Pilonidal publications in PubMed 2018
PubMed
(2018)
"Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease." Adv Skin Wound Care 31(7): E1.
Abdelnaby, M., et al
(2018)
"Rotational gluteal flap versus modified Limberg flap in treatment of sacrococcygeal pilonidal disease." J Surg Res 223: 174-182. BACKGROUND: Sacrococcygeal 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 METHODS: This 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
RESULTS: A 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
CONCLUSIONS: Both 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.
Abo-Ryia, M
H., et al
(2018)
"Fascio-Adipo-Cutaneous Lateral Advancement Flap for Treatment of Pilonidal Sinus: A Modification of the Karydakis Operation-Cohort Study." World J Surg 42(6): 1721-1726. BACKGROUND: Pilonidal sinus is a common chronic disease affecting young adults
Many surgical procedures have been developed for its treatment, but an optimal one has still not been achieved
This study presents a modification to the Karydakis operation
METHODS: A total of 265 patients with chronic pilonidal sinus between May 2008 and May 2015 were included in this study and submitted to fascio-adipo-cutaneous lateral advancement flap as 1-day case surgery
Any Septic complication was treated firstly
Follow-up examinations were conducted during the first three postoperative months at the outpatient clinic at regular intervals and thereafter by phone calls or direct examination to check for recurrences
RESULTS: Males constituted 93.6% with a mean age of 21.6 +/- 7.7 year
The median disease duration was 15 months
Twenty-eight patients had recurrent disease
The mean operative time was 41.4 +/- 12.7 min
The mean time out of work was 11.6 +/- 4.6 days
Complications occurred in 19 patients (7.1%) in the form of seroma in six patients (2.2%), superficial wound infection occurred in nine patients (3.3%), cuticular wound disruption occurred in four patients (1.5%)
All patients completed 3-months follow-up, but 48 patients were lost at variable intervals with the remaining 217 patients completed follow-up throughout the period of the study with a median follow-up of 43 months
No reported recurrence and 96.7% of the patients were satisfied about their wound
CONCLUSION: This modification is simple with low complication rate, no recurrence, and excellent patient satisfaction. Akcay, B
D., et al
(2018)
"Effects of subjective sleep quality on the quality of life in patients with chronic anorectal disorder." Turk J Surg 34(4): 276-281. OBJECTIVE: The aim of the present study was to evaluate the subjective sleep quality in patients with anorectal disorder, to determine the factors associated with subjective sleep quality, and to explore the relationship between subjective sleep quality and quality of life
MATERIAL AND METHODS: This descriptive study was conducted between April 8, 2015 and April 12, 2016
The research population consisted of 284 patients who attended the general surgery outpatient clinics of Konya Military Hospital and were subsequently diagnosed with one of the four most common anorectal disorders (hemorrhoidal disease, anal fissure, anorectal abscess/fistula, and sacrococcygeal pilonidal disease)
Data were collected from 114 patients who volunteered to participate in the study
After establishment of the diagnosis based on proctological anamnesis and physical examination, the Pittsburgh Sleep Quality Index, Short-Form Health Survey, Beck Anxiety Inventory, and Beck Depression Inventory were administered to the patients, along with a questionnaire on sociodemographic data, via a face-to-face interview technique
RESULTS: Ninety-six (84.2%) patients had poor sleep quality, whereas 18 (15.8%) patients had good sleep quality
Among the patients with poor sleep quality, 16 were diagnosed with anorectal abscess and fistula (100.0%), 40 with hemorrhoidal disease (90.9%), 16 with sacrococcygeal pilonidal disease (80.0%), and 24 with anal fissure (70.6%)
Overall, all patients with poor sleep quality (n=96) had low scores in all subcomponents of the quality of life scale
CONCLUSION: The sleep quality in patients with chronic anorectal disorder is significantly impaired, thus negatively affecting quality of life
Therefore, improvement in quality of life by improving sleep quality should be one of the main objectives in treating chronic anorectal disorders. Andersson, R
E., et al
(2018)
"Interdisciplinary Dialogue Is Needed When Defining Perioperative Recommendations: Conflicting Guidelines for Anesthetizing Patients for Pilonidal Surgery." A A Pract 11(8): 227-229. National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping
A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area
Its incidence is rising, reaching almost 100/100,000 inhabitants
Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia
Who should provide input into guidelines? And how can medical disciplines successfully collaborate? Anesthesiologists must be involved in defining perioperative recommendations not only in patients with pilonidal sinus disease. Arnous, M., et al
(2019)
"Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial." Ann R Coll Surg Engl 101(1): 21-29. BACKGROUND: Although several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure
In this study we compared excision with primary closure and Limberg flap in the treatment of SPND
METHODS: This was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique)
The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes
RESULTS: Sixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m(2)
Group 1 had significantly shorter operation time than group II
Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4)
Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II
Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence
CONCLUSIONS: The Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure
Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence. Arpaci, E., et al
(2018)
"A New Oval Advancement Flap Design for Reconstruction of Pilonidal Sinus Defect." World J Surg 42(11): 3568-3574. BACKGROUNDS: Pilonidal sinus is a common chronic disease of the sacrococcygeal region
Although many surgical methods have been described for treating pilonidal sinus disease, controversy still exists as to the best surgical technique
The aim of this study is to present a new modified advancement flap technique named "omega flap" for the treatment of pilonidal sinus disease
MATERIALS AND METHODS: This study included 18 patients with pilonidal sinus who were treated between March 2012 and August 2014
All cases underwent oval excision and omega advancement flap reconstruction
Defect size, postoperative complications, postoperative pain, painless sitting time, patient satisfaction and recurrence were evaluated retrospectively
RESULTS: All patients were discharged on the first postoperative day
There was no flap necrosis
No recurrence and no major complication were observed during follow-up period
The outcomes were also satisfactory regarding functionally and aesthetically, and the patients were satisfied with the results
CONCLUSIONS: Presented method has a different geometry than classical advancement flap methods
Our technique provides two-layered repair with minimal tension and off-midline closure for the reconstruction of pilonidal sinus defect
It is easily performed, reliable, associated with no recurrens and good aesthetic results. Arslan, N
C., et al
(2018)
"Effect of triclosan-coated sutures on surgical site infections in pilonidal disease: prospective randomized study." Int J Colorectal Dis 33(10): 1445-1452. PURPOSE: The aim of this study is to investigate the effect of triclosan-coated sutures on surgical site infections after wide excision and primary closure for pilonidal disease
METHODS: One hundred seventy-seven patients were randomized into two groups: 91 in control and 86 in triclosan groups
In the control group, 1/0 monofilament polypropylene retention sutures, 3/0 polyglactin subcutaneous sutures, and 3/0 polypropylene skin sutures were used
In the triclosan group, 1/0 triclosan-coated monofilament polydioxanone, 3/0 triclosan-coated polyglactin, and 3/0 triclosan-coated monofilament polydioxanone were used
Postoperative care and follow-up was made by a surgeon according to Centers for Disease Control guideline
Surgical site infection rates between groups were compared
Secondary outcomes were seroma and wound dehiscence
RESULTS: Seroma was seen in 30 (16.9%) patients: 20 (23.3%) in the triclosan group and 10 (10.9%) in the control group (p = 0.030)
Thirteen (7.3%) patients had superficial wound dehiscence: 5 (5.5%) patients in the control group and 10 (11.6%) patients in the triclosan group (p = 0.116)
Overall surgical site infection (SSI) rate was 15.8% (n = 28): 19 (20.8%) patients in the control group and 9 (10.5%) patients in the triclosan group (p = 0.044)
Healing was observed on mean 17.8 +/- 6.7 days
Primary and secondary healing rates and time to healing were similar between groups
CONCLUSION: Triclosan-coated sutures decreased surgical site infection rate but had no effect on time to healing in pilonidal disease
Seroma and wound dehiscence were more common in triclosan groups
Randomized trials are needed to clear the effect of triclosan-coated sutures on postoperative wound complications. Ates, U., et al
(2018)
"Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure." J Pediatr Surg 53(3): 452-455. INTRODUCTION: Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region
Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application
In this study, crystallized phenol application was compared to excision and primary closure
PATIENTS AND METHODS: This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application
The patients' medical data were analyzed retrospectively
RESULTS: This study included 117 patients with PS
There were 52 girls (44%) and 65 boys (56%)
Mean age of children was 15.6 (12-20) years
Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%)
The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days
Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group
CONCLUSION: Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown
Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children
TREATMENT STUDY: Level III. Bernardes Filho, F
(2018)
"Corrigendum: Man with a swollen mass on sacrococcygeal region." Pan Afr Med J 30: 60. [This corrects the article DOI: 10.11604/pamj.2018.29.10.14447.]. Bernardes Filho, F
and A
O
Alves (2018)
"Man with a swollen mass on sacrococcygeal region." Pan Afr Med J 29: 10. Bisceglia, M., et al
(2018)
"Glomus coccygeum: a review." Pathologica 110(4): 287-293. With limited information about the coccygeal glomus found in classic textbooks, we deemed it necessary to review the subject
The illustrations presented in this article derive from four coccygeal glomera incidentally encountered during examination of pilonidal disease specimens
Familiarization with its microanatomical features may help to avoid inappropriate interpretation of this enigmatic structure. Bosche, F., et al
(2018)
"The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests." World J Surg 42(2): 567-573. PURPOSE: Hair has been identified as the causative agent of Pilonidal Sinus Disease (PSD)
Stiffer, dark hair as well as hairiness has been postulated as causative factors
Astonishingly, despite the early clinical significance of this condition (Hodges in Boston Med Surg J 2:485-486, 1880), macroscopic and microscopic examinations of hair inside pilonidal sinus cavities have been scarce
The purpose of this study was to study the morphological aspects of the hair found in PSD in order to determine the origin of the hair
METHODS: Hair from inside pilonidal sinus cavities was collected intraoperatively from 20 PSD patients
Additionally, occipital, lumbar and intergluteal hair was harvested from the same patients and compared to the hair of volunteer-matched pair patients admitted to the hospital at the same time for non-PSD surgery
Intra- and intergroup variations of hair length were characterized with analysis of variance
Numbers and lengths of pilonidal sinus nest hair were recorded
Hair was examined clinically and with light and scanning electron microscopy using surface enhancing gold and carbon dust coating techniques
RESULTS: Analysis of 624 pilonidal sinus nest hair samples from 20 independent sinus cavities revealed that hair within pilonidal sinus nests is rootless in 74%
Shorter hair was found inside the pilonidal sinus compared to other sites (length 0.9 +/- 0.7 cm p < 0.0001)
Furthermore, hair found inside of the sinus was significantly shorter than hair protruding from pores (p < 0.000)
Hair samples show razor sharp but no broken or split ends
On electron microscopy, these spiky hair ends resemble cut hair ends
Pilonidal hair nests contained between 1 and over 400 hair fragments
CONCLUSION: Short hair fragments with rootless sharp cut ends were found within pilonidal sinus cavities
Morphologically, these fragments resemble short cut rather than intact body hair
Since short cut hair, e.g., derived from the head potentially enters the pilonidal cavity more easily than longer hair, the source of these cut hair fragments needs to be eliminated when aiming to prevent Pilonidal Sinus Disease. Boshnaq, M., et al
(2018)
"Limberg flap in management of pilonidal sinus disease: systematic review and a local experience." Acta Chir Belg 118(2): 78-84. OBJECTIVES: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD)
We also included our local experience of LF
METHODS: Medline and Embase database were searched for the words 'pilonidal, sinus, Limberg, flap'
Non-English articles and those not-related to our scope of search were omitted
We included a retrospective study of patients underwent LF in our district hospital
Data including length of hospital stay, post-operative complications and recurrence were collected
RESULTS: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses)
Recurrence rate was 0-7.4% in case series
Recurrence rate in comparative studies was 0-8.3%, compared to 4-37.7% for primary closure and 0-11% for Karydakis flap
RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap
About 26 patients included in the cohort study (16 male, average age 27 years)
Six patients presented with recurrent disease
Post-operative length of hospital stay was four to seven days
Post-operative complication rate was 11.5% - [two partial wound dehiscence, one wound infection]
Recurrence rate was 7.7%
Average follow-up was 18 months
CONCLUSIONS: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD. Boulanger, G., et al
(2018)
"Is histological analysis of pilonidal sinus useful? Retrospective analysis of 731 resections." J Visc Surg 155(3): 191-194. The pilonidal sinus (SP) is a common pathology
The treatment is a surgical excision
Many surgeons continue to systematically send this SP in histological analysis
The objective of our retrospective study was to evaluate the interest of this systematic histological analysis
The retrospective analysis of patients undergoing surgery was performed between 1 January 2006 and 31 December 2014
The primary observation was the presence of a malignant disease on the surgical specimen
Secondary observations were the wound healing time and the rate of recurrence
Seven hundred and thirty-one patients were analyzed
There was no malignant lesion
For 323 patients, the histological analysis did not describe the resection margins
Two hundred and eighty five patients had complete resect on and 38 were incomplete
Twenty-four patients had recurrence (7%)
There was no significant difference between those who had complete and incomplete resection
The healing time was 61 days
Our study raises the question about the value of systematic histological analysis of the PS specimen. Burnett, D., et al
(2018)
"The Surgical Management of Pilonidal Disease is Uncertain Because of High Recurrence Rates." Cureus 10(5): e2625. Background Pilonidal disease is a common condition with no consensus for the best management of chronic disease or current practice in Australia and New Zealand
Methods A survey was distributed among 190 colorectal and 592 general surgeons in Australia and New Zealand
Data was obtained regarding pilonidal surgery volume, procedures performed, non-operative management and recurrence rates
Three clinical scenarios were also presented
Results The response rate was 58% among colorectal surgeons, 18% among general surgeons
Nineteen percent of surgeons were high-volume (>23 operations per year), 47% low-volume (<12 operations per year)
The commonest procedure was the Karydakis procedure (77%), with many others performed including rhomboid flaps (36%), Bascom cleft lift (13%), Z-plasty (7%), and gluteal rotation flaps (5%)
Fifty-five percent of high-volume surgeons offered more than one operation while only 16% of low-volume surgeons did
Nineteen percent operated on all patients with pilonidal disease, 89% believing off-midline closure to be superior to midline
Disease extent was the main driver for non-operative management; patient factors such as cosmesis and time-off work being the least important
Sixty-four percent reported recurrence rates above 5%, and 37% recurrence rates >10%
Six percent reported no recurrences ever
Five percent reported recurrence rates over 20%, but 24% stated that over one-fifth of their practice consists of recurrent disease
Conclusions This study reports higher recurrence rates than in published series, suggesting many surgeons do not see their own recurrences, with current treatment not as successful as previously thought
Combined with the widespread variation in practice, optimal management of this disease remains unclear. Burney, R
E
(2018)
"Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients." Surgery 164(6): 1217-1222. BACKGROUND: 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
METHODS: 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
RESULTS: 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
CONCLUSION: 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%. Cetin, K., et al
(2018)
"Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study." Ann Surg Treat Res 94(2): 88-93. Purpose: We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure
Methods: From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both
Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure
Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups
Results: There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm(2), recurrence, operation, and mean follow-up time
Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05)
One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05)
Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05)
Conclusion: In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates
Future studies are needed to achieve greater detailed evaluation. Cevik, M., et al
(2018)
"Is conservative treatment an effective option for pilonidal sinus disease in children?" Int Wound J 15(5): 840-844. Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial
There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children
This study involved a retrospective review with telephone follow up
All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery
All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess)
Data collection included demographics, type of management, recurrence, presence of infection, and total healing time
In the study period, 29 children were identified
Their mean age was 14.94 +/- 1.09 (range: 12-16) years, and 51.7% were girls
The mean length of follow up was 8.34 +/- 6.36 (range: 1-25) months
Complete healing occurred in 79.3% of patients
Recurrence was evident in 12% of patients
Four patients underwent surgery
PSD is being seen in children more frequently in recent years
Conservative treatment may be the recommended initial approach for PSD in children. Craveiro-Lopes, B., et al
(2018)
"Trichogranuloma in a Hairdresser with Systemic Sclerosis." Cureus 10(5): e2690. Trichogranuloma is a rare occupational disease of hairdressers that develops when hair clippings penetrate the skin and cause a foreign-body reaction
We describe a case of a hairdresser with limited cutaneous systemic sclerosis who developed a chronic felon on her right third finger and received repeated courses of antibiotics without improvement
An occupational history and awareness of occupational diseases in hairdressers led to the correct diagnosis of trichogranuloma
Systemic sclerosis and concomitant finger ulcers may have predisposed the patient to this otherwise infrequent condition in an unusual location
Our case highlights the importance of occupational history and awareness of rare occupational diseases; we propose that treating and preventing skin disease may play a role in the prevention of trichogranuloma, thereby highlighting the need for protective measures in hairdressers. Dandin, O., et al
(2018)
"A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''." Turk J Surg 34(1): 43-48. Objective: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap
The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment
Material and Methods: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively
Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated
Results: The numbers of male and female patients in this study were 39 and 1, respectively
The median age of the patients was 25 years and the mean BMI was 26.6
The mean operating time was 43 min, and all patients were discharged 5 h after the operation
Wound healing time varied from 10 to 20 days
Median follow-up period was 9 months (4-17 months)
One patient with high body mass index suffered from partial wound separation
No other complications such as infections and fluid collections (hematoma and seromas) were observed
Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period
Conclusion: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates. De Robles, M
S., et al
(2019)
"Karydakis procedure can be effectively performed in the lateral position." ANZ J Surg 89(1-2): E10-E14. BACKGROUND: Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%
The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series
METHODS: Ninety-seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed
Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position
RESULTS: Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%)
The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only
Wound complications, mostly minor skin separation, occurred in 37 patients (38%)
Disease recurrence occurred in eight patients (8%)
There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups)
CONCLUSIONS: Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency
The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease. Delshad, H
R., et al
(2019)
"Pit-picking resolves pilonidal disease in adolescents." J Pediatr Surg 54(1): 174-176. PURPOSE: The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease
METHODS: Patients presenting to a Pilonidal Clinic were managed by evacuation of any un-drained collections, soaking, and as needed, hair removal
Once active inflammation resolved, they underwent pit-picking under local anesthesia
Those with >3 pits underwent sequential pit-pickings 2months apart
Hirsute patients also underwent laser hair epilation
Pilonidal disease was stratified by severity
Patient symptoms were collected prospectively and reviewed
RESULTS: Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017
There were 40 (69%) males with a mean age of 17.7years (range 13-24)
Thirty-seven hirsute patients (64%) underwent a series of laser epilation treatments
Patients required from 0 to 3days of non-narcotic analgesia, and all returned promptly to pre-procedure activities
Seven patients (12%) were lost to follow-up
Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0months (range 1-20) post-procedure
Four patients (8%) had persistent intermittent drainage
CONCLUSION: Pit-picking is a simple office procedure that may resolve pilonidal disease in many adolescents
A longer follow-up interval is needed to determine the long-term recurrence rate
TYPE OF STUDY: Case Series
LEVEL OF EVIDENCE: Level IV. Dolen, U
C
and U
Kocer (2018)
"Innovation in the planning of V-Y rotation advancement flaps: A template for flap design." Arch Plast Surg 45(1): 85-88. Local flaps exhibit excellent color matching that no other type of flap can compete with
Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap
However, local flaps can be much more difficult to design
We designed 2 templates to plan a V-Y rotation advancement flap
The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2)
The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1)
The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10)
The meningocele patients were younger than 8 days
The mean age of the adult patients was 50.4 years (range, 19-80 years)
All the donor areas of the flaps were closed primarily
None of the patients experienced wound dehiscence or partial/total flap necrosis
The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound
In addition, they could be used for the training of residents. Doll, D., et al
(2018)
"The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof." Int J Colorectal Dis 33(5): 567-576. PURPOSE: Hair in the pilonidal sinus is not growing within the sinus cavity, as hair follicles are not present there
Not few pilonidal patients do not have intergluteal hair, which is said to be the causative agent of folliculitis and pilonidal genesis
So, what is the real source of the hair forming the typical pilonidal hair nest? METHODS: A trifold approach was used: First, axial hair strength testing of pilonidal hair and body hair harvested from head, lower back (glabella sacralis), and cranial third of intergluteal fold
Hair strength match was compared clinically
Second, comparative morphological examination by expert forensic biologist of hair from sinus and dorsal body hair
Third, statistical Bayesian classification of every single sinus hair based on its strength was done to determine the most probable region of origin
RESULTS: Using clinical hair strength comparison, in 13/20 patients, head hair is the stiffest hair, followed by intergluteal hair
Only in 6/20 patients, this is the case with hair from the glabella sacralis
According to comparative morphological comparison, a minimum of 5 of 13 hair nests with possible hair allocation examined contain hair from the occiput
In 5/18 nests, hair could not be determined to a specific location though
Statistical classification with correction for multiple testing shows that 2 nests have hair samples that are at least 100 times more probable to originate from head or lower back than from intergluteal fold
CONCLUSION: We saw our null hypothesis that "hair in the sinus cavity is from the intergluteal region" rejected by each of three different approaches
There is strong evidence that occipital hair is present regularly in pilonidal sinus nests
We should start thinking of occipital hair as an important hair source for the development of the pilonidal hair nest. Dragoni, F., et al
(2018)
"Treatment of recurrent pilonidal cysts with nd-YAG laser: report of our experience." J Dermatolog Treat 29(1): 65-67. PURPOSE: Surgical treatment remains the first-line therapy of pilonidal cyst but is associated with high levels of postoperative pain, adverse events and a recurrence rate of 30%
We report our experience with laser hair removal using the Nd-YAG laser for the treatment of pilonidal cyst
MATERIALS AND METHODS: Ten patients affected by pilonidal cyst were examined and treated from October 2011 to November 2016
Treatments were carried out using the Nd-YAG laser (Deka M.E.L.A, Calenzano, Florence, Italy) at a wavelength of 1064 nm at 30-day interval
RESULTS: Nine patients were asymptomatic after the second treatment, while in one case the symptom disappeared after the fourth session
After 4-8 treatments, the pilonidal cyst had clinically disappeared and patients subjectively felt healed
In all cases, the soft-tissue ultrasounds performed before the first and after the last session showed the disappearance of the pilonidal cyst
In the follow-up, all the patients remained asymptomatic without any disease recurrence
CONCLUSIONS: Nd-YAG laser is an effective treatment for pilonidal cysts, providing excellent results with quick healing and no risk of serious adverse side-effects
It could be a very attractive alternative to open surgery, enabling patients to prevent the frequent and severe postoperative issues associated with surgery. Emile, S
H., et al
(2018)
"Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis." Surg Endosc 32(9): 3754-3762. BACKGROUND: Sacrococcygeal pilonidal disease (SPD) is a common surgical condition for which a multitude of surgical treatments have been described
The present review aimed to evaluate the efficacy and safety of a novel endoscopic procedure for the treatment of SPD
METHODS: An organized literature search was conducted
Electronic databases including PubMed/Medline, Scopus, Embase, and Cochrane library were searched for articles that assessed the endoscopic treatment for SPD
The main outcome parameters were failure of the technique including persistence and recurrence of SPD, postoperative complications and pain, time to complete healing, and time to return to work
RESULTS: Nine studies with a total of 497 patients were included
Mean age of patients was 24.8 years
Mean operation time was 34.7 min
The procedure was performed as day-case surgery in all studies
The mean Visual analogue score of pain within the first week was 1.35
Failure of the technique was recorded in 40 (8.04%) patients, 20 (4.02%) had persistent SPD and 20 (4.02%) developed recurrence
The weighted mean failure rate of the technique was 6.3% (95% CI 3.6-9.1)
Mean weighted complication rate was 1.1% (95% CI 0.3-2.4)
Mean time to complete healing was 32.9 days and mean time to return to work was 2.9 days
CONCLUSION: The endoscopic treatment of pilonidal sinus is a promising and safe method of treatment of SPD
The main advantages of the endoscopic treatment as compared to conventional surgery are the minimal postoperative pain, quick healing, and short time to return to work and daily activities. Ercil, H., et al
(2018)
"Recurrent Pilonidal Sinus Cyst on Penis." Arch Iran Med 21(3): 131-133. Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females
Pilonidal sinus on the penis is so rare that very few cases have been reported in literature
A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months
Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft
We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis. Erkent, M., et al
(2018)
"Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery." Med Sci Monit 24: 8959-8963. BACKGROUND Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region
There are many treatment options, but there is still no consensus on the ideal treatment
We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF)
MATERIAL AND METHODS The data for 924 PS patients from 2013 to 2017 were retrospectively examined
Demographic data, surgical procedures, schedules, and recurrence rates were examined
RESULTS The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162)
PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF
PMC was the first choice among females but LFR was the first choice in recurrent patients
The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group
In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05)
Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients
The KF group had the lowest complication rates (p<0.01)
CONCLUSIONS According to the results of this study, the reason for preferring PMC among women is cosmetic concerns
PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC
Considering their low recurrence rates, LFR or KF should be considered first
When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients. Esposito, C., et al
(2018)
"Pediatric Endoscopic Pilonidal Sinus Treatment, a Revolutionary Technique to Adopt in Children with Pilonidal Sinus Fistulas: Our Preliminary Experience." J Laparoendosc Adv Surg Tech A 28(3): 359-363. AIM: This study aimed to report our preliminary experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT)
PATIENTS AND METHODS: We retrospectively reviewed the reports of 15 patients, 6 girls and 9 boys, with an average age of 16 years (range 13-18) with noninfected pilonidal sinus disease who underwent PEPSiT in our institution over an 18-month period
Four cases were redo-procedures, for recurrence of disease after open excision repair
Surgical outcomes of sinus healing, recurrence of disease, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated and a comparison analysis with classic open repair was performed
RESULTS: All procedures were performed under subarachnoid spinal anesthesia
We always adopted a fistuloscope, an endoscopic forceps, and a monopolar electrode to remove the hairs and to heal the fistula
The average length of surgery was 28.5 minutes (range 26-41)
No intraoperative or postoperative complications were reported
The average pain score evaluated using Visual Analogue Scale (VAS) pain scale during the first 48 postoperative hours was 3.2 (range 2-5)
The average analgesic requirement was 22 hours (range 16-28)
The average hospital stay length was 28 hours (range 22-48)
They changed dressing daily, by applying a topical solution of eosin 2% and a silver sulfadiazine spray
At 1 month postoperatively, the external openings were closed in all patients and no recurrence was recorded at a mean follow-up of 6 month
PEPSiT was associated with a significantly shorter, painless, and better outcome compared to open technique
CONCLUSION: On the basis of our preliminary experience, we believe that PEPSiT is a promising technique for surgical treatment of pilonidal sinus in children
It is technically easy and quick to perform, with a short and painless hospital stay, without recurrences in our series
It allows operated patients an early return to full daily activities without restrictions that happen for the classic treatment. Filippou, D
K
(2018)
"Concerns: M
Dessily, F
Charara, S
Ralea & J.-L
Alle
Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience
Acta Chir Belg
2017; 117(3): 164-168." Acta Chir Belg 118(1): 72. Garg, P
(2018)
"Achieving the maximum by doing the minimum in the treatment of pilonidal sinus: where does evidence point?" Colorectal Dis 20(11): 1047. Garg, P
(2018)
"Management of Pilonidal Disease Needs Paradigm Shift From More to Less: Enough Evidence and Logic Available." Dis Colon Rectum 61(12): e376. Garg, P
(2018)
"Re: JSLS
2017 Jul-Sep; 21(3): e2017.00043
DOI: 10.4293/JSLS.2017.00043
Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series." JSLS 22(2). Georgiou, G
K
(2018)
"Outpatient laser treatment of primary pilonidal disease : the PiLaT technique." Tech Coloproctol 22(10): 773-778. BACKGROUND: The aim of the present study was to assess the effectiveness of the minimally invasive technique pilonidal disease laser treatment (PiLaT) in treating primary (non-recurrent) pilonidal disease in an outpatient setting under local anaesthesia
METHODS: A prospective observational study was conducted on consecutive patients suffering from primary pilonidal disease that were treated at Iasi Private Medical Center, Ioannina, Greece, between April 2015 and December 2016, using a 1.470 nm diode laser (BioLitec, Germany) emitting energy through a radial optic fiber that was inserted in the cyst and accompanying sinus tracts
Patients were discharged half an hour after completion of the procedure
Pain scores [visual analogue scale (VAS)], complications and patient satisfaction were assessed
Follow-up lasted 12 months
RESULTS: There were 60 patients, 51 males and 9 females, with a mean age of 22.7 years (range 15-58)
Successful treatment (complete epithelization of cyst and tracts) was documented in 55 out of the 60 patients (92% success rate)
VAS pain scores were low and no major complications were recorded
Healing was achieved in 25.4 days (range 17-40) and 53.3% of patients were able to return to work the same day (the rest within 3 days)
Of the failures, four patients did not heal and one patient recurred after 5 months
All failures were treated successfully with a second laser procedure except for one who denied re-intervention
Overall patient satisfaction reached 98%
CONCLUSIONS: PiLaT seems to be very close to the ideal treatment of pilonidal disease, since it is safe, easy to perform, almost painless and highly effective. Gosselink, M
P
and G
C
Ctercteko (2018)
"The Sharp End of Pilonidal Disease." Dis Colon Rectum 61(2): e12. Halleran, D
R., et al
(2018)
"Recurrence of Pilonidal Disease: Our Best is Not Good Enough." J Surg Res 232: 430-436. BACKGROUND: Recurrence rates of pilonidal disease have been reported to be high as 30%
Patients with recurrent pilonidal disease often develop chronic wounds and draining sinuses that incur long-term morbidity, disability, and decreased quality of life
The aim of this study was to characterize rates of recurrence in patients with pilonidal disease treated by pediatric surgeons
METHODS: A single center retrospective review of patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015 was performed
Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment
Repeated events proportional hazards regression modeling was performed to identify factors associated with time to recurrence
RESULTS: Among 307 patients treated for pilonidal disease, nearly 50% were male, and the median age at initial evaluation was 16 years (IQR 15-17)
Approximately 45% were obese (BMI >/= 95th percentile)
The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third
The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year
On multivariable analysis, obese BMI was the only factor independently associated with time to disease recurrence
CONCLUSIONS: Pilonidal disease has a substantial recurrence rate even after surgical excision
Future studies investigating treatments that can prevent disease recurrence are needed. Halleran, D
R., et al
(2018)
"Laser Hair Depilation in the Treatment of Pilonidal Disease: A Systematic Review." Surg Infect (Larchmt) 19(6): 566-572. BACKGROUND: Laser hair depilation has shown promise in small series of patients with pilonidal sinus disease
The purpose of this study was to review the published literature on laser hair depilation in pilonidal disease to determine its effect on disease recurrence
METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify all studies published through December 1, 2017 that examined the role of laser hair depilation in the treatment of pilonidal sinus disease
Study characteristics, including design, treatment regimen, number of patients evaluated, rate of recurrence, and duration of follow up were recorded
RESULTS: Thirty-five published studies were included
Of these, 28 studies were retrospective and seven were prospective
There were five comparative studies: two retrospective, one prospective observational, and two randomized controlled trials
The number of patients included in each study ranged from one to 86 patients and patients received between one and 11 laser treatments
The pilonidal disease recurrence rate after laser depilation ranged from 0% to 28% at a mean follow-up ranging from 6 months to 5 years across studies
Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort
CONCLUSION: Laser hair depilation is a promising therapy in the management of pilonidal disease
However, the literature published to date is heterogeneous and has limited generalizability
Additional research is needed to determine the effectiveness of laser hair depilation to prevent pilonidal disease recurrence. Hamnett, K., et al
(2018)
"Inferiorly based lotus petal flap & laser therapy in difficult pilonidal sinus management." J Plast Reconstr Aesthet Surg 71(11): 1631-1636. AIM: To assess the efficacy of the lotus petal flap in difficult pilonidal sinus management
BACKGROUND: Pilonidal sinuses may be difficult to treat
Five year recurrence rates range from 18% to 50% Recurrence rates fall with primary closure rather than healing by secondary intention
Techniques such as z-plasty however, distort natal architecture
The lotus petal flap taken from the superior buttock fills dead space whilst conforming to the natural concave appearance of the natal cleft
The contralateral buttock is spared
It is straightforward and reproducible
Multiple perforators make it robust and promote wound healing in this difficult group
METHOD: We present a series of 14 patients who had a lotus petal flap reconstruction following pilonidal sinus excision between 2007 and 2015
The majority of these patients had previous multiple failed attempts at eradication
Recurrence rates, re-operation rates, time for complete healing, wound breakdown, discharge, infection, cosmesis and patient comfort were assessed
RESULTS: Many patients had coarse hair; felt to predispose to recurrence of symptoms, poor hygiene and prolonged wound healing
50% of patients underwent Alexandrite laser (755nm wavelength) for a minimum of 6 treatments
There was excellent compliance and good patient outcome
Overall in this complex patient group only 14% had prolonged wound healing and recurrence rates were lower than those in the literature
CONCLUSION: The lotus petal flap is an excellent choice for problematic pilonidal sinus reconstruction
When combined with tumour like excision, meticulous surgical technique and complimentary laser hair removal results can be improved further. Hamza, M., et al
(2018)
"Excision of the Gluteal Cleft Pilonidal Sinus, Its Track, and the Sudoriferous Gland Area En-bloc with Primary Repair in the Management of this Disease." Cureus 10(6): e2806. Introduction Pilonidal disease is a common disease mostly affecting young males with a significant reduction in their working capabilities, hence, ideal and simple management of this disease is very important
Our study objective was to assess the recurrence rate of pilonidal sinus disease in patients with a complete excision of the pilonidal sinus, its track, and the sudoriferous gland area en-bloc with primary repair
Methods This descriptive study was conducted at Al-Noor Surgery, Chakwal, Pakistan, from February 2015 to July 2017
All patients who presented with acute and chronic pilonidal disease in the natal cleft, irrespective of age and gender, were included
We excluded from the study patients who had asymptomatic or recurrent pilonidal disease, previous pilonidal surgery, patients belonging to American Society of Anesthesiologists (ASA) Class III or above, immunodeficient patients, patients having bleeding disorders, patients on chemotherapy, and those diagnosed with comorbidities, e.g., anemia, tuberculosis, diabetes, and liver disease
Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, US)
Results During the study period, a total of one 112 patients were included
The male-to-female ratio was 55:1
The most common age group was the 21-25 age group
Chronic pilonidal disease was the most common presentation
Mean operative time was 22.09+/-3.65 minutes
There were no complications like bleeding, hematoma, edema, infection, and wound dehiscence
There was no recurrence in the six months follow-up
Hospital stay was 3.13+/-0.62 hours
Conclusion Simple excision of acute and chronic pilonidal sinus, its track, and the linked sudoriferous gland area en-bloc, followed by primary repair, is an effective approach to deal with this pathology. Hardy, E., et al
(2019)
"Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children." J Pediatr Surg 54(8): 1668-1670. BACKGROUND / PURPOSE: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2-2.5/1000 in children
Onset is around puberty
Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration
Treatments should cause minimal disruption while having good cure and recurrence rates
Curettage and Fibrin glue obliteration (FGO) show promising results in adults
We present our experience of its use in children
METHODS: Review of all pediatric patients receiving FGO of pilonidal sinus performed by a single surgeon from September 2014 to February 2018
RESULTS: Eighteen patients were identified
Median age was 16 (range 15-17), 55.6% were male
All procedures were completed as day cases
Median operative duration was 14 .1 (6-29) min
Twelve patients required only 1 procedure, 4 required 2 procedures, 1 required 5 procedures and 1 elected for formal excision after 2 FGO treatments
Median return to normal activities was 3days, with 1day school absence
Two patients developed minor surgical site infections
Median follow-up was 52weeks (17-102), during which time there was 1 recurrence (5.6%)
CONCLUSION: This study demonstrates FGO is a safe, effective procedure for pediatric PNS, with results comparable to off-midline flap techniques and without the need for extensive tissue excision and the associated morbidity
LEVEL OF EVIDENCE: IV. Harries, R
L., et al
(2019)
"Management of sacrococcygeal pilonidal sinus disease." Int Wound J 16(2): 370-378. The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity
A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious
Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease
This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease. Huda, F
and S
K
Singh (2018)
"Use of Otoscope as a Diagnostic and Therapeutic Aid in Umbilical Pilonidal Sinus: A Novel Technique." Niger J Surg 24(1): 16-18. Introduction: Umbilical disorders are frequently encountered in general surgical practice
Although the sacrococcygeal region is the most common site for pilonidal sinus disease, it can be seen occasionally in periumbilical area
Treatment is mostly conservative for umbilical pilonidal sinus in contrast to the sacrococcygeal sinus where it is always surgical
In the era of endoscopy and minimally invasive surgery, we describe the use of otoscope as a novel technique for the diagnosis and treatment of umbilical pilonidal sinus
Subject and Method: In this prospective study, patients with a clinical suspicion of umbilical pilonidal sinus were included and diagnosis was confirmed on the basis of otoscopic finding
All patients were planned for conservative management i.e
extraction of hair fragments with the help of an otoscope followed by oral antibiotics treatment
On follow-up, response of treatment was noted by evaluation of symptoms and otoscopic examination
Result: Total 15 patients were included in this study
By using otoscope for removal of hair fragments from umbilical sinus, we found successful result in all patients with conservative treatment
Discussion: In umbilical pilonidal sinus, the success of conservative treatment depends on the effective extraction of hair and maintenance of personal hygiene by the patient
Our study showed 100% successful result of conservative treatment, probably due to proper and complete extraction of hair fragment with the help of the otoscope
Conclusion: Otoscopic examination and hair extraction for umbilical pilonidal sinus is a simple, cost-effective, and easy treatment that can be done in the outpatient department and does not require any formal training for its use. Jabbar, M
S., et al
(2018)
"Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection." Pak J Med Sci 34(1): 49-53. Objective: Pilonidal sinus is a disorder of the sacrococcygeal region affecting younger individuals with a higher hair and weight distribution
Treatment involves the use of various surgical modalities, most of which are associated with a high rate of complications
Open procedure (OP) and Limberg Flap (LF) are two commonly performed surgical procedures for the correction of pilonidal sinus disease in our setup
The objective of our study was to compare the treatment of pilonidal sinus disease by primary closure with Limberg Flap verses Open procedure in terms of frequency of postoperative wound infection
Methods: The study is a randomized clinical trial (RCT) conducted at the department of surgery, military hospital, Rawalpindi, Pakistan
It was carried out over a period of 8 months from 16 February, 2015 to 16 September, 2015
Using consecutive non-probability sampling, a total of 60 patients were selected, 30 of whom underwent Limberg Flap procedure and the remaining 30 underwent open procedure
Postoperatively, observations for wound infection on date of discharge and then again on the various follow-up visits over the next 3 weeks
The data collected was then compared by applying the chi-square test, with p-value less than 0.05 considered statistically significant
Results: Our results showed that both primary closure with Limberg flap, and open procedure are comparable options in terms of wound infection
There was no statistical significance in the incidence of post operative infections, between the two surgeries
Conclusion: In terms of wound infection, both procedures are satisfactory surgical procedures for Pilonidal sinus disease. Johnson, E
K
(2018)
"Expert Commentary on Pilonidal Disease: Management and Definitive Treatment." Dis Colon Rectum 61(7): 777-779. Kallis, M
P., et al
(2018)
"Management of pilonidal disease." Curr Opin Pediatr 30(3): 411-416. PURPOSE OF REVIEW: Pilonidal disease, and the treatment associated with it, can cause significant morbidity and substantial burden to patients' quality of life
Despite the plethora of surgical techniques that have been developed to treat pilonidal disease, discrepancies in technique, recurrence rates, complications, time to return to work/school and patients' aesthetic satisfaction between treatment options have led to controversy over the best approach to this common acquired disease of young adults
RECENT FINDINGS: The management of pilonidal disease must strike a balance between recurrence and surgical morbidity
The commonly performed wide excision without closure has prolonged recovery, while flap closures speed recovery time and improve aesthetics at the expense of increased wound complications
Less invasive surgical techniques have recently evolved and are straightforward, with minimal morbidity and satisfactory results
SUMMARY: As with any surgical intervention, the ideal treatment for pilonidal disease would be simple and cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate and require minimal time off from school or work
Less invasive procedures for pilonidal disease may be favourable as an initial approach for these patients reserving complex surgical treatment for refractory disease. Karaca, O., et al
(2018)
"What happened? An inexplicable case: Accidental subdural block." Agri 30(1): 31-34. Epidural block is an appropriate anesthesia method for outpatient operation
This technique is generally safe and efficient
We present the case of a 20-year-old female patient with accidental subdural block after a single dose of epidural block for pilonidal sinus surgery
Sudden apnea, unconsciousness, and bilateral mydriasis occurred within a few minutes after injection
Within 80 minutes after injection, the patient regained full consciousness and spontaneous respiration, with motor block in lower extremities and sensory block until the T4 level
Motor block continued until 165 minutes after injection, whereas sensory block ended 225 minutes later. Karapolat, B., et al
(2018)
"Comparison of limberg flap and oval flap techniques in sacrococcygeal pilonidal sinus disease surgery." Turk J Surg 34(4): 311-314. OBJECTIVE: Although many surgical techniques have been described for treatment of pilonidal sinus disease (PSD), the ideal treatment method remains controversial
The purpose of this study was to compare Limberg flap and oval flap techniques in patients with PSD
MATERIAL AND METHODS: Patients diagnosed with PSD who underwent surgery using either the Limberg flap or oval flap technique between January 2012 and January 2016 at the general surgery outpatient clinic were retrospectively reviewed from the database of our hospital; 142 patients (124 males and 18 females) were invited for examination
The demographic characteristics of the patients such as age and gender, hospital stays, seroma occurrence, surgical site infections, wound dehiscence, flap necrosis, loss of sensation, and recurrences were evaluated based on the information obtained from the database and from physical examinations as well as questioning of the patients
The results were statistically compared, and a p value of <0.05 was considered significant
RESULTS: The mean age of the patients was 27.5+/-7.8 years in the Limberg flap group and 26.5+/-7.2 years in the oval flap group
No significant difference was found between the two groups regarding patients' mean age; gender distribution; postoperative hospital stay; recurrence; and complications, such as seroma, infection, wound dehiscence, and loss of sensation
Flap necrosis was not observed in any of the patients
CONCLUSION: The Limberg flap and oval flap procedures both involve minimum morbidity and short hospital stay because they were not superior to one another regarding treatment effectiveness, complications, and recurrence in the pilonidal sinus surgery. Kars, A., et al
(2018)
"Rare Location for Pilonidal Sinus: the Nasal Dorsum." J Craniofac Surg 29(6): e556-e557. Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin
Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method
A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum
Physical examination revealed a swelling in nasal dorsum and hair-containing fistula
Excision was performed with an open rhinoplasty approach
Histo-pathology examination revealed pilonidal sinus
While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum
Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed
It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made. Kartal, A., et al
(2018)
"Comparison of Three Surgical Techniques in Pilonidal Sinus Surgery." Prague Med Rep 119(4): 148-155. Our study aims to compare the surgical outcome of Limberg transposition flap, Karydakis flap, and primary closure after excision to treat sacrococcygeal pilonidal sinus disease
A total of 634 patients with pilonidal sinus who underwent surgery were evaluated retrospectively from January 2014 to January 2016
The patients were divided into three groups
Limberg transposition flap (LTF) was performed in 131 patients (group 1), Karydakis flap (KF) was performed in 232 patients (group 2) and primary closure (PC) after excision was performed in 271 patients (group 3)
Patient demographics, operative and postoperative outcomes were recorded and analyzed retrospectively
The mean age (p=0.98), sex ratio (p=0.74) and removed sinus volume (p=0.67) were not statistically different between groups
Mean operative time was 54.3 +/- 6.4 min for group 1, 46.8 +/- 10.5 min for group 2, and 26.9 +/- 5.8 min for group 3 respectively (p=0.01)
When the length of hospital stay was compared, there was a significant difference in favor of primary closure (p=0.01)
Regarding early surgical complication, Karydakis flap technique was superior to other groups (p<0.001)
The recurrent rate was higher in the primary closure group (p<0.001)
In our study, the primary closure method regarding the duration of surgery and hospitalization; Karydakis method regarding postoperative complications (seroma, hematoma, wound dissociation, infection, recurrence) were superior to the other two methods. Kelati, A., et al
(2018)
"Laser hair removal after surgery vs
surgery alone for the treatment of pilonidal cysts: a retrospective case-control study." J Eur Acad Dermatol Venereol 32(11): 2031-2033. BACKGROUND: Based on the presumed role of hair in pilonidal cyst (PNC) pathogenesis, laser epilation has been used to decrease recurrences
However, most of the data rely on case reports and uncontrolled series, and the rare controlled studies reported conflicting results
The objective of this study was to investigate the efficacy of laser hair removal (LHR) to decrease the recurrence rate after surgery of PNC vs
surgery alone
METHODS: We conducted a retrospective monocentric case-control study in the departments of Pediatric Surgery and Laser Center of Dermatology of the University Hospital of Nice in France from January 2010 to June 2017
We included all patients with PNC who had surgery during the period, and we compared patients who had LHR after surgery to those having surgery alone
The main outcome was the prevalence and number of recurrences of PNC in each group
RESULTS: Twelve patients - eight treated with alexandrite laser and four patients with Nd : YAG - were included in the cases group; 29 patients treated with surgery alone were included in the control group
The mean and the median number of laser sessions were 4.2 and 5, respectively (extremes 1-10)
The postsurgical recurrence rate without LHR was 51.7%, and their number varied from 1 to 3
A significant decrease in the recurrence rate was observed after LHR (8.3%) compared to control group (P < 0.001)
The median duration before recurrence was 14 months for surgery alone
The median follow-up was 18 months (1-30 months) for LHR group and 30 months (6-72 months) for surgery alone group
Two patients had abnormal healing or persistent sinus after surgery alone compared to none in the group who undergone laser procedure after surgery
CONCLUSIONS: Laser hair removal decreases the risk of delayed healing and of recurrences of PNL after surgical procedure. Kober, M
M., et al
(2018)
"Treatment options for pilonidal sinus." Cutis 102(4): E23-E29. Pilonidal sinus disease often presents as a chronic problem in otherwise healthy hirsute men
A range of conservative techniques to surgical flaps have been employed to treat this condition
We review the literature on management of pilonidal sinus disease, including conservative and surgical techniques as well as novel laser therapy
Given current evidence, off-midline repair is now considered the standard of care; however, no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap
Treatment should be tailored to the individual, taking into account recurrent disease, recovery time, and the surgeon's comfort with the procedure. Koca, Y
S., et al
(2018)
"Comparison of Unilateral Fasciocutaneous V-Y Flap Technique with Cleft Lift Procedure in the Treatment of Recurrent Pilonidal Sinus Disease: A Retrospective Clinical Study." Med Sci Monit 24: 711-717. BACKGROUND This study aimed to assess treatment outcomes of the cleft lift procedure and V-Y flap technique in the treatment of recurrent pilonidal sinus disease (PSD)
MATERIAL AND METHODS A total of 51 patients who underwent cleft lift procedure and 43 patients who underwent fasciocutaneous V-Y flap technique were evaluated
The demographic characteristics, previous operations, duration of symptoms, perioperative complications, duration of operation and hospital stay, duration of draining of all patients, and recurrence of PSD were recorded
RESULTS The mean operation time was 35.61+/-5.254 min in the cleft lift group (CLG) and 57.42+/-7.327 min in the V-Y flap group (VYFG) (p=0.001)
No wound dehiscence was found in the VYFG and 5 patients (9.8%) had wound dehiscence in the CLG (p=0.035)
Draining time was 1.39+/-0.603 days in the CLG and 2.79+/-0.638 days in VYFG (p=0.001)
The mean hospital stay was 1.75+/-0.523 days in the CLG and 3.77+/-1.02 days in the VYFG (p=0.001)
Two patients (3.9%) in the CLG had recurrence and no recurrence was reported in the VYFG (p=0.189) in the given time interval
CONCLUSIONS Both methods in treatment of recurrent PSD can be preferred because of low complication and recurrence rates
Because no recurrence was found after the V-Y flap technique, it appears to be a preferable method despite some disadvantages. Koca, Y
S., et al
(2018)
"The V-Y flap technique in complicated and recurrent pilonidal sinus disease." Ann Ital Chir 89: 66-69. OBJECT VES: This study presents early and long term (5 years) outcome of 61 complicated pilonidal sinus disease cases undergoing V-Y advancement flap method together with the literature data
METHOD: Data of 336 patients undergoing surgery for pilonidal sinus disease between 2008 and 2012 were retrospectively analyzed
Patients with defect size >/= 10 cm, and more than one subcutaneous sinus tunnels were assumed to have complicated pilonidal sinus disease
A total of 61 patients were included in the study
Age, gender, type of surgery, duration of hospitalization, time of drain removal, pre-operative complications, and relapse rates at post-operative 5th year were analyzed
RESULTS: Of the 66 patients, 51 underwent unilateral V-Y advancement and 10 patients had bilateral V-Y plasty
Mean duration of operations was 66.87+/-18.37 minutes for total, 61.02+/-12.30 minutes for unilateral V-Y plasty, and 96.70+/-15.04 minutes for bilateral V-Y plasty
Hemovac drains were removed at 5.59+/-1.91 days averagely, 5.16+/-1.37 in unilateral group, and 7.80+/-2.74 in bilateral V-Y plasty group
Of the 4 patients who developed wound site infection, 2 had unilateral and 2 had bilateral V-Y flap advancement
Postoperative hematomas developed in 2 patients with unilateral flap and one patient with bilateral flapss
Seroma occurred in 2 patients with unilateral flap and one patient with bilateral flaps
Dehiscence developed two patients, one patient from each group
The mean duration of hosptalization was 5.98+/-2.21 days; 5.49+/-1.52 in unilateral group, and 8.50+/-3.34 in bilateral group
Early or late relapse was not seen in any groups
CONCLUS ON: V-Y advancement flap technique can be applied as an efficient method in the treatment of complicated pilonidal sinus disease due to low relapse and complication rates
KEY WORDS: Advancement flap, Complicated pilonidal sinus, Pilonidal sinus, V-Y flap. Korenkov, M
(2018)
"Video-Assisted Subcutaneous Destruction of the Sinus Tract with Vessel-Loop Drainage as Minimally-Invasive Surgical Treatment for Pilonidal Sinus Disease." Surg Technol Int 32: 105-108. The video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD)
This is an advancement of the previously described subcutaneous destruction of the sinus tract and the removal of hairs as well as the long-term vessel-loop drainage of the wound channel (DST)
Although the first results of this operation seemed to be promising, some of my colleagues felt that the blind approach to this procedure could be its potential "weak point"
As a result of this critique, the procedure was enhanced with the subcutaneous video-assisted inspection of the natal cleft
Throughout most steps of VADST, like the widening of pilonidal pits with mosquito and/or Pean clamps, the subcutaneous destroying of the sinus tract, lifting the skin in a natal cleft with a curette, removing the hair with a Pean clamp and a subcutaneous vessel-loop drainage, were found to be similar to DST
The new steps involve the possibility of the video-assisted control of hair vestiges and bleedings as well as the removal of hair and debris under visual control
A rigid choledochoscope from Berci (Firma Richard Wolf GmbH, Knittlingen, Germany) was used for the subcutaneous endoscopic examination of the natal cleft area
Neither gas application nor water perfusion were necessary for this step
Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure
The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively
The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing
Due to the very small number of patients in this report, we were not able to asses this technique properly
Contrary to DST, we intend to use VADST, not only for the treatment of patients with simple forms (primary pilonidal sinus without abscessed inflammation with maximal three orifices, all of them inside the navicular area), but also for the treatment of complex PSD forms. Kuckelman, J
P
(2018)
"Pilonidal Disease: Management and Definitive Treatment." Dis Colon Rectum 61(7): 775-777. Lasithiotakis, K., et al
(2018)
"Aspiration for acute pilonidal abscess-a cohort study." J Surg Res 223: 123-127. BACKGROUND: The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities
The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess
MATERIAL AND METHODS: All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK, were treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7days
Patients with immunosuppression, diabetes, overlying skin necrosis, and perforation were excluded
Complications of the procedure were prospectively recorded
Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales (VAS) (0=not satisfied at all, 10=very satisfied)
RESULTS: One hundred sixty-nine patients presented with an acute pilonidal abscess and a total of 100 patients were treated with aspiration and antibiotics
There were 50 women (50%) and the median (interquartile range [IQR]) age of the cohort was 24 (14) years
Eleven patients had a history of a previous pilonidal procedure
Seven patients were treated successfully with a reaspiration
Overall, 10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months
Fifty-six patients returned completed questionnaires
The median (IQR) of the VAS for the overall satisfaction of the procedure was 9 (5)
CONCLUSIONS: Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates. Lee, J
H., et al
(2018)
"Prevalence and comorbidities associated with hidradenitis suppurativa in Korea: a nationwide population-based study." J Eur Acad Dermatol Venereol 32(10): 1784-1790. BACKGROUND: The prevalence of hidradenitis suppurativa (HS) in Asia is unknown
The associations between HS and other autoimmune disorders have rarely been reported
OBJECTIVE: We sought to determine the prevalence of and diseases associated with HS using the National Health Insurance (NHI) database
METHODS: We examined Korean NHI claim database data from 2007 to 2016
We enrolled all patients with HS and age- and sex-matched control subjects without HS
We estimated the period prevalence of HS and associated comorbidities in Korea
RESULTS: We identified 28 516 patients with HS (61.3% males and 38.7% females)
The period prevalence rate was 0.06%, 55.8 patients (95% confidence interval 55.1-56.4) per 100 000 persons, and the female-to-male ratio was 1 : 1.6
HS patients were at significantly increased risk of rheumatoid arthritis, ankylosing spondylitis, type 1 diabetes, ulcerative colitis, type 2 diabetes, hypertension, hyperlipidaemia, acne conglobata, pilonidal cysts, psoriasis, pyoderma gangrenosum, alopecia areata and vitiligo
CONCLUSION: The overall prevalence of HS in Korea was lower than that in Western populations, and male patients predominated. Liao, L
Y., et al
(2019)
"Idea and innovation: Secure fixation between dermis and periosteum using perforator flap to prevent recurrence of pilonidal sinus disease." Int Wound J 16(3): 862-865. In the past decades, numerous surgical techniques and conservative treatments for pilonidal sinus disease (PSD) had been discussed and published
There is still no consensus yet of the best techniques because of high recurrence rates and prolonged wound healing
In the case of complicated discharging sinus or recurrent PSD resistant to treatment with antibiotics, we recommend radical excision followed by a regional flap, which can obliterate the dead space with well-vascularised tissue
In this article, we presented the technique of snug suture fixation between the dermis and periosteum using a superior gluteal artery perforator (SGAP) flap
The study demonstrates a few key concepts on the prevention of PSD recurrence, an off-midline, well-perfused flap that allows flattened natal cleft and obliteration of gluteal cleft and eventually showed good aesthetic results
We aim to demonstrate a reliable surgical technique for wound closure of recurrent pilonidal sinus after radical excision followed by reconstruction with an SGAP flap
The history, surgery, and images are described, and the literature is reviewed
The pitfalls of disease recurrence will be discussed in this literature
Keys to successful treatment will be elaborated
An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection
She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone
After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured
A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery
A medial 3 cm of the SGAP flap was de-epithelised to provide soft tissue bulk to obliterate the deep cavity
Strong sutures were applied to secure the flap to the periosteum
There was no recurrence at 3 years of follow up
The patient stood the operation well and had prompt recovery. Liu, X., et al
(2018)
"Separation of pygopagus, omphalopagus, and ischiopagus with the aid of three-dimensional models." J Pediatr Surg 53(4): 682-687. BACKGROUND: The three-dimensional (3D) technique provides with accurate anatomical information
We present the separation surgeries for three different kinds of conjoined twins with the aid of three-dimensional techniques
METHOD: For the pygopagus twins, a pelvic and lower vertebral model was made
For the omphalopagus and ischiopagus, their enhanced computed tomography (CT) scan images were transferred to the Computer-Assisted Surgery Planning System (CASP) (Hisense, Qingdao, China) to generate the 3D models
RESULT: In the case of the pygopagus twins, the 3D model clearly showed that their coccyges were joined at a 120 degrees angle from each other horizontally which suggested that the blind-end orifice on their back was a pilonidal sinus, which separated the normal sphincter into two halves
In the omphalopagus, the 3D model revealed one of the branches of each twin's hepatic vein was connected with the other's
The 3D model of the ischiopagus twins revealed that both of the twins had duplicated bladders and each baby's duplicated bladders united with one of the bladders of the other baby and a single rectum passing through the middle of the four bladders
CONCLUSION: 3D techniques could provide more detailed anatomical information, which is helpful in planning procedures for such complicated separation surgery
LEVELS OF EVIDENCE: Level IV. Lopez, J
J., et al
(2018)
"High Rate of Major Morbidity after Surgical Excision for Pilonidal Disease." Surg Infect (Larchmt) 19(6): 603-607. BACKGROUND: Recurrent pilonidal disease has been reported to occur in up to 30% of patients after their initial infection
Surgical resection is often performed to prevent recurrence of disease, however, morbidity after surgical excision from incision complications and disease recurrence is common
The aim of this study was to quantify major morbidity after initial pilonidal excision
PATIENTS AND METHODS: Patients with pilonidal disease who had initial excision procedures between 2011-2013 at hospitals reporting data to the Pediatric Health Information System (PHIS) were included
Predictors of the composite outcome of major surgical site complication or surgical re-excision within one year were evaluated using multivariable logistic regression models
Kaplan-Meier analysis was used to examine time to surgical re-excision
RESULTS: Of the 1,932 patients included, 4.7% (n = 138) had a major surgical site complication, 8.0% (n = 154) had a surgical re-excision, and 8.7% experienced either event within one year of their initial excision
The majority of re-excisions for recurrent disease occurred during the first two years after the initial excision
Risk factors associated independently with a greater risk of the composite outcome included older age (odds ratio [OR] 1.04 [95% confidence interval {CI} 1.00-1.07), p = 0.03), male gender (OR 1.49 [95% CI 1.09-2.08), p = 0.01), and the presence of a complex chronic gastrointestinal condition (OR 4.33 [95% CI 1.96-9.59], p < 0.001)
CONCLUSIONS: Surgical excision of pilonidal disease is often complicated by site complications and nearly 1 of 10 patients develop recurrent disease requiring re-excision within two years after their initial excision
Future research into alternative therapies to treat pilonidal disease is warranted. Milone, M., et al
(2018)
"Endoscopic Pilonidal Sinus: How Far Have We Come?" Dis Colon Rectum 61(6): e343. Milone, M., et al
(2018)
"Long-term follow-up for pilonidal sinus surgery: A review of literature with metanalysis." Surgeon 16(5): 315-320. BACKGROUND: Sacrococcygeal pilonidal sinus disease (PSD) is a common chronic inflammation of the natal cleft and presents as an abscess or a chronically discharging, painful sinus tract
The management of chronic PSD is variable, contentious, and problematic
Although many surgical procedures have been tried, the best surgical method remains controversial
The aim of this systematic review with meta-analysis of literature is to provide surgeons an objective instrument of decision through an analysis of recurrence rate of various surgical techniques in a long-term follow-up
METHODS: Systematic literature searches were performed to identify all available studies
According to the pre-specified protocol, all studies reporting a surgical approach to PSD with a minimum follow-up of 5 years were included
RESULTS: Fifteen studies were included in the analysis
The number of patients varied from 50 to 1165 with a mean follow-up from 58.36 to 240 months
The overall incidence of recurrence was of 0.138; the resulting incidence of open healing, midline closure and out-midline closure were of 17.9%, 16.8% and 10% respectively
CONCLUSIONS: Interestingly, our data reveal a rate of relapsing disease higher than the one defined in previous studies both for the overall PSD and for each surgical procedure
A long-term follow-up of at least 5 years, should be considered the gold standard in pilonidal sinus surgery benchmarking
From our results, we can state that open healing and midline closure should not be considered effective for their high frequency of relapse disease and midline primary closure should be preferred. Milone, M., et al
(2019)
"Video-assisted ablation of pilonidal sinus (VAAPS) versus sinusectomy for treatment of chronic pilonidal sinus disease: a comparative study." Updates Surg 71(1): 179-183. Since its first description in 1883, different treatments for pilonidal sinus disease have been proposed, but we are still far from the identification of an ideal approach
The objective of this study is to determine if video-assisted ablation of pilonidal sinus (VAAPS) could be considered superior/non-inferior to standard sinusectomy for treatment of pilonidal sinus disease
After applying propensity score analysis, data from 40 patients who underwent sinusectomy and 40 patients who underwent VAAPS, from March 2011 to August 2013, were collected
The two groups were similar in terms of sex, age, BMI, smoking status and complexity of sinus
The mean operative time was less for the sinusectomy group compared with the minimally invasive treatment group (30.38 +/- 6.23 vs 44.39 +/- 7.76; p = 0.001)
On the other hand, the recurrence rate (7.5% vs 25%; p = 0.035) was significantly lower in the VAAPS group and the infection rate showed a trend toward reduction in the endoscopically treated patients (12.5% vs 30%; p = 0.057)
No differences were found in terms of pain score at 1 week from surgery (3.71 +/- 1.24 vs 3.76 +/- 1.39; p = 0.883), satisfaction at 6 months (8.3 +/- 1.2 vs 8.2 +/- 1.3; p = 0.78) and time off work (2.01 +/- 1.30 vs 2.08 +/- 1.24; p = 0.620)
The effectiveness of our new technique can be assessed again and the comparative analysis with the conventional sinusectomy shows the feasibility of VAAPS, suggesting that this procedure is the best way to perform a sinusectomy. Minneci, P
C., et al
(2018)
"Laser hair depilation for the prevention of disease recurrence in adolescents and young adults with pilonidal disease: study protocol for a randomized controlled trial." Trials 19(1): 599. BACKGROUND: Laser hair depilation is a promising therapy in the management of pilonidal disease
However, the large controlled trials needed to demonstrate the effectiveness of this practice have not been performed
METHODS: We designed a single-center randomized controlled trial that will enroll 272 patients with pilonidal disease
Patients will be randomized to receive laser hair depilation of the sacrococcygeal region or the best recommended standard of care
The primary outcome is the rate of recurrent pilonidal disease at 1 year, defined as development of a new pilonidal abscess, folliculitis, or draining sinus after treatment, which would require antibiotic treatment, additional surgical incision and drainage, or excision within 1 year of enrollment
Secondary outcomes include each of the following at 1 year: disability days of the patient, disability days of the caregiver, health-related quality of life, healthcare satisfaction, disease-related attitudes and perceived stigma, pilonidal disease-related complications, pilonidal disease-related procedures, surgical excision, postoperative complications, and compliance with recommended treatment
DISCUSSION: This study will determine the effectiveness of laser hair depilation to reduce pilonidal disease recurrence in adolescents and young adults as compared to the best recommended standard of care
TRIAL REGISTRATION: ClinicalTrials.gov, NCT03276065
Registered on 8 September 2017. Molina-Leyva, A
and C
Cuenca-Barrales (2019)
"Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features." Dermatology 235(1): 45-50. BACKGROUND/AIMS: Hidradenitis suppurativa (HS) is a chronic inflammatory and destructive skin disorder
Early diagnosis and treatment are critical to stop its progression
Data concerning adolescent-onset HS are scarce
The aims of this study are to describe the prevalence of adolescent-onset HS and to explore potential risk factors and the disease features of these patients
PATIENTS AND METHODS: A cross-sectional study including 134 patients was performed
RESULTS: Adolescent-onset HS occurred in 51.5% (69/134) of patients
Adolescent-onset HS was associated with female sex, positive family history, presence of pilonidal sinus, acne conglobata, longer disease duration and a worse perception of disease severity
CONCLUSION: Adolescent-onset HS might be more frequent than previously reported
Female sex, positive family history and the presence of elements of the follicular occlusion tetrad identify individuals with a higher risk of early onset
These patients experience a longer disease duration and perceive their disease as severer. Mutus, H
M., et al
(2018)
"Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease." J Pediatr Surg 53(2): 293-294. BACKGROUND/PURPOSE: Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques
This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic
METHODS: PSD patients surgically treated over an 8-year period were retrospectively evaluated
Classical midline incision and excision with primary repair was performed in all
Regular follow up visits were scheduled
Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6months ago were done for the long-term results, including coherence to regional hair care
RESULTS: There were 268 patients with a median age of 16years; 146 (54%) were males, and 122 (46%) were females
Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3months (7days-49months)
Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery
In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing
Recurrences were observed in 21 (7.8%) patients all having poor local hygiene
Laser epilation was employed in 32 (28%) patients, and none of these had recurrences
CONCLUSIONS: Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults
Postoperative hair removal seems to reduce recurrences
TYPE OF STUDY: Treatment study
LEVEL OF EVIDENCE: Level IV (Retrospective case series with no comparison group). Muzi, M
G., et al
(2018)
"Muzi's Tension Free Primary Closure of Pilonidal Sinus Disease: Updates on Long-Term Results on 514 Patients." J Gastrointest Surg 22(1): 133-137. BACKGROUND: The aim of this study is to evaluate the long-term results of Muzi's tension free primary closure technique for pilonidal sinus disease (PSD), in terms of patients' discomfort and recurrence rate
METHODS: This study is a retrospective analysis of prospectively collected data
Five hundred fourteen patients were treated
Postoperative pain (assessed by a visual analog scale, VAS), complications, time needed to return to full-day activities, and recurrence rate were recorded
At 12, 22, and 54 months postoperative, patients' satisfaction was evaluated by a questionnaire scoring from 0 (not satisfied) to 12 (greatly satisfied)
RESULTS: The median operative time was 30 min
The overall postoperative complication rate was 2.52%
Median VAS score was 1
The mean of resumption to normal activity was 8.1 days
At median follow-up of 49 months, recurrence rate was 0.4% (two patients)
At 12 months' follow-up, the mean satisfaction score was 10.3 +/- 1.7
At 22 and 54 months' follow-up, the score was confirmed
CONCLUSIONS: Muzi's tension free primary closure technique has proved to be an effective treatment, showing in the long-term follow-up low recurrence rate and high degree of patient satisfaction
Therefore, we strongly recommend this technique for the treatment of PSD. Oliveira, G
N., et al
(2018)
"Teenage boy with high fever and rash: what could we be missing?" BMJ Case Rep 2018. A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat
He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine
Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged
Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP
A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage
The microbiological culture of abscess material was positive for an enterotoxin-producing Staphylococcus aureus and Peptostreptococcus magnus He was free of symptoms after 4 days
This case report summarises a potential severe complication of the pilonidal disease. Ozcan, R., et al
(2018)
"Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing?" Asian J Surg 41(5): 506-510. OBJECTIVE: To evaluate the outcome and characteristics of patients who were operated for sacrococcygeal pilonidal sinus (SPS) treatment using primary repair or secondary healing technique
METHODS: Forty-seven patients (female: 25, male: 22) diagnosed with pilonidal sinus operated between 2009 and 2015 were retrospectively analyzed
The cases were evaluated for age, gender, body mass index (BMI), surgical technique, hospital stay, recovery time and recurrence
Mainly two types of surgical techniques were applied: primary repair and secondary healing
RESULTS: Mean age of the patients was 15.6 (+/-1.2) years
Excision and primary repair was performed in 36, excision and secondary healing was in 11
There was no statistically significant difference between the groups regarding length of hospital stay and duration of postoperative pain (p > 0.05)
There was a statistically significant difference between groups regarding recovery time (p < 0.05)
Recurrence was detected in a total of 11 (23.4%) patients
CONCLUSION: We did not find any significant difference concerning length of hospitalization, duration of postoperative pain and recurrence rate
However we determined that the primary repair group recovery time is significantly shorter compared to our secondary healing group
Therefore we recommended primary repair in the treatment of primary repair PS in children. Pappas, A
F
and D
K
Christodoulou (2018)
"A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients." Colorectal Dis 20(8): O207-O214. AIM: Various surgical techniques are available for the management of pilonidal sinus, but there is still controversy concerning the optimal surgical approach
The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus
METHOD: Patients suffering from pilonidal sinus were operated on with sinus laser therapy (SiLaT) in our institute
SiLaT was applied under local anaesthesia after a small skin incision of 0.5-1 cm and careful cleaning of the sinus tracts with a curette
A radial fibre connected to a diode laser set at a wavelength of 1470 nm was then introduced into the tracts
The laser energy was delivered in continuous mode
RESULTS: Two-hundred and thirty-seven patients (183 male, median age 24 years, range 14-58) suffering from pilonidal sinus were operated on using the SiLaT laser procedure in our referral Institute and prospectively evaluated
A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30-70 days)
A second treatment was offered for patients failing in the first session; this was successful in 78.3% (18/23)
The duration of the procedure ranged between 20 and 30 min and had limited morbidity (wound infection in 7.2%, 17 of 237)
CONCLUSION: SiLaT proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus
Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques. Pesce, A., et al
(2018)
"Pilonidal disease, hidradenitis suppurativa and follicular occlusion syndrome: a diagnostic challenge." Eur Rev Med Pharmacol Sci 22(15): 4755-4756. Pini Prato, A., et al
(2018)
"Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series." Pediatr Surg Int 34(6): 687-692. BACKGROUND: Pilonidal disease is a troublesome acquired condition for whom various surgical treatments have been proposed with relatively high recurrence and complication rates
Since EPSiT technique has been described in 2013, it became an alternative treatment in adult practice
Our study reports the results of a multicentre series of pediatric patients who underwent EPSiT procedure over a 21-month period
METHODS: Between July 2015 and March 2017, all consecutive patients undergoing EPSiT in four different pediatric surgical units have been enrolled
Details regarding demographic data, detailed surgical procedure, outcome and complications have been recorded
RESULTS: A total of 43 patients underwent EPSiT procedure
Mean age was 15 years
There was a slight female preponderance
Mean weight and height at surgery were 67 kg and 168 cm, respectively
In 14% of cases a previous ineffective procedure was performed
Mean length of procedure was 34 min and median hospital stay was 24 h (12-72 h)
Median length of follow-up was 4 months (range 3-18 months)
Complications leading to reoperation were reported in 9% of cases with an overall resolution rate of 88%
DISCUSSION: EPSiT proved to be feasible and safe even in the pediatric population
The effectiveness and safety of the procedure suggest that this technique can represent a valid alternative for the treatment of pilonidal disease in children. Prassas, D., et al
(2018)
"Karydakis flap reconstruction versus Limberg flap transposition for pilonidal sinus disease: a meta-analysis of randomized controlled trials." Langenbecks Arch Surg 403(5): 547-554. INTRODUCTION: The definitive treatment of pilonidal sinus disease (PSD) is surgical
There is still no consensus as to the most appropriate off-midline primary closure technique
The aim of this meta-analysis has been to compare Karydakis flap reconstruction (KF) to Limberg flap transposition (LF) with regard to short- and long-term postoperative outcomes
METHODS: A systematic literature search for randomized controlled trials (RCTs) comparing KF to LF was performed
Data regarding postoperative outcomes were extracted and compared by meta-analysis
The odds ratio and standardized mean differences with 95% confidence intervals (CIs) were calculated
RESULTS: Eight RCTs were identified comparing KF (n = 554) to LF (n = 567)
There was no significant difference noted between KF and LF with regard to the primary outcome variable, recurrence rate (OR = 1.07; 95% CI [0.59-1.92]; p = 0.83; 7 studies; I(2) = 40%)
LF was associated with a lower rate of post-operative seroma (OR = 2.03; 95% CI [1.15, 3.59]; p = 0.01; 7 studies; I(2) = 0%)
No further significant differences were noted in the secondary endpoints between the two study groups
CONCLUSIONS: Recurrence rates of PSD were found to be similar in both study groups
Post-operative seroma rate was significantly higher in the KF group
The meta-analysis did not indicate any further statistically significant differences between the two surgical procedures. Pronk, A
A., et al
(2018)
"The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature." Tech Coloproctol 22(1): 7-14. BACKGROUND: It has been suggested that removal of body hair in the sacrococcygeal area prevents recurrence after surgery for sacrococcygeal pilonidal sinus disease (SPSD)
The aim of this study was to review the literature regarding the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD
METHODS: A systematic search was performed in PubMed, EMBASE, and The Cochrane Library by using synonyms for SPSD
Title, abstract, and full text were screened by two independent reviewers
Data were systematically collected from all included studies by using a standardized data extraction form
RESULTS: The search and selection yielded 14 studies, involving 963 patients
The study design of the included studies was: retrospective cohort (n = 7), prospective cohort (n = 3), randomized controlled trial (n = 2), and case-control (n = 2).The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months
The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD
CONCLUSIONS: This systematic review showed a lower recurrence rate after laser hair removal compared to no hair removal and razor/cream depilation
Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required. Ricci, F., et al
(2018)
""Interdigital pilonidal sinus in a hairdresser" a case report." Dermatol Ther 31(3): e12594. Saedon, M., et al
(2018)
"Minimally Invasive Fibrin Sealant Application in Pilonidal Sinus: A Comparative Study." Prague Med Rep 119(2-3): 107-112. The aim of this study was to compare the filling of the pilonidal sinus tract with fibrin sealant (FS) against tract excision and primary closure (PC) as the primary procedure
Details of all patients who underwent treatment for a symptomatic first episode of pilonidal sinus disease between January 2011 and December 2015 were prospectively recorded in a custom database
Patients underwent PC (n=17) or FS (n=17) according to patient preference
Prior surgical treatment and ongoing infection precluded entry
Patients were treated with antibiotics if presenting with infection
Outcomes measured were recurrence, further procedures, outpatient attendances and length of follow-up to resolution
34 consecutive patients [FS vs
PC: male n=15 vs
12 p=0.398; mean age 29 (SEM 12) vs
30 (SEM 15) p=0.849] were included
Treated preoperative infections were similar FS (n=5) vs
PC (n=12) (p=0.038, chi-squared test)
FS cohort had more sinuses FS median (range) 2 (1-4) vs
PC 1 (1-3) (p=0.046)
Postoperative outcomes: recurrence rate FS (n=5) vs
PC (n=4) (p=0.629); infection rate FS (n=1) vs
PC (n=8) (p=0.045); total number of operations required FS 1 (1-2) vs
PC 1 (1-4) (p=0.19); total number of outpatient attendance FS 2 (1-7) vs
PC 3 (1-16) (p=0.629); follow-up FS 129 days +/- 33 vs
PC 136 +/- 51 (p=0.914)
Fibrin sealant is not inferior to excision followed by primary closure. Sahebally, S
M., et al
(2019)
"Classical Limberg versus classical Karydakis flaps for pilonidal disease- an updated systematic review and meta-analysis of randomized controlled trials." Surgeon 17(5): 300-308. INTRODUCTION: Pilonidal disease (PD) is associated with significant disability culminating in time off work/school
Recurrence rates remain high following conventional surgical interventions
Flap-based techniques are postulated to decrease recurrence
We performed a systematic review and meta-analysis to compare the effectiveness of the classical Limberg (LF) and Karydakis (KF) flaps in the treatment of PD
METHODS: The online databases of Medline, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials as well as Google Scholar were searched for relevant articles from inception until May 2017
All randomized studies that reported direct comparisons of classical LF and KF were included
Two independent reviewers performed data extraction
Random effects models were used to calculate pooled effect size estimates
A sensitivity analysis was also carried out
RESULTS: Five randomized controlled trials describing 727 patients (367 in LF, 360 in KF) were examined
There was significant heterogeneity among studies
On overall random effects analysis, there was a lower rate of seroma formation associated with LF, and this approached statistical significance (OR = 0.47, 95% CI = 0.22 to 1.03, p = 0.06)
However, there were no significant differences in recurrence (OR = 1.03, 95% CI = 0.48 to 2.21, p = 0.939), wound dehiscence (OR = 0.53, 95% CI = 0.09 to 2.85, p = 0.459), wound infection (OR = 0.59, 95% CI = 0.23 to 1.52, p = 0.278) or haematoma formation (OR = 2.08, 95% CI = 0.82 to 5.30, p = 0.124) between LF and KF
On sensitivity analysis, focusing only on primary and excluding recurrent PD, the results remained similar
CONCLUSIONS: LF and KF appear comparable in efficacy for primary PD, although LF is associated with less seroma formation. Salih, A
M., et al
(2018)
"Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy-a randomized controlled trial." Surgery. BACKGROUND: Pilonidal sinus disease is a common perianal inflammatory condition
Currently, operative therapy is the standard management strategy
The aim of this study is to investigate the efficacy of a preparation with antimicrobial, sclerosing, and wound-enhancing properties in the nonoperative management of pilonidal sinus disease
METHODS: A parallel randomized controlled trial was conducted between January 2013 and January 2017 to investigate the effect of a mixture of sclerosing agent and herbal product (Lawsonia inermis powder) in the management of sacrococcygeal pilonidal sinus disease
The patients were allocated randomly into the study group (group receiving injection of the mixture into the sinus track) and the control group (group receiving the classic technique of operative excision and primary closure)
RESULTS: This study was conducted among 400 patients, 316 (79%) male, 84 (21%) female
The age range was 18 to 40 years with a mean age of 27.1 years (standard deviation, +/-2.4); each group included 200 patients
None of the patients had an abscess or complicated pilonidal disease
Cure rate, defined as complete healing of the sinus, was high among both groups after the first intervention (94% for control group and 89% for the test group, respectively; P = .051)
In the study group, there was a statistically significant decrease in hospital stay, cost, perioperative pain, duration of absence from work, and duration of the procedure
CONCLUSION: According to this trial, the injection of this mixture appears to be better than the other therapeutic options for pilonidal sinus disease in terms of cost effectiveness, time off work, rate of complication, and perioperative pain. Sequeira, J
B., et al
(2018)
"Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population." J Pediatr Surg 53(10): 2003-2007. PURPOSE: To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes
METHODS: A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed
Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups
RESULTS: We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics
Operative time was similar for both groups (30 vs
38min; p>0.05)
No major intraoperative complications were reported
Wound infection rate was lower for EPSiT ((5.2% [n=1] vs
20.0% [n=12]); p>0.05)
Healing time was similar for both groups (28 vs
37.5days)
Recurrence occurred in 18,9% (n=15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC
There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p>0.05)
CONCLUSIONS: Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population
LEVEL OF EVIDENCE: Therapeutic study - level III. Seyed Jafari, S
M., et al
(2018)
"A Retrospective Cohort Study on Patients with Hidradenitis Suppurativa." Dermatology 234(1-2): 71-78. BACKGROUND: Hidradenitis suppurativa (HS) is one of the most distressing conditions observed in dermatology and has a substantial negative effect on the quality of life of affected persons
OBJECTIVES: The aim of this study was to evaluate different treatment strategies in patients with HS
METHODS: In a retrospective cohort, all patients with HS (July 2015 to March 2017) were reviewed
Collected data consisted of patients' demographics, clinical characteristics, psychosocial situation, and previous and current treatments
In addition, therapy response to the most recent prescribed treatments was assessed
RESULTS: 102 patients (38 females, 64 males; median age 37.5 years) were included in this study
68.4% of patients had BMI >/=25, and 76.5% of patients were current smokers
Hurley stages I, II, and III were detected in 13.5, 53.1, and 33.3% of patients, respectively
The most commonly administered treatments were surgery (67.6%), nonantibiotic topical therapies (72.5%), antibiotic topical therapies (55.9%), systemic antibiotics (88.2%), and biologics in 11.8% of the patients
84.6% of the patients showed a response (27.5 and 47.1% partial and complete response, respectively) to the treatments
CONCLUSION: HS as a chronic, recurrent inflammatory skin disease is associated with smoking and obesity
Application of systemic antibiotics is the most frequent treatment strategy for this disease
However, surgical intervention seems to be the most effective treatment strategy. Sian, T
S., et al
(2018)
"Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease." Tech Coloproctol 22(10): 779-784. BACKGROUND: Pilonidal sinus disease (PSD) is a common, chronic inflammatory condition involving hair follicles within the natal cleft
It mainly affects young males and creates a significant health, social and economic burden
Traditional surgery is often radical resulting in pain, wound complications, long recovery times and poor cosmesis
The aim of our study was to evaluate fibrin glue as a primary treatment for PSD
METHODS: Fibrin glue procedures for a single surgeon at our institution were identified from operative coding databases and the logbook from January 2011 to January 2016
Patients had curettage of the sinus with fibrin glue obliteration
Recurrence data was collected retrospectively
RESULTS: One hundred and forty-six patients were identified; (115 (79%) males, mean age 30 (range 16-78 years)
One hundred and forty-four (99%) were discharged the same day
Four (2.7%) were treated conservatively for wound discharge
Median operating time was 9 (range 4-28) min
There were 40 (27%) recurrences after one glue application
Median time to recurrence was 4 (range 0.25-36) months
Twenty-four (60%) of the recurrences had repeat glue treatment with 4 (16.6%) recurrences
After 2 rounds of treatment with glue alone, 126 out of 130 (96.9%) patients had healed
CONCLUSIONS: Fibrin glue application following curettage of the sinus is a quick and effective procedure for first and second line treatment of PSD. Sibbald, R
G., et al
(2018)
"Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease." Adv Skin Wound Care 31(7): 298-305. GENERAL PURPOSE: To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease
TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care
LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1
Recall risk factors for and pathophysiology of pilonidal sinus wounds.2
Summarize the evidence-based elements of wound assessment and treatment.3
Identify the study methodology and results
ABSTRACT: To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic
Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin
Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years
At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm)
The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14])
At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up
Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12
Participants reported improved mobility and ability to self-apply dressing
No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study. Soy, M., et al
(2018)
"High prevalence of sacrococcygeal pilonidal sinus disease in patients with ankylosing spondylitis." Joint Bone Spine 85(4): 505-506. Stauffer, V
K., et al
(2018)
"Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence." Sci Rep 8(1): 3058. We systematically searched available databases
We reviewed 6,143 studies published from 1833 to 2017
Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract
We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis
In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively
Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively
Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery
For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available
Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure. Suarez Valladares, M
J
and M
A
Rodriguez Prieto (2018)
"Neodymium-doped yttrium aluminium garnet laser to treat primary pilonidal cysts: an alternative treatment." Br J Dermatol 178(2): e127-e128. Tan, A
M., et al
(2018)
"A useful alternative surgical technique to reconstructing large defects following excision of recurrent pilonidal sinus disease in the intergluteal region: An operative approach for the transverse lumbar artery perforator flap." Int Wound J 15(4): 534-537. The reconstruction of defects in the intergluteal region following pilonidal sinus excision is challenging due to its anatomical location, close proximity to the anus, and being a high-tension area prone to wound-healing problems
Excision and primary closure is known to carry a higher risk of recurrence and subsequent complications compared with using nearby local healthy tissue, such as a flap, to reconstruct defect
Extra due diligence should be given to patient selection and flap choice when deciding the reconstruction of a defect
The senior author, who has briefly reviewed complication rates in previous published literature, prefers the transverse lumbar artery perforator (TLAP) flap for reconstruction following pilonidal sinus excision in the intergluteal region
This paper illustrates the operative approach used by the senior author when raising a TLAP flap. Tien, T., et al
(2018)
"Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review." Tech Coloproctol 22(5): 325-331. BACKGROUND: Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation
Various operative management options are available, but the ideal technique is still debatable
More recently minimally invasive approaches have been described
Our aim was to review the current literature on endoscopic pilonidal sinus treatment (EPSiT) and its outcomes
METHODS: A systematic literature review was conducted and reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines
A search of EMBASE, MEDLINE and Cochrane Library was conducted in November 2017
Full-text studies on the use of endoscopy for the treatment of pilonidal sinus were included in the review
RESULTS: Initial search results returned 52 articles
Eight studies (eight case series and one randomised control trial) were included in the final qualitative synthesis
These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates
There was also a high level of patient satisfaction and little time taken off work
Two studies reported modifications to the original technique
The main limitation was the lack of comparative studies
CONCLUSIONS: Initial studies on EPSiT have shown promising results
However, there is a need for a standardised technique and more comparative studies to validate this novel procedure. Umesh, V., et al
(2018)
"Long term outcome of the Bascom cleft lift procedure for adolescent pilonidal sinus." J Pediatr Surg 53(2): 295-297. PURPOSE: The purpose of this study was to assess whether adolescent patients who heal their pilonidal sinus disease with the Bascom cleft lift have a sustained result, or if younger age puts them at increased risk of relapse
METHODS: Twenty-two consecutive patients (18 male, median age 16years at surgery) who underwent Bascom procedures were contacted regarding long term outcomes following surgery
Additional clinical data were collected from the medical records of the subjects
RESULTS: Seventeen of 22 (77%) patients studied were completely healed at median 27 (range 9-268) days after a single procedure
Three of 22 (14%) required a second procedure during follow up
Of these, all three healed fully after the second procedure
Based on intention to treat, 20 of 22 (91%) patients had complete healing documented at a median of 31days after initial surgery
Half of the patients were fully healed and back to normal activities by one month and 68% by two months
Two patients (9%) failed surgery and had ongoing pilonidal disease
Fifteen of 22 (68%) patients completed a follow-up survey at a median of 44months elapsed from surgery
All responders were fully healed, and none reported relapse or further surgeries
CONCLUSIONS: Excision of pilonidal sinus disease by the Bascom procedure resulted in lasting cure for most adolescent patients studied
A small proportion of patients failed to heal in the first year and had ongoing pilonidal disease
No late failures occurred
LEVEL OF EVIDENCE: Level III, nonexperimental observational study. van Bemmelen, C
M., et al
(2018)
"[Interdigital pilonidal sinus of the foot: a peculiar place for a common lesion]." Ned Tijdschr Geneeskd 162. BACKGROUND: Besides the natal cleft, a pilonidal sinus can also occur in other areas of the body
An uncommon place is the interdigital web space of the toes
A sinus can arise due to penetration of the skin by a hair
The only curative treatment is surgical excision
CASE DESCRIPTION: A 55-year-old man was referred by the GP with an inflammation between his toes
On physical examination we saw a skin defect with hairs and granulation tissue between the fourth and fifth toes of the right foot
It was decided to surgically excise the affected area
Histopathological examination showed a chronical, fibrosing inflammation surrounding a free hair structure, consistent with a pilonidal sinus
The lesion was probably caused by dog hairs, in combination with poor personal hygiene
CONCLUSION: This patient had a pilonidal sinus at an uncommon site
In the event of poorly-understood inflammation between the toes, a pilonidal sinus should be considered. Vartanian, E., et al
(2018)
"Pilonidal Disease: Classic and Contemporary Concepts for Surgical Management." Ann Plast Surg 81(6): e12-e19. BACKGROUND: Pilonidal disease (PD) is a recalcitrant condition associated with significant morbidity
It affects 26 in 100,000 individuals; however, there is no consensus on optimal surgical treatment, and up to half of patients struggle with recurrence
This review appraises the current literature on techniques and outcomes of PD surgery, to better guide decision making
METHODS: A literature review using directed search terms was performed to identify studies addressing PD management, in accordance with the PRISMA guidelines
Data on techniques, outcomes, and complications were collected
RESULTS: Open healing remains the most widely used treatment method and achieves reliable outcomes at the expense of prolonged wound healing, between 21 and 71 days
Asymmetric closure reduces healing time to 10 to 23 days and produces significantly fewer recurrences relative to midline closure (P < 0.05)
Outcomes are similar between various asymmetric techniques; the Bascom cleft lift, Karydakis flap, and Limberg transposition are commonly used approaches which all demonstrate recurrence rates under 6%
Deroofing is associated with a significantly lower rate of complications than any closure procedure at 1.4% (P < 0.05), with recurrence in only 1% to 10% of patients, and represents a favorable treatment alternative
CONCLUSIONS: Despite the heterogeneous nature of studies on PD, certain techniques have been consistently shown to optimize postoperative outcomes
Deroofing sinuses and allowing secondary healing results in low rates of recurrence with minimal morbidity
When closure is preferred, off-midline flaps provide more effective coverage than midline repair
Treatment recommendations should be guided by individualized patient preferences and be grounded in high-quality data.
