Diathermy versus scalpel in Limberg flap in pilonidal sinus surgery. A prospective randomized trial.

BACKGROUND: Rhomboid excision with Limberg flap repair (RELIF) is an effective surgical procedure in pilonidal sinus disease (PSD) treatment. This study aimed to compare outcome of diathermy and scalpel in RELIF procedure in PSD surgery. METHODS: Patients undergoing RELIF procedure due to PSD at Adana Numune Training and Research Hospital between January 2012 and September 2012 were randomly assigned to diathermy (n=30) or scalpel (n=30) groups. The primary outcomes measured were duration of operation, drainage volume, postoperative numerical pain intensity scale (NPIS) scores, complications, duration of hospitalization length and time to return to daily activity. RESULTS: The mean age was 26.2 years (17-44 years). The mean operation duration was significantly lower in diathermy group (p=0.0001). Postoperative total NPIS score within the first 24 h was significantly lower in diathermy group (p=0.001). However, there were not any significant differences in term of NPIS scores in day 3 and day 7. There were no significant differences in terms of total drain output, drain removal time and length of hospital stay. There were no significant differences between groups in terms of duration to sit comfortably, return to daily activity and work. Recurrence of PSD was emerged in one patient in the diathermy group. CONCLUSION: Diathermy dissection in RELIF procedure in pilonidal sinus surgery is a safe technique and decreased operation time and postoperative pain.

Comparison of APACHE II, P-POSSUM and SAPS II scoring systems in patients underwent planned laparotomies due to secondary peritonitis.

BACKGROUND: The first aim of this study was to discuss the factors affecting mortality rate in patients with severe intraabdominal sepsis treated with planned relaparotomy. The second aim was to compare APACHEE II, P-POSSUM and SAPS II scoring systems to allow identification of high-risk patients. MATERIAL AND METHODS: A series of 34 patients who had intra-abdominal sepsis and treated with planned relaparotomy between January 2009 and January 2012 were included the study. The source of the peritonitis, type and number of surgical procedures, number of planned relaparatomies, microbiology surveillance, total intensive care unit (ICU) and hospital stay duration, number of intubated days, morbidity and mortality were analyzed. APACHEE II, SAPS II, P-POSSUM scores and estimated mortality ranges at admission were compared. RESULTS: The mean age was 46 (16-76 years) and 73.5 % (n=25) were male. A total of 119 operations and 50 surgical procedures were performed. The overall mortality rate was 20.6% (n=7). Complications developed in %53 (n=18) of the patients. Mortality was higher in upper GIS leaks (6/20 versus 1/14 patients). Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II and P-POSSUM were 0.958, 0.955 and 0.931, respectively. The highest values for sensitivity (100%) and specivity (85.2%) together were reached in APACHE II, when cut off value for it was set to 20.5. The SAPS II and P-POSSUM physiology scores were correlated with overall hospital stay (p=0.022 r=0.438 and p=0.001 r=0.609 respectively), but this correlation was not found for APACHEE II score (p=0.085 r=0.337). However, all three scoring systems provided clear estimation of ICU stay duration. CONCLUSION: We suggest that, in secondary peritonitis patients reserved for planned relaparotomy, APACHE II is more reliable for prediction of mortality and P-POSSUM scoring system is more reliable for prediction of overall hospital stay duration.

Prevention of bacterial translocation using glutamine and melatonin in small bowel ischemia and reperfusion in rats.

BACKGROUND: Ischemia/reperfusion (IR) injury of the intestine is a major problem in abdominal pathological condition and is associated with a high morbidity and mortality. The purpose of the study is to determine whether glutamine and melatonin can prevent BT of small intestinal IR injury in rats. METHODS: Forty Wistar-albino rats with a weight of 200 to 250 g were used in the study. They were randomly divided into four groups (n=10 for each group): sham operated group (Group I), IR group (Group II), IR+ glutamine treatment group (Group III) and IR+ melatonin treatment group (Group IV). All animals were given 10(10) E. Coli by orogastric intubation 12 hours before sampling. Seventy-two hours after the first operation, mesenteric lymph node and blood samples were obtained and cultured Two cc blood samples were obtained for a Polymerase chain reaction study. A piece of terminal ileum was also sampled for histopathologic examination. RESULTS: Mesenteric lymph node and blood cultures of all control animals were positive for microbiological growth, and polymerase chain reaction results were positive in seven of the eight rats. Histopathologically, edema, vasodilatation and inflammatory cell infiltration were found to be less in the other groups in comparison to the control group. The incidence of bacterial translocation was decreased in all treatment groups as compared to the control group. CONCLUSIONS: Glutamine and Melatonin reduced the incidence of BT in intestinal I/R. rats. These results suggest that glutamine and melatonin would be clinically useful in the treatment of intestinal I/R injury.