Fascio-Adipo-Cutaneous Lateral Advancement Flap for Treatment of Pilonidal Sinus: A Modification of the Karydakis Operation-Cohort Study.

BACKGROUND: Pilonidal sinus is a common chronic disease affecting young adults. Many surgical procedures have been developed for its treatment, but an optimal one has still not been achieved. This study presents a modification to the Karydakis operation. METHODS: A total of 265 patients with chronic pilonidal sinus between May 2008 and May 2015 were included in this study and submitted to fascio-adipo-cutaneous lateral advancement flap as 1-day case surgery. Any Septic complication was treated firstly. Follow-up examinations were conducted during the first three postoperative months at the outpatient clinic at regular intervals and thereafter by phone calls or direct examination to check for recurrences. RESULTS: Males constituted 93.6% with a mean age of 21.6 ± 7.7 year. The median disease duration was 15 months. Twenty-eight patients had recurrent disease. The mean operative time was 41.4 ± 12.7 min. The mean time out of work was 11.6 ± 4.6 days. Complications occurred in 19 patients (7.1%) in the form of seroma in six patients (2.2%), superficial wound infection occurred in nine patients (3.3%), cuticular wound disruption occurred in four patients (1.5%). All patients completed 3-months follow-up, but 48 patients were lost at variable intervals with the remaining 217 patients completed follow-up throughout the period of the study with a median follow-up of 43 months. No reported recurrence and 96.7% of the patients were satisfied about their wound. CONCLUSION: This modification is simple with low complication rate, no recurrence, and excellent patient satisfaction.

Prophylactic preperitoneal mesh placement in open bariatric surgery: a guard against incisional hernia development.

BACKGROUND: Incisional hernia is one of the most common late complications of open bariatric surgery. The aim of this study was to assess the safety and efficacy of preperitoneal prosthetic enforcement of midline incisions during open bariatric surgery in preventing incisional hernia development. METHODS: This study randomized 64 morbidly obese patients admitted to undergo open bariatric surgery into two equal groups (I and II). A prophylactic sheet of polypropylene mesh was fixed in the preperitoneal space during wound closure in group I while in group II the wound was closed conventionally. RESULTS: This study included 51 females and 13 males ranged in age from 19 to 60 years. No significant difference was observed in mean age, mean preoperative body weight, mean body mass index, mean hospital stay, and mean follow-up period of either group. Three open procedures were done: vertical banded gastroplasty, Roux-en-Y gastric bypass, and vertical sleeve gastrectomy. No significant difference in mean operative time in either group for each operation was noted. Early postoperative wound complications were similar in either group. Incisional hernia incidence was significantly higher in group II, nine cases (28.1%), than in group I, one case (3.1%). CONCLUSIONS: Using prophylactic preperitoneal Prolene mesh during wound closure in open bariatric surgery is safe and effective in preventing incisional hernia development.