Seroma Accumulation Research Articles

Persistent Seroma After Abdominoplasty in a Massive Weight-Loss Patient

Furosemide (Lasix) is a common diuretic used for the treatment of postoperative edema. However, caution is advised in post-bariatric patients as many are known to be deficient in albumin, which is a necessary component for Furosemide to bind allowing the adherence of interstitial fluid leading to the excretion of water. This case report discusses identifying such nutritional deficiency and switching to a less common alternative, with proven benefits in the reduction of seroma formation and tissue edema. It is important to plan accordingly in these post-bariatric patients by obtaining preoperative lab values and encouraging preoperative protein intake of 60 g/day at minimum. If patients present with persistent postoperative seroma accumulation, serial albumin levels are helpful to identify the need for using alternative diuretic medications. An example is the use of Torsemide (Demadex); a synonymous loop diuretic with a higher bioavailability and a longer half-life compared with Furosemide. This adjustment was key in resolving our patient’s persistent seroma and accompanying symptoms.

Toward Drainless Breast Reconstruction: A Pilot Study.

Background:Implant-based breast reconstruction with immediate tissue expander placement is the predominant form of breast reconstruction in the United States. Closed-suction drains are frequently employed to minimize seroma accumulation, although they carry the risk of serving as a port of entry for bacteria, posing a concern in the presence of implanted materials such as breast implants or acellular dermal matrix. Introduction of a dual-port tissue expander designed to facilitate the collection and removal of seroma fluid provides a new way of performing breast reconstruction without external drains.Methods:We conducted a pilot study using the AlloX2 dual-port expander on five consecutive patients to demonstrate feasibility of this approach at Cedars-Sinai Medical Center by the two senior authors (E.R. and D.K.).Results:Patients averaged seven clinic visits before they were ready for expander exchange, totaling a mean of 137.5 days. Patients averaged 1.9 clinic visits before output was less than 40cm3 (1.6 for right breasts and 2.2 for left breasts), with two of the patients never reaching that output. There was one complication; a single patient had unilateral flap necrosis and implant exposure due to excessively large breasts and thin skin flaps, necessitating expander removal and latissimus flap reconstruction. The other four patients underwent successful implant reconstruction.Conclusions:This pilot study demonstrates the feasibility of breast reconstruction without external drains using a dual-port expander with built-in seroma reservoir. From these results, it is apparent that dual-port tissue expanders with built-in seroma reservoir offer a safe and effective way to perform breast reconstruction without drains in appropriately selected patients. A larger prospective cohort will be needed to definitively demonstrate lower infection and reconstructive failure rates.

Randomized Clinical Trial for Comparison of Drain Versus no Drain Thyroidectomy

Drains have been traditionally used routinely after thyroidectomy despite limited evidence to suggest any benefit. In many facilities, drains are routinely inserted after thyroidectomy with the aim of preventing hematoma formation and accumulation of seroma. Objective: To compare the outcome of drain versus no drain after thyroidectomy in patients presenting with clinically benign lesions of thyroid Methods: Study design is Randomized control trail. Settings are Department of Surgery, Mayo University Hospital Ireland. Study was completed in 6 months after the approval of synopsis 13-07-2015 to 31-05-2016. After taking approval from Hospital Ethical Committee, 60 patients fulfilling the inclusion criteria were selected from ward of Department of Surgery, Mayo University Hospital Ireland. Informed consent was taken. The demographic information was obtained. Patients were randomly divided in two groups by using lottery method. In group A, drain was inserted after surgery while in group B, no drain was inserted. All surgeries were done by a single surgical team. After surgery patients were shifted to ward and were followed-up there. At time of discharge, duration of hospital stay was noted. Patients were advised to follow-up in OPD after 7 days of surgery. Patients were assessed for seroma and hematoma formation. Results: Mean age of women in Group-A and in Group-B was 43.73±10.51 years and 40.23±9.07 years. In Group-A there were 13(43.3%) male and 17(56.7%) females while in Group-B there were 18(60%) male and 12(40%) females. In Group-A mean hospital stay of patients was 5.80±1.42 days and in Group-B mean hospital stay of patients was 3.76±1.10 days. In Group-B patients rate of hematoma and seroma formation was low as compared to that of Group-A patients but this difference was not statistically significant. Conclusion: Outcome of thyroidectomy is better in terms of shorter hospital stay, and other post operative complications in patients without drain. Now the controversy is clear that thyroid surgery without drain results in good outcome for patients. So there is no beneficial aspect seen in patients with the use of drain after thyroidectomy. Keywords: Thyroidectomy, outcome, drain, benign lesions, thyroid disease.

Effect of the Trendelenburg position on the homeostasis during and post thyroidectomy

Introduction: Thyroidectomy is one of the most common surgeries that can be accompanied by postoperative hematoma. The present study aimed to evaluate the impact of the Trendelenburg position on the homeostasis of the surgery site during and after thyroidectomy. Methods: This clinical trial was performed on 60 euthyroid patients in the age range of 18-70 years within 2019-2021. Patients were randomly assigned to the two groups of routine surgery and Trendelenburg using a table of random numbers. The primary outcome was the number of bleeding points immediately after the Trendelenburg position, and secondary outcomes included demographics, final pathology, postoperative hematoma, duration of operation, rate of fluid and seroma accumulation, and patient satisfaction. Data were analyzed in SPSS software (version 19) using Mann Whitney, Chi-square, and Fisher’s exact test. The significance level was set to 5%. Results: The mean age of the patients was 40±13 years, and the majority of them (n=48) were female. The mean number of bleeding points identified intraoperatively was significantly higher in the Trendelenburg group, as compared to that in the routine surgery group (8.7±3.8 vs 5.4±1.8; P<0.001). In the Trendelenburg group, the mean scores of intra-operative blood loss and duration of operation were obtained at 6.4±1.8 g and 118.0±32.0 min, respectively. Conclusion: As evidenced by the obtained results, the Trendelenburg position significantly increased the number of bleeding points in patients undergoing thyroidectomy; nonetheless, it had no effect on the amount of bleeding and operation duration.

Comparison of Axillary Exclusion Versus no Exclusion on Seroma Formation after Modified Radical Mastectomy

Background: Accumulation of seroma in axilla and under mastectomy flaps is a common side effect after axillary lymph nodes dissection in mastectomy, which requires repeated aspirations and prolonged stay of the drain causing discomfort to person. Objective: To determine the effectiveness of axillary exclusion technique versus no axillary exclusion in Modified Radical Mastectomy in terms of mean drain output. Study Design: Randomized control trial. Settings: The study was conducted in department of Surgery, Allied Hospital Faisalabad Pakistan. Duration: 1 year from August 08, 2018 to August 07, 2019. Methodology: After permission from Hospital Ethical Review Committee, 60 Patients presenting for mastectomy were included in the study. They were randomly divided into two equal groups of 30 patients each applying computer generated random number table. Group A (underwent axillary exclusion) and Group B (did not undergo axillary exclusion) after modified radical mastectomy. Total amount of fluid collected in drain bag postoperatively was noted till the removal of drain and compared between the groups. Data was entered in a pre-designed proforma. Results: Comparison of axillary exclusion technique with no exclusion after modified radical mastectomy was done, it showed that the mean of the total drain output (+SD) in Group A was 1112.4ml (+66.78) whereas mean output in Group-B was 2184ml (+117.06). (Table No.1). p-value was <0.001 showing a considerable decrease in the total volume of the seroma fluid drained between the two groups. Conclusion: Study concluded that the axillary exclusion technique significantly reduces drain output in patients following modified radical mastectomy as compared to those who do not undergo axillary exclusion.

Local Triamcinolone Treatment Affects Inflammatory Response in Seroma Exudate of Abdominoplasty Patients: A Randomized Controlled Trial.

As the leading complication of abdominoplasty, seroma formation might represent an inflammatory process in response to surgical trauma. This prospective randomized trial investigated whether local administration of the antiinflammatory agent triamcinolone could prevent seroma accumulation. Weekly and cumulative seroma volumes were compared between the study groups A, B, and C over a 4-week follow-up (group A, with drain, without triamcinolone; group B, without drain, without triamcinolone; group C, without drain, with triamcinolone). Aspirated seroma samples were analyzed by enzyme-linked immunosorbent assay for selective inflammatory mediators. Triamcinolone significantly reduced cumulative seroma volume (n = 60; mA 845 ± SDA 578 ml, mC 236 ± SDC 381 ml, p = 0.001). The most accentuated suppressive effect of triamcinolone was observed shortly after the treatment (week 1) (mA1 616 ± SDA1 457 ml, mB1 153 ± SDB1 161 ml, mC1 22 ± SDC1 44 ml, pA1/C1 < 0.001, pB1/C1 = 0.014). Local triamcinolone administration resulted in a differential concentration of interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9 (week 1) in seroma exudate as measured by enzyme-linked immunosorbent assay (mIL-6A1 1239 ± SDA1 59 pg/ml, mIL-6C1 848 ± SDC1 80 pg/ml, p < 0.001; mMMP-9A1 2343 ± SDA1 484 pg/ml, mMMP-9C1 376 ± SDC1 120 pg/ml, p = 0.001). Local administration of 80 mg of triamcinolone reduced postabdominoplasty seroma accumulation significantly. Under triamcinolone treatment, suppressed levels of IL-6 and MMP-9 in seroma fluid were observed. Notably, inflammatory marker suppression correlated clinically with a decrease in seroma accumulation. Therapeutic, II.

Chromosome 20 loss is characteristic of breast implant–associated anaplastic large cell lymphoma

AbstractBreast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of T-cell lymphoma that is uniquely caused by a single environmental stimulus. Here, we present a comprehensive genetic analysis of a relatively large series of BIA-ALCL (n = 29), for which genome-wide chromosomal copy number aberrations (CNAs) and mutational profiles for a subset (n = 7) were determined. For comparison, CNAs for anaplastic lymphoma kinase (ALK)− nodal anaplastic large cell lymphomas (ALCLs; n = 24) were obtained. CNAs were detected in 94% of BIA-ALCLs, with losses at chromosome 20q13.13 in 66% of the samples. Loss of 20q13.13 is characteristic of BIA-ALCL compared with other classes of ALCL, such as primary cutaneous ALCL and systemic type ALK+ and ALK− ALCL. Mutational patterns confirm that the interleukin-6–JAK1–STAT3 pathway is deregulated. Although this is commonly observed across various types of T-cell lymphomas, the extent of deregulation is significantly higher in BIA-ALCL, as indicated by phosphorylated STAT3 immunohistochemistry. The characteristic loss of chromosome 20 in BIA-ALCL provides further justification to recognize BIA-ALCL as a separate disease entity. Moreover, CNA analysis may serve as a parameter for future diagnostic assays for women with breast implants to distinguish seroma caused by BIA-ALCL from other causes of seroma accumulation, such as infection or trauma.

Using quilting sutures in decreasing seroma formation after managing large ventral hernias: a comparative study

The aim of this study was to evaluate using quilting sutures in a prospective randomized controlled manner the decrease in the incidence of seroma formation among patients subjected to ventral hernia repair. The study was a prospective randomized controlled study. 370 patients with large ventral hernias were randomly distributed among two groups. Group A (control group) included 180 patients in whom the repair was done without quilting sutures. Group B (quilting group) included 190 patients, all performed with quilting. Method of dissection was unified as far as possible. All cases had an attached closed suction drain that was removed after two successive days of output ≤ 50cc. The output of the suction drain was recorded; accumulation of clinically detected seroma after 1, 2 and 4weeks of removal of the drain was monitored. There was no statistical difference between both groups as regards the demographic data and the hernia characteristics. There was significantly smaller amount of output of the drains in every day of the first five postoperative days as well as the total amount of the output before drain removal in favor of the quilting group. Drains were removed earlier in group B. The incidence of clinically detected seroma was less in group B as well. Quilting sutures is an effective and easy technique to reduce post-ventral hernia seroma accumulation.

Three‐layered scaffolds for artificial esophagus using poly(ɛ‐caprolactone) nanofibers and silk fibroin: An experimental study in a rat model

The purpose of this study was to determine the feasibility of an artificial esophagus using a three-layered poly(ε-caprolactone) (PCL)-silk fibroin (SF) scaffold in a rat model. The artificial esophagus was a three-layered, hybrid-type prosthesis composed of an outer and inner layer of PCL with a middle layer of SF. After depositing the inner layer of the PCL scaffold by electrospinning, the lyophilized middle SF layer was created. The outer layer of PCL was produced following the same procedure used to make the inner PCL layer. Eleven rats were anesthetized using inhaled anesthesia. Circumferential defects of the cervical esophagus (n=11) were created and reconstructed. Groups of rats were sacrificed after the 1st and 2nd weeks. Three rats died of an esophageal fistula and wound infection. No gross evidence of a fistula, perforation, abscess formation, seroma accumulation, or surrounding soft-tissue necrosis was observed in the other rats sacrificed after the 1st and 2nd weeks. The artificial esophagus constructs produced complete healing of the circumferential defects by the 2nd week. The composition of the three-layered artificial esophagus was confirmed histologically to have an outer and inner layer of PCL and a middle layer of SF. The fusion of the PCL-SF scaffold and the regenerative tissue remained intact. Our study proposes a more practical experimental model for studying a three-layered PCL-SF scaffold in the esophagus. However, further studies on circumferential defect reconstruction in a rat model are still required.

Use of the Pectoralis Major, Serratus Anterior, and External Oblique Fascial Flap for Immediate One-stage Breast Reconstruction with Implant

Skin- or nipple-sparing mastectomy facilitates immediate one-stage reconstruction with an implant. Traditionally, an acellular dermal matrix or a muscle flap has been used because the inferolateral portion of the implant cannot be covered by the pectoralis major muscle. However, this method has drawbacks, including infection, cost, and donor-site morbidity. Therefore, we used an autologous conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia in patients with small-to-medium breasts. A series of 11 immediate breast reconstructions in 11 patients was carried out from March 2010 to June 2011. The conjoined fascial flap and smooth round implants were used in all patients. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. Patient satisfaction was evaluated by a postoperative questionnaire that had five items designed to evaluate quality of life with the reconstruction. The mean body mass index was 23.2 kg/m(2), follow-up period was 30.9 months, and implant volume was 286.3 cc. Regarding complications, we observed one case of partial skin flap necrosis and one case of seroma accumulation in the axilla, both of which healed with conservative care. The mean overall breast satisfaction score was 3.18 ± 0.5. The conjoined fascial flap is a viable alternative for immediate one-stage breast reconstruction with an implant. We recommend appropriate patient selection with a body mass index greater than 20 kg/m(2) and small-to-medium sized nonptotic breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

To drain or not to drain after thyroid surgery: A randomized controlled trial at a tertiary Hospital in East Africa

In many facilities, drains are routinely inserted after thyroidectomy with the aim of preventing hematoma formation and accumulation of seroma. The continued use of drains may be based more on tradition rather than proven scientific evidence. To assess the benefit of drain use after thyroidectomy by determining; length of hospital stay, post operative pain and wound sepsis. This was a randomized controlled trial, carried out at a tertiary national referral hospital (Mulago, Kampala). Over a 6 month period in 2011, we recruited 68 patients. Socio-demographic information and clinical parameters were recorded. Outcomes measures were evaluated. Data were double entered into epidata version 3.1.1 and analyzed using STATA version 10.0. Ethical approval was secured. Mean age of participants was 46 and 43.7 years in drain and no drain arm respectively. Most participants were female. Mean duration of hospital stay after thyroidectomy was significantly higher among the drain arm as compared with the no drain arm [2.41 (± 0.89) vs 1.71 (± 0.76) days (p = 0.0008)]. One patient (drain arm) had wound infection. The pain score on the postoperative day was statistically higher among in the drain arm than the no drain arm [5.71 vs 2.53 (p = 0.001)]. Not inserting a drain post operatively after thyroid surgery was associated with short hospital stay and less operative pain. Results of this study do not support routine drainage after thyroid surgery.

Successful Use of Talc Sclerodesis to Control a Persistent High-Output Groin Seroma Following Endovascular Abdominal Aortic Aneurysm Repair

Groin wound lymphatic complications after vascular procedures are accompanied by increased risk of infection, prolonged hospital stay, and greater patient morbidity. High-output groin seromas can be difficult to manage and refractory to established interventions. Although subcutaneous talc has been used to prevent seroma accumulation in other high-risk surgical fields, such as after axillary lymph node dissection, it has not been described in the context of vascular surgery. This article presents the first reported case of a persistent high-output groin seroma after endovascular abdominal aortic aneurysm repair managed successfully with intraoperative application of sterile talc.

Negative effect of seroma on breast balloon brachytherapy dosimetry

PurposeBalloon brachytherapy is commonly used to deliver Accelerated Partial Breast Irradiation (APBI). Seroma interference is a relatively common phenomenon during APBI. The negative effect of seroma accumulation on the planning target volume evaluation (PTV_Eval) coverage is not well understood. Methods and MaterialsThis is a dosimetric replanning study on 10 patients with evidence of seroma collection at time of initial computed tomographic simulation around the catheter. Total dose was 34 Gy given at 3.4 Gy twice a day over 5 treatment days. A total of 20 plans were generated, 10 plans without accounting for and 10 after subtracting the seroma. We then compared the changes seen in PTV_Eval between plans as a factor of the seroma volume. ResultsMedian age was 62 years (51-83). Histology was invasive in 7/10 cases and in situ in 3/10. Median balloon to skin distance was 8.5 mm (3-14). Median balloon volume was 39 cc (30-104). Median seroma volume was 3.34 cc (1.13-13.71). For every 1 cc of accumulated seroma the percentage of PTV_Eval coverage by the 90% isodose line (V90) was found to decrease by 2.45% (P < .0001; confidence interval [CI], 1.87-3.03) and coverage by the 100% isodose line (V100) was decreased by 1.11% (P < .0001; CI, 0.81-1.41). Fifty percent (5/10) of previously acceptable plans with seroma not accounted for failed to meet the V90 ≥90% requirement after subtracting the seroma. ConclusionsAccumulation of seroma was associated with a considerable negative impact on PTV_Eval dosimetry with a greater impact on V90 compared with the V100. Clinicians must be careful in detecting and accounting for such accumulation in treatment plans to prevent underdosing of the at risk target breast tissue.

Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation

PurposeThe purpose of this study was to consider the indications and evaluate the clinical advantages and disadvantages including, results and complications, of immediate reconstruction using a latissimus dorsi (LD) free flap and reconstruction plate (R-plate) in advanced oro-mandibular tumour resection. Methods and materialsOur cohort included 116 patients who underwent LD free flap and R-plate reconstruction. Flap survival, postoperative function, donor/recipient site complication and aesthetics were evaluated. ResultsOur series demonstrated a 99.1% flap survival rate. One case required a contralateral LD free flap reconstruction after the initial flap failed due to pedicle kinking. Twelve patients needed the plate to be removed and replaced (n=4, plate fracture; n=2, plate exposure) or definite reconstruction with free fibular flap and implant installation. Donor site complications included seroma accumulation, scarring, and discomfort of the shoulder girdle. The size of the skin paddle ranged from 6×10cm to 12×18cm (12 were double paddled).The facial contour was acceptable without sagging of the flap. The flap was tolerant to irradiation and was resistant to the exposure of the plate at the symphyseal arch. ConclusionOur series of primary reconstruction with LD free flaps and R-plates showed the retention of mandibular function and the reconstruction of considerably large soft tissue can be achieved successfully. This reconstruction scheme can be indicated for large-volume defects in the oro-mandibular area when the area cannot be covered by a single osteocutaneous free flap, has undergone extensive oncologic resection for advanced or high recurrence rate malignancy and when immediate postoperative chemotherapy and/or irradiation is necessary.

Physics Contributions Impact of interfraction seroma collection on breast brachytherapy dosimetry – a mathematical model

PurposeBalloon brachytherapy is a widely accepted modality for delivery of accelerated partial breast irradiation (APBI). Our hypothesis was that inter-fraction seroma collection around the balloon surface would have an adverse effect on dosimetry of the target.Material and methodsThis is a dosimetric re-planning study using two volumetric models (30 cc and 45 cc) in a Contura® multi-lumen balloon (MLB) catheter. In a previously treated patient, two customized baseline plans were generated using multiple channels of the Contura® catheter prescribed to the Planning Target Volume Evaluation (PTV_Eval). Symmetric expansions of 1.0 mm (0-9 mm) increments around the balloon surface were performed to simulate a “Virtual Seroma” (VS) accumulation for both balloon volumes and plans were obtained for each expansion using Eclipse Brachyvision™. An analysis of these plans was then performed to evaluate the effect of seroma accumulation on dosimetric parameters of V100 and V90.Results20 plans were generated and analyzed (10 plans for each balloon volume), representing VS of 6.0-66.0 cc. There was a commensurate decrease in the dose delivered to the PTV_Eval V100 and V90 (as defined by the original treatment plan) with increasing VS accumulation leading to a sub-optimal coverage of the PTV_Eval. For 30 cc MLB catheter, V100 decreased by 1.4% and V90 decreased by 0.9% for every 1 cc of VS. For 45cc MLB catheter, V100 decreased by 1.3% and V90 decreased by 1.15% for every 1.0 cc accumulation of VS.ConclusionsBalloon catheter-tissue adherence ensures daily dose delivery to the planned PTV_Eval. Accumulation of seroma, hematoma or air between HDR fractions can significantly impact PTV_Eval dosimetry. Vacuum-port aspiration prior to delivery of each fraction, if available, should be considered to minimize the risk of geographic under dosing.

Interfraction accumulation of seroma during accelerated partial breast irradiation: Preliminary results of a prospective study

PurposeTo quantify and characterize the process of seroma accumulation during accelerated partial breast irradiation using multicatheter balloon brachytherapy. Materials and MethodsTwenty-two patients were treated using the Contura Multilumen brachytherapy catheter to a dose of 34Gy in 10 fractions over 5 treatment days. Serial aspirations of the vacuum port of the catheter were performed at the time of CT simulation and before each treatment. Volume and characteristics of fluid drawn were recorded. Univariate analysis was performed to evaluate various factors predictive of seroma formation. ResultsMedian patient age was 59.5 years, body mass index was 31, and volume of surgical specimen was 62.4cm3. Median time from breast conservation surgery to placement of Contura catheter was 18.5 days. Pericatheter seroma, typically scant with a median volume of 0.75mL, was noted in 91% of patients at CT simulation. A total of 203 aspirations were performed with a median-aspirated seroma volume of 4.05mL. There was no significant correlation between the volume of seroma and histology (invasive vs. in situ), quadrant of location, body mass index, reexcision or reoperation, days from breast conservation surgery to balloon placement, or the volume of specimen removed. Radiation treatment factors, including balloon volume, balloon to skin distance, and planning target volume evaluation, also did not correlate with aspirated seroma. ConclusionsInterfraction seroma accumulation has a variable pattern of development with no discernible predictors of occurrence. Routine pretreatment aspirations via vacuum port may potentially improve dosimetric reproducibility for a minority of patients.

628 poster SHORT-COURSE ACCELERATED PARTIAL BREAST IRRADIATION (OVER 2 DAYS) IS FEASIBLE WITH THE CONTURA(r) MULTI-LUMEN BRACHYTHERAPY DEVICE

PTV_EVAL volume did not correlate with aspirated seroma volume in our study. Conclusions: In our study, seroma accumulation seemed to have a variable pattern of development with no discernible predictors of occurrence. During a course of fractionated partial breast brachytherapy, serial aspirations via vacuum port, when available, should be considered for all patients to potentially improve dosimetry and reproducibility of PTV_EVAL. Further study is needed to establish factors predictive for seroma accumulation and resultant clinical significance.

Inter-Fraction Accumulation of Seroma During Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

Inter-Fraction Accumulation of Seroma During Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

Lichtenstein or darn procedure in inguinal hernia repair: a prospective randomized comparative study

The aim of this study was to assess the outcome of patients with inguinal hernia where the Moloney darn or Lichtenstein procedure was used as the surgical choice. A herniorrhaphy procedure was performed in a total of 306 patients at our clinic between January 2003 and December 2008. The duration of operations and complication and recurrent rates were compared between the two groups. Hematoma formation, seroma collection, and wound infection were accepted as early complications, whereas chronic pain, loss of sensation at the operation site, and the rejection of mesh were accepted as late complications. Considering early complications as hematoma formation, the accumulation of seroma and wound infection ratios were similar in the two groups. Loss of sensation at the operation site and chronic pain, which were classified as late complications, were similar in the groups. However, in considering rejection, there were three rejections in the group where mesh was used. The darn repair method is simple, safe, and has similar recurrence rates when compared to the Lichtenstein method in inguinal hernia patients.

The modified gluteal sliding plication closure in the treatment of chronic pilonidal sinus

The surgical approach to pilonidal sinus disease is open to debate with no ideal treatment. The aim of this work is to present the efficacy of the modified gluteal sliding plication closure technique in treatment of pilonidal sinus disease as regards the complication and recurrence rates, while maintaining a more cosmetically acceptable midline scar. All patients between the year 2000 and 2008 with symptomatic pilonidal disease were treated by the modified gluteal sliding plication closure method, except for recurrent cases after previous flap surgery. Outcome measures included wound complications, recurrence rate, follow-up period, and functional recovery. Patient esthetic satisfaction rates as regards the scar and shape of the buttocks were included on a scale of good, fair, or bad. Fifty-six patients, 41 male and 15 females, with 23 years median age (range, 17-45 years) were treated. After a median follow-up period of 12 months (range, 6-84 months), the incidence of recurrence was 1.8%, infection rate of 10.7%, paresthesia and seroma accumulation in 3.6% of cases. The median functional recovery achieved was 12 days (range, 10-45 days), while the esthetic satisfaction rates were good in 78.57%, fair in 17.86% and bad in 3.5% of cases. This study presents a successful modified technique of primary closure which allows an extensive en bloc removal of diseased tissues and permits a safe and complete primary closure without undue tension and with respect of cosmetic principles.