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Background Burnout resulting from long-term and unmanaged workplace stress is high among healthcare professionals, especially surgeons, and affects both individuals and the quality of patient care. The objective of this study was to determine the prevalence and associated factors for burnout among attending general surgeons and to identify possible preventive strategies. Methods A national cross-sectional survey using a 35-item questionnaire was conducted among members of the Turkish Surgical Society. The survey evaluated demographics, professional and practice characteristics, social participation, and burnout as well as interventions to deal with burnout. Burnout was defined as a high score on the emotional exhaustion (EE) and/or depersonalization (DP) subscales. Surgeons with high scores on both the EE and DP and a low score on personal accomplishment (PA) were considered to have severe burnout. Results Six hundred fifteen general surgeons completed the survey. The median EE, DP, and PA scores were 34 (IQR, 20–43), 9 (IQR, 4–16), and 36 (IQR, 30–42), respectively. Overall, the prevalence of burnout and severe burnout were 69.1 and 22.0%, respectively. On multivariable analysis, factors independently associated with burnout were working in a training and research hospital (OR = 3.34; P  < 0.001) or state hospital (OR = 2.77; P  = 0.001), working ≥ 60 h per week (OR = 1.57; P  = 0.046), and less frequent participation in social activities (OR = 3.65; P  < 0.001). Conclusions Burnout is an important problem among general surgeons with impacts and consequences for professionals, patients, and society. Considering that burnout is a preventable condition, systematic efforts to identify at-risk populations and to develop strategies to address burnout in surgeons are needed.

Background Pilonidal sinus is a common health problem. The current study aimed to compare the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques in terms of pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure. Methods Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled and randomly divided into three groups. Open surgery and moist dressings were applied to patients in group A. Open surgery followed by PRP application was performed on patients in group B. Group C underwent curettage of the sinus cavity followed by application of PRP. In this prospective randomized controlled study, patients completed questionnaires (including the Nottingham Health Profile (NHP), Short Form-36 (SF-36) and clinical information) before and after surgery. Demographics, preoperative characteristics, healing parameters, and quality-of-life scores were evaluated and calculated before and after surgery. Results and conclusion The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21. Each patient was followed up throughout the process of wound healing, and follow-up was continued afterward to monitor the patients for recurrence. Due to the nature of the treatment that group C received, this group achieved shorter healing times and smaller cavity volume than the other groups. In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups. Overall postoperative pain scores were significantly lower for both PRP groups (open surgery, group B; minimally invasive surgery, group C) than for group A (p < 0.001) and showed different time courses among the groups. In the treatment of PS disease, PRP application improves postoperative recovery in that it speeds patients’ return to daily activities, reduces their pain scores and increases their quality of life. Trial registration The current study is registered on the public website ClinicalTrials.gov (ClinicalTrials.gov identifier number: NCT04697082; date: 05/01/2021).

Background In recent years, there has been a noticeable decline in medical students’ interest in pursuing surgical specialties. While various factors such as lifestyle expectations, training length, and mentorship have been implicated internationally, limited data are available from Türkiye. This study aimed to assess the perspectives of preclinical and clinical Turkish medical students on surgical specialties and to identify the factors that influence their decisions when choosing a specialty. Methods A cross-sectional survey was conducted among 380 medical students at Ankara University School of Medicine between June 2023 and January 2024. The questionnaire explored demographic characteristics, interest in surgical fields, traineeship experiences, observation of surgeons’ working conditions, and perceptions of professional challenges. Statistical analyses included Chi-square, Fisher’s exact, and Mann-Whitney U tests. Results Among participants, 50.8% expressed a desire to specialize in surgical fields. Year of study ( p  = 0.008) and the opportunity to observe surgeons’ working conditions ( p  = 0.008) were significantly associated with surgical preference. While 54.9% of students who had undergone surgical traineeship expressed a preference for surgery, this was not statistically significant ( p  = 0.212). Mentorship, a positive training environment, and hands-on observation were reported as encouraging factors. Conversely, high patient load, malpractice concerns, emergency case stress, and perceived lack of work-life balance emerged as major deterrents. Conclusion The findings highlight that clinical exposure and observation of real surgical practice significantly influence students’ interest in surgical specialties. Early mentorship and structured surgical experiences may enhance interest, while systemic factors such as workload and litigation fears continue to pose barriers. These insights can inform educational and socio-economic strategies—such as improving work-life balance, reducing excessive workload, and addressing malpractice concerns—to sustain interest in surgery among future physicians.

Goblet cell adenocarcinoma (GCA) of the appendix is a rare and aggressive neoplasm characterized by goblet-like mucinous cells. Due to its rarity, there is limited data on its clinical course and management. Typically diagnosed incidentally or when mimicking acute appendicitis, GCAs require careful management to mitigate the risk of disseminated disease. This report discusses a case involving a 64-year-old man diagnosed with low-grade GCA, including the diagnostic workup, treatment approach, and outcomes. The management strategies parallel those for colorectal cancer, with potential benefits from cytoreductive surgery and intraperitoneal chemotherapy. The aim of this report is to enrich the knowledge base and offer insights into optimal management strategies.

Introduction Microsatellite instable (deficient mismatch repair, dMMR) colon cancer is associated with hypermutability and immune infiltration-activation. COVID-19 vaccines stimulate immune-inflammation response. This study aimed to investigate the types and rates of COVID-19 vaccines in patients with newly diagnosed colon cancer and compare it according to the microsatellite status. Methods The study was a single-center case-control study. Patients diagnosed with colon cancer at least three months after the last COVID-19 vaccine (BNT162b2, CoronaVac) dose were included. Patients with dMMR and microsatellite stable (MSS) tumors were defined as cases and controls, respectively, between June 2021 and June 2023. Baseline characteristics and vaccine status between case-control groups were compared as univariable and multivariable. Inflammation markers were compared between MSS+CoronaVac and dMMR+BNT162b2 groups. Results A total of 76 patients were included. The BMI was higher in the MSS group (BMI>25 84.3% vs. 57.9%, p=0.00), and right-sided tumors were more common in the dMMR group (71% vs.46.4%, p=0.00). The dMMR group had a higher BNT162b2 vaccine history than the MSS group (86.8% vs. 63.2%, p=0.01), while there was no difference in CoronaVac history (p=0.32). Significant variables in univariable analysis (BMI, localization, and BNT162b2) were included in multivariable logistic regression. The BNT162b2 vaccine was significantly associated with dMMR status (OR: 6.39, 95% CI: 1.55-26.26, p=0.01). The dMMR+BNT162b2 group had higher median C-reactive protein (CRP) level (p=0.01), erythrocyte sedimentation rate (p=0.05), and lower lymphocyte/CRP ratio (p=0.04) than the MSS+CoronaVac group. Conclusion Immune infiltration in dMMR colon cancer may interact with COVID-19 vaccine-induced immune activation. Long-term clinical and preclinical studies are needed to confirm these findings.

AimThe aim of this study is to evaluate the accuracy of Goodsall’s rule in predicting the internal orifice of perianal fistulas based on magnetic resonance imaging (MRI) findings and to assess its relevance in contemporary imaging and surgical planning.MethodIn the retrospective analysis of 1,473 consecutive MRI scans performed for perianal fistulas, a total of 305 patients (men/women: 214/91) with a single fistula were included in the study. Fistulas were classified as anterior or posterior based on the external orifice position relative to the transverse anal line.ResultsPosteriorly located fistulas were more common (61.3% vs. 38.7%). The accuracy of Goodsall’s rule was higher in anterior fistulas (64.4%) than in posterior fistulas (39.6%; p<0.001). There was no statistically significant difference in adherence to the rule between genders (p=0.416), different types of fistulas according to the Parks classification (p=0.588), or presence of abscess (p=0.464). Comorbidities significantly affected the accuracy of the rule (p=0.017). In the Bonferroni-adjusted analysis, no significant difference in adherence was found between the cryptoglandular and Crohn’s disease groups (p>0.05). Among the 11 patients with malignancy, only 1 (9.1%) adhered to the rule, indicating reduced accuracy.ConclusionGoodsall’s rule is more accurate for anterior fistulas; however, it does not apply to all perianal fistula cases, with greater exceptions observed in posterior fistulas. MRI should be considered for all perianal fistulas when possible to improve diagnosis and outcomes.

Objective:Anxiety is an unpleasant emotional stat with systemic effects. The anxiety level of the patients may increase the requirements for sedation during colonoscopy. The aim of the study was to evaluate the effect of pre-procedural anxiety on the dose of propofol.Methods:After ethical approval and informed consent, a total of 75 patients undergoing colonoscopy were enrolled in the study. Patients were informed about the procedure and the anxiety levels were assessed. The level of sedation was defined as a Bispectral Index (BIS) of 60 and was achieved by target-controlled infusion of propofol. Patients’ characteristics, hemodynamic profiles, anxiety levels, the propofol dosage and complications were recorded. The procedure duration, difficulty score for colonoscopy assessed by the surgeon, and the patient’s and surgeon’s satisfaction with sedation instrument scores were recorded.Results:A total of 66 patients were studied.Demographic and procedural data were similar among groups. The anxiety scores were not correlated with the total propofol dosage, hemodynamic parameters, the time needed to reach a BIS value of 60, surgeon and patient satisfaction and the time needed to regain consciousness. No complications were observed.Conclusion:In patients receiving deep sedation for elective colonoscopies, the pre-procedural anxiety level is not related to sedative requirement, post-procedural recovery, or surgeon and patient satisfaction.

The treatment of colorectal cancer, which is an important cause of cancer related death and is still an important public health problem, has become a matter of debate due to the COVID-19 pandemic that emerged in December 2019. This pandemic has forced us to rearrange our entire surgical practice. However, during these arrangements it should be ensured that patients are less affected by the pandemic, hospital resources should be used more efficiently and the risk of healthcare professionals should be minimized. This study discusses how to plan the multimodal treatment of colorectal cancer during the pandemic by using surgical, chemotherapeutic, and radiotherapeutic options while evaluating tailored treatments and the current international guidelines.

Background Colorectal cancer (CRC) screening rates are low in the general population and among health care providers. The aim of this study was to evaluate the CRC screening practices of general surgeons who provide specialized diagnostic testing and CRC treatment and to examine the CRC screening behaviors of their first-degree family members. Methods A cross-sectional survey was conducted among general surgeons who attended the 21st National Surgical Congress in Turkey held from April 11th to 15th, 2018. The survey included items on demographics, screening-related attitude, CRC screening options, barriers to CRC screening, and surgeons’ annual volumes of CRC cases. Results A total of 530 respondents completed the survey. Almost one-third of the responding surgeons (29.4%, n  = 156) were aged over 50 years, among whom approximately half (47.1%, n  = 74) reported having undergone CRC screening and preferring a colonoscopy as the screening modality (78.4%). Among general surgeons aged 50 years and older, high-volume surgeons (≥25 CRC cases per year) were more likely to undergo screening compared with low-volume surgeons (< 25 CRC cases per year). The respondents aged below 50 years reported that 56.1% ( n  = 210) of their first-degree relatives were up-to-date with CRC screening, mostly with colonoscopy. Compared to low-volume surgeons aged below 50 years, high-volume surgeons’ first-degree relatives were more likely to be up-to-date with CRC screening. Conclusion The survey results demonstrated that routine screening for CRC among surgeons and/or their first-degree relatives is currently not performed at the desired level. However, high-volume surgeons are more likely to participate in routine screening.

Objective This study aimed to investigate the cytomorphological effects of heavyweight and lightweight mesh on the ilioinguinal nerve in an experimental animal model. Methods Sixteen New Zealand male rabbits were included in the study. The left inguinal regions of the first six animals were assigned as controls and the right inguinal regions were assigned as the sham group. The left inguinal regions of the remaining 10 animals were assigned as the lightweight mesh group and the right inguinal regions were assigned as the heavyweight mesh group. No intervention was performed in the control group. In the sham group, only ilioinguinal nerve exploration was performed. In mesh groups, ilioinguinal nerve exploration was performed and the mesh was implanted on the ilioinguinal nerve. After three months, ilioinguinal nerve specimens were excised from both sides for cytomorphological examination. Results Myelin sheath thickening, separation of the myelin layers, and myelin vacuolization were more pronounced in the heavyweight mesh group compared to the lightweight mesh group. The G-ratio was moderately increased in the heavyweight mesh group when compared to other groups. The ratio of fibers with ≤4 µm diameter was higher in the lightweight mesh group compared to other groups, and the ratio of fibers with ≥9 µm diameter was higher in the heavyweight mesh group than in the other groups (p<0.05). Conclusion Both of the meshes induce cytomorphological alterations on the adjacent nerve tissues caused by foreign body reaction and compression. Ilioinguinal nerve degeneration was more pronounced in the heavyweight mesh than in the lightweight mesh. Histological alterations on the ilioinguinal nerves caused by different meshes may be related to chronic pain after hernia surgery. We believe our study will serve as a guide for future studies on the topic.