Treatment Options for Pilonidal Disease

2017 ◽  
Vol 83 (5) ◽  
pp. 453-457 ◽  
Author(s):  
Denis Ehrl ◽  
Cornelia Choplain ◽  
Paul Heidekrueger ◽  
Holger C. Erne ◽  
Horst-Guenter Rau ◽  
...  
Keyword(s):  
Pilonidal Disease ◽  
Treatment Options ◽  
Surgical Excision ◽  
Minimal Invasive ◽  
Tissue Loss ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Short Recovery Time ◽  
Flap Closure

Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38–101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was associated with faster recovery, no need for hospitalization and overall low complication rates. In summary, the main advantages of the pit-picking operation lie in its’ outpatient character, the simplicity of the procedure, low complication rates, short recovery time, and predictably good results.

scholarly journals Large Rhinophyma Treated by Surgical Excision and Electrocautery

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Nabeel K. Al Hamzawi ◽  
Salih M. Al Baaj
Keyword(s):  
Treatment Options ◽  
Psychological Impact ◽  
Treatment Protocol ◽  
Surgical Excision ◽  
Surgical Removal ◽  
Benign Condition ◽  
Secondary Intention ◽  
Short Recovery Time ◽  
Good Treatment Option ◽  
Abnormal Tissue

Rhinophyma is a benign condition characterized by a large, bulbous nose with prominent pores. It is commonly associated with untreated cases of rosacea. The disease can carry a substantial psychological impact that causes patients to seek advice about how to improve their physical appearance. Many treatment options are available for rhinophyma, but there is no standard treatment protocol. Here, we describe the case of a 65-year-old man with a large rhinophyma that caused him cosmetic and psychosocial embarrassment. The condition was treated by surgical excision and bipolar electrocautery. No complications occurred after the procedures, and healing was completed 2 weeks later by secondary intention and reepithelialization. A simple surgical removal using a scalpel to shave off the abnormal tissue with electrocauterization of the bleeding points can be considered as a good treatment option for rhinophyma, as it results in an excellent cosmetic outcome and has short recovery time.

Treatment of Pilonidal Disease with Laser Epilation

2006 ◽  
Vol 72 (6) ◽  
pp. 534-537 ◽  
Author(s):  
S.M. Schulze ◽  
N. Patel ◽  
D. Hertzog ◽  
L.G. Fares
Keyword(s):  
Adjunctive Therapy ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Treatment Options ◽  
Wound Dehiscence ◽  
Surgical Excision ◽  
Etiologic Agent ◽  
Laser Treatments ◽  
Superficial Wound ◽  
Laser Epilation

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite™ Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

Surgery for pediatric craniopharyngiomas: is less more?

2015 ◽  
Vol 28 (1-2) ◽  
Author(s):  
Jörg Flitsch ◽  
Jens Aberle ◽  
Till Burkhardt
Keyword(s):  
Surgical Complication ◽  
Imaging Techniques ◽  
Third Ventricle ◽  
Minimal Invasive ◽  
Interdisciplinary Treatment ◽  
Childhood And Adolescence ◽  
Complication Rates ◽  
First Choice ◽  
Surgical Methods

AbstractSurgery for craniopharyngiomas, especially in childhood and adolescence, has evolved from an era of aggressive strategies – with the primary goal of gross total removal and accepting an impaired functional outcome – to a more individually tailored therapy that avoids immediate treatment-related and long-term morbidity. Modern imaging techniques and a wider understanding of hypothalamic risk factors have led to surgical strategies adapted to the localization of these inhomogenously grown pathologies. Whereas purely infradiaphragmatic as well as supradiaphragmatic/infrachiasmatic tumors have a favorably surgical outcome with higher gross total resection rates in experienced hands, lesions within the third ventricle extending beyond the mammillary bodies remain a problem. The same is valid for lesions beyond 3 cm in diameter, more or less independent of their localization. Aside from the traditional microscopic approach via the subfrontal or pterional craniotomy, transsphenoidal approaches and other minimal invasive surgical methods, e.g., catheter implantation into cystic formations of the tumor have become popular. Radiotherapy, with its risks and limitations, can effectively be added to avoid recurrences. Nowadays, surgery as part of an interdisciplinary treatment strategy is still the typical first choice. However, taking the patient’s long-term prognosis into considertaion, the surgical complication rates have to be minimized.

scholarly journals Non surgical management of pilonidal sinus disease

2016 ◽  
Vol 63 (1) ◽  
pp. 95-100
Author(s):  
Gupta Pravin
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Low Cost ◽  
Secondary Infection ◽  
Treatment Options ◽  
Outpatient Setting ◽  
Tissue Loss ◽  
Pilonidal Sinus Disease ◽  
Sinus Disease ◽  
The One

When cosiidering how to treat pilonidal sinus, physicians should keep in mind that this condition is more than merely a particular form of foreign body granuloma. The ideal method of treatment for pilonidal sinus should be the one having minimal postoperative morbidity, excellent cosmetic results, minimal tissue loss, rapid resumption of daily activities, low cost, and a low recurrence rate. However, although numerous operative and non-operative treatment methods have been described, no approach comprises all of these features. Numerous treatment options have been proposed for the pilonidal disease, including shaving, removal with open packing, incision and drainage, excision with primary closure, phenol application, cryosurgery, excision with marsupialization, and recently, flaps surgery. The management of pilonidal sinus disease will depend on patient assessment, examination and history of the condition. A disease-specific history and physical examination should be performed, emphasizing symptoms, risk factors, and the presence of secondary infection. Conservative therapy can fairly control pilonidal sinus disease in the office outpatient setting while assuring a near-normal work status and should be pre ferred over excisional operations at the outset.

scholarly journals Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Annemarie Uhlig ◽  
Johannes Uhlig ◽  
Lutz Trojan ◽  
Marc Hinterthaner ◽  
Alexander von Hammerstein-Equord ◽  
...  
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Treatment Options ◽  
Operating Time ◽  
Surgical Techniques ◽  
Ureteropelvic Junction ◽  
Surgical Approaches ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Success Rates ◽  
Urinary Leakage

Abstract Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

2020 ◽  
Vol 12 (7) ◽  
pp. 688-694
Author(s):  
Valerio Da Ros ◽  
Francesco Diana ◽  
Federico Sabuzi ◽  
Emanuele Malatesta ◽  
Antioco Sanna ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Treatment Options ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Complication Rates ◽  
Lower Complication ◽  
Long Term Follow Up ◽  
Ischemic Complication

BackgroundThe management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.MethodsWe retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.ResultsSeven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.ConclusionsThe best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

scholarly journals Surgical management of extensive hypertrophic scarring of the halluces secondary to a decade of untreated onychocryptosis: An illustrative case report

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Dean J Samaras ◽  
Andrew C Kingsford
Keyword(s):  
Treatment Options ◽  
Rare Condition ◽  
Surgical Excision ◽  
Current Treatment ◽  
Illustrative Case ◽  
Hypertrophic Scarring ◽  
Psychosocial Effects ◽  
Term Outcome ◽  
Long Term Outcome

Extensive hypertrophic scarring of the halluces secondary to chronic onychocryptosis is a rare condition, which causes significant physical and psychosocial effects. In this case, a 31-year-old male developed large lesions on both great toes after he delayed treatment of chronic hallucal onychocryptosis for over a decade. Current treatment options for hypertrophic and keloid lesions in the foot and ankle vary considerably and differentiation is critical for appropriate treatment planning. In this case, surgical excision with total matrixectomy (modified Zadik–Syme) was considered optimal management. Histopathology testing confirmed the diagnosis of irritated hypertrophic scar secondary to onychocryptosis. The patient was monitored closely and at 3 months post-operatively, the incisional scars exhibited progressive maturation, and there was no recurrence of the lesions and no nail regrowth. Furthermore, the halluces were only marginally shorter providing good function and cosmesis. At the long-term follow-up consultation (5.5 years), the patient indicated complete satisfaction and had returned to regular footwear and social activities. Chronic onychocryptosis can trigger and facilitate proliferation of large benign keloid-like fibrous lesions; excision with total matrixectomy can provide an excellent long-term outcome.

scholarly journals The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
H. H. Chill ◽  
M. Safrai ◽  
A. Reuveni Salzman ◽  
A. Shushan
Keyword(s):  
Therapeutic Option ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
Term Treatment ◽  
Reproductive Age ◽  
Surgical Approaches ◽  
Common Benign Tumor ◽  
Long Term Treatment ◽  
Suitable Treatment

Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patient’s age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.

scholarly journals Testing methods to mitigate Caribbean yellow-band disease on Orbicella faveolata

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4800 ◽  
Author(s):  
Carly J. Randall ◽  
Elizabeth M. Whitcher ◽  
Tessa Code ◽  
Clayton Pollock ◽  
Ian Lundgren ◽  
...  
Keyword(s):  
Treatment Options ◽  
Treatment Success ◽  
Test Methods ◽  
Tissue Loss ◽  
Coral Tissue ◽  
Yellow Band ◽  
Orbicella Faveolata ◽  
In Situ Experiments ◽  
Yellow Band Disease

Outbreaks of coral diseases continue to reduce global coral populations. In the Caribbean, yellow band is a severe and wide-spread disease that commonly affects corals of the Orbicella spp. complex, significantly impeding coral reproduction, and hindering the natural recovery of Orbicella spp. populations. Caribbean yellow-band disease (CYBD) lesions may be severe, and often result in the complete loss of coral tissue. The slow spread of CYBD, however, provides an opportunity to test methods to mitigate the disease. Here we report the results of in situ experiments, conducted within Buck Island Reef National Monument in St. Croix, USVI, to test the effectiveness of three techniques to minimize disease impact on Orbicella faveolata: (1) shading, (2) aspirating, and (3) chiseling a “firebreak” to isolate the lesion. Neither shading nor aspirating the diseased tissue significantly reduced CYBD tissue loss. However, chiseling reduced the rate and amount of tissue lost by 31%. While 30–40% of the chiseled lesions appeared to be free of disease signs 12–16 months after treatment, success significantly and steadily declined over 23 months, indicating a possible lack of long-term viability of the technique. The results of this study demonstrate that creating a “firebreak” between diseased and healthy-appearing tissue slows the spread of the disease and may prolong the life of O. faveolata colonies. The firebreak method yielded the best results of all the techniques tested, and also required the least amount of effort and resources. However, we do not recommend that this treatment alone be used for long-term disease mitigation. Rather, we propose that modifications of this and other treatment options be sought. The results also highlight the need for extended monitoring of CYBD after any treatment, due to the slow but variable rate and pattern of tissue loss in this disease.

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