INTRODUCTION: A novel index called the pan-immune inflammation value (PIV) reflects the body’s systemic inflammation and immunological response. This study aimed to determine whether the PIV can be used as a diagnostic biomarker in assessing disease activity in patients with ulcerative colitis (UC).
METHODS: According to the Truelove and Witts criteria, this retrospective study included 64 clinically active UC patients and 64 UC patients in remission. For the differential diagnosis of active UC pa-tients from patients in remission, the cut-off value was estimated by making receiver-operator curves (ROC) of PIV, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR).
RESULTS: There were no significant differences between the active UC patients and UC patients in remis-sion regarding demographic characteristics such as age and gender. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, PLR, and PIV were significantly elevated in active UC patients than those in remission (p<0.001). According to ROC curve analysis, PIV had the greatest predictive accuracy for active UC (358.37 was the optimal PIV cut-off for active UC) with specificity and sensitivity of 71.9% and 73.4%, respectively (AUC: 0.821, p<0.001).
DISCUSSION AND CONCLUSION: PIV can be accepted as a promising marker that contributes to the evaluation of disease acti-vation/remission and severity for ulcerative colitis.

INTRODUCTION: Today, appendectomy is the most frequently performed emergency surgery in general surgery practice. While laparoscopic appendectomy is the gold standard, it is now performed more frequently under the use of antithrombotic drugs due to the increasing global quality of life. This study aimed to determine the incidence of postoperative bleeding and associated risk factors in patients receiving antithrombotic therapy who underwent laparoscopic appendectomy.
METHODS: A total of 847 patients who underwent laparoscopic appendectomy with a diagnosis of acute appendicitis between January 2019 and August 2025 were retrospectively evaluated. Patients were divided into two groups based on antithrombotic drug use: The antithrombotic group (n=42) and the control group (n=805). The primary endpoint was postoperative bleeding, and secondary endpoints included operative time, length of hospital stay, transfusion requirement, and mortality.
RESULTS: The postoperative bleeding rate was 7.1% (n=3) in the antithrombotic group and 1.2% (n=10) in the control group (p=0.019). Multivariable analysis identified antithrombotic drug use (OR: 5.84, 95% CI: 1.52–22.45; p: 0.010), age ≥65 years (OR: 3.12, 95% CI: 1.08–9.02; p: 0.036), and complicated appendicitis (OR: 2.67, 95% CI: 0.94–7.58; p: 0.065) as independent risk factors. Transfusion requirement was significantly higher in the antithrombotic group (4.8% vs. 0.5%, p=0.023).
DISCUSSION AND CONCLUSION: Antithrombotic drug use increases the risk of postoperative bleeding following laparoscopic appendectomy. However, this risk can be maintained at an acceptable level with careful patient selection and appropriate perioperative management. In emergency settings, proceeding with surgery without waiting for discontinuation of antithrombotic therapy may be a reasonable approach to prevent complications of appendicitis.

INTRODUCTION: Prophylactic intra-abdominal drains are still frequently used after colorectal resections despite inconsistent evidence regarding clinical benefit. This study evaluated the association between drain use and short-term postoperative outcomes after colorectal surgery.
METHODS: A retrospective observational cohort study was performed at Erzurum City Hospital including adult patients who underwent colorectal resection between January 2020 and October 2025. Patients were categorized as drain or no-drain based on intraoperative drain placement. Primary outcomes included overall postoperative complications, major morbidity (Clavien–Dindo ≥III), anastomotic leakage, surgical site infection, postoperative ileus, reoperation, readmission, in-hospital mortality, and length of stay. Group comparisons were conducted using appropriate univariable tests. Multivariable logistic regression was used to assess independent associations between drain use and key outcomes adjusting for procedure type, tumor localization, and operative approach.
RESULTS: A total of 432 patients were analyzed; 248 (57.4%) received drains and 184 (42.6%) did not. Operative time was longer in the drain group (p=0.039). Rates of overall complications, major morbidity, anasto-motic leakage, surgical site infection, reoperation, readmission, and in-hospital mortality were comparable between groups. Postoperative ileus was significantly more frequent in the drain group (14.9% vs 7.6%, p=0.020). In multivariable analysis, drain use remained independently associated with postoperative ileus (OR 2.17, 95% CI 1.11–4.25; p=0.024). Drain use was not independently associated with overall complications (OR 0.67, 95% CI 0.43–1.05; p=0.080) and showed a non-significant trend toward lower major morbidity (OR 0.51, 95% CI 0.25–1.03; p=0.061).
DISCUSSION AND CONCLUSION: In this single-center cohort, routine intra-abdominal drain placement after colorectal resection was not associated with improved major postoperative outcomes and was independently associated with a higher risk of postoperative ileus. Drain use should be individualized rather than routine.

INTRODUCTION: For living kidney donation, laparoscopic donor nephrectomy (LDN) is currently the universally accepted approach. Essential steps of the transperitoneal technique include mobilizing the left colon and dissecting Toldt’s fascia to expose the kidney. This study aims to assess how these specific surgical maneuvers influence postoperative bowel recovery and to determine the clinical relevance of requiring laxatives after surgery.
METHODS: We retrospectively reviewed data from 129 donors who underwent left LDN. Based on bowel function recovery and laxative requirements, the cohort was stratified into two groups: The “Early Group” (spontaneous gas/stool on day 1–2, no laxatives; n=90) and the “Late Group” (gas/stool on day 3–4, required laxatives; n=39). Comparison points included demographics (age, gender, BMI), length of stay (LOS), complications, and postoperative creatinine.
RESULTS: The Early Group comprised 69.7% (n=90) of the cohort, while 30.3% (n=39) fell into the Late Group. No significant differences were observed between groups in age (36.4±14.4 vs 41.3±18.5 years; p=0.234), gender distribution (56.7% vs 66.7% female; p=0.385), or BMI (25.60±5.54 vs 26.76±5.55 kg/m²; p=0.275). Likewise, no statistically significant difference was found in LOS (mean 4.14 days vs 4.41 days; p=0.275). Postoperative infection rates, drain usage, and maximum creatinine levels (p=0.881) were also comparable.
DISCUSSION AND CONCLUSION: Performing standard left colon mobilization and Toldt fascia dissection during LDN is safe and does not cause permanent bowel dysfunction. The requirement for postoperative laxatives indicates a temporary functional delay rather than structural injury, confirming the safety of the transperitoneal approach.

INTRODUCTION: Endoscopic treatment success rates and complication profiles in difficult bile duct stones may differ compared to standard cases. This study aimed to evaluate the clinical outcomes and the impact of pre-cut sphincterotomy and mechanical lithotripsy on complications in patients with difficult bile duct stones.
METHODS: A total of 343 adult patients who underwent ERCP for difficult bile duct stones between March 2024 and December 2025 were retrospectively analyzed. Difficult stones were defined as stones ≥15 mm in diameter, the presence of multiple stones, distal bile duct stricture, or stones not removable with standard techniques. Demographic data, procedural characteristics, complications, and clinical outcomes were evaluated. Factors associated with the development of complications were analyzed using univariate and multivariate logistic regression analyses.
RESULTS: At least one complication developed in 43 of 343 patients (12.5%). The most common complication was post-ERCP pancreatitis (7.9%). Pre-cut sphincterotomy was performed in 54 patients (15.7%), and mechanical lithotripsy in 41 patients (12.0%). The overall complete stone clearance rate was 83.4%. Although pre-cut appeared to be associated with complications in univariate analysis, it was not identified as an independent risk factor in multivariate analysis. ASA≥3, stone diameter, difficult cannulation, and procedure duration were found to be independent predictors of complications.
DISCUSSION AND CONCLUSION: In difficult bile duct stones, pre-cut sphincterotomy and mechanical lithotripsy can be safely performed with appropriate patient selection and in experienced centers. These findings support the effective use of advanced endoscopic techniques in difficult stone cases with an acceptable safety profile.

INTRODUCTION: Adenomatous colon polyps are important precancerous lesions. Important clinical questions include how patient follow-up should be conducted after the detection of adenomas and which risk factors increase the likelihood of adenoma development. The aim of this study was to compare the pathology results of repeat colonoscopies with those of the initial procedure and to identify risk factors for adenoma development by evaluating patients who underwent polypectomy in the general population, including those in whom adenomas were detected during both colonoscopies.
METHODS: Adenomatous colon polyps are important precancerous lesions. Important clinical questions include how patient follow-up should be conducted after the detection of adenomas and which risk factors increase the likelihood of adenoma development. The aim of this study was to compare the pathology results of repeat colonoscopies with those of the initial procedure and to identify risk factors for adenoma development by evaluating patients who underwent polypectomy in the general population, including those in whom adenomas were detected during both colonoscopies.
RESULTS: The probability of detecting adenomas in a subsequent colonoscopy was significantly higher in patients in whom adenomas were detected during the first colonoscopy compared with those in whom no adenomas were found initially (Z-test, p<0.05). It was also observed that patients in whom a polyp larger than 1 cm was detected during the first colonoscopy had a higher probability of adenoma detection in the second colonoscopy (Chi-square test, p<0.05).
DISCUSSION AND CONCLUSION: Conclusion, a second colonoscopy is recommended for follow-up in patients in whom adenomas or polyps larger than 1 cm are detected during the initial colonoscopy.

INTRODUCTION: Assessment of bowel viability in incarcerated inguinal hernia remains challenging, often leading to exploratory laparotomy due to uncertainty. Hernia sac laparoscopy (transhernial laparoscopy) has been proposed as a minimally invasive adjunct to guide intraoperative decision-making. This study evaluates the safety and diagnostic performance of hernia sac laparoscopy in patients with incarcerated indirect inguinal hernia.
METHODS: A retrospective single-center analysis was conducted on 48 consecutive patients undergoing emergency surgery for incarcerated indirect inguinal hernia. In all cases, bowel viability was assessed via insertion of an 11-mm trocar through the hernia sac prior to definitive repair. Laparotomy was performed when ischemia was suspected. All patients underwent open Lichtenstein repair. Diagnostic performance parameters were calculated using bowel resection as confirmation of ischemia.
RESULTS: Midline laparotomy was required in 6 patients (12.5%). Five patients had confirmed bowel ischemia requiring resection with primary anastomosis. One patient underwent non-therapeutic laparotomy without resection. No bowel perforation or intra-abdominal contamination was observed. There were no cases of missed ischemia. Hernia sac laparoscopy demonstrated a sensitivity of 100%, specificity of 97.7%, positive predictive value of 83.3%, and negative predictive value of 100% for detecting bowel ischemia.
DISCUSSION AND CONCLUSION: Hernia sac laparoscopy is a safe and effective decision-guiding tool in incarcerated indirect inguinal hernia, demonstrating excellent sensitivity and negative predictive value for bowel ischemia. This technique may help avoid unnecessary laparotomy while maintaining surgical safety.

INTRODUCTION: The primary objective of this study was to examine changes in serum adipokine Isthmin levels before and after surgery following weight loss, to determine its potential as a biomarker in this patient population, and to evaluate the relationship between reduced adipose tissue and adipokines after obesity surgery.
METHODS: Preoperative complete blood count (CBC) and biochemical values, as well as post-operative third-month CBC and biochemical values, were recorded through a prospective chart review. Pre-operative and postoperative height and weight measurements were obtained, and body mass index (BMI), excess weight loss, and total weight loss were calculated. Subsequently, a 5 mL blood sample was collected at presentation for measurement of serum Isthmin levels (BD Vacutainer, Plymouth, UK). The samples were centrifuged at 3500–4000 rpm for 10 min, transferred into Eppendorf tubes, and stored at −20°C until analysis. Preoperative and third-month postoperative serum Isthmin levels were then measured and recorded.
RESULTS: No statistically significant difference was observed between preoperative and postoperative serum Isthmin levels. However, statistically significant differences were observed in body weight and BMI values (p=0.138, p<0.001, and p<0.001, respectively). When stratified by BMI groups, no statistically significant difference was observed in the change in Isthmin levels between the preoperative and postoperative periods.
DISCUSSION AND CONCLUSION: Although a correlation between Isthmin, an adipokine, and weight loss was hypothesized, no statistically significant difference was found. Longer-term studies are required before adipokines can be used as reliable biomarkers. Isthmin appears to have a weaker relationship with adipose tissue and weight loss and may not be directly associated with obesity; however, these novel molecules are still considered to hold potential for future biomarker development.

Upper gastrointestinal bleeding is a common medical condition associated with high morbidity and mortality, and may occur as a late complication after gastrointestinal surgery. In this report, we present a sleeve gastrectomy patient with hematemesis and hemodynamic instability due to ulcer bleeding caused by splenic vein erosion. A 55-year-old female patient applied to the emergency service with hemorrhagic shock due to the upper gastrointestinal bleeding. The only notable details in the patient’s medical history were hypertension and a sleeve gastrectomy surgery in 2010. Blood pressure was 70/40 mmHg, and heart rate was 145 beats per minute. After a rapid resuscitation, she underwent emergency surgery since hematemesis continued and hemodynamic status was unstable. No hemorrhagic fluid was found in the intraperitoneal space during the exploratory laparotomy. However, when gastrotomy was performed a giant bleeding ulcer was found on the staple line of the previous sleeve gastrectomy, extending into the splenic vein. The patient underwent total gastrectomy, Roux-en-Y esophagojejunostomy, and splenectomy. The patient was discharged on the 10th day after surgery without any complications.