Endoscopic Pilonidal Sinus Treatment: A Tertiary Care Academic Center Experience.

Background: Pilonidal disease (PD) represents one of the most common proctological diseases in young adults. Although several approaches to treating PD have been described, there is still a lack of agreement on which is the best. The aim of this study was to evaluate the long-term efficacy of endoscopic pilonidal sinus treatment (EPSiT) at a tertiary care academic center. Methods: Between June 2017 and January 2021, a total of 32 patients [12 women (37.5%) and 20 men (62.5%)] with a mean age of 29.22 ± 12.98 years were treated with EPSiT. Pre- and post-operative symptoms were assessed with a score of 0-5. Success was defined as the absence of any subjective symptoms, as well as by complete post-operative wound healing. Results: Most of the patients had a midline external opening (17/32; 53.1%), with a mean number of external openings of 2.41 (1-4) ± 1.04. The median post-operative pain score was 0, and the mean follow-up period was 22 (4-42) ± 11.49 months. The time to wound healing was reduced in patients with one opening (28.14 ± 4.06 days) compared to patients with two or more openings (33.64 ± 7.3 days) (p = 0.067). The mean operative time was longer in patients who subsequently had a recurrence (41.75 ± 6.24 vs. 34.18 ± 6.24 min; p = 0.031). The overall success rate was 87.5% (28/32), and the mean time to recurrence was 3.25 (2-5) ± 1.26 months. Conclusions: EPSiT represents a viable option for the treatment of PD. More evidence and a longer follow-up period are needed to validate the results.

Excisional Haemorrhoidectomy: Where Are We?

Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most frequent and ancient anorectal conditions. Bleeding, during or after defecation, is the most common symptom. The color of the blood is typically bright red covering the outer surface of the stools. The severity of HD is based on the degree of the prolapse. There are several excisional surgery treatments. In this review, we describe the most common techniques such as Milligan and Morgan, Parks, Ferguson and Whitehead technique. Despite significant improvements in conservative treatments, excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree.

PPH vs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse.

BACKGROUND: The aim of this study was to assess the early and late complications of haemorrhoidectomy according to Milligan-Morgan (Milligan-Morgan laser optical fibers variant) vs haemorrhoidopexy with PPH-stapler and to assess the long-term results in terms of recurrences in circumferential prolapse patients classified P4-E4 (PATE 2000). METHODS: Onehundredsixty patients, with haemorrhoidal disease classified P4-E4, who underwent surgery between 2001 and 2007, were included in an retrospective observational study. Group A (M-M laser fibre) 80 patients (50%) (50 Male, 30 Female; median age 39 years, range 23-57 years). Group B (PPH-Stapler) 80 patients (50%) (58 Male, 22 Female; median age 40 years, range 23-60 years). RESULT: Early complications were thrombosis (6 cases in M-M vs 1 in PPH) and urinary retention (13 M-M vs 5 PPH). There weren't cases of sepsis. Late complications have been: occasional bleeding 13.5 % in the M-M-group vs 10 % in the PPH-group; defecatory urgency 2.5 % (M-M-group) vs 5% (PPH-group) with p < 0.1; persistent pain 2.5 % (M-M) vs 5 % (PPH) with p < 0.1; soiling 18.75 % (M-M) vs 0 % (PPH) with p < 0.001; recurrences 5 % in PPH-group vs 0 % in M-M (p < 0.05); residual disease 7.5 % in M-M-group vs 0 % in PPH p < 0.01. CONCLUSIONS: PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement, but may be followed by severe complications. We think that it has a clear indication in the treatment of haemorrhoidary disease with circumferential prolapse classified P4-E4.

PPH vs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse.

BACKGROUND: The aim of this study was to assess the early and late complications of haemorrhoidectomy according to Milligan-Morgan (Milligan-Morgan laser optical fibers variant) vs haemorrhoidopexy with PPH-stapler and to assess the long-term results in terms of recurrences in circumferential prolapse patients classified P4-E4 (PATE 2000). METHODS: Onehundredsixty patients, with haemorrhoidal disease classified P4-E4, who underwent surgery between 2001 and 2007, were included in an retrospective observational study. Group A (M-M laser fibre) 80 patients (50%) (50 Male, 30 Female; median age 39 years, range 23-57 years). Group B (PPH-Stapler) 80 patients (50%) (58 Male, 22 Female; median age 40 years, range 23-60 years). RESULT: Early complications were thrombosis (6 cases in M-M vs 1 in PPH) and urinary retention (13 M-M vs 5 PPH). There weren't cases of sepsis. Late complications have been: occasional bleeding 13.5 % in the M-M-group vs 10 % in the PPH-group; defecatory urgency 2.5 % (M-M-group) vs 5% (PPH-group) with p < 0.1; persistent pain 2.5 % (M-M) vs 5 % (PPH) with p < 0.1; soiling 18.75 % (M-M) vs 0 % (PPH) with p < 0.001; recurrences 5 % in PPH-group vs 0 % in M-M (p < 0.05); residual disease 7.5 % in M-M-group vs 0 % in PPH p < 0.01. CONCLUSIONS: PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement, but may be followed by severe complications. We think that it has a clear indication in the treatment of haemorrhoidary disease with circumferential prolapse classified P4-E4.

[Thyroid microcarcinoma and multinodular struma. Personal experience and considerations regarding surgical therapy]. / Frequenza di microcarcinoma tiroideo in gozzo multinodulaxe. Esperienza personale e considerazioni sugli aspetti chirurgici.

Thyroid microcarcinoma is a malignant papillary tumour of the thyroid gland measuring < or = 1.0 cm in diameter. Prognosis and treatment are controversial. We report on a personal series of 28 cases of thyroid microcarcinoma observed over the period from 2000 to 2004. From 2000 to 2004, 199 consecutive total thyroidectomies were performed in patients with multinodular struma. The histological diagnosis was made by a pathologist according to the recommendations of the World Health Organization by means of sections of the thyroid gland of no more than 2 mm. At routine histological examination, 28 cases (14.07%) of "incidental" thyroid microcarcinoma were found. The mean tumour size was 4.10 mm (range: 0.12 to 10 mm). The tumours were multifocal in 2 patients, and none presented lymph node metastases. Thyoid microcarcinoma is a malignant tumour associated with a good prognosis. Multifocality should be the main factor considered in selecting the type of thyroid surgery. A total thyroidectomy may be regarded as sufficient treatment.