Recurrent Pilonidal Sinus: Etiology and Treatment

Abstract

A clinical and histologic study of recurrent pilonidal sinus is presented. During a 5-year period 44 patients were treated for recurrent pilonidal sinus. Of these, recurrence had occurred within 1 year in 26 patients (76%). After 26 reoperations with excision and primary suture further recurrence was seen in 23% (6/26), and in 24% (6/25) after reoperations with open treatment. The histologic findings in recurrent sinuses (18 patients) were almost identical to that of primary disease. Recurrent sinuses were situated in the scar in 80% of the cases and caudal in 50% of the cases. A known wound infection had been present in 27% of the patients. Although keratin plugs were observed in 15/18 (83%) of those with a recurrence, the importance of this finding is uncertain. We conclude that recurrent pilonidal sinuses are chronic inflammatory processes usually located at the site of the surgical wound. The cause is uncertain, although there is an indication that wound infection plays a role. Keratin plugs have also been observed in scar tissue. Surgical treatment of recurrent disease has a higher recurrence rate than after that of primary disease.

Comparative Study between Excision with Primary Closure versus Flap Reconstruction in Management of Sacrococcygeal Pilonidal Sinus

“…These results agree with Youssef et al (33) as hyposthesia was recorded in (10%) of Limberg group and (3.3 %) in the primary repair group. This also comparable with the studies conducted by Akin et al (34) and Søndenaa et al (35) who reported hyposthesia in (8.9%) and (9.5%) of their patients, respectively.…”

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

“…Data on recurrence and follow-up times in primary open PSD treatment pertaining to 21,583 patients were extracted from 205 additional non-RCTs 4 , 60 , 74 , 75 , 111 , 112 , 114 , 115 , 117 , 118 , 121 – 126 , 128 – 134 , 136 , 137 , 141 , 143 , 149 , 153 – 156 , 160 , 161 , 163 , 167 – 171 , 174 , 175 , 177 , 181 , 182 , 188 – 192 , 194 , 196 , 197 , 199 – 201 , 203 , 206 , 208 , 215 , 216 , 218 , 220 , 221 , 223 , 224 , 230 , 233 , 237 – 373 . Among these patients, a recurrence of 3.4% (95% CI 3.1–3.6%) was observed in patients at 12 months, 7.0% (95% CI 6.5–7.4%) at 24 months, 16.8% (95% CI 15.8–17.8%) at 60 months, 32.0% (95% CI 29.6–34.4%) at 120 months, and 67.9% (95% CI 53.3–82.4%) at 240 months (Fig.…”

Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute

“…Some of the variables associated with recurrence of PNS are believed to be related to the "patient" such as obesity, hirsute nature, smoking, positive family history, and age at first surgery. Other factors are related to the "primary procedure", such as type of surgery, post-operative wound complications (mainly infection) and the timing of recurrence postoperatively [35]. All such variables were similar between the two groups under comparison, and so were the "sinus characteristics" that included the chief symptom, duration of symptoms, as well as location and number of sinuses.…”

“…In this study, we compared also the results of Karydakis technique versus midline closure in patients with "primary" and "recurrent" PNS separately, and demonstrated that complication and recurrence rates were significantly less with the Karydakis flap in both subgroups. Over a 5-year period, Sondenaa et al [35], treated 44 patients with recurrent PNS using excision and primary midline closure. They reported a high re-recurrence rate of 59.1% (26/44) during the first year post-operatively and attributed this high incidence, at least in part, to the high rate of post-operative infection.…”