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Nachbehandlung bei Sinus pilonidalis

Postoperative treatment of pilonidal sinus

  • Leitthema
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coloproctology Aims and scope

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.

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.

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Literatur

  1. Alptekin H, Yilmaz H et al (2013) Volume of the excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery). Surg Today 43(12):1365–1370

    Article  Google Scholar 

  2. Armstrong JH, Barcia PJ (1994) Pilonidal sinus disease. The conservative approach. Arch Surg 129(9):914–917 (discussion 917–9)

    Article  CAS  Google Scholar 

  3. Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137(10):1146–1150 (discussion 1151)

    Article  Google Scholar 

  4. Brook I (1989) Microbiology of infected pilonidal sinuses. J Clin Pathol 42(11):1140–1142

    Article  CAS  Google Scholar 

  5. Chaudhuri A, Bekdash BA (2002) Single-dose metronidazole versus 5‑day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective randomised controlled double-blinded study. Int J Colorectal Dis 17(5):355–358

    Article  CAS  Google Scholar 

  6. Colak T, Turkmenoglu O et al (2010) A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res 158(1):127–131

    Article  Google Scholar 

  7. Conroy FJ, Kandamany N et al (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61(9):1069–1072

    Article  CAS  Google Scholar 

  8. de Bruin AF, Gosselink MP et al (2012) Local application of gentamicin-containing collagen implant in the prophylaxis of surgical site infection following gastrointestinal surgery. Int J Surg 10(Suppl 1):S21–S27

    Article  Google Scholar 

  9. Demircan F, Akbulut S et al (2015) The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 8(2):2929–2933

    PubMed  PubMed Central  Google Scholar 

  10. Doll D, Bosche FD et al (2017) Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis Colon Rectum 60(9):979–986

    Article  Google Scholar 

  11. Fernandez R, Griffiths R (2012) Water for wound cleansing. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd003861.pub3

    Article  Google Scholar 

  12. Ganjoo A (2011) Laser hair reduction for pilonidal sinus—my experience. J Cutan Aesthet Surg 4(3):196

    PubMed  PubMed Central  Google Scholar 

  13. Hübner N‑O, Assadian O et al (2007) Anforderungen an die Wundreinigung mit Wasser. GMS Krankenhhyg Interdiszip 2(2):1–4

    Google Scholar 

  14. Iesalnieks I, Ommer A et al (2016) German national guideline on the management of pilonidal disease. Langenbecks Arch Surg 401(5):599–609

    Article  CAS  Google Scholar 

  15. Kanat BH, Kanat Z (2015) Letter to the editor in response to the article “The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial” by Demircan et al. Int J Clin Exp Med 2015; 8(2): 2929–2933. Int J Clin Exp Med 8(7):11642–11644

    PubMed  PubMed Central  Google Scholar 

  16. Kandamany N, Mahaffey PJ (2008) The importance of hair control and personal hygiene in preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61(8):986–987

    Article  CAS  Google Scholar 

  17. Kelati A, Lagrange S et al (2018) Laser hair removal after surgery vs. surgery alone for the treatment of pilonidal cysts: a retrospective case-control study. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.14991

    Article  PubMed  Google Scholar 

  18. Khan MA, Javed AA et al (2016) Control of hair growth using long-pulsed alexandrite laser is an efficient and cost effective therapy for patients suffering from recurrent pilonidal disease. Lasers Med Sci 31(5):857–862

    Article  Google Scholar 

  19. Kirkil C, Boyuk A et al (2011) The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease. Tech Coloproctol 15(4):425–429

    Article  CAS  Google Scholar 

  20. Kramer A, Müller G et al (2006) Indikationen und Wirkstoffauswahl zur antiseptischen Therapie sekundär heilender Wunden. GMS Krankenhhyg Interdiszip 1(1):1–11

    Google Scholar 

  21. KRINKO-Kommission (2005) Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI) Infektionsprävention in Heimen. Bundesgesundheitsblatt 48:1061–1080

    Article  Google Scholar 

  22. Kundes MF, Cetin K et al (2015) Does prophylactic antibiotic reduce surgical site infections after rhomboid excision and Limberg flap for pilonidal disease: a prospective randomized double blind study. Int J Colorectal Dis. https://doi.org/10.1007/s00384-015-2425-1

    Article  PubMed  Google Scholar 

  23. Lindemayr H (1984) Eczema in hairdressers. Derm Beruf Umwelt 32(1):5–13

    CAS  PubMed  Google Scholar 

  24. Lopez JJ, Cooper JN et al (2017) Safety and tolerability of laser hair depilation in pilonidal disease: a pilot study. Surg Infect (Larchmt) 18(8):890–893

    Article  Google Scholar 

  25. Lynch JB, Laing AJ et al (2004) Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases. Dis Colon Rectum 47(6):929–932

    Article  Google Scholar 

  26. Marsh A (2008) Caring for patients with pilonidal sinus disease. Nurs Stand 22(23):59

    Article  Google Scholar 

  27. Mavros MN, Mitsikostas PK et al (2013) Antimicrobials as an adjunct to pilonidal disease surgery: a systematic review of the literature. Eur J Clin Microbiol Infect Dis 32(7):851–858

    Article  CAS  Google Scholar 

  28. McGuinness JG, Winter DC et al (2003) Vacuum-assisted closure of a complex pilonidal sinus. Dis Colon Rectum 46(2):274–276

    Article  Google Scholar 

  29. Milone M, Di Minno MN et al (2013) The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis. Tech Coloproctol 17(6):625–630

    Article  CAS  Google Scholar 

  30. Milone M, Musella M et al (2011) 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 Colorectal Dis 26(12):1601–1607

    Article  Google Scholar 

  31. Nguyen AL, Pronk AA et al (2016) Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature. Tech Coloproctol 20(2):91–100

    Article  CAS  Google Scholar 

  32. Ommer A, Berg E et al (2014) S3-Leitlinie: Sinus pilonidalis. Coloproctology 36(4):272–322

    Article  Google Scholar 

  33. Oram Y, Kahraman F et al (2010) Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 36(1):88–91

    Article  Google Scholar 

  34. Pearson HE, Smiley DF (1968) Bacteroides in pilonidal sinuses. Am J Surg 115(3):336–338

    Article  CAS  Google Scholar 

  35. Petersen S, Wietelmann K et al (2009) Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 52(1):131–134

    Article  Google Scholar 

  36. Popeskou S, Christoforidis D et al (2011) Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J Surg 35(1):206–211

    Article  Google Scholar 

  37. Pronk AA, Eppink L et al (2018) The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol 22(1):7–14

    Article  CAS  Google Scholar 

  38. Schaffzin DM, Douglas JM et al (2004) Vacuum-assisted closure of complex perineal wounds. Dis Colon Rectum 47(10):1745–1748

    Article  Google Scholar 

  39. Segre D, Pozzo M et al (2015) The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 19(10):607–613

    Article  CAS  Google Scholar 

  40. Sharma D, Pratap A et al (2009) Malignant transformation of a pilonidal sinus. Surgery 145(2):243–244

    Article  Google Scholar 

  41. Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10(1):39–42

    Article  CAS  Google Scholar 

  42. Steele SR, Perry WB et al (2013) Practice parameters for the management of pilonidal disease. Dis Colon Rectum 56(9):1021–1027

    Article  Google Scholar 

  43. Stewart AM, Baker JD et al (2011) The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews. J Clin Nurs 20(21–22):3174–3182

    Article  Google Scholar 

  44. Swinton NW, Wise RE (1955) The significance of epilation as an adjunct in the treatment of pilonidal sinus disease. Am J Surg 90(5):775–779

    Article  CAS  Google Scholar 

  45. Tabori E, Weißgerber P et al (2017) Leitfaden und Empfehlungen für die Hygiene in der Koloproktologie – Teil 1. Coloproctology 39:111–120

    Article  Google Scholar 

  46. Tabori E, Weißgerber P et al (2018) Leitfaden und Empfehlungen für die Hygiene in der Koloproktologie – Teil 2. Coloproctology 39:205–220

    Article  Google Scholar 

  47. Timmons J (2007) Diagnosis, treatment and nursing management of patients with pilonidal sinus disease. Nurs Stand 21(52):48–56 (quiz 58)

    Article  Google Scholar 

  48. Viciano V, Castera JE et al (2000) Effect of hydrocolloid dressings on healing by second intention after excision of pilonidal sinus. Eur J Surg 166(3):229–232

    Article  CAS  Google Scholar 

  49. White TJ, Cronin A et al (2012) Don’t sit on chronic inflammation. ANZ J Surg 82(3):181–182

    Article  Google Scholar 

  50. Yamasaki R, Dekio S et al (1984) Allergic contact dermatitis to ammonium thioglycolate. Contact Dermatitis 11(4):255

    Article  CAS  Google Scholar 

  51. Kongressbericht Deutscher Koloproktologenkongress (2015) Medical tribune 50(19):14

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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.

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Authors and Affiliations

  1. End- und Dickdarm-Zentrum Essen, Rüttenscheider Straße 66, 45130, Essen, Deutschland

    A. Ommer

  2. St. Marienhospital Vechta, Vechta, Deutschland

    D. Doll

  3. Städtisches Klinikum Bogenhausen, München, Deutschland

    I. Iesalnieks

Authors
  1. A. Ommer
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  2. D. Doll
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  3. I. Iesalnieks
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Corresponding author

Correspondence to A. Ommer.

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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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Ommer, A., Doll, D. & Iesalnieks, I. Nachbehandlung bei Sinus pilonidalis. coloproctology 41, 179–184 (2019). https://doi.org/10.1007/s00053-019-0348-y

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