Zafer Ferahköşe

Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases.

PURPOSE In the past, various methods of surgical or nonsurgical treatment of sacrococcygeal pilonidal sinus have been used. The most common problem in the treatment of this disease is recurrence. In the present study, our aim was to determine the long-term results of the Limberg flap procedure. METHODS We present 200 consecutive patients with pilonidal sinus who underwent the Limberg flap procedure between 1992 and 2001. Twenty-six (13 percent) of the 200 patients were operated on because of recurrent pilonidal sinus. Under general or local anesthesia, all sinus tracts were resected en bloc, and the Limberg flap was prepared from the gluteal region. We used a suction drain. We met all patients and recorded their complaints and complications of treatment. RESULTS Five sinuses recurred (2.5 percent). Minimal flap necrosis occurred in only six patients (3 percent). In three patients (1.5 percent), seroma developed. Wound infection occurred in three patients (1.5 percent). The mean hospital stay was 3.1 days, whereas the mean time to return to work was 12.8 days. CONCLUSION The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.

Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients

Objective  To investigate the results of rhomboid excision and the Limberg flap procedure to treat pilonidal sinus disease.

Comparison of the classic limberg flap and modified limberg flap in the treatment of pilonidal sinus disease: A retrospective analysis of 416 patients

PurposePilonidal sinus disease (PSD) is usually seen on the sacrococcygeal region in adolescent patients. The current study analyzed the outcome of the rhomboid excision and the Limberg flap procedure (cLF) in comparison to the modified Limberg flap procedure (mlF) for PSD.MethodsFour hundred and sixteen patients with PSD were operated on under spinal or general anesthesia by cLF and mlF. The patients were divided into two groups. In Group 1, cLF was performed on 211 patients. In Group 2, mlF was performed on 205 patients.ResultsNo significant difference was detected between Groups 1 and 2 in terms of sex, age, preoperative disease period, follow-up time, the mean hospital stay, and hypoesthesia. The mlF group had better clinical results than the cLF group. The recurrence rate was statistically higher in the cLF group 1 than in the mlF group (P = 0.036). The time to return to work, time to walk without pain, and time to be able to sit on the toilet without pain were longer in the cLF group (P = 0.001). The maceration and wound infection rate were statistically higher in the cLF group than in the mlF group (P = 0.020 and P = 0.019, respectively).ConclusionThe mlF is a more effective treatment than cLF for the surgical management of PSD.

REduCtIon of poStSuRgICAl AdHESIonS In A RAt modEl: A CompARAtIvE Study

BACKGROUND: Adhesion formation after peritoneal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we compared the possible individual effects of phosphatidylcholine (PC), Seprafilm® II, and tissue plasminogen activator (t-PA) and the combined effects of phosphatidylcholine and t-PA on postoperative adhesion formation in a rat surgical model. MATERIALS AND METHODS: A total of 50 Wistar male rats underwent median laparotomy and standardized abrasion of the visceral and parietal peritoneum. phosphatidylcholine, Seprafilm II, and t-PA alone and phosphatidylcholine and t-PA in combination were applied intraperitoneally at the end of the surgical procedure. Seven days after surgery, a relaparotomy was performed for adhesion grading and histopathological examination. RESULTS: A comparison of adhesion stages demonstrated a significant difference between the control group and the study groups (p<0.001). The adhesion grade of the combined treatment group was statistically different from that of the other groups (p<0.05). In the t-PA group and the combined group, six and two rats, respectively, developed hematomas locally on the cecum. CONCLUSIONS: PC, t-PA, and Seprafilm II used individually reduced the adhesion grade. The t-PA and phosphatidylcholine combination was most effective in reducing adhesion formation. On the other hand, usage of t-PA alone or in combination may increase risk of bleeding. More detailed studies are needed, and future studies on the efficacy of a material for decreasing adhesion formation should include a comparison of several control materials in the same model.

Comparison of free jejunal graft with gastric pull-up reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma

The purpose of this study is to evaluate the operative outcomes of a gastric pull-up and free jejunal graft reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma. Records of all patients who underwent esophageal resection for carcinoma of the hypopharynx and cervical esophagus were reviewed. Reconstruction after esophagectomy was performed using the gastric pull-up (n = 38) or free jejunal graft (n = 14) techniques. The hypopharynx was the most common primary tumor site for the free jejunal graft group, whereas the gastric pull-up group had lesions more frequently in the cervical esophagus (P < 0.05). Both operative time and blood loss in the gastric pull-up group were significantly longer and excessive than those of the free jejunal graft group (P < 0.05). The graft survival rate was 95% (32/34) in the gastric pull-up group and 93% (13/14) for the free jejunal transfer group. The overall leakage rate was 1.9% (1/52). Three patients died (6%) in the postoperative period. There was no significant difference with regard to operative morbidity and mortality between the gastric pull-up group and free jejunal graft group. In conclusion, both free jejunal graft and gastric pull-up are safe and effective methods for the immediate restoration of alimentary continuity.

Fournier's gangrene after hemorrhoidectomy: Association with drug-induced agranulocytosis

An unusual case of Fourniers gangrene after hemorrhoidectomy and drug-induced agranulocytosis, as the predisposing condition, is described. The patient had severe granulocytopenia that was attributed to the recent use of dipyrone. Together with hemodynamic resuscitation, broad-spectrum antibiotic and recombinant human granulocyte colony-stimulating factor were started. Wide surgical excision of all the gangrenous tissues, in addition to laparoscopic formation of a defunctioning sigmoid loop colostomy, was performed. The white blood cell count rose steadily and the patient experienced a rapid recovery. We emphasize that radical surgery must be accompanied by pharmacologic interventions for a successful outcome in such cases.

Intestinal Endotoxins as Co-Factors of Liver Injury in Obstructive Jaundice

The concept of endotoxin-mediated rather than direct liver injury in biliary obsruction was investigated using the experimental rat model of bile duct ligation (BDL) and small bowel bacterial overgrowth (SBBO). Small identical doses of intravenous endotoxin (bacterial LPS) caused a significantly more severe liver injury in rats with BDL, compared with sham-operated rats, suggesting the possible contribution of LPS in this type of liver damage. BDL was then combined with surgically created jejunal self-filling blind loops, which resulted in SBBO. Plasma LPS level increased significantly, and once again a more severe liver injury, determined by liver histology and serum gamma-glutamyl transpeptidase levels, was observed compared with the control group of rats with BDL+self-emptying blind loops. The data presented suggest that small amounts of exogenous LPS and/or the ordinarily innocous amounts of LPS constantly absorbed from the intestinal tract may be critical in the hepatic damage caused by obstruction of the biliary tract.

Liver glutathione contents in patients with gastric adenocarcinomas.

Many antineoplastic agents alter the reduced glutathione (GSH) status of liver and tumor tissue by inhibiting cellular GSH-linked enzymes. Thus, intracellular GSH plays an important role in a wide variety of antineoplastic interventions regarding therapeutic efficacy and toxicity. Mean GSH values were 0.791 ± 0.072 mg/m wet weight (ww) and 0.719 ± 0.047 mg/g ww in gastric cancer tissue and nontumorous glandular mucosa, respectively. Whereas, the average GSH level of normal gastric mucosa was 1.709 ± 0.135 mg/g, the mean GSH level of normal liver biopsies was 2.378 ± 0.260 mg/g. The GSH values of normal liver tissue were higher than the hepatocellular GSH concentrations of patients with gastric adenocarcinoma and of another group of tumor-bearing patients who had received chemotherapy preoperatively. These results suggest that the GSH levels of tumor and liver may influence the efficacy and/or toxicity of chemotherapeutic agents.

Effect of systemic gastric acid stimulation and intragastric pH changes on synchronous antral gastrin and somatostatin release in anesthetized, nonatropinized duodenal ulcer patients and controls

The synchronous changes in antral gastrin and somatostatin release in anesthetized, nonatropinized duodenal ulcer patients and control subjects were investigated by serial intraoperative blood sampling from the right gastroepiploic vein. The mean basal antral plasma gastrin and somatostatin concentrations of the two groups did not differ significantly. The significantly greater gastric acid secretory response to systemic gastric acid stimulation (pentagastrin stimulation) in duodenal ulcer patients compared with that of control subjects was not linked to any difference in antral somatostatin release pattern. The decrease in antral plasma gastrin release was significantly lower after acid instillation and the increase was significantly higher after alkali instillation in duodenal ulcer patients compared with those of controls, indicating an abnormal gastrin response to intragastric pH changes in duodenal ulcer patients, which was again not found to be coupled to any significant difference in antral somatostatin release. The results suggest that an abnormal somatostatin-mediated inhibition of gastrin release and/or gastric acid secretion does not exist in duodenal ulcer patients.

Liver glycogen in gangrenous intestinal obstruction

SummaryConsiderable drops in liver glycogen contents of guinea pigs suffering from gangrenous intestinal obstruction were recorded in regard to control values (P < 0.001). An additional experiment was conducted by using carbontetrachloride (CT) to determine whether or not the shortening of survival related to liver glycogen content in animals with strangulation obstruction. The mean tissue glycogen content in the sham-operated group was 816.2 ∓ 13.3 µg/g, w. wt., whereas in the CT-treated group it was 73.5 ∓ 11.0 µg/g w. wt. This difference is highly significant (P < 0.001). The mean survival was 54.4 ∓ 5.8 h and 21.9 ∓ 5.5 h in animals with gangrenous intestinal obstruction before and after CT treatment, respectively. These results suggested that the liver glycogen depletion was a significant factor in decreasing the survival time of guinea pigs with strangulation obstruction.