Clin Colon Rectal Surg 2011; 24(1): 046-053
DOI: 10.1055/s-0031-1272823
© Thieme Medical Publishers

Pilonidal Disease

Amit Khanna1 , John L. Rombeau1
  • 1Department of Surgery, Temple University Hospital, Temple University School of Medicine, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
23 February 2011 (online)

ABSTRACT

Pilonidal disease presents many therapeutic challenges to surgeons throughout the world. Its varied clinical presentations necessitate a wide range of treatments, thus underscoring the need to tailor the treatment to the patient and the severity of disease. Recent studies confirm the efficacy of smaller, more conservative operations for appropriate indications. When flap closures are performed, every attempt should be directed to placing sutures off (lateral) to the midline gluteal cleft. Meticulous attention to the details of immediate and long-term postoperative care is paramount.

REFERENCES

  • 1 Søndenaa K, Andersen E, Nesvik I, Søreide J A. Patient characteristics and symptoms in chronic pilonidal sinus disease.  Int J Colorectal Dis. 1995;  10 (1) 39-42
  • 2 Akinci O F, Bozer M, Uzunköy A, Düzgün S A, Coşkun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers.  Eur J Surg. 1999;  165 (4) 339-342
  • 3 Mayo O H. Observations on Injuries and Diseases of the Rectum. London: Burgess and Hill; 1833
  • 4 Hodges R M. Pilo-nidal sinus.  Boston Med Surg J. 1880;  103 485-486
  • 5 Buie L A. Jeep disease.  South Med J. 1944;  37 103-109
  • 6 Ballas K, Psarras K, Rafailidis S, Konstantinidis H, Sakadamis A. Interdigital pilonidal sinus in a hairdresser.  J Hand Surg [Br]. 2006;  31 (3) 290-291
  • 7 Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures.  Arch Surg. 2002;  137 (10) 1146-1150 discussion 1151
  • 8 Karydakis G E. New approach to the problem of pilonidal sinus.  Lancet. 1973;  2 (7843) 1414-1415
  • 9 Karydakis G E. Easy and successful treatment of pilonidal sinus after explanation of its causative process.  Aust N Z J Surg. 1992;  62 (5) 385-389
  • 10 Kitchen P. Pilonidal sinus - management in the primary care setting.  Aust Fam Physician. 2010;  39 (6) 372-375
  • 11 Akinci O F, Kurt M, Terzi A, Atak I, Subasi I E, Akbilgic O. Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure.  Dis Colon Rectum. 2009;  52 (5) 1000-1002
  • 12 da Silva J H. Pilonidal cyst: cause and treatment.  Dis Colon Rectum. 2000;  43 (8) 1146-1156
  • 13 Solla J A, Rothenberger D A. Chronic pilonidal disease. An assessment of 150 cases.  Dis Colon Rectum. 1990;  33 (9) 758-761
  • 14 Lee P J, Raniga S, Biyani D K, Watson AJM, Faragher I G, Frizelle F A. Sacrococcygeal pilonidal disease.  Colorectal Dis. 2008;  10 (7) 639-650 discussion 651-652
  • 15 Hull T L, Wu J. Pilonidal disease.  Surg Clin North Am. 2002;  82 (6) 1169-1185
  • 16 Armstrong J H, Barcia P J. Pilonidal sinus disease. The conservative approach.  Arch Surg. 1994;  129 (9) 914-917 discussion 917-919
  • 17 Odili J, Gault D. Laser depilation of the natal cleft—an aid to healing the pilonidal sinus.  Ann R Coll Surg Engl. 2002;  84 (1) 29-32
  • 18 Nelson J M, Billingham R P. Pilonidal disease and hidradenitis suppurativa. In:, Wolff B C, Fleshman J W, Beck D E, Pemberton J H, Wexner S D, eds. The ASCRS Textbook of Colon and Rectal Surgery. New York, NY: Springer; 2007: 228-239
  • 19 Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M. Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial.  Dis Colon Rectum. 2009;  52 (3) 496-502
  • 20 Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.  Dis Colon Rectum. 2008;  51 (11) 1656-1662 discussion 1662-1663
  • 21 Bascom J. Pilonidal disease: long-term results of follicle removal.  Dis Colon Rectum. 1983;  26 (12) 800-807
  • 22 Bascom J U. Repeat pilonidal operations.  Am J Surg. 1987;  154 (1) 118-122
  • 23 Senapati A, Cripps N P, Thompson M R. Bascom's operation in the day-surgical management of symptomatic pilonidal sinus.  Br J Surg. 2000;  87 (8) 1067-1070
  • 24 Al-Khamis A, McCallum I, King P M, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus.  Cochrane Database Syst Rev. 2010;  (1) CD006213
  • 25 Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease.  Am J Surg. 2007;  193 (5) 606-609 discussion 609
  • 26 Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision.  Dis Colon Rectum. 2008;  51 (12) 1816-1822
  • 27 Cihan A, Ucan B H, Comert M, Cesur A, Cakmak G K, Tascilar O. Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease.  Dis Colon Rectum. 2006;  49 (2) 244-249
  • 28 Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients.  Langenbecks Arch Surg. 2008;  393 (2) 185-189
  • 29 Nursal T Z, Ezer A, Calişkan K, Törer N, Belli S, Moray G. Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease.  Am J Surg. 2010;  199 (2) 170-177
  • 30 Fazeli M S, Adel M G, Lebaschi A H. 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. 2006;  49 (12) 1831-1836
  • 31 McCallum I, King P M, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus.  Cochrane Database Syst Rev. 2007;  (4) CD006213
  • 32 Søndenaa K, Nesvik I, Gullaksen F P et al.. The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture.  J Am Coll Surg. 1995;  180 (2) 157-160
  • 33 Humphries A E, Duncan J E. Evaluation and management of pilonidal disease.  Surg Clin North Am. 2010;  90 (1) 113-124
  • 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 (11) 1934-1938
  • 35 Aygen E, Arslan K, Dogru O, Basbug M, Camci C. Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease.  Dis Colon Rectum. 2010;  53 (6) 932-935
  • 36 Rudkin G H, Miller T A. Growth factors in surgery.  Plast Reconstr Surg. 1996;  97 (2) 469-476
  • 37 Leitner G C, Gruber R, Neumüller J et al.. Platelet content and growth factor release in platelet-rich plasma: a comparison of four different systems.  Vox Sang. 2006;  91 (2) 135-139
  • 38 Spyridakis M, Christodoulidis G, Chatzitheofilou C, Symeonidis D, Tepetes K. The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results.  World J Surg. 2009;  33 (8) 1764-1769
  • 39 McGuinness J G, Winter D C, O'Connell P R. Vacuum-assisted closure of a complex pilonidal sinus.  Dis Colon Rectum. 2003;  46 (2) 274-276
  • 40 Lynch J B, Laing A J, Regan P J. Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases.  Dis Colon Rectum. 2004;  47 (6) 929-932

John L RombeauM.D. 

Department of Surgery, Temple University Hospital, Temple University School of Medicine

3401 N. Broad St., 4 Parkinson/Zone C, Philadelphia, PA 19140

Email: john.rombeau@tuhs.temple.edu

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