Randomized clinical trial comparing primary closure with the limberg flap in the treatment of primary sacrococcygeal pilonidal sinus

The purpose of the study to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary Sacrococcygeal pilonidal sinus [SPS]. Thirty consecutive patients with SPS were randomly allocated to undergo both excision and primary closure [group 1, n=15] or rhomboid excision and the Limberg flap procedure [group 2, n=15]. Duration of operation, postoperative pain, tithe to first mobilization, and length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients. Duration of operation was longer in group 2 than in group 1 [P=0.001]. However, postoperative pain was less [P<0.001], mobilization earlier [P<0.001], duration of hospital stay shorter [P<0.001], time to resumption of work shorter [P<0.001] and postoperative complications fewer [P<0.001] in group 2. During follow-up of 14 months, no recurrence was detected in patients in group 2 versus 3 patients in group 1 [P=0.001]. Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPS

Randomized clinical study of gastrografin[R] administration in patients with adhesive small bowel obstruction

Oral Gastrografin[R] has been used to differentiate partial from complete small bowel obstruction [SBO]. It may have a therapeutic effect and predict the need for early surgery in adhesive SBO. The aim of this study was to determine whether contrast examination in the management of SBO allows an early intake and reduces hospital stay. Thirty patients admitted in Department of General surgery, Tanta university hospital between January 2004 and February 2006 with symptoms and signs suggestive of postoperative adhesive SBO were randomized into two groups, a control group and Gastrografin[R] group. Patients in the control group were treated conservatively. If symptoms of strangulation developed or the obstruction did not resolve spontaneously after 4-5 days, a laparotomy was performed. Patients in the Gastrografin[R] group received 100 ml Gastrografin[R]. Those in whom the contrast medium reached the colon in 24 h were considered to have partial SBO, and were fed orally. If Gastrografin[R] failed to reach the colon and the patient did not improve in the following 24 h a laparotomy was performed. Conservative treatment was successful in 26 patients [86.67 percent] and 4 [13.33 percent] required operation. Among patients treated conservatively, hospital stay was shorter in the Gastrografin[R] group [P < 0.001]. All patients in whom contrast medium reached the colon tolerated an early oral diet. Gastrografin[R] did not reduce the need for operation [P=1.000]. No patient died in either group. Oral Gastrografin[R] helps in the management of patients with adhesive SBO and allows a shorter hospital stay