ObjectiveTo compare the clinical therapeutic efficacy of the pilonidal sinus with four kinds of surgical procedures. MethodsThe clinical data of 43 patients with sacrococcygeal pilonidal sinus treated from January 2008 to March 2013 were analyzed retrospectively. All of them were received surgery, in who 4 patients underwent pilonidal sinus resection alone(incision open group), 7 patients underwent incision and direct suturing after pilonidal sinus resection (incision and direct suturing group), 19 patients underwent marsupialization after pilonidal sinus resection(marsupialization group), and 13 patients underwent Limberg flap transposition after pilonidal sinus resection(rhombus flap transposition group). Results①There were not statistically significant differences regarding demographics among four groups (P > 0.05). 2 The hospital stay was(16.70±8.69) d, (16.43±10.68) d, (15.84±11.29) d, and(14.69±4.01) d in the incision open group, incision and direct suturing group, marsupialization group, and flap transposition group, respectively, and the healing time of incision was(64.75±6.50) d, (34.57±19.15) d, (35.16±15.49) d, and(17.92±4.29)d among the same four groups, respectively. The difference of the hospital stay was not statistically significant among four groups(P > 0.05). The healing time of incision in the flap transposition group was less than that in the other three groups(P < 0.05), which in the incision and direct suturing group and marsupialization group were shorter than those in the incision open group(P < 0.05), and which had no significant difference between the incision and direct suturing group and marsupialization group(P > 0.05).③The partial wound dehiscence occured in two patients and the wound was partially broken because of infection in two patients in the incision and direct suturing group. One patient was performed drainage because of emhysis and the wound tension blisters occurred in one patient in the flap transposition group. There was no complications in the other two groups. There was no recurrence after the wound healing of follow-up six months. ConclusionsAccording to this limited preliminary data, the selection of wound closure method depends on the incision tension. Direct suturing can be the choice for incision with lower tension. The marsupialization can be the choice for incision with higher tension. The Limberg flap transposition can be the choice for incision with extensive disease or postoperative recurrence.
ObjectiveTo compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. MethodsThe clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). ConclusionsCurative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.
ObjectiveTo summarize the recent development of surgical treatment for chronic anal fissure. MethodsThe related literatures on various operation treatment of anal fissure at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of anal fissure, includes the closed or open lateral internal sphincterotomy, excision of anal fissure, skin flap plasty, and other operation modes.The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications and the recurrence risk. ConclusionFor what kind of operation method is the most suitable for the treatment of chronic anal fissure is no fixed conclusion.