Pilonidal sinus disease: Karydakis flap procedure in our patients.

INTRODUCTION: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. METHODS: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. RESULTS: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. CONCLUSION: According to the available evidence and guidelines, off-midline procedures - the Karydakis flap, Bascom cleft lift, and Limberg flap procedures - are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

Duodenum-sparing resection of the pancreatic head combined with pancreatogastroanastomosis in the treatment of chronic pancreatitis--surgical technique.

Chronic pancreatitis is defined as progressively developing disease which reduces exocrine parenchyma and decreasing exocrine capacity of the pancreas. The disease is commonly manifested by recurrent attacks of severe and often incapacitating upper abdominal and back pain. The goal of surgical therapy is pain relief and unblocking of the stenosis of the common bile duct and duodenum. Our method of solving this problem is a duodenum sparing resection of the pancreatic head followed by simple reconstruction of the gastrointestinal tract using pancreatogastroanastomosis. All unnecessary anastomoses are thus reduced and the risk of anastomotic leak is minimized. The substantial advantage of this operation is the removal of the pancreatic head where the source of symptoms related to chronic pancreatitis is localized.

Portal hypertension as a complication of chronic pancreatitis.

BACKGROUND/AIMS: Intractable abdominal pain, duodenal stenosis and common bile duct stenosis are considered the main reasons for surgery in cases of chronic pancreatitis. The aim of the study was to discover the influence of the disease on the portal pressure. METHODOLOGY: Blood pressure was measured in the superior mesentric vein before and after resection of the head of the pancreas in 17 patients by direct method. RESULTS: Venous pressure was lower after resection of the head of the pancreas in all 17 measured patients. CONCLUSIONS: Chronic pancreatitis increases not only left-sided portal pressure but also right-sided portal pressure.

[External pancreatic fistulae]. / Zevní pankreatické pístele.

External pancreatic fistulas are feared complications of pancreatic surgery or to trauma of the pancreas. In our paper we report on 2 patients suffering of external pancreatic fistulas successfully treated by operation. We demonstrate the examinations suitable for preoperative mapping of the fistula, the possibilities of conservative treatment and the strategy of surgical management of the fistulas. During the follow-up time the results of the operation are excellent.