Sacrococcygeal Pilonidal Sinus Research Articles

Surgical Reconstruction after Excision of Pilonidal Sinus with Modified Limberg Transposition Flap

Background: Pilonidal sinus is a common infectious process which occurs in buttocks and sacral area which involves a wide range of symptoms that are different from an asymptomatic sinus to acute and chronic sinus track. Aim of the work: The aim of the study was to evaluate the outcome of modified Limberg transposition flap in surgical reconstruction after excision of pilonidal sinus. Patients and Methods: This prospective study was conducted at the Department of General Surgery, Al-Azhar University Hospitals (Al-Hussin & Sayed Galal hospitals). This study was carried out on 30 consecutive patients with primary non recurrent sacrococcygeal pilonidal sinus from 11/2018 to 6/2019 to allow a minimum follow-up period of at least 5 months for the last case operated upon. Results: Operative time and postoperative pain with mean operative time 47.37 ± 5.67, postoperative pain: 18 patients (60%) with mid pain, 10 patients (33.3%) with moderate pain, only 2 (6.7%) with severe pain. The complications among study group were 4 patients (13.3%) with wound seroma, 3 patients (10%) with wound hematoma, 3 patients (10%) with wound infection, 2 patients (6.7%) with wound gapping, only one patient (3.3%) with flap necrosis. The mean time for wound healing is 20.57 ± 5.72, 17 patients (56.7%) less than 20 days and 13 patients (43.3 %) more than 20 days, mean hospital stay is 3.63 ± 0.85, 17 patients (56.7%) = 3 days hospital stay and 13 patients (43.3%) more than 3 days hospital stay. Conclusion: Surgical reconstruction after excision of pilonidal sinus with modified Limberg transposition flap is an effective method for the management of pilonidal disease, especially when dealing with recurrent pilonidal sinus.

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus

A Retrospective Analysis of the Surgical Treatment Options for Sacrococcygeal Pilonidal Sinus, with Special Reference to Limberg Flap

A Retrospective Analysis of the Surgical Treatment Options for Sacrococcygeal Pilonidal Sinus, with Special Reference to Limberg Flap

Short-term outcomes of radical excision vs. phenolisation of the sinus tract in primary sacrococcygeal pilonidal sinus disease: a randomized-controlled trial.

Phenolisation of Sacrococcygeal pilonidal sinus disease (SPSD) seems to have advantages over radical excision; however, a randomized-controlled trial (RCT) comparing both techniques is lacking. The aim of our study was to compare sinus pit excision and phenolisation of the sinus tract with radical excision in SPSD in terms of return to normal daily activities. This study was a single-center RCT. Fifty patients who presented with primary SPSD were randomized to phenolisation and 50 patients to excision. The primary endpoint was time to return to normal daily activities. Secondary endpoints were quality of life, complaints related to SPSD, surgical site infection, and wound epithelialization. Patients were treated in a 1-day surgery setting. Complaints related to SPSD were evaluated and symptoms were scored by the participants on a 6-point scale before surgery, and patients kept a diary for 2weeks on complaints related to the surgical treatment (the same scoring system as preoperatively) and pain, evaluated with a VAS. Quality of life (QoL) was measured preoperatively with a VAS and the Short Form-36 Health Survey (SF-36). At 2, 6, and 12weeks after surgery, patients were evaluated using a questionnaire containing the following items: patients' satisfaction (disease, compared with preoperatively, scored as cured, improved, unchanged or worsened), five complaints related to the surgical treatment (the same scoring system as preoperatively and in the diary), QoL (VAS and SF-36), and return to normal daily activities. The wound was assessed 2, 6, and 12weeks postoperatively by one of the investigators (EF or NS), using an assessment form RESULTS: The mean time to return to normal daily activities was significantly shorter after phenolisation (5.2 ± SD 6.6days vs. 14.5 ± 25.0days, p = 0.023). 2weeks after surgery, all patients in the phenolisation group and 85.4% of patients in the excision group returned to normal daily activities (p = 0.026). Pain was significantly lower after phenolisation at 2weeks postoperatively (0.8 ± 1.0 vs. 1.6 ± 1.3, p = 0.003). Surgical site infection occurred significantly more often after radical excision (n = 10, 21.7% vs. n = 2, 4.0%, p = 0.020). At 6 and 12weeks, complete wound epithelialization was more frequently achieved after phenolisation (69.0% vs. 37.0%, p = 0.003 and 81.0% vs. 60.9%, p = 0.039, respectively). Pit excision with phenolisation of SPSD resulted in a quicker return to normal daily activities, less pain, and quicker wound epithelialization compared to radical excision. Surgeons should consider phenolisation in patients with primary SPSD.

Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature.

BackgroundThe efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic.MethodsA retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed.ResultsGroup 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 (107.7±60.3 cm2 vs. 61.4±33.8 cm2, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2.ConclusionsLimberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus

Although many surgical methods have been described for sacrococcygeal pilonidal sinus treatment, the best option is still controversial. We aimed to compare postoperative outcomes of these different methods in terms of advantages and disadvantages. The records of 320 patients undergone surgery for primary or recurrent pilonidal sinus between May 2013 and May 2017 were retrospectively analyzed. Demographical data, pre operative stories, wound site infection, seroma development, wound dehiscence, time of healing, duration of return to work, and if there is any recurrence of 303 patients included in the study were recorded. Upon wide local excision, the first surgeon performed marsupialisation and the lay open technique, second surgeon performed vertical excision and primary closure, third surgeon performed Limberg flap transposition and fourth surgeon performed Karydakis' flap transposition. There was no significant difference between the patients in terms of demographical characteristics. The duration of surgery was statistically significantly higher in primary closure method (p=0.001). The mean duration of return-to-work was statistically significantly lower in primary closure method (p=0.002). In primary closure method, the recurrence rate was found to be statistically significantly higher than the other methods (p=0.009). We do not suggest the use of primary closure method in treatment of pilonidal sinus. Because of lower rates of recurrence and shorter durations of return to work, the Karydakis and Limberg methods are seen as safer methods when compared to lay-open and marsupialization method.

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

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.

A comparative study between Limberg flap and cleft lift procedures in the treatment of sacrococcygeal pilonidal sinus disease

Introduction This was a prospective, randomized study designed to compare the effects and outcomes of Limberg flap (rhomboid excision) and cleft lift procedure. Patients and methods Between June 2014 and June 2017, 40 patients underwent surgical treatment for uncomplicated sacrococcygeal pilonidal sinus in the Surgery Department, Al-Azhar University Hospital, New Damietta. The patients were randomly subdivided into two groups: group A comprising 20 patients who underwent the Limberg flap procedure (rhomboid excision) and group B comprising 20 patients who underwent the cleft lift procedure. Results As regards operative time and weight of resected tissue, there was a significant decrease in group B (carried out by cleft lift procedure) in comparison with group A (carried out by Limberg flap procedure) (33±4.2, 12.1±5.23 vs. 42±5.1, 25.4±3.59, respectively). Moreover, there was a decrease in the postoperative pain (measured by a visual analog scale) in group B in comparison with group A, mainly on the first and seventh days, but this difference in the postoperative pain was nonsignificant. In addition, there was a nonsignificant decrease in the mean hospital stay and healing time in group B in comparison with group A. As regards the postoperative complications, there was nonsignificant decrease in postoperative seroma and superficial skin separation in group B in comparison with group A. The recurrence rate shows no statistically significant difference between the two groups. Conclusion Both the cleft lift and the Limberg flap procedures gave similar good results, except that the cleft lift procedure has a shorter operative time.

Efficacy of different surgical options in the treatment of sacrococcygeal pilonidal sinus disease: A comparative study

Efficacy of different surgical options in the treatment of sacrococcygeal pilonidal sinus disease: A comparative study

Management of sacrococcygeal pilonidal sinus disease: surgeons’ current practice in Taif—Saudi Arabia

Management of sacrococcygeal pilonidal sinus disease: surgeons’ current practice in Taif—Saudi Arabia

Inverse 'D' incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line.

PurposeSurgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (ᗡ) incision based on tissue loss, wound tension, and suture line location.MethodsThis prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the ‘ᗡ’ incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months.ResultsSixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a ‘ᗡ’ incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients.ConclusionThe method of sinus excision using the ‘ᗡ’ incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.

Rare complication of a common disease: Coccygeal osteomyelitis following Pilonidal sinus

Pilonidal sinuses commonly arise in the sacrococcygeal region. The common complications are local cellulitis, abscess formation which is related to the infectious process, and recurrence after surgery. They rarely evolve with osteomyelitis, meningitis, or malignant transformation. Coccygeal osteomyelitis as a direct complication of sacrococcygeal pilonidal sinus disease (PSD) is extremely rare with limited data. We report a case of complicated sacrococcygeal PSD with coccygeal osteomyelitis. It was managed with: wide local excision of the pilonidal sinus, coccygectomy, perineal musculature reconstruction, and defect closure by Limberg rhomboid flap.

Comparative study between Limberg flap and local rotation flap for pilonidal sinus, as a new modified technique

Introduction Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. Recurrent disease causes significant morbidity and consequent time off work. Aim The aim of this study was to assess the role of the local rotation flap in promoting primary healing in pilonidal disease and to evaluate morbidity and recurrence in comparison with Limberg flap. Patients and methods This prospective study was conducted at Al-Azhar University Hospitals, from April 2015 to July 2018. It involved 80 patients with pilonidal disease. There were 56 males and 24 females aged between 21 and 42 years old. They were divided randomly into two groups, with 40 patients each. Group A underwent Limberg flap, whereas group B underwent a local rotation flap closure for sacrococcygeal pilonidal sinus. Results The operative time was ∼1.5 h in group A, whereas in group B was ∼45–60 min. The duration of hospital stay was 1 day, as all patients were discharged on the same day of surgery in both groups. In group A, there was no wound infection, but two cases had wound dehiscence, one case flap necrosis, and two cases with seroma after removal of drain. In group B, there was no wound infection, flap necrosis, or wound dehiscence, but there were six cases with seroma in the follow-up period. There was one case of recurrence in group A and no recurrence in group B. Conclusion This study favors the local rotation flap for sacrococcygeal pilonidal sinus because it had the same outcomes as in Limberg flap, in addition to its simplicity and short operative time.

Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study.

IntroductionSacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty.AimTo assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG).Material and methodsFourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records.ResultsPatients were aged 18–45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients.ConclusionsTopical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.

The Incidence, Gender Predilection and Etiology of Sacrococcygeal Pilonidal Sinus

Pilonidal Sinus (PNS) is widely distributed in both the emergency department and General Surgery outpatient clinic. Most authors consider the disease as an acquired disease, occurs due to the insertion of broken hairs into the skin with the subsequent tissue inflammation and fibrosis. The incidence of PNS is particularly high in younger males, especially from the Mediterranean region. The aim of the current study was to determine the incidence of the PNS Disease in the city of Sulaimaniyah and the reasons behind the development of the disease. A prospective cohort study was performed in the period between January 2018 and January 2019(1 year) at the Department of Surgery of Shar Teaching Hospital, Sulaimaniyah City. All consecutive patients who presented to the Emergency Department or outpatient clinic and admitted to the Shar Hospital were investigated for the presence of Sacrococcygeal Pilonidal Sinus Disease. Those who found to have the disease were offered surgical excision and examination of the excised specimen for evaluation of the etiology of the Disease. Overall, 103 out of 1000 patients had Pilonidal sinus, while 897 out of 1000 patients did not show any sign of the disease. Fifty-three out of 103 patients with Pilonidal Sinus were symptomatic and the rest were asymptomatic. The factors which associated with the presence of PNS were: family history (23/103 compared with 45/897, p &lt; 0.0001); overweight defined as BMI &gt; 25 (39/103 compared with 213/897, p &lt; 0.0001); having excessive body hair distribution (41/103 compared with 122/897, p &lt; 0.05). PNS is considered one of the acquired clinical conditions, that is occurred due to insertion of a hair shaft into the skin, followed by subsequent local inflammation and granulation tissue formation. If the etiology is clearly identified, the condition can be readily prevented.

Management of sacrococcygeal pilonidal sinus disease

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.

Comparison of limberg flap and oval flap techniques in sacrococcygeal pilonidal sinus disease surgery.

Although many surgical techniques have been described for treatment of pilonidal sinus disease (PSD), the ideal treatment method remains controversial. The purpose of this study was to compare Limberg flap and oval flap techniques in patients with PSD. Patients diagnosed with PSD who underwent surgery using either the Limberg flap or oval flap technique between January 2012 and January 2016 at the general surgery outpatient clinic were retrospectively reviewed from the database of our hospital; 142 patients (124 males and 18 females) were invited for examination. The demographic characteristics of the patients such as age and gender, hospital stays, seroma occurrence, surgical site infections, wound dehiscence, flap necrosis, loss of sensation, and recurrences were evaluated based on the information obtained from the database and from physical examinations as well as questioning of the patients. The results were statistically compared, and a p value of <0.05 was considered significant. The mean age of the patients was 27.5±7.8 years in the Limberg flap group and 26.5±7.2 years in the oval flap group. No significant difference was found between the two groups regarding patients' mean age; gender distribution; postoperative hospital stay; recurrence; and complications, such as seroma, infection, wound dehiscence, and loss of sensation. Flap necrosis was not observed in any of the patients. The Limberg flap and oval flap procedures both involve minimum morbidity and short hospital stay because they were not superior to one another regarding treatment effectiveness, complications, and recurrence in the pilonidal sinus surgery.

Evaluation of Rhomboidal Flap in Recurrent Pilonidal Sinus

Background: A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor. The exact cause of pilonidal sinuses is unclear. It is generally thought they are caused by loose hairs pushing into the skin. They could also be caused by deep layers of skin being stretched and moved, leading to a hair follicle rupturing. Aim of the Work: The prospective study aimed at evaluating the outcomes of management of recurrent pilonidal sinuses by rhomboid flap. Patients and Methods: A prospective study of cases with recurrent pilonidal sinus, was done at the department of general surgery at In Al-Azhar University hospitals over the period from July 2017 with medium follow up period of three months. Results: Age: ranged between 17 to 36 years with mean = 24.7±5.57. Sex: included 12 male and 8 female. Conclusion: Based on this study, it seems to us that the rhomboid flap is a good alternative for recurrent sacrococcygeal pilonidal sinus, especially for complex sinuses, and it could be appropriate for cases where simpler techniques have failed. It permits early return to complete activity, does not require prolonged postoperative attention, and has very low recurrence rate and postoperative morbidity which may compensate the inconveniences related to an unfavorable cosmetic look.

A Prospective Randomized Trial Comparing Excision and Healing by Secondary Intention versus Rhomboid Excision and Limberg Flap Closure in the Treatment of Primary Sacrococcygeal Pilonidal Sinus

Background: Surgery is the only treatment for symptomatic saccrococcygeal pilonidal sinus. Various surgical techniques are described in literature; yet, the ideal technique is still controversial because of the high recurrence rate that is associated with the majority of the techniques. Aimof the work: To evaluate Limberg flap closure for the treatment of primary pilonidal sinus by comparing its operative and postoperative outcome with open excision and healing by secondary intention. Methods: This is a prospective randomized trial which enrolled eighty patients with primary pilonidal sinus from May 2015 to April 2018. The patients were divided into two groups. Group A included forty patients who underwent excision and the wound was left to heal by secondary intention. Group B included forty patients who underwent rhomboid excision and Limberg flap repair. Results: The operative time was significantly longer in group B. Duration for complete wound healing and return to work were significantly longer in group A. There was no statistically significant difference between both groups neither in recurrence nor in postoperative complications. Conclusion: Although recurrence was the same with in healing by secondary intention and Limberg flap, yet rhomboid excision and Limberg flap closure for the management of primary pilonidal sinus is better option in terms of wound healing and early return to work.

SURGICAL OUTCOME OF KARYDAKIS TECHNIQUE IN SACRO-COCCYGEAL PILONIDAL SINUS

Background: Pilonidal sinus is caused by repeated traumatic penetrations of the skin by hair with consequent infolding and sinus formation. The objective of the study was to determine the surgical outcome and post-operative satisfaction level of patients undergoing Karydakis technique in sacro-coccygeal pilonidal sinus. Material &amp; Methods: This descriptive cross-sectional study was conducted at the Department of General and Laparoscopic Surgery, Hayatabad Medical Complex, Peshawar, Pakistan from January 2013 to December 2014. Sample size was 38. All male sacro-coccygeal pilonidal sinus patients aging 16 to 65 years were included. Demographic variable was age in years. Research variables were duration of symptoms, follow up, length of stay, return to work, healing time, sacro-coccygeal pain, purulent or mucopurulent discharge, fever, swelling, tenderness and presence of frank abscess, seroma formation and over all satisfaction. Mean ±SD were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Data was analysed using IBM SPSS Statistics version 22.0 descriptively. Results: The mean age of the sample of 38 patients was 31.13 ±5.8 years; ranging from 16 to 65 years. Mean symptoms duration was 11.9 ±4.8 days. The mean follow-up duration was 9.87 ±1.89 months. The mean length of stay was 3.42±1.24 days. The mean return to work time was 8.79 ±2.1 days while mean healing time was 12.89 ±1.91 days. The presenting complaints were sacro-coccygeal pain in 34(89.5%), purulent or mucopurulent discharge in 30(78.9%), fever 22(57.9%), swelling 15(39.5%), tenderness 10(26.3%), presence of frank abscess 10(26.3%), seroma formation 3(7.9%) and over all satisfaction was (63%). Conclusion: Over all satisfaction rate was high in Karydakis technique in sacro-coccygeal pilonidal sinus patients.