Resit Inceoglu

Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial.

PURPOSE: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree hemorrhoids. However, whether the closed or open technique yields better results is unknown. The purpose of this study was to compare these techniques with respect to operating time, analgesic requirement, hospital stay, morbidity rate, duration of inability to work, healing time, and follow-up results. METHODS: In this prospective and randomized study, 80 patients with third- degree or fourth-degree hemorrhoidal disease were allocated to either the open- hemorrhoidectomy (Group A, n = 40) or the closed-procedure group (Group B, n = 40). Open hemorrhoidectomy was performed according to the St. Mark’s Hospital technique, whereas the Ferguson technique was used for the closed procedure under general anesthesia with the patient in the jackknife position. RESULTS: Mean operating time was significantly shorter in Group A (35 ± 7 vs. 45 ± 8 minutes, P < 0.001). Analgesic requirement on the day of surgery and the first postoperative day was also significantly lower (P < 0.05). The morbidity rate was higher in Group B (P < 0.05). Length of hospital stay and duration of inability to work were similar in both groups (P > 0.05). Healing time was significantly shorter in Group B (2.8 ± 0.6 vs. 3.5 ± 0.5 weeks, P < 0.001). Median follow-up time was 19.5 (range, 4–40) months. The only late complication (anal stenosis) was observed in one patient in Group B. CONCLUSIONS: Although the healing time is longer, the open technique is more advantageous with respect to shorter operating time, less discomfort in the early postoperative period, and lower morbidity rate. Gençosmanoğlu R, Ŝad O, Koç D, İnceoğlu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum 2002;45:70–75.

An unusual cause of hydropic gallbladder and biliary colic — Heterotopic pancreatic tissue in the cystic duct: Report of a case and review of the literature

We present herein an unusual case of heterotopic pancreas in the cystic duct with hydrops of the gallbladder and concomitant chronic pancreatitis of the heterotopic tissue. A review of the relevant literature is discussed following the presentation of this case.

Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula

BackgroundPosterior horseshoe fistula with deep postanal space abscess is a complex disease. Most patients have a history of anorectal abscess drainage or surgery for fistula-in-ano.MethodsTwenty-five patients who underwent surgery for posterior horseshoe fistula with deep postanal space abscess were analyzed retrospectively with respect to age, gender, previous surgery for fistula-in-ano, number of external openings, diagnostic studies, concordance between preoperative studies and operative findings for the extent of disease, operating time, healing time, complications, and recurrence.ResultsThere were 22 (88%) men and 3 (12%) women with a median age of 37 (range, 25–58) years. The median duration of disease was 13 (range, 3–96) months. There was one external opening in 12 (48%) patients, 2 in 8 (32%), 3 in 4 (16%), and 4 in 1 (4%). Preoperative diagnosis of horseshoe fistula was made by contrast fistulography in 4 (16%) patients, by ultrasound in 3 (12%), by magnetic resonance imaging in 6 (24%), and by physical examination only in the remainder (48%). The mean ± SD operating time was 47 ± 10 min. The mean ± SD healing time was 12 ± 3 weeks. Three of the 25 patients (12%) had diabetes mellitus type II. Nineteen (76%) patients had undergone previous surgery for fistula-in-ano, while five (20%) had only perianal abscess drainage. Neither morbidity nor mortality developed. All patients were followed up for a median of 35 (range, 6–78) months and no recurrence was observed.ConclusionsFistulotomy of the tracts along the arms of horseshoe fistula and drainage of the deep postanal space abscess with posterior midline incision that severs both the lower edge of the internal sphincter and the subcutaneous external sphincter and divides the superficial external sphincter into halves gives excellent results with no recurrence. When it is necessary, severing the halves of the superficial external sphincter unilaterally or even bilaterally in the same session does not result in anal incontinence. Close follow-up of patients until the wounds completely healed is essential in the prevention of premature wound closure and recurrence.

Primary mesenteric venous thrombosis: Report of a case

Two patients suffering from a small bowel infarction due to a primary mesenteric venous thrombosis are herein presented. One patient was a 38-year-old woman while the other was a 54-year-old man. An accurate diagnosis could not be made before operation. In both cases, the necrotic bowel was resected and a primary anastomosis was established. A second laparatomy and resection of a reinfarcted small bowel was necessary in one patient. Both patients were later discharged under a regimen of indefinite warfarin therapy.