1
|
Coco D, Leanza S. Minimally Invasive Pilonidal Sinus Treatment: A Brief Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With a prevalence of 26/100,000, pilonidal sinus disease is a frequent natal cleft condition that primarily affects young males. The disease site is often uncomfortable and the disease can result in problems such as abscess formation and recurrent acute or chronic infections. Minimally invasive treatment aims to form a small elliptical wedge of subcutaneous tissue containing all the inflammatory tissue. The sinus and its lateral tracks are removed while keeping the overlying skin intact. Following the notion of “less is more,” novel least invasive treatments such as sinotomy, sinusectomy, trephining, and video-assisted and endoscopic pilonidal sinus surgery have recently been proposed. We look at minimally invasive treatments to explain how research into modern techniques has revealed a low rate of short-term problems.
Collapse
|
2
|
Driouch J, Braumann C, Dehnst J, Ikram M, Alnammous G, Bausch D, Glatz T. [Results of the Limberg flap procedure in acute and chronic pilonidal abscesses]. Chirurg 2021; 93:182-189. [PMID: 34132822 PMCID: PMC8821484 DOI: 10.1007/s00104-021-01439-0] [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] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
Hintergrund In der Behandlung des Sinus pilonidalis werden unterschiedliche Therapiealgorithmen für den akuten sowie den chronischen Sinus pilonidalis empfohlen. Während sich beim chronischen Sinus pilonidalis ein einzeitiges Vorgehen als Exzision oder plastische Rekonstruktion nach Limberg oder Karydakis anbietet, ist die empfohlene Vorgehensweise beim akuten Pilonidalabszess zweizeitig. Ziel dieser Studie war es, die Ergebnisse der einzeitigen Operation mit Limberg-Plastik bei akutem Pilonidalabszess und chronischem Sinus pilonidalis bezogen auf Rezidive, Wundheilungsstörungen, stationärer Liegedauer sowie Patientenzufriedenheit zu vergleichen. Methoden Von 2009 bis 2014 wurden 39 Patienten in die prospektive Beobachtungsstudie eingeschlossen. 21 Patienten mit akutem Pilonidalabszess, 18 mit chronischem Sinus pilonidalis. Alle Patienten wurden einzeitig mittels Limberg-Rautenplastik operativ behandelt. Die Gruppen wurden in Bezug auf postoperative Komplikationsrate und Rezidivhäufigkeit miteinander verglichen. Ergebnisse Beide Gruppen waren im Wesentlichen vergleichbar. Die Analyse der postoperativen Ergebnisse zeigte eine vergleichbare Rate an Wundheilungsstörungen (10 % vs. 17 %, p = 0,647). In der Gruppe des akut abszedierten Sinus trat kein Rezidiv im Beobachtungszeitraum auf, während sich in der chronischen Gruppe 2 (11 %) Rezidive zeigten (p = 0,206). Diskussion Die Ergebnisse der Limberg-Plastik als einzeitige Therapie des Pilonidalabszesses sind mit denen beim chronischen Sinus pilonidalis vergleichbar. Es zeigt sich ein Trend zu einem geringeren Rezidivrisiko. Der Einsatz der Limberg-Plastik scheint daher auch in der akuten Infektsituation eine adäquate Therapieoption.
Collapse
Affiliation(s)
- Jamal Driouch
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Braumann
- Klinik für Chirurgie, St. Josef Hospital Bochum, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - J Dehnst
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - M Ikram
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - G Alnammous
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - D Bausch
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - T Glatz
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| |
Collapse
|
3
|
Gul VO, Destek S. Sinusectomy and primary closure versus excision and primary closure in pilonidal sinus disease: a retrospective cohort study. Int J Colorectal Dis 2020; 35:1117-1124. [PMID: 32248289 DOI: 10.1007/s00384-020-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various surgical procedures are available for the treatment of pilonidal sinus diseases (PSD), but the best surgical approach remains controversial. Minimally invasive surgical procedures are more popular than surgery. This study aimed to evaluate the efficacy of sinusectomy with primary closure (SPC) in comparison with excision and primary closure (EPC) in primary or recurrent cases. MATERIALS AND METHODS This single-center retrospective cohort study was conducted with two cohort groups in which 351 patients with PSD underwent either SPC or EPC. The two procedures were compared according to the presence of short-term complications and recurrence of PSD. RESULTS Of the patients, 134 underwent EPC and 217 underwent SPC. The length of stay and the wound healing time were significantly longer in the EPC group than in the SPC group. The occurrence rates of wound site infection and abscess were significantly higher in the EPC group than in the SPC group; however, seroma was statistically significantly more common in the SPC group than in the EPC group. The recurrence rates were 18.7% and 5.5% in the EPC and SPC groups, respectively. CONCLUSION SPC is an efficient procedure for the treatment of patients with PSD showing simple and complicated disease patterns.
Collapse
Affiliation(s)
- Vahit Onur Gul
- Department of General Surgery, Gulhane Education and Research Hospital, 06180, Ankara, Turkey.
| | - Sabahattin Destek
- Department of General Surgery, Bezmialem Vakıf University School of Medicine, 34000, Istanbul, Turkey
| |
Collapse
|
4
|
Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Hap W, Frejlich E, Rudno-Rudzińska J, Kotulski K, Kurnol K, Hap K, Skalski A, Kielan W. Pilonidal sinus: finding the righttrack for treatment. POLISH JOURNAL OF SURGERY 2017; 89:68-75. [DOI: 10.5604/01.3001.0009.6009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pilonidal cyst is a troublesome condition affecting usually young people. It significantly influences quality of life and causes low self-esteem. Despite its known pathophysiology and numerous therapeutic methods available, pilonidal cysts still constitute a significant problem in general surgery. A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success, and frequent complications cause both patient’s dissatisfaction and frustration of the operator. In many cases, therapy is based on methods developed in a given healthcare center and their efficacy is usually not scientifically verified. Search for optimal strategy is also impeded by lack of an unambiguous clinical classification. In this article, we reviewed publications on various methods of managing pilonidal cyst, and we also presented surgical treatment used in our department. However, we did not manage to point out a surgical method with efficacy high enough to become standard treatment. It indicates the need for further search for new techniques that will give chances for successful treatment of pilonidal cyst.
Collapse
Affiliation(s)
- Wojciech Hap
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Ewelina Frejlich
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Julia Rudno-Rudzińska
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Krzysztof Kotulski
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Krzysztof Kurnol
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Katarzyna Hap
- Katedra i Klinika Nefrologii i Medycyny Transplantacyjnej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Marian Klinger
| | - Adam Skalski
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Onkologicznej, Uniwersytet Medyczny we Wrocławiu, Kierownik: prof. dr hab. Wojciech Kielan
| |
Collapse
|