Pilonidal Sinus Journal (PSJ)
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Dorsosacral myxoma mimicking Pilonidal Sinus
No full textIntroduction: Sacrococcygeal Pilonidal Sinus Disease has a classical appearance. Rarely unrelated pathology may occur in the natal cleft.
Methods: Case report with follow up.
Results: 40 year old male with a 2 centimeter dorsosacral mass underwent excision with modified Limberg flap. Pre-operative Magnetic Resonance Imaging reported a pilonidal sinus without fistula opening. Histological examination revealed the mass to be a myxoma.
Conclusion: We present a quite uncommon case of postsacral myxoma, mimicking a pilonidal sinus. If midline pits are missing in uninflamed disease, there may be some diagnostic challenge to distinguish a – rare – myxoma from common Pilonidal Sinus Disease
Intermammary pilonidal sinus: case presentation and management
No full textoccurs usually in the sacro-coccygeal area. Intermammary pilonidal sinus is a very rare variant with few case reports. The aim of this study is to highlight the presentation and management of intermammary PNS.Methods: A retrospective multicenter case series including all cases of intermammary PNS admitted to any of 5 major tertiary hospitals in Kurdistan region of Iraq. Inclusion criteria were any case of intermammary PNS diagnosed by histopathological examination. The data were taken from the medical records and direct patient interviews.Results: The study included eleven cases, all of them were female. Ages ranged from 13 to 28 years with mean of 20.3 years. All had a body mass index (BMI) ranging from 30 to 32 kg/m2 with mean of 30.6 kg/m2. Three (27%) had a history of sacro-coccygeal PNS. Four (36%) presented with recurrence. All presented with discharge ranging from 5 weeks to 2 years (mean 8 months). Definitive preoperative diagnosis was made in three. Others were diagnosed preoperatively as sebaceous cysts. Resection and direct closure without flap were done for eight of them and the other three were excised and left for secondary healing. Three recurred.Conclusion: Intermammary PNS although uncommon, is a special clinical entity occurring in young, obese women with large breasts - possibly hair is trapped in tight brassieres. Resection and primary closure without flap is the most often used treatment method
Limberg flap technique for sacrococcygeal pilonidal sinus surgery: a report of 192 cases
No full textIntroduction: Pilonidal sinus disease commonly occurs in young adult males. Many surgical methods have been described - some have a high recurrence rate. The aim of this study was to evaluate the Limberg flap technique and relationship of the diseases genetic and environmental factors.Methods: The Limberg flap was performed as shown in Figure 1.Results: The mean duration of hospital stay was 3.55 ± 2.75 (range 2–17) days. One hundred forty nine patients (78%) had recurrent disease. Recurrences were observed in 6 patients (3.1%) at the end of the follow up period. Contrary to what is suspected, only 8 (4.1 %) patients had positive family history.Conclusion: Low complication and recurrence rate are important hallmarks of the Limberg flap. Limberg flap may be an ideal operation for pilonidal sinus disease. Regional factors were not associated with genetic factors. Further prospective clinical trials are needed to show the effectiveness of this technique
Minimal Excision and Primary Suture is a Cost-Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population-Based Interventional and a Cross-Sectional Cohort Study
No full textIntroduction: Conventional treatment of pilonidal disease with wide excision is associated with high morbidity. We describe the short- and long-term results and the impact on the health care system of a simple operation performed in the office under local anaesthesia, consisting of minimal excision of pilonidal sinuses with primary suture—the modified Lord–Millar operation (mLM).Methods: All patients operated with mLM from February 2008 till November 2012 were prospectively followed for recurrence by telephone interviews and examination of symptomatic patients till July 2015. The outcome is compared with that in all patients operated with conventional wide excision from January 2003 till February 2008. The effects on the health care system of a consistent use of mLM is analysed by comparing the management of all patients with pilonidal disease at three hospitals during 2013 and 2014.Results: Some 129 patients underwent conventional surgical treatment, and 113 had the mLM operation. The mLM operation was more often performed under local anaesthesia, was less often admitted to hospital, had fewer postoperative health care visits (2.4 vs. 14.6, p\0.001) and a shorter sick leave (1.0 vs. 34.7 days, p\0.001) indicating faster wound healing. The estimated 5-year recurrence rate was similar (32 vs. 23%, p = 0.091). The cost per operated patient was lower (2231 vs. 6222 EUR, p\0.001). The hospital consistently applying the mLM operation used less resources for pilonidal diseased patients (34,545 vs. 77,421 EUR per 100,000 inhabitants and year).Conclusion: The mLM operation is simple, cost-efficient and has low morbidity and good long-term results
Pilonidal Sinus Journal
No full textAs the first issue of the Pilonidal Sinus Journal (PSJ) goes to press, the most recent publication onthis condition on PubMed is titled “Effectiveness of Limberg and Karydakis flap in recurrentpilonidal sinus disease". Bali et al. found no difference in the recurrence rates but differentrates of surgical site complications. How much has our knowledge base changed since the earlypublications on pilonidal sinus
Recurrence rate after the Karydakis flap versus excision-only techniques for sacrococcygeal pilonidal disease
No full textIntroduction: Karydakis flap and Excision with Healing by Secondary Intention (EHSI) are among surgical procedures for Sacrococcygeal Pilonidal Disease (SPD). Various recurrence rates have been reported following these two procedures. This study describes recurrence rate in a large series of patients in these two groups.Methods: In this retrospective analytic cohort study, patients with SPD who underwent Karydakis flap (Group A) and EHSI (Groups B) were included. Patients were followed up for a minimum of 6 months and recurrence was recorded in each case. Recurrence rate was compared between the groups. Age and sex were also considered in the analysis.Results: 477 patients were studied (381 males, 96 females). Group A had 276 patients (male=231, female=45) and group B 201 patients (male=150, female=51). Mean age of patients was 26.23±7.94 years (A:26.81±8.13, B:25.58±7.78). Recurrence rate was significantly lower (P=0.001) in group A (1.1%: 2 males) versus B (9%: 10 males and 3 females). Average time from the operation to recurrence was 979±233 and 644±457 days, respectively (P=0.42). In the EHSI group (B) average days to recurrence revealed no significant difference among the sexes (male:753±537 versus female:620±471, P=0.73). Age of patients with recurrence was also statistically similar in both groups (A:22.50±6.36, B:22.31±6.25, P=0.968).Conclusion: Although the recurrence rate following the Karydakis flap was significantly lower than the EHSI procedure for the patients with SPD, the average time from the surgical procedure to recurrence was similar in both groups and sexes
Pilonidal Sinus Disease surveys
No full textIntroduction: A number of international guidelines have recently been developed to minimize variability in the treatment of pilonidal sinus disease (PSD). The aim of this study was to identify surgeon opinions and current practice in relation to technical aspects of elective surgery for PSD.Methods: A nine-question survey, focusing on clinical decision-making and operation selection, was sent to authors whose PSD publications were indexed by the PubMed database. Additional relevant PSD surveys were identified by literature search of Internet databases.Results: 56 surgeons responded to our survey (15%). The most common techniques employed were off-midline flap procedures (38%) followed by excision with midline closure (16%). 83% of surgeons excise all secondary sinuses when possible. Literature review identified one contemporary patient and two surgeon response surveys.Conclusion: PSD surgery and outcomes remain highly variable. Many surgeons continue to perform midline excision with or without closure
Perioperative perspectives in pilonidal disease - an interdisciplinary dialogue.
No full textWe hold a dialogue on perioperative perspectives in pilonidal disease to increase the value of perioperative outcome and patient satisfaction. Our review reveals that patients undergoing more extensive surgeries are better served by general or spinal anesthesia than by minimal approaches employing local anesthesia and the choice should be based on standard anesthesiological considerations such as neuraxial block time or recovery time after general anesthesia rather than the nature of pilonidal disease itself. To ensure sustainable outcome quality, surgeons, together with their anesthesiological partners must consider a wider perspective than the Operating Room and the recovery room, and should include dimensions of the other medical discipline in their decision making. This is best achieved with interprofessional dialogues
Postauricular pilonidal sinus: a case report with literature review
No full textIntroduction: Pilonidal sinus disease (PSD) usually occurs in sacrococcygeal region, with the rare extracoccygeal pilonidal sinus form representing only 2.2% of all pilonidal sinuses. We report a rare postauricular pilonidal sinus with literature review.Methods: Case report.Results: A 25-year-old man, presented with a postauricular nodule with chronic discharge for last three months. On examination, there was a 1 x 1 centimeter firm, tender nodule at the left post auricular area. Under local anaesthesia, the nodule was excited in toto and the wound closed primarily. Histopathological examination confirmed the diagnosis of PSD.Conclusion: The post-auricular region is another rare area of atypical PSD occurring. It may present as a chronic nodule, and excision with primary closure under local anaesthesia may lead to uneventful recovery
Pilonidal sinus of neck: a case report with literature review
No full textIntroduction: Pilonidal disease commonly occurs in the sacrococcigeal area. Rarely it may occur in the face, interdigital region, groin, and umbilicus. The aim of this report is to present and discuss a new case of pilonidal sinus of neck with literature review.Methods: Case report.Results: A 37-year-old male, presented with a discharging sinus in the left posterior triangle of the neck for six month duration. Under local anesthesia, excision of the sinus with primary closure was performed. Histopathological examination showed features consistent with pilonidal sinus. Two months later, the wound completely healed. The patient was followed up for the next 4 months with no signs of recurrence.Conclusion: Neck pilonidal sinus is a rare variant of pilonidal disease presenting as chronic discharging sinus. The main treatment strategy is excision and primary closure