A CONSERVATIVE TREATMENT OF PILONIDAL SINUS

Pilonidal sinus: an overview of historical and current management modalities

Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.

A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus

Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region. In recent years, the rate of recurrence and wound complications in PSD remains high, and no treatment is universally accepted. This study aimed to compare the efficacy of phenol treatment with surgical excision treatment for PSD through a meta-analysis of controlled clinical trials. We searched three electronic databases, PubMed, Embase, and Cochrane library, to comprehensively search the literature comparing phenol treatment and surgical treatment of pilonidal sinus. Fourteen publications were included, including five RCTs and nine non-RCTs. The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05). As compared to the surgical group, wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59]). Phenol treatment resulted in a significantly shorter operating time than surgery treatment (weighted mean difference -22.76, 95% CI [-31.13,-14.39]). The time to return to daily work was considerably shorter than in the surgical group (weighted mean difference -10.11, 95% CI [-14.58,-5.65]). Postoperative complete healing time was significantly shorter than surgical healing time (weighted mean difference -17.11, 95% CI [-32.18,-2.03]). Phenol treatment is effective for pilonidal sinus disease, and its recurrence rate is not significantly different from surgical treatment. The greatest advantage of phenol treatment is the low incidence of wound complications. Moreover, the time required for treatment and recovery are significantly lower than for surgical treatment.

Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease

There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior, and it was associated with some degree of recurrence. Crystallized phenol treatment is a non-operative procedure performed in outpatient settings. This retrospective study aimed to asses crystallized phenol treatment in patients with primary and recurrent SPD and the factors that influence disease recurrence. A total of 92 patients were included and followed up. Crystallized phenol was administered in an outpatient setting under local anesthesia. All demographic, patient, sinus features, procedure and outcome data were recorded and analyzed for treatment success and factors for recurrence were identified. Between January 2019 and December 2021, 92 patients (77 male and 15 female) with a mean age of 28.4 were treated with 1, 2, or 3 doses of crystallized phenol. Recurrence rate after the procedure was 20.7%. Univariate regression analysis showed that the grade of hirsutism, initial presence of abscess, pit number and number of showers per week had statistically significant effect on recurrence. Multivariate logistic regression analysis pointed on the hirsutism grade (P = .008) and the number of pit openings (P = .003) as a statistically significant factors for recurrence. Crystallized phenol application for primary and recurrent SPD is safe, inexpensive and efficient non-operative method with few minor complications, even when is repeated. Factors responsible for the recurrence of the procedure are grade of hirsutism and sinus pit number.

Comparison of Curettage Plus Platelet-Rich Plasma Gel and Curettage Plus Phenol Application in Treatment of Pilonidal Sinus Disease: A Randomized Trial

BACKGROUND

As a chronic condition, pilonidal disease affects a young population, and recovery after the surgical procedures performed to treat this condition require time off from work. Therefore, the search for an ideal treatment is still ongoing.

OBJECTIVE

The aim of this study was to compare early and late results of 2 minimally invasive treatment options used to treat pilonidal disease.

DESIGN

This study was designed as a parallel group randomized clinical trial.

SETTINGS

This study took place at an outpatient clinic in Turkey.

PATIENTS

Patients with pilonidal disease were evaluated for the study and were enrolled if they met the inclusion criteria and gave informed consent.

INTERVENTIONS

Patients in the platelet-rich plasma group were treated using curettage + platelet-rich plasma gel. Patients in the phenol group were treated by using curettage + crystallized phenol.

MAIN OUTCOME MEASURES

The primary study end point was the time to achieve healing; the secondary outcome was recurrence rate.

RESULTS

In the platelet-rich plasma group, 96% of patients achieved healing after 1 application. In the phenol group, only 53% patients achieved healing after 1 application. The median healing time was shorter in the platelet-rich plasma group: 6 (4-14) vs 10 (5-42) days (p < 0.001). The mean difference in healing was 5.8 days (95% CI, 4.27-7.38). After a mean follow-up of 43.1 months, there was a 4% recurrence rate in the platelet-rich plasma group in comparison with a 12% recurrence rate in the phenol group (95% CI, 0.024-0.251).

LIMITATIONS

Despite the randomized prospective nature of the study, neither the patients nor the investigators were blinded.

CONCLUSIONS

The curettage + platelet-rich plasma method can be safely applied with an improved healing time, low recurrence rate, and minimal time off work. See Video Abstract at http://links.lww.com/DCR/B722.Clinical Trial Registration: NCT03070028.

COMPARACIN DE CURETAJE MS GEL DE PLASMA RICO EN PLAQUETAS Y LA APLICACIN DE CURETAJE MS FENOL EN EL TRATAMIENTO DE LA ENFERMEDAD DEL SENO PILONIDAL ENSAYO ALEATORIZADO

ANTECEDENTES:Como condición crónica, la enfermedad pilonidal afecta a una población joven y los procedimientos quirúrgicos que se realizan para tratar esta condición requieren un tiempo de recuperación con baja laboral. Por lo tanto, la búsqueda del tratamiento ideal aún está en curso.OBJETIVO:El objetivo de este estudio es comparar los resultados tempranos y tardíos de dos opciones de tratamiento mínimamente invasivos utilizados para tratar la enfermedad pilonidal.DISEÑO:Este estudio está diseñado como un ensayo clínico aleatorizado de dos grupos paralelos.ENTORNO CLÍNICO:El estudio consta de dos grupos: curetaje + plasma rico en plaquetas y curetaje + fenol.PACIENTES:Los pacientes con enfermedad pilonidal fueron evaluados para el estudio y se inscribieron si cumplían con los criterios de inclusión y dieron su consentimiento informado.INTERVENCIONES:Los pacientes del grupo de plasma rico en plaquetas fueron tratados con curetaje + gel de plasma rico en plaquetas. En el grupo de fenol, los pacientes fueron tratados con curetaje + fenol cristalizado.PRINCIPALES MEDIDAS DE RESULTADO: El principal criterio de valoración del estudio fue el tiempo para lograr la curación; el resultado secundario fue la tasa de recurrencia.RESULTADOS:En el grupo de plasma rico en plaquetas, el 96% de los casos logró la curación después de una aplicación. En el grupo de fenol, solo el 53% de los casos lograron la curación después de una aplicación. La mediana del tiempo de curación fue más corta en el grupo de plasma rico en plaquetas; 6 (4-14) vs 10 (5-42) días (p < 0,001). La diferencia media en la curación fue de 5,8 días (IC del 95%: 4,27-7,38). Después de un seguimiento medio de 43,1 meses, hubo una tasa de recurrencia del 4% en el grupo de plasma rico en plaquetas en comparación con una tasa de recurrencia del 12% en el grupo de fenol (IC del 95%: 0.024-0.251).LIMITACIONES:A pesar de la naturaleza prospectiva aleatorizada del estudio, ni los pacientes ni los investigadores fueron cegados.CONCLUSIONES:El método de legrado + plasma rico en plaquetas se puede aplicar de forma segura con un mejor tiempo de curación, una tasa de recurrencia baja y un tiempo de baja laboral mínimo. Consulte Video Resumen en http://links.lww.com/DCR/B722 (Traducción-Dr. Yazmin Berrones-Medina).Este ensayo se registró para ensayos clínicos con ID: NCT03070028. El protocolo completo se puede encontrar en https://clinicaltrials.gov/ct2/show/NCT03070028.

Crystallized phenol treatment vs excision and primary closure in pilonidal sinus disease: A randomized clinical trial in adolescent patients

INTRODUCTION

Pilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group.

PATIENTS AND METHODS

Adolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study.

RESULTS

A total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5).

CONCLUSION

In our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments.

LEVEL OF EVIDENCE

Level II treatment study.

Radiological, Clinical, and Histological Findings in the Treatment of Pilonidal Sinus with Phenol Injection

Objective:

Sacrococcygeal pilonidal disease is a chronic discharging wound that causes pain and loss of quality of life. Phenol application is an outpatient procedure with low complications and low recurrence rates. We evaluated the radiological, histological, and clinical results of phenol application.

Methods:

A total of 44 consecutive patients with sacrococcygeal pilonidal disease underwent phenol application in Kocaeli University Faculty of Medicine, General Surgery Clinic between December 2015 and March 2017. Demographics, complaints, symptom duration, and the number of sinuses were recorded. Patients were examined using ultrasonography (USG) before surgery and two months after surgery. Four patients who wanted rhomboid excision and Limberg flap procedure underwent preoperative local phenol application and were excluded from the study. The excised tissues were used for pathological evaluation.

Results:

Purulent discharge was the leading symptom. All of the patients had hair in the preoperative USG evaluation, whereas five patients had still hairs in the sinuses in the postoperative USG examination. Four of these cases had recurrences on a 2-month follow-up. After phenol application, a 10% volume decrease was observed. Pathological examination was performed in four cases with phenol application, and in pathological material, the sinuses looked sclerotic and fibrotic.

Conclusions:

Our study revealed that a single phenol application achieved 90% success. However, no significant difference was observed in the cavity volume after phenol injection.

Crystallized phenol for treatment of pilonidal sinus disease in children: a comparative clinical study

BACKGROUND

The aim of this study was to present our experience in the use of crystallized phenol (CP) to treat pediatric patients with 'simple' and complex' Pilonidal sinus disease (PSD).

MATERIALS AND METHODS

Patients who underwent CP treatment in between January 2015 and January 2020 were evaluated retrospectively, using prospectively collected data. The patients were divided into simple and complicated groups. The groups were assigned depending on the number of sinuses and clinical presentation. The groups were compared in terms of age, sex, number of sessions, cost analysis, body mass index (BMI), recurrence, time resolution, cosmetic results, results /improvement, and complications.

RESULTS

This study included 54 patients: 28 (52%) girls and 26 (48%) boys. The mean number of sinuses was 2.4. Symptoms included discharge in 50 (92%) patients, and pain in 42 (78%) patients. Fifty (93%) patients experienced mild pain during the procedure, whereas four (7%) patients had moderate pain. The mean number of CP sessions was 2.9; mean numbers of CP sessions were 2.2 and 4.2 in the Simple and Complicated groups. In total, 5 of 54 patients (9%) had recurrence.At the end of treatment, therapeutic success was achieved in 49 of 54 (91%) patients: 31 of 33 (94%) patients in the Simple group and 18 of 21 patients (86%) in the complicated group. The mean treatment cost for the whole cohort was $17.40. One patient (2%) presented with moderate skin burns. Cosmesis was deemed acceptable by patients, although there was evidence of minor skin burns following the procedure.

CONCLUSIONS

The findings showed that the CP procedure was advantageous for treatment of PSD, because it was minimally invasive, cost-effective, provided good cosmesis, and had a high success rate and low complication rate. Furthermore, it did not require prior examination, and could be performed under local anesthesia. Therefore, the CP procedure may be useful as a first-line treatment option in children with PSD.

Long-term outcomes of crystallized phenol application for the treatment of pilonidal sinus disease

OBJECTIVE

This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience.

METHODS

One thousand and twenty-six patients who have primer pilonidal sinus were enrolled. The operation was applied outpatient clinic under local anesthesia. Recurrence rate, application number, healing time, and factors affecting them were analyzed.

RESULTS

The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks. The rate of recurrence was higher in patients with a long disease duration prior to initiating treatment (p = .04). The rate of recurrence was higher in patients with a higher number of opening and CPT application, those with longer application time, and those with a positive family history (respectively p = .01, p = .002, p = .008).

CONCLUSIONS

Long-term outcomes are also very successful in the treatment of pilonidal disease with CPT. We believe that CPT should be the first choice in the treatment of pilonidal disease because it is inexpensive, can be applied as an outpatient treatment, is a noninvasive procedure, has results comparable to surgical procedures, and does not cause loss of work and strength.

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

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.

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Multiple treatment modalities for pilonidal sinus disease exist with no universally accepted mode of treatment.

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Pilonidal sinus disease recurrence is high even after treatment.

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Endoscopic treatment has comparable short-term results to established treatments with reduced morbidity.

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Video Assisted-Ablation of Pilonidal Sinus and Endoscopic Pilonidal Sinus Treatment are emerging treatment modalities.

Long-Term Outcomes of Crystallized Phenol Application after Punch Excision for the Treatment of Pilonidal Sinus Disease

The aim of the study was to present the outcomes of topical crystallized phenol application in the treatment of pilonidal sinus disease. Under local anesthesia, a punch biopsy tool is used for the excision of the sinus opening holes; after cleaning the cavity, 150 to 250 mg of crystallized phenol was administered. Three sessions of additional therapy were given one week apart without anesthesia. The technique was well tolerated, and early results were observed two months after the procedure. Recurrence was detected in five patients (11.9%), one of whom underwent two more sessions, resulting in recovery. In the long-term results, 39 patients were available after 16 to 38 months (mean 23.7 months). Of these, recurrence was detected in five patients (12.8%). Analysis of the data was unable to identify significant effects of the characteristics of the disease (primary or recurrent), gender of patients, and the number of opening holes (single or multiple) on early and late recurrence ( P > 0.05). A close correlation can be drawn from the early- and long-term results after treatment ( P < 0.0001). In this study, the use of the punch biopsy tool in the treatment of pilonidal sinus disease with crystallized phenol was described first. This minimally invasive method achieved excellent aesthetic outcomes, and it can successfully be applied without the need for surgical intervention, especially in patients who are at the initial stage and with small in size openings.

Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery

Background

Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF).

Material/Methods

The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined.

Results

The mean age was 28.4 years (14–77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01).

Conclusions

According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Management of sacrococcygeal pilonidal sinus disease

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.

‘D’ Excision for Sacrococcygeal Pilonidal Sinus Disease

A new procedure is described for treating pilonidal sinus by an excision and primary suture technique, and the results reported in 30 consecutive patients so treated - 28 with chronic sinuses and 2 with an acute abscess. Seventeen patients (Group 1) had had no previous surgery, while 13 (Group 2) had had multiple previous operations. A total of 24 patients (80%) healed after the operation, their mean hospital stay being 16 days. In Group 1 the success rate was 88% with a mean hospital stay of 15 days; in Group 2 the comparable figures were 69% and 17 days. After additional procedures (usually curettage) all patients healed.

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

Endoscopic Pilonidal Sinus Treatment Combined With Crystalized Phenol Application May Prevent Recurrence

BACKGROUND

No single treatment yet exists for pilonidal disease that has a short healing time, good cosmetic results, and a low rate of recurrence. Phenol crystal application and diathermy ablation through an endoscope have been used for the treatment of pilonidal disease, but this cohort is the first one to combine them.

OBJECTIVE

The purpose of this study was to examine the safety, effectiveness, and short- and long-term outcomes of crystalized phenol treatment combined with endoscopic pilonidal sinus treatment for pilonidal disease.

DESIGN

This was a prospective cohort study.

SETTINGS

Procedures were performed in 2 hospitals by the same surgeon between February and July 2014.

PATIENTS

Twenty-three patients underwent surgical treatment for pilonidal disease.

INTERVENTIONS

Under local anesthesia and sedation, all of the patients underwent a video-assisted diathermy ablation of the sinus cavity and the application of phenol crystals.

MAIN OUTCOME MEASURES

Adverse events were recorded as a measure of safety and tolerability. Failure to heal and recurrence rate were documented and evaluated.

RESULTS

Patients were discharged on the same day as surgery. There was no or minimal postoperative pain (mean visual analog scale score, 1.40 ± 0.95). Mean operation time was 20.43 ± 6.19 minutes, and the median return-to-work duration was 2.00 days (mean, 3.03 ± 2.95 d). Patients were followed-up for 18 to 24 months (mean, 22.00 ± 1.88 mo). No serious complications or rehospitalization were observed. No primary failure to heal or recurrence was observed.

LIMITATIONS

This study did not include a control group with which to compare and consisted of a relatively small number of patients.

CONCLUSIONS

Crystalized phenol treatment combined with endoscopic pilonidal sinus treatment was safe, tolerable, and achieved fast and durable healing with no recurrence over an average of 22 months of follow-up.

Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial

BACKGROUND

Minimally invasive procedures may be an alternative to surgical excisions for pilonidal disease.

OBJECTIVE

The aim of the study was to compare phenol injection versus excision with open healing technique.

DESIGN

This is a prospective randomized study (ACTRN12612000868886).

SETTINGS

This study was conducted at the Ankara University and Ufuk University Departments of Surgery.

PATIENTS

One hundred forty patients were randomly assigned to phenol injection (n = 70) or excision with open healing (n = 70).

MAIN OUTCOME MEASURES

The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale pain score, painkiller intake, time to resume daily activities, recurrence rate, Short Form 36 Health Survey, and Nottingham Health Profile at 3 weeks after surgery.

RESULTS

Time to complete wound healing (16.2 ± 8.7 versus 40.1 ± 9.7 days) was significantly in favor of the phenol injection group (p < 0.001). The median operation time was 14.0 ± 3.8 minutes in the phenol group versus 49.0 ± 24.2 minutes in the excision with open healing group (p <  0.001). The time to resume daily activities (pain-free mobilization and defecation) was 0.8 ± 2.8 and 16.2 ± 12.6 hours after phenol injection and 9.3 ± 10.0 and 22.5 ± 15.1 hours after the excision with open healing treatment (p <  0.001, p = 0.008). Visual analog pain score at 48 hours and painkiller intake within 48 hours were significantly in favor of the phenol injection group. At the mean follow-up of 39.2 ± 9.0 months after surgery, no differences were seen in the recurrence rate between the treatment arms (13 recurrences in phenol vs 9 in excision with open healing; p = not significant). Short Form 36 and Nottingham Health Profile scores at 3 weeks after surgery were also in favor of phenol injection.

LIMITATIONS

The present study was not double blinded, and a history of abscess drainage was significantly higher in the surgery group.

CONCLUSIONS

Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.

Anatomic Effect of Classical Limberg Plastic Surgery Procedure in the Sacro-Coccygeal Region for Pilonidal Sinus Disease: A Pilot Study

Sacro-coccygeal pilonidal sinus disease is a frequent surgical problem. Some authors assign the low recurrence rates of the Limberg flap to the flattening or elevation of the natal cleft. Numerous authors describe a flattening or elevation of the natal cleft as a result of a Limberg flap that originated from the gluteal region. However, thus far, these have not been quantified. The aim of our study was to quantify the flattening or elevation of the natal cleft. In the context of our study on the Limberg flap plasty with a homogenous group of 12 male patients, we measured the depth of the rima ani after the excision, and we also measured the thickness of the Limberg flap. The median thickness of the rima ani at excision was 3.35 cm [interquartile range (IQR): 2.70; 4.18]. The median thickness of the Limberg flap was 4.85 cm (IQR: 3.90; 5.18). The thickness of the rima ani after excision was statistically significantly less compared with the thickness of the Limberg flap (P = 0.002). In our study, we showed the elevation of the crena ani with statistical significance by performing the Limberg flap for the treatment of sacro-coccygeal pilonidal sinus disease, leading to a flattening of the sacro-coccygeal region. Because a deep crena ani is a factor in the pathogenesis of pilonidal sinus, the flattening of the sacro-coccygeal region with a Limberg flap plasty, as reported in countless publications, may explain the low recurrence rates.

Effects of methylene-blue staining on the extent of pilonidal sinus excision

OBJECTIVE

We aimed to examine the effects of methylene-blue staining (MBS) on the volume of specimens after excision of pilonidal sinuses.

METHOD

This was a retrospective analysis of 135 excised specimens after pilonidal sinus (PS) surgery. All patients underwent procedures at the Department of Surgery of University Hospital Jena between 2000 and 2010. All specimens were measured in three dimensions. To calculate the volumes of excised specimens, we used a model of a hemi-ellipsoid. Demographic information (age, height, weight, body mass index, smoking status) were also obtained for all patients.

RESULTS

Excised specimens with MBS had significantly larger volumes (p<0.001) as reflected in length (p=0.001), width (p=0.001), and depth (p=0.017) of the excised specimen compared with specimens that were not stained with methylene blue (MB). In addition, the volume was larger in subjects with a recurrent PS (p=0.021), which was predominantly the case in female subjects (p=0.025).

CONCLUSION

These data suggest that excised specimens with MBS had significantly larger volumes of the excised specimen compared with specimens that were not stained with MB. MBS of a fistula system could enable such a system to be marked sufficiently, thereby facilitating complete resection of a PS.

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.

Pit excision with phenolisation of the sinus tract versus radical excision in sacrococcygeal pilonidal sinus disease: study protocol for a single centre randomized controlled trial

BACKGROUND

Excision of the pit of the sinus with phenolisation of the sinus tract and surgical excision are two treatment modalities for patients with sacrococcygeal pilonidal sinus disease. Phenolisation seems to have advantages over local sinus excision as it is performed under local anaesthesia with a relatively small surgical procedure, less postoperative pain, minor risk of surgical site infection (8.7%), and only a few days being unable to perform normal activity (mean of 2.3 days). The disadvantage may be the higher risk of recurrence (13%) and the necessity to perform a second phenolisation in a subgroup of patients. Wide surgical excision of sacrococcygeal pilonidal sinus disease has a recurrence rate of 4 to 11%. The disadvantages, however, are postoperative pain, high risk of surgical site infection, and a longer period being unable to perform normal activity (mean of 10 days). The objective of this study is to show that excision of the pit of the sinus of sacrococcygeal pilonidal sinus disease with phenolisation of the sinus tract is a successful first-time treatment modality for sacrococcygeal pilonidal sinus disease accompanied by a quicker return to normal daily activity compared to local excision of the sinus.

METHODS/DESIGN

Patients with sacrococcygeal pilonidal sinus disease will be randomly allocated to excision of the pit of the sinus followed by phenol applications of the sinus tract or radical surgical excision of the sinus. Patients are recruited from a single Dutch teaching, non-university hospital. The primary endpoint is loss of days of normal activity/working days. Secondary endpoints are anatomic recurrence rate, symptomatic recurrence rate, quality of life, surgical site infection, time to wound closure, symptoms related to treatment, pain, usage of pain medication and total treatment time. To demonstrate a reduction of return to normal activity from 7.5 days in the excision group to 4 days in the phenolisation group, with 80% power at 5% alpha, a total sample size of 100 is required.

DISCUSSION

This study is a randomised controlled trial to provide evidence that phenolisation of the sinus tract compared to radical excision reduces the total number of days unable to perform normal activity.

TRIAL REGISTRATION

Dutch trial register NTR4043 , registered on 24 June 2013.

Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.

Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study

OBJECTIVE

This study was designed to compare the efficacy of crystallized phenol method with Limberg flap in pilonidal sinus treatment.

MATERIAL AND METHODS

Patients with a diagnosis of pilonidal sinus disease treated with surgical excision + Limberg rhomboid flap technique and crystallized phenol method between 2010-2011 in the Şevket Yılmaz Training and Research Hospital, Department of General Surgery were evaluated retrospectively. Patients' age, sex, length of hospital stay, complications and recurrence rates were evaluated.

RESULTS

Eighty eight percent of patients were male and mean age was 26.84±6.41 in the Limberg group, and 24.72±5.00 in the crystallized phenol group. Sinus orifice locations and nature, and duration of symptoms before surgery were similar in the two groups. Length of hospital stay in the Limberg group was 1.46±0.61 days; whereas all patients in the crystallized phenol group were discharged on the same day. Infection, hematoma, wound dehiscence, and cosmetic problems were significantly higher in the Limberg group. There was no difference between the two groups in terms of recurrence and seroma formation.

CONCLUSION

The less invasive method of crystallized phenol application may be an alternative approach to rhomboid excision and Limberg flap in patients with non-complicated pilonidal sinus disease, yielding acceptable recurrence rates.

Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'

Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques. Crystallised phenol application seems to be an alternative therapy to surgery with higher success rates, lower costs, faster recovery and earlier return to work. We aimed to state the success of phenol application for PS in adolescence. A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised. All patients underwent phenol application in an outpatient setting. The patients were followed thereafter. The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus. Crystallised phenol application seems to be a promising non-operative therapy for PS in adolescents.

Treatment of pilonidal disease by combination of pit excision and phenol application

AIM

To examine the results of our minimal invasive treatment for pilonidal disease.

METHODS

Total 83 patients treated by pit excision and consecutive phenol applications on an outpatient setting. All procedures were performed under local anesthesia, without any preoperative testing, colon cleansing, prophylactic antibiotics or sedation. A pit excision (mean length 1.3 ± 0.5 cm) including several close midline orifices was done. Separated pit excisions were done to the remaining midline and lateral orifices. Sinus cavity was cleared of hair and debris, and the walls of the cavity were sclerosed using a cotton bud dipped in 80% liquid phenol. Phenolization was repeated twice on day one and seven.

RESULTS

Mean procedure time was 22.2 ± 7.4 min. Rates of patients who did not required analgesics at first, second, third and fourth days after surgery were 58, 85, 91 and 100%, respectively. All the patients returned to work/school after 3 days. Mean wound closure time was 28.5 ± 14.9 days. Total 86.7% of the patients were asymptomatic after a mean 25.7 ± 8.5 months follow-up.

CONCLUSION

Simple pit excision and sclerosing the pilonidal sinus cavity consecutively was an effective and minimal invasive method for relief of pilonidal symptoms.

The results of a one-time crystallized phenol application for pilonidal sinus disease

The aim of this study was to investigate the cure rate after a one-time phenol application for pilonidal sinus disease. Forty-eight patients diagnosed with pilonidal sinus from May 2006 to September 2009 were retrospectively reviewed. They were all managed under the same polyclinic conditions in different hospitals by the same surgeon under local anesthesia. Crystallized phenol was applied a total of 97 times on 48 patients. The median follow-up was 22 months (range, six to 38 months). Two patients (4 %) could not participate in the follow-up. One of these patients had 12 sinuses and didn't continue treatment after eight applications of phenol, and the other had nine sinuses and didn't continue treatment after five applications of phenol. The one-time application cure rate was 64.5 %, and the rate of success was 95 % with two or more applications. Recurrence did not occur during this period. A one-time phenol application is an effective treatment for pilonidal sinus disease. Hence, it can be an alternative to surgical treatment.

Phenol procedure for pilonidal sinus disease and risk factors for treatment failure

BACKGROUND

The present study was designed to evaluate the results of phenolization for pilonidal sinus disease and the risk factors for treatment failure.

METHODS

Between June 2005 and July 2009, 76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus were treated with a phenol treatment and included in the study. The clinical (age, sex, story of treatment for abscess formation, and comorbidity), operative (localization and number of sinus openings and volume of cavity), and follow-up data (healing time, time off work, postoperative complications, morbidity, and number of phenolization sessions) of the patients was recorded. Gender, age, history of abscess drainage, number of sinus openings, localization of sinus openings, volume of cavity, and the number of phenolization sessions were analyzed as risk factors for treatment failure.

RESULTS

The overall success rate was 67% (51 of 76 patients). The mean time to complete healing was 16 days (range, 10-45). The time off work was 0 days. Age and gender were not found to be risk factors for treatment failure (P > .05 and P > .05, respectively). Patients with a history of abscess drainage and more than 3 sinus openings had a significantly higher risk of treatment failure (P = .001 and P = .046, respectively). There was no difference between the localization of sinus openings and treatment failure (P > .05). There were statistically significant differences between treatment failure and both the cavity volume and number of phenolization sessions (P = .016 and P = .001, respectively). Patients were followed up for a mean period of 25 months (range, 13-48). One patient (2%) showed recurrence.

CONCLUSION

With an early return to work and low rates of complications and recurrence, phenolization is a simple outpatient procedure for the treatment of pilonidal sinus disease in selected patients.

Simple day-case surgery for pilonidal sinus disease

BACKGROUND

Pilonidal disease is a common and usually minor disease. Although wide excisional surgery has been common practice, there are more simple alternatives. This review focused on the aetiology and management of pilonidal disease.

METHODS

A comprehensive review of the literature on pilonidal disease was undertaken. MEDLINE searches for all articles listing pilonidal disease (1980-2010) were performed to determine the aetiology and results of surgical and non-surgical treatments. Single papers describing new techniques or minor modifications of established techniques were excluded. Further articles were traced through reference lists.

RESULTS

Patients with minimal symptoms and those having drainage of a single acute abscess can be treated expectantly. Non-surgical treatments may be of value but their long-term results are unknown. There is no rational basis or need for wide excision of the abscess and sinus. Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances. Hirsute patients with extensive primary disease and deep natal clefts, or with recurrent disease and unhealed midline wounds, may also require flattening of the natal cleft with off-midline skin closure. These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work. They also avoid the occasional debilitating complications of surgical treatment.

CONCLUSION

Simple day-case surgery to eradicate midline skin pits without wide excision of the abscesses and sinus is rational, safe and effective for patients with pilonidal sinus disease.

Pilonidal disease

Pilonidal disease is a common anorectal problem that typically affects young people. Numerous surgical procedures have been described, but treatment failure and disease recurrence are frequent, leading to considerable morbidity in these otherwise healthy patients. To manage this problem successfully, surgeons must consider the pathogenesis and presentation of the disease and weigh the advantages and disadvantages of any operation. Discussed in this article are the pathogenesis of pilonidal disease and basic treatment options for acute pilonidal abscesses, sinus tracts, and chronic or recurrent pilonidal disease.

Comparison of the application of low concentration and 80% phenol solution in pilonidal sinus disease

Objectives

Many conservative methods have been applied in the treatment of pilonidal sinus disease (PSD). The most commonly used conservative treatment is 80% phenol solution. Our observations demonstrated that 80% phenol solution caused much destruction in the sacrococcygeal region.

Design

In this study low concentrations of phenol were used with the aim of reducing the unwanted side-effects of high-concentration phenol without reducing the therapeutic effects.

Participants

We treated 112 patients (18 women, 94 men) with PSD using phenol solution. Patients were divided into two groups: Group A was treated with a 40% solution of phenol solution, and Group B was treated with an 80% solution of phenol solution.

Setting

All patients were treated on an outpatient basis. One mL of low (40%) or high (80%) concentration phenol solution was injected into the main sinus orifice. During the check it was observed and noted whether there was skin necrosis, fatty tissue necrosis or abscesses.

Main outcome measures

The mean age was 27.4 years (6–44). The median length of symptoms was seven months (0.5–132). In the 2.8 years (1–6) of mean follow-up period, the disease recurred in 13 (11.6%) patients.

Results

This treatment procedure was well-tolerated by all the patients except for those who had unwanted results. No patients in group A had skin necrosis, and only one had abscesses. In group B two patients had abscesses, and three had skin necrosis. Fatty tissue necrosis was seen in one patient in Group A and in five patients in Group B. Recurrence rates were four (7.4%) cases in Group A and nine (15.5%) cases in Group B.

Conclusions

It is possible to treat patients in a shorter time with a considerably smaller loss of working time, since the destruction of peripilonidal adipose tissue and skin is less. Therefore, the use of low-concentration phenol solution is an option to be considered in the treatment of PSD.

Review of phenol treatment in sacrococcygeal pilonidal disease

BACKGROUND

Investigating minimally invasive methods for treatment of pilonidal disease, we reviewed the techniques and the results of phenol treatment of pilonidal disease in the medical literature.

METHODS

A Pubmed search for all English language written papers and abstracts published between January 1964 and September 2007.

RESULTS

Mean time to return to work is 2.3 +/- 3.8 days and mean healing time is 20 +/- 14 days. Overall success rate is 87 +/- 10% with a mean follow-up of 2.0 +/- 1.1 years. The most common postoperative complications after phenolization are development of abscesses and cellulites. The incidence of morbidities was mean 8.9 +/- 4.7%.

CONCLUSIONS

Success rate looks better particularly in the cases that have 1-3 sinus orifices and comparable with the surgical methods. Though healing time of the wound is long, the procedure apparently lessens the time off work. Although results of this review indicate that phenol treatment may be beneficial for pilonidal disease, the lack of randomized studies results in only weak evidence. There is also the need for longer-term follow-up data.

Multiple Z-Plasty in Pilonidal Sinus—A New Technique under Local Anesthesia

BACKGROUND

Pilonidal sinus is a common surgical condition. Though benign, it causes a lot of distress with its associated morbidity and financial loss to the patient. Many procedures have been tried, ranging from nonsurgical to surgical methods (both conservative and radical ones). It is well known that recurrences are low when the scar is away from the midline.

MATERIALS AND METHODS

The author has described a new technique of multiple Z-plasty for the treatment of pilonidal sinus that has been effective in the cure of this problem. This article reports a prospective, nonrandomized noncomparative preliminary clinical study of 115 cases of pilonidal sinus operated on by the author over 14 years.

RESULTS

The results were compared with the results of other methods mentioned in the literature. There were only two recurrences.

CONCLUSIONS

The author proposes that multiple Z-plasty can be considered as an option in the surgical treatment of pilonidal sinus.

Pilonidal sinus treated with crystallized phenol: an eight-year experience

PURPOSE

The aim of this study was to determine the impact of crystallized phenol on the outpatient treatment of pilonidal disease.

PATIENTS AND METHODS

A retrospective analysis was undertaken of patients seen in the outpatient surgery clinic of the University Hospital, Elazlg, Turkey. Age, gender, body mass index, characteristics of sinuses at initial presentation, and the recovery time of 41 patients were analyzed. The relationship between recovery time and the number of sinus openings, presence of abscess, and status of the sinuses (acute vs. chronic) were noted.

RESULTS

Crystallized phenol was applied a total of 107 times on 41 patients. Seventy percent of the patients had two to three applications. Mean recovery time was 42.7 (+/- standard deviation of 24) days with a range of 13 to 120 days. Recurrences were observed in only two patients at the fifth and eighth months following recovery. The success rate was 95.1 percent. Median follow-up was 24 (range, 6-98) months. The status of sinuses (acute vs. chronic and presence or absence of abscess) and the number of sinus opening had no effect on recovery time (P > 0.005).

CONCLUSION

Crystallized phenol treatment is a simple and inexpensive method that can be readily applied on an outpatient basis, decreasing both the recurrence rate and lost work time. We suggest that this method be considered the first-line treatment of any type of pilonidal sinus.

Pilonidal sinus: management objectives

In spite of a number of ingenious operative and non-operative techniques in the management of pilonidal sinus no single technique can be relied upon to prevent recurrence of this benign yet troublesome condition. Once thought to be a congenital condition it is now appreciated that pilonidal sinus most often an acquired condition due to accumulation of tough, bristly hair penetrating the skin, or local hair growing into a skin crevice, pit or abnormal follicle. The most common site is the upper natal cleft but the condition may occur in other sites especially where there is a crevice or irregularity of skin surface with pressure or suction applied to that region. Most surgical procedures have been designed to eradicate the existing sinus and the crevice in which hair tends to accumulate. However, without the presence of hair there can be no pilonidal sinus and, in the past, little attention has been given to preventing the re-accumulation of hair in the troublesome site; hence the risk of recurrence. Management objectives should be directed not only at eradicating the obvious lesion present but also to preventing recurrence of aetiological factors; especially the re-accumulation or re-growth of hair.

Treatment of pilonidal sinuses by phenol injections

Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.

Chronic pilonidal disease. An assessment of 150 cases

During a four-year period, 150 consecutive patients were treated for chronic pilonidal disease by one of three different operative techniques. Patients with acute pilonidal abscesses or with complex or multiple recurrent pilonidal disease were excluded from this study. The average healing time was four weeks and the average length of hospital stay was one day. The overall recurrence rate was 8 percent (12 of 150 patients). The method of management most commonly used was fistulotomy with marsupialization of the sinus tract or cyst wall (125 of 150 patients). This simple and effective technique gave excellent results with a 6 percent recurrence rate (7 of 125 patients). On the basis of their experience, the authors propose that chronic pilonidal disease usually can be treated successfully on a same day surgery basis with fistulotomy, minimal excision, and marsupialization.

Pilonidal sinus: finding the right track for treatment

Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.

The management of patients with pilonidal disease--a comparative study

Patients with pilonidal disease presenting at Wellington Hospital between 1979 and 1982 have been studied retrospectively. Of 218 admissions, 113 were for pilonidal sinus and 105 for pilonidal abscess. Fifty-five sinuses and 82 abscesses were 'laid open'. Hospital stay, recurrence rates and costs were considerably lower in those patients who were laid open. It is suggested that laying open is the procedure of choice for patients with both pilonidal abscess and sinus.

[Causes of pilonidal sinus and pyoderma fistulans sinifica]

Pilonidal sinus is of the same origin as the Pyodermia fistulans sinifica . Both diseases are retention dermatopathies . These sinuses are not of congenital origin. Our observations have made an acquired origin seem more likely. Deep skin folds in the rima ani, the stiffness of the body hairs, the rolling movement of naturally separated hairs push the hair through the skin like a pin. If a hair is rubbed, it moves in the direction of its root with the peripherally directed hair scales. Excision of the sinus area and transplantation of an epithelial flap is the best therapy.