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Ankersen JL, Faurschou IK, Hougaard HT, Doll D, Oetzmann von Sochaczewski C, Sørensen M, Pedersen AG, Haas S. Long-term outcomes after cleft lift surgery for pilonidal sinus disease in post-pubertal adolescents: data from a prospective Danish cohort. Colorectal Dis 2024. [PMID: 39301876 DOI: 10.1111/codi.17169] [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: 02/27/2024] [Revised: 07/10/2024] [Accepted: 08/18/2024] [Indexed: 09/22/2024]
Abstract
AIM Pilonidal sinus disease (PSD) is a common condition. Despite a relatively large proportion of patients presenting as post-pubertal adolescents, only small cohorts focusing on this PSD subcategory have been published, and surgical treatment remains challenging. METHOD The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing Bascom's cleft lift (BCL) surgery from June 2016 until June 2020 were included in this study, focusing on patients ≤18 years of age comparing them to adult patients. Indications for BCL surgery were primary extensive manifestation, non-healing disease after previous elective surgery or disease recurrence. RESULTS In total, n = 380 PSD patients were operated, of which n = 79 were post-pubertal adolescents with a median age at time of surgery of 17.2 years (interquartile range 16.3, 18.0). Sixty-six (84%) were boys. Twenty-seven (34%) presented with primary extensive manifestation, 34 (43%) due to non-healing wounds and 18 (23%) due to recurrence. Fifty-four patients (69%) healed uneventfully. There was no difference between the indications of surgery groups in terms of overall healing or time to healing if prolonged (P = 0.6). The median follow-up was 62 months (interquartile range 48, 73), with a 5-year recurrence rate of 19%, compared to 17% (P = 0.6) in the adult population. CONCLUSION Our study is the first to investigate long-term clinical outcomes of BCL surgery for PSD in post-pubertal adolescent patients. Recurrences seem to occur more frequently compared to adults. However, we demonstrate that post-pubertal adolescent patients with advanced PSD can be treated with BCL surgery with acceptable outcomes.
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Affiliation(s)
- J L Ankersen
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
| | - I K Faurschou
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Hougaard
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
| | - D Doll
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
- Department of Procto-Surgery and Pilonidal Sinus, St Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
| | | | - M Sørensen
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
| | - A G Pedersen
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - S Haas
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
- International Pilonidal Research Group, Randers, Denmark
- International Pilonidal Research Group, Vechta, Germany
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Romanova A, Nissen M, Alrefai M, Hubertus J, Deska T, Senkal M. Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study. Tech Coloproctol 2024; 28:104. [PMID: 39141158 PMCID: PMC11324676 DOI: 10.1007/s10151-024-02972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 07/11/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT). METHODS We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed. RESULTS A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation). CONCLUSION The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.
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Affiliation(s)
- A Romanova
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany.
| | - M Nissen
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - M Alrefai
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - J Hubertus
- Department of Pediatric Surgery, Marien Hospital, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, 58452, Witten, Germany
| | - T Deska
- Department of Surgery, Marien Hospital, St. Elisabeth Gruppe, Marienplatz 2, 58452, Witten, Germany
| | - M Senkal
- Department of Surgery, Marien Hospital, St. Elisabeth Gruppe, Marienplatz 2, 58452, Witten, Germany
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Xing CY, Huang MY, Cheng SZ. A commentary on the article entitled 'Progress in the surgical treatment of sacrococcygeal pilonidal sinus'. Int J Surg 2024; 110:5232-5233. [PMID: 38701502 PMCID: PMC11325980 DOI: 10.1097/js9.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Chu-Yun Xing
- Department of Pain Management, The First Affiliated Hospital of Yangtze University
| | - Ming-Yan Huang
- Department of Ophthalmology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, People's Republic of China
| | - Shi-Zhou Cheng
- Department of Ophthalmology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, People's Republic of China
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Draullette M, de Parades V, Alam AA, Fathallah N, Rentien AL, Benfredj P, Aubert M, Pommaret É, Beaussier H, Fels A, Spindler L. SiLaT: A paradigm shift in the treatment of pilonidal disease? J Visc Surg 2024; 161:167-172. [PMID: 38849230 DOI: 10.1016/j.jviscsurg.2024.03.007] [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: 06/09/2024]
Abstract
BACKGROUND Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being "very satisfied" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.
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Affiliation(s)
- Mélanie Draullette
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - Vincent de Parades
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Amine Antonin Alam
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Nadia Fathallah
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Anne-Laure Rentien
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Paul Benfredj
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Manuel Aubert
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Élise Pommaret
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Hélène Beaussier
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
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King A, Fegan K, Morgan K, Hill JE, Harrison J. Commentary on packing vs non-packing of pilonidal sinus cavities after incision and drainage. Br J Community Nurs 2024; 29:S26-S30. [PMID: 38478417 DOI: 10.12968/bjcn.2024.29.sup3.s26] [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: 07/23/2024]
Abstract
Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income countries. This disease is associated with significant physical and psychosocial distress. Surgery is an option for managing PSD; yet, surgical methods vary, and a universally accepted gold standard approach is lacking, leading to current practices that are diverse and subject to ongoing debate. One such point of contention revolves around the decision to use packing or opt for a non-packing approach following surgery. Mohamedahmed et al (2021) conducted a systematic review to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body. This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.
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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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Sun H, Yu D. Commentary on 'the review on the progress in the surgical treatment of sacrococcygeal pilonidal sinus'. Int J Surg 2024; 110:635-636. [PMID: 37738007 PMCID: PMC10793773 DOI: 10.1097/js9.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Affiliation(s)
| | - Dengfeng Yu
- Department of General Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, People’s Republic of China
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnoseverzögerung, komorbide Hidradenitis suppurativa und die prognostische Bedeutung bakterieller Kulturen bei Folliculitis decalvans: eine Kohortenstudie. J Dtsch Dermatol Ges 2023; 21:1469-1478. [PMID: 38082530 DOI: 10.1111/ddg.15202_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 12/18/2023]
Abstract
ZusammenfassungHintergrundFolliculitis decalvans (FD) ist eine primäre neutrophile vernarbende Alopezie, die häufig zu irreversiblem Haarverlust führt. Daten zu Epidemiologie, klinischen Merkmalen, Folgen und prognostischen Faktoren sind nur eingeschränkt verfügbar.ZielDie Beurteilung einer Patientenkohorte mit FD sowie die Charakterisierung schwerer Krankheitsverläufe und prognostischer Faktoren, die eine Remission verhindern.Patienten und MethodenDiese retrospektive Kohortenstudie umfasste 192 Patienten, bei denen zwischen 2010 und 2020 an einem tertiären Zentrum eine FD diagnostiziert und die mindestens sechs Monate nachverfolgt wurden.ErgebnisseDie Diagnose wurde im Mittel um 22,2 (± 29,7) Monate verzögert gestellt. Komorbide Erkrankungen mit Okklusion der Haarfollikel waren häufig. In 45,6% der Fälle waren Bakterienkulturen positiv, am häufigsten mit Staphylococcus (S.) aureus. Schwere Krankheitsverläufe waren mit komorbider Hidradenitis suppurativa und positiver Bakterienkultur, insbesondere S. aureus, assoziiert. Bei 50,7% der Patienten kam es zu vollständiger Remission: Bei 32% innerhalb der ersten sechs Monate der Behandlung und bei 18,7% während der Nachkontrolle. Rezidive waren häufig. Negative Prognosefaktoren bezüglich der Remission waren jüngeres Alter und positive Bakterienkultur.SchlussfolgerungenEs besteht Bedarf hinsichtlich der Ausbildung von Dermatologen, um die Diagnoseverzögerung zu reduzieren. Das Screening von FD‐Patienten auf komorbide Hidradenitis suppurativa und Bakterienkulturen sind wichtig für die Behandlungsplanung.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: A cohort study. J Dtsch Dermatol Ges 2023; 21:1469-1477. [PMID: 37875786 DOI: 10.1111/ddg.15202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Folliculitis decalvans (FD) is a type of primary neutrophilic cicatricial alopecia often leading to irreversible hair loss. Data on its epidemiology, clinical features, outcomes, and prognostic factors are limited. OBJECTIVE To evaluate a cohort of patients with FD and identify characteristics of severe disease and prognostic factors which impede remission. PATIENTS AND METHODS This retrospective cohort study included 192 patients diagnosed with FD and followed for at least six months at a tertiary center between 2010 and 2020. RESULTS There was a diagnostic delay averaging 22.2 (± 29.7) months. Comorbid follicular occlusion disorders were common. Bacterial cultures were positive in 45.6% of the cases, with Staphylococcus (S.) aureus being the most common pathogen. Severe disease was associated with comorbid hidradenitis suppurativa and a positive bacterial culture, particularly S. aureus. 50.7% of patients experienced complete remission: 32% within the first six months of treatment and 18.7% later during follow-up. Relapses were frequent. Negative prognostic factors for achieving remission included younger age and a positive bacterial culture. CONCLUSIONS There is a need for the education of dermatologists to reduce the diagnostic delay. Screening FD patients for comorbid hidradenitis suppurativa and obtaining bacterial cultures is important for treatment planning.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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11
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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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12
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Walker H, Hamid O, Ramirez J, Glancy D. Diagnosis and management of sacrococcygeal pilonidal disease in primary care. BMJ 2023; 382:e071511. [PMID: 37696569 DOI: 10.1136/bmj-2022-071511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Hamish Walker
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Osama Hamid
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Jozel Ramirez
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Damian Glancy
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucestershire, UK
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13
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Wu P, Zhang Y, Zhang Y, Wang S, Fan Z. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. Int J Surg 2023; 109:2388-2403. [PMID: 37158142 PMCID: PMC10442091 DOI: 10.1097/js9.0000000000000447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. METHODS A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. RESULTS Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [ P =0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P =0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant ( P =0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant ( P =0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection ( P ≥0.05). CONCLUSIONS There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient's wishes, appearance of the SPS, and the professional ability of the surgeon.
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Affiliation(s)
| | | | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Wang
- Department of Endocrinology, Second Affiliated Hospital of Dalian Medical University, Dalian
| | - Zhe Fan
- Department of General Surgery
- Liaoning Province Key Laboratory of Corneal and Ocular Surface Diseases Research, The Third People’s Hospital of Daliana
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14
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Koskinen K, Harju J, Hermunen K. Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease. BMC Surg 2023; 23:99. [PMID: 37118772 PMCID: PMC10142197 DOI: 10.1186/s12893-023-02014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery. METHODS We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups. RESULTS PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001). CONCLUSIONS PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.
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Affiliation(s)
- K Koskinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland
| | - J Harju
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland
| | - K Hermunen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Helsinki University Hospital, Abdominal Center, Jorvi Hospital, Turuntie 150, PO Box 800, HUS 00029, Espoo, Finland.
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15
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Safadi MF, Dettmer M, Berger M, Degiannis K, Wilhelm D, Doll D. Demographic overview of pilonidal sinus carcinoma: updated insights into the incidence. Int J Colorectal Dis 2023; 38:56. [PMID: 36849571 PMCID: PMC9971075 DOI: 10.1007/s00384-023-04344-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this disease and to provide more precise information about its incidence. METHODS The study included questioning the surgeons and pathologists in Germany in addition to a literature research. The literature investigation included all published articles about pilonidal carcinoma in all languages. The questionnaire included 1050 pathologists and all 834 hospitals with a surgical division in Germany. The outcome measures included the total number of cases, the language of publication, gender, age, country of origin, interval until the diagnosis of carcinoma, and reported incidence based on local studies. RESULTS From 1900 to 2022, we found 140 cases of pilonidal sinus carcinoma in 103 articles. The investigation revealed two additional unpublished cases from Germany. The male-to-female ratio was 7.75:1. The countries with the most cases were the USA (35 cases, 25.0%), Spain (13 cases, 9.3%), and Turkey (11 cases, 7.6%). The average age was 54.0 ± 11.8 years and the interval between the diagnosis of the disease and the development of carcinoma was 20.1 ± 14.1 years. There was a parallel increase in reported cases of pilonidal sinus disease and pilonidal carcinoma over the last century. The reported incidence varied from 0.03% to 5.56%. The worldwide calculated incidence equaled 0.17%. CONCLUSION Due to underreporting and other causes, the incidence of carcinoma emerging on the background of pilonidal sinus disease is higher than reported.
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Affiliation(s)
- Mhd Firas Safadi
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.
- Vechtaer Institut für Forschungsförderung, VIFF e.V., Vechta, Germany.
| | - Marius Dettmer
- Vechtaer Institut für Forschungsförderung, VIFF e.V., Vechta, Germany
- Department of Trauma Surgery and Orthopedics, Reconstructive and Hand Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Matthias Berger
- Department of General and Visceral Surgery and Proctology, Diakoniekrankenhaus Chemnitzer Land, Hartmannsdorf, Germany
| | - Konstantinos Degiannis
- Department of Trauma, Orthopedic and Hand Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
| | - Dirk Wilhelm
- Faculty of Medicine, Clinic and Polyclinic of Surgery, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Dietrich Doll
- Vechtaer Institut für Forschungsförderung, VIFF e.V., Vechta, Germany
- Department of Procto-Surgery and Pilonidal Sinus, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
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16
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Odlo M, Horn J, Xanthoulis A. Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences-a survey among Norwegian surgeons. BMC Surg 2022; 22:442. [PMID: 36575391 PMCID: PMC9795610 DOI: 10.1186/s12893-022-01889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is frequently observed in young adults. There is no wide consensus on optimal treatment in the literature, and various procedures are used in clinical practice. The objective of this study was to assess current practice, experience, training, and attitudes towards PSD surgery among Norwegian surgeons. METHODS An online survey on PSD surgery was created and sent to all members of the Norwegian Surgical Association. Categorical data were reported as frequencies and percentages. RESULTS Most currently practicing Norwegian surgeons used the Bascom's cleft lift (93.2%) or minimally invasive procedures (55.4%). Midline excisions with primary closure (19.7%) or secondary healing (22.4%) were still used by some surgeons, though. Most surgeons had received training in PSD surgery supervised by a specialist, but only about half of them felt sufficiently trained. The surgeons generally performed few PSD operations per year. Many considered PSD as a condition of low surgical status and this patient group as underprioritized. CONCLUSIONS Our findings suggest that PSD surgery in Norway has been moving away from midline excisions and towards off-midline flap procedures and minimally invasive techniques. PSD and its treatment have a low status among many Norwegian surgeons. This study calls for attention to this underprioritized group of patients and shows the need for consensus in PSD treatment such as development of national guidelines in Norway. Further investigation on training in PSD and the role of supervision is needed.
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Affiliation(s)
- Mari Odlo
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Julie Horn
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Athanasios Xanthoulis
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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17
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Mirande MD, Backus JA, Linnaus ME. Intermammary pilonidal sinus disease in a 13-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Ergenç M, Uprak TK. Gender-specific prevalence of sacrococcygeal pilonidal sinus disease in Turkey: A retrospective analysis of a large cohort. Eur Surg 2022. [DOI: 10.1007/s10353-022-00777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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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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20
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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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21
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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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22
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Dettmer M, Bonni M, Doll D. The long-term recurrence rate of minimally invasive methods in pilonidal sinus disease therapy is still unclear. Tech Coloproctol 2021; 26:157-158. [PMID: 34436731 DOI: 10.1007/s10151-021-02509-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- M Dettmer
- Department of Internal Medicine, Armed Forces Hospital Westerstede, Westerstede, Germany.,Department of Proctosurgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Marienstrasse 6, 49377, Vechta, Germany
| | - M Bonni
- Department of Internal Medicine, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - D Doll
- Department of Proctosurgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Marienstrasse 6, 49377, Vechta, Germany.
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