SURGICAL OUTCOME OF KARYDAKIS TECHNIQUE IN SACRO-COCCYGEAL PILONIDAL SINUS

Background: Pilonidal sinus is caused by repeated traumatic penetrations of the skin by hair with consequent infolding and sinus formation. The objective of the study was to determine the surgical outcome and post-operative satisfaction level of patients undergoing Karydakis technique in sacro-coccygeal pilonidal sinus. Material & Methods: This descriptive cross-sectional study was conducted at the Department of General and Laparoscopic Surgery, Hayatabad Medical Complex, Peshawar, Pakistan from January 2013 to December 2014. Sample size was 38. All male sacro-coccygeal pilonidal sinus patients aging 16 to 65 years were included. Demographic variable was age in years. Research variables were duration of symptoms, follow up, length of stay, return to work, healing time, sacro-coccygeal pain, purulent or mucopurulent discharge, fever, swelling, tenderness and presence of frank abscess, seroma formation and over all satisfaction. Mean ±SD were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Data was analysed using IBM SPSS Statistics version 22.0 descriptively. Results: The mean age of the sample of 38 patients was 31.13 ±5.8 years; ranging from 16 to 65 years. Mean symptoms duration was 11.9 ±4.8 days. The mean follow-up duration was 9.87 ±1.89 months. The mean length of stay was 3.42±1.24 days. The mean return to work time was 8.79 ±2.1 days while mean healing time was 12.89 ±1.91 days. The presenting complaints were sacro-coccygeal pain in 34(89.5%), purulent or mucopurulent discharge in 30(78.9%), fever 22(57.9%), swelling 15(39.5%), tenderness 10(26.3%), presence of frank abscess 10(26.3%), seroma formation 3(7.9%) and over all satisfaction was (63%). Conclusion: Over all satisfaction rate was high in Karydakis technique in sacro-coccygeal pilonidal sinus patients.

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

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

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.

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Diagnostic Utility of Lower Extremity Radiographs of Young Children With Gait Disturbance

PEDIATRICS ◽

10.1542/peds.87.2.138 ◽

1991 ◽

Vol 87 (2) ◽

pp. 138-140

Author(s):

Steven D. Blatt ◽

Bruce M. Rosenthal ◽

Douglas C. Barnhart

Keyword(s):

Lower Extremity ◽

Failure To Thrive ◽

Gait Disturbance ◽

Diagnostic Utility ◽

Duration Of Symptoms ◽

Soft Tissue Swelling ◽

Chief Complaints ◽

The Mean ◽

Limiting Condition

The diagnostic utility of lower extremity radiographs was evaluated using 84 outpatients 1 to 5 years of age with gait disturbance whose lower extremities appeared physically normal. Chief complaints included limp (65 children [77%]), refusal to walk or stand (37 children [44%]), and frequent falling (6 children [7%]). A total of 43 children (51%) had more than one complaint. The mean age of patients was 26 months and the median duration of symptoms was 1 day. Trauma was reported in 43 (51%) cases and fever in 14 (17%). Results of radiographical studies appeared normal in 81 children (96%), demonstrated soft tissue swelling in 2 children, and revealed a bony island in 1 child. In 1 patient admitted to the hospital for failure to thrive and irritability, and whose radiographic results appeared normal, findings consistent with osteomyelitis later developed. Of the remaining children, 68 (81%) were available for follow-up observation 4 to 28 months after the initial visit and all reported spontaneous resolution of the initial complaint. It was concluded that in a well-appearing child with an otherwise normal physical examination results, an acute gait disturbance is likely to be a self-limiting condition and radiographs are unlikely to contribute to the diagnosis.

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Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study

Surgical Innovation ◽

10.1177/1553350618761757 ◽

2018 ◽

Vol 25 (3) ◽

pp. 236-241 ◽

Cited By ~ 7

Author(s):

Gabriella Giarratano ◽

Edoardo Toscana ◽

Claudio Toscana ◽

Giuseppe Petrella ◽

Mostafa Shalaby ◽

...

Keyword(s):

Return To Work ◽

Recurrence Rate ◽

Randomized Study ◽

Stapled Hemorrhoidopexy ◽

Secondary Outcome ◽

Sh Group ◽

The Mean ◽

Complications Rate ◽

Grade Iii

Aim. This study aims to compare the early and late outcomes of transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) for the treatment of hemorrhoidal disease. Methods. From January 2013 to December 2014, 100 patients—50 patients on each arm—were randomly allocated to THD or SH groups. The inclusion criteria were grade III and IV hemorrhoids diagnosed by clinical examination and proctoscopy. The primary outcome was to compare the recurrence rate with a minimum follow-up of 2 years, and the secondary outcome was to compare complications rate, time to return to work postsurgery, procedure length, and patient’s satisfaction between the 2 techniques. Results. The mean follow-up period was 33.7 ± 7.6. The recurrence rate was 4% in the SH group and 16% in the THD group ( P = .04). There was no difference in the intraoperative and postoperative complications rate; the pain score was significantly higher in the THD group. The mean operative time was significantly shorter in the SH group compared with the THD group. Patients in the THD group returned to work or routine activities significantly later compared with patients in the SH group. The overall satisfaction rate was also higher in the SH group. Conclusion. Both procedures are simple and easy to perform for the treatment of grade III and IV hemorrhoids. SH showed better results in terms of lower rate of recurrence, lower postoperative pain, quicker return to work, and higher patient satisfaction.

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Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413517204 ◽

2013 ◽

Vol 40 (4) ◽

pp. 384-391 ◽

Cited By ~ 5

Author(s):

S. M. Cha ◽

H. D. Shin ◽

K. C. Kim ◽

I. Y. Park

Keyword(s):

Analogue Scale ◽

High Speed ◽

Proximal Phalanx ◽

Healing Time ◽

Complete Healing ◽

Pathological Fractures ◽

Active Motion ◽

The Mean ◽

High Speed Burr

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients treated with different adjuvant methods after curettage for enchondromas of the hand. Sixty-two patients with enchondroma were treated with high-speed burring (29 patients) or alcohol instillation (33 patients) after curettage. The mean follow-up was 40.8 months. No significant differences in the visual analogue scale, Disabilities of the Arm, Shoulder, and Hand scores, total range of active motion, grip strength, and complete healing time were observed between the groups. The distribution of the results of the formula by Wilhelm and Feldmeier were not significantly different between the groups. No surgery-related complications, postoperative pathological fractures, or recurrence was found in either group. For the treatment of enchondroma in the metacarpal and proximal phalanx, alcohol instillation immediately after curettage was as effective as extensive curettage using a high-speed burr.

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Surgical Treatment in Bronchiectasis: Analysis of Our Patients.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i1.42 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

Fadil Gradica ◽

Lutfi Lisha ◽

Dhimitraq Argjiri ◽

Fahri Kokici ◽

Alma Cani ◽

...

Keyword(s):

Surgical Treatment ◽

Pulmonary Resection ◽

Lower Lobe ◽

Lung Abscess ◽

Duration Of Symptoms ◽

Operative Morbidity ◽

Massive Haemoptysis ◽

Localized Disease ◽

The Mean

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment. Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years. Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5. Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

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Haglund’s disease: surgical outcome of calcaneal osteotomy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170786 ◽

2017 ◽

Vol 3 (2) ◽

pp. 278 ◽

Cited By ~ 1

Author(s):

Veerabhadra Javali ◽

Virupaksha N. Reddy

Keyword(s):

Conservative Treatment ◽

Surgical Outcome ◽

Surgical Intervention ◽

Lateral Approach ◽

Lateral View ◽

Aofas Score ◽

Postoperative Score ◽

Calcaneal Osteotomy ◽

The Mean

Background: The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy.Methods: 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.Results: 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted. Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease.

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Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.11.peds17293 ◽

2018 ◽

Vol 21 (5) ◽

pp. 449-455 ◽

Cited By ~ 3

Author(s):

Julio D. Montejo ◽

Joaquin Q. Camara-Quintana ◽

Daniel Duran ◽

Jeannine M. Rockefeller ◽

Sierra B. Conine ◽

...

Keyword(s):

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pediatric Patients ◽

Lumbar Disc ◽

Low Back ◽

Duration Of Symptoms ◽

Patient Reported ◽

The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

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Treatment of persistent epithelial defects with single-dose autologous serum eye drops

European Journal of Ophthalmology ◽

10.1177/11206721211048372 ◽

2021 ◽

pp. 112067212110483

Author(s):

Selma Özbek-Uzman ◽

Züleyha Yalnız-Akkaya ◽

Evin Şingar Özdemir ◽

Ayşe Burcu

Keyword(s):

Single Dose ◽

Healing Time ◽

Autologous Serum ◽

Eye Drops ◽

Artificial Tears ◽

Duration Of Treatment ◽

The Mean ◽

Preservative Free ◽

Serum Eye Drops

Purpose: We aimed to investigate the efficacy and safety of single-dose autologous serum eye drops (ASEDs) for treatment of persistent corneal epithelial defects (PEDs). Methods: About 34 eyes of 26 patients treated from March 2016 to May 2020 with a single dose of ASEDs for PEDs that did not respond to conventional treatment were retrospectively evaluated. Patient demographics, predisposing factors, size, and duration of the PED, duration of treatment, and dosage of ASEDs, PED healing time, success rate of the ASED treatment, and follow-up time after the onset of ASED treatment were recorded. Autologous serum eye drops (20%) were prepared by diluting the serum with preservative-free artificial tears in single-dose vials. Vials were stored at −20°C and used daily after dissolving. Results: The mean patient age was 47.0 ± 18.5 years, and 13 (50%) of the patients were male. The most common indication for ASEDs was PED after keratoplasty. The mean duration of ASED treatment was 8.5 ± 6.3 months, and mean follow-up time was 22.8 ± 12.2 months. Autologous serum eye drop treatment was effective in 25 (73.5%) eyes and partially effective in 5 (14.7%) eyes. None of the eyes displayed complications related to the treatment. Conclusion: In patients with PED for whom conservative treatment is insufficient, ASEDs prepared by dilution with preservative-free artificial tears in single-dose vials and administered based on the daily use principle appear to be effective and safe.

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Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1728766 ◽

2021 ◽

Author(s):

Prashant Raj Singh ◽

Raghvendra Kumar Sharma ◽

Jitender Chaturvedi ◽

Nitish Nayak ◽

Anil Kumar Sharma

Keyword(s):

Posterior Fossa ◽

Surgical Outcome ◽

Karnofsky Performance Status ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Preoperative Embolization ◽

Initial Symptom ◽

Lower Cranial Nerve ◽

The Mean

Abstract Background Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Material and Method We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. Result The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. Conclusion Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.

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Factors Associated With Return to Work After Surgery for Degenerative Cervical Spondylotic Myelopathy: Cohort Analysis From the Canadian Spine Outcomes and Research Network

Global Spine Journal ◽

10.1177/2192568220958669 ◽

2020 ◽

pp. 219256822095866

Author(s):

Alexander Romagna ◽

Jefferson R. Wilson ◽

W. Bradley Jacobs ◽

Michael G. Johnson ◽

Christopher S. Bailey ◽

...

Keyword(s):

Confidence Interval ◽

Return To Work ◽

Odds Ratio ◽

Cohort Analysis ◽

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Research Network ◽

Duration Of Symptoms ◽

Factors Associated

Study design: Retrosepctive analysis of prospectively collected data from the multicentre Canadian Surgical Spine Registry (CSORN). Objective: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in North America. Few studies have evaluated return to work (RTW) rates after DCM surgery. Our goals were to determine rates and factors associated with postoperative RTW in surgically managed patients with DCM. Methods: Data was derived from the prospective, multicenter Canadian Spine Outcomes and Research Network (CSORN). From this cohort, we included all nonretired patients with at least 1-year follow-up. The RTW rate was defined as the proportion of patients with active employment at 1 year from the time of surgery. Unadjusted and adjusted analyses were used to identify patient characteristics, disease, and treatment variables associated with RTW. Results: Of 213 surgically treated DCM patients, 126 met eligibility, with 49% working and 51% not working in the immediate period before surgery; 102 had 12-month follow-up data. In both the unadjusted and the adjusted analyses working preoperatively and an anterior approach were associated with a higher postoperative RTW ( P < .05), there were no significant differences between the postoperative employment groups with respect to age, gender, preoperative mJOA (modified Japanese Orthopaedic Association) score, and duration of symptoms ( P > .05). Active preoperative employment (odds ratio = 15.4, 95% confidence interval = 4.5, 52.4) and anterior surgical procedures (odds ratio = 4.7, 95% confidence interval = 1.2, 19.6) were associated with greater odds of RTW at 1 year. Conclusions: The majority of nonretired patients undergoing surgery for DCM had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with RTW in this analysis.

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