Minimally invasive treatment of pilonidal sinus using the new Infinite Ring Fiber. A case series.

AIM: In this study, we present a small series of patients with pilonidal cyst, which were treated with NeoV1470 Laser System using Infinite Ring Fiber 600 microns (Mm) (NeoLaser, Caesarea, Israel) (Infinite Ring Fiber - IRF). This fiber is characterized by circular 360-degree heat release, an active 4 mm tip with 1470nm emission and up to now it has been used only for vessel surgery. We are investigating its use in the treatment of pilonidal cyst. MATERIAL AND METHODS: It is a case series study (December 2020 - December 2021) consisting of 13 patients. The choice criterion for the study was that the patient should have at least one fistula opening with maximum size of orifice < 5mm. All patients were treated as day clinic. Surgery was performed with intravenous sedation and local anesthesia using lidocaine. The pulse regime we use was (8w, 3sec, 24 J/per pulse). RESULTS: All the patients had successful treatment. None of the patients treated with the particular fiber had any complications or relapsed disease during the follow up period. DISCUSSION: In the international literature have been described various therapeutic options of pilonidal cyst therapy. The use of use of IRF is another one. CONCLUSIONS: The use of NeoV1470 laser system with IRF at pilonidal cyst therapy appears to be a safe and effective option, with less pain and necrotic detriments. KEY WORDS: Infinite ring fiber, Laser, Pilonidal sinus.

Management of blunt hepatic and splenic injuries (grade ≤ III) in patients receiving antithrombotic therapy.

BACKGROUND: Non-operative management (NOM) may be particularly challenging in patients receiving synchronous antithrombotic therapy (AT). The current study examined the feasibility of NOM in patients under AT who sustained blunt splenic or hepatic injuries. METHODS: We analyzed the results of a 5-year (2010-2014) pre-decided treatment protocol, including 15 patients under AT who were treated for splenic and/or hepatic injuries at our institution. The antithrombotic therapy consisted of acenocoumarol 4 mg, acetylsalicylic acid 100 mg and clopidogrel 75 mg. Vitamin K (Vit K), Fresh frozen plasma (FFP) and Prothrombin Complex Concentrate (PCC) were transfused to patients receiving anticoagulant therapy, while platelets (PLTs) were given to patients under antiplatelet therapy if their level was excessively low. The organ injury grading scale, injury severity score (ISS), the need for blood transfusion and intensive care unit (ICU)/ high dependency unit (HDU) admission, morbidity, mortality and duration of hospital stay were also recorded. RESULTS: Ten patients fulfilled the criteria for NOM and were treated accordingly. No conversion to operative management (OM) was required (success rate 100%). Five patients were managed surgically due to hemodynamic instability and/or signs of peritonitis. Reversal of AT was attempted in all cases. CONCLUSIONS: Hemodynamically stable patients under AT with blunt hepatic or splenic injuries (grade ≤ III) and no signs of peritonitis, may be good candidates for NOM, despite their bleeding tendency. The type of AT does not seem to influence the final outcome. Reversal of AT should be stratified individually. KEY WORDS: Antithrombotic therapy, Hemodynamic stability, Non-operative management.

Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice.

BACKGROUND: The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital. METHODS: We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated. RESULTS: One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM. CONCLUSION: Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.