Faculty of Medicine

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Chevrel's procedure for midline incisional hernia repair-not to be abandoned or forgotten
(Oxford University Press (OUP), 2024-10)
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Cako, Dajana
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Argirov, Ivan
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Limani, Nimetula
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Ulusoy, Cemal
The Chevrel technique is a well-established procedure for open repair of midline incisional hernia. This retrospective single-center case series aims to present the outcome of patients with midline incisional hernia treated with a modified Chevrel technique. The modification itself comprehended the use of a single-layer continuous suture for the inverted anterior rectus abdominis muscle sheet for the creation of the "new linea alba" without overlapping. Between January 2017 and December 2023, 40 patients were operated. The overall postoperative morbidity rate was 65%. Hernia recurrence occurred in three patients (7.5%). When the basic principles of the Chevrel technique are respected and conducted, this leads to satisfactory results. The postoperative outcome of this case series showed rates of complications and recurrences in concordance with the already published literature. Therefore, this technique should always be considered for the open approach for midline incisional hernia repair.
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Uncommon degloving intestinal injury accompanied by complete disruption of the rectus muscles in patient with seat belt sign: a case report
(Oxford University Press (OUP), 2025-07)
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Gelevski, Radomir
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Argirov, Ivan
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Ulusoy, Cemal
Blunt abdominal trauma rarely causes injury to hollow intraabdominal viscus. Still, in victims with seat belt sign, a high index of suspicion should be raised. Additionally, accompanied injury to the abdominal wall muscles is reported. We present a case of a male patient injured in a high-velocity car accident presented with seat belt sign and peritoneal signs. Laparotomy revealed uncommon degloving injury of the small intestine with additional mesentery lesions and lacerations of the ascending and descending colon. Concomitant transection of both rectus abdominis muscles was also encountered.
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Assessment of the Level of Middle Colic Artery Ligation Influence on Survival in Right-Sided Colon Cancer
(Walter de Gruyter GmbH, 2025-06-01)
Ulusoy, Cemal
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Duman, Mehmet Güray
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Aim: This study aims to investigate whether the addition of ligation of the Middle Colic Artery in its origin to Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) affects overall survival and lymph node retrieval. Method: Patients with right-sided colon cancer who underwent curative right or extended right hemicolectomy with CME and CVL were included. In cases with tumors located in the distal part of the ascending colon and the hepatic flexure, the middle colic artery was ligated in its origin. For the cecal and proximal localization of the tumor, the point of ligation was decided on the surgeons' decision. Results: A total number of 169 patients were operated. In 78 patients the tumor was localized in the caecum, in 70 patients in the ascending colon, and 21 in the hepatic flexure. In 59 patients, the middle colic artery was ligated in its origin. Different artery ligation sites according to tumor localization subgroup presented with statistical significance (P = 0.004). The mean number of harvested lymph nodes between the groups was presented with a difference (33.4 vs. 28.5; P = 0.037). Survival rates for cecal, ascending, and hepatic flexure cancer were as follows: 61.5%, 67.1%, and 85.7%, respectively (P = 0.22). The survival rate for all patients was 66.9% (69.5% for patients with middle colic artery ligation and 65.5% for the right branch of middle colic artery ligation, P = 0.42). Conclusion: Ligation of the middle colic artery in its origin did not improve overall survival. However, it resulted in a significantly higher number of harvested lymph nodes.
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Spontaneous omental infarction in an obese young female patient treated with laparoscopy: a case report
(Oxford University Press (OUP), 2024-06)
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Mojsilovic, Dino
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Argirov, Ivan
Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition's rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.
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The Incidence of Lymphovascular and Perineural Invasion and their Impact on Survival in Patients with Rectal Cancer
(Walter de Gruyter GmbH, 2023-12)
Misimi, Shqipe
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Cako, Dajana
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Demirel, Ali İlbey
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Ulusoy, Cemal
Aim: Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) represent undesirable but still realistic pathological features of rectal cancer, associated with poor prognosis and worse survival. The aim of this study is to assess the incidence of LVI and PNI in patients treated for rectal cancer and the impact of LVI and PNI on patient survival. Material and Methods: This retrospective single center observational study, conducted in the period of 2016-2019, includes patients with rectal cancer treated with/without long-course neoadjuvant chemoradiotherapy (nCRT). Data collection encompassed demographics, tumor characteristics, type of surgery (abdominal perineal rectal resection - APR and low anterior rectal resection - LAR), and LVI/PNI presence. Survival during follow-up was estimated and compared for patients with/without LVI and PNI involvement. Results: A total number of 234 patients (77 females and 157 males) with mean age of 61.3 enrolled in the study. Neoadjuvant CRT was conducted in 170 patients. APR procedure was performed in 67 of them and LAR in 167. LVI presence was noted in 55 (24.4%) and PNI in 77 (34.2%) patients. Mean survival during follow-up was 42.07 months. The use of nCRT influenced on survival (p < 0.033). Patients treated with LAR had better survival outcomes (p = 0.001). Presence of LVI and PNI was associated with a worse prognosis (p < 0.001). Conclusion: PNI was more frequent than the LVI in this study. Patients with nCRT conduction had better overall survival. LVI and PNI presence was associated with poor prognosis in terms of overall survival in patients with rectal cancer.
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Bleeding metastasis of renal cell cancer to anal canal treated with radiation
(Korean Society for Therapeutic Radiology and Oncology, 2023-09-18)
Ulusoy, Cemal
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Mete, Sila Guclu
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Uncommon causes of acute appendicitis: Retrospective analysis of 6785 histopathological findings in a tertiary center
(Kare Publishing, 2022-12)
Harman Kamali, Gülçin
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Ulusoy, Cemal
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Eğin, Seracettin
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Kamalı, Sedat
This study aims to determine the uncommon causes of acute appendicitis in analyzed post appendectomy specimens.
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Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease
(Lippincott/Ovid Technologies (Wolters Kluwer Health), 2022-12-16)
Ulusoy, Cemal
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Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer
(Macedonian Academy of Sciences and Arts / Sciendo, 2022-11-01)
Ulusoy, Cemal
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Aim: To evaluate the effect of extralevator abdominoperineal excision of the rectum (ELAPE) on the circumferential resection margin (CRM) and overall survival in comparison to standard abdominoperineal excision of the rectum (APE) in patients with advanced rectal cancer. Material and Methods: This retrospective study encompasses patients with advanced rectal cancer operated on with two different methods: prone Jack-Knife position ELAPE and APE. In part of them, neoadjuvant chemoradiation was conducted. Postoperative patient, tumor, and outcome data were analyzed in terms of differences in CRM positivity and overall survival. Results: Of 67 patients treated with either APE (52) or ELAPE (15), 43 were male and 24 were female. Neoadjuvant treatment was conducted on 49 of the total patients. Complete pathological response (T0) was achieved in 3 patients. Positive CRM was reported in 7 patients (11.5 %), 3 in ELAPE and 4 in APE group (p = 0.348). The overall postoperative complication rate was 56.7%. Mean survival period was 42.2 months. Overall survival rate for both groups was 67.2 %. No statistical differences were seen between the ELAPE and APE procedure in terms of overall survival (p = 0.483). Conclusions: Differences between the use of ELAPE and APE in terms of CRM positivity and overall survival were not statistically significant. Therefore, we conclude that ELAPE is not superior to standard APE in the treatment of advanced rectal cancer.
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Acute appendicitis: Covid-19 pandemic did not change presentation and treatment
(2022)
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Ulusoy, Cemal
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Dervishov, Kristijan
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Otljanski, Aleksandar
This single-tertiary non-Covid center retrospective study analyses the impact on Covid-19 pandemic on the presentation and the treatment in patients operated for acute appendicitis.

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