Management of sacrococcygeal pilonidal sinus disease

Abstract

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.

Comparison of postoperative quality of life of Limberg flap and Karydakis flap in pilonidal sinus operations

“…In the LF group, 3 (5.9%) developed seroma in the wound site, 1 (2%) hematoma in the wound site, 1 (2%) wound site infection and 1 (2%) dehiscence of incision when skin sutures were removed. During follow up, recurrence was found as 5.9% (n= 3) in the LF group with a mean duration to recurrence as 22 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. Duration to recurrence was statistically shorter in the KF group compared to the LF group (p= 0.001).…”

“…Although numerous conservative and surgical treatment methods have been described for PSD, the rates of surgery related complications and recurrences remain high, and the search for an ideal treatment method is continuing (1,2). The goal of treatment is to provide good wound healing, short duration of hospitalization, less complications, low recurrence rate, and high patient satisfaction (2,16). The principle in PSD surgery is to remove the pilonidal sinus tissue and epithelium-lined fistulas.…”

“…Wound closure is performed using mid-line and extramid-line techniques including primary closure, Z-plasty, VY advancement, Karydakis transposition, and Limbert rotation flap. Recently, extramid-line closure or flap techniques are more often preferred because of the lower recurrence rates compared to other methods (2,16).…”

“…Different rates of complications and recurrences have been reported in different series. A conservative approach is suitable for asymptomatic patients (16). Studies have reported recurrence rates after a 5-year follow up as 40.2% in incision and drainage, 13.1% in excision and secondary healing, 16.8% in excision and primary closure, 15.6% in Bascom technique, 1.9% in KF method, and 5.2% in LF methods (2,16).…”

“…A conservative approach is suitable for asymptomatic patients (16). Studies have reported recurrence rates after a 5-year follow up as 40.2% in incision and drainage, 13.1% in excision and secondary healing, 16.8% in excision and primary closure, 15.6% in Bascom technique, 1.9% in KF method, and 5.2% in LF methods (2,16). Among the minimally invasive surgeries, recurrence has developed by 6.3% in endoscopic pilonidal sinus treatment and 40.4% in sinus phenolization (16).…”