Pediyatrik Pilonidal Sinüs Hastalığında Klasik Açık Cerrahi Tekniğine Göre Deri Dokusunda Kayıp Olmaksızın Ters 'ᗡ' Tekniği

Öz

Amaç: Pilonidal sinus hastalığı genellikle cerrahi yöntemlerle tedavi edilmesine rağmen, optimal cerrahi prosedürler ve minimal invaziv yöntemler arayışı devam etmektedir. Bu çalışmanın amacı, minimal doku kaybı ile gerilimsiz bir kapatma sağlayan ters 'ᗡ' tekniğini klasik açık cerrahi tekniği ile karşılaştırarak değerlendirmektir. Gereç ve Yöntemler: Ocak 2014 ve Ekim 2020 tarihleri arasında başvuran, ters 'ᗡ' cerrahi ve klasik orta hat açık cerrahi uygulanan, yaş ortalaması 15,85±1,82 olan 37'si (%56,9) erkek ve 28'i (%43,1) kadın 65 hasta geriye dönük olarak değerlendirildi. Bulgular: Erken postoperatif komplikasyon olarak ters 'ᗡ' grubunda 2 (%7,4) hastada kanama görüldü ve 3 (%11,1) hastada yara enfeksiyonu vardı. Aynı komplikasyonlar klasik grupta sırasıyla 4 (%10,5) ve 4 (%10,5) idi. Tamamen normal yaşam aktivitelerine dönme süresi iki grup arasında istatistiksel olarak farklıydı (10,36±0,43'e karşı 11,30±0,93 gün, p<0.001). Takip süresi boyunca hastalarda ters 'ᗡ' grubunda 1 (%3,7) nüks, klasik grupta 9 (%23,7) nüks gelişmesi istatistiksel olarak anlamlı idi (p=0,037). Sonuç: Mevcut teknik, sakrokoksiks pilonidal hastalığa neden olan patolojik dokuyu 'ᗡ' kesi ile oluşturulan flebin altındaki deri altı cerrahi çalışma alanı ile ortadan kaldırmayı ve orta hattan doku kaybı olmadan gerilimsiz kapatmayı amaçlamaktadır. Sakrokoksiks pilonidal hastalığın tedavisi için basit ve etkili bir cerrahi teknik olması nedeniyle pediatrik hasta grubunda 'ᗡ' insizyonu ve primer sütür yöntemini içeren operasyonun ilk seçenek olarak değerlendirilmesi gerektiğine inanıyoruz.

Anahtar Kelimeler

• Sakrokoksigeal sinus hastalığı
• çocuk
• cerrahi

Inverted 'ᗡ' Technique without Loss of Skin Tissue Compared to Classical Open Surgery Technique in Pediatric Pilonidal Sinus Disease

Abstract

Aim: Although the pilonidal sinus disease is commonly treated with surgical methods, search for optimal surgical procedures and minimally invasive methods continues. The aim of this study was to evaluate the inverted 'ᗡ' technique which provides a tension-free closure with minimal tissue loss, by comparing with the classical open surgery technique. Material and Methods: Sixty-five patients, 37 (56.9%) male and 28 (43.1%) female, with a mean age of 15.85±1.82 years, admitted between January 2014 and October 2020 and underwent inverted 'ᗡ' surgery and classical midline open surgery were retrospectively evaluated. Results: As an early postoperative complication, bleeding was observed in 2 (7.4%) patients in inverted 'ᗡ' group and 3 (11.1%) patients had wound infection. The same complications were 4 (10.5%) and 4 (10.5%) in classical group, respectively. The time to return to full activities was statistically different between two groups (10.36±0.43 versus 11.30±0.93 days, p<0.001). During the follow-up period, 1 (3.7%) recurrence in the inverted 'ᗡ' group and 9 (23.7%) recurrences in the classical group were statistically significant (p=0.037). Conclusion: The present technique aims to remove the pathological tissue that causes sacrococcygeal pilonidal disease by the subcutaneous surgical work area under the flap created through the 'ᗡ' incision and to close it without tension, away from the midline without tissue loss. We believe that the operation involving the 'ᗡ' incision and primary suture method should be considered as the first choice in the pediatric patient group because of being a simple and effective surgical technique for sacrococcygeal pilonidal disease treatment.

Keywords

• sacrococcygeal sinus disease
• children
• surgery

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