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Öğe Diagnostic value of the pregnancy index for acute appendicitis in pregnant women(NATURE PORTFOLIO, 2025) Sezikli, I; Topçu, R; Tutan, MB; Aslan, O; Yüksek, MAAcute appendicitis is one of the most common non-gynecological and non-obstetric causes of acute abdominal conditions requiring urgent surgery during pregnancy. Due to the similarity between the symptoms of the disease and those of pregnancy, laboratory findings become particularly important in diagnosis. This study aimed to evaluate these parameters for the first time using a new index definition. Between 2015 and 2021, a total of 120 patients were included in the study, divided into the four groups: healthy pregnant woman (HPW), healthy woman (HW), unhealthy pregnant woman (UPW, pregnant patient with acute appendicitis), and unhealthy woman (UW, non-pregnant patient with acute appendicitis). Laboratory parameters, including white blood cell count (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), ischemia-modified albumin (iMA), and platelet-lymphocyte ratio (PLR), were assessed. In this study, significant differences were observed in various laboratory parameters between groups, such as WBC, CRP, NLR, and PLR, indicating potential markers for differentiating between pregnant women with and without appendicitis. An index was created for the diagnosis of acute appendicitis in pregnant women and was named the Pregnant Index. The Pregnant Index (PGIndex) values of pregnant women without appendicitis were compared with those of pregnant women with appendicitis. It was found that the PGIndex value was significantly higher in pregnant women with appendicitis (p < 0.001). Using the ROC curve and Youden index, the PGIndex cut-off value to best differentiate between the two groups was 10.62. This value provided a sensitivity of 73.3%, specificity of 96.7%, positive predictive value of 95.7%, negative predictive value of 78.7%, and test accuracy of 85% for identifying pregnant women with appendicitis. Compared to other markers, the PGIndex had the highest accuracy value, and it was observed that patients with a PGIndex value above 10.62 had a significantly increased likelihood of having appendicitis. These results indicate that the PGIndex is a significant marker for detecting appendicitis in pregnant women. Laboratory parameters, particularly NLR and PLR, show promise as diagnostic tools for appendicitis in pregnant women. Incorporating these markers, the Pregnant Index (PGIndex) demonstrated high sensitivity and specificity in distinguishing between pregnant women with and without appendicitis. This is the first study using the Pregnant Index in pregnant women to diagnose appendicitis. Early diagnosis is crucial for preventing maternal and fetal morbidity and mortality associated with appendicitis during pregnancy.Öğe Impact of Circular Stapler Diameter on Anastomotic Leakage in Left-Sided Colorectal Cancer: A Retrospective Single-Center Case-Control Analysis(MDPI, 2025) Alkurt, EG; Akdoğan, MY; Tutan, MB; Kartal, B; Turhan, VBBackground and Objectives: Anastomotic leakage (AL) is a major complication following sphincter-preserving surgeries for left-sided colorectal cancer. In this study, we aimed to evaluate the association between circular stapler diameter and the risk of AL. As a secondary objective, we investigated whether preoperative serum protein levels were associated with leakage development. Materials and Methods: We conducted a retrospective case-control study including 99 patients who underwent elective colorectal surgery with stapled anastomosis for left-sided colorectal cancer between January 2020 and May 2024. A total of 99 patients were included (60.6% male), with a mean age of 66.1 +/- 10.7 years. The patients were categorized into small (<= 29 mm) and large (>= 30 mm) stapler groups. Demographic, clinical, and laboratory variables were collected. Anastomotic leakage was defined as an International Study Group of Rectal Cancer (ISREC) Grade B or C leak requiring intervention. Univariate analyses and multivariate logistic regression analyses were performed, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). A STROBE-compliant flow diagram was prepared. Results: Anastomotic leakage occurred in 10 patients (10.1%), and leakage rates were not significantly different between stapler-size groups (<= 29 mm: 10.9% vs. >= 30 mm: 7.5%, p = 0.365). In multivariate analysis, stapler size was not independently associated with leakage (OR 1.68, 95% CI 0.40-6.97, p = 0.480). Lower preoperative serum protein levels were identified as the only independent predictor of leakage (OR 0.28, 95% CI 0.10-0.74, p = 0.011). Postoperative hospital stay was significantly longer for patients with leakage (median 17 vs. 7 days, p < 0.001). Conclusions: We found no significant associations between circular stapler diameter and anastomotic leakage in left-sided colorectal cancer surgery. Conversely, low serum protein levels were independently associated with increased leakage risk, highlighting the importance of preoperative nutritional assessment. Given the retrospective design, small number of leakage cases, and unmeasured confounders, these findings should be interpreted with caution. Further multicenter, prospective studies should be conducted to clarify the influence of stapler size and patient-related factors on anastomotic outcomes.Öğe The Impact of Aortic Calcification on Surgical Outcomes in Colorectal Cancer Patients: A Retrospective Analysis Focused on Anastomotic Leakage(MDPI, 2025) Turhan, VB; Karacif, O; Tutan, MB; Kartal, B; Şahin, F; Kendirci, M; Alkurt, EGBackground and Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery (CRS), increasing morbidity, mortality, and healthcare costs. While several AL risk factors have been identified, the role of aortic calcification (AC) remains unclear. As a marker of systemic atherosclerosis, AC may impair tissue perfusion and anastomotic healing. Additionally, tumor factors (TNM stage, histology, and localization) and patient comorbidities (hypertension, cardiovascular disease, and neoadjuvant therapy) may contribute to AL risk. This study evaluates the association between preoperative AC and AL incidence while considering additional risk factors. Materials and Methods: This retrospective cohort study included 151 patients undergoing CRS from January 2020 to October 2023. Preoperative CT scans classified AC into Stage 0 (none), Stage 1 (<50%), and Stage 2 (>50%) of the aortic circumference. Data on demographics, tumor characteristics, neoadjuvant therapy, and comorbidities were collected. AL risk factors were analyzed using univariate and multivariate logistic regression. Results: AL occurred in 5.96% (9/151) of patients. AL incidence was significantly higher in patients with >50% AC (44.47% vs. 11.27%, p = 0.012). Multivariate analysis confirmed AC as an independent AL predictor (OR = 10.38, 95% CI: 1.243-92.118, p = 0.032). Rectal tumor localization (p = 0.038), hypertension (p = 0.027), cardiovascular disease (p = 0.014), and neoadjuvant therapy (p = 0.045) were also associated with increased AL risk. Conclusions: Severe AC is an independent predictor of AL in CRS. Additionally, rectal tumors, hypertension, cardiovascular disease, and neoadjuvant therapy contribute to AL risk. Preoperative vascular assessments and comprehensive risk stratification models may help identify high-risk patients and guide perioperative management strategies to reduce AL incidence.Öğe The Predictive Value of Serum Sodium Levels and Inflammatory Markers in Differentiating Complicated and Uncomplicated Acute Diverticulitis: A Retrospective Cohort Study(MDPI, 2025) Kartal, B; Tutan, MB; Turhan, VB; Uğur, F; Alkurt, EGBackground and Objectives: This study aimed to investigate the role of serum sodium levels as an independent predictor of complications in acute diverticulitis and to evaluate their diagnostic value alongside inflammatory markers. Materials and Methods: A total of 134 patients diagnosed with acute diverticulitis between June 2018 and January 2024 at the Erol Ol & ccedil;ok Training and Research Hospital were retrospectively analyzed. Complicated diverticulitis was defined based on the presence of an abscess, perforation, fistula, or obstruction classified as Hinchey stage II-IV. Serum sodium, CRP, and WBC levels were assessed for their predictive value. Statistical analyses included ROC analysis to determine optimal thresholds and logistic regression to evaluate independent predictors. Results: A total of 29.1% of the patients were classified as having complicated diverticulitis. Serum sodium levels were significantly lower in the complicated group (median: 133 mmol/L, p < 0.001), whereas CRP (median: 86.5 mg/L, p < 0.001) and WBC levels (median: 11.62 x 10(3)/mu L, p = 0.001) were higher. The ROC analysis identified <135.5 mmol/L as the optimal threshold for serum sodium, with a 94.9% sensitivity and 94.7% specificity, making it the strongest predictor. The logistic regression revealed that each unit decrease in serum sodium increased the risk of complications by 5.7 times (p < 0.001). Conclusions: Serum sodium levels are an independent and strong predictor of complications in acute diverticulitis. When used alongside CRP and WBC levels, diagnostic accuracy can be enhanced, leading to improved patient management.
