SURGICAL TREATMENT OF SACROCOCCYGEAL PILONIDAL SINUS WITH THE LIMBERG FLAP: REVIEW OF 81 CASES

Pilonidal sinus disease is a complex condition that causes both discomfort and embarassment to suffers. Direct cost through absence from work is high. Controversy still exists regarding the best surgical technique for its treatment in terms of minimizing disease recurrence and patient discomfort. Thus, we conducted this study to evaluate the results of rhomboid excision and Limberg flap reconstruction in the surgical treatment of pilonidal sinus disease. This prospective study included 81 patients who had pilonidal sinus and were treated by the rhomboid excision and Limberg flap. The mean follow-up was 18 months and all patients were satisfied with the procedure. There were lower complication rates, minimal discomfort, patients disharged in 2-3 days and only two recurrences. The Authors recommend the Limberg flap procedure for pilonidal sinus disease. It is effective, with short hospitalization, low recurrence rate and shorter time off work

A 30 YEAR EXPERIENCE IN THE MANAGEMENT OF ANAL FISTULA

Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. in this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistilectomy, fistula plugging, or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24,5%) and fistulotomy (15,6%). High transphincteric fistulas were more likely to predict failure compared to low transphinteric; intersphinteric and subcutaneous fistulas (37,5% versus 9,5 %, 7,3% and 0% respectively). In clnclusion the scales seem to support fistulotomy. However, no standardized algorithm exist to guide the care of patients and the choice of operation is based on patient-related factors, the patient's surgical hispory and the surgeon's experience and familiarity with the various techniques for treating anal fistula

Estrogens control inflammation in experimental colitis.

There is now a wealth of experimental evidence indicating that the deficit in endogenous estrogen facilitates the onset of inflammation that can be antagonized by estrogen replacement therapy. This work investigated the role of estrogen in the control of intestinal inflammation in a panel of colitis models, focusing on the morphological changes, the activity of mast cells, the expression of cytokines (IL-1beta, IL-6, and TNF-alpha), fibronectin and reactive oxygen species. Two hundred adult male rats were divided into 4 groups: colitis was induced in Group I and Group II but only the latter was treated with estrogen; Group III received estrogen only, and Group IV saline. Colitis was induced in 4 models using: iodoacetamide; iodoacetamide + enteropathogenic E. coli; 2, 4, 6-Trinitrobenzene sulfonic acid; and dextran sulfate sodium salt. Macroscopic and microscopic evaluations of abdominal structures as well as molecular analysis were made on days 7, 14, 28 and 56. There was a significant improvement in the health condition of the estrogen-treated rats: the inflammation scores were reduced by at least 10-15%, the number of mast cells in the colon decreased by 30%, fibronectin expression was only 50% and reactive oxygen species decreased by 30%. In addition, there was a significant decrease in TNF-alpha, IL-6 and IL-1beta expression by about 25%. In conclusion, there was an improvement in the inflammatory status in all estrogen-treated groups through the duration of the experiment at all-time points. In addition, there was less tissue necrosis as depicted by less fibronectin and a marked antioxidant effect

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure