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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Yüce E, Şirvan SS, Demir IA, Eren HI, Karşıdağ S. Coexistance of Gynecomastia and Poland Syndrome: Case Report. SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:314-317. [PMID: 32377103 PMCID: PMC7192283 DOI: 10.14744/semb.2017.29494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/21/2017] [Indexed: 11/25/2022]
Abstract
Coexistence of the Poland syndrome and gynecomastia is a rare condition. Poland syndrome requires soft tissue augmentation of the affected side, whereas gynecomastia necessitates reduction of the breast tissue. To provide symmetry, breast reduction and fat grafting techniques should be combined. We report a 29-year-old male patient with left gynecomastia and right sided Poland syndrome. In order to correct his asymmetry on the anterior chest wall, left breast tissue resection and fat grafting to the right breast were performed. Having these two opposite conditions at the same time and on the same patient makes the deformities look more dramatic than they are separately. Accurate planning and selection of proper techniques enable to provide symmetry in such cases.
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Affiliation(s)
- Erkan Yüce
- Department of Plastic Surgery, Kirikkale State Hospital, Kirikkale, Turkey
| | - Selami Serhat Şirvan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Işıl Akgün Demir
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hikmet Ihsan Eren
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Semra Karşıdağ
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Ekici U, Ferhatoğlu MF. Obesity, Hypertrichosis and Sex Steroids: Are these Factors Related to the Pilonidal Sinus Disease? SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:263-266. [PMID: 32377093 PMCID: PMC7192277 DOI: 10.14744/semb.2019.78800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/05/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pilonidal sinus disease causes chronic inflammation of the skin and subcutaneous fatty tissue, and it commonly localises in the sacrococcygeal region. This study evaluated the effects of hypertrichosis, family history, obesity and sex steroids in 298 patients with pilonidal sinus disease. METHODS The medical records of 618 patients treated at the General Surgery Clinic of Malatya State Hospital for primary pilonidal sinus disease between January 2014 and December 2017 were evaluated retrospectively. RESULTS Female sex and family histories of pilonidal sinus disease and hypertrichosis were significantly higher in patients with than without hypertrichosis (p=0.030, p=0.035, p<0.001). The mean progesterone level was significantly lower in female patients with hypertrichosis than female patients without hypertrichosis (p=0.003). CONCLUSION Being overweight or obese, having an occupation that requires long-time sitting and having a family history predisposed to developing pilonidal sinus disease.
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Affiliation(s)
- Uğur Ekici
- College of Health Sciences, Gelisim University, Istanbul, Turkey
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Çetin K, Sikar HE, Kocaoğlu AE, Kündeş MF, Karahan M, Kaptanoğlu L. Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study. Ann Surg Treat Res 2018; 94:88-93. [PMID: 29441338 PMCID: PMC5801333 DOI: 10.4174/astr.2018.94.2.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. Methods From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. Results There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). Conclusion In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.
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Affiliation(s)
- Kenan Çetin
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
| | - Hasan Ediz Sikar
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
| | - Aytaç Emre Kocaoğlu
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
| | - Muhammet Fikri Kündeş
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
| | - Mehmet Karahan
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
| | - Levent Kaptanoğlu
- Dr. Lutfi Kirdar Kartal Research and Education Hospital, Department of General Surgery, Istanbul, Turkey
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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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Yamashita Y, Nagae H, Hashimoto I. Ambulatory Surgery for Pilonidal Sinus: Tract Excision and Open Treatment Followed by At-Home Irrigation. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:216-8. [DOI: 10.2152/jmi.63.216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yutaro Yamashita
- Department of Plastic Surgery, Tokushima Red Cross Hospital
- Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School
| | - Hiroaki Nagae
- Department of Plastic Surgery, Tokushima Red Cross Hospital
| | - Ichiro Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School
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