Chronic Pilonidal Disease Research Articles

A randomized study between excision and marsupialization and radiofrequency sinus excision in sacro-coccygeal pilonidal disease

Background The surgical approach to pilonidal sinus disease is open to debate. This prospective, randomized study was aimed to compare the outcome of the excision and marsupialization and the sinus excision technique by radiofrequency. Materials and methods Thirty patients of chronic pilonidal sinus disease were randomly assigned to radiofrequency sinus excision (n = 15) and excision and marsupialization (n = 15). The parameters measured included intraoperative and postoperative data, wound-related complications, and recurrence. Patient satisfaction score was assessed at 1-year follow-up. Results The operation time, postoperative pain, hospital stay, and off work periods were significantly less (p < 0.05) in the technique employing radiofrequency surgery. At 1-year follow-up, there was 1 case of recurrence in each group. The patients from radiofrequency group expressed better satisfaction than the patients operated by marsupialization. Conclusion Radiofrequency sinus excision technique needs a shorter hospital stay with reduced postoperative pain and early resumption to work in comparison with the sinus excision and marsupialization technique.

Gluteal V-Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease.

Although pilonidal disease is quite common, controversy still exists about the treatment. The procedure should cure the patient, and allow speedy resumption of normal activities by reducing pain and disability. This retrospective study was conducted to evaluate our experience with the V-Y fasciocutaneous advancement flap and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. We describe the application of the fasciocutaneous V-Y advancement flap for reconstruction of defects after radical excision of recurrent pilonidal sinus in 11 cases. Primary and uneventful wound healing was achieved in all patients but two who developed minor wound breakdown. Large defects after excision can easily be closed using the V-Y advancement flap. This type of flap closure in selected cases offers tension-free, recurrence-free, and reliable skin coverage while flattening the natal cleft that predisposes to recurrences. Reliable flap closure reduces hospital stay, costs, as well as disability and time spent off work.

Pilonidal sinus: experience with the Limberg flap

A personal series of 162 patients with chronic pilonidal disease was treated by rhombic excision and Limberg transposition flap. Each sinus was totally excised and covered primarily by a fasciocutaneous Limberg flap. Full primary healing was obtained in 161 out of 162 patients. One patient had ischaemia which resulted in necrosis of the flap tips that healed later with a scar. Minor infection occurred in 12 patients (7%). The average hospital stay was 4.2 days, and no patient remained in hospital more than 12 days. The mean follow-up period was 18 months, and three recurrences (2%) have occurred. Surgery for pilonidal sinus should not only eradicate the presenting sinus formation but should also aim to eliminate factors that predispose to formation of another sinus. This can be achieved using a Limberg flap which reduces the depth of the cleft and ensures that all parts of the wound and all suture holes are away from the midline.

Management of pilonidal sinus with the Limberg flap.

The aim of this study was to demonstrate the advantages of rhombic excision and Limberg flap closure in the treatment of pilonidal sinus disease. We treated 24 patients who had chronic pilonidal sinus disease with rhomboid excision and Limberg flap closure. All patients were followed up for a period of 27 months. Mean hospital stay was 4.1 days, and mean time until return to work was 17.5 days. There was no surgical wound infection. Complication rate was 12.5 percent. During the follow-up period, no recurrence was found. Because other treatment methods carry a significant failure rate, this technique is an effective alternative in the treatment of pilonidal sinus disease.

Treatment of chronic pilonidal disease

Pilonidal disease (PD) is a common chronic intermittent disorder of the sacrococcygeal region. Despite surgical therapy dating back more than one century, management remains controversial and recent reports have advocated different surgical approaches. A retrospective review was conducted of 129 patients who were treated for chronic PD in our institution during a five-year period, 1990 to 1994. Excision with primary closure was performed in 56 patients; 47 underwent open excision without closure, and 26 had marsupialization procedure. All were performed electively, with only minor complications. Complete healing was fastest in the primary closure group, despite a 14 percent postoperative wound infection rate. Recurrence rates of 11, 13, and 4 percent were found for primary closure, wide resection, and marsupialization procedures, respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Considering healing time, morbidity, and recurrence rate, we conclude that surgical treatment should be directed at either excision and primary closure or marsupialization. Wide excision with secondary healing should be performed only for grossly infected and complex cysts.

Oblique excision with primary closure for the treatment of pilonidal sinus

Although pilonidal disease of the sacrococcygeal region is common, controversy still exists regarding its treatment. The goal of treatment should be to prevent recurrence while minimizing the patient's postoperative pain and disability. During a two-year period, 32 consecutive patients (Group A) were treated for chronic pilonidal disease by oblique excision and primary closure. The results were compared with 45 patients (Group B) who had been treated by vertical excision and primary closure. Patients with acute pilonidal abscess or recurrent pilonidal disease were excluded from the study. The mean follow-up was 15.9 months for Group A and 19.6 months for Group B. The average length of hospital stay and time for return to daily activities were 3.18±1.31 vs. 5.53±4.11 days and 10.4±14.37 vs. 12.91±39.17 days in Groups A and B, respectively (p<0.001 and p<0.01). The overall recurrence rate was 35.5% in Group B whereas there were no recurrences in Group A. On the basis of our current experience, oblique excision with primary closure achieves the most promising treatment of this condition.

Patient characteristics and symptoms in chronic pilonidal sinus disease.

Three hundred and twenty two patients with pilonidal sinus disease were studied to determine factors for the development and maintenance of the disease. A calculated incidence of the disease of 26 per 100,000 inhabitants was found. It occurred 2.2 times more often in men than in women. Age at presentation was 21 years for men and 19 for women. Patients had two years (median) disease history before being referred for treatment. A family history could be found in 38% of the patients. 50% had normal body weight, and 37% were overweight. Local trauma or irritation preceded the condition in 34%, and a sedentary occupation was reported by 44%. Male sex, adolescence or youth, and a familial disposition seem to be associated with the development of pilonidal sinus. Local trauma and overweight are the most important conditioning factors for development of symptomatic pilonidal sinus disease.

Pilonidal Disease

It is the author's preference and recommendation that an acutely infected pilonidal abscess be urgently drained with a simple incision and drainage procedure that is not necessarily viewed as definitive treatment. The patient should be so instructed. The definitive treatment of chronic pilonidal disease can be accomplished in a variety of ways, but our recommendation is excision of all infected tissue and sinus tracts through an elliptical incision with either marsupialization of the wound or beveling of the skin edges. Both marsupialization and beveling serve to minimize the chance of premature skin closure and promote complete healing of the site from the inside out. Weekly postoperative follow-up is strongly encouraged to assess progress and promote proper wound healing.

Treatment of pilonidal sinus by excision and rhomboid flap

A series of 23 patients with chronic pilonidal disease have been treated by excision and transposition rhomboid flap. Full primary healing was obtained in all patients, with only two cases of wound seroma. The average hospital stay was 9 days. The mean follow-up period was 12 months, and no late recurrences have occurred.

Chronic pilonidal disease

During a four-year period, 150 consecutive patients were treated for chronic pilonidal disease by one of three different operative techniques. Patients with acute pilonidal abscesses or with complex or multiple recurrent pilonidal disease were excluded from this study. The average healing time was four weeks and the average length of hospital stay was one day. The overall recurrence rate was 8 percent (12 of 150 patients). The method of management most commonly used was fistulotomy with marsupialization of the sinus tract or cyst wall (125 of 150 patients). This simple and effective technique gave excellent results with a 6 percent recurrence rate (7 of 125 patients). On the basis of their experience, the authors propose that chronic pilonidal disease usually can be treated successfully on a same day surgery basis with fistulotomy, minimal excision, and marsupialization.