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Pilonidal Disease

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Fundamentals of Anorectal Surgery

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.

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References

  1. Anderson AW. Hair extracted from an ulcer. Boston M S J. 1847;36:74.

    Google Scholar 

  2. Hodges RM. Pilonidal sinus. Boston M S J. 1880;103:485–6.

    Article  Google Scholar 

  3. Warren JM. Abscess, containing hair, on the nates. Am J Med Sci. 1854;28:113.

    Article  Google Scholar 

  4. Buie LA. Jeep disease (pilonidal disease of mechanized warfare). South Med J. 1944;37:103–9.

    Article  Google Scholar 

  5. Close AS. Pilonidal cysts: an analysis of surgical failures. Ann Surg. 1955;141:523–6.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  Google Scholar 

  16. Sit M, Aktas G, Yilmaz EE. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg. 2013;79:1263–8.

    PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  22. Coskun A, Bulus H, Akinci OF, Ozgonul A. Etiological factors in umbilical pilonidal sinus. Indian J Surg. 2011;73:54–7.

    Article  Google Scholar 

  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. 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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  27. Armstrong JH, Barcia PJ. Pilonidal sinus disease. The conservative approach. Arch Surg. 1994;129:914–7.

    Article  CAS  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  33. Schneider IH, Thaler K, Kockerling F. Treatment of pilonidal sinus by phenol injections. Int J Color Dis. 1994;9:200–2.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  36. Stansby G, Greatorex R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg. 1989;76:729–30.

    Article  CAS  Google Scholar 

  37. Lund JN, Leveson SH. Fibrin glue treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum. 2005;48:1094–6.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. Olmez A, Kayaalp C, Aydin C. Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol. 2013;17:201–6.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Colorectal Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Eric K. Johnson

  2. Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Eric K. Johnson & Scott R. Steele

  3. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Aaron Womer

Authors
  1. Eric K. Johnson
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  2. Aaron Womer
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  3. Scott R. Steele
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Editor information

Editors and Affiliations

  1. Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    David E. Beck

  2. Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Scott R. Steele

  3. Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

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Johnson, E.K., Womer, A., Steele, S.R. (2019). Pilonidal Disease. In: Beck, D., Steele, S., Wexner, S. (eds) Fundamentals of Anorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-65966-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-65966-4_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65965-7

  • Online ISBN: 978-3-319-65966-4

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