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Article Fistulectomy and Primary Sphincteroplasty for Transsphincteric Fistula(Coll Physicians & Surgeons Pakistan, 2025) Emral, Ahmet Cihangir; Gulen, Merter; Ege, BahadirObjective: To evaluate the results of patients treated with fistulectomy and primary sphincteroplasty for uncomplicated perianal fistula. Study Design: Observational study. Place and Duration of the Study: Medicana International Hospital affiliated with Atilim University, Faculty of Medicine, Ankara, Turkiye, from January 2020 to September 2023. Methodology: In this study, patients who were operated on for perianal fistula between 2020 and 2023 were retrospectively examined. Data were obtained retrospectively. All patients underwent preoperative perianal MRI. Clinical notes were evaluated with the Cleveland Clinic Incontinence Score (CCIS) by physical examination. All patients were followed up on the first postoperative day, 1st week, 1st and 3rd postoperative months. Results: A total of 44 patients who underwent fistulectomy with primary sphincteroplasty were included in the study. Twenty-six patients (59.1%) had a history of perianal abscesses. It was observed that 34 (77.3%) of the patients had posterior, 7 (15.9%) anterior, and 3 (6.8%) lateral fistulas. A total of 3 patients (6.8%) were observed to have minor worsening in their incontinence scores. There was no statistically significant difference between the preoperative and postoperative 3rd month Cleveland Clinic Incontinence Score values of the patients (CCIS mean 1.6 vs. 1.7, respectively, p >0.05). Recurrence was observed in 1 patient (2.3%) during follow-ups. Conclusion: Fistulectomy with primary sphincteroplasty is an effective and reliable method to preserve anal continence and improve quality of life.Article The Predictive Effect of "Real Amylase Value": A More Accurate Predictor for Postoperative Pancreatic Fistula(Wiley, 2025) Emral, Ahmet Cihangir; Cetinkaya, Gokay; Dikmen, Kuersat; Kerem, MustafaBackgroundPostoperative pancreatic fistula (POPF) is a common and serious complication following pancreatic surgery. While several studies have attempted to predict the development of POPF using drain amylase concentration, predictive values vary widely due to factors like abdominal irrigation and chylous drainage, which can dilute the amylase levels. This study aims to evaluate whether the "Real Amylase Value" (RAV), calculated as the product of drain amylase concentration and drainage volume, provides a more reliable prediction of POPF compared to conventional amylase concentration. Better prediction of pancreatic fistula development could lead to closer clinical monitoring of these patients, reassessment of hospital stay duration, and more careful management of drains over an extended period. Additionally, carefully managing the timing of drain removal may improve patient recovery and discharge process.MethodologyData from 198 patients who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were retrospectively analyzed. Drain amylase concentrations and drainage volumes were measured on postoperative days (POD) 1 and 3, and the RAV (U) was calculated. Real Amylase Value (RAV) (U) was calculated using the formula: RAV (U) = Drain Amylase Concentration (U/L) x Drainage Amount (L). Predictive values for POPF were evaluated using receiver operating characteristic (ROC) curve analysis, comparing conventional amylase concentration (U/L) and RAV (U).ResultsOn POD1, the RAV (U) demonstrated greater predictive value for POPF compared to the conventional drain amylase concentration (U/L) with an area under the ROC curve (AUROC) of 0.85 versus 0.79, respectively. Similarly, on POD3, RAV showed superior predictive accuracy (AUROC 0.89) compared to amylase concentration (AUROC 0.79).ConclusionThe RAV (U) offers a more accurate and reliable prediction of POPF than traditional drain amylase concentration (U/L), with improved sensitivity and specificity. This method could refine clinical management, particularly in the timing of drain removal and early intervention strategies for patients at high risk of developing pancreatic fistulas.
