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Article
DAY CASE SURGERY FOR SACROCOCCYGEAL PILONIDAL SINUS USING EXCISION AND PRIMARY MIDLINE CLOSURE

Author: Nizar Hamawandi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 111-117
Publisher: Basrah University جامعة البصرة

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Abstract

Sacrococcygeal pilonidal sinus (PNS) is a common disease. There are different lines oftreatment but the best surgical technique is still controversial. The aim of this study is to showthe effectiveness of treatment of sacrococcygeal PNS with excision and primary midline closureas day case surgery. This is the first study on sacrococcygeal PNS to be done in Sulaymaniagovernorate, Iraq.A prospective study was done over a period of 3 years, between 1st Jan 2003 and 31st Dec2005 in a private general surgical office, in Sulaymania city, Iraq, where 78 cases of chronicsymptomatic, uncomplicated, nonrecurrent sacrococcygeal PNS were seen. From these 78patients 6 patients refused operation and they were excluded from the study. Data collectedfrom the remaining 72 patients were age, gender, presenting complaint and its duration,operative findings, duration of the operation, time of wound healing, any hospitalization ifrequired, time to return to work, postoperative complications, postoperative pain, woundhematoma, wound infection, wound disruption, recurrence of the sinus, cost of the operation,patient satisfaction about the treatment and follow up compliance of the patients. They weretreated with excision and primary midline closure technique. From the total no of 72 patients, 7patients were unable to complete the follow up period and they were excluded from the study,and we continued the study of the outcome data of the remaining 65 patients.Of those 65 patients treated excision and primary midline closure, 1 patient (1.53%) developedwound disruption, 4 patients (6.14%) developed surgical site infection (SSI) and only 3 patients(4.61%) had reccurence of the sinus.It is concluded that excision and primary midline closure technique is simple, convenient,economic and successful treatment as day case surgery for chronic, sympotomatic,uncomplicated and non recurrent sacrococcygeal PNS.K

Keywords

SACROCOCCYGEAL --- PILONIDAL --- SINUS


Article
Marsupialization after Undermining Excision and Flap-Like Margin Creation vs. (Marsupialization Only) or (Excision and Laying Open) Treatments for Pilonidal Sinus (PNS)

Author: Hadi Awad Hmoud
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2432-2335
Publisher: Kerbala University جامعة كربلاء

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Abstract

bAckground: Pilonidal disease treatment should be minimal, minimal pain, short hospitalization, low recurrence rate, minimal wound care, and allow rapid return to normal activity. Unfortunately, no treatment meets all these ideal goals.Aim: This study is conducted to find out a modality treatment for PNS that can achieve the above goals.Methodology: It is a retro and prospective study of 51 patients presented with PNS.All were divided randomly into 3 groups; First group treated by excision of the sinuses and laid the wound open. Second group treated by excision and marsupialization and third group treated by excision of skin containing sinuses’ openings only and further undermined (beneath the skin) resection of the infected tissues with flap forming with marsupialization of flap margins to the sacral fascia .Results: Healing time; Third group healed earlier.Post-operative painkillers; Third group needed less painkillers for shorter time.Return to daily activities; Third group return to their jobs and life activities earlier.Infection: Third group had only one case of cellulitis.Recurrent PNS; zero patient from third group had recurrent cellulitis.Discussion: Third group modality will reduce the tension on sutures and reduce the postoperative pain, and loosening sutures, also further reduces the recurrence rate.Conclusion: Third group modality yields a promising results in term of reducing the healing time, post-operative pain, recurrence of PNS and infection rates.It could be widely adopted, and would be largely cost-effective modality, as it will reduce the expenses of caring for wound, antibiotics use, painkiller use and the early return to the job.


Article
13- THE ROLE OF PHENOL INJECTION IN THE TREATMENT OF PILONIDAL SINUS DISEASE

Author: Qais K Baqirim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 78-80
Publisher: Basrah University جامعة البصرة

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Abstract

The aim of this study was to determine the impact of phenol injection on the outpatienttreatment of the sacrococcygeal pilonidal sinus disease. A prospective analysis was taken offorty patients between June 2002 to June 2006 as an outpatient. Age, sex, state of sinuses atinitial presentation & the recovery time was analyzed. Phenol injection applied on 40 patients,37 males & 3 females. Forty percent of the patients required one injection while 55 % of thepatients had two applications. The recovery time was between 1-3 months. Recurrence wasobserved in 15% (6 patients). Phenol treatment is simple, easy & inexpensive method that canapplied on an outpatient basis, decreasing both recurrence rate & the morbidity.


Article
Management of Pilonidal Sinus
العلاج الجراحي للناسور العصعصي

Author: Jasem Abed Al-Bedri د. جاسم عبيد البدري
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 1 Pages: 45-49
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background:- A Pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort, embarrassment and absence from work for thousands of young people (mostly men) annually.Objectives:-Assessment of our experience was done with the comparison between methods of treatment of the pilonidal sinus and other studies. Patients & Methods:-A retrospective study over 10 years from Jan. 1997 to Dec. 2007 one hundred eighty four patients with pilonidal sinus had been operated by the author. Analysis according to the age, sex, type of presentation, treatment and morbidity with each type compared with other studies. Results:-Group A; one hundred thirty three male patients, Mean time of healing (M.T.O.H.) 48 days, delayed healing time (more than two months) (6.7%). Recurrence rate 5.3% .Twenty three female patients, M.T.O.H. 45 days, delayed healing time (8.7%) and recurrence rate (4.35 %).Group B; sixteen male patients, M.T.O.H. 51 days, delayed healing time (12.5%) and recurrence rate (6.25%). four female patients M.T.O.H. 49 days, delayed healing time (25%) and recurrence rate zero. Group C; five male patients, recurrence rate 100%. All needed surgery. Three female patients, recurrence rate 67% needed surgery, one patient 33% missed during follow up.Conclusion:- Excision and healing by granulation tissue has low recurrence rate, long healing time, long absence of the work, and more nursing. Key words: - pilonidal sinus , management, acute, chronic.

الملخص: دراسة إستطلاعية عشوائية أجريت في عدة مستشفيات حكومية وأخرى خاصة لمدة عشرة سنوات (من 1997-2007), عدد المرضى الكلي 184 مريض, منهم 154 ذكور و30 إناث.الدراسة متعلقة بالعلاج الجراحي للناسور العصعصي يواسطة: 1. الأستئصال الواسع للناسور مع ترك الجرح مفتوحا كي يلتئم بواسطة النسيج الحبيبي, عولج 156 مريض, منهم 133 ذكور و23 إناث.2. في حالة وجود خراج عصعصي, يتم العلاج بواسطة بزل الخراج مع الجرف الألي لجوف خراج الناسور, وبعد إسبوع تجرى عملية إستئصال واسع للناسور مع ترك الجرح مفتوحا كي يلتئم بواسطة النسيج الحبيبي. عولج 20 مريض, منهم 16 ذكور و4 إناث.3. علاج الناسور العصعصي بدون أعراض يكون بالعلاج التحفضي. عولج 8 مرضى منهم 5 ذكور و 3 إناث. أهداف الدراسة:مقارنة بين هذه الدراسة ودراسات أخرى تتضمن طرائق إستئصال الناسور العصعصي و ترك الجرح مفتوحا مع مراعاة:1. معدل وقت إلتئام الجرح.2. معدل رجوع الحالة المرضية.3. تأخر شفاء الجرح (عندما يكون وقت الشفاء أكثر من شهرين).في المجموعة (1) معدل إلتئام الجرح 48 يوم عند الذكور و 45 يوم عند الأناث, 9 مرضى كان عندهم تأخر شفاء الجرح ينسبة ( 6.7%) للذكور و(8.6%) لللأناث, معدل رجوع الحالة المرضية كان 8 مرضى, (5.3%) للذكور و (4.35%) للأناث.في المجموعة (2) معدل التئـام الجرح كان 51 يوم للذكور و 49 يوم للأناث, تأخر إلتئام الجرح 3 مرضى (12.5%) للذكور و (25%) للأناث, رجوع الحالة المرضية واحد للذكور (6.25%), ولا توجد حالات رجوع للمرض للأناث. في المجموعة (3) معدل رجوع المرض (100%) ذكور و(67%) إناث, تمت معالجة رجوع المرض بطريقة الأستئصال الواسع للناسور مع ترك الجرح مفتوحا كي يلتئم بواسطة النسيج الحبيبي.


Article
OPEN VERSUS CLOSED METHODS IN TREATMENT OF PILONIDAL SINUS DISEASE

Authors: Ali A Ali علي عزيز علي --- Basher A Abdul-Hassan بشار عباس عبد الحسن --- Anees K. Nile انيس خليل نايل
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 2 Pages: 114-119
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Pilonidal sinus disease can be managed surgically either by excision & primary closure, or by excision and leaving the wound to heal by secondary intention. This study is designed to show the difference between these two methods.Objective: To assess the difference between excision and primary closure versus excision and healing by secondary intention in treatment of pilonidal sinus disease.Methods: Between January 2005 and January 2009, 60 median aged patients with Pilonidal sinus disease were studied in Al-Kadhimiya Teaching Hospital, Baghdad, Iraq; 30 cases were operated by excision and primary closure (group І); the remaining 30 cases were operated by excision and healing by secondary intention, without closure (group II). The principle outcome measures recorded were duration of hospital stay, operative time, duration of complete healing, wound infection and recurrence rate. Satisfaction and comfort of patient was monitored by using visual analogue scale during first five days post-operatively. Data were statistically analyzed by using SPSS & Chi square.Results: A total of 60 patients were divided into 2 groups, 30 patients operated by using primary closure (group I), and 30 patients operated without closure (group II). Age range of patients was from (16 - 37 yrs). Duration of hospital stay and duration of complete healing was longer in patients of group II than those of group I (p ≤ 0.001). Operative time in group I is more than that in group II (p ≤ 0.001). Pain scores were lower in group I than group II (p = 0.004). The frequency of wound infection and recurrence rate after one year follow up were more in group I than group II, this was statistically of little significance.Conclusions: Excision and primary closure is recommended as a preferred procedure in the management of chronic sacral PNS disease. It has the advantages of short hospital stay, early wound healing, rapid return to work.Key words:pilonidal sinus, primary closure, secondary intention


Article
Excision with Primary Closure and Suction Drainage for Pilonidal Sinus in Adolescent Patients

Author: Ibtesam Khalid Salih Al-Shadydy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 228-231
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND :Controversy persist regarding the treatment of pilonidal sinus. Sacrococcygeal pilonidal disease is a common chronic disorder of the natal cleft that is often considered a minor problem, but may cause substantial in convenience and local infection. Therefore, adequate treatment of a pilonidal sinus is important in order to improve the quality of life of affected patients.OBJECTIVE:To evaluate the technique of excision with primary suture and suction drainage (PSD) for the treatment of pilonidal sinus in adolescent patients.METHODS:Between 1996 and 2005, forty patients aged 14-19 years (are range 16.4) underwent PS excision with primary closure and suction drainage. Anesthesia was general in 18 (45%) and spinal in 22 (55%). Prophylactic cephalosporine was used is I.V antibiotic. Excision of the sinus done down to the social fascia. Closed continuous suction drain was used.RESULT:No complications due to the anesthesia were observed. Twenty five patients (62.5%) had day case surgery, while the others fifteen patients, (37.5%) were hospitalized for 2-4 days (average 2.3 days). The drain was removed on post operative day 3-6 days (average 3.2 days) primary healing with no postoperative complications occurred in 36 patients (90%). Postoperative infections requiring incision , drainage, and lay-open occurred in 3 cases (7.5%). No recurrence was found at 12-months follow-up. One recurrence (2.5%) was noted 2 years after surgery.CONCLUSION:Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a simple and effective method of treatment of uncomplicated PS in adolescents


Article
ELLIPTICAL ROTATION FLAP FOR COMPLICATED PILONIDAL SINUS

Authors: Mohammed J. Al Najjar محمد جواد النجار --- Sajid H.A. Al-Helfy ساجد حميد عبد الحلفي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2015 Volume: 13 Issue: 1 Pages: 56-63
Publisher: Al-Nahrain University جامعة النهرين

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Background:Pilonidal sinus is one of the most common sinuses seen in general surgical practice and usually seen in the natal cleft. Postoperative wound complications have always been the main cause of concern followed by the risk of recurrence in the surgical treatment of the pilonidal sinus disease. Various techniques evolved so far mainly aimed at solving these problems. This clinical study conducted to discuss the results of elliptical rotational flap in chronic pilonidal sinus.Objective:To assess the outcome of patients operated by rotational flap procedure in chronic pilonidal disease in term of healing time, complications and recurrence rate.Methods:The study was conducted in two different places from December 2007 till April 2011. Eighty two patients with chronic pilonidal sinus were treated by rotation flap. The setting was in two different places, at Nizwa General Hospital, Sultanate of Oman and from Al-Imamain Al-Kadhemain Medical City, Baghdad. Evaluation of operative and post-operative results, complications and recurrence in addition to demographic data.Results:Out of 82 Patients included in study, 2 cases (2.4%) failed to heal due to partial necrosis of the flap and underwent redo surgery, while 80 patients (97.4%) were cured completely and no further surgery was needed. Eighteen patients (22%) went home in the end of same day and the rest (78%) discharged in second day. Forty six Patients (56%) had dry dressing till suture removed after 8 days, while 20 Patients (24.4%) continued to discharge serosangunious fluid and spent more than 10 days to heal. Eight Patients (9.8%) developed seroma needed further time to becomes dry and the last 6 Patients (7.3%) developed wound infection and treated by proper antibiotics and surgical drainage in some case.Conclusion:Flap procedures may be promising especially in complex and recurrent pilonidal diseases as it is simple to be done and carry low recurrence rate and relatively shorter hospital stay in comparison to other surgical procedureKeywords:Chronic pilonidal sinus, elliptical rotation flap.


Article
EXCISION WITH MIDLINE CLOSURE VERSUS MODIFIED BASCOM PROCEDURE IN TREATMENT OF SACROCOCYGEAL PILONIDAL SINUS

Authors: Ahmed Falih Noori --- Nasseif Jassim Mohammed# --- Zeki A AL-Faddag
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2017 Volume: 23 Issue: 2 Pages: 69-73
Publisher: Basrah University جامعة البصرة

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Abstract

EXCISION WITH MIDLINE CLOSURE VERSUS MODIFIED BASCOM PROCEDURE IN TREATMENT OF SACROCOCYGEAL PILONIDAL SINUSAhmed Falih Noori*, Nasseif Jassim Mohammed# & Zeki A AL-Faddag@*MB, ChB, #CABMS, FICS, Dept.of Surgery, Al-Sadir Teaching Hospital. @CABS, FRCS, Professor of General Surgery, Dept. of Surgery, Basrah College of Medicine, University of Basrah, IRAQ.Abstract Pilonidal sinus is a frequently encountered condition in young adults. It is commonly found in the mid-line skin that covers sacrum and coccyx. Sinus can be found elsewhere, sometimes between the fingers in hair dressers, and in the umbilicus. It is characterized by chronic inflammation in one or more sinuses in the mid-line of the natal cleft that contain hairs and debris. Pilonidal disease is a significant social and economic problem affecting predominantly young males in the second decade of life. This study aimed to compare the results of excision and midline closure with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro-coccygeal pilonidal sinus in regard to the duration of the procedure and wound complication. This prospective randomized study was performed on 53 patients operated upon for a pilonidal sinus between June 2014 and December 2015 in Al-Sadir Teaching Hospital in Basrah. Patients were divided into two groups randomly. Group A (25) patients underwent modified Bascom procedure and group B (19) patients underwent excision and midline closure. The modified Bascom technique showed a significantly short wound healing time (30±10 days) compared to primary closure (55±25 days), p<0.01. The duration of this procedure was significantly longer(50±15 minute) in comparison with excision and midline closure (30±15 minutes) p< 0.01. No significant differences between the two groups regarding bleeding, wound infection, seroma formation and recurrence were recorded. In conclusion, modified Bascom procedure is feasible, effective and applicable for all patients with pilonidal sinus. It is of particular advantages in the treatment of complex, recurrent and chronic non-healing pilonidal sinuses when wound healing remains an important dilemma in the surgical treatment.


Article
PILONIDAL SINUS: COMPARATIVE STUDY - OPEN OR CLOSE PROCEDURE
الناصور العصعصي : دراسة مقارنة بين الطريقة المغلقة

Author: HAYDER H. IBRAHIM حير جسين ابراهيم
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2009 Volume: 3 Issue: 1 Pages: 45-50
Publisher: University of Dohuk جامعة دهوك

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ABSTRACTBackground Pilonidal disease is a disabling nuisance in young adults, yet its management remains controversial. Ambulatory treatment with minimal morbidity and a rapid return to normal activity is desirable. Objective Many techniques have been described for the treatment of patients with pilonidal sinus. The aim of this study is to compare two methods of surgical treatment of pilonidal sinus with regard to cure and recurrence rates. Methods A case series study. All patients were treated as a day case surgery from January 1992- December 2001; divided in two groups: Group A ( excision as lay open method) includes 100 patients and group B ( excision and primary closure) includes 90 patients. Results: One hundred ninety patients, 165 males, 25 females were treated for pilonidal sinus over a period of 10 years. 100 patients were managed by excision only and 90 patients were managed by excision and primary closure. Operation for recurrent sinus was performed on 16 patients by open method. All cases treated as day case .The average time for healing following laying open was 45 days while in closed method was 14 days. 15 cases developed recurrence following surgery, 6 in group A (6%), including those already recurrent 16 patients, in whom one patient developed recurrence again and 9 in group B (10%). P<0.001. The mean follow up peroid was 1.5 year. Conclusion The open method has less recurrence rate than closed procedure but the later one has many advantages and more acceptable by the patients.

الاهداف: مقارنة مجموعتين من المرضى المصابين بناسور العصعص , قسم إلى مجموعتين وعولجوا جراحيا , المجموعة الأولى بالطريقة المفتوحة والمجموعة الثانية بالطريقة المغلقة وقورنتا من ناحية الشفاء ونسبة رجوع الحالة المرضية.المرضى و طريقة البحث: دراسة سلسلة حالات . أجريت الدراسة على مائتي وتسعين مريضا كحالة جراحية يومية للفترة من كانون الثاني 1992- ولغاية كانون الاول2001 . المجموعة ( أ ) مكونة من مائة مريض عولجت بالطريقة المفتوحة والمجموعة الثانية ( ب ) مكونة من تسعين مريض عولجت بالطريقة المغلقة.النتائج: مائة وتسعون مريض , (165 ) من الذكور و( 25 ) من الإناث و عولجوا بالعملية الجراحية لناسور العصعص خلال مدة عشر سنوات . مائة مريض كانت معالجتهم بالطريقة المفتوحة وتسعون مريض بالطريقة المفلقة . معدل مدة التئام الجرح في المجموعة ( أ) هي 45 يوم بينما في المجموعة ( ب )كانت 14 يوم . عدد حالات رجوع المرض في المجموع ( أ ) كانت 6% وفي المجموعة (ب) .1 % , فقيمة ب اقل من 0.001 . معدل مدة المتابعة للمرضى في كلا المجموعتين كانت سنة ونصف. الاستنتاجات: نسبة رجوع الحالة المرضية في الطريقة المفتوحة اقل ولكن الطريقة المغلقة لها فوائد كثيرة كمدة التئام الجرح اقل والرجوع للعمل أسرع ومحبذة لدى الكثير من المرضى.


Article
A comparative Study between Open Excision and Modified Bascom's Technique in Sacro- Coccygeal Pilonidal Sinus

Author: Mohammed Hillu Surriah
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 53-61
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Pilonidal sinus is a common disabling disease of young adults involving the sacro- coccygeal area, in the natal cleft , consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous track lined by granulation tissue and containing hair lying loosely within the lumen. Many of the standard surgical procedures are associated with a significant risk both of delayed healing and of recurrent disease.OBJECTIVE: The study aimed to comparing the results of excision and packing method with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro - coccygeal pilonidal sinus in regard to the hospital stay, time required for complete healing , time required to return to daily job or activity, early complications (infection, wound hematoma or seroma ) and late complications (scar and recurrence) . METHODS : Eighty patients were operated on electively for pilonidal sinus, (62) male, (18) female who underwent elective operations of sacro-coccygeal pilonidal sinus at AL-Karama Teaching Hospital between June 2009 - June 2014 . Two surgical procedures were carried out, excision and packing (40 patients, group A) and modified Bascom's procedure (lateral approach) (40 patients, group B)" Five patients omitted from further follow 'up, two cases related to excision and packing and three of modified Bascom's procedure .RESULTS : It has been found that the third decade of life is the most frequent age group at which patient presenting symptoms was discharge (61.2%) and pain (26.2%) although both present in combination in most cases' 75% and 52%) of patients had discharge and pain respectively during the presenting period . The duration of the disease was from one month to two years.It has been concluded that there was no significant difference in the occurrence of the early complication ( infection , seroma / hematoma) 25% for group A and 37.5% group B, and recurrence rate l0.5 % for group A and 16.2% for group B , thus patients in group B provided a significantly quicker healing time { mean 49 days for group A and 28 days for group B }.Shorter time - work { mean 47.8 days for group A and 28 days for group B } with better patient convenience (more pain free period), needs only simple oral analgesia , no patient needed hospital admission for pain control no dressing required and less risk of wound break down .CONCLUSION : The study had shown that modified Bascom's procedure for pilonidal sinus is safe and feasible as day-care surgery and is associated with potential cost saving.

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