Pilonidal sinus disease—186 years since Mayo
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Pilonidalsinuserkrankungen – 186 Jahre seit Mayo
Some interesting aspects of the mechanism of PSD have been unraveled: It seems that short hair fragments from the head may play a role in PSD recurrence [7, 8, 9]. Is sweating an important aspect in PSD? An ongoing study will give us results in due time.
The therapeutic spectrum differs worldwide. In Indo-Arab countries, phenol is still popular, which is forbidden in Germany owing to toxicity and teratogenic effects [10, 11]. While other nations advocate the use of primary open treatment less —unless the wound situation dictates its use—it is predominantly applied in Germany, with some inherent disadvantages: high costs for insurance companies, high costs for the employer, and a long healing time. Recently, new methods such as laser and endoscopic treatment have gained attention [13, 14, 15], but their value is still to be determined. Surgeons in Germany are still cautious when performing pilonidal plastic surgery as recommended  because they fear potential complications. This may be one reason why so-called minimally invasive methods have increased in popularity during the last few years—therapies like Gips’s tract surgery and pit picking [17, 18]. Although these may be associated with a higher recurrence rate, some surgeons argue that they are considered a good start for uncomplicated pilonidal disease—and a flap procedure may be used later, if there is recurrence .
If we want to escalate therapy depending on clinical aspects, how can we judge which sinus needs which therapeutic tool? Staging systems are emerging, and their evidence is still weak: But do they provide the clinicians with useful information? Is this just gathering data, or is it a real benefit for the patients? There is still some common ground to be found before the use of these systems can be recommended.
Seven high-profile authors from Sweden, Switzerland, Turkey, the United Kingdom, Australia, and Germany have agreed to contribute their knowledge to this Pilonidal Sinus Series, which Alois Fürst initiated.
Who are the contributing authors? Peter Wysocki from Australia writes on primary open treatments, and Asha Senapati from St. Marks Hospital in London gives us a comprehensive overview of common flaps in pilonidal sinus surgery. Ekmel Tezel from Ankara, Turkey, describes current staging systems, and Andreas Ommer (Essen, Germany) was so kind as to compile an overview of the new kids on the block—laser and endoscopic treatment—and their results in the literature. Thomas Baur (Bern, Switzerland) presents the recurrence rates in uncommon surgical procedures for PSD, and Roland Andersson from Jönköping (Sweden) outlines less invasive surgical procedures. Nora Peters from Marburg is giving some informations on costs of PSD therapy—quite interesting in an increasingly cost orientated medical environment. Each author stands their own ground, and thus different aspects as well as common approaches can be identified.
Since PSD is related to puberty, there must still be yet undiscovered skin and humoral factors, other than hair strength.
Why is there a suspected higher incidence in Turkey and other Mediterranean countries, while this disease is not known in Asia and Africa?
Incidence is high in some families, sometimes with three generations in a row affected by PSD. Is there a co-genetic predisposition other than BMI (not proven yet) and hair strength?
The incidence of PSD seems to be rising, while recurrence is not. Does this mean we have to think of two different mechanisms between first and recurrent disease?
Conflict of interest
D. Doll declares that he has no competing interests.
- 1.Destatis (2017) Operationen und Prozeduren in Krankenhäusern. In. Interactive Online Database des Statistischen Bundesamt der Bundesrepublik Deutschland, Wiesbaden. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/OperationenProzeduren.html. Accessed 31 Aug 2018Google Scholar
- 10.Bundesministerium der Justiz (1991) Bundesgesetzblatt vom 02.10.1991 mit Anlagen. Bundesanzeiger, KölnGoogle Scholar
- 12.Fabricius R, Petersen LW, Bertelsen CA (2010) Treatment of pilonidal sinuses in Denmark is not optimal. Dan Med Bull 57:1–5Google Scholar
- 20.Mayo H (1833) Observations on injuries and diseases of the rectum. Burgess & Hill, LondonGoogle Scholar