Surgical Treatment Of Pilonidal Disease Research Articles

Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation.

There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Thirty-one National Health Service trusts. Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Surgery. Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. This trial is registered as ISRCTN95551898. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.

Surgical treatment of pilonidal disease - Short-term follow up results of minimally invasive pit-picking surgery versus radical excision without suturing: A prospective randomised trial

BackgroundIn this study we compared the potential benefits of surgical treatments for chronic symptomatic pilonidal disease (PD) - minimally invasive pit-picking surgery and radical excision without wound suturing. Materials and methodsA total of 100 adult patients with chronic symptomatic PD were enrolled in this study at the Kaunas Hospital of the Lithuanian University of Health Sciences. They were randomly divided into two groups: pit-picking surgery (n = 50) and radical excision with open healing (n = 50). Recurrent PD patients were not excluded. The comparison of the techniques was based on pain within the first postoperative week, failed surgery rates, and wound healing time. Additionally, pain levels at different time intervals following the treatment, analgesic consumption, and time off work, were assessed and compared. ResultsA total of 89 patients (89 %) were available for follow-up after 6 months. Pain levels the first postoperative week were significantly lower in the pit-picking group compared to the radical excision group, with median scores of 10.0 and 20.0, respectively (p = 0.002). The complete wound healing time was longer in the radical excision group (60 days) versus the pit-picking group (17 days), with a significant difference noted (p = 0.00). No significant difference was observed between the type of surgery and the rate of failed surgery, with 5 (11.9 %) cases in the pit-picking group and 4 (8.5 %) in the radical excision group. ConclusionBased on our short-term findings, minimally invasive pit-picking surgery is a better option regarding pain, wound healing time and failed surgery rate. In cases where this approach is not suitable, other alternatives should be contemplated, as radical surgery without wound suturing should not be employed as a treatment method for PD. Additionally, the relationship between PD and recurrence rates should be investigated further.

Treatment of recurrent pilonidal cysts in children: minimally invasive Gips technique

Introduction. Currently, long-term outcomes after surgical treatment of pilonidal disease are not always satisfactory. In particular, relapses can reach 40% by different authors and pose a big problem for operating surgeons. Repeated surgical interventions are technically more complicated, often require extensive excision and often lead to rough scars, which worsen cosmetic results. The minimally invasive Gips method has no abovementioned disadvantages and can be used in pilonidal cyst relapses. Purpose. To assess the Gips surgery effectiveness in relapses of pilonidal cysts in children.Material and methods. 7 children with relapses of pilonidal cysts have been treated with Gips technique in the surgical department of Ivano-Matreninskaya Children's Clinical Hospital (Irkutsk) since January 2020. All surgeries were performed by the generally accepted Gips technique: local infiltration anesthesia with 1% lidocaine solution; fistula excision with a trepan-circular knife and curettage of the pathological cavity. Then, wounds were processed openly with gauze tampons until complete healing.Results. Gender – 71.4% boys and 28.6% girls. The average age is 16.5 years (12–17 years). Previously performed surgical interventions: excision of the pilonidal cyst – 4 and Gips procedure – 3. Restoration of motor activity – on the first day after surgery. Duration of NSAIDs therapy – 2 days after the procedure. No early postoperative complications were registered. The average length of hospital stay – 4.75 days. Complete healing of postoperative wounds – 4.1 weeks, in average. Catamnesis – 9.5 months , in average; early relapses - in one patient (14.3%).Conclusion. Minimally invasive intervention for treating pilonidal cysts by the Gips technique can be used both in primary and recurrent forms of the disease. The discussed technique provides good cosmetic results and has a minimal number of postoperative complications.

Oxygen-enriched oleic matrix (NovoX) for wound healing in pediatric patients undergoing open surgical treatment for pilonidal disease: Preliminary experience.

Pilonidal disease (PD) is a common infectious and inflammatory condition affecting the gluteal cleft and sacrococcygeal region. The optimal treatment for PD remains controversial. While the open technique reduces the number of relapses compared to minimally invasive approaches, it is associated with a longer healing time. Reactive oxygen species are a key part of the normal wound-healing process. Herein, we reported our preliminary experience using a new oxygen-enriched oil-based product called NovoX for wound healing after open surgery for PD. We used a new oxygen-enriched product for wound healing in three pediatric patients undergoing open surgical repair for PD between December 2021 and April 2022. During postoperative follow-up, healing time and the aesthetic result were evaluated. Our preliminary study included three patients with chronic PD. The average follow-up time was 5 weeks, corresponding to the end of the healing process and the resumption of normal daily activities. Only one mild complication occurred during the study period. No short-term side effects were reported. The cosmetic result was reported as satisfactory. NovoX is easy to apply, safe, and effective for treating pediatric patients undergoing open surgical treatment for PD, leading to slightly faster wound healing with good aesthetic outcomes.

Surgical treatment of pilonidal disease with the use of «closed» techniques

The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.

Модельне обґрунтування просторових параметрів хірургічного доступу при мініінвазивному оперативному лікуванні пілонідальної хвороби у дітей

Модельне обґрунтування просторових параметрів хірургічного доступу при мініінвазивному оперативному лікуванні пілонідальної хвороби у дітей

Trephination versus wide excision for the treatment of pediatric pilonidal disease

Background/PurposeTo evaluate outcomes of trephination compared to wide excision in children undergoing initial surgical treatment of pilonidal disease. MethodsA retrospective review was conducted of patients undergoing initial pilonidal excision between September 2017 and September 2018. Operations were categorized as either trephination or wide excision via an open or closed-wound technique. Outcomes were evaluated and data analyzed by chi-squared and one-way ANOVA tests. ResultsOne-hundred and five patients were identified, with a mean follow-up of 4.6 months. Trephination was performed in 57% of patients, and of the remaining patients undergoing wide excision, 62% of wounds were left open. There were no demographic differences among the three groups. Compared to both the open and closed techniques, trephination was associated with fewer wound complications (17% vs 29% vs 3%, respectively, p = 0.006), and postoperative visits (4.4 vs 2.4 vs 1.4, respectively, p < 0.001). There was no difference in recurrence rates among groups. ConclusionTrephination for pilonidal disease in pediatric patients is associated with a lower wound complication rate and fewer postoperative visits compared to wide excision. Recurrence rates are similar among the various surgical methods. Further prospective study would be useful to describe long-term outcomes of patients undergoing trephination for pilonidal disease. Type of studyTreatment study. Level of evidenceIII (retrospective comparative).

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.

Selection of the method for surgical treatment of pilonidal disease without abscess formation

The problem of the treatment of pilonidal disease, affecting 5% of the adult working-age population and occupying the fourth place in the structure of coloproctological diseases after hemorrhoids, paraproctitis and anal fissure, is extremely relevant today. The history of the choice of approaches to surgical treatment has almost 2 centuries. Based on different theories of etiopathogenesis, various methods of surgical treatment have been proposed. However, the results of treatment leave much to be desired. To date, there is no 'gold standard' of surgical treatment of pilonidal disease, nor any standardization in this matter. The aim of the investigation is to compare the two, in our opinion, the most versatile methods of surgical treatment of the nosology under consideration, which allow to achieve a good cosmetic result in cases of any complexity without long-term disability - Limberg flap and Bascom II plastics. Indicators such as the duration of the intervention, the level of postoperative pain, postoperative complications, the duration of disability, patient satisfaction with the cosmetic result, relapses were evaluated. As a result, patients after performing Bascom II noted less postoperative pain and were more satisfied with the cosmetic result. A significantly lower percentage of relapses was noted in the group with Limberg flap. The percentage of complications and terms of disability was not significantly different.

Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients

The surgical treatment of pilonidal disease is highly variable. The present study examines the long-term results in over 500 patients treated by minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings. Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed. Symptoms, prior surgical treatments, extent of disease, number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded. Records were found for 570 patients; mean follow-up was 4.7 years. Two hundred forty-eight patients (44%) had a prior abscess requiring drainage; 80 had from 1 to 6 prior operations. Ninety-two percent of operations were performed under local anesthesia. Men had more extensive disease than women (5.2 vs 3.5 cm, P < .001) and took longer to heal (median 46 days in women, 51 days in men, P < .001). Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed. The majority of patients with pilonidal disease can be managed by simple, minimal excision of affected tissue under local anesthesia with healing by secondary intention. With careful attention to wound care, morbidity is minimal and the recurrence or failure rate is less than 5%.

Comparison of 'Excision and Primary Repair' with 'Bascom's Technique' in the Surgical Treatment of Pilonidal Disease

Comparison of 'Excision and Primary Repair' with 'Bascom's Technique' in the Surgical Treatment of Pilonidal Disease

Treatment of Pilonidal Disease Using the Bascom ‘Cleft-Lift’ Procedure

Introduction Treating pilonidal disease can be an unrewarding and frustrating experience for a general surgeon. It is not unusual for a busy surgeon to have several young people coming to the office each week for wound evaluations and dressing changes for failed surgical treatment of pilonidal disease, or for treatment of intentionally created open wounds. These patients are uniformly unhappy, and the situation is frustrating and stressful for the patient, the office staff, and the surgeon.

Volume of the excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery)

In previous studies, a lack of antibiotic prophylaxis, smoking and obesity were described as factors that contribute to the development of a surgical site infection (SSI) after pilonidal disease (PD) surgery. In this study, we evaluated whether the volume of the excised specimen (VS) was a risk factor for SSI. The patients who underwent surgical treatment for PD from January 2010 through December 2011 were retrospectively evaluated in terms of SSI, time off work and healing time. The single and multiple explanatory variable(s) logistic regression analyses were performed. One-hundred and sixty patients were included in the study. SSI occurred in 19 (11.9 %) patients. In the multiple explanatory variable logistic regression analysis, VS was emerged as a risk factor for SSI (OR 18.78, 95 % CI 2.38-148.10; P < 0.005). The healing time and time off work were longer when a SSI occurred (P < 0.001). This study suggests that the rate of SSI after the surgical treatment of PD is higher in patients with a high VS. A SSI significantly prolongs the healing time. Surgeons can use this data for assessing the SSI risk. As a preventive measure, prolonged use of an empiric broad-spectrum antibiotic may be beneficial in patients with a high VS.

Comparison of Three Surgical Methods in Treatment of Patients with Pilonidal Sinus: Modified Excision and Repair/Wide Excision/Wide Excision and Flap in RASOUL, OMID and SADR Hospitals( 2004–2007)

This study is a comparison between three methods that are frequently used for the surgical treatment of pilonidal disease all over the world: modified excision and repair, wide excision and secondary repair, and wide excision and flap. The first technique is done by our group for the first time, and has not been described previously in the literature. This is an interventional study performed at Omid, Sadr, and Rasoul Akram hospitals on patients who had undergone operation because of pilonidal sinus disease and met the inclusion criteria between 2004 and 2007. Exclusion criteria were (1) acute pilonidal sinus diseases, (2) history of pilonidal sinus surgery, (3) history of systemic diseases (DM, malignancy, etc.), and (4) pilonidal abscess. Essential information was extracted from complete medical archives. Any data not available in files or during follow-up visits (all patients supposed to be followed at least for 1year) were gathered by a telephone interview. A total of 194 patients met the criteria and had complete archived files. Longer duration of hospital stay was found in the "wide excision and closing with flap" method comparing with two other methods (P < 0.05). Length of incapacity for work was not different between the "wide excision and modified repair" and "wide excision" (P > 0.5) methods, but longer for "wide excision and flap" in comparison with two others (P < 0.05). Healing time was significantly longer in the "wide excision" method in comparison with two other methods (P < 0.05). However, "wide excision and modified repair" method had the least healing time between all above techniques, except for length of leaving the office. All the three recurrences (1.5%) occurred in the wide excision and flap method (P < 0.05). The frequency of postoperative complications was 2 (3.3%) in wide excision and modified repair, 15 (18.5%) in wide excision, and 17 (32.7%) in wide excision and flap closure; these differences in complications were statistically significant (P < 0.05). Our results show that the wide excision and modified repair technique, which has been described for the first time, is an acceptable method due to a low recurrence rate and better wound outcomes comparing with wide excision alone and wide excision and flap techniques for the surgical treatment of pilonidal sinus disease.

Secondary Healing versus Midline Closure and Modified Bascom Natal Cleft Lift for Pilonidal Sinus Disease

Pilonidal sinus disease is a common disease in young employed male adults. Ongoing discomfort usually indicates an operative intervention. The main drawback is however the complication of wound healing. Numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique. A retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between May 2005 and December 2006. Used techniques were: 'modified Bascom procedure', 'excision and primary closure' and 'excision with secondary wound healing'. Patients' characteristics, operative parameters and data on outcome were included. The primary endpoint was wound healing. Twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. There were no demographical differences between the groups of patients. The modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). The duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01). Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.

Local Administration of Antibiotics by Gentamicin–Collagen Sponge does not Improve Wound Healing or Reduce Recurrence Rate After Pilonidal Excision with Primary Suture: A Prospective Randomized Controlled Trial

Excision and primary suture for pilonidal disease is associated with a high rate of wound infection and recurrences. This randomized, controlled study was designed to analyze the effect of local application of a gentamicin-containing collagen sponge (Collatamp(®)) in reducing the wound infection rate and recurrences after excision of pilonidal sinus and wound closure with primary midline suture. From March 2003 to November 2005, 161 patients with symptomatic pilonidal disease were operated on at 11 hospitals with traditional wide excision of the sinus and all of its tracts. The patients were randomized to filling of the cavity with a gentamicin-containing collagen sponge (Collatamp(®)) before wound closure or to closure with no additional treatment. Information about the treatment allocation was hidden until the end of the study. Information about wound healing was noted at follow-up at the outpatient department after 2-4days, 2weeks, 3months, and 1year. No statistically significant differences were observed between the groups during follow-up. Patients who received prophylaxis with Collatamp(®) had slightly fewer wounds with exudate at 2-4days and 2weeks of follow-up (2% vs. 10%, p=0.051 and 57% vs. 65%, p=0.325, respectively), a slightly larger proportion of healed wounds at 3months follow-up (77% vs. 66%, p=0.138) but not at 1year (85% vs. 90%, p=0.42, respectively), and slightly more reoperations (10% vs. 4%, p=0.213). This randomized, controlled study showed no significant differences in the rates of wound infection, wound healing, and recurrences when a gentamicin-collagen sponge was added to the surgical treatment of pilonidal disease with excision and primary midline suture. This does not support the use of gentamicin-collagen sponge for the surgical treatment of pilonidal disease.

Dufourmentel Rhomboid Flap in the Radical Treatment of Primary and Recurrent Sacrococcygeal Pilonidal Disease

The aim of this study was to assess early and late results of the Dufourmentel procedure in patients with primary and recurrent sacrococcygeal pilonidal disease. Consecutive patients who underwent surgical treatment for pilonidal disease from November 1993 through July 2009 at the Second Department of General Surgery of the Second University of Naples were entered into the study. All patients underwent epidural anesthesia and radical excision followed by reconstruction with a Dufourmentel rhomboid flap. Study variables included preoperative body mass index, hospital stay, time to walking, sitting, and return to work, and pain score (visual analog scale) for evaluation early results and patient comfort. Time to complete wound healing, wound complications, and recurrence rates were recorded to assess late results. A total of 310 patients with pilonidal disease entered the study. Of these, 24 patients were asymptomatic (incidental diagnosis) and 55 had recurrent sinus. Obese patients had a significantly worse clinical presentation than patients with normal weight (P < .001). All operations were uneventful, with a mean operative time of 40 (range, 30-55) minutes after the surgeons' learning period, and no flap necrosis occurred. The median hospital stay was 1 day (range, 1-11 days), median time to return to work was 7 (range 5-30) days, and pain was minimal. Wound complications were experienced by 33 patients (10.6%). All but 2 patients were managed conservatively; in 2 patients (0.6%), the wound was resutured under local anesthesia and healed within 15 days. No patient was lost to follow-up. Recurrence was observed in 7 patients (2.3%). All relapses occurred in 25 months after the operation; no late recurrences were seen (5-, 10-, and 16-year recurrence-free rates were all 97.6%). The recurrence rate was significantly higher in obese than in normal-weight patients (6% vs. 0.5%; P = .0029). Permanent hypoesthesia was negligible (0.9%), and no patient complained about the cosmetic outcome. The Dufourmentel flap is associated with minimal discomfort and excellent results. This technique can be considered in the first- and second-line management of pilonidal disease.

Current management of adolescent pilonidal disease

Background Controversy persists regarding the optimal management for adolescent pilonidal disease. We reviewed the outcome of wide local excision (WLE) vs unroofing and marsupialization (UM) for pilonidal disease. Methods A retrospective review 2002 to 2007 of adolescents undergoing surgical treatment of pilonidal disease was performed. Data were analyzed using Student's t test. Results Twenty-six patients were treated for pilonidal disease during this period. Average age was 16.7 years (range, 14-19 years) with 50% males. Nine patients underwent WLE and 17 had UM. Before initial evaluation, 44% of patients in the WLE group had drainage of acute abscess compared to 59% in the UM group ( P > .05). Postoperative complications in the WLE group (78%) were significantly higher compared to the UM group (0%). Median time for final healing was significantly higher in the WLE group (32 weeks) compared to the UM group (6 weeks). The reoperative rate was also significantly higher in the WLE group (56%) compared to the UM group (0%). No patient had recurrent disease after complete healing in either group. Conclusion Unroofing and marsupialization for primary pilonidal disease has a shorter time to heal and carries a lower complication and reoperative rate compared to WLE.

Aetiology, presentation and management of pilonidal disease

Pilonidal disease is a common benign condition usually treated by coloproctologists. Its aetiology has been debated, but the evidence points to an acquired, rather than congenital mechanism. Symptom severity is variable, as are surgical approaches to management, with a lack of good quality evidence in the literature. The optimal surgical treatment of pilonidal disease remains controversial. Recurrence and unhealed midline wounds are the main problems following surgery. In general, those surgical procedures that result in wounds away from the midline (natal cleft) are considered to be more successful. Strict attention to nursing care of postoperative wounds is crucial to outcome.

Superiority of Asymmetric Modified Limberg Flap for Surgical Treatment of Pilonidal Disease

Cases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period. In this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6-44) months after wide excision plus classic Limberg flap (Group 1, n=35) and after asymmetric modified Limberg flap closure (Group 2, n=33). There were significantly more macerations in Group 1 (P<0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P=0.028). We noted that as a result of these complications, time to suture removal (P=0.001), discharge from hospital (P=0.001), and time off from work (P=0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P=0.493). The deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.