Mehmet Eşref Ulutaş

Introduction and Hypothesis Rectovaginal fistula (RVF) repair remains surgically demanding, and whether a diverting stoma genuinely improves outcomes after Martius flap interposition is still unclear. Although diversion is traditionally advocated to minimize contamination and enhance healing, emerging evidence challenges its routine use. This study evaluated the impact of stoma diversion on recurrence, postoperative complications, and quality-of-life outcomes following Martius flap repair. Methods This retrospective two-center cohort included women undergoing Martius flap repair for RVF between 2015 and 2025. Patients were grouped on the basis of whether a diverting stoma was present or created at surgery. Demographics, fistula characteristics, complications, recurrence, and Cleveland Global Quality of Life (CGQL) scores were compared. Results Seventeen patients were included (ten with diversion, seven without). Baseline characteristics were similar between groups. Recurrence was markedly lower in the diversion group (10.0%) compared with the non-diversion group (42.9%). The overall recurrence rate was 23.5%. Reoperation was required in 42.9% of the non-diversion patients but in none of the diversion patients. CGQL scores were comparable between groups. Conclusions The rate of unplanned fistula-related reoperation was lower in the stoma group following Martius flap repair for rectovaginal fistula. Recurrence also showed a trend toward a lower rate in the stoma group, although the difference was not statistically significant. Larger multicenter prospective studies are needed to confirm these findings and determine which patients may benefit most from diversion.

Background and Objectives: Laparoscopic sleeve gastrectomy has emerged as the most widely adopted bariatric procedure in the management of morbid obesity. Despite its efficacy, postoperative scarring at port sites remains a significant aesthetic concern for patients. To mitigate this issue, we developed the Modified Bikini Line Sleeve Gastrectomy technique. This study aims to delineate the surgical steps of the Modified Bikini Line Sleeve Gastrectomy procedure, define the requisite anatomical landmarks, and contribute to the literature by retrospectively evaluating a patient cohort to determine the clinical applicability of this modified approach. Materials and Methods: The Modified Bikini Line Sleeve Gastrectomy procedure has been performed at our center since 2020. Stringent patient selection is paramount to the clinical success of this technique. Consequently, specific inclusion criteria necessitate meticulous evaluation during both the preoperative and intraoperative phases. This study delineates the critical aspects of patient selection, provides a comprehensive description of the Modified Bikini Line Sleeve Gastrectomy surgical technique, and analyzes the fundamental intraoperative considerations essential for its successful implementation. Results: A total of 906 patients (844 females, 62 males) with a mean Body Mass Index of 40.7 ± 6.6 kg/m² were included. Postoperative surgical site infection occurred in 6.2% of cases, and 0.8% required blood transfusion. At 12 months, the mean total body weight loss and excess weight loss were 35% ± 3% and 86.9% ± 31.2%, respectively. The mean postoperative cosmetic satisfaction score was 4 ± 0.8 (on a 5-point scale). Conclusions: These findings constitute the first study in the literature to demonstrate that the Modified Bikini Line Sleeve Gastrectomy technique is safe regarding complication profiles, effective in achieving weight loss goals, and yields high patient-reported cosmetic satisfaction. However, certain clinical presentations may preclude the use of this technique. Specifically, the Modified Bikini Line Sleeve Gastrectomy approach may not be suitable for patients with large hiatal hernias, a history of major upper abdominal surgery, or those with hepatomegaly (left lobe hypertrophy). Furthermore, anatomical constraints such as xiphoid–umbilical, xiphoid–pubic symphysis, and xiphoid–anterior superior iliac spine distances exceeding 25 cm, 36 cm, and 33 cm, respectively along with the presence of a redundant panniculus, represent limiting factors for this modified procedure.

İntroduction: This study aims to investigate the impact of neoadjuvant chemotherapy (NAC) on the number of lymph nodes dissected during axillary lymph node dissection (ALND) in breast cancer patients, a topic of significant debate among surgeons and pathologists. Material and Methods: We conducted a retrospective analysis of 440 breast cancer patients who underwent surgery between January 1, 2018, and December 31, 2020. Patients were categorized into two groups based on NAC administration. We collected demographic, clinical, and pathological data, focusing on the total and malignant lymph node counts. Results: Among the 440 patients, 124 received NAC, while 316 did not. The mean number of lymph nodes removed was 18.1 in total, with 17.2 in the NAC group and 18.5 in the non-NAC group (P = 0.17). No significant differences were observed in the number of malignant lymph nodes between the two groups (P = 0.73). However, multivariate analysis indicated that NAC significantly influenced the total number of lymph nodes dissected (P = 0.05). Additionally, lymphovascular invasion (LVI) was found to significantly impact the number of malignant lymph nodes. Conclusion: Our findings suggest that NAC is associated with a reduced number of lymph nodes dissected during ALND in breast cancer patients. These results indicate that the standard guideline of removing at least 10 lymph nodes may require reconsideration for patients undergoing NAC. Further studies are needed to clarify the implications of these findings for staging and treatment protocols.