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Background: Pilonidal sinus (PNS) is a common disease which can lead to complications including infection and abscess formation. Different surgical approaches have been suggested, based on primary or secondary wound closure intention healing or endoscopic treatment (EPSiT). The aim of this study is to verify the superior outcomes of EPSiT, especially in comparison with the traditional open approach, and discuss the operators’ learning curve. Methods: A retrospective study was conducted identifying all the patients who underwent surgical treatment for PNS with EPSiT technique between 2019 and 2022 and with open technique between 2002 and 2022. We divided patients in two groups: open procedure (group 1) and EPSiT (group 2). We considered a p value < 0.05 as statistically significant. Results: The mean operative time was 58.6 ± 23.7 min for group 1 and 42.8 ± 17.4 min for group 2 (p < 0.01). The mean hospital stay was 2.6 ± 1.7 days for group 1 patients and of 0.8 ± 0.4 days for group 2 (p < 0.01). Complete healing was obtained in 18.7 ± 5.6 days for group 1 and 38.3 ± 23.5 days for group 2 (p < 0.01). Recurrences were of 23.4% for group 1 and 5.4% for group 2 (p = 0.03). Conclusions: EPSiT is a minimally invasive and effective approach for the treatment of pilonidal cyst that can be safely performed in pediatric patients with promising results concerning aesthetic outcome and pain control, and with a rapid and less complicated recovery compared to traditional open procedures.

This article discusses the treatment options for pilonidal sinus, a condition that affects the area near the buttocks. The most effective treatment method is still uncertain, but minimally invasive approaches are becoming more popular. The article focuses on a specific technique called endoscopic pilonidal sinus treatment, which involves using a fistuloscope. The authors provide a video tutorial with tips and tricks for performing this procedure, aiming to assist surgeons who are interested in using this technique. Despite positive outcomes reported in a meta-analysis, the endoscopic approach is still not widely used as a primary treatment method. The authors declare no conflicts of interest, and the data supporting their findings are available upon request. [Extracted from the article]

Objective: To compare mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol versus wide excision with open healing. Study Design: Randomized Controlled Trial. Setting: Department of Surgical, Allied Hospital Faisalabad. Period: 13-10-2018 to 12-04-2019. Material & Methods: A total of 60 patients were operated in our unit during the study period and were allocated into two groups randomly: Group A and Group B. The patients in Group A underwent treatment using crystallized phenol. Patients in Group B underwent wide local excision of the pilonidal sinus tract. All patients were given single dose of broad-spectrum antibiotic at time of procedure. Analgesia in post-operative period was maintained by using Diclofenac Sodium (Inj Artifen 75mg/3ml IM) as requested by the patient as long as the safe dose is not exceeded. First assessment of all patients was done at 24 hours after surgery. The analgesic requirement and visual analog scale score were documented for patients of both groups at this time. Follow up visit for patients in both groups was scheduled at 3 weeks after treatment. All the data was collected with the help of a specially designed Performa. Results: Mean pain score in Group-A was calculated as 1.36+0.55 and in Group-B it was 3.23+0.82, p value was 0.0001, comparison of wound healing in both groups shows that wound healing in Group-A was in 80%(n=24) and in Group-B, it was 30%(n=9), p value was 0.0001. Conclusion: We concluded that mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol is significantly lower when compared with wide excision with open healing. [ABSTRACT FROM AUTHOR]

Introduction: 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'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. Materials and methods: 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. Results: 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). Discussions: 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. [ABSTRACT FROM AUTHOR]

Background Pilonidal sinus is a common disease with high recurrence rate mostly due to residual unexcised side branches. As a result, methylene blue is injected in the sinus at the time of surgical excision. Patients and methods A total of 40 patients were recruited for the proposed techniques of complete layopen of all branches before excision and methylene blue dye injected at the start of the operation. The excised specimens were examined for the accuracy of both techniques to delineate all sinus tracts. Results Unstained side branches could be excised when using the preliminary lay-open technique. Conclusion Lay-open technique is feasible with better postoperative outcome when compared with the current methylene blue injection technique in cases of pilonidal disease. [ABSTRACT FROM AUTHOR]

Introduction: The preauricular sinus is a congenital abnormality which was initially identified by Van Heusinger in 1864. Preauricular sinus development is strongly related to the development of auricle in the sixth week of pregnancy. Preauricular sinus can be inherited or are sporadic. Most cases are sporadic and over half of all cases are unilateral. Bilateral cases are more frequent in inherited cases. Case Report: A 10 year old boy was brought with complaints of discharge from left pre auricular region on and off since birth. History of frequent episodes of discharge from left pre auricular region about 2-3 episodes per year. Local examination showed preauricular sinus tract at the root of helix on both sides. There was no discharge,no warmth, no tenderness. The child underwent necessary investigations and pre aneasthetic fitness was obtained. Pre auricular sinus tract excision on left side under general anasthesia was done. Multiple sinus tracts were excised and sent for histopathological examination which showed evidence of pilonidal sinus. There was presence of sinus tract line by epidermis, lumen filled with keratin and hair shafts. The child was brought for follow up on postoperative day 10, the sutured site was found to be healthy. Suture removal was done and the wound was healing well. The child is on regular follow up and has shown no signs of any recurrence. Discussion: The only definite treatment of recurrent infective sinuses is complete excision of the sinus tract. In our case, supra aural elliptical incision was placed and all visible sinus tracts were cleared and sent for histopathological analysis. When these sinuses get infected, most frequent cause being with gram-positive bacteria, the exudates should be sent for culture, and the appropriate antibiotics should be administered. The temporalis fascia, the cartilage of the helix, and the auditory canal are identified using the supra-auricular approach. An en bloc excision of the sinus is then carried out. Pilonidal sinus is a difficult condition that causes suffering and embarrassment to its victims. Despite it being rare and atypical, pilonidal sinus could also occur in the auricular region. Although pilonidal sinus has been reported in a number of uncommon areas of the body besides the sacrococcygeal region, this is the second case of pilonidal sinus that we are aware of in the preauricular region that is reported in literature. Conclusion: Thus we present a very rare case of pilonidal sinus in pre auricular region. Only two cases have been reported till date in literature and our case is the second one to be reported in the pre auricular region. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The lack of HS phenotype information is particularly relevant, as PSD is thought to be more common in follicular phenotypes of HS.[8] The use of International Classification of Disease codes in diagnosis of HS and PSD has limitations, including lack of information on how each diagnosis of PSD was made (clinically, histologically and/or radiographically). However, HS diagnosis is often delayed, and exclusion of these cases may result in exclusion of undiagnosed HS cases. The occurrence of pilonidal sinus disease in patients with HS was higher than in control subjects in all five included studies (see Table 1). [Extracted from the article]

Background: A pilonidal sinus is a common disease that usually occurs in the natal cleft in the sacrococcygeal region. Many conservative and surgical treatment methods are available. Malignancy is rarely detected; therefore, a routine histopathological examination is controversial. This study aimed to evaluate the pathology results of patients who underwent sacrococcygeal pilonidal sinus excision in our clinic. Methods: The records of patients who underwent pilonidal sinus excision at Istanbul Sultanbeyli State Hospital between January 2016 and October 2021 were reviewed retrospectively. The following parameters were evaluated: age, gender, location of disease, and histopathological examination outcome. Results: During the study period, 2,091 patients underwent surgery for pilonidal sinus disease at our general surgery clinic. The data of 2,068 patients were analyzed after excluding 23 patients who underwent excision for disease outside the sacrococcygeal region or had missing data. The age of the patients ranged from 13 to 72, with a female-to-male ratio of 535:1533. The mean age was 24.7±8.2 years. Pilonidal sinus specimen pathologies excised from the sacrococcygeal region were examined, and no malignancies were detected. Conclusion: Routine histopathological examination of pilonidal sinus specimens may be unnecessary if there are no risk factors such as atypical presentation and appearance, relapse, long-term disease, and advanced age. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinuses have many different methods of management to clinicians in the world. Its diverse clinical appearances requires differing types of intervention, with an optimal technique to manage patient severity and risk of recurrence. Aim: To attain ideal healing and prevent recurrence after overlapped fatty flap as new technique in pilonidal sinus disease with rhomboid flap. Patients and methods: all prospective patients admitted to this study were operated in Zagazig University Hospitals, surgical department between February 2020 and July 2022. In total, 50 patients had recurrent pilonidal sinus. We had two groups who underwent either overlapping flap (group A: 25 patients) or rhomboid flap (group B: 25 patients). Operation duration, degree of postoperative pain, hospital time duration, postoperative complications, and recurrence were all evaluated. Results: Equal duration of operations (60min.) In both groups. According to pain perception was reduced in group A (p=0.003). The recurrence rate was also lower in patients who underwent bilateral overlapped flap (p=0.005). Conclusion: wellbeing of overlapped fatty flap than rhomboid flab in recurrent pilonidal sinus. [ABSTRACT FROM AUTHOR]

Objective: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. Method: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. Results: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. Conclusion: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. Declaration of interest: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience. 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. 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). 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

According to the Tezel classification, the surgical method to be applied for type 4 and type 5 sacrococcygeal pilonidal disease (SPD) patients is controversial. Our aim is to discuss the success of the Bascom Cleft Lift (BCL) technique in treating these patients. In the present study, patients who were operated on for primary or recurrent pilonidal sinus disease by the same surgeon (IAT) in a tertiary medical faculty hospital between January 2018 and January 2020 were retrospectively analyzed. Complication and recurrence rates after BCL were compared with the available literature. There were 10 patients who underwent BCL for SPD Tezel type 4 and type 5. The average age of the patients was 21 (16-29) years and 9 (90%) of them were male. The mean follow-up time was 22 (11-26) months. The mean operation time was 42 (35-58) minutes. The duration of hospitalization was 2.4 (1-5) days. Although the first patients stayed in the hospital for a long time, the last three patients stayed for a day each. Seroma developed in 2 (20%) patients, superficial infection in 1 (10%) and recurrence in 1 (10%) patient. Recurrence developed only in the patient who was operated in the eigth row. No patient was reoperated. BCL is a successful technique for treating Tezel type 4 and type 5 SPD patients. [ABSTRACT FROM AUTHOR]

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. Materials 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%. Conclusions. 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. [ABSTRACT FROM AUTHOR]

Background: Sacrococcygeal pilonidal sinus disease is one of the most common annoying conditions that affecting commonly sacrococcygeal area. The best management of that disease is surgical treatment. Although many surgical methods used for treatment, recurrence rate is still the main challenge for all techniques. Karydakis procedure is one of the most commonly used methods for management of pilonidal sinus. Objective: In this study we tried to compare usual Karydakis procedure and tie over with pressing interrupted sutures as management for pilonidal sinus as regard rate of recurrence, wound complication and hospital stay and off-work time. Patients and methods: This is a prospective study done over 75 patients of sacrococcygeal pilonidal sinus who were divided in two groups (group A) included 35 patients managed by Karydakis procedure and (group B) included 40 patients managed by tie over with pressing interrupted sutures, between June 2017 till May 2019. Results: In group B all patients were discharged on the same day of surgery but in group A the mean hospital stay was of 3.9 ± 2.4 days. Three patients in group A developed seroma compared with one patient in group B. In group A, 11.4% of patients developed wound infection compared with 2.5% in group B. Three patients in group A had recurrence but No recurrences were noted in group B, although our study was limited as the duration of follow-up was short to accurately weigh recurrence rate. Conclusion: Tie over with pressing interrupted sutures is safe than usual Karydakis procedure with less hospital stay and less recurrence rates. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Pilonidal sinus disease affects many individuals in the UK and is associated with chronicity, pain and recurrence. It has a negative impact on the individual's quality of life and daily functioning and places a significant burden on the UK's healthcare service. Traditionally, treatment has involved excision and healing by primary or secondary intention; however, recent advances in surgical techniques have led to the development of endoscopic and video assisted treatments. Aim This paper evaluates the current research surrounding the endoscopic treatment of pilonidal sinus disease, with particular reference to patient benefits and harm. Methods A Medline search of endoscopic/video-assisted and pilonidal sinus disease in adults was undertaken. There was minimal level 1 evidence, due to the recent nature of the treatment's development, therefore levels 1-3 were reviewed. Findings Patients generally experience less pain and a quicker return to normal functioning following endoscopic treatment; however, this approach does not appear to improve recurrence rates and may only be replicable in uncomplicated pilonidal disease. Implications for clinical practice Endoscopic treatments appear to be an interesting new technique for the treatment of simple pilonidal disease; however, further work is required to identify a technique that also addresses recurrence rates. [ABSTRACT FROM AUTHOR]

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) [ABSTRACT FROM AUTHOR]

Introduction: A pilonidal sinus (PS) is a disease that arises from chronic irritation and secondary inflammation of hair follicles located in the sacrococcygeal and natal region. The purpose of this study was to determine the results of patients who underwent Limberg flap with the diagnosis of PS and the effectiveness of Limberg flap. Methods: The files of patients who were operated in our clinic between January 2015 and October 2019 with the diagnosis of PS were examined retrospectively. In addition to the demographical features of patients who have applied Limberg flap, type of the disease, the duration of the surgery, the hospitalization duration, the existence of complications after the surgery, and recurrence of the disease were analyzed. Results: Of 212 patients included in the study, 158 (74.5%) were male and 54 (25.4%) were female. The average age of the patients was 26.3 (18-44). 8 (3.73%) of the patients had Type-1, 48 (22.6%) had Type-3, 101 (47.6%) had Type-4, and 29 (13.6%) had Type-5 diseases. Patients who had Type-5 disease were found to recur after different surgical techniques. Due to the Type-2 disease, 26 (12.2%) patients underwent abscess drainage and Limberg flap approximately 3 weeks later. The average surgery period was 42.5 (32-78) min. Wound infection has been seen in 12 (5.6%) patients and wound dehiscence has been seen in 7 (3.3%) patients. Wet dressing and primary repair were performed at the lower edge of the flap because of the local recurrence to 5 (2.3%) patients. Discussion and Conclusion: Nowadays, though it is stated that minimal invasive methods are effective for the treatment of the disease, we believe that surgical methods are more appropriate for the treatment. Furthermore, the surgical method to be chosen should be Limberg flap that is a reliable and effective procedure with its low recurrence rates, short hospitalization period, and low rate of complications. [ABSTRACT FROM AUTHOR]

Introduction: Sacrococcygeal pilonidal sinus (PNS) is a common chronic benign disease of young age group, associated with morbidity, often with a prolong loss of normal activity. Still there is ongoing debate regarding the best treatment option as all the methods have complications, although; the current evidence supports the use of off-midline techniques because of lower recurrence rates and avoidance of all disadvantages of open treatment. This study was done to determine the postoperative outcome of rhomboid excision and Limberg flap reconstruction as a main procedure in the treatment of PNS disease in our institute. Patients and Method: A prospective study conducted at the Department of General Surgery-Baquba Teaching Hospital-Diyala-Iraq, from January 2017 to June 2019, in which 98 patients (78 male and 20 female) with chronic primary sacrococcygeal PNS were enrolled. The age of the patients ranged between 16 - 38 years. Patients with acute abscess were first treated by incision and drainage before definite surgery. Patients were operated by rhomboid excision and Limberg flap reconstruction. Results: In this study, 98 patients were enrolled, 78 male (79.59 %) and 20 female (20.4%) with male to female ratio of 3.9:1. The age of the patients ranged between 16 to 38 years with the mean age of 25 years. During the follow up period; 6 patients (6.12%) developed seroma, 4 patients (4.08%) had infection and 4 patients (4.08%) had recurrent sinus after few months and one patient (1.02%) had wound disruption. Conclusion: Rhomboid excision and Limberg flap reconstruction of PNS diseaseis safe and reliable technique with low complication and recurrence rates if performed according to appropriate surgical principles. [ABSTRACT FROM AUTHOR]

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. Result: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: Pilonidal sinus disease is characterized by chronic inflammatory and granulomatous epithelial tract, usually in the sacrococcygeal area. It is rarely seen in other regions of the body. In this study, we aimed to report our patients with intermammary pilonidal sinus (IMPS) and to present the flap operation technique applied to these patients. Methods: A total of nine patients who applied to the general surgery clinic between the years 2010 and 2019 for the treatment of IMPS were evaluated retrospectively. Demographic characteristics of patients, time of onset of the complaints, the length of the sinus tract, the treatment, and the presence of any recurrences were collected by reviewing the hospital records and calling the patients by phone. In the patients presenting with abscesses, drainage was performed and antibiotic treatment was given to the patients. A standard sinus excision was followed by the closure with a bilateral subcutaneous flap. Results: A total of nine female patients were included in the study. All patients were females between ages 15 and 28 years with a mean age of 19.2±3.4 years. The presenting complaints of all patients were intermittent drainage in the intermammary area, the formation of openings, and sometimes pain. The mean length of the sinus was 4.1±0.7 cm. No complications and complaints were seen in the patients in the postoperative period. Conclusion: IMPS is a disease of young women and is curable with surgery. The patients are successfully and safely treated with the flap method. [ABSTRACT FROM AUTHOR]

Incomplete obliteration of urachus during the fetal period can lead to urachal abnormalities. One of these abnormalities is the urachal sinus that can be asymptomatic, or it can be symptomatic by becoming infected or being malignant, and it can mimic other diseases' symptoms. Although it is rare in adults, it should be considered a significant differential diagnosis in patients with abdominal pain or umbilical discharge. This article presents a young patient with urachal sinus mimicking umbilical pilonidal sinus symptoms. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

VERNEUIL'S DISEASE IS A CHRONIC, SUPPURATIVE, AND OFTEN SCARRING INFLAMMATORY CONDITION OF THE APOCRINE GLANDS, OFTEN FOUND IN REGIONS OF THE BODY WHERE THE NUMBER OF THESE GLANDS IS INCREASED.10 THEREFORE THE AREAS OF CHOICE IN WHICH THIS CONDITION MAKES ITS PRESENCE FELT ARE THE ARMPIT, THE ANOGENITAL REGION AND RARELY THE SCALP. IT CAN OFTEN BE ASSOCIATED WITH CONGESTED ACNE AND DISSECTING SCALP FOLLICULITIS, WHICH HAS LED PILLSBURY AND HIS CO-WORKERS TO INCLUDE THEM IN A SINGLE NAME:,,FOLLICULAR OCCLUSION TRIAD''.11 FREQUENT ASSOCIATION WITH PILONIDAL CYST HAS TRANSFORMED THE TRIAD INTO AN ACNE TETRAD.12 SYNONYMS OF VERNEUIL'S DISEASE ARE CHRONIC HYDROSADENITIS (+/- SUPPURATIVE), SWEAT GLAND ABSCESSES, APOCRINITIS OR REVERSED ACNE. BEING A MOTHER-DAUGHTER DISEASE, IT AFFECTS WOMEN WITH A SLIGHT PREVALENCE, AND AS A LOCATION THE AXILLARY FORM IS MUCH MORE COMMON.13 THE PATHOGENESIS OF THIS DISEASE REMAINS UNKNOWN, BUT THE ETIOLOGICAL FACTORS INVOLVED ARE : OBESITY, HYPERANDROGENISM, BACTERIAL INFECTIONS, GENETIC PREDISPOSITION TO ACNE, IMMUNOLOGICAL FACTORS SUCH AS IL-12, IL-23 AND TNF-A.14,15 [ABSTRACT FROM AUTHOR]

Effective treatment of patients with sacrococcygeal pilonidal cysts includes several factors, one of which is bacterial environment of pilonidal cyst and surrounding tissues, which should be taken into account when planning and performing surgical treatment. The effectiveness of surgical treatment in case of radical surgery for pilonidal cyst excision depends on the probability of spreading the cyst content to the wound, its possible suppuration under favorable conditions. The data on pilonidal cysts microflora and antibacterial drugs effect make it possible to control the probability of postoperative wound suppuration. The study is aimed at the increase in efficiency of comprehensive surgical treatment for sacrococcygeal pilonidal cysts provided by metronidazole, which is imidazole derivative. A radical surgical treatment was performed in 112 patients with sacrococcygeal pilonidal cyst: (102 (91.1 %) men and 10 (8.9 %) women). To assess the effectiveness of antibacterial drugs application, the patients were distributed into two groups. In the main group, 56 patients (50 %) underwent radical surgery for sacrococcygeal pilonidal cyst, followed by administration of ciprofloxacin tablets in the postoperative period, at a dose of 500 mg twice a day, along with metronidazole at a dose of 500 mg. The duration of taking both drugs was 5 days. The comparison group included 56 (50 %) patients who underwent identical volume of surgical treatment, followed by administration of ciprofloxacin in tablets at a dose of 500 mg twice a day in the postoperative period; the duration of taking the drug was 5 days. Microbiological studies of pilonidal cysts content in patients of this group were not carried out. The presence of obligate anaerobic microbiota in combination with facultative anaerobic one was observed in all patients. When assessing the course of wound healing in the main group during the first 10 days of the postoperative period, suppuration of postoperative wound was detected in 1 patient (1.8 %) of the total number of 56 patients. In the comparison group, postoperative wound suppuration was observed in 5 patients (9 %), the presence of inflammatory infiltrate − in 3 patients (5.36 %) compared to 10 patients (17.8 %) in the comparison group. The most active drugs were carbapenems (imipenem, meropenem), vancomycin (glycopeptides). The study determined a high sensitivity to ciprofloxacin and metronidazole in patients. Given the synergistic antibacterial effect, provided by the simultaneous administration of metronidazole, which has a specific effect on anaerobic microflora and broad-spectrum antibiotics, this combination is rational. Involvement of this drug combination in the comprehensive surgical treatment provides better surgical treatment results, namely: a decrease in the frequency of both postoperative wound suppuration and occurrence of inflammatory infiltrate.

Median raphe cyst are rare lesions, with fewer than 15 case reports from the Indian subcontinent. They are usually present over the midline and ventral aspect of the penis, usually near the glans. They can be present over the glans, penile shaft, scrotum or perineum. Although present since childhood, they are usually reported by young adults when they increase in size, get infected or cause sexual discomfort. The typical location of the cysts helps in pin pointing the diagnosis. Although asymptomatic, in case of complications like infection, trauma or discomfort they should be referred to an Urologist. Case Report: A 4 year old male patient, presented with multiple cystic, fluctuant, opaque swellings present over the midline of the scrotum, ranging in size from 0.2cmX0.3cm to 0.5cmX0.5cm. They were present since birth and asymptomatic. No other pathology was detected in the genital or perianal area. As the lesion was not any source of discomfort, the mother was offered only reassurance and asked to follow up in case of any complications. Discussion: Median Raphe cysts are rare benign, congenital lesions over the male external genitalia. Histology demonstrates cysts lined by stratified columnar epithelium with no connection to the overlying epithelium. Differentials include epidermal cysts, pilonidal cysts, dermoid cysts etc. The pathogenesis is not fully understood, theories include defective urethral fold closure and ectopic periurethral glands among others. Surgical excision with primary closure leads to definitive cure. [ABSTRACT FROM AUTHOR]

GLO:HWR/01dec22:ans17691-fig-0001.jpg PHOTO (COLOR): 1 Ultrasound image of the umbilicus showing an isoechoic ovoid focus measuring 8 × 9 × 7 mm, with no associated hernia. gl The patient proceeded to surgery for excision of the cyst. J. Surg. 1976; 19: 422 - 6. 4 Eryilmaz R, Sahin M, Okan I, Alimoglu O, Somay A. Umbilical pilonidal sinus disease: predisposing factors and treatment. The most common presenting complaint is a chronic discharging sinus at the umbilicus.[5] Treatment options vary for patients suffering with UPS. [Extracted from the article]

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]

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Background: Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods: This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results: In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions: Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration: The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742 [ABSTRACT FROM AUTHOR]

Introduction: Despite the fact that the pilonidal cyst of the sacrococcygeal region is a long-known disease, the mechanism of accumulation or absence of hair in the cyst remains unclear, which affects the accuracy of the name of the disease, as well as understanding of its pathogenesis. Aim: Aim to perform morphological examination of pilonidal cysts of the sacrococcygeal region, to determine the nature of the cysts, the frequency of hair in the cyst cavity and to determine the causes and mechanism of its accumulation in cysts. Materials and methods: A morphological study of skin areas with altered tissues of the sacrococcygeal region after radical surgical treatment of 235 patients with a coccygeal cyst of the sacrococcygeal region was carried out. The gender distribution of patients with pilonidal cysts was as follows: 220 (93.4%) male patients, 15 female patients (6.6%). Results: Among 235 patients who underwent radical surgical treatment, the absence of hair shafts was recorded in 112 (46.8%) cases, hair in the cyst structure - in 123 male patients (53.2%), both visually and under a microscope, and in 4 of them (0.9%) only under a microscope. Among 15 patients, hair in the cyst cavity was found in 1 case (0.4%), in 14 patients they were not detected either visually or by microscopic examination. Discussion: Having observed the formation of foreign body granuloma and the accumulation of polynuclear histiocytes of foreign bodies around the hair in the pilonidal cyst cavity, a proportional increase in histiocytes depending on the number of hairs, that is, the body's reaction to the foreign body was registered. However, multinucleated histiocytes in lower numbers were also observed in cases in which hair shafts were not found either microscopically or macroscopically, which may indicate both completed phagocytosis and formation of a cyst without a hair component, registering the reaction of histiocytes to inflammatory changes in the cyst cavity. The detection of atypically located pilonidal cysts (cheek, navel) provides additional confirmation of the formation of pilonidal cyst as a result of disturbance of hair growth through the hair funnel due to inflammatory changes in the hair follicle and their accumulation subcutaneously. [ABSTRACT FROM AUTHOR]

Objective: Sacrococcygeal pilonidal disease is a chronic discharging wound that causes pain and loss of quality of life. Phenol application is an outpatient procedure with low complications and low recurrence rates. We evaluated the radiological, histological, and clinical results of phenol application. Methods: A total of 44 consecutive patients with sacrococcygeal pilonidal disease underwent phenol application in Kocaeli University Faculty of Medicine, General Surgery Clinic between December 2015 and March 2017. Demographics, complaints, symptom duration, and the number of sinuses were recorded. Patients were examined using ultrasonography (USG) before surgery and two months after surgery. Four patients who wanted rhomboid excision and Limberg flap procedure underwent preoperative local phenol application and were excluded from the study. The excised tissues were used for pathological evaluation. Results: Purulent discharge was the leading symptom. All of the patients had hair in the preoperative USG evaluation, whereas five patients had still hairs in the sinuses in the postoperative USG examination. Four of these cases had recurrences on a 2-month follow-up. After phenol application, a 10% volume decrease was observed. Pathological examination was performed in four cases with phenol application, and in pathological material, the sinuses looked sclerotic and fibrotic. Conclusions: Our study revealed that a single phenol application achieved 90% success. However, no significant difference was observed in the cavity volume after phenol injection. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease (PSD) is an inflammatory condition that mostly affects young people and adults, with a higher incidence in males. Many conservative and surgical methods have been de- scribed for the treatment of PSD, but there is still no method accepted as the ideal treatment, and most importantly, no treatment method can eliminate the risk of recurrence of the disease. Materials and Methods: The files of 49 patients who were operated on for PSD in our clinic between June 2016 and November 2021 were reviewed retrospectively. The patients were divided into 2 groups who were operated with the Karydakis flap (KF) method and Excision of the sinus with primary closure (EPC) method. Results: While the CF group returned to normal life in an average of 7.52 days, the EPK group was able to return in 11.53 days. Complications developed in 2 (8.7%) patients in the KF group, whereas 5 (19.2%) patients had complications in the EPC group. There was no statistically significant difference. Conclusions: Both the KF method and the EPC method are acceptable and safe in the treatment of PSD, but our study showed that the KF method is more effective. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a "special interest" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: "A + : strongly agree; A–: agree; N: unsure/no opinion; D–: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee. [ABSTRACT FROM AUTHOR]

Backgrounds and aim: A pilonidal sinus (PNS) is a common condition that affects men mostly especially young adults. The method of treatment of this surgical condition is controversial still. In this regard, we compared the outcomes of interest between excision and drainage of an abscess in PNS patients. Methods: Patients who were diagnosed with PNS abscess and admitted for the treatment between 2019 and 2020 were treated either by excision (n=48) or drainage of abscess (n=30). The patients were followed up for the outcomes of the interest, including infection, pain, discharge, and wound size at the first, third, and sixth months of surgery. Results: The patients who were treated by excision technique had significantly longer operative time compared to patients who were treated by drainage of abscess 9.65 vs. 5.50 min, P<0.0001. In addition, they had a longer postoperative hospitalization time, 4.19 vs. 3.43 hours, P=0.0002, and required longer time to back to normal activity, 4.69 vs. 4.20 days, Pr-0.0221, respectively. The patients in both groups had similar incidence rates of infection, pain, and discharge at the different periods and similar incidence rates of wound rate at the first month. The patients who were treated by drainage of abscess had significantly higher incidence rates of two and three cm wound size compared to those who were treated by excision. 75.00%, P=0.4287, whereas, the patients who were treated by drainage of abscess significantly developed postoperative fever, 16.67% vs. 0.00%, P=0.018. Conclusions: The study showed that total excision of pilonidal sinus abscess develop better outcomes of the wound at third and sixth months of operation. [ABSTRACT FROM AUTHOR]

Background: Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT)., Methods: We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed., Results: A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m -2 , respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation)., Conclusion: The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population., (© 2024. The Author(s).)

Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a 40-year-old patient with a symptomatic midline retrococcygeal lesion that was presumptively treated as a pilonidal cyst due to its clinical and imaging features. After surgical pathology rendered the diagnosis of chordoma, the patient required salvage surgery in the form of partial sacrectomy with soft tissue flap coverage. In addition to the unusually predominant retrococcygeal location, surgical pathology identified an intervertebral disc origin rather than the typical osseous origin. To our knowledge, this presentation of chordoma with coccygeal intervertebral origin and a large subcutaneous mass at imaging has rarely been reported in the literature. We describe this case to raise awareness of atypical presentations of sacrococcygeal chordoma that may lead to erroneous presumptive diagnosis and treatment., (© 2023. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Sacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM flap; 5. bilateral gluteal defects covered with single-layer dermal substitute of bovine collagen and elastin hydrolysate followed by immediate split-thickness skin grafting from bilateral thigh donor sites, and negative pressure wound therapy dressings. This approach resulted in a favorable outcome at 2-year follow-up in a male patient presenting with a large locally advanced sacral squamous cell carcinoma involving the external anal sphincter muscle., (© 2024. Italian Society of Surgery (SIC).)