European Journal of Surgery最新文献

Objective: To find out whether failure of primary wound healing after excision and primary suture for chronic pilonidal sinus predicts recurrence.

Design: Follow-up of one prospective study and one subsequent randomised, multicentre study.

Setting: Three teaching hospitals in Western Norway.

Subjects: A total of 197 consecutive patients operated on for chronic pilonidal sinus.

Interventions: Fifty two patients in the prospective group were given cloxacillin perioperatively. In the randomised study, 145 patients were randomised to have either a single preoperative dose of cefoxitin 2 g intravenously (n = 73) or no prophylaxis (n = 72). Patients were followed up for a median of 7 years.

Main outcome measures: Recurrence of pilonidal sinus.

Results: In the prospective group there were 10 recurrences (19%). In the randomised study 6 patients (8%) who had been given antibiotic prophylaxis had a recurrence compared with 14 patients (19%) who had not been given prophylaxis (p = 0.09). In both groups, failure of primary normal healing was significantly associated with early recurrence (p = 0.0002). Neither the use of antibiotics nor sex had any significant influence on the incidence of recurrences. Most recurrences occurred within the first year.

Conclusion: Wound complications significantly influenced the recurrence rate whereas antibiotics did not. Most recurrences were seen early.

Objective: To evaluate the outcome of patients treated for appendiceal abscess, and managed either conservatively or surgically, and to describe the short and long-term outcome as well as incidence of interval appendicectomy in those treated conservatively.

Design: Retrospective study.

Setting: University hospital, Sweden.

Patients: Ninety-three patients with the diagnosis of appendiceal abscess, 50 treated conservatively and 43 who were operated on, with a mean age of 46 (14–93) years. Mean (range) follow-up for patients operated on was 65 (11–135) and for those treated conservatively 66 (6–136) months.

Main outcome measures: Course of acute disease, recorded complications, recurrence of appendicitis and incidence of interval appendicectomy during follow-up.

Results: The duration of pain before admission was 4 (0.5–82) days for those operated on and 7 (2–60) days for those treated conservatively. A palpable mass was more common in the conservatively managed group. Complications were common among patients who were operated on. No interval appendicectomies were done during the second half of the study period. 4 of the patients treated conservatively (8%) had an underlying tumour diagnosed at follow-up.

Conclusions: Operative management of patients with appendiceal masses seems to be associated with a high risk of postoperative complications and the risk of a more extensive surgical procedure. If possible, a conservative approach should be advocated. Because of inaccurate radiological imaging during the acute phase and the risk of an underlying malignancy. routine follow-up is necessary. Routine interval appendicectomy cannot be recommended.

Objective: To audit the effect of changes in treatment of inguinal hernias on recurrence rate.

Design: Retrospective analysis of consecutive patients operated on in 1990 and prospective analysis of consecutive patients operated on in 1996. Follow up with questionnaire followed by selective clinical examination.

Setting: County hospital, Sweden.

Subjects: 144 patients with 147 inguinal hernias operated on in 1990 and 154 patients with 165 inguinal hernias operated on in 1996.

Interventions: In 1993, we changed many aspects of the treatment of inguinal hernia. We introduced new techniques such as Shouldice, Lichtenstein, and laparoscopic hernia repair. Non-absorbable polypropylene sutures replaced the braided absorbable sutures previously used. Inguinal herniorrhaphy went from a “low status” operation to a high status operation and became a primary teaching operation for surgical residents.

Main outcome measures: Recurrence rate at 5 year follow up.

Results: The 5 year recurrence rate decreased from 28% in 1990 to 3% in 1996 (p < 0.001). The median operating time increased from 35 minutes in 1990 to 78 minutes in 1996 (p < 0.001).

Conclusion: Changing the strategy of inguinal hernia surgery by introducing uniform operating techniques and new materials dramatically improved the results and allowed us to achieve recurrence rates comparable to those seen in specialised hernia centres.

Four cases are presented in which complications occurred during or after thoracic endoscopic sympathectomy (TES). In one patient inappropriate TES resulted in disabling hyperhidrosis. In one patient laceration of the subclavian artery required major surgery. In two cases intraoperative cerebral damage occurred. Training in TES is essential. Copyright © 1998 Taylor and Francis Ltd.