The Management of Pilonidal Sinus

Abstract

Background: Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year. Methods: This review is based on pertinent publications retrieved by a selective literature search. Results: The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV). Conclusion: Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.

Improving Resource Utilization and Outcomes Using a Minimally Invasive Pilonidal Protocol

“…A larger, prospective study should be conducted to demonstrate the long-term recurrence rate and impact on cost of care. With the overall incidence of pilonidal disease reported to be 0.026%-1.1% [29][30][31], widespread implementation of this protocol could result in a significant reduction in resource utilization for pilonidal care throughout the health system.…”

Pilonidal disease in children: some links of etiopathogenesis of the disease (clinical observation)

“…У 80-90% випадків захворювання маніфестує гострим запаленням (абсцесом) у крижово-куприковій ділянці, що є показом для звернення за медичною допомогою [8]. Захворювання схильне до рецидивуючого перебігу та вимагає радикального хірургічного лікування в період ремісії [6].…”

“…Формування вторинного норицевого ходу внаслідок прориву через шкіру та дренування вторинного гострого пілонідального абсцесу. 6. За умов хронічного перебігу -епітелізація вторинних норицевих ходів шляхом поширення епітелію з поверхні шкіри вздовж їх стінок.…”

Pilonidal Disease

“…According to authors advantages of this procedure is ease of performance in outpatient setting, it is well tolerated, requires minimal postoperative care and offers rapid recovery [14]. Reported recurrence rates with this procedure range from 1020% [15].…”

“…From the academic perspective, absence of wound healing is not correctly designated as a recurrence, but from the patient"s point of view, the only relevant fact is that repeat surgery must be done. For that reason the term "treatment failure" would be preferable [15].…”