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Pilonidal Disease

  • Eric K. Johnson
  • Aaron Womer
  • Scott R. Steele
Chapter

Abstract

It is arguable whether a disease exists that is more frustrating in failure or more satisfying in success, for both patient and surgeon, than pilonidal disease. The strategy utilized to manage this disease is critical, and should be based upon disease severity, anatomy, and a patient’s particular desire. While disease may be non-operatively approached, surgery is more likely to result in a durable and definitive cure. This chapter will outline several approaches to the patient with pilonidal disease. The surgeon best prepared to treat this disease will be familiar with three or four viable surgical options that can be applied to a variety of scenarios.

Keywords

Pilonidal disease Cleft lift Limberg flap Rhomboid flap Karydakis flap 

References

  1. 1.
    Anderson AW. Hair extracted from an ulcer. Boston M S J. 1847;36:74.Google Scholar
  2. 2.
    Hodges RM. Pilonidal sinus. Boston M S J. 1880;103:485–6.CrossRefGoogle Scholar
  3. 3.
    Warren JM. Abscess, containing hair, on the nates. Am J Med Sci. 1854;28:113.CrossRefGoogle Scholar
  4. 4.
    Buie LA. Jeep disease (pilonidal disease of mechanized warfare). South Med J. 1944;37:103–9.CrossRefGoogle Scholar
  5. 5.
    Close AS. Pilonidal cysts: an analysis of surgical failures. Ann Surg. 1955;141:523–6.CrossRefGoogle Scholar
  6. 6.
    Can MF, Sevinc MM, Yilmaz M. Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg Today. 2009;39:580–6.CrossRefGoogle Scholar
  7. 7.
    Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg. 2010;200:318–27.CrossRefGoogle Scholar
  8. 8.
    Bessa SS. Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon Rectum. 2013;56:491–8.CrossRefGoogle Scholar
  9. 9.
    Gendy AS, Glick RD, Hong AR, Dolgin SE, Soffer SZ, Landers H, Herrforth M, Rosen NG. A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg. 2011;46:1256–9.CrossRefGoogle Scholar
  10. 10.
    Dudink R, Veldkamp J, Nienhuijs S, Heemskerk J. Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg. 2011;100:110–3.CrossRefGoogle Scholar
  11. 11.
    Guner A, Boz A, Ozkan OF, Ileli O, Kece C, Reis E. Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg. 2013;37:2074–80.CrossRefGoogle Scholar
  12. 12.
    Altintoprak F, Gundogdu K, Ergonenc T, Dikicier E, Cakmak G, Celebi F. Retrospective review of pilonidal sinus patients with early discharge after limberg flap procedure. Int Surg. 2014;99:28–34.CrossRefGoogle Scholar
  13. 13.
    Kaya B, Eris C, Atalay S, Bat O, Bulut NE, Mantoglu B, Karabulut K. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol. 2012;16:55–9.CrossRefGoogle Scholar
  14. 14.
    Osmanoglu G, Yetisir F. Limberg flap is better for the surgical treatment of pilonidal sinus. Results of a 767 patients series with an at least five years follow-up period. Chirurgia (Bucur). 2011;106:491–4.Google Scholar
  15. 15.
    Khan PS, Hayat H, Hayat G. Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; a randomized clinical trial. Indian J Surg. 2013;75:192–4.CrossRefGoogle Scholar
  16. 16.
    Sit M, Aktas G, Yilmaz EE. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg. 2013;79:1263–8.PubMedGoogle Scholar
  17. 17.
    Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O. Which flap should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Colorpoctol. 2014;18:29–37.CrossRefGoogle Scholar
  18. 18.
    Saylam B, Balli DN, Duzgun AP, Ozer MV, Coskun F. Which surgical procedure offers the best treatment for pilonidal disease? Langenbeck's Arch Surg. 2011;396:651–8.CrossRefGoogle Scholar
  19. 19.
    Ates M, Dirican A, Sarac M, Aslan A, Colak C. Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg. 2011;202(5):568–73.CrossRefGoogle Scholar
  20. 20.
    Von Laffert M, Stadie V, Ulrich J, Marsch WC, Wohlrab J. Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology. 2011;223:349–55.CrossRefGoogle Scholar
  21. 21.
    Uysal AC, Alagoz MS, Unlu RE, Sensoz O. Hair dresser’s syndrome: a case report of an interdigital pilonidal sinus and review of the literature. Dermatol Surg. 2003;29:288–90.PubMedGoogle Scholar
  22. 22.
    Coskun A, Bulus H, Akinci OF, Ozgonul A. Etiological factors in umbilical pilonidal sinus. Indian J Surg. 2011;73:54–7.CrossRefGoogle Scholar
  23. 23.
    Armed Forces Health Surveillance Center (AFHSC). Pilonidal cysts, active component, U.S. Armed Forces, 2000-2012. MSMR. 2013;20:8–11.Google Scholar
  24. 24.
    Bolandparvaz S, Moghadam DP, Salahi R, Paydar S, Bananzadeh M, Abbasi HR, Eshraghian A. Evaluation of the risk factors of pilonidal sinus: a single center experience. Turk J Gastroenterol. 2012;23:535–7.CrossRefGoogle Scholar
  25. 25.
    Doll D, Matevossian E, Wietelmann K, Evers T, Kriner M, Petersen S. Family history of pilonidal sinus predisposes to earlier onset of disease and a 50% long-term recurrence rate. Dis Colon Rectum. 2009;52:1610–5.CrossRefGoogle Scholar
  26. 26.
    Harlak A, Mentes O, Kilic S, Coskun K, Duman K, Yilmaz F. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics. 2010;65:125–31.CrossRefGoogle Scholar
  27. 27.
    Armstrong JH, Barcia PJ. Pilonidal sinus disease. The conservative approach. Arch Surg. 1994;129:914–7.CrossRefGoogle Scholar
  28. 28.
    Odili J, Gault D. Laser depilation of the natal cleft—an aid to healing the pilonidal sinus. Ann R Coll Surg Engl. 2002;84:29–32.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg. 2005;31:726–8.CrossRefGoogle Scholar
  30. 30.
    Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C. Laser epilation is safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg. 2009;44:282–5.CrossRefGoogle Scholar
  31. 31.
    Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg. 2011;4:192–5.CrossRefGoogle Scholar
  32. 32.
    Petersen S, Wietelmann K, Evers T, Huser N, Matevossian E, Doll D. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum. 2009;52:131–4.CrossRefGoogle Scholar
  33. 33.
    Schneider IH, Thaler K, Kockerling F. Treatment of pilonidal sinus by phenol injections. Int J Color Dis. 1994;9:200–2.CrossRefGoogle Scholar
  34. 34.
    Dogru O, Camci C, Aygen E, Girgin M, Topuz O. Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon Rectum. 2004;47:1934–8.CrossRefGoogle Scholar
  35. 35.
    Hegge HG, Vos GA, Patka P, Hoitsma HF. Treatment of complicated or infected pilonidal sinus disease by local application of phenol. Surgery. 1987;102:52–4.PubMedGoogle Scholar
  36. 36.
    Stansby G, Greatorex R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg. 1989;76:729–30.CrossRefGoogle Scholar
  37. 37.
    Lund JN, Leveson SH. Fibrin glue treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum. 2005;48:1094–6.CrossRefGoogle Scholar
  38. 38.
    Seleem MI, Al-Hashemy AM. Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience. Color Dis. 2005;7:319–22.CrossRefGoogle Scholar
  39. 39.
    Greenberg R, Kashtan H, Skornik Y, Werbin N. Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol. 2004;8:95–8.CrossRefGoogle Scholar
  40. 40.
    Elsey E, Lund JN. Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol. 2013;17:101–4.CrossRefGoogle Scholar
  41. 41.
    Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Sosa Fernandez LM, Bianco P, Zizolfi B, Nappi C, Milone F. Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment—a pilot study. Surgery. 2014;155:562–6.CrossRefGoogle Scholar
  42. 42.
    Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD. Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc. 2018 32(9):3754–62.  https://doi.org/10.1007/s00464-018-6157-5.CrossRefGoogle Scholar
  43. 43.
    Alptekin H, Yilmaz H, Kayis SA, Sahin M. Volume of excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery). Surg Today. 2013;43:1365–70.CrossRefGoogle Scholar
  44. 44.
    Milone M, Musella M, Salvatore G, Leongito M, Milone F. Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Color Dis. 2011;26:1601–7.CrossRefGoogle Scholar
  45. 45.
    Milone M, Di Minno MN, Musella M, Maietta P, Ambrosino P, Pisapia A, Salvatore G, Milone F. The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis. Tech Colorpoctol. 2013;17:625–30.CrossRefGoogle Scholar
  46. 46.
    Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W. Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum. 2011;54:300–5.CrossRefGoogle Scholar
  47. 47.
    Rao MM, Zawislak W, Kennedy R, Gilliland R. A prospective randomized study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Color Dis. 2010;25:395–400.CrossRefGoogle Scholar
  48. 48.
    Aldagal SM, Kensarah AA, Alhabboubi M, Ashy AA. A new technique in management of pilonidal sinus, a university teaching hospital experience. Int Surg. 2013;98:304–6.CrossRefGoogle Scholar
  49. 49.
    Doll D, Novotny A, Rothe R, Kristiansen JE, Wietelmann K, Boulesteix AL, Dusel W, Petersen S. Methylene blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Color Dis. 2008;23:181–7.CrossRefGoogle Scholar
  50. 50.
    Colv EP, Bertelsen CA. Short convalescence and minimal pain after out-patient Bascom’s pit pick operation. Dan Med Bull. 2011;58:A4348.Google Scholar
  51. 51.
    Olmez A, Kayaalp C, Aydin C. Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol. 2013;17:201–6.CrossRefGoogle Scholar
  52. 52.
    Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Color Dis. 2012;14:143–51.CrossRefGoogle Scholar
  53. 53.
    Dass TA, Zaz M, Rather A, Bari S. Elliptical excision with midline primary closure versus rhomboid excision with limberg flap reconstruction in sacrococcygeal pilonidal disease: a prospective, randomized study. Indian J Surg. 2012;74:305–8.CrossRefGoogle Scholar
  54. 54.
    Onder A, Girgin S, Kapan M, Toker M, Arikanoglu Z, Palanci Y, Bac B. Pilonidal sinus disease: risk factors for postoperative complications and recurrence. Int Surg. 2012;97:224–9.CrossRefGoogle Scholar
  55. 55.
    Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffman S, Doll D. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Color Dis. 2013;28:1555–62.CrossRefGoogle Scholar
  56. 56.
    Doll D, Matevossian E, Hoenemann C, Hoffman S. Incision and drainage preceding definitive surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges. 2013;11:60–4.PubMedGoogle Scholar
  57. 57.
    Doll D, Evers T, Krapohl B, Matevossian E. Is there a difference in outcome (long-term recurrence rate) between emergency and elective pilonidal sinus surgery? Minerva Chir. 2013;68:199–205.PubMedGoogle Scholar
  58. 58.
    Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50:1928–34.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Eric K. Johnson
    • 1
    • 2
  • Aaron Womer
    • 3
  • Scott R. Steele
    • 2
  1. 1.Colorectal SurgeryUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Department of Colon and Rectal SurgeryCleveland ClinicClevelandUSA
  3. 3.Case Western Reserve University School of MedicineClevelandUSA

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