Yasemin Yildirim

Purpose: We aimed to demonstrate the Martius flap treatment in a patient who had a recurrent iatrogenic rectovaginal fistula following cystocele repair. Method: We performed a Martius flap procedure for the reconstruction. A vascularized flap was harvested from the labial fat pad, ensuring preservation of its blood supply via the internal pudendal vessels. The flap was then transposed to the defect site to provide adequate vascular support and promote healing. Results: The patient initially underwent a primary repair of the rectovaginal fistula, which did not achieve fistula healing. A diverting colostomy was then created. Following referral to our unit, a Martius flap using tissue from the left labium majus was performed. The patient was discharged on postoperative day 2 without complications. Conclusion: RVF is a debilitating condition that can significantly impair quality of life and often necessitates repeated surgical interventions. We believe that implementing techniques to facilitate the healing process may play a crucial role in optimizing patient outcomes.

Controversies in the Management of Pilonidal Disease: Expert Recommendations from a Modified Delphi Survey and Review of the Literature - Turkish Journal of Colorectal Disease

Laparoscopic Ventral Mesh Rectopexy and Lateral Suspension for Multicompartment Prolapse: A Video Vignette - Turkish Journal of Colorectal Disease

Background Botulinum toxin (BT) is a nonsurgical alternative to lateral internal sphincterotomy (LIS). While there are promising results, there is still a gap in knowledge regarding long-term outcomes and the predictors for healing after BT. Methods Chronic anal fissure (CAF) patients treated with 100 IU BT with a minimum 5-year follow-up were analyzed retrospectively. Patients with persistent or recurrent fissures after their first BT injection were offered either a second BT injection or LIS. Healing was defined as complete symptom resolution with fissure epithelization. The primary outcome measure was recurrence-free healing rate with BT at 5 years. Predictors of healing were assessed by logistic regression analysis. Results The mean age was 33.8 ± 10 years, and 139 (69.5%) patients were female. The complete healing rate at 5 years was 73.8% and 26.2% for the patients that underwent LIS. Multivariate analysis for LIS likelihood revealed that female gender (odds ratio, OR: 0.48, 95% confidence intervals, CI 0.25–0.92, p = 0.028), absence of chronic constipation (OR: 0.09, 95% CI 0.03–0.25, p = < 0.0001), and shorter constipation duration (OR: 1.10, 95% CI 1.06–1.13, p = < 0.0001) were predictors for recurrent-free healing after BT at 5-years. A cutoff value of 10 months of constipation yielded an accuracy of 88% for predicting nonhealing with BT (AUC: 0.881). BT-related incontinence was mild and resolved within 2 months, while LIS resulted in 19.2% permanent incontinence at 5 years. Conclusions BT is an effective and safe treatment for CAF, with acceptable long-term outcomes and minimal incontinence risk. Constipation duration and gender are key predictors of healing, aiding patient selection. Male patients with prolonged constipation may benefit from earlier consideration of LIS.

Purpose A valid comparison of immune function among different patients with different primary pathologies or even with different tumour burdens requires the common use of a reliable assessment of the patient’s condition. The combined immuno-PCI system can translate a complex clinical situation into a simple point value to improve postoperative outcomes to assess the prognostic significance of combined immuno-PCI in peritoneal metastatic patients treated with cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC). Patients and methods Four hundred twenty-four patients from the prospectively maintained database of Dokuz Eylul University Peritoneal Surface Malignancy Center were retrospectively analysed. In addition to the demographic findings and the well-known clinicopathologic factors, several systemic inflammation-based prognostic scores, including the modified Glasgow prognostic score (mGPS), CRP-albumin ratio (CAR), neutrophil–lymphocyte ratio (NLR), neutrophil-thrombocyte ratio (NTR), and thrombocyte count, were all searched and stratified into scoring categories as prognostic determinants of surgical complications, final oncologic outcomes, recurrent disease, disease-free survival (DFS), and overall survival (OS). ROC analyses were performed, and cut-off values were obtained for all immune parameters by using the Youden index method. Results There were 314 (74%) women and 110 (26%) men. The median age was 56 (ranging from 18 to 86) years. The most frequent sites of peritoneal metastasis were colorectal (n = 204; 48%) and gynaecologic carcinomas (n = 187; 44%). Thirty-three patients (8%) had primary malignant peritoneal mesothelioma. The median follow-up was 37.8 (ranging from 1 to 124) months. The overall survival was 51.7%. The 1-year, 3-year, and 5-year survival rates were estimated as 80%, 48.4%, and 32.6%, respectively. PCI-CAR-NTR (1 to 3) (p < .001) scoring was an independent prognostic factor for DFS. In a Cox backwards regression analysis, anastomotic leak (p = .002), completeness of cytoreduction (p = .0014), number of organ resections (p = .002), lymph node involvement (p = .003), and PCI-CAR-NTR (1 to 3) scoring (p = .001) were found to be independently significant prognostic factors for overall survival. Conclusion The PCI is a reliable and consistently valid prognostic factor to evaluate the tumour burden and tumour extent in patients treated with CRS/HIPEC. Staging the host by combining the PCI with an immunoscore may help to improve the outcomes of complications and overall survival in these complex cancer patients. The aggregate maximum immuno-PCI tool may be a better prognostic measure for outcome evaluation.

Background Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). In recent years ECMO was frequently used in patients suffering from influenza or coronavirus disease 2019 (COVID-19). However, data on comparison of clinical characteristics and outcome of patients with COVID-19 and influenza related severe ARDS requiring ECMO is scarce. Material & Methods This is a retrospective analysis of all consecutive patients treated with ECMO between 01/2009 – 01/2021 at the University Medical Centre Hamburg-Eppendorf (Germany). All patients with confirmed COVID-19 or influenza were included. Patient characteristics, parameters related to ICU- and ECMO as well as clinical outcomes were compared. Mortality was assessed up to 90 days after ECMO initiation. Results Overall 113 patients were included – of those 52 (46%) had COVID-19 and 61 (54%) had influenza. The median age of patients with COVID-19 and influenza was 58 (IQR 53 – 64) and 52 (39 – 58) years (p < 0.001), 35% and 31% (p = 0.695) were female, respectively. The median SAPS II score pre-ECMO was 27 (24 – 36) vs 32 (28 – 41) points (p = 0.009), and the SOFA score was 13 (11 – 14) vs 12 (8 – 15) points (p = 0.853) respectively. Median P/F-Ratio pre-ECMO was 64 (46 – 78) and 73 (56 – 104) (p = 0.089), pH was 7.20 (7.16 – 7.29) and 7.26 (7.18 – 7.33) (p = 0.166). The median duration of ECMO was 17 (7 – 27) and 11 (7 – 20) (p = 0.295), respectively. Renal replacement therapy was used in 71% and 69% (p = 0.790). 94% of patients with COVID-19 and 77% with influenza experienced ECMO associated bleeding events (p = 0.004). Overall, 34% and 55% were successfully weaned from ECMO (p = 0.025). 90-day mortality was 65% and 57% in patients with COVID-19 and influenza, respectively (p = 0.156). Median length of ICU stay was 24 (13 – 44) and 28 (16 – 14) days (p = 0.470), respectively. Conclusion Despite similar disease severity the use of ECMO in ARDS related to COVID-19 and influenza resulted in similar outcome at 90-days. A significant higher rate of bleeding complications and thrombosis was observed in patients with COVID-19. Article published online: 11 May 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany