Background
The aim of this study was to report on the application of a minimally invasive technique to the radical extirpation of primary and recurrent pilonidal disease. This technique does not ...require specific equipments, is ordinarily performed under local anesthesia on an outpatient basis, and provides optimal cosmetic results.
Methods
A total of 187 patients including 68% of patients with previous pilonidal surgery and 12% cases of extensive disease underwent surgery as day case. The series was thus reviewed in terms of perioperative data, time off daily activities, time to complete wound healing, and recurrence.
Results
Overall, the incidence of postoperative complications was 9%, with 2% being the relative rate of >grade I complications. The median time off school/work was of 2 days, while the median time to complete wound healing was 35 days. At a median follow-up of 16 months, the overall rate of disease recurrence was 5, 6%.
Conclusions
This analysis demonstrates that minimally invasive pilonidal excision is an effective option for pilonidal disease, also in the case of recalcitrant or extensive disease.
Abstract Background Pilonidal disease is a quite common chronic inflammatory disease that causes discomfort, embarrassment and absence from work or school. In line with its acquired pathogenesis, a ...number of surgical alternatives to conventional en bloc excision have been proposed over the last decades, yielding encouraging results. We reviewed our experience with minimally invasive sinusectomy to evaluate its safety and efficacy. Methods this study was a review of a prospectively maintained database of consecutive patients over a 7-year period. From November 2009 to December 2015, 2347 patients with pilonidal disease were operated on using the Gips procedure. Patients received surgery as a day-case procedure under local anesthesia. Operative and perioperative data were examined. Results there were 1714 men (73%) and 633 women (27 %) in the study; the median age was 19 years. Recurrent diseases in patients who had previously undergone surgery elsewhere composed 61% of cases. Globally, 102 cases of clinically relevant postoperative complication occurred (4.3%). At a median follow up of 16 months, the recurrence rate was 5.8 %. The treatment of recurrent disease did correlate to increased recurrence rate following sinusectomy. Recurrent patients were more likely to be male and have delayed wound healing. Conclusions the Gips procedure for the treatment of pilonidal disease is safe and feasible. It has a low complication and recurrence rate, early return to daily activities and offers a good cosmetic result.
The Cultures of Ancient Xinjiang, Western China: Crossroads of the Silk Roads unveils the ancient secrets of Xinjiang, western China, one of the least known but culturally rich and complex regions ...located at the heart of Asia. Historically, Xinjiang has been the geographic hub of the Silk Roads, serving international links between cultures to the west, east, north and south. Trade, artefacts, foods, technologies, ideas, beliefs, animals and people have traversed the glacier covered mountain and desert boundaries. Perhaps best known for the Taklamakan desert, whose name translates in the Uyghur language as 'You can go in, you will never come out', here the region is portrayed as the centre of an ancient Bronze Age culture, revealed in the form of the famous Tarim Mummies and their grave goods. Three authoritative chapters by Chinese archaeologists appear here for the first time in English, giving international audiences direct access to the latest research ranging from the central-eastern Xiaohe region to the western valleys of the Bortala and Yili Rivers. Other contributions by European, Australian and Chinese archaeologists address the many complexities of the cultural exchanges that ranged from Mongolia, through to Kashgar, South Asia, Central Asia and finally Europe in pre-modern times.
One of the least known but culturally rich and complex regions located at the heart of Asia, Xinjiang was a hub for the Silk Roads, serving international links between cultures to the west, east, ...north and south. Trade, artefacts, foods, technologies, ideas, beliefs, animals and people traversed the glacier covered mountain and desert boundaries.
Abstract Background In case of liver tumor, surgical resection is the therapeutic gold standard to increase patient survival. Among liver resections, right hepatectomy (RH) is defined as a major ...hepatectomy. The first aim of this study was to analyze the overall morbidity and mortality of patients undergoing RH, the second aim was to assess changes in both patients characteristic and surgical parameters and mortality rates in a single center institution. Materials From 2001 to December 2015, 225 RH were performed in our center. We analyzed two time period: 2001–2007 and 2008–2015. Results Ninety days post operative mortality was observed in 9 cases (4%) for the overall cohort. We observed a difference between the two groups in the use of Pringle Maneuver (p < 0,001). This result is consistent in each major surgical indication: HCC (p = 0,001), CLM (p = 0,015) and BT (p = 0,015). The estimated blood losses improved (p = 0,028), particularly for the HCC cases (p = 0,024). No difference was observed in terms of number of transfusions received between the two groups. Reduced length of stay was observed in the second group (p < 0,001), more markedly for CLM cases (p = 0,001). Conclusion To further improve the outcomes of RH, it is important to performed this major hepatectomy in hepatobiliary centers with an overall liver resection experience of at least few hundred cases.
Despite the technical difficulties, laparoscopic ileocolic resection for Crohn’s disease (CD) has become widely accepted in recent years, due to its potential benefits. There are numerous reports ...concerning the use of laparoscopy in successfully treating CD, including two randomized trials and few comparative studies. For the most part, these reports outline use of laparoscopic approach in primary distal ileal or ileocolic disease, with a careful selection of the patients. The purpose of this comparative case–control study was to point out potential advantages and disadvantages in short- and long-term outcomes of the laparoscopic approach compared with the open one. From January 1999 to January 2004, 200 patients were admitted in our Surgical Unit for complicated primary CD. 100 patients (group 1) underwent a laparoscopic ileocolic resection, 100 patients (group 2), with alike demographic and clinical characteristics, underwent the same procedure using a traditional approach. The incidence of perforative disease was 32 and 40% in groups 1 and 2, respectively. Average operative time was 140 min (range 90–245 min) in the video-assisted group and 98 min (range 65–255 min) in group 2 (
P
< 0.05). Postoperative morbidity was 6 and 8% in groups 1 and 2, respectively (
P
= NS). Recovery of peristalsis occurred within 2–3 days in group 1 and 3–4 days in group 2 (
P
= NS). Median postoperative hospitalization was 7 days (range 5–18 days) in group 1 and 9 days (range 7–22 days) in control group (
P
< 0.05). The overall rate of surgical relapse of CD was 8 and 13% in groups 1 and 2, respectively (
P
= NS), at a mean follow-up of 52 and 60 months, respectively. The 1-year surgical recurrence rate was similar (3%) for the two groups. In conclusions, in spite of the technical difficulties, video-assisted surgery for CD offers advantages over laparotomy, including less postoperative pain, reduced postoperative hospital stay, less disability of the patient, and better cosmetic results. Potential advantages are: easier approach for re-resection, lower rate of postoperative adhesions and bowel obstruction, and lower rate of wound complications.
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