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The Journal of International Medical... Mar 2024This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. (Observational Study)
Observational Study
OBJECTIVE
This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus.
METHODS
A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate.
RESULTS
Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference.
CONCLUSION
According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.
Topics: Humans; Pilonidal Sinus; Prospective Studies; Cross-Sectional Studies; Neoplasm Recurrence, Local; Lasers; Recurrence; Treatment Outcome
PubMed: 38530042
DOI: 10.1177/03000605241236057 -
Updates in Surgery Jun 2024Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting.... (Review)
Review
Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.
Topics: Pilonidal Sinus; Humans; Chronic Disease; Minimally Invasive Surgical Procedures; Acute Disease
PubMed: 38526695
DOI: 10.1007/s13304-024-01799-2 -
The British Journal of Surgery Mar 2024
Topics: Humans; Wound Healing; Pilonidal Sinus; Recurrence
PubMed: 38518113
DOI: 10.1093/bjs/znae054 -
The British Journal of Surgery Mar 2024Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal...
BACKGROUND
Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal intervention. The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial design.
METHODS
This UK-wide multicentre prospective cohort study, including patients (aged over 16 years) who had definitive treatment for symptomatic pilonidal disease, was conducted between May 2019 and March 2022. Patient and disease characteristics, and intervention details were analysed. Data on patient-reported outcomes, including pain, complications, treatment failure, wound issues, and quality of life, were gathered at various time points up to 6 months after surgery. Strategies were implemented to adjust for risk influencing different treatment choices and outcomes.
RESULTS
Of the 667 participants consenting, 574 (86.1%) were followed up to the study end. Twelve interventions were observed. Broadly, 59.5% underwent major excisional surgery and 40.5% minimally invasive surgery. Complications occurred in 45.1% of the cohort. Those who had minimally invasive procedures had better quality of life and, after risk adjustment, less pain (score on day 1: mean difference 1.58, 95% c.i. 1.14 to 2.01), fewer complications (difference 17.5 (95% c.i. 9.1 to 25.9)%), more rapid return to normal activities (mean difference 25.9 (18.4 to 33.4) days) but a rate of higher treatment failure (difference 9.6 (95% c.i. 17.3 to 1.9)%). At study end, 25% reported an unhealed wound and 10% had not returned to normal activities.
CONCLUSION
The burden after surgery for pilonidal disease is high and treatment failure is common. Minimally invasive techniques may improve outcomes at the expense of a 10% higher risk of treatment failure.
Topics: Humans; Aged; Treatment Outcome; Prospective Studies; Pilonidal Sinus; Quality of Life; Neoplasm Recurrence, Local; Pain; Recurrence
PubMed: 38488204
DOI: 10.1093/bjs/znae009 -
International Journal of Surgery Case... Mar 2024Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition...
INTRODUCTION
Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial.
CASE PRESENTATION
A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health.
CLINICAL DISCUSSION
This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus.
CONCLUSION
Skin malformations can be the underlying cause of pilonidal sinus in some cases.
PubMed: 38430899
DOI: 10.1016/j.ijscr.2024.109444 -
Polski Przeglad Chirurgiczny Oct 2023<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses...
<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.</br> <b><br>Material and methods:</b> We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.</br> <b><br>Results:</b> A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.</br> <b><br>Conclusions:</b> Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.</br>.
Topics: Adolescent; Humans; Hair Removal; Lasers, Solid-State; Retrospective Studies; Neoplasm Recurrence, Local; Pilonidal Sinus; Ultrasonography; Recurrence; Ultrasonography, Interventional
PubMed: 38348985
DOI: 10.5604/01.3001.0053.9305 -
Pediatric Surgery International Jan 2024Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal...
PURPOSE
Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches-excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).
METHODS
Single-center retrospective evaluation of patients 1-21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann-Whitney U tests.
RESULTS
18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).
CONCLUSION
In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.
Topics: Humans; Child; Male; Female; Pilonidal Sinus; Quality of Life; Retrospective Studies; Endoscopy; Reoperation; Skin Diseases
PubMed: 38294551
DOI: 10.1007/s00383-023-05629-1 -
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 -
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