No abstract

Although the healing rate of chronic anal fissure is considerably high with botulinum toxin injection with earlier recovery and less complications compared with sphincterotomy, it occasionally requires a repeat injection, and the healing is slower. The early (two months) and late (one year) healing rates are significantly higher in the sphincterotomy group, the two groups reaching similar healing rates only at six months.

OBJECTIVE:Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus.MATERIALS AND METHODS:This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935.RESULTS:The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001).CONCLUSION:In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.

Case 1An 82-year-old man was admitted to the hospital because of pain in the right lower quadrant of the abdomen for 3 d. Standard laboratory tests, serum levels of CA 19-9 and carcino-embryonic antigen (CEA) were within normal ranges. Ultrasonography (USG) and computerized tomography (CT) demonstrated a well demarcated, elliptical 7 cm × 5 cm cystic mass with parietal calcifications in the right lower quadrant of the abdomen. There was an indentation in the cecum by colonoscopy. Surgical exploration revealed the mass to be an AM. Simple appendectomy was performed. Pathological examination revealed a mucinous cystadenoma with dimensions of 8 cm × 6 cm × 5.5 cm. AM restricted to the appendix and cecum was free of the disease. The patient's postoperative course was unremarkable, and he was discharged home on the 4th postoperative day. Case 2A 65-year-old woman was referred to the emergency de- CASE REPORT AbstractThe mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute appendicitis-like symptoms. Sometimes, patients with mucocele can present with confusing symptoms. Preoperative suspicion and diagnosis of appendiceal mucocele are important. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. It may be also recognised by colonoscopy as a smooth submucosal lesion of the cecum. Optimal management of the mucocele could be achieved through accurate preoperative diagnosis. Preoperative diagnosis is a major component for minimizing intra-operative and post-operative complications. We herein report five cases and discuss the diagnostic methods and surgical treatment.

ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

Background/Aim: Delay of laparoscopic cholecystectomy after the diagnosis of biliary colic may increase the probability of recurrent emergency admission while awaiting elective cholecystectomy. The aim of this study was to compare the possible advantages and safety of urgent laparoscopic cholecystectomy (ULC) with elective laparoscopic cholecystectomy (ELC) in patients with biliary colic. Patients and Methods: Between 2001 and 2003, 75 patients with biliary colic were included in this study. The patients were classified into following two groups: patients who had ULC in 24 h were in group I (n = 28) and patients who had ELC (mean interval 4.22 ± 1.42 months) were in group II (n = 35). Conversion to open cholecystectomy, operative time, postoperative hospital stay, costs, and complications were evaluated. Results: In group II, 9 patients made a total of 13 return visits to the emergency department with recurrent attacks of biliary colic or complications of gallstone disease. Mean operative time increased from 35.1 ± 6.74 min for urgent laparascopic cholecystectomy to 49.9 ± 6.12 min for ELC (p > 0.05) and hospital stay time increased from 1.06 ± 0.4 to 2.31 ± 2.36 days (p < 0.05). Conversion to open cholecystectomy increased from 0% in group I to 17.2% in group II (p < 0.05). Discussion: ULC for biliary colic may be the most medically efficacious and cost-effective treatment.

The complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.

Moreover, the association of a lipoma within the inverted Meckel's diverticulum as a leading point of bleeding and recurrent episodes of partial intestinal obstruction is such an unusual circumstance that might be considered quite impossible.Meckel's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, which is reported to occur in 1%-3% of the general population and autopsy series [1,2] . However, the lifetime risk of complication development in patients with Meckel's diverticulum was proposed to be less than 5% in recent investigations [3] . These complications included intestinal obstruction, intussusceptions, inflammation and bleeding.Lipomas are the rare benign tumors of the small intestine with no malignant potential and mostly encountered incidentally during investigation of the gastrointestinal tract for another reason, since they are usually asymptomatic [4] . As small intestinal lipoma is relatively infrequent, it is even a rarer source of gastrointestinal bleeding.We present a case of a 47-year-old man with fatigue, chronic abdominal pain and tarry stool due to an inverted Meckel's diverticulum with a subserosal lipoma. This is a special case that has not appeared in literature over the past 4 decades. Although the incidence of Meckel's diverticulum is high, inversion is a scarsely diagnosed entity and the association of a lipoma within the inverted Meckel's diverticulum as a leading point of lower gastrointestinal hemorrhage without the existence of heterotopic gastric and pancreatic tissues and recurrent partial intestinal obstruction is an exceptional case. CASE REPORTA 47-year-old man was admitted to our clinic with fatigue, recurrent episodes of constipation and abdominal pain. Melena was mentioned on admission. He denied vomiting, fever, or chills. He had had symptoms intermittently for about 4 mo, leading to several hospital visits. Over the previous 2 mo, the episodes of pain became more pronounced with radiation to his back. The patient was not using any specific medication and his medical history did not suggest a major disease. Physical examination revealed a temperature of 37℃, a pulse rate of 90 beats per minute (bpm), a blood pressure of 110/70 mmHg, and a respiration rate of 18 breaths per minute. The CASE REPORT Lipoma within inverted AbstractLipoma within an inverted Meckel's diverticulum presenting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.