Limberg flap in management of pilonidal sinus disease: systematic review and a local experience.

OBJECTIVES: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF. METHODS: Medline and Embase database were searched for the words 'pilonidal, sinus, Limberg, flap'. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected. RESULTS: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0-7.4% in case series. Recurrence rate in comparative studies was 0-8.3%, compared to 4-37.7% for primary closure and 0-11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% - [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months. CONCLUSIONS: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.

Patient-related factors influence the risk of developing intestinal stoma complications in early post-operative period.

BACKGROUND: Few studies have investigated the risk factors associated with developing intestinal stoma complications using appropriate multivariable methods. We aimed to determine the prevalence of, and risk factors for, stomal complications. METHODS: A retrospective, case-control methodology was used to investigate 12 explanatory variables and four outcome variables in 202 consecutive patients receiving stomas in a district general hospital in the United Kingdom between January 2013 and December 2014. Univariable and multivariable logistic regression were used to calculate odds ratios (ORs). RESULTS: There were 69 complications (69/202; 34.2%) in the early post-operative period (median 12 months) in total, the most common being retraction (30.4%). Performance status (World Health Organization score 1 or more; OR 2.67; 95% confidence intervals (CIs) 1.33-5.33; P = 0.006) and body mass index (>30 kg/m2 ; OR 3.30; 95% CIs 1.61-6.78; P = 0.001) were significantly associated with developing complications in multivariable analysis. Surgery-related risk factors, such as time of day or week of operation and grade of surgeon, were not associated with the development of stoma complications. Thirty-eight patients (18.8%) died over the follow-up period, but mortality was not related to the development of stoma complications (1.01; 0.48-2.13, P = 0.98). CONCLUSION: Patient-related risk factors influence the risk of developing a stoma complication more than surgery-related risk factors. Preoperative and post-operative interventions, planning, vigilance and management should be focussed to at-risk groups, particularly obese patients.

Current attitudes and practices towards diathermy smoke.

INTRODUCTION: The hazards of surgical smoke are well documented and electrosurgical units (ESUs) are an integral part of surgical practice. The aim of this study was to gauge the opinions of general surgical consultants, specialist registrars and senior theatre nurses in the Wessex Region towards the hazards of ESU smoke. MATERIALS AND METHODS: A literature search was carried out using Ovid Medline. A questionnaire was sent to 169 consultants, SpRs and nurses in the 14 hospitals across the Wessex Region, exploring current practices, perceived hazards and whether adequate precautions were currently in use. RESULTS: Only 3 of 98 surgeons used dedicated smoke extractors, despite the fact the majority (72%) felt that, currently, inadequate precautions were taken to protect staff and patients from surgical smoke. There was also uncertainty about the hazards amongst the respondents. CONCLUSIONS: The use of smoke extraction equipment is very limited. Greater awareness of the hazards and available technology to extract fumes from the theatre environment might lead to greater uptake.