-
International Journal of Surgery... Aug 2023A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS.
METHODS
A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years.
RESULTS
Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [ P =0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P =0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant ( P =0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant ( P =0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection ( P ≥0.05).
CONCLUSIONS
There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient's wishes, appearance of the SPS, and the professional ability of the surgeon.
Topics: Humans; Pilonidal Sinus; Neoplasm Recurrence, Local; Surgical Flaps; Wound Closure Techniques; Wound Healing; Recurrence
PubMed: 37158142
DOI: 10.1097/JS9.0000000000000447 -
Journal of Surgical Case Reports May 2023Pilonidal sinus is a chronic infectious disease with large incision and high risk of relapse after surgical management. Therefore, effective intervention strategies are...
Pilonidal sinus is a chronic infectious disease with large incision and high risk of relapse after surgical management. Therefore, effective intervention strategies are urgently needed to reduce the relapse and shorten the wound healing time. Hydrogels have been widely used in regenerative medicine for its great biocompatibility, however, it remains challenging to integrate the material with wound tissues. Here, we reported a case of pilonidal sinus patient using a novel tissue integration material, Photo-crosslinking hydrogel after open surgery. A 38-year-old man with a pilonidal sinus for ˃5 years underwent open surgery. When the surgery was finished, the wound was injected with hydrogel that was irradiated with a ultraviolet light source until covered and solidified completely. Hydrogel needed to be changed 1-2 times per week. We evaluated the healing time as primary outcome and then followed up for ˃1 year to observe the relapse. The wound healed completely in 46 days after open surgery, which was shorter than that reported in other studies. Meanwhile, no recurrence was detected during follow-up. Photo-crosslinking hydrogel effectively promoted wound healing and has the potential to be easily applied in Pilonidal sinus patients after open surgery.
PubMed: 37153823
DOI: 10.1093/jscr/rjad152 -
Diseases of the Colon and Rectum Jun 2023
Topics: Humans; Pilonidal Sinus; Neoplasm Recurrence, Local; Surgical Flaps; Wound Healing; Skin Diseases; Recurrence; Treatment Outcome
PubMed: 37146121
DOI: 10.1097/DCR.0000000000002515 -
Updates in Surgery Sep 2023This study aimed to report a multicentric national experience about the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The medical records of all...
This study aimed to report a multicentric national experience about the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The medical records of all pediatric patients, aged up to 18 years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed. Patients' demographics, operative details, and post-operative outcomes were assessed. A total of 294 patients (182 boys), with median age of 14 years (range 10-18), receiving PEPSiT in the study period, were enrolled. Pilonidal sinus disease (PSD) was primary in 258 (87.8%) and recurrent in 36 (12.2%). The median operative time was 36 min (range 11-120). The median VAS pain score was 0.86 (range 0-3) and the median duration of analgesic use was 27 h (range 12-60). The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4 days (range 19-50). Six/294 (2.0%) patients developed Clavien 2 post-operative complications. The recurrence rate was 4.8% (14/294) and all recurrences were re-operated using PEPSiT. Redo-surgery for wound debridement was performed in one (0.3%) patient with late healing. On multivariate analysis, hirsutism and typology of sinus (pits ≥ 2, paramedian and more proximal to the anus) were predictors of PSD recurrence (p = 0.001). To date, this is the largest series of PEPSiT published in the pediatric population. The outcomes reported after a 3 years experience confirm that PEPSiT is a safe, effective, and real minimally invasive procedure to treat adolescents with PSD. It provides patients quick and painless recovery, satisfactory success, and high quality of life.
Topics: Male; Adolescent; Humans; Child; Aged; Pilonidal Sinus; Treatment Outcome; Retrospective Studies; Quality of Life; Neoplasm Recurrence, Local; Pain, Postoperative; Recurrence
PubMed: 37145226
DOI: 10.1007/s13304-023-01508-5 -
BMC Surgery Apr 2023Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no...
BACKGROUND
Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery.
METHODS
We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups.
RESULTS
PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001).
CONCLUSIONS
PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.
Topics: Young Adult; Humans; Pilonidal Sinus; Retrospective Studies; Surgical Flaps; Postoperative Complications; Recurrence; Treatment Outcome
PubMed: 37118772
DOI: 10.1186/s12893-023-02014-6 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2023To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal...
OBJECTIVE
To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.
METHODS
Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures.
RESULTS
All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.
CONCLUSION
Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.
Topics: Adult; Female; Humans; Male; Perforator Flap; Pilonidal Sinus; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Sutures; Treatment Outcome; Surgical Wound; Adolescent; Young Adult; Middle Aged
PubMed: 37070318
DOI: 10.7507/1002-1892.202301035 -
Wideochirurgia I Inne Techniki... Mar 2023New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment...
INTRODUCTION
New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery.
AIM
To compare the efficiency and safety of EPSIT with SiLaT.
MATERIAL AND METHODS
Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients' demographics, complications and postoperative course were collected and compared between the two groups.
RESULTS
We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12-46) years and body mass index (BMI) of 25.5 ±4.5 (18-38) kg/m. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1-3) vs. 1.9 ±1.1 (1-5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12-90) vs. 25.2 ±14.5 (14-90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2-5) vs. 3.6 ±1.2 (2-7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7).
CONCLUSIONS
Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients.
PubMed: 37064557
DOI: 10.5114/wiitm.2022.124206 -
Frontiers in Medicine 2023Perifolliculitis capitis abscedens et suffodiens (PCAS), also known as dissecting cellulitis of the scalp (DCS), is a part of the "follicular occlusion tetrad" that also...
RATIONALE
Perifolliculitis capitis abscedens et suffodiens (PCAS), also known as dissecting cellulitis of the scalp (DCS), is a part of the "follicular occlusion tetrad" that also includes acne conglobate (AC), hidradenitis suppurativa (HS), and pilonidal sinus, which share the same pathogenic mechanism, such as follicular occlusions, follicular ruptures, and follicular infections.
PATIENT CONCERNS
A 15-year-old boy had multiple rashes on the scalp accompanied by pain.
DIAGNOSIS
The patient was diagnosed with PCAS or DCS based on the clinical manifestations and laboratory examinations.
INTERVENTIONS
The patient was initially administered adalimumab 40 mg biweekly and oral isotretinoin 30 mg daily for 5 months. Because the initial results were insufficient, the interval between adalimumab injections was extended to 4 weeks, and isotretinoin was changed to baricitinib 4 mg daily for 2 months. When the condition became more stable, adalimumab 40 mg and baricitinib 4 mg were administered every 20 and 3 days, respectively, for two more months until now.
OUTCOMES
After 9 months of treatment and follow-up, the original skin lesions of the patient were almost cured, and most inflammatory alopecia patches disappeared.
CONCLUSION
Our literature review did not find any previous reports on treating PCAS with TNF-α inhibitors and baricitinib. Accordingly, we presented the first successful treatment of PCAS with this regimen.
PubMed: 37056728
DOI: 10.3389/fmed.2023.1132574 -
Wounds : a Compendium of Clinical... Mar 2023Pilonidal disease is a common condition of the gluteal cleft region, but involvement of the anterior perineum is rarely reported. Surgical options for gluteal cleft...
INTRODUCTION
Pilonidal disease is a common condition of the gluteal cleft region, but involvement of the anterior perineum is rarely reported. Surgical options for gluteal cleft disease include simple fistulotomy, excisional procedures with primary closure (ie, Bascom cleft lift, Karydakis and Limberg flaps), or excision with secondary healing. The Bascom cleft lift described here is an excisional procedure involving a rotational flap with an off-midline closure. Deep tissue is salvaged allowing for proper contouring of the gluteal cleft, resulting in a cosmetically pleasing result.
CASE REPORT
A 20-year-old man with recurrent pilonidal abscesses of the gluteal cleft underwent a Bascom cleft lift procedure for definitive care of his disease. During the procedure, involvement of the anterior perineum was found. Given the location of the pits relative to the flap, the anterior perineal disease was treated only with removal of hair from within the pits and clipping the hair of the perineum.
CONCLUSION
While this case highlights the current standard of care and surgical options for pilonidal disease, the ideal surgical options for rare cases of pilonidal disease of the anterior perineum remain to be determined.
Topics: Male; Humans; Young Adult; Adult; Perineum; Pilonidal Sinus; Surgical Flaps; Wound Healing; Recurrence
PubMed: 37023351
DOI: 10.25270/wnds/22078 -
Cureus Feb 2023Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease that significantly affects the quality of life of patients. Multiple factors affect the...
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease that significantly affects the quality of life of patients. Multiple factors affect the disease's course and severity. HS is a debilitating disease and often recalcitrant to treatment, resulting in a deterioration of quality of life; hence, there is a need to evaluate the factors affecting the quality of life in patients with HS.
OBJECTIVES
The objective of the study was to evaluate the various demographic and disease-related factors that affect the quality of life of patients with HS.
MATERIALS AND METHODS
This is a prospectively scored questionnaire-based observational study. Data from 30 patients with HS were analyzed for the association of disease-related factors like Hurley's staging, site, duration, past history, and comorbidities with the Dermatology Life Quality Index (DLQI).
RESULTS
A statistically significant relationship was found between DLQI and Hurley staging (p=0.000). The most common sites involved were the axilla and inguinal regions. Among the sites involved, the neck (p=0.002), abdomen (p=0.002), back (p=0.002), thighs (p=0.042), and gluteal (p=0.000) regions have a statistically significant association with DLQI. Prior histories of rheumatoid arthritis, scarring, surgery, lymphadenitis, and pilonidal sinus showed a statistically significant association with DLQI.
CONCLUSION
The disease severity significantly hampers the quality of life of patients with HS. The disease site and presence of other comorbidities also influence the outcome. Our study will help healthcare providers better understand and fulfill the needs of patients suffering from HS.
PubMed: 37007422
DOI: 10.7759/cureus.35510