Sinus pilonidalis – possibilities of surgical treatment
Authors:
J. Jandík
Authors‘ workplace:
Chirurgické oddělení, Oblastní nemocnice Náchod, a. s., Nemocnice Rychnov n. Kněžnou
primář: MUDr. D. W. Shihata
Published in:
Rozhl. Chir., 2014, roč. 93, č. 10, s. 496-501.
Category:
Original articles
Overview
Introduction:
The author presents current knowledge about the therapy of pilonidal disease and compares it to his own experience with a group of patients treated for this disease in the period 2007−2014.
Material and methods:
169 patients with symptoms of pilonidal disease were treated; in 72 cases, surgery was indicated because of chronic state or recurrence of the disease. In 2007−2012, radical excision of sinus with primary suture of the defect was performed in 42 cases. In the period 2012−2014, 30 patients were operated on and the defect after excision was closed by rhomboid fasciocutaneous flap.
Results:
When both methods of defect closure were compared, the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing.
Conclusion:
Closing the defect with rhomboid flap seems to be the optimal method for the surgical approach to pilonidal disease.
Key words:
pilonidal disease – fasciocutaneous rhomboid flap – Limberg flap
Sources
1. Doll D, Friederichs J, Dettman H, et al. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 2008;23:359−64.
2. Caestecker de J, Geibel J, et al. Pilonidal disease. Medscape Reference 2011; WebMD.
3. Laningan MD, Dyne PL, et al. Pilonidal Cyst and Sinus. Medscape Reference 2011; WebMD.
4. Hull TL, Wu J. Pilonidal disease. Surg Clin Nort Am 2002;82:1168−85.
5. Thompson MR, Senapati A, Kitchen P. Simple day-case surgary for pilonidal sinus disease- Br J Surg 2011;98:198−209.
6. Mohamed HA, Kadry I, Adly S. Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 2005;3:73−7.
7. Laningan MD, Dyne PL, et al. Pilonidal cyst and sinus. Medscape Reference 2011, WebMD
8. McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2010:CD006213.
9. Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W. Sinus excision and primary closure versus laying open in pilonidal disease: prospective study. Dis Colon Rectum 2011;54:300−5.
10. Gendy AS, Glick RD, et al. A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 2011;46:1256−9.
11. Al-Salamah SM, Hussain MI, Mirza SM. Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 2007;57:388−91.
12. Doll D, Novotny A, Rothe R, et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis 2008;23:181–7.
13. Vaughn CJ, Lalikos JF. The use of acellular dermal regeneration template for recalcitrant pilonidal disease. J Wound Care 2011;20:275−7.
14. Farrell D, Muprhy S. Negative pressure wound therapy for recurrent pilonidal disease: a review of the literature. J Wound Ostomy Continence Nurs 2011;38:373−8.
15. Petersen S, Wietelmann K, Evers T, Huser N, Matevossian E, el al. Long term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 2009;52:131−4.
16. Popeskou S, Christoforidis D, Ruffieux C, Demartines N. Wound infection after excision and primary midline closure for pilonidal disease. World J Surg 2011;35:206−11.
17. Ates M, Dirican A, Sarac M, Aslan A, Colak C. Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study . Am J Surg 2011;202:568−73.
18. Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 2010;200:9−14.
19. Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? Meta-analysis of randomized controlled trials. Colorectal Dis 2012;14:143−51.
20. Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 2008;51:1816−22.
21. Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, el al. Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective randomized clinical trial. Dis Colon Rectum 2009;53:496−502.
22. Kayaalp C, Aydin C. Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 2009;13:189−93.
23. Rao AC. Cutting seton for pilonidal disease: a new approach. Tech Coloproctol. 2006;10:242−4.
24. Kayaalp C, Olmez A, Aydin C, Piskin T. Tumescent local anesthesia for excision and flap procedures in treatment of pilonidal disease. Dis Colon Rectum 2009;52:1780−3.
25. Kirkuil C, Boyuk A, et al. The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstructions in patients with pilonidal disease. Tech Coloproctol 2011;15:425−9.
26. Knobloch J. Experience with phenolization of pilonidal sinus fistula. Rozhl Chir 1980;59:79−82.
27. Knobloch J. The technic of phenolization of fistulae in pilonidal cysts. Rozhl Chir 1985;64:368−9.
28. Mrázek M, Kuthan D. Sacral pilonidal sinus--the Limberg operation. Rozhl Chir 2003;82:435−7.
29. Šmíd D, Novák P, Liška V, Třeška V. Pilonidal sinus-surgical management at our surgical clinic. Rozhl Chir 2011;90:301−5.
30. Daphan C, Tekelioglu MH, Sayilgan C. Limberg flap repair for pilonidal sinus disease. Dis Colon Rectum 2004;47:233−7.
31. Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg. 2008;393:185−9.
32. Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S. Randomized clinical trial comparing primary closure with the Limberg flap in the pilonidal sinus. Br J Surg 2005;92:1081−4.
33. Aslam MN, Shoaib S, Choundry AM. Use of Limberg flap for pilonidal sinus – a viable option. J Ayub Med Coll Abbottabad 2009;21:31−33.
34. Lieto E, Castellano P, et al. Dufourmentel rhomboid flap in the radical treatment of primary and recurent sacrococcygeal pilonidal disease. Dis Colon Rectum 2010;53:1061−8.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2014 Issue 10
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