Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial

OBJECTIVE

To assess two techniques of primary closure after excision of pilonidal sinus.

DESIGN

Prospective randomised study.

SETTING

University department of surgery, United Arab Emirates.

SUBJECTS

46 patients with chronic pilonidal sinus disease, 24 treated by rhomboid flap transposition, and 22 by deep suturing technique.

MAIN OUTCOME

Early mobility and recurrence.

RESULTS

All patients in the rhomboid flap transposition group healed their wounds primarily compared with 17 in the primary deep suturing group (77%). (P = 0.02). Five patients wounds broke down as a result of haematoma and infection (23%). The mean hospital stay for the rhomboid flap technique was 6 days compared with 9 days after deep suturing, and the mean follow up for both groups was 18 months, the rhomboid flap group returned to work a mean of nine days earlier than the deep suturing group (23 days). No recurrence has been identified yet in the rhomboid flap group, while 2 recurrences have developed in the deep suturing group (9%).

CONCLUSION

Primary closure after excision of pilonidal sinus with a transposed rhomboid flap is successful in the management of pilonidal sinus and is superior to primary closure by deep suturing.

Early patient discharge following appendicectomy: safety and feasibility

One hundred and twenty patients with non-perforated acute appendicitis were discharged within 72 h of operation; 50 left hospital within 48 h of surgery. Criteria adopted for early discharge were: stable vital signs, active bowel sounds, ambulation and ability to tolerate fluid and food without discomfort. The patient's contact address was taken and every patient was requested to report to the out-patient department on the 7th post-operative day to remove stitches and assess the wound. There were three re-admissions. Five patients, however developed wound problems, three had wound infections, one had an indurated painful wound and the last developed erythema; the latter two patients were treated on an out-patient basis. Twenty patients were not happy about early discharge. Early discharge following appendicectomy is safe and can be practiced in uncomplicated cases of acute appendicitis.

A randomized prospective study of cefoxitin versus piperacillin in appendicectomy

A randomized prospective study of antibiotic prophylaxis using a single dose of either cefoxitin or piperacillin is presented. The trial was carried out in Al Ain Hospital in the period 1989-1992 on 250 adult patients with non-perforated appendicitis. One group (124 patients) received 2 g cefoxitin, the other group (126 patients) 2 g piperacillin. Antibiotics were administered intravenously in the operating theatre immediately before surgery. Wound infection occurred in three patients, 2.4% of the cefoxitin group and in five patients (4%) of the second group (with no significant difference). The commonest infecting organisms were Escherichia coli (5 out of 8). Mean hospital stay for patients with wound infection was 15 days (range 12-21) compared with 6 days, (range 4-8) for non-infected cases. Prophylactic cefoxitin or piperacillin were each therefore similarly effective in minimizing the rate of wound infections in patients with non-perforated appendicitis.

A comparison of two types of vacuum drainage after cholecystectomy

Following cholecystectomy, 50 patients were randomly allocated for suction drainage by small (2.5 mm) Redivac or large calibre (6 mm) Redivac drains. There were 25 patients in each group. Subhepatic collection was detected by ultrasonic examination in 5 patients on the seventh postoperative day. The smaller drain was used in all of these patients. Of these 5 patients, one developed pulmonary infection, a second had internal bleeding requiring laparotomy, while the remaining 3 were asymptomatic. Subhepatic fluid was not detected in any patient who had the larger drain.