Purpose: Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD. Methods: A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6. Results: The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively). Conclusion This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060

PURPOSE: We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. METHODS: From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. RESULTS: There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). CONCLUSION: In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.
Anal Canal ; Anti-Bacterial Agents ; Body Mass Index ; Follow-Up Studies ; Hair Follicle ; Humans ; Methods ; Necrosis ; Pilonidal Sinus ; Prospective Studies ; Recurrence ; Return to Work ; Skin ; Smoke ; Smoking ; Surgical Flaps ; Surgical Wound Infection ; Sutures ; Wound Infection ; Wounds and Injuries

PURPOSE: The aim of this study was to evaluate the effects of repeated porcelain firing process on the corrosion rates of the dental alloys. MATERIALS AND METHODS: Cr-Co, Cr-Ni and Pd-Ag alloys were used for this study. Each metal supported porcelain consisted of 30 specimens of 10 for 7, 9 and 11 firing each. Disc-shaped specimens 10 mm diameter and 3 mm thickness were formed by melting alloys with a propane-oxygen flame and casted with a centrifuge casting machine and then with the porcelain veneer fired onto the metal alloys. Corrosion tests were performed in quintuplicate for each alloy (after repeated porcelain firing) in Fusayama artificial saliva solution (pH = 5) in a low thermal-expansion borosilicate glass cell. Tamhane and Sheffe test was used to compare corrosion differences in the results after repeated firings and among 7, 9 and 11 firing for each alloy. The probability level for statistical significance was set at alpha=0.05. RESULTS: The corrosion resistance was higher (30 mV), in case of 7 times firing (Commercial). On the other hand, it was lower in case of 11 times firing (5 mV) (P<.05). CONCLUSION: Repeated firings decreased corrosion resistance of Pd-Ag, Cr-Co and Cr-Ni alloys. The Pd-Ag alloy exhibited little corrosion in in vitro tests. The Cr-Ni alloy exhibited higher corrosion resistance than Cr-Co alloys in in vitro tests.
Alloys ; Corrosion ; Dental Alloys ; Dental Porcelain ; Fires ; Freezing ; Glass ; Hand ; Saliva, Artificial