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Journal of Visceral Surgery Sep 2013Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located... (Review)
Review
Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.
Topics: Biopsy; Global Health; Humans; Incidence; Pilonidal Sinus; Surgical Flaps; Surgical Procedures, Operative; Wound Healing
PubMed: 23911903
DOI: 10.1016/j.jviscsurg.2013.05.006 -
International Wound Journal Apr 2019The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities,... (Review)
Review
The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pilonidal Sinus; Practice Guidelines as Topic; Sacrococcygeal Region; Surgical Procedures, Operative; Wound Healing
PubMed: 30440104
DOI: 10.1111/iwj.13042 -
Scientific Reports Aug 2020The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical... (Meta-Analysis)
Meta-Analysis
The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical interventions using network meta-analysis. Randomized controlled trial studies were searched systematically to identify all eligible studies in multiple databases and previous publications and Bayesian network meta-analysis was performed. Our primary outcome was the recurrence rate. Differences in the findings of the studies were explored in meta regressions and sensitivity analyses. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using CINeMA (Confidence in Network Meta-Analysis). A total of 39 studies and 5,061 patients were identified and the most common surgical intervention was the Limberg flap. In network meta-analysis, modified Limberg flap and off-midline closure were associated with the lowest recurrence rate. However, the Karydakis flap was associated with shorter operation time by several minutes compared with other interventions and few significant results were found in other outcomes. Modified Limberg flap and off-midline closure provided relatively low recurrence and complications rates. Therefore, they could be two promising surgical interventions for PSD patients.
Topics: Humans; Pilonidal Sinus; Randomized Controlled Trials as Topic; Surgical Procedures, Operative
PubMed: 32792519
DOI: 10.1038/s41598-020-70641-7 -
The Israel Medical Association Journal... Feb 2022
Topics: Humans; Minimally Invasive Surgical Procedures; Pilonidal Sinus
PubMed: 35187903
DOI: No ID Found -
Frontiers in Surgery 2022
PubMed: 36034357
DOI: 10.3389/fsurg.2022.950793 -
Polski Przeglad Chirurgiczny Feb 2017Pilonidal cyst is a troublesome condition affecting usually young people. It significantly influences quality of life and causes low self-esteem. Despite its known... (Review)
Review
Pilonidal cyst is a troublesome condition affecting usually young people. It significantly influences quality of life and causes low self-esteem. Despite its known pathophysiology and numerous therapeutic methods available, pilonidal cysts still constitute a significant problem in general surgery. A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success, and frequent complications cause both patient's dissatisfaction and frustration of the operator. In many cases, therapy is based on methods developed in a given healthcare center and their efficacy is usually not scientifically verified. Search for optimal strategy is also impeded by lack of an unambiguous clinical classification. In this article, we reviewed publications on various methods of managing pilonidal cyst, and we also presented surgical treatment used in our department. However, we did not manage to point out a surgical method with efficacy high enough to become standard treatment. It indicates the need for further search for new techniques that will give chances for successful treatment of pilonidal cyst.
Topics: Anti-Infective Agents; Humans; Pilonidal Sinus; Postoperative Care; Surgical Wound Infection; Wound Healing
PubMed: 28522786
DOI: 10.5604/01.3001.0009.6009 -
Deutsches Arzteblatt International Jan 2019Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000... (Review)
Review
BACKGROUND
Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year.
METHODS
This review is based on pertinent publications retrieved by a selective literature search.
RESULTS
The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV).
CONCLUSION
Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.
Topics: Humans; Pilonidal Sinus; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30782310
DOI: 10.3238/arztebl.2019.0012 -
Cirugia Pediatrica : Organo Oficial de... Oct 2021Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a...
INTRODUCTION
Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a decrease in patients' quality of life. The objective of our study was to evaluate the effectiveness and advantages of the endoscopic technique vs. conventional surgery of pilonidal sinus in the pediatric population.
METHODS
A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution in 2019. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) were compared. The surgical technique chosen was surgeon-dependent.
RESULTS
49 patients were studied - 14 undergoing PEPSiT, 23 undergoing EHSI, and 12 undergoing EPC. Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT, whereas complication rate with EHSI was 69.6%, and complication rate with EPC was 58.3% (p = 0.001).
CONCLUSIONS
Endoscopic pilonidal sinus treatment is effective, with a short and painless postoperative period, and easy wound care. It allows for an early return to normal life without restrictions.
Topics: Child; Endoscopy; Humans; Neoplasm Recurrence, Local; Pilonidal Sinus; Quality of Life; Recurrence; Treatment Outcome
PubMed: 34606699
DOI: No ID Found -
Polski Przeglad Chirurgiczny Feb 2022<b>Introduction:</b> As a rule, the treatment of pilonidal cysts is based on a surgical approach. Surgical treatment depends on the form of the disease and...
<b>Introduction:</b> As a rule, the treatment of pilonidal cysts is based on a surgical approach. Surgical treatment depends on the form of the disease and surgeon's preferences regarding the method. The treatment process does not consider preoperative treatment that would affect the structural components of the skin involved in the pathological process. The results of surgical treatment remain unsatisfactory, leading to a significant number of recurrences and long-term healing of the postoperative wound. </br></br> <b> Materials and methods:</b> Morphological examination of the pieces of skin with altered sacrococcygeal tissues after radical surgical treatment of 46 patients with pilonidal cyst of the sacrococcygeal region was performed, and 46 patients with acne inversa of the intergluteal cleft, groin and scalp were selected. The sex distribution of patients with pilonidal cysts was as follows: 43 (91.3%) male patients, 3 (6.5%) female patients. Among 46 patients with acne inversa and dissecting cellulitis, the distribution was as follows: 32 (69.6%) male patients and 14 (30.4%) female patients. Patients with pilonidal cysts of the sacrococcygeal region underwent surgical treatment according to the developed method of economical median resection using sutures with internal fixation. </br> </br> <b> Results:</b> Considering and comparing the morphological picture observed in the pathomorphological examination of histological specimens in patients with pilonidal cysts, acne inversa, dissecting cellulitis, the similarity of changes in most patients is noteworthy. "Acne inversa" was first described in 1839 by Velpeau, who originally called the disease "hydradenitis suppurativa", believing that inflammatory changes occur in the sweat glands [1-3]. In 1854, surgeon Verneuil described this disease, and later it was named after him. We observed chronic proliferative inflammation in different layers of the dermis and subcutaneous tissue (the main focus is in the subcutaneous tissue, but closely related to the dermis and epidermis). </br></br> <b>Discussions:</b> Pilonidal cyst of the sacrococcygeal region, especially without hair in the cavity of the cyst, can be considered as a type of acne inversa with appropriate location. We believe that the use of local and systemic retinoids, namely isotretinoin, in the treatment of patients with this disease other than surgery, together with other groups of drugs traditionally used in the treatment of pilonidal cysts, may be promising in the treatment of pilonidal cysts.
Topics: Acne Vulgaris; Cellulitis; Female; Hidradenitis Suppurativa; Humans; Male; Pilonidal Sinus; Sacrococcygeal Region
PubMed: 36047363
DOI: 10.5604/01.3001.0015.5983 -
Annals of Medicine and Surgery (2012) Sep 2020Pilonidal sinus disease is chronic acquired condition leading to significant morbidity and associated healthcare costs. Several techniques have been described to manage... (Review)
Review
Pilonidal sinus disease is chronic acquired condition leading to significant morbidity and associated healthcare costs. Several techniques have been described to manage this condition with no treatment gaining universal acceptance. With the shift towards minimally invasive surgery, Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic Pilonidal Sinus Treatment (EPiST) have gained prominence. The aim of this review is to analyse current treatment modalities and the evidence for endoscopic pilonidal sinus surgery. Reported surgical techniques range from wide excision with or without primary closure to various flap closures. These aim to eliminate the underlying causes driven by natal cleft hair and reducing recurrence. However, long term (≥5 years) recurrence rates range between 10 and 30% with significant complication rates. Trials with endoscopic treatment which have shown comparable short-term results to established treatments with reduced morbidity. However, the potential higher cost, learning curve, patient selection criteria and need for long term outcomes from randomised trials limit widespread application of this promising method. Endoscopic treatment of pilonidal sinus disease therefore provides a minimally invasive alternative to traditional surgical methods with the potential to reduce morbidity. However long-term outcomes data from further prospective randomised trials is needed to establish its efficacy compared to traditional surgical methods.
PubMed: 32793341
DOI: 10.1016/j.amsu.2020.07.050