Surgery In Turkey Research Articles

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.

Effect of Different Kinds of Music on Anxiety During Implant Surgery in Turkey: Randomized Controlled Study.

Dental anxiety causes patients to avoid or delay dental treatments. This delay leads to more serious dental problems, which can then lead to more invasive and expensive treatment with possible emergency situations. The purpose of this study was to determine the most successful and effective kind of music to lessen the anxiety of patients during dental implant surgery. This study was a prospective observational randomized controlled study. Eighty dental implant surgery patients aged between 40 and 70 years were chosen for the study. Patients were divided into four groups: group 1-classic Turkish music group (Saba or Rast Tune); group 2-classical music (Vivaldi); group 3-slow rock music; and group 4-control group. Blood pressures, heart rate, and O2 saturations of the patients were evaluated along with Corah's Dental Anxiety Survey (CDAS) at admittance. After 5 minutes of music in the room, the same evaluations were recorded, and the survey was repeated. All the groups with music treatment had a significant decrease in anxiety levels. It was observed that listening to music had a positive effect on dental anxiety regardless of the kind of music. There were significant differences in CDAS values postoperatively. Turkish music and classical music were much more effective in diminishing dental anxiety compared with soft rock music (P = .000 and .002, respectively). This study indicated that regardless of the kind of music, listening to music diminishes dental anxiety significantly; Turkish music and classical music were the most effective kinds of music.

Pioneering orthopaedic trauma surgery in Turkey: Burhaneddin Toker (1890-1951), the stormy 1930s, and refugees running from Nazism.

Orthopedic surgery, the medical discipline that deals with diseases and injuries of the musculoskeletal system has been considered a distinct medical discipline in the west since the beginning of the twentieth century. However, in Turkey, the acceptance of musculoskeletal traumatology as an integral part of orthopedic surgery actualized as late as 1961. Previously, orthopedic trauma patients were usually treated in general surgery departments. Dr. Burhaneddin Toker, a true pioneer, changed this conduct of the time in Turkey. He transformed Cerrahpaşa Hospital, then a municipality hospital today the well-known Cerrahpaşa Medical School of Istanbul University, to a trauma center. He pioneered systematic surgery of the musculoskeletal injuries, created a separate service for musculoskeletal traumatology, trained many surgeons in this field, wrote textbooks, and reported his clinical experience in scientific publications. This study examines the biography of Burhaneddin Toker and how he was able to further medical training in Turkey with a focus on Turkey in the stormy 1930s, the way the young republican government under Atatürk's leadership handled educational issues, and the refugee scientists who found a safe haven in Turkey fleeing Nazism.

A Market Research Of Obesity And Bariatric Surgery In Turkey And Tunisia

This article aims to discuss four topics according to the recent scientific data a) to overview the frequency of obese and overweight individuals among Tunisia and Turkey populations; b) to examine health technology assessment of bariatric surgery (BS) report (HTA) in Tunisia and Turkey; c) to evaluate the cost and cost reimbursements by social health systems for bariatric surgery in Turkey and Tunisia; d) to examine the total number of bariatric surgical procedures and their costs in state and private health organizations in Tunisia and Turkey. The OECD (2011-2017) Turkey report was included for the data for the frequency of obese and over-weighted people among the general population Turkey, while the WHO report of «Diabetes Prevalence and Diabetes Risk Factors» of 2016 was included for Tunisia. Also supporting data on the overweight and obese population in Tunisia was provided from the news site named Middle East Monitor and the «Tunisian Health Examination Survey» conducted in 2016. Surgery cost and reimbursement of cost, analyses of bariatric surgery in Turkey published in 2014 was included as well. The data about the patient profile to whom bariatric surgery can be applied, the indications for bariatric surgery, and centers where it can be applied in Turkey are obtained from the Cost-Effectiveness of Obesity Surgery in Turkey and Economic Value Study (CEVOS-T) and Turkey Bariatric Surgery HTA Report. The Turkey Health Management Center website has been used for the total bariatric surgery performed. The authors analyzed the general status of bariatric operations in Turkey and Tunisia. The overweighted and obese individuals constitute 64.4% of Turkey’s population while this frequency is obtained as 62.8% of the Tunisian population. The rate of increase in obesity was obtained by 10.8% between 2014 to 2017 in Turkey. According to the results of CEVOS-T study the total economic burden attributable to an obesity rate of 1.16% of GDP in 2004, the proportion of the GDP in 2012 was seen as 1.73%. A total of 15,800 bariatric surgical procedures were performed in Turkey in 2018. The operational cost of a tube stomach surgery in the health unit of the Turkish Union of Public Hospitals (TKHK) was found to be 8930 TL. The cost of bariatric surgery in Tunisia including hospitalization is £ 3950. As the majority of the population is overweighted and obese in both Turkey and Tunisia, it can be interpreted as the occurrence of obesity-related health problems that can be increased. When the complications and advantages of bariatric surgery were examined it was decided that these two countries should give importance to bariatric surgery. Turkey’s interest in this subject is revealed with HTA and CEVOS-T report. Health economics analyses such as bariatric surgery HTA reports, number of bariatric surgery operations, the cost-effectiveness of BS in Tunisia could not be reached due to lack of statistics and resources. Turkey and Tunisia made with these investigations demonstrated a general situation in bariatric surgery. Keywords: bariatric surgery, health technology, market of bariatric surgery, obesity, overweight population.

Comparing Different Music Genres in Decreasing Dental Anxiety in Young Adults Who Underwent Third Molar Surgery in Turkey: Randomized Controlled Trial

The purpose of this study was to determine the music genre reducing anxiety best in patients whose third molars were extracted. Eighty patients were included in this prospective, observational, randomized controlled trial. They were divided into 4 groups: group 1, Turkish music; group 2, classical music of a Western culture; group 3, soft rock music; and group 4, no music (control group). The preoperative blood pressure, heart rate (HR), and oxygen saturation of each patient were measured, and the Corah Dental Anxiety Scale (CDAS) questionnaire was applied, with the values being measured and recorded at 5-minute intervals. Descriptive and bivariate statistics were computed, and the P value was set at .05. Of the 80 patients, 44 were women and 36 were men. The average age was 24.1±5.9years. No significant differences between the groups were found in terms of age; gender; or preoperative HR, mean arterial pressure, oxygen saturation (as measured by pulse oximetry), and CDAS values (P>.05).Although no significant correlations was found between anxiety levels and age (P=.330), HR (P=.694), or mean arterial pressure (P=.775), it was detected that anxiety was high in women (P<.05). Anxiety levels decreased at all times in all groups, but the postoperative CDAS values of the classical music group were significantly lower than those of the other groups (P=.024). This study found that classical Western music that was started in the preoperative period and continued until the end of the operation significantly reduced the anxiety associated with third molar extraction in patients aged between 18 and 30years.

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.

Rates of Surgical Site Infection After Colorectal Surgery in Turkey

Rates of Surgical Site Infection After Colorectal Surgery in Turkey

Hand surgeon - to be or not to be? That is the question. Compulsory health service experience of hand surgery in Turkey

Objectives: Hand surgery has been a major theme throughout the education of orthopedics and traumatology (OT) along with plastic, reconstructive, and aesthetic (PRA) surgery residents. However, to work as a hand surgeon during compulsory health service (CHS) is a new topic for Turkey. We aimed to share the elective surgical experience of six hand surgeons during CHS in different centers of Turkey. Methods: The hand surgeons who have already finished their CHS or were up to finish their CHS was requested to fill operation records (OR) form for elective procedures performed in the surgeon's usual daily practice. The records from all six surgeons were integrated. Results: Five OT and one PRA originated hand surgeons were available for this study. Tendon procedures were the most commonly performed procedure (14.3%), followed by phalanx (10.6%), and then by nerve (10.4%) procedures. A small percentage (2.7%) of operations performed were beyond the scope of hand surgery. Simple procedures (trigger finger release, carpal tunnel release, foreign material extraction, ganglion cysts excision, de Quervain's tenosynovitis release) were comprising 20.9% of all the operations performed. Conclusion: Hand surgery comprises a broad spectrum of disorders and requires a distinct fellowship period. Hand surgeons bear an important mission about basic hand surgery education of OT and PRA residents and encourage them to perform simple procedures. The possibility of team-work will definitely increase the interest for hand surgery and result in better outcomes for patients. Finally, we honestly declare that we feel satisfied with our special work and invite residents to walk together in this endless hand surgery road.

Cost Effectiveness of Bariatric Surgery In Turkey: From A Long-Term Perspective

According to the most recent data, obesity rate has increased to 19,9% in 2014 from 15,2% in 2008 in Turkey. Bariatric surgery is among the most recent treatment alternatives increasingly used for morbid obese patients. Reimbursement agencies face the challenge to fight with the cost of obesity and its co-morbidities and also with the cost of bariatric surgery. The main objective of this study is to assess the cost effectiveness of bariatric surgery from a 20 years perspective in Turkey. A Markov model was developed to show the long-term clinical and economic benefits of bariatric surgery. Cost effectiveness of gastric bypass (GBP) and sleeve gastrectomy (SG) were compared with standard of care (SoC) (diet exercise etc) for BMI≥40 patients. The model not only covers the impact of surgery on BMI but also on Type 2 diabetes, cardiovascular diseases, cancer (only in women) sleep apnea and knee pain and complications due to surgery. Analyses were made from the Turkish Social Security Institution’s (SSI) perspective and for both package and fee for service prices. Markov transition probabilities were obtained from published research, Turkish cost data were obtained from literature and expert views. Incremental QALYs were 2,59 and 2,63 for GBP and SG respectively. Both modes of bariatric surgery dominated SoC under fee for service payment. With package prices, incremental costs per patient were 4,287 TRY for GBP vs SoC and 3,573 TRY for SG vs SoC. Incremental cost per patients with T2DM was 3,770TRY for GBP vs SoC. The ICERs were 1,655 TRY and 1,357 TRY for GBP and SG respectively. For patients with T2DM the ICER was 3,370 TRY. The results showed that bariatric surgery is a cost effective option for the Turkish health care system both under package and fee for service prices.

Information on the Internet Regarding Orthognathic Surgery in Turkey: Is It an Adequate Guide for Potential Patients?

To evaluate the quality of information on websites regarding orthognathic surgery in Turkey using the DISCERN toolkit. An Internet search was performed using the Google search engine with the terms "orthognathic surgery", "jaw surgery", "jaw operation", "correcting jaw surgery", and "surgery orthodontics." The first 25 websites obtained after searching for each term were evaluated. Duplicate websites, advertisements, discussion groups, links to research articles, videos, and images were not considered. The remaining websites were analyzed using the DISCERN toolkit. This toolkit is composed of 15 questions that were scored from 1 to 5. Results were calculated as mean scores, percentages, and ranges. Among the 36 evaluated websites, 12 (33.3%) belonged to plastic surgeons, 11 (30.6%) belonged to orthodontists, 8 (22.2%) belonged to private dental clinics, 3 (8.3%) belonged to maxillofacial surgeons, 1 (2.8%) was a professional organization website, and 1 (2.8%) belonged to a private hospital. The Turkish Orthodontic Society had the only listed professional organization website. The mean total DISCERN score was 28/75 (range: 15-48). The overall quality of information in 44.4% of the websites was low. The main problems of websites were as follows: no mention of the aims, sources, and production time of information; no links for additional sources of information; and no information for patient carers. The quality of web-based information on orthognathic surgery was generally low. Higher quality information provided by public organizations that do not have profit concerns is required.

Hand surgery in Turkey.

Hand surgery in Turkey.

Operational cost of obesity surgery in Turkey

Introduction: Obesity and its comorbidities are among the primary challenges health systems face globally. Obesity is rapidly becoming a problem in Turkey, as well. The real cost of obesity surgery differs from country to country mainly due to differences in the costs of health care services, medical devices and medicines. The objective of this study is to fi nd out the operational cost of obesity surgery in Turkey. Materials and Methods: Expert panel is the main methodology used in the study. An expert panel questionnaire form was designed after the literature review aiming at fi nding the costs. The form was sent to the experts in advance and a panel discussion was undertaken to reach a consensus. After the consensus building phase, the cost of surgical treatment of obesity was estimated based on the public reimbursement and auction price. Results: Laparoscopic by-pass surgery had the highest cost compared to others, in both operational and post-op costs. The highest cost for pre-op was the laparoscopic sleeve operations. The package payment included all costs and services between pre-operative period and 15 days after operation. Based on the analysis, the package reimbursement prices were below their actual costs for all surgical methods. Conclusion: Social Security Institution reimburses the obesity surgery with a fi xed amount of 4500 TL, 3100 TL and 2250 TL for by-pass, sleeve and banding surgeries, respectively. This fi xed amount covers pre-operative, operative and post operative period. It was shown that the fi xed amount is lower than the real cost of the practice of obesity surgery. As a result, hospital managements can avoid performing obesity surgery or reduce the quality of the surgical treatment by lowering possible losses. Decision makers may need to evaluate the results of the study to understand the real picture and to take action in order to improve the obesity surgery reimbursement.

Detailed evaluation of the centers that apply video-EEG monitorization and epilepsy surgery in Turkey

Detailed evaluation of the centers that apply video-EEG monitorization and epilepsy surgery in Turkey

Asian perspective in surgery: thoracic surgery in Turkey.

Turkey with a population of 78 million is located between Asia and Europe geographically and culturally. There are 577 active pure thoracic surgeon and 37 thoracic surgery teaching units. Thoracic surgeons usually deal with lung cancer patients due to relatively higher rate of tobacco usage as well as inflammatory diseases such as pulmonary hydatid disease, bronchiectasis and empyema. Minimally invasive thoracic surgery has been a new approach which is being adapted by increasingly more surgeons. There are a number of reasons to predict that the number of thoracic surgical cases will be increased and new generation of thoracic surgeons will be operating more minimally invasive resectional surgeries for most lung cancer in future.

Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life.

Background:Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality.Methods:This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36.Results:Patient mean age was 55.2 ± 11.8 years (33.0–83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ± 2.38 (0–10), 1.73 ± 1.54 (0–5), and 1.64 ± 2.31 (0–8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).Conclusions:PMPS seriously impacts patients’ emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.

Psychiatric management of obesity surgery in Turkey: the need for consensus and a guideline

Bariatric surgery operations in Turkey increasingly expands as well as in the world. Growing literature supports that psychiatric and psychosocial assessment of obesity surgery patients are crucial. Many of the weight loss surgery centers applies multidisciplinary approach including psychiatric and psychological assessments. However, a worldwide accepted guideline to manage obesity surgery patients regarding psychiatric and psychosocial assessment, is not available. Instead, there are variety of expert consensus texts are used by different centers which taken into account by the health authorities. Unfortunately, neither expert consensus texts nor a guideline are available yet, in Turkey. Patients, bariatric surgeons and even mental health professionals have been underestimated the importance of psychiatric evaluation in bariatric surgery in Turkey. The main themes to be discussed in this context are the necessity of psychiatric evaluation, assessment methods, qualification and competency of the professionals and the quality of the assessments. Patients should be screened routinely in terms of the presence of eating disorders, mood disorders, substance use disorders and other psychiatric disorders in both pre- and surgical period and those who needed should be follow for further psychiatric evaluation and treatment. Careful psychiatric and psychosocial assessment of the patients is important with regard to the improvement of the quality of life as well as preventing adverse effects on weight loss in the post-operative period. This article is aimed to review the current literature and guidelines in order to explore the main issues in psychiatric aspects of the assessment of bariatric surgery patients. It is also aimed that this article provide an orientation for the guidelines will be prepared in Turkey. This article has focused on the assessment of the common psychiatric conditions before and after bariatric surgery. Effectiveness of the treatments, selection of the interventions and advantages/disadvantages of psychopharmacologic, psychotherapeutic or psychosocial interventions are excluded from the scope of this article. It is obvious that to discuss these issues in the relevant platforms and to develop a guideline, are needed in order to reach a common approach.

Turkish endocrine surgery publications in international scientific journals.

In recent years, major progress has been made in the field of endocrine surgery in Turkey, similar to that in the rest of the world. Parallel to these developments, there has been a significant increase in the number of publications in the related field. Our study aimed to evaluate Turkey's publications related to endocrine surgery in the international arena. Members of the general surgery departments from academic centers in Turkey were determined. Using these member names, a PubMed search was performed for English papers related to "endocrine surgery." For searching papers from non-academic centers, the same engine was used. To reach manuscripts possibly missed by the PubMed search, 3 national calls were made through the website of the Turkish Society of Endocrine Surgery. The obtained papers were divided into "thyroid," "parathyroid," "adrenal," and "neuroendocrine tumors" and were listed according to the publication year. In addition, all manuscripts were listed according to the publishing journal and the 2012 impact factor of that journal. This study did not require ethical approval, because it did not involve evaluation of experimental or patient data. A search of Turkish general surgery clinics revealed 497 international publications, between 1976 and 2012. When listed according to the year of publication, most publications were found to be in the year 2009. Papers appeared mostly in "Surgery Today." The mean impact factor of the journals where the papers have been published was 1.9 (0.1-13.8). The rates of thyroid, parathyroid, adrenal tissue and neuroendocrine tumors related publications were 69%, 10%, 15% and 6%, respectively. Since this study is not an experimental study or a study related to patient data, we did not apply for ethical approval. The contribution of Turkish general surgeons' to world science is apparent when evaluated in terms of publications related to endocrine surgery until recently. Particularly, since 2002, with the increase in the number of publications in the field of endocrine surgery, there has been an increase in Turkey's importance on the international platform.

PMS44 - Cost-Effectiveness of Use of Barricaid® In Lumbar Discectomy Surgery in Turkey

PMS44 - Cost-Effectiveness of Use of Barricaid® In Lumbar Discectomy Surgery in Turkey

The approach of general surgeons to oncoplastic and reconstructive breast surgery in Turkey: a survey of practice patterns.

Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. Cross-sectional study. Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.

Peptic ulcer complications requiring surgery: what has changed in the last 50 years in Turkey.

The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.