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Salih AM, Ahmed MM, Baba HO, Kakamad FH, Salih KM, Muhedin SS, Abdalla BA, Abdullah HO, Hamad AK, Abdullah HS, Qadir VJ, Mahmood AJ, Mohammed SH. Non-operative management of pilonidal sinus disease; classification and outcome. Int Wound J 2023; 20:3639-3647. [PMID: 37259676 PMCID: PMC10588333 DOI: 10.1111/iwj.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success.
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Affiliation(s)
- Abdulwahid M. Salih
- College of MedicineUniversity of SulaimaniSulaimaniIraq
- Smart Health TowerSulaimaniIraq
| | | | - Hiwa O. Baba
- Smart Health TowerSulaimaniIraq
- Kscien OrganizationSulaimaniIraq
| | - Fahmi Hussein Kakamad
- College of MedicineUniversity of SulaimaniSulaimaniIraq
- Smart Health TowerSulaimaniIraq
- Kscien OrganizationSulaimaniIraq
| | - Karzan M. Salih
- Smart Health TowerSulaimaniIraq
- Iraqi Board for Medical Specialties, General Surgery DepartmentSulaimani CenterSulaimaniIraq
| | | | | | | | | | | | - Vian J. Qadir
- College of ScienceUniversity of SulaimaniSulaimaniIraq
| | - Ahmed J. Mahmood
- Kurdistan Health Staff Syndicate Sulaymaniyah branchSulaimaniIraq
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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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3
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Sinus pilonidalis. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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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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Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease. Tech Coloproctol 2021; 25:1269-1280. [PMID: 34176001 PMCID: PMC8580911 DOI: 10.1007/s10151-021-02487-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022]
Abstract
Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a “special interest” in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: “A + : strongly agree; A–: agree; N: unsure/no opinion; D–: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.
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Strong E, Callaghan T, Beal E, Moffatt C, Wickramasekera N, Brown S, Lee MJ, Winton C, Hind D. Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study. Colorectal Dis 2021; 23:1487-1498. [PMID: 33645880 DOI: 10.1111/codi.15606] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
AIM Little is known about optimal management strategies for pilonidal sinus disease (PSD). We conducted a mixed-methods study to understand why patients make, and sometimes regret, treatment decisions. METHOD We conducted longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients from 13 UK hospitals. Framework analysis was performed, and themes were mapped to (1) the coping in deliberation framework and (2) an acceptability framework. Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months. RESULTS Nine of 20 patients were not offered a choice of treatment, but this was not necessarily seen as negative (SDM median 4; range 2-4). Factors that influenced decision-making included previous experience and anticipated recovery time. Median (range) DR was 5 (0-50). Those with the highest DR (scores 40-50) were, paradoxically, also amongst the highest scores on SDM (scores 4). Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret. CONCLUSION To minimize regret about surgical decisions, people with PSD need better information about the burden of wound care and the risks of recurrence associated with different surgical approaches.
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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
| | - Erin Beal
- University of Liverpool, Liverpool, UK
| | - Christine Moffatt
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | | | - Steven Brown
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.,Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Matthew J Lee
- Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Catherine Winton
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
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Ommer A, Iesalnieks I, Doll D. S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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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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Short-term outcomes of radical excision vs. phenolisation of the sinus tract in primary sacrococcygeal pilonidal sinus disease: a randomized-controlled trial. Tech Coloproctol 2019; 23:665-673. [PMID: 31278458 DOI: 10.1007/s10151-019-02030-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Phenolisation of Sacrococcygeal pilonidal sinus disease (SPSD) seems to have advantages over radical excision; however, a randomized-controlled trial (RCT) comparing both techniques is lacking. The aim of our study was to compare sinus pit excision and phenolisation of the sinus tract with radical excision in SPSD in terms of return to normal daily activities. METHODS This study was a single-center RCT. Fifty patients who presented with primary SPSD were randomized to phenolisation and 50 patients to excision. The primary endpoint was time to return to normal daily activities. Secondary endpoints were quality of life, complaints related to SPSD, surgical site infection, and wound epithelialization. Patients were treated in a 1-day surgery setting. Complaints related to SPSD were evaluated and symptoms were scored by the participants on a 6-point scale before surgery, and patients kept a diary for 2 weeks on complaints related to the surgical treatment (the same scoring system as preoperatively) and pain, evaluated with a VAS. Quality of life (QoL) was measured preoperatively with a VAS and the Short Form-36 Health Survey (SF-36). At 2, 6, and 12 weeks after surgery, patients were evaluated using a questionnaire containing the following items: patients' satisfaction (disease, compared with preoperatively, scored as cured, improved, unchanged or worsened), five complaints related to the surgical treatment (the same scoring system as preoperatively and in the diary), QoL (VAS and SF-36), and return to normal daily activities. The wound was assessed 2, 6, and 12 weeks postoperatively by one of the investigators (EF or NS), using an assessment form RESULTS: The mean time to return to normal daily activities was significantly shorter after phenolisation (5.2 ± SD 6.6 days vs. 14.5 ± 25.0 days, p = 0.023). 2 weeks after surgery, all patients in the phenolisation group and 85.4% of patients in the excision group returned to normal daily activities (p = 0.026). Pain was significantly lower after phenolisation at 2 weeks postoperatively (0.8 ± 1.0 vs. 1.6 ± 1.3, p = 0.003). Surgical site infection occurred significantly more often after radical excision (n = 10, 21.7% vs. n = 2, 4.0%, p = 0.020). At 6 and 12 weeks, complete wound epithelialization was more frequently achieved after phenolisation (69.0% vs. 37.0%, p = 0.003 and 81.0% vs. 60.9%, p = 0.039, respectively). CONCLUSIONS Pit excision with phenolisation of SPSD resulted in a quicker return to normal daily activities, less pain, and quicker wound epithelialization compared to radical excision. Surgeons should consider phenolisation in patients with primary SPSD.
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Abstract
BACKGROUND Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic pilonidal sinus treatment (EPSiT) and compares that of the other minimally invasive techniques in practice. METHODS MEDLINE, EMBASE, Cochrane and CINAHL databases were searched to look at the peer-reviewed articles on minimally invasive treatments on PD. Primary endpoint was to determine complication rates. Data were pooled using random effect model. Heterogeneity among studies was estimated with χ2 tests. Statistical analysis was performed with Review Manager Version 5.1.2. RESULTS Out of 371 papers, ten were retrieved for full appraisal. One randomised clinical trial (RCT) and four case series presented retrospective data on EPSiT. Five RCTs were on alternative minimally invasive treatments. Complication rate, return to work, wound healing rate and pain scores were superior in minimally invasive treatments compared to excision surgery. There was no statistically significant difference in complication rate or return to work in EPSiT compared to that of alternate minimally invasive techniques. CONCLUSION Minimally invasive treatments of pilonidal disease were found to be safe and effective compared to conventional techniques. It is also demonstrated that EPSiT is a safe alternative with a low short-term complication rate. Further randomised controlled trials are required to more accurately define its effectiveness and closely evaluate the side effect profile.
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Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J 2018; 16:370-378. [PMID: 30440104 DOI: 10.1111/iwj.13042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Rhiannon L Harries
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Abdullah Alqallaf
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jared Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Keith G Harding
- Wound Healing Research Unit, Cardiff University, Cardiff, UK
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13
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Sian TS, Herrod PJJ, Blackwell JEM, Hardy EJO, Lund JN. Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease. Tech Coloproctol 2018; 22:779-784. [DOI: 10.1007/s10151-018-1864-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
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De Robles MS, Seyfi D, Zahid A, Young CJ. Karydakis procedure can be effectively performed in the lateral position. ANZ J Surg 2018; 89:E10-E14. [PMID: 30239096 DOI: 10.1111/ans.14844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/17/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series. METHODS Ninety-seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed. Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position. RESULTS Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%). The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only. Wound complications, mostly minor skin separation, occurred in 37 patients (38%). Disease recurrence occurred in eight patients (8%). There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups). CONCLUSIONS Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency. The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease.
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Affiliation(s)
- Marie S De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Doruk Seyfi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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Dandin Ö, Tihan D, Karakaş DÖ, Hazer B, Balta AZ, Aydın OU. A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''. Turk J Surg 2018; 34:43-48. [PMID: 29756106 DOI: 10.5152/ucd.2016.3632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/18/2016] [Indexed: 11/22/2022]
Abstract
Objective In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment. Material and Methods Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated. Results The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period. Conclusion "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.
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Affiliation(s)
- Özgür Dandin
- Department of General Surgery, Bursa Military Hospital, Bursa, Turkey
| | - Deniz Tihan
- Department of General Surgery, Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | | | - Batuhan Hazer
- Department of General Surgery, Kasımpaşa Military Hospital, İstanbul, Turkey
| | - Ahmet Ziya Balta
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Oğuz Uğur Aydın
- Department of General Surgery, Güven Hospital, Ankara, Turkey
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Muzi MG, Mascagni P, Buonomo O, Cianfarani A, Mosconi C, Colella M, Balla A, Petrella G, Quaresima S, Sileri P. Muzi's Tension Free Primary Closure of Pilonidal Sinus Disease: Updates on Long-Term Results on 514 Patients. J Gastrointest Surg 2018; 22:133-137. [PMID: 28752401 DOI: 10.1007/s11605-017-3502-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the long-term results of Muzi's tension free primary closure technique for pilonidal sinus disease (PSD), in terms of patients' discomfort and recurrence rate. METHODS This study is a retrospective analysis of prospectively collected data. Five hundred fourteen patients were treated. Postoperative pain (assessed by a visual analog scale, VAS), complications, time needed to return to full-day activities, and recurrence rate were recorded. At 12, 22, and 54 months postoperative, patients' satisfaction was evaluated by a questionnaire scoring from 0 (not satisfied) to 12 (greatly satisfied). RESULTS The median operative time was 30 min. The overall postoperative complication rate was 2.52%. Median VAS score was 1. The mean of resumption to normal activity was 8.1 days. At median follow-up of 49 months, recurrence rate was 0.4% (two patients). At 12 months' follow-up, the mean satisfaction score was 10.3 ± 1.7. At 22 and 54 months' follow-up, the score was confirmed. CONCLUSIONS Muzi's tension free primary closure technique has proved to be an effective treatment, showing in the long-term follow-up low recurrence rate and high degree of patient satisfaction. Therefore, we strongly recommend this technique for the treatment of PSD.
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Affiliation(s)
- Marco Gallinella Muzi
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Pietro Mascagni
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Oreste Buonomo
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Agnese Cianfarani
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Claudia Mosconi
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Marco Colella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Silvia Quaresima
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Khodakaram K, Stark J, Höglund I, Andersson RE. Minimal Excision and Primary Suture is a Cost-Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population-Based Interventional and a Cross-Sectional Cohort Study. World J Surg 2017; 41:1295-1302. [PMID: 27905018 PMCID: PMC5394151 DOI: 10.1007/s00268-016-3828-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Conventional treatment of pilonidal disease with wide excision is associated with high morbidity. We describe the short- and long-term results and the impact on the health care system of a simple operation performed in the office under local anaesthesia, consisting of minimal excision of pilonidal sinuses with primary suture—the modified Lord–Millar operation (mLM). Methods All patients operated with mLM from February 2008 till November 2012 were prospectively followed for recurrence by telephone interviews and examination of symptomatic patients till July 2015. The outcome is compared with that in all patients operated with conventional wide excision from January 2003 till February 2008. The effects on the health care system of a consistent use of mLM is analysed by comparing the management of all patients with pilonidal disease at three hospitals during 2013 and 2014. Results Some 129 patients underwent conventional surgical treatment, and 113 had the mLM operation. The mLM operation was more often performed under local anaesthesia, was less often admitted to hospital, had fewer post-operative health care visits (2.4 vs. 14.6, p < 0.001) and a shorter sick leave (1.0 vs. 34.7 days, p < 0.001) indicating faster wound healing. The estimated 5-year recurrence rate was similar (32 vs. 23%, p = 0.091). The cost per operated patient was lower (2231 vs. 6222 EUR, p < 0.001). The hospital consistently applying the mLM operation used less resources for pilonidal diseased patients (34,545 vs. 77,421 EUR per 100,000 inhabitants and year). Conclusions The mLM operation is simple, cost-efficient and has low morbidity and good long-term results.
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Affiliation(s)
- Kaveh Khodakaram
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joachim Stark
- Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden
| | - Ida Höglund
- Department of Surgery, Värnamo Sjukhus, Värnamo, Sweden
| | - Roland E Andersson
- Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden. .,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Abstract
BACKGROUND Pilonidal sinus disease is a common condition that mainly affects young adults. This condition can cause significant pain and impairment of normal activities. No consensus currently exists on the optimum treatment for pilonidal sinus and current therapies have various advantages and disadvantages. Fibrin glue has emerged as a potential treatment as both monotherapy and an adjunct to surgery. OBJECTIVES To assess the effects of fibrin glue alone or in combination with surgery compared with surgery alone in the treatment of pilonidal sinus disease. SEARCH METHODS In December 2016 we searched: the Cochrane Wounds Specialised Register; CENTRAL; MEDLINE; Embase and CINAHL Plus. We also searched clinical trials registries and conference proceedings for ongoing and unpublished studies and scanned reference lists to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) only. We included studies involving participants of all ages and studies conducted in any setting. We considered studies involving people with both new and recurrent pilonidal sinus. We included studies which evaluated fibrin glue monotherapy or as an adjunct to surgery. DATA COLLECTION AND ANALYSIS Two study authors independently extracted data and assessed risk of bias. We used standard methods expected by Cochrane. MAIN RESULTS We included four RCTs with 253 participants, all were at risk of bias. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap.For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (mean difference (MD) -2.50, 95% confidence interval (CI) -4.03 to -0.97) (evidence downgraded twice for risk of performance and detection bias). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days) (very low-quality evidence, downgraded as above and for imprecision).Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (risk ratio (RR) 0.27, 95% CI 0.05 to 1.61; very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for unexplained heterogeneity).A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for imprecision). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001, low-quality evidence downgraded twice for risk of selection, performance and detection bias). AUTHORS' CONCLUSIONS Current evidence is uncertain regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. We identified only four RCTs and each was small and at risk of bias resulting in very low-quality evidence for the primary outcomes of time to healing and adverse events. Future studies should enrol many more participants, ensure adequate randomisation and blinding, whilst measuring clinically relevant outcomes.
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Affiliation(s)
- Jon Lund
- University of NottinghamDivision of Health Sciences, School of MedicineMedical School, Royal Derby Hospital, Uttoxeter RoadDerbyUKDE22 3DT
| | - Samson Tou
- Royal Derby HospitalDepartment of Colorectal SurgeryUttoxeter RoadDerbyUKDE22 3NE
| | - Brett Doleman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of NottinghamDepartment of Surgery and AnaesthesiaUttoxeter New RoadDerbyUKDE22 3DT
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of NottinghamDepartment of Surgery and AnaesthesiaUttoxeter New RoadDerbyUKDE22 3DT
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Di Castro A, Guerra F, Levi Sandri GB, Ettorre GM. Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients. Int J Surg 2016; 36:201-205. [PMID: 27989917 DOI: 10.1016/j.ijsu.2016.10.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/06/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022]
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Gordon KJ, Hunt TM. Osteomyelitis as a complication of a pilonidal sinus. Int J Colorectal Dis 2016; 31:155-6. [PMID: 25796494 DOI: 10.1007/s00384-015-2184-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 02/04/2023]
Affiliation(s)
- K J Gordon
- Consultant Colorectal Surgeon, Royal Shrewsbury Hospital, SY3 8XQ, Shropshire, UK. .,Urology Specialty Registrar, Royal London Hospital, E1 1BB, London, UK.
| | - T M Hunt
- Consultant Colorectal Surgeon, Royal Shrewsbury Hospital, SY3 8XQ, Shropshire, UK
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Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice. Eur Surg 2015. [DOI: 10.1007/s10353-015-0375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lund J, Tou S, Doleman B, Williams JP. Fibrin glue versus surgery for treating chronic pilonidal sinus disease. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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23
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The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2015; 19:607-13. [DOI: 10.1007/s10151-015-1369-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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Furnée EJB, Davids PHP, Pronk A, Smakman N. 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. Trials 2015; 16:92. [PMID: 25872666 PMCID: PMC4359780 DOI: 10.1186/s13063-015-0613-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 02/18/2015] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Edgar J B Furnée
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Paul H P Davids
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Apollo Pronk
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Niels Smakman
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
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Kueper J, Evers T, Wietelmann K, Doll D, Roffeis J, Schwabe P, Märdian S, Wichlas F, Krapohl BD. Sinus pilonidalis in patients of German military hospitals: a review. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2015; 4:Doc02. [PMID: 26504731 PMCID: PMC4604736 DOI: 10.3205/iprs000061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pilonidal sinus disease (PSD) most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.
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Affiliation(s)
- Janina Kueper
- Department of Plastic Surgery, Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
| | | | | | - Dietrich Doll
- Department of Procto-Surgery, St. Marien Hospital, Vechta, Germany
| | - Jana Roffeis
- Department of Plastic Surgery, Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
| | - Philipp Schwabe
- Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
| | - Florian Wichlas
- Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
| | - Björn-Dirk Krapohl
- Department of Plastic Surgery, Center for Musculoskeletal Surgery, Charité – Medical University of Berlin, Germany
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Ommer A, Berg E, Breitkopf C, Bussen D, Doll D, Fürst A, Herold A, Hetzer F, Jacobi T, Krammer H, Lenhard B, Osterholzer G, Petersen S, Ruppert R, Schwandner O, Sailer M, Schiedeck T, Schmidt-Lauber M, Stoll M, Strittmatter B, Iesalnieks I. S3-Leitlinie: Sinus pilonidalis. COLOPROCTOLOGY 2014. [DOI: 10.1007/s00053-014-0467-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Saber A. Modified off-midline closure of pilonidal sinus disease. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:210-4. [PMID: 24926445 PMCID: PMC4049053 DOI: 10.4103/1947-2714.132936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Numerous surgical procedures have been described for pilonidal sinus disease, but treatment failure and disease recurrence are frequent. Conventional off-midline flap closures have relatively favorable surgical outcomes, but relatively unfavorable cosmetic outcomes. AIM The author reported outcomes of a new simplified off-midline technique for closure of the defect after complete excision of the sinus tracts. PATIENTS AND METHODS Two hundred patients of both sexes were enrolled for modified D-shaped excisions were used to include all sinuses and their ramifications, with a simplified procedure to close the defect. RESULTS The overall wound infection rate was 12%, (12.2% for males and 11.1% for females). Wound disruption was necessitating laying the whole wound open and management as open technique. The overall wound disruption rate was 6%, (6.1% for males and 5.5% for females) and the overall recurrence rate was 7%. CONCLUSION Our simplified off-midline closure without flap appeared to be comparable to conventional off-midline closure with flap, in terms of wound infection, wound dehiscence, and recurrence. Advantages of the simplified procedure include potentially reduced surgery complexity, reduced surgery time, and improved cosmetic outcome.
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Affiliation(s)
- Aly Saber
- Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Port-Said, Egypt
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S-shaped wide excision with primary closure for extensive chronic pilonidal sinus disease. Case Rep Surg 2014; 2014:451869. [PMID: 24987541 PMCID: PMC4060288 DOI: 10.1155/2014/451869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/20/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The management of complex pilonidal sinus disease (PSD) with multiple pits on and beside the natal cleft is variable, contentious, and problematic. Wide excision of the sinus and reconstruction of the defect using different flap techniques have become more popular in recent years. Case Report. We report a case with a complex chronic PSD to which we applied primary closure after S-shaped wide excision. The patient's postoperative course was uneventful, and at the end of one-year followup he is now disease-free and comes for routine checkups. Conclusion. The simplicity of the technique and the promising results support the applicability of the S-shaped wide excision in chronic bilaterally extended large PSDs. Further studies entailing large patient populations are needed to reach a definite conclusion.
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Ortega PM, Baixauli J, Arredondo J, Bellver M, Sánchez-Justicia C, Ocaña S, Hernández-Lizoain JL. Is the cleft lift procedure for non-acute sacrococcygeal pilonidal disease a definitive treatment? Long-term outcomes in 74 patients. Surg Today 2014; 44:2318-23. [DOI: 10.1007/s00595-014-0923-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Abstract
INTRODUCTION Ambulatory management is a modality of care defined in France by a hospitalization of less than 12h without an overnight stay. Currently, few data are available on its role in the management of gastrointestinal emergencies, such as appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis or emergency proctologic surgery. The aim of this systematic review was to study the published data regarding the feasibility of ambulatory management of emergency visceral surgery and to enquire about the possibilities of further development of this form of management. MATERIALS AND METHODS A literature search was conducted from the PubMed(®) databank taking into account all published data up to July 2013. RESULTS For acute appendicitis, the success rate of short-stay hospitalization was 72% with unplanned read-mission rates ranging from 0 to 53%, a rate of unscheduled consultations ranging from 0 to 11%, and unplanned inpatient hospitalization rates ranging from 0% to 5%. For acute cholecystitis and proctology, there are few published data. CONCLUSION Ambulatory management has been sparingly studied in the setting of gastrointestinal surgical emergencies. However, there is probably a place for development of this form of management.
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Smart PJ, Dungerwalla M, Heriot AG. Bascom's Simple Pilonidal Sinus Surgery: Simpler with Ultrasound Guidance. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O. Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 2013; 18:29-37. [DOI: 10.1007/s10151-013-0982-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
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Antimicrobials as an adjunct to pilonidal disease surgery: a systematic review of the literature. Eur J Clin Microbiol Infect Dis 2013; 32:851-8. [PMID: 23380885 DOI: 10.1007/s10096-013-1830-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/21/2013] [Indexed: 01/22/2023]
Abstract
Surgical site infection (SSI) after pilonidal disease surgery can lead to serious complications. We systematically searched the PubMed, Scopus, and ClinicalTrials.gov databases for studies evaluating the use of antimicrobials as an adjunct to pilonidal disease surgery. We identified 12 eligible studies [nine randomized controlled trials (RCTs), three retrospective cohort studies], enrolling a total of 1,172 patients. No difference was observed when single-dose prophylaxis was compared to no prophylaxis or to a long course of antibiotics (seven studies, 690 patients). Similarly, gentamicin collagen sponges (GCS) did not appear to be beneficial when compared with no GCS (with primary or secondary closure; four studies, 402 patients). One study (80 patients) reported faster healing and lower SSI and recurrence rates with GCS than a 7-day course of antibiotics. The clinical heterogeneity precluded a formal meta-analysis. Although the generalization of our findings may be limited by the relative paucity and clinical heterogeneity of the existing studies, prophylactic antibiotics or GCS did not appear to be beneficial in promoting healing or reducing SSI or recurrence rates. Large, double-blind, placebo-controlled RCTs are warranted in order to further elucidate this issue.
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Harris CL, Holloway S. Development of an evidence-based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified Reactive Delphi procedure. Part 2: methodology, analysis and results. Int Wound J 2012; 9:173-88. [PMID: 22296455 PMCID: PMC7950799 DOI: 10.1111/j.1742-481x.2011.00925.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This is the second part of the article based on the thesis work for a Masters of Science in Wound Healing and Tissue Repair, Cardiff University, to develop an evidence-based protocol for the care of pilonidal sinus wounds (PSWs) healing by secondary intent, using a modified Reactive Delphi process. The sample included surgeons, clinic physicians, nurses and enterostomal therapy nurses experienced in the care of these wounds. Item generation involved an extensive review of the literature to identify key aspects of evidence-based wound care essential to wound healing, infected wounds and pilonidal wounds healing by secondary intent and drawing on clinical experience. The participants responded via an electronic Delphi website, using a 4-point Likert rating scale and a ranking system. Comments were invited. Feedback was provided to the participants at the end of each round, that included comments, consensus scores, content validity index and additional information that provided rationale and references, or minor revision if requested. This project successfully achieved the objectives, which were to identify the areas of care that negatively or positively influences healing of postoperative PSWs and to inform, educate and broaden the considerations regarding these factors for health care professionals.
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Affiliation(s)
- Connie L Harris
- Wound Healing and Tissue Repair, CNS Wound and Ostomy/South West Regional Wound Care Framework, CarePartners, Unit B 207, 151 Frobisher Drive, Waterloo, Ontario, Canada.
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Abstract
BACKGROUND The pit-picking method was first described by J. Bascom in 1980, however, this minimally invasive technique is used only by a minority of surgeons yet. PATIENTS AND METHODS Surgery was performed under local anesthesia. All primary pits in the midline were removed by excising a border of skin of <1 mm and a 1 cm long incision was made parallel to one side of the cleft to open the chronic abscess cavity. No specific postoperative wound care was given. RESULTS Pit-picking surgery was carried out 157 times in a total of 153 patients (126 males) between June 2007 and November 2010. Follow-up information was available in 123 cases and 21 patients (17%) developed disease recurrence after a mean follow-up time of 7.1 months. By multivariate analysis, a body mass index (BMI) >25 kg/m(2) (p=0.019) and duration of the disease of ≥6 months (p=0.017) were statistically significantly associated with disease recurrence after pit-picking surgery. The recurrence occurred more often in male than in female patients (20% versus 4.5%, p=0.12) CONCLUSION Patients with pilonidal disease can be successfully treated by the pit-picking procedure in more than 80% of selected cases. Female patients and non-overweight male patients with short-term disease benefit most from this treatment method.
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Kim JK, Jeong JC, Lee JB, Jung KH, Bae BK. S-plasty for pilonidal disease: modified primary closure reducing tension. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:63-9. [PMID: 22347707 PMCID: PMC3278637 DOI: 10.4174/jkss.2012.82.2.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/19/2011] [Accepted: 11/24/2011] [Indexed: 11/30/2022]
Abstract
Purpose S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. Methods S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. Results All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). Conclusion We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.
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Affiliation(s)
- Jae Keun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
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