Pilonidal Sinus Journal (PSJ)
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Laser treatment of pilonidal sinus: Our first experience at the Day Surgery Unit in a University Hospital Centre Zagreb
No full textINTRODUCTION
There are limited data available concerning laser treatment of pilonidal disease. Our study demonstrates a single institution first experience with SiLaC® (Sinus Laser-Assisted Closure, Biolitec, Germany) and analyzes outcomes of this novel approach in pilonidal sinus management.
METHODS
In a prospective study, we analyzed the first 12 patients who underwent laser treatment of pilonidal disease. The aim was to determine the success of pilonidal sinus healing and one-year outcomes (recurrence rate, complications and cosmetic result).
RESULTS
The study analyzed 12 patients treated in a University Hospital, at the Day Surgery Unit over a follow-up period of 12 months. None of the patients had earlier excisional procedure done, but five patients had previous urgent drainage of acute pilonidal abscess. Local anesthesia was used in 8 and general in 4 patients. Patients were discharged on the same day between 4-8 hours postoperatively. One year recurrence rate was 8% (1/12) and complications occurred in just one patient presenting as abscess formation on postoperative day 3, which was successfully treated by incision, drainage and antibiotic therapy. The mean duration of complete orifice closure was 28 days (range 12-41 days).The majority of patients (11/12) were very satisfied with overall cosmetic result after 1 year.
CONCLUSION
SiLaC® is a promising minimally invasive alternative to other methods of pilonidal disease management and it could represent a first-line therapy for less extensive disease. Quick recovery, possibility to utilize
local anesthesia and acceptable cosmetic result are main advantages of this technique, but future larger clinical studies are required to evaluate long term results of this procedure
Towards a classification for sacrococcygeal pilonidal disease – Berlin 2017
No full textIntroduction: Sacrococcygeal Pilonidal Disease (SPD) presents in a variety of patterns. Multiple classifications have been proposed but none are in everyday use. In order to compare treatment outcomes, a method of categorizing is required.
Methods: Discussion over e-mail between several surgeons was performed over a period of 10 months.
Results: Surgeons recognize that SPD presents in a variety of patterns but there is a lack of scientific evidence on which to base a categorization system or treatment.
Conclusion: A simple classification system suitable for everyday use can be defined
Pilonidal sinus of atypical areas: presentation and management
No full textIntroduction: Pilonidal sinus (PNS) is an inflammatory disorder due to hair penetrating the epidermis. It occurs usually in sacro-coccygeal region. Clinical course and management of PNS in atypical areas has never been addressed in a systematic review.Methods: Google scholar was used to identify articles describing pilonidal sinus in any place other than the sacro-coccygeal area.Results: From 37 papers, there were reports of 302 cases of pilonidal sinus occurring in various sites other than sacro-coccygeal area. 253 cases (85%) were male. The age of presentation ranged from 16 to 70 years with average of 24.3 years. The most common atypical sites of pilonidal sinus was umbilicus (91%), followed by hand (4%).Conclusion: Umbilical PNS is the most common one. Pain, swelling and discharge is the usual presentation. Apart from umbilical PNS which is mostly managed conservatively, PNS of atypical sites is managed by excision and primary repair
Another Pilonidal classification - PLLATIN
No full textIntroduction: Pilonidal disease is a troublesome disease of young adults, and associated with real discomfort for the patient. More than 40,000 operations are performed every year in Germany alone.
Methods: Two classification systems are reviewed and novel approach presented.
Results: PLLATIN classification is described: Proximity to anus; Length from distal to proximal sinus; LATeral openings distance from midline; Infection; Number of previous definitive surgery attempts.
Conclusion: Classification systems require validation
Modified Endoscopic Pilonidal Sinus Treatment (mEPSiT): a prospective study of mid to long term results in an Asian population
No full textIntroduction: Surgical treatment of pilonidal sinus disease (PSD) is debated. Endoscopic pilonidal sinus treatment is a new minimally invasive technique with early outcomes reported by the first author and other investigators. Mid to long term results have not been investigated and reported in the Asian population. A modified technique of mEPSiT will be discussed and demonstrated in the form of a video.Methods: A prospective data collection of 20 consecutive patients, with PSD, who had mEPSiT performed from February 2014 to June 2016, at Khoo Teck Puat Hospital, Singapore, was done. Patients with pilonidal abscess were excluded and were managed with incision and drainage or saucerisation. The primary outcome measure for this study was complete wound healing, defined as complete healing of the sinus opening with no discharge and healthy scar. Secondary outcome measures were time taken for complete healing, persistence of sinus, recurrence of PSD and failure of EPSiT. Other surgical outcomes such as operation time, post-operative pain, and use of analgesia were also analyzed.Results: All patients had a good postoperative recovery with no immediate complications. Patients were followed-up for a median period of 71 days (range 26-167days). Complete wound healing was achieved in 80% patients (n=16) and of these 16 patients, 75% (n=12) had complete wound healing in less than two months. No patients were lost to follow-up before complete wound healing. Two patients (10%) had persistence of external opening of pilonidal sinus disease but had no discharge. 2 patients (10%) had recurrence of symptoms after apparent healing.Conclusion: EPSiT is gaining popularity with encouraging results published over the last one or two years. Effectiveness and modifications of this procedure need to be further evaluated in the setting of different population groups and races and in comparison to other treatment modalities of pilonidal sinus disease
Karydakis flap in the management of pilonidal sinus disease: Results of 15 years single author experience
No full textIntroduction: Pilonidal sinus (PS) is notorious for its ability to recur and presents significant challenge to surgeons. Worldwide, surgeons practice different surgical methods and each one has its own concepts and conclusions. Laying the wound open followed by prolonged dressing regimen, lot of time and unsatisfactory results in term of healing and high recurrence rates prompted the surgeons to consider other procedures. Z-plasty, V-Y plasty, W-palsty, Limberg's rhomboid flap, Karydakis advancement flap and Bascom’s technique had been reported with satisfactory healing and low recurrence rates. Karydakis operation is considered best as it addresses the primary aetiological factors.Methods: The present multicenter study was conducted in Services Institute of Medical Sciences, Lahore, Pakistan, King Khalid University Hospital, Riyadh and Almana General Hospital Dammam, Saudi Arabia during the period April 2002 to April 2017. All the cases were operated by the author. Initially 730 patients were recruited for Karydakis operation, 38 patients were excluded as they did not follow up after their first visit. Remaining 692 patients, 636 (92 %) were male. 161 (23.2%) patients had history of PS surgery. Mean age of the patients was 23 years 5 months (16 to 49 years). 175 (25.35 %) patients had a single midline sinus, 269 (38.8%) had multiple midline sinuses and 248 (35.8 %) had unilateral lateral tract in addition midline sinuses. Out of 692 patients, 596 (86.2 %) operations were performed under general anesthesia, 52 (7.6%) under spinal and 44 (6.4%) under local anesthesia. Karydakis flap was done in the all the patients. Patient was divided into groups according their ages and BMI. Mean operating time, blood loss, complications within 30 days and recurrence were the end point of study.Results: Asymmetrical excision of PS was performed as described by Karydakis. Final suture line was 1-1.5 cm away from the midline. Mean operating time was 29 minutes (range 23-70 min), mean blood loss was 26 ml (10-70ml) and mean hospital stay 3 days (range 2-7 days). All patients tolerated the procedure. Complications occurred in 80 (11.76 %). 26 (3.8 %) patients developed major wound infection requiring opening of the suture and regular dressing followed by secondary suturing. 35 (5.2%) patients developed minor wound infection, 15 (2.16%) patients developed seroma and 18 (2.6%) patients had leakage of serous fluid from drain site. There were only 18 (2.6 %) recurrences during the follow up period of 23 months (range 11 months to 4 years). 14 patient with recurrence were obese (BMI > 35) who could not maintain their personal hygiene according to the given advice. Majority of the patients were satisfied with the procedure.Conclusion: Karydakis flap is a logical approach in PS. It addresses the aetiological factors making the natal cleft shallow, is less time consuming compared to other flaps and is not associated with a scar in the midline which could result in recurrence. Recurrence rate is low on short and long term follow up
Endoscopic Pilonidal Sinus Abscess Drainage EPSiAD
No full textIntroduction: Pilonidal Sinus abscess drainage with Storz Fistuloscope has been a boon to early healing, minimal morbidity and time off from work. Patients can resume work early. The procedure can be done under local anesthesia.Methods: Requirements: Storz Fistuloscope, laparoscopic camera, light source & cable, glycine 3 liter with manitol 100 ml 20%w/v, mono-polar underwater cautery. Position: left lateral or prone. Anesthesia: Local anesthesia or spinal. Procedure: incision as lateral as possible or through draining site in case of ruptured pilonidal abscess. Clean, wash, curettage, cauterize walls. Inject methylene blue to look for secondary sinus tracks. Keep fenestrated tube drain for post op wash for first 2 days.Results: Post op results: Drainage stops in 48 hours. Cavity shrinks in 5-7 days. No need for a dressing after 10 days.Conclusion: Endoscopic Pilonidal Sinus abscess drainage is a simplified technique of draining effectively the abscess. Patient has minimal pain, early recovery and return to work. The wound size is 5mm diameter, and heals from base upwards. Recurrence seen in one patient, repeat endoscopic drainage procedure was acceptable to the patient. As the procedure allows a thorough visualization of the abscess cavity, the surgeon can manage the problem more efficiently
Dermato traction : a new device to improve scarring after pilonidal sinus excision
No full textexisting approaches in the pilonidal sinus treatment: The first one is to not close the wound and to achieve a controlled wound healing which is often a long and painful procedure with and important impact on social life.The second is the initial drain free closure which can easily become infected, resulting in dehiscence.We propose an alternative solution by introducing a new medical device which has obtained its CE marking in June 2016: the Mid Sew. It is an elastic thread that accelerates wound healing by providing a partial closure. This suture has dynamic proprieties.Methods: These were always secondary excisions performed long enough from the initial inflammatory episode. The patient is operated in the ventral decubitus and the cyst is resected to the post sacral fascia after the injection of blue carmen dye via the fistula. The Mid Sew is then tensioned in the upper part of the incision and a drain wick is left in place. The elastic device is left in place for about ten days. Technique is illustrated in Figures 1 – 3.Results: 15 clinical cases were treated with Mid Sew. We observed 4 complications, two of which were directly related to the new device: 2 wire breaks and 2 hyperalgesic patients. Healing occurred on average at 35 days. Figure 4 shows unhealed wound.Conclusion: This preliminary study encourages us to continue the experiment. The surgical technique deserves to be improve. Total high perianal wick closure or partial closure full height? Use only wire or use with soft paddings and foam protection? A European multi-centric study could be put in place in the near future
Approach To Interdigital Pilonidal Sinus – Extended case report and literature summary
No full textIntroduction: Interdigital pilonidal sinus disease, also called “Barber’s Disease,” is an acquired occupational disease. It is much less prevalent than sacrococcygeal pilonidal sinus disease and it occurs between the fingers and toes.Methods: Two new cases are reported. 50 cases were identified through a PubMed search.Results: Incidence of this disease is not known. It is caused by the penetration of newly cut, short, and sharp hair through interdigital skin. Surgical excision and primary closure is the accepted treatment.Conclusion: Because of the complex structure of the hand, preoperative determination of excision margins is important. It is thought that protective measures may be of some benefit in preventing this occupationally acquired disease. Surgical treatment of interdigital pilonidal sinus disease is reviewed
Surgical Treatment of Sacrococcygeal Pilonidal Sinus Disease with "Non-Touch" Method
No full textIntroduction: Pilonidal sinus disease is a chronic illness with acute episodes, which is very common in the society, primarily in males. It is often symptomatic in young adults. Even today, recurrence of the pilonidal sinus after surgery and wound dehiscence occur following surgery. In this study, we discuss the results of a specific surgical treatment of complicated pilonidal sinus cases: "Non-Touch" method. We review the literature.Methods: Between June 2010 and June 2017, all hospital records of patients with complicated pilonidal sinus treated in our group were reviewed retrospectively. Demographic characteristics, treatment methods and results of the patients were evaluated. The results were compared with the results of the methods applied in the literature. “Non-Touch” excision was employed in all patients to avoid hanging from the lesion.Results: Thirty-two patients were involved in the study. 21 (65.6%) were male and 11 were female (34.4%). Mean age at operation was 34.2 ± 3.5 years (range: 14-85). Karydakis method was applied in 18 cases (56.2%), Limberg method in 14 cases (43,8%). Pilonidal sinus excision (“Non touch” excision) was performed with primary surgery by hanging from the lesion corners. The mean hospital stay was 2.1 days. Antibiotic treatment with cefazolin and metronidazole and dressings were continued for 2 weeks. Sutures were taken out at 2 weeks. During follow-up, patient recovery was smooth. Wound infection occurred in 2 cases (6.3%).Conclusion: In pilonidal sinus surgery, the incision is suspended with the sutures from the corners and we think that the wound edges will be gently held with fine-threaded clamps to speed up wound healing, reduce wound infections and prevent recurrences