All you need to know about ankle brachial pressure index

New inguinal hernia microsite

A new microsite for all you need to know about inguinal hernias now available. click on the link. Anatomy videopodcast on this region coming soon!

new page on hereditary colorectal cancer

A new page on hereditary colorectal cancer now available on www.learncolorectalsurgery.com.

Anatomy video podcasts

New anatomy video podcasts of the abdomen with Richard Tunstall now available at http://www.learncolorectalsurgery.com/Podcasts_AbdoAnatomy.php

Podcasts on YouTube

Podcasts now becoming available on YouTube. Go to http://www.youtube.com/, search for learncolorectalsurgery and subscribe.

New podcasts

3 new podcasts available to listen to on learncolorectalsurgery.com

Management of small bowel obstruction with Gill Tierney

Management of large bowel obstruction with Gill Tierney

Appendicitis with Nick Watson

New glue technique for treatment of pilonidal sinus

Pilonidal sinus disease is treated surgically. There are over 50 operations described, all of which cause some pain and discomfort and have a recurrence rate of 5-30%. Building on the use of glue for fistula in ano I have used fibrin glue to treat pilonidal disease with success, the patients going home the same day and often back to work within 40hours. recurrence rate so far is 10-15%.

The sinus complex is curetted to remove hairs, debris and granulation tissue.

Fibrin glue is injected into the sinus complex

No dressing is needed and the patient can go home when recovered from the anaesthetic

New video podcast on fistula

A new video podcast on anal fistula can be seen on learncolorectalsurgery.com

New video podcast

A new video podcast on anal fissure can be seen on learncolorectalsurgery.com

new podcast

A new podcast on diverticular disease has been added to learncolorectalsurgery.com

new podcast on colorectal cancer screeing

Listen to the new podcast on screening for colorectal cancer on www.learncolorectalsurgery.com 

Rhomboid flap for recurrent pilonidal disease

45 year old man had pilonidal disease since his early 20s. His first operation was 23 years ago and he has had multiple procedures since. His natal cleft was often painful and discharged pus frequently. He had multiple pits and hard indurated tissue in the natal cleft.

To cure the recurrent disease, radical excision of the affected area and coverage of the defect with a rhomboid flap was performed.

First the flap is marked out on the skin

The skin is incised along the lines and the diseased area removed leaving a large defect

The rhomboid flap is mobilized and sutured in place.

The patient was kept in for 2 days nursed on his side or prone.

panproctocolectomy for severe perianal crohns with rectus abdominis flap reconstruction

A man in his 30s presented with a history of 18 years of crohns disease confined to his colon and rectum with a watering can anus. He was unresponsive to medical treatment and continued to smoke

The colon was fully mobilized and extensive excision of peranal skin affected by multiple fistulae performed. The colon, rectum and anus were removed from the perineum.

This left a big defect!

A vertical rectus abdominis flap was raised based on inferior epigastic vessels (forceps pointing to these)

The flap was rotated around and placed in perineum to fill the defect.

The patient went home 9 days after the operation with all healed