Pilonidal sinus disease in Kuwait a modified method of excision with primary closure: study of 280 cases

A modified method of excision of pilonidal sinus with primary closure was used in 280 patients with one year follow up. The technique involves prophylactic pipracillin, limited excision with 1 cm skin safety margin and the use of interrupted and subcuticular polypropylene sutures with Radivac drainage. The mean healing time was 15 days. Primary healing failure occurred in 1.42% of patients and recurrence at one year occurred in 4.64%. The mean time to return to work was 16 days. Ten out of 13 recurrent cases were reaching caudally to the external anal sphincter and were managed by an open method

Laparoscopic management of idiopathic varicocele

Twenty patients with idiopathic varicoceles were managed by laparoscopic endoclipping of the testicular vein on outpatient basis. In 3 patients the varicoceles were bilateral. Clinical, as well as pre- and postoperative Doppler ultrasound, confirmed the complete cure of the varicocele. Laparoscopy proved to be special value in the management of bilateral varicoceles and the clipping of the unusually branching testicular vein. A maneuver of clipping the testicular vein while the varicocele is firmly squeezed, was used. It helps to distend the vein under vision decongesting the testis and encouraging venous collateral circulation

Laparoscopic cholecystectomy: modifications of the technique

Laparoscopic cholecystectomy has been rapidly replacing the traditional method of open cholecystectomy. With experience of the technique surgeons are adding and developing technical "tips" and modifying the procedure for better safety and convenience of the patients. This work presented the patients in whom minor modifications of the technique in special situations is made. Three parts only for easy cholecystectomy in 20 patients are used. The second modification is aspiration and retraction of the gallbladder while keeping the Veress needle inside the gallbladder dissection for acute cholecystitis in 10 patients. Modification of umbilical port closure is by the use of Vicryl stay sutures in 10 patients or the use of prolene plug in 10 patients. Laparoscopic cholecystectomy with modifications of the technique was attempted in 54 patients with symptomatic gallbladder disease during the period from January 1992 to January 1994. There was no mortality. The mean operative time was 105 minutes [60-150 minutes]. In 4 patients laparoscopic cholecystectomy was converted to open cholecystectomy. The average hospital stay was 3.6 days [2-8 days] and the mean time taken for return to normal activity was 12 days [7-35 days]

technique for safe liver resection: the value of the argon beam coagulator

25 patients with primary hepatic tumors [20 patients with hepatocellular carcinoma and 5 patients with liver cell adenoma] were subjected to liver resection in one year. 2 patients were operated upon as an emergency due to bleeding tumors. A technique of liver resection with preliminary temporary vascular control of the corresponding branches, securing the hepatic veins with great attention to the caval ligament and liver transection using the argon beam coagulator is described with median loss of 450 ml. No mortality occurred in this series. The argon beam coagulators is highly recommended for safe and almost bloodless liver resection