Excision Of Fistula Research Articles

Capillary hemangioma of the sphenoid sinus excision through the endonasal endoscopic approach

Background: Sinonasal hemangiomas are rare, especially hemangiomas of the sphenoid sinus, for which very few cases have been reported. Observation: We report the case of a 20-year-old patient who had consulted for epistaxis associated with headache. A CT scan of the nose and sinuses revealed a heterogeneous tumor process filling the sphenoid sinus. A minimally invasive endonasal surgery under endoscopic guidance allowed complete removal of the tumor. The histological study of the surgical specimen had revealed capillary hemangioma. After 27 months of decline, no recurrence was noted. Conclusion: Capillary hemangioma is very rare in its sphenoidal location. Endonasal endoscopic excision allows optimal control, after a good pre-operative evaluation.

Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.

Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.

Complicated congenital dermal sinus: Diagnosis and management

ObjectiveCongenital dermal sinus tracts of the spine are a rare form of spinal dysraphism, and should be considered in the differential diagnosis of lumbar subcutaneous abscesses, The CDS tracts can be associated with several pathological findings, including inclusion tumors (for example, epidermoid, dermoid, and teratoma), split-cord malformations, and tethered spinal cords. Excision of the sinus and its track with untethering of the cord should be done as early as possible to avoid intraspinal infection and abscess formation. Our study aims to find out the value of early diagnosis & rapid management of complicated CDS, to re-establish neurological function. Patients and methodsTen cases (2 females and 8 males), with age range (13 months −4 years) presented with acute paraparesis and one case of quadriparesis, MRI spine showed spinal abscess, operative drainage was done with excision of the dermal sinus and track. ResultsNeurological deficits improved in all cases, but 4 cases showed residual deficits, while the other 6 cases got complete recovery. ConclusionEstablishing diagnosis and rapid management of abscess complicating a congenital dermal sinus, is crucial to restore neurological function.

MODIFIED METHODS OF SURGICAL TREATMENT REST OF THE RECT

Summary. The use of mini-invasive technologies for the treatment of rectal fistula prevents many postoperative complications. Complete excision of the rectal fistula is not the only important result of treatment. Ensuring a high quality of life for patients is also very important. The proposed methods of surgical correction are a significant addition to the list of existing operations.
 Objective. To compare and analyze the results of the treatment patients with anal fistula by using standard techniques, the modified method LIFT and excision anal fistula with biowelding.
 Materials and methods. A retro- and prospective study of the surgical treatment of 90 patients with uncomplicated transsphincteric anal fistula using different techniques from September 2018 to February 2020 was conducted.
 Results. The introduction of these methods has shown a decrease in the number of relapses. This was achieved by combining complete excision of the fistula tract and minimal damage to the sphincter complex.
 Conclusion. The use of combined methods of surgical treatment of rectal fistula has significant advantages over standard techniques.

Pediatric airway surgery under spontaneous respiration using high-flow nasal oxygen

ObjectivesIn pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway. MethodsThis retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO2 sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered. ResultsThe median age of the patients was 16.0 months (range: 1–215 months) and the median weight was 10.2 kg (range: 2.4–38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10–140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients. ConclusionsSTRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.

Case report of conjunctival sac fistula after cosmetic lateral canthoplasty

BackgroundTo report a case of conjunctival sac fistula after cosmetic lateral canthoplasty which is rare.Case presentationA young women who underwent bilateral canthoplasty appeared with lacrimation of the right eye. We found there was a skin fistula with transparent tears at 2 mm lateral to the right canthus ligament and the liquid containing fluorescein was seen to overflow at the fistula after using fluorescein sodium eye drops. The number 7 lacrimal duct probe was visible under the temporal conjunctiva when exploring the fistula, and the fistula was about 4 mm. The patient was diagnosed with conjunctival sac fistula and fistula excision was performed. The patient did not tear abnormally after observation 3 months later and the incision healed well.ConclusionsThe case report illustrates an uncommon post-lateral canthoplasty complication. We suggested that surgeons who perform this kind of surgery should ask about epiphora and look for conjunctival sac fistula at follow-up assessment.

PILONIDAL SINUS: SURGICAL EXCISION OF PILONDIAL SINUS AND SUTURING SKIN EDGE TO PRE-SACRAT FASCIA (PARTIAL CLOSURE)

Surgical treatment of pilonidal sinus is by surgical excision of sinus and partial closure by suturing skin to pre-sacral fascia. This study was carried out on 20 patient with pilonidal sinus admitted to surgical department in Kobry-El-Kobba Military Medical Campus. This patient was treated by surgical exciting of pilonidal sinus and partial closure of the wound by suturing skin edge to presacral fascia. This study covers the introduction and incidence, pathology, clinical presentationand different method in management of pilonidal sinus. This study proposes that excision of pilonidal sinus and partial closure of the wound by suturing skin edge to pre-sacral fascia, safe, with low recurrent rate- short hospital stay. No postoperative discomfort or food restriction and early ambulation and return to work. This study was done up on 20 young male troops “soldiers” patients with mean age 25 years admitted to surgical department, Kobry El-Kobba Military MedicalCampus, from January 2016 to December 2018, treated by suturing skin edge to pre sacral fascia, and study the effect of operation on patient convenience, infection, recurrence, bleeding postoperative, healing time, hospital stay and histopathological examination of specimens.

PILONIDAL SINUS: SURGICAL EXCISION OF PILONDIAL SINUS AND SUTURING SKIN EDGE TO PRE-SACRAT FASCIA (PARTIAL CLOSURE)

Surgical treatment of pilonidal sinus is by surgical excision of sinus and partial closure by suturing skin to pre-sacral fascia. This study was carried out on 20 patient with pilonidal sinus admitted to surgical department in Kobry-El-Kobba Military Medical Campus. This patient was treated by surgical exciting of pilonidal sinus and partial closure of the wound by suturing skin edge to presacral fascia. This study covers the introduction and incidence, pathology, clinical presentationand different method in management of pilonidal sinus. This study proposes that excision of pilonidal sinus and partial closure of the wound by suturing skin edge to pre-sacral fascia, safe, with low recurrent rate- short hospital stay. No postoperative discomfort or food restriction and early ambulation and return to work. This study was done up on 20 young male troops “soldiers” patients with mean age 25 years admitted to surgical department, Kobry El-Kobba Military MedicalCampus, from January 2016 to December 2018, treated by suturing skin edge to pre sacral fascia, and study the effect of operation on patient convenience, infection, recurrence, bleeding postoperative, healing time, hospital stay and histopathological examination of specimens.

Z Plasty Single Center Results in The Treatment of Pilonidal Sinus Disease in Children

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Treatment varies according to the clinical presentation of the disease. Although many surgical methods have proposed, the ideal approach is still lacking due to high recurrence rates. This study aimed to evaluate the role of Z-plasty in achieving primary recovery in pilonidal disease and morbidity and recurrence. Twenty-four patients (15 males and nine females) who underwent sinus excision and Z-plasty closure for the sacrococcygeal pilonidal sinus included in this study. Follow-up ranged from 6 to 12 months. There were 15 males and nine females with a median age of 16 years. The mean hospital stay was two days. There was no recurrence, and all patients were satisfied with the cosmetics. Two patients (5%) had numbness on the flap. No flap necrosis observed in any patient. Only three patients had a wound infection (7.5%). Wound seroma developed in five patients (12.5%). Although some technical expertise is required, excision of sinus and Z-plasty provides superior results in terms of recurrence and hospitalization of pilonidal sinus patients during hospitalization.

P528 Response to biologic therapy in operated Crohn’s disease patients

Abstract Background About 70% of Crohn’s disease (CD) patients undergo surgery due to disease complication. According to the ECCO consensus, in such cases, the tumour necrosis factor-α (TNF-α) antagonists are a means of choice to prevent post-operative relapse. Methods The aim is to evaluate endoscopic, clinical and biochemical outcomes in CD patients, who have undergone surgery, in the course of the subsequent treatment with anti-TNFα mono/combination therapy—anti-TNFα + AZA. Among patients with CD who are undergoing biological treatment, we performed a retrospective analysis of the data of those who underwent surgical intervention associated with Crohn’s disease and subsequently started biological therapy. Results Of the 69 CD patients on biological therapy, surgical intervention was performed in 44.92% (n = 31) of cases prior to the initiation of the treatment. The prevalence of patients with right-sided hemicolectomy with subsequent ileotransverse anastomosis was 54.80%, followed by incision and abscess cavity drainage 22.6%, fistula excision 19.4% and left-sided hemicolectomy 3.2%. In 22 patients (71.0%) there was a clinical response (CDAI decline ≤ 100 points), with 66.66% of them achieving clinical remission (CDAI ≥ 150) (p = 0.001, strong correlation r = 0.596, p = 0.001). During the course of treatment, 23.80% lost clinical response after 18 months of treatment. We compared the mean value of the faecal calprotectin (FCP) before starting, and during the course of the biological treatment, we found that the FCP values decreased 1.5 times: 516.78 ± 273.93, (range 100 – 857)/330.46 ± 432.25, (range 5.32–1800). The activity of the disease measured by CDAI decreases twice during the course of the biological treatment: CDAI 378.00 ± 92.89 (range 258–695)/177.93 ± 116.38 (range 34–414) and CRP values decrease over four times: CRP 59.65 ± 64.52 (range 0.9–225)/13.14 ± 23.59 (range 0.13–116.10). During the course of the biological treatment, intestinal complications were observed in 33.33%, and 9.67% of the patients who had both progression and presence of intestinal complications had a subsequent surgery. In 33.33% of cases, the treatment was intensified. 16.70% of them had to switch to another biological drug. Perianal disease prior to biological treatment in operated patients is twice as common (x2 = 3.82, p = 0.050), which in turn appears to be a risk factor for surgical treatment (OR = 3.47 (0.953–12.685)). Conclusion In the follow up of the relationship between the occurrence of a clinical response and the onset of biological therapy, we found that the time interval was essential. The earlier the anti-TNFα therapy begins, the greater the likelihood of achieving a clinical and biochemical response (r = 0.326, p < 0.05).

Acne inversa (hidradenitis suppurativa)

Hidradenitis suppurativa (acne inversa) is achronic inflammatory follicular skin disease which leads to fistulae, abscesses and scarring. The Hurley classification is used to quantify the extent of the disease whereby stageIII is associated with extensive disfiguring lesions. The most frequently used conservative treatment options are topical clindamycin, systemic antibiotics, e.g. clindamycin and rifampicin, anti-TNF antibodies and laser epilation. Complete excision of fistulae with or without plastic coverage of defects are the mainstays of surgical treatment. Preoperative and postoperative strategies to diminish tissue loss and options for recurrence prevention are discussed.

Opened versus closed procedures in management of pilonidal sinus (P.M.S.)

Background: PNS is a common surgical disease and there are many methods of treatment such as wide excision of sinus and lay wound open to heal by granulation tissue (open), excision of a sinus with primary closure (closed), track debridement and excision or phenolization of epithelial pit and excision of PNS with primary closure using oblique incision. Methods: Setting: In Fallujah Teaching Hospital from Jan. 2017 to Dec. 2018. Design: Prospective study. These cases were chosen and divided into 2 groups: Group A: were treated by open procedure (31). Group B: were treated by closed procedure (27). The average period of follow up after completion of surgery was six months for both groups. Results: In group A symptomatic improvement occurs in 26 (83.8%) of patients and the duration of healing was about 45 days, 5 (16.2%) patients were delayed healing while recurrence were 4 (12.9%). In group B symptomatic improvement occurs in 19 (73.7%) of patients and the duration of healing was about 2 weeks. 8 (26.3%) patients were delayed healing while recurrence were 6 (22.2%). Conclusions: From this study we find that there is no ideal treatment of pilonidal sinus according to: 1. Meantime of healing. 2. Delay healing. 3. Recurrence.

Closure of excisional defects of pilonidal sinus surgery using a perforator-based island flap

Background and Aim of the Work: Pilonidal sinus disease is a common condition in the young adults, which carries significant patient discomfort. There is no consensus regarding the best surgical technique for the treatment of this disease. A controversy is present about the various options for closure of the wound following resection of the affected tissue. In this study, the perforator-based island flap was successfully used for closing the defect left after excising the pilonidal sinus. Methods: Twenty-three patients with a primary complex pilonidal sinus disease were operated upon and followed up in the period from October 2014 to October 2018 at the General Organization of Teaching Hospitals and Institutes hospitals. After wide excision of the pilonidal sinuses, the defects were reconstructed with perforator-based flaps, which were designed with an axis of 45°–90° angle to the vertical axis of the defects. Results: Of the 23 patients included in this study, only three patients developed minor complications (one case of mild seroma and two cases of minor wound infections), and they were treated conservatively. Mean time of hospital stay was <2 days. Mean time to return to normal daily activities was 5 days (range: 3–7). Mean time to complete healing of the wound was 12 days (range: 10–15). Mean time off-work days was14 days (range 12–17). All the patients did not show recurrences during the period of follow-up which continued for at least 9 months postoperatively with a mean time of 10 months (range: 9–15). Conclusions: This study shows that closure of postexcisional defect of pilonidal sinus using a perforator-based island flap is a reliable option for the treatment that fulfill the principles and criteria required to achieve complete cure of the condition in a short period of time.

Rhomboid excision and Limberg flap operation for managing pilonidal sinus: our experience at Patan Hospital, Patan Academy of Health Sciences

Introduction: Pilonidal sinus is a common disease. Various surgical techniques for management of sacrococcygeal pilonidal sinus have been described. Among them, the most commonly used is the rhomboid excision with the Limberg flap. With this technique of flattening the natal cleft and tension-free repair is made using a wide, well-vascularized flap. It is reported the best treatment methods, with 0-16 % of surgical area-related complications and a recurrence rate of 0-5 %. We conducted a study to evaluate the patient’s profile and outcomes of the patients of pilonidal sinus treated with rhomboid excision and Limberg flap reconstruction at our center.&#x0D; Methods: Data were recorded retrospectively by reviewing the charts of patients who underwent rhomboid excision and Limberg flap operation for sacrococcygeal pilonidal sinus from September 2015 to September 2019.&#x0D; Results: Thirty-four patients were included in the study. Twenty-nine (85.4%) were males and 5 (14.7%) were females. The mean age was 25.29 years (range 17-40 years). Mean hospital stay was 4.5 days (range 3 – 7 days. Nine (26.5%) patients had surgical site infections. Two patients (5.9%) had a recurrence.&#x0D; Conclusion: Limberg flap for reconstruction after rhomboid excision of pilonidal sinus is an effective and feasible technique with good outcome.

Laser pilonidotomy — a new approach in management of complex pilonidal sinus disease: an exploratory study

BackgroundThe treatment of pilonidal sinus disease still remains challenging mainly because of multiple factors responsible for wound healing and its recurrence. With recent advances in surgical field, use of laser found to be an effective technique in the destruction of a pilonidal cyst. Laser Piolonidotomy is a new promising technique. MethodologyAn exploratory study was planned with the Aim, to evaluate a new technique for the excision of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity the degree of postoperative complications and rate of recurrence and patient’s satisfaction. All the patients with pilonidal sinus were categorized and laser pilonidotomy was planned for patients satisfying inclusion criteria. Data collected in pre-structured, pre-tested proforma and analyzed using SPSS. ResultsMean duration of Procedure was 33 min (SD = 11), mean duration of Hospital Stay was 12 h (SD = 3), resumption of normal activity within 4 days (SD = 2), mean duration for Complete Wound Healing by secondary intention 6 Weeks (SD = 1.25). Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient’s satisfaction was 97.84%. ConclusionLaser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient’s satisfaction.

Current trends and 30-day surgical outcomes for thyroglossal duct cyst excision in children

ObjectiveIdentify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery. MethodsCross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012–2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent. Results1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008). ConclusionsThe most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.

Surgical Reconstruction after Excision of Pilonidal Sinus with Modified Limberg Transposition Flap

Background: Pilonidal sinus is a common infectious process which occurs in buttocks and sacral area which involves a wide range of symptoms that are different from an asymptomatic sinus to acute and chronic sinus track. Aim of the work: The aim of the study was to evaluate the outcome of modified Limberg transposition flap in surgical reconstruction after excision of pilonidal sinus. Patients and Methods: This prospective study was conducted at the Department of General Surgery, Al-Azhar University Hospitals (Al-Hussin & Sayed Galal hospitals). This study was carried out on 30 consecutive patients with primary non recurrent sacrococcygeal pilonidal sinus from 11/2018 to 6/2019 to allow a minimum follow-up period of at least 5 months for the last case operated upon. Results: Operative time and postoperative pain with mean operative time 47.37 ± 5.67, postoperative pain: 18 patients (60%) with mid pain, 10 patients (33.3%) with moderate pain, only 2 (6.7%) with severe pain. The complications among study group were 4 patients (13.3%) with wound seroma, 3 patients (10%) with wound hematoma, 3 patients (10%) with wound infection, 2 patients (6.7%) with wound gapping, only one patient (3.3%) with flap necrosis. The mean time for wound healing is 20.57 ± 5.72, 17 patients (56.7%) less than 20 days and 13 patients (43.3 %) more than 20 days, mean hospital stay is 3.63 ± 0.85, 17 patients (56.7%) = 3 days hospital stay and 13 patients (43.3%) more than 3 days hospital stay. Conclusion: Surgical reconstruction after excision of pilonidal sinus with modified Limberg transposition flap is an effective method for the management of pilonidal disease, especially when dealing with recurrent pilonidal sinus.

Three cases of branchial fistula in one family: a rare presentation

&lt;p&gt;Branchial cleft anomalies comprise approximately 30% of congenital neck mass and present as cyst, sinus or fistula. They occur due to disturbance in the maturation of the branchial apparatus during fetal development. They are congenital lesions usually present in childhood, but they are usually diagnosed in later childhood or early adulthood because of enlargement or infection. Branchial cleft fistulae are usually diagnosed earlier than cysts. Correct diagnosis leads to proper management. Complete surgical excision is the treatment of choice. Second branchial cleft and pouch anomalies are commonest amongst all branchial cleft lesions, but complete second branchial cleft anomalies with external and internal opening is rare. Branchial anomalies with family history are also very rare. Here we present a case report of complete branchial fistula with family history which was managed by complete excision of fistula through transcervical and transoral approaches. 3 members of one family in 2 generations presented with branchial apparatus anomalies (father and his two children, elder son and younger daughter). All of them were having branchial fistula on right side of neck since birth.&lt;/p&gt;

Pilonidal sinus disease: Preliminary case-control study on heat-related wound dehiscence.

BackgroundPilonidal disease is a morbid condition of the young population, that could impair quality of life with a high cost for the health care system. No consensus exists on optimal surgical treatment, even if several techniques have been proposed. In this preliminary case-control study we compared excision by knife and diathermy to investigate if wound dehiscence could be related to heat spreading during excision of the sinus.Materials and methodBetween January 2017 and February 2018, 29 patients underwent to sinus excision.16 patients underwent sinus excision by diathermy (named “Hot” group, case-group) while 13 patients underwent excision by the knife as the control group (named “Cold” group). The temperature data were recorded for both groups. Were considered primary and secondary outcomes.Resultsthe cold group has worse outcomes in operative time and blood loss, but better results in post-operative pain at first day and first control, number of weekly and total dressings until healing, time for full wound recovery, days to return to work, patient feeling feedback and scar aspect. Wounds healed within 8–12 days were 84.6% in the Cold group and 18.8% in the Hot one. I° Dindo-Clavien complications were respectively 15.4% and 100.0% for the Cold and Hot group. No differences were recorded for II° Dindo-Clavien complications and in days of hospitalization.Conclusioncold excision of the sinus pilonidalis has better results both in terms of precarious healing and quality of life, probably because the tissues are not subjected to diathermocoagulation damage and therefore the healing occurs more quickly. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT 03764657, www.researchregistry.com UIN 5003).