Share This Article:

25 years’ experience in the management of pilonidal sinus disease

DOI: 10.4236/ojgas.2014.41001    3,782 Downloads   6,753 Views   Citations

ABSTRACT

Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Oueidat, D. , Rizkallah, A. , Dirani, M. , Assi, T. , Shams, A. and Jurjus, A. (2014) 25 years’ experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology, 4, 1-5. doi: 10.4236/ojgas.2014.41001.

References

[1] Mayo, O.H. (1833) Observations on injuries and disease of rectum. Burgess and Hill, London, 45-46 (Quoted from da Silva, J.H. (2000) Pilonidal cyst: Cause and treatment. Diseases of the Colon & Rectum, 43, 1146-1156.
http://dx.doi.org/10.1007/BF02236564)
[2] Hodge, R.M. (1880) Pilonidal sinus. Boston Medical and Surgical Journal, 103, 485-486, 493, 544. (Quoted from da Silva J.H. (2000) Pilonidal cyst: Cause and treatment. Diseases of the Colon & Rectum, 43, 1146-1156.
http://dx.doi.org/10.1007/BF02236564).
[3] Mahdy, T. (2008) Surgical treatment of the pilonidal disease: Primary closure of flap reconstruction after excision. Diseases of the Colon & Rectum, 51, 1816-1822.
http://dx.doi.org/10.1007/s10350-008-9436-8
[4] Goldberg, S.M., Gordon, P.H. and Nivatongs, S. (1980) Essentials of anorectal surgery. JB Lippincott, Philadelphia, 128-133.
[5] Mentes, O., Bagci, M., Bilgin, T., Coskun, I., Ozgul, O. and Ozdemir, M. (2006) Management of pilonidal sinus disease with oblique excision and primary closure results of 493 patients. Diseases of the Colon & Rectum, 49, 104-108. http://dx.doi.org/10.1007/s10350-005-0226-2
[6] Basom, J. (1983) Pilonidal disease: Long-term results of follicle removal. Diseases of the Colon & Rectum, 26, 800-807. http://dx.doi.org/10.1007/BF02554755
[7] Chintapatla, S., Safarowi, N., Kumar, S. and Haboubi, N. (2003) Sacrococcygeal pilonidal sinus: Historical review, pathological insight and surgical options. Techniques in Coloproctology, 7, 3-8.
http://dx.doi.org/10.1007/s101510300001
[8] Weston, S.D. and Schlachter, I.S. (1963) Pilonidal cyst of the anal canal: Case report. Diseases of the Colon & Rectum, 6, 139-141.
http://dx.doi.org/10.1007/BF02633468
[9] Eryilmaz, R., Sahin, M., Okan, I., Alimoglu, O. and Somay, A. (2005) Umbilical pilonidal sinus disease: Predisposing factors and treatment. World Journal of Surgery, 29, 1158-1168. http://dx.doi.org/10.1007/s00268-005-7895-9
[10] Sondeno, K., Andersen, E., Nesvik, I. and Spreide, J.A. (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. International Journal of Colorectal Disease, 10, 39-42.
http://dx.doi.org/10.1007/BF00337585
[11] Berry, D.P. (1992) Pilonidal disease. Journal of Wound Care, 1, 29-32.
[12] Allen-Mersh, T.G. (1990) Pilonidal sinus: Finding the right track for treatment. The British Journal of Surgery, 77, 123-132. http://dx.doi.org/10.1002/bjs.1800770203
[13] Dwight, R.W. and Maloy, J.K. (1953) Pilonidalis sinus experience with 449 cases. New England Journal of Medicine, 249, 926-930.
http://dx.doi.org/10.1056/NEJM195312032492303
[14] Keiglhey, M.R.B. (1993) Pilonidal disease. In: Keiglhey, M.R.B. and Williams, N.S., Eds., Surgery of Anus, Rectum and Colon, W.B. Saunders, London, 467-489.
[15] Tinsley, P. (2002) The management of a pilonidal sinus and its follow-up care. British Journal of Nursing, 11, S31-S32, S34, S36.
[16] Timmons, J. (2007) Diagnosis, treatment and nursing management of patients with pilonidal sinus disease. Nursing Standard, 21, 48-56.
http://dx.doi.org/10.7748/ns2007.09.21.52.48.c6597
[17] Goodall, P. (1961) The etiology and treatment of pilonidal sinus: A review of 163 patients. The British Journal of Surgery, 49, 212-218.
http://dx.doi.org/10.1002/bjs.18004921421
[18] Clothiers, P.R. and Haywood, I.R. (1984) The natural history of the post anal (pilonidal) sinus. Annals of the Royal College of Surgeons of England, 66, 201-203.
[19] Lord, P.H. and Millar, D.M. (1965) Pilonidal sinus: A simple treatment. The British Journal of Surgery, 52, 298-300. http://dx.doi.org/10.1002/bjs.1800520413
[20] Weinsten, M.A., Rubin, R.J. and Salvate, E.P. (1977) Pilonidal cyst anatomy: Reappraisal of an old technique. Diseases of the Colon & Rectum, 20, 287-289.
http://dx.doi.org/10.1007/BF02586424
[21] Hull, T.L. and Wu, J. (2002) Pilonidal disease. The Surgical Clinics of North America, 82, 1169-1185.
http://dx.doi.org/10.1016/S0039-6109(02)00062-2
[22] Me Laren, C.A. (1984) Partial closure and other technique in pilonidal surgery: An assessment of 157 cases. The British Journal of Surgery, 71, 561-562.
http://dx.doi.org/10.1002/bjs.1800710731
[23] Iesalnieks, I., Fürst, A., Rentsch, M. and Jauch, K.W. (2003) Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Der Chirurg, 74, 461-468.
http://dx.doi.org/10.1007/s00104-003-0616-8
[24] McCallum, I.J., King, P.M. and Bruce, J. (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: Systematic review and meta-analysis. BMJ, 336, 868-871.
http://dx.doi.org/10.1136/bmj.39517.808160.BE
[25] Hemmati, H., Ghorbani, R. and Torshizi E.N. (2013) Recurrence rate in the pilonidal sinus after excision with or without primary closure. Koomesh, 15, 78-82.
http://www.koomeshjournal.ir/browse.php?a_code=A-10-1116-1&slc_lang=en&sid=1
[26] Testini, M., Piccinni, G., Miniello, S., Di Venere, B., Lissidini, G., Nicolardi, V. and Bonomo, G.M. (2001) Treatment of chronic pilonidal sinus with local anesthesia: A randomized trial of closed compared with open technique. Colorectal Disease, 3, 427-430.
http://dx.doi.org/10.1046/j.1463-1318.2001.00278.x
[27] Bradley, L. (2006) Pilonidal sinus disease: A misunderstood problem. Wounds UK, 2, 45-53.
http://www.wounds-uk.com/pdf/content_9049.pdf
[28] Maurice, B.A. and Greenwood, R.K. (1964) A conservative treatment of pilonidal sinus. The British Journal of Surgery, 51, 510-51.
http://dx.doi.org/10.1002/bjs.1800510711
[29] Shorey, B.A. (1975) Pilonidal sinus treated by phenol injection. The British Journal of Surgery, 62, 407-408.
http://dx.doi.org/10.1002/bjs.1800620521
[30] Schneider, I.H., Thaler, K. and Kockerling, F. (1994) Treatment of pilonidal sinuses by phenol injections. International Journal of Colorectal Disease, 9, 200-202.
http://dx.doi.org/10.1007/BF00292250
[31] Dag, A., Colak, T., Turkmenoglu, O., Sozutek, A. and Gundogdu, R. (2012) Phenol procedure for pilonidal sinus disease and risk factors for treatment failure. Surgery, 151, 113-117.
http://dx.doi.org/10.1016/j.surg.2011.07.015
[32] Dogru, O., Camci, C., Aygen, E., Girgin, M. and Topuz, O. (2004) Pilonidal sinus treated with crystallized phenol: An eight-year experience. Diseases of the Colon & Rectum, 47, 1934-1938.
http://dx.doi.org/10.1007/s10350-004-0720-y
[33] Jones, D.J. (1992) ABC of colorectal diseases. Pilonidal sinus. BMJ, 305, 410-412.
http://dx.doi.org/10.1136/bmj.305.6850.410
[34] Gwynn, B.R. (1986) Use of the rhomboid flap in pilonidal sinus. Annals of the Royal College of Surgeons England, 68, 40-44.
[35] Topgul, K. (2010) Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap. Journal of the European Academy of Dermatology and Venereology, 24, 7-12. http://dx.doi.org/10.1111/j.1468-3083.2009.03350.x
[36] Karydakis, G.E. (1973) New approach to the problem of pilonidal sinus. Lancet, 2, 1414-1415.
http://dx.doi.org/10.1016/S0140-6736(73)92803-1
[37] Morden, P., Drongowski, R.A., Geiger, J.D., Hirschl, R.B. and Teitelbaum, D.H. (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatric Sugery International, 21, 793-796.
http://dx.doi.org/10.1007/s00383-005-1543-1
[38] Borkurt, M.K. and Tezel, E. (1998) Management of pilonidal sinus with the Limberg flap. Diseases of the Colon & Rectum, 41, 775-777.
http://dx.doi.org/10.1007/BF02236268
[39] Ertan, T., Koc, M., Gocmen, E., Aslar, A.K., Keskek, M. and Kilic, M. (2005) Does technique alter quality of life after pilonidal sinus surgery? The American Journal of Surgery, 190, 388-392.
http://dx.doi.org/10.1016/j.amjsurg.2004.08.068
[40] Ince, M. and Aslan, E. (2013) Comment on day-care surgery for pilonidal sinus using sinotomy technique and fibrin glue injection. Archives of Clinical and Experimental Surgery, 2, 136-137.
http://dx.doi.org/10.5455/aces.20130203022117
[41] Elsey, E. and Lund, J.N. (2013) Fibrin glue in the treatment for pilonidal sinus: High patient satisfaction and rapid return to normal activities. Techniques in Coloproctology, 17, 101-104.
http://dx.doi.org/10.1007/s10151-012-0956-9
[42] Sasse, K.C., Brandt, J., Lim, D.C. and Ackerman, E. (2013) Accelerated healing of complex open pilonidal wounds using MatriStem extracellular matrix xenograft: Nine cases. Journal of Surgical case reports, 4, rjt025.
http://dx.doi.org/10.1093/jscr/rjt025
[43] Smart, P.J., Dungerwalla, M. and Heriot, A.G. (2013) Bascom’s simple pilonidal sinus surgery: Simpler with ultrasound guidance. Journal of Medical Ultrasound, 21, 97-99.
http://dx.doi.org/10.1016/j.jmu.2013.04.001

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.