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Introduction: Carcinoma secondary to pilonidal disease is very rare with fewer than 130 reported cases so far. It is presumed that underreporting and underpublishing contribute to the low reported incidence., Methods: A post was published on a closed Facebook group with about 30,000 Syrian doctors asking if anyone had ever seen a patient with pilonidal carcinoma before. The patients' data were collected retrospectively from the treating physicians., Results: Between 2010 and 2019, we identified eight patients with pilonidal carcinoma. All patients were males with a mean age of 55.5 years. The mean interval between diagnosis of pilonidal disease and diagnosis of carcinoma was 6.9 years. A growing ulcer on the background of a pilonidal sinus disease was the presenting complaint in 50% of cases. Three patients were lost from follow-up after the diagnosis due to referral. All other five patients underwent surgical resection and three of them received postoperative chemoradiation. Four patients were followed for six months or longer: two died of metastases, one survived after recurrence and re-excision, and one survived with no recurrence., Conclusion: This paper presents the largest cohort of pilonidal carcinoma so far and the first that describes the disease in the Syrian population. Due to underreporting, the real incidence of pilonidal carcinoma exceeds what is reported so far in the literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Safadi et al.)

Background: Several anesthetic techniques have been used for pilonidal sinus surgery such as general, spinal, and local anesthesia infiltration. However, the most effective technique remains controversial. The aim of this study was to assess the effectiveness of sacrococcygeal local anesthesia for complicated pilonidal cysts in terms of postoperative analgesic consumption., Methods: This was a retrospective cohort study conducted by collecting data from medical records for male patients who underwent pilonidal surgery using sacrococcygeal local anesthesia from 2008 to 2018. Patients' demographics, operative data, and postoperative outcomes such as pain, nausea, as well as analgesic consumption at 0 and 3 hours were analyzed. Pain scores at rest and upon pressure were recorded using the Visual Analogue Scale. The length of complicated pilonidal sinus was considered to be greater than or equal to 7 cm with multiple openings., Results: A total of 394 patients were included in the study, 173 patients (43.9%) had complicated cysts while 221 patients (56.1%) had uncomplicated cysts. The majority of patients were males (85.5% vs. 76.9% in the complicated and uncomplicated groups respectively). Patients' weight was significantly higher in the complicated cyst group (87.12 ± 17.07 vs. 82.43 ± 20.30 kg, P value = 0.02). Around 41% of the patients in the complicated group were obese (body mass index ≥ 30 kg/m^2) compared to 32.0% of the patients in the uncomplicated group. Mean arterial pressure and heart rate at baseline, intraoperatively and at the end of the operation were similar between the two groups. Pain scores at rest and upon pressure were low in both groups. Analgesic consumption was similar between the two groups. Eight patients (4.6%) in the complicated group required acetaminophen at 0 hour compared to 6 patients (2.7%) in the uncomplicated group. Three patients (1.7%) received ketoprofen at 0 hour in the complicated group and 3 patients (1.4%) in the other group. Three patients, 2 (1.2%) in the complicated group and 1 (0.5%) in the second group required tramadol hydrochloride., Conclusions: Sacrococcygeal local anesthetic technique for complex pilonidal sinus surgery provided intra-operative hemodynamic stability as well as low post-operative pain and analgesic consumption.

Background: Although pilonidal sinus disease is common, development of associated malignancy is very rare. After surgical treatment, most surgeons send the excision material for a histopathological examination. The aim of this study was to examine whether it is necessary to routinely send the pilonidal sinus surgical excision material for this examination., Method: The data of 3146 patients were retrospectively screened, and 2486 patients with available histopathological reports of the excision material were included in the study., Results: Of the 2486 patients included in the study, 2165 were men and 321 were women, and 94.7% of the patients were under the age of 50 years while 5.3% were 50 years or above. The rate of patients who underwent surgery due to recurrence was 1.2%. No malignancy was detected in any patient after the histopathological examination., Discussion: In this study, none of the pathology results was reported as malignant. This confirms that it is necessary to ask the question whether we should routinely send the surgical excision material for a histopathological examination.

Aim: We aimed to compare conventional epidural anesthesia with segmental epidural anesthesia which was achieved with small doses of local anesthetics in pilonidal sinus surgery with respect to epidural block characteristics, time to the first analgesic requirement, discharge time from post anesthetic care unit (PACU), time to the first urination and to achieve discharge criteria. Material and Method: After the approval of local ethics committee and informed consent was obtained from all participants, ASA I, 40 adult patients were enrolled into the study. Patients were randomly divided into 2 groups; in Group I (n=20) conventional epidural anesthesia technique with 75 mg bupivacaine (0.5 %), in Group II (n=20) low-dose epidural anesthesia technique with 30 mg bupivacaine (0.5 %) were performed. Drug injection time was considered as time 0 and sensory block was evaluated at 5 minute intervals with the pinprick test. Maximum sensory block level, complete loss of sensory block, motor block onset time, maximum motor block level, discharge time from PACU, time to the first miction and analgesic requirement were recorded. Statistical analyses were performed using Mann-Whitney U and Fishers's exact test. Results: Demographic data, patient and surgeon satisfaction were similar in two groups. Although sensory block onset time was shorter in Group I, sensory block offset time, discharge time from PACU, time to the first urination and analgesic requirement was shorter in Group II. Maximum sensory and motor block levels were lower in Group II. Sacral spread was limited in Group II but apparent in Group I. Cephalic spread was apparent in Group I. Conclusion: In conclusion, in the pilonidal sinus surgery closed with primary suturation low-dose epidural anesthesia induces adequate sensorial block and because motor block did not develop, discharge criteria were achieved in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds., Objectives: To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting., Search Methods: In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting., Selection Criteria: We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound., Data Collection and Analysis: We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome., Main Results: We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low., Authors' Conclusions: At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objective: To compare the results of commonly used treatments (Karydakis Flap method and crystallized phenol application) in the treatment of pilonidal sinus., Study Design: Comparative study., Place and Duration of Study: Adana Seyhan State Hospital, Adana City Hospital, and Hisar Intercontinental Hospital Pediatric Surgery Clinic, from January 2016 to December 2020., Methodology: Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study. The efficacy and complications of both treatments were compared., Results: Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method. Of the patients included in the study, 166 (52%) were male and 153 (48%) were female. The mean age was calculated as 15.5 (± 1.4). The mean hospital stay in the surgery group was 1.6 ± 0.4 days. The mean time to return to school was 2.8 ± 1.02 days in the phenol group and 12.3 ± 2.2 days in the Surgery group. Despite the third session of phenol application, recovery could not be achieved in 12 (5.7%) patients. Among those who had surgery, recurrence occurred in 7 (6.3%) patients and they had to be operated once more., Conclusion: Crystallized Phenol application can be applied in uncomplicated cases due to high success, low complication, rapid recovery, early return to daily activities., Key Words: Crystallized phenol, Surgical treatment, Pilonidal sinus disease.

Objective: This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience., Methods: One thousand and twenty-six patients who have primer pilonidal sinus were enrolled. The operation was applied outpatient clinic under local anesthesia. Recurrence rate, application number, healing time, and factors affecting them were analyzed., Results: The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks. The rate of recurrence was higher in patients with a long disease duration prior to initiating treatment ( p  = .04). The rate of recurrence was higher in patients with a higher number of opening and CPT application, those with longer application time, and those with a positive family history (respectively p  = .01, p  = .002, p  = .008)., Conclusions: Long-term outcomes are also very successful in the treatment of pilonidal disease with CPT. We believe that CPT should be the first choice in the treatment of pilonidal disease because it is inexpensive, can be applied as an outpatient treatment, is a noninvasive procedure, has results comparable to surgical procedures, and does not cause loss of work and strength.

Background: As a chronic condition, pilonidal disease affects a young population, and recovery after the surgical procedures performed to treat this condition require time off from work. Therefore, the search for an ideal treatment is still ongoing., Objective: The aim of this study was to compare early and late results of 2 minimally invasive treatment options used to treat pilonidal disease., Design: This study was designed as a parallel group randomized clinical trial., Settings: This study took place at an outpatient clinic in Turkey., Patients: Patients with pilonidal disease were evaluated for the study and were enrolled if they met the inclusion criteria and gave informed consent., Interventions: Patients in the platelet-rich plasma group were treated using curettage + platelet-rich plasma gel. Patients in the phenol group were treated by using curettage + crystallized phenol., Main Outcome Measures: The primary study end point was the time to achieve healing; the secondary outcome was recurrence rate., Results: In the platelet-rich plasma group, 96% of patients achieved healing after 1 application. In the phenol group, only 53% patients achieved healing after 1 application. The median healing time was shorter in the platelet-rich plasma group: 6 (4-14) vs 10 (5-42) days (p < 0.001). The mean difference in healing was 5.8 days (95% CI, 4.27-7.38). After a mean follow-up of 43.1 months, there was a 4% recurrence rate in the platelet-rich plasma group in comparison with a 12% recurrence rate in the phenol group (95% CI, 0.024-0.251)., Limitations: Despite the randomized prospective nature of the study, neither the patients nor the investigators were blinded., Conclusions: The curettage + platelet-rich plasma method can be safely applied with an improved healing time, low recurrence rate, and minimal time off work. See Video Abstract at http://links.lww.com/DCR/B722.Clinical Trial Registration: NCT03070028., Comparacin De Curetaje Ms Gel De Plasma Rico En Plaquetas Y La Aplicacin De Curetaje Ms Fenol En El Tratamiento De La Enfermedad Del Seno Pilonidal Ensayo Aleatorizado: ANTECEDENTES:Como condición crónica, la enfermedad pilonidal afecta a una población joven y los procedimientos quirúrgicos que se realizan para tratar esta condición requieren un tiempo de recuperación con baja laboral. Por lo tanto, la búsqueda del tratamiento ideal aún está en curso.OBJETIVO:El objetivo de este estudio es comparar los resultados tempranos y tardíos de dos opciones de tratamiento mínimamente invasivos utilizados para tratar la enfermedad pilonidal.DISEÑO:Este estudio está diseñado como un ensayo clínico aleatorizado de dos grupos paralelos.ENTORNO CLÍNICO:El estudio consta de dos grupos: curetaje + plasma rico en plaquetas y curetaje + fenol.PACIENTES:Los pacientes con enfermedad pilonidal fueron evaluados para el estudio y se inscribieron si cumplían con los criterios de inclusión y dieron su consentimiento informado.INTERVENCIONES:Los pacientes del grupo de plasma rico en plaquetas fueron tratados con curetaje + gel de plasma rico en plaquetas. En el grupo de fenol, los pacientes fueron tratados con curetaje + fenol cristalizado.PRINCIPALES MEDIDAS DE RESULTADO: El principal criterio de valoración del estudio fue el tiempo para lograr la curación; el resultado secundario fue la tasa de recurrencia.RESULTADOS:En el grupo de plasma rico en plaquetas, el 96% de los casos logró la curación después de una aplicación. En el grupo de fenol, solo el 53% de los casos lograron la curación después de una aplicación. La mediana del tiempo de curación fue más corta en el grupo de plasma rico en plaquetas; 6 (4-14) vs 10 (5-42) días (p < 0,001). La diferencia media en la curación fue de 5,8 días (IC del 95%: 4,27-7,38). Después de un seguimiento medio de 43,1 meses, hubo una tasa de recurrencia del 4% en el grupo de plasma rico en plaquetas en comparación con una tasa de recurrencia del 12% en el grupo de fenol (IC del 95%: 0.024-0.251).LIMITACIONES:A pesar de la naturaleza prospectiva aleatorizada del estudio, ni los pacientes ni los investigadores fueron cegados.CONCLUSIONES:El método de legrado + plasma rico en plaquetas se puede aplicar de forma segura con un mejor tiempo de curación, una tasa de recurrencia baja y un tiempo de baja laboral mínimo. Consulte Video Resumen en http://links.lww.com/DCR/B722 (Traducción-Dr. Yazmin Berrones-Medina).Este ensayo se registró para ensayos clínicos con ID: NCT03070028. El protocolo completo se puede encontrar en https://clinicaltrials.gov/ct2/show/NCT03070028., (Copyright © The ASCRS 2022.)

Background: Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment and treatment. This retrospective, non-randomized, observational study is the first Australian study of EPSiT and its largest long-term study to date., Methods: From January 2014 to November 2019, 137 patients with PSD underwent EPSiT. Seventy-two had undergone previous surgery for PSD. Specialized Karl Storz video equipment (fistuloscope) was used. The rigid fistuloscope allowed direct visualization of cavities and secondary tracts. Cavities and tracts were then curetted endoscopically to remove all granulation tissues and hair/follicles. Ablation was then carried out under direct vision along with removal of debris. Patients were then followed up for a mean 56.2 months., Results: 72.2% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks; 13.5% (n = 17) experienced healing followed by recurrence while 14.3% (n = 18) experienced non-healing. Of the recurrence/non-healing groups, 20/35 underwent repeat EPSiT with healing occurring in 18/20 patients at a median of 7 weeks. The balance of patients (n = 15) underwent other definitive procedures. The mean operating time was 34 min. There were no major complications and 85% of patients were discharged the same day. Eleven patients were lost to follow-up., Conclusion: EPSiT combines high efficacy of treatment for PSD along with relatively low rates of recurrence. The minimally invasive nature of the procedure means repeat procedures can be performed (where necessary) with low morbidity and a reasonable rate of success., (© 2022 Royal Australasian College of Surgeons.)

Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps. Objective To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital. Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018. Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence. Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures.

Background: The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an effect on the method and clinical results in the treatment of pilonidal sinus disease (PSD)., Methods: Between September 2019 and September 2020, patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey, were matched for age, pit location and number, body mass index (BMI), and sex. The primary endpoint was complete wound healing and the secondary endpoints were quality of life, cosmetic results, and cost., Results: Twenty-four LEPSIT patients were matched to 72 EPSIT patients. Eighty-one (84.4%) of the included patients were male, and the median age was 26 years (range 16-52 years). The median follow-up time was 9 months (range 3-15 months).Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups. In patients who underwent LEPSIT, the operative time (p = 0.00086) was significantly shorter, time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less. However, the time taken to return to daily activities and the percentage of wound complications were similar in both groups. The pain scores on postoperative -days 1 7, and 14 were significantly higher after EPSIT (p = 0.0083, p = 0.00054, and p = 0.0479, respectively). The postoperative analgesic requirement was significantly higher after EPSIT (p = 0.01492). The total hospital cost was significantly less in patients who underwent EPSIT (p < 0.00001). Significantly better cosmetic improvement was observed in LEPSIT procedure (p = 0.00694). First month quality of life (evaluated with the Short Form 36 Health Survey Questionnaire) was similar except for bodily pain (better after LEPSIT)., Conclusions: The success rates of LEPSIT and EPSIT are similar. LEPSIT results in better wound healing and patient comfort, and a shorter time to return to work., (© 2022. Springer Nature Switzerland AG.)

Background: Pilonidal sinus disease (PNSD) is considered as the challenging disease for surgeons since decades. The term pilo-nidal is derived from Latin meaning "nest of hair". It is a commonly occurring disease usually involved young male adults. It is considered as an acquired condition with unidentified aetiology and pathogenesis. The objective was to observe the results of Limberg's flap operation in patients with Pilonidal sinus disease.., Methods: We performed an observational study at Hamdard University Hospital from 1st January 2016 to 31st December 2019 on patients who came to the outpatient department for the treatment of pilonidal sinus diseases and underwent surgery (Limberg's flap) after consent. The patient's presentation varied from single sinus and dry, multiple sinuses and dry, single sinus with serous discharge, single sinus with pus discharge, and pilonidal abscess. Forty-six patients were selected after applying inclusion and exclusion criteria and operated by Limberg's flap technique., Results: Results were observed for postoperative seroma, hematoma, wound infection, persistent pain, and recurrence. Out of 46 patients, 30 (65.21%) were male and 16 (34.7%) were female. 28 patients (60.8%) were between 31-40 years of age and 12 patients (26.08%) were between 41-50 years of age. After performing Limberg's flap procedure, 35 patients (76%) had no complications at all. 2 patients (4.3%) had seroma formation. 4 patients had Hematoma formation (8.6%). Two patients (4.3%) patients developed superficial wound infection. 2 patients (4.3%) had persistent pain after 3 months of the procedure. One patient (2.1%) had recurrence during the follow-up period of 12 months., Conclusions: Limberg's flap operation is associated with low recurrence as well as a low rate of other complications such as seroma or hematoma formation, wound infection, and persistent pain irrespective of the presentation of the pilonidal sinus.

Introduction: Pilonidal sinus (PNS) disease affects the skin and subcutaneous tissue of the natal cleft of the buttocks. The treatment is variable and depends on presentation and the extent of disease. The mainstay of surgical management for PNS disease is to excise all sinus tracts and pits. There are numerous surgical techniques and none of them are considered optimal. Residual dead space is responsible for the majority of complications in PNS surgery., Objective: In this study, the authors describe a modified technique of the Karydakis procedure and investigate the effects of this new method., Materials and Methods: In this trial, 80 patients were included between January 2014 and January 2015. A new technique in PNS surgery, which can be described as a modified Karydakis procedure, was performed. In this technique, following total sinus excision, the excised defect was closed with the standard Karydakis method, but in order to reduce the dead space under the standard Karydakis flap, an advancement tissue flap with additional skin excision was performed. During a mean follow-up period of 20 months, some complications occurred, including wound dehiscence, the formation of a seroma, the formation of a hematoma, and infection. These complications were monitored., Results: There were 19 female and 61 male patients with a mean age of 24 years (range, 18-49 years). The mean volume of the sinus was 26 cc (range, 8-80 cc). A total of 10 patients (12.5%) experienced complications. All complications were managed successfully with follow-up treatment and appropriate wound care., Conclusions: The results of this pilot study suggest this technique may be considered as an alternative surgical method in PNS surgery, provided the results are corroborated by further randomized controlled trials.

Introduction: Pilonidal sinus (PS) is an infectious/inflammatory condition of the sacrococcygeal region, with frequent relapses. There is no clear consensus as to which management technique is best. The most widely used technique is en bloc resection (EBR), but less invasive methods (Gips procedure) are now being developed., Objective: To compare complications and progression of pediatric patients undergoing PS surgery in our institution using two different surgical techniques., Material and Methods: A retrospective study of patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020 was carried out. Demographic variables, complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected. Qualitative variables were expressed as absolute frequency and percentage, whereas quantitative variables were expressed as mean and standard deviation., Results: 60 patients underwent surgery. EBR was used in the first group, and the Gips procedure was used in the second group (76.67%, n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex (32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI (26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention (10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips procedure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%., Conclusion: The Gips procedure is a minimally invasive alternative to EBR. It avoids dehiscence, and time to healing is shorter. Therefore, it should be regarded as the first-line treatment in PS patients.

Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are available options for the treatment of this pathology, but the ideal technique is still debatable. Analyzing the literature we found out that more recently minimally invasive approaches have been described. In particular, the mechanism of an endoscopic approach relies on the use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to daily activities. Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery. However, very poor reports are available in literature about pediatric population.

Background: There are several surgical options for the management of pilonidal disease, including midline and off midline closure, but prospective studies are rare. The study hypothesis was that Karydakis flap surgery would result in shorter wound healing and fewer recurrences than excision of pilonidal sinus and suture in the midline., Methods: A randomized clinical trial was conducted in two hospitals in Sweden between 2006 and 2015 to compare excision and suture in the midline with Karydakis flap surgery. Adult patients with a chronic pilonidal sinus disease were randomized 1:1 at the outpatient clinic without blinding. Power calculation based on recurrence of 2 per cent for Karydakis flap and 10 per cent for excision and primary closure in the midline required 400 patients with 90 per cent statistical power at 5 per cent significance assuming 10 per cent loss during follow-up. Participants were followed up until complete wound healing; late follow-up after 6-13 years was performed by telephone by two blinded assessors. The two co-primary outcomes were time to complete wound healing and recurrence rate., Results: The study was terminated early at a planned interim analysis due slow recruitment and a significant difference in primary outcome. In total, 125 patients were randomized, of whom 116 were available for the present analysis. Median wound healing time was 49 days (95 per cent confidence interval (c.i.) 32 to 66) for excision with suture in the midline and 14 days (95 per cent c.i. 12 to 20) for Karydakis flap surgery (P < 0.001). There were five recurrences in each group, after a median follow-up of 11 years (P = 0.753)., Conclusion: Karydakis flap surgery for pilonidal sinus disease led to a shorter wound healing time than excision and suture in the midline but no difference in recurrence rates.Registration number: NCT00412659 (http://www.clinicaltrials.gov)., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)

Background: Minimally invasive surgical (MIS) techniques for pilonidal sinus disease (PNS) have gained popularity in recent years, due to faster recovery and lower complication rate compared with conventional methods. Our aim was to assess recurrence rate following MIS Trephine procedure for PNS and to identify possible risk factors for recurrence. Materials and Methods: A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years in a large tertiary medical center was established. Patient data were collected from medical charts and patient telephone survey to asses recurrence rate. Results: Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%). Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients). Univariate analysis of preoperative and clinical factors, including body mass index ( P  = .77), smoking status ( P  = .53), number of sinus tracts ( P  = .78), previous abscess drainage ( P  = .45), and diameter size of the trephine blade ( P  = .72) demonstrated no correlation to disease recurrence following surgery. Multivariate Cox regression analysis showed similar results, with only young age (<30 years) associated with disease recurrence ( P  = .01). Conclusion: Recurrence following minimally invasive trephine excision for PNS is fairly high, but repeat surgery in recurring patients has a high rate of a successful outcome.

Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Introduction: Pilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group., Patients and Methods: Adolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study., Results: A total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5)., Conclusion: In our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments., Level of Evidence: Level II treatment study., Competing Interests: Declaration of competing interest None, (Copyright © 2021 Elsevier Inc. All rights reserved.)

&lt;b&gt;Introduction:&lt;/b&gt; As a rule, the treatment of pilonidal cysts is based on a surgical approach. Surgical treatment depends on the form of the disease and surgeon&apos;s preferences regarding the method. The treatment process does not consider preoperative treatment that would affect the structural components of the skin involved in the pathological process. The results of surgical treatment remain unsatisfactory, leading to a significant number of recurrences and long-term healing of the postoperative wound. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Materials and methods:&lt;/b&gt; Morphological examination of the pieces of skin with altered sacrococcygeal tissues after radical surgical treatment of 46 patients with pilonidal cyst of the sacrococcygeal region was performed, and 46 patients with acne inversa of the intergluteal cleft, groin and scalp were selected. The sex distribution of patients with pilonidal cysts was as follows: 43 (91.3%) male patients, 3 (6.5%) female patients. Among 46 patients with acne inversa and dissecting cellulitis, the distribution was as follows: 32 (69.6%) male patients and 14 (30.4%) female patients. Patients with pilonidal cysts of the sacrococcygeal region underwent surgical treatment according to the developed method of economical median resection using sutures with internal fixation. &lt;/br&gt; &lt;/br&gt; &lt;b&gt; Results:&lt;/b&gt; Considering and comparing the morphological picture observed in the pathomorphological examination of histological specimens in patients with pilonidal cysts, acne inversa, dissecting cellulitis, the similarity of changes in most patients is noteworthy. "Acne inversa" was first described in 1839 by Velpeau, who originally called the disease "hydradenitis suppurativa", believing that inflammatory changes occur in the sweat glands [1-3]. In 1854, surgeon Verneuil described this disease, and later it was named after him. We observed chronic proliferative inflammation in different layers of the dermis and subcutaneous tissue (the main focus is in the subcutaneous tissue, but closely related to the dermis and epidermis). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Discussions:&lt;/b&gt; Pilonidal cyst of the sacrococcygeal region, especially without hair in the cavity of the cyst, can be considered as a type of acne inversa with appropriate location. We believe that the use of local and systemic retinoids, namely isotretinoin, in the treatment of patients with this disease other than surgery, together with other groups of drugs traditionally used in the treatment of pilonidal cysts, may be promising in the treatment of pilonidal cysts.

Background: The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease., Methods: All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses., Results: We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being "very satisfied" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014)., Conclusions: Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits., (© 2021. Springer Nature Switzerland AG.)

Background: An emerging and promising minimally invasive treatment for pilonidal disease (PD) is sinus laser-assisted closure (SiLaC®). Previous studies have shown encouraging results concerning safety, patient satisfaction, wound healing and acceptable recurrence rates. This study investigated outcomes for a large cohort of PD patients treated with SiLaC®., Methods: A multicentre cohort study with a prospective design and partial retrospective data collection for patients with PD treated with SiLaC® in three hospitals in the Netherlands (Albert Schweitzer Hospital, Flevoziekenhuis and Medical Centre Zuiderzee) from January 1st 2017 to March 1st 2020. The primary outcome was recurrence. Secondary outcomes were incidence of complete wound closure, time until wound closure, postoperative complications, ability to perform daily activities and reported patient satisfaction., Results: A total of 311 patients were included with a median follow-up of 10 months (range 1-52 months). The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively. Mean time until wound closure was 6 weeks (range 1-24 weeks). Seven patients (2%) were still unsuccessfully treated after three SiLaC® treatments and required additional and extensive surgery. Mean time to perform regular daily activities including working was 6 days (range 0-42 days) and the vast majority of patients (84%) did not require painkillers or only paracetamol. Twelve patients (4%) developed a postoperative wound infection. The mean satisfaction score was 9 (range 5-10)., Conclusions: SiLaC® is a promising minimally invasive treatment for PD with high patient satisfaction and an acceptable success rate. These results suggest that SiLaC® could be used as a safe and effective primary treatment for PD., (© 2021. Springer Nature Switzerland AG.)

Background: Pilonidal disease (PD) is a common condition of the sacrococcygeal region leading to inflammation and abscess formation. PD is a topic of renewed interest due to the lack of satisfactory management options. Minimally invasive techniques have recently been investigated, with promising results in adult and pediatric populations. Our technique, the "EPIC procedure," Endoscopic-assisted Pilonidal Irrigation and Cleaning, involves removal of hair under direct visualization using a small endoscope while flushing saline through the cavity via an angiocatheter. We aim to show that the EPIC procedure is a safe and effective operation for the treatment of pilonidal disease in the pediatric population., Materials and Methods: We performed a retrospective chart review including 20 consecutive patients. All had a primary sacrococcygeal pilonidal sinus; all underwent the EPIC procedure. Post-operative care instructions included daily bathing and weekly depilatory application. We evaluated gender, age, weight, disease severity, operative duration, recurrence of PD, and other complications., Results: In the 20 patients studied, 22 EPIC procedures were performed. The median follow-up duration was 27.95 (range 0.63-45.27) months. The mean operative duration was 28.8 (SD 10.2) min. There was a 15% recurrence rate (95% CI 0.00%, 30.65%)., Conclusions: The EPIC procedure is an endoscopic-assisted operation that simplifies previously published techniques in pursuit of reduced operative complexity, cost, and time, with comparable recurrence and complication rates. All three recurrences occurred in patients that did not follow instructions for post-operative depilatory care. Two of these patients underwent repeat EPIC procedure and had no further complications. The third was lost to follow-up. The EPIC procedure provides a simple, effective, and minimally invasive approach to the treatment of pilonidal disease., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of minimally invasive surgeries., Objectives: To compare the efficacy of wide excision operations and minimal trephine surgery in patients with primary pilonidal disease., Methods: In this retrospective study we examined surgical and inpatient records of 2039 patients who underwent surgery for primary pilonidal disease in five private hospitals between 2009 and 2012. Most procedures were of lay-open, primary midline closure, and minimal surgery types. Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons each performing one type of surgery, regardless of patient characteristics or disease severity., Results: With a mean follow-up of 7.2 years, 81.5%, 85%, and 88% of patients were disease-free after minimally invasive surgery, wide excision with primary closure, and lay-open surgery, respectively, with no statistically significant difference in recurrence rates. Minimal surgeries were usually performed under local anesthesia and involved lower pain levels, less need for analgesics, and shorter hospital stays than wide excision operations, which were normally performed under general anesthesia. The use of drainage, antibiotics, or methylene blue had no effect on recurrence of pilonidal disease., Conclusions: Minimally invasive surgeries have the advantage of reducing the extent of surgical injury and preserving patient's quality of life. They should be the treatment of choice for primary pilonidal disease.

Background: Pilonidal sinus is a chronic, inflammatory condition. Controversy exists regarding the best surgical management for pilonidal sinus, including the extent of excision and type of closure of the surgical wound., Objectives: To assess the short- and long-term outcomes and success rate of the trephine procedure for the treatment of pilonidal sinus., Methods: A retrospective observational cohort study was conducted at a single center. Patients who underwent trephine procedure between 2011 and 2015 were included. Data collection included medical records review and a telephone interview to establish long-term follow-up., Results: A total of 169 patients underwent the trephine technique for the repair of pilonidal sinus. Follow-up included 113 patients, median age 20 years. Initial postoperative period, 35.6% recalled no pain and 58.6% reported a mild to moderate pain. Postoperative complications included local infection (7.5%) and mild bleeding (15.1%). On early postoperative follow-up, 47.1% recalled no impairment in quality of life, and 25%, 21.2 %, and 6.7% had mild, moderate and sever disturbance respectively. The median time to return to work or school was 10 days. At a median follow-up of 29 months (IQR 19-40), recurrence rate was 45.1% (51/113), and 38 (33.9%) of the patients underwent another surgical procedure Overweight, smoking, and family history were associated with higher recurrence rate., Conclusions: The trephines technique has a significant long-term recurrence rate. Short-term advantages include low morbidity, enhanced recovery, and minimal to mild postoperative impairment to quality of life. The trephine procedure may be justified as a first treatment of pilonidal disease.

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., (© 2021. The Author(s).)

Introduction: Fistula Laser Closure (FiLAC) is a method that was originally applied in the treatment of perianal fistulas. Because of promising results, diode lasers were later on used to treat pilonidal sinus disease in a method called sinus Laser Closure (SiLaC). The aim of this study is to compare between SiLaC and Limberg flap in management of pilonidal disease., Methods: A prospective, nonrandomized comparative study. A short-term follow-up of 71 patients with pilonidal disease was analyzed (24 operated on using the SiLaC technique and 47 using the Limberg technique). With a primary outcome is healing rate and recurrence and a secondary outcome is other measures i.e. complications, hospital stay and postoperative pain., Results: The median operative time in the SiLaC group was 26.45 ± 5.41 min (20-35 min) and in the Limberg group 58.63 ± 7.42 min (50-75 min). In the SiLaC group, the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group., Conclusion: Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2021. Published by Elsevier Taiwan LLC.)

Objective: Pilonidal Sinus is a considerably problematic disease due to its recurrences which tend to become chronic and are exacerbated by abscess formation. There is little consensus regarding treatment - most probably due to limited understanding of its pathophysiology and progression. Despite this, it is accepted that accurate identification of pathogenesis and the clinical grade of PS are crucial for the determination of surgical approach., Method: This study presents the surgical treatment techniques we employed for Pilonidal Sinus disease with retrospective analysis of management and follow-up data of 5338 outpatient cases from 16 years of practice., Results: At the follow-up period of 16 years, recurrence was 12.5%. All recurrences were also treated with an individualized minimally invasive surgical approach, which was proportional to the clinical presentation., Conclusion: The importance of designing surgical technique according to the needs of the patient and the condition of the disease is clear. Our results with over 5000 patients indicate that effective treatment for PS is individualized minimally invasive surgery., Key Words: Classification, Grade, Minimally invasive surgery, Pilonidal sinus, Pilonidal cyst.

Background: Postoperative complications and recurrence are major diffficulties in the flap techniques for the treatment of pilonidal sinus (PS), however, the risk factors remain unclear. While magnetic resonance imaging (MRI) offers the highest soft tissue resolution, few studies have applied MRI to investigate the basic parameters of PS., Methods: A total of 100 patients receiving Limberg flap (LF) or Karydakis flap (KF) surgery at the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed, and the median follow-up period was 42 (range, 20-90) months. We performed a multivariate logistic analysis on the clinicopathological parameters and MRI data to identify risk factors for complications and recurrence., Results: The basic parameters of PS were obtained by MRI analysis. The multivariate analysis revealed a large longitudinal sinus diameter (OR = 1.020, 95%CI = 1.000-1.041) and sacrococcygeal dermal thickness (OR = 1.680, 95%CI = 1.142-2.472) to be independent risk factors for early complications. Meanwhile, a small sacrococcygeal fat thickness (OR = 0.923, 95%CI = 0.864-0.987) and a high BMI (OR = 1.291, 95%CI = 1.067-1.563) are independent risk factors for late complications and recurrence, respectively., Conclusion: We used MRI to measure the basic parameters of PS accurately, including size, volume, location and some key points of the surrounding tissues, and identified, besides the selection of surgical approach, some specific basic parameters of PS might be the risk factors for complications and recurrence after flap techniques., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. All authors have no financial relationships to disclosure. There is no funding to support publication., (Copyright © 2021. Published by Elsevier Taiwan LLC.)

Aim and Background: The primary purpose of pilonidal sinus treatment is to minimize complications, accelerate wound healing, and minimize recurrence. However, invasive and minimally invasive methods are being developed to reduce these problems. Early and late postoperative complications remain significant problems in pilonidal surgery. This study aimed to contribute to this issue in surgery by comparing the results of the Karydakis flap (KF) technique and those of the partial primary closure (PPC) technique, to which we applied suture modification., Methods: A total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups. Apply the partial primary closure in 46 patients and the Karydakis technique in 50., Results: In comparison to the Karydakis technique, the partial primary closure (PPC) group's hospitalization stay was shorter, although the difference was not significant. Healing time was also longer in uncomplicated cases (p = 0.200 and 0.064, respectively). Abscesses and hematomas were not observed with partial primary closure, but the total complication rate was similar to that of the Karydakis technique. Surgical site infections were often seen in the PPC group (21.7% vs. 10%). In contrast, healing time for complicated cases was found to be significantly shorter in the PPC technique (p < 0.05)., Conclusion: Postoperative abscess, hematoma, and seroma are the most common causes of total wound dehiscence, and delay in wound healing in off-midline techniques. We recommend the PPC technique with suture modification as an alternative to off-midline techniques in clean and chronically infected cases, other than cellulitis, abscess, and purulent discharge cases. However, we primarily recommend off-midline techniques in clean or asymptomatic cases., (Copyright © 2021. Published by Elsevier Taiwan LLC.)

Objective: The purpose of this study is to investigate whether there was a difference between the midline skin and the healthy skin in the lateral by means of total amount of collagen and Type I/III ratio which was the indicator of the collagen structure., Material and Methods: Fifty patients with pilonidal sinus disease were enrolled. Samples were prepared from the midline skin of the sinus where the holes were located and lateral skin of the resected material., Results: It was determined that the lateral line had significantly more collagen intensity and a higher collagen Type I/III ratio (p < 0.001)., Conclusions: One of the reasons why hair mostly pricks into the midline in the intergluteal sulcus in pilonidal sinus disease is the fact that the amount of total collagen and collagen Type I/III ratio of the midline are lower than those of the lateral tissue. Complications are more common in cases with low Type I/III ratio and low total collagen rates., (Copyright: © 2022 Permanyer.)

Background: The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations., Methods: Systemic literature review., Results: Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent., Conclusion: Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Pilonidal sinus (PS) disease is a chronic inflammatory disease of the sacrococcygeal region. Although various methods have been described for surgical treatment, there is no consensus on the best surgical technique. The aim of this study was to present the results of a new advancement flap technique named the "Keystone flap (KSF)" and compared with the Limberg flap (LF) technique in pilonidal sinus surgery. A retrospective review was made of 124 consecutive patients surgically treated for PS disease with KSF and LF procedures. Baseline characteristics, operation time, volume of excised specimen, duration of hospitalization, duration of drainage, duration of healing, time to return to work, local complications and recurrence were evaluated and compared between the two procedures. Operation time, healing time, and time to return to work were significantly shorter in the KSF group. Partial wound dehiscense and prolonged wound healing were more common in the LF group. An additional intervention in the operating room was required by 21.1% of the LF group and was a significantly lower rate in the KSF group at 7.5%. There was no significant difference between the groups in terms of recurrence. The KSF procedure seems promising for treating pilonidal sinus disease, with the advantages of shorter operation, healing, and return to work times. It also provides lower partial wound dehiscence and necrosis rates., (© 2021. Italian Society of Surgery (SIC).)

This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure., (© 2021. The Author(s).)

Different methods for managing pilonidal sinus have been described in the literature. Our purpose was to evaluate the influence of postoperative drainage in Limberg flaps.Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively. After patients were assigned randomly to the two groups, the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate.Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Early wound complication rate was 7.5 percent and recurrence rate was 2.5 percent for both groups. There was no significant difference between the groups in early wound complications (P>0.05). The length of hospital stay was significantly longer in the drainage group (P<0.001).We conclude that Limberg flaps with no drains in place will result in shorter hospital stays without deleteriously affecting the surgical results of wide excision and primary closure with well-vascularized tissue. [ABSTRACT FROM AUTHOR]

Aim: There is no agreed definitive surgical treatment for pilonidal sinus disease (PSD) with several techniques in use with varying success. Negative pressure wound therapy (NPWT) is used to accelerate wound healing but literature in the context of PSD remains sparse. The aim of this study was to evaluate outcomes in patients with PSD treated by a standardised technique of complete surgical excision followed by the application of NPWT., Methods: A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed over a five year period. The primary endpoints were PSD recurrence and failed wound healing., Results: Sixty-one patients underwent treatment during the study period. There was 100% compliance with NPWT. All patients' wounds healed successfully, with the median time to healing being 28 days. One patient (1.6%) developed recurrent PSD and required further surgery. Two patients (3.3%) developed postoperative wound infections. Five patients, who had been managed previously by other operative approaches and subsequently developed recurrence, were successfully managed by this technique. Most patients (52.4%) were managed as a day case procedure., Conclusions: Surgery for PSD should have low recurrence rates, prompt wound healing, minimal complications, short inpatient lengths of stay and be tolerated by the patient. Our results demonstrate that our technique meets these criteria. To our knowledge, this study contains the largest number of patients with PSD managed by excision and NPWT in the literature., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)

Background: Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. The traditional surgical approach includes wide excision of the involved area and carries a high rate of postoperative morbidity. A minimally invasive surgical approach using trephines was described by Gips in 2008 and has since been widely adopted by many surgeons. The aim of this study was to explore outcomes of the trephination procedure for pediatric and adolescent patients by evaluating postoperative wound healing and disease recurrence., Materials and Methods: A retrospective cohort study for patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease from November 1, 2019-November 1, 2020 was performed. Patient demographics, presenting characteristics, and previous treatment history were identified. Outcome measures included healing time, recurrent disease, and need for reoperation., Results: A total of 19 patients underwent the trephination procedure at a mean age of 16.4 years of age. An average of 3.8 pits were excised and there were no reported intraoperative complications. Following trephination, 26.3% of patients were healed at 30-day's, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery., Conclusion: Early results for trephination at our institution show a high rate of healing complications and frequent reoperation. Future research is needed to establish the role of the trephination procedure in the context of defining the best practices for treating this challenging disease., (Copyright © 2021. Published by Elsevier Inc.)