Personalized Approach to the Treatment of Pilonidal Disease Complicated by Multiple Fistulas of the Coccygeal-Sacral Gluteal Region

Abstract

Introduction. Pilonidal disease (pilonidal sinus, epithelial pilonidal sinus) is a common pathology detected by surgeons and coloproctologists. The disease is observed in 3-5% of the population. The vast majority of patients with pilonidal sinus are operated on under 30 years. Postoperative complications occur in 13-24% of patients, and 6-30% have relapses of the disease.The aim of the study was to improve the treatment results of patients with pilonidal disease complicated by multiple fistulas of the coccygeal-sacral-gluteal region by developing new surgical treatment options, prediction and prevention of pathological scarring.Materials and methods. The study involved 141 patients with pilonidal disease complicated by multiple fistulas of the coccygeal-sacral gluteal region. Depending on the treatment options used, all patients were divided into 2 groups: 45 (31.9%) patients were treated with conventional techniques; a comprehensive personalized approach was used in 96 (68.1%) patients. A developed personalized approach to the treatment of pilonidal disease included: predicting pathological scar formation (studying the acetylator properties of the body, the concentration of acute phase inflammatory proteins in the peripheral blood); performing original surgical procedures considering prevalence of the inflammatory process, the shape of the gluteal structure, the wound size after excision of the pilonidal sinus, pathologically altered tissues in the gluteal region. Therapeutic measures were aimed at preventing pathological scar formationResults. A comparison of the immediate and long-term treatment results of patients with pilonidal disease complicated by the sacrococcygeal-gluteal region fistulas, who were exposed to the comprehensive treatment, demonstrated that their parameters were markedly better than those received conventional treatment: the number of early postoperative complications reduced from 17.8 to 6.3% (P0.05); relapses - from 11.1 to 3.1% (P0.05), development of excessive scar formation - from 35.6 to 4.1% (P0.05); complaints of discomfort – from 17.8 to 6.3% (P0.05). The duration of hospital treatment decreased by 4.1 days (P0.05), and the period of complete healing reduced by 11 days (P0.05).Conclusions. To obtain adequate short-term and long-term results in the treatment of patients with pilonidal disease complicated by multiple fistulas, the following steps are required: thorough preoperative preparation; an individual approach to choose a surgical option considering the prevalence of the inflammatory process, the topographic and anatomical structure of the coccygeal-sacral gluteal region; a postoperative wound size; rational management of patients in the postoperative period. Study of the dynamics of proteins in the acute phase of inflammation and the acetylator activity of the body helped reveal a group of patients with a predisposition to pathological scar formation, who then were performed timely anti-scar therapy.