Single-incision laparoscopic cholecystectomy: a new retraction technique.

BACKGROUND: Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. SURGICAL TECHNIQUE: Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS port was placed through an open approach. We inserted a 10-mm 30 degrees camera through the SILS port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose needle. This device provided retraction of the gallbladder in every direction. CONCLUSIONS: Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

The wound area as a parameter guiding the timing of abdominal closure in the management of patients undergoing open abdominal procedures.

OBJECTIVE: Surgical site infections (SSI) are incomparably troublesome and complicated, and some of them require an open abdomen (OA) procedure. While deciding the timing of abdominal closure, wound area calculation method and laboratory parameters can be used to guide the timing of abdominal closure after OA procedures. PATIENTS AND METHODS: The records of the patients who had undergone open abdomen during their treatment course and were followed up with vacuum-assisted closure (VAC) technique between December 2015 and December 2019 were retrospectively analyzed. The laboratory results before the first VAC application and the results after the VAC change were compared to determine a predictive parameter. The ImageJ program was used in five patients to compare the size of the wounds at the time of the decision to close them and before the first VAC application. RESULTS: 102 patients were analyzed. The ratio of the last wound area to the wound area at the time of the first VAC application in five patients was 0.30, 0.41, 0.34, 0.27, 0.46 (mean: 0.36, standard deviation: 0.078) which were measured and calculated by ImageJ software. CONCLUSIONS: We think that the concept of wound reduction ratio, which was calculated by a computer program, can be used as a concrete equivalent of the wound closure eligibility criteria decided by clinical experience.

Modified Limberg transposition flap in the treatment of pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease (PSD) is a common problem in surgical practice. Different non-surgical and surgical methods have been used for treating PSD. Flap techniques including the Limberg flap have become more popular in recent years. A modified Limberg flap was used to reduce the problems of skin maceration and recurrence associated with the conventional Limberg flap technique. The aim of this retrospective study was to assess the effectiveness of the modified Limberg flap technique for PSD. METHODS: Medical records of 94 patients with PSD who had been treated with a modified Limberg flap between December 2006 and 2009 were evaluated. The patients' age, sex, duration of preoperative symptoms, operative time, mean hospital stay, postoperative complications, wound infection rate, maceration rate and recurrence rate, time until return to work, time until sitting on the toilet without pain, hypoesthesia in the gluteal region, and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at the end of the 5th postoperative day and at 1, 3, 6, and 12 months following surgery. RESULTS: There were 83 male and 11 female patients. The mean operative time was 38.95 ± 6.77 min (range 30-67 min). All patients were followed up longer than 12 months, and the mean follow-up period was 30.97 ± 12.7 months (range 12-54 months). While wound dehiscence was observed in only one patient, we did not detect any case of flap necrosis. Two cases of seroma were observed. Wound infection was detected in 5 patients (5.3%). Surgical drainage was performed in 2 cases. Another 3 patients were treated with oral antibiotics. Maceration of the surgical incision site was detected in 8 patients (8.5%) who were all successfully treated with conservative measures. There were 4 patients (4.2%) with recurrence in this series. CONCLUSIONS: When compared with the available data on use of the conventional Limberg flap for PSD, our results suggest that use of the modified Limberg flap is associated with a lower maceration and recurrence rate, and greater patient satisfaction.