Sacrococcygeal Pilonidal Disease Research Articles

Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center.

Background: Sacrococcygeal Pilonidal Disease (PD) is commonly treated with excision and primary closure techniques (EPC). Minimally invasive techniques (MIT), such as EPSiT and Pit-picking, had been recently advocated promising better outcomes. We analyzed mid-term results from our center after introduction of MIT to treat PD.Methods: Patients submitted to MIT (n = 44) with a median follow-up of 37 months were analyzed and compared with patients submitted to EPC (n = 70) with a median follow-up of 5 years. Both groups included patients operated in our department between 2011 and 2016 and have similar demographic and clinical characteristics. We compared operative time and post-operative parameters such as time with pain, dressing time and time to relapse.Results: The post-operative time with pain was significantly lower, whereas the dressing time was significantly longer, in MIT when compared to the EPC group. The relapse rate was similar in both groups but the follow-up is shorter in the MIT group. In addition, the analysis of patients free of disease using Kaplan-Meier curves revealed that relapse tends to occur more precociously in MIT than in EPC patients (p = 0.014). Interestingly, in the subgroup of patients with previous surgery, MIT's relapse rate was significantly lower than in the EPC group (30 vs. 100%, p < 0.001).Conclusions: MIT has the advantage of having a shorter time with pain in the postoperative period, while EPC benefits from a shorter dressing time. In general, the relapse of the disease tends to manifest more precociously in MIT patients. Moreover, in the subgroup of patients with previous surgery, MIT seems to have significantly better results when compared to EPC.

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.

Erratum zu: Die primär offene Behandlung des sakrokokzygealen Pilonidalsinus

Erratum to: coloproctology 2019 https://doi.org/10.1007/s00053-019-0346-0 In Fig. 2 the color correlation was not clearly given. You can see the corrected figure …

Primary open treatment of sacrococcygeal pilonidal disease

Surgical management of sacrococcygeal pilonidal disease ranges from pit/sinus procedures through excision with healing by secondary intent to various flap techniques. Short- and long-term outcomes differ between surgeons and techniques. An overview of primary open treatment of sacrococcygeal pilonidal disease, including technique, wound complications and recurrence is presented. Relevant articles were identified from PubMed. Of the three primary open treatment procedures (deroofing, marsupialization and wide local excision), marsupialization may have the lowest recurrence rate. Primary open treatment has a significant rate of non-healing as well as recurrence. Primary open treatment is widely practiced but wound healing may be a challenge for the patient and recurrence a challenge for the surgeon.

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.

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

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.

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.

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.

Could Early Postoperative Complications be Considered as Risk Factor for Recurrence after Pilonidal Sinus Surgery?

Background: There is no widespread consensus in treatment techniques of sacrococcygeal pilonidal disease (PD). Among surgical techniques, especially Karydakis procedure (KP) or modified Limberg flap (MLF), are frequently preferred. Causing prolonged follow-up and return to daily activity, postoperative complications are very annoying. We aimed to determine risk factors for possible complications and especially recurrence in the patients undergoing surgical treatment for PD. Methods: This is a seven-year retrospective study, which was conducted between January 2011 and January 2018. Eight hundred forty-one patients were evaluated in this work. We performed the same technique-the same surgeon approach in our surgical treatment. All cases were divided into two groups as KP (n=417) and MLF (n=424). Results: It was found no significant difference between the KP and MLF groups in terms of age, gender, BMI, smoking, history of acute abscess drainage (HAAD), the timing of suture removal, the follow-up period, seroma, hematoma, dehiscence, wound infection (WI), pain and recurrence. In this study, the follow-up period of patients was 48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group (Mean - SD). American Society of Anesthesiologists (ASA) score were found to be higher in the KP group. While mean duration of operation (DO) was shorter in the KP group, the timing of drain removal, hospitalisation period and return to daily activity (RDA) were longer. There was an established enhancing effect of BMI, HAAD, DO, and RDA on the early complications (EC) development in both of the groups, and of ASA scores on the EC development in the KP group. The rate of recurrence ratio was determined to be 6% in the KP and 4.72% in the MLF groups. In both of the groups, dehiscence or WI was found to be risk factors for recurrence. Conclusion: Although its DO is short, KP technique bear some of the disadvantages such as prolonged HP and delayed RDA. A significant positive correlation was found between various factors such as higher BMI, presence of HAAD, prolonged DO, prolonged RDA and the development of EC in both groups. We concluded that dehiscence and WI from EC may be evaluated as independent risk factors for recurrence. We also concluded that recurrence may be prevented if wound care is carried out carefully in the patients who developed dehiscence or wound infection.

Random pattern rotation flaps in the treatment of advanced sacrococcygeal pilonidal disease with damaged skin structure

Random pattern rotation flaps in the treatment of advanced sacrococcygeal pilonidal disease with damaged skin structure

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.

PİLONİDAL SİNÜS NEDENİ İLE OPERE EDİLEN HASTALARDA FLEP KALINLIĞININ ULTRASONOGRAFİK DEĞERLENDİRMESİ

Background and Objective: Various risk factors have been defined for recurrence in pilonidal disease. This study was designed to investigate the local subcutaneous tissue thickness in patients who were operated on for sacrococcygeal pilonidal disease. Materials and Methods: Ninety-eight patients who had been operated on with the diagnosis of pilonidal sinus were retrospectively evaluated between January 2008 and January 2014. In evaluation of the flap thickness, the nearest and farthest margins were measured by ultrasonography between the skin and sacrum. Results: Resection and primary closure and Limberg flap transposition were performed in 46 (46.9%) and 52 (53.1%) patients, respectively. Mean flap thickness was found to be 17.2 mm (range: 3.9 - 36.4) and 20.5 mm (range: 4.0 - 42.3) in the primary repair group and the Limberg group, respectively. The recurrence rate was 10.8% in the primary repair group, 3.8% in the Limberg group at a mean of 27.1 months (range: 12-54 months) of follow-up. Conclusion: Subcutaneous tissue thickness in the place of surgery was greater in patients with the Limberg flap procedure compared to the patients with primary closure in pilonidal sinus disease. Flap thickness may be a parameter that can be used to predict the possibilty of recurrence.

Pilonidal Sinus—Plenty of Literature yet Lack of Direction: A Pooled Analysis

A systematic analysis was conducted to compare various surgical treatment modalities and evaluate the short- and long-term outcomes in the management of sacrococcygeal pilonidal disease. Pilonidal sinus is a common and debilitating condition often requiring a surgical approach to treatment, of which many are available. Despite numerous treatment methods, no universal decision has been made as to the most efficient and effective surgical treatment. All randomized control trials published between January 1, 2003 and January 8, 2013 were accessed. Interventions included classic and modified Limberg flap, Karydakis flap, primary closure, and healing by secondary intention. Primary outcome measures included rate of surgical site infection, recurrence, and length of hospital stay. Secondary outcome measures were hematoma or seroma, and return to work. The search identified 22 articles suitable for inclusion in this review totaling 3693 patients. Analysis showed a 50% reduction in the rate of infection and recurrence in patients receiving closure with flaps compared with primary midline closure and healing by secondary intention. The Karydakis flap was shown to be more favorable cosmetically; however, it failed to compete with the classic and modified Limberg flap in treatment of complicated disease. No significant difference was noted between the modified Limberg and Limberg flap. These results show that the Karydakis flap, classic, and modified Limberg flap demonstrate significant benefits over healing by secondary intention and primary closure.

Effects of subjective sleep quality on the quality of life in patients with chronic anorectal disorder.

The aim of the present study was to evaluate the subjective sleep quality in patients with anorectal disorder, to determine the factors associated with subjective sleep quality, and to explore the relationship between subjective sleep quality and quality of life. This descriptive study was conducted between April 8, 2015 and April 12, 2016. The research population consisted of 284 patients who attended the general surgery outpatient clinics of Konya Military Hospital and were subsequently diagnosed with one of the four most common anorectal disorders (hemorrhoidal disease, anal fissure, anorectal abscess/fistula, and sacrococcygeal pilonidal disease). Data were collected from 114 patients who volunteered to participate in the study. After establishment of the diagnosis based on proctological anamnesis and physical examination, the Pittsburgh Sleep Quality Index, Short-Form Health Survey, Beck Anxiety Inventory, and Beck Depression Inventory were administered to the patients, along with a questionnaire on sociodemographic data, via a face-to-face interview technique. Ninety-six (84.2%) patients had poor sleep quality, whereas 18 (15.8%) patients had good sleep quality. Among the patients with poor sleep quality, 16 were diagnosed with anorectal abscess and fistula (100.0%), 40 with hemorrhoidal disease (90.9%), 16 with sacrococcygeal pilonidal disease (80.0%), and 24 with anal fissure (70.6%). Overall, all patients with poor sleep quality (n=96) had low scores in all subcomponents of the quality of life scale. The sleep quality in patients with chronic anorectal disorder is significantly impaired, thus negatively affecting quality of life. Therefore, improvement in quality of life by improving sleep quality should be one of the main objectives in treating chronic anorectal disorders.

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.

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.

Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population

PurposeTo evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes. MethodsA retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups. ResultsWe analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38min; p>0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n=1] vs. 20.0% [n=12]); p>0.05). Healing time was similar for both groups (28 vs. 37.5days). Recurrence occurred in 18,9% (n=15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p>0.05). ConclusionsOur results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population. Level of evidenceTherapeutic study – level III.

Methylene Blue Provides an Efficient Resection for the Treatment of Pilonidal Sinus Disease

Aim: The Methylene Blue (MB) is commonly used dye for Sacrococcygeal Pilonidal Sinus Disease (SPSD). The aim of this randomized prospective trial was to determine the benefits and effectiveness of (MB) for (SPSD) by comparing the results of Karydakis flap procedure. Patients and Methods: Between January 2016 and April 2017, a total of 100 patients with sacrococcygeal pilonidal sinus disease were randomly assigned to two equal groups which underwent Karydakis flap procedure with or without MB usage. Patients age, gender, BMI, duration of the disease and number of the orifices, excised specimen height, width, area, circumference, depth, volume,postoperative complications and duration of hospital stay were recorded. Results: Characteristics of the patients were similar in both groups. In the MB used group all the parameters except the depth of the excised specimens found as statistically significant (p<0.01). Conclusion: Our results s