Sacrococcygeal Pilonidal Disease Research Articles

Minimally invasive techniques for surgical treatment of sacrococcygeal pilonidal disease

Sacrococcygeal pilonidal disease (SPD) is a common disease that affects mainly young men and leads to a decrease in their quality of life and a long‑term loss of working capacity. According to the available statistical data, the disease prevalence in Europe and North America ranges from 26 to 40 cases per 100,000 people.
 Objective — to determine the effectiveness of minimally invasive techniques for surgical treatment of chronic and recurrent forms of SPD.
 Materials and methods. The study included 23 patients with SPD. It was clinical prospective, with a follow‑up period of 18 months. The evaluation criteria were defined as recurrences, the frequency of postoperative complications, the severity of the pain syndrome, the patient’s self‑assessment of the cosmetic effect, the duration of hospitalisation, and the duration of surgery.
 The results. The recurrence rate during the 18 months of observation was 39.1%. The overall frequency of postoperative complications was 21.7%. The median duration of surgery was 20 (CI 95% 15—25) minutes, and the median duration of hospitalisation was 2 (CI 95% 1—3) days. The median score of the pain syndrome according to the modified visual analogue scale was 5 (CI 95% 4—5) points on the 0th postoperative day, 3 (CI 95% 3—4) points on the third postoperative day, and 2 (CI 95% 2—2) points on the fifth postoperative day. The cosmetic effect of surgical intervention was rated as rather dissatisfied (17.4%), rather satisfied (52.2%), and completely satisfied (30.4%).
 Conclusions. Minimally invasive techniques are effective for the surgical treatment of chronic and recurrent forms of sacrococcygeal pilonidal disease, reducing both the inpatient period and the surgery duration. Minimally invasive surgical treatment for chronic and recurrent forms of sacrococcygeal pilonidal disease has been observed to cause a moderate pain syndrome in the early postoperative period while contributing to satisfactory cosmetic results in the remote period. The surgical treatment of chronic and recurrent forms of sacrococcygeal pilonidal disease with minimally invasive techniques has been found to result in a relatively high recurrence rate (39.1% over 18 months of follow‑up).

Efficiency of the new modified inverted Y cleft lift advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease with low-lying tracts near the anus

Propose This study aimed to assess the efficiency of the new modified inverted Y cleft lift procedure, utilizing an advancement flap technique with off-midline primary wound closure for patients with lower pits of the sinus near the anus. Patients and methods This prospective case series was conducted from September 2018 to September 2020. Forty patients with sacrococcygeal pilonidal sinus disease with lower pits near the anus presented either as new cases or recurrent cases. All patients were offered the new modified inverted Y cleft lift advancement flap procedure and were followed up for 48.5 months (range, 21–57 months). Patients were evaluated in terms of operation time, postoperative complications, recurrence rate, return-to-work time, and cosmetic satisfaction. Results The average age was 27.4 years (range, 16–52 years); 29 (72.5%) patients were male and 11 (27.5%) were female. The mean operating time was 25 min (range, 22–45 min) and the mean length of hospital stay was 0.8 days (range, 0.4–2 days). Primary healing occurred in 35 (87.5%) patients. Complete healing for complicated wounds (five patients) was achieved in an average of 21 (14–60) days. Two (5%) patients developed a superficial wound infection, four (10%) patients experienced a seroma, and five (12.5%) had partial dehiscence (some complications observed in the same patient). There was no case of deep infection, hematoma formation, or complete dehiscence. Conclusion This series proved that the new modification inverted Y cleft lift flap reconstruction is an effective operative procedure for primary and recurrent pilonidal sinus cases with pits located very close to the anus, associated with low complication and recurrence rates. What does this paper add to the literature? This paper discusses a new modification to the modified cleft lift procedure named the inverted Y flap procedure, achieving off-midline primary wound closure in patients with a difficult situation with lower pits of the sinus very close to the anus, for pilonidal disease either primary or recurrent.

Outcomes of Crystallized Phenol Treatment in Sacrococcygeal Pilonidal Sinus Disease and Factors Affecting Recurrence: A Retrospective Study

Outcomes of Crystallized Phenol Treatment in Sacrococcygeal Pilonidal Sinus Disease and Factors Affecting Recurrence: A Retrospective Study

An algorithm for the diagnosis of sacrococcygeal pilonidal disease in resource-limited settings

Pilonidal disease (PD) is a very common condition. In the countries of the global West, which have high per capita income and advanced health care systems, the average lifetime incidence is about 26 cases per 100,000 people. In the USA, about 70,000 new cases of the disease are registered annually. The full‑scale aggression of the Russian Federation in February 2022 resulted in a drastic decline in access to high‑quality health care in Ukraine, particularly affecting people living in temporarily occupied territories, communities with significant destruction, and internally displaced persons. Pilonidal disease substantially reduces patients’ working capacity, diminishes their quality of life, and, in some cases, can result in severe complications that pose an immediate threat to their lives.
 Objective — to develop a standardised algorithm for diagnosing sacrococcygeal pilonidal sinus disease (PD) in resource‑limited settings (combat zones, territories located in the close vicinity of the theatre of military operations where the population does not have full access to specialised health services; de‑occupied territories, which are temporarily deprived of access to qualified medical personnel and appropriate technical resources).
 A standardised algorithm for diagnosing PD has been developed. It consists of nine stages organised into consecutive blocks. Each stage is designed according to the «task‑step‑commentary» principle and includes detailed explanations for performing the diagnostic procedure.
 Conclusions. Sacrococcygeal pilonidal sinus disease is a common condition that requires timely diagnosis and further management. In resource‑limited settings, the creation of diagnostic algorithms is one of the important ways to improve access to health services.

Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)

Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.

Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long-term analysis.

Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus. A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded. Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow-up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence. The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence.

Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease.

Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

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.

Surgical Practice Parameters for the Definitive Management of Sacrococcygeal Pilonidal Sinus Disease: Surgeons' Perspective.

Background Sacrococcygeal pilonidal sinus disease (SPD) is a common general surgical condition encountered in practice and predominantly affects young males. Surgical practice parameters for the management of SPD are variable. This study aimed to review current surgical practice parameters for SPD management in Western Australia. Methodology This study conducted a de-identified 30-item multiple-response ranking, dichotomous, quantitative, and qualitative survey of self-reported surgeon practice preferences and outcomes. The survey was sent to 115 Royal Australian College of Surgeons - Western Australia general/colorectal surgical fellows. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results The survey response rate was 66% (N = 77). The cohort comprised mostly senior collegiate (n = 50, 74.6%), and most were low-volume practitioners (n = 49, 73.1%). For local disease control, most surgeons perform a complete wide local excision (n = 63, 94%). The preferred wound closure method was an off-midline primary closure (n = 47, 70.1%). Self-reported SPD recurrence, wound infection, and wound dehiscence rates were 10%, 10%, and 15%, respectively. The three high-ranked closure techniques were the Karydakis flap, Limberg's flap (LF), and Z-Plasty flap. Each surgeon's median annual SPD procedures were 10 (interquartile range = 15). The surgeons could utilize their preferred SPD closure technique (mean = 83.5%, standard deviation = ±15.6). Univariate analysis showed significant associations between years of experience and SPD flap techniques utilized, with senior surgeons significantly less likely to use either the LF (p = 0.009) or the Bascom procedure (BP) (p = 0.034). Instead, there was a preference for using healing by secondary-intention technique (SIT) compared to younger fellows (p = 0.017). A significant negative correlation existed between practice volume and SPD flap technique utilization, with low-volume surgeons less likely to prefer the gluteal fascia-cutaneous rotational flap (p = 0.049) or the BP (p = 0.010). However, low-volume practice surgeons were significantly more likely to use SITs (p = 0.023). The three most important patient factors in choosing SPD techniques were comorbidities, likely patient compliance, and attitude toward the disease. Meanwhile, factors influencing local conditions included the proximity of the disease to the anus, the number and location of pits and sinuses, and previous definitive SPD surgery. Key informants for technique preference were perceived low recurrence rate, familiarity, and overall good patient outcomes. Conclusions Surgical practice parameters for managing SPD remain highly variable. Most surgeons perform midline excision with off-midline primary closure as the gold standard.There is a clear and present need for clear, concise, and yet comprehensive guidelines on managing this chronic and often disabling condition to ensure the delivery of consistent, evidence-based care.

An effective and considerable treatment of pilonidal sinus disease by laser ablation

The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470‐nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470‐nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14–42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470‐nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.

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.

Keystone Versus Rhomboid Flaps in The Management of The Sacrococcygeal Pilonidal Disease; A Prospective Randomized Trial in A Tertiary Surgical Center

Keystone Versus Rhomboid Flaps in The Management of The Sacrococcygeal Pilonidal Disease; A Prospective Randomized Trial in A Tertiary Surgical Center

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial.

There are many surgical approaches for sacrococcygeal pilonidal sinus disease (PSD) therapy, ranging from wide excision repair to less morbid excisions with primary/flap closure. The off-midline flaps, which shift the incision line away from the midline natal cleft, have been associated with lower recurrence rates than the conventional mid-line closure techniques. This single-blinded randomized controlled trial aims to compare the short/long-term efficacy and outcome of the slide-swing flap technique with the conventional secondary wound closure. This study was a prospective randomized controlled trial conducted on patients with PSD. Patients were assigned into two groups: secondary closure (control) and slide-swing flap (trial). Patients were advised to visit the surgical clinic two times weekly for the two weeks after the operation for at least six months. In this study, 100 patients were enrolled. They were assigned into two groups of control, and trial. The mean age of all participants was 29.15 ± 8.36 years old (age range: 18-62 years old). The mean operation time was 39.65 ± 12.63 for both groups, with the control group being 29.70 ± 7.71 and the swing flap group 46.90 ± 7.81. Patient visual analog scale (VAS) scores in both groups revealed that the trial group was associated with lower VAS scores compared with patients who underwent secondary closure (p-value = 0.006). Also, the trial group demonstrated a higher rate of healing, better cosmetic outcomes, and quicker recovery time compared with the controls. Compared with secondary closure, the slide-swing flap was associated with excellent cosmetic outcomes, disease recurrence, and recovery time. Also, the post-operative complications were significantly lower compared with the traditional method.

Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease

There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior, and it was associated with some degree of recurrence. Crystallized phenol treatment is a non-operative procedure performed in outpatient settings. This retrospective study aimed to asses crystallized phenol treatment in patients with primary and recurrent SPD and the factors that influence disease recurrence. A total of 92 patients were included and followed up. Crystallized phenol was administered in an outpatient setting under local anesthesia. All demographic, patient, sinus features, procedure and outcome data were recorded and analyzed for treatment success and factors for recurrence were identified. Between January 2019 and December 2021, 92 patients (77 male and 15 female) with a mean age of 28.4 were treated with 1, 2, or 3 doses of crystallized phenol. Recurrence rate after the procedure was 20.7%. Univariate regression analysis showed that the grade of hirsutism, initial presence of abscess, pit number and number of showers per week had statistically significant effect on recurrence. Multivariate logistic regression analysis pointed on the hirsutism grade (P = .008) and the number of pit openings (P = .003) as a statistically significant factors for recurrence. Crystallized phenol application for primary and recurrent SPD is safe, inexpensive and efficient non-operative method with few minor complications, even when is repeated. Factors responsible for the recurrence of the procedure are grade of hirsutism and sinus pit number.

Closure of pilonidal sinus by the modified off-midline method in the Kurdistan Region, Iraq

Background and objective: Sacrococcygeal pilonidal sinus disease is an inflammation in the natal cleft of the sacrococcygeal region, which develops to abscesses and sinus formation. The incidence of sacrococcygeal pilonidal sinus disease notably increased in the last 50 years, however, there is no accurate data about the frequency of the disease and incidence rate among the Kurdistan region-Iraq population. In this study, we have introduced a simplified off-midline surgical technique without flap reconstruction. The main objective was to find out the rate of postoperative complications, hospitalization time, the recovery time to daily activity and work, and esthetic satisfaction. Methods: This study was conducted in Kurdistan region, Iraq from March 2016 to September 2019 on individuals suffering from sacrococcygeal pilonidal sinus disease. Two hundred ninety-eight individuals from different gender and ages enrolled for operation by modified simple closure of sacrococcygeal pilonidal sinus disease. Results: The median age of the patients was 22.4 years (24.1 male and 20.5 female). 33.9% of our patients were female students (P = 0.002). Most of the patients (89.2%) did not have postoperative complications. However, wound infection was detected in 3.0% of patients. Sacrococcygeal pilonidal sinus disease recurred in 5.4% of patients; furthermore, the disease recurred twice in 7 females (2.4%). All the recurrences happened in the patients that had a severe form of sacrococcygeal pilonidal sinus disease. Conclusion: Significant number of our patients were students, and female students for unclear reasons are at risk in our region. The post-surgical complications only occur in patients with a severe form of sacrococcygeal pilonidal sinus disease. In terms of simplicity, hospitalization time, the recovery time to daily activity and work, esthetic satisfaction, and post-surgical complications, our surgery technique was superior to other open wound surgery such as V-Y Advancement flap, and Karydakis flap.

Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study

Abstract Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.

The progress of different surgical treatment methods for chronic sacrococcygeal pilonidal sinus disease

The progress of different surgical treatment methods for chronic sacrococcygeal pilonidal sinus disease

A RARE CASE REPORT OF PILONIDAL SINUS MIMICKING FISTULA IN ANO

Pilonidal Sinus typically presents as an abscess, purulent discharge, or pits around midgluteal cleft.. In rare cases sinuses progress anteriorly mimicking Fistulas in Ano. Clinicians and especially surgeons should be aware of this situation, in order to avoid reoperations and patient's discomfort and frustration. These complex cases with secondary openings may create problems in diagnosis and treatment when the secondary openings are close to the anus. In this case a single-stage surgical procedure for treatment of sacrococcygeal pilonidal disease with healing by secondary intention is described

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience.

Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment.A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.

Platelet-Rich Plasma (PRP) for Sacrococcygeal Pilonidal Disease: An Updated Systematic Review and Meta-Analysis.

Pilonidal disease can be a debilitating condition which carries a significant physical and economic burden. This systematic review and updated meta-analysis presents the evidence for the use of platelet-rich plasma (PRP) for wound healing following open and minimally-invasive sacrococcygeal pilonidal surgery. A literature search was performed during December 2021 for studies relating to platelet-rich plasma and pilonidal wound healing following surgery. Nine studies remained after applying the exclusion criteria, incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively. Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time (mean difference [MD] = -13.98days, 95% CI -18.41 to -9.55, p < 0.001, I2 = 98%). Three open surgery group studies compared post-operative time off work, while three recorded mean pain duration; pooled analysis also revealed a significant reduction in both outcomes, respectively (MD = -8.7days, 95% CI -9.4 to -8.0, p < 0.001, I2 = 57%; MD = -9.5days, 95% CI -15.6 to -3.3, p = 0.002, I2 = 98%). Methodological heterogeneity among the minimally-invasive studies precluded formal meta-analysis; however, two studies demonstrated a modest improvement in wound healing when treated with PRP. This systematic review and updated meta-analysis provide further evidence supporting the use of PRP for wound healing in sacrococcygeal pilonidal disease. PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group. Nevertheless, there is still considerable heterogeneity among PRP manufacture and administration techniques, and further high-powered RCTs with consistent methodology are required to substantiate these findings.