Tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea. Experiencia de un centro en los últimos 4 años

Objetivo: Evaluar los resultados a largo plazo en el tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea (EPS), comparando las diferentes técnicas quirúrgicas utilizadas, complicaciones, tiempo de cicatrización y recidiva. Material y Método: Estudio trasversal retrospectivo. Se revisaron las fichas de los pacientes intervenidos por EPS entre enero 2017 hasta agosto 2021. Para el seguimiento se obtuvo la información desde los registros de los controles periódicos en nuestro centro y aquellos que no continuaron con estos controles se contactaron telefónicamente. Resultados: Se recopilaron 309 casos, con una media de seguimiento de 15,6 meses. Las técnicas más utilizadas para la fase crónica de EPS fueron marsupialización y Karydakis, con tiempo de cicatrización completa de 54,5 y 18,2 días, respectivamente. La presencia de complicaciones prolongó el tiempo de cicatrización en 46,5 días en Karydakis, con mínimo impacto en marsupialización. La tasa de recidiva fue menor en Karydakis y en etapa aguda cuando se realiza destechamiento y legrado. La profilaxis antibiótica no afectó el riesgo de complicaciones postoperatorias. Discusión: El desarrollo de complicaciones postoperatorias tiene mayor impacto en la cicatrización de la técnica cerrada que en la abierta, siendo esta última más tolerante en cuanto a la cicatrización frente a complicaciones. Conclusión: La intervención con técnica de Karydakis logra la cicatrización de la herida operatorio en menor tiempo que la marsupialización, sin embargo, al desarrollar complicaciones, este tiempo aumenta 3,5 veces más. La recurrencia fue menor en Karydakis. En absceso se recomienda el desteche y legrado por sobre el drenaje exclusivo

Aim: To evaluate long-term results in the surgical treatment of sacrococcygeal pilonidal disease (SPD) comparing the different surgical techniques used, complications, healing time and recurrence. Material and Method: Retrospective cross-sectional study. The files of the patients operated on for EPS between January 2017 and August 2021 were reviewed. For follow-up, information was obtained from the records of the periodic controls in our center; those who did not continue with these controls were contacted by telephone. Results: 309 cases were collected, with a mean follow-up of 15.6 months. The most used techniques for the chronic phase of EPS were marsupialization and Karydakis, achieving complete wound healing in 54.5 and 18.2 days, respectively. The presence of complications prolonged the healing time by 46.5 days in Karydakis, with minimal impact on marsupialization. The recurrence rate was lower in Karydakis and in the acute stage when unroofing and curettage were performed. Antibiotic prophylaxis did not increase the risk of postoperative complications. Discussion: The development of postoperative complications has a greater impact on the healing of the closed technique than in the open technique, the last one seems to be more tolerant in terms of healing in the presence of complications. Conclusion: The intervention with the Karydakis technique achieves healing of the surgical wound in less time than marsupialization, however, when complications develop, this time increases 3.5 times more. Recurrence was lower in Karydakis. In abscess weaning and curettage is recommended over the exclusive drainage.

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.@*METHODS@#Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures.@*RESULTS@#All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.@*CONCLUSION@#Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Use of the laser in the pilonidal sinus alone or in combination with phenol

SUMMARY OBJECTIVE: We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus. METHODS: We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022. RESULTS: Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing. CONCLUSION: Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.

Surgical outcome of modified Karydakis flap and modified Limberg flab in the management of sacroccygeal pilonidal disease: a comparative study

Introduction: Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective: To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods: The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results: The mean patient age was 28.85 (range, 18-44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25-40) and 54.5 (range, 45-65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion: Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes. (AU)

Quiste pilonidal. Preferencias en su manejo de los cirujanos/as colorrectales de Latinoamérica

Objetivo: Caracterizar las preferencias y frecuencia de las técnicas quirúrgicas para la resolución de la enfermedad pilonidal (EPS) en los cirujanos/as colorrectales de Latinoamérica. Material y Método: Estudio transversal descriptivo analítico mediante encuesta electrónica validada por pares expertos. Distribuida entre los cirujanos/as colorrectales de Latinoamérica. Fueron excluidos los cirujanos/as no subespecialistas en cirugía colorrectal. Resultados: Se obtuvieron 372 respuestas de 15 países latinoamericanos, con media de 18,9 ± 12,5 años como subespecialistas. El 66,7% utiliza técnicas abiertas para EPS crónica, las técnicas más usadas son marsupialización (31,5%), destechamiento (27,7%) y resección con técnica de Karydakis (17,7%), colgajo de Limberg (6,1%), Bascom (5,4%), plastias en Z o V-Y (4%), McFee (3,8%) y Epsit (3,8%). La intervención más utilizada para la resolución de la EPS aguda es el drenaje bajo anestesia formal con curetaje y/o marsupialización (51,1%). El 45,3% de los cirujanos/as cambia de técnica durante su carrera. Discusión: Gracias a la amplia distribución y representatividad de los encuestados se logró plasmar la preferencia de manera realista acerca de las inclinaciones en el manejo de la EPS por parte de los subespecialistas del continente, aportando información de la que no se tiene precedente. Conclusión: Las técnicas abiertas son las preferidas para la resolución de la EPS crónica, las técnicas más utilizadas son marsupialización, destechamiento y Karydakis. Es frecuente el cambio de técnica quirúrgica preferente dentro de los subespecialistas, existiendo una relación entre escoger técnicas abiertas en la medida que los cirujanos/as tienen más años de experiencia.

Aim: To characterize the preferences and frequency of surgical techniques for the resolution of pilonidal disease (PSD) in colorectal surgeons of Latin America. Materials and Method: Cross-sectional descriptive and analytical study using an electronic survey validated by expert peers. Distributed among colorectal surgeons in Latin America. Surgeons who were not subspecialists in colorectal surgery were excluded. Results: 372 responses were obtained from subspecialist surgeons in colorectal surgery from 15 Latin American countries, with a mean of 18.9 ± 12.5 years as subspecialists. 66.7% use open techniques for chronic PSD, the most used techniques: marsupialization (31.5%), unroofing (27.7%) and resection with the Karydakis technique (17.7%), Limberg flap (6, 1%), Bascom (5.4%), Z or VY plasties (4%), McFee (3.8%) and Epsit (3.8%). The most used intervention for the resolution of acute PSD is drainage under formal anesthesia with curettage and/or marsupialization (51.1%). 45.3% of surgeons change techniques during their career. Discussion: Due to the wide distribution and representativeness of the respondents, it was possible to capture the preference in a realistic way about the management of the PSD by the subspecialists of the continent, contributing with information with which there is no precedent. Conclusion: Open techniques are preferred for the resolution of chronic PSD, marsupialization, unroofing and Karydakis were used the most. The change of surgical technique within subspecialists is frequent, there is a relationship between preferring open techniques to the extent that surgeons have more years of experience.

Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease

Introduction:Pilonidal sinus disease (PSD) is a disease of natal cleft in sacrococcygeal region. The main goal of treatment is low recurrence rate, short hospital stays, early return to work and decrease post-operative work. Present study was undertaken to compare and find clinical outcome between simple closure and flap techniques. Methodology:30 patients of Pilonidal sinus disease (PSD) which were fit to undergo surgery were included. 15 patients undergone simple closure and 15 undergone flap technique (Limberg). Result: Wound Infection, Post-operative discharge and Recurrence rate was found higher in group I patients (20 %, 23.33 %, 30 % and 26.66 % respectively) compared to Group II cases. Difference is statistically significant (p Value 0.03, 0.04, 0.008 and 0.02 respectively). Discussion:Recurrence of the sinus probably depend mainly on the ability of the procedure to obliterate the depth of natal cleft. In the present study we found flap procedures superior in combating the disease recurrence than excision with simple closure. Conclusion: It is recommended that Limberg flap method should be used in the treatment of pilonidal sinus disease over other modalities

Clinical efficacy of off-midline closure techniques for treatment of chronic pilonidal sinus / 中华医学美学美容杂志

Objective:To evaluate the clinical efficacy of off-midline closure technique in the treatment of chronic pilonidal sinus.Methods:From July 2014 to July 2018, 59 patients suffered from chronic pilonidal sinus treated by off-midline closure were admitted to the Department of Proctology, Linyi Central Hospital, including 34 males and 25 females. According to the size and scope of the chronic pilonidal sinus, the off-midline flap was designed and sutured.Results:In this group of 59 patients, there were 52 cases of primary healing and 7 cases of incision complications, such as partial incision dehiscence and subcutaneous effusion. After follow-up for 2 years, no recurrence was observed. The scar was not obvious after wound healing. The patient was satisfied with the postoperative appearance.Conclusions:Using the off-midline closure technique to treat chronic pilonidal sinus can deviate from the midline to make the suture tension-free and the gluteal groove elevated. It not only effectively reduce the complication rate in patients, but also has high cure rate, low recurrence rate and does not affect appearance.

Radical versus conservative methods in one-stage pilonidal abscess surgery: the experience of a tunisian center / Métodos radicais versus métodos conservadores em uma etapa da cirurgia de abscesso pilonidal: a experiência de um centro tunisiano

ABSTRACT BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.

RESUMO RACIONAL: O tratamento cirúrgico do abscesso pilonidal é a indicação habitual, mas ainda não está bem codificado. Diferentes técnicas propostas podem ser conservadoras ou radicais. OBJETIVOS: Comparar os resultados pós-operatórios de ambos os métodos, em uma única etapa da estratégia de tratamento. MÉTODOS: Estudo comparativo incluindo todos os pacientes operados por abscesso pilonidal, com um seguimento pós-operatório satisfatório, durante um período de 4 anos. Foi avaliada a ocorrência de recidiva pós-operatória nos prontuários médicos ou entrevistando pacientes. RESULTADOS: Foram incluídos no estudo 57 pacientes: 33 homens e 24 mulheres. A média de idade foi de 26,9±10 anos. O tipo de operação foi a excisão em 46 casos (81%) e a incisão em 11 casos (19%) associada à curetagem em três casos e a drenagem em um caso. A excisão do abscesso pilonidal foi significativamente associada a um tempo maior para retornar à atividade (p=0,04). A cirurgia conservadora foi significativamente associada a uma cicatrização mais rápida da ferida cirúrgica (p<0,001). A taxa de recidiva foi de 19% em cirurgia radical e de 54% em cirurgia conservadora. A cirurgia radical foi significativamente associada a uma taxa de recidiva menor do que o procedimento de incisão (p=0,02). CONCLUSÕES: A excisão do abscesso pilonidal foi a técnica comum nesta casuística, com taxa de recidiva da doença significativamente menor do que após a incisão. No entanto, a longa convalescença após a excisão e o maior tempo de operação, pode às vezes levar à escolha de uma cirurgia conservadora.

Quiste pilonidal del ombligo: presentación de dos casos / Umbilical pilonidal sinus: presentation of two cases

Resumen Introducción: El quiste pilonidal del ombligo (QPO) es una entidad muy infrecuente y por eso no es reconocida precozmente. El objetivo de este manuscrito es dar a conocer esta patología. Reporte de casos: Presentamos dos pacientes referidos por un proceso inflamatorio del ombligo, con descarga de mal olor. El primer paciente, luego de dos meses de tratamiento local sin resolución, es intervenido resecando la lesión umbilical, comprobando en ese momento la existencia de contenido piloso en el quiste. En el segundo paciente se plantea el diagnóstico durante la anamnesis y se confirma con el examen físico. En ambos casos se efectuó una resección parcial del ombligo incluyendo la lesión pilonidal. La biopsia confirmó el diagnóstico. El resultado posoperatorio ha sido satisfactorio y sin recaídas. Discusión y Conclusión: Hay escasa literatura relacionada con el QPO. Se proponen el tratamiento conservador y la opción de resección quirúrgica del quiste. En nuestra limitada experiencia se procedió a resecar la lesión y recomendar la depilación de la región periumbilical. No podemos descartar la alternativa de manejo conservador en futuros casos, antes de proponer la cirugía.

Introduction: Umbilical pilonidal sinus (UPS) is a rare condition and is therefore not detected early. The aim of this document is to discuss this pathology. Case report: We present two patients referred due to an inflammatory process of the navel, with the presence of a malodor. The first patient, after two months of unsuccessful local treatment, was intervened by a resection of the umbilical lesion, verifying hair content in the sinus. In the second patient the diagnosis was evident during anamnesis and confirmed with the physical examination. In both cases, a partial resection of the umbilicus was performed, including the pilonidal sinus. Biopsy confirmed the diagnosis. The postoperative result has been satisfactory, without relapse. Discussion and Conclusion: There are not much literature related to UPS. Conservative treatment or surgical resection of the sinus is proposed. In our limited experience we proceeded to a surgical resection of the lesion and recommend eliminating the hairs of the periumbilical region. We cannot rule out the conservative management option in future cases, before proposing surgery.

Pediatric endoscopic pilonidal sinus treatment (PEPSiT): technical description and initial experience / Tratamento endoscópico pediátrico do seio pilonidal (PePSiT, em inglês): Descrição técnica e experiência inicial

Pilonidal sinus is an acquired condition characterized by lesions at the median or paramedic intergluteal crease resulting form in grown hair at the subcutaneous, deep sacrococcygeal issue. Multiple surgicalmethods havebeen described, the optimal pilonidal sinus treatment remains controversial. The preset retrospective study reports outcome form pediatric endoscopic pilonidal sinus treatment in patient under 18 years old. (AU)

O seio pilonidal é uma condição adquirida caracterizada por lesões na prega interglútea mediana ou paramédica, resultando em cabelo crescido na área subcutânea e profunda do sacrococcígeo. Vários métodos cirúrgicos foram descritos, o tratamento ideal do seio pilonidal permanece controverso. O estudo retrospectivo predefinido relata os resultados do tratamento endoscópico do seio pilonidal pediátrico em pacientes com menos de 18 anos de idade. (AU)

Modified Karydakis procedure for uncomplicated pilonidal sinus

Background: Pilonidal sinus disease is a chronic infection of the natal cleft commonly affecting young adults. Out of the standard operative techniques, the Karydakis procedure is a relatively simple procedure associated with low rates of wound complications and recurrence. In this study we present a modified version of the Karydakis procedure to treat less extensive disease, which enables better skin closure without cavitation and tension.Methods: Patients with uncomplicated pilonidal sinus who presented to our centre during the period from April 2015 to March 2019 were prospectively enrolled. Patients with recurrent or complex sinus disease were excluded. In those enrolled, our modified Karydakis procedure was performed. In this method, after excision a flap of skin and subcutaneous tissue was raised to one side and sutured across the midline by advancement in layers.Results: 34 patients underwent our modified Karydakis procedure. 91% (31/34) of patients had uncomplicated recovery and could return to work after two weeks. There were minimal post-operative complications, in the form of erythema around the wound (8.8%), wound discharge (5.9%), seroma (5.9%) and infection (2.9%). No patient developed wound dehiscence or flap necrosis. There were excellent cosmetic results and no recurrence at one year post-surgery.Conclusions: Our modification of the Karydakis procedure is a simple and effective surgery for the management of uncomplicated pilonidal sinus disease which achieves good results.

Laser pilonidotomy - a new approach in management of complex pilonidal sinus disease: an exploratory study / Pilonidotomia a laser - uma nova abordagem no tratamento da doença do seio pilonidal complexo: um estudo exploratório

Abstract Background The treatment of pilonidal sinus disease still remains challenging mainly because of multiple factors responsible for wound healing and its recurrence. With recent advances in surgical field, use of laser found to be an effective technique in the destruction of a pilonidal cyst. Laser Piolonidotomy is a new promising technique. Methodology An exploratory study was planned with the Aim, to evaluate a new technique for the excision of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity the degree of postoperative complications and rate of recurrence and patient's satisfaction. All the patients with pilonidal sinus were categorized and laser pilonidotomy was planned for patients satisfying inclusion criteria. Data collected in pre-structured, pre-tested proforma and analyzed using SPSS. Results Mean duration of Procedure was 33 min (SD = 11), mean duration of Hospital Stay was 12 h (SD = 3), resumption of normal activity within 4 days (SD = 2), mean duration for Complete Wound Healing by secondary intention 6 Weeks (SD = 1.25). Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient's satisfaction was 97.84%. Conclusion Laser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient's satisfaction.

Resumo Justificativa O tratamento da doença do seio pilonidal ainda permanece desafiador, principalmente devido a vários fatores responsáveis pela cicatrização das feridas e sua recorrência. Com os recentes avanços no campo cirúrgico, o uso do laser mostrou ser uma técnica eficaz na destruição de um cisto pilonidal. A piolonidotomia a laser é uma nova técnica promissora. Metodologia Foi planejado um estudo exploratório com o objetivo de avaliar uma nova técnica para a excisão de seio pilonidal. Os objetivos foram investigar sua eficácia quanto aos tempos de operação, de cicatrização, de internação e de retomada da atividade normal, além do grau de complicações pós-operatórias, a taxa de recorrência e o índice de satisfação do paciente. Todos os pacientes com seio pilonidal foram categorizados, e a pilonidotomia a laser foi planejada para os pacientes que satisfizessem os critérios de inclusão. Os dados foram coletados em forma pré-estruturada e pré-testada e analisados usando o SPSS. Resultados O tempo médio do procedimento foi de 33 min (DP = 11), o tempo médio da internação hospitalar foi de 12 horas (DP = 3), o tempo médio de retomada da atividade normal foi de 4 dias (DP = 2) e o tempo médio de cicatrização completa por intenção secundário foi de 6 semanas (DP = 1,25). Entre as complicações, infecção foi observada em 1,08%. A diferença entre as médias do escore EVA pré e pós-operatório foi estatisticamente significativa (p < 0,0001). A taxa de recorrência foi de 3,24%. A taxa de sucesso foi de 96,75% e o índice de satisfação geral do paciente foi de 97,84%. Conclusão A pilonidotomia a laser é eficaz na destruição de um cisto pilonidal com boa taxa de sucesso, menos complicações e com alta satisfação do paciente.

Clinical efficacy of modified Limberg flaps for treatment of sacrococcygeal pilonidal sinus / 中华医学美学美容杂志

Objective To compare the clinical efficacy of the flaps of modified Limberg and direct incision followed by suture in the treatment of sacrococcygeal pilonidal sinus,aiming to provide the academic guide for its clinical surgery.Methods A total of 76 patients suffered from sacrococcygeal pilonidal sinus were treated with two surgical methods in Department of General Surgery and Department of Burn and Plastic Surgery in Sixth Medical Center of PLA General Hospital from 2013 to 2017.Among these patients,37 cases were resected and reconstructed using the flaps of modified Limberg,the other 39 cases were sutured after beingresected.These patients were followed up during the next 1 or 2 years.Five indexes including surgery period,length of hospital stay,postoperative infection,recurrence and complication,were investigated to statistically compare two different surgery methods' efficacy,using independent t test or chi-square test respectively.Results There were 76 patients in the Limberg flap group and the direct suture group,the operation time was about one and a half hours,and the hospitalization time was about 15 days (P＞0.05);there was no statistical difference between them.There were no complications in 35 of the 37 patients in the Limberg flap group,but skin cracking and infection in 2 patients.In the direct suture group,there were 39 patients,16without complications and 23 with complications,(x2=1133.2393,P=0.0000);there were statistical differences.Among the 37 patients in the Limberg flap group,only one recurred;among the 39patients in the direct suture group,9 recurred (x2=1192.9211,P=0.0000);there were statistical differences.Conclusions Limberg flap incision shows good healing and fewer complications.Within the group of Limberg flap incision healing,only few cases of recurrences occur after the surgery.It not only effectively reduce the complication rate in patients,but also release the pain from long-term,reduplicated medication.The author proposes that this operation should be promoted in the future clinical practice.

Results of Primary Closure and Excision of Pilonidal Sinus Disease

Objective: The aim of this analysis was to determine the results of excision and primary closure of pilonidal sinus disease. Study Design: A Prospective Study. Place and Duration: In the Surgical department of PIMS Hospital Islamabad for the one-year duration from May 2018 to May 2019. Methodology: Eighty cases were included for excision with primary closure. Individuals having recurrent pilonidal sinus disease and with acute pilonidal sinus, abscess were excluded from the analysis. All subjects were operated in prone position under general anaesthesia. To clean the sinus tract; Methylene blue dye was injected. Postoperative complications and recurrence were recorded. All patients were followed at the outpatient department for three months and then every three months. Results: Eighty patients who met the criteria of inclusion were underwent surgery. 68 were male of the 80 patients, the female was 12, and 34 years was the mean age. Six days was the mean hospital stay and three weeks was the average duration when patients return to their work. From 80 patients; 10 (12.5%) had wound infection and 3 from them had minor wound infection. The seroma formation was noted in 5 (6.25%) which was aspirated. Only 6 patients had a recurrence, representing a 7.5% overall recurrence rate. Conclusion: It is concluded that pilonidal sinus disease primary closure and excision are related to early wound healing, short hospital stay, reduced chance of recurrence and rapid return to work.

A Comparative Study of Various Surgical Methods for Sacrococcygeal Pilonidal Disease at a Tertiary Care Hospital in India

Introduction: Pilonidal sinus disease is a very common anorectal problem without a clinical consensus on its optimalmanagement.Objective: The objective of this study was to compare the surgical methods used in our hospital and determine the outcomesin relation to hospitalization time, healing, post-operative complications and recurrence.Materials and Methods: All patients with pilonidal sinus disease that was treated surgically at our hospital between January2014 and March 2018 were considered.Results: A total of 74 patients of whom 57 were male and 17 females. 12 were treated with simple excision, 25 with simpleexcision and closure, 26 with Limberg’s flap, and 11 with Karydakis flap. Duration of surgery and duration of hospital stay weresignificantly larger for the flap procedures. Complications such as infection (11.5%) and seroma (24.5%) were common with flapprocedures. Recurrence was common with simple excision with or without closure (82%) compared to flap procedures (24.5%).Conclusion: The two flap techniques show no difference among each other.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Modified Bascom cleft lift procedure for chronic pilonidal sinus / 中华普通外科杂志

Objective To evaluate the clinical efficacy of modified Bascom cleft lift procedure in the treatment of chronic sinus.Methods Modified Bascom cleft lift procedure was performed in 53 patients admitted from Oct 2012 to Jul 2016.49 cases were male and 4 were female.The average age was (25.4± 2.3) years.Results All patients were satisfied with the operation.There were 49 cases of primary healing and 4 cases of incision complications.The average follow-up was (12.1 ±4.3) months,no recurrence was observed.Conclusion The modified Bascom cleft lift technique is effective and reliable,with less complications and a lower recurrence rate.

A prospective randomised trial comparing MUTAF technique with Limberg flap technique in surgical treatment of chronic pilonidal sinus

Introduction: Pilonidal sinus is a common condition usually seen in young adult. Although several methods have been described all have been associated with high recurrence rate. This study is a prospective randomized trial comparing MUTAF technique with Limberg flap reconstruction in the management of chronic pilonidal sinus. Materials and methods: This prospective study was conducted in Department of General Surgery in Al Azhar Medical College, from June 2018 to June 2019 who were treated for chronic pilonidal sinus by comparing MUTAF technique with Limberg flap technique. Results: A total of 60 patients were included in our study. They were randomly divided into two groups. The demographic data: mean age and sex ratio were not statistically different when compared between two groups. Duration of symptoms in both the groups was 18 months. Mean follow up duration was almost 12 to 18 months in both groups. Mean operative time was less in group 1 with 34.5 +/-14.7 and 46.3 +/- 10.3 in group 2. When length of hospital stay compared there was significant difference between the groups (p < 0.001). Mean hospital stay time was more in group 2 (3.8+/- 1.6) than group 1 (2.1+/-1.2). Between the groups there was no significant difference in recurrence rate. In our study we had no recurrence in both groups. Most common complication was seroma (group 1 =02, group 2 =03) and wound infection (group = 01, group 2 = 03). The seroma patient was treated with wound aspiration without wound open. One patient had wound dehiscence in group 2 and was treated with local wound care and improved in a month. Manjunath H R, Reny Jayaprakas, Anjali Nair. A prospective randomized trial comparing MUTAF technique with Limberg flap technique in surgical treatment of chronic pilonidal sinus. IAIM, 2019; 6(8): 41-46. Page 42 Conclusion: MUTAF technique can be a good alternative for the treatment of chronic pilonidal sinus because of excellent surgical outcome. In Mutaf technique due to double flap there is less flap tension reduced postoperative pain and early return to work. In both Flap techniques natal cleft is flattened and displace the incision scar from midline resulting in low recurrence.

Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature

BACKGROUND: The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. METHODS: A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. RESULTS: Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 (107.7±60.3 cm² vs. 61.4±33.8 cm², respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. CONCLUSIONS: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

Inverse ‘D’ incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line

PURPOSE: Surgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (ᗡ) incision based on tissue loss, wound tension, and suture line location. METHODS: This prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the ‘ᗡ’ incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months. RESULTS: Sixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a ‘ᗡ’ incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients. CONCLUSION: The method of sinus excision using the ‘ᗡ’ incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.