Cable tie seton in surgical treatment of high perianal fistula

Background: Seton is any string-like material which when tied through the fistula tract causes an inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity when it is divided. In this way, it maintains sphincter continuity during cutting process

Aim of work: was to evaluate the cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of fecal incontinences and recurrence

Patients and Methods: This prospective study included a total of 20 cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of the seton

Results: All the patients were followed up for the state of incontinence for flatus, liquid and solid stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn't dislodged or slipped

Conclusion: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic, precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient

Hydrocelectomy through the inguinal approach versus scrotal approach for idiopathic hydrocele in adults

Hydrocele is a common chronic condition in men that causes physical, psychological, social, and economic distress. This study aimed to evaluate the outcome of hydrocelectomy through the inguinal approach as compared with the scrotal approach in adults. This prospective study was conducted on 40 patients who presented to the El-Hussein University Hospital with idiopathic hydrocele and underwent hydrocelectomy. These patients were divided into two groups: group I [inguinal approach group] included 20 patients with a mean age of 30.75 +/- 10.76 years and who underwent hydrocelectomy through the inguinal approach, group II [scrotal approach group] included 20 patients with a mean age of 29.35 +/- 8.93 years and who underwent hydrocelectomy through the scrotal approach. A comparison was made between the two groups as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. The mean volume of hydroceles was 196.00 +/- 30.28ml in the inguinal approach group and 197.75 +/- 26.72ml in the scrotal approach group. The mean operative time was 25.50 +/- 4.60min in the inguinal approach group and 24.40 +/- 4.08min in the scrotal approach group. The mean length of hospital stay was 1.35 +/- 0.48 days in the inguinal approach group and 2.50 +/- 0.68 days in the scrotal approach group. Postoperative complications in the scrotal approach group included one wound sepsis, one partial wound dehiscence, two persistent scrotal edemas, and adherence of the testis to the scrotum in one patient. No postoperative complications or discomfort were observed in the inguinal approach group. The mean time to return to normal activity was 12.10 +/- 1.33 days in the inguinal approach group and 17.70 +/- 4.13 days in the scrotal approach group. Hydrocelectomy through the inguinal approach in adults is associated with low or no postoperative morbidity and discomfort. It is easily applied and facilitates dealing with any associated lesions in the inguinal canal

Surgical reconstruction after excision of pilonidal sinus with modified limberg transposition flap

to evaluate the outcome of modified Limberg transposition flap in surgical reconstruction after excision of pilonidal sinus. This prospective study was performed on 40 consecutive patients presented by chronic sacrococcygeal pilonidal sinus, underwent surgical excision and reconstruction with the modified Limberg transposition flap. Patients were 32 [80%] males and 8 [20%] females. The mean age was 24.13 +/- 6.88 [15 - 48] years. Thirty four [85%] patients were presented by primary pilonidal sinus and six [15%] patients were presented by recurrent pilonidal sinus; two after lay-open method and four after simple primary closure method without lateralization of the scar. All patients were operated upon under spinal anaesthesia. The mean length of hospital stays was 2.60 +/- 0.86 days [range, 2-5] and the mean time to return to normal activities was 10.67 +/- 1.67 days. There was no flap necrosis or evidence of recurrence has been observed after mean follow-up of 8.10 +/- 2.29 months [range, 5-12 months]. Reported complications included; two partial wound dehiscence after removal of sutures, three seroma formation, and two patients had developed superficial wound infection. Surgical reconstruction after excision of pilonidal sinus with modified Limberg transposition flap is an effective method for the management of pilonidal disease, especially when dealing with recurrent pilonidal sinus. It is easily learned and is a valuable technique available to the general surgeon

Virtual colonoscopy-comparison with optical colonoscopy for the detection of colonic space- occupying lesions

This prospective study was performed on 20 consecutive patients with suspected or known colonic neoplasia to evaluate the sensitivity and accuracy of a new virtual colonoscopy technique for the detection of colorectal lesions in comparison with optical [conventional] colonoscopy as the standard of reference. They were 12 males and 8 females with age ranging between 48-72 years and mean age of 56.3 years. All patients were subjected to a thorough history and clinical examination, routine laboratory tests and abdominal ultrasonography. After standard bowel preparation, all patients underwent a non-contrast helical CT scan of the abdomen and pelvis followed by conventional colonoscopy in the same day. The images of CT colonography were reconstructed into a virtual colonoscopy [VC] presentation and compared with subsequent conventional colonoscopy in a blinded manner. Conventional colonoscopy identified 22 polyps 5 mm or greater in 12 patients, and no polyps were detected in 8 patients. Virtual colonoscopy correctly identified 5 polyps of 9 polyps 5-9 mm in size, and 11 of 13 lesions greater than or equal to 10 mm in diameter. Per-patient findings of VC for lesions 5-9 mm were; sensitivity 55.6%, specificity 81.8%, positive predictive value 71.4%, negative predictive value 69.2%, over all accuracy 70% and for lesions greater than or equal to 10 mm were; sensitivity 91.7%, specificity 87.5%, positive predictive value 91.7%, negative predictive value 87.5%, over all accuracy 90%. It could he concluded that VC is feasible and has excellent sensitivity and specificity for detection of colorectal lesions 10 mm and larger and provide another effective complement for the diagnosis and screening

Comparative study of subinguinal microscopic varicocelectomy and laparoscopic varicocele ligation

This study was carried out to compare the operative time, post-operative complications and semen analysis between subinguinal microscopic varicocelectomy [SMV] and laparoscopic varicocele ligation [LVL]. A total of 60 subfertile patients with varicocele, were assigned into two groups according to the method of treatment. Groups 1 included 30 patients treated by subinguinal microscopic varicocelectomy and group 2 included 30 patients treated by laparoscopic varicocele ligation. There were no difference between both groups as regard age, site of affection, symptoms and grade of varicocele. The mean operative time was significantly shorter among patients with LVL and therefore decreased the cost of the operation [P < 0.5]; there is no difference between the two groups as regarding to the duration of hospital stay, time off work and the duration of post-operative analgesic use. Post-operative semen analysis showed a significant increase in the density and motility and a significant reduction in the percentage of abnormal forms in the two groups. The recurrence rate at follow up was reported among patients of SMV [6.7%] and hydrocele formation was reported among patients of LVL [6.7%]. It is concluded that, LVL resulted in significant shorter operative time and lower incidence of recurrence compared with SMV