Techniques in coloproctology
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Review
Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options.
Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. ⋯ From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.
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We report pneumatosis cystoides intestinalis in a 10-month-old girl who developed bloody diarrhea following chemotherapy for leukemia. The diagnosis was made only by colonic endoscopic ultrasonography, whereas the abdominal plain radiogram and computed tomography failed to elucidate the diagnosis. She was successfully treated with hyperbaric oxygen therapy. Wider application of endoscopic ultrasonography may lead to the more frequent detection of pneumatosis cystoides intestinalis, currently a rare disorder.
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Sacrococcygeal pilonidal sinus disease affects younger persons, resulting in long-term loss of productive power. It also has a high rate of morbidity because there is no standard treatment approved by all surgeons. ⋯ The complication rate was 4.7% and the long-term relapse rate was 3.5: Insufficient personal hygiene and inadequate excision were the main causes for recurrence. On the basis of the literature and our previous experiences, we conclude that the Limberg flap is the ideal treatment for sacrococcygeal pilonidal sinus disease with low morbidity, mortality and recurrence rates.
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To evaluate whether surgical resection confers survival advantages in selected patients with resectable locally recurrent rectal cancer, data on 430 patients who underwent R0 resection for primary rectal cancer were prospectively collected over a 14-year period. Resection of recurrent disease was considered R0 when all cancer tissue was resected with microscopically tumor-free surgical margins. Microscopic evidence of disease at resection margins was considered an R1 resection. ⋯ Median survival rate was not reached at the 146-month follow-up in patients with R0 resection. Median survival rate was 16.6 months in patients with R1 resection. In conclusion, uninvolved microscopic margins produce long-term survivors after surgical resection for locally recurrent rectal cancer.
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Following stoma construction, parastomal hernia is the most frequent complication. Many surgical techniques have been postulated for these patients, and prosthetic surgery represents the first-choice treatment. We report our personal experience with 8 cases of parastomal hernia in patients submitted to abdominal perineal resection according to Miles, for carcinoma of the lower rectum. ⋯ The mesh was placed in suprafascial position, after suturing the fascial tear. One case of wound infection occurred and, to date, none of the patients have presented with recurrence after a 3-year follow-up. In conclusion, the use of polypropylene mesh for parastomal hernia repair represents a safe and successful technique.