“Jeep Disease” and Optimal Treatment Strategy for Sacrococcygeal Pilonidal Sinus in a High Volume Tertiary Military Medical Center

Abstract

Sacrococcygeal pilonidal sinus (SPS), a well-known “army” disease, is a relatively common condition affecting mostly males. Several factors have been described as contributing to the etiology of SPS, including irritation from trauma, obesity, a sedentary lifestyle, and intense hair growth in the intergluteal region. Over a period of 7 years (2010–2017), 1,100 patients with SPS underwent surgery using different surgical methods, the efficacy of which was evaluated by recording complications and recurrences and duration of hospitalization. The methods used were the semi-closed method (SCM) with marsupialization, the open method, the Limberg flap (LF) and the closed method (primary closure). Complications, including postoperative bleeding, abscess formation and cellulitis were recorded, and also recurrence at one year. The efficacy of the SCM modified marsupialization technique showed statistically significant superiority, with a shorter hospital stay and quicker recovery, and the lowest rate of complications (2.9%, p<0.05) and recurrence (2.5%). The pathological etiology of the disease is outlined, the intraoperative details of our technique are described and the importance of patient compliance with postoperative instructions is emphasized, as this plays a major role in the prevention of recurrence. The SCM modified marsupialization technique presents advantages compared with other surgical methods of treatment of SPS, including the creation of a new natal cleft, with low rates of complications and recurrence, and it is associated with a short hospital stay and quick recovery. Finally, as the majority of the patients with SPS are adolescents and young military personnel, it is important to take into consideration the satisfactory cosmetic results in the intergluteal region with the marsupialization technique, compared with the other techniques, and especially the flap procedures.