New closed technique in treatment of pilonidal sinus

Although many methods of surgical and non-surgical approaches for treatment of pilonidal sinus [PNS] have been proposed, an optimal treatment modality has not been achieved yet. In the case of pilonidal sinus treated with primary intention surgery, the uneventful healing is still difficult to obtain as indirectly proven by the number of different procedures. The aim of this study was to determine the advantages of adding an antibiotic carrier [Septocoll, septomycin] in the closed method technique after primary excision of the PNS. This randomized controlled prospective study included one hundred sixty-four consecutive patients who had primary or recurrent pilonidal sinus. These patients were treated by excision of the pilonidal sinus and primary closure. They were divided into 2 groups each included 82 patients: For Group I an antibiotic carrier [Septocolll] was introduced into the resulted cavity after excision of the PNS before skin closure. For Group II no antibiotic carrier was used and the cavity was closed directly. For group I: There was no operative mortality. Seventy-two patients [88%] had complete healing by the end of the study and were asymptomatic. Sixty six patients [80%] had healing by primary intention and in 16 patients [20%], the wounds healed by secondary intention. Fourteen patients [17%] developed postoperative prolonged pain. Ten patients [12%] developed recurrence. Mean length of hospital stay was 2.2 days [range Ito 3 days]. For group II: There was no operative mortality. Forty-nine patients [60%] had complete healing by the end of the study and were asymptomatic. Forty-six patients [56%] had healing by primary intention and in 36 patients [44%], the wounds healed by secondary intention. Thirty-three patients [40%] developed recurrence. Eighteen patients [21%] developed postoperative prolonged pain. Mean length of hospital stay was 3.1 days [range hto4 days]. Wide excision and primary closure by tension sutures after application of antibiotic carrier in the cavity is associated with short postoperative hospital stay, low morbidity, and low recurrence rate. It can be performed for managing primary or recurrent, clean or infected pilonidal sinuses with good long-term results

Selective criteria for predicting choledocholithiasis before laparscopic cholecystectomy

The objective of this study was to evaluate the sensitivity of criteria used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy [LC] We conducted a prospective preoperative study on 250 patients with symptomatic gallstones who underwent LC at Ain Shams University hospitals From April 1998 to April 2002. endoscopic retrograde cholangiopancreatography [ERCP] was performed in 54 patients. . Six indicators-jaundice, acute biliary pancreatitis, stones in common bile duct [CBD] on sonography, dilated [CBD] >7 mm on ultrasonography, dilated [CBD] with deranged liver function tests, and deranged liver function tests without jaundice-were used for suspecting choledocholithiasis and endoscopic removal before LC. Results: There were 194/250 patients [77.6%] who had a LC without the need for preoperative ERCP. 56/250 patients [22.4%] were thought likely to have stones on clinical, laboratory and Ultrasound [US] findings as part of their initial evaluation, and were referred for preoperative ERCP for removal of CBD stones. US correctly predicted bile duct stone in 91.6% [11/12 patients],followed by dilated CBD with deranged liver function test 66.6% [6/9 patients],.Followed by biliary pancreatitis 57% [4/7 patients], and jaundice50% [4/8 patients]. Sensitivity of dilated CBD on ultrasonography in predicting duct stone was only 40% [4/10 patients]. Deranged liver function without jaundice was the least sensitive of the predictors 37.5%[3/8 patients]. Overall, these indicators correctly diagnosed CBD stones in 59.2%[32/54 patients] before LC. Using selected criteria to select patients for preoperative ERCP can avoid operative cholangiography and unnecessary ERCP. As soon as postoperative patients have clinical signs or symptoms, endoscopic treatment should be performed

Modified mesh rectopexy: a prospective study of 37 patients

The objective of this study was to evaluate the sensitivity of criteria used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy [LC] We conducted a prospective preoperative study on 250 patients with symptomatic gallstones who underwent LC at Ain Shams University hospitals From April 1998 to April 2002. endoscopic retrograde cholangiopancreatography [ERCP] was performed in 54 patients. . Six indicators-jaundice, acute biliary pancreatitis, stones in common bile duct [CBD] on sonography, dilated [CBD] >7 mm on ultrasonography, dilated [CBD] with deranged liver function tests, and deranged liver function tests without jaundice-were used for suspecting choledocholithiasis and endoscopic removal before LC. Results: There were 194/250 patients [77.6%] who had a LC without the need for preoperative ERCP. 56/250 patients [22.4%] were thought likely to have stones on clinical, laboratory and Ultrasound [US] findings as part of their initial evaluation, and were referred for preoperative ERCP for removal of CBD stones. US correctly predicted bile duct stone in 91.6% [11/12 patients],followed by dilated CBD with deranged liver function test 66.6% [6/9 patients],.Followed by biliary pancreatitis 57% [4/7 patients], and jaundice50% [4/8 patients]. Sensitivity of dilated CBD on ultrasonography in predicting duct stone was only 40% [4/10 patients]. Deranged liver function without jaundice was the least sensitive of the predictors 37.5%[3/8 patients]. Overall, these indicators correctly diagnosed CBD stones in 59.2%[32/54 patients] before LC. Using selected criteria to select patients for preoperative ERCP can avoid operative cholangiography and unnecessary ERCP. As soon as postoperative patients have clinical signs or symptoms, endoscopic treatment should be performede of premature or retrograde ejaculation. The complications included prolonged ileus [3 patients], faecal impaction [1 patient], partial mucosal prolapse [2 patients] and post-operative obstruction [1 patient]. There was no recurrence. the mean follow up period was 9 +/- 1.8months ;range[5-15]months. This technique aligns the rectum, avoids excessive mobilisation and division of lateral ligaments thus preventing constipation and preserving potency. We recommend this technique for patients with complete rectal prolapse with up to grade 1, 2 and 3 incontinence based on Browning and Parks classification