Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742

AUDIT OF MANAGEMENT OF ADULT CHOLEDOCHAL CYSTS

Objective: To analyze the complexity and diversity of type, surgical management and complications in adult choledochal cysts presenting to a Hepatobiliary unit of a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2019. Methodology: All the patients diagnosed with choledochal cyst and underwent surgical procedure between Jan 2017 to June 2019 were analyzed. The clinical features, types, operative procedure and outcomes of the patients in terms of post-operative morbidity and mortality were assessed. Calvin Dindo classification was used to assess complications. Results: A total of 17 patients were studied, out of which, 13 were females (76.5%) and 4 were males (23.5%) with mean age of 37.41 ± 16.96 years. There were 13 type I (76.5%), 2 type IVa (11.8%) and 1 type II (5.9%) choledochal cysts according to Todani’s classification. Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on all 17 patients. There was no mortality in the series. Post-operative complications occurred in 4 (23.5%) patients, 2 were grade II, 1 was grade I and 1 grade III according to Clavin Dindo scale. Long-term follow up revealed recurrent cholangitis in 3 (17.6%) patients which settled on antibiotic regime. The median follow up time was 1.5 years. Conclusion: The total extra-hepatic excision with Roux-en-Y hepaticojejunostomy is the treatment of choice for adult choledochal cyst. The procedure has low morbidity and very low mortality.

Transoral Complete vs Partial Excision of the Sublingual Gland for Plunging Ranula

Objectives Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. Study Design A nonrandomized comparative study. Setting Academic medical center. Methods This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. Results Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton’s duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG ( P > .1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. Conclusions Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence.

Case Report: Giant Epidermoid Cyst on the Neck with Hypopharyngeal Propulsion

Introduction: Dermoid cyst is a cystic mass lined with stratified squamous epithelium with skin adnexal structure. Histopathologically dermoid cysts consist of 3 types, namely epidermoid cysts, true dermoid cysts and teratoid cysts. Epidermoid cysts are characterized by masses with a simple squamous epithelial lining. When the cyst ruptures, it releases a cheesy white matter that smells bad. Epidermoid cysts are most commonly found in the age range of 15 and 35 years with almost the same frequency between male and female sexes. Case description: We report a case of a 52-year-old man with a lump on the left side of the neck that has been slowly growing since 1 year and a computer tomography of the neck suspected a cyst in the anterior glottis. The patient was diagnosed as a neck cyst. Management was carried out by excision of the cyst under general anesthesia and histopathological examination with the results of an Epidermoid cyst. Conclusion: Epidermoid cysts can develop in any part of the body, but are very rare on the head and neck. Definitive management of epidermoid cysts with complete excision of the cyst gives satisfactory results Keywords: Giant Epidermoid Cyst, excision, hypopharyngeal propulsion

Meniscal Repair and Parameniscal Cyst Excision with Knee Arthroscopic Surgery: A Case Report

Background: Meniscal cysts were rare case. There’s a 50 to 100% chance forming cyst to the tear if there was an injury happens. Trauma would cause tears happen in meniscus, leads to formation of hemorrhage which formed mucoid degeneration. The necrosis happens locally plus degeneration of mucoid forming a cyst. Thus, the meniscal cysts challenge the clinician to have clinical reasoning so then the patient can get accurate diagnosis and preferred management. Method: This paper is a case report of surgery on a patient present with cysts on lateral para meniscus which done arthroscopically with all inside technique. Results: The procedure which done by arthroscope and motorized shaver had a great outcome in this patient which were analyze from Visual Analog Scale (VAS) and Western Ontario and McMaster Index (WOMAC) 3 months after the procedure, and reach VAS score of 2/10 which was mild pain and 59,8 in WOMAC score. Conclusion: The arthroscopy and all inside technique with motorized shaver is a choice of lateral para meniscal cysts surgery with good results to be considered by orthopedic surgeons. Key words: Lateral, Meniscus Tear, Parameniscal cyst, Arthroscopy.