TP7.2.19 Review of bascom cleft lift and flap-procedures versus excision for pilonidal disease in a single centre (2017-2019)

Introduction Pilonidal disease continues to be managed with varying surgical techniques. We review results with Bascom cleft lift comparing to other practices at our institution. Methods All elective procedures for pilonidal disease reviewed from December 2017 to December 2019. Patient demographics, previous emergency and elective procedures for pilonidal disease, follow-up, dehiscence and recurrence rates, and all-cause morbidity were examined retrospectively. Results In the study period there were 106 procedures. Average age was 27 years (range 15-64). Male to female ratio was 83:23. Procedures were excision and primary closure (48), excision and packing (19), rhomboid flap (2), Bascom cleft lift flap (31), other rotational/perforator or V to Y flaps (6). Rates of previous elective procedures in the flap procedures versus excision group were 31% and 10% respectively (P = 0.01). Rates of previous emergency procedures in the flap-procedures versus excision group were 41% and 31% respectively (P = 0.40). In 50 procedures there was a documented follow up encounter at a mean time of 55 days (median 34 days, range 2-239). Dehiscence (partial and full) in flap procedures versus excision and closure was 33% and 27% respectively (P = 0.64). Recurrence rates in flap procedures versus excision +/- closure or packing were 0% and 8% respectively (P = 0.16). Conclusion Flap procedures have a lower rate of recurrence and comparable dehiscence rates despite being performed in patients with higher rates of prior procedures for pilonidal disease. Bascom cleft lift was the simplest flap procedure most commonly performed and matches the results of more complex flaps.

SURGICAL TREATMENT OF PILONIDAL DESEASE (review)

The treatment of pilonidal disease (PD) is extremely important now. Its incidence is up to 5% of the adults. PDtakes the fourth place among such coloproctological diseases as hemorrhoids, abscess and fistula-in-ano and anal fissure. The first experience of PD was described two centuries ago. During this period, various theories on etiology and pathogenesis of the disease were suggested. The western papers support the idea that the acquired genesis is a cause of PD. This point of view is the opposite to the countries of the former USSR, where pilonidal disease is considered as congenital pathology. Numerous procedures have been proposed because of the different theories of the etiopathogenesis if you take the point of view that the PD is a congenital disease it should be mentioned that the main goal of these methodsiselimination of pilonidal cyst with closure of the wound or without. If to consider PD as an acquired disease, the surgical break of pathogenetic mechanism is a key. Thisapproach includes: Bascom I, Cleft Lift, EPSiT procedures. Every procedure for PD has certain indications and contraindications. The aim of the review is to compare the main methods and determine their strengths and weaknesses. Unfortunately, today there is no "gold standard" in the treatment of pilonidal disease.