Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032

 

Hakan Kulaçoğlu1, Haydar Celasin2

1Department of Surgery, Ankara Hernia Center, Ankara, Turkey
2Department of Surgery, Lokman Hekim Akay Hospital, Ankara, Turkey

Abstract

Objective: The aim of the present study was to search the most-cited articles from Turkey on abdominal wall hernias and analyze their characteristics with several parameters.

Material and Methods: In March 2019, a search was conducted through all databases in the Web of Science (WoS) to determine the most-cited articles on abdominal wall hernias. Each article was evaluated in regard to host journal, year of publication, the complete list of authors, the type of article, main subject of the study, institution of the study group. Citation counts in Google Scholar (GSch) were also obtained.

Results: Mean number of citations of the top 100 articles in herniology was 30.50. Articles were published in 38 journals; Hernia is the leading host. No correlation was observed between the journal impact factors and the number of the citations. Two thirds of the articles were clinical studies. Article types had no significant effect on the citation counts. Inguinal hernia was the most frequent topic by taking place in 58 papers. Articles related to incisional hernias had a higher mean number of citations in comparison with other topics. Ankara University School of Medicine had most cited articles, the highest number of total citations, and the highest citation per articles. Ankara Numune Training and Research Hospital and Istanbul University School of Medicine had the highest number of the articles in the list.

Conclusion: Citation counts of hernia related articles from Turkey are relatively low. Hernia is the leading journal for Turkish studies. Inguinal hernia is the most frequent topic whereas papers about incisional hernias receive more citations than others.

Keywords: Hernia, abdominal wall, bibliometric, citation

Introduction

The number of publications from Turkey displays an obvious growth as biomedical publishing advances globally (1). However, recently Onat has performed a citation analysis and stated that Turkey’s contribution to the medicine by scientific articles is not enough compared with the potential of the country (2). Citation (a reference to subsequent studies) in another paper is one of the criteria to value an article. Citation analysis of the publications in a specific subject is performed by bibliometric methodology. The earliest example was published in the Journal of the American Medical Association as one of the most-cited articles in the same journal in 1985 (3). In 2002, a study on 100 citation classics in general surgery journals was published (4). Mayir et al. have searched the most cited articles from Turkey in the general surgery field and revealed that hydatid disease, pilonidal sinus, breast diseases, and inguinal hernia were the most frequent subjects (5). Scientific papers on abdominal wall hernias also show a steady rise worldwide (6). Hernia repairs, especially those for inguinal hernias, can be performed in every institution, and the surgeons find opportunity to prepare scientific papers more easily in comparison with major operations in surgical practice.

The present study was done with the purpose of listing the most-cited articles from Turkey in the field of abdominal wall hernia and analyzing their characteristics with several parameters.

Material and Methods

Database Search

In March 2019, a search was conducted through all databases in the Web of Science (WoS) to determine the most-cited articles on abdominal wall hernias from Turkey. The keywords for the topic line of the search were “inguinal hernia,” “ventral hernia,” “incisional hernia,” “umbilical hernia,” “paraumbilical hernia,” and “femoral hernia.” Additionally, combinations of “hernia and emergency,” “hernia and mesh” were added. The keywords were searched in the titles, abstracts, and keywords given.

Data Recording

The study adhered to the Helsinki Declaration developed by the World Medical Association for medical research involving human material and data. After the top-cited 100 articles were determined and ranked by the number of citations, all full texts were reached. Each article was evaluated in regard to journal name, main field of the journal (surgery, general medicine, others), year of publication, the complete list of authors, number of authors, the type of article (clinical study; review/systematic review/meta-analysis/literature search; case report/case series; laboratory study/animal experiment/cadaver dissection), main subject of the study (inguinal, incisional, umbilical, femoral, etc; emergency; mesh and other materials—if the study focused on the characteristics or properties of prosthetic materials, or if several meshes were compared in repairing certain hernia types), institution of the study group. Citation counts in Google Scholar (GSch) were also obtained. The data were recorded in Office Excel 2016 (Microsoft, Redmond, WA).

Statistical Analysis

Data were exported to SPSS v.21 (IBM, Chicago, IL) for statistical analysis. A one-way ANOVA test was used to determine the differences between mean values. A correlation coefficient (r) was calculated to determine whether recorded parameters correlated with the citation counts of the listed articles. A p value less than 0.05 was accepted as significant.

Results

The top 100 list of hernia related papers from Turkey is given in Table 1. The total number of citations of the top 100 articles in herniology was 3.050 in WoS (range: 12-145), and 5.672 in GSch (range: 16-272). Mean number of citations was 30.50 in WoS, and 56.72 in GSch.

The publication year was evaluated in 3 consecutive decades (Table 2). No article published before 1995 or earlier took place in the list. The most productive decade was 2000-2009, with 72 papers. The year with the highest number of articles in the list was 2006 (14 papers). The most recent paper in the list was published in 2014. No effect of the publication decade was observed on citation counts (Table 3).

One hundred top cited articles were published in 38 different journals: 80 papers in surgical journals and 20 papers in others (anesthesia, biomaterials, etc.). Hernia was the most frequent host journal with 23 articles (Table 4). Articles published in surgical journals had more citations than the ones in the journals from other disciplines (WoS: 32.85 vs. 21.10; p= 0.030, and GSch: 60.70 vs. 40.80; p= 0.57). No correlation was observed between the journal impact factors and the number of the citations. The number of the authors differed 1 to 11 with a mean number of 5.66; only 3 papers were written by one single author, and 2 by two authors. There was no correlation between the number of the authors and the citation counts. Interestingly, four papers had no authors from general surgery at all; two by anesthesiologists, one by radiologists, and another one by neurologists and urologist.

Two thirds of the articles were clinical studies. The types of the articles had no significant effect on citation counts (Table 5). Amongst the clinical studies, retrospective series had more citation counts than prospective studies (WoS: 44.38 vs. 27.76; p= 0.007, and GSch: 85.43 vs. 51.47; p= 0.011).

Inguinal hernia was the most frequent topic by taking place in 58 papers, incisional hernia was the second with 16 studies (Table 6). Twenty-one articles studied mesh materials. Six studies which investigated hernia repairs in emergency conditions had the highest mean citation number (WoS: 95.50; GSch: 177.50). Articles related to incisional hernias had a higher mean number of citations in comparison to ones about inguinal hernias (WoS: 38.73 vs. 28.12; p= 0.080).

The top 100 articles originated from 43 institutions. There were 29 university hospitals, 10 teaching hospitals other than medical schools, 3 private hospitals and 1 rural public hospital. From another view, there were 39 publications from Ankara, 22 from Istanbul, 11 from Izmir and 28 from other cities. Ankara University School of Medicine had the most-cited article, the highest number of total citations, and the highest citation counts per articles. Ankara Numune Training and Research Hospital and Istanbul University School of Medicine had the highest number of the articles in the list (Table 7). On the other hand, no differences in citation counts were determined in comparison of university hospitals and other training hospitals.

Discussion

Bibliometric analyses for citation counts in medical publishing have revealed that the most-cited articles were published between 1990 and 2010 (7-12). The most productive decade in the present study was 2000-2009. Even the most scientific articles need time to get citations by subsequent publications. Citation count lists are dynamic, and rankings may change by time, and we can see a rapid rise in the citation counts of papers produced in the last decade. Similarly, some articles that are not yet in the top 100 list can also enter the list in, and there may be changes in the ranking of some papers already on the list. Also, the citation and publication numbers of the authors in top 100 lists may not thoroughly reflect their overall productivity in those fields.

van Noorden et al. have reported that 43.8% of all scientific publications have collected no citations at all, and 1.84% of all stay in the citation band of 100-999 citations (13). Amongst articles in herniology from Turkey, only two papers have passed the 100 citations threshold, and other 13 papers have collected more than 50 citations. Mean number of citations in WoS is only 30. In 2002, Paladugu et al. have reported that the mean citation number of the 100 citation classics in general surgery journals is 405 (4). There was no article on abdominal wall hernias in that top 100 list. A very recent bibliometric study in general surgery has found a median number of 490 citations within the 5 journals with the highest impact factor (14). On the other hand, Mayir et al. have reported that 7.7% of the most cited articles in general surgery from Turkey was on inguinal hernias (5). Onat has detected 6 papers from general surgery field in a list of 271 articles for Turkey’s contribution to medicine, and only one of those was related to the abdominal wall hernias (2). That paper was produced by the Surgical Department of Ankara University School of Medicine (15). Its citation count had been 76 that time and was found to reach 145 in the present search.

The top 100 articles in the herniology field were produced by 43 institutions. Five of the 10 most productive institutions were complied with Nayir et al.’s list for general surgery publications from Turkey (5). Moreover, the most productive city was Ankara in both studies, and non-academic teaching hospitals exhibited as great success as university hospitals did. This difference probably originated from the nature of the hernia surgery, which is suitable for almost all surgical facilities. On the contrary, vast majority of the publications on more complex surgical procedures like transplantation is produced by university hospitals (16). Onat’s study on citation counts of Turkish papers from all disciplines revealed a different picture, 90% of the medical publications in that list were produced by university hospitals (2). A bibliometric study for orthopedic publications originating from Turkey concordantly revealed that only one out of the most productive 10 institutions was non-academic teaching hospital (17); it was Ankara Numune Training and Research Hospital, which is also in the second rank in the present study.

The 100 top-cited papers were published in 38 journals. This figure ranges between 10 and 46 in previous publications on citation analyses in different fields (7-9,18,19). Top 100 papers in general surgery was published in only 10 surgical journals (4). In the present study, 80 articles were published in surgical journals, and these articles collected more citations than those in the journals from other disciplines. As a specific journal in its field, Hernia journal receives a large number of submissions related to abdominal wall hernias. It is clearly the top journal in the present study. Unfortunately, no single article published in a journal from Turkey entered the top 100 list.

Journal impact factor is a reflection of the average number of citations to recent articles published in journals. A positive correlation between the journal impact factor and the citation counts is an expected finding. Accordingly, some studies have shown that journal impact factors are strong predictors for citation counts (7,11,12,19,20). However, no correlation was detected between the journal impact factors and the number of the citations in the present study.

Clinical studies are the most frequent article types in the previous bibliometric analyses for citation counts (10,11,18). Unlike, in a bibliometric study on hepatocellular carcinoma articles revealed that review articles collected higher mean number of citations than that for other types (18). In the present study, clinical studies and review articles received more citations than case reports and laboratory studies; however, the difference was not significant. Retrospective clinical series collected more citation counts than prospective studies, possibly because of their larger number of patients from the archives of tertiary reference hospitals than prospective randomized studies with small number of subjects.

Classification of the articles in the top 100 list regarding the topic of the study revealed interesting results. The number of papers on inguinal hernias were more than three times of those about incisional hernias. This is somewhat expected given the fact that inguinal hernia repairs comprise the majority of operations for abdominal wall hernias (21,22). However, incisional hernia articles had a higher mean number of citations than papers on inguinal hernias. On the other side, the total number in the list and the mean citation counts for papers about umbilical hernias are lower than those for incisional hernias despite the fact that the share of these two types of hernias within surgical repairs are quite similar. One reason for this situation may be the complexity in repair of incisional hernias together with more frequent and more serious complications following them.

Conclusion

Citation counts of hernia related articles from Turkey are relatively low. Hernia is the leading journal for Turkish studies. Inguinal hernia is the most frequent topic, whereas papers about incisional hernias receive more citations than others.

Cite this article as: Kulaçoğlu H, Celasin H. Most cited 100 articles from Turkey on abdominal wall hernias: a bibliometric study. Turk J Surg 2020; 36 (2): 180-191.

Ethics Committee Approval

Not relevant.

Peer Review

Externally peer-reviewed.

Author Contributions

Consept – H.K.; Design – H.K; Supervision – H.K.; Data Collection and/or Processing – H.K., H.C.; Analysis and Interpretation – H.K.; Literature Search – H.C.; Writing Manuscript – H.K.; Critical Reviews – H.K., H.C.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.

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