Sacrococcygeal Pilonidal Sinus Disease Research Articles

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.

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.

Comparison of the effectiveness of laser and crystallized phenol in the treatment of sacrococcygeal pilonidal sinus.

The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease. A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study. The procedure time was significantly shorter in the crystallized phenol group than in the laser group (543 and 837 s, p < 0.001). While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05). There was no significant difference between the number of sinuses and recurrence, bleeding, pain, and patient satisfaction (p > 0.05). Crystallized phenol and laser used in the treatment of SPS disease have a low recurrence and similar long-term patient satisfaction. However, laser treatment has fewer intraoperative complications and post-operative pain severity than crystallized phenol.

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.

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.

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.

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

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.

Manuka Honey Versus Wet to Dry Dressing for Wound Closure Time After Open Pilonidal Sinus Surgery

Background: Sacrococcygeal pilonidal sinus disease is a very common chronic inflammation of the natal cleft that presents frequently as an abscess. Management requires the eradication of the sinus tract and postoperative wound care. Manuka honey (Medihoney) was used in acute and chronic wounds. In our study, we sought to investigate the clinical effectiveness of Manuka honey in decreasing wound healing time post excision. Material and Methods: We describe patients’ characteristics using traditional descriptive statistics. We compared the study endpoint (wound closure time) in patients who received Medihoney versus those who did not by Kaplan-Meier analysis. Results: A total of 119 patients underwent pilonidal cyst surgery between the years 2017 and 2018. The median time for healing in the Medihoney group was 40 days compared with 39 days in the control group. After adjusting for age, BMI, wound length, wound volume, smoking and operative time, the time to healing in the Medihoney group was significantly less compared to the group not receiving the treatment (Hazard Ratio 1.56, 95% Confidence interval 1.02- 2.49, p= 0.041). Conclusion: Postoperative use of Manuka honey showed a significant decrease in wound healing time when compared to gauze fabric dressings. Further research would be beneficial to explore optimal treatment protocols for this dressing technique.

Can the recurrence rate of open pilonidal sinus surgery be reduced by preventing premature epithelialization

Background and objective: Many surgical options are known to treat chronic pilonidal sinus disease; the procedure that has the least recurrence rate is the open method. This study aimed to evaluate the effect of adding one step in management, on the recurrence rate of the same procedure. Methods: This is a prospective study, started at 1st Feb. 2018; the last data collection was at 31 Jan. 2020. Thirt-eight patients included in the study, all were suffering from chronic sacrococcygeal pilonidal sinus disease. Sinus excision and lying open the wound to heal by secondary intention is the procedure that is adopted.At time of follow up, frequent separation of wound edges and breaking of any premature bridging of skin at the excision site, were adopted, local anesthesia was needed in 7 patients. Results: The recurrence rate for lying open the wound to heal by secondary intention is significantly reduced from (8-21%) to (2.63%) by adding one step in management during the follow up period, this step involved the frequent separation of wound edges and breaking of any premature bridging of skin even if local anesthesia is needed. Conclusion: Preventing premature bridging of wound skin after surgical excision of pilonidal sinus can significantly reduce the recurrence rate of the procedure

Educational Guidelines on Surgical Nurses' Knowledge and Practice regarding Phenolisation Dressing Technique for Patients with Sacrococcygeal Pilonidal Sinus Disease

Educational Guidelines on Surgical Nurses' Knowledge and Practice regarding Phenolisation Dressing Technique for Patients with Sacrococcygeal Pilonidal Sinus Disease

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.

The Outcome of Limberg Flap Procedure in the Management of Primary Chronic Sacrococcygeal Pilonidal Sinus Disease

Introduction: Sacrococcygeal pilonidal sinus (PNS) is a common chronic benign disease of young agegroup, associated with morbidity, often with a prolong loss of normal activity. Still there is ongoingdebate regarding the best treatment option as all the methods have complications, although; the currentevidence supports the use of off- midline techniques because of lower recurrence rates and avoidanceof all disadvantages of open treatment.This study was done to determine the postoperative outcomeof rhomboid excision and Limberg flap reconstruction as a main procedure in the treatment of PNSdisease in our institute.Patients and Method: A prospective study conducted at the Department of General Surgery- BaqubaTeaching Hospital- Diyala- Iraq, from January 2017 to June 2019, in which 98 patients (78 male and20 female) with chronic primary sacrococcygeal PNS were enrolled. The age of the patients rangedbetween 16 – 38 years. Patients with acute abscess were first treated by incision and drainage beforedefinite surgery. Patients were operated by rhomboid excision and Limberg flap reconstruction.Results: In this study, 98 patients were enrolled, 78 male (79.59 %) and 20 female (20.4%) with maleto female ratio of 3.9:1. The age of the patients ranged between 16 to 38 years with the mean age of25 years. During the follow up period; 6 patients (6.12%) developed seroma, 4 patients (4.08%) hadinfection and 4 patients (4.08%) had recurrent sinus after few months and one patient (1.02%) hadwound disruption.Conclusion: Rhomboid excision and Limberg flap reconstruction of PNS diseaseis safe and reliabletechnique with low complication and recurrence rates if performed according to appropriate surgicalprinciples.

Tie Over with Pressing Interrupted Sutures versus Usual Karydakis in Management of Sacrococcygeal Pilonidal Sinus Disease

Tie Over with Pressing Interrupted Sutures versus Usual Karydakis in Management of Sacrococcygeal Pilonidal Sinus Disease