Lateral Incision Surgery for Pilonidal Sinus: Death of a Dogma

Cheetham, Mark

doi:10.1007/s00268-011-1388-9

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…We are glad that our study triggered the search for the ideal procedure. Moreover, we agree with the other researchers that only time will tell the truth [1,2].Additional studies will clarify the situation. For this purpose we have begun a randomized prospective study that compares the results of tension-free primary closure, tension-free primary oblique closure, and Limberg flap reconstruction.…”

supporting

confidence: 87%

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In our recent article [1], the results of tension-free primary closure and of the Limberg flap were similar. These results have caused immediate comment [2,3]. Azizi et al [4] reported no recurrence at 1-year follow-up after performing the Limberg flap procedure.

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mentioning

confidence: 99%

“…These results have caused immediate comment [2,3]. Azizi et al [4] reported no recurrence at 1-year follow-up after performing the Limberg flap procedure.…”

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confidence: 99%

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Trends in Surgical Treatment of Pilonidal Sinus Diseases: Primary Closure or Flap: Reply

Okuş¹,

Sevinç²,

Karahan³

2012

World j. surg.

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In our recent article [1], the results of tension-free primary closure and of the Limberg flap were similar. These results have caused immediate comment [2,3]. Azizi et al. [4] reported no recurrence at 1-year follow-up after performing the Limberg flap procedure. In addition, there are studies that reported a 1 % recurrence rate after flap reconstruction for pilonidal sinus [5] in our country. Therefore, flap reconstruction is a highly chosen procedure. However, as Azizi et al. [4] reported, there is no consensus among surgeons about the ideal treatment method. There are successful results for primary closure but the choices of surgeons show variability in the treatment method.In our study we tried to find whether there is a commonality between the different procedures. Our results showed that being tension-free is the key to reduce recurrences. We are glad that our study triggered the search for the ideal procedure. Moreover, we agree with the other researchers that only time will tell the truth [1,2].Additional studies will clarify the situation. For this purpose we have begun a randomized prospective study that compares the results of tension-free primary closure, tension-free primary oblique closure, and Limberg flap reconstruction. The study began 4 months ago and when it is finished we will publish the results.

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confidence: 87%

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confidence: 99%

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Trends in Surgical Treatment of Pilonidal Sinus Diseases: Primary Closure or Flap: Reply

Okuş¹,

Sevinç²,

Karahan³

2012

World j. surg.

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“…Our patients' high satisfaction score supports our results of excision with minimal tissue loss and tensionless closure. There has been a consensus that operations with a lateral incision and closure are more effective than those using midline excision and closure as evidenced by several randomized controlled studies and subsequent meta-analysis [320]. Zorlu et al [18] reported that techniques with primary lateral suture line might be offered as a viable surgical therapeutic option among off-midline closure approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Closed methods involve excision with primary closure to the midline or lateral suture line. Several closed methods of excision and suturing techniques have been described for surgical treatment of PS [34567]. In the last 5–10 years, minimally-invasive procedures, such as endoscopic methods, laser therapy, microsinusectomy, and pit-picking, have been described for the treatment of PS, with evidence of short-term positive results[58910111213].…”

Section: Introductionmentioning

confidence: 99%

Inverse ‘D’ incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line

2019

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PurposeSurgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (ᗡ) incision based on tissue loss, wound tension, and suture line location.MethodsThis prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the ‘ᗡ’ incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months.ResultsSixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a ‘ᗡ’ incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients.ConclusionThe method of sinus excision using the ‘ᗡ’ incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.

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