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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Protective ileostomy in rectal cancer surgery - is it really temporary?
(2023-03-27)
Ulusoy, Cemal
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Duman, Mehmet Güray
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Güçlü Mete, Sıla
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Demirel, Ali İlbey
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Aim: This single-center retrospective study aimed to evaluate the rate of protective ileostomy closure in patients with rectosigmoid junction/rectal cancer and to investigate the factors that prevent ileostomy reversal. Material and Method: Patients with rectal cancer treated with/without neoadjuvant chemoradiotherapy were included in this study. All were treated with anterior rectal resection and temporary protective ileostomy creation. Decision for ileostomy closure was brought upon predefined ileostomy closure protocol. Results: Total number of 115 patients (17 with rectosigmoid junction and 98 with rectal cancer) were operated. Neoadjuvant chemoradiotherapy was conducted in 90 of them. Ileostomy closure rate was 73.9%. Mean time for stoma closure in patients with chemoradiotherapy conduction was 227.8 days, while in the rest, time was shorter (168.3 days), without statistical difference. Multivariate analysis revealed that endoscopic examination of the anastomosis during its creation was independent prognostic factor that affected ileostomy closure. Conclusion: More than one quarter of the patients with protective ileostomy experienced non-closure of their stoma due to various events after index rectal cancer surgery. Endoscopic examination of the anastomosis during its creation presented as independent factor affecting ileostomy closure.
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Outcome and Survival in Patients with Stage II/III Sigmoid, Rectosigmoid and Upper Third Rectal Cancer Treated with Upfront Surgery
(Galenos Yayinevi, 2023-03-01)
Ulusoy, Cemal
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Analysis of Survival in Complete Pathological Response after Long-Course Chemoradiotherapy in Patients with Advanced Rectal Cancer
(MDPI AG, 2023-01-12)
Ulusoy, Cemal
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Kamalı, Gülçin Harman
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<jats:p>Background: Neoadjuvant chemoradiotherapy prior to surgery is the standard treatment for locally advanced rectal cancer. This consists in the patient’s complete pathological response being achieved with no residual tumor presence in the resected specimen, which results in survival improvement. Methods: This retrospective study aimed to examine the rate of complete pathological response in patients with advanced rectal cancer treated with neoadjuvant long-course chemoradiotherapy and to examine the survival differences between the different tumor regression grade (TRG) scores. Results: A total of 154 patients were operated prior to long-course chemoradiotherapy with a total of 50 Gy plus FOLFOX protocol. Complete pathologic response was achieved in 29 (18.8%) patients. There was no statistical difference for the different pathologic responses according to gender, type of surgery, and number of harvested lymph nodes. Mean survival for all the groups was 37.2 months. Survival within a different TRG score exhibited statistical significance (p = 0.006). Overall, the survival rate during the follow-up period was of 81.8%. Conclusions: The complete pathological response rate in this study was of 18.8%. High tumor regression grade scores (TRG0 and TRG1) had a survival rate of over 90% during follow-up. Multivariate analysis identified perineural invasion and tumor regression grade as independent factors that affect survival.</jats:p>
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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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