COMPARING OF SURGICAL TECHNIQUES IN PILONIDAL SINUS DISEASE

Year 2021, Volume: 2 Issue: 3, 1 - 4, 31.12.2021

Ali Erdinç Çiftçiler , Serap Ulusoy

Abstract

Background: Pilonidal sinus is commonly encountred in the sacrococcygeal areas and effects daily activities and life quality. Several surgical techniques and methods have been explained for the treatment of pilonidal sinus. In this retrospective study, we aimed compare clinical outcomes and complications of these methods.

Material and methods: This retrospective study was performed over 136 sacrococygeal pilonidal sinus operations done between January 2014 and December 2015 in Ankara Atatürk Research and Training Hospital General Surgery Clinic-B.

Results:. Mean age of the patients was calculated as 26,10. 121 (89%) of the patients were male and 15 (11%) were female. Total excision and leaving to secondary healing was applied to 88, total excision and primary repair to 23, Karydakis Flep to 9, VAC application to 8 and Limberg Flep to 7 of the patients involved in this study. Mean period of hospitalisation of VAC Application was longer than other surgical methods (p<0,001). Mean period of hospitalisation of patients that applied total anesthesia was shorter than patients applied spinal and local anesthesia but there is no statistically significant difference (p>0,001). Postoperative analgesia needs of patients that operated by Karydakis and Limberg Flep methods was less than other methods (p<0,026). There is no difference between patients in aspect of relaps (p>0,05). Postoperative complication ratio of flep techniques was higher than other methods (p<0,001). Total excision and leaving to secondary healing operation results in earlier return to work (p<0,001).

Conclusion: Methods applied in our clinic were compared in this study. %9,6 relaps was seen in all patients and there is no statistically significant difference between groups. There is no optimal treatment of sacrococygeal pilonidal sinus,and we are in conclusion that method of treatment should be chosen according to the size, occasion of infection or relaps and job of the patient.
1. Urhan MK, Kücükel F, Topgul K, Özer İ, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus. Diseases of the colon & rectum. 2002;45(5):656-9.
2. Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Diseases of the colon & rectum. 1998;41(6):775-7.
3. Bailey H, Ford D. Pilonidal Disease. ed: Zuidema GD, Yeo JC. Shackelford’s Surgery of the Alimentary Tract 5th Ed. Vol: 4. Philadelphia: Saunders; 2002.
4. Madhusudhan A, Swamy MD, Arif M. Pilonidal sinus-limberg versus karidakis flap our experience at SIMS, Shivamogga. International Surgery Journal. 2017;4(11):3641-5.
5. Abcarian H, Orangio GR. Complex Pilonidal Disease and Acute and Chronic Perineal Wounds: Point–Counterpoint. Complexities in Colorectal Surgery: Springer; 2014. p. 377-90.
6. Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? The American journal of surgery. 2005;190(3):388-92.
7. Jaschke C, Mährlein R, Mangold G. Results of the Limberg transposition flap in the treatment of pilonidal sinus. Zentralblatt Fur Chirurgie. 2002;127(8):712-5.
8. Dwight RW, Maloy JK. Pilonidal sinus: experience with 449 cases. New England Journal of Medicine. 1953;249(23):926-30.
9. Akinci ÖF, Bozer M, Uzunköy A, Düzgün ŞA, Coşkun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. The European journal of surgery. 1999;165(4):339-42.
10. Brearley R. Pilonidal sinus a new theory of origin. British Journal of Surgery. 1955;43(177):62-8.
11. Kooistra HP. Pilonidal sinuses: review of the literature and report of three hundred fifty cases. The American Journal of Surgery. 1942;55(1):3-17.
12. AĞCA B, ALTINLI E, DURAN Y, MİHMANLI M. Pilonidal sinüs tedavisinde Limberg Flep ve primer onarımın karşılaştırılması. Çağdaş Cerrahi Dergisi. 2002;16(3):152-4.
13. Khaira H, Brown J. Excision and primary suture of pilonidal sinus. Annals of the Royal College of Surgeons of England. 1995;77(4):242.
14. Al‐Jaberi TM. Excision and simple primary closure of chronic pilonidal sinus. European Journal of Surgery. 2001;167(2):133-5.
15. Muzi M, Milito G, Nigro C, Cadeddu F, Farinon A. A modification of primary closure for the treatment of pilonidal disease in day‐care setting. Colorectal Disease. 2009;11(1):84-8.
16. Iesalnieks I, Fürst A, Rentsch M, Jauch K. Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2003;74(5):461-8.
17. Cubukcu A, Gönüllü N, Paksoy M, Alponat A, Kuru M, Özbay O. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. International journal of colorectal disease. 2000;15(3):173-5.
18. Kaya B, Uçtum Y, Şimşek A, Kutaniş R. Treatment of pilonidal sinus with primary closure. A simple and effective method. Turkish Journal of Colorectal Disease. 2010;20(2):59-65.
19. Jensen S, Harling H. Prognosis after simple incision and drainage for a first‐episode acute pilonidal abscess. British journal of surgery. 1988;75(1):60-1.
20. Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta‐analysis of randomized controlled trials. Colorectal Disease. 2012;14(2):143-51.
21. Biter LU, Beck GM, Mannaerts GH, Stok MM, van der Ham AC, Grotenhuis BA. The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Diseases of the colon & rectum. 2014;57(12):1406-11.
22. HOEHN JG, ELLIOTT JR RA, STAYMAN III JW. The use of Limberg flaps for repairing small decubitus ulcers. Plastic and reconstructive surgery. 1977;60(4):548-57.

Keywords

Pilonidal sinus, flep techniques, primary, secondary, karydakis, limberg

Project Number

-

References

• 1. Urhan MK, Kücükel F, Topgul K, Özer İ, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus. Diseases of the colon & rectum. 2002;45(5):656-9.
• 2. Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Diseases of the colon & rectum. 1998;41(6):775-7.
• 3. Bailey H, Ford D. Pilonidal Disease. ed: Zuidema GD, Yeo JC. Shackelford’s Surgery of the Alimentary Tract 5th Ed. Vol: 4. Philadelphia: Saunders; 2002.
• 4. Madhusudhan A, Swamy MD, Arif M. Pilonidal sinus-limberg versus karidakis flap our experience at SIMS, Shivamogga. International Surgery Journal. 2017;4(11):3641-5.
• 5. Abcarian H, Orangio GR. Complex Pilonidal Disease and Acute and Chronic Perineal Wounds: Point–Counterpoint. Complexities in Colorectal Surgery: Springer; 2014. p. 377-90.
• 6. Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? The American journal of surgery. 2005;190(3):388-92.
• 7. Jaschke C, Mährlein R, Mangold G. Results of the Limberg transposition flap in the treatment of pilonidal sinus. Zentralblatt Fur Chirurgie. 2002;127(8):712-5.
• 8. Dwight RW, Maloy JK. Pilonidal sinus: experience with 449 cases. New England Journal of Medicine. 1953;249(23):926-30.
• 9. Akinci ÖF, Bozer M, Uzunköy A, Düzgün ŞA, Coşkun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. The European journal of surgery. 1999;165(4):339-42.
• 10. Brearley R. Pilonidal sinus a new theory of origin. British Journal of Surgery. 1955;43(177):62-8.
• 11. Kooistra HP. Pilonidal sinuses: review of the literature and report of three hundred fifty cases. The American Journal of Surgery. 1942;55(1):3-17.
• 12. AĞCA B, ALTINLI E, DURAN Y, MİHMANLI M. Pilonidal sinüs tedavisinde Limberg Flep ve primer onarımın karşılaştırılması. Çağdaş Cerrahi Dergisi. 2002;16(3):152-4.
• 13. Khaira H, Brown J. Excision and primary suture of pilonidal sinus. Annals of the Royal College of Surgeons of England. 1995;77(4):242.
• 14. Al‐Jaberi TM. Excision and simple primary closure of chronic pilonidal sinus. European Journal of Surgery. 2001;167(2):133-5.
• 15. Muzi M, Milito G, Nigro C, Cadeddu F, Farinon A. A modification of primary closure for the treatment of pilonidal disease in day‐care setting. Colorectal Disease. 2009;11(1):84-8.
• 16. Iesalnieks I, Fürst A, Rentsch M, Jauch K. Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2003;74(5):461-8.
• 17. Cubukcu A, Gönüllü N, Paksoy M, Alponat A, Kuru M, Özbay O. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. International journal of colorectal disease. 2000;15(3):173-5.
• 18. Kaya B, Uçtum Y, Şimşek A, Kutaniş R. Treatment of pilonidal sinus with primary closure. A simple and effective method. Turkish Journal of Colorectal Disease. 2010;20(2):59-65.
• 19. Jensen S, Harling H. Prognosis after simple incision and drainage for a first‐episode acute pilonidal abscess. British journal of surgery. 1988;75(1):60-1.
• 20. Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta‐analysis of randomized controlled trials. Colorectal Disease. 2012;14(2):143-51.
• 21. Biter LU, Beck GM, Mannaerts GH, Stok MM, van der Ham AC, Grotenhuis BA. The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Diseases of the colon & rectum. 2014;57(12):1406-11.
• 22. HOEHN JG, ELLIOTT JR RA, STAYMAN III JW. The use of Limberg flaps for repairing small decubitus ulcers. Plastic and reconstructive surgery. 1977;60(4):548-57.