Tugrul Tansug

Which technique for treatment of pilonidal sinus : open or closed ?

PURPOSE: After excision of the pilonidal sinus, some surgeons leave the wound open, and others close the wound primarily. The aim of this study is to compare length of hospital stay, length of time to return to work, wound infection rate, and recurrence rate in chronic pilonidal sinus patients, after modification of both closed and open techniques. METHODS: One hundred ten patients who had chronic-stage pilonidal sinus were randomly assigned to receive one of two excisional surgical procedures. One-half were treated by surgical excision and primary closure (closed technique, Group A). The other one-half were treated with Obeids surgical excision (open technique, Group B). RESULTS: Ninety-one (46 in Group A and 45 in Group B) of 110 patients were followed for a period four months to three years. Although patients with primary closure had significantly longer hospital stays (P<0.05) than patients in the open group, they returned to work significantly earlier (P<0.05). In Group A and Group B, infection rates were 3.6 percent and 1.8 percent (P>0.01), and recurrence rates were 4.4 percent and 0 percent (P>0.01), respectively. CONCLUSION: Because both techniques have very low complication rates, treatment of chronic pilonidal sinus should be based on patient preference and characteristics, especially employment status.

Acute Intraperitoneal Rupture of Hydatid Cysts

BackgroundRupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.MethodsSeventeen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 18 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.ResultsFive cases (29.4%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases. Intraperitoneal multiple cysts with heterogeneous cavity or cystic structures in the liver were shown in 14 cases. Computed tomography and magnetic resonance imaging showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Four patients (23.5%) died in the early postoperative period. A total of nine morbidities developed in six patients (35.3%). Median hospital stay was 18 days and median follow-up was 78 months. Intra-abdominal recurrence occurred in one case (7.7%).ConclusionsRupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

Prosthetic repair of incarcerated inguinal hernias: is it a reliable method?

Background and aimIt is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft.Materials and methodsOne hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Students t-tests were used.ResultsNo statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036).ConclusionsMesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

Synchronous Primary Gastric Adenocarcinoma and Gastrointestinal Stromal Tumor

Background: The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumors is extremely rare. We report a case of synchronous gastric adenocarcinoma and three stromal tumors, incidentally detected in the stomach and in the esophagus. Case Report: A 67-year-old woman presented with nausea, vomiting, and abdominal pain. Ultrasound and CT scans revealed a thickening of the wall of the stomach and cholelithiasis. Upper gastrointestinal endoscopy demonstrated a mass in the distal stomach. Histological examination of the endoscopic biopsy specimens showed a poorly differentiated adenocarcinoma. The patient underwent total gastrectomy and cholecystectomy. Microscopically, the gastric tumor was a poorly differentiated adenocarcinoma. Microscopic examination also showed one stromal nodule in the stomach and two nodules in the esophagus at the proximal resection margin which were composed of spindle cells with no pleomorphism and mitotic activitiy. Immunohistochemically, all three nodules were focally positive for CD117 and negative for CD34, smooth muscle actin, S-100 protein, desmin, and Ki-67. Conclusion: Synchronous gastric tumors may be detected preoperatively by endoscopic ultrasound. Moreover, the extratumoral wall of the stomach should be meticulously palpated during surgery to rule out any synchronous tumors.

Retroperitoneales Weichgewebssarkom zusammen mit einem muzinözen Zystadenom des Appendix

Background: Soft-tissue sarcomas may develop in the retroperitoneal space, in the peritoneal cavity and in the lower extremities. They are rare tumors, and make up 1% of all adult malignancies. Complete resection of the tumor is of crucial importance to achieve a long-term survival. Multivisceral resections are required in the majority of cases. Mucinous cystadenoma of the appendix is an uncommon condition, too. Most of the patients with mucinous cystadenoma present with clinical symptoms of acute appendicitis. The diagnosis is usually made postoperatively by histopathological examination. Case Report: We here present a rare co-existence of a retroperitoneal liposarcoma and an appendiceal mucinous cystadenoma. Conclusion: En bloc resection of retroperitoneal soft-tissue sarcomas also provides removal of invaded adjacent organs with any co-existing disease.

Prognostic Factors of Retroperitoneal Soft-Tissue Sarcomas

Retroperitoneal soft-tissue sarcomas are rare malignant tumors and make up 1% of all adult malignancies. We aimed to evaluate the morbidity, the mortality, and the prognostic factors that affect survival of the patients with retroperitoneal soft-tissue sarcoma in this study. Patients and Methods: 27 adult patients with retroperitoneal soft-tissue sarcoma underwent surgery between 1992 and 2005 in our clinic. Long-term survival and the independent prognostic factors that affect survival, e.g. age, gender, type of resection (complete resection, partial resection, or only laparotomy and biopsy), site of the tumor, invasion to adjacent organs, tumor size, type of tumor histology, histologic grading, stage of the tumor, and adjuvant radiochemotherapy application, were evaluated. Results: Overall survival rate was 58.1% at 1 year, 58.1% at 3 years, and 32.3% at 5 years. Resection type (p = 0.002), grade (p = 0.011), and stage (p = 0.005) were the prognostic features identified by univariate analysis. Among the significant prognostic factors in the univariate analysis, only two factors, surgical resection (p = 0.011, hazard ratio = 15.570) and tumor grade (p = 0.002, hazard ratio = 12.491), proved to be independently significant in the multivariate analysis. Conclusion: The completeness of resection and tumor grade significantly influence overall survival in this tumor entity.