Ömer Faruk Akinci

Incidence and aetiological factors in pilonidal sinus among Turkish soldiers

OBJECTIVE To study the incidence and causes of pilonidal sinus in Turkish soldiers. DESIGN Open study by questionnaire. SETTING Military and University hospitals, Turkey. SUBJECTS 1000 soldiers who presented for their first medical examination. MAIN OUTCOME MEASURES Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus. RESULTS 88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001). CONCLUSIONS Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if the aetiological factors are understood.

Simple and effective surgical treatment of pilonidal sinus

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patients age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

Systemic stress responses after laparoscopic or open hernia repair.

OBJECTIVE To compare systemic stress responses after laparoscopic and open hernia repair to find out if the laparoscopic approach caused less stress than an open operation. DESIGN Prospective randomised trial. SETTING Teaching hospital, Sanliurfa, Turkey. SUBJECTS 50 patients who required preperitoneal hernia repair were randomised to be treated by either the open or laparoscopic approach (n = 25 in each). INTERVENTIONS Samples of venous blood were taken before operation and at 2, 24, and 48 hours afterwards for measurement of the concentrations of: glucose, cortisol, malonyldialdehyde (MDA), C-reactive protein (CRP), creatine phosphokinase (CPK), caeruloplasmin, transferrin, fibrinogen, and albumin, and counts of leucocytes, neutrophils, and lymphocytes. MAIN OUTCOME MEASURES Changes in these indicators of a stress response. RESULTS Concentrations of glucose, cortisol, CRP, MDA, and CPK, and counts of leucocytes and neutrophils increased significantly, and the concentration of albumin decreased significantly, in both groups postoperatively. Lymphocyte counts were lower postoperatively but not significantly so. Concentrations of CRP, MDA, and CPK, and leucocyte counts were significantly lower in the laparoscopic group. CONCLUSION These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair.

The value of pre-emptive analgesia in the treatment of Postoperative pain after laparoscopic cholecystectomy

Background and Aim: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with pre-operative administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after laparoscopic cholecystectomy. Methods: 45 patients undergoing laparoscopic cholecystectomy were randomized into three groups. Bupivacaine was injected into the area of skin incision before trocar entry and after trocar removal in group 1 and 2, respectively; however, this procedure was not applied to the control group. The pain score of the patients was evaluated by the visual analogue scale (VAS) at 1, 4, 12and 24 h after surgery. The daily analgesic requirement was evaluated in terms of diclophenac sodium (Diclomec, Abdi Ibrahim, 75 mg) intake/day. Analgesics were given to the patients whose VAS was 5 or higher. Results: While there was no significant difference in VAS scores between group 1 and 2, the mean pain scores of these two groups were found to be significantly lower than of the control group although the analgesic requirement of the patients in each group was not statistically significant. Conclusion: Pre-emptive analgesia is as effective as postsurgical local anaesthesia in reducing postoperative pain.

Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure.

PURPOSE: The study was planned to evaluate the depth of natal cleft in patients with pilonidal sinus disease and in healthy persons. METHODS: The study included 50 patients with pilonidal sinus disease and 51 volunteers. Data including body mass index and natal cleft depth were recorded. Natal cleft depth was measured in millimeters by using a caliper instrument. Data were evaluated with the use of the statistical package program (SPSS) with a chi-squared test analysis. P < 0.01 was evaluated as significant. RESULTS: There was no discernable difference in age, occupation, and sex between the groups. The mean natal cleft depth was 27.06 mm in the pilonidal sinus group and 21.07 in the nonpilonidal sinus group. The differences between the two groups were statistically significant (P < 0.01) for natal cleft depth. The mean body mass index was 25.71 in the pilonidal sinus group and 25.28 in the nonpilonidal sinus group. The difference between groups was statistically insignificant for body mass index. CONCLUSIONS: The natal cleft of patients with pilonidal sinus disease is deeper than the natal cleft of members of the volunteer group.

Active gas aspiration to reduce pain after laparoscopic cholecystectomy.

Objective To investigate to what effect active subdiaphragmatic gas aspiration reduces pain after a laparoscopic cholecystectomy. Materials and Methods A total of 104 patients undergoing laparoscopic cholecystectomy were randomly placed into 2 groups. Group I included active subdiaphragmatic gas aspiration (n=52) while group II included simple evacuation (n=52) without any additional procedures. Postoperative analgesic requirements were recorded and the level of postoperative abdominal and shoulder pain was assessed using a numeric scale after 24 postoperative hours. Data were analyzed using the &khgr;2 test for nonparametric data and Student t test for parametric data. Results Age, volume of CO2 used during surgery, and operation duration were similar in the 2 groups. The simple evacuation group (group II) experienced more shoulder and abdominal pain postoperatively when compared with the active subdiaphragmatic aspiration group (group I) and had a higher use of analgesics during the postoperative period. Conclusions Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics.

Etiological Factors in Umbilical Pilonidal Sinus

The objective of this study is to investigate factors leading to the development of umbilical pilonidal sinus (UPS). 31 patients with UPS treated at Harran University and Keçiören State Training Hospital between January 1997 and November 2007. 100 consecutive volunteer outpatients were administered questionnary. The questionnary included questions on age, sex, profession, body mass index (BMI), skin color, hirsute status, frequency of taking baths, personal history of pilonidal sinus (PS), familyal history of PS, and whether –they wear tight clothes and wheteher they use belt. The results obtained from two groups were compared. UPS is one of the PS group diseases and involves umbilical region. There was statistically significant difference between the patient and control groups in terms of age, profession, hirsute status, familial history of PS, wearing tight clothes and BMI. Improvement in these factors may contribute to the reduction of the prevalance of the disease.

Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure.

Objective  We aimed at treating complicated pilonidal sinus (PS) patients by a simple and effective surgical procedure.

Small intestinal obstruction due to self-deflated free intragastric balloon

Morbid obesity has become a severe health problem, especially in Western countries. The prevalence of morbid obesity has been gradually increasing in recent years. Morbidly obese people develop concomitant diseases, in addition to the severity of the obesity itself. Obesity can be treated using several methods—employed individually or combined—such as diet, a change in eating habits, exercise, medical therapy, intragastric balloon implantation, or surgery. Depending on the medical condition and socioeconomic status of the patient, 1 of these methods, or a combination of them, can be used. Each method has its pros and cons. Implanting a balloon device in the stomach is a method that can accelerate weight loss by giving the patient the sensation of satiety. In the present report, we describe patients with an obstructed intestine related to the spontaneous deflation of a free intragastric balloon. Case report A 32-year-old female patient was given a free intragastric balloon implant using endoscopy at another medical center 8 months previously. The patient stated that she had lost weight after implantation of the device but reported that the weight loss had ceased during the past 2 months. She added that the sensation of satiety had also disappeared. She complained of intermittent severe stomach pain that had started 3 days before she came to our hospital. She had experienced no defecation or flatulence in those 3 days, but had vomited 7 times. Our evaluation of the patient in the emergency room revealed abdominal distension and oversensitivity. The blood test results included hemoglobin 12 mg/dl, hematocrit 39%, and white blood count 12,000/mm3. The urea, alanine aminotransferase, and aspartate aminotransferase values were normal. She informed us of the presence of an intragastric balloon (Heliosphere Intragastric Air Balloon, Helioscopie Medical Implements, Vienne, France). We ordered an abdominal computed tomography scan to investigate the possibility of a relevant complication. The computed tomography scan revealed a hyperdense material measuring 10 3.5 cm in the intestines in the right lower segment of the abdomen. The scan confirmed the presence of a dislocated implant. Dilation was present in the proximal intestine segments, which clearly verified the obstruction (Figs. 1 and 2). Thus, the patient was immediately prepared for surgery with the diagnosis of intestinal obstruction due to a deflated intragastric balloon. The abdomen was explored by way of a vertical right pararectal incision. Serous fluid was detected in the abdomen. The deflated balloon had resulted in complete obstruction in the terminal ileum. No necrosis or perforation was observed. The balloon was removed by way of enterotomy (Figs. 3 and 4). The intestine was sutured primarily. The patient was discharged on the third postoperative day.

Modified technique for correction of gynaecomastia

OBJECTIVE To test a modification of the circumareolar incision for correction of a gynaecomastia from the points of view of complications and appearance of the scar. DESIGN Clinical study. SETTING Military and university hospitals, Turkey. SUBJECTS 32 patients with gynaecomastia operated on between 1992 and 2000. INTERVENTIONS Simon I patients were treated with an inferior semicircular periareolar incision (n = 12). Half of the Simon II patients had the same incision and the others were treated with a modified extended incision (n = 10 in each group). MAIN OUTCOME MEASURES Haematoma, skin necrosis, nipple inversion, low-seated nipple, asymmetry, hypoaesthesia and hypertrophic scar. RESULTS Simon II patients treated with the unmodified incision had more haematomas and seromas than Simon I patients and worse cosmesis (p = 0.009 and p = 0.02). However, the complication rates did not differ significantly compared with the Simon II patients who had the modified incision. CONCLUSION A modified extended circumareolar incision results in fewer complication and better cosmesis in grade II gynaecomastia than the standard incision.