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PubMedDate not supplied

[Ambulatory closed surgery for the treatment of pilonidal sinus].

Pilonidal disease (PD) is a common chronic disorder of the sacrococcygeal region afflecting young people. Despite several methods for treating PD have been described, the management remains controversial. Recent reports have advocated different surgical approaches such as open or closed technique, but recurrence plagues all forms of therapy. We conducted this case review to evaluate the validity of an outpatient closed technique in the treatment of chronic pilonidal disease. Between January 1997 and July 1999, 65 consecutive patients with quiescent chronic PD were electively treated by surgical excision of the cyst and primary closure. There were 47 men (72%) and 18 women (28%) in this study. Patients ranged in age from 14 to 47 years, the average age being 21 years. The median healing time was 8 days and the median time to return to full work was 20 days (range 10-25). Infection and recurrence rates were 1.5% and 4.6% respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Cyst excision and primary closure is a safe, low cost operation with a very high long-term success rate and a negligible rate of complications. It can successfully be performed under local anaesthesia in an outpatient facility.

Adolescent↗
PubMed2002

Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing.

BACKGROUND: In the case of pilonidus sinus treated with primary intention surgery the uneventful healing is still difficult to obtain, as indirectly proven by the number of different procedures that have been suggested, such as cyst excision with or without primary closure, excision followed by marsupialisation, and excision followed by skin flap transposition. The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution. METHODS: Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region at least 5 cm laterally to the lower end of the suture. Suction was stopped on the first postoperative day and the drain was cut just above the skin. On day 2, a 5F catheter was inserted through the drain and the cavity was flushed with an antiseptic solution followed by sterile saline solution; the same treatment was repeated on days 4 and 6. The drain was removed on day 8 or 9, some of the stitches on day 8 or 9 and the rest on day 9 or 10. The surgery was performed on a day hospital basis in 207 cases; the remaining 36 were hospitalized overnight and discharged on the following day. RESULTS: Healing was always by first intention, with none of the 243 patients experiencing any complications. The postoperative follow-up now ranges from 5 to 15 years, and there have not been any recurrences. CONCLUSIONS: The drainage of blood from the bottom of the wound and the use of antiseptic/saline flushing are essential for primary intention healing and the avoidance of recurrences.

Adolescent↗
PubMed1990

Chronic pilonidal disease. An assessment of 150 cases.

During a four-year period, 150 consecutive patients were treated for chronic pilonidal disease by one of three different operative techniques. Patients with acute pilonidal abscesses or with complex or multiple recurrent pilonidal disease were excluded from this study. The average healing time was four weeks and the average length of hospital stay was one day. The overall recurrence rate was 8 percent (12 of 150 patients). The method of management most commonly used was fistulotomy with marsupialization of the sinus tract or cyst wall (125 of 150 patients). This simple and effective technique gave excellent results with a 6 percent recurrence rate (7 of 125 patients). On the basis of their experience, the authors propose that chronic pilonidal disease usually can be treated successfully on a same day surgery basis with fistulotomy, minimal excision, and marsupialization.

Adolescent↗
PubMed1965

Pilonidal disease--a surgical enigma.

A retrospective review of 72 patients with pilonidal disease was conducted in order to examine current methods of treatment and establish certain guiding principles for success. The criteria for diagnosis included a pit of variable depth lined by epithelium or granulation tissue containing hair or from which hair had been extracted. A study of these patients suggested the possibility of a dual etiology for pilonidal disease, either congenital or acquired, acting singly or in combination. Management will be influenced by the surgeon's concept of origin in each case. These 72 patients who underwent a total of 116 operations were divided into two groups: (1) unifected sinuses and cysts, (2) infected and recurring cysts. The results of various operative procedures in both these groups indicate a higher probability of success when wide excision and open healing is employed.

Pilonidal Sinus↗
PubMed1996

Treatment of chronic pilonidal disease.

PURPOSE: Pilonidal disease (PD) is a common chronic intermittent disorder of the sacrococcygeal region. Despite surgical therapy dating back more than one century, management remains controversial and recent reports have advocated different surgical approaches. METHODS: A retrospective review was conducted of 129 patients who were treated for chronic PD in our institution during a five-year period, 1990 to 1994. RESULTS: Excision with primary closure was performed in 56 patients; 47 underwent open excision without closure, and 26 had marsupialization procedure. All were performed electively, with only minor complications. Complete healing was fastest in the primary closure group, despite a 14 percent postoperative wound infection rate. Recurrence rates of 11, 13, and 4 percent were found for primary closure, wide resection, and marsupialization procedures, respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. CONCLUSION: Considering healing time, morbidity, and recurrence rate, we conclude that surgical treatment should be directed at either excision and primary closure or marsupialization. Wide excision with secondary healing should be performed only for grossly infected and complex cysts.

Adolescent↗
PubMedDate not supplied

Sonographic evaluation of caudal spine anomalies in children.

Retrospective analysis of B-mode spinal sonography in 15 pediatric patients with spinal dysraphism and caudal anomalies documents a high degree of accuracy in identifying the presence, site, size, and configuration of meningoceles; and slightly less accuracy in identifying extension of neural tissue into the meningocele and presence of concurrent lipoma. B-mode sonography is capable of displaying spinal anatomy clearly enough to permit accurate retrospective interpretation of pathologic changes. When radiologists learn to interpret sonographic images well enough to achieve equal accuracy in prospective diagnosis, then B-mode spinal sonography will supplant computed tomography and myelography as the preferred screening procedure in the initial evaluation of children with selected anomalies of the caudal spine.

Child↗