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Vejdan SA, Danesh HA, Amirian F, Amirian Z. Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial. Ann Med Surg (Lond) 2024; 86:2715-2722. [PMID: 38694311 PMCID: PMC11060272 DOI: 10.1097/ms9.0000000000001866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/07/2024] [Indexed: 05/04/2024] Open
Abstract
Background The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. Material and method The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Result Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Conclusion Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.
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Affiliation(s)
- SA Vejdan
- University of Medicine, Birjand
- Imam Reza Hospital
| | - HA Danesh
- University of Medicine
- Clinical Immunology Research Center at Zahedan University of Medical Science, Zahedan
| | - F. Amirian
- Faculty of Medicine, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad
| | - Z. Amirian
- University of Medicine
- Imam Ali Hospital, Meshginshahr, Iran
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Zhuang Y, Feng WZ. Platelet-rich plasma for pilonidal disease: a systematic review. J Int Med Res 2023; 51:3000605231216590. [PMID: 38141657 DOI: 10.1177/03000605231216590] [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: 12/25/2023] Open
Abstract
OBJECTIVE To examine the use of platelet-rich plasma (PRP) for treatment of pilonidal disease (PD) and thus provide a reference for clinical application. METHODS A systematic review of PubMed and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We considered all studies that reported the use of PRP for treatment of PD. Extracted data included the first author's name, year of publication, study type, number of included patients, inclusion and exclusion criteria, interventions, anesthesia, application of PRP (source, preparation, dose, and operation), antibiotics, follow-up time, therapeutic outcomes, and adverse events. RESULTS In total, eight randomized controlled trials and one prospective cohort study involving 809 patients were included. PRP reduced pain, accelerated healing, and reduced adverse events. The application of combined minimally invasive surgery achieved better results. However, overfilling of the wound with PRP in minimally invasive surgeries was shown to potentially increase the risk of adverse events. CONCLUSION PRP can be used as an adjuvant treatment in PD surgery to improve the therapeutic effect and reduce adverse events. The optimal combination of PRP and various factors is an important direction of future research.INPLASY registration number: INPLASY2023100070.
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Affiliation(s)
- Yu Zhuang
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Wen-Zhe Feng
- Department of Anorectal Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Garg P, Hemrajani P. Terminal Hairs That Resemble Occipital Hairs in Pilonidal Sinus Disease: A Case Report. Adv Skin Wound Care 2023; 36:1-2. [PMID: 37729171 DOI: 10.1097/asw.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
ABSTRACT This is the first demonstrated case in which terminal hairs that resembled occipital hairs and ranged from 2 to 13 cm in length were extracted from a patient with primary pilonidal sinus disease. This case provides evidence that occipital hairs may enter the pilonidal sinus and perhaps also play a role in the pathogenesis of the disease.
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Affiliation(s)
- Pankaj Garg
- At the Garg Fistula Research Institute, Panchkula, India, Pankaj Garg, MBBS, MS, is Senior Colorectal Surgeon. In the Department of Dermatology, ESI Hospital, Delhi, Priyanka Hemrajani, MD, MBBS, is Senior Resident
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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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De Decker M, Sels T, Van Hoof S, Smets Q, Hendrickx T, Van Dessel E, Komen N. Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients. Int J Colorectal Dis 2023; 38:33. [PMID: 36763170 DOI: 10.1007/s00384-023-04324-w] [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] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE The minimally invasive character, the possibility to perform under local anesthesia, and the ease to repeat have led to increasing popularity of laser-assisted treatment of pilonidal sinus disease. Hereby, potentially avoiding prolonged need for medical care at home, incapacity to work, and high expenses for patients and society. This retrospective, multi-center study is aimed at evaluating the feasibility of laser-assisted treatment for pilonidal sinus disease. METHODS The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021. Data were retrospectively collected. The primary endpoint was overall wound healing after one or more laser assisted procedures. RESULTS A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]. The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures. Wound infections were the main postoperative complication (8.0%) of which 5 patients required drainage (2.2%). For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap). CONCLUSION This study shows that laser-assisted treatment is feasible for pilonidal sinus disease. The minimally invasive character of this technique might make up for a higher non-healing rate compared to other techniques like flap repair. However, care must be taken that healing rate might be related to the presentation of the sinus and expectations should be lowered as presumed high healing rates are not always achieved.
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Affiliation(s)
- Marjolein De Decker
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium.
| | - Toon Sels
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Sander Van Hoof
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Quinten Smets
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Tom Hendrickx
- Department of General and Abdominal Surgery, AZ Turnhout, 2300, Turnhout, Belgium
| | - Els Van Dessel
- Department of General and Abdominal Surgery, GZA Hospitals, 2018, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
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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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Olcucuoglu E, Şahin A. Unroofing curettage for treatment of simple and complex sacrococcygeal pilonidal disease. Ann Surg Treat Res 2022; 103:244-251. [PMID: 36304191 PMCID: PMC9582619 DOI: 10.4174/astr.2022.103.4.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Sacrococcygeal pilonidal disease is a chronic inflammatory condition with an incidence of 26:100,000 in the United States. However, its etiology and optimal treatment remain controversial. Methods We included 129 and 74 patients with simple and complex sacrococcygeal pilonidal disease, respectively. The primary outcome was pilonidal sinus recurrence after unroofing curettage. Secondary outcomes were pain scores, time to return to work/school, and time to complete recovery. Results At a median follow-up of 53 months, the recurrence rate was 4.9% in all patients, not significantly higher in subjects with the complex disease. Duration of surgery (15.4 minutes vs. 12.2 minutes), time to return to school/work (9.8 days vs. 7.7 days), and complete healing time (44 days vs. 36 days) were longer in patients with the complex disease. Postoperative complication rates, pain scores, and quality of life scores between the 2 groups did not differ. Conclusion Unroofing curettage may be a good first-choice treatment for both simple and complex sacrococcygeal pilonidal disease.
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Affiliation(s)
- Engin Olcucuoglu
- Department of Surgery, University of Health Science, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Alpaslan Şahin
- Department of Surgery, University of Health Science, Konya City Hospital, Konya, Turkey
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Sahin A, Simsek G, Arslan K. Unroofing Curettage Versus Modified Limberg Flap in Pilonidal Disease: A Retrospective Cohort Study. Dis Colon Rectum 2022; 65:1241-1250. [PMID: 34840296 DOI: 10.1097/dcr.0000000000002227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sacrococcygeal pilonidal disease (estimated incidence, 25/100,000) is a chronic inflammatory condition that commonly affects young adults. However, the ideal surgical treatment for this disease remains undetermined. OBJECTIVE This study aimed to compare the results of the unroofing curettage and those of the modified Limberg flap surgical technique. DESIGN This is a retrospective cohort study. SETTINGS Procedures were performed by 2 surgeons between January 2013 and January 2017. PATIENTS The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed. INTERVENTIONS Unroofing curettage was performed under local or spinal anesthesia, whereas spinal anesthesia was used for the modified Limberg flap procedure. MAIN OUTCOME MEASURES The primary outcome was recurrence rate. Secondary outcomes included adverse events, limitation of daily activities, and healing time. RESULTS Between the 2 groups (unroofing curettage, n = 135; modified Limberg flap, n = 143), recurrence was lower in the unroofing curettage group after a 60-month median follow-up period, but the difference was not statistically significant (1.5% vs 4.2%, p = 0.45). The duration of surgery and length of hospital stay were shorter in the unroofing curettage group (11.44 ± 3.56 minutes vs 52.47 ± 7.92 minutes and 0.27 ± 0.45 days vs 1.07 ± 0.26 days, p < 0.001). Postoperative complications were significantly higher in the modified Limberg flap group (9.8% vs 2.2%, p = 0.009). The time required to return to work or school was shorter in the unroofing curettage group (8.6 ± 7.8 days vs 25.01 ± 6.3 days, p < 0.001). The complete healing time was longer in the unroofing curettage group (35.3 ± 9.2 days vs 23.2 ± 5.4 days, p < 0.001). LIMITATIONS The retrospective study design was a limitation of this study. CONCLUSIONS Unroofing curettage provided more clinical benefits than the modified Limberg flap approach. Unroofing curettage should be considered as the first choice of surgical treatment for pilonidal disease. See Video Abstract at http://links.lww.com/DCR/B824 . DESTECHAMIENTO Y CURETAJE VERSUS COLGAJO DE LIMBERG MODIFICADO EN LA ENFERMEDAD PILONIDAL UN ESTUDIO DE COHORTE RETROSPECTIVE ANTECEDENTES:La enfermedad pilonidal sacrococcígea (incidencia estimada, 25 / 100.000) es una enfermedad inflamatoria crónica que comúnmente afecta a adultos jóvenes. Sin embargo, el tratamiento quirúrgico ideal para esta enfermedad permanece indeterminado.OBJETIVO:Comparar los resultados del destechamiento y curetaje y los de la técnica quirúrgica con colgajo de Limberg modificado.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Los procedimientos fueron realizados por dos cirujanos, entre enero del 2013 y enero del 2017.PACIENTES:Se analizaron datos de 278 pacientes intervenidos quirúrgicamente para el tratamiento de la enfermedad pilonidal.INTERVENCIONES:Se realizó destechamiento y curetaje con anestesia local o raquídea, mientras que para el procedimiento de colgajo de Limberg modificado se utilizó anestesia raquídea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de recurrencia. Los resultados secundarios incluyeron eventos adversos, limitación de las actividades diarias y tiempo de curación.RESULTADOS:Entre los dos grupos (destechamiento y curetaje, n = 135; colgajo de Limberg modificado, n = 143), la recurrencia fue menor en el grupo con destechamiento y curetaje después de un período de seguimiento medio de 60 meses, pero la diferencia no fue estadísticamente significativa (1,5% vs 4,2%, p = 0,45). La duración de la cirugía y la estancia hospitalaria fueron más cortas en el grupo de destechamiento y curetaje (11,44 ± 3,56 min vs a 52,47 ± 7,92 min y 0,27 ± 0,45 días vs 1,07 ± 0,26 días, p < 0,001). Las complicaciones posoperatorias fueron significativamente mayores en el grupo de colgajo de Limberg modificado (9,8% vs 2,2%, p = 0,009). El tiempo necesario para regresar al trabajo o la escuela fue menor en el grupo de destechamiento y curetaje (8,6 ± 7,8 días vs 25,01 ± 6,3 días, p < 0,001). El tiempo de cicatrización completo fue mayor en el grupo de destechamiento y curetaje (35,3 ± 9,2 días vs 23,2 ± 5,4 días, p < 0,001).LIMITACIONES:El diseño del estudio retrospectivo.CONCLUSIONES:El destechamiento y curetaje proporcionó más beneficios clínicos que el abordaje con colgajo de Limberg modificado. El destechamiento y curetaje debe considerarse como la primera opción de tratamiento quirúrgico para la enfermedad pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/B824 . (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Alpaslan Sahin
- Department of Surgery, University of Health Science Konya City Hospital, Konya, Turkey
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Pilonidal disease: A new look at an old disease. SEMINARS IN COLON AND RECTAL SURGERY 2022. [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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Surgery for uncomplicated pilonidal disease: simpler is better. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Garg P, Yagnik VD, Dawka S. Pilonidal Sinus Is Like an Ordinary Abscess and Should Be Treated Like One. Dermatol Surg 2022; 48:690-691. [PMID: 35333203 DOI: 10.1097/dss.0000000000003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Pankaj Garg
- Colorectal Surgeon, Indus International Hospital, Mohali, Punjab, India.,Garg Fistula Research Institute, Panchkula, India
| | - Vipul D Yagnik
- Surgical Gastroenterologist, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
| | - Sushil Dawka
- Surgery, SSR Medical College, Belle Rive, Mauritius
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Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg 2021; 406:2569-2580. [PMID: 33950407 PMCID: PMC8097120 DOI: 10.1007/s00423-020-02060-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations. METHODS Systemic literature review. RESULTS Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent. CONCLUSION Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.
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Affiliation(s)
- I Iesalnieks
- Dept. of Surgery, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
| | - A Ommer
- End- und Dickdarm-Zentrum Essen, Essen, Germany
| | - A Herold
- End- und Dickdarmzentrum Mannheim, Mannheim, Germany
| | - D Doll
- Dept. of Procto-Surgery, St. Marienhospital Vechta, Vechta, Germany
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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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Gulcu B, Ozturk E. Endoscopic Pilonidal Sinus Treatment: Rapid Recovery, Satisfactory Success, and High Quality of Life. Surg Laparosc Endosc Percutan Tech 2021; 31:711-715. [PMID: 34310558 DOI: 10.1097/sle.0000000000000974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In the treatment of pilonidal sinus disease (PD), endoscopic pilonidal sinus treatment (EPSIT), a skin-sparing minimally invasive technique, has attracted attention as an effective treatment. The aim of this study to evaluate the treatment success, cosmetic outcomes, and the quality of life in the patients who underwent an EPSIT for PD. MATERIALS AND METHODS The prospectively maintained data of 86 patients who underwent EPSIT for PD were retrospectively analyzed. The primary end-point of this study was complete wound healing, while the secondary end-points were the quality of life and cosmetic outcomes. RESULTS Seventy-two (83.7%) patients were male, and the median age was 28 (16 to 52). The median operative time was 32 (24 to 44) minutes, the median time to return to daily activities was 1 (1 to 4) day, and the median time to return to work was 3 (1 to 11) days. Fifty-two patients (60.4%) required no analgesics. No wound complication was observed. The median follow-up period was 12 (3 to 23) months. The complete wound healing rate was 94.2%, incomplete wound healing rate was 4.6% and the recurrence rate was 1.2%. Treatment failure was observed in 5 of the 6 patients with >3 pits located in the midline. The first-year median Wound evaluation scale score was 0 (0 to 4). The quality of life [physical function, physical role difficulty, pain, general health perception, energy/vitality, social functioning, emotional role, and mental health (P<0.0001)] significantly increased from preoperative levels a month after the EPSIT procedure. CONCLUSION EPSIT, a minimally invasive treatment modality for the treatment of sacrococcygeal PD, is an effective treatment that does not hamper the daily life of the patients, presents high success rates, and has satisfactory cosmetic outcomes.
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Affiliation(s)
- Baris Gulcu
- Department of Surgery, Bursa Medicana Hospital, Bursa
| | - Ersin Ozturk
- Department of Surgery, Bursa Medicana Hospital, Bursa
- Department of Surgery, KTO Karatay University School of Medicine, Konya, Turkey
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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: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [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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Foti N, Passannanti D, Libia A, Campanile FC. A minimally invasive approach to pilonidal disease with endoscopic pilonidal sinus treatment (EPSiT): a single-center case series with long-term results. Tech Coloproctol 2021; 25:1045-1054. [PMID: 34110535 DOI: 10.1007/s10151-021-02477-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Minimally invasive techniques for treating pilonidal disease are safe and effective alternatives to conventional surgery, with improved recovery time, cosmetic results, and pain control. The aim of this study was to evaluate the 5-year surgical outcomes of a single-center case series treated with endoscopic pilonidal sinus treatment (EPSiT). METHODS We conducted a retrospective single-center analysis of all patients treated with EPSiT, by a single surgical team, from March 2015 to December 2019, for primary or recurrent pilonidal disease. The primary outcomes were recurrence, persistence and treatment failure. The secondary outcomes were postoperative pain, painkiller use, time off work, satisfaction, complications, wound healing time, time to persistence or recurrence. RESULTS Forty-two patients underwent 46 EPSiT procedures [34 males, 8 females, median age 25 (IQR 13.75) years] for primary (47.8%) or recurrent pilonidal disease (52.2%). All patients completed the follow-up [median 62 (IQR 43) months]. The single procedure healing rate was 76.1%. The healing rate for the first procedures plus the second EPSiT procedure (performed in 4 cases) was 83.3%. Among the 46 EPSiT procedures, we recorded six cases of persistence (13.0%) and five cases of recurrence (10.9%) The median operative time was 32.5 (IQR 18.75) minutes, the median pain score (visual analog scale) in week 1 was 2 (IQR 2), and the median time off work was 4 (IQR 2) days. Four patients (8.7%) experienced complications: serosanguineous (n = 2) or seropurulent discharge (n = 2). The satisfaction rate was 95.7%. CONCLUSIONS In our experience, EPSiT is safe, well accepted. and associated with a low level of postoperative pain, short hospitalization, short time off work, as well as optimal cosmetic results. Its failure rate is similar to that of excisional surgery.
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Affiliation(s)
- N Foti
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - D Passannanti
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - A Libia
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - F C Campanile
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy.
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Garg P. Patient's preference should be given importance while deciding procedure to treat pilonidal sinus disease. ANZ J Surg 2021; 90:2146-2148. [PMID: 33710726 DOI: 10.1111/ans.16066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Pankaj Garg
- Department of Colorectal Surgery, Indus Super Specialty Hospital, Mohali, India.,Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India
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18
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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: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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19
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Garg P. An Unusual Presentation of Pilonidal Sinus Due to Tuberculosis and a Review of Literature. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Garg P. Re: JSLS. 2017 Jul-Sep; 21(3): e2017.00043. DOI: 10.4293/JSLS.2017.00043. Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series. JSLS 2019; 22:JSLS.2017.00083. [PMID: 29765193 PMCID: PMC5916220 DOI: 10.4293/jsls.2017.00083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pankaj Garg
- Indus Super Specialty Hospital Mohali, India Garg Fistula Research Institute Haryana, India Tel: 0091-9501522000 E-mail:
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21
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Garg P. Anal fistula and pilonidal sinus disease coexisting simultaneously: An audit in a cohort of 1284 patients. Int Wound J 2019; 16:1199-1205. [PMID: 31412425 DOI: 10.1111/iwj.13187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/28/2019] [Indexed: 01/08/2023] Open
Abstract
Fistula-in-ano and pilonidal disease are not known to occur together. In a retrospective study, all patients having fistula-pilonidal disease coexisting simultaneously were included. Out of 1284 patients, 933 were operated (fistula-in-ano, 849; pilonidal disease, 77; and coexisting fistula-pilonidal, 7). A total of 351 patients did not undergo any surgery (two patients had coexisting fistula-pilonidal). Thus, a total of nine patients having coexisting fistula-pilonidal sinus were included in the study (mean age 35.8 ± 19.9 years, M/F 7/2). pIn 6/9 patients, the pilonidal tract was communicating with fistula-in-ano, and in 3/9 patients, they were not communicating/connected. The connection could be established preoperatively with the help of MRI. In all patients with communicating fistula-pilonidal sinus (n=6), the fistula was posterior. 6/9 patients had recurrent fistula and all (9/9) had multiple tracts. The fistula was high and complex in 8/9 patients (grade IV-7, grade V-1). 4/9 patients tested positive for tuberculosis while one patient was suffering from hidradenitis suppurativa. The latter improved on medical treatment. One patient did not agree for surgery and seven were operated. The disease healed in four patients, the disease did not heal in one patient, and two patients were in the convalescent stage. Anal fistula and pilonidal disease can coexist in a same patient and can even be connected. Such diseases are more complex and have a higher incidence of associated diseases like tuberculosis. Magnetic resonance imaging plays a pivotal role in diagnosis. If the connection is missed, the disease treatment becomes difficult.
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Affiliation(s)
- Pankaj Garg
- Indus Super Speciality Hospital, Mohali, Punjab, India.,Garg Fistula Research Institute, Panchkula, Haryana, India
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22
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Berthier C, Bérard E, Meresse T, Grolleau JL, Herlin C, Chaput B. A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta-analysis of randomised studies. Int Wound J 2019; 16:1119-1135. [PMID: 31230414 DOI: 10.1111/iwj.13163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta-analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound-healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed. Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta-analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.
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Affiliation(s)
- Charline Berthier
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, University Hospital of Toulouse, Toulouse, France
| | - Thomas Meresse
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Jean-Louis Grolleau
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Christian Herlin
- Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital, Montpellier, France
| | - Benoit Chaput
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
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23
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The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum 2019; 62:146-157. [PMID: 30640830 DOI: 10.1097/dcr.0000000000001237] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Management of Pilonidal Disease Needs Paradigm Shift From More to Less: Enough Evidence and Logic Available. Dis Colon Rectum 2018; 61:e376. [PMID: 30399051 DOI: 10.1097/dcr.0000000000001236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25
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Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J 2018; 16:370-378. [PMID: 30440104 DOI: 10.1111/iwj.13042] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022] Open
Abstract
The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.
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Affiliation(s)
- Rhiannon L Harries
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Abdullah Alqallaf
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jared Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Keith G Harding
- Wound Healing Research Unit, Cardiff University, Cardiff, UK
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26
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Garg P. Achieving the maximum by doing the minimum in the treatment of pilonidal sinus: where does evidence point? Colorectal Dis 2018; 20:1047. [PMID: 30218628 DOI: 10.1111/codi.14423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 12/13/2022]
Affiliation(s)
- P Garg
- Indus Super Specialty Hospital, Mohali, India.,Garg Fistula Research Institute, Panchkula, India
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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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28
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Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD. Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 2018; 32:3754-3762. [DOI: 10.1007/s00464-018-6157-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/21/2018] [Indexed: 01/01/2023]
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29
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Salih AM, Kakamad FH, Salih RQ, Mohammed SH, Habibullah IJ, Hammood ZD, Aziz MS, Baba HO. Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy-a randomized controlled trial. Surgery 2018; 164:S0039-6060(17)30886-3. [PMID: 29402447 DOI: 10.1016/j.surg.2017.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pilonidal sinus disease is a common perianal inflammatory condition. Currently, operative therapy is the standard management strategy. The aim of this study is to investigate the efficacy of a preparation with antimicrobial, sclerosing, and wound-enhancing properties in the nonoperative management of pilonidal sinus disease. METHODS A parallel randomized controlled trial was conducted between January 2013 and January 2017 to investigate the effect of a mixture of sclerosing agent and herbal product (Lawsonia inermis powder) in the management of sacrococcygeal pilonidal sinus disease. The patients were allocated randomly into the study group (group receiving injection of the mixture into the sinus track) and the control group (group receiving the classic technique of operative excision and primary closure). RESULTS This study was conducted among 400 patients, 316 (79%) male, 84 (21%) female. The age range was 18 to 40 years with a mean age of 27.1 years (standard deviation, ±2.4); each group included 200 patients. None of the patients had an abscess or complicated pilonidal disease. Cure rate, defined as complete healing of the sinus, was high among both groups after the first intervention (94% for control group and 89% for the test group, respectively; P = .051). In the study group, there was a statistically significant decrease in hospital stay, cost, perioperative pain, duration of absence from work, and duration of the procedure. CONCLUSION According to this trial, the injection of this mixture appears to be better than the other therapeutic options for pilonidal sinus disease in terms of cost effectiveness, time off work, rate of complication, and perioperative pain.
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Affiliation(s)
- Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq.
| | - Rawezh Q Salih
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
| | - Imad J Habibullah
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
| | - Zuhair D Hammood
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
| | - Masrur S Aziz
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq
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30
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Mutus HM, Aksu B, Uzun E, Gulcin N, Gercel G, Ozatman E, Durakbasa CU, Okur H. Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease. J Pediatr Surg 2018; 53:293-294. [PMID: 29217319 DOI: 10.1016/j.jpedsurg.2017.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. METHODS PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6months ago were done for the long-term results, including coherence to regional hair care. RESULTS There were 268 patients with a median age of 16years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3months (7days-49months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. CONCLUSIONS Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV (Retrospective case series with no comparison group).
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Affiliation(s)
- Huseyin Murat Mutus
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Burhan Aksu
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ersan Uzun
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Neslihan Gulcin
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gonca Gercel
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Erdem Ozatman
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Ulukaya Durakbasa
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Hamit Okur
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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31
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Abstract
Pilonidal sinus is a very common inflammatory disease of the gluteal region. The ideal method of pilonidal sinus treatment should have a low recurrence rate with minimum excision. Moreover, the treatment method should have a short hospitalization time, should let the patient return to his normal life rapidly, should cause minimum loss of labour and should result a small scar only. In the presented review, modalities in pilonidal sinus treatment in the light of current information in the literature are evaluated.
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Affiliation(s)
- Arda Isik
- Department of General Surgery, School of Medicine, Erzincan University, Erzincan, Turkey.
| | - Oguz Idiz
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Deniz Firat
- Department of General Surgery, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey
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32
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Encabo B, Pascual J, Romero D, Ruiz de Apodaca R, Selva J, Jemec G. Pilonidal sinus: clinical and ultrasonographic response to topical resorcinol 15%. Br J Dermatol 2016; 175:1103-1104. [DOI: 10.1111/bjd.14872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B. Encabo
- Department of Dermatology; University General Hospital; Alicante Spain
| | - J.C. Pascual
- Department of Dermatology; University General Hospital; Alicante Spain
| | - D. Romero
- Department of Dermatology; University General Hospital; Alicante Spain
| | | | - J. Selva
- Department of Pharmacy; University General Hospital; Alicante Spain
| | - G.B.E. Jemec
- Department of Dermatology; Roskilde Hospital; University of Copenhagen; Copenhagen Denmark
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33
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Elalfy K, Emile S, Lotfy A, Youssef M, Elfeki H. Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: A prospective cohort study. Int J Surg 2016; 29:1-8. [DOI: 10.1016/j.ijsu.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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