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The Israel Medical Association Journal... Feb 2022Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of... (Comparative Study)
Comparative Study
BACKGROUND
Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of minimally invasive surgeries.
OBJECTIVES
To compare the efficacy of wide excision operations and minimal trephine surgery in patients with primary pilonidal disease.
METHODS
In this retrospective study we examined surgical and inpatient records of 2039 patients who underwent surgery for primary pilonidal disease in five private hospitals between 2009 and 2012. Most procedures were of lay-open, primary midline closure, and minimal surgery types. Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons each performing one type of surgery, regardless of patient characteristics or disease severity.
RESULTS
With a mean follow-up of 7.2 years, 81.5%, 85%, and 88% of patients were disease-free after minimally invasive surgery, wide excision with primary closure, and lay-open surgery, respectively, with no statistically significant difference in recurrence rates. Minimal surgeries were usually performed under local anesthesia and involved lower pain levels, less need for analgesics, and shorter hospital stays than wide excision operations, which were normally performed under general anesthesia. The use of drainage, antibiotics, or methylene blue had no effect on recurrence of pilonidal disease.
CONCLUSIONS
Minimally invasive surgeries have the advantage of reducing the extent of surgical injury and preserving patient's quality of life. They should be the treatment of choice for primary pilonidal disease.
Topics: Adolescent; Adult; Aged; Analgesics; Anesthesia, General; Anesthesia, Local; Child; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative; Pilonidal Sinus; Quality of Life; Recurrence; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 35187897
DOI: No ID Found -
Cureus Jul 2022Introduction Although there are several methods used in the treatment of pilonidal sinus, research is still ongoing for the most effective method. Minimally invasive...
Evaluation of the Early Outcomes of Laser-Endoscopic Pilonidal Sinus Treatment Combination and Comparison With the Combination of Cautery-Phenol-Endoscopic Pilonidal Sinus Treatment.
Introduction Although there are several methods used in the treatment of pilonidal sinus, research is still ongoing for the most effective method. Minimally invasive surgical methods, alone or in combination, are currently considered the closest treatment modalities to the ideal. The purpose of this study was to evaluate the early outcomes of laser-endoscopic pilonidal sinus treatment combination and compare it with the combination of phenol-cautery-endoscopic pilonidal sinus treatment. Materials and methods This is a retrospective study of 42 patients with pilonidal sinus disease treated between September 2020 and April 2022. A total of 26 participants in group one were treated with the laser-endoscopic pilonidal sinus treatment combination, and the remaining 16 in group two were treated with the cautery-phenol-endoscopic pilonidal sinus treatment combination. Both primary and recurrent patients over 16 years of age without active infection were included. In the postoperative period, each patient was followed up at the outpatient clinic. Perioperative and follow-up data were recorded. Results Patients were predominantly male. There was no significant difference between the two groups with regards to the time to return to daily life, pain-free walking, recovery time, and recurrence. However, in group one, the operation time was statistically shorter (p = 0.02), and the rate of sitting on the toilet without pain on the day of surgery was significantly higher (p = 0.029). In addition, none of the patients in this group needed painkillers and all returned to work earlier. Conclusion The combination of laser-endoscopic pilonidal sinus treatment is a feasible procedure with a 92.3% complete recovery rate according to the early results. However, studies with a larger sample size and longer follow-up period are required to confirm the validity of our results.
PubMed: 35989794
DOI: 10.7759/cureus.26948 -
Turkish Journal of Surgery Dec 2021This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus...
OBJECTIVES
This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus disease treated in single step and to investigate the feasibility of final pilonidal sinus treatment in single step in patients with pilonidal abscess.
MATERIAL AND METHODS
A total of 58 patients who were operated on using the marsupialization method were included in this study. Patients with acute pilonidal abscess were included in Group 1 (23 patients) and those with chronic pilonidal sinus disease were included in Group 2 (35 patients). Pilonidal sinus was excised as a whole by a vertical elliptic incision, with some surrounding intact tissue. After excision, the wound edges were sutured to the postsacral fascia. Daily dressings were performed by relatives at home. The patients were instructed to visit the hospital for follow-up 1-2 times a week. Student's t-test was used to compare the parameters between the groups.
RESULTS
The mean wound length was 73.4 and 61.7 mm in Group 1 and Group 2, respectively. The mean duration of wound closure was 59.3 and 54.1 days in Group 1 and Group 2, respectively. There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1.
CONCLUSION
The definitive treatment of acute pilonidal abscess can be achieved in single step by using marsupialization method as well as in patients with chronic pilonidal disease.
PubMed: 35677490
DOI: 10.47717/turkjsurg.2021.5002 -
European Journal of Pediatrics Jan 2023Quality of life (QOL) outcome is an ideal method for determining the efficacy of a surgical treatment. In children operated for pilonidal sinus disease (PSD), open... (Review)
Review
UNLABELLED
Quality of life (QOL) outcome is an ideal method for determining the efficacy of a surgical treatment. In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates. Endoscopic treatment (PEPSIT) overcomes these limitations. We report our experience in the management of PSD to evaluate the QOL of patients undergoing open and endoscopic treatment. The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed. Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2). We analyzed QOL through the following criteria: hospital stay (HS), healing time (HT), return to sport (RTSp), return to school (RTSc), resumption of social life (RSL), and recurrence rate and reoperation (RRR). Moreover, we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) for a more subjective evaluation of life satisfaction. We found significant differences in all the analyzed criteria: HS varied from 3 to 7 days in G1 and from 1 to 2 days in G2; HT from 40 to 75 days in G1 while from 20 to 41 days in G2; RTSp from 50 to 80 days in G1 while from 7 to 21 days in G2; RTSc from 9 to 15 days in G1 while from 2 to 4 days in G2; RSL from 13 to 20 days in G1 while from 2 to 5 days in G2; RRR was 25% in G1 and 4.4% in G2.
CONCLUSION
Endoscopic treatment (PEPSIT) significantly improves the quality of life of patients operated for PSD. Compared to open surgery, PEPSIT presents shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, and lower rates of recurrence and reoperation. In addition, PQ-LES-Q demonstrated a good overall quality of life and life satisfaction. Further prospective studies should be obtained to consider PEPSIT as the gold standard for the treatment of PSD in pediatric patients.
WHAT IS KNOWN
• Many techniques have been proposed in the last 20 years for the surgical treatment of PSD. • PEPSIT is showing promising results in terms of safety and long-term efficacy.
WHAT IS NEW
• The main impact in QOL of patients operated with PEPSIT is on their daily activity, including a shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, lower rates of recurrence and reoperation. • After PEPSIT, children maintain a satisfactory quality of life according to the analysis of PQ-LES-Q.
Topics: Humans; Child; Treatment Outcome; Quality of Life; Pilonidal Sinus; Prospective Studies; Retrospective Studies; Neoplasm Recurrence, Local; Skin Diseases; Recurrence
PubMed: 36348071
DOI: 10.1007/s00431-022-04678-3 -
Dermatology Online Journal Jun 2013Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest... (Review)
Review
Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.
Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Arthritis; Autoimmune Diseases; Cellulitis; Chronic Pain; Comorbidity; Depressive Disorder; Hair Follicle; Hidradenitis Suppurativa; Inflammatory Bowel Diseases; Keratosis; Metabolic Syndrome; Obesity; Pilonidal Sinus; Pyoderma Gangrenosum; Staphylococcal Skin Infections
PubMed: 24011308
DOI: No ID Found -
Annals of Coloproctology Dec 2015Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis...
Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.
PubMed: 26817020
DOI: 10.3393/ac.2015.31.6.243 -
Annals of Coloproctology Apr 2021This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure).
PURPOSE
This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure).
METHODS
The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed.
RESULTS
Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks.
CONCLUSION
The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.
PubMed: 33171038
DOI: 10.3393/ac.2019.11.19.2 -
JSLS : Journal of the Society of... 2017Pilonidal sinus is a common problem in the sacrococcygeal region, especially in obese, sedentary young men. The ideal surgical solution is still under debate, and there... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Pilonidal sinus is a common problem in the sacrococcygeal region, especially in obese, sedentary young men. The ideal surgical solution is still under debate, and there is a high rate of recurrence. In the present study, we analyzed the long-term results of a video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease: endoscopic pilonidal sinus treatment (EPSiT).
METHODS
From October 2013 through November 2015, a total of 77 consecutive patients (69 Males and 8 Females, median age: 23 y) were referred to our colorectal units. Sixty-eight patients had a primary sacrococcygeal pilonidal sinus, and 9 had recurrent pilonidal sinus; all underwent EPSiT. A fistuloscope was introduced through an external opening and the sinus cavity was completely ablated under direct vision. Postoperative complications, wound infection rate, recurrence rate, time until return to work, and patient satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7, 15, and 30 days and at 6, 12, and 24 months after surgery.
RESULTS
All patients completed the follow-up (median follow-up was 25 (range, 17-40) months. Median operative time was 18 (range, 12-30) minutes. The median hospital stay was 6.5 (range, 5-9) hours, and the median time to return to work was 5 days. Median healing time was 26 (range, 15-45) days. There were no major or minor complications. Six patients experienced recurrence. The overall satisfaction rate was 97%.
CONCLUSIONS
The ideal surgical treatment for pilonidal sinus disease should be simple and effective. In our experience, EPSiT can be performed as a day surgery, with early return to daily activities. This technique is an uneventful procedure, with good aesthetic results and a low recurrence rate.
Topics: Adolescent; Adult; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pilonidal Sinus; Prospective Studies; Treatment Outcome; Video-Assisted Surgery; Young Adult
PubMed: 28904522
DOI: 10.4293/JSLS.2017.00043 -
Biomedical Journal Dec 2019In this issue of the Biomedical Journal, we learn that the sport injury-prone knee ligaments might harbour their own repair kit in the form of mesenchymal stem cells,...
In this issue of the Biomedical Journal, we learn that the sport injury-prone knee ligaments might harbour their own repair kit in the form of mesenchymal stem cells, and that TERT transformation helps to keep these cells longer in culture for more extensive studies. In addition, we get a demonstration that diffusion tensor imaging can reliably show the activity of specific neural circuits, that rheumatoid arthritis patients are more prone to insulin resistance, and that platelet-enriched plasma gels significantly improve wound healing after pilonidal sinus surgery. Furthermore, two procreation-related articles inform us that growth hormone treatment improves endometrial receptivity in older women, and that elevated maternal liver enzymes do not impact on the outcome of laser therapy for twin-twin transfusion syndrome. Finally, our attention is brought to the importance of subjective well-being evaluation for orthodontic correction needs, as well as the possibility that exercise could maybe increase sperm telomere length.
Topics: Aged; Anterior Cruciate Ligament; Cell Line; Diffusion Tensor Imaging; Female; Humans; Mesenchymal Stem Cells; Telomerase; Wound Healing
PubMed: 31948600
DOI: 10.1016/j.bj.2019.12.001 -
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