Assessment of Surgical Strategies for Pilonidal Sinus Disease in the Netherlands

Huurman, Eleonora A; Galema, Hidde A.; Raaff, Christel de; Toorenvliet, Boudewijn; Smeenk, R.M.

doi:10.7759/cureus.25050

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…A majority of the participating surgeons in our study reported to use flap procedures. This is in contrast to findings from a recent study that reported an infrequent use of flap techniques (22.6%) by Dutch surgeons [28]. It seems like most hospitals in Norway have followed the example of The University Hospital of North Norway, Tromsø, that introduced this technique as their standard procedure for all symptomatic, chronic PSD already in 2002 [29].…”

Section: Discussioncontrasting

confidence: 76%

“…Currently, the specialization in general or gastrointestinal surgery in Norway does not require a specific number of PSD procedures performed. Like numbers from other countries, a large proportion of the surgeons performing PSD surgery in current practice performed fewer than ten PSD operations per year [11,27,28]. This indicates that it may take longer time to achieve competence in PSD surgery.…”

Section: Discussionmentioning

confidence: 99%

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Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences—a survey among Norwegian surgeons

2022

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Background Pilonidal sinus disease (PSD) is frequently observed in young adults. There is no wide consensus on optimal treatment in the literature, and various procedures are used in clinical practice. The objective of this study was to assess current practice, experience, training, and attitudes towards PSD surgery among Norwegian surgeons. Methods An online survey on PSD surgery was created and sent to all members of the Norwegian Surgical Association. Categorical data were reported as frequencies and percentages. Results Most currently practicing Norwegian surgeons used the Bascom’s cleft lift (93.2%) or minimally invasive procedures (55.4%). Midline excisions with primary closure (19.7%) or secondary healing (22.4%) were still used by some surgeons, though. Most surgeons had received training in PSD surgery supervised by a specialist, but only about half of them felt sufficiently trained. The surgeons generally performed few PSD operations per year. Many considered PSD as a condition of low surgical status and this patient group as underprioritized. Conclusions Our findings suggest that PSD surgery in Norway has been moving away from midline excisions and towards off-midline flap procedures and minimally invasive techniques. PSD and its treatment have a low status among many Norwegian surgeons. This study calls for attention to this underprioritized group of patients and shows the need for consensus in PSD treatment such as development of national guidelines in Norway. Further investigation on training in PSD and the role of supervision is needed.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences—a survey among Norwegian surgeons

2022

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“…He personally advocated closed excision but admitted that the reported incidence of failure for that procedure ranged from less than 1% to 50%. Currently, there is a dichotomy among the world's surgeons regarding the treatment of this disease and many have not yet deviated from open or closed excision as advocated in 1942 nor have they improved on its success rate [4,[6][7][8]. Fortunately, others are performing more contemporary procedures which provide greater success.…”

Section: Discussionmentioning

confidence: 99%

Revision of the Failed Cleft Lift for Pilonidal Disease

Immerman¹

2023

Cureus

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The cleft lift has been demonstrated to be one of the most successful operations for the treatment of pilonidal disease, however, there are times this procedure fails and further surgery is necessary. This article describes a reproducible and successful technique for the revision of a failed cleft lift. This procedure was performed on 76 consecutive patients who had previous cleft lift procedures. Failures were manifested by either a wound, sinus, abscess, dehiscence or fragile scar. The revision flattened the lower gluteal cleft with a rotation and advancement flap that placed the skin incision off-midline. Follow-up over the 10 years of this series was between six and 124 months with an average of 36 months. The revision was initially successful in 96.1% of patients; if the procedure was unsuccessful a repeat revision was subsequently curative. This procedure is proposed as an essential part of the treatment algorithm for patients with recurrent pilonidal disease after a cleft lift operation.

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“…A recent national survey from the Netherlands on the surgical treatment of PD concluded that traditional excision techniques are still the most frequently performed in that country, but the majority of surgeons and surgical residents remain unsatisfied with the current treatments [10].…”

Section: Introductionmentioning

confidence: 99%

An international survey exploring the management of pilonidal disease

Gallo,

Goglia,

Senapati

et al. 2023

Colorectal Disease

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AimPilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The aim of this study was to snapshot the current management of PD across European countries.MethodMembers affiliated to the European Society of Coloproctology were invited to join the survey. An invitation was extended to others via social media. The predictive power of respondents' and hospitals' demographics on the change of therapeutic approach was explored.ResultsRespondents (n = 452) were mostly men (77%), aged 26–60 years, practising in both academic and public hospitals and with fair distribution between colorectal (51%) and general (48%) surgeons. A total of 331 (73%) respondents recommended surgery at first presentation of the disease. Up to 80% of them recommended antibiotic therapy and 95% did not use any classification of PD. A primary closure technique was the preferred procedure (29%), followed by open technique (22%), flap creation (7%), sinusectomy (7%) and marsupialization (7%). Approximately 27% of subjects would choose the same surgical technique even after a failure. Almost half (46%) perform surgery as office based. A conservative approach was negatively associated with acutely presenting PD (p < 0.001). Respondents who were not considering tailored surgery based on patient presentation tended to change their approach in the case of a failed procedure.ConclusionWith the caveat of a heterogeneous number of respondents across countries, the results of our snapshot survey may inform the development of future guidelines.

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Assessment of Surgical Strategies for Pilonidal Sinus Disease in the Netherlands

Cited by 5 publications

References 15 publications

Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences—a survey among Norwegian surgeons

Surgery for pilonidal sinus disease in Norway: training, attitudes and preferences—a survey among Norwegian surgeons

Revision of the Failed Cleft Lift for Pilonidal Disease

An international survey exploring the management of pilonidal disease

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