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Manigrasso M, D'Amore A, Benatti E, Bracchitta LM, Bracchitta S, Cantarella F, Carpino A, Ferrari F, Gallo G, La Torre M, Magnani C, Magni E, Margiotta A, Masetti M, Mori L, Pata F, Pezza M, Tierno S, Tomassini F, Vanini P, De Palma GD, Milone M. Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience. Tech Coloproctol 2023; 27:929-935. [PMID: 37597082 DOI: 10.1007/s10151-023-02846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence. METHODS All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database. RESULTS Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden's test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%. CONCLUSIONS This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.
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Affiliation(s)
- M Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy.
| | - A D'Amore
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - E Benatti
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - L M Bracchitta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - S Bracchitta
- Coloproctolgy Center, Clinica del Mediterraneo, Ragusa, Italy
| | - F Cantarella
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Carpino
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ferrari
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - G Gallo
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - M La Torre
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - C Magnani
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - E Magni
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Margiotta
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - M Masetti
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - L Mori
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - F Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, CS, Italy
| | - M Pezza
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - S Tierno
- Department of Surgery, Ospedale Vannini, Rome, Italy
| | - F Tomassini
- Department of Surgery, Ospedale Grassi, Rome, Italy
| | - P Vanini
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - M Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
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Maione F, D'Amore A, Milone M, Vertaldi S, Anoldo P, Chini A, Sorrentino C, Marello A, Cantore G, Maione R, D'Angelo S, D'Alesio N, De Simone G, Servillo G, De Palma GD, Manigrasso M. Endoscopic approach to complex or recurrent pilonidal sinus: A retrospective analysis. Int Wound J 2023; 20:1212-1218. [PMID: 36271666 PMCID: PMC10031245 DOI: 10.1111/iwj.13980] [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: 07/30/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022] Open
Abstract
Pilonidal Sinus is a benign, chronic disease that affects the hair follicles of the natal cleft of the sacrococcygeal area. Its ideal treatment is controversial, especially in complex or recurrent cases. The aim of this study is to evaluate the use of minimally invasive endoscopic approach in this setting. We enrolled patients affected by complex or recurrent sacrococcygeal pilonidal sinus from January 2015 through December 2020 who underwent Video-Assisted Ablation of Pilonidal Sinus. All patients enrolled were re-evaluated once a year with a standard physical examination. The patients included were 38. Recurrence rate at 1-, 3- and 5-years follow-ups were 28.9%, 22.2% and 38.1% respectively. Of interest, the mean (SD) distance from the most lateral orifice to the midline was higher in group of patients with recurrence and the multivariate analysis demonstrated that it was the limiting factor, which influences the recurrence rate. In complex or recurrent pilonidal sinus disease with pits off the midline the endoscopic approach should not be the first choice. This makes us think that these cases should have their own classification to be identified and guide surgeons in choosing the appropriate approach.
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Affiliation(s)
- Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rosa Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Salvatore D'Angelo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola D'Alesio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
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Milone M, Gallo G, Grossi U, Pelizzo P, D'Amore A, Manigrasso M, Perinotti R, La Torre M, De Palma GD, Basso L. Endoscopic sinusectomy: 'a rose by any other name'. A systematic review of different endoscopic procedures to treat pilonidal disease. Colorectal Dis 2023; 25:177-190. [PMID: 36217688 DOI: 10.1111/codi.16361] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
AIM Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition. Although commonly encountered in practice, its ideal treatment is controversial. One of the most validated treatments is video-assisted surgery. In this context, very similar endoscopic techniques have been published under different names. The aim of this systematic review is to assess the differences among these proposed techniques and their outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during all stages of this systematic review. A systematic search of the English literature was performed on multiple databases from 1 January 2014 to 3 April 2022. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measures were the adherence to the IDEAL reporting guidelines, the Blencowe framework and the core outcome set (COS) for studies evaluating the introduction and evaluation of novel surgical techniques, the qualitative assessment using appropriate tools, the procedural variations and outcomes of each technique. RESULTS A total of 38 articles were included reporting a very similar technique under eight different acronyms. The number of patients varied from 9 to 250. Mean follow-up ranged from 1 to 60 months. There was only one published study of IDEAL 3. The majority (58%) were IDEAL 2a studies. Reporting of domains in the IDEAL reporting guidelines and Blencowe framework was poor, with most studies not reporting the component steps of procedures or efforts to standardize them. Half of COS domains were markedly underreported. The quality of the evidence was categorized as having a risk of bias from moderate to critical level in all nine comparative non-randomized series. Postoperative complications occurred in 0%-6% of cases, including surgical site infection, poor or failed wound healing bleeding, granuloma, haematoma, and pain requiring intervention. The recurrence rate varied from 0% to 22%. CONCLUSION The study demonstrates that reporting on technical aspects of interventions for PD is poor, thus warranting a better-quality control of surgical techniques. It is advisable to group all endoscopic procedures under the umbrella term of 'endoscopic sinusectomy', thus embracing the two main principles of this technique, that is, video assistance and PD ablation.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Gaetano Gallo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Padua, Italy
| | - Patrizia Pelizzo
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Padua, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, 'Federico II' University of Naples, Naples, Italy
| | - Roberto Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Rimini, Italy
| | - Marco La Torre
- Coloproctology Unit, Salvator Mundi International Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | | | - Luigi Basso
- 'Pietro Valdoni' Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Kargın S, Doğru O, Turan E, Kerimoğlu RS, Nazik EE, Esen E. Previously operated recurrent pilonidal sinus treated with crystallized phenol: Twenty-year experience in a cohort study. Turk J Surg 2022; 38:187-195. [PMID: 36483163 PMCID: PMC9714652 DOI: 10.47717/turkjsurg.2022.5247] [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: 02/09/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Postoperative recurrent pilonidal sinus disease is troublesome, and its treatment is a challenge. In this study, it was aimed to present the long-term efficacy of crystallized phenol treatment on postoperative recurrent pilonidal sinus disease through our results collected within the last 20 years. MATERIAL AND METHODS Two hundred and twenty-seven patients who had been previously operated on and suffered from recurrent pilonidal sinus disease were enrolled. The operation was applied in our outpatient clinic under local anesthesia. Demographic data of the patients, number of crystallized phenol treatment, duration of follow-up and recurrence numbers were prospectively recorded. Treatment success and factors affecting recurrence were examined. RESULTS Our success rate was found as 71.5%. This success rate belongs to the group of patients who never quit treatment and complied with the treatment. The patients were followed up for a mean 45.8 months. Of the post-crystallized phenol treatment recurrences, 72.4% took place within the first five years, while 97.4% did so within the first 10 years. Mean number of crystallized phenol applications was 2.6. The longer the duration of the disease before treatment, the more recurrence was observed after treatment (p= 0.02). There was no correlation between the number of previous operations and recurrence after treatment. As the number of sinus openings increased, so did the number of applications (p= 0.001). CONCLUSION Crystallized phenol treatment yields promising long-term results in recurrent pilonidal sinus disease as well and may be recommended as the first choice in recurrent pilonidal sinus disease treatment since it is an effective non-operative treatment modality.
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Affiliation(s)
- Süleyman Kargın
- Department of General Surgery, KTO Karatay University Faculty of Medicine, Konya, Türkiye
| | - Osman Doğru
- Clinic of General Surgery, Konya Research and Education Hospital, Konya, Türkiye
| | - Ersin Turan
- Clinic of General Surgery, Beyhekim State Hospital, Konya, Türkiye
| | | | - Emet Ebru Nazik
- Clinic of General Surgery, Konya Research and Education Hospital, Konya, Türkiye
| | - Ebru Esen
- Clinic of General Surgery, Konya Research and Education Hospital, Konya, Türkiye
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Vertaldi S, Anoldo P, Cantore G, Chini A, D'Amore A, D'Armiento M, Gennarelli N, Maione F, Manigrasso M, Marello A, Schettino P, Sorrentino C, Sosa Fernandez LM, De Palma GD, Milone M. Histopathological Examination and Endoscopic Sinusectomy: Is It Possible? Front Surg 2022; 9:793858. [PMID: 35310433 PMCID: PMC8927015 DOI: 10.3389/fsurg.2022.793858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Although carcinomatous degeneration is a rare occurrence, some authors support the need for a histopathological examination after pilonidal cyst excision. Today, minimally invasive techniques are widely spread for the treatment of pilonidal sinus disease but opposed to standard procedures, these techniques could not allow to perform a histopathological examination because of the absence of a specimen. The aim of this two-institutions study is to evaluate whether histopathological examination of the pilonidal sinus excision material can be successfully performed after an endoscopic ablation of the cyst. Materials and Methods We identified all consecutive patients from January 2021 to September 2021 with diagnosis of pilonidal sinus disease who underwent Video Assisted Ablation of Pilonidal Sinus (VAAPS) followed by histopathological examination. Results A total of 45 patients were included in the study. All patients were Caucasians and aged below 50 years. Nine of them underwent surgery due to recurrence of PSD. No evidence of malignancy was detected in the histopathological examination of the pilonidal sinus sampling material. Discussion We were able to send pilonidal sinus sampling material for a histopathological examination in all patients who underwent minimally invasive technique for the treatment of pilonidal sinus disease. No evidence of malignancy was found in any of the 45 samples. Our findings prove that minimally invasive ablation of pilonidal sinus does not preclude histopathological examination of the cysts.
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Affiliation(s)
- Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
- *Correspondence: Sara Vertaldi
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Maria D'Armiento
- Pathology Unit, Department of Public Health, University of Naples “Federico II”, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Pietro Schettino
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | | | - Giovanni D. De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
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Milone M, Velotti N, Manigrasso M, Vertaldi S, Di Lauro K, De Simone G, Cirillo V, Maione F, Gennarelli N, Sosa Fernandez LM, De Palma GD. Long-term results of a randomized clinical trial comparing endoscopic versus conventional treatment of pilonidal sinus. Int J Surg 2020; 74:81-85. [PMID: 31926328 DOI: 10.1016/j.ijsu.2019.12.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the new era of minimally invasive surgery, recent studies encouraged the adoption of endoscopic approaches as the most effective way to treat (pilonidal sinus disease) PSD but little is known about long-term results of minimally invasive procedures. MATERIALS AND METHODS A total of 145 patients with chronic non recurrent pilonidal sinus were enrolled for this randomized controlled trial. The follow-up rate was 97% at 5 years for a total of 74 patients assigned to the minimally invasive treatment group and 67 patients assigned to the conventional Bascom cleft lift treatment group. We evaluated the following outcomes: long-term recurrence rate, patients' satisfaction, cosmetic outcome and cost-effectiveness results. RESULTS Long-term data confirm that the recurrence rate was similar in both groups and, in minimally invasive patients, there were a higher satisfaction and better cosmetic results. Costs analysis revealed improved outcome in favour of VAAPS with a much lower mean global cost. CONCLUSION Minimally invasive treatment has all the characteristics of an ideal approach to PSD with advantages including minimal patient inconveniences, high satisfaction and good aesthetics results. It was also more cost effective to carry out the treatment.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Nunzio Velotti
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Katia Di Lauro
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Vera Cirillo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Loredana Maria Sosa Fernandez
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, Anoldo P, Aprea G, Simone GD, Vitiello A, Musella M, Milone M, De Palma GD, Milone F, Sosa Fernandez LM. Minimally Invasive Pilonidal Sinus Treatment: A Narrative Review. Open Med (Wars) 2019; 14:532-536. [PMID: 31428682 PMCID: PMC6698053 DOI: 10.1515/med-2019-0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
The management of chronic pilonidal disease remains controversial, but recently, new minimal invasive approaches have been proposed. Whereas in the conventional surgical treatment an elliptical wedge of skin and subcutaneous tissue is created to remove the sinus and its lateral tracks, the basis for our new treatment is to create a minimal elliptical wedge of the subcutaneous tissue, including all the inflamed tissue and debris while leaving the overlying skin intact. The mechanism of an endoscopic approach relies on use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to work and daily activities. However, it is mandatory that further studies would analyze surgical approaches to pilonidal sinus disease (PSD) with a consistent and adequate follow-up of at least 5 years. Both sinusectomy and endoscopic approach to PSD were found to be safe and effective compared with conventional techniques. Publishedresults of studies of newer approaches have demonstrated a low short-term complication rate, comparable to conventional surgery results.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, "Federico II" University, Via S. Pansini 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Katia Di Lauro
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Enrico Araimo
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Federica Calculli
- Department of Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Francesco Milone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Loredana Maria Sosa Fernandez
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
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Abstract
BACKGROUND Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic pilonidal sinus treatment (EPSiT) and compares that of the other minimally invasive techniques in practice. METHODS MEDLINE, EMBASE, Cochrane and CINAHL databases were searched to look at the peer-reviewed articles on minimally invasive treatments on PD. Primary endpoint was to determine complication rates. Data were pooled using random effect model. Heterogeneity among studies was estimated with χ2 tests. Statistical analysis was performed with Review Manager Version 5.1.2. RESULTS Out of 371 papers, ten were retrieved for full appraisal. One randomised clinical trial (RCT) and four case series presented retrospective data on EPSiT. Five RCTs were on alternative minimally invasive treatments. Complication rate, return to work, wound healing rate and pain scores were superior in minimally invasive treatments compared to excision surgery. There was no statistically significant difference in complication rate or return to work in EPSiT compared to that of alternate minimally invasive techniques. CONCLUSION Minimally invasive treatments of pilonidal disease were found to be safe and effective compared to conventional techniques. It is also demonstrated that EPSiT is a safe alternative with a low short-term complication rate. Further randomised controlled trials are required to more accurately define its effectiveness and closely evaluate the side effect profile.
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Tien T, Athem R, Arulampalam T. Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 2018; 22:325-331. [PMID: 29850944 DOI: 10.1007/s10151-018-1803-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. More recently minimally invasive approaches have been described. Our aim was to review the current literature on endoscopic pilonidal sinus treatment (EPSiT) and its outcomes. METHODS A systematic literature review was conducted and reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of EMBASE, MEDLINE and Cochrane Library was conducted in November 2017. Full-text studies on the use of endoscopy for the treatment of pilonidal sinus were included in the review. RESULTS Initial search results returned 52 articles. Eight studies (eight case series and one randomised control trial) were included in the final qualitative synthesis. These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates. There was also a high level of patient satisfaction and little time taken off work. Two studies reported modifications to the original technique. The main limitation was the lack of comparative studies. CONCLUSIONS Initial studies on EPSiT have shown promising results. However, there is a need for a standardised technique and more comparative studies to validate this novel procedure.
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Affiliation(s)
- T Tien
- Department of General Surgery, Colchester Hospital University Foundation Trust, Colchester, UK.
| | - R Athem
- Department of General Surgery, Colchester Hospital University Foundation Trust, Colchester, UK
| | - T Arulampalam
- Department of General Surgery, Colchester Hospital University Foundation Trust, Colchester, UK
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Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD. Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 2018; 32:3754-3762. [DOI: 10.1007/s00464-018-6157-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/21/2018] [Indexed: 01/01/2023]
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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: 118] [Impact Index Per Article: 19.7] [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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Bernier GV, Johnson EK, Maykel JA, Steele SR. Reoperative surgery for pilonidal disease. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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