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Pili Multigemini Is a Possible Risk Factor for Pilonidal Sinus Disease. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00219.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to analyze both previously proposed and new risk factors for the development of pilonidal sinus. This is a prospective case-control study consisting of 145 patients with pilonidal sinus disease (n = 45) and a control group (n = 100). All patients were admitted to the department of general surgery between January 2013 and May 2015. The patients' age, family history, medical history, sitting time in a day, sitting posture, body mass index (BMI), Garn hairiness score, and hair type were evaluated. There were significant differences between the groups in the following characteristics: age (P = 0.01); positive family history (P = 0.01); medical history (P = 0.01); sitting time in a day (P = 0.01); sitting posture (P = 0.01); BMI (P = 0.01); Garn score (P = 0.01); and hair type. Multivariate logistic regression analysis indicated that positive family history (P = 0.03); Garn score (P = 0.05); medical history (P = 0.01); and sitting posture (P = 0.02) were independent risk factors for the development of pilonidal sinus disease.
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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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3
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Gul VO, Destek S. Sinusectomy and primary closure versus excision and primary closure in pilonidal sinus disease: a retrospective cohort study. Int J Colorectal Dis 2020; 35:1117-1124. [PMID: 32248289 DOI: 10.1007/s00384-020-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various surgical procedures are available for the treatment of pilonidal sinus diseases (PSD), but the best surgical approach remains controversial. Minimally invasive surgical procedures are more popular than surgery. This study aimed to evaluate the efficacy of sinusectomy with primary closure (SPC) in comparison with excision and primary closure (EPC) in primary or recurrent cases. MATERIALS AND METHODS This single-center retrospective cohort study was conducted with two cohort groups in which 351 patients with PSD underwent either SPC or EPC. The two procedures were compared according to the presence of short-term complications and recurrence of PSD. RESULTS Of the patients, 134 underwent EPC and 217 underwent SPC. The length of stay and the wound healing time were significantly longer in the EPC group than in the SPC group. The occurrence rates of wound site infection and abscess were significantly higher in the EPC group than in the SPC group; however, seroma was statistically significantly more common in the SPC group than in the EPC group. The recurrence rates were 18.7% and 5.5% in the EPC and SPC groups, respectively. CONCLUSION SPC is an efficient procedure for the treatment of patients with PSD showing simple and complicated disease patterns.
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Affiliation(s)
- Vahit Onur Gul
- Department of General Surgery, Gulhane Education and Research Hospital, 06180, Ankara, Turkey.
| | - Sabahattin Destek
- Department of General Surgery, Bezmialem Vakıf University School of Medicine, 34000, Istanbul, Turkey
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Volkan Tumay L, Serhat Guner O, Gurluler E. Comparison of classical versus modified Limberg flap techniques in pilonidal sinus surgery. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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5
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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Galal Elshazly W, Said K. Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Walid Galal Elshazly
- Surgical, Alexandria Faculty of Medicine , Alexandria University , Alexandria, Egypt
| | - Kaled Said
- Surgical, Alexandria Faculty of Medicine , Alexandria University , Alexandria, Egypt
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D-shape asymmetric excision in recurrent pilonidalis disease: an analytic longitudinal long-term evaluation. Updates Surg 2019; 71:723-727. [PMID: 30887467 DOI: 10.1007/s13304-019-00644-1] [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: 11/09/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
Sacrococcigeal pilonidalis disease (SPD) recurrence is a major factor influencing surgical outcomes. Several different surgical treatments have been reported, however, there is a lack of long-term data on reoperation. Aim of this study was to analyze outcomes of a single center adopting a standardized off-midline asymmetric procedure (D-shape). Analytic longitudinal assessment of 83 patients (median age 35 years, range 23-59 years) with recurrent SPD that completed the 5-year study design following D-shape reoperation. Among a cohort of 607 patients, we enrolled 83 recurrent SPD. After D-shape reoperation, second recurrence rate was 9.6% (8/83). Second recurrence rate was not statistically significantly different among patients undergone D-shape as first surgery compared to patients of symmetric excision group (11.8% vs. 7.4%, p = 0.57). Similarly, there was no statistical difference among patients who underwent D-shape as first surgery compared to patients who underwent symmetric excision elsewhere (11.8% vs. 9.1%, p = .75). D-shape is a safe and effective when adopted as revisional surgery at a long-term follow-up. Comparative evaluation is warranted to establish the potential superiority over different surgical surgery in case of recurrence.
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Özcan B, İlkgül Ö. Contralateral Limberg flap reconstruction for pilonidal disease recurrence. Asian J Surg 2019; 42:787-791. [PMID: 30711442 DOI: 10.1016/j.asjsur.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022] Open
Abstract
To identify surgical techniques applied in case of recurrence in patients with pilonidal sinus, who have undergone primary treatment with Limberg flap, and to present our cases treated with Limberg flap reconstruction prepared from the contralateral gluteal region. Nine patients with recurrence out of 219 patients who underwent Limberg flap reconstruction between 2009 and 2016 at our clinics, and 6 patients who have been referred to our clinics with total 15 recurrence after primary Limberg flap reconstruction at other institutes were included in the study. Total excision and primary repair was applied in 3 patients while 2 patients underwent excision with lay open procedures. The remaining 10 patients underwent rhomboid excision of the recurrence area and Limberg flap repair from the contralateral gluteal area. All patients who underwent primary repair or excision-lay open procedures recurred again. These two patients also underwent contralateral Limberg flap reconstruction as their second revision surgery. There were no complications or recurrences in the study group. We believe that reconstruction with contralateral Limberg flap is an effective and feasible method in recurrent pilonidal sinus cases who have been initially treated surgically by the Limberg flap.
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Affiliation(s)
- Barış Özcan
- Memorial Oncology Group, Medstar Antalya Hospital, Department of General Surgery, Antalya, Turkey.
| | - Özer İlkgül
- Memorial Oncology Group, Medstar Antalya Hospital, Department of General Surgery, Antalya, Turkey
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9
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The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum 2019; 62:146-157. [PMID: 30640830 DOI: 10.1097/dcr.0000000000001237] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Jabbar MS, Bhutta MM, Puri N. Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection. Pak J Med Sci 2018; 34:49-53. [PMID: 29643877 PMCID: PMC5857027 DOI: 10.12669/pjms.341.13929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Pilonidal sinus is a disorder of the sacrococcygeal region affecting younger individuals with a higher hair and weight distribution. Treatment involves the use of various surgical modalities, most of which are associated with a high rate of complications. Open procedure (OP) and Limberg Flap (LF) are two commonly performed surgical procedures for the correction of pilonidal sinus disease in our setup. The objective of our study was to compare the treatment of pilonidal sinus disease by primary closure with Limberg Flap verses Open procedure in terms of frequency of postoperative wound infection. Methods The study is a randomized clinical trial (RCT) conducted at the department of surgery, military hospital, Rawalpindi, Pakistan. It was carried out over a period of 8 months from 16 February, 2015 to 16 September, 2015. Using consecutive non-probability sampling, a total of 60 patients were selected, 30 of whom underwent Limberg Flap procedure and the remaining 30 underwent open procedure. Postoperatively, observations for wound infection on date of discharge and then again on the various follow-up visits over the next 3 weeks. The data collected was then compared by applying the chi-square test, with p-value less than 0.05 considered statistically significant. Results Our results showed that both primary closure with Limberg flap, and open procedure are comparable options in terms of wound infection. There was no statistical significance in the incidence of post operative infections, between the two surgeries. Conclusion In terms of wound infection, both procedures are satisfactory surgical procedures for Pilonidal sinus disease.
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Affiliation(s)
| | - Mahwish Mahboob Bhutta
- Dr. Mahwish Mahboob Bhutta, Medical Student, Bahria University Medical and Dental College, PNS Shifa Hospital, Karachi, Pakistan
| | - Nayyab Puri
- Dr. Nayyab Puri, FCPS Part 2 Resident, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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12
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Kunduz E, Idiz UO, Aysan E, Guzel M, Yapalak Y, Baskoy L. Videoendoscopic pilonidal sinus surgery: early results with a new technique. Eur Surg 2017. [DOI: 10.1007/s10353-017-0497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Tavangari FR, Lee JA, Garza D, Tejirian T. Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease. Am Surg 2017. [DOI: 10.1177/000313481708301006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.
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Affiliation(s)
- Farees Ricky Tavangari
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Jennifer Amy Lee
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - David Garza
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Talar Tejirian
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Zagory JA, Golden J, Holoyda K, Demeter N, Nguyen NX. Excision and Primary Closure May be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population. Am Surg 2016. [DOI: 10.1177/000313481608201023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13–20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure. Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively. Ten (16.7%) patients developed postoperative complications, which were similar among surgical groups, gender, and body mass index. The average length of stay was 0.67 (median 0, range, 0–5) days. Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01). Pilonidal disease remains surgically challenging. Our data suggest that excision and primary closure is a better option in the pediatric population.
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Affiliation(s)
- Jessica A. Zagory
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Jamie Golden
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Kathleen Holoyda
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Natalie Demeter
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Nam X. Nguyen
- From the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
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15
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Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Nouritaromlou MK. Risk factors for complications and recurrence after the Karydakis flap. J Surg Res 2016; 204:55-60. [DOI: 10.1016/j.jss.2016.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/31/2016] [Accepted: 04/15/2016] [Indexed: 12/19/2022]
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Elalfy K, Emile S, Lotfy A, Youssef M, Elfeki H. Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: A prospective cohort study. Int J Surg 2016; 29:1-8. [DOI: 10.1016/j.ijsu.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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Garg P, Menon GR, Gupta V. Laying open (deroofing) and curettage of sinus as treatment of pilonidal disease: a systematic review and meta-analysis. ANZ J Surg 2015; 86:27-33. [PMID: 26612320 DOI: 10.1111/ans.13377] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Pankaj Garg
- Department of General Surgery; Indus Super Specialty Hospital; Mohali Punjab India
| | | | - Vikas Gupta
- Postgraduate Institute of Medical Education and Research; Chandigarh India
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Chia CLK, Tay VWY, Mantoo SK. Endoscopic Pilonidal Sinus Treatment in the Asian Population. Surg Laparosc Endosc Percutan Tech 2015; 25:e95-7. [DOI: 10.1097/sle.0000000000000131] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Omer Y, Hayrettin D, Murat C, Mustafa Y, Evren D. Comparison of modified limberg flap and modified elliptical rotation flap for pilonidal sinus surgery: A retrospective cohort study. Int J Surg 2015; 16:74-77. [DOI: 10.1016/j.ijsu.2015.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/14/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
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Abstract
Treatment options of pilonidal sinus, which has high recurrence rates, is still controversial. In this study, we aimed to analyze for possible factors affecting recurrence. Forty-one patients with recurrent pilonidal sinus were included in this study. Of them, 33 were male and 9 were female (mean age, 24.9 years; age range, 16-42). Factors (i.e., risk factors) were detected in 32 patients. Excision-secondary healing and lay open was performed on 30 of the patients admitted with recurrence. Excision and flap closure was applied on 11 patients. Our recurrence rate was 9.7%. The recurrence rate of our study is compatible with the literature. Comparative studies are needed to determine the appropriate method to decrease recurrence rate.
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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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22
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Brusciano L, Limongelli P, del Genio G, Tolone S, Amoroso V, Docimo G, Docimo L. D-Shape Asymmetric Excision of Sacrococcygeal Pilonidal Sinus With Primary Closure, Suction Drain, and Subcuticular Skin Closure. Surg Innov 2014; 22:143-8. [DOI: 10.1177/1553350614535856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Few studies have reported long-term recurrence rates after asymmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. Methods. A retrospective analysis of a prospectively maintained database of 550 surgical excisions performed for sacrococcygeal pilonidal disease between 1988 and 2005 was performed. Results. A total of 550 patients with a diagnosis of pilonidal sinus underwent surgical excision over a period of 17 years. Thirty-eight out of the 550 patients (3.5%) were lost at follow-up. At a mean follow up of 11.2 ± 5.3 years, median 11 years (range = 3-22), the recurrence rate was 8.9%. Actuarial 1-, 5-, 10-, and 20-year disease-free survival rates were 98%, 94%, 92%, and 83%, respectively, with a median overall disease-free survival of 10 years (95% confidence interval [CI] = 3-15). When patients were stratified according to several variables known to influence recurrence, an age of less or ≥22 years (odds ratio [OR] = 1.5, 95% CI = 0.3-7.5, P = .001), a family history of sinus (OR = 5.9, 95% CI = 2.7-12, P = .0001), and intraoperative methylene blue use (OR = 6.3, 95% CI = 1.2-31, P = .024) were indicated as independent predictors of disease-free survival rates. Conclusions. D-shape asymmetric excision and scar lateralization, with primary multilayer subcuticular closure, suction drain insertion, and skin closure in patients with sacrococcygeal pilonidal disease is a safe and adequate surgical treatment offering an effective healing rate as well as low recurrence. Several features are likely to predict a better or a worse long-term recurrence rate in patients undergoing surgery for sinus pilonidalis.
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Formanek MB, Herwaldt LA, Perencevich EN, Schweizer ML. Gentamicin/collagen sponge use may reduce the risk of surgical site infections for patients undergoing cardiac operations: a meta-analysis. Surg Infect (Larchmt) 2014; 15:244-55. [PMID: 24773201 PMCID: PMC4063378 DOI: 10.1089/sur.2012.209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A meta-analysis of all published randomized controlled trials of the effectiveness of gentamicin/collagen sponges for preventing surgical site infections (SSIs). BACKGROUND Despite routine use of systemic prophylactic antimicrobial agents, SSIs continue to be associated with substantial morbidity. RESULTS conflict of studies of the efficacy of gentamicin/collagen sponges for preventing SSIs. However, many of these studies have assessed sponge use in only a single specific type of operation. The general effect of sponge use among different types of operations has not been previously assessed. METHODS The PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for articles appearing from 1990 through January 2012 that were related to gentamicin/collagen sponge use and SSIs. Summary estimates were obtained through a random effects model. After reviewing 714 article abstracts and reviewing 22 articles in detail, we pooled the odds ratios (OR) for 13 independent study populations (cardiac, n=4; colorectal, n=4; pilonidal sinus, n=2; hernia, n=2; gastrointestinal, n=1) in which the association between prophylactic use of gentamicin/collagen sponges and SSIs was assessed. RESULTS Pooling of the results of all studies included in the review in a random effects model showed a significant protective effect of prophylactic use of gentamicin/collagen sponges against SSI (pooled OR: 0.66; 95% confidence interval [CI]: 0.45, 0.97; n=13). However, when the data were stratified by type of operation, a significant protective effect was observed in cardiac procedures (pooled OR: 0.59; 95% CI: 0.37, 0.96; n=4) but not in colorectal procedures (pooled OR: 0.74; 95% CI: 0.29-1.92; n=4). CONCLUSION Use of gentamicin/collagen sponges was associated with a reduced risk of SSI following cardiac operations but not following colorectal procedures.
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Affiliation(s)
- Michelle B. Formanek
- College of Public Health, University of Iowa, Iowa City, Iowa
- Center for Comprehensive Access and Delivery Research and Evaluation VA Health Care System, Iowa City, Iowa
| | - Loreen A. Herwaldt
- College of Public Health, University of Iowa, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Eli N. Perencevich
- Center for Comprehensive Access and Delivery Research and Evaluation VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Marin L. Schweizer
- College of Public Health, University of Iowa, Iowa City, Iowa
- Center for Comprehensive Access and Delivery Research and Evaluation VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Fitzpatrick EB, Chesley PM, Oguntoye MO, Maykel JA, Johnson EK, Steele SR. Pilonidal disease in a military population: how far have we really come? Am J Surg 2014; 207:907-14. [DOI: 10.1016/j.amjsurg.2013.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 11/25/2022]
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Limongelli P, Brusciano L, Di Stazio C, del Genio G, Tolone S, Lucido FS, Amoroso V, D'Alessandro A, Docimo G, Docimo L. D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. Am J Surg 2014; 207:882-9. [DOI: 10.1016/j.amjsurg.2013.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
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Pilonidal sinus disease: risk factors for postoperative complications and recurrence. Int Surg 2014; 97:224-9. [PMID: 23113850 DOI: 10.9738/cc86.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus number (P = 0.005), cavity diameter (P = 0.002), and primary closure (P = 0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.
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Milone M, Musella M, Maietta P, Bianco P, Taffuri C, Salvatore G, Milone F. Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method? Surg Today 2013; 44:1638-42. [PMID: 24078028 DOI: 10.1007/s00595-013-0741-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/07/2013] [Indexed: 12/01/2022]
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Sacrococcygeal foreign body progressing with pilonidal sinus clinical picture: report of a case. J Emerg Med 2013; 45:e205-7. [PMID: 23871483 DOI: 10.1016/j.jemermed.2013.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/09/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pilonidal sinus is a benign anorectal disease that is frequently seen in the sacrococcygeal area when a foreign body reaction develops after the invasion of hair follicles. OBJECTIVES Trauma in this region and clinical abscesses that recur after trauma due to foreign bodies are not frequently observed. CASE REPORT This study presents the case of a patient with chronic leakage who had a history of three surgical procedures due to recurrent pilonidal abscesses and the presence of a foreign body in the sacrococcygeal area. CONCLUSION The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware.
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Karydakis flap procedure in patients with sacrococcygeal pilonidal sinus disease: experience of a single centre in Istanbul. ScientificWorldJournal 2013; 2013:807027. [PMID: 23766710 PMCID: PMC3666289 DOI: 10.1155/2013/807027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this retrospective study was to evaluate the results of patients with sacrococcygeal pilonidal sinus who underwent surgery using the Karydakis technique. Methods. Two hundred fifty-seven patients with sacrococcygeal pilonidal sinus disease were treated by the Karydakis flap procedure between December 2003 and June 2011. Patients were evaluated with respect to age, gender, preoperative symptoms, duration of preoperative symptoms, history of pilonidal sinus surgery, early postoperative complications, recurrence rates, and cosmetic satisfaction. Results. There were 223 (86.8%) male and 34 (13.2%) female patients. The mean age of the patients was 27.15 ± 7.69 years. The most frequent symptom was seropurulent discharge (57.58%). Postoperative morbidity was noted in 24 patients (9.3%). The mean hospital length of stay was 3.34 ± 1.42 days. The cosmetic satisfaction rate was 91.06%. Recurrences were noted in 6 patients (2.3%). Conclusion. The Karydakis flap procedure is a safe treatment alternative for the surgical treatment of sacrococcygeal pilonidal sinus disease owing to the associated low complication rate, short hospital length of stay, rapid healing, and a high patient satisfaction rate.
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Harris CL, Laforet K, Sibbald RG, Bishop R. Twelve common mistakes in pilonidal sinus care. Adv Skin Wound Care 2012; 25:324-32; quiz 333-4. [PMID: 22713784 DOI: 10.1097/01.asw.0000416004.70465.8a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healing of pilonidal sinus wounds (PSWs) by secondary intention requires an average of 2 to 6 months, but delayed healing may require 1 to 2 years or even longer. Characteristically, these midline wounds are in the natal cleft of the buttocks or sacrococcygeal area of the back. These PSWs have costly financial consequences to the healthcare system and negatively affect the quality of life of the individual with the wound. This article contains an evidence-based literature review supplemented by the clinical expert opinion of the authors. Twelve leading mistakes in assessment and treatment have been identified with appropriate solutions to optimize patient outcomes. A case study is included to illustrate the common clinical challenges with strategies to optimize healing.
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Affiliation(s)
- Connie L Harris
- South West Regional Wound Care Framework Initiative, London, Ontario, Canada
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32
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Ragab Raga AM. Oblique Excision and Primary Closure of Pilonidal Sinus (Sacrococcygeal). ACTA ACUST UNITED AC 2012. [DOI: 10.3923/tmr.2012.62.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sakr MF, Elserafy ME, Hamed HM, Ramadan MA, Kantoush HE, El-Torky HM. Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ss.2012.33029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Colorectal Dis 2011; 26:1601-7. [PMID: 21573899 DOI: 10.1007/s00384-011-1242-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the influence of cavity drainage in the surgical treatment of sacrococcygeal pilonidal sinuses. METHODS The study was prospectively carried out in 803 patients randomized into two groups of respectively 401 and 402 patients. In the first group, primary excision and closure were associated with drainage of the wound; in the second group, the wound was not drained. We have analyzed time off work, time to walk without pain, time to sitting on the toilet without pain, recurrences, and wound infections. We have also evaluated the satisfaction rate and esthetic results. RESULTS On comparing time off work, time to walk without pain, and time to sitting on toilet without pain postoperatively, there were no significant differences between the two groups. A significant difference between the two groups with regard to wound infection rates (p = 0.5) and recurrence rates (p = 0.6) was not observed. In order to prevent prolonged inpatient stay and social intolerance, this study suggests that the post-operative period is tolerated by a few when a drain was used. The visual analog scale (VAS) in the drained group was 3.2 ± 0.9, and VAS in the non-drained group was 3.5 ± 0.9 with a significant statistical difference (p = 0.0001). As regards the cosmetic appearance of the scar after surgery, we achieved a high satisfaction rate among patients in either group with 82.9% good cosmetic results. CONCLUSIONS The use of a drain, in our experience, appears to be useless in achieving a quick healing of the sacral wound; in addition, it has a low satisfaction rate.
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Gendy AS, Glick RD, Hong AR, Dolgin SE, Soffer SZ, Landers H, Herrforth M, Rosen NG. A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 2011; 46:1256-9. [PMID: 21683232 DOI: 10.1016/j.jpedsurg.2011.03.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 03/26/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE The cleft lift for pilonidal disease is a flap procedure designed to counteract suspected causes of closed-technique failure. This study compares cleft lift with wide excision and packing in adolescents with respect to complications, healing, and recurrence. METHODS Charts of all patients surgically treated for pilonidal disease at our institution from August 2000 to August 2009 were reviewed retrospectively. Wide excision was routinely performed until May 2007 when the cleft lift as described by Bascom was instituted here. Factors examined were postoperative complications, wound healing, and disease recurrence. RESULTS Seventy patients (49 males, 21 females; mean age, 16 years; mean weight, 170.5 lb) with pilonidal disease underwent a total of 39 cleft lift procedures and 34 wide excision procedures. All but 1 cleft lift patient (97.4%) healed completely, whereas 25 (73.5%) of 34 patients in the excision group healed (P < .001). The remaining 9 excision patients had chronic wounds, 3 of whom have undergone cleft lift with full healing. One cleft lift patient had recurrent disease (2.5%) compared with 7 (20.6%) of 34 excision patients (P < .02). CONCLUSIONS The cleft lift procedure is a superior treatment method of pilonidal disease in adolescents, resulting in primary healing, lower likelihood of recurrent disease, and simplified wound care.
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Affiliation(s)
- Amir S Gendy
- Department of General Surgery, Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA
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Bognár G, Barabás L, Ledniczky G, Tamás R, Lóderer Z, Kovács I, Ondrejka P. [Definitive treatment of multiple recurrences of sacral dermoid cysts using an inferior gluteal artery perforator fasciocutaneous flap]. Magy Seb 2011; 64:37-42. [PMID: 21330262 DOI: 10.1556/maseb.64.2011.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM Treatment of sacral dermoid cysts (SDC) is a surgical challenge. Etiology and adequate operative technique of that are debated widely up to now, and recurrence rates remained high despite various surgical techniques applied. In cases of unsuccessfully operated and repeatedly recurrent SDC a fascio-cutaneous flap on the first perforating branch of the inferior gluteal artery (IGA) is a definitive procedure. MATERIAL AND METHOD Following preparation and dissection of sidebranches of IGA in cadavers, a repeatedly recurrent SDC was operated. CONCLUSION a flap harvested and transferred on the first superficial perforating branch(es) of the inferior gluteal artery offers a definitive and recurrence-free surgical solution for SDC.
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Affiliation(s)
- Gábor Bognár
- Semmelweis Egyetem II. sz. Sebészeti Klinika 1125 Budapest Kútvölgyi út 4.
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Thompson MR, Senapati A, Kitchen P. Simple day-case surgery for pilonidal sinus disease. Br J Surg 2011; 98:198-209. [PMID: 21125608 DOI: 10.1002/bjs.7292] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- M R Thompson
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, UK.
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39
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Affiliation(s)
- L. Bradley
- Ulster Community & Hospitals Trust & School of Nursing & Midwifery, Queen's University, Belfast
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40
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Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 2010; 200:9-14. [PMID: 20637332 DOI: 10.1016/j.amjsurg.2009.05.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The best surgical technique for sacrococcygeal pilonidal disease is still controversial. The aim of this randomized prospective trial was to compare both the results of Limberg flap procedure and primary closure. METHODS A total of 260 patients with sacrococcygeal pilonidal disease were assigned randomly to undergo Limberg flap procedure or tension-free primary closure. RESULTS Success of surgery was achieved in 84.62% of Limberg flap patients versus 77.69% of primary closure (P = .0793). Surgical time for primary closure was shorter. Wound infection was more frequent in the primary closure group (P = .0254), which experienced less postoperative pain (P < .0001). No significant difference was found in time off from work (P = .672) and wound dehiscence. Recurrence was observed in 3.84% versus 0% in the primary closure versus Limberg flap group (P = .153). CONCLUSIONS Our results do not show a clear benefit for surgical management by Limberg flap or primary closure. Limberg flap showed less convalescence and wound infection; our technique of tension-free primary closure was a day case procedure, less painful, and shorter than Limberg flap.
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Affiliation(s)
- Marco Gallinella Muzi
- Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, Rome, Italy
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Abstract
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.
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Affiliation(s)
- Franklin P Bendewald
- Department of General Surgery, Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Yetim I, Ozkan OV, Derviłoglu A, Erzurumlu K, Canbolant E. Effect of Gentamicin-absorbed Collagen in Wound Healing in Pilonidal Sinus Surgery: A Prospective Randomized Study. J Int Med Res 2010; 38:1029-33. [DOI: 10.1177/147323001003800329] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.
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Affiliation(s)
- I Yetim
- Department of General Surgery, Mustafa Kemal University Medical Faculty, Antakya-Hatay, Turkey
| | - OV Ozkan
- Department of General Surgery, Mustafa Kemal University Medical Faculty, Antakya-Hatay, Turkey
| | - A Derviłoglu
- Department of General Surgery, Medicalpark Private Hospital, Istanbul, Turkey
| | - K Erzurumlu
- Department of General Surgery, Ondokuz Mayis University (OMU) Medical Faculty, Samsun, Turkey
| | - E Canbolant
- Department of General Surgery, Mustafa Kemal University Medical Faculty, Antakya-Hatay, Turkey
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43
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Humphries AE, Duncan JE. Evaluation and Management of Pilonidal Disease. Surg Clin North Am 2010; 90:113-24, Table of Contents. [DOI: 10.1016/j.suc.2009.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH. Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 2009; 11:705-10. [PMID: 18637924 DOI: 10.1111/j.1463-1318.2008.01646.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The study was designed to compare the early postoperative results of the commonly used two surgical flap procedures in pilonidal disease: Karydakis and Limberg. METHOD One hundred patients were randomized into two groups and standard Limberg or Karydakis procedures were performed. All had primary sinus orifices. Infected cases and the ones with secondary orifices over 2 cm distant from primary were excluded. Data were recorded concerning complications, need for analgesia and wound dressing, periods of time off work and off driving. Patients were asked to classify their first defecation manner after the operation and also pain according to a Visual Analogue Scale with range of 1-10. RESULTS There was a significantly higher wound infection rate in the Karydakis group than in the Limberg group (13/50 and 4/50 respectively). This also resulted in significantly higher values for wound dressings and need for analgesia. The time off work and off driving and also the Visual Analogue Scale scores were not significantly different between the two groups. CONCLUSION Both procedures can be safely performed in pilonidal disease with a standard length of stay in hospital and a similar loss of productive power. However, the Karydakis flap seems to have a significant higher infection rate and this probably increases the cost.
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Affiliation(s)
- E Ersoy
- Department of General Surgery, Ataturk Research and Training Hospital, Ankara, Turkey.
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Topgül K. Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap. J Eur Acad Dermatol Venereol 2009; 24:7-12. [PMID: 19627408 DOI: 10.1111/j.1468-3083.2009.03350.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this review, we summarized the general characteristics of pilonidal sinus disease and details of rhomboid flap (RF) technique used in its treatment, and discussed the results of RF methods and its comparison with other techniques, principally with flap technique available in the literature. When performed studies are examined, RF technique has come into prominence nowadays with low recurrence and infection rates, and with a comfortable surgical technique. Recently, it has been anticipated that with the modification of this technique, the recurrence rate would be lower.
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Affiliation(s)
- K Topgül
- Department of Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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Moosavi SR, Kharazm P, Vaghardoost R. Surgical treatment of pilonidal sinus with a fasciocutaneous rotation flap based on an inferior pedicle. ACTA ACUST UNITED AC 2009; 40:281-3. [PMID: 17065117 DOI: 10.1080/02844310600869811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pilonidal sinus is a common disorder of the sacrococcygeal region and several surgical treatments have been described. However, rates of recurrences and complications vary, so there is no consensus on one specific approach. In this prospective study from 1 August 2000 to 1 August 2003, 60 patients with pilonidal sinus were treated by our new surgical technique. All patients were operated on by the first author or under his supervision. A vertical elliptical excision was made, and the defect repaired by a fasciocutaneous rotation flap based on the inferior pedicle under general anaesthesia. All patients were discharged from hospital on the first postoperative day. By the 12th day, the wound had healed completely. There were no recurrences during one years' follow-up. Postoperative pain was negligible and the scar was cosmetically acceptable. The inferiorly-based rotation flap is an ideal technique for treatment of pilonidal sinus, cures the disease, has low recurrence rates, little postoperative pain, and few complications. Stay in hospital was short and patients returned to their regular activities in a short time.
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Affiliation(s)
- Seyyed Reza Moosavi
- Department of Vascular and General Surgery, Shohada-E-Tajrish Hospital, Tehran, Iran.
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48
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49
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El-Tawil S, Carapeti E. Use of a double rhomboid transposition flap in the treatment of extensive complex pilonidal sinus disease. Colorectal Dis 2009; 11:313-7. [PMID: 18513189 DOI: 10.1111/j.1463-1318.2008.01596.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Rhomboid transposition flaps are safe and successful in treating recurrent, complex pilonidal disease. There are little data on treatment of very large (> 12 cm) pilonidal sinuses. We describe a new technique using two simultaneous rhomboid flaps to achieve primary closure following extensive wide-excision. METHOD With antibiotic prophylaxis, the sinus is excised en-bloc as a parallelogram (two adjacent rhomboids). Two rhomboid fasciocutaneous flaps are transposed to close this defect over suction-drains. Sutures are removed after 14 days. RESULTS Eight patients (seven males) were treated with this technique (median age 26 years; range 22-35 years). All had very extensive and recurrent disease, having had multiple previous procedures. Median drain-duration was 2 days (range 1-5 days) and postoperative stay was 2 days (range 0-5 days). One complication arose: a wound infection with partial dehiscence which healed with conservative treatment. No recurrence or further complication arose in a 33-month follow-up (range 8-41 months). CONCLUSION This is the first description of the use of two simultaneous rhomboid flaps for very large recurrent pilonidal disease. It is a relatively simple and safe alternative to major plastic reconstruction which is often resorted to in such large-scale disease.
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Affiliation(s)
- S El-Tawil
- Department of Colorectal Surgery, St Thomas' Hospital, London, UK
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50
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el-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the Rhomboid Flap for Recurrent Pilonidal Disease. World J Surg 2009; 33:1064-8. [DOI: 10.1007/s00268-009-9920-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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