Morgagni hernia is a rare congenital anomaly arising through the fusion defect between the septum transversum and sternum. Diagnosis is usually confusing as the presentation may be asymptomatic as well as with respiratory symptoms, abdominal and/or retrosternal pain, abdominal fullness or gastrointestinal obstruction. In this paper, we discussed the clinical presentation and management of this rare situation with five consecutive cases. Between 2009 and 2015, five cases underwent surgery for Morgagni hernia (3 laparoscopic and 2 open repair); one patient had recurrent hernia after 7 months from laparoscopic surgery. This case is the first recurrence in the literature after laparoscopic repair in an adult group. In Morgagni hernias, the only treatment is surgery, which can be performed by transthoracic, transabdominal, laparoscopic or thoracoscopic approaches. The issues of using mesh and reducing the hernia sac are still controversial.

Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 8090% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device. Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 8090% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

Objective: Diagnosing and managing the treatment of gastrointestinal subepithelial lesions are often difficult for the clinician. The study aimed to investigate the contribution of endoscopic ultrasonography to the diagnosis of gastrointestinal subepithelial lesions and determine their potential for malignancy. Methods: A total of 170 patients who underwent endoscopic ultrasonography with the suspicion of subepithelial lesions after upper gastrointestinal endoscopy or abdominal imaging between March 2009 and December 2019 were included in the study. Results: In 170 patients who underwent endoscopic ultrasonography for gastrointestinal subepithelial lesions, the preliminary diagnosis was leiomyoma in 87 (51.2%) patients, gastrointestinal stromal tumor in 32 (18.8%), lipoma in 27 (15.9%), ectopic pancreas in 13 (7.6%), neuroendocrine tumor in 10 (5.8%), and cyst in 1 (0.6%) patient. The most common location of subepithelial lesions was the stomach (67.1%), and the most common origin of these lesions was the muscularis propria (47.1%). Among patients with pathological biopsy samples, 71.1% were accurately diagnosed using endoscopic ultrasonography. The percentages of an accurate diagnosis for different diseases were 94.4% for gastrointestinal stromal tumors, 81.8% for leiomyoma, and 75% for neuroendocrine tumors. Among the criteria used for establishing the preliminary diagnosis of gastrointestinal stromal tumor using endoscopic ultrasonography and determining the possibility of lesion malignancy, the most frequently used criteria with the highest sensitivity were lesion size >3 cm and the presence of cystic space. However, the specificity of the combination of the criteria that were less frequently used, such as irregular borders, ulceration, and the presence of necrotic focus, was 100%. Conclusion: Endoscopic ultrasonography and endoscopic ultra sonog raphy -fine -need le aspiration biopsy are the still most sensitive methods for the diagnosis of subepithelial lesions.

Background/Objectives: While perioperative chemotherapy is standard for locally advanced gastric cancer, no baseline blood marker reliably identifies which patients will respond to treatment. In this retrospective study, we compared eleven inflammatory and nutritional indices against pathological response and survival using data collected between 2020 and 2025. Methods: We analyzed 130 patients with gastric adenocarcinoma receiving perioperative systemic therapy at two centers. Eleven indices—the neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), Prognostic Nutritional Index (PNI), and eight further indices defined—were assessed against the Mandard tumor regression grade (TRG), overall survival (OS), and disease-free survival (DFS). Results: The median age was 63 years, and the median follow-up was 22.1 months from diagnosis. A Mandard TRG was assigned in 123 patients, 32 of whom achieved a major pathological response (TRG 1–2). The PNI had the highest point estimate of discrimination for major pathological response (AUC 0.618, 95% CI 0.490–0.746; p = 0.070), but its area under the curve did not differ significantly from that of any other index (all p ≥ 0.18), and bootstrap validation incorporating index selection and threshold derivation yielded an optimism-corrected AUC of 0.567. While PNI ≥ 53 was nominally associated with TRG 1–2 (OR 3.823, 95% CI 1.503–9.722; p = 0.005), no association survived correction for multiple comparisons, and the PNI was selected as the best-performing index in only 49% of bootstrap resamples. No index showed a statistically significant association with overall survival, and the event count is insufficient to establish the presence or absence of an association. Conclusions: None of the eleven baseline blood-based indices demonstrated statistically robust or clinically useful discrimination for major pathological response, and none were associated with survival. Although the PNI represented the most promising exploratory signal, its apparent advantage was not statistically distinguishable from the other indices and did not survive internal validation. The threshold of approximately 53 should be regarded as hypothesis-generating only.

Objective: The aim of this study was to investigate the surgical treatment methods and outcomes of difficult duodenal defects due to perforation. Material and Methods: Data of patients who had undergone surgery for difficult duodenal defect between January 2012 and November 2022 were collected. Duodenal defect size of 2 cm or more was defined as difficult duodenal defect. Characteristics of the patients, the etiology of perforation, American Society of Anesthesiology (ASA) scores, Mannheim peritonitis index (MPI), surgical treatment, need for re-operation, and morbidity and mortality were evaluated. Results: Nineteen patients were detected. Etiology was peptic ulcer perforation in 12 (63.1%) patients, aortaduodenal fistula in 2 (10.5%), tumor implant in 2 (10.5%), cholecystoduodenal fistula in 1 (5.2%), endoscopic retrograde cholangio pancreatography (ERCP) in 1 (5.2%), and cholecystectomy related injury in 1 (5.2%) patient. The first surgical procedure was duodenoraphy + omentopexy in 8 (42.1%), Graham repair in 5 (26.3%), duodenal segment 3-4 resection and Roux-en-Y side to side duodenojejunostomy in 4 (21.0%), Roux-en-Y side to side duodenojejunostomy in 1 (0.5%), and 1 (0.5%) subtotal gastrectomy + duodenum 1^st part resection + Roux-en-Y gastroenterostomy, cholecystectomy and external biliary drainage via cystic duct. Four patients who had previously undergone Graham repair (3) and duodenoraphy + omentopexy (1) required salvage surgery. As a salvage surgery; 1 end-to-side and 3 side-to-side Roux-en-Y duodenojejunostomies were performed. Overall, mortality occurred in 6 (31.6%) patients. High ASA score and MPI were considered as significant risk factors for mortality (p= 0.015, p= 0.002). Conclusion: Primary repair techniques can be used in the surgical treatment of difficult duodenal defects when peritonitis is not severe and tensionfree repair is possible. Otherwise, duodenojejunostomy may be preferred as a fast, easy, and safe technique for both initial and salvage surgeries.