Comparison of 'Excision and Primary Repair' with 'Bascom's Technique' in the Surgical Treatment of Pilonidal Sinus

Karim, Muhammad Osman; Khan, Kashuf Arooj; Khan, Abdul Jalil; Abbas, Syed Hussain; Abdalla, Omer; Aslam, Muhammad Imran

doi:10.7759/cureus.7338

Cited by 5 publications

(3 citation statements)

References 11 publications

(11 reference statements)

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“…11 Fewer complications characterize asymmetric restoration by the Karydakis and Bascom technique. 12,13 Also, good results were obtained by Limberg and rotational flaps. However, despite its radicality and the difficulty of execution, most of these treatment methods are characterized by a high recurrence rate and complications, so wound repair with plastic flaps is recommended in complex, repeated chronic diseases.…”

Section: Resultsmentioning

confidence: 95%

Comparative Analysis of Pilonidal Abscess Drainage

Gratiashvili,

Akhmeteli,

Ivanishvili

et al. 2023

Georgian Biomedical News

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Background: A chronic sinus or a fast recurrence occurs after simple drainage of an acute pilonidal abscess. It is reasonable to expect that the risk of recurrence will reduce if the acute abscess is removed with minimal excision of the primary orifices. Objectives: Our study aimed to evaluate the effectiveness of pilonidal abscess drainage performed by minimal excision of the primary ducts. Methods: From January 2019 through April 2022, 120 patients with pilonidal abscesses underwent outpatient proctology surgeries at the Todua Clinic (19 females, 101 males; age range, 18-57 years). 60 underwent drainage through an incision made by minimal excision of the primary ducts (Group 1), and the other 60 underwent simple drainage by dissection of the skin closest to the abscess (Group 2). Complete wound healing, the time of healing, recurrence, and complication rates were the primary comparison and success criteria defined. The length of the procedure, the time spent in the hospital, the time missed from work, the severity of the intraoperative pain, and the postoperative cosmetic outcomes were secondary variables. After surgery, an average follow-up time was 28 months (12-42 months). Results: In the simple drainage group, complete healing was achieved in 35 patients (58.3%), and in the excision group -in 58 patients (96.6%) -Chi2=25.07, p<0.001. Wound healing was rapid in the simple drainage group -3.1±1.4 weeks, and 5.3±1.8 weeks -in the excision group (p<0.001). There were no significant differences in terms of complication rates. In the simple drainage group, an abscess developed in 1 case (1.66%) within 10 days after surgery; in the excision group, a wound infection developed in 2 cases (3.3%). In the simple drainage group, recurrence occurred in 15 cases (25.0%), and in the excision group -in 1 case (1.7%) -OR=19.7 (95%CI -2.5-154.5, p=0.005). No significant difference was found in cosmetic results, length of hospital delay, and period off work. Conclusions: Compared to simple drainage, pilonidal abscess drainage with excision of the primary ducts has a significantly better rate of complete cure and a lower recurrence rate. It is a safe outpatient operation that can be recommended as the first-line therapy for an acute pilonidal abscess.

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Section: Resultsmentioning

confidence: 95%

Comparative Analysis of Pilonidal Abscess Drainage

Gratiashvili,

Akhmeteli,

Ivanishvili

et al. 2023

Georgian Biomedical News

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“…12 Asymmetric excision and nonmidline reconstruction with the Karydakis technique and Bascom technique are characterized by fewer complications and a lower recurrence rate. 13,14 Limberg plasty, rotational plasty, Z-plasty, and V-Y-plasty also have good results. However, in addition to their radicality and difficulty of performance, these methods of treatment are associated with a risk of recurrence and characterized by a high rate of severe complications; moreover, they require general or regional anesthesia and hospitalization.…”

Section: Discussionmentioning

confidence: 96%

Efficacy of laser obliteration with limited excision of pilonidal sinus

Gratiashvili,

Akhmeteli,

Ivanishvili

et al. 2024

J Int Med Res

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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.

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“…The brief procedure involves an oval incision to resect the skin and lesion and free the contralateral skin flap to flatten the gluteal groove. In 2020, Karim et al 65 randomly divided 60 patients with chronic SPS to undergo a Bascom operation or a simple excision of diseased tissue with primary suture for comparison. The Bascom operation group had lower infection (6.7% vs. 23.3%) and recurrence rates (3.3% vs. 16.7%).…”

Section: Discussionmentioning

confidence: 99%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

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Background: A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. Methods: A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. Results: Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [P=0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P=0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant (P=0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant (P=0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection (P≥0.05). Conclusions: There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient’s wishes, appearance of the SPS, and the professional ability of the surgeon.

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Comparison of 'Excision and Primary Repair' with 'Bascom's Technique' in the Surgical Treatment of Pilonidal Sinus

Cited by 5 publications

References 11 publications

Comparative Analysis of Pilonidal Abscess Drainage

Comparative Analysis of Pilonidal Abscess Drainage

Efficacy of laser obliteration with limited excision of pilonidal sinus

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

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