Selim Sözen

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.

Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis.

AIM To assess the reliability and practical applicability of the widely used Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems in patients with suspected acute appendicitis. METHODS Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group. Patients were divided into two groups. appendicitis group (Group A) consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis, and non-appendicitis group (Group N-A) consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively. The operative findings for the patients, the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms. RESULTS One hundred and thirteen patients with suspected acute appendicitis were included in the study. Of the 113 patients (62 males, 51 females), the mean age was 30.2 ± 10.1 (range 18-67) years. Of the 113 patients, 94 patients underwent surgery, while the rest were followed non-operatively. Of the 94 patients, 77 patients were histopathologically diagnosed with acute appendicitis. Our study showed a sensitivity level of 81% for the Alvarado system when a cut-off value of 6.5 was used, a sensitivity level of 83.1% for the Ohmann system when a cut-off value of 13.75 was used, a sensitivity level of 80.5% for the Eskelinen system when a cut-off value of 63.72 was used, and a sensitivity level of 83.1% for the RIPASA system when a cut-off value of 10.25 was used. CONCLUSION The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.

Minimizing Shoulder Pain Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Trial

UNLABELLED Abstract Background: Postoperative abdominal and shoulder pains after laparoscopic cholecystectomy (LC) are the most frequent complaints and are related to delayed recovery. There is a strong correlation between the residual gas volume and the severity of pain following various laparoscopic procedures. We aimed to investigate the effects of aspiration of residual gas on postoperative outcomes and pain following LC. SUBJECTS AND METHODS Patients were randomly assigned to either the active gas reduction group (Group 1, n=105) or the control group (Group 2, n=95). After completion of the operative procedures, residual gas was aspirated with a flexible cannula in Group 1. In Group 2, gas release from the abdomen was performed using the port site by opening the gas tap only. The demographic data, operation time, insufflated CO2 volume during the operation, hospitalization period, and time to return to daily activities were recorded. Postoperative shoulder and abdominal pain assessment was performed using a numerical pain intensity scale (NPIS) at 1 hour, 24 hours, 3 days, and 7 days postoperatively. RESULTS There was no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. NPIS scores for shoulder pain at 1 hour and 24 hours were significantly lower in Group 1 (P=.001 and P=.021, respectively). However, there were no significant differences in the NPIS scores for shoulder and abdominal pain following 24 hours. No differences were found in the hospitalization duration and time to return to daily activities data (P>.05). CONCLUSIONS Active aspiration of the residual gas just before the removal of the trochars is a simple procedure and leads to a more comfortable hospital stay for patients.

Crystallized Phenol Treatment of Pilonidal Disease Improves Quality of Life

The effects of crystallized phenol treatment of pilonidal sinus on quality of life has not been investigated before. This study aimed to compare the phenol treatment with surgical excision plus primary closure technique in terms of life quality by means of a life quality questionnaire. This is a prospective randomized clinical study. The study was conducted at Training and Teaching Hospital, Kayseri, Turkey. In total, 40 patients with pilonidal disease were randomly assigned into 2 clinically comparable groups between September 2010 and June 2011. Cristallyzed phenol application was done to 20 patients and surgical excision plus primary closure was done to 20 patients for the treatment of pilonidal disease. Data regarding demographic variables were recorded. To evaluate quality of life and patient comfort all patients asked to fill the questionnaire after complete healing occurred. There was no difference between the groups in age, sex and occupation. Two of the 20 patients in the excision and primary closure group had complication of wound dehiscience and needed prolonged wound care. There was significant differences in favor of the phenol group in all terms of life quality except for complete healing time. As a first degree treatment, phenol treatment is better than the other treatment choices of pilonidal disease in terms of time off work perioperative pain, being away from school and social life. Also phenol treatment can be done without any pretreatment laboratory examination. Further studies will be needed about cost-effectivity of phenol treatment.

Sakrokoksigeal pilonidal sinüsün cerrahi tedavisinde Karydakis flep ile Limberg flep ameliyatlarının karşılaştırılması (erken dönem sonuçları)

GIRIŞ Pilonidal sinus intergluteal bolgede, ozellikle genc erkeklerde daha sik izlenen akut agrili veya kronik sekli olan bir hastaliktir. Pilonidal sinus hastaliginin insidansi 26/100000 olarak bildirilmekte ve erkeklerde kadinlardan 2 kat fazla gozlenmektedir (1). Pilonidal sinus tedavisinde tanimlanmis cok sayida konservatif ve cerrahi yontem olmasina ragmen nuks oranlari hala yuksektir ve ideal bir tedavi arayisi surmektedir (2,3). Tum tedavi seceneklerinin kendisine gore avantaj ve dezavantajlari vardir. Temel cerrahi tedavi eksizyondur. Eksizyon sonrasi defektin kapatilmasi cerrahin tercihine gore; primer kapama, marsupiyalizasyon veya flep (Limberg, Karydakis, V-Y flep, Z-plasti, Rhomboid) yardimi ile olmaktadir. Ancak son zamanlarda yapilan calismalar, flep ile onarim metodlarinin sonuclarinin daha iyi oldugunu gostermektedir (4,5). Bu calismadaki amacimiz, genis bir hasta serisinde primer pilonidal sinus icin uygulanan Karydakis flep teknigi ile rhomboid eksizyon + Limberg flep yonteminin sonuclarinin bildirilmesidir.

Intestinal malrotation in an adult: case report

Intestinal malrotation is a developmental anomaly of the midgut in which the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity fail. Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. While difficult to diagnose, prompt recognition and surgical treatment usually lead to a successful outcome. Intestinal malrotation is rarely asymptomatic and generally diagnosed incidentally in adults. In the present report, a case of incidental intestinal malrotation with clinical findings of small bowel obstruction is discussed with a literature review.

Ingested bone fragment in the bowel: Two cases and a review of the literature

Generally, ingested foreign bodies are excreted from the digestive tract without any complications or morbidity. In adults, ingestion of foreign bodies frequently occurs in alcoholics and elderly individuals with dentures. The most commonly ingested foreign bodies are food stuffs or their parts, such as fish bones or fragments of bone and phytobezoars. Sharp foreign bodies like fish and chicken bones can lead to intestinal perforation and peritonitis. We report herein two cases, one of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are not common and preoperative diagnosis remains a challenge and therefore it must be considered in susceptible cases.

Effect of melatonin and misoprostol on bacterial translocation in portal hypertensive rats

Background and Aim:  Portal hypertension is the main complication of cirrhosis and it is responsible for its most common complications. Bacterial translocation increases the morbidity and mortality rates in patients with portal hypertension. We aimed to investigate the effects of melatonin and misoprostol on bacterial translocation induced by portal hypertension.

Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü

Tiroidektomi sonrasi postoperatif hipokalsemi ve rekurren laringeal sinir yaralanmasi, en sik karsilasilan komplikasyonlardir (1,2). Diger onemli komplikasyonlar arasinda superior laringeal sinir hasari, infeksiyon, havayolu zedelenmesi ve kanama sayilabilir. Tiroid cerrahisinde kabul edilebilir kalici hipokalsemi ve vokal kord paralizisi oranlari % 1-2’dir (3). Gecici hipokalsemi literaturde % 6-50 arasinda genis bir insidans araliginda bildirilmektedir (4-6). Literaturde tiroidektomi sonrasi rekurren sinir yaralanmalari % 0,3-14 arasinda degismekle beraber, deneyimli cerrahlar tarafindan yapildigi zaman bu oran % 0.2-0.3 ’lere yaklasmaktadir (7,8). Literaturde gecici sinir yaralanmasi orani, bir anlamda sinir iyilesmesi orani % 50-86 arasinda degismektedir (9-11). Tiroid cerrahisi sonrasi postoperatif komplikasyonlar hastanede kalis suresini ve biyokimyasal tetkik ihtiyacini arttirdigindan tiroidektominin maliyetini yukseltmektedir. Bu calismada tiroidektomi komplikasyonlari ve cerrahin deneyimi ile komplikasyonlar arasindaki baglantiyi arastirmak amaclandi.

Virginal Breast Hypertrophy and Symptomatic Treatment: A Case Report

Virginal breast hypertrophy is a rare benign disease. It is characterized by rapid and excessive growth of one or two breasts during peripubertal period. There is no specific treatment algorithm, subcutaneous mastectomy and prosthesis replacement, reduction mammoplasty, medical treatment with particularly tamoxifen are all recommended in the literature. Unfortunately, all treatment methods have some disadvantages in this patient group who have not completed their sexual and physical maturation. Although these treatments are usually required, it should be noted that spontaneous remission could rarely be seen in virginal hypertrophy. We aimed to present a case of virginal hypertrophy, in whom symptomatic treatment has been used and breast growth regressed spontaneously.