Skip to main content
SpringerLink
Log in

Sacrococcygeal Pilonidal Sinus

  • Chapter
Prevention and Treatment of Complications in Proctological Surgery

  • 895 Accesses

Abstract

I was a 25-year-old trainee at the Department of Surgery of the Catholic University in Rome when I operated on my first patient with sacrococcygeal pilonidal sinus. The only such procedure I had seen until then had been carried out at our institution, i.e., excision of the infected sinus, leaving the wound open after suturing of the gluteal to the presacral fascia. This is the procedure I performed, packing the wound with a wad of gauze anchored with several plasters to the iliac crest. The patient was then returned to his room, where he remained, immobile in bed in a prone position with a heavy bag of sand compressing the surgical wound.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Readings

  • Akin M, Gokbayir H, Kilic K et al (2008) Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis 10:945–948

    PubMed  CAS  Google Scholar 

  • Al-Homoud SJ, Habib ZS, Abdul Jabbar AS, Isbister WH (2001) Management of sacrococcygeal pilonidal disease. Saudi Med J 22:762–764

    PubMed  CAS  Google Scholar 

  • Al-Jaberi TM (2001) Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg 167:133–135

    Article  PubMed  CAS  Google Scholar 

  • Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 20:CD006213

    Google Scholar 

  • Al-Khayat H, Al-Khayat H, Sadeq A et al (2007) Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 205:439–444

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Bascom JU (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572

    PubMed  CAS  Google Scholar 

  • Bascom JU (1983) Pilonidal disease: long-term results of follicle removal. Dis Colon Rectum 26:800–807

    Article  PubMed  CAS  Google Scholar 

  • Bascom JU (2008) Surgical treatment of pilonidal disease. BMJ 336:842–843

    Article  PubMed  Google Scholar 

  • Bascom JU, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150

    Article  PubMed  Google Scholar 

  • Bascom JU (1996) Procedures for Pilonidal Sinus. In: Pitt HA, Carter DC, Russell RCG (eds) Atlas of general surgery, 3rd edn. Chapman and Hall, Melbourne

    Google Scholar 

  • Bessa SS (2007) Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease. Dis Colon Rectum 50:1935–1940

    Article  PubMed  Google Scholar 

  • Bissett IP, Isbister WH (1987) The management of patients with pilonidal disease-a comparative study. Aust N Z J Surg 57:939–942

    Article  PubMed  CAS  Google Scholar 

  • Borges VF, Keating JT, Nasser IA, Cooley TP, Greenberg HL, Dezube BJ (2001) Clinicopathologic characterization of squamous-cell carcinoma arising from pilonidal disease in association with condylomata acuminatum in HIV-infected patients: report of two cases. Dis Colon Rectum 44:1873–1877

    Article  PubMed  CAS  Google Scholar 

  • Brasel KJ, Gottesman L, Vasilevsky CA; Members of the Evidence-Based Reviews in Surgery Group (2010) Meta-analysis comparing healing by primary closure and open healing after surgery for pilonidal sinus. J Am Coll Surg 211:431–434

    Article  PubMed  Google Scholar 

  • Brook I, Anderson KD, Controni G, Rodriguez WJ (1980) Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children. Am J Dis Child 134:679–680

    PubMed  CAS  Google Scholar 

  • Can MF, Sevinc MM, Hancerliogullari O et al (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200:318–327

    Article  PubMed  Google Scholar 

  • Can MF, Sevinc MM, Yilmaz M (2009) Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg Today 39:580–586

    Article  PubMed  Google Scholar 

  • Cavanagh CR, Schnug GE, Girvin GW, McGonigle DJ (1970) Definitive marsupialization of the acute pilonidal abscess. Am Surg 36:650–651

    PubMed  CAS  Google Scholar 

  • Cihan A, Mentes BB, Tatlicioglu E, Ozmen S, Leventoglu S, Ucan BH (2004) Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery. ANZ J Surg 74:238–242

    Article  PubMed  Google Scholar 

  • Collazo E, Luna M (1994) Obeid’s technique for treatment of pilonidal sinus. Dis Colon Rectum 37:731–732

    Article  PubMed  CAS  Google Scholar 

  • Courtney SP, Merlin MJ (1986) The use of fusidic acid gel in pilonidal abscess treatment: cure, recurrence and failure rates. Ann R Coll Surg Engl 68:170–171

    PubMed  CAS  Google Scholar 

  • Darwish AM, Hassanin A (2010) Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous Limberg flap. J Plast Reconstr Aesthet Surg 63:1176–1180

    Article  PubMed  Google Scholar 

  • Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S (2008) Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 23:359–364

    Article  PubMed  Google Scholar 

  • Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W (2007) Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum 50:1928–1934

    Article  PubMed  Google Scholar 

  • Ekçi B, Gökçe O (2009) A new flap technique to treat pilonidal sinus. Tech Coloproctol 13:205–209

    Article  PubMed  Google Scholar 

  • El-Tawil S, Carapeti E (2009) Use of a double rhomboid transposition flap in the treatment of extensive complex pilonidal sinus disease. Colorectal Dis 11:313–317

    Article  PubMed  CAS  Google Scholar 

  • Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoan M, Gündodu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 11:705–710

    Article  PubMed  CAS  Google Scholar 

  • Faux W, Pillai SC, Gold DM (2005) Limberg flap for pilonidal disease: the “no-protractor” approach, 3 steps to success. Tech Coloproctol 9:153–155

    Article  PubMed  CAS  Google Scholar 

  • Fazeli MS, Adel MG, Lebaschi AH (2006) Comparison of outcomes in Z-plasty and delayed healing by secondary intention of the wound after excision of the sacral pilonidal sinus: results of a randomized, clinical trial. Dis Colon Rectum 49:1831–1836

    Article  PubMed  Google Scholar 

  • Füzün M, Bakir H, Soylu M, Tansu T, Kaymak E, Hamanciolu O (1994) Which technique for treatment of pilonidal sinus—open or closed? Dis Colon Rectum 37:1148–1150

    Article  PubMed  Google Scholar 

  • Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20:415–422

    Article  PubMed  Google Scholar 

  • Gidwani AL, Murugan K, Nasir A, Brown R (2010) Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir J Med Sci 179:207–210

    Article  PubMed  CAS  Google Scholar 

  • Goodall P (1961) The aetiology and treatment of pilonidal sinus. A review of 163 patients. Br J Surg 49:212–218

    Article  PubMed  CAS  Google Scholar 

  • Greenberg R, Kashtan H, Skornik Y, Werbin N (2004) Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol 8:95–98

    Article  PubMed  CAS  Google Scholar 

  • Gupta PJ (2003) Radiofrequency incision and lay open technique of pilonidal sinus (clinical practice paper on modified technique). Kobe J Med Sci 49:75–82

    PubMed  Google Scholar 

  • Hanley PH (1980) Acute pilonidal abscess. Surg Gynecol Obstet 150:9–11

    PubMed  CAS  Google Scholar 

  • Hosseini SV, Bananzadeh AM, Rivaz M et al (2006) The comparison between drainage, delayed excision and primary closure with excision and secondary healing in management of pilonidal abscess. Int J Surg 4:228–231

    Article  PubMed  Google Scholar 

  • Jensen SL, Harling H (1988) Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 75:60–61

    Article  PubMed  CAS  Google Scholar 

  • Kayaalp C, Aydin C (2009) Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 13:189–193

    Article  PubMed  Google Scholar 

  • Keighley MA (2001) Anorectal Disorders. In: Baker RJ, Fischer JE (eds) Mastery of surgery, 4th edn. Lippincott Williams & Kilkins, Sydney

    Google Scholar 

  • Kement M, Oncel M, Kurt N, Kaptanoglu L (2006) Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. Dis Colon Rectum 49:1758–1762

    Article  PubMed  Google Scholar 

  • Kepenekci I, Demirkan A, Celasin H, Gecim IE (2010) Unroofing and curettage for the treatment of acute and chronic pilonidal disease. World J Surg 34:153–157

    Article  PubMed  Google Scholar 

  • Khan MN, Vidya R, Lee RE (2006) The limited role of microbiological culture and sensitivity in the management of superficial soft tissue abscesses. Scientific World Journal 6:1118–1123

    Article  PubMed  Google Scholar 

  • Khatri VP, Espinosa MH, Amin AK (1994) Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap. Dis Colon Rectum 37:1232–1235

    Article  PubMed  CAS  Google Scholar 

  • Kitchen P (2010) Pilonidal sinus — management in the primary care setting. Aust Fam Physician 39:372–375

    PubMed  Google Scholar 

  • Korownyk C, Allan GM (2007) Evidence-based approach to abscess management. Can Fam Physician 53:1680–1684

    PubMed  Google Scholar 

  • Krand O, Yalt T, Berber I et al (2009) Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon Rectum 52:1172–1177

    Article  PubMed  Google Scholar 

  • Lee SL, Tejirian T, Abbas MA (2008) Current management of adolescent pilonidal disease. J Pediatr Surg 43:1124–1127

    Article  PubMed  Google Scholar 

  • Licheri S, Pisano G, Erdas E, Farci S, Pomata M, Daniele GM (2004) Radical treatment of acute pilonidal abscess by marsupialization. G Chir 25:414–416

    PubMed  CAS  Google Scholar 

  • Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W (2011) Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 54:300–305

    Article  PubMed  Google Scholar 

  • Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C (2009) Laser depilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 44:282–285

    Article  PubMed  Google Scholar 

  • Lund JN, Leveson SH (2005) Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum 48:1094–1096

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Maghsoudi H, Nezami N, Ghamari AA (2011) Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54 epub ahead of print

    Google Scholar 

  • Mahdy T (2008) Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 51:1816–1822

    Article  PubMed  CAS  Google Scholar 

  • Marrie TJ, Aylward D, Kerr E, Haldane EV (1978) Bacteriology of pilonidal cyst abscesses. J Clin Pathol 31:909

    Article  PubMed  CAS  Google Scholar 

  • Matter I, Kunin J, Schein M, Eldar S (1995) Total excision versus non-resectional methods in the treatment of acute and chronic pilonidal disease. Br J Surg 82:752–753

    Article  PubMed  CAS  Google Scholar 

  • McCallum I, King PM, Bruce J (2007) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus s: systematic review and meta-analysis. BMJ 336:868–871

    Article  Google Scholar 

  • McLaren CA (1984) Partial closure and other techniques in pilonidal surgery: an assessment of 157 cases. Br J Surg 71:561–562

    Article  PubMed  CAS  Google Scholar 

  • Menteş BB, Leventoğlu S, Cihan A et al (2004) Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 34:419–423

    Article  PubMed  Google Scholar 

  • Menteş O, Bagci M, Bilgin T et al (2006) Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Dis Colon Rectum 49:104–108

    Article  PubMed  Google Scholar 

  • Monro RS (1967) A consideration of some factors in the causation of pilonidal sinus and its treatment by Z-plasty. Am J Proctol 18:215–225

    PubMed  CAS  Google Scholar 

  • Monro Rs, Mcdermott FT (1965) The elimination of causal factors in pilonidal sinus treated by Z-plasty. Br J Surg 52:177–181

    Article  PubMed  CAS  Google Scholar 

  • Muzi MG, Milito G, Nigro C, Cadeddu F, Farinon AM (2009) A modification of primary closure for the treatment of pilonidal disease in day-care setting. Colorectal Dis 11:84–88

    Article  PubMed  CAS  Google Scholar 

  • Notaras MJ (1970) A review of three popular methods of treatment of postanal (pilonidal) sinus disease. Br J Surg 57:886–890

    Article  PubMed  CAS  Google Scholar 

  • Payne CJ, Walker TW, Karcher AM, Kingsmore DB, Byrne DS (2008) Are routine microbiological investigations indicated in the management of non-perianal cutaneous abscesses? Surgeon 6:204–206

    Article  PubMed  CAS  Google Scholar 

  • Perruchoud C, Vuilleumier H, Givel JC (2002) Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995. Swiss Surg 8:255–258

    Article  PubMed  CAS  Google Scholar 

  • Petersen S, Aumann G, Kramer A, Doll D, Sailer M, Hellmich G (2007) Short-term results of Karydakis flap for pilonidal sinus disease. Tech Coloproctol 11:235–240

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Pope CE, Hudson HW (1946) Pilonidal sinus; a review of 130 consecutive cases in which patients were treated by closure; a new closed operative method and management. Arch Surg 52:690–700

    Article  PubMed  CAS  Google Scholar 

  • Rabie ME, Al Refeidi AA, Al Haizaee A, Hilal S, Al Ajmi H, Al Amri AA (2007) Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study. ANZ J Surg 77:177–180

    Article  PubMed  Google Scholar 

  • Rushfeldt C, Bernstein A, Norderval S, Revhaug A (2008) Introducing an asymmetric cleft lift technique as a uniform procedure for pilonidal sinus surgery. Scand J Surg 97:77–81

    PubMed  CAS  Google Scholar 

  • Sakr M, El-Hammadi H, Moussa M, Arafa S, Rasheed M (2003) The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. Int J Colorectal Dis 18:36–39

    Article  PubMed  Google Scholar 

  • Schoeller T, Wechselberger G, Otto A, Papp C (1997) Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery 121:258–263

    Article  PubMed  CAS  Google Scholar 

  • Seleem MI, Al-Hashemy AM (2005) Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience. Colorectal Dis 7:319–322

    Article  PubMed  CAS  Google Scholar 

  • Senapati A, Cripps NP, Flashman K, Thompson MR (2011) Cleft closure for the treatment of pilonidal sinus disease. Colorectal Dis 13:333–336

    Article  PubMed  CAS  Google Scholar 

  • Shpitz B, Kaufman Z, Kantarovsky A, Reina A, Dinbar A (1990) Definitive management of acute pilonidal abscess by loop diathermy excision. Dis Colon Rectum 33:441–442

    Article  PubMed  CAS  Google Scholar 

  • Søndenaa K, Andersen E, Nesvik I, Søreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

    Article  PubMed  Google Scholar 

  • Stephens FO, Stephens RB (1995) Pilonidal sinus: management objectives. Aust N Z J Surg 65:558–560

    Article  PubMed  CAS  Google Scholar 

  • Stewart A, Donoghue J, Mitten-Lewis S (2008) Pilonidal sinus: healing rates, pain and embarrassment levels. J Wound Care 17:468–470

    PubMed  CAS  Google Scholar 

  • Tezel E (2007) A new classification according to navicular area concept for sacrococcygeal pilonidal disease. Colorectal Dis 9:575–576

    Article  PubMed  CAS  Google Scholar 

  • Tezel E, Bostanci H, Anadol AZ, Kurukahvecioglu O (2009) Cleft lift procedure for sacrococcygeal pilonidal disease. Dis Colon Rectum 52:135–139

    Article  PubMed  Google Scholar 

  • Tinsley P (2002) The management of a pilonidal sinus and its follow-up care. Br JNurs 11:S31–S36

    Google Scholar 

  • Tocchi A, Mazzoni G, Bononi M et al (2008) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 196:28–33

    Article  PubMed  Google Scholar 

  • Topgül K, Ozdemir E, Kiliç K et al (2003) Long-term results of Limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 46:1545–1548

    Article  PubMed  Google Scholar 

  • Vahedian J, Nabavizadeh F, Nakhaee N, Vahedian M, Sadegh-pour A (2005) Comparison between drainage and curettage in the treatment of acute pilonidal abscess. Saudi Med J 26:553–555

    PubMed  Google Scholar 

  • Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15 (in press)

    Google Scholar 

  • Yalcin S, Ergul E (2010) A single-surgeon, single-institute experience of 59 sinotomies for sacrococcygeal pilonidal disease under local anesthesia. Bratisl Lek Listy 111:284–285

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Coloproctology Unit, Ars Medica Hospital and La Sapienza University, Rome, Italy

    Mario Pescatori MD, FRCS, EBSQ

Authors
  1. Mario Pescatori MD, FRCS, EBSQ
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

Pescatori, M. (2012). Sacrococcygeal Pilonidal Sinus. In: Prevention and Treatment of Complications in Proctological Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2077-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2077-1_5

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2076-4

  • Online ISBN: 978-88-470-2077-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation