LAST) and to raise awareness related to this subject. Material and Method: A 16-item questionnaire was applied to orthopaedic surgeons of different academic levels in different hospitals in Turkey. The items sought to identify demographic information, general knowledge related to local anaesthetic drugs, general knowledge related to toxicity and current treatment options. Results: The study included a total of 172 orthopaedic surgeons in Turkey, of which 18.6% were orthopaedic residents, 51.7% orthopaedic and traumatology specialists, and 29.7% faculty members. Tenure in the orthopaedic area was determined to be &amp;gt;10 years in 45.3% of the participants. Local anaesthetic was seen to be used most in the operating theatre, followed by the Emergency Department, polyclinic intervention rooms, and on the wards. Of the total participants, 59.6% stated that they had never heard of the use of lipids in the treatment of LAST, 29.8% had heard of it but did not use it and 5.3% knew about the manner and area of use of lipid treatments. Conclusion: Awareness of physicians about LAST and preparedness for complications can ensure safer use of these local anaesthetics.

Management of acute limb compartment syndrome: A survey of clinical practice among orthopedics and traumatology surgeons in Turkey

Aim: The aim is to conduct a survey of currently practising orthopedics and traumatology surgeons and residents in Turkey regarding their current practice and perceptions on compartment syndrome management.Materials and Methods: A structured survey was developed for the study. Diagnosis in alert and unconscious patients, clinical signs of the condition, compartment pressure measurement, optimal time frame and technique for performing a fasciotomy, and preventive measures in patients with limb injuries were assessed. Results: Due to the evaluation, most significant and earliest symptom thought to be pain in 74% and 82.2% respectively. In diagnostic approach of conscious patients, 59.6% find intense pain and intense pain with passive stretching sufficient for diagnosis. In unconscious patients, 22.6% measure intracompartment pressure in every patient and if high in first measurement, indicates emergent fasciotomy, whereas 59.5% apply emergent fasciotomy in clinical suspicion without measuring intracompartment pressure. 89.7% don’t use pressure gauge in case of a compartment syndrome suspicion. 55.5% have not seen manually constructed mechanism before. 25.3% participants have sufficient knowledge to construct the mechanism. Conclusion: There are controversies in the management of compartment syndrome in Turkey, development of clinical practice guidelines may encourage best practice, reduce variations and reduce the incidence of complications.

General surgeons' approach to laparoscopic inguinal hernia surgery and training expectations in Turkey: A web-based survey

Aim: In this study, we aimed to determine the approach of general surgeons toward laparoscopic inguinal hernia surgery and training needs of surgeons and to collate data that will help formation of training programs or the development of current training programs. Material and Methods: A survey study was designed with 15 questions, including questions regarding determination of characteristics of their trainings, surgical preferences, and their knowledge and approach toward laparoscopic inguinal hernia surgery. General surgeons in Turkey invited to study on a voluntary basis by using Turkish Surgical Association’s official website. Results: A total of 160 surveys were completed included to the study. Of the total participants, 54.4% included laparoscopic hernia surgery in their daily applications. It was observed that most prevalently used surgical method (60.9%) was total extraperitoneal approach. Of 73 participants, 39 (52.8%) who did not include laparoscopic inguinal hernia surgery into daily surgical procedures stated that they inform the patients about laparoscopic inguinal hernia surgery during the pre-operative evaluation. The rate of performing laparoscopic inguinal hernia surgery was found to be lower among those who had been working for ≥10 years (p = 0.001). Moreover, it was observed that only 18 (34.6%) of the 52 participants, who had been working for ≥10 years and who did not include laparoscopic hernia repair into their daily surgical procedures, wanted to receive training. Conclusion: General surgeons have a difference of opinion on the benefits of laparoscopic inguinal hernia repair. It is necessary to determine the obstacles for laparoscopic inguinal hernia surgery to be performed prevalently. Academic institutions designing and bringing the training programs into action can help inform surgeons who want and need the trainings, and success can be obtained in shortening the time the learning curve takes and lowering of the recurrence and complication rates by continuous medical training programs conducted routinely.

Preferences of the Thoracic-Surgery Academic Teaching Staff on Thoracotomy Opening/Closure and Post-Thoracotomy Pain Management

Background: A survey was conducted on preferences for thoracotomy opening and closure as well as post-thoracotomy pain management among academic teaching staff of thoracic surgeons in Turkey. It was aimed to assess the attitudes of the thoracic surgery training-center academicians on aforesaid topic. Methods: A 7-question questionnaire was performed by face-to-face interview or online by e-mail to the academic professionals working at resident-training centers. Eighty-eight randomly selected academicians were invited to complete the questionnaire, and 48 of them answered. Based on the complete and valid responses, the methods for opening and closure of thorax, the number of chest drains placed, the method of analgesia in per-or postoperative period and the analgesic agents used commonly were assessed. Results: Thirty-three (68.8%) of 48 were working at university hospitals and 24 (50.0%) were in age group of 40 - 49 years. Muscle-sparing (41.7%) and standard posterolateral thoracotomies (41.7%) were the most preferred incision. The most used method for closing thorax was pericostal sutures. Per-or postoperative analgesia was stated to be performed by all of the participants, while 45 (93.75%) of them reported that they preferred to administrate more than one procedure. Intercostal/paravertebral nerve block (26.4%), epidural analgesia (24.5%), systemic parenteral non-steroid drugs (24.5%) and systemic parenteral opioid (20.9%) were the most commonly used methods. Conclusion: Preventing intercostal nerve injury decreaseed post-thoracotomy pain, as well as the necessity of post-operative analgesic use. Conversely, most of the academic staff did not prefer the methods for preserving intercostal nerve. More than one analgesia procedure were said to be used by majority of the participants.

Bianchi’s bowel lengthening procedure for short bowel syndrome: Report of two cases and approach of pediatric surgeons in Turkey

Bianchi’s bowel lengthening procedure for short bowel syndrome: Report of two cases and approach of pediatric surgeons in Turkey

Surgeons’ Approaches and Professional Perspectives on Breast Masses: A National Survey in Turkey

General surgeons' approaches to breast masses in their daily practices and their perspectives for issues on breast diseases and breast surgery are investigated through a survey. Answers of 524 general surgeons for the survey "Approach to breast diseases and breast surgery" between November 2012 and February 2013 were assessed. Demographic features, approaches to the breast masses, and answers for the clinical scenerios of surgeons were questioned. Surgeons were asked about management of breast cancer and the future role of surgeons for oncoplastic breast surgery and breast diseases. Participants were representing 14.6% of all general surgeons in Turkey. The survey revealed that breast diseases are the most common cause for admission in general surgery outpatient clinics. Needle biopsies were employed by 241 (60%) respondents. Three hundred and seventy-one (71%) participants indicated that breast cancer management could be accurately conducted by the general surgeons. Two hundred and seventy-three (52%) respondents think that oncoplastic breast surgery should be performed by a general surgeon and 241 (41%) respondents predict that the role of general surgeons for breast diseases and breast surgery will decrease in the future. Basic approaches towards breast masses need to be improved in our country despite the highest frequency of breast diseases in outpatient admissions. The views and opinions of surgeons on breast diseases and the course of breast surgery in different regions and different communities need to be defined and clarified.