INTRODUCTION: Perianal fistula (PAF) is a benign anorectal disease that can seriously affect the quality of life of patients if diagnosis and treatment are delayed. In this study, we compared the diagnostic performance of Magnetic Resonance Imaging (MRI) and contrast-enhanced anal ultrasonography (EAUS), which are commonly used before surgical planning for PAF treatment.
METHODS: Between 2022-2024, the records of 40 patients who underwent contrast-enhanced EAUS and MRI examinations and subsequent surgical treatment for PAF at Sakarya University Training and Research Hospital during the preoperative period were retrospectively evaluated. Using intraoperative findings as the “gold standard” reference, the sensitivity, specificity, and positive/negative predictive values of both preoperative diagnostic methods for mapping the fistula tracing, detecting the internal orifice, and identifying existing abscesses were investigated.
RESULTS: The mean age of the patients was 41 years (19-73) and 72.5% were male (n=29). Of the 40 patients, 29 were classified as having primary (72.5%) and 11 as having recurrent perianal fistulas (27.5%). Contrastenhanced EAUS accurately mapped the fistula tracts 85% of the time, with a success rate of 100%, especially in primary fistulas. In contrast, in the presence of recurrent disease, the diagnostic sensitivity of EAUS was insufficient in 22 patients (54.5%). EAUS was found to be advantageous in detecting submucosal or small abscesses, whereas MRI was more effective in identifying multiple and complex tracts because of its advantage of wide anatomical mapping. In addition, real-time evaluation of EAUS was found to be an important advantage in determining the relationship between the fistula tract and anal sphincter structures.
DISCUSSION AND CONCLUSION: Contrast-enhanced EAUS and MRI are complementary modalities for the preoperative mapping of perianal fistulas. Although MRI provides superior anatomical details in the presence of complicated and recurrent disease, EAUS provides real-time evaluation, is easily reproducible, and can be used even in the operating room. The sequential or combined use of both methods, especially in the presence of complicated or recurrent disease, can significantly contribute to increasing surgical success.

INTRODUCTION: Inguinal hernia repair is among the most frequently performed surgical procedures worldwide. Although both anterior open mesh repair (Lichtenstein) and posterior laparoscopic repair (TEP) are widely used, the impact of surgical experience and setting on perioperative outcomes remains inadequately studied. The objective is to compare the clinical outcomes of Lichtenstein and TEP techniques in inguinal hernia repair and assess the influence of surgical experience in training versus routine settings.
METHODS: This retrospective cohort study included 361 patients who underwent elective inguinal hernia repair between January 2015 and June 2019. Patients were grouped based on the setting: Training (residents under supervision, n=78) and routine (attending surgeons, n=283). Surgical techniques (Lichtenstein vs TEP) were compared regarding operation time, complication rates, length of hospital stay, and recurrence. Statistical analyses were performed using SPSS version 23.0 with a significance level of p<0.05.
RESULTS: The mean patient age was 52.6±16.1 years, with males comprising 94.7% of the cohort. Lichtenstein repair was performed in 202 patients (56%) and TEP in 159 patients (44%). Operative time was significantly longer in the training group than in the routine group (74.3±37.5 vs 58.0±38.5 min, p=0.001). Complication rates were also higher in the training group (p<0.05). Bilateral hernia repair significantly increased operative time in both techniques. No significant differences were observed in hospital stay duration. Early and late recurrence occurred in 1.4% and 4.4% of patients, respectively, without technique-specific differences.
DISCUSSION AND CONCLUSION: Both Lichtenstein and TEP techniques are safe and effective for inguinal hernia repair. However, outcomes are significantly influenced by the surgeon’s experience and the procedural context. Structured training and careful supervision are essential to minimize complications and standardize results in surgical education environments.

INTRODUCTION: Recurrence is a significant health concern following inguinal hernia surgery, and pseudo-recurrence is another significant problem among recurrence cases. This retrospective multicenter study aimed to examine pseudo-recurrence and its characteristics after laparoscopic inguinal hernia surgery.
METHODS: Patients who underwent inguinal hernia surgery using the Transabdominal Preperitoneal Procedure (TAPP) and Total Extraperitoneal Procedure (TEP) procedures at various centers between 2007 and 2020 were included. Patient details, including gender, age, unilateral and bilateral sides, type of surgery, and postoperative diagnostic parameters, were obtained.
RESULTS: Age mean of pseudo-recurrence patients was 62.58±10.34 with 32-75 range. For inguinal hernia patients, age range was 20 to 89 with 52.14±13.29 mean value. Age difference between inguinal hernia and pseudo-recurrence patients were statistically significant (p<0.05). All pseudo-recurrence patients were males, and 95.7% of inguinal hernia patients were males. Gender differences were insignificant as below 5% percentage (p<0.05). 77.0% of inguinal hernia, 78.9% of pseudo-recurrence patients had unilateral diagnosis, and differences were statistically insignificant (p>0.05). 8.6% of TAPP patients and 5.9% of TEPP patients were pseudo-recurrence, and differences were statistically insignificant (p>0.05). All pseudo-recurrence patients were males, and only 4 of patients had unilateral diagnosis. Nine patients in TAPP procedure included five aspiration hematoma, one cord lipoma, and three aspiration seroma cases. Ten patients in TEP procedure included six aspiration hematoma, three aspiration seroma and one cord lipoma. Ages were ranged from 32 to 75.
DISCUSSION AND CONCLUSION: Pseudo-recurrence is highly prevalent in both TAPP and TEP procedures, creating unnecessary invasive procedures for patients and a significant burden on the healthcare system. Therefore, further clinical research and studies are needed to identify and treat pseudo-recurrences in inguinal hernia surgery using medical or other methods before surgery.

INTRODUCTION: Alkaline reflux gastritis (ARG) is a chronic inflammatory condition caused by exposure of gastric mucosa to bile and duodenal contents. The relationship between bile reflux and Helicobacter pylori infection remains controversial. This study aimed to evaluate H. pylori prevalence and histopathological findings in patients with endoscopically detected bile reflux.
METHODS: This retrospective observational study included 136 patients with bile reflux who underwent simultaneous antrum and corpus biopsies between January 2022 and January 2024. Histopathological examinations were performed using hematoxylin-eosin and modified Giemsa stains. H. pylori status, gastritis type, inflammation severity, activity, atrophic changes, intestinal metaplasia, and lymphoid aggregates were evaluated according to Sydney classification.
RESULTS: H. pylori was positive in 76 patients (55.9%) overall, with higher prevalence in antrum (51.5%) compared to corpus (43.4%). Chronic active gastritis was significantly more common in H. pylori positive patients in both antrum (74.3% vs 18.2%, p<0.001) and corpus (78.0% vs 14.3%, p<0.001). Inflammation severity was
significantly higher in H. pylori positive patients in both locations (p<0.001). Intestinal metaplasia was three
times more frequent in antrum than corpus (14.7% vs 4.5%). Lymphoid aggregates were significantly more
common in H. pylori positive patients in antrum (48.6% vs 21.2%, p<0.001).
DISCUSSION AND CONCLUSION: Despite bile reflux presence, H. pylori prevalence remains high (55.9%), suggesting that endoscopically observed bile may reflect transient reflux rather than chronic alkaline reflux gastritis. The synergistic effect of H. pylori and bile reflux leads to more severe inflammatory changes. Histopathological confirmation is essential for alkaline reflux gastritis diagnosis, as endoscopic bile presence alone is insufficient.

INTRODUCTION: There are conflicting results in studies regarding the effect of laparoscopic surgery on postoperative complications in colorectal cancer patients. This study aims to evaluate the effect of laparoscopic surgery on major complications in patients undergoing surgery for colorectal cancer.
METHODS: A retrospective review was conducted on 370 patients who underwent oncologic surgery for colorectal cancer at Kartal Koþuyolu High Specialization Hospital between 2013 and 2022. Patients with missing data were excluded, and a total of 257 patients were included in the study. Patients were divided into two groups based on the development of major or no complications, and clinical and pathological data were compared. The relationship between surgical method (laparoscopic vs. conventional) and complications was evaluated using multivariate Cox regression analysis.
RESULTS: Major complications occurred in 106 of the 257 patients included in the study. The rate of major complications was found to be significantly lower in patients who underwent laparoscopic surgery (12.2% vs. 30.4%; p<0.001). In univariate analysis, conventional surgery (OR: 3.134; p<0.001), high body mass index (p=0.046), and history of Chronic Obstructive Pulmonary Disease/asthma (p=0.046) were found to be associated with major complications. In multivariate analysis, only conventional surgery was identified as an independent risk factor (OR: 2.969; p=0.002).
DISCUSSION AND CONCLUSION: Laparoscopic surgery significantly reduces the risk of major complications in patients with colorectal cancer and can be considered a safe and effective surgical option, even in patient populations with high comorbidities.

INTRODUCTION: Tracheoesophageal fistula (TEF) is a rare but serious complication, particularly in critically ill patients undergoing prolonged mechanical ventilation or tracheostomy. Management of non-malignant TEFs in intensive care settings is particularly challenging. This retrospective descriptive case series was designed to evaluate the characteristics, management strategies, treatment methods and clinical outcomes of patients with acquired TEF in a cardiovascular surgery intensive care unit, with Ethics Committee approval.
METHODS: All patients who were followed for more than 24 hours in the cardiovascular surgery intensive care unit during a 6.5-year period were evaluated. Adult patients who underwent endoscopy due to suspected TEF and were confirmed to have TEF were included in the study. The following parameters were examined: patient age, sex, type of surgery performed, use of mechanical ventilation, presence of tracheostomy and tracheostomy-related complications, length of ICU stay, use of inotropic support, presence of infections, timing of TEF development, TEF treatment methods, mortality, and outcomes.
RESULTS: Total of 23 patients underwent endoscopic evaluation due to suspected TEF. Among these, TEF was confirmed in 10 patients. Four of these patients underwent endoscopic and surgical treatment for TEF. These methods included endoscopic clipping alone (n=1), surgical repair alone (n=2), or a combination of endoscopic clipping and surgical repair (n=1). Two of these four patients died during hospitalization. One patient was discharged with complete recovery, while the other was discharged with a tracheostomy.
DISCUSSION AND CONCLUSION: Given the complexity of TEF management, both surgical and endoscopic treatment approaches should be undertaken in specialized centers with a multidisciplinary team.

INTRODUCTION: Asthma and Chronic Obstructive Pulmonary Disease (COPD) are prevalent chronic respiratory diseases worldwide. In both conditions, respiratory tract infections are a significant cause of morbidity and
mortality. Bronchoscopic sampling is an important diagnostic method for evaluating the microbiological
flora. There is limited data on whether the microbiological culture results differ in patients with asthma and
COPD from patients without asthma and COPD. This study aimed to investigate potential differences in the
respiratory tract microbial profiles of asthma, COPD, and non-asthma/non-COPD patients.
METHODS: This study included patients aged 18 years and older who underwent bronchoscopy between 2019 and 2024. Bronchoscopic samples were collected using the bronchoalveolar lavage method, and the microbiological culture results of these samples were examined in a laboratory setting. All procedures were performed using a flexible bronchoscope under local anesthesia and sedation.
RESULTS: A total of 526 patients were included in the study: 389 Without asthma and COPD, 35 with asthma, and 102 with COPD. The age in the COPD group was significantly higher than in the other groups (p=0.009). There was no difference between gender and procedure indications. Heart failure was more common in the asthma group, and coronary artery disease was more frequent in the COPD group. No significant difference was found between the groups in microbiological cultures (p>0.05).
DISCUSSION AND CONCLUSION: The bronchial microbial profile in patients with asthma and COPD did not differ from those without these diseases. These findings suggest that microbial colonization is independent of the disease.

INTRODUCTION: Laparoscopic gastrectomy with D2 lymphadenectomy has become increasingly accepted in high-volume Eastern centers. However, concerns remain regarding the adequacy of nodal dissection and long-term oncological safety, particularly in advanced gastric cancer.
METHODS: 246 Patients who underwent laparoscopic subtotal or total gastrectomy with D2 lymphadenectomy between 2012 and 2022 were analyzed. Demographic, perioperative, and pathological variables were collected. Outcomes included lymph node yield, complications, margin status, overall survival (OS), and disease-free survival (DFS). The impact of indocyanine green (ICG) fluorescence mapping and robotic assistance was evaluated.
RESULTS: Of 246 patients, 162 (65.8%) underwent laparoscopic subtotal gastrectomy and 84 (34.2%) underwent total gastrectomy. The mean number of retrieved lymph nodes was 37.8±9.4, with 100% adequacy. The 30-day mortality was 1.6%, and major complications occurred in 12.6%, with anastomotic leakage in 3.6%. R0 resection was achieved in 94.3% of patients. At a median follow-up of 46 months, 5-year OS and DFS were 58.7% and 52.1%, respectively. In 72 patients with ICG-guided lymphadenectomy, nodal yield increased to 41.6, and robotic assistance (28 patients) was associated with lower morbidity and shorter hospital stay.
DISCUSSION AND CONCLUSION: Laparoscopic gastrectomy with D2 lymphadenectomy is feasible, safe, and oncologically adequate in high-volume centers. Technical innovations such as ICG fluorescence mapping and robotic assistance enhance surgical precision and may further improve outcomes.

INTRODUCTION: This prospective randomized study aimed to compare the effectiveness and outcomes of three- dimensional (3D) versus two-dimensional (2D) laparoscopic systems in donor nephrectomy.
METHODS: A total of 25 laparoscopic donor nephrectomy cases, which were performed between March 30, 2022, and January 12, 2023, were randomized into 2D and 3D groups. Donor demographics, perioperative data, postoperative complications, pain scores, hospital stay, and graft function up to 18 months were evaluated.
RESULTS: No significant differences were observed between the 2D (n=12) and 3D (n=13) groups regarding donor characteristics, operative time, warm ischemia time, complication rates, transfusion requirements, postoperative pain, or length of hospital stay. Although multiple renal vessels were more frequent in the 2D group (p=0.039), this did not affect overall outcomes. Postoperative kidney function remained comparable in both groups. The use of 3D systems did not result in statistically significant improvements in surgical metrics but may provide enhanced depth perception.
DISCUSSION AND CONCLUSION: While 3D laparoscopy may improve depth perception and spatial orientation, this study did not demonstrate statistically significant advantages over 2D systems in donor nephrectomy outcomes. Larger, multicenter studies are needed to further assess the clinical impact of 3D laparoscopy in this setting.

INTRODUCTION: The timing of adjuvant chemotherapy initiation is a critical determinant of oncologic outcomes in colorectal and gastric cancer. Delays beyond 6–8 weeks have been associated with inferior survival. Minimally invasive surgery and enhanced recovery protocols may facilitate earlier rehabilitation and timely initiation of systemic therapy.
METHODS: We retrospectively analyzed 543 patients who underwent curative resection for colorectal (n=396) or gastric cancer (n=147) at Erzurum City Hospital between January 2022 and June 2025. Surgical approach (laparoscopic vs open), perioperative outcomes, Enhanced Recovery After Surgery (ERAS) adherence, complications, and the interval from surgery to adjuvant chemotherapy were assessed. The primary outcome was the initiation of chemotherapy within 6 weeks (≤42 days).
RESULTS: Laparoscopic surgery was performed in 323 (59.5%) patients, while 220 (40.5%) underwent open surgery. ERAS adherence was significantly higher after laparoscopy (median 78 vs 67, p<0.001). Major complications (Clavien–Dindo≥Ⅱ) occurred less frequently in laparoscopic cases (10.8% vs 25.0%). Median length of stay was shorter after laparoscopy (6.4 days vs 9.3 days, p<0.001). Among 370 patients who received adjuvant chemotherapy, the median time-to-chemo was 30 days after laparoscopy versus 39 days after open surgery (p<0.001). The proportion initiating chemotherapy within 6 weeks was significantly higher in the laparoscopic group (94% vs 66%, p<0.001). In multivariable analysis, open surgery (OR 0.20, 95% CI 0.09–0.43, p<0.001) and major complications (OR 0.22, p<0.001) independently predicted failure to commence chemotherapy within 6 weeks.
DISCUSSION AND CONCLUSION: Laparoscopic surgery for colorectal and gastric cancer was associated with higher ERAS adherence, lower morbidity, shorter hospital stay, and earlier initiation of adjuvant chemotherapy compared with open surgery. These findings highlight the importance of minimally invasive approaches and structured perioperative care in optimizing oncologic treatment timelines.

Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures worldwide. Although generally safe, it is not without complications. We present a rare case of intraoperative entrapment of a nasogastric tube (NGT) in the stapler line during LSG, which resulted in a staple line leak. The complication was identified and managed intraoperatively. This case highlights the importance of communication between surgical and anesthesia teams, as well as meticulous intraoperative control.