Selected Abstracts

Abstract

Abridged abstracts from the medical literature Day-case Limberg flap for recurrent pilonidal sinus: Does obesity complicate the issue? Madbouly KM. Am Surg. 2010;76:995-999.PURPOSE: This study analyzed the long-term outcomes of Limberg Flap (LF) repair for recurrent pilonidal disease with respect to obesity. METHODS:This was a retrospective review of 1 surgeon's experience with 49 patients who underwent LF repair for recurrent pilonidal disease at the University of Alexandria (Egypt) between March 2005 and October 2008. Perioperative and postoperative complication data were tracked, as well as long-term follow-up data. A standard technique using the rhomboid flap and perioperative and postoperative antibiotics were used. No drains were used, and the cases were all performed as same-day operations. Patients with a BMI Ͼ28 were defined as being obese. RESULTS:Of the 49 patients (38 men) studied, 34 patients were obese vs 15 who were not. Patients who were obese had a significantly longer operation (60.3 min vs 42.1 min). There were no significant differences in postoperative seroma, wound infection, or time to complete healing. There were no recurrences in either group over a mean follow-up period of Ͼ32 months. CONCLUSION: Obesity significantly increased the time for the LF operation, but it did not affect the rates of complication or recurrence. The LF is a safe and effective operation for patients with recurrent pilonidal disease regardless of BMI. Abstractor's Comments: Recurrent, complex pilonidal disease is a difficult problem, but this study (and the literature in general) demonstrated great success with the LF operation. Although this study carries with it the selection bias inherent in allretrospective studies, it provides elegant and convincing evidence the LF can be used in all patients with recurrent pilonidal disease, regardless of BMI.-Joshua I. S. Bleier, M.D. International preoperative rectal cancer management: Staging, neoadjuvant treatment and impact of multidisciplinary teams Augestad KM, Lindsetmo RO, Stulberg J, et al. World J Surg. 2010;34:2689 -2700. PURPOSE: This study evaluated practice variations in the staging and neoadjuvant management of rectal carcinoma. METHODS:A survey was sent via email to 173 colorectal surgeons in 28 countries. The survey had been created by 6 members of the international (USA, Australia, and Europe) rectal carcinoma study group using 6 central rectal carcinoma treatment guidelines with recommendations for radiologic T staging and neoadjuvant treatment. Respondents were evaluated as US-based surgeons and non-US-based surgeons. Regression analysis was performed to evaluate the role of caseload and team meetings on preoperative decision making. RESULTS:A total of 123 surgeons responded (71%) to the survey (93% had Ͼ5 years experience with operations for rectal carcinoma and 70% reported Ͼ50 rectal resections for carcinoma per year). The preoperative staging preference was CT scan (55%), followed by MRI (35%), then endorectal ultrasound (ERUS) (29%). All surgeons use...