Treatment Of Sacrococcygeal Pilonidal Disease Research Articles

Minimally invasive techniques for surgical treatment of sacrococcygeal pilonidal disease

Sacrococcygeal pilonidal disease (SPD) is a common disease that affects mainly young men and leads to a decrease in their quality of life and a long‑term loss of working capacity. According to the available statistical data, the disease prevalence in Europe and North America ranges from 26 to 40 cases per 100,000 people.
 Objective — to determine the effectiveness of minimally invasive techniques for surgical treatment of chronic and recurrent forms of SPD.
 Materials and methods. The study included 23 patients with SPD. It was clinical prospective, with a follow‑up period of 18 months. The evaluation criteria were defined as recurrences, the frequency of postoperative complications, the severity of the pain syndrome, the patient’s self‑assessment of the cosmetic effect, the duration of hospitalisation, and the duration of surgery.
 The results. The recurrence rate during the 18 months of observation was 39.1%. The overall frequency of postoperative complications was 21.7%. The median duration of surgery was 20 (CI 95% 15—25) minutes, and the median duration of hospitalisation was 2 (CI 95% 1—3) days. The median score of the pain syndrome according to the modified visual analogue scale was 5 (CI 95% 4—5) points on the 0th postoperative day, 3 (CI 95% 3—4) points on the third postoperative day, and 2 (CI 95% 2—2) points on the fifth postoperative day. The cosmetic effect of surgical intervention was rated as rather dissatisfied (17.4%), rather satisfied (52.2%), and completely satisfied (30.4%).
 Conclusions. Minimally invasive techniques are effective for the surgical treatment of chronic and recurrent forms of sacrococcygeal pilonidal disease, reducing both the inpatient period and the surgery duration. Minimally invasive surgical treatment for chronic and recurrent forms of sacrococcygeal pilonidal disease has been observed to cause a moderate pain syndrome in the early postoperative period while contributing to satisfactory cosmetic results in the remote period. The surgical treatment of chronic and recurrent forms of sacrococcygeal pilonidal disease with minimally invasive techniques has been found to result in a relatively high recurrence rate (39.1% over 18 months of follow‑up).

Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)

Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.

An effective and considerable treatment of pilonidal sinus disease by laser ablation

The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470‐nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470‐nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14–42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470‐nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.

A RARE CASE REPORT OF PILONIDAL SINUS MIMICKING FISTULA IN ANO

Pilonidal Sinus typically presents as an abscess, purulent discharge, or pits around midgluteal cleft.. In rare cases sinuses progress anteriorly mimicking Fistulas in Ano. Clinicians and especially surgeons should be aware of this situation, in order to avoid reoperations and patient's discomfort and frustration. These complex cases with secondary openings may create problems in diagnosis and treatment when the secondary openings are close to the anus. In this case a single-stage surgical procedure for treatment of sacrococcygeal pilonidal disease with healing by secondary intention is described

D-shape asymmetric excision with primary closure versus limberg flap surgery for sacrococcygeal pilonidal sinus

Background: Treatment of sacrococcygeal pilonidal disease with off-midline closure after excision has been suggested to improve surgical outcomes. The aim of this study was to compare the short-term outcomes in patients with sacrococcygeal pilonidal disease, who underwent D shaped asymmetrical excision with flap reconstruction and Limberg flap reconstruction.Methods: An analysis of 50 patients was done; 25 were treated with D shaped asymmetrical excision with flap reconstruction and 25 with Limberg flap reconstruction procedure from September 2015 to Feb 2017 and were followed up for six months to 1 year.Results: There were significant difference between group 1 and group 2 with respect to operation time (mean: 40.20±3.19 min and 49.24±3.76 min, p<0.001), blood loss (mean: 45.64±2.93 mland 61.04±3.34 ml, p<0.001). Visual analog scale score was evaluated on postoperative day 15 and 30. On postoperative day 15, VAS score was 2.52±0.77 in group 1 and 3.12±0.97 in group 2. On day 30, VAS score was 1.56±0.77 in group 1 and 2.16±0.94 in group 2, and the differences were statistically significant. The complications were lesser I patients with D shaped asymmetric excision when compared to Limberg flap.Conclusions: The D-shape procedure is an easier and safer treatment option when compared to Limberg flap for the surgical treatment of sacrococcygeal pilonidal sinus disease owing to the associated low complication rate, short duration to return to normal activity, faster healing, and a high patient satisfaction rate and an easier learning curve.

Semilunar excision of pilonidal sinus with advancement flap wound closure in the treatment of sacrococcygeal pilonidal disease

Introduction: Sacrococcygeal pilonidal disease is common and had a lot of variants treatment techniques. Aim: This study presents the results of treatment of the pilonidal sinus by the Suchorski method. Material and methods: The study was conducted from 2010 to 2017 on 148 patients who underwent Suchorski’s method of wound closure, using the displaced skin-fat flap after the crescent-like excision of the hair sinus in the sacroiliac area. We analyzed length of observation, duration of the surgery, length of hospital stay, complications healing of the surgical wound, duration of pain, number of relapses, disturbances of superficial skin and fat flap sensation, and cosmetic effect. Results and discussion: The average follow-up time after surgery was 47 months (12–101 months). During the postoperative period, 11 (7.4%) cases reported complications related to wound healing 8 (5.4%) cases experiencedlimited wound dehiscence, and 1 (0.67%) case showed the wound had completely diverged. Only 2 (1.34%) patients developed a seroma. Conclusions: The crescent-like excision of the pilonidal sinus of the sacrococcygeal region using the Suchorski’s method is worth recommending, as a modern approach to treating pilonidal disease. This method offers the surgeon the ability to cut not only the small sinuses, but effect large-scale changes and improve patient outcomes.

Erratum to: Primary open treatment of sacrococcygeal pilonidal disease

Erratum to: coloproctology 2019 https://doi.org/10.1007/s00053-019-0346-0 In Fig. 2 the color correlation was not clearly given. You can see the corrected figure …

Primary open treatment of sacrococcygeal pilonidal disease

Surgical management of sacrococcygeal pilonidal disease ranges from pit/sinus procedures through excision with healing by secondary intent to various flap techniques. Short- and long-term outcomes differ between surgeons and techniques. An overview of primary open treatment of sacrococcygeal pilonidal disease, including technique, wound complications and recurrence is presented. Relevant articles were identified from PubMed. Of the three primary open treatment procedures (deroofing, marsupialization and wide local excision), marsupialization may have the lowest recurrence rate. Primary open treatment has a significant rate of non-healing as well as recurrence. Primary open treatment is widely practiced but wound healing may be a challenge for the patient and recurrence a challenge for the surgeon.

Prospective randomized comparative study of a Karydakis flap versus ordinary midline closure for the treatment of primary pilonidal sinus

Background There is a high incidence of sacrococcygeal pilonidal disease (SPD) among young males. Despite increasing data on the treatment of SPD, no standard treatment has been established as yet. Karydakis pioneered a procedure that involved raising a flap to overlap the midline with the scar sited to one side to reduce recurrence. Objective This study evaluated the outcomes of the Karydakis flap method versus the ordinary midline closure (OMC) method for the treatment of pilonidal sinus. Patients and methods This was a prospective study that included 40 patients with SPD. They were divided into two groups according to the surgical technique used. Group I was treated by excision and closure using the transposition Karydakis flap technique at one side of the midline and group II was treated by excision and simple closure at the midline. Both groups were compared. Results The duration of the surgery was 12 min longer in the Karydakis group (P Conclusion The Karydakis method may be a preferable option in the treatment of SPD because of the low rate of recurrence and the excellent satisfaction rates.

Rotational gluteal flap versus modified Limberg flap in treatment of sacrococcygeal pilonidal disease

BackgroundSacrococcygeal pilonidal disease (SPND) is a common surgical condition with a multitude of surgical treatments. The aim of this study was to compare the outcome of modified Limberg flap (MLF) and that of rotational gluteal flap (RGF) in treatment of SPND. Materials and methodsThis was a retrospective case-controlled study involving adult patients of both genders who were treated with either MLF or RGF for SPND. The main outcomes of the study were the recurrence of SPND, complications, operation time, hospital stay, time of healing, time to return to daily activities, and cosmetic outcomes. ResultsA total of 189 (143 males) patients with a mean age of 23.5 y were included. Ninety-five patients were treated with RGF (cases), and 94 were treated with MLF (controls). Both the groups were matched regarding age, gender, body mass index, and disease severity. The operation time of RGF was longer than that of MLF (P < 0.0001). No significant difference in recurrence was noted between RGF and MLF (3.1% versus 7.4%, P = 0.21). RGF had lower complication rate than MLF (17.9% versus 40.4%; P = 0.001). Time to return to work was similar in both the groups. RGF conferred significantly better cosmetic outcomes than MLF. ConclusionsBoth RGF and MLF achieved comparable, low recurrence rates. Although the operation time of RGF was significantly longer than that of MLF, the RGF had shorter healing time; lower complication rate, particularly seroma formation; and better cosmetic appearance.

Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series.

Background and Objectives:Pilonidal sinus is a common problem in the sacrococcygeal region, especially in obese, sedentary young men. The ideal surgical solution is still under debate, and there is a high rate of recurrence. In the present study, we analyzed the long-term results of a video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease: endoscopic pilonidal sinus treatment (EPSiT).Methods:From October 2013 through November 2015, a total of 77 consecutive patients (69 Males and 8 Females, median age: 23 y) were referred to our colorectal units. Sixty-eight patients had a primary sacrococcygeal pilonidal sinus, and 9 had recurrent pilonidal sinus; all underwent EPSiT. A fistuloscope was introduced through an external opening and the sinus cavity was completely ablated under direct vision. Postoperative complications, wound infection rate, recurrence rate, time until return to work, and patient satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7, 15, and 30 days and at 6, 12, and 24 months after surgery.Results:All patients completed the follow-up (median follow-up was 25 (range, 17–40) months. Median operative time was 18 (range, 12–30) minutes. The median hospital stay was 6.5 (range, 5–9) hours, and the median time to return to work was 5 days. Median healing time was 26 (range, 15–45) days. There were no major or minor complications. Six patients experienced recurrence. The overall satisfaction rate was 97%.Conclusions:The ideal surgical treatment for pilonidal sinus disease should be simple and effective. In our experience, EPSiT can be performed as a day surgery, with early return to daily activities. This technique is an uneventful procedure, with good aesthetic results and a low recurrence rate.

Dufourmentel Rhomboid Flap for Sacrococcygeal Pilonidal Sinus: Technical Details

SUMMARY: Sacrococcygeal pilonidal disease (SPD) is a chronic an uncommon entity with a variety of alternatives for treatment. One of those is the excision of the sinus tract followed by a reconstruction with the rhomboid flap described by Dufourmentel. The aim of this paper is to describe the main phases of the technique. A detailed explanation of the key steps for the implementation of Dufourmentel flap for the treatment of SPD is exposed. Excision of sacrococcygeal pilonidal sinus followed by Dufourmentel rhomboid flap is an alternative to consider in the treatment of pilonidal disease. © 2016, Universidad de la Frontera. All rights reserved.

A modified surgical approach to sacrococcygeal pilonidal disease: our experience

Background: Pilonidal disease is a fairly common condition encountered in clinical practice with recurrent follicular infection being the causative factor. Inspite of many surgical options available, controversy still exists for the best procedure. Pilonidal disease has been treated for a long time with the conventional open excision technique. Limberg procedure is a safe and reliable technique in the treatment of sacrococcygeal pilonidal disease, with low complications and recurrence rates if performed according to appropriate surgical principles. Epilation is a very useful adjunct to the surgery for Pilonidal disease to prevent recurrence, which is almost a rule.Methods: In our study we recruited 27 patients of pilonidal disease who underwent modified Limberg flap procedure and were followed up for two years post-surgery. All the patients were subjected to epilation in preoperative period and post operatively for 6 months.Results: During our study period (2011-2016) 27 patients were enrolled with a median age of 25 years and were followed up 2 years post-surgery. 22 patients were males while 5 were females, 13 were recurrent cases with previous history of one or more surgeries, 11 cases had a sinus without any surgical intervention in the past and 3 had an abscess. There was no recurrence noted for a follow up period of 2 years and there was no flap failure as well.Conclusions: Modified Limberg flap with epilation for pilonidal disease is safe and easy to perform with minimal morbidity, early recovery and no recurrence.

Rhomboid excision with modified Limberg flap in the treatment of sacrococcygeal pilonidal disease

Background: Optimal treatment for sacrococcygeal pilonidal disease has not been determined because of high complications and recurrence rate. We conducted this study to evaluate the effectiveness of rhomboid excision with modified Limberg flap in the treatment of sacrococcygeal pilonidal disease. Patients and Methods: Twenty one patients with pilonidal sinus of both primary and recurrent presentations were operated from July 2011-July 2012. Following rhomboid excision of the pilonidal sinus a modified Limberg flap was performed and used to cover the defect under spinal anesthesia. Cases were followed up for median of 4 months post operatively. Results: Of the 21 cases, 16 (76%) had no post operative complications, either during their stay in the hospital (3-9 days) or during the follow up period (4 months). Five cases presented with different complications. One patient had recurrence, two had complications of both wound infection and wound dehiscence and underwent second operation under local anaesthesia. Conclusion: Rhomboid excision with modified Limberg flap is a promising surgical technique proved to be safe and effective in the treatment of both primary and recurrent pilonidal sinuses with less post-operative complications, short hospital stay and low recurrence rate.

D-shape asymmetric excision of sacrococcygeal pilonidal sinus with primary closure, suction drain, and subcuticular skin closure: an analysis of risks factors for long-term recurrence.

Few studies have reported long-term recurrence rates after asymmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. A retrospective analysis of a prospectively maintained database of 550 surgical excisions performed for sacrococcygeal pilonidal disease between 1988 and 2005 was performed. A total of 550 patients with a diagnosis of pilonidal sinus underwent surgical excision over a period of 17 years. Thirty-eight out of the 550 patients (3.5%) were lost at follow-up. At a mean follow up of 11.2 ± 5.3 years, median 11 years (range = 3-22), the recurrence rate was 8.9%. Actuarial 1-, 5-, 10-, and 20-year disease-free survival rates were 98%, 94%, 92%, and 83%, respectively, with a median overall disease-free survival of 10 years (95% confidence interval [CI] = 3-15). When patients were stratified according to several variables known to influence recurrence, an age of less or ≥22 years (odds ratio [OR] = 1.5, 95% CI = 0.3-7.5, P = .001), a family history of sinus (OR = 5.9, 95% CI = 2.7-12, P = .0001), and intraoperative methylene blue use (OR = 6.3, 95% CI = 1.2-31, P = .024) were indicated as independent predictors of disease-free survival rates. D-shape asymmetric excision and scar lateralization, with primary multilayer subcuticular closure, suction drain insertion, and skin closure in patients with sacrococcygeal pilonidal disease is a safe and adequate surgical treatment offering an effective healing rate as well as low recurrence. Several features are likely to predict a better or a worse long-term recurrence rate in patients undergoing surgery for sinus pilonidalis.

Direct closure versus local flaps in management of pilonidal sinus

Objectives The aim of this randomized prospective trial was to compare both the results of direct closure and local flaps in management of pilonidal sinus. Background The best surgical technique for sacrococcygeal pilonidal disease is still controversial in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. Materials and methods From February 2012 to February 2013, 30 consecutive patients with chronic pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group 1, n = 15 patients) or excision and flap reconstruction [group 2, n = 15 patients; classic Limberg flap ( n = 5), modified Limberg flap ( n = 5), and V-Y advancement flap ( n = 5)]. Demographic data, operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence were recorded. Results The mean follow-up was 12 months. A significant difference was observed between the two groups in terms of operative time (min), postoperative complications, and patient satisfaction (P 0.05) for all comparisons. In the modified Limberg flap, no wound infection or recurrence of the disease occurred. Conclusion Flap reconstructions were superior to primary closure after excision of pilonidal sinus, and modified Limberg flap was superior with respect to wound infection and recurrence.

D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease

BackgroundOff-midline closure after excision and primary closure in the treatment of sacrococcygeal pilonidal disease has been suggested to improve surgical outcomes and reduce median recurrence rate. The aim of this study was to investigate several features known to be related to recurrence, allowing adequate comparison of recurrence between D-shaped asymmetric and symmetric excision in the treatment of sacrococcygeal pilonidal disease. MethodsAn analysis of a prospectively maintained database of 569 surgical excisions performed for sacrococcygeal pilonidal disease between 1988 and 2007 was performed. ResultsThe recurrence rate was lower in the asymmetric (n = 423) than in the symmetric (n = 101) group (9% vs 22.0%, P = .0001). After a median follow-up period of 11 years, 5-year 10-year, and 20-year disease-free survival rates were higher in the asymmetric group (94%, 92%, and 89% vs 84%, 79%, and 71%, respectively, P = .005). ConclusionsD-shaped asymmetric excision is an effective treatment of sacrococcygeal pilonidal sinus. Better long-term recurrence rates are achieved compared with symmetric excision, when stratified for several features known to be related to recurrence.

Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients

Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients

Erratum to: Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients

Erratum to: Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients

Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients

The aim of this study was to evaluate the influence of cavity drainage in the surgical treatment of sacrococcygeal pilonidal sinuses. The study was prospectively carried out in 803 patients randomized into two groups of respectively 401 and 402 patients. In the first group, primary excision and closure were associated with drainage of the wound; in the second group, the wound was not drained. We have analyzed time off work, time to walk without pain, time to sitting on the toilet without pain, recurrences, and wound infections. We have also evaluated the satisfaction rate and esthetic results. On comparing time off work, time to walk without pain, and time to sitting on toilet without pain postoperatively, there were no significant differences between the two groups. A significant difference between the two groups with regard to wound infection rates (p = 0.5) and recurrence rates (p = 0.6) was not observed. In order to prevent prolonged inpatient stay and social intolerance, this study suggests that the post-operative period is tolerated by a few when a drain was used. The visual analog scale (VAS) in the drained group was 3.2 ± 0.9, and VAS in the non-drained group was 3.5 ± 0.9 with a significant statistical difference (p = 0.0001). As regards the cosmetic appearance of the scar after surgery, we achieved a high satisfaction rate among patients in either group with 82.9% good cosmetic results. The use of a drain, in our experience, appears to be useless in achieving a quick healing of the sacral wound; in addition, it has a low satisfaction rate.