Modified Sinotomy with Marsuplization versus Excision with Lay Open in Treatment of Pilonidal Sinus Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ashraf Farouk Abdeer ◽  
Amr Mohamed Elhefny ◽  
Wadie Boshra Gerges ◽  
John Sobhy Mamlouk Sawires
Keyword(s):  
Pilonidal Sinus ◽  
Wound Care ◽  
Randomized Study ◽  
Normal Activity ◽  
The Body ◽  
Open Group ◽  
Pilonidal Sinus Disease ◽  
P Value ◽  
Sinus Disease ◽  
Number Of Patients

Abstract Pilonidal sinus disease (PSD) is a common infection of the skin in the gluteal cleft, with a prevalence of 0.7% in the general population. Pilonidal sinus can occur in many different areas of the body but most are found in the sacrococcygeal area, in the natal cleft, approximately 5 cm from the anus. This is a prospective comparative randomized study conducted at Department of General Surgery, Imbaba General Hospital to compare the modified sinotomy with marsupialization versus excision with lay open in treatment of pilonidal sinus disease. Pre-study power analysis revealed that a sample size of 30 patients in each group would be sufficient with 80% power and a P value of 0.05. The perfect approach for the management of PNS should be simple, cause minimal pain, have best chance for success and least recurrence rate with low risk for complications, avoid general anesthesia, require minimal wound care, and ensure minimal inconvenience for the patient with rapid return to normal activity. Number of Patients participated in this study were n = 60 77% of the participants were males aged from 17-52 and 26.3 works as drivers. Operative time in modified sinotomy group ranged from 20-40 minutes and in lay open group ranged from 20-35 min (P-value: 0.07). Presence of hair in the back in the modified sinotomy group in 83.3% while in the lay open group 76.6% (P-value: 0.004). In conclusion, we believe that execution of a minimally invasive surgical technique for PSD can be among the most important methods for treating not only primary PSD but also complicated and recurrent PSD cases.

scholarly journals Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Children ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. 187
Author(s):  
Michèle Pfammatter ◽  
Tobias E. Erlanger ◽  
Johannes Mayr
Keyword(s):  
Pilonidal Sinus ◽  
Wound Care ◽  
Outpatient Setting ◽  
Pilonidal Sinus Disease ◽  
Open Wound ◽  
Invasive Treatment ◽  
Sinus Disease ◽  
Explanatory Variables ◽  
Less Invasive ◽  
Open Wound Treatment

We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

scholarly journals Pilonidal sinus- limberg versus karidakis flap our experience at SIMS, Shivamogga

2017 ◽  
Vol 4 (11) ◽  
pp. 3641
Author(s):  
Madhusudhan A. ◽  
Madhan D. P. Swamy ◽  
Mohhamad Arif
Keyword(s):  
Pilonidal Sinus ◽  
Long Term Results ◽  
Pilonidal Sinus Disease ◽  
Surgical Removal ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Number Of Patients ◽  
Successful Recovery ◽  
Surgical Methods

Background: The etiology and pathogenesis of sacro-coccygeal pilonidal sinus are not clear. The pathogenesis of the disease is hypothesized to be related to the accumulation of weak and lifeless hair in the intergluteal region, which over time gives rise to foreign body reaction, causing abscess and sinus formation. A deep natal cleft with one of favourable factors enhance sacro-coccygeal pilonidal sinus, e.g., sweating, maceration, bacterial contamination and penetration of hairs. Obesity, trauma, local irritation and a sedentary lifestyle are usually associated with PS. Although pilonidal sinus can be treated using various conservative and surgical methods, recurrence rate remains high. Complete surgical removal of the pilonidal sinus or sinuses and appropriate reconstruction can lead to successful recovery. However, collection of the lifeless hair depends on the anatomy of the intergluteal area, and accompanying risk factors can lead to subsequent recurrence.Methods: The objective of this study is to compare the immediate post-operative and long-term results of Limberg flap and Karydakis flap, which are being widely used now to treat pilonidal sinus disease. It was a retrospective observational study where the patients (total number of patients-30) who underwent both the procedures were compared, Limberg flap (LF; n = 13) and Karydakis flap (KF; n = 17).Results: Present study found out that short and long-term results of the LF and KF procedures are similar. In present study we also noted that all patients with pilonidal sinus disease were men, and most of them had jobs which involved sitting for long durations. Poor hygiene and hirsutism however was not noted in most of the patients, and was not objectively assessed.Conclusions: Both the techniques can be used safely and effectively in sacro coccygeal pilonidal sinus disease.

scholarly journals Sinus Excision, Release of Coccycutaneous Attachments and Dermal-Subcuticular Closure (XRD Procedure): A Novel Technique in Flattening the Natal Cleft in Pilonidal Sinus Treatment

2008 ◽  
Vol 90 (5) ◽  
pp. 371-376 ◽  
Author(s):  
Deya M Marzouk ◽  
Ahmed A Abou-Zeid ◽  
Anthony Antoniou ◽  
Amyn Haji ◽  
H Benziger
Keyword(s):  
Pilonidal Sinus ◽  
Wound Dehiscence ◽  
Normal Activity ◽  
Pilonidal Sinus Disease ◽  
Natal Cleft ◽  
Sinus Disease ◽  
Novel Technique ◽  
Before And After ◽  
A New Technique

INTRODUCTION The objective of this study was to analyse, prospectively, the outcome of a new technique – excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision. PATIENTS AND METHODS Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence. RESULTS Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78–1.85) to a mean of 3.8 cm (95% CI, 3.77–3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12–38 months). CONCLUSIONS Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.

scholarly journals Unusual sites and presentations of pilonidal sinus disease

2014 ◽  
Vol 61 (2) ◽  
pp. 107-111
Author(s):  
Gupta Pravin ◽  
Gupta Shalini ◽  
Heda Purushottam
Keyword(s):  
Malignant Transformation ◽  
Pilonidal Sinus ◽  
Endemic Area ◽  
Clinical Suspicion ◽  
The Body ◽  
Pilonidal Sinus Disease ◽  
Occupational Hazard ◽  
Sinus Disease ◽  
Male Sheep

Pilonidal sinus usually develops in the sacrococcygeal area or other hair-bearing areas. However, it can present at some other sites with varied presentations and can mimic like other infective pathologies which are more common in that area. It has also been described as an occupational hazard in barbers, especially when presented interdigitally. Occupational pilonidal sinuses tend to occur even in non-hair-bearing areas where there is no presence of individual?s own hair. Pilonidal sinus occurs in many areas of the body such as web of fingers, penis shaft, axilla, intermammary area, groin, nose, neck following trauma during shaving, clitoris, sternum, suprapubic area, occiput, prepuce, chin, periungual region, breast, face or navel. Sporadic incidences of implantation of pilonidal sinus have been reported. The disease is mostly observed in hairdressers, but it has also been reported sporadically in other professions, as male sheep shearer, dog groomer, slaughter men or milker of cows. Short customers? hairs that penetrate the supple interdigital skin of the hands produce barber?s disease. Though there are only a few reports about these peculiar sinuses in the available literature, they should be suspected in any chronically discharging, non-healing sinus or wound. A clinical suspicion of malignant transformation or affection with tuberculosis in the endemic area should also be kept in mind to avoid any delay in the treatment and the outcome of the disease.

scholarly journals Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

2019 ◽  
Vol 35 (6) ◽  
pp. 313-318 ◽  
Author(s):  
Mina Alvandipour ◽  
Mohammad Sadegh Zamani ◽  
Mojtaba Ghorbani ◽  
Jamshid Yazdani Charati ◽  
Mohammad Yasin Karami
Keyword(s):  
Pilonidal Sinus ◽  
Randomized Study ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Flap Surgery ◽  
Sinus Disease

799 Negative Pressure Wound Therapy Following Excision of Pilonidal Sinus Disease: A Retrospective Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Harding
Keyword(s):  
Recurrence Rate ◽  
Pilonidal Sinus ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Surgical Excision ◽  
Pilonidal Sinus Disease ◽  
Wound Therapy ◽  
Sinus Disease ◽  
Complete Surgical Excision ◽  
Number Of Patients

Abstract Background Pilonidal sinus disease (PSD) is a common condition that can have a detrimental impact on patient quality of life. Definitive surgical management for PSD is challenging and remains a contentious issue. Primary closure is associated with a high recurrence rate, while healing by secondary intention comes with slow healing and burdensome wound care. Negative pressure wound therapy (NPWT) is widely used to accelerate healing. Aim To evaluate outcomes in patients with PSD treated by a standardised technique of complete surgical excision followed by the application of NPWT. Method A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed over a 5-year period. Results 41 patients underwent excision of PSD with application of NPWT during the observation period. All patients’ wounds healed successfully with NPWT. Only one patient (2.4%) developed recurrent PSD and required further surgery. Discussion The ideal surgery for PSD should have a low recurrence rate. Our results demonstrate that our technique of complete surgical excision followed by application of NPWT meets all these criteria. To our knowledge, this study contains the largest number of patients with PSD managed by excision and NPWT in the literature.

Pilonidal sinus disease: Karydakis flap procedure in our patients

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Healing Process ◽  
Pilonidal Sinus Disease ◽  
Wound Complications ◽  
Limberg Flap ◽  
New Disease ◽  
Sinus Disease ◽  
Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

scholarly journals Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

2021 ◽  
Author(s):  
Christina Oetzmann von Sochaczewski ◽  
Jan Gödeke
Keyword(s):  
Pilonidal Sinus ◽  
Regional Variation ◽  
Disease Incidence ◽  
Age Groups ◽  
Pilonidal Sinus Disease ◽  
National Guidelines ◽  
Reconstructive Procedures ◽  
Sinus Disease ◽  
The Mean ◽  
Almost All

Abstract Purpose Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

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