Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease

The aim of this study was to compare modified Limberg flap procedure with excision and primary closure in the treatment of uncomplicated pilonidal disease. This study was conducted on 120 patients with uncomplicated sacrococcygeal pilonidaldisease that were randomly allocated into two groups: group I underwent excision and primary closure; group II underwent modified Limberg flap procedure. The duration of operation, postoperative pain, length of hospital stay, duration of incapacity for work, postoperative complications and postoperative recurrence were recorded. Duration of operation was longer in group II than in group 1 [P < 0.001]. However, postoperativepain was less [P< 0.001], duration of hospital stay shorter [P < 0.001], time to resumptionof work shorter [P <0.001] and postoperative complications were significantly fewer in group II. During follow-up period of 21.5 +/- 6.82 [months] for group I and 22 +/- 7.64 [months] for group II, single case of recurrence 1.67% was detected in patients in group II versus four patients [6.67%patients] in group I [P =0.032]. Wide excision with a modified Limberg transposition flap reconstruction is a very effective operative procedure for uncomplicated pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate

Evaluation of distal splenorenal shunt as an urgent surgical intervention in the management of acute variceal bleeding

The aim of the work was to evaluate distal splenorenal shunt as an urgent surgical intervention in management of acute variceal bleeding in Egyptian patients with portal hypertension. This study included 26 patients with acute variceal bleeding needing urgent surgery. All patients underwent distal splenorenal shunt, and patients were followed up for at least one year. Preoperatively and during the follow up period hepatic functions, portal homodynamic, and the state of varices were assessed. Control of bleeding was achieved in 88.46% of patients, re bleeding varices was reported in 3 patients [11.54%]. No infra-operative mortality, with a reasonable operative time of 148.00 +/- 50.05 minutes. The immediate post-operative mortality was 7.69%, and one patient died during follow up. Post operative morbidity was in the form of encephalopathy in 23.08% of patients, severe ascites in 15.38%, and partial wound dehiscence in 11.54% of patients. The mean follow up period was 21 +/- 4.34 months. Distal splenorenal shunt is a good surgical option for management of urgent variceal bleeding after failure of conservative measures, provided that there are available well trained personnel