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Pilonidal Sinus

Living reference work entry
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Abstract

Pilonidal sinus disease is a relatively common condition that affects hirsute adolescents and young adults. The generally accepted pathophysiology is the burrowing of hairs into the base of the gluteal cleft. This can cause acute and chronic infections. Treatment options of the chronic wound are varied including excision and closure, excision while allowing the wound to heal by secondary intention or with a vacuum-assisted closure, or a variety of flap repairs. There is however no clear consensus as to which operative treatment is the ideal.

Keywords

Pilonidal sinus Children Operative treatment Endoscopic treatment Pilonidal cyst Karydakis Bascom Cleft lift 

References

  1. Afşarlar CE, Yılmaz E, Karaman A, Karaman I, Ozgüner IF, Erdoğan D, Cavuşoğlu YH, Maden HA. Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique. J Pediatr Surg. 2013;48(8):1744–9.CrossRefGoogle Scholar
  2. Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010;20(1):CD006213.Google Scholar
  3. Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, Shamsah A, Zarka ZA, Al-Hajj H, Al-Momen A. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg. 2005;205(3):439–44.CrossRefGoogle Scholar
  4. Arda IS, Güney LH, Sevmiş S, Hiçsönmez A. High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg. 2005;29(4):469–71.CrossRefGoogle Scholar
  5. Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O. Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol. 2014;18(1):29–37. EPub ahead of print.Google Scholar
  6. 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.CrossRefGoogle Scholar
  7. Banasiewicz T, Bobkiewicz A, Borejsza-Wysocki M. Portable VAC therapy improve the results of the treatment of the pilonidal sinus – randomized prospective study. Pol Przegl Chir. 2013;85(7):371–6.CrossRefGoogle Scholar
  8. Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg. 2002;137(10):1146–50.CrossRefGoogle Scholar
  9. Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg. 2007;193(5):606–9.CrossRefGoogle Scholar
  10. 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(4):491–8.CrossRefGoogle Scholar
  11. 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(3):318–27.CrossRefGoogle Scholar
  12. Cevik M, Dorterler ME, Abbasoglu L. Is conservative treatment an effective option for pilonidal sinus disease in children? Int Wound J. 2018;15(5):840–4.CrossRefGoogle Scholar
  13. Cubukçu A, Gönüllü NN, Paksoy M, Alponat A, Kuru M, Ozbay O. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Color Dis. 2000;15(3):173–5.CrossRefGoogle Scholar
  14. Fike FB, Mortellaro VE, Juang D, Ostlie DJ, St Peter SD. Experience with pilonidal disease in children. J Surg Res. 2011;170(1):165–8.CrossRefGoogle Scholar
  15. 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. 2014;14(2):143–51.CrossRefGoogle Scholar
  16. Humphries AE, Duncan JE. Evaluation and management of pilonidal disease. Surg Clin North Am. 2010;90(1):113–24.CrossRefGoogle Scholar
  17. Iesalnieks I, Deimel S, Zülke C, Schlitt HJ. Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease. J Dtsch Dermatol Ges. 2013;11(10):1001–5.PubMedGoogle Scholar
  18. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018;30(3):411–6.CrossRefGoogle Scholar
  19. Karaca T, Yoldaş O, Bilgin BÇ, Ozer S, Yoldaş S, Karaca NG. Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg. 2012;10(10):601–6.CrossRefGoogle Scholar
  20. Karydakis GE. New approach to the problem of pilonidal sinus. Lancet. 1973;2(7843):1414–5.CrossRefGoogle Scholar
  21. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992;62(5):385–9.CrossRefGoogle Scholar
  22. Khanna A, Rombeau JL. Pilonidal disease. Clin Colon Rectal Surg. 2011;24(1):46–53.CrossRefGoogle Scholar
  23. Lee SL, Tejirian T, Abbas MA. Current management of adolescent pilonidal disease. J Pediatr Surg. 2008;43(6):1124–7.CrossRefGoogle Scholar
  24. Limongelli P, Brusciano L, Di Stazio C, Del Genio G, Tolone S, Lucido FS, Amoroso V, D’Alessandro A, Docimo G, Docimo L. D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. Am J Surg. 2014;207(6):882–9. (Epub ahead of print).Google Scholar
  25. Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg. 2009;44(1):282–5.CrossRefGoogle Scholar
  26. Mann CV, Springall R. ‘D’ Excision for Sacrococcygeal Pilonidal Sinus Disease. J Roy Soc Med. 2018;80(5):292–295Google Scholar
  27. Morden P, Drongowski RA, Geiger JD, Hirschl RB, Teitelbaum DH. Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int. 2005;21(10):793–6.CrossRefGoogle Scholar
  28. Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg. 2010;200(1):9–14.CrossRefGoogle Scholar
  29. Nordon IM, Senapati A, Cripps NP. A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg. 2009;197(2):189–92.CrossRefGoogle Scholar
  30. Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg. 2010;36(1):88–91.CrossRefGoogle Scholar
  31. Petersen S, Aumann G, Kramer A, Doll D, Sailer M, Hellmich G. Short-term results of Karydakis flap for pilonidal sinus disease. Tech Coloproctol. 2007;11(3):235–40.CrossRefGoogle Scholar
  32. Petersen S, Wietelmann K, Evers T, Hüser N, Matevossian E, Doll D. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum. 2009;52(1):131–4.CrossRefGoogle Scholar
  33. Pini Prato A, Mazzola C, Mattioli G, et al. Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series. Pediatr Surg Int. 2018;34(6):687–92.CrossRefGoogle Scholar
  34. Saylam B, Balli DN, Düzgün AP, Ozer MV, Coşkun F. Which surgical procedure offers the best treatment for pilonidal disease? Langenbeck’s Arch Surg. 2011;396(5):651–8.CrossRefGoogle Scholar
  35. Sequeira JB, Coelho A, Marinho AS, et al. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg. 2018;53(10):2003–7.CrossRefGoogle Scholar
  36. Speter C, Zmora O, Nadler R. Minimal incision as a promising technique for resection of pilonidal sinus in children. J Pediatr Surg. 2017;52(9):1484–7.CrossRefGoogle Scholar
  37. Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, Colace L. Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg. 2008;196(1):28–33.CrossRefGoogle Scholar
  38. Yamout SZ, Caty MG, Lee YH, Lau ST, Escobar MA, Glick PL. Early experience with the use of rhomboid excision and Limberg flap in 16 adolescents with pilonidal disease. J Pediatr Surg. 2009;44(8):1586–90.CrossRefGoogle Scholar
  39. Zagory JA, Golden J, Holoyda K, et al. Excision and primary closure may be the better option in the surgical management of pilonidal disease in the pediatric population. Am Surg. 2016;82(10):964–7.PubMedGoogle Scholar

Authors and Affiliations

  1. 1.Children’s Mercy HospitalKansas CityUSA

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