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Singh S, Desai K, Gillern S. Management of Pilonidal Disease and Hidradenitis Suppurativa. Surg Clin North Am 2024; 104:503-515. [PMID: 38677816 DOI: 10.1016/j.suc.2023.11.003] [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] [Indexed: 04/29/2024]
Abstract
Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.
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Affiliation(s)
- Sneha Singh
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Kaushal Desai
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Suzanne Gillern
- Colon & Rectal Surgery, Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA.
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Sabapaty A, Salimi-Jazi F, Abrajano C, Yousefi R, Garza D, Dalusag KS, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease. Pediatr Surg Int 2024; 40:66. [PMID: 38436736 DOI: 10.1007/s00383-024-05644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. METHODS A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. RESULTS Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2 years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18 years) and adults (≥ 18 years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. CONCLUSIONS Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.
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Affiliation(s)
- Akanksha Sabapaty
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Fereshteh Salimi-Jazi
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, 301 University Boulevard Galveston, University of Texas Medical Branch, 108 Basic Science Building, Galveston, TX, 77555, USA
| | - Deanna Garza
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
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Gratiashvili E, Akhmeteli L, Ivanishvili T, Kobadze S, Giorgadze N. Efficacy of laser obliteration with limited excision of pilonidal sinus. J Int Med Res 2024; 52:3000605241236057. [PMID: 38530042 DOI: 10.1177/03000605241236057] [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] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.
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Affiliation(s)
- Erekle Gratiashvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Lali Akhmeteli
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Teimuraz Ivanishvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Salome Kobadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Nodar Giorgadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
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Tyrväinen E, Nuutinen H, Savikkomaa E, Myllykangas HM. Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease. Lasers Med Sci 2024; 39:52. [PMID: 38291247 PMCID: PMC10827894 DOI: 10.1007/s10103-024-03993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.
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Affiliation(s)
- Emmi Tyrväinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Henrik Nuutinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Elina Savikkomaa
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Heidi-Mari Myllykangas
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland.
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Şahin AG, Alçı E. Use of the laser in the pilonidal sinus alone or in combination with phenol. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230740. [PMID: 37971129 PMCID: PMC10645176 DOI: 10.1590/1806-9282.20230740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus. METHODS We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022. RESULTS Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing. CONCLUSION Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.
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Affiliation(s)
- Azad Gazi Şahin
- Balikesir University, School of Medicine, Department of General Surgery – Balikesir, Turkey
| | - Erman Alçı
- Balikesir University, School of Medicine, Department of General Surgery – Balikesir, Turkey
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Bilgin IA, Tanal M, Ramoglu N, Ozben V, Sahin I, Aghayeva A, Sahar AA, Saylik O, Baca B, Hamzaoglu I, Karahasanoglu T. Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes. Tech Coloproctol 2023; 27:921-928. [PMID: 37356014 DOI: 10.1007/s10151-023-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.
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Affiliation(s)
- I A Bilgin
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - M Tanal
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - N Ramoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - V Ozben
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - I Sahin
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - A Aghayeva
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - A A Sahar
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - O Saylik
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - B Baca
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - I Hamzaoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - T Karahasanoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Amorim M, Estevão-Costa J, Santos C, Fernandes S, Fragoso AC. Minimally invasive surgery for pilonidal disease: Outcomes of the Gips technique-A systematic review and meta-analysis. Surgery 2023; 174:480-486. [PMID: 37419759 DOI: 10.1016/j.surg.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/01/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Pilonidal disease is a common inflammatory condition that significantly impacts quality of life. Currently, there is a tendency to favor minimally invasive procedures. The present review aims to summarize the evidence and assess the outcomes of the Gips procedure. METHODS A systematic review was conducted on MEDLINE/Pubmed, Scopus, Web of Science, and Cochrane Library databases until December 2022. Eligible studies included patients with pilonidal disease submitted to the Gips procedure, reporting at least 1 of the following outcomes: wound complications, wound healing time, time to resume daily activities, and recurrence (International Prospective Register of Systematic Reviews protocol: CRD42023389269). The National Institutes of Health assessment tool was used for risk of bias evaluation. Meta-analysis was performed using OpenMeta[Analyst] and R software, and a subgroup analysis was performed when applicable. RESULTS Thirteen observational studies with a total of 4,286 patients submitted to Gips were included. The pooled wound complications rate was 7.8% (95% confidence interval: 5.1-10.6), the median time to resume daily activities was 1 day (95% confidence interval: 1-2), and the mean wound healing time was 4.7 weeks (95% confidence interval: 3.0-6.4). Subgroup analysis showed that pooled recurrence rate was 6.5% (95% confidence interval: 5.2-7.8) up to 2 years and 38.9% (95% confidence interval: 27.1-50.7) after more than 2 years of surgery. Most results showed substantial heterogeneity across studies. CONCLUSION Despite apparent favorable outcomes of the Gips procedure, there is a high recurrence rate over time. Because included studies had an observational nature and unstandardized methodologies, comparative randomized controlled trials with longer follow-ups are needed for high-level evidence regarding these outcomes.
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Affiliation(s)
- Marta Amorim
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
| | - José Estevão-Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Cristina Santos
- CINTESIS@RISE, Faculty of Medicine of the University of Porto, Portugal
| | - Sara Fernandes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Ana Catarina Fragoso
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
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Jastrząb B, Szepietowski JC, Matusiak Ł. Hidradenitis suppurativa and follicular occlusion syndrome: Where is the pathogenetic link? Clin Dermatol 2023; 41:576-583. [PMID: 37690621 DOI: 10.1016/j.clindermatol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The follicular occlusion tetrad complex encompasses several entities (hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal cyst) that share common clinical features, risk factors, and pathophysiology. Follicular occlusion is a crucial triggering mechanism in the etiology in each of these disorders, leading to development of distinctive skin lesions such as deep-seated nodules, abscesses, comedones, and draining sinuses, often with accompanying scarring. Despite the fact that the follicular occlusion tetrad components manifest multiple similarities, they also exhibit many differences among themselves and require individual approaches and treatment.
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Affiliation(s)
- Beata Jastrząb
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland.
| | - Łukasz Matusiak
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Forde E. Managing pilonidal sinus disease. Br J Gen Pract 2023; 73:299. [PMID: 37385777 PMCID: PMC10325587 DOI: 10.3399/bjgp23x733233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
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Horesh N, Meiri H, Anteby R, Zager Y, Maman R, Carter D, Meyer R, Nachmany I, Ram E. Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease. J Laparoendosc Adv Surg Tech A 2023. [PMID: 36888964 DOI: 10.1089/lap.2022.0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Hila Meiri
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Zager
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronny Maman
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Carter
- Department of Gastroenterology, and Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Ram
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Evaluation of the coexistence of pilonidal sinus disease and hirsutism in female patients: a retrospective cross-sectional study. Ann Med Surg (Lond) 2023; 85:130-135. [PMID: 36845798 PMCID: PMC9949818 DOI: 10.1097/ms9.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/22/2022] [Indexed: 02/28/2023] Open
Abstract
This study aimed to investigate the coexistence of pilonidal sinus disease (PSD) and hirsutism in female patients. Materials and methods The demographic and clinical data of 164 female patients who underwent surgery for PSD between January 2007 and May 2014 were evaluated for this retrospective cross-sectional study. Data collected for this study were age, BMI, the modified Ferriman and Gallwey scale (mFGS) for hirsutism, main symptoms, type of surgery, early postoperative complications (wound infection, wound dehiscence), recurrence, and follow-up. The independent variables are hirsutism (mFGS scores) and BMI. Dependent variables are early postoperative complications and recurrence. Results The median age was 20 years (95% CI for median: 19-21 years). According to the BMI, 45.7, 50.6, and 3.7% of patients were considered normal, overweight, and obese, respectively. According to the mFGS, 11, 9.8, 52.4, and 26.8% of patients were considered to have none, mild, moderate, or severe hirsutism, respectively. Fourteen (8.5%) patients had developed recurrence. Recurrence developed in six patients with primary closure, five patients with Limberg flaps, two patients with Karydakis, and one with marsupialization. There was no statistical difference between recurrent and nonrecurrent patients in terms of BMI (P=0.054) and mFGS (P=0.921). On the other hand, BMI was statistically significantly higher in those who developed early postoperative complications than in those who did not (P<0.001). Conclusion PSD is no longer a 'men's only disease'. BMI increases the risk of early postoperative complications, but this association was not found between BMI and recurrence. Prospective multicenter studies are needed on the relationship between PSD and hirsutism.
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Odlo M, Horn J, Xanthoulis A. Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences-a survey among Norwegian surgeons. BMC Surg 2022; 22:442. [PMID: 36575391 PMCID: PMC9795610 DOI: 10.1186/s12893-022-01889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is frequently observed in young adults. There is no wide consensus on optimal treatment in the literature, and various procedures are used in clinical practice. The objective of this study was to assess current practice, experience, training, and attitudes towards PSD surgery among Norwegian surgeons. METHODS An online survey on PSD surgery was created and sent to all members of the Norwegian Surgical Association. Categorical data were reported as frequencies and percentages. RESULTS Most currently practicing Norwegian surgeons used the Bascom's cleft lift (93.2%) or minimally invasive procedures (55.4%). Midline excisions with primary closure (19.7%) or secondary healing (22.4%) were still used by some surgeons, though. Most surgeons had received training in PSD surgery supervised by a specialist, but only about half of them felt sufficiently trained. The surgeons generally performed few PSD operations per year. Many considered PSD as a condition of low surgical status and this patient group as underprioritized. CONCLUSIONS Our findings suggest that PSD surgery in Norway has been moving away from midline excisions and towards off-midline flap procedures and minimally invasive techniques. PSD and its treatment have a low status among many Norwegian surgeons. This study calls for attention to this underprioritized group of patients and shows the need for consensus in PSD treatment such as development of national guidelines in Norway. Further investigation on training in PSD and the role of supervision is needed.
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Affiliation(s)
- Mari Odlo
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Julie Horn
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Athanasios Xanthoulis
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Platelet-Rich Plasma (PRP) for Sacrococcygeal Pilonidal Disease: An Updated Systematic Review and Meta-Analysis. World J Surg 2022; 46:2910-2918. [PMID: 36064868 DOI: 10.1007/s00268-022-06711-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pilonidal disease can be a debilitating condition which carries a significant physical and economic burden. This systematic review and updated meta-analysis presents the evidence for the use of platelet-rich plasma (PRP) for wound healing following open and minimally-invasive sacrococcygeal pilonidal surgery. METHODS A literature search was performed during December 2021 for studies relating to platelet-rich plasma and pilonidal wound healing following surgery. RESULTS Nine studies remained after applying the exclusion criteria, incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively. Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time (mean difference [MD] = - 13.98 days, 95% CI - 18.41 to - 9.55, p < 0.001, I2 = 98%). Three open surgery group studies compared post-operative time off work, while three recorded mean pain duration; pooled analysis also revealed a significant reduction in both outcomes, respectively (MD = - 8.7 days, 95% CI - 9.4 to - 8.0, p < 0.001, I2 = 57%; MD = - 9.5 days, 95% CI - 15.6 to - 3.3, p = 0.002, I2 = 98%). Methodological heterogeneity among the minimally-invasive studies precluded formal meta-analysis; however, two studies demonstrated a modest improvement in wound healing when treated with PRP. CONCLUSIONS This systematic review and updated meta-analysis provide further evidence supporting the use of PRP for wound healing in sacrococcygeal pilonidal disease. PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group. Nevertheless, there is still considerable heterogeneity among PRP manufacture and administration techniques, and further high-powered RCTs with consistent methodology are required to substantiate these findings.
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Fernandes S, Soares-Aquino C, Teixeira I, Monteiro JM, Campos M. Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques. ANZ J Surg 2022; 92:3288-3292. [PMID: 35678224 DOI: 10.1111/ans.17838] [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: 01/06/2022] [Revised: 03/27/2022] [Accepted: 05/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). CONCLUSIONS MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.
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Affiliation(s)
- Sara Fernandes
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carolina Soares-Aquino
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Inês Teixeira
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Mafalda Monteiro
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Miguel Campos
- Department of Paediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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Mirande MD, Backus JA, Linnaus ME. Intermammary pilonidal sinus disease in a 13-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Chen S, Dai G, Liu P, Zhao X, Zhang J, Yang C, Xu X, Wang L, Chen W, Wang M, Zhang D. Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials. Medicine (Baltimore) 2022; 101:e31767. [PMID: 36397424 PMCID: PMC9666099 DOI: 10.1097/md.0000000000031767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pilonidal sinus is a common disease in the sacrococcygeal region. Although many treatments have been described in recent years, the recurrence of each method remains high. Surgeons did not reach a consensus on the preferred approach for pilonidal sinus. We carried out a meta-analysis of controlled clinical trials comparing the outcomes of endoscopic treatment versus conventional treatment for pilonidal sinus disease in this study. METHODS We performed a systematic literature search, and we used electronic databases such as PubMed/Medline, Embase, and the Cochrane library to search for the relevant literature comparing endoscopic management to other conventional treatments for pilonidal sinus disease. The primary outcome parameters were operative time, recurrence, postoperative complications and pain, and total healing time. RESULTS Six studies were included in the review. Endoscopic pilonidal sinus treatment had a lower overall complication rate than the conventional surgery group (risk ratio = 0.33 [0.19-0.58], P = .0001) and lower pain score with a weighted mean difference of -2.44 (95% confidence interval: (-3.96) to (-0.92), I2 = 99%, P = .002). There was no significant difference in recurrence (risk ratio = 0.75, 95% confidence interval [0.30-1.90],P = .55). Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar. CONCLUSIONS Endoscopic pilonidal sinus treatment is a unique and potential method of sacrococcygeal pilonidal disease treatment. The foremost benefits of this technique are mild postoperative pain, lower complications rate, and return to routine for a shorter time. However, due to the limited number of articles, we need to conduct more rigorous large-sample prospective randomized controlled trials to clarify the efficiency of endoscopic treatment for pilonidal cysts.
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Affiliation(s)
- Sihan Chen
- People’s Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - Guangyao Dai
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
- * Correspondence: Guangyao Dai, Department of Anus and Intestine Surgery, People’s Hospital of Shijiazhuang affiliated to Hebei Medical University, 365 Jianhua Nan Street, Shijiazhuang City, Hebei Province, China (e-mail: )
| | - Peng Liu
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xian Zhao
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jie Zhang
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | | | - Xin Xu
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | - Liwei Wang
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | - Wen Chen
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
| | | | - Dian Zhang
- People’s Hospital of Shijiazhuang, Shijiazhuang, China
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Ergenç M, Uprak TK. Gender-specific prevalence of sacrococcygeal pilonidal sinus disease in Turkey: A retrospective analysis of a large cohort. Eur Surg 2022. [DOI: 10.1007/s10353-022-00777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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18
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Zubaidi AM, Alali MN, AlShammari SA, Zikry AH, Habib M, AlSalem AS, Sirelkhatim MH, Alharbi R. Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience. Cureus 2022; 14:e29388. [PMID: 36304355 PMCID: PMC9586186 DOI: 10.7759/cureus.29388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment. A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.
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Oliveira L, Galindo GFHR, Silva-Velazco JD. Benign Anorectal Disorder Management in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:376-389. [PMID: 36111076 PMCID: PMC9470292 DOI: 10.1055/s-0042-1755188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There are many benign anorectal disorders, which can make patients seek care. In low-resource settings, the incidence of those pathologies is not different from the industrialized and western world. However, an interesting difference colorectal surgeons and gastroenterologists can face is the fact that many patients do not seek help or are not aware and have little opportunities to be helped. Latin America population is estimated to be around 8% of the world population, with Brazil having the largest percentage. Infectious diseases, which were previously under control or were steadily declining, have emerged. For example, we have seen resurgence of dengue, malaria, and syphilis in pregnancy, as well as other sexually transmitted diseases that can affect the anorectal region. In this article, we will address the most common benign anorectal disorders.
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Affiliation(s)
- Lucia Oliveira
- Department of Anorectal Physiology of Rio de Janeiro, Ipanema Rio de Janeiro, Rio de Janeiro, Brasil
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Sophie VG, Marlene SJ, Helene HT, Lilli L, Allan PG, Susanne H. Injection of freshly collected autologous adipose tissue in complicated pilonidal disease: a prospective pilot study. Tech Coloproctol 2022; 26:883-891. [PMID: 35963978 DOI: 10.1007/s10151-022-02683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is a frequent disorder. Treatment failure and recurrence are common, leading to significant morbidity. The aim of this study was to investigate the impact and need for repeated treatment of injected autologous adipose tissue into non-healing PSD wounds and primary anal-near PSD or anal-near recurrence. METHODS At the Department of Surgery, Randers Regional Hospital, Denmark, a prospective pilot study was conducted on consecutive PSD patients with lack of healing 3 months after surgery (Bascom's cleft lift) or with primary or recurrent anal-near pilonidal sinus disease from December 2018 to March 2020. The primary endpoint was time to healing. Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision. Patients were examined 2 and 12 weeks after surgery. Patients with lack of healing after 12 weeks (undermining or no skin coverage) were offered re-injection. RESULTS We included 30 patients [26 men and 4 women, median age 24 years (range 18-59 years)]. Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9-96.7)]. Two patients had recurrence (6.7%). The median time to complete healing was 159 (189) days. The mean operation time was 70.6 ± 23.7 min and the mean amount of injected autologous adipose tissue was 19 ± 10 ml. There were no major complications. CONCLUSION Freshly collected autologous adipose tissue injected into chronic non-healing or primary and recurrent PSD lesions near the anal verge is safe and efficient.
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Affiliation(s)
| | | | | | - Lundby Lilli
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Pedersen G Allan
- Department of Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Haas Susanne
- Department of Surgery, Randers Regional Hospital, Randers, Denmark.
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21
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Pilonidal disease: A new look at an old disease. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Chopde SP, Adhikari GR. Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India. Cureus 2022; 14:e26396. [PMID: 35915671 PMCID: PMC9337795 DOI: 10.7759/cureus.26396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/05/2022] Open
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23
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Salehi V, Yavari Barhaghtalab MJ, Mehrabi S, Iraji A, Sadat SA, Yusefi SH, Malekzadeh JM. Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial. Perioper Med (Lond) 2022; 11:1. [PMID: 35000582 PMCID: PMC8744332 DOI: 10.1186/s13741-021-00237-w] [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: 08/22/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742
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Affiliation(s)
- Vahid Salehi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Saadat Mehrabi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Aida Iraji
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alimohammad Sadat
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Hadi Yusefi
- School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Jan Mohamad Malekzadeh
- Department of Nutrition, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
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Segre D. What You Should Remember in Managing Pilonidal Disease. Front Surg 2021; 8:792121. [PMID: 34950697 PMCID: PMC8688353 DOI: 10.3389/fsurg.2021.792121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Diego Segre
- Formerly Responsible Colonproctology Unit, S.Croce Hospital, Private Practice, Cuneo, Italy
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DAL MB, ALTUN H. Pilonidal Sinüsün Cerrahi Tedavisinde Limberg Flep ile Karydakis Flep Karşılaştırılması: Retrospektif Klinik Çalışma. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.854347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abdelnaby M, Fathy M, Emile SH, Arnous M, Balata M, Abdelmawla A, Abdallah E. Sinus laser therapy versus sinus lay open in the management of sacrococcygeal pilonidal disease. Colorectal Dis 2021; 23:2456-2465. [PMID: 34042233 DOI: 10.1111/codi.15755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/13/2022]
Abstract
AIM There is no standard method for the management of sacrococcygeal pilonidal disease (SPND); however, surgery remains the gold standard treatment. Wide surgical excision of the sinus is the traditional surgical treatment of SPND, yet it is associated with extended healing time and delayed recovery. This study aimed to compare the outcomes of sinus laser therapy (SiLaT) and sinus lay open in the management of SPND. METHODS Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed. The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL). RESULTS A total of 139 patients with a mean age of 25 years were included to the study. Sixty-two patients underwent SiLaT and 77 underwent lay open. Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007). Sinus lay open had a shorter operation time than SiLaT (P < 0.0001). On the other hand, SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group. The complication rates were comparable between the two groups. CONCLUSION Sinus lay open was associated with better success than SiLaT. On the other hand, SiLaT was associated with quicker healing, better cosmesis, better QoL and longer operation time. The complication rate of the two procedures was comparable.
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Affiliation(s)
- Mahmoud Abdelnaby
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Mohammad Fathy
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Mohamed Arnous
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Mohamed Balata
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdelmawla
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Emad Abdallah
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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Alrashid FF, Idris SA, Qureshi AG. Current trends in the management of pilonidal sinus disease and its outcome in a periphery hospital. AIMS MEDICAL SCIENCE 2021. [DOI: 10.3934/medsci.2021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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