Seyfi Emir

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.

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.

The effects of melatonin on liver functions in arsenic-induced liver damage

OBJECTIVE Arsenic exposure is increasing in communities due to environmental pollution and industrial development. Arsenic is toxic to organ systems because it causes oxidative stress, enzymatic inhibition, and damage to protein structures. The liver, for example, is an organ that may be damaged by arsenic, and this damage may cause various clinical conditions like hepatic failure or cancer. Melatonin is a hormone that acts like an antioxidant, an anti-inflammatory agent, and a cytoprotective agent. In this study, we aimed to evaluate melatonins protective effects on livers damaged by arsenic toxicity. MATERIALS AND METHODS Twenty-four Sprague-Dawley male rats were classified into three groups: a control group, an arsenic applied group, and an arsenic plus 10 mg/kg melatonin applied group. At the end of the fifteen-day experiment, the rats were sacrificed. Albumin, interleukin-6 (IL-6), total protein, alanine transaminase, aspartate transaminase, macrophage migration inhibitory factor, and monocyte chemotactic protein-1 measurements were obtained. RESULTS In rats with liver damage due to arsenic exposure, melatonin administration significantly decreased the levels of IL-6, macrophage migration inhibitory factor, and monocyte chemotactic protein-1 (p<0.001, p=0.02 and p=0.04, respectively). CONCLUSION After evaluating liver enzymes and inflammatory markers, this study determined that melatonin exposure improves liver tissue damage caused by arsenic exposure, with the degree of improvement varying based on the levels of arsenic exposure.

Sinotomy technique versus surgical excision with primary closure technique in pilonidal sinus disease

Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Many surgical treatment modalities have been suggested, but an ideal and widely accepted treatment has yet to be established. The aim of this study was to compare quality of life of patients treated with the sinotomy technique with quality of life of patients treated with surgical excision plus primary closure technique by means of quality of life questionnaire. The data of patients who had been treated for pilonidal sinus in our clinic from September 2010 to June 2012 were analyzed retrospectively. Forty patients were treated with sinotomy technique and 40 patients were treated with surgical excision plus primary closure technique. Time to return to work and to time to complete wound healing were evaluated. All patients were asked to fill the questionnaire after complete healing occurred. Postoperative complications were bleeding in 2.5%, infection in 3.75% and fever in 2.5% patients. There were no significant differences between the two groups in terms of complete healing (p=0.1) and sport times (p=0.1). There were significant differences between the groups in terms of length of hospital stay (p ≤ 0.001), time off work (p ≤ 0.001),times to sitting on toilet and walking without pain (p=0.002 and p ≤ 0.001,respectively). The mean postoperative VAS scores were 5.2 ± 3.2 and 2.8 ± 2.2, respectively (p=0.02). The technique of sinotomy with good wound and surrounding skin care seems to be an ideal approach with high chance of cure. The patients returned to their routine in a short period of time.

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.

Comparison Of Early Surgery (Unroofing Curettage) And Elective Surgery (Karydakis Flap Technique) In Pilonidal Sinus Abscess Cases

BACKGROUND The aim of this study is to compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases. METHODS The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively. Those who had early surgery were determined as Group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months. RESULTS Of the 53 patients included in the study, 28 were in Group S and 25 in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02). CONCLUSION In treating acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.

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.

An obstruction not to forget: Pseudo-obstruction (Ogilvie syndrome): Single center experience.

Purpose: Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic. Methods: Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period. Results: A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine. Conclusion: Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices.

A complication of thyroidectomy: Do not forget suture reaction

OBJECTIVE In this study, we aimed to present patients who have developed suture reaction and were treated in our clinic following thyroidectomy operation. MATERIAL AND METHODS Patients who had been treated for suture reaction following thyroidectomy between January 2012 and December 2014 were retrospectively evaluated. The patients were analyzed in terms of their age, gender, duration of the symptoms, type of previous operation and treatment modality. RESULTS Between January 2012 and December 2014, 559 thyroid/parathyroid operations were performed in our clinic. A total of 12 patients were admitted with suture reaction within this period thus yielding a suture reaction incidence of 2.1%. The mean age of these patients was 42±7.65 years, 75% of them were female while 25% of them were male. The types of previous operations were bilateral total thyroidectomy in 83.3%, lobectomy in 8.3% and near total thyroidectomy in 8.3% of the patients. The mean symptom duration was 7.2±4.3 (2-16) months. Two patients (16.7%) underwent a second surgical operation for suture reaction, while 10 patients (83.3%) were treated conservatively. None of the patients developed complications. CONCLUSION One of the most common complications that develop after thyroidectomy is bleeding. Ligation must be performed in order to prevent this complication. As it is known, surgical ligation with sutures may cause tissue reaction. Sutures that are absorbable and have a low risk for reaction formation should be chosen if suturing is preferred.

Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy

BACKGROUND Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy. METHODS This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared. RESULTS A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups. CONCLUSION In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopy.