Comparative study between ileo colic pedicle versus superior mesenteric pedicle division for mesenteric lengthening

Lengthening of the mesentery by vascular division may be necessary to perform an ileal pouch anal anastomosis without tension. Our objective is to compare the increase in mesentery length after division of ileo colic pedicle [ICP] and the superior mesenteric pedicle [SMP]. Was to compare the increase in length of the mesentery after division of the [ICP] and after division of the [SMP]. Total colectomy was performed in [14] patients. Which were then randomly divided into two groups. Pouch anal anastomosis was performed with division of the [ICP] in one group of seven patients and with division of the [SMP] in the other. The ileum was measured and the increase in length was recorded and compared statistically. The mean [s.d.] increase in length was 2.9 [0.8] cm. after [ICP] division and 6.5 [1.1] cm after [SMP] division [P<0.001]. The distance between the end of the ileum and the point giving the greatest length was 27.5 [4] cm in the [ICP] group and 46.8 [4.2] cm in [SMP] group [P<0.001]. The increase in mesenteric length was greater after [SMP] division than after [ICP] division, but if pouch-anal anastomosis is performed a short segment of small bowel must be removed

Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients

Controversy persist regarding the treatment of pilonidal sinus. Sacrococcygeal pilonidal disease is a common chronic disorder of the natal cleft that is often considered a minor problem, but may cause substantial in convenience and local infection. Therefore, adequate treatment of a pilonidal sinus is important in order to improve the quality of life of affected patients. To evaluate the technique of excision with primary suture and suction drainage [PSI]] for the treatment of pilonidal sinus in adolescent patients. Between 1996 and 2005, forty patients aged 14-19 years [are range 16.4] underwent PS excision with primary closure and suction drainage. Anesthesia was general in 18 [45%] and spinal in 22 [55%]. Prophylactic cephalosporine was used is I.V. antibiotic. Excision of the sinus done down to the social fascia. Closed continuous suction drain was used. No complications due to the anesthesia were observed. Twenty five patients [62.5%] had day case surgery, while the others fifteen patients, [37.5%] were hospitalized for 2-4 days [average 2.3 days]. The drain was removed on post operative day 3-6 days [average 3.2 days] primary healing with no postoperative complications occurred in 36 patients [90%]. Postoperative infections requiring incision, drainage, and lay-open occurred in 3 cases [7.5%]. No recurrence was found at 12-months follow-up. One recurrence [2.5%] was noted 2 years after surgery. Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a simple and effective method of treatment of uncomplicated PS in adolescents