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coloproctology

, Volume 41, Issue 2, pp 111–116 | Cite as

Antibiotika, Laser und Endoskopie – „new kids on the block“

  • A. OmmerEmail author
  • D. Doll
Leitthema
  • 63 Downloads

Zusammenfassung

Hintergrund

Der Sinus pilonidalis ist eine Erkrankung des Unterhautgewebes, bei dem Infektionen und Haare eine zentrale Rolle spielen. Derzeit stehen verschiedene Therapieoptionen zur Verfügung, die sich insbesondere in ihrer Invasivität deutlich unterscheiden. Es existiert jedoch kein Verfahren, das alle Vorteile einer hohen Heilungsrate, einer geringen Rezidivrate und minimaler Belastung für den Betroffenen vollkommen erfüllt.

Fragestellung

Unklar ist zum einen der Stellenwert der Antibiotikagabe als unterstützende Maßnahme zu operativen Verfahren. Als neue minimal-invasive Verfahren wurden endoskopische Techniken und die Anwendung des Lasers zur Behandlung des Sinus pilonidalis eingeführt.

Ergebnisse und Schlussfolgerungen

Nach den derzeit vorliegenden Studien kann keine Empfehlung für die Anwendung von Antibiotika als parenterale bzw. enterale Gabe oder als lokale Anwendung gegeben werden; dies muss dem Ermessen und der Erfahrung des Operateurs überlassen werden. Während für die alleinige Behandlung eines Sinus pilonidalis durch eine Laserkoagulation derzeit noch keine ausreichende Evidenz vorliegt, könnte die Laserepilation im Rahmen der postoperativen Rezidivvermeidung durchaus eine Rolle spielen. Studien deuten darauf hin, dass sie anderen Verfahren zur Haarentfernung (Rasur, Cremes) überlegen ist und die Rezidivrate senken kann. Eine Anwendung könnte insbesondere bei Problemfällen erwogen werden. Für die endoskopischen Techniken ist derzeit ebenfalls keine abschließende Bewertung möglich. Es handelt sich um ein minimal-invasives Verfahren, das seine Vorteile gegenüber der wesentlich einfacher und kostengünstiger durchzuführenden Pit-Picking-Methode erst noch unter Beweis stellen muss.

Schlüsselwörter

Sinus pilonidalis Operative Therapie Pit-Picking Laserepilation Rezidivrate 

Antibiotics, laser and endoscopy—new kids on the block

Abstract

Background

Pilonidal sinus is a disease of subcutaneous tissue, where infections and hair play an important role. Several therapeutic surgical options are currently available but show clear differences particularly with respect to invasiveness; however, there is no procedure that completely combines all advantages of a high healing rate, low recurrence rate and minimal discomfort for the patient.

Objective

It is unclear if antibiotic therapy can play a supportive role in pilonidal surgery. Furthermore, several minimally invasive procedures, such as endoscopic and laser techniques have been put forward for treatment of pilonidal sinus.

Results and conclusion

Concerning the currently available worldwide literature there is no compelling evidence for the use of antibiotics by parenteral, enteral or local administration. This must be left to the discretion of the surgeon. Whereas sufficient evidence for laser coagulation of pilonidal sinus alone has not yet been achieved, laser depilation as a means of possible postoperative recurrence prevention might play a role. The results of studies indicate that laser depilation is superior to other methods of depilation (shaving, creams) and is able to lower the recurrence rate. Its use could be considered particularly for problem cases. A final conclusion for the use of endoscopic techniques is currently also not possible. Endoscopic techniques are a new approach and the minimally invasive nature has some advantages. Nevertheless, its advantages compared to the easier to handle and more cost-effective pit-picking methods have to be proven.

Keywords

Pilonidal sinus Operative surgery Pit picking Laser depilation Recurrence rate 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Ommer und D. Doll geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Alptekin H, Yilmaz H et al (2013) Volume of the excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery). Surg Today 43(12):1365–1370CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Andersson RE, Lukas G et al (2010) Local administration of antibiotics by gentamicin-collagen sponge does not improve wound healing or reduce recurrence rate after pilonidal excision with primary suture: a prospective randomized controlled trial. World J Surg 34(12):3042–3048CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Arda IS, Guney LH et al (2005) High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 29(4):469–471CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Armstrong JH, Barcia PJ (1994) Pilonidal sinus disease. The conservative approach. Arch Surg 129(9):914–917 (discussion 917–9)CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Benedetto AV (2010) Commentary: hair and pilonidal sinus disease. Dermatol Surg 36(1):92–93CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bolandparvaz S, Moghadam Dizaj P et al (2012) Evaluation of the risk factors of pilonidal sinus: a single center experience. Turk J Gastroenterol 23(5):535–537CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Brieler HS (1997) Infected pilonidal sinus. Langenbecks Arch Chir Suppl Kongressbd 114:497–500PubMedPubMedCentralGoogle Scholar
  8. 8.
    Brook I (1989) Microbiology of infected pilonidal sinuses. J Clin Pathol 42(11):1140–1142CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chaudhuri A, Bekdash BA (2002) Single-dose metronidazole versus 5‑day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective randomised controlled double-blinded study. Int J Colorectal Dis 17(5):355–358CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chia CL, Tay VW et al (2015) Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech 25(3):e95–e97CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Conroy FJ, Kandamany N et al (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61(9):1069–1072CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    de Bruin AF, Gosselink MP et al (2012) Local application of gentamicin-containing collagen implant in the prophylaxis of surgical site infection following gastrointestinal surgery. Int J Surg 10(Suppl 1):S21–S27CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Demircan F, Akbulut S et al (2015) The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 8(2):2929–2933PubMedPubMedCentralGoogle Scholar
  14. 14.
    Doll D, Evers T et al (2011) Does gentamycin affect long term recurrence rate in pilonidal sinus surgery. Eur Surg 43(4):236.  https://doi.org/10.1007/s10353-011-0615-9 CrossRefGoogle Scholar
  15. 15.
    Dragoni F, Moretti S et al (2018) Treatment of recurrent pilonidal cysts with nd-YAG laser: report of our experience. J Dermatolog Treat 29(1):65–67CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Emile SH, Elfeki H et al (2018) Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 32(9):3754.  https://doi.org/10.1007/s00464-018-6157-5 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gecim IE, Goktug UU et al (2017) Endoscopic pilonidal sinus treatment combined with crystalized phenol application may prevent recurrence. Dis Colon Rectum 60(4):405–407CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gecim IE, Goktug UU et al (2016) Video-assisted treatment of pilonidal disease, using a combination of diathermy ablation and phenol application. BMJ Case Rep.  https://doi.org/10.1136/bcr-2016-214629 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Giarratano G, Toscana C et al (2017) Endoscopic pilonidal sinus treatment: long-term results of a prospective series. JSLS.  https://doi.org/10.4293/jsls.2017.00043 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Holzer B, Grussner U et al (2003) Efficacy and tolerance of a new gentamicin collagen fleece (Septocoll) after surgical treatment of a pilonidal sinus. Colorectal Dis 5(3):222–227CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Iesalnieks I, Ommer A et al (2016) German national guideline on the management of pilonidal disease. Langenbecks Arch Surg 401(5):599–609CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jain Y, Javed MA et al (2016) Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess. Ann R Coll Surg Engl 99(2):134–136CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Javed MA, Fowler H et al (2016) Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT). Tech Coloproctol 20(12):871–873CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kandamany N, Mahaffey PJ (2008) The importance of hair control and personal hygiene in preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61(8):986–987CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kelati A, Lagrange S et al (2018) Laser hair removal after surgery vs. surgery alone for the treatment of pilonidal cysts: a retrospective case-control study. J Eur Acad Dermatol Venereol 32(11):2031–2033CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    KRINKO-Kommission (2018) Präventionen postoperativer Wundinfektionen – Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt 4:448–473Google Scholar
  27. 27.
    Kronborg O, Christensen K et al (1985) Chronic pilonidal disease: a randomized trial with a complete 3‑year follow-up. Br J Surg 72(4):303–304CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kundes MF, Cetin K et al (2016) Does prophylactic antibiotic reduce surgical site infections after rhomboid excision and Limberg flap for pilonidal disease: a prospective randomized double blind study. Int J Colorectal Dis 31:1089–1091CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lindemayr H (1984) Eczema in hairdressers. Derm Beruf Umwelt 32(1):5–13PubMedPubMedCentralGoogle Scholar
  30. 30.
    Lindholt-Jensen CS, Lindholt JS et al (2012) Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 27(2):505–508CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mavros MN, Mitsikostas PK et al (2013) Antimicrobials as an adjunct to pilonidal disease surgery: a systematic review of the literature. Eur J Clin Microbiol Infect Dis 32(7):851–858CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Meinero P, Mori L et al (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18(4):389–392CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Meinero P, Stazi A et al (2016) Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis 18(5):O164–O170CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Milone M, Bianco P et al (2014) A technical modification of video-assisted ablation for recurrent pilonidal sinus. Colorectal Dis 16(11):O404–O406CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Milone M, Fernandez LM et al (2016) Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg 151(6):547–553CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Nguyen AL, Pronk AA et al (2016) Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature. Tech Coloproctol 20(2):91–100CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Ommer A, Berg E et al (2014) S3-Leitlinie: Sinus pilonidalis. Coloproctology 36(4):272–322CrossRefGoogle Scholar
  38. 38.
    Ozbalci GS, Tuncal S et al (2014) Is gentamicin-impregnated collagen sponge to be recommended in pilonidal sinus patient treated with marsupialization? A prospective randomized study. Ann Ital Chir 85(6):576–582PubMedPubMedCentralGoogle Scholar
  39. 39.
    Pappas AF, Christodoulou DK (2018) A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis 20:O207–O214CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Pearson HE, Smiley DF (1968) Bacteroides in pilonidal sinuses. Am J Surg 115(3):336–338CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Petersen S, Wietelmann K et al (2009) Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 52(1):131–134CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Popeskou S, Christoforidis D et al (2011) Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J Surg 35(1):206–211CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pronk AA, Eppink L et al (2018) The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol 22(1):7–14CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Segre D, Pozzo M et al (2015) The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 19(10):607–613CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10(1):39–42CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Steele SR, Perry WB et al (2013) Practice parameters for the management of pilonidal disease. Dis Colon Rectum 56(9):1021–1027CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Suarez Valladares MJ, Rodriguez Prieto MA (2018) Neodymium-doped yttrium aluminium garnet laser to treat primary pilonidal cysts: an alternative treatment. Br J Dermatol 178(2):e127–e128CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Swinton NW, Wise RE (1955) The significance of epilation as an adjunct in the treatment of pilonidal sinus disease. Am J Surg 90(5):775–779CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Tien T, Athem R et al (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22(5):325–331CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Vogel P, Lenz J (1992) Behandlung des Sinus pilonidalis durch Excision und Primärverschluß unter Verwendung eines lokalen, resorbierenden Antibiotikaträgers. Ergebnisse einer prospektiven randomizierten Studie. Chirurg 63(9):748–753PubMedPubMedCentralGoogle Scholar
  51. 51.
    Yamasaki R, Dekio S et al (1984) Allergic contact dermatitis to ammonium thioglycolate. Contact Dermatitis 11(4):255CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Yetim I, Ozkan OV et al (2010) Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study. J Int Med Res 38(3):1029–1033CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.End- und Dickdarm-Zentrum EssenEssenDeutschland
  2. 2.Department of SurgeryUniversity of the Witwatersrand Medical SchoolJohannesburgSüdafrika
  3. 3.Department of Procto-SurgeryCatholic Clinics Oldenburger Münsterland gGmbHOldenburgerDeutschland
  4. 4.St. Marys Hospital VechtaAcademic Teaching Hospital of the MH HannoverVechtaDeutschland

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