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coloproctology

, Volume 41, Issue 3, pp 179–184 | Cite as

Nachbehandlung bei Sinus pilonidalis

  • A. OmmerEmail author
  • D. Doll
  • I. Iesalnieks
Leitthema
  • 111 Downloads

Zusammenfassung

Hintergrund

Der Sinus pilonidalis stellt ein Krankheitsbild dar, das sich regelmäßig in der proktologischen Sprechstunde findet, auch wenn es nicht unmittelbar der Analregion zuzuordnen ist. Eine Heilung ist nur operativ möglich.

Fragestellung

Neben den klassischen Exzisionstechniken mit offener Wundbehandlung, die analog den Wunden nach Analeingriffen zu behandeln sind, kommen hier auch aseptische, rekonstruierende Operationsverfahren zur Anwendung. Insbesondere bei den letzten Verfahren könnte eine Komplikationsvermeidung durch intraoperative Antibiotika-Anwendung und/oder die Anwendung von Drainagen erfolgen. Des Weiteren wird die Frage einer postoperativen Haarentfernung in der Literatur kontrovers diskutiert.

Ergebnisse und Schlussfolgerungen

Aktuelle Studien geben keinen Hinweis für den Vorteil einer perioperativen Antibiotika-Anwendung oder der Einlage einer Wunddrainage, sodass diese Entscheidung weiterhin der Erfahrung des Operateurs überlassen werden muss. Während die primär verschlossene Wunde wie jede andere aseptische Wunde zu behandeln ist, können offene Wunden analog zu den Analwunden mit Leitungswasser in Trinkwasserqualität ausgeduscht und unsteril verbunden werden. Auch wenn für eine Haarentfernung mittels Rasur oder Enthaarungscreme keine Evidenz besteht, sollte die dauerhafte Depilation mittels Laser bei komplexen Fällen erwogen werden.

Schlüsselwörter

Abszess Operative Therapie Enthaarung Antibiotikatherapie Wunddrainage 

Postoperative treatment of pilonidal sinus

Abstract

Background

Pilonidal sinus is a disease that is regularly treated in proctology departments even if not directly assigned to the anal area. Definitive healing is only possible by surgical procedures.

Objective

Besides classical excision techniques with open wound treatment, which are treated analogously to wounds after anal surgery, aseptic reconstructive surgical procedures are also used. Particularly in the latter procedures the intraoperative administration of antibiotics and/or the placement of a drainage could reduce complications. Furthermore, the indications for postoperative epilation for prevention of recurrences are controversially discussed in the literature.

Results and conclusion

Current studies do not provide any indications for an advantage of perioperative antibiotic administration or the use of wound drainage so that the decision must still be left to the personal experience of the surgeon. Whereas the primary closed wound has to be treated like every other aseptic wound, open wounds can be cleansed with drinking quality tap water and bandaged analogous to perianal wounds. While there is no evidence for an advantage of epilation by shaving or epilation creams, permanent epilation using a laser should be considered in complex cases.

Keywords

Abscess Surgery Depilation Antibiotics Drainage 

Notes

Danksagung

Vielen Dank an Herrn Dr. med. E. Tabori, BZH GmbH Deutsches Beratungszentrum für Hygiene, für die kritische Durchsicht des Kapitels über die postoperative Wundbehandlung, das an die geltenden Empfehlungen der KRINKO angelehnt wurde.

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Ommer, D. Doll und I. Iesalnieks geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.End- und Dickdarm-Zentrum EssenEssenDeutschland
  2. 2.St. Marienhospital VechtaVechtaDeutschland
  3. 3.Städtisches Klinikum BogenhausenMünchenDeutschland

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