Advertisement

International Journal of Colorectal Disease

, Volume 23, Issue 2, pp 177–180 | Cite as

A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more

  • Christopher Soll
  • Dieter Hahnloser
  • Daniel Dindo
  • Pierre-Alain Clavien
  • Franc Hetzer
Original Article

Abstract

Background

The surgical management of sacrococcygeal pilonidal sinus (PS) is still a matter of discussion. Therapy ranges from complete wide excision with or without closure of the wound to excochleation of the sinus with a brush. In this paper, we introduce a novel limited excision technique. The aim of this study was to assess the morbidity and recurrence rate of this technique.

Materials and methods

Limited excision consisted of a selective extirpation of the sinus after tagging the tract with methylene blue. Ninety-three consecutive patients, who underwent surgery between 2001 and 2004, were analyzed. The patients’ survey was performed by mail questionnaire and telephone interview inquiring recurrence, time off work, and time to wound healing.

Results

Seventy-three percent of the patients were treated in an outpatient setting. With a median follow-up of 2 years, the recurrence rate was 5%. The median time off work was 2 weeks. The median wound healing time was 5 weeks.

Conclusion

Limited excision for PS can be done in an outpatient setting with a low recurrence rate and short time off work.

Keywords

Pilonidal sinus Pilonidal cyst Surgery Therapy 

Abbreviations

PS

pilonidal sinus

References

  1. 1.
    Spivak H, Brooks VL, Nussbaum M, Friedman I (1996) Treatment of chronic pilonidal disease. Dis Colon Rectum 39:1136–1139PubMedCrossRefGoogle Scholar
  2. 2.
    Sondenaa K, Nesvik I, Andersen E, Soreide JA (1996) Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J Surg 162:237–240PubMedGoogle Scholar
  3. 3.
    Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S (2005) Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 92:1081–1084PubMedCrossRefGoogle Scholar
  4. 4.
    Fazeli MS, Adel MG, Lebaschi AH (2006) Comparison of outcomes in Z-plasty and delayed healing by secondary intention of the wound After excision of the sacral pilonidal sinus: results of a randomized, clinical trial. Dis Colon Rectum 49:1831–1836PubMedCrossRefGoogle Scholar
  5. 5.
    Topgul K, Ozdemir E, Kilic K, Gokbayir H, Ferahkose Z (2003) Long-term results of Limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 46:1545–1548PubMedCrossRefGoogle Scholar
  6. 6.
    Aydede H, Erhan Y, Sakarya A, Kumkumoglu Y (2001) Comparison of three methods in surgical treatment of pilonidal disease. ANZ J Surg 71:362–364PubMedCrossRefGoogle Scholar
  7. 7.
    Gupta PJ (2005) Comparative study between radiofrequency sinus excision and open excision in sacro-coccygeal pilonidal sinus disease. Dig Surg 22:459–463PubMedCrossRefGoogle Scholar
  8. 8.
    Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctology 7:3–8CrossRefGoogle Scholar
  9. 9.
    Sharma PP (2006) Multiple Z-plasty in pilonidal sinus—a new technique under local anesthesia. World J Surg 30:2261–2265PubMedCrossRefGoogle Scholar
  10. 10.
    Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H (2002) Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169PubMedCrossRefGoogle Scholar
  11. 11.
    Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20:415–422PubMedCrossRefGoogle Scholar
  12. 12.
    Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O (2006) Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 49:244–249PubMedCrossRefGoogle Scholar
  13. 13.
    Perruchoud C, Vuilleumier H, Givel JC (2002) Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995. Swiss Surg 8:255–258PubMedCrossRefGoogle Scholar
  14. 14.
    Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304PubMedCrossRefGoogle Scholar
  15. 15.
    al-Hassan HK, Francis IM, Neglen P (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699PubMedGoogle Scholar
  16. 16.
    Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K (2002) Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 45:1458–1467PubMedCrossRefGoogle Scholar
  17. 17.
    Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300PubMedCrossRefGoogle Scholar
  18. 18.
    Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMedGoogle Scholar
  19. 19.
    Parvaiz A, Kennedy R (2001) Bascom’s procedure in the day-surgical management of symptomatic pilonidal sinus. Br J Surg 88:155–156PubMedCrossRefGoogle Scholar
  20. 20.
    Senapati A, Cripps NP, Thompson MR (2000) Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus. Br J Surg 87:1067–1070PubMedCrossRefGoogle Scholar
  21. 21.
    Muller XM, Rothenbuhler JM, Frede KE (1992) [Sacro-coccygeal cyst: surgical techniques and results]. Helv Chir Acta 58:889–892PubMedGoogle Scholar
  22. 22.
    Asch DA, Jedrziewski MK, Christakis NA (1997) Response rates to mail surveys published in medical journals. J Clin Epidemiol 50:1129–1136PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Christopher Soll
    • 1
  • Dieter Hahnloser
    • 1
  • Daniel Dindo
    • 1
  • Pierre-Alain Clavien
    • 1
  • Franc Hetzer
    • 2
  1. 1.Department of Visceral and Transplantation SurgeryUniversity Hospital ZuerichZuerichSwitzerland
  2. 2.Department of SurgeryCantonal HospitalSt. GallenSwitzerland

Personalised recommendations