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Romanova A, Nissen M, Alrefai M, Hubertus J, Deska T, Senkal M. Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study. Tech Coloproctol 2024; 28:104. [PMID: 39141158 PMCID: PMC11324676 DOI: 10.1007/s10151-024-02972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 07/11/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT). METHODS We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed. RESULTS A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation). CONCLUSION The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.
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Affiliation(s)
- A Romanova
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany.
| | - M Nissen
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - M Alrefai
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - J Hubertus
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - T Deska
- Department of Surgery, Marien Hospital, St. Elisabeth Gruppe, Marienplatz 2, 58452, Witten, Germany
| | - M Senkal
- Department of Surgery, Marien Hospital, St. Elisabeth Gruppe, Marienplatz 2, 58452, Witten, Germany
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Tam A, Steen CJ, Chua J, Yap RJ. Pilonidal sinus: an overview of historical and current management modalities. Updates Surg 2024; 76:803-810. [PMID: 38526695 PMCID: PMC11129967 DOI: 10.1007/s13304-024-01799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.
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Affiliation(s)
- Adrian Tam
- Department of General Surgery, Eastern Health, Maroondah Hospital, 1-15 Davey Drive, Ringwood, Victoria, 3135, Australia
| | - Christopher J Steen
- Department of Surgery, Cabrini Monash University, Melbourne, Victoria, Australia.
- Department of Surgery, Cabrini Monash University, Cabrini Health Australia, Melbourne, Australia.
| | - Jonathan Chua
- Department of General Surgery, Eastern Health, Maroondah Hospital, 1-15 Davey Drive, Ringwood, Victoria, 3135, Australia
| | - Raymond J Yap
- Department of Surgery, Cabrini Monash University, Melbourne, Victoria, Australia
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3
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Gratiashvili E, Akhmeteli L, Ivanishvili T, Kobadze S, Giorgadze N. Efficacy of laser obliteration with limited excision of pilonidal sinus. J Int Med Res 2024; 52:3000605241236057. [PMID: 38530042 DOI: 10.1177/03000605241236057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.
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Affiliation(s)
- Erekle Gratiashvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Lali Akhmeteli
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Teimuraz Ivanishvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Salome Kobadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Nodar Giorgadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
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Xu M, Wang Y, Ma X, Liu Y, Xue C, Dai H. Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease. Int Wound J 2024; 21:e14353. [PMID: 37691134 PMCID: PMC10784422 DOI: 10.1111/iwj.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. METHODS This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. RESULTS The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. CONCLUSIONS Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.
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Affiliation(s)
- Mingze Xu
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Yuchong Wang
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Xinyi Ma
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Yanjun Liu
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Haiying Dai
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
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Gallo G, Goglia M, Senapati A, Pata F, Basso L, Grossi U. An international survey exploring the management of pilonidal disease. Colorectal Dis 2023; 25:2177-2186. [PMID: 37794562 DOI: 10.1111/codi.16760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 10/06/2023]
Abstract
AIM Pilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The aim of this study was to snapshot the current management of PD across European countries. METHOD Members affiliated to the European Society of Coloproctology were invited to join the survey. An invitation was extended to others via social media. The predictive power of respondents' and hospitals' demographics on the change of therapeutic approach was explored. RESULTS Respondents (n = 452) were mostly men (77%), aged 26-60 years, practising in both academic and public hospitals and with fair distribution between colorectal (51%) and general (48%) surgeons. A total of 331 (73%) respondents recommended surgery at first presentation of the disease. Up to 80% of them recommended antibiotic therapy and 95% did not use any classification of PD. A primary closure technique was the preferred procedure (29%), followed by open technique (22%), flap creation (7%), sinusectomy (7%) and marsupialization (7%). Approximately 27% of subjects would choose the same surgical technique even after a failure. Almost half (46%) perform surgery as office based. A conservative approach was negatively associated with acutely presenting PD (p < 0.001). Respondents who were not considering tailored surgery based on patient presentation tended to change their approach in the case of a failed procedure. CONCLUSION With the caveat of a heterogeneous number of respondents across countries, the results of our snapshot survey may inform the development of future guidelines.
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Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Marta Goglia
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- General Surgery Unit, Department of Surgery, Cosenza, Italy
| | - Luigi Basso
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Padua, Italy
- Surgery Unit 2, Regional Hospital Treviso, AULSS2 Marca Trevigiana, Treviso, Italy
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Koskinen K, Harju J, Hermunen K. Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease. BMC Surg 2023; 23:99. [PMID: 37118772 PMCID: PMC10142197 DOI: 10.1186/s12893-023-02014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery. METHODS We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups. RESULTS PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001). CONCLUSIONS PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.
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Affiliation(s)
- K Koskinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland
| | - J Harju
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland
| | - K Hermunen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland.
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7
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Serup CM, Svarre KJ, Kanstrup CTB, Kleif J, Bertelsen CA. Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study. Colorectal Dis 2023; 25:413-419. [PMID: 36268754 DOI: 10.1111/codi.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022]
Abstract
AIM Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance. METHODS Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received. RESULTS A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance. CONCLUSION Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.
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Affiliation(s)
- Camilla Mattesen Serup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristina Johansen Svarre
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Tiffanie Bendtz Kanstrup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Graduate School, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kleif
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Anders Bertelsen
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Johnson DE, Granville R, Lovett E, Runau F, Chaudhri S. Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes. Ann R Coll Surg Engl 2023; 105:132-135. [PMID: 35446708 PMCID: PMC9889171 DOI: 10.1308/rcsann.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review. METHODS All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used. RESULTS A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05). CONCLUSIONS Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.
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Affiliation(s)
- DE Johnson
- University Hospitals of Leicester NHS Trust, UK
| | - R Granville
- University Hospitals of Leicester NHS Trust, UK
| | - E Lovett
- University Hospitals of Leicester NHS Trust, UK
| | - F Runau
- University Hospitals of Leicester NHS Trust, UK
| | - S Chaudhri
- University Hospitals of Leicester NHS Trust, UK
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Seow-Choen F, Seow-En I. Pilonidal disease: A new look at an old disease. SEMINARS IN COLON AND RECTAL SURGERY 2022; 33:100909. [DOI: 10.1016/j.scrs.2022.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Fernandes S, Soares-Aquino C, Teixeira I, Monteiro JM, Campos M. Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques. ANZ J Surg 2022; 92:3288-3292. [PMID: 35678224 DOI: 10.1111/ans.17838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/27/2022] [Accepted: 05/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). CONCLUSIONS MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.
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Affiliation(s)
- Sara Fernandes
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carolina Soares-Aquino
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Inês Teixeira
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Mafalda Monteiro
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Miguel Campos
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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11
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Pilonidal sinus disease: a 25-year experience and long-term results of different surgical techniques. Eur Surg 2022. [DOI: 10.1007/s10353-022-00767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Summary
Background
The incidence of pilonidal disease is increasing. The choice of surgical approach differs between surgeons and countries. With better understanding of the etiology of the disease, there is a shift toward more successful concepts of treatment. In many cases, management can be challenging owing to the number of previous failed operations.
Objective
The aim of this retrospective single-center cohort study was to compare recurrence rates and postoperative wound complications between five treatment arms.
Methods
A total of 299 patients who underwent surgery for pilonidal disease between November 1994 and May 2019 were included. Primary endpoint was time to recurrence, secondary endpoint was wound care complication rate.
Results
Median follow-up was 85.8 months in 286 patients. An overall recurrence rate of 16.1% was observed at 24 months, 21.4% at 60 months, and 47.4% at 303 months; 24 months postoperatively, there was a range from 10.5% for excision with primary midline closure to 30.0% for the Bascom I procedure. Recurrence in excision with primary midline closure was 71.8% 268 months postoperatively. No statistically significant differences were observed between the five groups (p = 0.54). The highest prevalence of wound complications (46.3%) was in excision with midline closure. Cox regression showed that previous pilonidal operations are an independent prognostic factor for developing recurrence (p = 0.006). Multivariate logistic regression revealed that previous pilonidal operations have a significant predictive value for developing postoperative wound complications (odds ratio = 4.04, 95% confidence interval [1.61–10.18]; p = 0.003).
Conclusion
In order to improve surgical outcomes, emphasis should be given to adoption of techniques with high success rates.
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12
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Basso L, Pietroletti R, Micarelli A, Bicaj A, Costi U, Crocetti D, D'Ermo G, Gallo G. The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease. Colorectal Dis 2022; 24:984-991. [PMID: 35344244 PMCID: PMC9541250 DOI: 10.1111/codi.16126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 02/08/2023]
Abstract
AIM We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified 'merged' version of both the Bascom 'pit picking' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the Bascom-Gips procedure. METHODS In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 ± 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C). RESULTS The mean operating time was 34 ± 24.45 min. Postoperative complications included early (<24 h; n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 ± 12.72 days and work/school/university activities were resumed after a mean of 4 ± 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (ꭓ2 = 16.87, P = 0.0002) difference was found in the recurrence rates: 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (ꭓ2 = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (ꭓ2 = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (ꭓ2 = 2.23, P = 0.32) in groups A, B and C respectively. CONCLUSIONS BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD.
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Affiliation(s)
- Luigi Basso
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Renato Pietroletti
- Surgical Coloproctology, ‘Val Vibrata’ HospitalL'Aquila UniversityTEItaly
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR)RomeItaly
- Eurac Research, Institute of Mountain Emergency MedicineBolzanoItaly
| | - Agreta Bicaj
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Umberto Costi
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Daniele Crocetti
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Giuseppe D'Ermo
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Gaetano Gallo
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
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Nechai IA, Bozhchenko AA, Maltcev NP, Vetochkin VА, Yakunina MY. Surgical treatment of pilonidal disease with the use of «closed» techniques. GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-33-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.
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Affiliation(s)
| | | | | | | | - M. Yu. Yakunina
- North-Western State Medical University named after I. I. Mechnikov
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14
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Coco D, Leanza S. Minimally Invasive Pilonidal Sinus Treatment: A Brief Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With a prevalence of 26/100,000, pilonidal sinus disease is a frequent natal cleft condition that primarily affects young males. The disease site is often uncomfortable and the disease can result in problems such as abscess formation and recurrent acute or chronic infections. Minimally invasive treatment aims to form a small elliptical wedge of subcutaneous tissue containing all the inflammatory tissue. The sinus and its lateral tracks are removed while keeping the overlying skin intact. Following the notion of “less is more,” novel least invasive treatments such as sinotomy, sinusectomy, trephining, and video-assisted and endoscopic pilonidal sinus surgery have recently been proposed. We look at minimally invasive treatments to explain how research into modern techniques has revealed a low rate of short-term problems.
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15
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Milone M, Basso L, Manigrasso M, Pietroletti R, Bondurri A, La Torre M, Milito G, Pozzo M, Segre D, Perinotti R, Gallo G. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease. Tech Coloproctol 2021; 25:1269-1280. [PMID: 34176001 PMCID: PMC8580911 DOI: 10.1007/s10151-021-02487-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022]
Abstract
Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a "special interest" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: "A + : strongly agree; A-: agree; N: unsure/no opinion; D-: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - L Basso
- "Pietro Valdoni" Department of Surgery, Policlinico "Umberto I", "Sapienza" University of Rome, viale del Policlinico 155, 00161, Rome, Italy.
| | - M Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - R Pietroletti
- Surgical Coloproctology, "Val Vibrata" Hospital, "L'Aquila" University, Sant'Omero, TE, Italy
| | - A Bondurri
- Department of General Surgery, ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milan, Italy
| | - M La Torre
- Coloproctology Unit, "S. Anna" Clinic, Pomezia, RM, Italy
| | - G Milito
- Department of General Surgery, "Tor Vergata" University, Rome, Italy
| | - M Pozzo
- Department of General Surgery, "Degli Infermi" Hospital, Biella, Italy
| | - D Segre
- General Surgery Operative Unit, "Città di Bra" Clinic, Bra, CN, Italy
| | - R Perinotti
- Department of General Surgery, "Degli Infermi" Hospital, Biella, Italy
| | - G Gallo
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
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The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease. Surg Endosc 2021; 36:1380-1384. [PMID: 33721093 DOI: 10.1007/s00464-021-08422-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pilonidal disease (PD) is a common condition of the sacrococcygeal region leading to inflammation and abscess formation. PD is a topic of renewed interest due to the lack of satisfactory management options. Minimally invasive techniques have recently been investigated, with promising results in adult and pediatric populations. Our technique, the "EPIC procedure," Endoscopic-assisted Pilonidal Irrigation and Cleaning, involves removal of hair under direct visualization using a small endoscope while flushing saline through the cavity via an angiocatheter. We aim to show that the EPIC procedure is a safe and effective operation for the treatment of pilonidal disease in the pediatric population. MATERIALS AND METHODS We performed a retrospective chart review including 20 consecutive patients. All had a primary sacrococcygeal pilonidal sinus; all underwent the EPIC procedure. Post-operative care instructions included daily bathing and weekly depilatory application. We evaluated gender, age, weight, disease severity, operative duration, recurrence of PD, and other complications. RESULTS In the 20 patients studied, 22 EPIC procedures were performed. The median follow-up duration was 27.95 (range 0.63-45.27) months. The mean operative duration was 28.8 (SD 10.2) min. There was a 15% recurrence rate (95% CI 0.00%, 30.65%). CONCLUSIONS The EPIC procedure is an endoscopic-assisted operation that simplifies previously published techniques in pursuit of reduced operative complexity, cost, and time, with comparable recurrence and complication rates. All three recurrences occurred in patients that did not follow instructions for post-operative depilatory care. Two of these patients underwent repeat EPIC procedure and had no further complications. The third was lost to follow-up. The EPIC procedure provides a simple, effective, and minimally invasive approach to the treatment of pilonidal disease.
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Abstract
This review is devoted to comparison of the most common methods of surgical treatment of pilonidal disease. It was found that «closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period.
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Affiliation(s)
- I A Nechai
- St. Petersburg State University, St. Petersburg, Russia.,St. Petersburg City Hospital No. 40, St. Petersburg, Russia
| | - N P Maltsev
- St. Petersburg City Hospital No. 40, St. Petersburg, Russia
| | - M V Pavlov
- St. Petersburg State University, St. Petersburg, Russia
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Ommer A, Iesalnieks I, Doll D. S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Alkatta MA, Mejally A. Excision and tension-free primary closure of pilonidal disease. Turk J Surg 2020; 35:278-284. [PMID: 32551424 DOI: 10.5578/turkjsurg.4368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/04/2019] [Indexed: 11/15/2022]
Abstract
Objectives This study aimed to estimate simple excision and tension free primary closure and to study its effectiveness in terms of operating and healing time, duration of hospital stay, degree of post operation complications, and rate of recurrence. Material and Methods This is study included 78 patients, of whom 71 were (91%) males and 7 (9%) females, who underwent excision and tension free closure. The procedure was based on bilateral side flaps, which were released and dissected 2-3 cm from the edge of the wound. Patient's age, gender, body mass index, wound healing, operation, drain removal, length of hospital stay, and complications and recurrence were analysed. Results The study involved 78 patients, 71 (91%) males and 7 (9%) females. Median age of the patients was 28.5 years. Mean operation time was 44.6 minutes . Sixty-one patients (78.2%) had full primary healing without any complication. No one had hematoma or seroma, but five (6.4%) cases had a minor wound infection and three (3.8%) obese patients developed recurrence. Mean length of hospital stay was 2.5 days , most patients went back to their work within 3 weeks. Median follow-up period was in a 26.2 weak range (1-51.4 weak). Five (6.41%) cases had wound infection and three (3.85%) developed recurrence. Conclusion Excision and tension free primary closure were found to be simple procedures associated with lower rates of wound infection, shorter hospital stay, lower recurrence, early wound recovery and short period of being absent from work. Surgery can be easily performed and preferred for cases of non-recurrent pilonidal sinus and cyst.
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20
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Esposito C, Turrà F, Cerulo M, Del Conte F, Esposito G, Prato AP, Escolino M. Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation. J Pediatr Surg 2020; 55:761-766. [PMID: 31126689 DOI: 10.1016/j.jpedsurg.2019.04.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/31/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to standardize the technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation. METHODS All pediatric patients presenting with acute or chronic pilonidal sinus disease (PSD) who underwent PEPSiT in our institution over a 36-month period (July 2015-July 2018), were included in the study. Pre- and postoperative management, recurrence rate, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated. RESULTS A total of 59 patients (23 girls and 36 boys) underwent PEPSiT during the study period. Ten/59 patients (16.9%) had recurrent PSD after open repair, and 4/59 (6.7%) presented a concomitant pilonidal cyst. All children underwent laser epilation pre- and postoperatively over the last 15 months. The average length of surgery was 27.5 min (range 20-45). The average pain score during the first 48 postoperative hours was 2.7 (range 2-5), and the average analgesic requirement was 20 h (range 16-24). The average hospitalization was 22.4 h (range 18-36). At 1 month postoperatively, external openings were healed in all patients. During follow-up, 1 recurrence (1.6%) was recorded and successfully re-treated with PEPSiT. CONCLUSIONS We believe that PEPSiT represents the technique of choice for treatment of PSD in the pediatric population. It is crucial to standardize the technique consisting of pre- and postoperative laser epilation, PEPSiT, and accurate postoperative wound management with eosin and sulfadiazine spray. LEVEL OF EVIDENCE Treatment study - Level IV.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.
| | - Francesco Turrà
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Giorgia Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Alessio Pini Prato
- Division of Pediatric Surgery, The Children Hospital, AON, SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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21
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Prieto JM, Checchi KD, Kling KM, Ignacio RC, Bickler SW, Saenz NC, Fairbanks TJ, Nicholson SI, Lazar DA. Trephination versus wide excision for the treatment of pediatric pilonidal disease. J Pediatr Surg 2020; 55:747-751. [PMID: 31301885 DOI: 10.1016/j.jpedsurg.2019.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/13/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE To evaluate outcomes of trephination compared to wide excision in children undergoing initial surgical treatment of pilonidal disease. METHODS A retrospective review was conducted of patients undergoing initial pilonidal excision between September 2017 and September 2018. Operations were categorized as either trephination or wide excision via an open or closed-wound technique. Outcomes were evaluated and data analyzed by chi-squared and one-way ANOVA tests. RESULTS One-hundred and five patients were identified, with a mean follow-up of 4.6 months. Trephination was performed in 57% of patients, and of the remaining patients undergoing wide excision, 62% of wounds were left open. There were no demographic differences among the three groups. Compared to both the open and closed techniques, trephination was associated with fewer wound complications (17% vs 29% vs 3%, respectively, p = 0.006), and postoperative visits (4.4 vs 2.4 vs 1.4, respectively, p < 0.001). There was no difference in recurrence rates among groups. CONCLUSION Trephination for pilonidal disease in pediatric patients is associated with a lower wound complication rate and fewer postoperative visits compared to wide excision. Recurrence rates are similar among the various surgical methods. Further prospective study would be useful to describe long-term outcomes of patients undergoing trephination for pilonidal disease. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE III (retrospective comparative).
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Affiliation(s)
- James M Prieto
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego; Department of Surgery, Naval Medical Center San Diego
| | | | - Karen M Kling
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - Nicholas C Saenz
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - Timothy J Fairbanks
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - Sneha I Nicholson
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego
| | - David A Lazar
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego.
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Romaniszyn M, Swirta JS, Walega PJ. Long-term results of endoscopic pilonidal sinus treatment vs Limberg flap for treatment of difficult cases of complicated pilonidal disease: a prospective, nonrandomized study. Colorectal Dis 2020; 22:319-324. [PMID: 31532869 DOI: 10.1111/codi.14857] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
AIM To present the results of a prospective, nonrandomized comparative study on the treatment of complicated pilonidal sinus by endoscopic pilonidal sinus treatment (EPSiT) compared with Limberg flap surgery, based on experience of a single surgical centre. METHOD A prospective, nonrandomized comparative study. Long-term follow-up of 62 patients with complicated pilonidal disease was analysed (36 operated on using the Limberg flap technique and 26 using the EPSiT method). The median follow-up was 27 months (12-44). RESULTS The median operating time in the EPSiT group was 60 min (25-80 min) and in the Limberg group 67 min (35-95 min). In the EPSiT group, primary healing was achieved in 22 out of 26 patients (84.6%) in a median of 42 days with a total complication rate of 11.5%. There were seven recurrences after initial healing. The total success rate of the EPSiT procedure with long-term follow-up was 57.7%. In the Limberg flap group, all patients healed (100%) in a median of 21 days. The complication rate in this group was 26.5%, and there were two recurrences in this group. The total success rate of the Limberg flap procedure was 94.1%. CONCLUSION For patients with complicated pilonidal sinus, the endoscopic procedure has a significantly lower success rate than the Limberg flap procedure, but a lower risk of complications. Such patients should be offered a choice between a safer, minimally invasive procedure with a higher risk of recurrence or flap surgery, which is more effective, but with a higher risk of complications.
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Affiliation(s)
- M Romaniszyn
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - J S Swirta
- 3rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - P J Walega
- 3rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
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Esposito C, Mendoza-Sagaon M, Del Conte F, Cerulo M, Coppola V, Esposito G, Cortese G, Crocetto F, Montaruli E, Escolino M. Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol. Front Pediatr 2020; 8:345. [PMID: 32671004 PMCID: PMC7326782 DOI: 10.3389/fped.2020.00345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique. Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction. Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities (p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4-10) to achieve complete hair removal. The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]. The recurrence rate was also significantly lower in G1 (n = 1, 1.4%) compared with G2 (n = 5, 9%) [p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [p = 0.001]. Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Mario Mendoza-Sagaon
- Pediatric Surgery Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Giuseppe Cortese
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Felice Crocetto
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Ernesto Montaruli
- Pediatric Surgery Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
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Brusciano L, Del Genio G, Tolone S, Schiano di Visconte M, Gualtieri G, Terracciano G, Gambardella C, Docimo L. D-shape asymmetric excision in recurrent pilonidalis disease: an analytic longitudinal long-term evaluation. Updates Surg 2019; 71:723-727. [PMID: 30887467 DOI: 10.1007/s13304-019-00644-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
Sacrococcigeal pilonidalis disease (SPD) recurrence is a major factor influencing surgical outcomes. Several different surgical treatments have been reported, however, there is a lack of long-term data on reoperation. Aim of this study was to analyze outcomes of a single center adopting a standardized off-midline asymmetric procedure (D-shape). Analytic longitudinal assessment of 83 patients (median age 35 years, range 23-59 years) with recurrent SPD that completed the 5-year study design following D-shape reoperation. Among a cohort of 607 patients, we enrolled 83 recurrent SPD. After D-shape reoperation, second recurrence rate was 9.6% (8/83). Second recurrence rate was not statistically significantly different among patients undergone D-shape as first surgery compared to patients of symmetric excision group (11.8% vs. 7.4%, p = 0.57). Similarly, there was no statistical difference among patients who underwent D-shape as first surgery compared to patients who underwent symmetric excision elsewhere (11.8% vs. 9.1%, p = .75). D-shape is a safe and effective when adopted as revisional surgery at a long-term follow-up. Comparative evaluation is warranted to establish the potential superiority over different surgical surgery in case of recurrence.
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Affiliation(s)
- Luigi Brusciano
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy.
| | - Gianmattia Del Genio
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Salvatore Tolone
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Michele Schiano di Visconte
- Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy
| | - Giorgia Gualtieri
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Gianmattia Terracciano
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Claudio Gambardella
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Ludovico Docimo
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
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Dessily M, Dziubeck M, Chahidi E, Simonelli V. The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study. Tech Coloproctol 2019; 23:1133-1140. [PMID: 31773347 DOI: 10.1007/s10151-019-02119-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 2014, we started to treat pilonidal sinus disease in our institution with sinus laser-assisted closure (SiLaC) procedure. The aim of the present study was to evaluate the safety and efficacy of the SiLaC procedure in a single institution prospective study on a large cohort of patients and with a long follow-up period, and try to determine what factors that could influence healing and recurrence. METHODS A prospective study was conducted on consecutive patients with primary pilonidal sinus disease operated on with the SiLaC procedure at our institution from March 2015 to August 2017. Demographic and surgical data, outcomes, and complications were prospectively recorded and compared between the healed and not healed/recurrence groups to find factors influencing healing. Postoperative follow-up was performed in the outpatient clinic every 2 weeks for 2 months. In March 2018, patients were questioned by mail or phone to assess long-term recurrences. RESULTS There were 200 patients. The healing rate was high (94%) with a mean healing time of 19.5 ± 14.4 days. Mean operative time (9.4 ± 2.6 min) and mean duration of postoperative analgesic therapy (4.72 ± 5.64 days) were short. Postoperative complications (15%) were mainly infection (9.5%). There was a response rate of 77.5% to mail/phone questionnaires about recurrence. The recurrence rate was 14.9%. Mean time until recurrence was 193.5 ± 87.19 days. The incidence of secondary openings, complications, and infection in the healing vs not healed or recurrence groups, was 24.8% vs 56.6%, 19.2% vs 40%, and 8.8% vs 30%, respectively. CONCLUSIONS SiLaC is an effective, easy to perform, reproducible, and almost painless procedure. Factors influencing healing seem to be the presence of secondary openings, postoperative complications, and, especially, infection. The SiLaC procedure could become one of the treatments of choice for pilonidal sinus disease.
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Affiliation(s)
- M Dessily
- Department of Coloproctology and Digestive Surgery, CHU Tivoli, 34 Avenue Max Buzet, 7100, La Louvière, Belgium.
| | - M Dziubeck
- Department of General Surgery, Université Libre de Bruxelles, CHU Tivoli, La Louvière, Belgium
| | - E Chahidi
- Department of General Surgery, Université Libre de Bruxelles, CHU Tivoli, La Louvière, Belgium
| | - V Simonelli
- Department of Coloproctology and Digestive Surgery, CHU Tivoli, 34 Avenue Max Buzet, 7100, La Louvière, Belgium
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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, Anoldo P, Aprea G, Simone GD, Vitiello A, Musella M, Milone M, De Palma GD, Milone F, Sosa Fernandez LM. Minimally Invasive Pilonidal Sinus Treatment: A Narrative Review. Open Med (Wars) 2019; 14:532-536. [PMID: 31428682 PMCID: PMC6698053 DOI: 10.1515/med-2019-0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
The management of chronic pilonidal disease remains controversial, but recently, new minimal invasive approaches have been proposed. Whereas in the conventional surgical treatment an elliptical wedge of skin and subcutaneous tissue is created to remove the sinus and its lateral tracks, the basis for our new treatment is to create a minimal elliptical wedge of the subcutaneous tissue, including all the inflamed tissue and debris while leaving the overlying skin intact. The mechanism of an endoscopic approach relies on use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to work and daily activities. However, it is mandatory that further studies would analyze surgical approaches to pilonidal sinus disease (PSD) with a consistent and adequate follow-up of at least 5 years. Both sinusectomy and endoscopic approach to PSD were found to be safe and effective compared with conventional techniques. Publishedresults of studies of newer approaches have demonstrated a low short-term complication rate, comparable to conventional surgery results.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via S. Pansini 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Katia Di Lauro
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Enrico Araimo
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Federica Calculli
- Department of Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Antonio Vitiello
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Mario Musella
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Francesco Milone
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
| | - Loredana Maria Sosa Fernandez
- Department of Clinical Medicine and Surgery. University “Federico II” of Naples, Via S. Pansini 5, 80131Naples, Italy
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Kalaiselvan R, Liyanage A, Rajaganeshan R. Short-term outcomes of endoscopic pilonidal sinus treatment. Ann R Coll Surg Engl 2019; 102:94-97. [PMID: 31379189 DOI: 10.1308/rcsann.2019.0097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Endoscopic treatment for pilonidal disease was initially described by Meinero in 2013. This minimally invasive technique has both technical and aesthetic advantages. The diagnostic application helps identify the anatomy of the pilonidal disease and the operative phase ablates and cleans the infected cavity. Our aim was to study the short-term outcomes of endoscopic treatment for pilonidal disease and to evaluate complications and recurrence rates. MATERIALS AND METHODS A prospectively maintained database of all consecutive patients who underwent endoscopic treatment for pilonidal disease by a single surgeon in a district general hospital from 1 November 2014 to 31 March 2018 was analysed. Follow-up was available until 30 September 2018. RESULTS A total of 74 patients (56 men) underwent endoscopic treatment for pilonidal disease. The median age was 21 years (range 16-62 years). All patients underwent the procedure as daycase procedures, seven under local anaesthesia. There were no immediate postoperative complications and no return to theatre or readmission within 90 days. On a median follow-up of 52 weeks (range 2-114 weeks), 57 patients healed completely and 8 lost to follow-up. We achieved primary healing rates of 67% (44/66) and delayed healing rate of 77% (51/66). CONCLUSIONS Endoscopic treatment for pilonidal disease is a safe and effective minimally invasive technique that should be considered as first-line treatment in selected cases of pilonidal sinus disease, thereby reducing morbidity related to conventional procedures.
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Affiliation(s)
- R Kalaiselvan
- Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - Asd Liyanage
- Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - R Rajaganeshan
- Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
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Alvandipour M, Zamani MS, Ghorbani M, Charati JY, Karami MY. Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study. Ann Coloproctol 2019:313-318. [PMID: 31113167 PMCID: PMC6968717 DOI: 10.3393/ac.2018.09.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD. Methods A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study. Results Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group. Conclusion Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.
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Affiliation(s)
- Mina Alvandipour
- Department of Colorectal Surgery, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mojtaba Ghorbani
- Department of Colorectal Surgery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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30
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Cairo SB, Zhao J, Ha M, Bass KD. Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation. J Wound Care 2019; 28:S12-S19. [PMID: 31067171 DOI: 10.12968/jowc.2019.28.sup5.s12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. METHOD A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. RESULTS We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. CONCLUSION Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.
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Affiliation(s)
- Sarah B Cairo
- Pediatric Surgery Research Fellow, John R. Oishei Children's Hospital, Department of Pediatric Surgery, 1001 Main Street, Buffalo, NY 14202, US
| | - Jane Zhao
- Bioinformatics Research Fellow, State University of New York, University at Buffalo, Department of Surgery, Buffalo, NY 14222, US
| | - Minje Ha
- Medical Student, State University of New York, University at Buffalo, Jacobs School of Biomedical Sciences, Buffalo, NY 14222, US. reference numbers
| | - Kathryn D Bass
- John R. Oishei Children's Hospital, Department of Pediatric Surgery, 1001 Main Street, Buffalo, NY 14202, US, State University of New York, University at Buffalo, Department of Surgery, Buffalo, NY 14222, US
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Khafagy A, Al Haddad E, AlSabah S. The endoscopic treatment of pilonidal sinus disease: a short-term case-series study. Ann Saudi Med 2019; 39:192-196. [PMID: 31215233 PMCID: PMC6832333 DOI: 10.5144/0256-4947.2019.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/05/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pilonidal disease (PNS) is a common inflammatory disease that can significantly impact the quality of life of the patient. Previous open techniques for the management of this condition have been unsatisfactory, with high recurrence rates reported. OBJECTIVE Investigate a new endoscopic procedure for the management of PNS disease. DESIGN Case series. SETTING Single hospital in Kuwait. PATIENTS From April 2014 to October 2017, patients with symptomatic chronic or recurrent PNS were consecutively enrolled to undergo the endoscopic pilonidal sinus treatment (EPSiT) procedure. MAIN OUTCOME MEASURES Control of pain, wound complications, recurrence rate over a 6-month follow up. SAMPLE SIZE 35 patients. RESULTS The mean age of the patients was 22 years, with 33 (94%) males. Fourteen (40%) presented with recurrent disease and were recommended to undergo an EPSiT procedure. A single tract was used in 32 (91%) of the cases, with an average operative time of 51 mins. On follow-up 5 patients reported minimal pain judging by the need of only mild analgesics for the control of pain. No patient experienced early wound complications necessitating hospitalization. There were 2 (6%) recurrences encountered by the time of the 6-month follow-up period. CONCLUSION In these early results, the EPSiT procedure provided effective healing with acceptable recurrence rates and aesthetics. In addition, the procedure allows the surgeon to see the PNS, fistula tracts or any abscess cavities. LIMITATIONS Short follow-up period with a small number of patients CONFLICTS OF INTEREST: None.
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Affiliation(s)
| | - Ellana Al Haddad
- From the Department of Surgery, Kuwait Ministry of Health, Kuwait
| | - Salman AlSabah
- From the Department of Surgery, Kuwait Ministry of Health, Kuwait
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32
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Kartal A, Aydın HO, Oduncu M, Ferhatoğlu MF, Kıvılcım T, Filiz Aİ. Comparison of Three Surgical Techniques in Pilonidal Sinus Surgery. Prague Med Rep 2019; 119:148-155. [PMID: 30779699 DOI: 10.14712/23362936.2019.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Our study aims to compare the surgical outcome of Limberg transposition flap, Karydakis flap, and primary closure after excision to treat sacrococcygeal pilonidal sinus disease. A total of 634 patients with pilonidal sinus who underwent surgery were evaluated retrospectively from January 2014 to January 2016. The patients were divided into three groups. Limberg transposition flap (LTF) was performed in 131 patients (group 1), Karydakis flap (KF) was performed in 232 patients (group 2) and primary closure (PC) after excision was performed in 271 patients (group 3). Patient demographics, operative and postoperative outcomes were recorded and analyzed retrospectively. The mean age (p=0.98), sex ratio (p=0.74) and removed sinus volume (p=0.67) were not statistically different between groups. Mean operative time was 54.3 ± 6.4 min for group 1, 46.8 ± 10.5 min for group 2, and 26.9 ± 5.8 min for group 3 respectively (p=0.01). When the length of hospital stay was compared, there was a significant difference in favor of primary closure (p=0.01). Regarding early surgical complication, Karydakis flap technique was superior to other groups (p<0.001). The recurrent rate was higher in the primary closure group (p<0.001). In our study, the primary closure method regarding the duration of surgery and hospitalization; Karydakis method regarding postoperative complications (seroma, hematoma, wound dissociation, infection, recurrence) were superior to the other two methods.
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Affiliation(s)
- Abdulcabbar Kartal
- Department of General Surgery, Okan University Medicine Faculty, Istanbul, Turkey.
| | - Hüseyin Onur Aydın
- Department of General Surgery, Başkent University Medicine Faculty, Ankara, Turkey
| | - Mehmet Oduncu
- Department of General Surgery, Defne Hospital, Antakya, Turkey
| | | | - Taner Kıvılcım
- Department of General Surgery, Okan University Medicine Faculty, Istanbul, Turkey
| | - Ali İlker Filiz
- Department of General Surgery, Okan University Medicine Faculty, Istanbul, Turkey
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Abstract
BACKGROUND Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic pilonidal sinus treatment (EPSiT) and compares that of the other minimally invasive techniques in practice. METHODS MEDLINE, EMBASE, Cochrane and CINAHL databases were searched to look at the peer-reviewed articles on minimally invasive treatments on PD. Primary endpoint was to determine complication rates. Data were pooled using random effect model. Heterogeneity among studies was estimated with χ2 tests. Statistical analysis was performed with Review Manager Version 5.1.2. RESULTS Out of 371 papers, ten were retrieved for full appraisal. One randomised clinical trial (RCT) and four case series presented retrospective data on EPSiT. Five RCTs were on alternative minimally invasive treatments. Complication rate, return to work, wound healing rate and pain scores were superior in minimally invasive treatments compared to excision surgery. There was no statistically significant difference in complication rate or return to work in EPSiT compared to that of alternate minimally invasive techniques. CONCLUSION Minimally invasive treatments of pilonidal disease were found to be safe and effective compared to conventional techniques. It is also demonstrated that EPSiT is a safe alternative with a low short-term complication rate. Further randomised controlled trials are required to more accurately define its effectiveness and closely evaluate the side effect profile.
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34
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Meinero P, La Torre M, Lisi G, Stazi A, Carbone A, Regusci L, Fasolini F. Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study. Int J Colorectal Dis 2019; 34:741-746. [PMID: 30719564 DOI: 10.1007/s00384-019-03256-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pilonidal disease (PD) is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. Recurrent PD after surgical treatment is frequent event for the 25-30% of cases. The present study evaluated endoscopic pilonidal sinus treatment (EPSiT) in recurrent and multi-recurrent PD. METHODS Of the consecutive prospective patients with recurrent PD, 122 were enrolled in a prospective international multicenter study conducted at a secondary and tertiary colorectal surgery centers. Primary endpoint was to evaluate short- and long-term outcomes: healing rate/time, morbidity rate, re-recurrence rate, and patient's quality of life (QoL). RESULTS Complete wound healing rate was occurred in 95% of the patient, with a mean complete wound healing time of 29 ± 12 days. The incomplete healing rate (5%) was significantly related to the number of external openings (p = 0.008), and recurrence was reported in six cases (5.1%). Normal daily activity was established on the first postoperative day, and the mean duration before patients returned to work was 3 days. QoL significantly increased between the preoperative stage and 30 days after the EPSiT procedure (45.3 vs. 7.9; p < 0.0001). CONCLUSIONS The EPSiT procedure seems to be a safe and effective technique in treating even complex recurrent PD. It enables excellent short- and long-term outcomes than various other techniques that are more invasive.
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Affiliation(s)
- Piercarlo Meinero
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - Marco La Torre
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,General Surgery and Proctology, University Pittsburgh Medical Center - Salvator Mundi International Hospital, Rome, Italy
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Rome, Italy. .,Department of General Surgery, Sant'Eugenio Hospital, Rome, Italy.
| | - Alessandro Stazi
- Pelvic Care Center, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - Antonella Carbone
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Luca Regusci
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
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Milone M, Velotti N, Manigrasso M, Milone F, Sosa Fernandez LM, De Palma GD. Video-assisted ablation of pilonidal sinus (VAAPS) versus sinusectomy for treatment of chronic pilonidal sinus disease: a comparative study. Updates Surg 2019; 71:179-183. [PMID: 30542957 DOI: 10.1007/s13304-018-00611-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
Since its first description in 1883, different treatments for pilonidal sinus disease have been proposed, but we are still far from the identification of an ideal approach. The objective of this study is to determine if video-assisted ablation of pilonidal sinus (VAAPS) could be considered superior/non-inferior to standard sinusectomy for treatment of pilonidal sinus disease. After applying propensity score analysis, data from 40 patients who underwent sinusectomy and 40 patients who underwent VAAPS, from March 2011 to August 2013, were collected. The two groups were similar in terms of sex, age, BMI, smoking status and complexity of sinus. The mean operative time was less for the sinusectomy group compared with the minimally invasive treatment group (30.38 ± 6.23 vs 44.39 ± 7.76; p = 0.001). On the other hand, the recurrence rate (7.5% vs 25%; p = 0.035) was significantly lower in the VAAPS group and the infection rate showed a trend toward reduction in the endoscopically treated patients (12.5% vs 30%; p = 0.057). No differences were found in terms of pain score at 1 week from surgery (3.71 ± 1.24 vs 3.76 ± 1.39; p = 0.883), satisfaction at 6 months (8.3 ± 1.2 vs 8.2 ± 1.3; p = 0.78) and time off work (2.01 ± 1.30 vs 2.08 ± 1.24; p = 0.620). The effectiveness of our new technique can be assessed again and the comparative analysis with the conventional sinusectomy shows the feasibility of VAAPS, suggesting that this procedure is the best way to perform a sinusectomy.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Nunzio Velotti
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | | | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Delshad HR, Dawson M, Melvin P, Zotto S, Mooney DP. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg 2019; 54:174-176. [PMID: 30661599 DOI: 10.1016/j.jpedsurg.2018.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/01/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease. METHODS Patients presenting to a Pilonidal Clinic were managed by evacuation of any un-drained collections, soaking, and as needed, hair removal. Once active inflammation resolved, they underwent pit-picking under local anesthesia. Those with >3 pits underwent sequential pit-pickings 2 months apart. Hirsute patients also underwent laser hair epilation. Pilonidal disease was stratified by severity. Patient symptoms were collected prospectively and reviewed. RESULTS Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017. There were 40 (69%) males with a mean age of 17.7 years (range 13-24). Thirty-seven hirsute patients (64%) underwent a series of laser epilation treatments. Patients required from 0 to 3 days of non-narcotic analgesia, and all returned promptly to pre-procedure activities. Seven patients (12%) were lost to follow-up. Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure. Four patients (8%) had persistent intermittent drainage. CONCLUSION Pit-picking is a simple office procedure that may resolve pilonidal disease in many adolescents. A longer follow-up interval is needed to determine the long-term recurrence rate. TYPE OF STUDY Case Series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hajar R Delshad
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Michele Dawson
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA
| | - Susan Zotto
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
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Arnous M, Elgendy H, Thabet W, Emile SH, Elbaz SA, Khafagy W. Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial. Ann R Coll Surg Engl 2019; 101:21-29. [PMID: 30286636 PMCID: PMC6303836 DOI: 10.1308/rcsann.2018.0144] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND. METHODS This was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes. RESULTS Sixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence. CONCLUSIONS The Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.
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Affiliation(s)
- M Arnous
- General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
| | - H Elgendy
- General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
| | - W Thabet
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
| | - SH Emile
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
| | - SA Elbaz
- General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
| | - W Khafagy
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Mansoura City, Egypt
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Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Moreira-Pinto J. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg 2018; 53:2003-2007. [PMID: 29602548 DOI: 10.1016/j.jpedsurg.2018.02.094] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/04/2018] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes. METHODS A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups. RESULTS We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38min; p>0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n=1] vs. 20.0% [n=12]); p>0.05). Healing time was similar for both groups (28 vs. 37.5days). Recurrence occurred in 18,9% (n=15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p>0.05). CONCLUSIONS Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population. LEVEL OF EVIDENCE Therapeutic study - level III.
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Affiliation(s)
- Joana Barbosa Sequeira
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Coelho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Sofia Marinho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Berta Bonet
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Fátima Carvalho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - João Moreira-Pinto
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
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Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D. The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg 2018. [PMID: 28639004 DOI: 10.1007/s00268-017-4093-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hair has been identified as the causative agent of Pilonidal Sinus Disease (PSD). Stiffer, dark hair as well as hairiness has been postulated as causative factors. Astonishingly, despite the early clinical significance of this condition (Hodges in Boston Med Surg J 2:485-486, 1880), macroscopic and microscopic examinations of hair inside pilonidal sinus cavities have been scarce. The purpose of this study was to study the morphological aspects of the hair found in PSD in order to determine the origin of the hair. METHODS Hair from inside pilonidal sinus cavities was collected intraoperatively from 20 PSD patients. Additionally, occipital, lumbar and intergluteal hair was harvested from the same patients and compared to the hair of volunteer-matched pair patients admitted to the hospital at the same time for non-PSD surgery. Intra- and intergroup variations of hair length were characterized with analysis of variance. Numbers and lengths of pilonidal sinus nest hair were recorded. Hair was examined clinically and with light and scanning electron microscopy using surface enhancing gold and carbon dust coating techniques. RESULTS Analysis of 624 pilonidal sinus nest hair samples from 20 independent sinus cavities revealed that hair within pilonidal sinus nests is rootless in 74%. Shorter hair was found inside the pilonidal sinus compared to other sites (length 0.9 ± 0.7 cm p < 0.0001). Furthermore, hair found inside of the sinus was significantly shorter than hair protruding from pores (p < 0.000). Hair samples show razor sharp but no broken or split ends. On electron microscopy, these spiky hair ends resemble cut hair ends. Pilonidal hair nests contained between 1 and over 400 hair fragments. CONCLUSION Short hair fragments with rootless sharp cut ends were found within pilonidal sinus cavities. Morphologically, these fragments resemble short cut rather than intact body hair. Since short cut hair, e.g., derived from the head potentially enters the pilonidal cavity more easily than longer hair, the source of these cut hair fragments needs to be eliminated when aiming to prevent Pilonidal Sinus Disease.
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Affiliation(s)
- Friederike Bosche
- Department of Procto-Surgery, Sankt Marienhospital Vechta, Vechta, Germany
| | - Markus M Luedi
- Department of Anesthesiology and Pain Therapy, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Dominic van der Zypen
- Swiss Federal Office of Social Insurance, Statistics and Epidemiology, Bern, Switzerland
| | - Philipp Moersdorf
- Department of Trauma, Hand and Reconstructive Surgery, Universitat des Saarlandes, Saarbrücken, Germany
| | - Bjoern Krapohl
- Plastic and Hand Surgery, St. Marien-Krankenhaus, Berlin, Germany
| | - Dietrich Doll
- Department of Procto-Surgery, Sankt Marienhospital Vechta, Vechta, Germany.
- Department of Surgery, Medical School, University of the Witwatersrand, Johannesburg, South Africa.
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Abstract
BACKGROUND Pilonidal disease (PD) is a recalcitrant condition associated with significant morbidity. It affects 26 in 100,000 individuals; however, there is no consensus on optimal surgical treatment, and up to half of patients struggle with recurrence. This review appraises the current literature on techniques and outcomes of PD surgery, to better guide decision making. METHODS A literature review using directed search terms was performed to identify studies addressing PD management, in accordance with the PRISMA guidelines. Data on techniques, outcomes, and complications were collected. RESULTS Open healing remains the most widely used treatment method and achieves reliable outcomes at the expense of prolonged wound healing, between 21 and 71 days. Asymmetric closure reduces healing time to 10 to 23 days and produces significantly fewer recurrences relative to midline closure (P < 0.05). Outcomes are similar between various asymmetric techniques; the Bascom cleft lift, Karydakis flap, and Limberg transposition are commonly used approaches which all demonstrate recurrence rates under 6%. Deroofing is associated with a significantly lower rate of complications than any closure procedure at 1.4% (P < 0.05), with recurrence in only 1% to 10% of patients, and represents a favorable treatment alternative. CONCLUSIONS Despite the heterogeneous nature of studies on PD, certain techniques have been consistently shown to optimize postoperative outcomes. Deroofing sinuses and allowing secondary healing results in low rates of recurrence with minimal morbidity. When closure is preferred, off-midline flaps provide more effective coverage than midline repair. Treatment recommendations should be guided by individualized patient preferences and be grounded in high-quality data.
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Is histological analysis of pilonidal sinus useful? Retrospective analysis of 731 resections. J Visc Surg 2018; 155:191-194. [DOI: 10.1016/j.jviscsurg.2017.10.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Esposito C, Izzo S, Turrà F, Cerulo M, Severino G, Settimi A, Iannazzone M, Masieri L, Cortese G, Escolino M. Pediatric Endoscopic Pilonidal Sinus Treatment, a Revolutionary Technique to Adopt in Children with Pilonidal Sinus Fistulas: Our Preliminary Experience. J Laparoendosc Adv Surg Tech A 2018; 28:359-363. [DOI: 10.1089/lap.2017.0246] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Serena Izzo
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Severino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Settimi
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Marta Iannazzone
- Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Giuseppe Cortese
- Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Tavangari FR, Lee JA, Garza D, Tejirian T. Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease. Am Surg 2017. [DOI: 10.1177/000313481708301006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.
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Affiliation(s)
- Farees Ricky Tavangari
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Jennifer Amy Lee
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - David Garza
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Talar Tejirian
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Abstract
BACKGROUND Pilonidal sinus disease is thought to be caused by intrusion of hair into healthy skin; loose hair in the intergluteal fold is thought to promote disease. However, compelling evidence to support these postulates is lacking; the cause of pilonidal sinus disease remains uncertain. OBJECTIVE To determine whether particular properties of hair are associated with susceptibility to pilonidal sinus disease, we compared physical properties of hairs of patients with pilonidal sinus disease with hairs from control subjects who were matched for sex, BMI, and age. DESIGN This was an experimental study with establishment of a mechanical strength test for single hairs to quantify the maximum vertical force that a hair could exert, following tests of strength of occipital, lumbar, and intergluteal hair. SETTINGS Hair from patients with pilonidal sinus disease and matched control subjects were harvested from patients of the St. Marienhospital Vechta Department of Procto-Surgery. PATIENTS A total of 17 adult patients with pilonidal sinus disease and 217 control subjects were included. MAIN OUTCOME MEASURES ANOVA and intraclass and interclass variations of data gained from mechanical strength tests of occipital, lumbar, and intergluteal hair were included. RESULTS Vertical hair strength was significantly greater in patients with pilonidal sinus disease. Occipital hair exhibited 20% greater, glabella sacralis 1.1 times greater, and intergluteal hair 2 times greater strength in patients with pilonidal sinus disease than in matched control subjects (all p = 0.0001). In addition, patients with pilonidal sinus disease presented with significantly more hair at the glabella sacralis and in the intergluteal fold. LIMITATIONS The study was limited by its relatively small number of patients from a specific cohort of European patients. CONCLUSIONS Occipital hair exhibited considerable vertical strength. Because occipital hair exerted the greatest force and cut hair fragments were found in the pilonidal nest in large quantities, these data suggest that pilonidal sinus disease is promoted by occipital hair. See Video Abstract at http://links.lww.com/DCR/A435.
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Khodakaram K, Stark J, Höglund I, Andersson RE. Minimal Excision and Primary Suture is a Cost-Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population-Based Interventional and a Cross-Sectional Cohort Study. World J Surg 2017; 41:1295-1302. [PMID: 27905018 PMCID: PMC5394151 DOI: 10.1007/s00268-016-3828-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Conventional treatment of pilonidal disease with wide excision is associated with high morbidity. We describe the short- and long-term results and the impact on the health care system of a simple operation performed in the office under local anaesthesia, consisting of minimal excision of pilonidal sinuses with primary suture—the modified Lord–Millar operation (mLM). Methods All patients operated with mLM from February 2008 till November 2012 were prospectively followed for recurrence by telephone interviews and examination of symptomatic patients till July 2015. The outcome is compared with that in all patients operated with conventional wide excision from January 2003 till February 2008. The effects on the health care system of a consistent use of mLM is analysed by comparing the management of all patients with pilonidal disease at three hospitals during 2013 and 2014. Results Some 129 patients underwent conventional surgical treatment, and 113 had the mLM operation. The mLM operation was more often performed under local anaesthesia, was less often admitted to hospital, had fewer post-operative health care visits (2.4 vs. 14.6, p < 0.001) and a shorter sick leave (1.0 vs. 34.7 days, p < 0.001) indicating faster wound healing. The estimated 5-year recurrence rate was similar (32 vs. 23%, p = 0.091). The cost per operated patient was lower (2231 vs. 6222 EUR, p < 0.001). The hospital consistently applying the mLM operation used less resources for pilonidal diseased patients (34,545 vs. 77,421 EUR per 100,000 inhabitants and year). Conclusions The mLM operation is simple, cost-efficient and has low morbidity and good long-term results.
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Affiliation(s)
- Kaveh Khodakaram
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joachim Stark
- Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden
| | - Ida Höglund
- Department of Surgery, Värnamo Sjukhus, Värnamo, Sweden
| | - Roland E Andersson
- Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden. .,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Ehrl D, Choplain C, Heidekrueger P, Erne HC, Rau HG, Broer PN. Treatment Options for Pilonidal Disease. Am Surg 2017. [DOI: 10.1177/000313481708300517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38–101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was associated with faster recovery, no need for hospitalization and overall low complication rates. In summary, the main advantages of the pit-picking operation lie in its’ outpatient character, the simplicity of the procedure, low complication rates, short recovery time, and predictably good results.
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Affiliation(s)
- Denis Ehrl
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Cornelia Choplain
- Department of Visceral and Thoracic Surgery, Helios Amper-Clinic of Dachau, Dachau, Germany
| | - Paul Heidekrueger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Holger C. Erne
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Horst-Guenter Rau
- Department of Visceral and Thoracic Surgery, Helios Amper-Clinic of Dachau, Dachau, Germany
| | - P. Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
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A comparison of surgical outcome of fasciocutaneous V–Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease. Asian J Surg 2017; 40:197-202. [DOI: 10.1016/j.asjsur.2015.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/17/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022] Open
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Kaplan M, Ozcan O, Bilgic E, Kaplan ET, Kaplan T, Kaplan FC. Distal scar-to-midline distance in pilonidal Limberg flap surgery is a recurrence-promoting factor: A multicenter, case-control study. Am J Surg 2017; 214:811-819. [PMID: 28359560 DOI: 10.1016/j.amjsurg.2017.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Limberg flap (LF) procedure is widely performed for the treatment of sacrococcygeal pilonidal sinus (SPS); however, recurrences continues to be observed. The aim of this study was to assess the relationship between LF designs and the risk of SPS recurrence. METHODS Sixty-one cases with recurrent disease (study group) and 194 controls, with a minimum of 5 recurrence-free years following surgery (control group), were included in the study. LF reconstructions performed in each group were classified as off-midline closure (OMC) and non-OMC types. Subsequently, the 2 groups were analyzed. RESULTS After adjustment for all variables, non-OMC types showed the most prominent correlation with recurrence, followed by interrupted suturing type, family history of SPS, smoking, prolonged healing time, and younger age. The best cut-off value for the critical distance from the midline was found to be 11 mm (with 72% sensitivity and 95% specificity for recurrence). CONCLUSIONS We recommend OMC modifications, with the flap tailored to create a safe margin of at least 2 cm between the flap borders and the midline.
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Affiliation(s)
- Mehmet Kaplan
- Department of General Surgery, Bahcesehir University (BAU) School of Medicine, İstanbul, Turkey.
| | - Onder Ozcan
- Department of General Surgery, Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Ethem Bilgic
- Department of General Surgery, Karasu Government Hospital, Sakarya, Turkey
| | - Elif Tugce Kaplan
- MP Research Program, Kemerburgaz University Medical School, Istanbul, Turkey
| | - Tugba Kaplan
- GAZU Research Program, Gaziantep University Medical School, Gaziantep, Turkey
| | - Fatma Cigdem Kaplan
- 25-Aralik Health Center, Ministry of Health Republic of Turkey, Gaziantep, Turkey
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