Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals SURGICAL TREATMENT OF CHRONIC PILONIDAL SINUS

2019 ◽  
Vol 141 (3-4) ◽  
pp. 63-67
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Limberg Flap ◽  
Secondary Intention ◽  
One Year ◽  
Flap Closure

Chronic pilonidal sinus is an acquired skin disease resulting from chronic inflammation of an affected skin area. It creates a cyst with epithelized subcutaneous channels. The disease mostly affects younger men with elevated BMI and sedentary lifestyle being the main risk factors. The aim of this study was to compare wound healing times, seroma, wound infection and wound dehiscence frequency, average length of hospital stay and recurrence rate in patients undergoing first-time operation for chronic pilonidal sinus at the Surgery clinic of University hospital Mostar from June 2015 to June 2017, with recurrence rate monitoring for one one year after the operative procedure. The patients were divided into three groups by the type of operating procedure: excision with primary closure (23.0%), excision with healing by secondary intention (55.2%) and excision with Limberg flap closure (21.8%). Most of the patients included in this study had elevated BMI (72.4%). Patients who were operated using primary closure and Limberg flap closure had on average shorter wound healing times than patients operated with excision and secondary intention healing. Seroma frequency was highest in patients operated using primary closure (70.6%) and lowest in patients operated using Limberg flap closure (29.4%). Average length of hospital stay was 6.4 days (min 3, max 13; SD 1.919). There were no statistically significant differences in hospital stay between different types of operating procedures used. Patients operated using Limberg flap closure had two (10.5%) cases of recurrence in the one year period after the operation. There were seven (35.0%) recurrences of the disease in patients operated using primary closure and six (12.5%) recurrences in patients operated using healing with secondary intention. The difference in the number of recurrences between patients operated using primary closure, healing by secondary intention and Limberg flap closure was borderline statistically significant. We find that Limberg flap closure reduces postoperative complications and wound healing time which improves postoperative recovery.

scholarly journals Comparative study between excision with lay open and excision with primary closure in treatment of pilonidal sinus

2019 ◽  
Vol 6 (4) ◽  
pp. 1242
Author(s):  
B. N. Anandaravi ◽  
Aswath Viswanathan
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Open Group ◽  
Limberg Flap ◽  
Surgical Methods ◽  
Considerable Morbidity ◽  
Closure Method

Background: Pilonidal sinus is a common anorectal condition affecting young adults with various etiological factors. Various surgical methods have been described, but treatment failure and recurrence are frequent, causing considerable morbidity. This study was undertaken to study the different surgical methods in treatment of pilonidal sinus.Methods: This study was done between January 2017 and June 2018. 20 cases underwent excision with open healing and 10 cases underwent excision with primary closure. The surgeries for primary closure included Limberg flap, Karydakis technique and Z plasty. Patients were analyzed with respect to post operative complications, duration of hospital stay, duration of getting back to work and duration of wound healing.Results: Spectrum of clinical presentation included pain, discharge, sinus and swelling. No recurrences were observed in the present study. Wound infection occurred in only three cases. Duration of wound healing was found to be an average of 51.6 days in Excision with open healing method and 14.2 days in excision with primary closure method. The average length of hospital stay in excision and lay open group was 4.35 days and 5.4 days in the excision and primary closure group. The average duration to return to work was 34 days in excision and lay open group, while it was 8 days in excision and primary closure group.Conclusions: Excision with primary closure is a better modality than excision with lay open technique in treatment of pilonidal sinus.

Neurogenic claudication associated with posterior vertebral rim fractures in children

2012 ◽  
Vol 10 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Jonathan G. Thomas ◽  
Jerome Boatey ◽  
Alison Brayton ◽  
Andrew Jea
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Pediatric Age Group ◽  
Fractures In Children ◽  
The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

scholarly journals Triple tubostomy and its outcome for blunt duodenal injury

2019 ◽  
Vol 22 (1) ◽  
pp. 12-17
Author(s):  
Narendra Pandit ◽  
Tek Narayan Yadav ◽  
Laligen Awale ◽  
Shailesh Adhikary
Keyword(s):  
Hospital Stay ◽  
Primary Closure ◽  
Early Stage ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
Damage Control Surgery ◽  
Duodenal Fistula ◽  
Duodenal Injury ◽  
Female Ratio ◽  
The Mean

Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes.  

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience

Endoscopy ◽  
2018 ◽  
Author(s):  
Michel Kahaleh ◽  
Jean-Michel Gonzalez ◽  
Ming-ming Xu ◽  
Iman Andalib ◽  
Monica Gaidhane ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Hospital Stay ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Novel Therapy ◽  
Gastric Emptying Scintigraphy ◽  
Post Procedure ◽  
The Mean ◽  
Procedure Duration

Abstract Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 – 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 – 14 days). The mean follow-up duration was 11.5 months (2 – 31 months). Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

scholarly journals Evaluation of Rib Fractures due to Trauma

2021 ◽  
pp. 46-50
Author(s):  
Suphi Aydin ◽  
Ahmet Dumanli ◽  
Adem Gencer
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Traffic Accidents ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Rib Fractures ◽  
The Mean ◽  
One Year ◽  
The One

Introduction and Aim: We aimed to evaluate the one-year mortality rates and the effect of comorbid diseases on mortality in patients with trauma and isolated rib fractures. Materials and Methods: Ninety patients who had trauma, isolated rib fracture between January 2016 and December 2016 and could be reached after one year after the trauma were included in the study. The files of the patients were scanned retrospectively. Age, gender, and length of hospital stay were recorded. After one-year follow-up, they were contacted by phone to evaluate the rates of additional disease and mortality. Results: 27 of the patients were female (30%), 63 of them were male (70%). Regarding the causes of injury, there were falls in 42 patients at most and in-vehicle traffic accidents in 35 patients. The mean age was 56.85 ± 16.33, the mean hospital stay was 4.04 ± 4.55 days. The most common comorbidities were diabetes mellitus in 13 patients and hypertension in 11 patients. The least detected additional diseases are; Ulcerative colitis, epilepsy, arrhythmia, gastroesophageal reflux, gastrointestinal bleeding, rheumatism, Alzheimer and Familial Mediterranean Fever in 1 patient each. One patient died who had gastrointestinal bleeding. Mortality rate was 1.11%. Conclusions: Post-traumatic rib fractures disrupt people's quality of life and cause morbidity and mortality. Although the risk of comorbid mortality increases, close follow-up is important in preventing or reducing mortality rates.

scholarly journals Minor vs complete excision of pilonidal sinus: Early postoperative period

2012 ◽  
Vol 59 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Jelena Petrovic ◽  
Ivan Dimitrijevic ◽  
Zoran Krivokapic
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Healing Time ◽  
Early Postoperative Period ◽  
Surgical Approaches ◽  
Complete Excision ◽  
Surgical Incision ◽  
Natal Cleft ◽  
Incision And Drainage

Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair. It is predominantly a condition of younger people. When presenting as an abscess it usually requires surgical incision and drainage, or bursts spontaneously. In general, there are various surgical approaches to this condition, from very simple to complex ones. Each technique has its supporters and justifications. In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department. Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done. The average discharge time was 1.14 days. Failure to heal occurred in 15 patients (13.63%). During that period we saw recurrence in 4 patients (3.63%). All the patients were coming to our department for postoperative care. The shortest healing time was 4 weeks and longest 21 weeks. During the period may 2011-may 2012 we performed 17 less extensive excisions. All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks. In only one patient with the extensive excision healing time was 8 weeks. Although we had a short follow up period of 11.11 months, we saw no recurrence yet. Our results show that simple individual approach to every patients gives fastest and most comfortable results.

National randomized clinical trial on subdural drainage time after chronic subdural hematoma evacuation

2021 ◽  
pp. 1-8
Keyword(s):  
Hospital Stay ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Length Of Hospital Stay ◽  
Burr Hole ◽  
Drainage Time ◽  
Postoperative Length ◽  
The Mean ◽  
Burr Hole Evacuation

OBJECTIVE Placement of a subdural drain reduces recurrence and death after evacuation of chronic subdural hematoma (CSDH), but little is known about optimal drainage duration. In the present national trial, the authors investigated the effect of drainage duration on recurrence and death. METHODS In a randomized controlled trial involving all neurosurgical departments in Denmark, patients treated with single burr hole evacuation of CSDH were randomly assigned to 24 hours or 48 hours of postoperative passive subdural drainage. Follow-up duration was 90 days, and the primary study outcome was recurrent hematoma requiring reoperation. Secondary outcome was death. In addition, complications and length of hospital stay were recorded and analyzed. RESULTS Of the 420 included patients, 212 were assigned 24-hour drainage and 208 were assigned 48-hour drainage. The recurrence rate was 14% in the 24-hour group and 13% in the 48-hour group. Four patients died in the 24-hour group, and 8 patients died in the 48-hour group; this difference was not statistically significant. The ORs (95% CIs) for recurrence and mortality (48 hours vs 24 hours) were 0.94 (0.53–1.66) and 2.07 (0.64–7.85), respectively, in the intention-to-treat analysis. The ORs (95% CIs) for recurrence and mortality per 1-hour increase in drainage time were 1.0005 (0.9770–1.0244) and 1.0046 (0.9564–1.0554), respectively, in the as-treated sensitivity analysis that used the observed drainage times instead of the preassigned treatment groups. The rates of surgical and drain-related complications, postoperative infections, and thromboembolic events were not different between groups. The mean ± SD postoperative length of hospital stay was 7.4 ± 4.3 days for patients who received 24-hour drainage versus 8.4 ± 4.9 days for those who received 48-hour drainage (p = 0.14). The mean ± SD postoperative length of stay in the neurosurgical department was significantly shorter for the 24-hour group (2 ± 0.9 days vs 2.8 ± 1.6 days, p < 0.001). CONCLUSIONS No significant differences in the rates of recurrent hematoma or death during 90-day follow-up were identified between the two groups that randomly received either 24- or 48-hour passive subdural drainage after burr hole evacuation of CSDH.

scholarly journals A New Technique in Management of Pilonidal Sinus, a University Teaching Hospital Experience

2013 ◽  
Vol 98 (4) ◽  
pp. 304-306 ◽  
Author(s):  
Saleh M. Aldaqal ◽  
Ahmed A. Kensarah ◽  
Mostafa Alhabboubi ◽  
Abdulrahman A. Ashy
Keyword(s):  
Recurrence Rate ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Healing Time ◽  
New Technique ◽  
Controlled Study ◽  
P Value ◽  
Minimal Amount ◽  
The Mean ◽  
A New Technique

Abstract This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H202) and primary closure, or excision without closure, or excision after injection of H202 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H202 without closure was the lowest (1.8%) with P-value &lt; 0.005, and the mean duration of healing was 30.7 days with P-value &lt; 0.005. We recommend using excision after injection of H202 without closure in management of PNS. Injection of H202 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate.

scholarly journals Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Bioactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads

2017 ◽  
Vol 2 (4) ◽  
pp. 194-201 ◽  
Author(s):  
Albert Ferrando ◽  
Joan Part ◽  
Jose Baeza
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Chronic Osteomyelitis ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Calcium Sulphate ◽  
Bone Defects ◽  
Group 2 ◽  
Group 1

Abstract. Aim: To evaluate the efficacy of bioglass (BAG-S53P4) in the treatment of patients with chronic osteomyelitis and compare the results with calcium sulphate antibiotic beads in one medical centre.Methods: Retrospective analysis of 25 cases. Inclusion criteria: patients diagnosed clinically and radiographically of osteomyelitis and treated surgically (Group 1: cavitary bone defects treated with bioglass and Group 2: cavitary bone defects treated with calcium sulphate antibiotic beads) during the period of 2014 and 2015 in one medical centre.Results: Patients in group 1 (bioglass treatment): total of 12 patients (11 males and 1 female) with mean age: 50 years (30-86). Average length of hospital stay was 22 days and mean follow-up time: 23 months (16-33). Mean erythrocyte sedimentation rate (ESR) and mean c-reactive protein (CRP) before surgery: 55mm/hr and 54 mg/L, respectively. Mean ESR and mean CRP in last blood exam: 18 mm/hr and 8 mg/L, respectively. There were 2 postoperative complications: seroma formation and delayed wound healing. Only 1 patient had recurrence of infection.Patients in group 2 (calcium sulphate antibiotic beads treatment): total of 13 patients (9 males and 4 females) with mean age: 48 years (17-67). Average length of hospital stay was 21 days and mean follow-up time 22 months (16-29). Mean ESR and mean CRP before surgery: 51mm/hr and 41 mg/L, respectively. Mean ESR and mean CRP in last blood test: 15 mm/hr and 11 mg/L. 2 postoperative complications were registered: chronic expanding hematoma of the muscle flap donor site and seroma formation. 1 patient had recurrence of infection. Overall, there were no differences in recurrence of infection, p=0.740 and in complication rate, p=0.672. 11 (91,7%) patients in group 1 and 12 (92,3%) patients in group 2 showed no signs of recurrence of infection both clinically and radiologically at final follow-up.The most frequent cause of osteomyelitis in group 1 was post traumatic while a postsurgical aetiology was more frequent in group 2. The distal tibia was the most common location. The most frequent pathogen isolated in both groups was methicillin sensible staphylococcus aureus.Conclusions: An advance in treatment of patients with cavitary bone defects in chronic osteomyelitis is the use of synthetic bone substitutes although current evidence is low. In this study, we demonstrate how bioglass without local antibiotics and calcium sulphate antibiotic beads are both equally effective treatment options. Overall, there were no differences between groups in mean hospital stay, complication rates and recurrence of infection.

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