Management Of Pilonidal Sinus Research Articles

Management of Pilonidal Sinus with Chitraka Kshara Sutra - A Case Study

Pilonidal sinus means nest of hairs also called Jeep-bottom because it was very common in jeep drivers. It is an acquired condition commonly found in hairy males. Different surgical methods have been described for this disease such as excision and primary closure and excision with reconstructive flap, etc. However, the recurrence after surgery is very high. There is similarity between Pilonidal sinus and Shalyaja Nadi Vrana described in Sushruta Samhita. Acharya Sushruta has described minimally invasive Para surgical procedure viz. Kshara Sutra for Nadi Vrana (Pilonidal sinus). This treatment not only minimizing the complications and recurrence but also enables the patient to resume work quickly with less discomfort. The patient attended Shalya Tantra OPD of Sri Kalabyraveshwara Ayurvedic College was treated with the Chitraka Kshara Sutra. The patient recovered well with complete excision of the tract within span of seven weeks.

Role of Vaccum Dressings In Open Wounds of Pilonidal Sinus

Pilonidal sinus is an acute suppurative condition occurring beneath the sacrococcygeal area presenting as an abscess acutely while as intermittent discharge in its chronic form. Objective: To determine the role of NPWT in the management of pilonidal sinus in a tertiary care hospital in Karachi, Pakistan over 6 months. Methods: 50 patients were divided into two groups; control and NPWT. It was an open-label randomized trial. The patients in the control group were being managed by wet dressing compared to the NPWT group where VAC therapy was used for wound healing. Both groups were followed for 14 days. Healing was measured by VAS score, wound size, and number of complications. Results: Wound size post-operatively was measured in both groups and was 36.33 squared centimeters in the control group with 30. 97 squared centimeters in the intervention group showed no statistical significance. On the 14th day of the trial, the wound size was compared again and in the control group, the size was found to be 24.4 cm2 and 14.9 cm2 in the intervention group. However, no statistical significance was shown. On the visual analog scale for pain after 14 days, both groups demonstrated a steep decline falling to nearly 1.5 from 9 on the first postoperative day however showing no significant difference across the two groups. Conclusions: There was no significant difference between the two methods and similar time was required in both groups before resuming daily life activities.

Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease.

Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.

Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India.

IntroductionA pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention.MethodsIn a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence.ResultsMean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study.ConclusionAccording to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.

Comparative Study between Rhomboid Flap and De-epithelization Technique in Management of Pilonidal Sinus

Comparative Study between Rhomboid Flap and De-epithelization Technique in Management of Pilonidal Sinus

Sacro-coxxygial hygiene, a key factor in the outcome of pilonidal sinus surgical treatment?

BackgroundSurgical wound infection contributes to prolonged recovery time after pilonidal sinus excision. As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post-operative period. Our hypothesis is that this should reduce healing time and complication rates. The aim of this study was to measure the importance of sacro coccygeal hygiene in the management of pilonidal sinus disease.MethodsWe retrospectively collected data after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period. Patients were divided into three groups according to their local hygiene during postoperative follow-up and scored one (G1: good hygiene) to three (G3: poor hygiene). Primary outcome was complication rates. Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate.ResultsIn G1 (N = 112), complication rate was 3.6%. In G2 (N = 109), it was 5.5%, whereas in G3 (N = 71), it reached 7.03%. However, there were no statistically significant differences between hygiene groups regarding complication rates in both univariate and multivariable analysis. Regarding secondary outcomes, there were significant differences between hygiene groups concerning median follow-up (p = 0.0001) and median time off work (p = 0.0127).ConclusionGood hygiene of wound is essential for optimal, rapid healing without complications. The importance of this report is to show that thanks to our hygiene follow-up strategy with frequent perineal irrigations and regular follow-up checks, patients with at a first glance “unclean local conditions”, reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level.

A comparative study of wide excision and Z-plasty in the management of pilonidal sinus at tertiary care hospital

Background: Treatment of pilonidal disease is challenging to surgeon. Post-operative course is lengthy, painful and patients are often unsatisfied. Several treatment modalities have been tried for pilonidal disease including incision & drainage of abscess, excision with primary closure, excision with open packing, excision with marsupilization and recently flap surgery. The aim of present study was to compare the results of wide excision and Z-plasty technique in management of pilonidal sinus.Materials and Methods: The present study was conducted on 50 cases diagnosed as a case of pilonidal sinus and admitted in department of surgery of Dr. S. N. Medical College Jodhpur. Patients were randomly divided into two groups. In Group A, wide excision was done and Group B wide excision was followed by Z-plasty.Results: Wound infection was present in 32% of Group A and 16% of Group B patients as postoperative early complication. Localized loss of sensation observed in 16% of Group A and 24% of Group B patients. Postoperative pain was present for 36.6±1.22 days in Group A and 14.32±1.83 days in Group B. Total healing of wound was reported in 42.2±2.62 days in Group A and 16.6±1.99 days in Group B. Mean days for return to work was 34.64±2.66 days in Group A and 15.44±1.80 days in Group B.Conclusion: Excision with Z-plasty was better technique in terms of less post-operative complications, less time in healing of wound, and early days for return to work.

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap

Background: Pilonidal sinus disease is a common condition usually affecting young individuals and has been conventionally treated by open excision technique. Rhomboid Limberg is a transposition flap that has been pleaded for treatment of this condition. Aim: To study the outcome of Rhomboid excision with Limberg flap closure for the treatment of Sacrococcygeal Pilonidal sinus. Material and Methods: The study was conducted prospectively in the department of surgery Skims Medical College Srinagar from March 2014 to February 2019 and total of 55 patients with primary or recurrent pilonidal sinus disease were studied. Results: The average operative time was 60 minutes (range 50-80 minutes) Postoperative stay of patients in the hospital was 3-4 days.The complications were seen in total of four patients which included Seroma and mild gaping of the wound in one patient each and dehiscence in two patients. None of the patients had recurrence till date.Conclusions: Rhomboid excision with Limberg flap transposition is an effective surgical technique for management of pilonidal sinus. Keywords: Pilonidal sinus, Limberg flap, rhomboid transposition flap, fasciocutaneous flap,

Management of Pilonidal sinus by partial sinus excision along with Ksharsutra ligation

Pilonidal sinus is a disease of a midline pit situated in mid gluteal cleft at post anal region associated with hairs. Continued sitting, obesity, hairy part, family history which increases the risk of diseases. The prevalence rate in males is more (Male & Female ration 3:1) and incidence is about 26 per 100,000 population. The treatment of pilonidal sinus includes excision and primary closure, excision with reconstructed flap technique etc. In Ayurveda pilonidal sinus is correlated with Nadivrana and it can be considered under shalyaj Nadivrana and Shushruta has explained Shastrakarma with intervention of ksharsutra as one of the treatment of Nadivrana (sinus) excision. In this case study, a case of pilonidal sinus, 21yr / Male patient diagnosed and treated successfully with integrated approach i.e. partial sinus excision adjuvant to Ksharsutra therapy. Partial sinus excision followed by Ksharsutra ligation in the remaining intact tract was performed under local anaesthesia, Patient was asked to attend surgical OPD for dressing on alternate days, and Seitz bath with lukewarm water was advocated before dressing. The Ksharsutra was changed weekly for 3 sitting. To reduce pain, inflammation and control infection, Analgesic,anti-inflammatory and oral antibiotic drug were also prescribed for 5 days. Observation revealed that sinus- track cut through and healed by 4 weeks. Patient was under observation for period of one year to check for recurrence. This innovative partial sinus excision along with Ksharsutra ligation under local anesthesia, proved an effective ,time conserving and non-recurrent, minimal invasive treatment alternative for pilonidal management.

Five Layers Repair in Management of Pilonidal Sinus

Five Layers Repair in Management of Pilonidal Sinus

Pilonidal sinus management using diode laser

Background: Published results have shown that Laser pilonidoplasty may be effective in management of pilonidal sinus (PNS). We report the final results of a case series study evaluating the safety and efficacy Diode Laser 980 nm in management of PNS. Methods: this small case series study including twenty patient suffering from chronic primary PNS (single or branched ) between 18 and 36 years old, we carried out laser pilonidoplasty usind diode laser 980nm on continuous mode (power of 5 watt with power density 994 W/ cm2) with aradial fiber that emits heat energy in 3600 direction leading to photocoagulation of sinus tract by vaporization of water content of blood and tissues at rate 1.5 cm / min., the mean operative time was ( 27.2±4.18 )minute., at Sayed Galal Hospital and Tanta Insurance Hospital Egypt between January 2019 and December 2019 with follow up for ten months. The outcome was evaluated by recurrence or not. Results: All twenty patients were treated using diode laser 980nm, The mean time for complete healing was (28.5±3.87 ) day. after ten months follow up ; recurrence occurs in one case ( 5% ). Conclusion: Laser Pilonidoplasty is a simple, reasonable, feasible,minimal invasive, reproducible technique and competitive alternative to other surgical intervention. It is accompanied by a reduction in pain, early resuming work with decreased rate of recurrence. Inspite of surgical approach is still the standard modality for PNS treatment.

Conceptual & clinical application of kshara in anorectal disease.

Pilonidal disease is a common anorectal problem that typically affects young people. Pilonidal sinus describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region known as the natal cleft. the pilonidal sinus, presented with boil with slight seropurulent foul discharge from post anal region in the natal cleft.
 The most commonly used surgical techniques for pilonidal sinus includes excision with primary closure and excision with reconstructive flap with their own limitation(PNS).In Ayurveda acharya Sushruta has considered it under shalyaj nadi vrana ( sinus or fistula due to foreign body). Sushruta mentioned the chedana as well as ksharkarma in the management of Nadivrana. Hence the study concluded that excision & ksharkarma in pilonidal sinus is one of the potential treatment option to avoid recurrence.
 Nowadays Pilonidal Sinus (PNS) is becoming common disease in between 20-50 years of age, in men and mostly dense hairy persons. Commonly it occurs midline over the coccyx. It results in purulent discharge, pain and discomfort. In Ayurvedic practice, there are many surgeons who are practicing classical Ksharasutra management to treat PNS, which is very effective but there are some problems using classical Kshara in the management of PNS, such as discomfort, burning sensation, itching and irritation due to Snuhi-ksheera. So patients can do their daily routine work without any pain or discomfort.
 In Ayurveda, Shastra and Anushstra Karma are described in detail. Kshara is best among Shastra and Anushastras. Two types of Kshara are there - Paneeya and Pratisarneeya. Pratisarneeya Kshara is of three types- Mridu, Madhyama and Teekshana. Kshara Karma include - Pratisarneeya Kshara application, Kshara Sutra therapy and Kshara Varti. Pratisaraniya Kshara is mainly used in wound management, various anorectal disorders such as Arsha (Haemorrhoids), kushtha, Arbuda, Dushta Nadivrana, Guda Bhramsha (Rectal prolapse). Kshara is a caustic material. It causes chemical burn on the area where it is applied. It helps in sloughing of necrosed and infected tissues. Kshara Sutra therapy is used specially in Bhagandara (Fistula in Ano), Nadivrana (Pilonidal sinus) and various benign growth of skin such as papilloma, warts etc. Kshara Varti is used in chronic non healing wounds for debridement and in sinuses or fistula in ano. Ksahra Karma has been very much effective non surgical means in the management of various disorders especially in anorectal disorders.

PILONIDAL SINUS: SURGICAL EXCISION OF PILONDIAL SINUS AND SUTURING SKIN EDGE TO PRE-SACRAT FASCIA (PARTIAL CLOSURE)

Surgical treatment of pilonidal sinus is by surgical excision of sinus and partial closure by suturing skin to pre-sacral fascia. This study was carried out on 20 patient with pilonidal sinus admitted to surgical department in Kobry-El-Kobba Military Medical Campus. This patient was treated by surgical exciting of pilonidal sinus and partial closure of the wound by suturing skin edge to presacral fascia. This study covers the introduction and incidence, pathology, clinical presentationand different method in management of pilonidal sinus. This study proposes that excision of pilonidal sinus and partial closure of the wound by suturing skin edge to pre-sacral fascia, safe, with low recurrent rate- short hospital stay. No postoperative discomfort or food restriction and early ambulation and return to work. This study was done up on 20 young male troops “soldiers” patients with mean age 25 years admitted to surgical department, Kobry El-Kobba Military MedicalCampus, from January 2016 to December 2018, treated by suturing skin edge to pre sacral fascia, and study the effect of operation on patient convenience, infection, recurrence, bleeding postoperative, healing time, hospital stay and histopathological examination of specimens.

PILONIDAL SINUS: SURGICAL EXCISION OF PILONDIAL SINUS AND SUTURING SKIN EDGE TO PRE-SACRAT FASCIA (PARTIAL CLOSURE)

Surgical treatment of pilonidal sinus is by surgical excision of sinus and partial closure by suturing skin to pre-sacral fascia. This study was carried out on 20 patient with pilonidal sinus admitted to surgical department in Kobry-El-Kobba Military Medical Campus. This patient was treated by surgical exciting of pilonidal sinus and partial closure of the wound by suturing skin edge to presacral fascia. This study covers the introduction and incidence, pathology, clinical presentationand different method in management of pilonidal sinus. This study proposes that excision of pilonidal sinus and partial closure of the wound by suturing skin edge to pre-sacral fascia, safe, with low recurrent rate- short hospital stay. No postoperative discomfort or food restriction and early ambulation and return to work. This study was done up on 20 young male troops “soldiers” patients with mean age 25 years admitted to surgical department, Kobry El-Kobba Military MedicalCampus, from January 2016 to December 2018, treated by suturing skin edge to pre sacral fascia, and study the effect of operation on patient convenience, infection, recurrence, bleeding postoperative, healing time, hospital stay and histopathological examination of specimens.

Opened versus closed procedures in management of pilonidal sinus (P.M.S.)

Background: PNS is a common surgical disease and there are many methods of treatment such as wide excision of sinus and lay wound open to heal by granulation tissue (open), excision of a sinus with primary closure (closed), track debridement and excision or phenolization of epithelial pit and excision of PNS with primary closure using oblique incision. Methods: Setting: In Fallujah Teaching Hospital from Jan. 2017 to Dec. 2018. Design: Prospective study. These cases were chosen and divided into 2 groups: Group A: were treated by open procedure (31). Group B: were treated by closed procedure (27). The average period of follow up after completion of surgery was six months for both groups. Results: In group A symptomatic improvement occurs in 26 (83.8%) of patients and the duration of healing was about 45 days, 5 (16.2%) patients were delayed healing while recurrence were 4 (12.9%). In group B symptomatic improvement occurs in 19 (73.7%) of patients and the duration of healing was about 2 weeks. 8 (26.3%) patients were delayed healing while recurrence were 6 (22.2%). Conclusions: From this study we find that there is no ideal treatment of pilonidal sinus according to: 1. Meantime of healing. 2. Delay healing. 3. Recurrence.

Combined Open and Closed Approach for Management of Pilonidal Sinus by Special U-shaped Sutures Without Drain.

Combined Open and Closed Approach for Management of Pilonidal Sinus by Special U-shaped Sutures Without Drain.

A comparative study between sinotomy with or without marsupialization versus sinotomy and primary closure with or without drain in the management of pilonidal sinus

Background: pilonidal sinus (PNS) is a common condition. Although many methods for treatment are available, there is no consensus on the optimal treatment. Aim of the study: The aim of the work was to compare the outcome of sinotomy procedure with or without marsupialization versus sinectomy and primary closure with or without drain in the management of pilonidal sinus as regards operative times, postoperative complications, and time of healing and return of work. Patients and Methods: This is a comparative randomized comparative study. Sixteen patients undergoing surgery for primary PNS were enrolled. The patients were randomized into four groups. Each group included 15 patients. Group A underwent sinotomy without marsupialization; group B underwent sinotomy with marsupialization; group C underwent limited excision and primary closure with a drain and group D underwent the same procedure as group C but without drain. Each patient was followed up for 6 months. Results: Significantly short operative time was recorded in group B. Postoperative wound complications occurred in 3.2% of patients in group A, in 1.7% of patients in B, in 7.4% of patients in group C and in 4.2% of patients in group D. Recurrence rate was a slightly higher in group C but with no statistical significance. Conclusion: The sinotomy with marsupialization for treatment of PNS is superior to excision with primary closure either with or without a drain and sinotomy without marsupialization.

A comparative study between sinotomy with or without marsupialization versus sinotomy and primary closure with or without drain in the management of pilonidal sinus

A comparative study between sinotomy with or without marsupialization versus sinotomy and primary closure with or without drain in the management of pilonidal sinus

Pilonidal Sinus : Management through Guggulu Apamarga Ksharasutra

Nowadays Pilonidal Sinus (PNS) is becoming common disease in between 20-30 years of age, in men and mostly dense hairy persons. Commonly it occurs midline over the coccyx. It results in purulent discharge, pain and discomfort. In Ayurvedic practice, there are many surgeons who are practicing classical Ksharasutra management to treat PNS, which is very effective but there are some problems using classical Ksharasutra in the management of PNS, such as discomfort, burning sensation, itching and irritation due to Snuhi-ksheera. So to overcome these problems Guggulu Apamarga Ksharasutra has been used, which is very effective in curing PNS and has no complications. So patients can do their daily routine work without any pain or discomfort.

Comparative study between excision with primary closure versus Limberg flap for treatment of primary sacrococcygeal pilonidal sinus

Background: Surgical treatment of sacrococcygeal pilonidal sinus is associated with significant recurrence rate. However; recent study suggested the use of rhomboid excision and Limberg flap repair as feasible procedure for treatment of pilonidal sinus disease. Our aim is to evaluate the role of rhomboid excision of the pilonidal sinus with Limberg flap by comparing this procedure with the traditional excision and primary closure.Methods: This prospective study included 60 patients with sacrococcygeal pilonidal sinus. The patients were randomly divided into 2 equal groups. Rhomboid excision of the sinus with limberg flap was performed in 30 patients (group A), and excision of the sinus with primary closure was done to the other 30 cases (group B). Demographic data and surgical outcome were compared between both groups.Results: Group A showed significant early retained to work and significant less postoperative pain than group B (P=0.04 and P=0.02 respectively). Incidence of wound dehiscence, postoperative hematoma and seroma was less among group A but without significant difference. The incidence of postoperative infection and recurrence rate was significantly less in group A than group B (P=0.04 and P= 0.035 respectively).Conclusions: Rhomboid excision and Limberg flap repair is an advantageous and effective modality than simple excision with primary closure in treatment of sacrococcygeal disease. In addition, it is safe and easily procedure; it may be an ideal treatment option in management of pilonidal sinus.