Advertisement

coloproctology

, Volume 41, Issue 2, pp 121–126 | Cite as

Trends toward a tailored approach for pilonidal sinus disease

Classification, staging, and treatment algorithms
  • E. TezelEmail author
  • S. Leventoglu
  • A. P. Wysockı
Leitthema
  • 13 Downloads

Abstract

This review article summarizes the approach to patients with pilonidal sinus disease based on morphologically different stages. Pilonidal sinus disease is a very common condition especially among young people. The proposed classifications for pilonidal disease and commonly used procedures are summarized here. There is currently limited literature to justify a particular treatment over another based on disease stage. Off-midline closure has the lowest long-term recurrence rate.

Keywords

Pilonidal disease Classification Staging Treatment Algorithms 

Tendenzen zu einem individualisierten Ansatz bei Pilonidalsinus

Klassifizierung, Stadieneinteilung und Behandlungsalgorithmen

Zusammenfassung

Die vorliegende Übersichtsarbeit bietet die Zusammenfassung eines Therapieansatzes bei Patienten mit Pilonidalsinuserkrankungen auf der Basis morphologisch unterschiedlicher Stadien. Ein Pilonidalsinus ist eine sehr häufige Erkrankung, insbesondere bei jungen Menschen. Die vorgeschlagenen Klassifikationen der Pilonidalsinuserkrankung und die üblicherweise eingesetzten Therapieverfahren werden zusammengefasst. Derzeit gibt es nur begrenzt Literatur, um auf der Basis des Krankheitsstadiums die Bevorzugung einer bestimmten Behandlung gegenüber einer anderen zu rechtfertigen. Die niedrigste Langzeitrezidivrate weist der Verschluss abseits der Mittellinie auf.

Schlüsselwörter

Pilonidalsinuserkrankungen Klassifikation Stadieneinteilung Therapie Algorithmen 

Notes

Compliance with ethical guidelines

Conflict of interest

E. Tezel, S. Leventoglu, and A. P. Wysockı declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Sondenaa K, Andersen E, Nesvik I, Soreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10(1):39–42CrossRefGoogle Scholar
  2. 2.
    Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62(5):385–389CrossRefGoogle Scholar
  3. 3.
    Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87(5):567–572PubMedGoogle Scholar
  4. 4.
    Doll D, Bosche F, Hauser A, Moersdorf P, Sinicina I, Grunwald J et al (2018) The presence of occipital hair in the pilonidal sinus cavity—a triple approach to proof. Int J Colorectal Dis 33(5):567–576CrossRefGoogle Scholar
  5. 5.
    Doll D, Bosche FD, Stauffer VK, Sinicina I, Hoffmann S, van der Zypen D et al (2017) Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis Colon Rectum 60(9):979–986CrossRefGoogle Scholar
  6. 6.
    Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D (2018) The hair in the sinus: sharp-ended rootless head hair fragments can be found in large amounts in pilonidal sinus nests. World J Surg 42(2):567–573CrossRefGoogle Scholar
  7. 7.
    Gosselink MP, Jenkins L, Toh JWT, Cvejic M, Kettle E, Boadle RA et al (2017) Scanning electron microscope imaging of pilonidal disease. Tech Coloproctol 21(11):905–906CrossRefGoogle Scholar
  8. 8.
    Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S (2008) Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 23(4):359–364CrossRefGoogle Scholar
  9. 9.
    Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD006213.pub3 CrossRefPubMedGoogle Scholar
  10. 10.
    Skobelkin OK, Efendiev AI, Derbenev VA, Ste’nko VG, Dadashev AI (1989) Radical treatment of suppurative pilonidal cysts. Vestn Khir Im I I Grek 142(6):123–124PubMedGoogle Scholar
  11. 11.
    Murphy S, Wysocki AP (2017) Pilonidal sinus disease surveys. Pilonidal Sinus J 3(1):19–27Google Scholar
  12. 12.
    Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K et al (2018) Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 8(1):1–27CrossRefGoogle Scholar
  13. 13.
    Doll D, Luedi MM, Wieferich K, van der Zypen D, Maak M, Glanemann M (2015) Stop insulting the patient: neither incidence nor recurrence in pilonidal sinus disease is linked to personal hygiene. Pilonidal Sinus J 1(1):11–18Google Scholar
  14. 14.
    Zinicola R, Cracco N, Serventi A, Martina S, Milone M, Sallustio P et al (2014) Pilonidal sinus: are we missing something? Colorectal Dis 16(11):929–930CrossRefGoogle Scholar
  15. 15.
    Kuzu MA (2008) Commentary. Colorectal Dis 10(7):651–652CrossRefGoogle Scholar
  16. 16.
    Brown SR (2013) Invited comment on Elsey and Lund: fibrin glue in the treatment of pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol 17(1):105–106CrossRefGoogle Scholar
  17. 17.
    Wysocki AP, Andersson RE, Gips M, Girgin M, Guner A, Immerman S et al (2018) Towards a classification for sacrococcygeal pilonidal disease—Berlin 2017. Pilonidal Sinus J 4(1):5–12Google Scholar
  18. 18.
    International Pilonidal Society (2018) Survey towards pilonidal classification. http://www.pilonidal.com.au/blog/item/survey-towards-pilonidal-classification. Accessed 9 Sept 2018Google Scholar
  19. 19.
    Tezel E (2007) A new classification according to navicular area concept for sacrococcygeal pilonidal disease. Colorectal Dis 9(6):575–576CrossRefGoogle Scholar
  20. 20.
    Awad MM, Elbaset AA, Ebraheem S, Tantawy E, Elhafez MA, Elsayed AM (2009) A scoring system as a method to evaluate pilonidal sinus disease to make an easy decision for its management. Indian J Plast Surg 42(1):43–48CrossRefGoogle Scholar
  21. 21.
    Karakaş DO, Yılmaz I, Hazer B, Dandin Ö, Sücüllü I (2017) A new approach to classification of pilonidal disease. Turk J Colorectal Dis 27:65–66CrossRefGoogle Scholar
  22. 22.
    Irkörücü OE, Erdem H, Reyhan E (2012) The best therapy for pilonidal disease: which management for which type? World J Surg 36:691–692CrossRefGoogle Scholar
  23. 23.
    Quinodoz PD, Chilcott M, Grolleau JL, Chavoin JP, Costagliola M (1999) Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience. Eur J Surg 165(11):1061–1065CrossRefGoogle Scholar
  24. 24.
    Abdelrazeq AS, Rahman M, Botterill ID, Alexander DJ (2008) Short-term and long-term outcomes of the cleft lift procedure in the management of nonacute pilonidal disorders. Dis Colon Rectum 51(7):1100–1106CrossRefGoogle Scholar
  25. 25.
    Guner A, Cekic AB, Boz A, Turkyilmaz S, Kucuktulu U (2016) A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach. BMC Surg 16:18CrossRefGoogle Scholar
  26. 26.
    Irkörücü O (2016) Management for pilonidal disease: before you compare, use a classification system. Asian J Surg 39(4):260–261CrossRefGoogle Scholar
  27. 27.
    Doll D, Vassiliu P (2018) Another Pilonidal classification—PLLATIN. Pilonidal Sinus J 4(1):1–3Google Scholar
  28. 28.
    Akin M, Leventoglu S, Mentes BB, Bostanci H, Gokbayir H, Kilic K et al (2010) Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today 40(8):757–762CrossRefGoogle Scholar
  29. 29.
    Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M (2004) Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 34(5):419–423CrossRefGoogle Scholar
  30. 30.
    Wysocki AP (2018) Flaps for pilonidal sinus disease. Turk Klin J Gen Surg Spec Top 11(2):124–129Google Scholar
  31. 31.
    Bascom J, Bascom T (2007) Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg 193(5):606–609 (discussion 9)CrossRefGoogle Scholar
  32. 32.
    Tezel E, Bostanci H, Anadol AZ, Kurukahvecioglu O (2009) Cleft lift procedure for sacrococcygeal pilonidal disease. Dis Colon Rectum 52(1):135–139CrossRefGoogle Scholar
  33. 33.
    Yuksel ME (2017) Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique. Acta Dermatovenerol Alp Pannonica Adriat 26(1):15–17PubMedGoogle Scholar
  34. 34.
    Petersen S, Wietelmann K, Evers T, Huser N, Matevossian E, Doll D (2009) Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 52(1):131–134CrossRefGoogle Scholar
  35. 35.
    Doll D, Friederichs J, Boulesteix AL, Dusel W, Fend F, Petersen S (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 23(9):839–844CrossRefGoogle Scholar
  36. 36.
    Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15(2):179–183CrossRefGoogle Scholar
  37. 37.
    Zukiwskyj M, Webb PM (2016) The associated microbiology of pilonidal sinus disease in a small rural hospital. Pilonidal Sinus J 2(1):1–4Google Scholar
  38. 38.
    Kaplan M, Ozcan O, Bilgic E, Kaplan ET, Kaplan T, Kaplan FC (2017) Distal scar-to-midline distance in pilonidal Limberg flap surgery is a recurrence promoting factor: a multicenter, case-control study. Am J Surg.  https://doi.org/10.1016/j.amjsurg.2017.02.008 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Olmez A, Kayaalp C, Aydin C (2013) Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol 17(2):201–206CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of General SurgeryGazi University School of MedicineBesevler, AnkaraTurkey
  2. 2.Griffith Health Centre—G40, Gold Coast CampusGriffith University Medical SchoolQueenslandAustralia
  3. 3.Department of General SurgeryLogan HospitalMeadowbrook, QueenslandAustralia

Personalised recommendations