Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center

Abstract

Background: Sacrococcygeal Pilonidal Disease (PD) is commonly treated with excision and primary closure techniques (EPC). Minimally invasive techniques (MIT), such as EPSiT and Pit-picking , had been recently advocated promising better outcomes. We analyzed mid-term results from our center after introduction of MIT to treat PD. Methods: Patients submitted to MIT ( n = 44) with a median follow-up of 37 months were analyzed and compared with patients submitted to EPC ( n = 70) with a median follow-up of 5 years. Both groups included patients operated in our department between 2011 and 2016 and have similar demographic and clinical characteristics. We compared operative time and post-operative parameters such as time with pain, dressing time and time to relapse. Results: The post-operative time with pain was significantly lower, whereas the dressing time was significantly longer, in MIT when compared to the EPC group. The relapse rate was similar in both groups but the follow-up is shorter in the MIT group. In addition, the analysis of patients free of disease using Kaplan-Meier curves revealed that relapse tends to occur more precociously in MIT than in EPC patients ( p = 0.014). Interestingly, in the subgroup of patients with previous surgery, MIT's relapse rate was significantly lower than in the EPC group (30 vs. 100%, p < 0.001). Conclusions: MIT has the advantage of having a shorter time with pain in the postoperative period, while EPC benefits from a shorter dressing time. In general, the relapse of the disease tends to manifest more precociously in MIT patients. Moreover, in the subgroup of patients with previous surgery, MIT seems to have significantly better results when compared to EPC.

Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus

“…The treatment objectives are simple, requiring local anesthesia, minimum hospitalization, short recovery and quick return to daily activities, less postoperative pain, a high success rate, and low cost [8]. Conservative methods are either primary or secondary closure, and flap techniques entail a high risk of recurrence arising from the pathophysiology of pilonidal sinus disease [9][10][11]. Recently, as in other branches of surgery, minimally invasive meth-Photo 1.…”

Pilonidal sinüs cerrahisinde etkin minimal invaziv bir yöntem: Sinüsotomi

“…Karaca et al [5] likewise compared the flap methods and found that the mean length of hospital stay was 1.1 days. In the study by Oliveira et al [6], minimally invasive methods (MIT) (endoscopic treatment and pit-picking) were compared with primary closure and the mean operative time was 36.1 and 48.7 minutes, respectively.…”

“…Another important issue in the treatment of SPS is postoperative pain. In the study of Oliveira et al [6], when the primary closure and MIT were compared, the number of painful days after MIT was zero. In the Alvandipour et al [3] study, pain with sitting after Limberg and Karydakis flap operations was questioned and VAS score was 4 and 4.1, respectively.…”

Laser Ablation of Pilonidal Sinus Disease: A Pilot Study

“…If, upon exploration, any patients were found to have PD with large subcutaneous cavities and no sinus tracts laterally, the laser was not used. These patients were treated using other previously described techniques, 11 such as a WLE or incision and drainage with curettage, and were not included in this study. The exclusion criteria for laser ablation of the tracts were pits with active infection needing incision and drainage and pilonidal pits without lateral sinus tracts.…”