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La Revue Du Praticien Dec 2023PLACE DE L'IRM POUR EXPLORER LES PATHOLOGIES ANORECTALES. L'imagerie par résonance magnétique (IRM) est l'un des examens d'imagerie les plus utiles à l'exploration...
PLACE DE L'IRM POUR EXPLORER LES PATHOLOGIES ANORECTALES. L'imagerie par résonance magnétique (IRM) est l'un des examens d'imagerie les plus utiles à l'exploration des pathologies ano rectales. Elle est complémentaire de l'examen clinique et de l'endo scopie. Elle permet de fournir des données indispensables à une prise en charge optimale du patient par le proctologue, le chirurgien ou l'oncologue en fonction de la nature de l'atteinte anale ou rectale. Il est nécessaire de respecter les différentes indications de cet examen, qui ont été bien définies pour chaque pathologie par les différentes sociétés savantes. Le protocole de l'IRM varie en fonction de la zone explorée et de la pathologie suspectée. C'est pourquoi il est indispensable de fournir au radiologue les informations nécessaires telles que la suspicion diagnostique, les données cliniques, ainsi que les résultats des examens complémentaires déjà réalisés. Les indications les plus fréquentes de l'IRM en proctologie sont les tumeurs anales et rectales. L'IRM permet le bilan initial de l'extension locorégionale de la tumeur ainsi que le suivi oncologique précoce et tardif grâce à l'étude comparative des examens de surveillance par rapport au bilan initial. L'IRM est indispensable pour l'exploration des suppurations anopérinéales complexes, en particulier liées à la maladie de Crohn. Elle permet la réalisation du bilan lésionnel initial ainsi que le contrôle post-drainage. En cas de suspicion de maladie de Verneuil ou de sinus pilonidal infecté, l'IRM participe à l'orientation vers le diagnostic étiologique. La déféco-IRM est une variante particulière de l'IRM pelvienne et périnéale. Elle fait partie du bilan des dysfonctions du plancher pelvien, car elle permet l'étude du comportement des différents organes pelviens au cours des efforts de poussée et de défécation. Les fissures anales et les thromboses hémorroïdaires sont les causes les plus fréquentes de douleurs anales. Leur diagnostic est purement clinique. En cas d'examen proctologique normal, l'IRM sert à chercher une autre cause à ces douleurs.
Topics: Humans; Magnetic Resonance Imaging; Affect; Awards and Prizes; Suppuration
PubMed: 38294482
DOI: No ID Found -
Lasers in Medical Science Jan 2024Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to...
Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.
Topics: Young Adult; Humans; Pilonidal Sinus; Retrospective Studies; Neoplasm Recurrence, Local; Surgical Flaps; Laser Therapy; Recurrence; Treatment Outcome
PubMed: 38291247
DOI: 10.1007/s10103-024-03993-5 -
International Journal of Surgery... Dec 2023
Review
PubMed: 38259010
DOI: 10.1097/JS9.0000000000000948 -
The Cochrane Database of Systematic... Jan 2024Pilonidal sinus disease is a common and debilitating condition. Surgical treatment remains the mainstay for managing chronic disease, with options including midline and... (Review)
Review
BACKGROUND
Pilonidal sinus disease is a common and debilitating condition. Surgical treatment remains the mainstay for managing chronic disease, with options including midline and off-midline wound closure methods. However, the optimal approach remains uncertain. Recent developments in tension-free midline techniques require further exploration.
OBJECTIVES
To assess the effects of midline and off-midline wound closure methods for pilonidal sinus, and to determine the optimal off-midline flap procedures.
SEARCH METHODS
In June 2022, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus EBSCO, and clinical trials registries. We also scanned the reference lists of included studies, as well as reviews, meta-analyses, and health technology reports. We applied no language, publication date, or study setting restrictions.
SELECTION CRITERIA
We included parallel RCTs involving participants undergoing midline closure without flap techniques and off-midline closure for pilonidal sinus treatment. We excluded quasi-experimental studies and studies that enroled participants presenting with an abscess.
DATA COLLECTION AND ANALYSIS
We followed standard Cochrane methodology. The critical outcomes included wound healing (time to wound healing, proportion of wounds healed), recurrence rate, wound infection, wound dehiscence, time to return to work, and quality of life. We assessed biases in these outcomes utilising the Cochrane risk of bias 2 tool and appraised evidence certainty via the GRADE approach.
MAIN RESULTS
We included 33 studies with 3667 analysed participants. The median or average age of the participants across the included studies ranged from 21.0 to 34.2 years, with a predominant male representation. Geographically, the trials were primarily conducted in the Middle East. We identified nine intervention comparisons. In this abstract, we focus on and present the summarised findings for the three primary comparisons. Off-midline closure versus conventional midline closure Off-midline closure probably reduces the time to wound healing (mean difference (MD) -5.23 days, 95% confidence interval (CI) -7.55 to -2.92 days; 3 studies, 300 participants; moderate-certainty evidence). However, there may be little to no difference between the two methods in the proportion of wounds healed (100% versus 88.5%, risk ratio (RR) 1.13, 95% CI 0.92 to 1.39; 2 studies, 207 participants; very low-certainty evidence). Off-midline closure probably results in lower rates of recurrence (1.5% versus 6.8%, RR 0.22, 95% CI 0.11 to 0.45; 13 studies, 1492 participants; moderate-certainty evidence) and wound infection (3.8% versus 11.7%, RR 0.32, 95% CI 0.22 to 0.49; 13 studies, 1568 participants; moderate-certainty evidence), and may lower rates of wound dehiscence (3.9% versus 8.9%, RR 0.44, 95% CI 0.27 to 0.71; 11 studies, 1389 participants; low-certainty evidence). Furthermore, off-midline closure may result in a reduced time to return to work (MD -3.72 days, 95% CI -6.11 to -1.33 days; 6 studies, 820 participants; low-certainty evidence). There were no data available for quality of life. Off-midline closure versus tension-free midline closure Off-midline closure may reduce the time to wound healing (median 14 days in off-midline closure versus 51 days in tension-free midline closure; 1 study, 116 participants; low-certainty evidence) and increase wound healing rates at three months (94.7% versus 76.4%, RR 1.24, 95% CI 1.06 to 1.46; 1 study, 115 participants; low-certainty evidence), but may result in little to no difference in rates of recurrence (5.4% versus 7.8%, RR 0.69, 95% CI 0.30 to 1.61; 6 studies, 551 participants; very low-certainty evidence), wound infection (2.8% versus 6.4%, RR 0.44, 95% CI 0.16 to 1.17; 6 studies, 559 participants; very low-certainty evidence), and wound dehiscence (2.5% versus 3.0%, RR 0.82, 95% CI 0.17 to 3.84; 3 studies, 250 participants; very low-certainty evidence) compared to tension-free midline closure. Furthermore, off-midline closure may result in longer time to return to work compared to tension-free midline closure (MD 3.00 days, 95% CI 1.52 to 4.48 days; 1 study, 60 participants; low-certainty evidence). There were no data available for quality of life. Karydakis flap versus Limberg flap Karydakis flap probably results in little to no difference in time to wound healing compared to Limberg flap (MD 0.36 days, 95% CI -1.49 to 2.22; 6 studies, 526 participants; moderate-certainty evidence). Compared to Limberg flap, Karydakis flap may result in little to no difference in the proportion of wounds healed (80.0% versus 66.7%, RR 1.20, 95% CI 0.77 to 1.86; 1 study, 30 participants; low-certainty evidence), recurrence rate (5.1% versus 4.5%, RR 1.14, 95% CI 0.61 to 2.14; 9 studies, 890 participants; low-certainty evidence), wound infection (7.9% versus 5.1%, RR 1.55, 95% CI 0.90 to 2.68; 8 studies, 869 participants; low-certainty evidence), wound dehiscence (7.4% versus 6.2%, RR 1.20, 95% CI 0.41 to 3.50; 7 studies, 776 participants; low-certainty evidence), and time to return to work (MD -0.23 days, 95% CI -5.53 to 5.08 days; 6 studies, 541 participants; low-certainty evidence). There were no data available for quality of life.
AUTHORS' CONCLUSIONS
This Cochrane review examines the midline and off-midline wound closure options for pilonidal sinus, predominantly based on young adult studies. Off-midline flap procedures demonstrate there may be benefits over conventional midline closure for pilonidal sinus, with various off-midline flap techniques. When off-midline flap closures were compared to tension-free midline closure, low-certainty evidence indicated there may be improved wound healing and increased time to return to work for off-midline closure, whilst very low-certainty evidence indicated there may be no evidence of a difference in other outcomes. There may be no evidence of an advantage found amongst the off-midline techniques evaluated. The choice of either procedure is likely to be based on a clinician's preference, experience, patient characteristics, and the patients' preferences. To more accurately determine the benefits and potential harms of these closure techniques, further large-scale and meticulously-designed trials are essential. Specifically, there is a pressing need for more studies addressing the paediatric population, in addition to adult studies.
Topics: Young Adult; Child; Humans; Male; Adult; Pilonidal Sinus; Quality of Life; Wound Healing; Postoperative Complications; Wound Infection
PubMed: 38226663
DOI: 10.1002/14651858.CD015213.pub2 -
The British Journal of General Practice... Jan 2024
Topics: Humans; Pilonidal Sinus; Neoplasm Recurrence, Local; Skin Diseases; Primary Health Care; Treatment Outcome; Recurrence
PubMed: 38154940
DOI: 10.3399/bjgp24X736113 -
Chirurgie (Heidelberg, Germany) Dec 2023The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often... (Review)
Review
BACKGROUND
The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum.
MATERIALS AND METHODS
In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula.
RESULTS
Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect.
CONCLUSION
The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.
PubMed: 38097850
DOI: 10.1007/s00104-023-02014-5 -
Techniques in Coloproctology Dec 2023Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the...
BACKGROUND
Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in patients with PSD.
METHODS
A retrospective cohort study was conducted at a large tertiary medical center, including all adult patients with PNS who underwent trephine surgery with/without laser therapy between 2016 and 2021[AUTHORS TO INSERT MONTH]. Propensity score matching was used to address confounding factors, and the primary outcome was the 1-year recurrence rate.
RESULTS
The study included 221 patients with PSD, with a mean age of 23.73 years (87.7% male). In the unmatched cohort (130 trephine surgery alone, 91 trephine surgery + laser therapy), significant differences were observed in mean age (23 vs. 25 years; p < 0.01)[AUTHROS TO USE MEDIAN PLUS RANGE OR ADD SD] and surgeons' experience (p = 0.014). Propensity score matching was applied to overcome confounding factors, resulting in a matched cohort including 73 patients in each group. The addition of laser therapy demonstrated a significantly lower recurrence rate (8.2% vs. 32.9%; p < 0.001) compared to pit excision without laser therapy. Logistic regression analysis showed that the addition of laser was significantly associated with a lower risk for recurrence (OR 0.23; 95% CI 0.089-0.633; p < 0.01).
CONCLUSION
The incorporation of laser therapy along with trephine/pit excision surgery significantly reduces the recurrence rate in patients with PNS. Further prospective studies are needed to confirm our findings.
Topics: Adult; Humans; Male; Young Adult; Female; Treatment Outcome; Pilonidal Sinus; Retrospective Studies; Neoplasm Recurrence, Local; Laser Therapy; Recurrence
PubMed: 38093161
DOI: 10.1007/s10151-023-02897-w -
Cureus Dec 2023The Bascom cleft-lift procedure is a superior approach for treating pilonidal disease. The purpose of this study was to establish healing time after cleft-lift,...
INTRODUCTION
The Bascom cleft-lift procedure is a superior approach for treating pilonidal disease. The purpose of this study was to establish healing time after cleft-lift, operative success, and any associated clinical or operative variables.
METHODS
The study group comprises all patients who underwent cleft-lift procedures at our center between December 2021 and February 2023. Many clinical and operative variables were collected before surgery. Postoperatively, patients were examined every two weeks until full epithelialization was achieved; thereafter, they were seen at 6, 16, and 30 months and as needed for recurrence surveillance. A successful cleft-lift was defined as one that fully healed by 120 days and showed no recurrence within 18 months of follow-up. Patients with failed cleft lifts were offered revision.
RESULTS
In total, 261 cleft -lifts were performed in 258 patients. Of these patients, 40.3% had at least one previous excisional surgery and 19.4% had a chronically open surgical wound. The median follow-up time was 19.8 (6.5 to 25.5) months. There were a total of 12 failed cleft-lifts, yielding an operative success rate of 95.4%. Recurrence was detected in two (0.08%) cases. The median healing time was 43 (15-387) days and did not differ by any covariate. Previous Limberg flap surgery and a shorter distance from the inferior extent of the wound/disease to the anal mucosa were associated with decreased operative success.
CONCLUSION
Our data reinforce that the cleft-lift procedure is a highly successful cure for this disease and its surgical failures. Notably, the operation was a successful cure for many patients with extensive disease and previously failed excisional surgeries, including flap reconstructions.
PubMed: 38077680
DOI: 10.7759/cureus.50174 -
Hand Surgery & Rehabilitation Feb 2024Pilonidal sinus of the hand is an occupational hazard for barbers, cow milkers, sheep shearers and dog groomers. Here, we report on a dog groomer who had four pilonidal...
OBJECTIVE
Pilonidal sinus of the hand is an occupational hazard for barbers, cow milkers, sheep shearers and dog groomers. Here, we report on a dog groomer who had four pilonidal sinuses.
CASE PRESENTATION
A 49-year-old woman working as a dog groomer complained of multiple non-erythematous and fluctuant nodules on both hands, associated with pain, which had been identified five years previously. On the skin of her right hand, three nodules were observed on the volar (diameter: 1.5 cm) and medial (diameter: 1.4 cm) sides of fifth metacarpophalangeal joint and the volar aspect of the distal phalanx of the small finger (diameter: 0.7 cm). On the left hand, a 2-cm diameter nodule was identified on the volar side of the fifth metacarpophalangeal joint region. The nodules were excised surgically. A 5-mm long hair was removed from one nodule. Histopathology confirmed pilonidal sinus, treated by excision. One month postoperatively, the wound had healed uneventfully.
CONCLUSION
When nodules are found in dog groomers, clinicians should consider the possibility of pilonidal sinus disease.
Topics: Humans; Female; Cattle; Dogs; Animals; Sheep; Middle Aged; Pilonidal Sinus; Hand; Metacarpophalangeal Joint
PubMed: 38072305
DOI: 10.1016/j.hansur.2023.11.010 -
International Journal of Surgery Case... Jan 2024For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high...
INTRODUCTION
For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high surgical difficulty, significant local damage, numerous complications, slow healing, and a high risk of recurrence. This article reports a case of recurrent complex pilonidal sinus and discusses the advantages of Bascom II combined with VSD treatment involving the preservation of tissue bridges.
CASE PRESENTATION
The patient, a 31-year-old male, presented with recurrent swelling, pain, and purulent discharge from the sacrococcygeal region for over a year. Upon physical examination, extensive lumps and sinus tracts were observed in the lumbosacral tail area, with the lesion extending from L4 to the tip of the coccyx. Under general anesthesia, a segmental resection was performed, and the lumbosacral mass lesion was excised, preserving normal tissue bridges. The mature sinus tract at the upper part of the coccyx was removed, and Bascom II reconstruction surgery was performed. In the late stage at the site of lumbar sacral lesion excision, VSD was applied to promote wound healing.
DISCUSSION
The combination of Bascom II with lesion tunnel-like removal can reduce the damage, elevate gluteal cleft, and lower the recurrence rate. Subsequently, with the addition of VSD, it can accelerate the elimination of necrotic tissue, reduce infection risk, and expedite wound healing.
CONCLUSION
This case explores the advantages and characteristics of combining various techniques in the treatment of recurrent complex pilonidal sinuses, emphasizes the utility of VSD as an adjunctive therapy for large lesions.
PubMed: 38064859
DOI: 10.1016/j.ijscr.2023.109108