Surgeons' Experience and Practices in Managing the Pilonidal Sinus in the Kurdistan Region of Iraq.

Background Despite pilonidal sinus disease being a prevalent issue, there are still many challenges and controversies regarding its management. This study aimed to evaluate the experiences and practices of surgeons in the Kurdistan region of Iraq in the management of the pilonidal sinus and determine the most preferred treatment method, recurrence rates, and other complications related to different treatment methods. Methods This cross-sectional study was conducted on a convenience sample of 104 surgeons in the Kurdistan region of Iraq from January to February 2024 using an online survey based on Google Forms. A questionnaire was developed for data collection that included data on the experience and practice of pilonidal sinus treatment. Results The most common procedure followed by the study participants to manage the pilonidal sinus included primary open (n = 61/104, 58.7%), followed by primary closure (n = 20/104, 19.2%). The most common reasons or advantages for performing specific procedures to manage the pilonidal sinus were a lower recurrence rate (n = 73/104, 70.2%), safer procedures (n = 60/104, 57.7%), shorter operation times (n = 57/104, 54.8%), and shorter hospital stays (n = 53/104, 51.0%). The primary open method was the most commonly used method (n = 46/104, 44.3%), followed by simple incision and drainage (n = 25/104, 24.0%), primary closure (n = 23/104, 22.1%), and off-midline closure (n = 10/104, 9.6%). Most of the participants agreed that the primary open had the lowest recurrence rate (n = 68/104, 65.4%), while simple incision and drainage (n = 50/104, 48.1%) and primary closure (n = 29/104, 27.9%) were associated with frequent recurrence. Conclusions Standard treatment of pilonidal sinus disease is still not available. Most surgeons in the Kurdistan region of Iraq prefer the open method, which is the easiest, safest, and least recurrent yield method. However, it is the most painful and has the longest recovery time.

Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study.

Objectives: To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease. METHODS: The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05). CONCLUSIONS: Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.

SiLaT: A paradigm shift in the treatment of pilonidal disease?

BACKGROUND: Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM: Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS: All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS: In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being "very satisfied" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION: SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.

The application of ERAS in pilonidal sinus: comparison of postoperative recovery between primary suture and Limberg flap procedure in a multicenter prospective randomized trial.

Purpose: We evaluated the clinical effect of utilizing a Limberg rhomboid flap graft in conjunction with Enhanced Recovery After Surgery (ERAS) protocols for the management of pilonidal sinus in the sacrococcygeal region to demonstrate the feasibility of applying ERAS to the treatment of pilonidal sinus. Methods: Between January 2010 and August 2018, prospective data analysis was undertaken on 109 patients who received surgical treatment for pilonidal sinus in the sacrococcygeal region at the Department of Colorectal and Anal Surgery, Jingzhou Hospital affiliated to Yangtze University, and Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine. The patients were randomly separated into two groups based onoperation technique: the control group (pilonidal sinus resection with primary suture) and the observation group (pilonidal sinus resection with Limberg flap graft). Some patients in the above two groups received ERAS after surgery, which included early feeding and early ambulation, etc. Therefore, we further subdivided each group into group A (without ERAS) and group B (with ERAS) according to whether they received ERAS. Comparative analysis was conducted to assess differences in pertinent data before and after surgery across the respective groups. Results: The length of postoperative hospitalization was shorter and wound dehiscence was more common in control group B than in control group A [(9.00 ± 1.20) vs. (11.07 ± 1.78), 26.7% (8/30) vs. 7.1% (2/28), P < 0.05]. Observation group B exhibited significantly shorter wound recovery periods and postoperative hospital stays compared to observation group A [(8.08 ± 1.20) vs. (9.16 ± 2.21), (26.23 ± 3.97) vs. (29.08 ± 4.74), P < 0.05]. The hospitalization duration and wound healing time in observation group B were notably shorter than those observed in control group B [(8.08 ± 1.20) vs. (9.00 ± 1.20), [26.23 ± 3.97 vs. (43.67 ± 7.26), P < 0.05], but the operation time was longer and scar acceptance was lower [(78.85 ± 10.16) vs. (43.30 ± 6.06), (4.00 ± 0.69) vs. (7.53 ± 0.86), P < 0.05]. The VAS score, infection rate, wound dehiscence rate, subcutaneous hematoma rate and 5-year recurrence rate in observation group B were lower than those in control group B [(5.00 ± 1.39) vs. (7.13 ± 0.78), 3.8% (1/26) vs. 23.3% (7/30), 3.8% (1/26) vs. 26.7% (8/30), 3.8% (1/26) vs. 26.7%(8/30), 7.7% (2/26) vs. 30.0% (9/30), P < 0.05], but the rate of flap ischemia or necrosis was higher [15.4% (4/26) vs. 0(0/30), P < 0.05]. Conclusion: The combination of ERAS with pilonidal sinus resection using Limberg flap graft demonstrated a reduction in infection rates, wound dehiscence, subcutaneous hematoma occurrence, and recurrence rates, along with alleviation of postoperative pain and acceleration of healing time. Comparatively, this approach offers superior advantages over pilonidal sinus resection with primary suture in the management of sacrococcygeal pilonidal sinus.

Co-occurrence of posterior chest wall pilonidal sinus with melanocytic nevus: a challenging presentation: a case report.

INTRODUCTION: To date, only a limited number of case reports have documented the co-occurrence of PNS and melanocytic nevus in the medical literature. This study aims to report an exceptionally rare case of posterior chest wall PNS in conjunction with a melanocytic nevus. CASE PRESENTATION: A 46-year-old female presented with a long-standing black lesion on her left upper posterior chest wall, that had become painful in the two months prior to presentation. There was a painful, dark blue, non-erythematous, and non-tender nodule on the left upper posterior chest wall. Based on the patient's desire for cosmetic purposes, the lesion was excised totally with primary closure under local anaesthesia. Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus. DISCUSSION: The rarity of posterior chest wall PNS associated with nevi poses unique diagnostic and therapeutic challenges for clinicians. The distinct anatomical location, different from the conventional region, and the rare association between the two conditions may delay accurate diagnosis and result in mismanagement or inappropriate interventions. CONCLUSION: The posterior chest wall PNS is another type of atypical PNS that is extremely rare. The association between PNS and blue nevus is a fascinating medical finding that deserves further investigation.

Limberg Transpositional Fasciocutaneous Flap in Sacrococcygeal Pilonidal Sinus Disease (SPSD): A Case Series.

Introduction Among young male adults, sacrococcygeal pilonidal sinus disease (SPSD) is a prevalent condition. There are several possibilities for treatment, including both conservative and surgical methods. Medical supervision or conservative management is not the cutting-edge and preferred management nowadays. Although not fatal, it negatively impacts young people's quality of life in terms of schooling and means of subsistence and is socially awkward. Method About 10 individuals in this case series have serous drainage from the sinus in the sacral region, which is a common symptom. The patients were entitled to a full recovery from their illness. In all these patients, the Limberg flap procedure was recommended, and just one patient out of 10 had a minimal infection. Every patient was satisfied with how the surgery turned out. Overall, the Limberg flap (rhomboid flap) approach is becoming the norm for care since it has a lower rate of recurrence, fewer postoperative problems, and a shorter learning curve. Result Flap necrosis instances were absent in all the cases. And out of 10 cases, one patient came with a surgical site infection during the follow-up, suggesting a complication rate of 10%. Conclusion For the treatment of primary pilonidal illness, rhomboid excision utilising the Limberg transpositional fasciocutaneous flap technique is seen as a safer option that encompasses numerous sinuses. It requires less time in the hospital and has fewer postoperative problems.

Advancements and Innovations in the Surgical Management of Sacrococcygeal Pilonidal Sinus: A Comprehensive Review.

Sacrococcygeal pilonidal sinus (SPS) is a common condition characterized by the formation of a sinus tract or cavity in the sacrococcygeal region, often containing hair and debris. Surgical management plays a crucial role in its treatment due to its chronic and recurrent nature. This comprehensive review explores the advancements and innovations in the surgical management of SPS. The review begins with an overview of the historical perspective, anatomy, and pathophysiology of the condition, followed by a discussion of current surgical techniques, including conventional excision, flap procedures, and minimally invasive approaches. Recent advancements, such as laser therapy, radiological guidance techniques, and robotic-assisted surgery, are also examined. The key findings from outcomes research are summarized, including postoperative pain management, recurrence rates, and patient satisfaction. The implications for clinical practice are discussed, emphasizing the importance of staying updated on the latest surgical techniques and adopting a personalized approach to treatment. Recommendations for future research are provided, highlighting the need for prospective studies comparing different surgical techniques, as well as research focusing on minimally invasive approaches and predictive models for recurrence risk. Collaboration among researchers, clinicians, and industry partners is essential to drive innovation and improve outcomes for patients with SPS.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

Background: The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. Material and method: The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Result: Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Conclusion: Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease.

Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.

Laser Ablation of Pilonidal Sinus in a Patient With Hemophilia Type A: A Case Report and Review of the Literature.

Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area. Hemophilia type A is a hemorrhagic disorder caused by a deficiency of factor VIII. It presents with excessive bleeding, either spontaneously or secondary to trauma. The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used. In this article, we present a case of a young man with hemophilia A presenting with recurrent PNS successfully managed with laser ablation with no complications.

Research and practice priorities in pilonidal sinus disease: a consensus from the PITSTOP study.

AIM: Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field. METHOD: Patients and surgeons were invited to participate. A 'So what, now what' exercise was conducted, informed by data from PITSTOP. This generated statements for research and practice priorities. A three-round online Delphi study was conducted, ranking statements based on policy and research separately. Statements were rated 1 (not important) to 9 (important). Statements that were rated 7-9 by more than 70% of participants were entered into the consensus meeting. Personalized voting feedback was shown between rounds. A face-to-face meeting was held to discuss statements, and participants were asked to rank statements using a weighted choice vote. RESULTS: Twenty-two people participated in the focus group, generating 14 research and 19 policy statements. Statements were voted on by 56 participants in round 1, 53 in round 2 and 51 in round 3. A total of 15 policy statements and 19 research statements were discussed in the consensus round. Key policy statements addressed treatment strategies and intensity, surgeon training opportunities, need for classification and the impact of treatment on return to work. Research recommendations included design of future trials, methodology considerations and research questions. CONCLUSION: This study has identified research and policy priorities in pilonidal sinus disease which are relevant to patients and clinicians. These should inform practice and future research.

Classification and stratification in pilonidal sinus disease: findings from the PITSTOP cohort.

AIM: Research in pilonidal disease faces several challenges, one of which is consistent and useful disease classification. The International Pilonidal Society (IPS) proposed a four-part classification in 2017. The aim of this work was to assess the validity and reliability of this tool using data from the PITSTOP cohort study. METHOD: Face validity was assessed by mapping the items/domains in the IPS tool against tools identified through a systematic review. Key concepts were defined as those appearing in more than two-thirds of published tools. Concurrent and predictive validity were assessed by comparing key patient-reported outcome measures between groups at baseline and at clinic visit. The outcomes of interest were health utility, Cardiff Wound Impact Questionnaire (CWIQ) and pain score between groups. Significance was set at p = 0.05 a priori. Interrater reliability was assessed using images captured during the PITSTOP cohort. Ninety images were assessed by six raters (two experts, two general surgeons and two trainees), and classified into IPS type. Interrater reliability was assessed using the unweighted kappa and unweighted Gwet's AC1 statistics. RESULTS: For face validity items represented in the IPS were common to other classification systems. Concurrent and predictive validity assessment showed differences in health utility and pain between groups at baseline, and for some treatment groups at follow-up. Assessors agreed the same classification in 38% of participants [chance-corrected kappa 0.52 (95% CI 0.42-0.61), Gwet's AC1 0.63 (95% CI 0.56-0.69)]. CONCLUSION: The IPS classification demonstrates key aspects of reliability and validity that would support its implementation.

Infrequent Presentation of Pilonidal Sinus over the Nasal Bridge.

We report a patient with recurrent discharging sinus over the nasal bridge which was finally diagnosed as pilonidal sinus over the nasal bridge. Nasal pilonidal sinus is a rare condition that presents as a chronic and recurrent inflammation of the hair follicles and surrounding tissues of the nose, leading to the formation of abscesses and sinus tracts. The following report deals the dilemma of diagnosing and management of the patient. Though rare, nasal pilonidal sinus should be included as a differential diagnosis to aid in management as well as to improve awareness and inclusion of this condition. This report provides an overview of the clinical presentation, diagnosis and management of nasal pilonidal sinus.

Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery.

BACKGROUND: Pilonidal sinus disease (PSD) is a common surgical disease. Multiple surgical methods exist in the literature, without clear consensus regarding which should be the first-line treatment. Minimally invasive methods such as the Gips procedure are gaining popularity in recent years. The aim of our study was to assess recurrence rates following the Gips procedure and to determine whether using the same surgical approach during re-operation is efficient and successful. METHODS: This is a single-center retrospective observational study of pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022. RESULTS: 565 pediatric patients underwent an elective surgery for PSD in the study period. Recurrence rate was 8.1% (n = 46). In all the patients with recurrence, re-operation took place on average 9 months following the first surgery and using the same surgical method. Following the second surgery, only 8 patients (1%) had multiple recurrences. CONCLUSIONS: We found a relatively low recurrence rate in the pediatric population using the Gips method, and nearly 100% success rate following the second operation. Our findings set a new benchmark for pediatric recurrence following PSD operation, with clear recommendation to use the same method of surgery upon further recurrences as well.

Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study.

INTRODUCTION: Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up. METHODOLOGY: All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan-Meier analyses. RESULTS: Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan-Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026). CONCLUSION: This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.

Efficacy of laser obliteration with limited excision of pilonidal sinus.

OBJECTIVE: This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS: A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS: Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION: According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.

Commentary on packing vs non-packing of pilonidal sinus cavities after incision and drainage.

Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income countries. This disease is associated with significant physical and psychosocial distress. Surgery is an option for managing PSD; yet, surgical methods vary, and a universally accepted gold standard approach is lacking, leading to current practices that are diverse and subject to ongoing debate. One such point of contention revolves around the decision to use packing or opt for a non-packing approach following surgery. Mohamedahmed et al (2021) conducted a systematic review to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body. This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.

A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents.

PURPOSE: Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease. METHODS: PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant. RESULTS: A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score. CONCLUSIONS: Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.

Unusual position of pilonidal sinus in children may explain its malformative etiology: Case report and review of the literature.

INTRODUCTION: Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial. CASE PRESENTATION: A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health. CLINICAL DISCUSSION: This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus. CONCLUSION: Skin malformations can be the underlying cause of pilonidal sinus in some cases.

Pilonidal sinus: an overview of historical and current management modalities.

Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.