Pilonoidal Sinus Disease and Surgical Treatment in Childhood

Abstract

Background: Pilonidal sinus disease (PSD) is an inflammatory condition that mostly affects young people and adults, with a higher incidence in males. Many conservative and surgical methods have been described for the treatment of PSD, but there is still no method accepted as the ideal treatment, and most importantly, no treatment method can eliminate the risk of recurrence of the disease. Materials and methods: The files of 49 patients who were operated on for PSD in our clinic between June 2016 and November 2021 were reviewed retrospectively. The patients were divided into 2 groups who were operated with the Karydakis flap (KF) method and Excision of the sinus with primary closure (EPC) method. Results: While the CF group returned to normal life in an average of 7.52 days, the EPK group was able to return in 11.53 days. Complications developed in 2 (8.7%) patients in the KF group, whereas 5 (19.2%) patients had complications in the EPC group. There was no statistically significant difference. Conclusion: Both the KF method and the EPC method are acceptable and safe in the treatment of PSD, but our study showed that the KF method is more effective.

Keywords

• Pilonidal sinus
• Karydakis flap
• Excision+primary closure
• Child

Çocukluk Çağı Pilonidal Sinüs Hastalığı ve Cerrahi Tedavisi

Abstract

Amaç: Pilonidal sinüs hastalığı (PSH), çoğunlukla gençleri ve genç erişkinleri etkileyen, erkek cinsiyette daha yüksek insidans ile görülen inflamatuar bir hastalıktır. PSH tedavisi için birçok konservatif ve cerrahi yöntem tanımlanmıştır ancak halen ideal tedavi olarak kabul edilen bir yöntem yoktur ve en önemlisi hiçbir tedavi yöntemi hastalığın tekrarlama riskini ortadan kaldıramamaktadır Materyal ve metod: Haziran 2016 ile kasım 2021 tarihleri arasında kliniğimizde PSH nedeniyle ameliyat edilen 49 hastanın dosyası retrospektif olarak incelendi. Hastalar Karydakis flep (KF) yöntemi ve eksizyon+primer kapatma (EPK) yöntemiyle ameliyat edilen hastalar olmak üzere 2 gruba ayrıldı. Bulgular: KF grubu normal hayata ortalama 7.52 günde dönerken EPK grubu 11.53 günde dönebildi. KF grubunda hastaların 2 (%8.7)sinde komplikasyon gelişirken, EPK grubunda 5 (%19.2) hastada komplikasyon gelişti, istatistiki olarak anlamlı fark saptanmadı. Sonuç: PSH tedavisinde hem KF yöntemi hem de EPK yöntemi kabul edilebilir ve güvenlidir, ancak bizim çalışmamızda KF yönteminin daha etkili olduğunu göstermiştir.

Keywords

• Pilonidal sinüs
• Karydakis flep
• Eksizyon+primer kapatma
• Çocuk

References

1. Esposito C, Mendoza-Sagaon M, Del Conte F, Cerulo M, Coppola V, Esposito G, et al. Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol. Front Pediatr. 2020 Jun 24;8:345.
2. Ozcan R, Hüseynov M, Bakır AC, Emre S, Tütüncü C, Celayir S, et al. Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing? Asian J Surg. 2018 Sep;41(5):506-10.
3. Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Meysamie A, Nouritaromlou MK. Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res. 2015 Sep;198(1):260-6.
4. Pfammatter M, Erlanger TE, Mayr J. Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children. Children (Basel). 2020 Oct 17;7(10):187.
5. Dotlacil V, Rygl M, Frybova B. Initial experience with minimally invasive treatment of pilonidal sinus in children. Wideochir Inne Tech Maloinwazyjne. 2021 Jun;16(2):417-22.
6. Rashidian N, Vahedian-Ardakani J, Baghai-Wadji M, Keramati MR, Saraee A, Ansari K, et al. How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: a dilemma. J Wound Care. 2014 Dec;23(12):630-3.
7. Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C. Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech Coloproctol. 2014 Oct;18(10):863-72.
8. Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol. 2014 Apr;18(4):389-92.

9. Ates U, Ergun E, Gollu G, Sozduyar S, Kologlu M, Cakmak M, et al. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. J Pediatr Surg. 2018 Mar;53(3):452-5.
10. Humphries AE, Duncan JE. Evaluation and management of pilonidal disease. Surg Clin North Am. 2010 Feb;90(1):113-24.
11. Emir S. , Kanat B. , Yazar F. , Gürdal S. Sakrokoksigeal Pilonidal Sinüsün Cerrahi Tedavisinde Karydakis Flep Ameliyatının Kısa ve Uzun Dönem Sonuçları. International Journal of Basic and Clinical Medicine. 2015; 1(1): 15-18.
12. Dal M. B. , Altun H. Pilonidal Sinüsün Cerrahi Tedavisinde Limberg Flep ile Karydakis Flep Karşılaştırılması: Retrospektif Klinik Çalışma. Mustafa Kemal Üniversitesi Tıp Dergisi. 2021; 12(44): 140-43.
13. Roldón Golet M, Siles Hinojosa A, González Ruiz Y, Escartín Villacampa R, Goded Broto I, Bragagnini Rodríguez P. Pilonidal sinus in adolescence: is there an ideal surgical approach? Cir Pediatr. 2021 Jul 1;34(3):119-24.
14. Erkent M, Şahiner İT, Bala M, Kendirci M, Yıldırım MB, Topçu R, et al. Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery. Med Sci Monit. 2018 Dec 11;24:8959-63.
15. Toydemir T, Peşluk O, Diler Ermeç E, Turhan AN. Comparison of the clinical outcomes of Karydakis flap versus primary closure procedures in the surgical treatment of sacrococcygeal pilonidal sinus disease. Med J Bakirkoy 2012;8:78-81.
16. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992 May;62(5):385-9.
17. Kartal A, Aydın HO, Oduncu M, Ferhatoğlu MF, Kıvılcım T, Filiz Aİ. Comparison of Three Surgical Techniques in Pilonidal Sinus Surgery. Prague Med Rep. 2018;119(4):148-55.
18. Morden P, Drongowski RA, Geiger JD, Hirschl RB, Teitelbaum DH. Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int. 2005 Oct;21(10):793-6.