25 years’ experience in the management of pilonidal sinus disease — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
25 years’ experience in the management of pilonidal sinus disease
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Department of Surgery, Al-Zahra Hospital, Beirut, Lebanon
,
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
,
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
,
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
,
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
,
Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
1 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Department of Surgery, Al-Zahra Hospital, Beirut, Lebanon
2 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
3 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
4 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
5 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
6 Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.
KeywordsPilonidal SinusPhenol InjectionExcision with Primary ClosureExcision with Packing
Mayo, O.H. (1833) Observations on injuries and disease of rectum. Burgess and Hill, London, 45-46 (Quoted from da Silva, J.H. (2000) Pilonidal cyst: Cause and treatment. Diseases of the Colon & Rectum, 43, 1146-1156. http://dx.doi.org/10.1007/BF02236564)
Hodge, R.M. (1880) Pilonidal sinus. Boston Medical and Surgical Journal, 103, 485-486, 493, 544. (Quoted from da Silva J.H. (2000) Pilonidal cyst: Cause and treatment. Diseases of the Colon & Rectum, 43, 1146-1156. http://dx.doi.org/10.1007/BF02236564).
Mahdy, T. (2008) Surgical treatment of the pilonidal disease: Primary closure of flap reconstruction after excision. Diseases of the Colon & Rectum, 51, 1816-1822. http://dx.doi.org/10.1007/s10350-008-9436-8
Goldberg, S.M., Gordon, P.H. and Nivatongs, S. (1980) Essentials of anorectal surgery. JB Lippincott, Philadelphia, 128-133.
Mentes, O., Bagci, M., Bilgin, T., Coskun, I., Ozgul, O. and Ozdemir, M. (2006) Management of pilonidal sinus disease with oblique excision and primary closure results of 493 patients. Diseases of the Colon & Rectum, 49, 104-108. http://dx.doi.org/10.1007/s10350-005-0226-2
Basom, J. (1983) Pilonidal disease: Long-term results of follicle removal. Diseases of the Colon & Rectum, 26, 800-807. http://dx.doi.org/10.1007/BF02554755
Chintapatla, S., Safarowi, N., Kumar, S. and Haboubi, N. (2003) Sacrococcygeal pilonidal sinus: Historical review, pathological insight and surgical options. Techniques in Coloproctology, 7, 3-8. http://dx.doi.org/10.1007/s101510300001
Weston, S.D. and Schlachter, I.S. (1963) Pilonidal cyst of the anal canal: Case report. Diseases of the Colon & Rectum, 6, 139-141. http://dx.doi.org/10.1007/BF02633468
Eryilmaz, R., Sahin, M., Okan, I., Alimoglu, O. and Somay, A. (2005) Umbilical pilonidal sinus disease: Predisposing factors and treatment. World Journal of Surgery, 29, 1158-1168. http://dx.doi.org/10.1007/s00268-005-7895-9
Sondeno, K., Andersen, E., Nesvik, I. and Spreide, J.A. (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. International Journal of Colorectal Disease, 10, 39-42. http://dx.doi.org/10.1007/BF00337585
Berry, D.P. (1992) Pilonidal disease. Journal of Wound Care, 1, 29-32.
Allen-Mersh, T.G. (1990) Pilonidal sinus: Finding the right track for treatment. The British Journal of Surgery, 77, 123-132. http://dx.doi.org/10.1002/bjs.1800770203
Dwight, R.W. and Maloy, J.K. (1953) Pilonidalis sinus experience with 449 cases. New England Journal of Medicine, 249, 926-930. http://dx.doi.org/10.1056/NEJM195312032492303
Keiglhey, M.R.B. (1993) Pilonidal disease. In: Keiglhey, M.R.B. and Williams, N.S., Eds., Surgery of Anus, Rectum and Colon, W.B. Saunders, London, 467-489.
Tinsley, P. (2002) The management of a pilonidal sinus and its follow-up care. British Journal of Nursing, 11, S31-S32, S34, S36.
Timmons, J. (2007) Diagnosis, treatment and nursing management of patients with pilonidal sinus disease. Nursing Standard, 21, 48-56. http://dx.doi.org/10.7748/ns2007.09.21.52.48.c6597
Goodall, P. (1961) The etiology and treatment of pilonidal sinus: A review of 163 patients. The British Journal of Surgery, 49, 212-218. http://dx.doi.org/10.1002/bjs.18004921421
Clothiers, P.R. and Haywood, I.R. (1984) The natural history of the post anal (pilonidal) sinus. Annals of the Royal College of Surgeons of England, 66, 201-203.
Lord, P.H. and Millar, D.M. (1965) Pilonidal sinus: A simple treatment. The British Journal of Surgery, 52, 298-300. http://dx.doi.org/10.1002/bjs.1800520413
Weinsten, M.A., Rubin, R.J. and Salvate, E.P. (1977) Pilonidal cyst anatomy: Reappraisal of an old technique. Diseases of the Colon & Rectum, 20, 287-289. http://dx.doi.org/10.1007/BF02586424
Hull, T.L. and Wu, J. (2002) Pilonidal disease. The Surgical Clinics of North America, 82, 1169-1185. http://dx.doi.org/10.1016/S0039-6109(02)00062-2
Me Laren, C.A. (1984) Partial closure and other technique in pilonidal surgery: An assessment of 157 cases. The British Journal of Surgery, 71, 561-562. http://dx.doi.org/10.1002/bjs.1800710731
Iesalnieks, I., Fürst, A., Rentsch, M. and Jauch, K.W. (2003) Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Der Chirurg, 74, 461-468. http://dx.doi.org/10.1007/s00104-003-0616-8
McCallum, I.J., King, P.M. and Bruce, J. (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: Systematic review and meta-analysis. BMJ, 336, 868-871. http://dx.doi.org/10.1136/bmj.39517.808160.BE
Hemmati, H., Ghorbani, R. and Torshizi E.N. (2013) Recurrence rate in the pilonidal sinus after excision with or without primary closure. Koomesh, 15, 78-82. http://www.koomeshjournal.ir/browse.php?a_code=A-10-1116-1&slc_lang=en&sid=1
Testini, M., Piccinni, G., Miniello, S., Di Venere, B., Lissidini, G., Nicolardi, V. and Bonomo, G.M. (2001) Treatment of chronic pilonidal sinus with local anesthesia: A randomized trial of closed compared with open technique. Colorectal Disease, 3, 427-430. http://dx.doi.org/10.1046/j.1463-1318.2001.00278.x
Bradley, L. (2006) Pilonidal sinus disease: A misunderstood problem. Wounds UK, 2, 45-53. http://www.wounds-uk.com/pdf/content_9049.pdf
Maurice, B.A. and Greenwood, R.K. (1964) A conservative treatment of pilonidal sinus. The British Journal of Surgery, 51, 510-51. http://dx.doi.org/10.1002/bjs.1800510711
Shorey, B.A. (1975) Pilonidal sinus treated by phenol injection. The British Journal of Surgery, 62, 407-408. http://dx.doi.org/10.1002/bjs.1800620521
Schneider, I.H., Thaler, K. and Kockerling, F. (1994) Treatment of pilonidal sinuses by phenol injections. International Journal of Colorectal Disease, 9, 200-202. http://dx.doi.org/10.1007/BF00292250
Dag, A., Colak, T., Turkmenoglu, O., Sozutek, A. and Gundogdu, R. (2012) Phenol procedure for pilonidal sinus disease and risk factors for treatment failure. Surgery, 151, 113-117. http://dx.doi.org/10.1016/j.surg.2011.07.015
Dogru, O., Camci, C., Aygen, E., Girgin, M. and Topuz, O. (2004) Pilonidal sinus treated with crystallized phenol: An eight-year experience. Diseases of the Colon & Rectum, 47, 1934-1938. http://dx.doi.org/10.1007/s10350-004-0720-y
Gwynn, B.R. (1986) Use of the rhomboid flap in pilonidal sinus. Annals of the Royal College of Surgeons England, 68, 40-44.
Topgul, K. (2010) Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap. Journal of the European Academy of Dermatology and Venereology, 24, 7-12. http://dx.doi.org/10.1111/j.1468-3083.2009.03350.x
Karydakis, G.E. (1973) New approach to the problem of pilonidal sinus. Lancet, 2, 1414-1415. http://dx.doi.org/10.1016/S0140-6736(73)92803-1
Morden, P., Drongowski, R.A., Geiger, J.D., Hirschl, R.B. and Teitelbaum, D.H. (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatric Sugery International, 21, 793-796. http://dx.doi.org/10.1007/s00383-005-1543-1
Borkurt, M.K. and Tezel, E. (1998) Management of pilonidal sinus with the Limberg flap. Diseases of the Colon & Rectum, 41, 775-777. http://dx.doi.org/10.1007/BF02236268
Ertan, T., Koc, M., Gocmen, E., Aslar, A.K., Keskek, M. and Kilic, M. (2005) Does technique alter quality of life after pilonidal sinus surgery? The American Journal of Surgery, 190, 388-392. http://dx.doi.org/10.1016/j.amjsurg.2004.08.068
Ince, M. and Aslan, E. (2013) Comment on day-care surgery for pilonidal sinus using sinotomy technique and fibrin glue injection. Archives of Clinical and Experimental Surgery, 2, 136-137. http://dx.doi.org/10.5455/aces.20130203022117
Elsey, E. and Lund, J.N. (2013) Fibrin glue in the treatment for pilonidal sinus: High patient satisfaction and rapid return to normal activities. Techniques in Coloproctology, 17, 101-104. http://dx.doi.org/10.1007/s10151-012-0956-9
Sasse, K.C., Brandt, J., Lim, D.C. and Ackerman, E. (2013) Accelerated healing of complex open pilonidal wounds using MatriStem extracellular matrix xenograft: Nine cases. Journal of Surgical case reports, 4, rjt025. http://dx.doi.org/10.1093/jscr/rjt025
Smart, P.J., Dungerwalla, M. and Heriot, A.G. (2013) Bascom’s simple pilonidal sinus surgery: Simpler with ultrasound guidance. Journal of Medical Ultrasound, 21, 97-99. http://dx.doi.org/10.1016/j.jmu.2013.04.001