Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.

PURPOSE: This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. METHODS: From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts. RESULTS: One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years. CONCLUSIONS: Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.

Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of single versus double mesh laparoscopic totally extraperitoneal repair.

The aim of this study was to compare the double and the single mesh techniques, both used in the laparoscopic totally extra peritoneal (TEP) repair of bilateral inguinal hernia. Sixty-five patients with bilateral inguinal hernia were enrolled in a prospective, randomized trial comparing the single and the double mesh techniques. The single and the double mesh techniques compared favorably in terms of operating time, long-term morbidity, hospital stay, time for return to work, postoperative quality of life and recurrence rate. However, the cost of a single, large prosthesis was 38% to 40% lower than that of 2 small ones. The laparoscopic TEP repair of bilateral inguinal hernia with a large, single prosthetic mesh is a technically simple and safe procedure, which offers clear cost savings and a potentially shorter operating time over the double mesh repair. It is strongly recommended for the routine, laparoscopic TEP repair of bilateral inguinal hernias.

Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients.

BACKGROUND: It is generally accepted that most inguinal hernias should be operated on electively in order to avoid the high morbidity and mortality associated with incarceration and small bowel obstruction. The present study reassesses the indication for surgery in asymptomatic inguinal hernia patients. METHODS: We analyzed profiles, separately, for elective and emergency inguinal herniorrhaphies and compared the morbidity and mortality rates. RESULTS: Two hundred randomly selected elective hernia repairs were compared with 67 incarcerated cases. Postoperative complications were more common following emergency (23.9%) than elective repair (10.5%); however, in both groups, minor complications predominated. The mortality rate in the incarcerated group (6%) was clearly linked with a high preoperative American Society of Anesthesiologists (ASA) score. A bowel resection rate of 4.5% was found in the incarcerated cases, which was not correlated with mortality. CONCLUSIONS: Patients with asymptomatic inguinal hernia and unfavorable medical conditions should be recommended an elective repair, preferably under local anesthesia, to avoid the high mortality associated with an emergency operation.