The analysis of results of pilonidal sinus treatment of pilonidal sinus at the differentiated choice of operation

The work purpose was the analysis of results of operative treatment at the traditional and differentiated approach to a choice of a method of operation at chronic fistulous forms of a pilonidal sinus. Classification with gradation of a pilonidal sinus on three degrees of complexity is offered. 210 patients are included in the basic group with a choice of the operation, depending on degree of complexity of a pilonidal sinus and anatomic features of sacrococcygeal area. Alignment of an intergluteal cleft was an obligatory component of operation. 102 patients are included in control group with traditional operative treatment In the basic group frequency purulent wound complications was 3,8 %, in control group 17,6 %, considerably increasing at complicating of the form of a pilonidal sinus. Frequency of relapses in the basic group has made 2,3 %, in control group 13,6 %, also correlating with degree of complexity of a pilonidal sinus. Conclusions are drawn on necessity of the account at a choice of operation of degree of complexity of a pilonidal sinus and anatomic features of sacrococcygeal area, preferring methods with possibility of alignment of an intergluteal cleftЦелью работы явился анализ результатов оперативного лечения при традиционном и дифференцированном подходе к выбору метода операции при хронических свищевых формах эпителиального копчикового хода. Предложена классификация с градацией копчикового хода по трем степеням сложности. В основную группу включено 210 больных с выбором операции в зависимости от степени сложности копчикового хода и анатомических особенностей крестцово-копчиковой области. Обязательным компонентом операции было выравнивание межягодичной складки. В контрольную группу включено 102 больных с традиционным оперативным лечением. В основной группе частота гнойных раневых осложнений была 3,8%, в контрольной 17,6%, значительно возрастая при усложнении формы копчикового хода. Частота рецидивов в основной группе составила 2,3%, в контрольной 13,6%, также коррелируя со степенью сложности копчикового хода. Сделаны выводы о необходимости учета при выборе операции степени сложности копчикового хода и анатомических особенностей крестцово-копчиковой области, отдавая предпочтение методам с возможностью выравнивания межягодичной складки

ANALYSIS OF COMPLICATIONS IN ELIMINATION OF THE COLOSTOMY AFTER HARTMANN SURGERY

An analysis of early postoperative complications was made in reconstructive surgery on the colon in case of the end colostomy in patients with left-half colon cancer complicated by intestinal obstruction. This work investigated the prognostic factors, which could influence on incidence of complications. The research included results of reconstructive operations in 192 patients. The early postoperative complications were noted in 18 (9,4%) patients. The univariant analysis of risk factors showed, that the presence COPD increased the possibility of complication incidence in 1,7 times (p=0,044). The incidence of purulent complications on previous stage of treatment increased complications in 4,3 times (p=0,011) and the third degree of adhesions process intensity compared with the first degree - in 9,7 times (p=0,001). The multivariant analysis demonstrated a correlation of the complication risks in reconstructive operations with presence of complications on the previous stage of treatment. This correlation was 4,3 (CI 1,7-23,3; p=0,021) and it consisted of 7, 5 (CI 1,3-15,6; p=0,001) in case of presence of the third degree of adhesion process

RESULTS OF TREATMENT OF COLON CANCER WITH EXTENTION ON THE DUODENUM

The article includes the experience of radical surgical treatment of colon cancer with tumor invasion into the duodenum. Patients (7 cases) underwent surgery. Their average age consisted of 72.3 years old. Right-sided hemicolectomy with atypical resection of the duodenum was performed on 6 patients. Pancreoduodenal resection with removal of the right half of the colon was carried out in one patient. The replacement of defect by overlay duodenojejunostomy with initial part of the small intestine was completed in 5 patients and the defect was sutured in one case during the atypical resection of the duodenum. There weren’t lethal outcomes after surgery. There was noted 3-year survival without relapse in 5 patients. According to the author, the atypical resection could be possible in limited invasion of the colon cancer in the duodenum with acceptable reliability level

RESULTS OF RESTORATIVE OPERATIONS USING MODIFIED METHOD OF FORMATION OF TEMPORARY LOOP INTESTINAL STOMAS

The article estimated the results of excision of temporary loop colo- and ileostomas using method of their formation with fixation of parietal peritoneum to aponeurosis of abdominal external oblique muscle in 18 patients. The authors concluded that the formation of temporary loop stoma with fixation of parietal peritoneum to aponeurosis had many advantages and could improve the results of the restorative operation

TREATMENT OF THE PARASTOMAL HERNIAS

The article presents the results of 16 operations for the parastomal hernias. The operations were differentiated: the colostomy was relocated to the left retroperitoneal space and in case of hernioplasty it was performed with use of mesh transplant. The fascial defects were closed using the mesh transplant. There weren’t any complications in early postoperative period. Long-term five-year results showed no recurrence

COMPARATIVE RESULTS OF RECOVERY STAGE IN TWO-STEP TREATMENT OF MALIGNANT COLONIC OBSTRUCTION

The aim of the study was a comparative analysis of results of different approaches to two-stage treatment of malignant colonic obstruction on the stage of recovery of the integrity of intestinal tract. The main group included 260 patients. A double-barreled colostomy was formed at the first stage, than resection of the colon with tumor removing and stoma excision were performed. The control group consisted of 192 patients. An obstructive resection of the colon was made at the first stage with following reconstructive operation. Intraoperative damage of the small intestine was observed in 6,9% patients of the main group and 18,2% patients of the control group. Postoperative mortality consisted of 1,2% in the main group and it was 1,5% in the control group. The early postoperative complications numbered 9,2% and 17,7%, respectively. The main risk factor of complication development was an expressed adhesion process of the abdominal cavity in the control group of patients. CONCLUSIONS. The method, which included the colostomy formation at the first stage with following radical surgery at the second stage, had advantages in case of elimination of malignant colonic obstruction

LONG-TERM RESULTS OF SURGICAL TREATMENT OF DIVERTICULAR DISEASE OF COLON

The work evaluated the long-term treatment results of 103 patients with complicated diverticular disease, who underwent the elective surgery in the volume of left hemicolectomy. The first group included 53 patients with recurrent diverticula. The second group consisted of 50 patients, who underwent the operation on diverticula of sigmoid colon with formation of sigmostoma on the first stage. The number of patients with functional gastro-intestinal and psyco-emotional disorders was more significant in the first group compared with the second group and it was associated with presence of these disorders before the operation. There was noted the reliable decrease of quality of life rates according to questionnaire scales MOS-SF 36 in the first group. The average indices of scales had some matching to the rates of health people in the patients of the second group. The authors came to conclusion, that indications for elective surgery should be determined very carefully in case of recurrent diverticula

CHOICE OF THE METHOD OF RECOVERY OPERATION IN SHORT RIGHT PARTS OF THE COLON

The results of treatment were analyzed in 41 patients (the mean age 62,1 years old). Overall postoperative lethality consisted of 2,4%. The best functional results were reached in transmesenteric bringing down of the right parts of colon to small pelvis with isoperistaltic colorectal anastomosis. However, an application of this operation demands the presence of certain anatomic conditions. Limited mobilization of the right colon with antiperistaltic cecorectal anastomosis is feasible under any conditions

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