Pilonidal Sinus Journal (PSJ)
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The Associated Microbiology of pilonidal Sinus Disease in a Small Rural Hospital
No full textoai:ojs2.www.pilonidal.com.au:article/4Introduction: Microbiology of pilonidal disease is usually polymicrobial with a predominance of anaerobic organisms but limited data exists as to standard antibiotic therapy.Methods: Patients with pilonidal sinus disease who had a pus sample sent for microbiological studies were identified retrospectively.Results: 21 swabs from 15 patients over a 12 month period. 7 patients had a chronic pilonidal sinus and 8 had an abscess. 20 / 21 (95.2%) cultured anaerobic bacteria. No consensus existed within our own data as to antibiotic prophylaxis at the time of surgery, nor as to whether antibiotics should be continued post abscess drainage.Conclusion: The microbiology of pilonidal disease was predominantly anaerobic and polymicrobial
Australian Pilonidal Sinus Society
No full textThe Australian Pilonidal Sinus Society (APSS: www.pilonidal.com.au) was set up with the aim of improving patient outcomes through surgeon, researcher and patient collaboration. APSS publishes the quarterly Pilonidal Sinus Journal (PSJ). Membership is open to surgeons as well as trainees and researchers. APSS communicates by a monthly email. The web site also allows patients to find a surgeon
Skin preserving pit excision, so-called pit picking
No full textIntroduction: Potential advantages of minimally invasive surgery have been topical over last few decades. Results of minimally invasive surgery for pilonidal sinus are presented: skin-preserving pit picking as a “how I do it – presentation”.Methods: All fistula tracts were excised by 3.5 mm punch biopsy needle. Tracts leading to subcutaneous cavities were then excised down to the cavity. Pits were left open or sutured with absorbable sutures.Results: From January 2014 to November 2016, 19 patients underwent pit picking. The mean age was 27.4 years and the majority (17 of 19 patients) were male. Mean body mass index was 24.5 kg/m2. The mean duration of surgery was 6 minutes (± 3 minutes). On average 2 pits (± 1) were excised. 5 Wound healing disorders were observed, which were considered as recurrence: actuarial recurrence rate 18% after 12 months.Conclusion: Pit picking is a fast and safe procedure with a low perioperative and postoperative complication rate. Nevertheless, pit picking is no panacea and further data are necessary to evaluate which patients might benefit most from this as a primary treatment option
Stop insulting the patient: neither incidence nor recurrence of pilonidal sinus disease is linked to personal hygiene.
No full textINTRODUCTION: Pilonidal sinus disease (PSD) has been correlated with excessive sweating, exposure to adverse conditions such as military service, war, prolonged jeep driving, and also with inadequate personal hygiene. Aiming to destigmatise PSD, the purpose of this study was to shed light on the impact of obesity, sweating and chronically intermittent contamination of the rima ani, especially in the cohorts of extreme ages on the incidence and recurrence of PSD.METHODS: Literature and epidemiological German data for the years 2000 to 2012 were reviewed and analysed. Pairwise comparisons were performed using the Wilcoxon rank sum test, median and mean values were supplemented with bootstrap confidence intervals. Cumulative abundances of explantations were fitted with a logistic model to compare the qualitative properties of individual methods.
RESULTS: Our investigation does not support an association between incidence and recurrence of PSD with exemplary measures of personal hygiene such as more often and longer contact of skin with sweat, faeces and urine in the intergluteal fold.
CONCLUSIONS: Neither urine or faecal contamination nor a potential increase in sweating due to higher BMI promote PSD incidence. The causative factors of pilonidal disease still remain incompletely understood till today. Patients who are blighted with PSD classically experience embarrassing recurrent infections before the disease is surgically cured; they should not be further insulted by emphasizing “maintaining exquisite personal hygiene” in the discharge letter. Recommending this is insulting and neither prevents the development of PSD nor its recurrence
Injection of combined seclerosing agent and herbal product may replace surgical management of pilonidal sinus disease
No full textIntroduction: Pilonidal sinus disease (PNS) is a common perianal disorder. Although it has been described for a long time, none of the current management modalities seem to represent the ideal treatment.Methods: In this prospective, case series study, we describe the effectiveness of a mixture (composed of a sclerosing agent with a herbal product (Lawsonia Inermis powder)). The preparation was applied in outpatient clinic without anaesthesia with mean duration of follow up of about 2 years.Results: The study included 203 patients. One hundred fifty seven of them (77.34%) were male, 146 (22.66%) cases were female. Seventy percent received a single session of mixture application, 20% received two sessions and 10% three sessions. One hundred seventy eight patients (87.69%) were cured of PNS. The mean duration from the intervention to cure was 5 weeks. The only reported side effect was pain which was continued for about 24 hours and responded to non-steroidal anti-inflammatory analgesia. There was no loss of daily activity. There were no hospital admissions.Conclusion: Local application of combined sclerosing agent and a herbal product is an effective treatment of PNS. It is cheap and safe with minimal complication rate
Endoscopic management of recurrent pilonidal sinus communicating with anal fistula: Non-extirpative solution to a unique problem.
No full textIntroduction: Communication between pilonidal sinus (PNS) and anal fistula is unusual. Extirpative surgery can be mutilating and associated with prolonged healing time.Methods: 32 year young male, operated elsewhere 7 months previously for pilonidal sinus and fistula-in-ano, presented with recurrent discharge and pain in lower back with 2 discharging openings over the sacro-coccygeal region. Preoperative imaging by CT sinography did not confirm communication of PNS with anal canal.Under general anesthesia, Meinero’s Fistuloscope was used to access the sinus openings, followed by thorough debridement, cleaning and fulguration of PNS tract. Upon completion to level of coccyx, visualization with pressurized saline helped to diagnose communication with anal fistula by free egress of saline through anal canal. Scope was angled and advanced to anal communication tract and managed similarly. Anal fistulous opening was corrected by rectal advancement flap.Surgery could be accomplished with no fresh surgical opening without any tissue extirpation or volume loss.Results: Patient was discharged on first postoperative day in pain free condition and could return to work within the first week. Regular (once every week for 4 weeks) cleaning of openings was done in out-patient department, after which these closed spontaneously. At short follow-up of 3 months he was free of complications, without any pain or fresh discharge. Quality of life scoring was impressive.Conclusion Accarpio in 1988, described one similar case out of a series of 5 cases, of pilonidal sinus communicating with anal fistula. Feigen in 1956 described a series of cases with pilonidal sinus fistulizing to perianal area, not inside the anal canal. Other case reports of intra-anal pilonidal sinus with presence of hair tuft within anal opening, have been described. Ours is a unique case similar to one described previously by Acarpio in 1988, with a long tract connecting the pilonidal sinus with anal fistulous opening. Careful attention during clinical examination can provide clue to such a unique diagnosis.Surgical treatment aims to: adequately debride the whole of tract; prevent repeated contamination from anal fistula by either rectal advancement or inter-sphincteric ligation of tract; sacro-coccygeal part is dealt by providing external drainage until the tract heals completely. We have been successful in fulfilling these principles by the endoscopic method, though surgically laying open of the tract has also been attempted.Endoscopy has the additional advantage of magnified well illuminated vision with improved diagnostic capability and ability to check adequacy of procedure upon completion. The high pressure of saline used in combination with Volkman’s spoon has tremendous cleaning effect with adequate debridement. Non-extirpation and no disturbance of tissue architecture helps in rapid healing. Spectrum of sepsis/ fistulisation of ano-recto-coccygeal region is diverse and awareness of communication of anal fistula with pilonidal sinus is important to diagnose and manage. Endoscopic technique offers advantages of adequate surgical management and quick recovery, without mutilation or loss of gross tissue architecture
Pilonidal sinus of the face: presentation and management - a literature review.
No full textIntroduction: Pilonidal sinus (PNS) occurs commonly in the sacrococcygeal area. However, it may also occasionally occur in other areas. PNS of the face is rarely reported in the literature. The aim of the current review is to highlight the presentation and management of PNS occurring on the face.
Methods: Literature search using 4 search engines.
Results: 9 patients with facial pilonidal sinus were found. Presentation and management of PNS occurring on the face are discussed.Conclusion: Facial PNS occurs commonly in males with predominantly nose involvement. Excision with primary repair under general anesthesia is the main modality of treatment
Comparative Clinical Evaluation Of Ksharasutra (Indian Seton 800 BCE) With Surgical Excision In The Management Of Pilonidal Sinus - A Review
No full textIntroduction: Pilonidal sinus is a common disease that mostly affects young people. Although various surgical techniques have been described for treating sacrococcygeal pilonidal disease (SPD), controversy still exists as to the best surgical technique. The purpose of this study was to compare the efficiency and short-term and long-term results of the Ksharasutra technique (Indian seton 800 BCE) with that of surgical excision.Methods: In this prospective randomized study, 69 patients with SPD were recruited to undergo either the Ksharasutra (Indian seton) (n = 39) or surgical excision (n = 30) between September 2010 and September 2016.Surgical excision. The operation was carried out with patients in the prone position. Shaving of the operative area was performed just before the operation, and the skin was cleaned with an antiseptic solution. Local anaesthesia was applied in the subcutaneous skin around the orifices using 2% lidocaine solution with adrenaline. Entrance to the sinus opening was made with a small incision. The incision technique was preferred to ensure better communication of the openings. Minimal bleeding was stopped using compression. Curettage was used for cleaning all cavities and tracts from hair, debris, and granulation tissue. The cavity was packed with a sterile dressing.Ksharasutra (Indian seton) application: with the above asceptic procedure, the pilonidal sinus track was probed from the external opening to the weak point of the track near by anal canal and thus was tied with ksharasutra (Indian seton). Every week the thread was changed until the sinus healed.Results: The cutting time in Ksharasutra (Indian seton), the visual analogue scale score for postoperative pain, discharge and wound healing were assessed and subjected for statistical evaluation. This showed Ksharasutra (Indian seton) was superior to surgical excision with p < 0.01.Conclusion: This clinical trial showed the Ksharasutra (Indian seton 800 BCE) to be superior to surgical excision. The statistical evaluation also confirmed the same with the p value of 0.01 in all parameters
The outcomes of ultrasonic curettage of pilonidal abscess
No full textIntroduction: 3% of Ukraine population suffer from pilonidal sinus. A commonly accepted approach to surgical management patients with acute pilonidal abscess hasn't been developed. Some propose a two-stage procedure: incision of an acute pilonidal abscess (first stage) followed by planned radical excisional surgery (cleft-lift, flap procedures, Karydakis etc. – the second stage). Others propose to perform delayed radical surgery after cleaning the acute pilonidal abscess (Bascom's pit picking procedure). Others perform one-stage radical operation in stage of acute pilonidal abscess. The aim of research was to estimate the results of surgical treatment of acute pilonidal abscess with using ultrasonic curettage of pilonidal abscess.Methods: Outcomes of surgical treatment of 102 patients with acute piolonidal abscess are presented. Control group - 54 (52.9%) patients who were treated by Karydakis operation (as the second stage of two-stage surgery) and main group - 48 (47.1 %) who were treated by the developed method of the ultrasonic curettage of pilonidal abscess. All Patients had no secondary openings. The ultrasonic curettage of pilonidal abscess was performed under local anesthesia. 1.0-1.5cm incision over the area of maximum fluctuation parallel and away from midline was performed (Figure 1). The ultrasonic curettage of pilonidal sinus was conducted with using "Sonoca-190" device («Suring», Germany), as an intermediary substance we used 0.25% solution of Novocaine. Ultrasonic excision of the abscess cavity was performed using unipolar hoof-type wave-conductor with these features: frequency of oscillation was 25kHz; wave amplitude was 40-80 μm; duration of sonication was 3-5 min (depending of the size of abscess). Through the treated abscess cavity toward to primary opening(s) the gutter-type probe was conducted. Along the bottom of probe's gutter, incision was performed of 1.0-2.0 cm in length strictly along the midline, with obligatory dissection of all primary openings (Figure 1). Through this incision ultrasonic curettage was performed with these characteristics: frequency of oscillation 25kHz; wave amplitude 100-120 μm; duration of sonication was determined by the time necessary for complete removing all visualized fragments of the pilonidal sinus and appearance of well-marked diffuse petechial bleeding from the wound walls. In the event of a bilateral abscess, only one incision was performed (on the caudal end of the gluteal cleft) as in Figure 2. Wounds were managed by open method: repeated sonication of wound every 1-2 days was performed until the perifocal inflammatory process associated with pilonidal abscess had completely subsided and the wound was free of detritus and hairs.Results: The control and the main group of the patients didn’t significantly differ by gender (χ2 = 0.35; p = 0.55) and age (t = 0.12; p = 0.90) of patients. The results of patients' treatment have been estimated in terms from 2 to 4 years. The control and the main group of the patients didn’t significantly differ by gender (χ2 = 0.35; p = 0.55) and age (t = 0.12; p = 0.90) of patients. The results of patients' treatment have been estimated in terms from 2 to 4 years
Pilonidal Sinus: From Then to Now but where to Next?
No full textIntroduction: Pilonidal Sinus has been described in the literature since 1880. To understand where we are going, we need to know where we have been.Methods: Prominent surgical and medical journals have been searched for the term pilonidal sinus and some of the earliest articles in English were reviewed.Results: Importantly, early literature demonstrates a significant rate of acute surgical failure and a disturbing recurrence rate. Over time, the description of etiology has moved from congenital to acquired. Marsupialization has been replaced by excision with off midline closure. Whether every abscess should be followed by excision remains unclear.Conclusion: Unfortunately “The diagnosis once established, the problem of treatment is easily solved” is still not true