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Which surgical procedure offers the best treatment for pilonidal disease?

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Abstract

Purpose

Our aim was to determine the most effective surgical procedure for treatment of pilonidal disease, by comparing different surgical techniques.

Methods

A total of 354 patients who underwent operation for pilonidal disease were enrolled in this prospective study. The data included patient’s demographic characteristics, age, gender, body mass index, occupation, smoking, concomitant diseases, surgeon’s experience, wound-healing problems (wound separation and infection), time to return to work, and development of recurrence.

Results

Of the 354 patients, total excision + primary closure was performed in 133 (37.6%), D-flap in 101 (28.5%), Karydakis technique in 74 (20.9%), and Limberg flap surgery in 46 (13%). The male/female ratio was 8.5:1, which is a statistically significant difference (p < 0.05). The average follow-up period was 37 months (range, 12–97 months); during this period, wound-healing problems were observed in 70 (19.7%) patients, and 34 (9.6%) patients developed recurrence. There was no difference in the rate of recurrence of pilonidial disease between procedures done by trainees and staff surgeons. Recurrence rates were similar for all four treatment methods (7.5–13.5%). Wound-healing problems were higher for D-flap than for other methods (p = 0.027). The average time to return to work with the D-flap method was longer than that for the other methods (p < 0.01). Recurrence increased 14.44-fold following the development of wound infection. Higher recurrence rates were also noted in obese patients (8.10-fold) and in females (6.72-fold).

Conclusions

Despite the increasing volume of data on the treatment of pilonidal disease, the optimal treatment has yet to be established.

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References

  1. Kitchen PR (1996) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83:1452–1455

    Article  PubMed  CAS  Google Scholar 

  2. Mann CV, Springall R (1987) D-excision for sacrococcygeal pilonidal sinus disease. J R Soc Med 80:292–295

    PubMed  CAS  Google Scholar 

  3. Azab AS, Kamal MS, Saad RA, al Atta KA Abou, Ali NA (1984) Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 71:154–155

    Article  PubMed  CAS  Google Scholar 

  4. Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62:385–389

    Article  PubMed  CAS  Google Scholar 

  5. Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K (2002) Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 45:1458–1467

    Article  PubMed  Google Scholar 

  6. Topgül K (2010) Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap. J Eur Acad Dermatol Venereol 24(1):7–12

    Article  PubMed  Google Scholar 

  7. Petersen S, Aumann G, Kramer A, Doll D, Sailer M, Hellmich G (2007) Short-term results of Karydakis flap for pilonidal sinus disease. Tech Coloproctol 11:235–240

    Article  PubMed  CAS  Google Scholar 

  8. Toccaceli S, Persico Stella L, Diana M, Dandolo R, Negro P (2008) Treatment of pilonidal sinus with primary closure. A twenty-year experience. Chir Ital 60:433–438

    PubMed  Google Scholar 

  9. Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M (2009) Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 52:496–502

    Article  PubMed  Google Scholar 

  10. Nordon IM, Senapati A, Cripps NP (2009) A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197:189–192

    Article  PubMed  Google Scholar 

  11. Nursal TZ, Ezer A, Calikan K, Törer N, Belli S, Moray G (2010) Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199:170–177

    Article  PubMed  Google Scholar 

  12. Darwish AM, Hassanin A (2010) Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous limberg flap. J Plast Reconstr Aesthet Surg 63:1176–1180

    Article  PubMed  Google Scholar 

  13. Krand O, Yalt T, Berber I, Kara VM, Tellioglu G (2009) Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon Rectum 52:1172–1177

    Article  PubMed  Google Scholar 

  14. Ekmel Tezel (2009) Pilonidal Hastaliğin Cerrahi Tedavisi, Nobel Tip Kitabevleri, Ankara, Bascom J 5-15

  15. Can MF, Sevinc MM, Yilmaz M (2009) Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg Today 39:580–586

    Article  PubMed  Google Scholar 

  16. Anderson JH, Yip CO, Nagabhushan JS, Connelly SJ (2008) Day-case Karydakis flap for pilonidal sinus. Dis Colon Rectum 51:134–138

    Article  PubMed  Google Scholar 

  17. Jamal A, Shamim M, Hashmi F, Qureshi MI (2009) Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J Pak Med Assoc 59:157–160

    PubMed  Google Scholar 

  18. Coşkun F, Bilgin A, Karabeyoğlu M, Yildirim O, Eroglu A (1996) Pilonidal sinus’un geliştirilmiş flep disseksiyonu yöntemi ile tedavisi. Türkiye Klinikleri J Med Sci 16:72–76

    Google Scholar 

  19. McCallum I, King PM, Bruce J (2007) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 17:CD006213, Review

    Google Scholar 

  20. Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W (2007) Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum 50:1928–1934

    Article  PubMed  Google Scholar 

  21. Doll D, Evers T, Matevossian E, Petersen S (2009) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 197:693–694

    Article  PubMed  Google Scholar 

  22. Al-Khayat H, Al-Khayat H, Sadeq A et al (2007) Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 205:439–444

    Article  PubMed  Google Scholar 

  23. Sakr M, El-Hammadi H, Moussa M, Arafa S, Rasheed M (2003) The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. Int J Colorectal Dis 18:36–39

    Article  PubMed  Google Scholar 

  24. Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 11:705–710

    Article  PubMed  CAS  Google Scholar 

  25. Tezel E, Bostanci H, Anadol AZ, Kurukahvecioglu O (2009) Cleft lift procedure for sacrococcygeal pilonidal disease. Dis Colon Rectum 52:135–139

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. General Surgery, Ankara Numune Teaching and Research Hospital, 3, Kizilirmak mah. 1443. cadde No:35/10 Çankaya, 06510, Ankara, Turkey

    Bariş Saylam, Arife Polat Düzgün, M. Vasfi Özer & Faruk Coşkun

  2. Nigde Saglik Müdürlüğü, Ankara, Turkey

    Derya Nurhan Balli

Authors
  1. Bariş Saylam
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  2. Derya Nurhan Balli
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  3. Arife Polat Düzgün
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  4. M. Vasfi Özer
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  5. Faruk Coşkun
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Correspondence to Faruk Coşkun.

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Saylam, B., Balli, D.N., Düzgün, A.P. et al. Which surgical procedure offers the best treatment for pilonidal disease?. Langenbecks Arch Surg 396, 651–658 (2011). https://doi.org/10.1007/s00423-011-0768-9

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  • DOI: https://doi.org/10.1007/s00423-011-0768-9

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