ABSTRACT
OBJECTIVE: The aim of this study was to compare the surgical outcome of fasciocutaneous V-Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. METHODS: A total of 58 patients with recurrent pilonidal sinus who underwent surgery were evaluated retrospectively between January 2008 to December 2013. Fasciocutaneous V-Y advancement flap was performed in 25 patients (Group VYF), and limberg transposition flap repair was performed in 33 patients (Group LTF). Patient demographics, operative and postoperative outcomes were recorded then retrospectively analyzed. RESULTS: The mean age (p = 0.69), sex ratio (p = 0.48), and concomitant diseases (p = 0.98) were not statistically different when compared the VYF with LTF groups. Mean operative time was 55 ± 19 min for the LTF group and 75 ± 25 min for the VYF group (p = 0.01). When length of hospital stay were compared, there was a significant difference between the groups (p = 0.01). Return to work was carryed out after a mean of 23 ± 1.1 days in VYF group and 16.7 ± 1.2 days in LTF group, which is significantly different (p < 0.0004). Between the groups, there was no significantly different regarding surgical complication and recurrent rate. Only one recurrence (4%) was found in VYF group. CONCLUSION: Limberg transposition flap may be use in recurrent cases of PSD, because of the lower recurrence rate and less hospital stay time, early return to work. Most important advantage of fasciocutaneous V-Y advancement flap is the ability to close larger defects in recurrent cases.
Subject(s)
Pilonidal Sinus/surgery , Surgical Flaps , Suture Techniques , Adolescent , Adult , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time , Recurrence , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The aim of this study was to investigate the effect of preoperative low ejection fraction (≤30%) on postoperative morbidity and mortality in patients undergoing isolated on-pump coronary artery bypass grafting. We also investigated the effect of pre- and perioperative factors on survival. METHODS: Between January 2002 and December 2009, 103 (6.2%) patients with an ejection fraction ≤30% and 1554 (93.8%) with an ejection fraction >30% underwent coronary artery bypass grafting. RESULTS: In multivariate logistic regression analysis, cardiopulmonary bypass time, operation time, prolonged inotropic support, and intensive care unit stay were independent predictors of mortality in patients with low ejection fraction. Intensive care unit and hospital stays were significantly longer in these patients, and the postoperative mortality rate was significantly higher. Advanced age (≥70 years) influenced mortality during the follow-up of patients with low ejection fraction. Midterm survival was significantly reduced in patients with ejection fraction ≤30%. Smoking, prolonged inotropic support, and prolonged ventilatory support were independent predictors of midterm survival in patients with ejection fraction ≤30%. CONCLUSION: On-pump coronary artery bypass grafting can be performed in patients with ejection fraction ≤30%, with reasonable mortality and morbidity rates.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/surgery , Stroke Volume , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Age Factors , Aged , Cardiopulmonary Bypass , Cardiotonic Agents/therapeutic use , Chi-Square Distribution , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Female , Humans , Intensive Care Units , Kaplan-Meier Estimate , Length of Stay , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Operative Time , Proportional Hazards Models , Respiration, Artificial , Risk Factors , Severity of Illness Index , Smoking/adverse effects , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/mortalityABSTRACT
BACKGROUND/AIMS: Non-traumatic spontaneous intramural hematoma of the small intestine is a rare clinical condition, most commonly caused by over-anticoagulation. In this study, the clinical approach algorithm for patients diagnosed with a spontaneous isolated intramural hematoma of the small intestine associated with over-anticoagulation and the long-term outcomes of the patients are presented. MATERIAL AND METHODS: The records of patients who were diagnosed with intramural hematoma in 3 different medical faculty hospitals between 2007 and 2011 were retrospectively analyzed. After excluding patients with trauma history, hematoma in organs other than the small intestine, and with etiological factors other than over-anticoagulation, 15 patients with an isolated intramural hematoma of the small intestine were evaluated within the scope of the study. RESULTS: The sites of first admission were emergency departments for 10 patients (66.6%) and other clinics for 5 patients (33.3%). Thirteen patients (86.6%) received medical treatment and two patients (13.3%) underwent surgical treatment. During the hospitalization period, a total of two patients (13.3%) died. Out of the 11 patients with an average follow-up of 22 months (range: 4-48 months), no patient had a relapseof intramural hematoma and three patients (27.7%) died due to reasons not related to intramural hematoma. CONCLUSION: Intramural hematoma diagnosis should be known by all physicians, because the site of first admission may be different clinics, since the clinical presentation begins with non-specific complaints. Early and accurate diagnosis by non-invasive methods will preclude unnecessary surgical interventions.
