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Kaba M. New factors affecting wound healing and recurrence after pilonidal sinus surgery in adolescents; seborrheic dermatitis and psychiatric co-occurring conditions. Int Wound J 2024; 21:e14404. [PMID: 37722760 PMCID: PMC10788639 DOI: 10.1111/iwj.14404] [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] [Received: 08/21/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
Postoperative wound healing problems and recurrence remain common for pilonidal sinus disease (PSD). Our study aimed to examine the effect of comorbidities in addition to the classic known factors that may affect wound complications and recurrence after PSD surgery. We retrospectively analysed 282 adolescent patients operated on in our clinic between 2014 and 2021. We gathered the postoperative wound healing patterns of the patients under four groups. With a mean age of 15.49 ± 1.45, 59.9% (n = 169) were male, 40.1% (n = 113) were female and 23.8% (n = 67) had recurrence. When examined according to the wound healing groups, 53.5% (n = 151) had an uneventful wound, 22.6% (n = 64) had prolonged wound care, 17.7% (n = 50) of the postoperative wounds did not close and had a recurrence and 6% (n = 17) had recurrence after the wound was healed. The number of sinuses, abscess presentation and the incidence of comorbid disease in group 1 were found to be statistically significantly lower than all other groups. Seborrheic dermatitis, obesity and psychiatric diagnoses showed high statistical association with group 3 and acne with group 4. In patients with seborrheic dermatitis or psychiatric diagnosis, a significant correlation was found between wound healing according to the type of surgery (p < 0.05). The wound healing patterns of these patients after total excision and primary closure surgeries were included in Group 3 with a statistically significant high rate. As two new factors, the significance of the presence of seborrheic dermatitis and psychiatric comorbidities should be evaluated in these patients whose wounds remain open postoperatively and do not respond to primary wound care and eventually relapse. Further histologic and pathologic investigations are needed for seborrheic dermatitis and PSD relation. Awareness of these diseases may change the decision of the type of surgery, and their treatment within the same time may support wound healing and ultimately reduce recurrence.
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Affiliation(s)
- Meltem Kaba
- Department of pediatric surgery, Sisli Hamidiye Etfal Training and Research HospitalMinistry of HealthİstanbulTurkey
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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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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] [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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Luedi MM, Schober P, Stauffer VK, Diekmann M, Andereggen L, Doll D. Gender-specific prevalence of pilonidal sinus disease over time: A systematic review and meta-analysis. ANZ J Surg 2021; 91:1582-1587. [PMID: 34101331 DOI: 10.1111/ans.16990] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gender-specific risk factors have been suggested to promote a fourfold higher incidence of pilonidal sinus disease (PSD) in male as compared to female patients. However, in recent decades there has been an apparent shift towards an increasing prevalence of PSD in women, as body weight and other risk factors influence the disease. We aimed at determining whether PSD prevalence actually changed in men and women over time. METHODS Following PRISMA guidelines (PROSPERO ID: 42016051588), databases were systematically searched. Papers reporting on PSD published between 1833 and 2018 in English, French, German, Italian and Spanish containing precise numbers of male and female participants were selected for analysis. Gender-specific prevalence of PSD over several decades was the main outcome measure. RESULTS We screened 679 studies reporting on 104 055 patients and found that the male/female ratio in patients with PSD has remained constant over time, with women being affected in about 20% of all PSD cases (I2 = 96.18%; meta-regression p < 0.001). CONCLUSION While the prevalence of PSD has risen over the past decades, the ratio between affected males and affected females has remained constant, with women invariably representing about 20% of patients despite wide ranging socioeconomic and behavioural changes.
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Affiliation(s)
- Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Verena K Stauffer
- Department of Emergency Medicine, Lindenhofgruppe Bern, Bern, Switzerland
| | - Maja Diekmann
- Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dietrich Doll
- Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the MHH Hannover, Vechta, Germany
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Schneider R, Dettmer M, Peters N, Lamdark T, Luedi MM, Adamina M, Doll D. The current status of surgical pilonidal sinus disease therapy in Germany. Eur Surg 2021. [DOI: 10.1007/s10353-021-00715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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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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Oliveira AI, Barroso C, Osório A, Correia-Pinto J. Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center. Front Pediatr 2019; 7:215. [PMID: 31214552 PMCID: PMC6558067 DOI: 10.3389/fped.2019.00215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Sacrococcygeal Pilonidal Disease (PD) is commonly treated with excision and primary closure techniques (EPC). Minimally invasive techniques (MIT), such as EPSiT and Pit-picking, had been recently advocated promising better outcomes. We analyzed mid-term results from our center after introduction of MIT to treat PD. Methods: Patients submitted to MIT (n = 44) with a median follow-up of 37 months were analyzed and compared with patients submitted to EPC (n = 70) with a median follow-up of 5 years. Both groups included patients operated in our department between 2011 and 2016 and have similar demographic and clinical characteristics. We compared operative time and post-operative parameters such as time with pain, dressing time and time to relapse. Results: The post-operative time with pain was significantly lower, whereas the dressing time was significantly longer, in MIT when compared to the EPC group. The relapse rate was similar in both groups but the follow-up is shorter in the MIT group. In addition, the analysis of patients free of disease using Kaplan-Meier curves revealed that relapse tends to occur more precociously in MIT than in EPC patients (p = 0.014). Interestingly, in the subgroup of patients with previous surgery, MIT's relapse rate was significantly lower than in the EPC group (30 vs. 100%, p < 0.001). Conclusions: MIT has the advantage of having a shorter time with pain in the postoperative period, while EPC benefits from a shorter dressing time. In general, the relapse of the disease tends to manifest more precociously in MIT patients. Moreover, in the subgroup of patients with previous surgery, MIT seems to have significantly better results when compared to EPC.
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Affiliation(s)
- Ana Isabel Oliveira
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Catarina Barroso
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Angélica Osório
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
| | - Jorge Correia-Pinto
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Video-assisted ablation of pilonidal sinus (VAAPS) versus sinusectomy for treatment of chronic pilonidal sinus disease: a comparative study. Updates Surg 2018; 71:179-183. [PMID: 30542957 DOI: 10.1007/s13304-018-00611-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
Since its first description in 1883, different treatments for pilonidal sinus disease have been proposed, but we are still far from the identification of an ideal approach. The objective of this study is to determine if video-assisted ablation of pilonidal sinus (VAAPS) could be considered superior/non-inferior to standard sinusectomy for treatment of pilonidal sinus disease. After applying propensity score analysis, data from 40 patients who underwent sinusectomy and 40 patients who underwent VAAPS, from March 2011 to August 2013, were collected. The two groups were similar in terms of sex, age, BMI, smoking status and complexity of sinus. The mean operative time was less for the sinusectomy group compared with the minimally invasive treatment group (30.38 ± 6.23 vs 44.39 ± 7.76; p = 0.001). On the other hand, the recurrence rate (7.5% vs 25%; p = 0.035) was significantly lower in the VAAPS group and the infection rate showed a trend toward reduction in the endoscopically treated patients (12.5% vs 30%; p = 0.057). No differences were found in terms of pain score at 1 week from surgery (3.71 ± 1.24 vs 3.76 ± 1.39; p = 0.883), satisfaction at 6 months (8.3 ± 1.2 vs 8.2 ± 1.3; p = 0.78) and time off work (2.01 ± 1.30 vs 2.08 ± 1.24; p = 0.620). The effectiveness of our new technique can be assessed again and the comparative analysis with the conventional sinusectomy shows the feasibility of VAAPS, suggesting that this procedure is the best way to perform a sinusectomy.
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Long-term follow-up for pilonidal sinus surgery: A review of literature with metanalysis. Surgeon 2018; 16:315-320. [PMID: 29699781 DOI: 10.1016/j.surge.2018.03.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
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Zagory JA, Golden J, Holoyda K, Demeter N, Nguyen NX. Excision and Primary Closure May be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population. Am Surg 2016. [DOI: 10.1177/000313481608201023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13–20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure. Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively. Ten (16.7%) patients developed postoperative complications, which were similar among surgical groups, gender, and body mass index. The average length of stay was 0.67 (median 0, range, 0–5) days. Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01). Pilonidal disease remains surgically challenging. Our data suggest that excision and primary closure is a better option in the pediatric population.
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Affiliation(s)
- Jessica A. Zagory
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Jamie Golden
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Kathleen Holoyda
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Natalie Demeter
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Nam X. Nguyen
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
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