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Dainius E, Vaiciute MK, Parseliunas A, Latkauskas T, Venskutonis D. Surgical treatment of pilonidal disease - Short-term follow up results of minimally invasive pit-picking surgery versus radical excision without suturing: A prospective randomised trial. Heliyon 2024; 10:e31497. [PMID: 38845858 PMCID: PMC11153105 DOI: 10.1016/j.heliyon.2024.e31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
Background In this study we compared the potential benefits of surgical treatments for chronic symptomatic pilonidal disease (PD) - minimally invasive pit-picking surgery and radical excision without wound suturing. Materials and methods A total of 100 adult patients with chronic symptomatic PD were enrolled in this study at the Kaunas Hospital of the Lithuanian University of Health Sciences. They were randomly divided into two groups: pit-picking surgery (n = 50) and radical excision with open healing (n = 50). Recurrent PD patients were not excluded. The comparison of the techniques was based on pain within the first postoperative week, failed surgery rates, and wound healing time. Additionally, pain levels at different time intervals following the treatment, analgesic consumption, and time off work, were assessed and compared. Results A total of 89 patients (89 %) were available for follow-up after 6 months. Pain levels the first postoperative week were significantly lower in the pit-picking group compared to the radical excision group, with median scores of 10.0 and 20.0, respectively (p = 0.002). The complete wound healing time was longer in the radical excision group (60 days) versus the pit-picking group (17 days), with a significant difference noted (p = 0.00). No significant difference was observed between the type of surgery and the rate of failed surgery, with 5 (11.9 %) cases in the pit-picking group and 4 (8.5 %) in the radical excision group. Conclusion Based on our short-term findings, minimally invasive pit-picking surgery is a better option regarding pain, wound healing time and failed surgery rate. In cases where this approach is not suitable, other alternatives should be contemplated, as radical surgery without wound suturing should not be employed as a treatment method for PD. Additionally, the relationship between PD and recurrence rates should be investigated further.
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Affiliation(s)
- Edvinas Dainius
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
| | | | - Audrius Parseliunas
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
| | - Tadas Latkauskas
- Lithuanian University of Health Sciences, Department of Surgery, Lithuania
| | - Donatas Venskutonis
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
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Lee WG, Short C, Zhong A, Vojvodic V, Sundin A, Spurrier RG, Wang KS, Pelayo JC. Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment. Pediatr Surg Int 2024; 40:46. [PMID: 38294551 PMCID: PMC10830615 DOI: 10.1007/s00383-023-05629-1] [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] [Accepted: 12/28/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches-excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT). METHODS Single-center retrospective evaluation of patients 1-21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann-Whitney U tests. RESULTS 18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031). CONCLUSION In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.
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Affiliation(s)
- William G Lee
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
- Department of Pediatric Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Celia Short
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Allen Zhong
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Vanya Vojvodic
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Andrew Sundin
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Ryan G Spurrier
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Kasper S Wang
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
- Division of General and Thoracic Surgery, The Hospital for Sick Children, 555 University Avenue, 1526 Hill Wing, Toronto, ON, M5G 1X8, Canada
| | - Juan Carlos Pelayo
- Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
- Department of Pediatric Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
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3
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Cai Z, Zhao Z, Ma Q, Shen C, Jiang Z, Liu C, Liu C, Zhang B. Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2024; 1:CD015213. [PMID: 38226663 PMCID: PMC10790338 DOI: 10.1002/14651858.cd015213.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Pilonidal sinus disease is a common and debilitating condition. Surgical treatment remains the mainstay for managing chronic disease, with options including midline and off-midline wound closure methods. However, the optimal approach remains uncertain. Recent developments in tension-free midline techniques require further exploration. OBJECTIVES To assess the effects of midline and off-midline wound closure methods for pilonidal sinus, and to determine the optimal off-midline flap procedures. SEARCH METHODS In June 2022, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus EBSCO, and clinical trials registries. We also scanned the reference lists of included studies, as well as reviews, meta-analyses, and health technology reports. We applied no language, publication date, or study setting restrictions. SELECTION CRITERIA We included parallel RCTs involving participants undergoing midline closure without flap techniques and off-midline closure for pilonidal sinus treatment. We excluded quasi-experimental studies and studies that enroled participants presenting with an abscess. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. The critical outcomes included wound healing (time to wound healing, proportion of wounds healed), recurrence rate, wound infection, wound dehiscence, time to return to work, and quality of life. We assessed biases in these outcomes utilising the Cochrane risk of bias 2 tool and appraised evidence certainty via the GRADE approach. MAIN RESULTS We included 33 studies with 3667 analysed participants. The median or average age of the participants across the included studies ranged from 21.0 to 34.2 years, with a predominant male representation. Geographically, the trials were primarily conducted in the Middle East. We identified nine intervention comparisons. In this abstract, we focus on and present the summarised findings for the three primary comparisons. Off-midline closure versus conventional midline closure Off-midline closure probably reduces the time to wound healing (mean difference (MD) -5.23 days, 95% confidence interval (CI) -7.55 to -2.92 days; 3 studies, 300 participants; moderate-certainty evidence). However, there may be little to no difference between the two methods in the proportion of wounds healed (100% versus 88.5%, risk ratio (RR) 1.13, 95% CI 0.92 to 1.39; 2 studies, 207 participants; very low-certainty evidence). Off-midline closure probably results in lower rates of recurrence (1.5% versus 6.8%, RR 0.22, 95% CI 0.11 to 0.45; 13 studies, 1492 participants; moderate-certainty evidence) and wound infection (3.8% versus 11.7%, RR 0.32, 95% CI 0.22 to 0.49; 13 studies, 1568 participants; moderate-certainty evidence), and may lower rates of wound dehiscence (3.9% versus 8.9%, RR 0.44, 95% CI 0.27 to 0.71; 11 studies, 1389 participants; low-certainty evidence). Furthermore, off-midline closure may result in a reduced time to return to work (MD -3.72 days, 95% CI -6.11 to -1.33 days; 6 studies, 820 participants; low-certainty evidence). There were no data available for quality of life. Off-midline closure versus tension-free midline closure Off-midline closure may reduce the time to wound healing (median 14 days in off-midline closure versus 51 days in tension-free midline closure; 1 study, 116 participants; low-certainty evidence) and increase wound healing rates at three months (94.7% versus 76.4%, RR 1.24, 95% CI 1.06 to 1.46; 1 study, 115 participants; low-certainty evidence), but may result in little to no difference in rates of recurrence (5.4% versus 7.8%, RR 0.69, 95% CI 0.30 to 1.61; 6 studies, 551 participants; very low-certainty evidence), wound infection (2.8% versus 6.4%, RR 0.44, 95% CI 0.16 to 1.17; 6 studies, 559 participants; very low-certainty evidence), and wound dehiscence (2.5% versus 3.0%, RR 0.82, 95% CI 0.17 to 3.84; 3 studies, 250 participants; very low-certainty evidence) compared to tension-free midline closure. Furthermore, off-midline closure may result in longer time to return to work compared to tension-free midline closure (MD 3.00 days, 95% CI 1.52 to 4.48 days; 1 study, 60 participants; low-certainty evidence). There were no data available for quality of life. Karydakis flap versus Limberg flap Karydakis flap probably results in little to no difference in time to wound healing compared to Limberg flap (MD 0.36 days, 95% CI -1.49 to 2.22; 6 studies, 526 participants; moderate-certainty evidence). Compared to Limberg flap, Karydakis flap may result in little to no difference in the proportion of wounds healed (80.0% versus 66.7%, RR 1.20, 95% CI 0.77 to 1.86; 1 study, 30 participants; low-certainty evidence), recurrence rate (5.1% versus 4.5%, RR 1.14, 95% CI 0.61 to 2.14; 9 studies, 890 participants; low-certainty evidence), wound infection (7.9% versus 5.1%, RR 1.55, 95% CI 0.90 to 2.68; 8 studies, 869 participants; low-certainty evidence), wound dehiscence (7.4% versus 6.2%, RR 1.20, 95% CI 0.41 to 3.50; 7 studies, 776 participants; low-certainty evidence), and time to return to work (MD -0.23 days, 95% CI -5.53 to 5.08 days; 6 studies, 541 participants; low-certainty evidence). There were no data available for quality of life. AUTHORS' CONCLUSIONS This Cochrane review examines the midline and off-midline wound closure options for pilonidal sinus, predominantly based on young adult studies. Off-midline flap procedures demonstrate there may be benefits over conventional midline closure for pilonidal sinus, with various off-midline flap techniques. When off-midline flap closures were compared to tension-free midline closure, low-certainty evidence indicated there may be improved wound healing and increased time to return to work for off-midline closure, whilst very low-certainty evidence indicated there may be no evidence of a difference in other outcomes. There may be no evidence of an advantage found amongst the off-midline techniques evaluated. The choice of either procedure is likely to be based on a clinician's preference, experience, patient characteristics, and the patients' preferences. To more accurately determine the benefits and potential harms of these closure techniques, further large-scale and meticulously-designed trials are essential. Specifically, there is a pressing need for more studies addressing the paediatric population, in addition to adult studies.
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Affiliation(s)
- Zhaolun Cai
- Department of General Surgery, Gastric Cancer Center, Research Laboratory of Tumor Epigenetics and Genomics for General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyuan Jiang
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunyu Liu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chunjuan Liu
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, Gastric Cancer Center, Research Laboratory of Tumor Epigenetics and Genomics for General Surgery, West China Hospital, Sichuan University, Chengdu, China
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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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Liu X, Zhao X, Shen G, Fan S, Xu J, Fan Z, Li K. Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus. Int Wound J 2023; 20:3474-3482. [PMID: 37218401 PMCID: PMC10588358 DOI: 10.1111/iwj.14218] [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: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.
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Affiliation(s)
- Xiao Liu
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Xiaoyu Zhao
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Guoliang Shen
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Shuwen Fan
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Jun Xu
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Zhaojun Fan
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Ke Li
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople'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: 2.0] [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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Manigrasso M, D'Amore A, Benatti E, Bracchitta LM, Bracchitta S, Cantarella F, Carpino A, Ferrari F, Gallo G, La Torre M, Magnani C, Magni E, Margiotta A, Masetti M, Mori L, Pata F, Pezza M, Tierno S, Tomassini F, Vanini P, De Palma GD, Milone M. Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience. Tech Coloproctol 2023; 27:929-935. [PMID: 37597082 DOI: 10.1007/s10151-023-02846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence. METHODS All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database. RESULTS Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden's test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%. CONCLUSIONS This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.
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Affiliation(s)
- M Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy.
| | - A D'Amore
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - E Benatti
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - L M Bracchitta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - S Bracchitta
- Coloproctolgy Center, Clinica del Mediterraneo, Ragusa, Italy
| | - F Cantarella
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Carpino
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ferrari
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - G Gallo
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - M La Torre
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - C Magnani
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - E Magni
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Margiotta
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - M Masetti
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - L Mori
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - F Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, CS, Italy
| | - M Pezza
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - S Tierno
- Department of Surgery, Ospedale Vannini, Rome, Italy
| | - F Tomassini
- Department of Surgery, Ospedale Grassi, Rome, Italy
| | - P Vanini
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - M Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
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Abstract
Importance The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. Observations There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. Conclusions and Relevance Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
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9
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Iesalnieks I. [Is Pit Picking Surgery the Standard of Treatment for Uncomplicated Pilonidal Disease?]. Zentralbl Chir 2023; 148:254-258. [PMID: 37267980 DOI: 10.1055/a-2044-0850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Minimally invasive surgery for pilonidal disease was first described in 1965, but it has only become widespread in the last two decades. The present manuscript discusses the technique of pit picking surgery, its variations, indications, alternatives and the results.
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Affiliation(s)
- Igors Iesalnieks
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Ev. Krankenhaus Köln-Kalk, Köln, Deutschland
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10
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陈 王, 张 明, 陶 科, 游 兴, 孙 广. [Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:478-481. [PMID: 37070318 PMCID: PMC10110742 DOI: 10.7507/1002-1892.202301035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/02/2023] [Indexed: 04/19/2023]
Abstract
Objective To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. Methods Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. Results All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. Conclusion Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.
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Affiliation(s)
- 王浩男 陈
- 遵义医科大学第二附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 明月 张
- 遵义医科大学第二附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 科融 陶
- 遵义医科大学第二附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 兴 游
- 遵义医科大学第二附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 广峰 孙
- 遵义医科大学第二附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
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11
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Li Z, Jin L, Gong T, Qin K, Cui C, Wang Z, Wu J. An effective and considerable treatment of pilonidal sinus disease by laser ablation. Lasers Med Sci 2023; 38:82. [PMID: 36856904 PMCID: PMC9977879 DOI: 10.1007/s10103-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470-nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470-nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470-nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.
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Affiliation(s)
- Zhicheng Li
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Lei Jin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Tianyun Gong
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kaijian Qin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Can Cui
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhenyi Wang
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jiong Wu
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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12
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Song Y, Zang Y, Chen Z, Li J, Zhu M, Zhu H, Chu W, Liu G, Shen C. The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease. Int Wound J 2023. [PMID: 36802113 DOI: 10.1111/iwj.14105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0 kg/m2 , average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing-changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.
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Affiliation(s)
- Yaoyao Song
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Zang
- Department of General surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zequn Chen
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianjun Li
- Department of General surgery, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minhui Zhu
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongjuan Zhu
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wanli Chu
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Gang Liu
- Department of General surgery, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chuan'an Shen
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
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13
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Baz Y, Orban YA, Ezzat MM. Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1759740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study.
Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD.
Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure.
Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction.
Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.
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Affiliation(s)
- Yasser Baz
- Surgery Department, Helwan University, Helwan, Egypt
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14
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Sinus pilonidalis. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Svarre KJ, Serup CM, Kanstrup CTB, Kleif J, Bertelsen CA. Long-term outcome after Bascom's cleft-lift procedure under tumescent local analgesia for pilonidal sinus disease: a cohort study. Colorectal Dis 2022; 25:707-716. [PMID: 36401803 DOI: 10.1111/codi.16420] [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: 06/27/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
AIM Bascom's cleft-lift procedure for pilonidal sinus disease under tumescent local analgesia is feasible and well tolerated with favourable short-term outcomes. We aimed to assess the 10-year treatment success rate after cleft-lift under tumescent local analgesia. METHOD This was a single-centre cohort study based on prospectively registered perioperative data and survey data with additional data from electronic medical records. The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting at a tertiary referral hospital between 1 July 2008 and 31 March 2014. The primary outcome was the 10-year risk treatment success defined as complete wound healing within 180 days of surgery or no recurrence assessed with competing risk analyses. Secondary outcomes were time to complete wound healing, persistent pain and cosmetic satisfaction. RESULTS Two hundred patients with complex pilonidal sinus disease were included. Indication was incomplete wound healing after pilonidal sinus surgery in 43 (21.5%) patients, recurrence after previous intervention in 78 (39.0%) or moderate to complex sinuses assessed by a consultant surgeon in 79 (39.5%). One hundred and ninety-five patients had complete wound healing within 180 days with a median time of 29 days (interquartile range 16-47). The cumulative risk of 10-year recurrence was 11.3% (95% CI 6.2%-16.4%) with a median follow-up time of 8.5 (1.0-10.7) years. Treatment success was 86.1% (95% CI 80.6%-91.5%). No significant predictors were associated with recurrence, and 90% of patients experienced no persistent pain. CONCLUSION Cleft-lift performed under tumescent local analgesia has an acceptable 10-year treatment failure rate, making the method feasible in a day-surgery setting.
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Affiliation(s)
- Kristina J Svarre
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Camilla M Serup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte T B Kanstrup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark.,Graduate School, Faculty of 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, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus A Bertelsen
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Mamaloudis I, Perivoliotis K, Zlatanos C, Baloyiannis I, Spyridakis M, Kouvata E, Samara AA, Christodoulidis G, Tepetes K. The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial. Int Wound J 2022; 19:1528-1538. [PMID: 35043571 PMCID: PMC9493221 DOI: 10.1111/iwj.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
In this trial, we evaluated the role of alginate dressings in the secondary intention wound healing and quality of life (QoL) after pilonidal sinus resection. The study was designed as a prospective randomised controlled trial (RCT). In the experimental group, alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision, whereas in the control group, simple gauges were used. The primary end point was the difference in terms of the wound healing period. Blinding existed at the level of the investigator. Overall, 65 patients were included during the study period. Wound healing duration was comparable between the two groups (P = .381). No difference in postoperative pain scores or recovery outcomes was found. The experimental group was associated with reduced wound secretions at specific time end points. Similarly, no effect was identified, on overall Wound-QoL or SF-36 scores. Alginate dressings do not accelerate wound healing or improve QoL. Due to suboptimal sample size and several study limitations, further RCTs are required to confirm our findings.
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Affiliation(s)
| | | | | | | | | | | | - Athina A. Samara
- Department of SurgeryUniversity Hospital of LarissaLarissaGreece
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17
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Gallo G, Milone M, La Torre M, Basso L. Editorial: Management and Treatment of Pilonidal Disease: 189 Years After Mayo. Front Surg 2022; 9:950793. [PMID: 36034357 PMCID: PMC9407246 DOI: 10.3389/fsurg.2022.950793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gaetano Gallo
- Department of Surgical Sciences, La Sapienza University of Roma, Roma, Italy
- Correspondence: Gaetano Gallo
| | - Marco Milone
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Marco La Torre
- Coloproctology Unit, Salvator Mundi International Hospital, UPMC University of Pittsburgh Medical Center, Roma, Italy
| | - Luigi Basso
- “Pietro Valdoni” Department of Surgery, Policlinico Umberto I, Sapienza University of Roma, Roma, Italy
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18
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Cai Z, Zhao Z, Ma Q, Shen C, Jiang Z, Liu C, Liu C, Zhang B. Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus. Hippokratia 2022. [DOI: 10.1002/14651858.cd015213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhaolun Cai
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Zhou Zhao
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Qin Ma
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Zhiyuan Jiang
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Chunyu Liu
- Department of Pharmacy; West China Second University Hospital, Sichuan University; Chengdu China
- Evidence-Based Pharmacy Center; West China Second University Hospital, Sichuan University; Chengdu China
| | - Chunjuan Liu
- West China School of Nursing/West China Hospital, Sichuan University; Chengdu China
| | - Bo Zhang
- Department of Gastrointestinal Surgery; West China Hospital, Sichuan University; Chengdu China
- Sanya People's Hospital/West China (Sanya) Hospital, Sichuan University; Sanya China
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19
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Doll D, Petersen S, Andreae OA, Matner H, Albrecht H, Brügger LE, Luedi MM, Puhl G. Pit picking vs. Limberg flap vs. primary open method to treat pilonidal sinus disease - A cohort of 327 consecutive patients. Innov Surg Sci 2022; 7:23-29. [PMID: 35974777 PMCID: PMC9352183 DOI: 10.1515/iss-2021-0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background Minimally invasive methods in pilonidal sinus disease (PSD) surgery are becoming standard. Although long-term results are available for some techniques, long-term outcome data of patients after pit picking is lacking. We aimed at investigating perioperative and long-term outcomes of patients undergoing pit picking, Limberg flap or primary open surgery to treat PSD. Methods In a single-centre observational study, we evaluated the outcomes of 327 consecutive patients undergoing PSD surgery between 2011 and 2020. Results PSD had recurred in 22% of Limberg flap patients and 62% of pit picking patients at 5 years (p=0.0078; log rank test). Previous pilonidal surgeries, smoking, body mass index, immunodeficiency, and diabetes did not significantly influence the long-term recurrence rate. Primary open treatment was performed for 72% of female patients presenting with primary disease. Conclusions Due to its especially dismal long-term results, pit picking should be abandoned, and Limberg flap should be promoted instead, even for primary disease and in females.
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Affiliation(s)
- Dietrich Doll
- Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
- Pilonidal Research Group, Vechta, Germany
| | - Sven Petersen
- Pilonidal Research Group, Vechta, Germany
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg-Altona, Hamburg, Germany
| | | | - Hanne Matner
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg-Altona, Hamburg, Germany
| | - Henning Albrecht
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg-Altona, Hamburg, Germany
| | - Lukas E. Brügger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M. Luedi
- Pilonidal Research Group, Vechta, Germany
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gero Puhl
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg-Altona, Hamburg, Germany
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20
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Manigrasso M, Anoldo P, Cantore G, Chini A, D'Amore A, Gennarelli N, Maione F, Marello A, Schettino P, Sorrentino C, Vertaldi S, Sosa Fernandez LM, De Palma GD, Milone M. Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature. Front Surg 2022; 8:812128. [PMID: 35059431 PMCID: PMC8764178 DOI: 10.3389/fsurg.2021.812128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 02/01/2023] Open
Abstract
Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD. Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted). Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction. Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique. Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.
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Affiliation(s)
- Michele Manigrasso
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, Italy
- *Correspondence: Michele Manigrasso
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Pietro Schettino
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | | | | | - Marco Milone
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
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Iesalnieks I. Pit-Picking bei Sinus pilonidalis. COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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