Stop insulting the patient: neither incidence nor recurrence of pilonidal sinus disease is linked to personal hygiene.

  • Dietrich Doll Department of General and Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg / Saar, Germany.
  • Markus M Markus M. Luedi Department of Anaesthesiology and Pain Medicine, Bern University Hospital Inselspital, Bern, Switzerland
  • Katharina Wieferich Vechtaer Institut für Forschungsförderung VIFF e.V., Vechta, Germany
  • Dominic van der Zypen Federal Social Insurance Office, Swiss Confederation, Bern, Switzerland
  • Matthias Maak Department of Surgery, University Hospital Erlangen of the Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
  • Matthias Glanemann Department of General and Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg / Saar, Germany
Keywords: pilonidal disease, hygiene, surgery

Abstract

INTRODUCTION: Pilonidal sinus disease (PSD) has been correlated with excessive sweating, exposure to adverse conditions such as military service, war, prolonged jeep driving, and also with inadequate personal hygiene. Aiming to destigmatise PSD, the purpose of this study was to shed light on the impact of obesity, sweating and chronically intermittent contamination of the rima ani, especially in the cohorts of extreme ages on the incidence and recurrence of PSD.
METHODS: Literature and epidemiological German data for the years 2000 to 2012 were reviewed and analysed. Pairwise comparisons were performed using the Wilcoxon rank sum test, median and mean values were supplemented with bootstrap confidence intervals. Cumulative abundances of explantations were fitted with a logistic model to compare the qualitative properties of individual methods.

RESULTS: Our investigation does not support an association between incidence and recurrence of PSD with exemplary measures of personal hygiene such as more often and longer contact of skin with sweat, faeces and urine in the intergluteal fold.

CONCLUSIONS: Neither urine or faecal contamination nor a potential increase in sweating due to higher BMI promote PSD incidence. The causative factors of pilonidal disease still remain incompletely understood till today. Patients who are blighted with PSD classically experience embarrassing recurrent infections before the disease is surgically cured; they should not be further insulted by emphasizing “maintaining exquisite personal hygiene” in the discharge letter. Recommending this is insulting and neither prevents the development of PSD nor its recurrence.

References

1. Mayo H. Observations on injuries and diseases of the rectum. London, Burgess & Hill, 1833.
2. Anderson AW: Hair extracted from an ulcer. Boston Med Surg J 1847;36:74.
3. Patey DH, Scarff RW. Pathology of postanal sinus: its bearing on treatment. Lancet 1946;2:484.
4. BUIE LA. Jeep Disease (Pilonidal Disease of Mechanized Warfare). Southern Medical Journal 1944;37:103-109.
5. FAVRE R, DELACROIX P. [Apropos of 1,110 Cases of Pilonidal Disease of Coccy-Perineal Localization.]. Mem Acad Chir (Paris) 1964;90:669-676.
6. Marza L. Reducing the recurrence of pilonidal sinus disease. Nurs Times 2013;109:22-24.
7. Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 2011;4:192-195.
8. Harlak A, Mentes O, Kilic S, Coskun K, Duman K, Yilmaz F. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics (Sao Paulo) 2010;65:125-131.
9. Kandamany N, Mahaffey PJ. The importance of hair control and personal hygiene in preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 2008;61:986-987.
10. Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 2008;61:1069-1072.
11. Butter A, Hanson M, VanHouwelingen L, Merritt N, Seabrook J. Hair epilation versus surgical excision as primary management of pilonidal disease in the pediatric population. Can J Surg 2015;58:209-211.
12. DESTATIS.de: Gesundheitszustand, Gesundheitsversorgung. https://www destatis de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Gesundheit html.
13. GBE-Bund.de: Gesundheitsdaten der Bundesregierung. https://www gbe-bund de/oowa921-install/servlet/oowa/aw92/dboowasys921 xwdevkit/xwd_init?gbe isgbetol/xs_start_neu/&p_aid=3&p_aid=92068171&nummer=550&p_sprache=D&p_indsp=-&p_aid=61162433.
14. Evers T, Doll D, Matevossian E, Noe S, Neumann K, Li HL, Huser N, Ludde R, Hoffmann S, Krapohl BD. [Trends in incidence and long-term recurrence rate of pilonidal sinus disease and analysis of associated influencing factors]. Zhonghua Wai Ke Za Zhi 2011;49:799-803.
15. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 1992;62:385-389.
16. Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg 1990;77:123-132.
17. Karydakis GE. New approach to the problem of pilonidal sinus. Lancet 1973;2:1414-1415.
18. DESTATIS: Migration und Migrationshintergrund in Deutschland 2014 - Pressemitteilung. https://www destatis de/DE/PresseService/Presse/Pressemitteilungen/2014/06/PD14_193_125 html.
19. Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 2008;23:359-364.
20. Akinci OF, Bozer M, Uzunkoy A, Duzgun SA, Coskun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 1999;165:339-342.
21. Bolandparvaz S, Moghadam DP, Salahi R, Paydar S, Bananzadeh M, Abbasi HR, Eshraghian A. Evaluation of the risk factors of pilonidal sinus: a single center experience. Turk J Gastroenterol 2012;23:535-537.
22. Akinci OF, Kurt M, Terzi A, Atak I, Subasi IE, Akbilgic O. Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure. Dis Colon Rectum 2009;52:1000-1002.
23. Kasim K, Abdhlamid NM, Badwan BR, Allowbany A. Is there a relation between natal cleft depth and post-operative morbidity after different methods of excision of sacro-coccygeal pilonidal sinus? Indian J Surg 2012;1:762-767.
24. Sion-Vardy N, Osyntsov L, Cagnano E, Osyntsov A, Vardy D, Benharroch D. Unexpected location of pilonidal sinuses. Clin Exp Dermatol 2009;34:599-601.
25. Stirnemann H, Blasimann B. [Is preventive epilation following sacral dermoid operation useful or ineffective?]. Chirurg 1983;54:548-549.
26. Petersen S, Wietelmann K, Evers T, Huser N, Matevossian E, Doll D. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 2009;52:131-134.
27. Demircan F, Akbulut S, Yavuz R, Agtas H, Karabulut K, Yagmur Y. The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 2015;8:2929-2933.
28. Bazex A. [An occupational disease of hairdressers: penetration of hair into the interdigital spaces (pilonidal sinus).]. Arch Mal Prof 1953;14:488-489.
Published
2018-04-26