Sinus Track Research Articles

Epididymo-orchitis with epididymal abscess in a patient with disseminated tuberculosis

Abstract Tuberculosis remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations like genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old male with left scrotal swelling, backache, and fever, highlighting the importance of considering tuberculosis in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and contrast-enhanced magnetic resonance imaging Dorso-lumbar spine, confirmed disseminated tuberculosis. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital tuberculosis, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of tuberculous epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications like hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.

A unique case of laproscopic port site tuberculosis.

We report a case of 27 years old lady who presented after 04 weeks of laproscopic cholecystectomy, with purulent discharge from 03 port sites most likely due to improper sterilization of re-usable laproscopic instruments. Patient was initially managed conservatively by repeated incision and drainage and multiple antibiotics including second line drugs against atypical mycobacterium were prescribed but infection did not settle. Her routine bacterial cultures and acid fast bacillus (AFB) stains were negative. After 07 months patient started developing abscesses in surrounding primary port sites and it was finally decided to excise the discharging sinus tracks and sent for histopathology. Histopathology confirmed tuberculosis as it showed epithelioid granulomas. Patient was started with standard first line anti tuberculous treatment (ATT) to eradicate the disease and she became alright after 06 months of ATT.

Factors Associated With the Development of a Confirmed Fracture-Related Infection.

To identify factors associated with the development of fracture-related infection (FRI) in patients who have undergone operative fixation of their fracture. Retrospective study. Academic medical center. Patients with peripheral extremity long-bone fractures and shoulder and pelvic girdle fractures who underwent operative repair. This included patients who had undergone fixation inside and outside of our institution. Chi-square, Fisher exact testing, analysis of variance (ANOVA), and t tests were used for analysis of data, as appropriate. Binomial logistic regression analysis was performed to determine risk factors of FRI. Demographics, fracture location, injury mechanism, open wound status, and wound complication type. One hundred ninety-three patients comprised the FRI cohort. Of those with confirmed signs of FRI, 36 (18.7%) had wound breakdown to bone or implant, 120 (62.1%) had a sinus track, and 170 patients (88.1%) had the confirmed presence of microorganisms in deep tissue samples obtained during operative intervention. Factors associated with development of an FRI were as follows: higher BMI; being of Black and Hispanic race; higher American Society of Anesthesiologists class; history of tobacco, alcohol, and drug use; and fractures of the lower extremity (foot, tibia, and femur/pelvis). The results of binary logistic regression demonstrated that treatment at an urban level I trauma center and drug use positively predicted the development of FRI. Our results demonstrate that higher BMI; being of Black or Hispanic race; higher American Society of Anesthesiologists; history of tobacco, alcohol, and drug use; and fractures of the foot, tibia, and femur/pelvis are all factors associated with development of FRI. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Mycobacterium tuberculosis infection of a reverse total shoulder arthroplasty: a case report.

We describe the case of a 78-years-old male with dyspnea, inappetence and weight loss over a period of two weeks. The CT scan suggested disseminated tuberculosis and T5-T6 spondylodiscitis. During hospitalization, he developed a left shoulder pain where a reverse total shoulder arthroplasty was implanted 11 years ago. Open debridement and lavage with retention of the implant was performed first and intraveinous antibiotics were administered. 3 months after surgery the patient developed a painful sinus track at the incision site. Resection of the fistula tract, soft tissue debridement and removal of the implants were performed before restarting chemotherapy. As the incidence of reverse total shoulder arthroplasty continues to increase throughout the world, periprosthetic joint infection (PJI) will probably raise as well. Diagnosing and treatment of shoulder PJI with atypical germs remains a challenge and explantation seems to be the safer surgical option to avoid recurrent surgeries on patient with increasing comorbidities.

Single versus multiple visits for endodontic treatment of permanent teeth.

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016. To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years. We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022. We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite). We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth). As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.

Transcriptome Meta-Analysis Confirms the Hidradenitis Suppurativa Pathogenic Triad: Upregulated Inflammation, Altered Epithelial Organization, and Dysregulated Metabolic Signaling.

Hidradenitis suppurativa (HS) is an inflammatory skin condition clinically characterized by recurrent painful deep-seated nodules, abscesses, and sinus tracks in areas bearing apocrine glands, such as axillae, breasts, groins, and buttocks. Despite many recent advances, the pathophysiological landscape of HS still demands further clarification. To elucidate HS pathogenesis, we performed a meta-analysis, set analysis, and a variant calling on selected RNA-Sequencing (RNA-Seq) studies on HS skin. Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling. Upregulation of specific genes, such as KRT6, KRT16, serpin-family genes, and SPRR3 confirms the early involvement of hair follicles and the impairment of barrier function in HS lesioned skin. In addition, our results suggest that adipokines could be regarded as biomarkers of HS and metabolic-related disorders. Finally, the RNA-Seq variant calling identified several mutations in HS patients, suggesting potential new HS-related genes associated with the sporadic form of this disease. Overall, this study provides insights into the molecular pathways involved in HS and identifies potential HS-related biomarkers.

296 Knowing When to Put the Knife Down - a Case Report on Osteoradionecrosis of the Chest Wall

Abstract Radiation therapy is a common treatment for carcinoma of the breast. It has shown to reduce the incidence of local reoccurrence and improve life expectancy, but it is not without complications. Osteoradionecrosis (ORN) of the chest wall is a recognised but rare complication, which can lead to full thickness necrosis, localised infection, and pathological rib fractures. This case report discusses a 78-year-old female with a history of adjuvant radiotherapy for a left breast malignancy, who developed three distinct wounds on her left anterior chest wall. Over five years, these wounds ulcerated and formed sinus tracks exposing the rib cage. The patient also developed various local infections requiring antibiotics. Management options were explored, ranging from conservative dressings, anti-inflammatories and steroids to medical options traditionally used to treat ORN of the mandible, such as the combination of Pentoxifylline and vitamin E, and Hyperbaric Oxygen Therapy (HBO2). However, the most beneficial definitive treatment proposed was surgical intervention using either a latissimus dorsi or an upper limb fillet flap. Despite this, the patient's social, cosmetic, and surgical concerns focussed the current management towards the conservative highlighting the importance of “putting down the knife” and the role of monitoring the disease with biannual clinic follow ups. While surgery is likely a necessity in the future, this case study highlights the importance of considering medical input and keeping the patient's interests at the forefront of surgical practice.

Gastrocutaneous fistula after laparoscopic cholecystectomy: An unforeseen mishap

A middle-aged woman presented to us with complaints of purulent discharge which was coming from the epigastric port site for two years following laparoscopic cholecystectomy, which was performed at an outside hospital for asymptomatic gall stone disease. Computed tomography and magnetic resonance imaging (MRI) confirmed the fistulous sinus track communicating with the anterior body wall of the stomach. At re-laparotomy, the sistulous sinus track was found and excised with primary repair of the defect in the stomach wall. The patient had an uneventful post-operative recovery and was doing well on follow-up. This was the second such case reported in literature where a common surgical procedure like laparoscopic cholecystectomy has led to the formation of gastrocutaneous fistula, which is a rare complication and was successfully managed.

HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

Dermal Sinus Track with Intraspinal Dumbbell Mature Cystic Teratoma in an Infant Presenting as Recurrent Meningitis: A Case Report

Cystic mature teratomas presenting in the spine are rare, comprising less than 0.1% of all spinal tumors. They arise from all three germ cell layers and usually accompany other congenital abnormalities. Spinal teratomas are more common in children as compared to adults and are usually associated with spinal dysraphism. Dermal Sinus is a closed type of Spinal dysraphsim, lined with epithelium and are mostly associated with Dermoid, Epidermoid and Posterior arch defect [1]. We present a case of an infant with recurrent meningitis. His examination was remarkable for a lumbar dimple. Imaging revealed a dermal sinus track continuous with a dumbbell appearance of extradural and intradural nodules, while the histopathology confirmed mature cystic Teratoma.

Post-treatment Flare-up Incidence after Using Nano Zinc Oxide Eugenol Sealer in Mandibular First Molars with Irreversible Pulpitis.

Statement of the Problem: Some patients may report moderate-to-severe pain and/or swelling following root canal treatment, which is undesirable for both the patient and dentist and may require an unscheduled emergency visit by patients to relieve their symptoms.Purpose: The aim of this study was to evaluate the post-treatment flare-up incidence following application of nano zinc oxide-eugenol (NZOE) sealer in mandibular first molars with irreversible pulpitis.Materials and Method: This single-blinded study was performed on 60 patients having mandibular first molars with irreversible pulpitis. After signing the written consent form, the patients were randomly divided into two groups considering their age range (20-34 and 35-50 years). Individuals without systemic diseases and with a first mandibular molar diagnosed with irreversible pulpitis due to caries, no sinus track and abscess, normal periapical radiographic appearance, no spontaneous pre-treatment pain, not taken any medication for at least 8 hours before the treatment visit were included in this study. Patients of both sexes with age range of 20 to 50 years were selected. In order to obturate the root canal space, AH26 sealer was used in the one group and the synthesized NZOE was applied in another group. The patients were then given questionnaires to report the severity of pain and presence of swelling during 6, 18, 24, and 48 hours of follow-up. The data was analyzed using SPSS v.19 software applying repeated measures ANOVA. The significance level was set at 0.05.Results: The severity of pain was significantly lower in NZOE group at 24 hours post-treatment (p= 0.003). Patients reported no symptoms of swelling in any group. Conclusion: NZOE sealer manifested satisfactory results and could be regarded as a promising substitute to routine sealers since patients may experience less pain during the first hours after receiving root canal therapy.

EP18 Testicular sarcoidosis: a challenging diagnosis

EP18 Testicular sarcoidosis: a challenging diagnosis

MANAGEMENT OF SHALYAJ NADIVRAN BY MODIFIED KSHARASUTRA W.S.R. TO PILONIDAL SINUS

Pilonidal sinus is a disease that most commonly arises in the hair follicles of the natal cleft of the sacrococcygeal. Incidence is more common in men as they are hairier than women. The factor which increases the risk of pilonidal sinus is continuous sitting, obesity, sedentary occupation, family history, local trauma. The surgical management commonly practiced are included incision and drainage, excision and primary closure, excision and healing by secondary intention, excision with reconstructive flap technique (Bascom’s method). However, the risk of recurrence or of developing an infection of the wound after the operation is high. In Ayurveda as clinical features, the pathology of Pilonidal sinus and Shalyaj nadivrana described in Sushruta Samhita are very much similar to each other we can correlate with Shalyaj type of Vrana with Pilonidal sinus. Sushruta has explained Shastrakarma with the intervention of ‘Ksharsutra’ procedure for the management of Nadi vran (PNS). This case study was presented on a male patient aged 39 years. He was suffering from pilonidal sinus for 9 months and treated successfully with partial sinus excision along with Ksharsutra therapy. Partial sinus excision followed by Ksharsutra ligation in the remaining intact tract was performed under local anaesthesia. The Ksharasutra was changed weekly for 3 sittings. Observation revealed that sinus track cut through and healed by 5 weeks. The patient was under observation for one year to check for recurrence. Ksharasutra treatment not only minimizes complications and recurrences, causing minimal scar but also facilitates the patient to resume early working with less discomfort as well as reduced time and cost.

Sutureless versus interrupted sutures techniques for neonatal circumcision; a randomized clinical trial

and objective: Male circumcision is a common procedure all over the world; in Saudi Arabia, circumcision is the most frequent elective surgical procedure performed on males. The use of sutures for neonatal circumcision may decrease bleeding; however, it may lead to skin sinus formation. The objective of this study was to compare the sutureless to the interrupted sutures technique for neonatal circumcision with Gamco clamp. We performed a randomized controlled clinical trial between 2017 and 2018. The study included 182 newborns assigned into two groups. Group 1 (n=94) included neonates who had sutureless circumcision, and group 2 (n=89) included neonates who underwent circumcision using interrupted absorbable 6/0 sutures. Study endpoints were bleeding, wound gaping, skin tunneling or sinus, and cyst formation. There was no significant difference in patients' age and weight between groups. The procedure was significantly longer in group 2 (12.24±2.17 vs. 6.54±1.42min; p<0.001). There was no difference in bleeding between both groups (4 (4.26%) vs. 2 (2.27%) in groups 1 and 2, respectively, p=0.683). Cyst formation was significantly reduced in group 1 (2 (2.13%) vs. 13 (14.77%); p=0.002) and skin sinus formation increased in group 2 (14 (15.91%) vs. 0 in group 2 and 1, respectively; p<0.001). Circumcision can be performed with several techniques, and the superiority of one approach over the other is still debated. Many surgeons use interrupted sutures to oppose the skin edges, and in some reports, tissue glue was used for skin edges re-approximation with acceptable cosmetic results. In our study, the mean time taken for sutureless circumcision was about 7min, and for the suture circumcision, it took around 11min. In addition, the formation of a skin tunnel or sinuses rate was high despite the use of very thin sutures. Male circumcision is a common and safe technique with minor and treatable complications. Risks of bleeding and sinus track formation are low with the sutureless method. The sutureless technique is recommended after Gamco circumcision as the standard technique for male circumcision in the newborn.

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.

Outcomes of minimally invasive endoscopic pilonidal sinus surgery.

Pilonidal disease is a common condition that is often treated with morbid and painful surgeries. A minimally invasive, endoscopic approach has been described as an alternative to traditional open procedures. It allows the full visualization of the sinus tracks, leaves minimal scarring and results in less pain and a quicker recovery. Patients who underwent minimally invasive endoscopic surgery for pilonidal disease at a major metropolitan hospital in Australia were retrospectively identified. Their operative reports and medical records were assessed to determine analgesic requirements, lengths of hospital stay, recurrence rates of pilonidal disease, and wound complications. Nine patients had endoscopic sinus surgery (six male, three female). All patients received treatment from the same surgeon. No patients required opiate analgesia for pain and only one stayed post-operatively in hospital overnight. There were no recorded wound complications. The median follow-up period was 28 months (range, 8-36 months). Eight patients had satisfactory healing recorded during their post-operative consultations. Three patients suffered recurrent disease. Minimally invasive surgery is safe and well tolerated when employed to treat pilonidal disease. It could be considered as a first-line treatment for the obliteration of symptomatic pilonidal sinuses.

Biologics for hidradenitis suppurativa: an update.

Hidradenitis suppurativa (HS) is a chronic, inflammatory dermatosis characterized by an occurrence of nodules, abscesses, sinus tracks and scarring. Its pathogenesis is multifactorial and still not fully understood, therefore, current systemic therapies still remain a serious challenge. Increased levels of several proinflammatory cytokines have been reported in patients suffering from HS, therefore biologics appear as a new approach to therapy for this condition. Adalimumab is the only one internationally registered agent and should be considered first after the conventional therapies appear insufficient. The efficacy and safety profile of some preparations, like infliximab and etanercept was confirmed so far in randomized trials, but there are some new biologics which are still being evaluated and require more rigorous examination.

The Islamic Perspective of Lingual Dens Evaginatus in a Mandibular Left Second Premolar: A Case Report

Dens evaginatus (DE) is a developmental anomaly. It is an extra cusp or tubercle that protrudes from the occlusal surface of posterior teeth, as well as the lingual surface of anterior teeth. Tubercles are susceptible to pulp exposure from wear or fracture because of malocclusion;leading to pulpal complications early after eruption.DE may also complicate the process of daily routine oral health care. A 13-year-old girl presented to our polyclinic with sinus track at the posterior lower left buccal gingiva forthe past1 year. All 35 teeth were sound. At the lingual side, there was an accessory tooth in close relation to tooth 35 covered with supra-gingival inflammation. Electric pulp test (EPT) showed that tooth 35 was already non-vital. Intraoral periapical (IOPA) radiograph and cone beam computed tomography (CBCT) scan showed an abnormalappearing root which shows DE with radiolucency at the periapical area. Root canal treatment was performed using crown down pressureless (CDP) technique and obturation was done using lateral condensation technique. The tooth was restored using composite restoration. DE is a rare condition. It is quite a challenge for dental practitioner since the diagnosis is difficult and the treatment options are limited. In the case of DE with necrotic pulp and periapical abscess, root canal treatment is a treatment of choice. We have to accept and appreciate any gift from Allah SWT whether it is good or bad, no equal divine creation except from Allah SWT.Therefore we need to take care of our oral hygiene to prevent diseases. In every disease, there is a cure; we thus need to try to do the best to find the cure and to not easily get rid of the tooth and replace it with a denture. Early diagnosis of DE can lead to proper treatment which can result in high success rate if it is followed by adequate restoration.

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.

Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study

Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track was practiced with encouraging results. The limited excision and modification of the primary closed technique has shown both low wound dehiscence and recurrence rates. The objective of this study is to evaluate and compare the local application of phenol 80% in the pilonidal sinus tracks after minimal debridement with the limited excision and modified primary closure technique. Methods: 52 patients suffering from chronic pilonidal sinus disease were divided equally into 2 groups. Patients in group I were managed with local phenol application under local anesthesia. In group II, the patients were operated upon by limited excision of the skin bearing the sinus pits and the underlying granulation tissue with modified primary closure technique using the gluteus maximus fasciae to close the cavity left followed by closure of the subcutaneous tissue and skin with leaving a suction drain inside. Results: The median duration of phenol applications procedure was 20 ± 11 minutes versus 41 ± 13 minutes in the modified primary closure technique. There was a significant difference between both groups as regards the duration of pain killers’ use. By 5 weeks, signs of complete healing were shown in 22 patients (84.5%) of the phenol group, versus 25 patients (96.2%) in the surgery group with no statistic difference between both. The recurrence of PSD in the phenol group was detected in 2 cases (7.7%) while it was one case (3.8%) in the surgery group (p=0.163). Conclusion: both procedures are simple, less surgically demanding, having simple postoperative care, low complication and recurrence rates, early recovery and good patient satisfaction.