Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience

Abstract

Purpose: This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure).Methods: The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed.Results: Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks.Conclusion: The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.

Bascom Cleft Lift Technique in Sacrococcygeal Pilonidal Disease: Results of Tezel Type 4 and 5 Cases

“…On the contrary, in a prospective randomized study by (14), none of the 61 patients who underwent BCL developed recurrence (14). In literature, this rate is seen to be between 1.3% and 6% (9,(12)(13)(14)(15)(16). In our results, it is seen that recurrence developed in one case (10%).…”

“…We think that our experience will improve as the number of patients we apply BCL increases and our operation time will shorten a little. In literature, there were reported values between 1.28 days and 2.95 days for hospital stay after BCL (12)(13)(14)(15)(16). In our results, the duration of hospital stay was found to be 2.4 (1-5) days.…”

“…The low number cases studied makes this rate seem high. Dutkiewicz et al reported the superficial infection rates as 0% ( 16), but in literature, this rate ranges from 1% to 10% (2,9,(12)(13)(14)(15). Our superficial infection rate is at the upper limit of this average and it is high in our opinion.…”

“…In our study of the 10 cases, the median follow-up period of the patients was 22 (11-26) months and the median duration of operation was 42 (35-58) minutes. There are studies reporting operation time between 25-54 minutes (12)(13)(14)(15). We think that our experience will improve as the number of patients we apply BCL increases and our operation time will shorten a little.…”

“…We hope that our complication and recurrence rates will decrease once our number of patients increases and our learning curve process is completed. There are many studies in literature evaluating the results of the BCL method and reporting success results (9,(12)(13)(14)(15)(16). Despite these studies, the BCL technique has not yet become a standard technique by surgeons.…”