Management Of Pilonidal Sinus Disease Research Articles

Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study.

Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up. All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan-Meier analyses. Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05).The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan-Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340).Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026). This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.

A comparative study between wide local excision with lay open versus Limberg flap transposition in the management of pilonidal sinus disease – A single center study

A comparative study between wide local excision with lay open versus Limberg flap transposition in the management of pilonidal sinus disease – A single center study

Evaluation of De Epithelization Technique in Management of Pilonidal Sinus Disease

Abstract Background Pilonidal sinus disease (PSD) is a common disorder of the sacrococcygeal region. The incidence is reported in 6 per 100,000 individuals, this method is defined as a flap or graft of thinned cutaneous layer. Aesthetic surgeons usually perform this method for mammoplasty. In this method, after de-epithelization of the cutaneous tissue is performed, cutaneous flap and fatty tissue are inverted to fill the dead space (1). De-epithelialized skin grafts are used for many indications. Objective To evaluate De epithelization technique as a new approach in management of pilonidal sinus disease as regard post operative complications and recurrence rate. Patients and Methods This Cohort retrospective and prospective study will include 50 cases, admitted to Ain Shams University and Agouza Police hospital from august 2019 till February 2020 who met the inclusion criteria. A total of 50 adult patients with PSD were randomly allocated intraoperatively to undergo De epithelization technique. Results According to our scale evaluating outcome, De-epithelization technique is effective and safe with least post operative complications regarding pilonidal sinus disease. Conclusion It allows a quicker return to daily activities and reduces costs. Furthermore, we believe that the risk of recurrence may be reduced by increasing the angle of the natal cleft during this technique. Also, this method has a satisfying aesthetic outcome. This preliminary report suggests that this new surgical approach seems to be a reasonable method in the treatment of PSD, especially in patients with uncomplicated primary disease, and is worth studying further.

Non-operative management of pilonidal sinus disease; classification and outcome.

The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success.

Outcome of Limberg Flap Reconstruction in the Management of Pilonidal Sinus Disease: A Retrospective Study

Introduction: Pilonidal Sinus Disease (PSD) is a tract or cavity commonly seen in the sacrococcygeal region, usually containing a tuft of hair. It is mostly observed in drivers who have excessive hair in the natal cleft region. Although several surgical procedures have been described for the management of PSD, none have been universally accepted as the gold standard. Limberg flap reconstruction, following wide excision, offers a tension-free repair using a well-vascularised flap. This technique flattens the natal cleft, avoiding a midline scar and reducing the chance of recurrence. Aim: The aim of this study was to determine the outcomes of Limberg flap reconstruction in sacrococcygeal PSD. Materials and Methods: A retrospective descriptive study was conducted in the Department of General Surgery at M S Ramaiah Medical College, Bangalore, Karnataka, India. The study duration was six years, from January 2011 to January 2017. The study included a total of 40 patients aged between 15-70 years, with Tezel type III sacrococcygeal Pilonidal Disease (PND), who underwent the Limberg flap procedure. Data was collected and analysed from January to June 2021. Outcome measures such as duration of hospital stay, time required to return to work, and procedure-related complications associated with procedure were analysed and entered into an Excel sheet. Results: The mean age of the study participants was 18.02±6.87 years. Out of the 40 patients, 4 (10%) developed complications. Superficial wound infection was observed in 1 (2.5%) patient, which healed within two weeks. Minimal flap necrosis was observed in 2 (5%) patients, who underwent debridement and dressings on an outpatient basis. The wounds healed within three to four weeks. Recurrence was reported in 1 (2.5%) patient. The mean time to return to work was 18.7±4.88 days. Conclusion: Limberg flap reconstruction for sacrococcygeal PSD is a simple technique with a lower complication rate, faster return to normal activity, and a low recurrence rate.

Comparison of two Different Surgical Modalities in the treatment of Pilonidal Sinus (Primary Closure and Open Technique)

Background: Pilonidal sinus is disease of young age andits prevalence is higher in men compared to women (almost twice).It is a disease that arises from hair follicles particularly present in the natal cleft. It occurs commonly in Jeep Drivers and hence gets the name from there “Jeep Drivers Disease” and also commonly occurs in Barbers. It leads to formation of abscesses and chronic wounds with discharge and pain. Disease can have huge impact on social life and quality of life. In most cases the treatment is incision and drainage. Study design: It is a case series study. Place and duration of study: Department of General Surgery at Shaikh Zayed Hospital Lahore from January 2019 to January 2021. Aim: To compare the relative effects of open and closed surgical techniques on the recurrence rate, rate of infection and time of healing for pilonidal sinus. Methodology: Patients with pilonidal sinus disease from January 2019 to January 2021 received surgical treatment either excision followed by primary closure as in closed technique (group A) or excision followed by leaving the wound open for healing by secondary intention as in open technique (group B). Surgical management is widely based upon two techniques open and closed. In open technique wound is left open and heals by secondary intention while in closed technique it is closed primarily and heals by primary intention. The better choice between these two techniques is still a topic of debate. Results: The most common age group for pilonidal sinus was between 16-25 years of age. The mean age came out to be 26.7 years. The mean healing time was 15 days in group A and 42 days in group B. The duration of hospital stay ranged between 2-8 days for group A and 5-16 days for group B. Early postoperative complications seen was infection in 1 patient (7.69%) in group A and 5 patients (35.71%) in group B and these cases were managed conservatively.1 (7.69%) case of aseptic gaping of wound after stitch removal was seen in group A and was managed with closed technique. Recurrences reported in group A was 1 case (7.69%) at 6 months and was surgically managed by open technique. There were a total of 4 (28.57%) recurrences which were left open to heal by granulation. Conclusion: It is concluded that better management option for pilonidal sinus disease is primary closure of defect. So it is suggested that management of pilonidal sinus disease should be individualized but preference must be given to closure of wound after excision. Keywords: Pilonidal sinus, Primary Closure, Open Technique.

Different Surgical Approaches for Pilonidal Sinus – Our Experience in a Peripherally Located Tertiary Care Hospital

Introduction: Pilonidal disease in sacrococcygeal or intergluteal region is an acquired chronic inflammatory disorder with superimposed infection. It is commonly seen in young hairy individuals and usually presents as an abscess or a painful sinus tract in the natal deft with sero/purulent discharge. Aims and Objectives : The objectives of the study were to assess and compare different surgical techniques in the management of pilonidal sinus disease. Materials and Methods This retrospective study was conducted in the Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Mandya (D), from August 2018 to January 2020. Results During the study period, 30 patients were enrolled, 22 patients were male and 8 were female, with a mean age of 24.3 years. The mean operative time for primary closure was 61 min and flap reconstructions were 70 min with mean hospital stay of 8 and 6 days, respectively. The mean time to walk without pain is 30 and 12 days, respectively. Wound dehiscence was noted in a patient with primary closure. No recurrence was noted for a mean follow-up period of 6 months in any patients. Conclusions: Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence for pilonidal disease.

A Retrospective Study of the Safety and Efficacy of a Radial Diode Laser Probe in the Management of Pilonidal Sinus Disease

Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries. To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus. Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period. Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication. This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.

Combination of Side-Swing Flap With Negative-Pressure Wound Therapy Is Superior to Open Excision or Flap Alone in Children With Pilonidal Sinus-But at What Cost?

Background: Pilonidal sinus (PS) disease frequently occurs in adolescents and young adults, and in many cases involves wide excision or local flaps as treatment. These treatments are associated with a significant recurrence rate, a long healing time, and thus absence from school or work. The hybrid technique, which is a combination of side-swing plasty with negative-pressure wound therapy (NPWT) may improve these outcomes. The aim of the study was to compare the latter with other current methods.Methods: Children presenting with a pilonidal sinus to two referral centers for pediatric surgery from January 2017 till June 2019 and subsequent (1) slide-swing plasty, (2) open excision, or (3) slide-swing plasty in combination with NPWT were included in this retrospective study. Type of therapy, number of interventions, duration of hospitalization, complications, and recurrence rate were recorded. In addition, data was retrieved from the national diagnosis-related group for inpatient statistics, for all patients who underwent surgery for pilonidal sinus in 2015 and 2016.Results: In total, 85 children were included, with a mean age of 15 years and a near equal gender distribution (53% female). The minimum follow-up was 1 year. In 56% open resection was performed, while 18% underwent a slide-swing plasty and 26% a slide-swing plasty in combination with NPWT. While the hybrid technique was superior regarding recurrence rate in comparison to open excision (24 vs. 5%, p = 0.047), it had significantly longer hospital stay [17.41 (15.63) vs. 3.65 (1.68) days, p < 0.001] and number of interventions [4.14 (4.07) vs. 1.04 (0.29), p < 0.001].Conclusions: Management of PS disease using slide-swing plasty in combination with NPWT is an effective treatment and is associated with low recurrence rate and minimal morbidity. However, this type of treatment is accompanied by an elongated hospitalization time and more frequent interventions. A diligent case by case evaluation and thorough patient counseling is thus necessary when choosing the right technique for the treatment of PS disease.

Current trends in the management of pilonidal sinus disease and its outcome in a periphery hospital

<abstract><sec> <title>Background</title> The attention of surgeons to pilonidal sinus disease is increasing. We aimed to estimate the incidence of Pilonidal sinus disease, and verify the employed management and its outcome in term of surgical site infection, recurrence and patients' satisfaction. </sec><sec> <title>Methods</title> A cohort study included 224 patients with pilonidal sinus disease (Jan 2014 to April 2020). </sec><sec> <title>Results</title> Mean age was 23.83 ± 4.9 years, with male predominance (male to female ratio of 2.25:1). Incidence of pilonidal sinus disease was 2.9% of all surgical clinic population. Mean duration of symptoms was 65.8 ± 50.7 days. Majority (80.8%) had chronic pilonidal sinus, whereas the remainder 19.2% had acute onset with abscess. In pilonidal sinus the surgical modality was fashioned according to the extent of the disease keeping in mind the number of sinus opening in form of Limberg flap (44.2%), primary closure (19.6%), or laid open to heal by secondary intention (17%). Recurrence of pilonidal sinus was seen in 2.2% and not affected by the procedure employed (P = 0.4). Whereas, in cases of pilonidal abscess the recurrence rate was 27.9%. The difference was significant (p = 0.00001). Over all patients' satisfaction was very good/excellent in 187 (83.4%). </sec><sec> <title>Conclusions</title> To reduce congestion of the operating lists in central hospitals, one can use a clear criterion based on the extent of the disease and the number of sinus openings, this will facilitate the management of pilonidal sinus disease in peripheral hospital settings, and comparable results can be achieved in terms of recurrence rate and patient satisfaction. </sec></abstract>

Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol.

Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique.Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction.Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities (p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4–10) to achieve complete hair removal. The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]. The recurrence rate was also significantly lower in G1 (n = 1, 1.4%) compared with G2 (n = 5, 9%) [p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [p = 0.001].Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.

Management of pilonidal sinus disease with Limberg flap: our experience

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019. Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.

Comparison of 'Excision and Primary Repair' with 'Bascom's Technique' in the Surgical Treatment of Pilonidal Sinus.

IntroductionThe management of the chronic pilonidal disease is variable and the principles of treatment are aimed to eradicate the sinus tract, promote wound healing, prevent disease recurrence, and improve the quality of life of the patient. This study aims to compare the effectiveness of excision and primary closure, and Bascom’s technique in the management of pilonidal sinus disease.Methods The study was performed at a tertiary hospital from April to October 2011. All patients with chronic pilonidal sinus were included in the study (n=60) and randomly allocated into Group A - undergoing excision and primary closure (n=30) and Group B - undergoing Bascom’s repair. Comparative outcomes of interest were duration of hospital admission, post-operative pain, wound infection, wound-healing and disease recurrence. ResultsThe mean age of presentation was 24.18±5.6 years. A higher number of patients in Group A were discharged within 24 hours compared to Group B (p = 0.001). Group B had significantly less post-operative pain by the first postoperative week (p = 0.049). Group B had lower infection rates with clean wounds observed in 28 (93.3%) patients compared to 23 (76.7%) in Group A by the first postoperative week (p = 0.07). Recurrence rate during 12-week follow-up was observed in one (3.3%) patient in Group B, and five (16.7%) in Group A (p= 0.085).ConclusionsPatients who underwent Bascom's operation had less postoperative pain, lower infection rates and disease recurrence, and better wound healing. Therefore, in our patient cohort, we conclude Bascom’s repair appears to be superior to primary excision and repair in reducing patient morbidity.

Minimal tissue excision in the treatment of pilonidal sinus disease: results from a single surgical unit.

Pilonidal sinus disease is a common surgical disorder for which a clearly superior corrective operation remains elusive. Recurrence after surgery requiring re-operation is a frequent outcome. This retrospective study examines healing rates, recurrence rates and time to healing of a minimalist approach - employing deroofing of tracks, curettage and minimal skin excision - at one centre over the last decade. The results of all minimal excision pilonidal sinus operations performed from 2005 to 2018 by two surgeons at one centre have been analysed retrospectively. Ethics approval for this study was granted by the St John of God Health Care Human Research Ethics Committee on 11 June 2018. A total of 84 patients were included in this study with 19 females and 65 males. The median age at operation was 22 years. Of the 84 total patients, 78 achieved primary healing (93%) with an average healing time of 55 days. Of those that healed, seven recurred with an average time to recurrence of 812 days. In our study, minimal excision management of pilonidal sinus disease achieved primary healing in 93% with an average healing time of 55 days and a recurrence rate of 8%. These outcomes are similar, but not significantly inferior, to those reported for other surgical modalities of management. Given this, we suggest less invasive management may be a preferable first surgical option given smaller surgical intervention for similar outcomes.

Limberg Flap Reconstruction in Treating Sacrococcygeal Pilonidal Sinus

Background: Pilonidal sinus is the relatively common condition affecting men almost twice as often as the women we experienced. The estimated incidence is 0.26 per thousand populations in general. The management of pilonidal sinus disease remains controversial, and gold standard treatment modality has yet to be established. Limberg procedure is a safe and reliable technique in the treatment of the sacrococcygeal pilonidal sinus disease, with a low complication and recurrence rates if performed according to the appropriate surgical principles.&#x0D; Methods: This is a Prospective study on 24 patients between the period from July 2014 to Dec 2018 in the Department of Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) as well as other different hospitals in Dhaka, Bangladesh. The patients having primary or recurrent pilonidal sinus disease underwent the foresaid surgical treatment.&#x0D; Results: Twenty four patients underwent this operation. Among them, the picture was that 20(83.3%) were males and 4(16.7%) were female. The mean age was 31, (Range: 17-45 years). 6(25%) patients were presented with recurrent sinus and 5 of them had one or more occasion previous surgery. Twenty one patients (87.5%) had full primary healing without any complication. But 1(4.2%) patient had minimal sarcoma, 1(4.2%) patient had superficial infection and the remaining other 1(4.2%) had partial flap necrosis. However, all three healed completely with conservative treatment. The mean length of hospital stay was 2.45 (Range: 1-5) days and the most patients returned to their work within 3 weeks.&#x0D; Conclusion: Limberg flap is very effective for sacrococcygeal pilonidal sinus disease with low complication rates, shorter hospital stay, low recurrence rates, earlier healing and reduced off-work period. The surgery can be easily mastered. We recommend Limberg flap as preferred surgery in the cases of Sacrococcygeal Pilonidal sinus.&#x0D; Bangladesh Journal of Medical Science Vol.19(1) 2020 p.105-109

Management of Pilonidal Sinus Disease with the Aesthetically Shaped Parasacral Perforator Flap: Multicenter Evaluation of 228 Patients.

The management of pilonidal sinus disease is still not standardized. Currently, the two main procedures are a lay-open excision procedure with secondary healing or coverage with local flaps. The authors present their experience with a one-stage excision-coverage with an innovative parasacral artery perforator flap propeller designed to respect the aesthetic unity of the buttocks. Study patients were managed with this procedure in the Toulouse, Montpellier, and Rennes university hospitals between 2012 and 2018. Data were collected on clinical and surgical details, immediate and late postoperative complications, and long-term recurrence. Aesthetic satisfaction was evaluated with a self-evaluation questionnaire. The authors operated on 228 consecutive patients for pilonidal sinus disease with an aesthetically shaped parasacral artery perforator flap. The median patient age was 23.5 years, the median operative time was 46 minutes, the median flap length was 9.3 cm (range, 6.5 to 14 cm), and the median flap width was 4.1 cm (range, 4 to 6.5 cm). There were five distal necroses but no complete flap necrosis. There were six postoperative hematomas, 11 infections, and 18 wound dehiscences. The median follow-up period was 27.9 months. Median hospital length of stay was 4.2 days. Three recurrences of pilonidal sinus disease and six instances of hidradenitis suppurativa were detected. Approximately 82 percent of the women and more than 85 percent of the men were "satisfied" or "very satisfied" with the aesthetic outcome, without significant differences between the sexes (p = 0.901). The aesthetically shaped parasacral artery perforator flap combines very satisfactory results regarding recurrence and postoperative recovery with cosmetic outcome. This procedure is technically more demanding than other flap procedures, although it is accessible to numerous surgeons as the first-line treatment for pilonidal sinus disease after initial learning. Therapeutic, IV.

A Case Report: Pilonidal Sinus Management with Medical-Grade Honey

Due to its antimicrobial properties, medical-grade honey has shown to be effective in management of pilonidal sinus disease. This case report describes the potential therapeutic options of medical-grade honey for preventing infection and inducing wound healing.

Minimally invasive management of pilonidal sinus disease by phenol intra-cavitary application: A single surgeon experience

Aim: The objective of the present study is to share single surgeon’s experience in management of pilonidal sinus disease by phenol application.Material and Methods: Fifty-two patients, who were treated by phenol application for pilonidal sinus disease between September 2010 and August 2013, were analyzed retrospectively.Results: During this period phenol application was performed in 52 patients due to pilonidal sinus disease. Phenol application was performed three times for each patient (1st, 2nd and 7th days). Forty-eight (92%) patients were male and 4 (8%) female with a mean age of 22 years (range: 16-38 y). The mean follow-up period of the patients was 11 months (range: 4-18 m). Three (5.7%) patients had a recurrence and the mean follow up period was 11 months.Conclusion: Many surgical techniques are available in the treatment of pilonidal sinus disease. But all of them remain controversial due to recurrence and complication rates. Phenol treatment is easily applicable and has low costs with acceptable recurrence rates and provides rapid healing. For this reason, we suggest this non-invasive treatment in pilonidal sinus disease.Keywords: Pilonidal sinus disease; phenol; minimally invasive; treatment experience.

Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy—a randomized controlled trial

BackgroundPilonidal sinus disease is a common perianal inflammatory condition. Currently, operative therapy is the standard management strategy. The aim of this study is to investigate the efficacy of a preparation with antimicrobial, sclerosing, and wound-enhancing properties in the nonoperative management of pilonidal sinus disease. MethodsA parallel randomized controlled trial was conducted between January 2013 and January 2017 to investigate the effect of a mixture of sclerosing agent and herbal product (Lawsonia inermis powder) in the management of sacrococcygeal pilonidal sinus disease. The patients were allocated randomly into the study group (group receiving injection of the mixture into the sinus track) and the control group (group receiving the classic technique of operative excision and primary closure). ResultsThis study was conducted among 400 patients, 316 (79%) male, 84 (21%) female. The age range was 18 to 40 years with a mean age of 27.1 years (standard deviation, ±2.4); each group included 200 patients. None of the patients had an abscess or complicated pilonidal disease. Cure rate, defined as complete healing of the sinus, was high among both groups after the first intervention (94% for control group and 89% for the test group, respectively; P = .051). In the study group, there was a statistically significant decrease in hospital stay, cost, perioperative pain, duration of absence from work, and duration of the procedure. ConclusionAccording to this trial, the injection of this mixture appears to be better than the other therapeutic options for pilonidal sinus disease in terms of cost effectiveness, time off work, rate of complication, and perioperative pain.

Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study

Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track was practiced with encouraging results. The limited excision and modification of the primary closed technique has shown both low wound dehiscence and recurrence rates. The objective of this study is to evaluate and compare the local application of phenol 80% in the pilonidal sinus tracks after minimal debridement with the limited excision and modified primary closure technique. Methods: 52 patients suffering from chronic pilonidal sinus disease were divided equally into 2 groups. Patients in group I were managed with local phenol application under local anesthesia. In group II, the patients were operated upon by limited excision of the skin bearing the sinus pits and the underlying granulation tissue with modified primary closure technique using the gluteus maximus fasciae to close the cavity left followed by closure of the subcutaneous tissue and skin with leaving a suction drain inside. Results: The median duration of phenol applications procedure was 20 ± 11 minutes versus 41 ± 13 minutes in the modified primary closure technique. There was a significant difference between both groups as regards the duration of pain killers’ use. By 5 weeks, signs of complete healing were shown in 22 patients (84.5%) of the phenol group, versus 25 patients (96.2%) in the surgery group with no statistic difference between both. The recurrence of PSD in the phenol group was detected in 2 cases (7.7%) while it was one case (3.8%) in the surgery group (p=0.163). Conclusion: both procedures are simple, less surgically demanding, having simple postoperative care, low complication and recurrence rates, early recovery and good patient satisfaction.