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1. | Frontmatters Pages I - V |
RESEARCH ARTICLE | |
2. | Determination of The Relationship Between Postoperative Delirium Development and Analgesia Nociception Index Values in Pediatric Patients Feyza Özaltun, Seniyye Ülgen Zengin, Meliha Orhon Ergün, Pelin Çorman Dinçer, Tumay Umuroğlu doi: 10.14744/iksstd.2021.54366 Pages 113 - 119 INTRODUCTION: The aim of the study was to determine the relation of the pain levels measured numerically in the intraoperative and post-operative period by analgesia nociception index (ANI) monitor with the emergence delirium in pediatric patients. METHODS: American society of anesthesiologists 1–2 group, aged 2–6, 132 patients who have undergone minor surgical intervention were enrolled in the study. Children were divided into two groups according to their ages, Group S (2–3 years) and Group B (4–5 years), and three groups according to ANI values. Electrocardiogram, non-invasive blood pressure, SpO2, etCO2, temperature, bispectral index monitoring, and ANI monitoring’s were done. ICC value in mask induction, ANI values from pre-operative to post-operative 15 min, face, legs, activity, cry, and consolability (FLACC), and Pediatric Anesthesia Emergence Delirium (PAED) scores to post-operative 5–10–15 min were recorded. RESULTS: Post-operative 10th min FLACC values (p=0.047) and 5–10–15th min PAED values (p<0.01) were statistically significantly higher in the Group S as compared to the other group. Post-operative 15th min ANI values were higher in the Group B than in the other group (p=0.032), and there was no difference between the other measurement periods. PAED values, 10 as the cut-off value, when compared to pre-operative-incision and preextubation ANI values at the 5–10–15th min postoperatively, there was no statistically significant difference; so a cut-off value for ANI could not be determined. Patients with preextubation ANI values of 50–70 had significantly lower FLACC and PAED values at 5th and 10th min (p<0.05). DISCUSSION AND CONCLUSION: It has been concluded that ANI measured before preextubation is not effective in predicting the emergence delirium in pediatric patients aged 2–6 years. |
EXPERIMENTAL WORK | |
3. | Investigation of Expression of the ERAP1 Gene in Plasma Cell Dyscrasia Melda Sarıman, Büşra Karaçam, Mesut Ayer, Sema Sırma Ekmekçi, İlknur Suer, Kıvanç Çefle, Şükrü Palanduz, Şükrü Öztürk, Meliha Nalçacı, Neslihan Abacı doi: 10.14744/iksstd.2021.29494 Pages 120 - 124 INTRODUCTION: Monoclonal gammopathy of unknown significance (MGUS) is asymptomatic, and multiple myeloma (MM) is a symptomatic plasma cell dyscrasia. In our RNA sequencing study, the expression of the ERAP1 gene from the cell pools of MM patients and healthy bone marrow controls was found to be high in the patient group and it was investigated in this study whether it has a direct or indirect effect on MM pathogenesis. METHODS: The expression levels of the ERAP1 gene from the bone marrow materials of 38 newly diagnosed and untreated MM patients, 23 MGUS, and 16 control groups were examined by the qRT-PCR method. The results were analyzed in the SPSS.25 statistics program. RESULTS: Expression levels of the ERAP1 gene were not statistically significant between the MM group, the MGUS group, and the control group (p>0.05) (p=0.280). DISCUSSION AND CONCLUSION: The ERAP1 candidate gene with high RPKM value in our RNA sequencing study did not find a significant relationship between the validated patient and control groups. This issue should be investigated in more samples to reach a definite conclusion. In addition, it was concluded that the polymorphisms of the ERAP1 gene, highly polymorphic, should be studied in this aspect, and its effect on gene expression in myeloma. |
RESEARCH ARTICLE | |
4. | Laparoscopic and Open Method Comparative Inguinal Hernia Repair in Girls Single Center Results Yusuf Atakan Baltrak, Seniha Esin Söğüt, Onursal Varlıklı doi: 10.14744/iksstd.2021.34635 Pages 125 - 129 INTRODUCTION: Inguinal hernia surgeries are among the most common surgical procedures performed in pediatric surgery clinics. Hernia surgery has become the gold standard with the traditional open approach in the treatment of inguinal hernias in children. Low complications and high success rates have been the strongest pillars of this treatment. METHODS: Female patients who applied to our clinic with swelling in the groin area and were diagnosed with inguinal hernia in the evaluation were determined as the study group. The clinical data of the patients included in the study were analyzed retrospectively. The patients were divided into two groups according to the surgical method applied. The first group constituted the group in which laparoscopic inguinal hernia was applied (group LG, n=41) and the second group constituted the traditional surgery group (group OG, n=45). RESULTS: Eighty-six cases were included in the study. Forty-one of the cases were evaluated in the group where hernia repair was performed by laparoscopic method (Group LG) and 45 of the cases underwent hernia repair by the traditional open method (Group OG). There was no statistical difference between the two groups in terms of operation time, length of hospital stay, recurrent hernia rates, and cost per patient (p>0.05). DISCUSSION AND CONCLUSION: In the surgical treatment of inguinal hernia in girls, laparoscopic percutaneous internal ring suturing method is a simple, safe, single-port, easy to learn procedure, low complication and recurrence rates, and an effective method. |
5. | Evaluation of the Management, Mortality, and Morbidity in Acute Appendicitis in Elderly Patients: A Tertiary Care Hospital Experience Yasin Kara, Erkan Somuncu, Mehmet Abdussamet Bozkurt, Ali Kocataş doi: 10.14744/iksstd.2021.38278 Pages 130 - 136 INTRODUCTION: This study aimed to present our clinical experiences in the management, mortality, and morbidity and discuss the possible influencing factors of elderly patients with acute appendicitis (AA). METHODS: In this case series analysis, we evaluated the elders presented and operated as AA between January 2015 and May 2019 in Kanuni Sultan Süleyman Training and Research Hospital General Surgery Clinic. Primary goals were to determine the mortality, morbidity, and managements. RESULTS: The study cohort consisted of 83 elders. The mean age was 70.5±6.36 years, of 83 patients, 47 (57%) were female and 36 (43%) were male. The mean duration of symptoms of cases was 9±3 days and the median time from the onset of symptoms to hospital admission was 5 days. The rate of appendiceal perforation and morbidity was 45% (n=37) and 39% (n=32), respectively. The length of time from the onset of first symptoms to hospital admission of perforated cases was 7–9 days. Computerized tomography was used and provided valuable information in 17 (20%) cases in the diagnosis of AA. Operative modality was laparoscopy in 18 (22%) of patients, open appendectomy in 61 (73%), and conversion to open procedure in 4 (5%). There were 3 (4%) mortality in our study group. DISCUSSION AND CONCLUSION: Perforation, morbidity, and mortality rates were 45% (n=37), 39% (n=32), and 4% (n=3) in our study. Late presentation and delay in diagnosis and treatment result in increased rates of perforation and morbidities. Laparoscopic appendectomy was safe and feasible in elderly patients. |
6. | Our Total Excision Results in Hidradenitis Suppurativa Nihat Gülaydın doi: 10.14744/iksstd.2022.94547 Pages 137 - 143 INTRODUCTION: In our study, the effectiveness of surgical total excision was evaluated in cases of hidradenitis suppurativa (HS), which was diagnosed late and could not be treated medically. METHODS: In this retrospective study, patients who applied to our clinic between January 2001 and February 2021, were diagnosed with HS, and underwent surgical treatment were evaluated. The patients’ age, gender, BMI characteristics, clinical presentation characteristics, habits, surgical treatments, post-operative hospital stay, post-operative follow-up, and pathological findings were recorded. Recurrence rates were evaluated in long-term follow-ups. RESULTS: Surgical total excision was performed in ten cases due to HS. All of the patients were male, with a mean age of 32.2 and a mean BMI of 24.79. While one patient had extensive abscesses and ulcers in both axillary areas, all other patients had extensive draining wounds and abscesses in the sacrococcygeal area and gluteal areas. Three patients had previously been operated for the diagnosis of pilonidal sinus (Cyst dermoid sacral). Most of the patients were smokers. In surgical treatment, flap reconstruction was performed in all cases following total excision, considering the intact surgical margin. The mean length of stay was 1.8 days. In the follow-up period of 1 year or more, all patients were cured except for one. DISCUSSION AND CONCLUSION: In patients with HS who cannot be treated medically, total excision and flap reconstruction with a sound surgical margin may be an adequate treatment option. |
7. | Single-Center Experience in the Surgical Treatment of Primary Hyperparathyroidism Ümit Turan, Hüseyin Kılavuz, Ali Kaan Sanal doi: 10.14744/iksstd.2022.74436 Pages 144 - 149 INTRODUCTION: Although there are medical treatment options in primary hyperparathyroidism (pHPT), the only current curative option is total surgical excision of the pathological parathyroid gland or glands. The aim of our study is to present our single-center experiences in the surgical treatment of pHPT in the light of advanced pre-operative evaluations. METHODS: Our single-center and retrospective study included 145 patients who underwent pHPT-induced parathyroid surgery in the general surgery clinic between March 2015 and April 2021. All patients were evaluated with neck US and Tc-99 sestamibi before the operation. Minimally invasive parathyroidectomy was applied if these two methods showed the same localization or if only one imaging method indicated localization. If it could not be localized by both imaging methods or showed different localizations, bilateral neck exploration operation was performed. RESULTS: In pre-operative imaging methods, the localization of the diseased parathioride was detected by US in 112 (77.2%) patients and by Tc-99 sestamibi in 108 (74.5%) patients. Minimally invasive surgery was performed in 108 patients (74.5%), while bilateral neck exploration was performed in 20 (13.8%) patients, and thyroidectomy with adenoma excision was performed in 16 (11%) patients. At the end of the first 6 months of follow-up, hyperparathyroidism and hypercalcemia findings continued in 5 patients (3.4%). DISCUSSION AND CONCLUSION: Curative treatment of pHPT is possible with appropriate pre-operative evaluation and very low morbidity rate in centers experienced in parathyroid surgery. |
8. | Flexible Endoscopy Instead of Rigid Endoscopy in Volvulus Treatment: 25 Years Experiance Levent Eminoğlu doi: 10.14744/iksstd.2022.35762 Pages 150 - 152 INTRODUCTION: Volvulus results from the torsion of intestinal mesentery around itself and is most commonly seen in the sigmoid colon culminating in mechanical intestinal obstruction. We investigated the therapeutic approach to volvulus patients in our hospital in the past 25 years. METHODS: Patients who were admitted to general surgery department for volvulus between January 01, 1995 and March 01, 2020 were included in the study. The endoscopic and surgical therapeutic approaches were noted. The patients who were discharged without surgery were followed for readmissions. RESULTS: Fifty patients were included in the study. All patients were admitted for volvulus. Endoscopic de torsion was tried in all patients. İn five patients, endoscopic approach was unsuccessful and in three patients, necrosis was detected, and these eight patients were operated. Forty-two patients were discharged. Four patients were readmitted for recurrent volvulus. Two of these patients were operated and two were discharged after endoscopic detorsion. DISCUSSION AND CONCLUSION: Endoscopic approach is the first step treatment of choice in volvulus patients which prevents surgery. |
9. | The Effect of Prolotherapy in Plantar Fasciitis Cases: Patient Expectations and Treatment Effects Zeki Taşdemir, Deniz Gülabi doi: 10.14744/iksstd.2022.89166 Pages 153 - 157 INTRODUCTION: Plantar fasciitis (PF) manifests as pain surrounding the calcaneal tubercle. While a pain occurs when the ground is pressed first in the morning, this pain decreases during the day as the plantar fascia warms. Ice, relaxation, anti-inflammatory agents, and exercises have been used in the treatment of PF. This study, in the prolotherapy treatment of PF; whether a detailed description of the treatment modality had an impact on recovery was examined. METHODS: This study has been designed retrospectively. Adults diagnosed with PF and followed for at least 3 months were included in the study. All patients followed the same exercise protocol and used the same anti-inflammatory agents. The patients were informed that at the end of conservative treatment, some of them would be given prolotherapy injection. At the controls at 3, 24, and 48 weeks, the severity of the pain was evaluated based on the Visual Analog Scale (VAS) for pain. RESULTS: According to the results of the comparison of VAS of 29 patients who were not informed that the injection can be applied after conservative treatment and 44 patients who were reported to be injected during conservative post-treatment; a significant difference was found between the mean of VAS1 and VAS2 (before injection). DISCUSSION AND CONCLUSION: In this study, prolotherapy caused pain relief in the early period. In addition, patients who were informed about prolotherapy before treatment had lower VAS scores than patients who were not informed. |
10. | Examination of Isokinetic Knee Strength and Hamstring/Quadriceps Ratios in Individuals with Anterior Cruciate Ligament Injury: ACL Injured Knee Versus Non-Injured Knee Lokman Kehribar, Hüseyin Sina Coşkun, Ali Kerim Yılmaz, Menderes Kabadayı, Özgür Bostancı, Coşkun Yılmaz, Serkan Sürücü, Mahmud Aydın doi: 10.14744/iksstd.2022.34467 Pages 158 - 162 INTRODUCTION: The aims of this study were to compare the isokinetic forces and Hamstring/Quadriceps (H/Q) ratios in individuals with anterior cruciate ligament (ACL) injury sides and contralateral non-injured sides. METHODS: Twenty-three male patients with unilateral acute ACL injury were included in the study. The isokinetic extension (Ex) and flexion (Flx) forces of both knees were measured using an isokinetic dynamometer. Isokinetic tests were performed with three different angular speeds (60° s/180° s/240° s) with five repetitions for 60° s and 180° s and 15 repetitions for 240° s or concentric contraction. RESULTS: The mean age of the patients was 25.18, the mean height was 176.81, and the mean weight was 77.12. The mean time from ACL injury to the time of measurements was 37.47±11.11 days. When the isokinetic strengths of knees with ACL injury and knees without ACL injury were examined, there was a significant difference in Ex phase at an angular velocity of 60°s (p=0.012, 95% CI: 5.95–41.54). No significant difference was detected in both Ex and Flx phases of other angular velocities (p>0.05). DISCUSSION AND CONCLUSION: As a result, the knee with an ACL injury generates less force than the knee without an ACL injury. H/Q ratios were also outside the normal range on the ACL damaged side only at 60 s angular velocity, as expected. The absence of a significant difference in both strength and H/Q ratios at high angular velocities indicates that the movement is performed with less force than at lower angular velocities, and this situation strains the hamstring and quadriceps muscles less. |
11. | Does 1 cm Make a Difference? Evaluation of Kocher Point and Its Modifications in Terms of White Matter Pelin Kuzucu doi: 10.14744/iksstd.2022.80388 Pages 163 - 169 INTRODUCTION: Kocher point is the most common point used to access the lateral ventricle frontal horn in neurosurgical practice. Approximately 2.5 cm from the midline is located lateral and at least 1 cm in front of the coronal suture. METHODS: “Kocher point,” “frontal horn,” “periventricular zone,” “third ventricle,” and “ventricular entry point” keywords were scanned using PubMed database. Duplicate works were excluded from the study. Anatomical dissections were dissected step by step in accordance with the Klingler method and photographed at each stage. RESULTS: A total of 40 studies were found that met the criteria of our study. In anatomical dissections, the SLFII, SLFIII, UF, IFOF, and FAT white matter pathways were associated with KP and its variations. DISCUSSION AND CONCLUSION: The Kocher Point defined by Emil Theodor Kocher continues to be used as the entry point that is often used in lateral ventricular attempts all over the world today. Due to the proximity of this point to the superior sagittal sinus, the primary motor cortex, and the white matter pathways, the detection of the entry area is important. Even small changes of 1–2 cm from KP will cause the white matter pathways to be affected. |
12. | Patient Factors Affecting COVID-19 Vaccination in Pregnancy: A Survey Study Gülseren Polat, Zeynep Aybikem Sağlam, İbrahim Polat, Burak Yücel doi: 10.14744/iksstd.2022.31644 Pages 170 - 175 INTRODUCTION: Pregnant women are defined as a high-risk group in terms of severe complications of COVID-19 infection. Vaccination of them not only protects their own health but also that of their unborn child. In this study, we aim to investigate the opinion and behavior of pregnant women in regards to COVID-19 vaccines which reduce both maternal and perinatal mortality and morbidity. METHODS: Four hundred and eighty-two pregnant women were surveyed on their source of information on COVID-19 vaccines, reasoning behind refusal of vaccination and their general opinion on vaccines. RESULTS: About 51.50% of the participants agreed to get vaccinated during their pregnancy. Self or family history or loss of a relative from COVID-19 infection was not shown to affect the decision to be vaccinated. Those who agreed on vaccination thought that the infection would cause greater harm than the vaccine itself; vaccination of their spouses and consent to pediatric vaccination protocols after birth were also elevated. They primarily obtained information from their health-care provider. In contrary, lack of trust in vaccination was stated as a reason in the rejecting group, they both refuse vaccination even after delivery and pediatric vaccinations after birth. They seem to obtain information on vaccinations from their close relations and their family. DISCUSSION AND CONCLUSION: In our opinion, it is more effective for information about vaccination during pregnancy to be given by health-care professionals who have up-to-date information. We believe that investigating the reason behind rejection and hesitation of COVID-19 vaccine among pregnant women is a crucial step in our battle with the disease. |
13. | Evaluation of the Early Treatment Response with Microwave Ablation Technique Applied to Fibroadenomas of the Breast Süleyman Sönmez, Sevinç Dağıstanlı, Nilüfer Bulut doi: 10.14744/iksstd.2022.01488 Pages 176 - 179 INTRODUCTION: Benign breast lesions are one of the most common diseases detected in women and the popularity of minimally invasive methods has increased in recent years for the treatment of these lesions. The purpose of the present study was to evaluate the safety and efficacy of the microwave ablation (MWA) technique as a potential therapeutic option for fibroadenomas. METHODS: Pre- and post-procedure magnetic resonance images of a total of 20 patients, who were diagnosed with fibroadenomas, who underwent MWA ther-apy, were evaluated. Follow-up was performed with MR imaging for 6 months after the ablation treatment. RESULTS: The mean age of the patients was found to be 27.6 (15–50) years. The mean size of fibroadenomas was measured within the range of 20.2 (9–35) mm. Technical success was achieved in all patients. After the procedure, central enhancement disappeared (100%). Furthermore, approximately 79.6% regression was obtained in tumor volume. DISCUSSION AND CONCLUSION: MWA technique is an effective in the treatment of fibroadenomas. Treatment efficacy can be measured in the early period with MR imaging reliably. |
14. | Is the Season of Diagnosis Changing in Children with Type 1 Diabetes Mellitus? Hasan Önal, Seda Yılmaz Semerci, Hanım Şeyma Topuz, Servet Erdal Adal doi: 10.14744/iksstd.2022.60024 Pages 180 - 185 INTRODUCTION: By the effect of global warming, climate model of Turkey is suggested to evolve through semi-arid seasons and to the tropical climate. This study aimed to determine the seasonability for clinical onset of Type 1 diabetes mellitus (T1DM). METHODS: T1DM patients newly diagnosed between 2014 and 2019 in our pediatric endocrinology department located in Istanbul were included in this study. Clinical onset date and age of diagnosis of diabetes were recorded for each patient. Using the worldwheatheronline.com website, regional average rainy days, cloudy days, sunny days, temperature, and ultraviolet index (UVI) were calculated per month for the past 6 years. RESULTS: A total of 659 patients with the new onset T1DM included in this study. A number of new diagnosed patients were 29.1% (192) in winter, 22.8% (150) in spring, 17.6% (116) in summer, and 30.5% (201) in autumn, respectively. No significant effect of the rainy day, cloudy day, sunny day, temperature, and UVI average of the month of diagnosis could be detected on this seasonal shift. Similar results were obtained when 132 patients whose under 4 years of age at the time of diagnosis were excluded from the study data. DISCUSSION AND CONCLUSION: Although weather conditions seemed to have no considerable effect on this seasonal shift, the T1DM onset in the autumn season was seen to be shifted to the spring season, partially. Further studies including large number of participants are needed for a better understanding of the seasonality of T1DM worldwide. |
15. | The Role of Imaging Methods and Laboratory Parameters in the Prediction of Malignancy Potential for Adnexal Masses Edis Kahraman, Pınar Kadiroğulları, Emine Karabük, Tolga Karacan, Şefik Eser Özyürek doi: 10.14744/iksstd.2021.36693 Pages 186 - 194 INTRODUCTION: The aim of the study was to evaluate the ability of clinical features, ultrasonography (USG), magnetic resonance imaging (MRI), and tumor markers to predict malignity potential in the pre-operative period for adnexal mass cases investigated by intra-operative frozen section. METHODS: The clinical features, USG, MRI, and tumor markers of the adnexal mass cases investigated by intra-operative frozen section were evaluated as poten-tial predictive parameters. The patients were divided into two groups as benign (n=160) and malignant (n=55) according to the post-operative histopathologic findings. Logistic regression analysis was performed for parameters that gave significant differences between the two groups to find the high yield ones (independent variables) for pre-operative malignity potential prediction. RESULTS: The parameters that showed significant difference between the two groups were age and chief complaints as clinical features, presence of ascites in USG and/or MRI, solid areas in USG and/or MRI, contrast-enhancement in MRI as radiologic findings, malignancy suspect in the imaging, CA125, CA19–9, CA153, and AFP levels as tumor markers (p<0.05). The multivariant logistic analysis, contrast-enhancement in MRI (p=0.033), presence of solid areas in MRI (p=0.0001), and high CA125 levels (p=0.012) were found as independently effective parameters. DISCUSSION AND CONCLUSION: The addition of MRI to pre-operative evaluation with clinical features, USG and tumor markers provides benefits for patients if pre-operative distinction of benign versus malignant is aimed. This study shows that the contrast-enhancement and/or solid areas in of MRI and high CA125 are effective and independent pre-operative factors in predicting the malignity potential. It has been observed that these pre-operative findings are critical and especially decisive criteria for predicting the possible ovarian cancer in the patient and referring the patient to gynecological oncological surgery. |
16. | The Effect of Pelvicalyceal Anatomy on the Success of Retrograde Intrarenal Surgery in the Treatment of Lower Pole Calyceal Stones Süleyman Hilmi Aksoy, Basri Çakıroğlu, Tuncay Taş, Orhun Sinanoğlu doi: 10.14744/iksstd.2022.25593 Pages 195 - 201 INTRODUCTION: The aim of the study was to evaluate the effects of pelvicalyceal anatomy on the success of RIRS performed to treat lower pole stones. METHODS: A total of 164 patients with lower calyceal stones were analyzed retrospectively. Besides demographic characteristics of the patients; size (diameter) and density (HU) of the stones, upper ureter diameter, infundibular width (IW), length (IL) and height (IH), and infundibular pelvic angle (IPA) measured in CT scans were recorded. Successful treatment was defined as absence of residual fragments or a fragment <4 mm measured at the follow-up. RESULTS: The mean age of the patients was 43.36±12.21. Male/female ratio was 40/124. The mean stone size was measured as 13.12 mm. The overall mean upper ureteral diameter was measured as 5.58±2.45 (min–max: 2–19) mm, IW as 6.77±2.55 (min–max: 3–18) mm, IL as 20.33±4.24 (min–max: 8–35) mm, IH as 17.99±5.22 (min–max: 9–40) mm, and IPA as 46.99±12.10 (min–max: 25–96) degrees. Stone free rate was defined as absence of stones or presence of fragments <4 mm and was found as 83.54%. The most important factors affecting treatment success and stone-free rate were found as the stone size and density and IPA. DISCUSSION AND CONCLUSION: There is no standardized method of measuring the pelvicalyceal anatomy, making comparison of the findings between the studies difficult. Consistently with the literature, the most important pelvicalyceal anatomy factors affecting success rate included stone size and density and IPA. |
17. | Transanal Endoscopic Surgery in Rectal Tumors: A Single-Center Experience Safa Vatansever, Osman Bozbıyık doi: 10.14744/iksstd.2022.45722 Pages 202 - 206 INTRODUCTION: In this study, we aimed to investigate the feasibility, safety, and oncological results of the TEO platform and report our clinical experience. METHODS: Patients who were operated with transanal endoscopic surgery at Ege University Hospital between 2014 and 2020 were included in the study. The data of the patients were obtained retrospectively. The surgeries were performed using the transanal endoscopic operating platform (TEO®; Karl Storz, Tuttlingen, Germany). RESULTS: A total of 39 patients were included in this study. Twelve (31%) of the patients were female. The median age was 63 (range, 17–88) years. The median distance of the tumor from the anal verge was 8 (4–15) cm. The median tumor diameter was 39 (4–90) mm. Histopathological examination revealed malignancy in 23 (59%) patients (pTis: 14 [36%], pT1: 9 [23%]). Complication was seen in one (3%) patient. The median follow-up period was 38 (10–88) months. Two (5%) recurrences took place. DISCUSSION AND CONCLUSION: Transanal endoscopic surgery allows the excision of rectal lesions that cannot be excised with a conventional approach, with a low morbidity rate. It can also be used for definitive histopathological diagnosis of lesions whose pathology has not been fully revealed, and for the removal of the early stage malignant rectal tumors with appropriate surgical margins. |