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Background: A number of different treatment algorithms are recommended for the treatment of an acute pilonidal abscess and a chronic pilonidal sinus. While a 1-stage surgical procedure using excision or plastic reconstruction according to Limberg or Karydakis is suggested for chronic pilonidal sinus, a 2‑stage procedure is recommended for an acute pilonidal abscess. The aim of this study was to compare the results of the 1‑stage surgery with plastic reconstruction according to Limberg for acute pilonidal abscess and chronic pilonidal sinus in terms of recurrence, disorders of wound healing, inpatient length of stay and patient satisfaction. Methods: From 2009 to 2014 a total of 39 patients were included in this prospective observational study: 21 patients with acute pilonidal abscess and 18 patients with chronic pilonidal sinus. All patients were surgically treated with a 1‑stage procedure using the Limberg flap method. The groups were compared in terms of postoperative complication rates and frequency of recurrence. Results: Both groups were basically comparable with respect to demographic characteristics and risk factor profiles. Analysis of the postoperative results showed a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647). In the group with acute pilonidal abscesses there was no recurrence during the observational period, while in the chronic pilonidal sinus group there were 2 (11%) recurrences (p = 0.206). Conclusion: The results of the Limberg flap procedure regarding acute pilonidal abscesses were comparable to those of chronic pilonidal sinus. The results of this study show a trend to a lower risk of recurrence. The use of the Limberg flaps therefore also seems to be an adequate treatment option in an acute infection situation. [ABSTRACT FROM AUTHOR]

Background: The current German S3 guidelines recommend radical excision for pilonidal sinus disease. Furthermore, the Karydakis operation and the plastic surgery procedure according to Limberg are also recommended. Contrary to the S2 guidelines of 2008, these two plastic surgery procedures for coverage are recommended for the treatment of the first-time manifestation of this disease. Most studies on the classical Limberg plastic surgical procedure are comparative in nature and describe a simultaneous intervention from which patients with an abscess are excluded. Aim: The aim of this present study was to analyze the results of a sequential procedure including primary excision followed by a Limberg plastic surgery procedure for the treatment of acute abscesses and chronic pilonidal sinus disease. Material and methods: From July 2010 to June 2013 a total of 50 patients with pilonidal sinus disease were treated at the University Hospital Jena with an initial radical excision. In accordance with the Association of the Scientific Medical Societies in Germany (AWMF) guidelines which were valid during that time, patients were offered plastic surgery coverage for recurrence prophylaxis and in cases of recurrence a Limberg plastic surgery procedure was recommended. Results : Of the 50 patients 22 opted for a Limberg plastic surgery procedure during the interval. The mean follow-up after the Limberg plastic surgery procedure was 20.1 months (range 2-36 months). During the follow-up period, there were no recurrences (0 %) but four major complications (18.2 %) and one minor complication (4.5 %) were observed. Conclusion: This concept can be applied in cases of acute abscess formation and in chronic pilonidal sinus disease. The patient's decision with respect to a Limberg plastic surgery procedure for recurrence prophylaxis does not have to be made immediately. In addition, the Limberg plastic surgery procedure is performed in an infection-free stage. The second inpatient stay, second surgical procedure and prolonged time off work are a disadvantage. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive procedures have increasingly been used to treat pilonidal disease; however, the mid-term and long-term results have not been evaluated extensively yet. Patients and methods: All patients underwent 'pit picking' surgery. The surgery was performed under local anesthesia. The technique of 'pit picking' was: all midline pits were removed by excising a margin of skin of < 1 mm. An incision of 1 cm parallel to one side of the natal cleft opened the chronic abscess cavity. No specific postoperative wound care was given. Results: A total of 153 patients (126 males) underwent 'pit picking' surgery between June 2007 and November 2010. Follow-up information was available for 148 patients (97 %). Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second'pit picking' procedure. By multivariate analysis, smoking (hazard ratio [HR] 2.1) and occurrence of an abscess during the course of disease (HR 2.7) were statistically significantly associated with the disease recurrence after 'pit picking' surgery. Conclusion: Approximately three quarters of selected patients with pilonidal disease benefit from minimally invasive 'pit picking' surgery. [ABSTRACT FROM AUTHOR]

Background: The pit-picking method was first described by J. Bascom in 1980, however, this minimally invasive technique is used only by a minority of surgeons yet. Patients and methods: Surgery was performed under local anesthesia. All primary pits in the midline were removed by excising a border of skin of <1 mm and a 1 cm long incision was made parallel to one side of the cleft to open the chronic abscess cavity. No specific postoperative wound care was given. Results: Pit-picking surgery was carried out 157 times in a total of 153 patients (126 males) between June 2007 and November 2010. Follow-up information was available in 123 cases and 21 patients (17%) developed disease recurrence after a mean follow-up time of 7.1 months. By multivariate analysis, a body mass index (BMI) >25 kg/m (p=0.019) and duration of the disease of ≥6 months (p=0.017) were statistically significantly associated with disease recurrence after pit-picking surgery. The recurrence occurred more often in male than in female patients (20% versus 4.5%, p=0.12) Conclusion: Patients with pilonidal disease can be successfully treated by the pit-picking procedure in more than 80% of selected cases. Female patients and non-overweight male patients with short-term disease benefit most from this treatment method. [ABSTRACT FROM AUTHOR]