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 diffetences 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

Swallowed Three Needles and Resulting in Treatment with Three Different Approach: A Case Report

Foreign body swallowing in pediatric age group are seen more frequently than adult age group. Engulfed foreign bodies exhibits clinical medical complications. Although treatment modalities may vary, the foreign body is mostly spontaneously excreted through the gastrointestinal tract. Treatment approach against swallowed foreign bodies is performed according to the clinical presentation in patient. In this case report three different treatment approaches were reported in patient who swallowed three needle

Long and Short Term Results of Karydakis Flap Technique for Surgical Treatment of Sacrococcygeal Pilonidal Sinus Disease

Amaç Bu çalışmanın amacı kliniğimizde Karydakis flep ile tedavi edilen sakrokoksigeal pilonidal sinüs hastalığının kısa ve uzun dönem sonuçlarını retrospektif olarak sunmaktır. Gereç ve Yöntem Kasım 2008 ile Aralık 2012 tarihleri arasında sakrokoksigeal pilonidal sinüs tanısıyla ameliyat edilen ve cerrahi yöntem olarak Karydakis flep prosedürü uygulanan 186 hasta incelendi. Hastalar yaş, cinsiyet, ameliyat süresi, postoperatif erken dönem komplikasyon ve nüksler açısından değerlendirildi. Bulgular Olguların 147’si (% 79) erkek, 39’u (% 21) kadındı. Hastaların yaş ortalaması 26±13 yıl idi. Ortalama ameliyat süresi 56 (38-76) dakika olarak bulundu. Hastaların takip süresi ortalama 24 (4-48) ay idi. Bu süre içerisinde 4 hastada (% 2,1) nüks saptandı. Ayrıca 6 hastada (% 3) seroma, 3 hastada (% 1,6) yara yeri enfeksiyonu ve 1 hastada (% 0,53) flep iskemisi gelişti. Sonuç Pilonidal sinüs hastalığı için ideal bir tedavi yöntemi henüz netlik kazanmamıştır. Bu konu güncel cerrahide hâla tartışmaya açıktır. Cerrahi ve cerrahi olmayan yöntemler mevcut olup bu çalışmaya göre Karydakis flep tekniği düşük nüks oranı ile sakrokoksigeal pilonidal sinüsün tedavisinde iyi bir cerrahi yöntemdir.Aim The aim of this study was to determine the long and short term results of Karydakis flap technique retrospectively. Material and Methods A retrospective analysis was done in patients who were treated with Karydakis flap techniques between November 2008 and December 2012. Patients are evaluated in terms of age, sex, time of surgery, postoperative early period complication and recurrences. Results One hundred and forty-seven cases (79%) were male and 39 (21%) were female. The mean age was 26 ± 13 years. Mean operation time was 56 (38-76) minutes. Mean followup time was 24 (4-48) months. Four patients (2.1%) had recurrence in this time. The rates of postoperative complications as seroma, wound infection and flap ischemia are respectively 3 % (n=6), 1.6 % (n=3) and 0.53 % (n=1). Conclusion There isn’t any ideal treatment for pilonidal disease yet. This subject has controversies in actual surgery. There are different procedures, surgical and nonsurgical, for this disease. According to this study Karydakis flap technique, with low recurrence rate, is a good surgical procedure for the treatment of sacrococcygeal pilonidal disease

Damage Control Surgery

Objective: The basis of damage control surgery rests on quick control of life-threatening bleeding, injuries, and septic sources in the appropriate patients before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complementary surgery

Rectus Sheath Hematoma

A hematoma is a collection of blood in an extravascular space and is named according to its location. Rectus sheath hematoma (RSH) was first described by Hippocrates and Galen about 25 centuries ago due to abdominal trauma, which is a rare cause of acute abdomen. It is uncommon, which may lead to delayed diagnosis in patients with acute abdomen. This condition arises due to trauma or hypertension in patients with bleeding disorders, using anticoagulants, doing heavy physical exercise, pregnant women, connective tissue diseases, and hematological diseases. The diagnosis can be made by detailed anamnesis, physical examination, ultrasonography, and contrast-enhanced abdominal tomography. For a accurate diagnosis, first of all, the medical history of these patients should be carefully questioned. CT and ultrasonography (USG) are used in the diagnosis of this condition. In many patients, conservative treatment by eliminating the predisposing factor is sufficient. In conclusion, with the increase in use of anticoagulation, the incidence of RSH is expected to increase. Every physician in the surgical field should keep rectus sheath hematoma at the top of the differential diagnosis list in patients presenting with acute abdominal pain and palpable abdominal mass

Surgical Recovery of Intestinal Obstructions: Pre- and Postoperative Care and How Could it Be Prevented?

Although initial data on intestinal obstructions are based on Hippocrates, there is still no consensus on approaches today. However, parallel to the development of medical technology and the increasing experience of us surgeons, morbidity and mortality rates due to intestinal obstruction have decreased. Obstruction can occur at any point in the gastrointestinal tract. The main thing is to make a correct diagnosis and to treat the patient in the most correct way. Intestinal obstructions usually present with colic abdominal pain, nausea, vomiting, and constipation. Intestinal obstructions may be present due to various reasons. Surgeons have an important role in preventive mechanical obstructions due to adhesions. Patients must be hospitalized. If there is no emergency surgical indication, conservative methods can be applied. Patients should be mobilized early, and fluid-electrolyte balance should be adjusted and followed closely

Mullerian inhibiting substance expression in papillary thyroid cancer

SummaryObjectiveTo examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer.Materials and methodsThe MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23).ResultsIn all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining.ConclusionThe MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis

Laparoscopic Sleeve Gastrectomy; Technical Tips and Pitfalls

Today, bariatric surgery is the most effective treatment for obesity, and the techniques continue to evolve. Laparoscopic sleeve gastrectomy, which is only one step of biliopancreatic diversion/duodenal switch surgery, has become the most common bariatric procedure due to its efficacy when performed alone. Additionally, the rate of complications has decreased as a result of increased technical experience and the development of stapler technology. The widespread adoption of laparoscopic sleeve gastrectomy is also attributable to its technical simplicity. Although it is assumed to be a simple procedure, mistakes at specific stages significantly increase the risk of complications. We focus on our method in detail, including all operative steps, which we believe is the simplest and most effective technique after performing over 5000 surgeries at our institution. Paying attention to the sleeve size, selecting the appropriate stapler, not narrowing the incisura angularis, resecting the fundus without getting too close to the esophagus, creating a smooth, non-rotating staple line, and suturing the staple line are highlighted

Abdominal Trauma

Abdominal trauma accounts for 7–10% of hospital admissions due to trauma. Depending on the mechanism of occurrence, abdominal traumas are classified as either blunt or penetrating. The most important risk after trauma is hypovolemic shock. Deaths caused by blunt trauma are frequently the result of diagnostic difficulties and treatment delays. Abdominal surgery after traumatic injury is performed for two reasons; bleeding due to injury to vascular structures or a solid organ (e.g., spleen, liver, kidney) or injury due to perforation of a hollow organ (stomach, small intestine, colon, gallbladder). Patients may remain asymptomatic until they have lost 50–60% of their blood volume. Through inspection, auscultation, and palpation, the damaged organs and the presence of hemorrhage should be examined during the physical examination. The findings of peritoneal irritation are incredibly critical. Even though some studies indicate a mortality rate as high as 25.8% for abdominal injuries, the overall mortality rate is 10%. Other studies reveal mortality rates ranging from 15% to 17.1%. It should not be forgotten that the patient with abdominal trauma may have multi-trauma. The patient’s vital signs, abdominal examination, and hematocrit should be checked at frequent intervals. Early surgical evaluation is important. It is important to remember that the main source of bleeding and shock may be the abdomen