Anal fissürde semptom süresinin botulinum toksini uygulaması sonrası sonuçlara etkisi

Aim: To assess the effect of duration of the symptoms on outcome after botulinum toxin injection in anal fissure treatment. Method: Data of the patients who underwent botulinum toxin injection for chronic anal fissur were reviewed. Patients with a minimum follow-up of 18 months were included. One-hundred IU botulinum toxine was injected in the internal anal sphincter through 4 quadrants. Follow-up was carried out by clinic visits on post-procedure days 7, 15 and 30 and by telephone survey in 3, 6, 12 and 18th months. Refractory symptoms or recurrence were recorded as failure. The relationship between duration of the symptoms and failure was investigated and a cut-off value was determined. Patients were divided into two groups according to duration of the symtoms and outcome was compared with the patients who underwent lateral internal sphincterotomy within the same period. Results: There were 56 patients fulfilling inclusion criteria. Mean age was 33.1±9.4 and 39 (69.6%) patients were female. Presence of the symptoms longer than 8.5 months was predicting treatment failure (Area under curve: 0.721, confidence interval: 0.500-0.942, p=0.037). There were 38 patients in shorter symptoms group, 18 patients in longer sypmtoms group and 32 patients in lateral internal sphincterotomy group. The compelte healing rates after 21 (18-28) months of median survival were 61.1% in longer symptom botulinum toxin group, 94.7% in shorter symptom botulinum toxin group and 96.2% in lateral internal sphincterotomy group (p=0.003). One patient in botulinum toxin groups had local hematoma and one (3.1%) had minor incontinence in lateral internal sphincterotomy group. Conclusion: Botulinum toxin has similar outcome with lateral internal sphincterotomy in patients with shorter suration of sypmtoms. Proper patient selection may contribute to the success of the treatment in chronic anal fissur.Amaç: Anal fissürde semptom süresinin botulinum toksini uygulaması sonrası tedaviye yanıtsızlık ve nüks üzerindeki etkisini araştırmaktır. Yöntem: Mart 2016’dan itibaren anal fissür nedeniyle botulinum toksini uygulanan hastaların verileri incelendi. Takip süresi en az 18 ay olan hastalar çalışmaya dahil edildi. Hastalara internal sfinktere 4 kadrandan 100 IU botulinum toksin-A uygulandı. İşlem sonrası 7, 15, 30. günlerde poliklinik kontrolü ile; 3, 6, 12 ve 18. aylarda telefonla aranarak değerlendirme yapıldı. Botulinum toksini uygulamasına yanıtsızlık ya da nüks başarısızlık olarak kaydedildi. Semptom süresi ve başarısızlık arasındaki ilişki alıcı işletim karakteristiği analizi ile araştırıldı ve bulunan kesme değerine göre iki gruba ayrılan botulinum toksini uygulanan hastalar aynı dönemde lateral internal sfinkterotomi ile tedavi edilmiş hastalarla karşılaştırıldı. Bulgular: Botulinum toksini uygulanan 56 hastada ortalama yaş 33,1±9,4 idi. Hastaların 39’u (%69,6) kadındı. Ortalama semptom süresi 8,5±7,4 aydı. Ortanca 21 (18-28) aylık izlem süresinde 47 (%83,9) hastada iyileşme oldu. Semptom süresinin 8,5 aydan uzun olması tedavi başarısızlığını öngörmekteydi (Eğri altındaki alan: 0,721, güven aralığı: 0,500-0,942, p=0,037). Hastalar semptom süresine göre 2 gruba ayrılarak aynı dönemde lateral internal sfinkterotomi yapılan 32 hasta ile sonuçları karşılaştırıldı. İyileşme oranları semptom süresi uzun olan botulinum toksini grubunda %61,1, semptom süresi kısa olan botulinum toksini grubunda %94,7 ve lateral internal sfinkterotomi grubunda %96,2 idi (p=0,003). Botulinum toksini uygulaması sonrası 1 hastada lokal hematom, lateral internal sfinkterotomi uygulaması sonrası 1 (%3,1) hastada minör inkontinens görüldü. Sonuç: Anal fissür tedavisinde botulinum toksini uygulaması semptom süresi kısa olan hastalarda lateral internal sfinkterotomi ile benzer etkinliktedir. Botulinum toksini uygulamasında hasta seçimi tedavi başarısını etkileyebilir

Factors associated with postoperative chronic pain and recurrence after laparoscopic total extraperitoneal inguinal hernia repair

Objective: To assess the risk factors for chronic pain and recurrence after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Methods: Data of the patients who underwent laparoscopic TEP repair were analyzed. Clinical and surgical characteristics, including learning curve, mesh weight, the pore size of the mesh, use of mesh fixation, and fixation methods, were assessed. Fixation by absorbable or nonabsorbable tackers was performed in all procedures except for self-fixating meshes. Mesh brands were tiered into groups regarding pore size and weight. Operative time was defined as the duration between skin incision and dressing. The minimum follow-up was 24 months. Postoperative chronic pain was defined as moderate to severe groin pain, which was accepted as a Visual Analog score ≥3 longer than three months. Pain and recurrence were evaluated at 1 and 6 weeks in clinic visits and at 3, 12, and 24 months by telephone questionnaires. The occurrence of a fascial defect in physical examination or ultrasound was defined as recurrence. Results: Three-hundred and eighty-two procedures were included. Postoperative chronic pain was seen in 31 (8.1%) patients and was higher with micropore mesh (p=0.004), mesh fixation (p=0.002), fixation with titanium tacks (p<0.001) and at first 50 cases (p=0.043). Fifteen (3.9%) patients had a recurrence. Older age (p=0.046), prolonged operative time (p=0.040), body mass index (BMI) (p=0.008) and learning curve (p=0.034) were significantly associated with higher recurrence rate. In multivariate analysis pore size [Odds ratio (OR): 2.911, 95% confidence interval (CI): 1.153-7.351, p=0.024] and fixation with titanium tacks (OR: 8.776, 95% CI: 4.040-14.893, p=0.004) were independent risk factors for chronic pain; BMI (OR: 1.307-95% CI:1.138-1.501, p<0.001) was the only independent risk factor for recurrence. Conclusion: The outcome of laparoscopic TEP repair is related to the technic as well as patient-based factors. Titanium tacks and micropore meshes increase postoperative pain risk without any benefit on recurrence. Patients with higher BMI have an increased recurrence risk

Effect of triclosan coated sutures on surgical site infections in pilonidal sinus: Single blind randomized controlled study

Giriş: Cerrahi dikişlerin yara kontaminasyonu için odak oluşturabileceği 30 yıldan fazladır bilinmektedir. Triklosan ile kaplı dikiş materyalinin in vitro ve in vivo çalışmalarında bakteri yükünü azalttığı bildirilmiştir. Bu çalışmada trikolsan kaplı dikişlerin cerrahi alan enfeksiyonu üzerindeki etkisini araştırmak amaçlanmıştır. Genel cerrahi pratiğinde yara iyileşmesi ve cerrahi alan enfeksiyonu ile ilişkili sorunların en sık yaşandığı hastalıklardan birisi olması nedeniyle antibiyotik kaplı dikişlerin etkinliğini araştırmak üzere pilonidal sinüs hastaları seçilmiştir. Gereç-Yöntem: Ocak 2010-Ocak 2013 tarihleri arasında pilonidal sinüs nedeniyle Dokuz Eylül Üniversitesi Genel Cerrahi ve İzmir Atatürk Eğitim ve Araştırma Hastanesi polikliniklerine başvuran 125 hasta randomize edildi. Hastaların hepsine sinüs eksizyonu ve primer kapama yapıldı. Çalışma grubundaki 63 hastada monoflaman polidioksanon 1/0, triklosan kaplı poliglaktin 3/0 ve triklosan kaplı monoflaman polidioksanon 3/0; kontrol grubundaki 62 hastada monoflaman polipropilen 1/0, poliglaktin 3/0 ve poliproplen 3/0 dikişlerle primer kapama yapıldı. İki grup cerrahi alan enfeksiyonu açısından karşılaştırıldı. Bulgular: Demografik ve cerrahi özellikler açısından iki grup arasında herhangi bir fark yoktu. Postoperatif ilk 1 ay içinde 17 (%13.6) hastada cerrahi alan enfeksiyonu saptandı. Triklosan kaplı dikişlerle yarası kapatılan 63 hastada cerrahi alan enfeksiyonu oranı %9.5 (n=6) ve kontrol grubundaki 62 hastada CAE oranı %17.7 (n=11) idi. İki grup arasındaki fark istatistiksel olarak anlamlı değildi (p=0.180). Yirmi beş (%20) hastada seroma saptandı. Bu hastaların 19?u triklosan, 6?sı kontrol grubundaydı. Triklosan grubundaki hastalarda seroma oranı istatistiksel olarak anlamlı şekilde yüksekti (p= 0.004). Triklosan grubundaki 9 hastada, kontrol grubundaki 3 hastada CAE olmaksızın yara yeri ayrılması gözlendi. Aradaki fark istatistiksel olarak anlamlı değildi (p=0.073). Ortalama iyileşme süresi tüm hastalar için 18.2±7.3 (14-45), triklosan grubunda 18.4±7.9 (14-40) ve kontrol grubunda 18±6.5 (14-45) gün idi. İyileşme süresi açısından iki grup arasında bir fark yoktu (p=0.818) Sonuç: Çalışma sonucunda triklosan kaplı dikişlerin kullanıldığı grupta cerrahi alan enfeksiyonu oranı kontrol grubuna göre daha düşük bulunmasına karşın aradaki fark istatistiksel olarak anlamlı değildi. Triklosan kaplı dikişler cerrahi alan enfeksiyonu oranını azaltabilir. Konuyla ilgili daha çok hasta içeren çalışmalara gereksinim vardır. Introduction: Surgical sutures have been considered as an infectious focus for over 30 years. Bacterial colonization on suture materials was showed in many studies. In vivo and in vitro studies have shown that triklosan coated sutures may decrease bacterial colonization in surgical site. In this study we aimed to investigate the effect of triklosan coated sutures on surgical site infections in pilonidal sinus disease. Materials-Method: Between January 2010-January 2013 116 patients presented with pilonidal sinus in Dokuz Eylul University General Surgey and Izmir Ataturk State hospital policlinics were randomized into 2 groups. In study group triklosan coated monofilament polydioxanone 1/0, triklosan coated polyglactin 3/0 and triklosan coated monofilament polydioxanone 3/0; in control group monofilament polypropylene 1/0, polyglactin 3/0 and monofilament polypropylene 3/0 sutures were used for primary closure. Surgical site infection rates were compared between two groups. Results: Demographic and surgical features were similar between two groups. Overall surgical site infection rate after 30 days was 13.6% (n=17). In triklosan group 6 (9.5%) patients had surgical site infection. Surgical site infection rate in control group was 17.7% (n=11). Difference between two groups was not statistically significant (p=0.180). Overall seroma rate was %20 (n=25). Seroma rate in triklosan group was significantly higher than control group (30% vs 9.6%, p=0.004). Wound dehiscence rates in triklosan and control groups were 14.2% and 4.8% respectively (p=0.073). Conclusion: In regard to our study triklosan coated sutures have a lower surgical site infection rate but the difference between two groups was not statistically significant. Triklosan coated sutures may decrease surgical site infections but more randomized studies with large series should be performed

Duration of the Sypmtoms Influence the Outcome after Botulinum Toxin Injection in Anal Fissure

Aim: To assess the effect of duration of the symptoms on outcome after botulinum toxin injection in anal fissure treatment. Method: Data of the patients who underwent botulinum toxin injection for chronic anal fissur were reviewed. Patients with a minimum follow-up of 18 months were included. One-hundred IU botulinum toxine was injected in the internal anal sphincter through 4 quadrants. Follow-up was carried out by clinic visits on post-procedure days 7, 15 and 30 and by telephone survey in 3, 6, 12 and 18th months. Refractory symptoms or recurrence were recorded as failure. The relationship between duration of the symptoms and failure was investigated and a cut-off value was determined. Patients were divided into two groups according to duration of the symtoms and outcome was compared with the patients who underwent lateral internal sphincterotomy within the same period. Results: There were 56 patients fulfilling inclusion criteria. Mean age was 33.1±9.4 and 39 (69.6%) patients were female. Presence of the symptoms longer than 8.5 months was predicting treatment failure (Area under curve: 0.721, confidence interval: 0.500-0.942, p=0.037). There were 38 patients in shorter symptoms group, 18 patients in longer sypmtoms group and 32 patients in lateral internal sphincterotomy group. The compelte healing rates after 21 (18-28) months of median survival were 61.1% in longer symptom botulinum toxin group, 94.7% in shorter symptom botulinum toxin group and 96.2% in lateral internal sphincterotomy group (p=0.003). One patient in botulinum toxin groups had local hematoma and one (3.1%) had minor incontinence in lateral internal sphincterotomy group. Conclusion: Botulinum toxin has similar outcome with lateral internal sphincterotomy in patients with shorter suration of sypmtoms. Proper patient selection may contribute to the success of the treatment in chronic anal fissur

Effect of triclosan-coated sutures on surgical site infections in pilonidal disease: Prospective randomized study

WOS: 000444736000015PubMed ID: 30062657Purpose The aim of this study is to investigate the effect of triclosan-coated sutures on surgical site infections after wide excision and primary closure for pilonidal disease. Methods One hundred seventy-seven patients were randomized into two groups: 91 in control and 86 in triclosan groups. In the control group, 1/0 monofilament polypropylene retention sutures, 3/0 polyglactin subcutaneous sutures, and 3/0 polypropylene skin sutures were used. In the triclosan group, 1/0 triclosan-coated monofilament polydioxanone, 3/0 triclosan-coated polyglactin, and 3/0 triclosan-coated monofilament polydioxanone were used. Postoperative care and follow-up was made by a surgeon according to Centers for Disease Control guideline. Surgical site infection rates between groups were compared. Secondary outcomes were seroma and wound dehiscence. Results Seroma was seen in 30 (16.9%) patients: 20 (23.3%) in the triclosan group and 10 (10.9%) in the control group (p= 0.030). Thirteen (7.3%) patients had superficial wound dehiscence: 5 (5.5%) patients in the control group and 10 (11.6%) patients in the triclosan group (p = 0.116). Overall surgical site infection (SSI) rate was 15.8% (n = 28): 19 (20.8%) patients in the control group and 9 (10.5%) patients in the triclosan group (p = 0 .0 44). Healing was observed on mean 17.8 +/- 6.7 days. Primary and secondary healing rates and time to healing were similar between groups. Conclusion Triclosan-coated sutures decreased surgical site infection rate but had no effect on time to healing in pilonidal disease. Seroma and wound dehiscence were more common in triclosan groups. Randomized trials are needed to clear the effect of triclosan-coated sutures on postoperative wound complications

Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature

WOS: 000448481300008PubMed ID: 30397611Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs

The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats

Purpose: To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. Methods: Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. Results: The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). Conclusion: Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy

Wound irrigation with chlorhexidine gluconate reduces surgical site infection in pilonidal disease: Single-blind prospective study

Background: The aim of this study was to determine whether incision irrigation with chlorhexidine gluconate (CHG) reduces surgical site infections (SSIs) in pilonidal disease surgery. Methods: Between 2013 and 2018, patients who underwent wide excision with primary closure for pilonidal disease were enrolled in this prospective observational multi-institutional cohort. The incision was irrigated with either saline or 0.05% CHG before skin closure. The infection risk of each patient was determined by the National Nosocomial Infection Surveillance System. Post-operative site care and follow-up were carried out according to the U.S. Centers for Disease Control and Prevention guideline by two surgeons blinded to the irrigation solution used. Surgical site infection rates in the saline and 0.05% CHG groups were compared. The secondary outcomes were seroma formation, incision dehiscence, and time to healing. Results: There were 129 patients in the control group and 138 patients in the CHG group. The mean age was 25.1 +/- 5.4, and 225 patients (84.3%) were male. Surgical site infection was seen in 35 patients (13.1%): 26 (20.2%) in the control group and 9 (6.5%) in the CHG group (p = 0.001). There were no differences in seroma formation (n = 12; 9.3% in the control vs n = 12; 8.7% in the CHG group; p = 0.515) or incision dehiscence (n = 9; 7% in the control vs n = 9; 6.5% in the CHG group; p = 0.537). The primary healing rate was higher in the CHG group (n = 130; 94.2%) than in the control group (n = 104; 80.6%). Time to healing was 20.5 +/- 7.8 days in the control group and 16 +/- 4.3 days in the CHG group (p < 0.001). Conclusion: Intra-operative incision irrigation with CHG decreased the SSI rate and time to healing in pilonidal disease surgery. Further randomized trials should focus on specific irrigation methods and procedures to build a consensus on the effect of incision irrigation on SSIs