Endometriosis is an estrogen-dependent benign disease that generally affects women at childbearing age. Despite its high incidence, pathogenesis of endometriosis is poorly clarified. There are several theories explaining the mechanism of disease such as retrograde menstruation, coelomic metaplasia, vascular and lymphatic metastasis. While endometriosis has been described in many intra- and extra-abdominal organs including the ovaries, omentum, colon, liver, lungs and brain, parenchymal splenic endometriosis is a rare situation. In recent years, with reported cases, this rare condition came onto the scene. We also wanted to present our case and question the idea of splenic immunity against endometriosis according to current literature. From now on, splenic endometriosis can be thought of as a differential diagnosis for unidentified lesions of spleen.

AIM:Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. METHOD:In this multicentre retrospective cohort study (Nov. 2017-Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann-Whitney U test depending on distribution normality. RESULTS:Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2, male-to-female ratio: 4:1). The number of sinuses/pits was 2-3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%-86%). CONCLUSION:Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.

Although laparoscopic total extraperitoneal (TEP) procedure has gained wide acceptance for inguinal hernia repair, there is still debate on the optimal technique in patients with a history of previous radical prostatectomy (RP). We aimed to evaluate the feasibility and safety of laparoscopic TEP in patients with a previous history of RP using a propensity score case-match analysis. This study included male patients undergoing laparoscopic TEP repair between 2013 and 2024. According to the RP status, patients were case-matched based on age, BMI, ASA score, site of hernia and the year of surgery. A total of 162 patients were matched in a 1:5 ratio. The RP and non-RP groups were compared with respect to perioperative outcomes. The RP and non-RP group included 27 and 135 patients, respectively. The rate ofconversion to transabdominal preperitoneal repair (11.1

Evisceration of the small intestine from a perforated rectum is a rare condition, particularly seen in elderly women. We present a case involving an 83-year-old woman with a history of chronic rectal prolapse and no other comorbidities. The patient declined surgical intervention for her rectal prolapse, and one month later, she presented with evisceration of the small intestine from the anus. The intervention was a laparotomy followed by Hartmann's procedure, which is the most recommended procedure. No small bowel resection was necessary. Although the management of this case was adequate and timely, the patient did not survive. This case underscores that elective repair of rectal prolapse might prevent this very rare but potentially fatal complication of transanal small intestinal evisceration.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BACKGROUND:This study aimed to investigate the causes of failure after the ileal pouch-anal anastomosis (IPAA) procedure for ulcerative colitis (UC) and to determine the independent risk factors affecting their quality of life. METHODS:This multi-center cohort study included all UC patients who underwent IPAA at nine referral centers in Türkiye from 2010 to 2018. Centers were categorized as high-volume (≥10 cases/year) or low-volume (<10 cases/year). Outcomes assessed included postoperative complications, pouch failure, and QoL using the Cleveland Global Quality of Life (CGQL) and modified Oresland Score. Logistic and linear regression analyses were used to identify risk factors for pouch failure and QoL determinants, respectively. RESULTS:Of 296 patients included, pouches were constructed in 172 (58.1%) as a two-staged and in the remaining patients as a three-staged procedure. The high-volume center had higher rates of biologic (45.1% versus 16%) and steroid use (63.9% versus 22.1%). The overall pouch failure rate was 4.7% at the end of follow-up of 66.1 months. Independent risk factors for pouch failure included pelvic sepsis (OR = 47.47, P = 0.002), biologic use (OR = 13.45, P = 0.033), chronic pouchitis (OR = 14.31, P = 0.013), postoperative blood transfusion (OR = 7.04, P = 0.048), and low annual case volume (OR = 30.86, P = 0.047). CGQL and Oresland scores averaged 0.77 ± 0.1 and 6.3 ± 1.1, respectively. Factors negatively impacting QoL included two-staged procedures, small bowel obstruction, venous thromboembolism, chronic pouchitis, increased frequency of bowel movements, and low annual case volume. CONCLUSIONS:IPAA surgery in UC patients in Türkiye demonstrates acceptable rates of complications and pouch failure, with high patient satisfaction in terms of QoL and functional outcomes. Optimizing long-term results requires enhanced surgical expertise and coordinated multidisciplinary management strategies.

Objective: Crohn’s disease of the pouch is defined as the appearance of Crohn’s disease complications such as fistula or stricture in an ulcerative colitis patient in the postoperative period, who had restorative proctocolectomy with ileal pouch anal anastomosis. The aim of this study is to investigate the long-term prognosis of Crohn’s disease in the pouch patients. Methods: A total of 1166 records of ulcerative colitis patients were examined, and 57 patients who underwent ileal pouch anal anastomosis were detected. We formed 2 control groups from ileal pouch anal anastomosis patients: patients with pouchitis (n = 12) and asymptomatic patients (control group, n = 17). Results: Ten out of 28 patients with chronic pouchitis were grouped as Crohn’s disease of the pouch. In this group, there were 6 patients with fistula, including 5 with perianal fistula and 1 with pouch–vagina fistula. In 2 patients, there was also concomitant stricture. Four patients had strictures without perinal fistula. In the perianal fistula group, all patients received tumor necrosis factor-alpha blocker treatment (5 infliximab and 1 adalimumab) combined with azathioprine in 5 of them. In the stricture group, 2 patients received azathioprine, 1 patient received infliximab combined with azathioprine, and 1 patient received infliximab monotherapy. In the fistula group, diverting ileostomy was performed in 3 patients; in only 1 patient, fistula flow stopped. During the follow-up period, none of the Crohn’s disease of the pouch patients were in remission except 1 who had diverting ileostomy. Total remission rate in the pouchitis group was 33% (4/12). Conclusion: Crohn’s disease of the pouch is not an uncommon clinical entity with a frequency of 20% in the long term follow-up. Despite combined medical treatment, one-third of the patients ended with permanent end ileostomy due to pouch failure. Cite this article as: Gündoğdu Karaköse T, Eşkazan T, Kepil N, et al. Long-term prognosis of crohn’s disease of the pouch: A singlecenter experience of 17 years. Cerrahpaşa Med J. 2023;47(1):37-42.

Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. There were 80 (75

Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acıbadem Mehmet Ali Aydınlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.

Extra-intestinal manifestations are encountered in 6%-47% of patients with inflammatory bowel disease.Musculoskeletal and dermatologic systems are the most frequently affected sites.Some extra-intestinal manifestations arise before the disease flares; therefore, early awareness of these symptoms has great importance in inflammatory bowel disease management.In this article, we describe 2 cases with inflammatory bowel disease exhibiting 2 different skin manifestations, namely, Sweet's syndrome and erythema nodosum, and related issues in the diagnosis and management of extra-intestinal manifestations.

The aim of study was to evaluate the prognostic role of MSI status and PD-L1 expression in gastric cancer and the relationship of these parameters with clinicopathological features. Eighty-six gastric cancer patients who underwent surgical resection were analysed. MSI status and PD-L1 expression in tumour samples were evaluated by immunohistochemistry (IHC). PD-L1 IHC was scored using the combined positive score (CPS). Survival analysis was conducted using the Kaplan-Meier method. The rate of PD-L1 expression in tumour cells was 34.9% (n=30), and the frequency of PD-L1 expression in immune cells with a CPS >= 1% was 57% (n=49). MSI-high (MSI-H) was detected in 11.6% (n=10) of cases and was more common among PD-L1-positive cases (p=0.021). MSI-H status was significantly correlated with older age, larger tumours, positive PD-L1 expression, and the adenocarcinoma subtype. PD-L1 expression was associated with lymph node metastasis, the adenocarcinoma subtype, MSI, preoperative treatment and an improved response to preoperative chemotherapy. In our study, the impact of MSI status on survival was not demonstrated, but positive PD-L1 expression (>= 1%) in tumour cells (15.7 vs. 53.4 months. p=0.008)and in immune cells (20.4 vs. not reached (NR); p=0.027) was associated with decreased overall survival. PD-L1 expression is related to a poor prognosis in patients with gastric cancer.

Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. There were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I–III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.

Objectives:In this study, it was aimed to compare short-term outcomes of minimally invasive and open surgery for gastric cancer in the Turkish population carrying both European and Asian characteristics. Material and Methods:Short-term (30-day) outcomes of the patients undergoing minimally invasive and open gastrectomy with D2 lymphadenec- tomy for gastric adenocarcinoma between January 2013 and December 2017 were compared. Patient demographics, history of previous abdominal surgery, comorbidities, short-term perioperative outcomes and histopathological results were evaluated between the study groups. Results:There were a total of 179 patients. Fifty (28%) patients underwent minimally invasive [laparoscopic (n= 19) and robotic (n= 31)] and 129 (72%) patients underwent open surgery. There were no differences between the two groups in terms of age, sex, body mass index and ASA scores. While operative time was significantly longer in the minimally invasive surgery group (p <0.0001), length of hospital stay and operative morbidity were com- parable between the groups. Conclusion:While both laparoscopic and robotic surgery is safe and feasible in terms of short-term outcomes in selected patients, long operating time and increased cost are the major drawbacks of the robotic technique preventing its widespread use.

Benlice, Cigdem M.D.; Usta, Taner M.D.; Ozkaynak, Aysel M.D.; Kurtul Sahin, Inci M.D.; Aghayeva, Afag M.D.; Hamzaoglu, Ismail M.D.; Karahasanoglu, Tayfun M.D.; Baca, Bilgi M.D. Author Information

Background: Obesity is one of the contributing factors to technical difficulties in minimally invasive colorectal surgery. However, there are no data regarding the outcomes for obese patients undergoing robotic complete mesocolic excision (CME) for colon cancer. In this study, we aimed to investigate whether robotic CME in obese patients can be performed with similar morbidity and pathological results compared with nonobese patients. Methods: Patients who underwent robotic CME between 2014 and 2019 were classified into obese and nonobese groups. Obesity was defined as body mass index ≥30 kg/m2. Demographic data, perioperative outcomes and pathological results were compared between the groups. Results: There were 42 and 105 patients in the obese and nonobese group, respectively. The groups were comparable regarding preoperative characteristics. There were no significant differences with respect to operative times (244 ± 64 versus 304 ± 75 minutes, P = .29), blood loss (median, 50 versus 80 mL, P = .20), intraoperative complications (0% versus 3.8%, P > .99), and conversions (0% versus 1.9%, P > .99). No differences were detected in length of hospital stay (6 ± 1 versus 6 ± 2 days, P = .73), anastomotic leak (2.4% versus 1.9%, P > .99), septic complications, reoperations (2.4% versus 3.8%), and readmissions (2.4% versus 2.9%) (P > .05). The mean number of harvested lymph nodes (33 ± 11 versus 34 ± 13, P = .79), resection margin status, and mesocolic fascia grading were similar. Conclusion: Robotic CME in obese patients can be performed with a similar morbidity and pathological profile compared with nonobese patients. The Clinical Trial Registration number is not applicable for this study.

BACKGROUND:Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi® robotic system versus straight laparoscopy for gastric adenocarcinoma.METHODS:Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes.RESULTS:Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047).CONCLUSION:Totally robotic technique with the da Vinci Xi® robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.

BACKGROUND/AIMS:This study aimed to determine the predictors of endoscopic recurrence in a cohort of patients with Crohn's disease (CD) with prior intestinal resections. MATERIALS AND METHODS:The charts of the patients with CD were reviewed in a retrospective manner. Eighty-three patients were eligible for the final analysis. Demographic features of these patients and time between resection and colonoscopy, presence of any macroscopic residual disease in the remnant intestine, and postoperative medications were noted. Rutgeerts score was used to define postoperative endoscopic recurrence. RESULTS:The patients' mean age±SD at their final colonoscopy was 42.81±11.99 yr; and 37 of 83 patients (45%) were female. The mean follow-up time between resection and the final colonoscopy was 51.16±51.08 months. A total of 51 of 83 patients (61%) were in endoscopic remission (i0, i1); whereas 32 (39%) had an endoscopic recurrence (i2, i3, i4). History of multiple resections (χ2=6.12; p=0.013) and the presence of any postoperative residual disease in the remnant intestine (χ2=5.86; p=0.015) were risk factors; whereas the regular use of azathioprine (AZA) was significantly more common among patients without recurrence (χ2=4.515; p=0.034). In an age-sex adjusted Cox regression analysis history of multiple resections, presence of any postoperative residual disease proved to be independent risk factor for endoscopic recurrence, whereas the regular use of AZA proved to be ineffective. CONCLUSION:In a retrospective long-term follow-up cohort of resected patients with CD, having multiple resections for CD and the presence of any residual synchronous disease after ileocolonic resection were identified as risk factors for endoscopic recurrence; the latter was never reported in previous studies.

Baca, Bilgi M.D.; Benlice, Cigdem M.D.; Ozben, Volkan M.D.; Hamzaoglu, Ismail M.D.; Karahasanoglu, Tayfun M.D. Author Information