Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options

Abstract

Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. All these factors rendered the acquired thesis of pilonidal sinus disease to be more accepted. In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. Additional sinuses are frequent and have lateral openings. Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported. Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Asymptomatic pits do not require treatment. Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage. The choice of a particular surgical approach depends on the surgeon's familiarity with the procedure and perceived result in terms of low recurrence of sinus and a quick healing of resulting cavity or surgical wound. Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used. From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.

Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report

“…Additional sinuses are also frequent, often with lateral openings [14]. Pilonidal sinuses often penetrate deep into the ischioanal fossa; however, they would not be expected to penetrate the sphincters and involve the anus [7, 10]. In our patient, the fistula involved the anal canal.…”

“…SPD frequently occurs as a chronic skin infection in the region of the buttock crease or natal cleft [1, 10]. It is assumed that the disease results from the in-growth of a hair from the surrounding skin [11].…”

Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study

“…Its incidence throughout the whole population is reported as 6 in 100,000 (1). In recent studies, acquired factors are blamed for etiopathogenesis of the disease (2,3). Although there are many different opinions regarding the surgical treatment of pilonidal sinus disease in the literature, the common issues are that surgery should be simple and easily applicable, that the hospital length of stay should be short, with less postoperative wound care and pain, low recurrence rates and short period to return to daily activities (4)(5)(6).…”

Modified Limberg Flap for Pilonidal Sinus

“…It is an acquired disease resul ng from invagina on of broken hair into the skin, and subsequently inci ng an infl ammatory reac on. [1][2][3] It was termed 'jeep driver's bo om disease' during World War II because many drivers were found to have the condi on 4 .…”