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Rhomboid excision and limberg flap reconstruction for pilonidal disease

May 2018 AEMED 164 Views

Aim: Pilonidal sinus is a common disease that affects generally younger patients and occurs mostly in the sacro-coccygeal region. The main treatment of
pilonidal sinus is still controversial. This study aimed to evaluate the usefulness and surgical results of Limberg flap reconstruction in pilonidal sinus disease.
Material and Method: Between January 2012 and January 2017, 78 patients were operated on electively and rhomboid excision with Limberg flap reconstruction
was performed for pilonidal sinus disease in our clinic. Demographic features, clinical data, operative findings, postoperative complications, and patient
follow-up were retrospectively analyzed. Results: The mean age of the patients was 27.91± 6.49 years. Out of the 78 patients, 59 (75.6%) were male and 19
(24.4%) were female. The mean duration of symptoms was 5.38 months (2-13 months) and the mean operative time was 68.4 ± 18.7 min. The median amount
of blood loss during surgery was 75 ml (range from 30 to 200 ml). The mean hospital stay was 7.79 ± 1.85 days. In the postoperative period, recurrences were
noted in only 2 (2.56%) patients in the follow-up period, which ranged from 1 to 6 years. Discussion: Limberg flap is an efficient and easy technique with less
complication. It is especially useful in patients with large diseased pilonidal sinus tissue and multiple sinuses with lateral openings. This technique results in a
reduced hospital stay and recurrence rate which means that the patients can go back to their daily lives sooner.

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Simultaneous combined spinal epidural anesthesia technique without catheter

May 2018 AEMED 138 Views

Aims: The extension of spinal anesthesia by extradural injection has been identified as a modification of the combined spinal-epidural anesthesia. Epidural
volume extension (EVE) is a rescue strategy that can raise the level of insufficient post-spinal sensory block. Material and Method: After approval of Adnan
Menderes University Ethics Committee (Decision 2016/834/37), the data of 455 patients who had undergone insufficient simultaneous combined spinal epidural
without catheter between 2010 and 2016 were retrospectively analyzed in terms of ASA scores; demographic and hemodynamic data; surgery type; preoperative
and postoperative sensory and motor block levels; operation onset times after anesthesia; need for peroperative additional anesthesia, vasopressor
(ephedrine) and atropine; and postoperative pain onset times. Results: Of the 455 patients, there were two groups. In the first group, there were 238 patients
who had undergone cesarean section and in the second group there were 217 patients who had undergone surgery for inguinal hernia. There was no mortality
and morbidity in any group. There was a statistically significant decrease in heart rate, systolic, diastolic, and mean arterial pressures during the peroperative
period in both groups (p<0.05). Discussion: The simultaneous combined spinal-epidural technique (sCSEA) without catheter may be considered as an alternative
to conventional methods for appropriate surgeries. It can be safely used with local anesthetic combinations instead of saline for EVE. The advantages and
disadvantages of EVE compared to the conventional method should be demonstrated with clinical randomized studies.

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Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

May 2018 AEMED 135 Views

Aim: Laparoscopic colorectal surgery has become widely performed in many centers today. We planned to present the first 65 cases in our clinic. Material and
Method: Sixty-five patients who underwent laparoscopic colorectal surgery between September 2014 and March 2018 were retrospectively reviewed. Cases
returning open surgery despite laparoscopic onset were excluded from the study. Demographic data, operative types, duration, tumor stages were recorded.
Results: 65 cases were included, 39 were male (60%), 26 were female (40%), mean age was 63.2 (40-81). Low anterior resection (LAR) in 20 cases (%30.7),
anterior resection (AR) in 19 cases (29,2%), right colectomy in 18 cases (27,6%), abdomino-perineal resection (APR) in 5 cases (7,7%), colloanal anastomosis
in 2 cases, total colectomy in 1 case (1.6%) were performed. It have been showed anastomotic leakage in 3 cases (4,6%), wound infection in 10 cases
(15.3%), 3 patient incisional hernia (4,6%), ureter injury in a patient (1.5%) and urethra injury in a patient (1.5%). There was no mortality. Discussion: Although
our experience with laparoscopic colorectal surgery is compatible with the literature and is not yet gold standard, we think that it gives better results than
open surgery due to its advantages.

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