Minimally invasive pilonidal sinus treatment: A narrative review

Velotti, Nunzio; Manigrasso, Michele; Lauro, Katia Di; Araimo, Enrico; Calculli, Federica; Vertaldi, Sara; Anoldo, Pietro; Aprea, Giovanni; Simone, G.; Vitiello, Antonio; Musella, Mario; Milone, Marco; Palma, Giovanni Domenico De; Milone, Francesco; Fernandez, Loredana Maria Sosa

doi:10.1515/med-2019-0059

Cited by 28 publications

(25 citation statements)

References 32 publications

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“…Compared to excision and primary closure techniques, EPSiT is a minimally invasive procedure, has a low recurrence rate, and requires a minimal hospital stay. Both sinusectomy and endoscopic approaches to PSD are safe and more effective than conventional techniques 32 . Our report suggests that this surgical approach could be proposed as a first‐line treatment of PSD and, therefore, is worth further study.…”

Section: Discussionmentioning

confidence: 74%

Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique

Azhough

Azari

Taher

et al. 2020

Asian J Endoscop Surgery

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Introduction Pilonidal sinus disease (PSD) is a common skin and subcutaneous disease that is mainly seen in men (mean age, 30 years); its incidence rate is 26 cases per 100 000. PSD greatly affects quality of life. Ideally, a surgical procedure to treat PSD should involve a minimal hospital stay and require minimal time off work, discomfort, operative time, and cost; it should also limit recurrence. In this study, we present a new minimally invasive technique for pilonidal sinus surgery known as endoscopic pilonidal sinus treatment (EPSiT). Methods From February 2017 to April 2019, 100 patients diagnosed with PSD were treated with the EPSiT method at the Department of General Surgery, Imam Reza Hospital. Patient information was recorded prospectively. During the operation, the fistula cavity and tracts were ablated by an electrode that was introduced through the operative channel. All the epithelial and granulation tissues were removed by a brush inserted into the operative channel or by a Volkmann spoon. Results None of the patients had postoperative complications, such as hematoma, seroma, or wound infection, during the follow‐up period. Recurrence was seen four patients (4%). At 1 week postoperatively, the visual analog scale score was 3 for 37 patients (37%) and 2 for 28 patients (28%). The maximal cosmetic satisfaction rate was reported in 85 patients (85%). Conclusion As a minimally invasive procedure, EPSiT is effective for treating PSD. Compared with excision and primary closure techniques, EPSiT has a very low recurrence rate after the procedure and a short hospital stay.

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Section: Discussionmentioning

confidence: 74%

Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique

Azhough

Azari

Taher

et al. 2020

Asian J Endoscop Surgery

View full text Add to dashboard Cite

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“…The observed preference for fistulectomy in Switzerland may be associated with it first being described by Swiss surgeons [7]. Another minimally invasive technique using video-assisted ablation of PD was described in 2014 in Italy showing promising results [13][14][15]. Nevertheless, VAAPS was not assessed in the present survey.…”

Section: Discussionmentioning

confidence: 87%

“…Other treatments include injection of fibrin glue [10,11] or phenol [4,12] into sinus tracts. Video-assisted ablation of pilonidal sinus (VAAPS) was described in 2014 where sinus cavity ablation and cleaning are minimally invasively performed under videoscopic guidance [13][14][15]. Acute abscess formation is typically treated by incision and drainage.…”

Section: Introductionmentioning

confidence: 99%

Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria

et al. 2020

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Background and objective: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. Materials and Methods: A survey including 196 certified institutions (Switzerland, N = 99 and Austria, N = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. Results: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (p = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; p < 0.001). Primary resection and off-midline closure (p = 0.017) and the use of tissue flaps (p = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. Conclusion: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.

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“…Their findings compare well with ours. A first systematic review of EPSiT demonstrated high cure rates, low recurrence rates (<5%), high patient satisfaction, and little time off work or school [ 55 ]. However, in the guidelines elaborated by the ASCRS, only a weak recommendation for endoscopic and video-assisted treatment of PSD was made [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Minimally invasive pilonidal sinus treatment: A narrative review

Cited by 28 publications

References 32 publications

Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique

Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique

Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

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