Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Fixation of the mesh to the abdominal wall has been associated with various postoperative complications for no additional benefit in lowering recurrence rates. For non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable. Further studies with larger sample sizes are necessary for subgroup analyses.

Objective:Endometriosis is seen in women during their reproductive period, where stromal tissue and functional endometrial glands of the uterus are observed outside the uterine cavity. In this study, we aimed to identify the clinical characteristics of our patients who underwent surgery with scar endometriosis and to discuss the surgical results in light of the literature.Materials and Methods:A total of 24 patients who underwent surgery and diagnosed as having endometriosis as the result of a pathologic examination were retrospectively evaluated.Results:The mean age of the patients was 31 years. Thirteen presented to general surgery and 11 presented to gynecology outpatient clinics. The pain was cyclical in 19 patients. There was history of cesarean section in 9 patients, twice in 12, and 3 times in three patients. The mean diameter was 39.1 mm on ultrasound, and 37.5 mm on magnetic resonance imaging. Endometriosis was on the left side of the incisions in 13, whereas it was on the right in 11. The mean weight of the lesions was 61.6 grams.Conclusion:The occurrence of endometriosis is supported by the iatrogenic implantation theory. In the event of a mass in the abdominal wall, previous obstetric and gynecologic operations and a history of a painful mass during menstruation periods must be questioned. In the treatment of scar endometriosis, excision is required by obtaining secure margins. If diagnosis can be established preoperatively, unnecessary surgeries can prevented.

No abstract

IntroductionLaparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery.AimTo compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA).Material and methodsAll total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded.ResultsThe mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004).ConclusionsSpinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

No abstract

Objective: Thyroid cancer constitutes approximately 1% of all cancers, approximately 90% of the endocrine malignancies, and is responsible for 0.4% of cancer-related deaths. Additional markers are required for the accurate diagnosis of thyroid malignancies. There is no marker that can accurately facilitate pre-operative benign-malignant differentiation of thyroid nodules. The present study aims to evaluate the diagnostic value of preoperative serum Galectin-3 levels in thyroid cancer and to avoid unnecessary aggressive interventions. Material and Methods:Sixty-four patients who were operated between May 2009 and April 2011 were included in this study prospectively. Patients with toxic nodules and those with malignancies detected in preoperative fine needle aspiration biopsies (FNAB) were excluded. Patients with thyroid nodules of >3 cm in ultrasonography or having suspicious cytological findings in their preoperative FNABs regardless of the nodule size were included. Patients were divided into 2 groups, "control"and "cancer," according to the postoperative pathology results. Results:The control group included 50 and cancer group included 14 patients. The mean age of the control group was 44.84±13