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Brown SR, Hind D, Strong E, Bradburn M, Din F, Lee E, Lund J, Moffatt C, Morton J, Senapati A, Jones H, Lee MJ. Real-world practice and outcomes in pilonidal surgery: Pilonidal Sinus Treatment Studying The Options (PITSTOP) cohort. Br J Surg 2024; 111:znae009. [PMID: 38488204 PMCID: PMC10941257 DOI: 10.1093/bjs/znae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal intervention. The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial design. METHODS This UK-wide multicentre prospective cohort study, including patients (aged over 16 years) who had definitive treatment for symptomatic pilonidal disease, was conducted between May 2019 and March 2022. Patient and disease characteristics, and intervention details were analysed. Data on patient-reported outcomes, including pain, complications, treatment failure, wound issues, and quality of life, were gathered at various time points up to 6 months after surgery. Strategies were implemented to adjust for risk influencing different treatment choices and outcomes. RESULTS Of the 667 participants consenting, 574 (86.1%) were followed up to the study end. Twelve interventions were observed. Broadly, 59.5% underwent major excisional surgery and 40.5% minimally invasive surgery. Complications occurred in 45.1% of the cohort. Those who had minimally invasive procedures had better quality of life and, after risk adjustment, less pain (score on day 1: mean difference 1.58, 95% c.i. 1.14 to 2.01), fewer complications (difference 17.5 (95% c.i. 9.1 to 25.9)%), more rapid return to normal activities (mean difference 25.9 (18.4 to 33.4) days) but a rate of higher treatment failure (difference 9.6 (95% c.i. 17.3 to 1.9)%). At study end, 25% reported an unhealed wound and 10% had not returned to normal activities. CONCLUSION The burden after surgery for pilonidal disease is high and treatment failure is common. Minimally invasive techniques may improve outcomes at the expense of a 10% higher risk of treatment failure.
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Affiliation(s)
- Steven R Brown
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emily Strong
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Farhat Din
- Academic Coloproctology, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Lund
- Department of Surgery, Derby Royal Infirmary, University Hospitals of Derby and Burton, Derby, UK
| | - Christine Moffatt
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan Morton
- Department of Surgery, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Asha Senapati
- Department of Surgery, St Mark’s Hospital, London, UK
- Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Helen Jones
- Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
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Tyrväinen E, Nuutinen H, Savikkomaa E, Myllykangas HM. Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease. Lasers Med Sci 2024; 39:52. [PMID: 38291247 PMCID: PMC10827894 DOI: 10.1007/s10103-024-03993-5] [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: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.
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Affiliation(s)
- Emmi Tyrväinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Henrik Nuutinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Elina Savikkomaa
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Heidi-Mari Myllykangas
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland.
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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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Huurman EA, Galema HA, de Raaff CAL, Wijnhoven BPL, Toorenvliet BR, Smeenk RM. Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review. Tech Coloproctol 2023; 27:1191-1200. [PMID: 37930579 PMCID: PMC10638206 DOI: 10.1007/s10151-023-02870-7] [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: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.
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Affiliation(s)
- E A Huurman
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - H A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - C A L de Raaff
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - B P L Wijnhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B R Toorenvliet
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - R M Smeenk
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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5
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Luna-Abanto J, Galvez A, Biondo S. Upgrading pilonidal sinus unroofing and curettage: Introducing the potential of wound negative-pressure therapy. Colorectal Dis 2023; 25:2105-2106. [PMID: 37674348 DOI: 10.1111/codi.16730] [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] [Received: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Jorge Luna-Abanto
- General and Digestive System Surgery Department, Bellvitge University Hospital, Barcelona, Spain
| | - Ana Galvez
- General and Digestive System Surgery Department, Bellvitge University Hospital, Barcelona, Spain
| | - Sebastiano Biondo
- General and Digestive System Surgery Department, Bellvitge University Hospital, Barcelona, Spain
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Kansal R, Garg A, Arora B, Singh C, Malhotra K, Mehta M, Gupta A, Kishore H, Mondal H, Bawa A. Wide Local Excision of Complex or Infected Pilonidal Sinus Followed by Negative Pressure Wound Therapy: Does It Enhance Wound Healing? Cureus 2023; 15:e48049. [PMID: 38034161 PMCID: PMC10688510 DOI: 10.7759/cureus.48049] [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] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Background Pilonidal sinus disease (PSD) is a chronic skin condition caused by hair retention that affects the sacrococcygeal cleft. The purpose of this study is to compare the efficacy of negative pressure wound therapy (NPWT) to routine daily dressings (DDs) in wound healing after complex or infected pilonidal sinus tract excision. Materials and methods The study included 81 individuals who had extensive local excisions for pilonidal sinuses that were complex or infected. Randomly selected participants were given either NPWT or the usual dressing. Between the two groups, the length of hospitalization, the amount of time needed to resume daily activities, and the amount of time needed for full wound closure were compared. Results Forty-two patients received NPWT, while 39 patients received DDs as usual. There was no discernible difference between the two groups in terms of operating time or hospital stay. However, patients who underwent NPWT experienced a quicker final wound closure (59.24 ± 10.21 days compared to routine DD with a mean time of 75.31 ± 14.68 days, P = 0.001) and returned to normal activities earlier (17.36 versus 21.75 days in NPWT and routine DD, respectively). Conclusion Compared to patients who received standard DDs, those who were postoperatively managed with NPWT showed faster wound healing and return to normal activities. Whenever feasible, this strategy may be employed to improve patient recovery.
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Affiliation(s)
- Rohin Kansal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ayushi Garg
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Baninder Arora
- Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, IND
| | - Carol Singh
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Kashish Malhotra
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Madhav Mehta
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Anubhavv Gupta
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Harsh Kishore
- Department of Research, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Ashvind Bawa
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
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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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Nyandoro MG, Teoh M, Thompson A, Fletcher D. Surgical Practice Parameters for the Definitive Management of Sacrococcygeal Pilonidal Sinus Disease: Surgeons' Perspective. Cureus 2023; 15:e39480. [PMID: 37250606 PMCID: PMC10211397 DOI: 10.7759/cureus.39480] [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] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Sacrococcygeal pilonidal sinus disease (SPD) is a common general surgical condition encountered in practice and predominantly affects young males. Surgical practice parameters for the management of SPD are variable. This study aimed to review current surgical practice parameters for SPD management in Western Australia. Methodology This study conducted a de-identified 30-item multiple-response ranking, dichotomous, quantitative, and qualitative survey of self-reported surgeon practice preferences and outcomes. The survey was sent to 115 Royal Australian College of Surgeons - Western Australia general/colorectal surgical fellows. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results The survey response rate was 66% (N = 77). The cohort comprised mostly senior collegiate (n = 50, 74.6%), and most were low-volume practitioners (n = 49, 73.1%). For local disease control, most surgeons perform a complete wide local excision (n = 63, 94%). The preferred wound closure method was an off-midline primary closure (n = 47, 70.1%). Self-reported SPD recurrence, wound infection, and wound dehiscence rates were 10%, 10%, and 15%, respectively. The three high-ranked closure techniques were the Karydakis flap, Limberg's flap (LF), and Z-Plasty flap. Each surgeon's median annual SPD procedures were 10 (interquartile range = 15). The surgeons could utilize their preferred SPD closure technique (mean = 83.5%, standard deviation = ±15.6). Univariate analysis showed significant associations between years of experience and SPD flap techniques utilized, with senior surgeons significantly less likely to use either the LF (p = 0.009) or the Bascom procedure (BP) (p = 0.034). Instead, there was a preference for using healing by secondary-intention technique (SIT) compared to younger fellows (p = 0.017). A significant negative correlation existed between practice volume and SPD flap technique utilization, with low-volume surgeons less likely to prefer the gluteal fascia-cutaneous rotational flap (p = 0.049) or the BP (p = 0.010). However, low-volume practice surgeons were significantly more likely to use SITs (p = 0.023). The three most important patient factors in choosing SPD techniques were comorbidities, likely patient compliance, and attitude toward the disease. Meanwhile, factors influencing local conditions included the proximity of the disease to the anus, the number and location of pits and sinuses, and previous definitive SPD surgery. Key informants for technique preference were perceived low recurrence rate, familiarity, and overall good patient outcomes. Conclusions Surgical practice parameters for managing SPD remain highly variable. Most surgeons perform midline excision with off-midline primary closure as the gold standard. There is a clear and present need for clear, concise, and yet comprehensive guidelines on managing this chronic and often disabling condition to ensure the delivery of consistent, evidence-based care.
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Affiliation(s)
- Munyaradzi G Nyandoro
- General and Colorectal Surgery, Fiona Stanley Hospital, Perth, AUS
- School of Medicine, The University of Western Australia, Perth, AUS
| | - Mary Teoh
- General and Colorectal Surgery, Sir Charles Gairdner Hospital, Perth, AUS
| | | | - David Fletcher
- General Surgery, Fiona Stanley Hospital, Perth, AUS
- General Surgery, Harry Perkins Institute of Medical Research, Perth, AUS
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Serup CM, Svarre KJ, Kanstrup CTB, Kleif J, Bertelsen CA. Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study. Colorectal Dis 2023; 25:413-419. [PMID: 36268754 DOI: 10.1111/codi.16383] [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: 10/31/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022]
Abstract
AIM Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance. METHODS Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received. RESULTS A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance. CONCLUSION Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.
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Affiliation(s)
- Camilla Mattesen Serup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristina Johansen Svarre
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Tiffanie Bendtz Kanstrup
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Graduate School, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kleif
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Anders Bertelsen
- Department of Surgery, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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10
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De Decker M, Sels T, Van Hoof S, Smets Q, Hendrickx T, Van Dessel E, Komen N. Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients. Int J Colorectal Dis 2023; 38:33. [PMID: 36763170 DOI: 10.1007/s00384-023-04324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE The minimally invasive character, the possibility to perform under local anesthesia, and the ease to repeat have led to increasing popularity of laser-assisted treatment of pilonidal sinus disease. Hereby, potentially avoiding prolonged need for medical care at home, incapacity to work, and high expenses for patients and society. This retrospective, multi-center study is aimed at evaluating the feasibility of laser-assisted treatment for pilonidal sinus disease. METHODS The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021. Data were retrospectively collected. The primary endpoint was overall wound healing after one or more laser assisted procedures. RESULTS A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]. The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures. Wound infections were the main postoperative complication (8.0%) of which 5 patients required drainage (2.2%). For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap). CONCLUSION This study shows that laser-assisted treatment is feasible for pilonidal sinus disease. The minimally invasive character of this technique might make up for a higher non-healing rate compared to other techniques like flap repair. However, care must be taken that healing rate might be related to the presentation of the sinus and expectations should be lowered as presumed high healing rates are not always achieved.
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Affiliation(s)
- Marjolein De Decker
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium.
| | - Toon Sels
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Sander Van Hoof
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Quinten Smets
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Tom Hendrickx
- Department of General and Abdominal Surgery, AZ Turnhout, 2300, Turnhout, Belgium
| | - Els Van Dessel
- Department of General and Abdominal Surgery, GZA Hospitals, 2018, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
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11
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Wickramasekera N, Strong E, Shackley P, Callaghan T, Lee M, Hind D, Brown S. Patient preferences for pilonidal sinus treatments: a discrete choice experiment survey. Colorectal Dis 2023; 25:984-994. [PMID: 36636796 DOI: 10.1111/codi.16482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND A range of treatments are available for pilonidal sinus disease (PSD), each of which has a different risk/benefit profile. The aim of this study was to collect patient views on which interventions they would rather avoid and which outcomes they most value for PSD. METHOD We conducted an online survey using the discrete choice experiment (DCE) method. DCE task involved participants choosing the best treatment option when presented with a set of competing hypothetical treatment profiles. Participants with symptomatic PSD, referred for elective surgery were recruited from 33 NHS trusts between 2020 and 2022. Collected DCE data were analysed using regression analyses. RESULTS One hundred and eleven participants completed the survey. In the overall group, low risk of infection/persistence was the most important characteristic when making a treatment decision (attribute importance score of 70%), followed by treatments with shorter recovery time with an attribute importance score of 30%. The results demonstrated that patients are willing to accept trade-offs between treatment recovery time and risk of infection/persistence. Patients above 30 years old are willing to accept a higher chance of treatment failure in exchange for rapid treatment recovery (risk tolerance between 22.35 - 34.67 percentage points). Conversely, patients in the younger age groups, were risk averse, and were only willing to accept a small risk 1.51-2.15 in exchange for a treatment with faster recovery time. All patient groups appear to the reject the excision and leave open technique due to the need for protracted nursing care. CONCLUSION This study highlights the need for shared decision making when it comes to surgery for PSD.
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Affiliation(s)
| | - Emily Strong
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Tia Callaghan
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Matthew Lee
- Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, UK
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Beech Hill Road, Sheffield, South Yorkshire, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Steven Brown
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
- Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, UK
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12
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Shlyk D, Kitsenko Y, Barkhatov S, Smirnova V, Tulina I, Tsarkov P. Pilonidal cyst with primary transverse closure. Colorectal Dis 2022; 24:1450-1451. [PMID: 35678485 DOI: 10.1111/codi.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 12/13/2022]
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13
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Oliveira L, Galindo GFHR, Silva-Velazco JD. Benign Anorectal Disorder Management in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:376-389. [PMID: 36111076 PMCID: PMC9470292 DOI: 10.1055/s-0042-1755188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There are many benign anorectal disorders, which can make patients seek care. In low-resource settings, the incidence of those pathologies is not different from the industrialized and western world. However, an interesting difference colorectal surgeons and gastroenterologists can face is the fact that many patients do not seek help or are not aware and have little opportunities to be helped. Latin America population is estimated to be around 8% of the world population, with Brazil having the largest percentage. Infectious diseases, which were previously under control or were steadily declining, have emerged. For example, we have seen resurgence of dengue, malaria, and syphilis in pregnancy, as well as other sexually transmitted diseases that can affect the anorectal region. In this article, we will address the most common benign anorectal disorders.
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Affiliation(s)
- Lucia Oliveira
- Department of Anorectal Physiology of Rio de Janeiro, Ipanema Rio de Janeiro, Rio de Janeiro, Brasil
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14
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Sophie VG, Marlene SJ, Helene HT, Lilli L, Allan PG, Susanne H. Injection of freshly collected autologous adipose tissue in complicated pilonidal disease: a prospective pilot study. Tech Coloproctol 2022; 26:883-891. [PMID: 35963978 DOI: 10.1007/s10151-022-02683-0] [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: 10/04/2021] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is a frequent disorder. Treatment failure and recurrence are common, leading to significant morbidity. The aim of this study was to investigate the impact and need for repeated treatment of injected autologous adipose tissue into non-healing PSD wounds and primary anal-near PSD or anal-near recurrence. METHODS At the Department of Surgery, Randers Regional Hospital, Denmark, a prospective pilot study was conducted on consecutive PSD patients with lack of healing 3 months after surgery (Bascom's cleft lift) or with primary or recurrent anal-near pilonidal sinus disease from December 2018 to March 2020. The primary endpoint was time to healing. Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision. Patients were examined 2 and 12 weeks after surgery. Patients with lack of healing after 12 weeks (undermining or no skin coverage) were offered re-injection. RESULTS We included 30 patients [26 men and 4 women, median age 24 years (range 18-59 years)]. Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9-96.7)]. Two patients had recurrence (6.7%). The median time to complete healing was 159 (189) days. The mean operation time was 70.6 ± 23.7 min and the mean amount of injected autologous adipose tissue was 19 ± 10 ml. There were no major complications. CONCLUSION Freshly collected autologous adipose tissue injected into chronic non-healing or primary and recurrent PSD lesions near the anal verge is safe and efficient.
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Affiliation(s)
| | | | | | - Lundby Lilli
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Pedersen G Allan
- Department of Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Haas Susanne
- Department of Surgery, Randers Regional Hospital, Randers, Denmark.
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15
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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: 3] [Impact Index Per Article: 1.5] [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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16
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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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17
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Herrod PJ, Doleman B, Hardy EJ, Hardy P, Maloney T, Williams JP, Lund JN. Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus. Cochrane Database Syst Rev 2022; 5:CD013439. [PMID: 35593897 PMCID: PMC9121912 DOI: 10.1002/14651858.cd013439.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds. OBJECTIVES To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting. SEARCH METHODS In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low. AUTHORS' CONCLUSIONS At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.
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Affiliation(s)
| | - Brett Doleman
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | | | - Paul Hardy
- Department of Tissue Viability, Royal Derby Hospital, Derby, UK
| | - Trevor Maloney
- Department of Tissue Viability, Royal Derby Hospital, Derby, UK
| | - John P Williams
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Jon N Lund
- Division of Health Sciences, School of Medicine, University of Nottingham, Derby, UK
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18
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Huurman EA, Galema HA, de Raaff C, Toorenvliet B, Smeenk R. Assessment of Surgical Strategies for Pilonidal Sinus Disease in the Netherlands. Cureus 2022; 14:e25050. [PMID: 35719773 PMCID: PMC9200110 DOI: 10.7759/cureus.25050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Pilonidal sinus disease (PSD) is a subcutaneous infection of the sacrococcygeal region due to entrapment of hair and/or debris. International guidelines recommend minimally invasive techniques and flap techniques. A Dutch guideline for the treatment of PSD is not available and this may lead to practice variation. The aim of this study was to perform a national survey on the surgical treatment of PSD in the Netherlands. Method An online survey was sent by e-mail to all surgeons and surgical residents of the Dutch Association for Surgeons. Respondents were asked to reflect on their preferences in the treatment of PSD, their perceived satisfaction with this treatment, and the need for national guidelines. Results A total of 819 (48.6%) of 1684 invitees responded to the survey, of whom 615 (37%) met the inclusion criteria. Traditional excision techniques were most frequently performed for all types of PSD (50.7%) followed by flap techniques (22.6%) and minimally invasive techniques (22%). Only 22.6% of the participants were satisfied with the current treatment and 82% supported the development of a national guideline. Conclusion Traditional excision techniques are most frequently performed for PSD in the Netherlands but the majority of surgeons and surgical residents are not satisfied with the current treatment. There is a demand for a national guideline.
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Bisol M, Tykhomyrova S, Pagliara C, Scarpa MG, Guida E, Olenik D, Codrich D, Schleef J, Boscarelli A. Oxygen-enriched oleic matrix (NovoX) for wound healing in pediatric patients undergoing open surgical treatment for pilonidal disease: Preliminary experience. Front Pediatr 2022; 10:1068280. [PMID: 36507121 PMCID: PMC9732366 DOI: 10.3389/fped.2022.1068280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Pilonidal disease (PD) is a common infectious and inflammatory condition affecting the gluteal cleft and sacrococcygeal region. The optimal treatment for PD remains controversial. While the open technique reduces the number of relapses compared to minimally invasive approaches, it is associated with a longer healing time. Reactive oxygen species are a key part of the normal wound-healing process. Herein, we reported our preliminary experience using a new oxygen-enriched oil-based product called NovoX for wound healing after open surgery for PD. MATERIALS AND METHODS We used a new oxygen-enriched product for wound healing in three pediatric patients undergoing open surgical repair for PD between December 2021 and April 2022. During postoperative follow-up, healing time and the aesthetic result were evaluated. RESULTS Our preliminary study included three patients with chronic PD. The average follow-up time was 5 weeks, corresponding to the end of the healing process and the resumption of normal daily activities. Only one mild complication occurred during the study period. No short-term side effects were reported. The cosmetic result was reported as satisfactory. CONCLUSION NovoX is easy to apply, safe, and effective for treating pediatric patients undergoing open surgical treatment for PD, leading to slightly faster wound healing with good aesthetic outcomes.
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Affiliation(s)
- Marta Bisol
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sophia Tykhomyrova
- Municipal Non-Profit Enterprise "Lviv Territorial Medical Union", Multidisciplinary Clinical Hospital of Emergency and Intensive Care - Separated Division "Hospital of Saint Nicolaus", Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Camilla Pagliara
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Chief of Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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20
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Coco D, Leanza S. Minimally Invasive Pilonidal Sinus Treatment: A Brief Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With a prevalence of 26/100,000, pilonidal sinus disease is a frequent natal cleft condition that primarily affects young males. The disease site is often uncomfortable and the disease can result in problems such as abscess formation and recurrent acute or chronic infections. Minimally invasive treatment aims to form a small elliptical wedge of subcutaneous tissue containing all the inflammatory tissue. The sinus and its lateral tracks are removed while keeping the overlying skin intact. Following the notion of “less is more,” novel least invasive treatments such as sinotomy, sinusectomy, trephining, and video-assisted and endoscopic pilonidal sinus surgery have recently been proposed. We look at minimally invasive treatments to explain how research into modern techniques has revealed a low rate of short-term problems.
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21
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Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort. Tech Coloproctol 2021; 26:143-146. [PMID: 34855026 DOI: 10.1007/s10151-021-02552-2] [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: 03/25/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. METHODS All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses. RESULTS We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being "very satisfied" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014). CONCLUSIONS Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.
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Öztürk A. The comparison of short-term results of marsupialization method in operated patients with acute pilonidal abscess and chronic pilonidal sinus. Turk J Surg 2021; 37:307-312. [PMID: 35677490 PMCID: PMC9130949 DOI: 10.47717/turkjsurg.2021.5002] [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: 03/23/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
Objectives This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus disease treated in single step and to investigate the feasibility of final pilonidal sinus treatment in single step in patients with pilonidal abscess. Material and Methods A total of 58 patients who were operated on using the marsupialization method were included in this study. Patients with acute pilonidal abscess were included in Group 1 (23 patients) and those with chronic pilonidal sinus disease were included in Group 2 (35 patients). Pilonidal sinus was excised as a whole by a vertical elliptic incision, with some surrounding intact tissue. After excision, the wound edges were sutured to the postsacral fascia. Daily dressings were performed by relatives at home. The patients were instructed to visit the hospital for follow-up 1-2 times a week. Student's t-test was used to compare the parameters between the groups. Results The mean wound length was 73.4 and 61.7 mm in Group 1 and Group 2, respectively. The mean duration of wound closure was 59.3 and 54.1 days in Group 1 and Group 2, respectively. There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1. Conclusion The definitive treatment of acute pilonidal abscess can be achieved in single step by using marsupialization method as well as in patients with chronic pilonidal disease.
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Affiliation(s)
- Alaattin Öztürk
- Clinic of General Surgery, Adatıp Hospitals, Istanbul, Turkey
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Almadani YH, Vorstenbosch J, Davison PG, Murphy AM. Wound Healing: A Comprehensive Review. Semin Plast Surg 2021; 35:141-144. [PMID: 34526860 DOI: 10.1055/s-0041-1731791] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Wound healing is an intricate, tightly regulated process that is critical to maintaining the barrier function of skin along with preserving all other skin functions. This process can be influenced by a variety of modifiable and nonmodifiable factors. As wound healing takes place in all parts of the human body, this review focuses on cutaneous wound healing and highlights the classical wound healing phases. Alterations in any of these phases can promote chronic wound development and may impede wound healing.
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Affiliation(s)
- Yasser H Almadani
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Peter G Davison
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Amanda M Murphy
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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Foti N, Passannanti D, Libia A, Campanile FC. A minimally invasive approach to pilonidal disease with endoscopic pilonidal sinus treatment (EPSiT): a single-center case series with long-term results. Tech Coloproctol 2021; 25:1045-1054. [PMID: 34110535 DOI: 10.1007/s10151-021-02477-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Minimally invasive techniques for treating pilonidal disease are safe and effective alternatives to conventional surgery, with improved recovery time, cosmetic results, and pain control. The aim of this study was to evaluate the 5-year surgical outcomes of a single-center case series treated with endoscopic pilonidal sinus treatment (EPSiT). METHODS We conducted a retrospective single-center analysis of all patients treated with EPSiT, by a single surgical team, from March 2015 to December 2019, for primary or recurrent pilonidal disease. The primary outcomes were recurrence, persistence and treatment failure. The secondary outcomes were postoperative pain, painkiller use, time off work, satisfaction, complications, wound healing time, time to persistence or recurrence. RESULTS Forty-two patients underwent 46 EPSiT procedures [34 males, 8 females, median age 25 (IQR 13.75) years] for primary (47.8%) or recurrent pilonidal disease (52.2%). All patients completed the follow-up [median 62 (IQR 43) months]. The single procedure healing rate was 76.1%. The healing rate for the first procedures plus the second EPSiT procedure (performed in 4 cases) was 83.3%. Among the 46 EPSiT procedures, we recorded six cases of persistence (13.0%) and five cases of recurrence (10.9%) The median operative time was 32.5 (IQR 18.75) minutes, the median pain score (visual analog scale) in week 1 was 2 (IQR 2), and the median time off work was 4 (IQR 2) days. Four patients (8.7%) experienced complications: serosanguineous (n = 2) or seropurulent discharge (n = 2). The satisfaction rate was 95.7%. CONCLUSIONS In our experience, EPSiT is safe, well accepted. and associated with a low level of postoperative pain, short hospitalization, short time off work, as well as optimal cosmetic results. Its failure rate is similar to that of excisional surgery.
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Affiliation(s)
- N Foti
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - D Passannanti
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - A Libia
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy
| | - F C Campanile
- General Surgery Unit, San Giovanni Decollato Andosilla Hospital, Civita Castellana, Viterbo, Italy.
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25
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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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Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg 2021; 406:2569-2580. [PMID: 33950407 PMCID: PMC8097120 DOI: 10.1007/s00423-020-02060-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations. METHODS Systemic literature review. RESULTS Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent. CONCLUSION Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.
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Affiliation(s)
- I Iesalnieks
- Dept. of Surgery, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
| | - A Ommer
- End- und Dickdarm-Zentrum Essen, Essen, Germany
| | - A Herold
- End- und Dickdarmzentrum Mannheim, Mannheim, Germany
| | - D Doll
- Dept. of Procto-Surgery, St. Marienhospital Vechta, Vechta, Germany
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Albabtain IT, Alkhaldi A, Aldosari L, Alsaadon L. Pilonidal sinus disease recurrence at a tertiary care center in Riyadh. Ann Saudi Med 2021; 41:179-185. [PMID: 34085545 PMCID: PMC8176377 DOI: 10.5144/0256-4947.2021.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is a chronic inflammatory disease of the sacrococcygeal area. Pilonidal sinus recurrence is a matter of concern to both patients and healthcare providers. OBJECTIVES Estimate the rate of PSD recurrence in our center and identify any risk factors contributing to disease recurrence. DESIGN Retrospective. SETTING Tertiary care center in Riyadh. PATIENTS AND METHODS All patients who underwent surgery for primary or recurrent pilonidal sinus between 1 January 2016 to 30 June 2019 were included to allow for at least 1-year of follow-up at the time of data collection. MAIN OUTCOME MEASURE Recurrence rate of PSD and risk factors for recurrence. SAMPLE SIZE AND CHARACTERISTICS 369 patients: 329 males (89.2%) and 40 (10.8%) females. Median (interquartile range) age was 21 (18-26) years. RESULTS Of the 369 included patients, recurrence was identified in 84 (22.8%) cases [95% confidence interval (CI) 18.6-27.4], and the mean timing of recurrence was 1.8 (1.6) years after the primary surgery. In a multivariate logistic regression analysis, increased age and post-operative seroma fluid discharge were independent risk factors for recurrence. In contrast, preoperative antibiotic prophylaxis and postoperative hair removal were effective in reducing recurrence. Type of surgery closure had no effect on recurrence, yet primary closure was associated with early onset of recurrence compared to secondary closure (P=.02). CONCLUSION Our findings on the factors associated with recurrence of PSD are consistent with many reports in the literature. Reported prevalence estimates vary widely. LIMITATION Single center, small sample size, retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Abdullah Alkhaldi
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lama Aldosari
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lina Alsaadon
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Dupuis A, Christou N, Teterycz D, Balaphas A, Robert-Yap J, Zufferey G, Skala K, Alketbi M, Liot E, Buchs NC, Roche B, Ris F. Sacro-coxxygial hygiene, a key factor in the outcome of pilonidal sinus surgical treatment? BMC Surg 2021; 21:197. [PMID: 33865363 PMCID: PMC8052720 DOI: 10.1186/s12893-021-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Surgical wound infection contributes to prolonged recovery time after pilonidal sinus excision. As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post-operative period. Our hypothesis is that this should reduce healing time and complication rates. The aim of this study was to measure the importance of sacro coccygeal hygiene in the management of pilonidal sinus disease. METHODS We retrospectively collected data after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period. Patients were divided into three groups according to their local hygiene during postoperative follow-up and scored one (G1: good hygiene) to three (G3: poor hygiene). Primary outcome was complication rates. Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate. RESULTS In G1 (N = 112), complication rate was 3.6%. In G2 (N = 109), it was 5.5%, whereas in G3 (N = 71), it reached 7.03%. However, there were no statistically significant differences between hygiene groups regarding complication rates in both univariate and multivariable analysis. Regarding secondary outcomes, there were significant differences between hygiene groups concerning median follow-up (p = 0.0001) and median time off work (p = 0.0127). CONCLUSION Good hygiene of wound is essential for optimal, rapid healing without complications. The importance of this report is to show that thanks to our hygiene follow-up strategy with frequent perineal irrigations and regular follow-up checks, patients with at a first glance "unclean local conditions", reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level.
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Affiliation(s)
- Arnaud Dupuis
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Niki Christou
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland.
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU de Limoges, Hôpital Dupuytren, 87042, Limoges Cedex, France.
| | - Dorota Teterycz
- Service de Chirurgie, Etablissements Hospitaliers du Nord Vaudois, Hôpital de la Vallée, Yverdon-les-bains, Switzerland
| | - Alexandre Balaphas
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Joan Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Guillaume Zufferey
- Service de Chirurgie, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland
| | - Karel Skala
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Mariam Alketbi
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Emilie Liot
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Nicolas C Buchs
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Bruno Roche
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
| | - Frederic Ris
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 121, Geneva 14, Switzerland
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Garg P, Yagnik VD. Laying Open and Curettage under Local Anesthesia to Treat Pilonidal Sinus: Long-Term Follow-Up in 111 Consecutively Operated Patients. Clin Pract 2021; 11:193-199. [PMID: 33915743 PMCID: PMC8167585 DOI: 10.3390/clinpract11020028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this study, the long-term follow-up in a large series was analyzed. (2) Methods: The laying open approach was performed for all types of consecutive PSD patients-simple, complicated, and abscess. The primary outcome parameter of the study was the healing rate. The secondary outcome parameters were operating time, hospital stay, time to resumption of normal work, and healing time. (3) Results: 111 (M/F-92/19, mean age-22.9 ± 5.7 years) consecutive patients were operated on and followed for 38 months (6-111 months). Of these, 24 had pilonidal abscesses, 87 had chronic pilonidal disease, while 22 had recurrent disease. Operating time and hospital stay were 24 ± 7 min and 66 ± 23 min, respectively. On average, patients could resume normal work in 3.6 ± 2.9 days and the healing time was 43.8 ± 7.4 days. Three patients were lost to follow-up. Complete resolution of the disease occurred in 104/108 (96.3%) patients, while 4 (3.7%) had a recurrence. One recurrence was due to a missed tract, while three recurrences presented after complete healing had occurred. Two patients with recurrence were operated on again with the same procedure, and both healed completely. Thus, the overall success rate of this procedure was 98.1% (106/108) with a recurrence rate after first surgery of 3.7% over a median follow-up of 38 months. (4) Conclusions: Pilonidal disease managed by laying open (deroofing) with curettage under local anesthesia is associated with a high cure rate. This procedure is effective in treating all kinds of pilonidal disease (simple, complicated, and abscess).
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Affiliation(s)
- Pankaj Garg
- Chief Colorectal Surgeon, Indus International Hospital, Mohali 140507, India
| | - Vipul D. Yagnik
- Nishtha Surgical Hospital and Research Centre, Patan 384265, Gujarat, India; or
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30
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Metzger GA, Apfeld JC, Nishimura L, Lutz C, Deans KJ, Minneci PC. Principles in treating pediatric patients with pilonidal disease - An expert perspective. Ann Med Surg (Lond) 2021; 64:102233. [PMID: 33868675 PMCID: PMC8040102 DOI: 10.1016/j.amsu.2021.102233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. Traditionally, surgery included wide excision of the involved area with primary closure. Post-operative complication rates were high and recurrence of disease common, leading to a search for alternative approaches for treating pilonidal disease. A minimally invasive (trephination) approach was described by Gips in 2008 and has since been adopted by many surgeons. Although the trephination procedure is less morbid than total excision, the risk of wound complications is not insignificant and post-operative recurrence has been reported in more than 10% of patients. The lack of a clear advantage for any single treatment strategy has led a wide variation in provider approach. To standardize the care for pediatric patients with pilonidal disease, a dedicated clinic was created at our institution in 2018. The aim of this paper is to describe an approach to treating pediatric patients with pilonidal disease that has been established through the experience of treating hundreds of adolescent males and females per year. Given the impact on quality of life for those that are affected by pilonidal disease, it is important that future research be directed toward discovery of the best practices for treating this challenging disease. Pilonidal disease occurs frequently in adolescent males and females and leads to significant morbidity. Surgical options for patients with pilonidal disease frequently have post-operative complications and/or disease recurrence. Treatment strategies for pilonidal disease should be personalized and based on the limitations of the available techniques. Better treatment strategies for mitigating the negative effects of pilonidal disease on quality-of-life are needed for pediatric patients.
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Affiliation(s)
- Gregory A Metzger
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jordan C Apfeld
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leah Nishimura
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carley Lutz
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine J Deans
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.,The Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter C Minneci
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.,The Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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Gabor S, de Lima Favaro M, Pimentel Pedroso RF, Duarte BHF, Novo R, Iamarino AP, Ribeiro MAF. Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3473. [PMID: 33907657 PMCID: PMC8062152 DOI: 10.1097/gox.0000000000003473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Background Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision. Methods Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing. Results The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively (P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group (P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 (P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively (P < 0.05). Conclusion These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.
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Affiliation(s)
- Silvio Gabor
- Clínica Silvio Gabor de Gastroenterologia, São Paulo, Brazil
| | | | | | | | - Rafaela Novo
- General Surgery Residency Program, Santo Amaro University, São Paulo, Brazil
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Abraham MN, Raymond SL, Hawkins RB, Iqbal A, Larson SD, Mustafa MM, Taylor JA, Islam S. Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease. Front Surg 2021; 8:613605. [PMID: 33718427 PMCID: PMC7947800 DOI: 10.3389/fsurg.2021.613605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults. Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease. Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497). Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.
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Affiliation(s)
- Mackenzie N Abraham
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Steven L Raymond
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Russell B Hawkins
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Atif Iqbal
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Shawn D Larson
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Moiz M Mustafa
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Janice A Taylor
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Saleem Islam
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
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Dorth D, Königs I, Elrod J, Ghadban T, Reinshagen K, Boettcher M. Combination of Side-Swing Flap With Negative-Pressure Wound Therapy Is Superior to Open Excision or Flap Alone in Children With Pilonidal Sinus-But at What Cost? Front Pediatr 2021; 9:595684. [PMID: 33937143 PMCID: PMC8079623 DOI: 10.3389/fped.2021.595684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Pilonidal sinus (PS) disease frequently occurs in adolescents and young adults, and in many cases involves wide excision or local flaps as treatment. These treatments are associated with a significant recurrence rate, a long healing time, and thus absence from school or work. The hybrid technique, which is a combination of side-swing plasty with negative-pressure wound therapy (NPWT) may improve these outcomes. The aim of the study was to compare the latter with other current methods. Methods: Children presenting with a pilonidal sinus to two referral centers for pediatric surgery from January 2017 till June 2019 and subsequent (1) slide-swing plasty, (2) open excision, or (3) slide-swing plasty in combination with NPWT were included in this retrospective study. Type of therapy, number of interventions, duration of hospitalization, complications, and recurrence rate were recorded. In addition, data was retrieved from the national diagnosis-related group for inpatient statistics, for all patients who underwent surgery for pilonidal sinus in 2015 and 2016. Results: In total, 85 children were included, with a mean age of 15 years and a near equal gender distribution (53% female). The minimum follow-up was 1 year. In 56% open resection was performed, while 18% underwent a slide-swing plasty and 26% a slide-swing plasty in combination with NPWT. While the hybrid technique was superior regarding recurrence rate in comparison to open excision (24 vs. 5%, p = 0.047), it had significantly longer hospital stay [17.41 (15.63) vs. 3.65 (1.68) days, p < 0.001] and number of interventions [4.14 (4.07) vs. 1.04 (0.29), p < 0.001]. Conclusions: Management of PS disease using slide-swing plasty in combination with NPWT is an effective treatment and is associated with low recurrence rate and minimal morbidity. However, this type of treatment is accompanied by an elongated hospitalization time and more frequent interventions. A diligent case by case evaluation and thorough patient counseling is thus necessary when choosing the right technique for the treatment of PS disease.
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Affiliation(s)
- Deborah Dorth
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Königs
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Practical Management of Pilonidal Disease. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3270. [PMID: 33425585 PMCID: PMC7787313 DOI: 10.1097/gox.0000000000003270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 10/26/2022]
Abstract
Pilonidal disease is a common problem across the globe, with a wide variety of options for management, ranging from healing by secondary intention to flap closure. As new techniques have been introduced, the ideal method to reduce complications and limit recurrence has become unclear. In this review, we highlight the most common methods used to treat pilonidal disease, as well as the senior author's preferred technique for management. Ideally, surgeons are able to choose the optimal procedure for each patient and maximize outcomes with minimal patient care burden and morbidity.
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Initial experience with minimally invasive treatment of pilonidal sinus in children. Wideochir Inne Tech Maloinwazyjne 2020; 16:417-422. [PMID: 34136040 PMCID: PMC8193749 DOI: 10.5114/wiitm.2020.100714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Sinus pilonidalis (SP) is an acquired inflammatory disease, which is relatively common in the paediatric population. Surgery is indicated in symptomatic patients. In 2017, minimally invasive pilonidal sinus treatment (EPSiT) was adapted to the paediatric population. Aim To evaluate the first experience with minimally invasive endoscopic treatment of SP (PEPSiT) in children and adolescents in the Czech Republic. Material and methods A retrospective review of all consecutive paediatric patients who underwent PEPSiT from November 2018 to February 2020. The monitored parameters were demographics, perioperative course of the disease, surgery, length of hospitalisation, postoperative complications, healing, disease recurrence, and follow-up. Results Seventeen patients were enrolled in the study. The median age at surgery was 17.1 years (range: 12.5-18). The subjects comprised 76% males, and the median body mass index was 25.6 kg/m2 (range: 17-30.3 kg/m2). Thirteen patients underwent previous surgical treatment (76%) under local anaesthesia. The median duration of PEPSiT was 50 min (range: 30-85 min). The subjective evaluation of pain by patients on the VAS scale was 0 on the day of discharge. There were no postoperative complications up to the 30th postoperative day. Two disease recurrences were successfully managed by re-PEPSiT. By the end of follow-up, 14/15 patients had healed. Two patients are still within 3 months of surgery, which is too soon to definitively evaluate possible recurrence of the disease. Conclusions These preliminary results show that PEPSiT is a highly promising method. It is safe and well-tolerated by patients (short hospital stay, quick return to normal life, low pain and analgesic consumption). Two recurrences of disease were treated by re-PEPSiT.
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Imam A, Khalayleh H, Pines G, Khoury D, Mavor E, Pelta A. Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience. Ann Coloproctol 2020; 37:109-114. [PMID: 33171038 PMCID: PMC8134928 DOI: 10.3393/ac.2019.11.19.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure). Methods The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed. Results Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks. Conclusion The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.
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Affiliation(s)
- Ashraf Imam
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
| | - Harbi Khalayleh
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
| | - Guy Pines
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
| | - Deeb Khoury
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
| | - Eli Mavor
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
| | - Arie Pelta
- Department of General Surgery, Kaplan Medical Center, Rehovot; Hebrew University School of Medicine, Jerusalem, Israel
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Pfammatter M, Erlanger TE, Mayr J. Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children. CHILDREN-BASEL 2020; 7:children7100187. [PMID: 33080769 PMCID: PMC7602958 DOI: 10.3390/children7100187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/13/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.
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Affiliation(s)
- Michèle Pfammatter
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland;
| | - Tobias E. Erlanger
- Department of Clinical Research, University of Basel, University Hospital Basel, 4031 Basel, Switzerland;
| | - Johannes Mayr
- Department of Pediatric Surgery, University Children’s Hospital Basel, 4031 Basel, Switzerland;
- Correspondence:
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Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment. Ann Med Surg (Lond) 2020; 57:212-217. [PMID: 32793341 PMCID: PMC7415633 DOI: 10.1016/j.amsu.2020.07.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023] Open
Abstract
Pilonidal sinus disease is chronic acquired condition leading to significant morbidity and associated healthcare costs. Several techniques have been described to manage this condition with no treatment gaining universal acceptance. With the shift towards minimally invasive surgery, Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic Pilonidal Sinus Treatment (EPiST) have gained prominence. The aim of this review is to analyse current treatment modalities and the evidence for endoscopic pilonidal sinus surgery. Reported surgical techniques range from wide excision with or without primary closure to various flap closures. These aim to eliminate the underlying causes driven by natal cleft hair and reducing recurrence. However, long term (≥5 years) recurrence rates range between 10 and 30% with significant complication rates. Trials with endoscopic treatment which have shown comparable short-term results to established treatments with reduced morbidity. However, the potential higher cost, learning curve, patient selection criteria and need for long term outcomes from randomised trials limit widespread application of this promising method. Endoscopic treatment of pilonidal sinus disease therefore provides a minimally invasive alternative to traditional surgical methods with the potential to reduce morbidity. However long-term outcomes data from further prospective randomised trials is needed to establish its efficacy compared to traditional surgical methods. Multiple treatment modalities for pilonidal sinus disease exist with no universally accepted mode of treatment. Pilonidal sinus disease recurrence is high even after treatment. Endoscopic treatment has comparable short-term results to established treatments with reduced morbidity. Video Assisted-Ablation of Pilonidal Sinus and Endoscopic Pilonidal Sinus Treatment are emerging treatment modalities.
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Lamdark T, Vuille-dit-Bille RN, Bielicki IN, Guglielmetti LC, Choudhury RA, Peters N, Doll D, Luedi MM, Adamina M. Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria. ACTA ACUST UNITED AC 2020; 56:medicina56070341. [PMID: 32660027 PMCID: PMC7404453 DOI: 10.3390/medicina56070341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/21/2022]
Abstract
Background and objective: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. Materials and Methods: A survey including 196 certified institutions (Switzerland, N = 99 and Austria, N = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. Results: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (p = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; p < 0.001). Primary resection and off-midline closure (p = 0.017) and the use of tissue flaps (p = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. Conclusion: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.
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Affiliation(s)
- Tenzin Lamdark
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8400 Winterthur, Zurich, Switzerland; (T.L.); (L.C.G.); (M.A.)
| | - Raphael Nicolas Vuille-dit-Bille
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8400 Winterthur, Zurich, Switzerland; (T.L.); (L.C.G.); (M.A.)
- Department of Pediatric Surgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland;
- Correspondence:
| | - Isabella Naomi Bielicki
- Department of Pediatric Surgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland;
| | - Laura C. Guglielmetti
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8400 Winterthur, Zurich, Switzerland; (T.L.); (L.C.G.); (M.A.)
| | - Rashikh A Choudhury
- Department of Surgery, University of Colorado Hospital, Aurora, CO 80045, USA;
| | - Nora Peters
- Faculty of Medicine, Philipps- University of Marburg, 35037 Marburg, Germany;
- Vechtaer Institut für Forschungsförderung VIFF, 49377 Vechta, Germany;
| | - Dietrich Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377 Vechta, Germany;
| | - Markus M Luedi
- Vechtaer Institut für Forschungsförderung VIFF, 49377 Vechta, Germany;
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8400 Winterthur, Zurich, Switzerland; (T.L.); (L.C.G.); (M.A.)
- Faculty of Medicine, University of Basel, 4051 Basel, Switzerland
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Popeskou SG, Pravini B, Panteleimonitis S, Vajana AFDT, Vanoni A, Schmalzbauer M, Posabella A, Christoforidis D. Conservative Sinusectomy vs. excision and primary off-midline closure for pilonidal disease: a randomized controlled trial. Int J Colorectal Dis 2020; 35:1193-1199. [PMID: 32144531 DOI: 10.1007/s00384-020-03551-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Pilonidal sinus disease (PD) is a common acquired disease, responsible for discomfort and time off work. There is currently no consensus on the best surgical therapy. We aimed at comparing conservative sinusectomy (S) to excision and paramedian primary closure (PC). METHODS This is a randomized controlled trial compatible with the CONSORT statement standards. We included all patients with chronic PD between 2012 and 2017. We excluded patients with acute abscesses, recurrent PD after surgery with a curative intent and patients needing complex reconstructions with rotation flaps. Patients with chronic symptomatic PD were randomized to S or PC. Primary end-point was the rate of patients healed at 3 weeks, secondary outcomes were total healing time, pain, time off work, patient satisfaction and recurrence at 1 year. Patients were seen at a wound clinic until healed and contacted at 3, 6, and 12 months for follow-up. RESULTS After inclusion of 58 patients the study was stopped prematurely due to discrepancy between expected and observed outcomes. Only 4/30 (13.3%) patients in the S group had healed completely at 3 weeks compared with 14/28 (50%) in the PC group (p = 0.01). Median time to complete healing was 54 (23-328) days in the S group compared to 34 (13-141) in the PC group (p = 0.025). Number of outpatient visits, time off work, analgesia requirement, and recurrence rates at 12 months 4 (16%) in the S group and 3 (11.1%) in the PC group (p = 0.548) were similar. CONCLUSIONS PC leads to faster healing compared to S, with similar healthcare burden. TRIAL REGISTRATION The study was approved by the local ethics committee and registered in www.clinicaltrials.gov (REF: NCT03271996). The study was carried out at the Regional Hospital of Lugano, Switzerland.
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Affiliation(s)
| | - Barbara Pravini
- Depatment of Surgery, Regional Hospital of Lugano, Lugano, Switzerland
| | | | | | - Alice Vanoni
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Mike Schmalzbauer
- Depatment of Surgery, Regional Hospital of Lugano, Lugano, Switzerland
| | - Alberto Posabella
- Department of Surgery, Standort Unispital Clarunis, Universitäres Bauchzentrum Basel, Basel, Switzerland
| | - Dimitri Christoforidis
- Department of Surgery, Regional Hospital of Lugano, Lugano, Switzerland
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Vice-Primario, Chirurgia, Ospedale Regionale di Lugano, via Tesserete 42, 6900, Lugano, Switzerland
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Eastment J, Slater K. Outcomes of minimally invasive endoscopic pilonidal sinus surgery. Asian J Endosc Surg 2020; 13:324-328. [PMID: 31415131 DOI: 10.1111/ases.12748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/18/2019] [Accepted: 07/28/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Pilonidal disease is a common condition that is often treated with morbid and painful surgeries. A minimally invasive, endoscopic approach has been described as an alternative to traditional open procedures. It allows the full visualization of the sinus tracks, leaves minimal scarring and results in less pain and a quicker recovery. METHODS Patients who underwent minimally invasive endoscopic surgery for pilonidal disease at a major metropolitan hospital in Australia were retrospectively identified. Their operative reports and medical records were assessed to determine analgesic requirements, lengths of hospital stay, recurrence rates of pilonidal disease, and wound complications. RESULTS Nine patients had endoscopic sinus surgery (six male, three female). All patients received treatment from the same surgeon. No patients required opiate analgesia for pain and only one stayed post-operatively in hospital overnight. There were no recorded wound complications. The median follow-up period was 28 months (range, 8-36 months). Eight patients had satisfactory healing recorded during their post-operative consultations. Three patients suffered recurrent disease. CONCLUSION Minimally invasive surgery is safe and well tolerated when employed to treat pilonidal disease. It could be considered as a first-line treatment for the obliteration of symptomatic pilonidal sinuses.
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Affiliation(s)
- Jacques Eastment
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Kellee Slater
- School of Medicine, University of Queensland, Brisbane, Australia.,Division of Surgery, Greenslopes Private Hospital, Brisbane, Australia
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Pronk A, Vissink M, Smakman N, Furnee E. Phenolisation of the Sinus Tract in Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Prospective Cohort Study. Cureus 2020; 12:e8129. [PMID: 32550049 PMCID: PMC7294870 DOI: 10.7759/cureus.8129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose Phenolisation is a minimally invasive treatment option in patients with primary pilonidal disease. However, most studies focus on patients with primary pilonidal sinus disease, while data of patients with recurrent pilonidal disease are very scarce. The purpose of this study was to evaluate phenolisation of the sinus tract in patients with recurrent pilonidal sinus disease after previous surgery for SPSD. Methods This single-center prospective cohort study included 60 patients with recurrent pilonidal disease. Loss of days of normal daily activities, surgical site infection, wound epithelization, quality of life, and complaints related to pilonidal disease were postoperatively assessed. Results A total of 57 patients (95%) were treated with phenolisation and the median loss of days of normal daily activities was 5.0 (1.0 - 12.0) days. Fifty-one patients (89.5%) resumed normal daily activities after two weeks. Surgical site infection occurred in five patients (8.8%). Compared to preoperative scores, quality of life was significantly higher 12 weeks postoperatively (p=0.014) and pain and itch scores were lower after six and 12 weeks (p ≤ 0.005). Wounds were completely healed in 45 of 51 patients (89.8%) who were available after 12 weeks of follow-up. Conclusion Phenolisation for recurrent pilonidal disease is safe with a median complete return to daily activities within five days and complete wound healing after three months in 90%. Therefore, phenolisation should be considered as a treatment option in patients with recurrent pilonidal sinus disease.
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Affiliation(s)
| | | | | | - Edgar Furnee
- Surgery, University Medical Center Groningen, Groningen, NLD
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Volkan Tumay L, Serhat Guner O, Gurluler E. Comparison of classical versus modified Limberg flap techniques in pilonidal sinus surgery. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Romain B, Mielcarek M, Delhorme JB, Meyer N, Brigand C, Rohr S. Dialkylcarbamoyl chloride-coated versus alginate dressings after pilonidal sinus excision: a randomized clinical trial (SORKYSA study). BJS Open 2020; 4:225-231. [PMID: 32020765 PMCID: PMC7093794 DOI: 10.1002/bjs5.50259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings. Methods This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities. Results A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings. Conclusion The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 (
https://clinicaltrials.gov/).
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Affiliation(s)
- B Romain
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.,Laboratory of Stress Response and Innovative Therapies, Institut National de la Santé et de la Recherche Médicale (INSERM) IRFAC UMR_S1113, University of Strasbourg, Strasbourg, France
| | - M Mielcarek
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - J B Delhorme
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Meyer
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
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Arslan B, Erol V, Özvardar Pekcan Y. Primer pilonidal sinüs hastalığı için cerrahi tedavide geniş eksizyon-açık bırakma, primer kapama ve flep uygulama sonuçlarının karşılaştırılması. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.665148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Caliskan M, Kosmaz K, Subasi IE, Acar A, Evren I, Bas G, Atayoglu AT. Comparison of Common Surgical Procedures in Non-complicated Pilonidal Sinus Disease, a 7-Year Follow-Up Trial. World J Surg 2019; 44:1091-1098. [DOI: 10.1007/s00268-019-05331-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mohamadi S, Norooznezhad AH, Mostafaei S, Nikbakht M, Nassiri S, Safar H, Moghaddam KA, Ghavamzadeh A, Kazemnejad A. A randomized controlled trial of effectiveness of platelet-rich plasma gel and regular dressing on wound healing time in pilonidal sinus surgery: Role of different affecting factors. Biomed J 2019; 42:403-410. [PMID: 31948604 PMCID: PMC6963006 DOI: 10.1016/j.bj.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/02/2018] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study was to assess the possible association between different factors such as age, sex, antibiotic consumption duration, angiogenesis and pain and “acceleration of wound healing” in pilonidal sinus patients after treating with platelet-rich plasma (PRP). Methods In this clinical trial, 110 patients were randomly divided into treatment arm and control group. After surgery, control group underwent classic wound dressing and the treatment arm experienced PRP gel therapy. Before achieving complete healing, wound incisional biopsy was performed in order to evaluate angiogenesis. During the study, other data such as pain and antibiotic consumption duration were also collected. Wound healing time of pilonidal sinus disease was analyzed using Extended and Stratify Cox model. Data were analyzed using R and STATA software. p<0.05 were considered statistically significant. Results The average wound volume was calculated 41.9 ± 8.01 cc in the controls and 42.35 ± 10.81 in the treatment arm group. The mean of healing time was 8.7 ± 1.18, 4.8 ± 0.87 weeks for control and treatment arm, respectively. There was a significant and strong negative association between healing time and wound volume (p<0.01). Moreover, a significant negative association was found between pain duration and angiogenesis (p<0.001), a strong positive significant association was found between healing time of the treatment arms (p<0.01), and the rate of wound healing for participants treated with PRP gel was 37.2 times more than that of controls. Conclusion Authors hope for these finding to help the future researches to more thoroughly focus on the mentioned factors in order to find a suitable strategy for wound healing using PRP.
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Affiliation(s)
- Saeed Mohamadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Norooznezhad
- Regenerative Medicine Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shayan Mostafaei
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Epidemiology and Biostatistics Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Nikbakht
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nassiri
- Surgery Ward, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Safar
- Pathology Ward, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Ali Moghaddam
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Brown SR, Lund JN. The evidence base for pilonidal sinus surgery is the pits. Tech Coloproctol 2019; 23:1173-1175. [PMID: 31754976 PMCID: PMC6890656 DOI: 10.1007/s10151-019-02116-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S R Brown
- University of Sheffield, Sheffield, UK.
| | - J N Lund
- University of Nottingham, Nottingham, UK
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Iesalnieks I, Ommer A. The Management of Pilonidal Sinus. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:12-21. [PMID: 30782310 DOI: 10.3238/arztebl.2019.0012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/05/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year. METHODS This review is based on pertinent publications retrieved by a selective literature search. RESULTS The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV). CONCLUSION Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.
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Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study. Postepy Dermatol Alergol 2019; 36:431-437. [PMID: 31616217 PMCID: PMC6791160 DOI: 10.5114/ada.2018.77255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty. Aim To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG). Material and methods Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records. Results Patients were aged 18–45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients. Conclusions Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.
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