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Acta Dermato-venereologica Sep 2023Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may...
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
Topics: Humans; Male; Young Adult; Adult; Middle Aged; Female; Hidradenitis Suppurativa; Pilonidal Sinus; Cross-Sectional Studies; Comorbidity; Patient Acuity
PubMed: 37766657
DOI: 10.2340/actadv.v103.6569 -
Medicina (Kaunas, Lithuania) Jul 2020: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the...
: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. : A survey including 196 certified institutions (Switzerland, = 99 and Austria, = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. : In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis ( = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; < 0.001). Primary resection and off-midline closure ( = 0.017) and the use of tissue flaps ( = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. : Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.
Topics: Adult; Austria; Female; Humans; Male; Middle Aged; Pilonidal Sinus; Surgical Flaps; Surveys and Questionnaires; Switzerland; Treatment Outcome; Wound Healing
PubMed: 32660027
DOI: 10.3390/medicina56070341 -
Journal of Ayub Medical College,... 2022Pilonidal sinus disease (PNSD) is considered as the challenging disease for surgeons since decades. The term pilo-nidal is derived from Latin meaning "nest of hair". It... (Observational Study)
Observational Study
BACKGROUND
Pilonidal sinus disease (PNSD) is considered as the challenging disease for surgeons since decades. The term pilo-nidal is derived from Latin meaning "nest of hair". It is a commonly occurring disease usually involved young male adults. It is considered as an acquired condition with unidentified aetiology and pathogenesis. The objective was to observe the results of Limberg's flap operation in patients with Pilonidal sinus disease..
METHODS
We performed an observational study at Hamdard University Hospital from 1st January 2016 to 31st December 2019 on patients who came to the outpatient department for the treatment of pilonidal sinus diseases and underwent surgery (Limberg's flap) after consent. The patient's presentation varied from single sinus and dry, multiple sinuses and dry, single sinus with serous discharge, single sinus with pus discharge, and pilonidal abscess. Forty-six patients were selected after applying inclusion and exclusion criteria and operated by Limberg's flap technique.
RESULTS
Results were observed for postoperative seroma, hematoma, wound infection, persistent pain, and recurrence. Out of 46 patients, 30 (65.21%) were male and 16 (34.7%) were female. 28 patients (60.8%) were between 31-40 years of age and 12 patients (26.08%) were between 41-50 years of age. After performing Limberg's flap procedure, 35 patients (76%) had no complications at all. 2 patients (4.3%) had seroma formation. 4 patients had Hematoma formation (8.6%). Two patients (4.3%) patients developed superficial wound infection. 2 patients (4.3%) had persistent pain after 3 months of the procedure. One patient (2.1%) had recurrence during the follow-up period of 12 months.
CONCLUSIONS
Limberg's flap operation is associated with low recurrence as well as a low rate of other complications such as seroma or hematoma formation, wound infection, and persistent pain irrespective of the presentation of the pilonidal sinus.
Topics: Adult; Child; Female; Hematoma; Hospitals; Humans; Male; Pain; Pilonidal Sinus; Recurrence; Seroma; Skin Diseases; Treatment Outcome; Wound Infection
PubMed: 35576277
DOI: 10.55519/JAMC-02-9371 -
La Pediatria Medica E Chirurgica :... Mar 2022Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are... (Review)
Review
Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are available options for the treatment of this pathology, but the ideal technique is still debatable. Analyzing the literature we found out that more recently minimally invasive approaches have been described. In particular, the mechanism of an endoscopic approach relies on the use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to daily activities. Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery. However, very poor reports are available in literature about pediatric population.
Topics: Child; Endoscopy; Humans; Operative Time; Pilonidal Sinus; Treatment Outcome
PubMed: 35293199
DOI: 10.4081/pmc.2022.281 -
Annals of the Royal College of Surgeons... Feb 2023Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and...
INTRODUCTION
Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review.
METHODS
All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used.
RESULTS
A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (>0.05).
CONCLUSIONS
Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.
Topics: Male; Female; Humans; Adult; Treatment Outcome; Follow-Up Studies; Pilonidal Sinus; Retrospective Studies; Lasers
PubMed: 35446708
DOI: 10.1308/rcsann.2022.0005 -
International Journal of Colorectal... Feb 2023There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this...
PURPOSE
There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this disease and to provide more precise information about its incidence.
METHODS
The study included questioning the surgeons and pathologists in Germany in addition to a literature research. The literature investigation included all published articles about pilonidal carcinoma in all languages. The questionnaire included 1050 pathologists and all 834 hospitals with a surgical division in Germany. The outcome measures included the total number of cases, the language of publication, gender, age, country of origin, interval until the diagnosis of carcinoma, and reported incidence based on local studies.
RESULTS
From 1900 to 2022, we found 140 cases of pilonidal sinus carcinoma in 103 articles. The investigation revealed two additional unpublished cases from Germany. The male-to-female ratio was 7.75:1. The countries with the most cases were the USA (35 cases, 25.0%), Spain (13 cases, 9.3%), and Turkey (11 cases, 7.6%). The average age was 54.0 ± 11.8 years and the interval between the diagnosis of the disease and the development of carcinoma was 20.1 ± 14.1 years. There was a parallel increase in reported cases of pilonidal sinus disease and pilonidal carcinoma over the last century. The reported incidence varied from 0.03% to 5.56%. The worldwide calculated incidence equaled 0.17%.
CONCLUSION
Due to underreporting and other causes, the incidence of carcinoma emerging on the background of pilonidal sinus disease is higher than reported.
Topics: Female; Male; Humans; Adult; Middle Aged; Aged; Incidence; Pilonidal Sinus; Carcinoma; Germany; Hospitals
PubMed: 36849571
DOI: 10.1007/s00384-023-04344-6 -
BJS Open Mar 2022There are several surgical options for the management of pilonidal disease, including midline and off midline closure, but prospective studies are rare. The study... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There are several surgical options for the management of pilonidal disease, including midline and off midline closure, but prospective studies are rare. The study hypothesis was that Karydakis flap surgery would result in shorter wound healing and fewer recurrences than excision of pilonidal sinus and suture in the midline.
METHODS
A randomized clinical trial was conducted in two hospitals in Sweden between 2006 and 2015 to compare excision and suture in the midline with Karydakis flap surgery. Adult patients with a chronic pilonidal sinus disease were randomized 1:1 at the outpatient clinic without blinding. Power calculation based on recurrence of 2 per cent for Karydakis flap and 10 per cent for excision and primary closure in the midline required 400 patients with 90 per cent statistical power at 5 per cent significance assuming 10 per cent loss during follow-up. Participants were followed up until complete wound healing; late follow-up after 6-13 years was performed by telephone by two blinded assessors. The two co-primary outcomes were time to complete wound healing and recurrence rate.
RESULTS
The study was terminated early at a planned interim analysis due slow recruitment and a significant difference in primary outcome. In total, 125 patients were randomized, of whom 116 were available for the present analysis. Median wound healing time was 49 days (95 per cent confidence interval (c.i.) 32 to 66) for excision with suture in the midline and 14 days (95 per cent c.i. 12 to 20) for Karydakis flap surgery (P < 0.001). There were five recurrences in each group, after a median follow-up of 11 years (P = 0.753).
CONCLUSION
Karydakis flap surgery for pilonidal sinus disease led to a shorter wound healing time than excision and suture in the midline but no difference in recurrence rates.Registration number: NCT00412659 (http://www.clinicaltrials.gov).
Topics: Adult; Humans; Pilonidal Sinus; Prospective Studies; Recurrence; Surgical Flaps; Sutures
PubMed: 35289848
DOI: 10.1093/bjsopen/zrac007 -
Asian Journal of Surgery Nov 2017Pilonidal sinus disease is frequently observed in the producing population; despite it not being a malignant disease, attention of clinicians to this disease has...
BACKGROUND
Pilonidal sinus disease is frequently observed in the producing population; despite it not being a malignant disease, attention of clinicians to this disease has increased. Studies on this disease have not clearly revealed its prevalence. We aimed to detect its dispersion characteristics in our country.
MATERIALS AND METHODS
Our study was designed as a descriptive study involving a large number of patients. A total of 19,013 candidates, aged between 17 years and 28 years and coming from different regions of the country, who applied to be students or officials of the state's schools and institutions, were enrolled in the study. Examination was performed including the perineal region, the presence of any comorbid diseases was noted, and clinical types of pilonidal sinus disease were detected according to Tezel's classification and recorded.
RESULTS
Pilonidal sinus was detected in a total of 1258 (6.6%) candidates, of whom 72 (0.37%) were female and 1186 (6.23%) male. Our clinical experience showed that pilonidal cysts had a higher incidence in the Turkish population than in other populations, and it was especially increased in individuals of military age.
CONCLUSION
We believe that soldiers coming from different regions of Turkey and candidates applying for auxiliary staff positions provide a small sample group resembling a representation of the whole of Turkey.
Topics: Adolescent; Adult; Age Distribution; Cohort Studies; Female; Humans; Male; Military Personnel; Pilonidal Sinus; Prevalence; Sacrococcygeal Region; Sex Distribution; Turkey; Young Adult
PubMed: 27188235
DOI: 10.1016/j.asjsur.2016.04.001 -
BMJ Case Reports Mar 2019Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of...
Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain. Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity. Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment.
Topics: Abscess; Anti-Bacterial Agents; Breast; Breast Diseases; Combined Modality Therapy; Female; Humans; Middle Aged; Pilonidal Sinus; Recurrence; Treatment Outcome
PubMed: 30936332
DOI: 10.1136/bcr-2018-227381 -
Journal of Cutaneous and Aesthetic... 2019Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various... (Review)
Review
Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
PubMed: 31057263
DOI: 10.4103/JCAS.JCAS_97_18