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    Effective treatment and good cosmetic results in the treatment of pilonidal sinus disease; Comparison of four surgical methods
    (2020) Akturk, Remzi; Serinsoz, Serdar
    Aim: In the treatment of pilonidal sinus disease (PSD), the patient wishes to be able to get rid of the disease quickly and effectively with the ideal treatment, which not only improves the patient's satisfaction with the best cosmetic result but also has a low recurrence rate. The aim of this study is to demonstrate that the gluteal sliding transposition (GST) method is more advantageous and preferred by patients in terms of better cosmetic results and lower loss with lower recurrence and complication rates.Materials and Methods: Between 2008 and 2017, patients who were operated for PSD were retrospectively reviewed using hospital digital records. Four groups of patients were included in the study: those who underwent excision and secondary healing (ESH), excision and primary repair (EPR), GST, and Limberg flap transposition (LFT). The groups were compared based on time of hospitalization, time of healing, time of labor loss, infection, hematoma, seroma and wound dehiscence, flap necrosis, paresthesia, recurrence and aesthetic satisfaction.Results: Between 2008 and 2017, 1526 patients underwent PSD surgery in the hospital. Of the patients, 276 were female and 1250 were male, and their median age was 21.3 (16-45) years. The mean follow-up was 24 months (6-120 months). The longest mean operation time (46.04 ± 9.1 min) was found in LFT patients. The longest time of healing was in the ESH group (49.62 ± 12.7 days) (p0.05). Although there was no significant difference between GST and LFT in terms of healing time, the time of healing was shorter in GST than in ESH and EPR methods (18.72 ± 7.72 days) (p0.05). The shortest loss of labor was observed in EPR (13.53 ± 2.02 days) (p0.05). The hematoma, seroma and the wound opening were more significant with the EPR method than other methods (p0.05). While the aesthetic satisfaction was expected to be greater for the reconstructive procedure of LFT, the results showed that aesthetic satisfaction was found to be better with the GST method (p0.05). In terms of recurrence, GST was also found to be the most advantageous method (4.4%) (p0.05).Conclusion: The GST method provides lower hospitalization and complication rates, similar to the ESH, and quicker wound healing with lower recurrences, as in LFT. In addition, GST has better aesthetic satisfaction than LFT.
  • Küçük Resim
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    Which method for the laparoscopic repair of inguinal hernia?; TAPP versus TEP
    (2020) Akturk, Remzi; Serinsoz, Serdar
    Aim: The aim of this study is to prove that the total extraperitoneal patch plasty (TEP) method can be accepted as a standard method in elective and appropriate cases. Materials and Methods: Six hundred sixty-five (665/678) patients with an uncomplicated primary inguinal hernia who consented to participate in the study were randomized into two groups: Group I transabdominal preperitoneal patch plasty (TAPP) repair and Group II TEP repair. Perioperative and postoperative complications and recurrence were detected with the help of radiology unit of our hospital and recorded. The patients were followed up for 1, 6, 12, 24 and 48 weeks.Results: The difference between the number of Tackers and return to work was significant (p0.05). While complications related to bleeding and anaesthesia were more common in TAPP (p0.05). A significant difference was found between the two methods in terms of all complications except for chronic pain, seroma of inguinal area, subcutaneous emphysema and testicular ischemia (p 0.05).Conclusion: It is indisputable that the TEP method is less invasive than TAPP. TAPP should still remain method used in the laparoscopic hernia learning curve for the pushing forward of laparoscopic anatomy vision and used for very complicated inguinal hernias such as the undescended testis and giant inguinal hernias.