Treatment Of Pilonidal Disease Research Articles

Pilonidal disease treatment by radial laser surgery (FiLaC™): The first Finnish experience.

Pilonidal disease is common, and it afflicts especially young adults, causing disability. Several types of treatment methods are applicable, but no consensus exists regarding the best method. The aim of our study was to assess the novel radial laser probe treatment in pilonidal disease and report the success rate and recurrence rate. We studied retrospectively 86 patients who, according to our hospital patient records, underwent radial laser probe surgery between January 2017 and September 2019. In a mean follow-up time of 14 months, the success rate at 2 months was 86%. Most operations were done under local anesthesia on a day-surgery basis. The recovery time was rapid, and median sick leave was 12 days. Of those initially successfully treated, 3% developed a recurrence. Altogether 17% of the patients underwent a re-operation. Spillage of pus during surgery, however, reduced the success rate to 53%. Radial laser probe treatment is a quick, safe, and minimally invasive treatment choice for pilonidal disease, especially when no active infection is present.

Long-term outcomes of crystallized phenol application for the treatment of pilonidal sinus disease

Objective This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience. Methods One thousand and twenty-six patients who have primer pilonidal sinus were enrolled. The operation was applied outpatient clinic under local anesthesia. Recurrence rate, application number, healing time, and factors affecting them were analyzed. Results The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks. The rate of recurrence was higher in patients with a long disease duration prior to initiating treatment (p = .04). The rate of recurrence was higher in patients with a higher number of opening and CPT application, those with longer application time, and those with a positive family history (respectively p = .01, p = .002, p = .008). Conclusions Long-term outcomes are also very successful in the treatment of pilonidal disease with CPT. We believe that CPT should be the first choice in the treatment of pilonidal disease because it is inexpensive, can be applied as an outpatient treatment, is a noninvasive procedure, has results comparable to surgical procedures, and does not cause loss of work and strength.

Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria.

Background and objective: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. Materials and Methods: A survey including 196 certified institutions (Switzerland, N = 99 and Austria, N = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. Results: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (p = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; p < 0.001). Primary resection and off-midline closure (p = 0.017) and the use of tissue flaps (p = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. Conclusion: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.

Determine the effect of crystallized phenol in management of sacrococcygeal pilonidal sinus

Background: The present study was conducted to determine the effect of crystallized phenol in sacrococcygeal pilonidal sinus cases. Materials & Methods: The present study was conducted in the department of general surgery on 18 patients. The nature of disease, number of sinus openings and phenol application was assessed.Results: out of 24 patients, age group 20-40 years had 4 males and 2 females, age 40-60 years had 5 males and 3 females and group >60 years had 5 males and 5 females. 7 lesions were acute and 17 were chronic. The position of orifice was midline in 13 cases and lateral in 6 cases. The difference was non- significant (P>0.05). Nine patients had 1 application, three had 2, two had 3, four had 4, two had 5, one had 6, two had seven and one had 8 applications. The difference was significant (P< 0.05). Conclusion: Author concluded that 7 lesions were acute and 17 were chronic. Crystallized phenol can be effectively used for treatment of pilonidal disease.

LASER ABLATION FOR PILONIDAL DISEASE

AIM: to evaluate short-term results of pilonidal disease treatment using different methods: the excision of pilonidal sinus and fistula with open wound healing, the primary closure of the wound and the laser ablation (2017-2019).PATIENTS AND METHODS: ninety patients with pilonidal disease without abscess were included in the comparative non-randomized study. The control group included 30 patients with excision and open wound healing. The first main group included 30 patients with the excision of pilonidal sinus and fistula with primary wound closure. The second main group included 30 patients with laser ablation of pilonidal sinus and fistula. The evaluation criteria included gender, age, BMI, number of previous procedures, operative time, hospital stay, postoperative pain intensity (VAS), cosmetic result (VAS), complication rate and recurrence rate.RESULTS: all three groups were homogeneous in gender, age, BMI. The control group showed no complications (р&lt;0.0001) and no recurrence (р&lt;0.0001) rate but had more intensive pain (mean 5.9 points; р&lt;0.0001) and worse cosmetic result (mean 4.4 points; р&lt;0.0001). The group with primary wound closure (1st main group) had the highest complication rate (23.4%; р=0.004) and recurrence rate (16.7%; р=0.02). The group with laser ablation had significantly shorter hospital stay (1.1 days; р&lt;0.0001), good cosmetic result (mean 8.9 points; р&lt;0.0001) and less postoperative pain (1.4 points; р&lt;0.0001) with low recurrence rate (3.3%; p=0.32).CONCLUSION: the laser ablation of pilonidal sinus and fistula provides less postoperative pain intensity and low recurrence rate, better cosmetic result and short hospital stay. It can be used for outpatient treatment.

Short term outcomes of Endoscopic Pilonidal Sinus Laser Treatment: a Single Centre experience.

Short term outcomes of Endoscopic Pilonidal Sinus Laser Treatment: a Single Centre experience. Pilonidal sinus (PS) is a widespread pathologic condition. The etiology of Pilonidal Disease (PD) is in favor of an acquired cause. Multiple surgical options have been advocated. In the last few years a minimally invasive approach to PD has been proposed. We performed a retrospective analysis of short-term surgical outcomes of combining EpSiT approach with the use of a radial laser fiber in the treatment of PD in a Single Centre. At our Proctology Centre, we performed 10 consecutive Endoscopic Pilonidal Sinus Laser Treatment procedures in the period from march 2019 to september 2019. The review of our initial experience suggests that the combination of fistuloscopy and laser ablation in treating fistulizing PD is feasible, safe and reproducible. Pilonidal sinus (PS) is a widespread pathologic condition. The etiology of Pilonidal Disease (PD) is in favor of an acquired cause. Multiple surgical options have been advocated. In the last few years a minimally invasive approach to PD has been proposed. We performed a retrospective analysis of short-term surgical outcomes of combining EpSiT approach with the use of a radial laser fiber in the treatment of PD in a Single Centre. At our Proctology Centre, we performed 10 consecutive Endoscopic Pilonidal Sinus Laser Treatment procedures in the period from march 2019 to september 2019. The review of our initial experience suggests that the combination of fistuloscopy and laser ablation in treating fistulizing PD is feasible, safe and reproducible

Management of pilonidal sinus disease with Limberg flap: our experience

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019. Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.

Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK.

Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, laser depilation has been proposed as an adjunct to surgery and has shown improved results in some studies. We present our experience of laser depilation in the treatment of pilonidal disease in a district general hospital setting in the UK. A prospectively maintained database of all consecutive patients who received laser depilation after elective surgery for pilonidal disease was analysed. Patients were offered a minimum of two sessions of laser depilation. The primary outcome measure was disease recurrence. Evidence of new symptoms or signs of pilonidal disease after one year from the latest surgical intervention was defined as recurrent disease. Data are presented as medians with interquartile ranges. A total of 64 patients underwent laser depilation after elective surgery between 1 June 2013 and 1 June 2018; 57 were eligible for final analysis. Sixty-five per cent of patients received six or more sessions of laser treatment. There were no short- or long-term complications related to laser depilation. Patients who had more than two sessions of laser depilation showed an improved recurrence rate. Overall, recurrence rate in our series was 12% at a median follow-up of 172 weeks. Laser depilation is a safe and effective adjunct to surgery in minimising the recurrence of pilonidal disease. Patients with primary pilonidal disease and those who are undergoing minimally invasive surgery may also benefit from adjuvant laser depilation. Further high-quality control trials are required to assess its efficacy and safety.

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

Short-term outcomes of endoscopic pilonidal sinus treatment.

Endoscopic treatment for pilonidal disease was initially described by Meinero in 2013. This minimally invasive technique has both technical and aesthetic advantages. The diagnostic application helps identify the anatomy of the pilonidal disease and the operative phase ablates and cleans the infected cavity. Our aim was to study the short-term outcomes of endoscopic treatment for pilonidal disease and to evaluate complications and recurrence rates. A prospectively maintained database of all consecutive patients who underwent endoscopic treatment for pilonidal disease by a single surgeon in a district general hospital from 1 November 2014 to 31 March 2018 was analysed. Follow-up was available until 30 September 2018. A total of 74 patients (56 men) underwent endoscopic treatment for pilonidal disease. The median age was 21 years (range 16-62 years). All patients underwent the procedure as daycase procedures, seven under local anaesthesia. There were no immediate postoperative complications and no return to theatre or readmission within 90 days. On a median follow-up of 52 weeks (range 2-114 weeks), 57 patients healed completely and 8 lost to follow-up. We achieved primary healing rates of 67% (44/66) and delayed healing rate of 77% (51/66). Endoscopic treatment for pilonidal disease is a safe and effective minimally invasive technique that should be considered as first-line treatment in selected cases of pilonidal sinus disease, thereby reducing morbidity related to conventional procedures.

Long term results of minimally invasive treatment of pilonidal disease by platelet rich plasma.

Although, there are several treatment options for treatment of pilonidal disease, nowadays minimally invasive modalities are becoming more common. The aim of this study is to evaluate the results of platelet rich plasma application for pilonidal disease. For this prospective cohort study, cases with pilonidal disease were evaluated. All cases that are eligible and accepted to be involved were included in the study. Platelet rich plasma was applied into the pilonidal sinus under local infiltration anesthesia. Healing of the disease and recurrence rates were recorded. The success rate of the application was 97.1% at the first month. With a median follow up of 60.2 months the recurrence rate was 8.2%. Platelet rich plasma can be safely used for treatment of pilonidal disease with high success and low recurrence rate.

Specialized Pilonidal Care

Introduction In March 2014, a specialized Pilonidal Care Clinic was started at Boston Children's Hospital to standardize care; evaluate predictors of pilonidal treatment success/failure; decrease morbidity; and improve outcomes, including recurrences and quality of life. Methods A staging system for pilonidal disease was developed. Patients were treated with shaving and improved hygiene until inflammation and drainage subsided, then underwent pit-picking under local anesthesia and/or laser epilation, and followed for recurrences. Results In bivariate analysis, mild disease severity, longer duration of care in Pilonidal Care Clinic, undergoing pit-picking procedure, and female gender were statistically significant predictors of treatment success. Using multivariate regression analysis, we found that laser epilation independently led to statistically significant disease resolution. To date, the provider team (physician, physician assistant, and registered nurse) have performed &gt;400 laser procedures without a single adverse event—establishing laser epilation as a safe, easy, and effective procedure to utilize in the treatment of pilonidal disease. Analyzing the initial 58 patients who underwent pit picking, only six patients required intraoperative treatment. Of patients with complete follow-up (n = 51), 47 (92%) were symptom- and recurrence-free for an average of 5 months without requiring narcotics or experiencing postoperative morbidity. Conclusion Minimally invasive pilonidal care with pit picking and/or laser epilation is an effective, safe, and well-tolerated treatment approach offering lower recurrence rates with minimal morbidity and avoidance of major operations.

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 methods in treatment of pilonidal disease (review of the literature)

Theobjectivewas to compare the most common methods of minimally invasive treatment of pilonidal disease and to evaluate their effectiveness according to the literature. Minimally invasive methods of treatment could be successfully used in patients with a small spread of pilonidal disease. Improving the effectiveness of treatment of this category of patients was directly related to the strict selection of patients.

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.

Pilonidal Sinus Disease; What is the Best Treatment Option?

Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patient's needs. Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results. The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term. Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.

PILONIDAL DISEASE

Pilonidal disease is a common and well-recognized medical condition. It affects people in reproductive age, especially men and in combination with in-patient and outpatient treatment and absence from work it causes a considerable socioeconomic loss. This fact led to a renewed interest in understanding of the disease and search for the ideal method of treatment. The purpose of this review was to provide update on therapeutic options for patients with pilonidal disease. In case of chronic or recurrent pilonidal disease various treatment options exist, addressing different measures of surgical outcome. Like for many conditions, there is increase in the use of minimally invasive techniques in the treatment, which could be alternative to surgical excisions for pilonidal disease. Procedures for treatment of pilonidal disease can be divided in two large groups: minimally invasive treatment and excisional procedures. Although various treatment options exist nowadays, surgery is still preferred as definitive treatment. The optimal closure of the wound following an excision is still under debate since outcome measures depend mostly on type of closure selected. Most of the procedures fail to achieve the goals altogether. The final decision on treatment should be made based on surgeon and the patient’ preference.

Laser Hair Removal for Treatment of Pilonidal Disease

Laser Hair Removal for Treatment of Pilonidal Disease

Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation.

Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.

Standardization of modified Limberg flap technique by using an acetate template for the treatment of pilonidal disease

Standardization of modified Limberg flap technique by using an acetate template for the treatment of pilonidal disease