Surgical Division, Ahmadi Hospital, KOC, Ahmadi, Kuwait; Department of Surgery, Medical Research Institute, University of Alexandria, Alexandria, Egypt
4 Surgical Division, Ahmadi Hospital, KOC, Ahmadi, Kuwait; Department of Surgery, Medical Research Institute, University of Alexandria, Alexandria, Egypt
Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.
H. S. Khairi and J. H. Brown, “Excision and Primary Suture of Pilonidal Sinu,” Annals of the Royal College of Surgeons of England, Vol. 77, No. 4, 1995, pp. 242-244.
D. P. Berry, “Pilonidal Sinus Disease,” Journal of Wound Care, Vol. 1, No. 3, 1992, pp. 29-32.
G. E. Karydakis, “Easy and Successful Treatment of Pilonidal Sinus after Explanation of Its Causative Process,” Australian and New Zealand Journal of Surgery, Vol. 62, No. 6, 1992, pp. 385-389. doi:10.1111/j.1445-2197.1992.tb07208.x
M. Sakr, M. Habib and A. Shaheed, “Assessment of Karydakis Technique as Compared with Midline Closure for the Management of Chronic Pilonidal Sinus,” Journal of Pelvic Medicine & Surgery, Vol. 12, No. 4, 2006, pp. 201-206. doi:10.1097/01.spv.0000217399.78641.43
S. Chintapatla, N. Safarani, S. Kumar and N. Haboubi, “Sacrococcygeal Pilonidal Sinus: Historical Review, Pathological Insight and Surgical Options,” Techniques in Coloproctology, Vol. 7, No. 1, 2003, pp. 3-8. doi:10.1007/s101510300001
M. F. Can, M. M. Sevinc and M. Yilmaz, “Comparison of Karydakis Flap Reconstruction versus Midline Closure in Sacrococcygeal Pilonidal Disease: Results of 200 Military Service Members,” Surgery Today, Vol. 39, No. 7, 2009, pp. 580-586. doi:10.1007/s00595-008-3926-0
G. Nessar, C. Kayaalp and C. Seven, “Elliptical Rotation Flap for Pilonidal Sinus,” The American Journal of Surgery, Vol. 187, No. 2, 2004, pp. 300-303. doi:10.1016/j.amjsurg.2003.11.012
W. P. T. James, “Review: WHO Recognition of the Global Obesity Epidemic,” International Journal of Obesity, Vol. 32, 2008, pp. 120-126. doi:10.1038/ijo.2008.247
G. E. Karydakis, “New Approach to the Problem of Pilonidal Sinus,” Lancet, 1973, No. 7843, 1973, pp. 1414-1415. doi:10.1016/S0140-6736(73)92803-1
R. L. Rosenfield, “Clinical Practice. Hirsutism,” New England Journal of Medicine, Vol. 353, 2005, pp. 2578-2588. doi:10.1056/NEJMcp033496
A. E. Humphries and J. E. Duncan, “Evaluation and Management of Pilonidal Disease,” Surgical Clinics of North America, Vol. 90, No. 1, 2010, pp. 113-124. doi:10.1016/j.suc.2009.09.006
M. Sakr, H. El-Hammadi, M. Moussa, S. Arafa and M. Rasheed, “The Effect of Obesity on the Results of Karydakis Technique for the Management of Chronic Pilonidal Sinus,” International Journal of Colorectal Disease, Vol. 18, No. 1, 2003, pp. 36-39. doi:10.1007/s00384-002-0407-6
A. Cubukcu, N. N. Gonullu, M. Paksoy, A. Alponat, M. Kuru and O. Ozbay, “Role of Obesity on the Recurrence of Pilonidal Sinus Disease in Patients Who Were Treated by Excision and Limberg Flap Transposition,” International Journal of Colorectal Disease, Vol. 15, No. 3, 2000, pp. 173-175. doi:10.1007/s003840000212
T. G. Allen-Mersh, “Pilonidal Sinus: Finding the Right Track for Treatment,” British Journal of Surgery, Vol. 77, No. 2, 1990, pp. 123-132. doi:10.1002/bjs.1800770203
M. Fuzun, I. Bakir, M. Soylu, T. Tansung, E. Kaymak and O. Harmancioglu, “Which Technique for Pilonidal Sinus—Open or Closed?” Diseases of the Colon & Rectum, Vol. 37, No. 11, 1994, pp. 1148-1150.
K. Sondenaa, E. Andeersen and J. A. Soreide, “Morbidity and Short Term Results in a Randomized Trial of Open Compared to Closed Treatment of Chronic Pilonidal Sinus,” European Journal of Surgery, Vol. 158, 1992, pp. 351-355.
J. A. Solla and D. A. Rothenberger, “Chronic Pilonidal Disease. An Assessment of 150 Cases,” Diseases of the Colon & Rectum, Vol. 33, No. 9, 1990, pp. 753-761. doi:10.1007/BF02052321
I. P. Bissett and W. H. Isbister, “The Management of Patients with Pilonidal Disease—A Comparative Study,” Australian and New Zealand Journal of Surgery, Vol. 57, No. 12, 1987, pp. 939-942. doi:10.1111/j.1445-2197.1987.tb01298.x
H. Spivac, V. L. Brooks, M. Nussbaum and I. Friedman, “Treatment of Chronic Pilonidal Disease,” Diseases of the Colon & Rectum, Vol. 39, No. 10, 1996, pp. 1136-1139. doi:10.1007/BF02081415
M. J. Notaras, “A Review of Three Popular Methods of Treatment of Postanal (pilonidal) Disease,” British Journal of Surgery, Vol. 57, No. 12, 1970, pp. 886-890. doi:10.1002/bjs.1800571204
H. T. Khawaja, S. Bryan and P. C. Weaver, “Treatment of Natal Cleft Sinus: A Prospective Clinical and Economical Evaluation,” BMJ, Vol. 304, 1992, pp. 1282-1283. doi:10.1136/bmj.304.6837.1282
K. K. Hameed, “Outcome of Surgery for Chronic Natal Cleft Pilonidal Sinus: A Randomized Trial of Open Compared with Closed Technique,” Medical Forums, Vol. 12, 2001, pp. 20-23.
H. A. Mohamed, I. Kadry and S. Adly, “Comparison between Three Therapeutic Modalities for Non-Complicated Pilonidal Sinus Disease,” Surgeon, Vol. 3, No. 2, 2005, pp. 73-77. doi:10.1016/S1479-666X(05)80065-4
M. Miocinovic, M. Horzic and D. Bunoza, “The Treatment of Pilonidal Disease of the Sacrococcygeal Region by the Method of Limited Excision and Open Wound Healing,” Acta Medica Croatica, Vol. 54, No. 1, 1999, pp. 27-31.
M. Oncel, N. Kurt, M. Kemet, E. Colak, M. Eser and H. Uzun, “Excision and Marsupialization versus Sinus Excision for the Treatment of Limited Chronic Pilonidal Disease: A Prospective Randomized Trial,” Techniques in Coloproctology, Vol. 6, No. 3, 2002, pp. 165-169. doi:10.1007/s101510200037
J. R. Notaro, “Management of Recurrent Pilonidal Disease,” Seminars in Colon & Rectal Surgery, Vol. 14, No. 4, 2003, pp. 173-185. doi:10.1053/j.scrs.2004.03.002
M. F. Can, M. M. Sevinc, O. Hancerliogullari, M. Yilmaz and G. Yagci, “Multicenter Prospective Randomized Trial Comparing Modified Limberg Flap Transposition and Karydakis Flap Reconstruction in Patients with Sacrococcygeal Pilonidal Disease,” The American Journal of Surgery, Vol. 200, No. 3, 2010, pp. 318-327. doi:10.1016/j.amjsurg.2009.08.042
S. A. M. Abdulrahman, A. S. Mohammed and H. A. Hamdoun, “Pilonidal Sinus in Males: To Preserve or Obliterate the Natal Cleft,” Saudi Medical Journal, Vol. 23, 2002, pp. 875-876.
O. F. Akinici, A. Coskun and A. Uzunkoy, “Simple and Effective Treatment of Pilonidal Sinus: Asymmetric Excision and Primary Closure Using Suction Drain and Subcuticular Skin Closure,” Diseases of the Colon & Rectum, Vol. 43, 2000, pp. 706-707.
H. Patel, M. Lee, I. Bloom and T. G. Allen-Mersh, “Prolonged Delay in Healing after Surgical Treatment of Pilonidal Sinus Is Avoidable,” Colorectal Disease, Vol. 1, No. 2, 1999, pp. 107-110. doi:10.1046/j.1463-1318.1999.00030.x
A. C. Anyanwi, S. Hossain, A. Williams and A. C. Montgomery, “Karydakis Operation for Sacrococcygeal Pilonidal Sinus Disease: Experience in a District General Hospital,” Annals of the Royal College of Surgeons of England, Vol. 80, 1998, pp. 197-199.
P. R. B. Kitchen, “Pilonidal Sinus: Experience with the Karydakis Flap,” British Journal of Surgery, Vol. 83, No. 10, 1996, pp. 1452-1455. doi:10.1002/bjs.1800831040
T. M. El-Jaberi, “Excision and Simple Closure of Chronic Pilonidal Sinus,” European Journal of Surgery, Vol. 167, No. 2, 2001, pp. 133-135. doi:10.1080/110241501750070600
A. Senapati, N. P. Cripps and M. R. Thompson, “Bascom’s Operation in the Day-Surgical Management of Symptomatic Pilonidal Sinus,” British Journal of Surgery, Vol. 87, No. 8, 2000, pp. 1067-1070. doi:10.1046/j.1365-2168.2000.01472.x
K. Sondenaa, I. Nesvik, E. Andersen, L. Pollard and J. R. Soreide, “Recurrent Pilonidal Sinus: Etiology and Treatment,” Digestive Surgery, Vol. 12, No. 2, 1995, pp. 117-120. doi:10.1159/000172329
T. Z. Nursal, A. Ezer, K. Caliskan, N. Torer, S. Belli and G. Moray, “Prospective Randomized Controlled Trial Comparing V-Y Advancement Flap with Primary Suture Methods in Pilonidal Disease,” American Journal of Surgery, Vol. 199, No. 2, 2010, pp. 170-177. doi:10.1016/j.amjsurg.2008.12.030
D. Doll, E. Matevossian, K. Wietelmann, T. Evers, M. Kriner and S. Petersen, “Family History of Pilonidal Sinus Predisposes to Earlier Onset of Disease and a 50% Long-Term Recurrence Rate,” Diseases of the Colon & Rectum, Vol. 52, No. 9, 2009, pp. 1610-1615. doi:10.1007/DCR.0b013e3181a87607
D. Doll, C. M. Krueger, S. Schrank, H. Dettmann, S. Petersen and W. Duesel, “Timeline of Recurrence after Primary and Secondary Pilonidal Sinus Surgery,” Diseases of the Colon & Rectum, Vol. 50, No. 11, 2007, pp. 1928-1934. doi:10.1007/s10350-007-9031-4
G. E. Theodoropoulos, K. Vlahos, A. C. Lazaris, E. Tahteris and D. Panoussopoulos, “Modified Bascom’s Asymmetric Midgluteal Cleft Closure Technique for Recurrent Pilonidal Disease: Early Experience in a Military Hospital,” Diseases of the Colon & Rectum, Vol. 46, No. 9, 2003, pp. 1286-1291. doi:10.1007/s10350-004-6729-4
T. W. Khanzada and A. Samad, “Recurrence after Excision and Primary Closure of Pilonidal Sinus,” Pakistan Journal of Medical Sciences, Vol. 23, No. 3, 2007, pp. 375-379.
A. Gurer, I. Gomceli, M. Ozdogan, et al., “Is routine Cavity Drainage Necessary in Karydakis Flap Operation? A Prospective, Randomized Trial,” Diseases of the Colon & Rectum, Vol. 48, No. 9, 2005, pp. 1797-1799. doi:10.1007/s10350-005-0108-7
S. Petersen, R. Koch, S. Stelzner, et al., “Primary Closure Techniques in Chronic Pilonidal Sinus: A Survey of the Results of Different Surgical Approaches,” Diseases of the Colon & Rectum, Vol. 45, No. 11, 2002, pp. 1458- 1567. doi:10.1007/s10350-004-6451-2