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

PURPOSE: 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 = 0.044). 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.

Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid-low rectal cancer.

PURPOSE: To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer. METHODS: Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed. RESULTS: 125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3.64, confidence interval (CI) 1.409-7.327] and tumor volume after neoadjuvant chemoradiotherapy (OR 1.59, CI 1.018-2.767). The operative time (p = 0.014, OR 1.453) and pelvic depth (p = 0.023, OR 1.116) were independent predictive factors for anastomotic leak. The median follow-up was 72 (2-113) months. Local recurrence was seen in 17 (14.1%) patients. Anastomotic leak (OR 1.799, CI 0.978-3.277), the circumferential resection margin status (OR 3.217, CI 1.262-7.870) and the relative tumor volume rate (OR 1.260, CI 1.004-1.912) were independent prognosticators of local recurrence. The 5-year overall survival was 66.7%. The circumferential resection margin status (hazard ratio: 4.739, CI 2.276-9.317), pN stage (OR 3.267, CI 1.195-8.930) and relative tumor volume rate (OR 2.628, CI 1.042-6.631) were independent prognostic factors for the overall survival. CONCLUSIONS: Relative dimensions of the tumor in the pelvis influence the local recurrence and overall survival rates. Magnetic resonance-based measurements can predict the difficulty of surgery and allow surgeons to consider the appropriate surgical approach.

Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy.

BACKGROUND/AIMS: Development of pancreatic fistula after distal pancreatectomy is still a major problem. Various methods have been defined to prevent the development of the fistula. In this study, the results of suture closure of pancreatic duct and closure of pancreatic stump with "U" sutures passing through each other and the risk factors affecting the development of fistula are studied. METHODOLOGY: Fifty-one patients with prospectively collected data were included in the study. In all patients, pancreatic stump was closed with the same surgical technique. Risk factors that may affect fistula formation were studied between groups with and without fistula. Pancreatic fistula definition was made according to the International Study Group on Pancreatic Fistulas classification. RESULTS: Eight (15.7%) of the 51 patients had fistula. Clinically significant fistula ratio was 9.8% (according to ISGPF B and C). Additional organ resections were performed in 18 patients (35.3%). In multivariate analysis, the soft texture of pancreatic parenchyma (OR: 12.420, p = 0.048) and over 150 mL of blood loss (OR: 1.003, p = 0.043) were found as risk factors for the development of fistula. CONCLUSIONS: Closure of pancreatic stump after distal pancreatectomy with "U" shaped sutures passing through each other is a method that can be performed safely.

Comparison of Milan and UCSF criteria for liver transplantation to treat hepatocellular carcinoma.

AIM: To assess the validity of the Milan and University of California San Francisco (UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) in a single-center study. METHODS: This study is a retrospective review of prospectively collected data. Between 1998 and 2009, 56 of 356 OLTs were performed in patients with HCC. Based on pathological examination of liver explants, patients were retrospectively categorized into 3 grou-ps: Milan + (n = 34), Milan -/UCSF + (n = 7) and UCSF - (n = 14). RESULTS: Median follow-up period was 39.5 (1-124) mo. The 5-year overall survival rates in the Milan +, Milan -/UCSF + and UCSF-groups were 87.7%, 53.6% and 33.3%, respectively (P < 0.000). Within these groups, tumor recurrence was determined in 5.8%, 14.3% and 40% of patients, respectively (P < 0.011). Additionally, the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival (74.7% vs. 46.7%, P < 0.044). CONCLUSION: The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC. For cases of OLT involving living donors, the UCSF criteria may be applied.