Print ISSN: 2790-0207

Online ISSN: 2790-0215

Keywords : recurrence


Treatment of recurrent pilonidal sinus by flap technique (Limberg flap )

abdulkareem omer Mohamed salih

Kirkuk Journal of Medical Sciences, In Press

Background: pilonidal sinus(PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning a nest of hair PNS can be asymptomatic, or may be present as a recurrent abscess or as chronic inflamed cavity and local discharge from sinus or sinuses and local pain and discomfort .
retrospective study was done from (November 2017 to November 2018) at surgical department in Kirkuk General Hospital in 50 patients with recurrent PNS all will be treated with Limberg flap then follow up for one year this surgery done by excision of PNS till we reach fascia overlying sacrum inferiorly and laterally till we reach gluteal fascia and dissection was performed with electro cautery and reconstruction done by flap (Limberg flap) from gluteal area
in 50 patient with recurrent PNS we have 45 (90%) were male and 5 (10%) were female ,30 patient (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%)

Treatment of recurrent pilonidal sinus by flap technique(Limberg flap)

Kirkuk Journal of Medical Sciences, 2022, Volume 10, Issue 1, Pages 34-43
DOI: 10.32894/kjms.2022.174184

Abstract
 
Background: pilonidal sinus (PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning  a nest of hair  PNS can be asymptomatic, or may be present  as a recurrent  abscess or as  chronic  inflamed cavity and local  discharge from sinus or sinuses and local pain and discomfort .
Materials and Methods: retrospective  study was done  from (November 2017 to November   2018) at surgical department in  Kirkuk General Hospital in 50 patients with  recurrent PNS all will be treated with  Limberg  flap then follow up for one year  this surgery done  by excision of PNS till  we reach  fascia overlying  sacrum inferiorly  and laterally till  we reach gluteal fascia and dissection was performed with electro cautery and  reconstruction done by  flap (Limberg flap) from gluteal area.
Results: in 50  patient  with recurrent PNS   we have 45 (90%) were male and 5 (10%) were female ,30 patient  (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then  we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%)
Discussion: pilonidal sinus not classified as  dangerous condition but any  patients  with PNS live in  non-comfortable   state and may have complications such as abscess formation   or discharging sinus even  severe  pain  therefore Limberg flap is  commonly used method to treat  recurrent PNS and this good  result with  healing in short period  also satisfactory results   in long duration but this method  with  Sacrococcygeal area  disfigure mentation  as one long duration complications  but   less  recurrence rates and  short stay in hospital and better patient  tolerability  in this way if we  compare it  to all other methods even  with  surgical challenge  to create a flap  but it less wound infection,  hematoma ,edema , wound separation  if we compare it  to  other surgical techniques but fluid accumulation in close space under flap is one of important complications in this method and we decrease it   by  using a  drain  and putted  in site until fluid drainage in area  decreased to be less than 50 ml/day .
In this method recurrence rate in our study is 2%  but  reported recurrence rate for Limberg flap are from 0.8 to 2.7% if we compare to 12% recurrent rate   in  primary closure therefore we have very good recurrence rate
Conclusions: the approach for recurrent PNS should be differ  from  primary PNS flap reconstruction methods in treatment for recurrent PNS  is very good  and efficient method even with surgical challenge procedure  to create flap, personal hygiene are the keystones for preventing recurrence

Meshplasty in Ventral &Incisional Hernia (A Comparative Study between Onlay & Inlay Techniques)

Abdulghafor Abdullah Amin

Kirkuk Journal of Medical Sciences, 2016, Volume 4, Issue 1, Pages 13-18
DOI: 10.32894/kjms.2021.169461

Introducion&Objectives: Ventral hernia of both types spontaneous & incisional are commonly encountered in surgical practice. Despite the frequency of surgical repair, perfect results continue to elude surgeons & the rate of surgical failure may approach 10- 30%. Nowadays meshplasty is regarded as ideal procedure for hernia repair & actually primary suture repair is abandoned except for hernia with defect size of less than 2.5cm.Different types of mesh used for repair &different sites of placement described including onlay, inlay, sublay & sandwich pattern with different results. Aim of this study is to evaluate meshplasty in ventral &incisional hernia &to compare between onlay &inlay techniques in regard of operative ease, time, early& late postoperative complications. 
Design: Prospective comparative study. 
Patients and Methods: This study was conducted on (60) patients with ventral &incisional hernia admitted to surgical department of Kirkuk general hospital between the periods Feb-2010 to Feb-2013. All patients were grouped randomly into two groups: Group (1) including (30) patients with onlay meshplasty &Group (2) including (30) patients with inlay technique. 
Results: The age of the patients was ranged (22-75) years with mean age of (48.5) years. Most of the patients were at fourth decade (48.3%) (n=29). (70%) of all patients (n=42) were females & (30%) of them (n=18) were males. (66.6%) of all patients (n=40) had incisional hernia & (33.3%) of patients with spontaneous hernia (n=20). The operative time in patients of Group (1) onlay technique was (60-100) minutes compared to (50-80) minutes in patients of Group (2) inlay technique. (3) Patients (10%) of Onlay Group developed seroma, (2) patients (6.6%) had deep wound infection. None of all patients of either group had sinus or enterocutanous fistula. (4)patients(13.3%) of Onlay Group had recurrence of their hernia during(12)months period follow up but only one patient (3.3%) of Inlay Group developed recurrence during same period of follow up. 
Conclusion:-Inlay meshplasty for repair of ventral abdominal hernia is more effective& gives better results in regard of operative ease, time, early &postoperative complications.