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.

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 endoscopic pilonidal sinus treatment (EPSiT): personal experience / Tratamento endoscópico do cisto pilonidal modificado (EPSiT): experiência pessoal

Abstract Pilonidal disease is common problem in the sacrococcygeal region, especially among young adults. The optimal surgical approach is debatable. Herein, we present our experience in management of recurrent pilonidal disease using the endoscopic approach.

Resumo A doença pilonidal é um problema comum na região sacrococcígea, principalmente em adultos jovens. A literatura ainda não apresenta consenso quanto à abordagem cirúrgica ideal. Aqui, os autores apresentam sua experiência no tratamento de doença pilonidal recorrente usando a abordagem endoscópica.

Enfermedad pilonidal sacrocoxígea: análisis de 2 técnicas quirúrgicas: experiencia personal / Sacrocoxygeal pilonidal disease: analysis of 2 surgical techniques: personal experience

Resumen Introducción: La enfermedad pilonidal sacrocoxígea (EPSC) es una patología crónica de resorte quirúrgico. Para su tratamiento se han descrito múltiples técnicas quirúrgicas, existiendo 2 grandes grupos: las técnicas abiertas y las cerradas. El objetivo del presente trabajo es comparar y analizar los resultados quirúrgicos de 2 técnicas, una abierta (marsupialización) y otra cerrada (Karydakis). Materiales y Método: Estudio de cohorte retrospectivo de pacientes operados electivamente con diagnóstico de quiste pilonidal por un único cirujano, entre julio de 2013 y julio de 2017 utilizando estas dos técnicas. Resultados: Se incluyeron 71 pacientes. 30 pacientes con marsupialización y 41 con Karydakis. Todos hospitalizados. Todos de alta al día siguiente de la cirugía. Ningún paciente requirió rehospitalización ni cirugías adicionales. En el análisis estadístico se identifican beneficios de la técnica de Karydakis en cuanto a complicaciones, dolor postoperatorio, dolor para sentarse, incapacidad laboral y tiempo de cicatrización. Conclusiones: En este artículo la cirugía con técnica de Karydakis tiene ventajas en relación a la marsupialización, considerándola como primera opción para la EPSC simple.

Introduction: Sacrocoxygeal pilonidal disease (EPSC) is a chronic pathology of surgical solution. For its treatment, multiple surgical techniques have been described, there being 2 large groups: open and closed techniques. The aim of the present study is to compare and analyze the surgical results of 2 techniques, one open (Marsupialization) and another closed (Karydakis). Materials and Method: Retrospective cohort study of electively operated patients with diagnosis of pilonidal cyst by a single surgeon, between July 2013 and July 2017 using these two techniques. Results: 71 patients were included. 30 patients with marsupialization and 41 with Karydakis. All hospitalized. All discharge the day after surgery. No patient required rehospitalization or additional surgeries. In the statistical analysis, benefits of the Karydakis technique are identified in terms of complications, postoperative pain, sitting pain, work incapacity and healing time. Conclusions: In this study, surgery with Karydakis technique has advantages in relation to Marsupialization, considering it as the first option for simple EPSC.

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.

Cáncer escamoso asentado sobre sinus pilonidal recurrente: la evolución de una patología benigna y frecuente a una causa de muerte infrecuente / Squamous cancer settled on recurrent pilonidal sinus: the evolution of a benign and frequent pathology to an infrequent cause of death

El sinus pilonidal es una patología frecuente cuya malignización es infrecuente aunque su pronóstico puede ser fatal. El objetivo de esta publicación es presentar un caso de un paciente intervenido en múltiples ocasiones de escisiones de sinus pilonidal con degeneración maligna del mismo y evolución fatal, con el fin de recalcar la importancia del examen anatomopatológico sistemático de todas las muestras de escisión quirúrgica. (AU)

The pilonidal sinus is a frequent pathology whose malignization is uncommon although its prognosis can be fatal. The objective of this publication is to present a case of a patient intervened on multiple occasions of pilonidal sinus excisions with malignant degeneration and fatal evolution, in order to emphasize the importance of the systematic pathological examination of all surgical excision samples. (AU)

Reparación plástica con colgajo de Limberg en seno pilonidal sacrococcigeo / Plastic repair with Limberg flap in sacrococcygeal pilonidal sinus

En este trabajo se presenta la técnica quirúrgica descrip-ta por Limberg para las reparaciones plásticas, su uso para el tratamiento del seno pilonidal sacro coccígeo junto con sus resultados, tasas de éxito, complicaciones y recaídas. Para ello se realizó una búsqueda bibliográfica sobre el tema y se analizaron los resultados para determinar con-clusiones sobre la misma.La elección del tema la realicé en base a mi interés sobre la patología. El mismo surge a partir de mi observación en la práctica clínica de pacientes sometidos a técnicas no resectivas, abiertas, con una alta tasa de lechos cruentos, cicatrizaciones lentas y recaídas que podrían beneficiar-se de los principios que la reparación de Limberg ofrece. La técnica se describe como algo simple y fácilmente re-producible mientras se respeten sus principios, lo cual la vuelve una opción viable y atractiva. Lo antedicho sumado al respaldo bibliográfico hallado han sido los motores de la investigación actual.

Brazilian and argentinean multicentric study in the surgical minimally invasive treatment of pilonidal cyst / Estudo multicêntrico brasileiro e argentino no tratamento cirúrgico do cisto pilonidal por técnica minimamente invasiva

ABSTRACT Background: The pilonidal cyst is an infection of the skin and the subcutaneous tissue, secondary to a chronic inflammation with a greater frequency in the sacrococcygeal region, and associated to the presence of hair. The treatment is eminently surgical. Aim: To demonstrate the endoscopic treatment of pilonidal cyst. Method: Prospective study with 67 patients who had as surgical indication the diagnosis of pilonidal cyst. They were submitted to a surgical procedure from June 2014 to March 2018. The equipment used was the Meinero fistuloscope, a shutter, a monopolar electrode, a brush and endoscopic forceps. Results: Of the 67 patients, 67% (n=45) were male and 33% (n=22) female, with a mean age of 25 years (17-45). Surgical time in average was 40 min (20-120) and mean healing time of four weeks (3-12). Surgical complications were presented in 7% cases (n=5) and recurrences in 9% (n=6). Conclusion: The endoscopic treatment of the pilonidal cyst is feasible and presents good surgical results.

RESUMO Racional: O cisto pilonidal é infecção da pele e do tecido subcutâneo, secundário à inflamação crônica, com maior frequência na região sacrococcígea, e associado à presença de pelos nesta região. O tratamento é eminentemente cirúrgico. Objetivo: Demonstrar os resultados do tratamento endoscópico de cisto pilonidal. Método: Estudo prospectivo, com 67 pacientes que tiveram como indicação cirúrgica o diagnóstico de cisto pilonidal. Os equipamentos utilizados foram o fistuloscópio Meinero, um obturador, um eletrodo monopolar, uma escova e pinça endoscópica. Resultados: Dos 67 pacientes 67% (n=45) eram homens e 33% (n=22) mulheres, com média de idade de 25 anos (17-45). O tempo cirúrgico teve com média 40 min (20-120) e o tempo médio de cicatrização de quatro semanas (3-12). Complicações cirúrgicas ocorreram em 7% da amostra (n=5) e recidivas da doença em 9% (n=6). Conclusão: O tratamento endoscópico do cisto pilonidal é viável e apresenta bons resultados cirúrgicos.

Operación de Bascom para el tratamiento de la enfermedad pilonidal sacrococcígea abscedada: experiencia inicial / Bascom operation for the treatment of abscessed pilonidal sacrococcygeal disease: initial experience

Resumen Introducción: Una de las formas de presentación de la enfermedad pilonidal sacrococcígea (EPSC) es el absceso, para el que existen distintas alternativas de tratamiento. Objetivo: Presentar nuestra experiencia con la técnica de Bascom para el tratamiento de la EPSC abscedada. Material y Método: Serie prospectiva, consecutiva y no aleatoria. Incluye todos los pacientes mayores de 15 años que presentan un absceso o supuración masiva al momento de la cirugía. Resultados: La serie corresponde a 10 pacientes, 7 de género masculino. No se encuentran los factores de riesgo reconocidos por la literatura como riesgo de EPSC. Ocho pacientes mejoran completamente en un período máximo de 18 días y 2 presentan supuración persistente, por lo que se considera fracaso del tratamiento. Estos son sometidos a una segunda cirugía con otra técnica, con curación de la enfermedad. Conclusión: La técnica de Bascom es sencilla, segura y ofrece una curación de un 80% en un período corto de cicatrización.

Introduction: One of the form of presentation of the sacral coccygeal pilonidal disease is the abscess, for this cases there are various treatment alternatives. Objective: We present our experience with Bascom technique for the treatment of pilonidal abscess. Material and Method: Prospective, consecutive, non-randomized series. It includes all patients older than 15 years who have an abscess or mass discharge at the time of surgery. Results: The series consists of 10 patients, 7 males. They are not risk factors recognized in the literature as risk of pilonidal disease. Eight patients completely better within a maximum period of 18 days and two with persistent discharge by what is considered treatment failure. They were subjected to a second surgery treatment with another technique with good results. Conclusion: Bascom's technique is simple, safe and offers a 80% cure in a short period of healing.

Manejo quirúrgico del quiste pilonidal. Técnica cerrada con colgajo de avance / Management of pilonidal cyst with closure technique

Introducción:La técnica cerrada es cada vez más utilizada en el tratamiento quirúrgico del quiste pilonidal, ya que es simple, con periodo de corto tiempo quirúrgico, hospitalización y cicatrización, aunque en nuestro medio aún no sea la más utilizada. Objetivo: Describir la experiencia del tratamiento del quiste pilonidal con la técnica cerrada con colgajo de avance en nuestro servicio.Materiales y método:El trabajo presenta un diseño observacional, descriptivo de corte transversal. Se estudió 30 pacientes de ambos sexos con diagnóstico de quiste pilonidal, intervenidos quirúrgicamente con la técnica cerrada con colgajo de avance en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas en el periodo enero 2014 a enero 2017. Resultados: 30 pacientes, edad promedio: 27,4 conrango entre 17 a 41 años, de los cuales el 70% (21) eran del sexo masculino y 30% (9) del sexo femenino, el promedio del tiempo quirúrgico fue 39 min y la estancia hospitalaria de 6 a 12 horas post quirúrgicas, el 90% (27) de los pacientes no presentó complicación alguna, presentando buena cicatrización en 15 días, la morbilidad fue del 10% (2 infecciones del sitio quirúrgico y 1 hematoma) y mortalidad nula. Discusión: En el trabajo de Karydakis, la edad promedio fue de 24,5 años en el nuestro de 27,4; el 53% fue hombre, en el nuestro 70%; la hospitalización promedio fue de 2,5 días, el nuestro de 6 a 12 horas. La recuperación completa de la mayoría fue de 15 días en ambos trabajos.

Introduction: The closed techinique is one of the most used in the surgical treatment of the pilonidal cyst, because it is simple and reproductible, it presents a period of short surgical time, of hospital stay and cicatrizacion. Objective: to describe experience of treatment of the pilonidal cyst with the closed flap technique in our servise. Materials and methods: the study has an observational, descriptive, and transverse cut desing, 30 patients where included, they submited to this technique during the period January 2014 to january 2017 in the II service of clinical surgery in The Clinical Hospital (Paraguay) Result: 30 pacients, with a range between 17 to 41 years of age, with 70%(21) were male, and 30%(9) were female, the average surgical time was 39 minutes, and the avarege hospital stay was 6 to 12 hours post surgical procedure, 90%(27) of the patients did not present any complications, presenting good healing in an average of 15 days, the morbidity was 10% (2 surgical site infections and 1 hematoma), and mortality was null. Discussion: in a Word of Karydakis obtained similar results to our work, the average age was 24,5 years in our 27,4; the 53% was a man, in our 70%; the average hospitalization was 2,5 days, in our 6 to 12 hour period. The complete recovery of the major-ity of the patients was of 15 days in both works.

Dufourmentel rhomboid flap for sacrococcygeal pilonidal sinus: technical details / Técnica quirúrgica del colgajo de Dufourmentel para el tratamiento de la enfermedad pilonidal sacro-coccígea

Sacrococcygeal pilonidal disease (SPD) is a chronic an uncommon entity with a variety of alternatives for treatment. One of those is the excision of the sinus tract followed by a reconstruction with the rhomboid flap described by Dufourmentel. The aim of this paper is to describe the main phases of the technique. A detailed explanation of the key steps for the implementation of Dufourmentel flap for the treatment of SPD is exposed. Excision of sacrococcygeal pilonidal sinus followed by Dufourmentel rhomboid flap is an alternative to consider in the treatment of pilonidal disease.

La enfermedad pilonidal sacrococcígea (EPS) es una entidad clínica crónica e infrecuente. Para su tratamiento se han descrito numerosas alternativas. Una de ellas es la exéresis de la zona afectada seguida de un cierre primario sin tensión, por medio de un colgajo romboidal descrito por Dufourmentel. El objetivo de este artículo es describir las fases más relevantes de la técnica. Se realiza una detallada explicación de los pasos clave para ejecutar la exéresis romboidal de la zona afectada, con la ulterior rotación de un colgajo de Dufourmentel para el tratamiento de la EPS. La exéresis romboidal de EPS seguida de la rotación de un colgajo de Dufourmentel constituye una alternativa a considerar en el tratamiento de la EPS.

Comparación entre el colgajo de limberg y el colgajo de karydakis en el tratamiento de la enfermedad del seno pilonidal / Comparison between limberg and karydakis flap for wound closure after pilonidal cyst resection

Background: The aim of pilonidal cyst surgical treatment is to avoid recurrence of the disease. Aim: To compare the results of Karydakis or Limberg flap for wound closure after pilonidal cyst resection. Material and Methods: Analysis of clinical parameters of patients operated for pilonidal cysts, in which all secondary sinuses and orifices were resected in a block reaching the posterior sacral fascia. The reconstruction technique used (Karydakis or Limberg flap) was according to the surgeon criterion. Results: Of 103 operated patients, in 24 aged 21.4 +/- 7.2 years (14 males) the Limberg closure was used and in 49, aged 22.2 +/- 6.3 years (26 males), the Karydakis closure was used. Rates of complications were 4.1 and 12.2 percent for Limberg and Karydakis closure, respectively (p = 0.04). The rates of recurrence were 8.3 and 12.2 percent respectively (Ns). Conclusions: Karydakis closure technique after pilonidal cyst resection has a higher rate of complications than Limberg closure.

Objetivo: Comparar los resultados de la resección de la enfermedad del seno pilonidal y el cierre de la herida mediante la técnica de Karydakis (CK) y de Limberg (CL) en pacientes no tratados previamente y que presentan uno o más senos, fístulas o nódulo subcutáneo. Método: Pacientes operados entre enero de 2000 y diciembre de 2012, en los que se resecan todos los senos y orificios secundarios, en bloque hasta la fascia sacra posterior. La reconstrucción se realiza según la preferencia del cirujano. Los pacientes fueron evaluados según edad, sexo, duración de síntomas, duración de la cirugía, tiempo de hospitalización, complicaciones post operatorias, tiempo de cicatrización y recurrencia. Resultados: Se intervinieron 103 pacientes, 20 fueron excluidos porque se utilizó otra técnica y en 11 no se cumplió el seguimiento mínimo. El grupo de análisis incluye 24 casos operados con CL y 49 casos con CK. No hubo diferencias de edad, distribución por sexo, duración de síntomas, presentación clínica, tiempo de cicatrización, período de inactividad post operatoria y tiempo de seguimiento entre los dos grupos. La frecuencia de complicaciones de herida en el grupo CL fue 4,1 por ciento y 12,2 por ciento en el grupo CK, p = 0,04. La tasa de recurrencia fue, de 8,3 por ciento para el CL y 12,2 por ciento para el CK, p = 0,91. Conclusión: nuestros resultados muestran una tasa de recurrencia similar para las técnicas de cierre de Limberg y Karydakis, en la resección de la enfermedad del seno pilonidal con una tasa de complicaciones significativamente mayor en la segunda.

Umbilical Pilonidal Sinus: A Rare Presentation.

Pilonidal sinus is common in the sacrococcygeal region. It is rare at the umbilicus. Incidence being 0.6%, we report a case of umbilical pilonidal sinus treated in our hospital. A 20-year-old male patient was admitted to our hospital with complaints of purulent discharge from the umbilicus since 3 months. Patient was posted for omphalectomy. Intraoperatively, a tuft of hair was found in a sinus tract communicating with the umbilicus. Histopathological evaluation was compatible with pilonidal sinus disease. There are only a few reports of the umbilical pilonidal sinus in the literature. Umbilical sinus tract differs from the sacrococcygeal variety in the absence of multiple tracts and low recurrence rates. Treatment options and differential diagnosis are discussed in the article.

Tratamiento de la enfermedad pilonidal crónica. Comparación de 3 técnicas quirúrgicas / Treatment of chronic pilonidal disease. Comparison of 3 surgical techniques

Introducción: actualmente no existe una técnica “gold standard” para el tratamiento definitivo de la enfermedad pilonidal crónica. Las técnicas empleadas en nuestro servicio son la técnica de Karydakis, Colgajo Romboidal y una variante de la técnica de Soll y col. a la que denominamos “Técnica de preservación cutánea”. Objetivo: evaluar y comparar la eficacia de las técnicas de Karydakis (TK), Colgajo de Limberg (CL) y de Preservación cutánea (PC) en el tratamiento de la enfermedad pilonidal crónica. Material y Métodos: estudio retrospectivo sobre 136 pacientes operados por enfermedad pilonidal crónica en el Sanatorio Allende, entre Enero del 2006 y Septiembre del 2013, basado en revisión de historias clínicas y entrevista telefónica. Se incluyeron 125 pacientes, 38 operados mediante CL, 50 con TK, y 37 con PC. Se excluyeron 11 pacientes por enfermedad pilonidal supurada. Las variables de evaluación primarias fueron el tiempo operatorio, complicaciones postoperatorias, tasa de recidiva; y las secundarias fueron el tiempo de reincorporación a actividades normales y deportivas, y el grado de satisfacción del paciente. Los test estadísticos empleados fueron el análisis de varianza, el postest de Tukey y Chi-cuadrado. Resultados: el tiempo quirúrgico fue menor en el grupo TK (37 min) en comparación con el grupo CL (53 min) (p0.05) aunque la reincorporación a actividades deportivas fue más prolongada en el grupo TK (43 días) respecto de los otros dos grupos (32 días) (p=0,042)...

Introduction: actually, there is no consensus as to the optimal surgical operation for sacrococcygeal pilonidal disease. The techniques used in our institution are Karydakis flap reconstruction, Limberg flap transposition, and a modified Soll et al procedure, which includes sinusectomy with primary closure called “Cutaneous preservation technique”. Objectives: to evaluate and to compare the efficacy and morbidity of Karydakis flap reconstruction (KF), Limberg flap transposition (LF) and Cutaneous preservation technique (CP) in the treatment of chronic pilonidal sinus disease. Patients and methods: a retrospective study was performed in 136 consecutive patients operated for chronic pilonidal sinus disease at Sanatorio Allende between January 2006 and September 2013, using KF, LF and CP procedures. Eleven patients were excluded for presenting suppurated pilonidal disease. One hundred and twenty five patients were included, 50 in the KF, 38 in LF and 37 in the CP group. Primary endpoints included operation time, complications and recurrence rates. Secondary end-points were healing time, return to normal and sports activities and degree of patient’s satisfaction. Data was obtained via a revision of digital clinical history and a standardized telephone interview. Statistical tests used were Anova with Tukeypost test and Chi-square test. Results: operating time was shorter in the KT group (37 min) compared with LF group (53min) (p0.05). However, return to sports activities was delayed in KF group (43 days), compared with LF and PC group (32 days) (p=0,042)...

Comparison of depression, anxiety and long-term quality of health in patients with a history of either primary closure or Limberg flap reconstruction for pilonidal sinus

OBJECTİVE: Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus. METHODS: A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales. RESULTS: There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p = 0.014 and p = 0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group. CONCLUSION: Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group. .

Carcinomatous degeneration of pilonidal cyst with sacrum destruction and invasion of the rectum / Degeneracao carcinomatosa do cisto pilonidal com destruicao do sacro e invasao da parede do reto

Malignant degeneration of pilonidal cysts is rare. The most common histologic type is the squamous cell carcinoma, triggered by the chronic inflammatory process. The growth of the lesion is typically slow. The diagnosis must be early and the appropriate treatment is ample surgical resection, including the presacral fascia. In some cases, as the present one, the diagnosis is made at a stage when the disease has progressed and invaded adjacent structures. In these cases the surgery involves multiple organ resection. We report the case of a patient with carcinomatous degeneration of pilonidal cyst, with bulky disease that extended up to the wall of the rectum. The treatment was extended resection, sacrectomy and abominoperineal resection of the rectosigmoid with permanent colostomy.

A degeneração maligna do cisto pilonidal é rara. O tipo histológico mais freqüente é o carcinoma epidermóide e tem como fator desencadeante o processo inflamatório crônico. O tumor é de crescimento lento. O diagnóstico deve ser precoce e o tratamento cirúrgico adequado é a ressecção ampla incluindo a fáscia pré-sacral. Em alguns casos, como o que apresentamos, o diagnóstico é feito numa fase em que a doença progrediu e invadiu as estruturas adjacentes. Nestes a cirurgia necessária envolve a ressecção multiorgânica. Apresentamos paciente com degeneração carcinomatosa do cisto pilonidal, com doença volumosa que se estendia até a parede do reto. O tratamento realizado foi ressecção alargada, sacralectomia e ressecção abominoperineal do retossigmóide com colostomia definitiva.

Resultados a corto y largo plazo con la técnica de Karydakis para la enfermedad pilonidal sacrocoxígea / Short-and long-term results with Karydaki’s technique for sacrococcygeal pilonidal disease

Introduction: Sacrococcygeal pilonidal cyst or sinus is a common condition in young people. There is still discussion about which of the many existing techniques is best suited to resolve this condition. Objective: To analyze the short-and long-term use of Karydaki's technique in our Hospital. Material and Methods: We analyzed prospective protocols from patients with pilonidal cyst with Karydaki's technique from June 2005 to August 2010. Clinical and telephonic follow-up was done to all patients and a satisfaction survey done to a random sample of the series. Results: We analyzed 62 patients with mean age of 24.5 years (15-45), being 33 men (53 percent). Cysts were previously relapsed in 20.9 percent of cases. The average hospital stay was 2.5 days (1-3). Early complications occurred in 14.3 percent of patients being the most common seroma in 8 percent and dehiscence in 6.4 percent. At a mean follow up of 38 months (12-62), relapse occurred in two patients (3.2 percent), one at 6 months and the other at 3 years, being resolved one by a new Karydaki's technique and the other with marsupialization. Among the group surveyed for satisfaction, 75 percent found the technique satisfactory or very satisfactory in terms of aesthetics and 95 percent would recommend this technique. Conclusions: Karydaki's operation achieves with a simple and aesthetic technic a low recurrence and morbidity and a complete recovery after 15 days in most patients.

Introducción: El quiste o seno pilonidal sacrocoxígeo es una patología frecuente en gente joven. Aún hay discusión sobre cual de las múltiples técnicas existentes es la más adecuada para resolver esta patología. Objetivo: Analizar los resultados a corto y largo plazo con la utilización de la técnica de Karydakis en nuestro medio. Material y Método: Se analizan los protocolos prospectivos de pacientes intervenidos por quiste pilonidal con la técnica de Karydakis desde junio de 2005 hasta agosto de 2010. Se realizó seguimiento clínico y telefónico de los pacientes y una encuesta de satisfacción a una muestra aleatoria de la serie. Resultados: Se analizan 62 pacientes con promedio de edad de 24,5 años (15-45), siendo de ellos 33 hombres (53 por ciento). En un 20,9 por ciento de los casos eran quistes recidivados. La hospitalización promedio fue de 2,5 días (1-3). Un 14,3 por ciento presentó complicaciones precoces siendo las más frecuentes el seroma (8 por ciento) y dehiscencia de sutura (6,4 por ciento). El seguimiento promedio fue de 38 meses (i: 12-62). Dos pacientes tuvieron recidivas (3,2 por ciento), a los 6 meses y a los 3 años, resolviéndose una con nueva técnica de Karydakis y la otra con marsupialización. Del grupo encuestado, el 75 por ciento consideró que la técnica fue satisfactoria o muy satisfactoria (estética) y el 95 por ciento de los pacientes la recomendaría. Conclusiones: La operación de Karydakis logra con una técnica simple y estética una baja recidiva y morbilidad y una recuperación definitiva a los 15 días en la mayoría de los pacientes.