Conventional fistula surgery techniques have their place, but new technologies such as fibrin glues, dermal collagen injection, the anal fistula plugs, and stem cell injection offer alternative approaches whose long-term efficacy needs to be further clarified in large long-term randomized trials.

Adrenal pseudocysts are rare cystic masses usually nonfunctional and asymptomatic, discovered incidentally during diagnostic imaging or when complicated by rupture and hemorrhage or infection. Few cases of hemorrhagic adrenal pseudocyst during pregnancy are reported, but a causal relationship between pregnancy and pseudocyst formation has not been shown. We describe a case of a 30-year-old pregnant woman referred to our surgical unit at the 20th week of gestation for incidental detection of left-side upper abdominal cystic mass, with signs of intralesion hemorrhage. The lesion was monitored and the woman gave birth at the 39th week, without complications. After 3 months from delivery, a multislide computed tomography scan confirmed a cystic mass measuring 10×7×10 cm. An elective transperitoneal laparoscopy was performed and a well-capsulated, hemorrhagic adrenal pseudocyst was removed. The optimal surgical treatment for hemorrhagic adrenal pseudocyst during pregnancy is still controversial. The present case shows that adrenal pseudocyst should be carefully monitored and can be treated by elective laparoscopic surgery after delivery.

Biofeedback therapy plus transanal electrostimulation provided sustained improvement in bowel symptoms and anorectal function in constipated subjects with dyssynergic defecation, whereas standard therapy was largely ineffective.

Chronic pilonidal disease is a debilitating condition that typically affects young adults. Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with our modified primary closure. This retrospective study involving consecutive patients with pilonidal disease was conducted over a 6-year period. From January 2004 to January 2010, 450 consecutive patients with primary pilonidal sinus disease received this new surgical treatment. Times for complete healing and return to work, the duration of operation and of hospitalization, postoperative pain, time to first mobilization, and postoperative complications were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale. The median long-term follow-up was 54 months (range, 24 to 84 months). Four hundred fifty consecutive patients (96 female, 354 male) underwent excision. The median age was 25 years (range, 17 to 43 years). The median follow-up period was 54 months (range, 24 to 84 months). Four hundred twenty completed questionnaires were returned (87% response rate). The median duration of hospital stay was eight hours (range, 7 to 10 hours) No patient reported severe postoperative pain. Primary operative success (complete wound healing without recurrence) was achieved in 98.2 per cent. Two (0.5%) patients had a recurrence. The mean time lost to work/school after modified primary closure was eight days. Excision and primary closure with this new technique is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to work, and excellent cosmetic result and a high degree of patient satisfaction in the long-term follow-up.

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