Comparison of Surgical Methods in Sacrococcygeal Pilonidal Sinus Treatment

Year 2021, Volume: 5 Issue: 3, 126 - 131, 20.09.2021

Hasan Çantay , Yavuz Daşdemir

https://doi.org/10.30621/jbachs.944359

Abstract

Purpose: Although many conservative and surgical methods have been described in the treatment of sacrococcygeal pilonidal sinus, which is a common disease of the sacrococcygeal region, affecting especially young men, recurrence rates are still high and the search for ideal treatment continues. The aim of the study is to compare the primary closure, Limberg and Karydakis flap methods for pilonidal sinus surgery in terms of wound healing, complications and recurrence and to present the results accordingly.
Material and method: The data of 184 patients who were operated between 2018 and 2020 were retrospectively evaluated. Patient data on age, gender, comorbidity, Body Mass Index (BMI), smoking, recurrence, history of preoperative abscess drainage, surgical methods, length of hospital stay, postoperative drain, recurrence and complications were evaluated.
Results: No statistically significant difference was found between the treatment methods in terms of age, gender, Body Mass Index, and smoking (p>0.005). A statistically significant difference was found between the treatment methods in terms of reoperation for recurrence and preoperative abscess drainage (p = 0.012) (p = 0.044). However, a significant difference was found between the treatment methods in terms of length of hospital stay, presence of drainage, recurrence and complications (p <0.005).
Conclusion: Although primary suturation has a short hospital stay, the rate of recurrence and complications is higher than the Limberg and Karydakis flap methods. In this context, it can be maintained that the Limberg and Karydakis flap methods are safer methods than the primary closure method.

Keywords

Pilonidal sinus, Recurrence, Limberg flap, Karydakis flap, Primary closure, Surgical Flaps

Supporting Institution

yok

Project Number

yok

Thanks

.

References

• 1. Iesalnieks I, Ommer A, Petersen S, Doll D, Herold A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg. 2016; 401: 599-609.
• 2. Strong E, Callaghan T, Beal E, et al. Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study. Colorectal Disease. 2021; 00: 1–12.
• 3. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018; 30: 411-416.
• 4. Johnson EK. Expert Commentary on Pilonidal Disease: Management and Definitive Treatment. Dis Colon Rectum. 2018; 61: 777-779.
• 5. Emile SH, Khan SM, Barsom SH, Wexner SD. Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials. International Journal of Colorectal Disease 2021 https://doi.org/10.1007/s00384-021-03922-w.
• 6. Çiftci F, Abdurrahman I. A different disease: extra sacrococcygeal pilonidal sinuses etiopathogenesis. Int J Clin Exp Med. 2015; 8: 11567-11571.
• 7. Duman K, Gırgın M, Harlak A. Prevalence of sacrococcygeal pilonidal di-sease in Turkey. Asian J Surg. 2017; 40: 434-437.
• 8. Gordon KJ, Hunt TM. Osteomyelitis as a complication of a pilonidal sinus. Int J Colorectal Dis. 2016; 31: 155-156.
• 9. Payne CJ, Walker TWM, Karcher AM, Kingsmore DB, Byrne DS. Are routine microbiological investigations indicated in the manage-ment of non-perianal cutaneous abscesses? Surgeon. 2008 ; 6: 204-206.
• 10. Bolandparvaz S, Moghadam DP, Salahi R, et al. Evaluation of the risk factors of pilonidalsinus: a sing-le center experience. Turk J Gastroenterol. 2012; 23: 535-537.
• 11. Doll D, Brengelmann I, Schober P, Ommer A, Bosche F, Papalois AE et al. Rethinking the causes of pilonidal sinus disease: a matched cohort study. Scientifc Reports. 2021; 11: 6210
• 12. Ekici U, Kanlioz M, Ferhatoglu MF, Kartal A. A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus. Asian Journal of Surgery. 2019; 42: 907-913.
• 13. Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Nouritaromlou MK. Risk factors for complications and recurrence after the Karydakis flap. Journal of Surgical Research. 2016; 204: 55-60.
• 14. Calis H, Guler Y, Sengul S, Karabulut Z. The effects of perioperative antibiotherapy on surgical site infections in sacrococcygeal pilonidal sinus treated with rhomboid excision and Limberg transposition procedure. Int Wound J. 2019; 16: 974–978.
• 15. Demiryas S, Donmez T. Could Early Postoperative Complications be considered as risk factor for recurrence after pilonidal sinus surgery? Chirurgia. 2019; 114: 475-486.
• 16. Kartal A, Aydin HO, Oduncu M, Ferhatoğlu MF, Kivilcim T, Filiz AI. Comparison of three surgical techniques in pilonidal sinus surgery. Prague Medical Report. 2018; 119(4): 148–155.
• 17. Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Mor-eira-Pinto J. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg. 2018; 53(10): 2000-2007.
• 18. Boshnaq M, Phan YC, Martini I, Harilingam M, Akhtar M, Tsavellas G. Limberg flap in management of pilonidal sinus disease: systematic review and a local experience. Acta Chir Belg. 2018; 118(2): 78-84.
• 19. Luedi MM, Kauf P, Evers T, Sievert H, Doll D. Impact of spinal versus general anesthe-sia on postoperative pain and long term recurrence after surgery for pilo-nidal disease. J Clin Anesth. 2016; 33: 236–42
• 20. Mahdy T. Surgical treatment of the pilonidal disease: Primary closure or flap reconstruction after excision. Dis Colon Rectum. 2008; 51(12): 1816–22.
• 21. Oueidat D, Rizkallah A, Dirani M, Bou Assi T, Shams A, Jurjus A. 25 years’ experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology. 2014; 4: 1–5.
• 22. Arnous M, Elgendy H, Thabet W, Emile SH, Elbaz SA, Khafagy W. Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilo-nidal disease: A randomised clinical trial. Ann R Coll Surg Engl. 2018; 101: 21–29.
• 23. Milone M, Velotti N, Manigrasso M, Anoldo P, Milone F, DePalma GD. Long-term follow-up for pilonidal sinus surgery: a review of literature with metanalysis. Surgeon. 2018; 16(5): 315-20.
• 24. Muzi MG, Milito G, Nigro C, Cadeddu F, Farinon AM. A modification of primary closure for the treatment of pilonidal disease in day-care setting. Colorectal Dis. 2009; 11(1): 84-88.
• 25. Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. SciRep. 2018; 8(1): 3058.
• 26. Kose E, Hasbahceci M, Tonyali H, Karagulle M. Comparative analysis of the same technique-the same surgeon approach in the surgical treatment of pilonidal sinus disease: a retrospective cohort study. Ann Surg Treat Res. 2017; 93(2): 82-87.
• 27. McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ. 2008; 336 (7649): 868-871.