Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease / 대한외과학회지

PURPOSE: In this study, we investigated whether there is a factor that can aid determi nation of the preferred technique by comparing the early and late results of two different surgical techniques for the treatment of pilonidal sinus. METHODS: The medical records of 176 patients in whom the Limberg flap (LF) or V-Y flap techniques were applied for reconstruction after the excision were evaluated retrospectively. RESULTS: The development rates of postoperative hematoma, wound separation, wound infection, and seroma were 2.8%, 5.1%, 5.6%, and 6.3%, respectively, while total flap necrosis was not observed in any patient. Return to daily activities was achieved after a mean of 17.1 days (13 to 21 days) days in the LF group and 32.7 days (18 to 47 days) in the V-Y flap group. During the average follow-up of 65 months (36 to 110 months), nine patients (5.1%) developed recurrent disease. There was no difference between the two groups with respect to early surgical complications (P = 0.286) or disease recurrence (P = 0.094), whereas the resumption of daily activities was longer in patients with a V-Y flap (P < 0.001). CONCLUSION: The early postoperative and long-term results of the LF and V-Y flap techniques for the treatment of pilonidal sinus were similar. Because the resumption of daily activities at work is achieved later in patients undergoing the V-Y flap compared with the LF technique, patients' employment (or position in working life) must be considered when determining the most appropriate surgical technique.

The Effect of Hyaluronate Membrane on Prevention of Adhesion after Rectal Cancer Surgery: a Prospective Study

PURPOSE: The aim of this study was to evaluate the efficacy of using a Hyaluronate (HA) bioresorbable membrane (SeprafilmTM, Genzyme Corp., Cambridge, MA) to prevent adhesion after rectal cancer surgery. METHODS: We recruited 362 rectal cancer patients who underwent a curative resection between April 2001 and December 2002. We excluded patients with a previous operation history, a stoma procedure, a multivisceral resection, an extended lymphadenectomy, a total colectomy, or a pouch procedure. An adhesive ileus was defined as a symptomatic, radiological intestinal obstruction without evidence of recurrence. RESULTS: We placed the HA membrane under the midline incision in 153 patients. There was no difference between the groups regarding demographic findings and clinicopathological findings, including locations of the tumors, surgery performed, AJCC stage, and adjuvant treatment. While only 1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identified in the control group (P=0.008). Every patient, except 1 in the control group, underwent conservative management. CONCLUSIONS: A Hyaluronate membrane may be effective in preventing an adhesive ileus after rectal cancer surgery. However, a prospective, randomized, double-blind study is needed.