Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery.

BACKGROUND Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). MATERIAL AND METHODS The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. RESULTS The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). CONCLUSIONS According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Long term efficacy of laparoscopic adjustable gastric banding--retrospective analysis.

BACKGROUND: Laparoscopic procedures have emerged over the past decade for treatment of obesity. Laparoscopic adjustable gastric banding is the easiest surgical technique for morbid obesity. OBJECTIVES: The authors analyzed the long term results of laparoscopic adjustable gastric banding in their center. MATERIAL AND METHODS: A total of 172 consecutive patients who had undergone laparoscopic adjustable gastric banding between May 2005 and February 2011 in authors clinic were contacted for evaluation. The main outcome measures were complications, secondary operations, percent excess weight loss, mortality, patient satisfaction and band removal rate. RESULTS: The follow-up rate was 62.2%. Mean age of patients was 30.6 years. Mean body mass index of patients was 48.47 +/- 7.8 kg/m2. Median follow-up interval was 36 months (min 8, max 81) and band removal rate was 19.1%. There was one mortality. Of all patients, 33 had band removal. The band was removed laparoscopically in 21 patients. The main reason for band removal was slippage followed by band erosion. After band removal, 4 patients had re-banding, 5 had Roux-en-Y gastric bypass. Overall, the mean percent excess weight loss was 50.6 +/- 7.8% (range, 5-100%). Mean percent excess weight loss for those who had band removal was 27.8 +/- 5.78% (range 12.5-34.1%). Overall satisfaction index was rated as "good" for 42% of patients. CONCLUSIONS: Despite a low satisfaction index, considerable mean percent excess weight loss and vast improvement in co-morbidities is achieved after laparoscopic adjustable gastric banding. The authors conclude that laparoscopic adjustable gastric banding can be utilized as the initial surgical procedure in morbid obesity.

Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity.

BACKGROUND: There are differences in the levels of inflammation mediators, lipids, and formed elements of the blood in morbidly obese patients compared with individuals of normal weight. In the current study, the change in these parameters was determined in patients who achieved weight loss by undergoing laparoscopic adjustable gastric banding (LAGB) by comparing preoperative, and early (3 months) and late (12 months) postoperative values. METHODS: The body mass index (BMI), weight, blood pressure, and waist circumference of 72 patients treated by LAGB procedures between September 2006 and February 2009 were measured and recorded. Pre- and postoperative 3- and 12-month C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, IgM, fibrinogen (Fbg), complement components C3 and C4, total cholesterol, triglycerides, low-density lipoprotein-C and high-density lipoprotein-C levels, and leukocyte, neutrophil, lymphocyte, and platelet counts were also measured. Results were presented as mean +/- SD. The preoperative values were compared with the 3- and 12-month values. A p value < 0.05 was considered statistically significant. RESULTS: BMI, weight, blood pressure, and waist circumference measurements were reduced at 3 and 12 months postoperatively compared with preoperative values (p < 0.05). Among the inflammatory mediators, IgG, IgM, and Fbg were reduced to near-normal values, beginning in the early postoperative period (p < 0.05). There was no significant reduction parallel to weight loss with respect to CRP, C3, C4, and IgA values at 3 months postoperatively (p > 0.05). However, the 12-month values of these parameters were significantly reduced (p < 0.05). CONCLUSIONS: Morbid obesity leads to significant changes in the levels of inflammation mediators. While there is a significant reduction in some of these mediators accompanying slight weight loss in the early period following an LAGB procedure, significant changes occur in other mediators in the late period when there is a larger amount of weight loss.

Frantz's tumor (solid pseudopapillary tumor) of the pancreas. A case report.

CONTEXT: A solid pseudopapillary tumor of the pancreas is a rare neoplasm which, for the most part, affects young women and has a relatively favorable prognosis with a low malignant potential. These tumors usually have unclear clinical features and may form very large masses before being diagnosed. CASE REPORT: We report the case of a 29-year-old woman who underwent complete resection of the tumor using a distal pancreatectomy and splenectomy procedure. The patient is being followed-up and in good condition. A review of the relevant literature is also presented. CONCLUSIONS: A solid pseudopapillary tumor of the pancreas is a rare condition with a low potential for malignancy and favorable prognosis; surgical resection is generally curative.

[Pancreatic injuries: analysis of 20 cases]. / PANKREAS YARALANMALARI: 20 OLGUNUN ANALIZI.

BACKGROUND: The aim of this study is to stage pancreatic injury and to assess the appropriate surgical approach. Trauma leading to pancreatic injury, factors responsible for the mortality and complication rates are evaluated and compared with the literature. METHODS: Records of 20 patients with pancreatic injuries treated at the Emergency Surgical Unit of Research Hospital between January 1997 to October 2001 were retrospectively evaluated. RESULTS: In this series 20 per cent of the mortality occurred within the first 48 hours. The factor responsible for the mortality in these patients was major bleeding; related to major vascular, hepatic, splenic, renal or thoracic injuries. Late mortality was seen in 3 patients (15 per cent) due to sepsis, respiratory insufficiency or ARDS. ln the literature mortality rate is between 5 to 30 per cent and morbidity rate is 30 to 64 per cent. In this series, these percentages were 35 per cent and 43 per cent respectively. CONCLUSION: The surgical therapy should be tailored up to the presence of ductal injury and the extent and anatomical localization of the injured segment. In principle the control of bleeding and contamination, and application of the appropriate surgical treatment can lower the morbidity and mortality. Key words: Abdominal trauma, pancreatic injury, pancreatic drainage

Use of laparoscopic splenectomy in developing countries: analysis of cost and strategies for reducing cost.

BACKGROUND: In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. PATIENT AND METHODS: Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. RESULTS: The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US $1,055 in the LS group and $1,664 in the OS group. The overall total cost was $1,664 for the OS group and $2,064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. CONCLUSION: The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.