Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for tr...Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.展开更多
Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of...Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the errors of the unevacuated rectum, non-dynamic展开更多
AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus ...AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients(84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates(9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies(mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.展开更多
AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonida...AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.展开更多
Background: Pilonidal disease is a common chronic disorder of the sacrococcygeal region;and its surgical management is still a matter of discussion. The ideal therapy would be a quick cure that allowed patients to ret...Background: Pilonidal disease is a common chronic disorder of the sacrococcygeal region;and its surgical management is still a matter of discussion. The ideal therapy would be a quick cure that allowed patients to return rapidly to normal activity, that is minimally invasive with no morbidity, a low risk of complication and easy to learn. Methods: Sixty seven patients with pilonidal disease were subjected to excision and partial closure procedure, from November 2006 to March 2010 at General Surgery Department, Zagazig University Hospital, Zagazig University, Egypt. The mean age was 27.5 years. Complete but close excision of all diseased tissues was achieved. Then, the wound partially was closed from the deepest parts only by multiples buried vertical mattress sutures by using Lasheen’s needle, and left the superficial wound parts to heal by second intention. The follow up period was ranged from 14 - 39 months (mean 27 months). Results: The mean hospital stay was 12 hours, mean operation time was 30 minutes and mean time to return to normal activity was 8 days (range 7 - 12 days). Nine cases show superficial wound infection and one case of recurrence. Conclusion: Excision and partially closure technique by using Lasheen’s needle for pilonidal diseases is minimal invasive and less morbidity, easy to learn and has favorable results regarding to return to normal activity, rate of recurrence and cosmetically acceptable.展开更多
<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span...<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Pilonidal disease is a chronic inflammatory disease of the sacrococcygeal region that mainly affects young people. Its incidence is 26 cases per 100,000 persons. Although many techniques have been described, there is no consensus on the treatment of pilonidal sinus disease (PSD). </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">This study included 30 patients with PSD who were treated between May 2014 and September 2017. All cases underwent excision and flap reconstruction. The operative time, postoperative complications, the length of hospital stay, painless sitting and walking time, patient satisfaction and recurrence were evaluated prospectively. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verda展开更多
Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgi...Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.展开更多
Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 ...Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.展开更多
Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease f...Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.展开更多
BACKGROUND Retrorectal hamartomas or tailgut cysts(TCs)are rare.In most cases,they are asymptomatic and benign;however,rarely,they undergo malignant transformation,mainly in the form of adenocarcinoma.CASE SUMMARY A 5...BACKGROUND Retrorectal hamartomas or tailgut cysts(TCs)are rare.In most cases,they are asymptomatic and benign;however,rarely,they undergo malignant transformation,mainly in the form of adenocarcinoma.CASE SUMMARY A 55-year-old woman presented to our hospital with lower back pain.On magnetic resonance imaging,a large pelvic mass was found,which was located on the right of the ischiorectal fossa,extending to the minor pelvis.The patient underwent extensive surgical resection of the lesion through the right buttock.Histological examination confirmed the diagnosis of a retrorectal mucinous adenocarcinoma originating from a TC.Surgical resection of the tumour was complete,and the patient recovered without complications.The pilonidal sinus was then excised.One year later,semi-annual positron emission tomographycomputed tomography and magnetic resonance imaging scans did not reveal any evidence of local recurrence or metastatic disease.CONCLUSION Preoperative recognition,histological diagnosis,and treatment of TCs pose significant challenges.In addition,the possibility of developing invasive mucinous adenocarcinoma,although rare,should be considered.展开更多
Aim: Pilonidal disease is generally located at sacrococcygeal region whereas it is rarely located near anus. The aim of this study is to discuss the results of crystallized phenol application that we performed for pat...Aim: Pilonidal disease is generally located at sacrococcygeal region whereas it is rarely located near anus. The aim of this study is to discuss the results of crystallized phenol application that we performed for patients with sinus pilonidalis located near anus with 95% success rate. Patients and Methods: Patients admitted between 2005 to 2011 with sinuses located in 2 cm range of anus or were primarily located up to 2 cm to the anal verge were enrolled in the study. Patients’ demographic features, Body Mass Index (BMI), family history, skin color, hair thickness, number of sinus openings, and the status of the sinus (acute vs. chronic) were recorded. Crystallized phenol was applied into the sinus. The pa tients were followed-up after recovery during the first 6 months and annually afterwards. Results: A total of 25 sinus pilonidalis cases located near anus were encountered. All patients were male;crystallized phenol application was per formed on all patients a total of 115 times. The mean number of applications was 5.6 (between 4 and 8 times). The mean recovery period was 74.5 days (range: 31 - 154) and the mean follow-up period was 36.16 months (range: 18 - 48). No surgical intervention was required. Conclusion: Sinus pilonidalis cases located in perianal region can be successfully treated with the crystallized phenol application which is a simple and inexpensive method, that can easily be performed in an outpatient setting.展开更多
美国结直肠外科医师协会(The American Society of Colon and Rectal Surgeons,ASCRS)于2019年2月公布了最新的藏毛窦诊治临床实践指南。指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对藏毛窦的一些争议进行了汇总和...美国结直肠外科医师协会(The American Society of Colon and Rectal Surgeons,ASCRS)于2019年2月公布了最新的藏毛窦诊治临床实践指南。指南是由国际知名结直肠外科专家组成的临床实践指南委员会修订,对藏毛窦的一些争议进行了汇总和分析。展开更多
文摘Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.
文摘Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the errors of the unevacuated rectum, non-dynamic
文摘AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients(84% male, mean age 24.2 ± 7.8). RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates(9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies(mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.
文摘AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.
文摘Background: Pilonidal disease is a common chronic disorder of the sacrococcygeal region;and its surgical management is still a matter of discussion. The ideal therapy would be a quick cure that allowed patients to return rapidly to normal activity, that is minimally invasive with no morbidity, a low risk of complication and easy to learn. Methods: Sixty seven patients with pilonidal disease were subjected to excision and partial closure procedure, from November 2006 to March 2010 at General Surgery Department, Zagazig University Hospital, Zagazig University, Egypt. The mean age was 27.5 years. Complete but close excision of all diseased tissues was achieved. Then, the wound partially was closed from the deepest parts only by multiples buried vertical mattress sutures by using Lasheen’s needle, and left the superficial wound parts to heal by second intention. The follow up period was ranged from 14 - 39 months (mean 27 months). Results: The mean hospital stay was 12 hours, mean operation time was 30 minutes and mean time to return to normal activity was 8 days (range 7 - 12 days). Nine cases show superficial wound infection and one case of recurrence. Conclusion: Excision and partially closure technique by using Lasheen’s needle for pilonidal diseases is minimal invasive and less morbidity, easy to learn and has favorable results regarding to return to normal activity, rate of recurrence and cosmetically acceptable.
文摘<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:Verdana;"> Pilonidal disease is a chronic inflammatory disease of the sacrococcygeal region that mainly affects young people. Its incidence is 26 cases per 100,000 persons. Although many techniques have been described, there is no consensus on the treatment of pilonidal sinus disease (PSD). </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"></span></strong><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">This study included 30 patients with PSD who were treated between May 2014 and September 2017. All cases underwent excision and flap reconstruction. The operative time, postoperative complications, the length of hospital stay, painless sitting and walking time, patient satisfaction and recurrence were evaluated prospectively. </span><span style="font-family:Verdana;"><strong></strong></span><strong><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;"></span></strong><strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verda
文摘Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.
文摘Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.
文摘Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.
文摘BACKGROUND Retrorectal hamartomas or tailgut cysts(TCs)are rare.In most cases,they are asymptomatic and benign;however,rarely,they undergo malignant transformation,mainly in the form of adenocarcinoma.CASE SUMMARY A 55-year-old woman presented to our hospital with lower back pain.On magnetic resonance imaging,a large pelvic mass was found,which was located on the right of the ischiorectal fossa,extending to the minor pelvis.The patient underwent extensive surgical resection of the lesion through the right buttock.Histological examination confirmed the diagnosis of a retrorectal mucinous adenocarcinoma originating from a TC.Surgical resection of the tumour was complete,and the patient recovered without complications.The pilonidal sinus was then excised.One year later,semi-annual positron emission tomographycomputed tomography and magnetic resonance imaging scans did not reveal any evidence of local recurrence or metastatic disease.CONCLUSION Preoperative recognition,histological diagnosis,and treatment of TCs pose significant challenges.In addition,the possibility of developing invasive mucinous adenocarcinoma,although rare,should be considered.
文摘Aim: Pilonidal disease is generally located at sacrococcygeal region whereas it is rarely located near anus. The aim of this study is to discuss the results of crystallized phenol application that we performed for patients with sinus pilonidalis located near anus with 95% success rate. Patients and Methods: Patients admitted between 2005 to 2011 with sinuses located in 2 cm range of anus or were primarily located up to 2 cm to the anal verge were enrolled in the study. Patients’ demographic features, Body Mass Index (BMI), family history, skin color, hair thickness, number of sinus openings, and the status of the sinus (acute vs. chronic) were recorded. Crystallized phenol was applied into the sinus. The pa tients were followed-up after recovery during the first 6 months and annually afterwards. Results: A total of 25 sinus pilonidalis cases located near anus were encountered. All patients were male;crystallized phenol application was per formed on all patients a total of 115 times. The mean number of applications was 5.6 (between 4 and 8 times). The mean recovery period was 74.5 days (range: 31 - 154) and the mean follow-up period was 36.16 months (range: 18 - 48). No surgical intervention was required. Conclusion: Sinus pilonidalis cases located in perianal region can be successfully treated with the crystallized phenol application which is a simple and inexpensive method, that can easily be performed in an outpatient setting.
