Treatment Of Pilonidal Disease Research Articles

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.

Pilonidal disease: comparative analysis of leading professional organizations clinical guidelines

pilonidal disease is an inflammatory disease that is most often localized in the sacrococcygeal area and is characterized by the formation of a cyst or abscess with the possible secondary formation of fistulas. Pilonidal disease is a fairly common disease, according to individual studies, the incidence ranges from 26 cases per 100,000 people (USA) to 48 per 100,000 people (Germany). Men are three times more likely to suffer than women. Most often, the disease manifests itself between the ages of 18 and 30. The risk factors for developing the disease are: excess weight, increased hair growth, chronic trauma to the sacrococcygeal area and anatomical features of the gluteal cleft (its shape, depth, configuration). The occurrence and development of the disease in persons of working age often leads to a sharp decrease in work capacity and quality of life. There is still no single, generally accepted classification of pilonidal disease in the world. Today, there are 3 clinical guidelines created by professional associations (USA, Germany, Italy), based on the principles of evidence-based medicine. The purpose of the study is to perform a comparative analysis of the main points of the clinical guidelines of leading professional organizations (German National Guideline on the management of pilonidal disease, The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease, Consensus statement of the Italian society of colorectal surgery: management and treatment of pilonidal disease) regarding the clinical-diagnostic approach and the choice of optimal treatment tactics for patients with certain forms of pilonidal disease. In the study, a review and comparative analysis of literary sources from the scientific databases of medical literature PubMed Central (U.S. National Institutes of Health's National Library of Medicine), ScienceDirect (Elsevier publishing house), Wiley online library, Springer Link, Cochrane library, materials of the 3rd International Pilonidal Conference ( 2023, Copenhagen, Denmark) and clinical guidelines of specialized organizations of the USA, Germany and Italy. The following issues of diagnosis and treatment of diseases are selected for comparative analysis: choice of prevention method and non-surgical procedures that reduce the risk of disease recurrence; choice of treatment method and assessment of its necessity for asymptomatic pilonidal cysts; the choice of a surgical method of treatment for symptomatic pilonidal cysts; the choice of a method of surgical treatment for a recurrent form of PC. According to the performed analysis, it can be concluded that the diagnostic and therapeutic strategies reflected in the clinical guidelines are based on the evidence base and the analysis of research data conducted in the field of treatment of pilonidal disease, which leads to the existence of an essential correlation between the recommendations related to the choice of a method of prevention and non-surgical procedures that reduce the risk of recurrence of the disease, the method of treatment and assessment of its necessity for the asymptomatic form of the disease, methods of surgical treatment of the recurrent form of the disease. There are differences between clinical guidelines due to varying general consensus structures and main questions chosen to form a list of general provisions.

Real-world practice and outcomes in pilonidal surgery: Pilonidal Sinus Treatment Studying The Options (PITSTOP) cohort.

Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal intervention. The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial design. This UK-wide multicentre prospective cohort study, including patients (aged over 16 years) who had definitive treatment for symptomatic pilonidal disease, was conducted between May 2019 and March 2022. Patient and disease characteristics, and intervention details were analysed. Data on patient-reported outcomes, including pain, complications, treatment failure, wound issues, and quality of life, were gathered at various time points up to 6 months after surgery. Strategies were implemented to adjust for risk influencing different treatment choices and outcomes. Of the 667 participants consenting, 574 (86.1%) were followed up to the study end. Twelve interventions were observed. Broadly, 59.5% underwent major excisional surgery and 40.5% minimally invasive surgery. Complications occurred in 45.1% of the cohort. Those who had minimally invasive procedures had better quality of life and, after risk adjustment, less pain (score on day 1: mean difference 1.58, 95% c.i. 1.14 to 2.01), fewer complications (difference 17.5 (95% c.i. 9.1 to 25.9)%), more rapid return to normal activities (mean difference 25.9 (18.4 to 33.4) days) but a rate of higher treatment failure (difference 9.6 (95% c.i. 17.3 to 1.9)%). At study end, 25% reported an unhealed wound and 10% had not returned to normal activities. The burden after surgery for pilonidal disease is high and treatment failure is common. Minimally invasive techniques may improve outcomes at the expense of a 10% higher risk of treatment failure.

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

PurposePilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches—excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).MethodsSingle-center retrospective evaluation of patients 1–21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann–Whitney U tests.Results18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).ConclusionIn pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.

Sinus Laser Closure (SiLaC) with pit excision versus Limberg Flap in pilonidal disease: A prospective, randomized study

BackgroundPilonidal disease is a chronic suppurative condition of the natal cleft associated with significant morbidity primarily affecting the working population causing daily discomfort and activity limitation. Although several treatment modalities have been suggested for the management of this condition, the gold standard continues to be undefined. We conducted a randomized prospective study on the treatment of Pilonidal disease by Sinus Laser Closure (SiLaC) compared with Limberg Flap. Materials and methods100 patients with primary Pilonidal disease were randomized to undergo either SiLaC or Limberg Flap. The primary objective of our study was to establish the advantage of SiLaC over Limberg Flap in terms of the operative time, postoperative pain, duration of hospital stay, healing time, cosmesis and recurrence rates over a period of 2 years. The patient satisfaction and return to normal activities were also documented. ResultsWe analysed a total of 50 cases that underwent SiLaC and 50 that underwent Limberg Flap with similar demographic characteristics. Significantly lower operative time was noted in the SiLaC group. SiLaC was associated with decreased postoperative pain and duration of hospital stay with faster healing and better cosmetic outcome. The patient satisfaction and return to normal activites were also reported to be better in the SiLaC group. Recurrence was reported in 4 patients in SiLaC group versus 6 patients in Limberg Flap group. ConclusionOur study reports SiLaC as superior to Limberg Flap with shorter operative time, lower pain scores, length of hospital stay, faster healing time, decreased recurrence rates and good cosmetic satisfaction.

Karydakis versus marsupialization – short-term comparative outcomes of intergluteal pilonidal disease treatment in men

Background: Intergluteal pilonidal disease (IPD) is a common chronic disease occurring in the natal cleft of the sacrococcygeal region. This disease may drastically decrease the quality of life, and lead to incapacity for work for up to several months. Various treatment methods are described in the literature, however, each of the methods has its privileges and disadvantages, and no final recommendations are available regarding a superior surgical treatment method. The present study aimed to contribute to filling the gap in the knowledge regarding the superiority of the available surgical techniques used in the treatment of IPD. Methods: The short-term outcomes of two surgical treatment options for IPD, namely the Karydakis procedure (n = 32) and the Marsupialization technique (n = 33), were retrospectively compared. The duration of complete scar formation, the rate of short-term postoperative complications, the persistence of postoperative pain and the recurrence rate during 3-month postoperative follow-up were investigated. The study was based on a retrospective analysis of data extracted from medical records of adult male patients treated for IPD. Results: The Karydakis procedure was found to be superior in terms of all the abovementioned parameters, except for the rate of short-term postoperative complications, where the two surgical techniques showed comparable results. Conclusions: The results of this retrospective study suggest that marsupialization technique could be mostly replaced by the Karydakis procedure in surgical practice. The latter appears to be associated with a faster return to daily activities and more cost effective.

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.

Kamaszkori sinus pilonidalis: a localis kezeléstől a lebenyelforgatásig

The treatment of pilonidal disease (PD) is often challenging, due to the frequent recurrences and adverse events. The risk factors are well known: obesity, male sex, hairy sacral region, inactivity, inadequate hygiene. To diagnose the PD the physical examination is enough. The acute form is a local imflammation in the sacral region (cellulitis or abscess) and the chronic one can be “sacral pit(s)” or fistula(s). In case of abscess the local therapy with antibiotics or “off-midline” incision can be the best solution. In chronic PD the most important is to reduce the risk factors: weight control, epilation, to enhance the physical activity and local hygiene. If surgery cannot be avoid, the minimally invasive one must be chosen at first (trephination, PEPSiT). In case of complications, recurrence more complicated surgeries can be performed (ie. flap rotation). The surgery itself is not sufficient, the postoperative care (ie. hygiene, epilation) must be adequate.

Sequential, ultrasound-guided, minimally invasive pit-picking procedure with Nd:YAG laser epilation treatment for pilonidal disease.

&lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.&lt;/br&gt.

Laser Treatment of Pilonidal Disease — Immediate and Mid-term Results

Different forms of treatment of pilonidal disease include traditional open surgery with or without flap reconstruction, phenolization, and laser treatment. However, no significantly large series have been published about the laser method. This case series analysis consisted of 69 consecutive pilonidal disease patients, who were operated upon with a Fistula-tract laser Closure in the plastic surgery department of a single academic teaching hospital between August 2019 and December 2021. The follow-up was done by phone at 2 weeks and 4 weeks. The outpatient clinic follow-ups were at 6 weeks and 6 months postoperatively. The mean number of sick leave days was 6.2 ± 8.9 days. The mean number of outpatient clinic visits (including phone calls) was 3.4 ± 3.9. The mean secretion time was 22.1 ± 20.3 days. During the follow-up, 54 (81.8%) patients wounds healed. Eight (12.1%) patients had postoperative wound infection. There were no other complications. The mean follow-up time was 15.3 ± 7.7 months. Laser treatment for sinus pilonidal is promising and minimally invasive procedure. The procedure can be performed under local anesthesia. A re-operation comes into question if the operation area does not heal in the primary operation.

Karydakis Technique for the Treatment of Pilonidal Disease.

Melkonian, Ernesto D. M.D.1; Mordojovich, Eduardo A. M.D.2; Baeza, Pablo M.D.3 Author Information

Endoscopic Treatment of Pilonidal Sinus Disease in Children: A Systematic Review.

Background: Pilonidal sinus disease (PSD) is a common inflammatory disease. PSD management in pediatric patients changed dramatically in the last few years especially when concerning the latest minimally invasive techniques. This article aims to identify clinical evidence about the reliability of the different techniques in managing PSD in children. Materials and Methods: We performed a PubMed search for articles published during the last 10 years, using the keywords "pilonidal," "sinus," "disease," "pediatric," "surgery," and "children." Results: We pooled 38 studies, 18 of these were excluded because they were either not relevant or concerned an adult population. Conclusions: Literature analysis shows that endoscopic techniques for PSD are superior to excision and primary closure (EPC) in terms of tolerance and postoperative conditions and, with the growing number of studies in the matter, important endpoints such as wound healing time and length of hospital stay will be proved to be superior. Pediatric Endoscopic pilonidal disease treatment showed to be a very promising alternative even from a statistical point of view, especially when considered that in this group, studies seemed to be more solid. Literature analysis showed that minimally invasive techniques were statistically superior to EPC in terms of recurrence and complications.

Revision of the Failed Cleft Lift for Pilonidal Disease.

The cleft lift has been demonstrated to be one of the most successful operations for the treatment of pilonidal disease, however, there are times this procedure fails and further surgery is necessary. This article describes a reproducible and successful technique for the revision of a failed cleft lift. This procedure was performed on 76 consecutive patients who had previous cleft lift procedures. Failures were manifested by either a wound, sinus, abscess, dehiscence or fragile scar. The revision flattened the lower gluteal cleft with a rotation and advancement flap that placed the skin incision off-midline. Follow-up over the 10 years of this series was between six and 124 months with an average of 36 months. The revision was initially successful in 96.1% of patients; if the procedure was unsuccessful a repeat revision was subsequently curative. This procedure is proposed as an essential part of the treatment algorithm for patients with recurrent pilonidal disease after a cleft lift operation.

Follicular occlusion syndrome in the practice of a coloproctologist

BACKGROUND: Pilonidal disease is the 4th most common disease among inpatient coloproctological patients and surgery remains the gold standard of its treatment. However, patients with pilonidal disease often have combined conditions with other follicular occlusion diseases which are most often encountered by dermatologists in their practice. In most cases it is difficult to treat follicular occlusion syndrome with pilonidal disease within one specialty. We demonstrate the complexity of follicular occlusion diseases diagnostics in combination with pilonidal disease, systemize the diagnostic protocol for patient management and present the treatment strategy for coloproctologists.&#x0D; CLINICAL CASE DESCRIPTION: There was one case of patient with pilonidal disease combined with other conditions of follicular occlusion syndrome noted in the clinic of coloproctology and minimally invasive surgery. Surgery was the first step. There were no complications in the early postoperative period. After hospital discharge, the patient was consulted by a dermatologist, and local and systemic conservative therapy was prescribed for concomitant diseases, which resulted in a significant improvement. There have been no recent reports of recurrence.&#x0D; CONCLUSION: The treatment of follicular occlusion syndrome with pilonidal disease requires a multidisciplinary approach. At the same time the optimal treatment for pilonidal disease is radical excision of all altered tissues. In cases of such diseases as hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp treatment should be comprehensive and begin with a dermatologist consultation.

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.

СОВРЕМЕННЫЕ МЕТОДЫ ЛЕЧЕНИЯ ЭПИТЕЛИАЛЬНОГО КОПЧИКОГО ХОДА

Pilonidal disease is a common disease worldwide, with a wide range of treatment options, from various cyst excision options to patchwork. Surgeons from all over the world are looking for effective, low-traumatic methods of treating the epithelial coccygeal passage. This review reflects the most common, modern traditional and minimally invasive methods of pilonidal disease treatment used both in our country and abroad. Analysis of literature data showed a great variability of surgical approaches in the treatment of this pathology. As a result of this situation, a unified approach to the surgical tactics of treating the epithelial coccygeal passage has not yet been determined. The accumulated experience of using surgical laser technologies in the treatment of pilonidal disease has proven itself positively. The main advantage of interstitial laser thermotherapy of pilonidal cysts is minimal tissue trauma, leading to a decrease in the duration and severity of pain syndrome, a decrease in the period of disability, a good cosmetic result in comparison with traditional methods of surgery.

Pilonidal disease: A new look at an old disease

Pilonidal disease is a very common affliction that affects mainly young, hirsute, obese males during their young adult years of life. Previous etiological theories of this ailment centred on congenital causes. The current understanding is that pilonidal disease is an acquired affliction. Some patients, however, may have confounding hereditary tendencies to form pilonidal disease. There is a myriad of methods of treatment for chronic pilonidal disease. Such treatments vary from the creation of large skin flaps to simple instillation of chemicals into the sinuses. No single technique is favoured by every surgeon and each technique has its ardent supporters. The current favoured treatments however, are toward the use of the less invasive options compared to the large extensive flaps. Favoured options include minimally invasive techniques as well as simple lay open and marsupialisation. No proposed classification system for the assessment of severity of pilonidal disease has correlated disease severity with treatment options. Therefore, no classification system is in widespread use by the surgical community. Post-operative supportive management, especially in the early post-operative period, and laser hair epilation after the initial healing phase, have some usefulness in the overall treatment of pilonidal disease.

The minimally invasive approach to the treatment of pilonidal disease

Pilonidal disease (PD) is a common suppurative condition located beneath the skin of the sacrococcygeal region. Diagnosis is clinical and usually doesn't require any instrumental examination or imaging. To date, there is still no gold standard treatment for symptomatic PD, although most clinicians advocate surgical excision as a definitive treatment. Recently, several comparative studies between traditional excision and minimally invasive techniques have been published. However, there are still methodological limitations and selection biases that prevent the achievement of an adequate level of scientific evidence. The main advantages of the minimally invasive procedures include fewer wound infections, less pain, quicker return to work, and higher patient satisfaction. However, the success rate is still unclear and further studies are needed. This article briefly highlights the different minimally invasive approaches introduced in the last years, including both the endoscopic treatment and the laser surgery.

Establishing an Association between Polycystic Ovarian Syndrome and Pilonidal Disease in Adolescent Females

We sought to determine whether pilonidal disease (PD) is associated with polycystic ovarian syndrome (PCOS) in adolescent females. Retrospective cohort study SETTING: Urban tertiary children's hospital PARTICIPANTS: All girls aged 12 to 21 who received a diagnosis of PD and/or PCOS from 2012 to 2019 INTERVENTIONS: Treatment for PCOS and PD MAIN OUTCOME MEASURES: The variables analyzed included age, race/ethnicity, body mass index, age at menarche, tobacco use, payer status, treatment of PCOS and PD, and serum markers of hyperandrogenism and metabolic syndrome. During the study period, 100,043 patients presented to an urban tertiary medical center. Of these patients, 966 were diagnosed with PD, and 219 were diagnosed with both PD and PCOS. Compared with patients with only PD, patients with both diagnoses had a higher body mass index (31.4 vs 27.4 kg/m2; P < .01) and were older (18.76 vs 18.30 years; P=.003). The prevalence ratio for patients with PD having PCOS per the original Rotterdam criteria was 26.1 (CI, 22.0-31.0) and 28.7 (CI, 24.3-33.9) for having PCOS per the modified Rotterdam criteria. Patients with both diagnoses were less likely to receive intervention for PD (OR=0.22; CI, 0.13-0.37; P < .001). Adolescent females diagnosed with PD are likely to demonstrate features of PCOS. PCOS treatment could positively alter the disease course of PD. As such, surgical providers should consider referring adolescent females with PD to endocrinologists, gynecologists, and adolescent medicine specialists for evaluation of PCOS.

TH3.9 Cleft closure is an effective procedure for the treatment of pilonidal disease with low recurrence rate

Abstract Aims The surgical treatment of pilonidal sinus disease has evolved over time, with reported time to healing, post-operative complications and disease recurrence rates still significant. The modified Karydakis procedure such as the Bascom's cleft lift operation or “cleft closure” flattens the cleft and has shown promising results. The purpose of this single-centre study is to analyse outcomes of this technique. Method This is a retrospective study of 192 patients undergoing cleft closure as a day case over 10 years. The technique involves an off-midline cleft closure with an advancement flap and primary closure. Outcome measures were postoperative complications, time to healing and recurrence requiring surgery. Results The median age at surgery was 25 years (IQR 21–33), with males representing 76%. Overall, 91 (47%) were smokers. 141(73%) patients had previous emergency treatment. The median numbers of pits/sinuses were 3 and in 71% of patients were localized in the midline. The median time to wound healing was 3 weeks (IQR 2–6). Twenty-five (13%) patients had postoperative complications including infection (n=21) and hematoma (n=4). Disease recurrence requiring surgery occurred in 7 (3.6%) patients. Median time to recurrence was 9 months (IQR 5–15). Conclusion Cleft closure is an effective procedure for the treatment of pilonidal disease, with a low rate of postoperative complications and recurrence.