Elliptical excision with midline primary closure versus rhomboid excision with limberg flap reconstruction in sacrococcygeal pilonidal disease: a prospective, randomized study.

To compare elliptical excision with primary midline closure and rhomboid excision with limberg flap reconstruction techniques for the sacrococcygeal pilonidal sinus. This prospective randomized study of 80 patients of sacrococcygeal pilonidal sinus was performed in SKIMS medical college from 2004 to 2007. After assigning patients randomly to either of the surgical groups, group A patients (40/80) were operated by using rhomboid excision with limberg flap reconstruction whereas group B patients (40/80) were operated by using elliptical excision with primary midline closure. Data was compiled in terms of operative period required, immediate post operative complications, post operative pain (VAS scores), work-off period, hospital stay and recurrences over a follow up of 3 years for the two study groups. Data thereby collected was analyzed by using Microsoft excel. The parameters in which the two techniques were found to differ significantly were work-off period, immediate post operative complications profiles and recurrence rates. Rhomboid excision with limberg flap reconstruction technique surely outscores elliptical excision with primary midline closure in certain important parameters. While facing a patient with uncomplicated sacrococcygeal pilonidal sinus, instead of, which procedure for the patient? Surgeons should pose the question why not rhomboid excision with limberg flaps reconstruction?

Conservative management of acute appendicitis.

BACKGROUND: The acute appendicitis is the most common abdominal emergency, and the primary treatment has been appendicectomy. Antibiotics are started preoperatively and continued postoperatively as needed. METHODS: This prospective study was carried out at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India to determine the role of antibiotics as the only treatment in acute appendicitis and the analgesic consumption needed. Total of 80 patients were included in the study with a duration of abdominal pain less than 72 h. Out of 80 patients, 40 patients received antibiotics intravenously for 2 days followed by oral treatment for 7 days, while another 40 patients considered as controls were randomized to surgery. RESULTS: Patients managed conservatively were discharged within 3 days except for two--patients who required surgery after 12 and 24 h, respectively, because of peritonitis due to perforated appendicitis. Four patients were readmitted within 1 year as a result of recurrent appendicitis and had to undergo surgery when appendicitis was confirmed. The diagnostic accuracy within the operated group was 90%. Two patients had perforated appendicitis at operation. CONCLUSION: Our conclusion is that antibiotic treatment in the patients with acute appendicitis is quite effective, and these patients may not need surgery. The patients managed conservatively with antibiotics alone experience less pain and require less analgesia but have high recurrent rate.

Delayed diagnosis of traumatic rupture of hydatid cyst of the liver--a case report.

We present a patient with slow rupture of hydatid cyst into the peritoneal cavity, presenting as massive abdominal distension and respiratory embarrassment. On paracentesis, no fluid could be drained. A small lateral incision was made under local anaesthesia to drain the 'ascites', but daughter cysts typical of hydatid came out. On laparotomy, there was a cyst in the right lobe of liver which had ruptured into the peritoneal cavity leading to secondary echinococcosis.

Ascaris liver abscess in children.

BACKGROUND: Liver abscess in childhood is a very challenging subject both for patients and doctors. In India, pyogenic liver abscesses have been found mostly in children, especially in rural areas. Liver abscess due to wandering ascarids is a common complication in children in Kashmir, although it is rare outside. METHODS: The study was carried over a period of 10 years at Sheri-Kashmir Institute of Medical Sciences Srinagar India. Ten cases of liver abscesses due to wandering ascarids in children were encountered. The children were aged 2 years to 13 years. RESULTS: 70% of the children were from rural areas. All ten patients presented with fever, while three patients presented with peritonitis. Ultrasonography was the main tool of diagnosis. All ten patients were managed by open surgical drainage. CONCLUSION: We conclude that Ascaris infestation should always be kept in mind while dealing with liver abscess in children.

Percutaneous aspiration versus open drainage of liver abscess in children.

Liver abscess, though a very grave problem, is rarely seen in infancy and childhood. Affected children are usually immunocompromised and are of poor socioeconomic status. Although liver abscess due to wandering ascarids is rare outside, it is common complication among children of Kashmir. Usual site of abscess is the right lobe of the liver and USG and CT of the abdomen are the main tools of diagnosis. The study was conducted over a period of 10 years from January 1991 to December 2000 and total of 129 cases were studied in the age group of 0-14 years. Diagnosis was made by a detailed clinical examination together with USG and CT of the abdomen. Out of 129 cases, 49 were treated with antibiotics alone, 55 cases were taken for open drainage, and 27 cases were taken for percutaneous aspiration under USG guidance. Percutaneous aspiration failed in five patients who were later taken for open drainage. Open method was found still to be the best modality of management, although percutaneous aspiration is safe and effective but needs lot of expertise.