Karydakis versus rhomboid flap in management of sacrococcygeal pilonidal sinuses

Many procedures have been described for the management of symptomatic pilonidal sinus, none of which, judged by the yardsticks of primary healing and recurrence of disease, is perfect. In our study, we are trying to compare the results of two widely practiced flap techniques, the Karydakis asymmetrical unilateral sliding flap and the rhomboid transposition flap suggested by Azab et al.1984. Forty patients were randomly divided into two groups. The first group was 20 patients and was treated by Karydakis flap. The second group was 20 patients and treated by rhomboid. The mean duration of symptoms was 7 months. The two groups were compared for age, sex, severity of the disease, operation time, complications and recurrence. Results and Discussion: We reported no great difference in recurrence rate [2 patients in Karydakis operation group and 1 patient in Rhomboid flap group], and also no great difference in the postoperative complications. The difference was recorded in the mean operative time [75 min in Karydakis flap group and 120 in Rhomboid flap group] and hospital stay [2 -5 days in Karydakis flap group and 7-9 days in Rhomboid flap group] and this reflects that the Rhomboid flap is more techniqually demanding procedure and so the patient usually needs to stay longer at hospital. The more complexity of the procedure explains the slight increase in the incidence of the postoperative complications

Stoppa preperitoneal approach [GPRVS] versus laparoscopic TAPP approach in management of bilateral inguinal hernia: a multicenter study

The preperitoneal approach for inguinal hernia avoids distorting the inguinal anatomy, markedly reducing the risk of damage to the testicular vessels and permits inspection of all potential groin hernia sites. In this, study we are trying to validate and compare two preperitoneal approaches used for repairing bilateral inguinal hernias; the Stoppa [GPRVS, giant prosthetic reinforcement of the visceral sac] and the laparoscopic transabdominal approach [TAPP]. Two hundred forty two [242] patients with bilateral inguinal hernia were treated at 3 University hospitals. They were randomly divided into two groups the first group [gp I] was 97 patients and underwent laparoscopic TAPP repair while the second group [gp II] was 143 patients and submitted for Stoppa preperitoneal repair [5 patients were turned from TAPP to Stoppa repair due to instrument failure in 2 patients, adherent intestinal loops with difficult reduction of the contents in 2 patients and bleeding from inferior epigastric vessel in l patient]. Operative time was 110 +/- 65 min in TAPP group and 90 +/- 20 min in Stoppa group. Hospital stay and need for analgesics were less with TAPP group than Stoppa group. Recurrence rate was- 5.1% in TAPP group and 2.1% in Stoppa group. Complications were slightly higher with Stoppa group except for chronic groin pain which was higher with TAPP. Both Stoppa and TAPP are valid preperitoneal repairs for bilateral inguinal hernias. Both are techniqually demanding operations. Stoppa has fewer recurrences but has slightly higher complication rate except for chronic groin pain which is more reported after TAPP. TAPP has the advantages of posing smoother postoperative course with shorter hospital stay