Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742

Chronic deep recurrent pyoderma in the outpatient practice of the surgeon

Introduction. Chronic deep pyoderma occurs relatively rare in the surgeon practice and, due to the poor knowledge of this pathology, its diagnosis is difficult by surgeons. Misdiagnosis leads to erroneous treatment tactics. Chronic deep recurrent pyoderma includes: abscessing and disrupting perifolliculitis of the head (Hoffmann) (ADPH), axillary and inguinal-perineal suppurative hydradenitis, pilonidal cyst of the sacrococcygeal area. The diseases listed follow the same pathogenesis.The purpose of the publication: to acquaint surgeons with the diagnosis and treatment of a particular type of chronic deep recurrent pyoderma – abscessing and disrupting head perifolliculitis (Hoffmann) in the conditions of the surgery room, since this problem is purely issued in the literature of the subject.Material and methods. Since 2007 until to 2020, we had observed 20 cases of deep chronic recurrent pyoderma (15 men and 5 women), but only two cases were correctly detected before treatment, in other cases – retrospectively. Research method: analyzing of clinical observation data and laboratory tests.Results. In our practice, nine men suffered from abscessing and disrupting perifolliculitis of the head. We had described and classificated the features of this disease, focused on three clinical cases.Conclusions. Abscessing and disrupting perifolliculitis of the head is still purely diagnosable and curable disease, the treatment as follows: regimen and hygienic measures, surgical treatment, conservative treatment. Surgical treatment should be as radical as possible.

Intracranial hypotension as a unique complication of the rupture of an anterior sacral meningocele into a recurrent pilonidal cyst

Background: Intracranial hypotension (IH) is an underdiagnosed, but important cause of new-onset, daily persistent headache, especially among the young- and middle-aged population. It results from a cerebrospinal fluid (CSF) leak with subsequent lowered CSF pressure. Case Description: A 37-year-old female presented to the emergency department with sudden onset severe headaches. Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC). The night before admission, she had watery discharge from the recurrent PC and severe diffuse positional headaches associated with photophobia and neck pain. The head computed tomography showed pneumocephalus in the posterior fossa and a spine magnetic resonance imaging revealed an anterior sacral meningocele (ASM) in close contact with the recurrent PC. A final diagnosis was made of headaches due to IH. The leakage site was the rupture of the ASM in the PC. The surgical repair of the ASM was achieved suturing two overlapping dural flaps. There was no more CSF leakage from the PC and the headaches disappeared. Conclusion: This is a unique case of IH due to the rupture of an ASM into a recurrent PC. The association of an ASM and PC, at the best of our knowledge, is unique. Moreover, the fistulation of the ASM to the PC is exceptional. ASM can be successfully closed with a posterior approach, using two overlapping dural flaps.

RESOLUCIÓN DE QUISTE PILONIDAL MEDIANTE TÉCNICA DE COLGAJO EN H. RESOLUTION OF THE PILONIDAL CYST USING THE FLAP TECHNIQUE IN H.

RESUMEN Introducción: Objetivo: describir el rendimiento de la técnica de colgajo en H para el tratamiento del quiste pilonidal. Materiales y Métodos: se realizó un estudio observacional descriptivo prospectivo en pacientes sometidos a técnica de colgajo en H entre abril de 2017 y abril de 2018. Se incluyeron pacientes con masa o tumefacción a nivel sacro. Con seguimiento a 12 meses, Se excluyeron aquellos pacientes con infecciones en el área quirúrgica o recidivas por cirugías previas. Resultados: de 15 candidatos que cumplieron los criterios de inclusión y ninguno de exclusión. Discusión: Técnica quirúrgica con tasas de complicación aceptable, recurrencia nula a seguimiento a un año, con excelente aceptación por los pacientes. Conclusión: El colgajo en H para la resolución del quiste pilonidal, es una alternativa terapéutica más para la resolución de esta patología, con buena tolerancia por parte del paciente y resultados satisfactorios. Palabras claves: Quiste pilonidal, Quiste Sacroccígeo, Colgajo, Tratamiento, Cirugía, Recurrencia.

689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience

Introduction The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates. Method The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up. Results The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period. Conclusions SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.

EPEN-13. PRIMARY EXTRADURAL SACROCOCCYGEAL SUBCUTANEOUS MYXOPAPILAR EPENDYMOMA MISDIAGNOSED AS PILONIDAL CYST IN A 7 YEAR-OLD BOY: A CASE REPORT

BACKGROUND Ependymomas occur in the brain or spinal cord and rarely as an extraspinal variety at the sacrococcygeal region, separated from the spinal cord. This rare presentation is thought to originate from a group of heterotopic ependymal cells called the coccygeal medullary vestige. There are few reports of this occurrence in children. CLINICAL CASE: A 7-year-old male presented with a history of a soft mass arising in the sacrococcygeal area 3 years earlier, diagnosed as pilonidal cyst at primary level and treated with surgery twice, as this mass recurred the boy was sent to our hospital, a 3rd surgery was performed, all tumoral tissue was removed, no attachment with dural space was founded, pathology revealed myxopapilar ependymoma with positivity for PS100, EMA and Vimentin. After surgery a Follow up MRI of cranium and spine showed absence of disease, no radiotherapy neither chemotherapy was implemented. He has been on surveillance from 3 years now without recurrence. CONCLUSION This report highlights the fact that pediatric ependymoma can have an extradural presentation and can be confounded with pilonidal cyst, total resection is needed to control the disease. Potential for recurrence or metastatic disease can continue 20 years from the time of primary tumor, so prolonged surveillance is important.