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Liu X, Zhao X, Shen G, Fan S, Xu J, Fan Z, Li K. Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus. Int Wound J 2023; 20:3474-3482. [PMID: 37218401 PMCID: PMC10588358 DOI: 10.1111/iwj.14218] [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: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.
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Affiliation(s)
- Xiao Liu
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Xiaoyu Zhao
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Guoliang Shen
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Shuwen Fan
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Jun Xu
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Zhaojun Fan
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
| | - Ke Li
- Department of Burn and Plastic Surgerythe First Affiliated Hospital of Soochow UniversitySuzhouPeople's Republic of China
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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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3
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Wu P, Zhang Y, Zhang Y, Wang S, Fan Z. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. Int J Surg 2023; 109:2388-2403. [PMID: 37158142 PMCID: PMC10442091 DOI: 10.1097/js9.0000000000000447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. METHODS A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. RESULTS Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [ P =0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P =0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant ( P =0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant ( P =0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection ( P ≥0.05). CONCLUSIONS There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient's wishes, appearance of the SPS, and the professional ability of the surgeon.
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Affiliation(s)
| | | | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Wang
- Department of Endocrinology, Second Affiliated Hospital of Dalian Medical University, Dalian
| | - Zhe Fan
- Department of General Surgery
- Liaoning Province Key Laboratory of Corneal and Ocular Surface Diseases Research, The Third People’s Hospital of Daliana
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Parente G, Ruspi F, Thomas E, Di Mitri M, Cravano SM, D'Antonio S, Gargano T, Lima M. Endoscopic Pilonidal Sinus Treatment: Preliminary Results, Learning Curve and Comparison with Standard Open Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1063. [PMID: 37371294 DOI: 10.3390/children10061063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Background: Pilonidal sinus (PNS) is a common disease which can lead to complications including infection and abscess formation. Different surgical approaches have been suggested, based on primary or secondary wound closure intention healing or endoscopic treatment (EPSiT). The aim of this study is to verify the superior outcomes of EPSiT, especially in comparison with the traditional open approach, and discuss the operators' learning curve. Methods: A retrospective study was conducted identifying all the patients who underwent surgical treatment for PNS with EPSiT technique between 2019 and 2022 and with open technique between 2002 and 2022. We divided patients in two groups: open procedure (group 1) and EPSiT (group 2). We considered a p value < 0.05 as statistically significant. Results: The mean operative time was 58.6 ± 23.7 min for group 1 and 42.8 ± 17.4 min for group 2 (p < 0.01). The mean hospital stay was 2.6 ± 1.7 days for group 1 patients and of 0.8 ± 0.4 days for group 2 (p < 0.01). Complete healing was obtained in 18.7 ± 5.6 days for group 1 and 38.3 ± 23.5 days for group 2 (p < 0.01). Recurrences were of 23.4% for group 1 and 5.4% for group 2 (p = 0.03). Conclusions: EPSiT is a minimally invasive and effective approach for the treatment of pilonidal cyst that can be safely performed in pediatric patients with promising results concerning aesthetic outcome and pain control, and with a rapid and less complicated recovery compared to traditional open procedures.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Francesca Ruspi
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Eduje Thomas
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Sara Maria Cravano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Simone D'Antonio
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, 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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Basso L, Pietroletti R, Micarelli A, Bicaj A, Costi U, Crocetti D, D'Ermo G, Gallo G. The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease. Colorectal Dis 2022; 24:984-991. [PMID: 35344244 PMCID: PMC9541250 DOI: 10.1111/codi.16126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 02/08/2023]
Abstract
AIM We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified 'merged' version of both the Bascom 'pit picking' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the Bascom-Gips procedure. METHODS In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 ± 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C). RESULTS The mean operating time was 34 ± 24.45 min. Postoperative complications included early (<24 h; n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 ± 12.72 days and work/school/university activities were resumed after a mean of 4 ± 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (ꭓ2 = 16.87, P = 0.0002) difference was found in the recurrence rates: 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (ꭓ2 = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (ꭓ2 = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (ꭓ2 = 2.23, P = 0.32) in groups A, B and C respectively. CONCLUSIONS BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD.
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Affiliation(s)
- Luigi Basso
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Renato Pietroletti
- Surgical Coloproctology, ‘Val Vibrata’ HospitalL'Aquila UniversityTEItaly
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR)RomeItaly,Eurac Research, Institute of Mountain Emergency MedicineBolzanoItaly
| | - Agreta Bicaj
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Umberto Costi
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Daniele Crocetti
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Giuseppe D'Ermo
- ‘Pietro Valdoni’ Department of Surgery, Faculty of Medicine and Dentistry, Policlinico ‘Umberto I’‘Sapienza’ University of RomeRomeItaly
| | - Gaetano Gallo
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
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8
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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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Basso L, Gallo G, Milone M, Pietroletti R. Authors' reply to: "The long-term recurrence rate of minimally invasive methods in pilonidal sinus disease therapy is still unclear". Tech Coloproctol 2022; 26:159-160. [PMID: 34993687 DOI: 10.1007/s10151-021-02559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- L Basso
- "Pietro Valdoni" Department of Surgery, "Sapienza" University of Rome, Policlinico "Umberto I", viale del Policlinico 155, 00161, Rome, Italy.
| | - G Gallo
- Department of Surgical and Medical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - M Milone
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - R Pietroletti
- Surgical Coloproctology, "L'Aquila" University, "Val Vibrata" Hospital, Sant'Omero, TE, Italy
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10
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Manigrasso M, Anoldo P, Cantore G, Chini A, D'Amore A, Gennarelli N, Maione F, Marello A, Schettino P, Sorrentino C, Vertaldi S, Sosa Fernandez LM, De Palma GD, Milone M. Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature. Front Surg 2022; 8:812128. [PMID: 35059431 PMCID: PMC8764178 DOI: 10.3389/fsurg.2021.812128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 02/01/2023] Open
Abstract
Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD. Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted). Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction. Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique. Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.
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Affiliation(s)
- Michele Manigrasso
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, Italy
- *Correspondence: Michele Manigrasso
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Alessia Chini
- 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
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples, Italy
| | - Francesco Maione
- 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
| | - Pietro Schettino
- 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
| | - Sara Vertaldi
- 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
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11
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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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