The value of honey dressings in pilonidal cyst healing: a prospective randomized single-center trial.

BACKGROUND: Honey is described as a wound healing agent. Many virtues have been attributed to it, in particular, antibacterial properties. The aim of our study was to evaluate its value in healing of wounds after wide excision on pilonidal cyst healing. METHODS: A prospective randomized trial was conducted from March 2016 to February 2022 which included patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision. Patients were randomly allocated to simple alginate wick dressings or the same design plus honey. RESULTS: Fifty patients were included in each arm. There were 57 men and 43 women. The median age was 22 years (range 19-28 years). The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094). There was no significant difference between the two groups in terms of time off work and time without physical activity The VQ-Dermato quality of life score was equivalent in both groups. CONCLUSIONS: Tolerability for honey dressings is good and is equivalent to that of alginate dressings in cavity wound care. This trial did not reach a significant difference in its primary endpoint but it shows the value of honey in this indication, although its use requires further study. TRIAL REGISTRATION NUMBER: CLINICAL TRIALS: NCT02485860 and EUDRACT: 2015-A00452-47 (10/03/2015).

Evaluation of a treatment pathway for the management of uncomplicated diverticulitis.

INTRODUCTION: Recent clinical practice recommendations have radically modified the management of colonic diverticulitis. The goal of our study was to evaluate a treatment pathway for uncomplicated diverticulitis and to analyze the outcome (patient compliance, treatment failure and complications). PATIENTS AND METHODS: All patients who presented to the emergency department with the diagnosis of uncomplicated diverticulitis were prospectively included in this study. The treatment pathway included an outpatient clinical re-assessment by a gastrointestinal surgeon. In case of symptomatic treatment failure, oral antibiotics were prescribed. If developed clinical signs of severity developed, the patient was referred to the emergency department for new laboratory and imaging workup. RESULTS: Eighty-seven patients were included. The mean interval before re-assessment was 2.8 days. Fifty-nine patients (67.8%) had symptomatic treatment upon discharge from the emergency department and were reassessed as outpatients by the surgical team. Patient evolution was satisfactory for 45 (76.3%); 10 (16.9%) required oral antibiotics. One (1.7%) patient developed complicated diverticulitis. Thirty-four (39.1%) patients did not comply with the current recommendations. CONCLUSION: In our experience, uncomplicated diverticulitis can be treated effectively in an ambulatory setting followed by early re-assessment by a surgeon.

Evaluation of the efficacy and morbidity of radiofrequency thermocoagulation in the treatment of hemorrhoidal disease.

INTRODUCTION: Grade III hemorrhoidal disease may require surgical treatment. Several minimally invasive techniques can be offered to the patient, particularly ligation of the hemorrhoidal arteries/mucopexy or even stapled hemorrhoidopexy. A technique of radiofrequency thermocoagulation of hemorrhoids has recently been introduced. The aim of our study was to assess the efficacy and early morbidity of this procedure. METHODS: Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated. RESULTS: Seventy-four patients, with a mean age of 53 years, underwent operation during the study period. The major indication was grade III hemorrhoidal disease in 95% of patients. More than 80% of patients underwent operation as an outpatient. Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery for rectal bleeding and severe anal pain, respectively. Seven (9.5%) patients were re-admitted to hospital and 18 (24.3%) had an unscheduled early return visit within 30 postoperative days. At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients. CONCLUSION: Radiofrequency hemorrhoidal thermocoagulation is an effective technique in the treatment of grade III hemorrhoidal disease. Despite a non-negligible rate of minor postoperative complications requiring an early consultation or re-hospitalisation, severe complications occurred in less than 3% of operated patients.

Does the degree of calcification of the celiac trunk and superior mesenteric artery on preoperative computerized tomography predict the risk of anastomotic leak after right colectomy? A single center retrospective study.

Anastomotic leak is a serious complication of colonic surgery. The aim of our study is to evaluate the impact of vascular calcifications of the celiac axis and superior mesenteric artery in patients undergoing elective right colectomy, and particularly their relationship to the risk of anastomotic leak. MATERIALS AND METHODS: We performed a retrospective analysis of preoperative abdominal computerized tomography (CT) scans of patients who underwent right colectomy at the Vendean Departmental Hospital (France) between January 2011 and December 2016. We established a calcification score, which was correlated to the incidence of anastomotic leak and to the patients' American Society of Anesthesiologists (ASA) score. RESULTS: The charts of 250 patients were reviewed. Twenty-three patients had a postoperative anastomotic leak. A stratified analysis revealed that the risk of developing an anastomotic leak was statistically significantly increased in patients whose calcification score was equal to or greater than 3 (P<0.05). In these patients, the risk was increased by a factor of 3.48 [odds ratio: 3.48 (1.45-8.36)]. A second stratified analysis showed that a calcification score of 2 at the level of the celiac axis takeoff was correlated with a statistically significantly increased risk of anastomotic leak (P<0.01). There was a correlation between a calcification score≥3 and an ASA score≥3. CONCLUSION: A calcification score≥3 correlates to an increased risk of anastomotic leak. The analysis of CT findings is simple, easy and reproducible. This calcification score should be confirmed by a prospective study.

Is histological analysis of pilonidal sinus useful? Retrospective analysis of 731 resections.

The pilonidal sinus (SP) is a common pathology. The treatment is a surgical excision. Many surgeons continue to systematically send this SP in histological analysis. The objective of our retrospective study was to evaluate the interest of this systematic histological analysis. The retrospective analysis of patients undergoing surgery was performed between 1 January 2006 and 31 December 2014. The primary observation was the presence of a malignant disease on the surgical specimen. Secondary observations were the wound healing time and the rate of recurrence. Seven hundred and thirty-one patients were analyzed. There was no malignant lesion. For 323 patients, the histological analysis did not describe the resection margins. Two hundred and eighty five patients had complete resect on and 38 were incomplete. Twenty-four patients had recurrence (7%). There was no significant difference between those who had complete and incomplete resection. The healing time was 61 days. Our study raises the question about the value of systematic histological analysis of the PS specimen.

Laparoscopic incisional hernia repair: long term results.

OBJECTIVE: The aim of this prospective monocenter study was to evaluate the long-term results of laparoscopic treatment of incisional hernias using intra-peritoneal prosthetic mesh. PATIENTS AND METHODS: Seventy-seven patients underwent laparoscopic treatment of incisional hernia between January 2002 and January 2008. All patients were followed for at least five years after surgery. The parameters assessed were hernia recurrences and post-operative pain. In case of doubt as to the diagnosis of recurrence or pain, a CT examination was performed. RESULTS: Nine patients were excluded: four patients refused to participate in the study and five died of unrelated disease during follow-up. Sixty-eight patients (89.7%) were followed for a mean of 92.3 (± 19.8)months. Mean age of patients was 58 (± 11.3)years. There were no deaths and no conversions. The mean operative time was 104 (± 48)minutes. The morbidity rate was 13.2%. Major complications included one case each of mesh infection, post-operative peritonitis (bowel injury), and surgical site pain requiring revisional surgery. Five patients developed seroma. The mean duration of hospitalization was 4.5 (± 2.3) days. The long-term recurrence rate was 8.8%. The average interval to onset of recurrence was 45.8 (± 31.1)months. Trocar site hernias were observed in three patients. Four patients had post-operative pain requiring long-term medical treatment. CONCLUSION: Laparoscopic incisional hernia repair using intra-peritoneal prosthetic mesh is a safe technique with satisfactory long-term outcome. One major complication occurred: bowel injury. Suture closure of 10mm trocar sites should be routine.

Sexual function and laparoscopic ventral rectopexy for complex rectocoele.

AIM: Laparoscopic ventral rectopexy (LVR) has recently been shown to be feasible, safe and efficient in restoring anatomy and improving rectal emptying in female patients presenting with a posterior pelvic floor prolapse. However, little is known about the sexual function of these patients. This study aimed to assess sexual activity in a group of patients referred for complex rectocoele and the consequences on sexual comfort of their treatment after LVR. METHOD: We prospectively assessed 41 consecutive patients who underwent LVR (either laparoscopic or robotic-assisted) for symptomatic complex rectocoele from January 2009 to January 2010. We first identified sexually active patients in the cohort using a nonvalidated simplified questionnaire. The Brief Index Sexual Functioning for Women (BISF-W) questionnaire was used postoperatively to assess the impact of LVR on sexual function. Acceptability of the assessment of sexuality was also tested. The postoperative outcome of the sexually active patients was compared with data obtained from the French general population. RESULTS: Among 38 patients in whom a successful LVR had been performed (three conversions), 22 (57.9%) were sexually active preoperatively and 18 (47.4%) were sexually active postoperatively at a mean of 7±4.2months of follow-up (P=0.44). No de novo dyspareunia was reported. At baseline, 13 patients experienced dyspareunia compared with six after LVR (P=0.02). A significant improvement in dyspareunia was observed (seven patients vs two patients; P=0.03). 19 (86%) of the 22 patients responded to the BISF-W questionnaire. The mean composite score was 26.7±8.2, with 63.2% of patients estimating sexual activity as important or very important. Compared with a reference population, sexual comfort was similar in LVR patients (32.2±12.6 vs 26.7±8.2; P=0.14). CONCLUSION: Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.

Minimally invasive ventral mesh rectopexy for complex rectocoele: impact on anorectal and sexual function.

AIM: Minimally invasive surgery for pelvic floor prolapse has recently been shown to be feasible and safe. This study presents the results of robotic-assisted and laparoscopic rectopexy for complex rectocoele, focusing on less frequently reported outcomes of bowel and sexual function. METHOD: We prospectively assessed 41 consecutive patients who underwent ventral mesh rectopexy (robotic-assisted or laparoscopic) for a symptomatic complex rectocoele from January 2009 to January 2010. Complex rectocoele was defined as having one or more of the following features: larger than 3 cm, an enterocoele or internal rectal prolapse. Patients with cystocoele underwent bladder suspension concurrently. Both groups were assessed for anatomical recurrence and function, comparing preoperative and postoperative faecal incontinence, obstructive defaecation syndrome and Gastrointestinal Quality-of-life Index scores, as well as vaginal discomfort and sexual function. RESULTS: Forty-one women underwent the procedure (16 robotic-assisted), with four (10.5%) having minor complications and two developing anatomical recurrence. There was significant relief of the commonest predominant symptoms of vaginal bulge/fullness (P<0.0001) and sexual dysfunction (P=0.02). There were three conversions to laparotomy (one robotic-assisted) and five patients declined postoperative functional assessment. In the remaining 33 patients [follow-up median 12 (8-21) months], analysis revealed no significant difference in overall functional score (P>0.740) or between patients with one or two meshes inserted (P>0.486). Only patients with a preoperative obstructive defaecation syndrome score >6 had a significant improvement postoperatively (P=0.030). CONCLUSION: Minimally invasive ventral mesh rectopexy for complex rectocoele offers satisfactory anatomical correction and functional results, with the potential for alleviating symptoms of outlet obstruction and improving vaginal comfort and sexual dysfunction.

Safety and efficacy of laparoscopic ventral mesh rectopexy for complex rectocele.

AIM: Laparoscopic ventral mesh rectopexy, previously described for external rectal prolapse, was evaluated for symptomatic complex rectocoele. METHOD: From January 2004 to December 2008, 84 (50.9%) patients (mean age 64 ± 5 years) underwent laparoscopic ventral mesh rectopexy for symptomatic complex rectocoele, confirmed preoperatively on dynamic defaecography, with 26 (31%) patients having a concurrent cystocoele. The operative technique was standardized, and those with cystocoele underwent bladder mesh suspension during the same procedure. Prospectively collected data were analysed for preoperative symptoms, operative and functional results [constipation, faecal incontinence (FI), dyspareunia and satisfaction score]. RESULTS: The conversion rate was 3.6% and perioperative morbidity 4.8% with no mortality. At a median follow up of 29 (4-59) months, there was a significant decrease in vaginal discomfort (86-20%) and obstructed defaecation symptoms (83-46%), P < 0.001. There was no significant change in FI (20-16%), no worsening of preoperative symptoms or new complaints of constipation, dyspareunia or FI. Overall, 88% of patients reported an improvement in overall well-being. CONCLUSION: Laparoscopic ventral mesh rectopexy is a safe and effective method for treating symptomatic complex rectocoele.