Pilonidal sinus: a comparative study of treatment methods.

INTRODUCTION: Pilonidal disease is a very common anorectal problem without a clinical consensus on its optimal management. OBJECTIVE: To compare the methods used by our clinic and determine the outcomes in relation to healing, hospitalization time and recurrence. MATERIALS AND METHODS: We have studied all the cases of patients with pilonidal sinus that were treated surgically in our clinic from January 1, 1997 to December 31, 1999. RESULTS: A total of 111 patients were treated of whom 92 (82,8%) were men and 19 (17,2%) were women. Ages ranged from 16 to 65 years with an average age of about 25,1 years. Of the 111 patients, 63 were treated with marsupializationand the remaining 48 were treated by excision (29 with open excision and 19 with the primary suture technique). One hundred and two (91,9%) patients were discharged from the hospital after the surgical procedure, while the remaining 9 patients were hospitalized for 24 hours. The healing time for marsupialization was 27,3 days, the primary suture technique was 11,7 days and the open excision method took 46,4 days. Recurrence was observed in 16 patients (14,4%). Recurrence appeared in 4 (6,35%) of the 63 patients subjected to marsupialization, 1 of the 29 patients subjected to open incision, and 11 (57,8%) of the 19 patients subjected to primary closure. CONCLUSION: In the absence of inflammation and/or recurrence, marsupialization is the surgical method of choice as it has a low percentage of recurrence and an acceptably short healing period.In apparently large, inflamed and recurrent situations, open excision is preferred.

Hernia mesh repair of the anterior abdominal wall and antibiotic chemoprophylaxis: multiple doses of antibiotics failed to prevent or reduce wound infection.

BACKGROUND: Mesh repair of the anterior abdominal wall hernias is a popular technique and commonly accepted among the majority of surgeons. The technique used most frequently today is the free tension technique. It is uncertain whether antibiotic prophylaxis is necessary to prevent post operative wound infection, especially when a foreign body like a polypropylene mesh is used. METHODS: We have studied retrospectively the patients who received surgical treatment in our department for anterior abdominal wall hernia during the period of January 1995 -December 2004. Patients were divided into 3 groups based on the doses of antibiotics administered. RESULTS: In 780 out of 1245 cases, a mesh of polypropylene was used. In our sample, we excluded 221 patients due to diseases that made the use of antibiotics necessary. We have studied the frequency of superficial and deep infections in correlation with the use of antibiotics (cephalosporin of second generation or a combination of ampicillin plus sulbactam). CONCLUSION: No difference was observed in the incidence of surgical trauma infection in relation to the duration and the doses of antibiotic cover. The wound infection rate in the current study does not support the use of multiple doses of antibiotics, as this rate does not differ from the rates of infection reported in the literature. Further studies are needed to clarify if antibiotic chemoprophylaxis with one dose or no chemoprophylaxis should be recommended.

Intraperitoneal administration of local anesthetics in laparoscopic surgery: pharmacological, anatomical, physiological and pathophysiological considerations.

Local anesthetics, because of their ability to cause a reversible blockade in transmission of impulses along the central and peripheral neural pathways are used to induce analgesia. In laparoscopic surgery procedures, the reduction of postoperative pain is one of the biggest benefits compared with open surgery. However, the pain is not completely absent after laparoscopic surgery. The intraperitoneal administration of local anesthetic intraoperatively in laparoscopic surgery can reduce the intensity of postoperative pain. This method has been in use since the early nineties and seems to be effective. The purpose of this review is to assess the pharmacology of local anesthetics, the anatomy and physiology of the peritoneum, the physiology of preemptive analgesia, and the pathophysiology of pain and review the data from the use of this method so as to make it more effective. For the safest and longest intraperitoneal administration of local anesthetics the following significant points must be taken into consideration: administration of local anesthetic should be done at the beginning, in short-term intervention and both at the beginning and end of surgery for longer-term intervention, administration of local anesthetic should be combined with a vasoconstrictor, usage of solutions of small volume and high concentration of local anesthetic, coverage of the greatest possible surface of the parietal peritoneum (by using a nebulizer), adherence to a waiting period of 10-15 minutes after administration of local anesthetic and usage of a safe and longer duration local anesthetic like levobupivacaine.

Primary gallbladder cancer discovered postoperatively after elective and emergency cholecystectomy.

BACKGROUND: Gallbladder cancer is a rare neoplasm associated with high mortality and poor prognosis. It is usually correlated with cholelithiasis and presents more commonly in elderly and female patients. Diagnosis is seldom made preoperatively because of the indolent progression of the tumor. METHODS: The hospitalization and surgical records of our surgical department were examined from January 1992 to December 2001, searching for patients who had undergone cholecystectomy. Additionally, the histopathological diagnoses of the same period were studied searching for patients with the diagnosis of gallbladder cancer established post-operatively and not intraoperatively by frozen section. RESULTS: In the period of 1992- 2001, a total of 1,536 cholecystectomies took place and 14 cases of gallbladder cancer were diagnosed postoperatively. The ratio of men to women is 3/ 11 with a mean age of 69.4 years. The clinical symptoms were nonspecific and mortality was 57%. CONCLUSION: In most cases gallbladder cancer is diagnosed after cholecystectomy and even in these cases it can be in an advanced stage and the prognosis of this rare neoplasm is poor.