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PubMed2003

Pilonidal sinus disease: MR imaging distinction from fistula in ano.

PURPOSE: To describe magnetic resonance (MR) imaging features in patients with proved pilonidal sinus disease and to compare these features with those in a matched group of patients with proved fistula in ano to determine the accuracy with which MR imaging can be used to distinguish between the two diseases. MATERIALS AND METHODS: Seven patients with pilonidal sinus disease underwent MR imaging with a body coil. The site and morphology of sepsis were noted, with particular reference to natal cleft sepsis and deep-seated sepsis, including intersphincteric anal canal sepsis and any enteric communication. Comparison was made with 14 age- and sex-matched patients with fistula in ano. Categoric frequencies were compared to calculate differences between the groups and sensitivities, specificities, and predictive values. RESULTS: All patients with pilonidal sinus had natal cleft sepsis, but five (71%) had sepsis at deep-seated sites more characteristic of fistula in ano. Eight patients with fistula in ano (57%) had natal cleft sepsis that was thought characteristic of pilonidal sinus. No patient with pilonidal sinus had intersphincteric sepsis or an enteric communication, in contrast to all patients with fistula in ano having both (P <.001). Natal cleft sepsis reached the subcutaneous tissues overlying the coccyx and sacrum in only one patient with fistula (7%), in contrast to six (86%) with pilonidal sinus (P <.001). MR imaging had a sensitivity of 86% (six of seven), specificity of 100% (14 of 14), positive predictive value of 100% (six of six), and negative predictive value of 93% (14 of 15) for diagnosis of pilonidal sinus disease. CONCLUSION: MR imaging features of perianal and deep-seated sepsis, characteristic of fistula in ano, are also found in patients with pilonidal sinus, but the absence of intersphincteric sepsis or enteric opening allows reliable MR imaging distinction between the two.

Adolescent↗
PubMed1999

Pilonidal sinus of the penis. A report of two cases, one of them associated with actinomycosis.

Pilonidal sinus is a long-standing chronic inflammatory condition which occurs most commonly in the sacrococcygeal area and it is rare in the penis. Two cases of penile pilonidal sinus in patients aged 25 and 28 years are reported and the literature is reviewed. The lesion is acquired and has to be distinguished from balanoposthitis, epidermal cyst and carcinoma. For pilonidal sinus to occur at this site, it is hypothesized that the coronal sulcus acts as a cleft where hair may accumulate and be driven into the shaft and prepuce by the natural movement between these two surfaces. One of our cases was associated with actinomycosis. Actinomycosis associated with pilonidal sinus of the penis is extremely rare and there are only two previous reports. It is suggested that pilonidal sinus may have been predisposed to the infection with the actinomyces organisms. Information stating that penile pilonidal sinus and actinomycosis may occur simultaneously is necessary to accomplish an early diagnosis.

Actinomyces↗
PubMed2005

Pilonidal sinus disease treated by depilation using an 800 nm diode laser and review of the literature.

BACKGROUND: Pilonidal sinus disease is a debilitating, disfiguring chronic ailment that is often resistant to therapy. Its etiology and treatment remain in question. OBJECTIVE: To assess the efficacy of an 800 nm diode laser in the treatment of recalcitrant pilonidal sinus disease. METHODS: Two patients with recalcitrant pilonidal sinus disease were treated in the lower back, buttocks, and perigluteal cleft area with an 800 nm diode laser with a spot size of 9 x 9 mm, fluences of 30 to 48 J/cm2, and pulse widths of 15 to 24 milliseconds. RESULTS: Long-term relief of pilonidal sinus disease was produced with as few as two treatments 2 months apart to as many as six treatments over a 2-year period. With each successive treatment, fewer pulses were needed and the interval between treatments increased. CONCLUSION: The 800 nm diode laser may be an effective tool in the treatment of pilonidal sinus disease. By eliminating the source of hair and hair fragments that course along the surface of the lower back and buttocks, interruption of the etiologic source for pilonidal sinus disease can be accomplished.

Buttocks↗
PubMed2006

Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients.

PURPOSE: Pilonidal sinus disease is a common and well-known entity. Many surgical methods have been described for the treatment of pilonidal sinus disease. The aim of this study was to determine the advantages and long-term results of oblique excision and primary closure techniques. METHOD: Between January 1999 and December 2001, 493 patients (490 male, 3 female; average age = 23.48 +/- 3.90 (range, 15-51) years) were operated on for primary or recurrent pilonidal sinus disease. An oblique fusiform-shaped incision was made and the skin was excised. The operation was completed with primary closure. All patients' follow-up examinations were made at the end of the 6 weeks and 3, 6, 12, and 18 months after surgery. RESULTS: The mean duration of symptoms was 22.09 +/- 17.12 (range, 1-120) months. The mean duration of hospital stay was 5.51 +/- 2.85 (range, 2-17) days. At the end of the follow-up period, the recurrence rate was 5.6 percent. CONCLUSION: The ideal operation for pilonidal sinus disease treatment must be simple and effective. The technique of oblique excision and primary closure may be considered an alternative operation for pilonidal sinus resulting in a low recurrence rate.

Adolescent↗
PubMed2004

Pilonidal sinus of the glans penis associated with actinomyces case reports and review of literature.

Pilonidal sinus is a well-recognized condition that occurs most commonly in the sacrococcygeal area of younger men. It is hypothesized to be an acquired chronic inflammation condition due mainly to hair trapped beneath the surface. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, fistulae, and rarely, squamous cell carcinoma. A pilonidal sinus of the penis is a rare entity. The association of a penile pilonidal cyst and Actinomyces is even more uncommon with only three cases reported previously. Two cases of pilonidal sinus are reported in this paper. One of the cases was associated with actinomycosis. Pilonidal sinus of the penis should be considered in the clinical and pathological differential diagnosis and has to be distinguished from balanoposthitis, epidermal cyst, and carcinoma. The knowledge about possible association with actinomycosis is important to ensure early treatment.

Actinomyces↗
PubMed2004

Treatment of pilonidal sinus disease using fibrin glue as a sealant.

BACKGROUND: Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension-free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing. METHODS: A curved incision of the carried out, 2-3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2-4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space. RESULTS: Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow-up period (23+/-3 months). CONCLUSIONS: Complete excision with tension free closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.

Administration, Topical↗
PubMed2000

The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition.

Recurrence of pilonidal sinus disease after surgical intervention is not a very rare problem although sophisticated reconstruction procedures have been developed. Recurrence is thought to be related to the anatomical status of the patients, i.e., depth of the intergluteal groove. Obese patients have deeper intergluteal grooves. The aim of this study was to use body mass index (BMI) as an objective indicator of obesity to determine whether there is a relationship between BMI and recurrence of pilonidal sinus disease. BMI was calculated preoperatively in 114 patients with pilonidal sinus disease who were treated by excision and Limberg flap transposition between 1996-1999 in general surgery departments of two university hospital clinics. Fifteen patients were referred to our clinics after surgical intervention carried out at other institutions. Their average BMI was calculated by using their hospital records. The mean follow-up period was 24 months (range 10-36). Six of the 114 patients (5%) had recurrence. The mean BMI of patients with and without recurrence was 29.35 and 27.415, respectively (P<0.05). The mean BMI of 15 patients referred to us because of recurrent disease was 29.41; however, that of patients with primary pilonidal sinus disease was 27.212 (P<0.05). Their BMI before their first operation was 29.30. This was also significantly higher than patients with primary disease (P<0.05). We conclude that obese patients with high BMI have a higher risk of recurrence of pilonidal sinus disease after surgical intervention.

Adolescent↗
PubMed1995

Patient characteristics and symptoms in chronic pilonidal sinus disease.

Three hundred and twenty two patients with pilonidal sinus disease were studied to determine factors for the development and maintenance of the disease. A calculated incidence of the disease of 26 per 100,000 inhabitants was found. It occurred 2.2 times more often in men than in women. Age at presentation was 21 years for men and 19 for women. Patients had two years (median) disease history before being referred for treatment. A family history could be found in 38% of the patients. 50% had normal body weight, and 37% were overweight. Local trauma or irritation preceded the condition in 34%, and a sedentary occupation was reported by 44%. Male sex, adolescence or youth, and a familial disposition seem to be associated with the development of pilonidal sinus. Local trauma and overweight are the most important conditioning factors for development of symptomatic pilonidal sinus disease.

Adolescent↗
PubMed2004

A case of subcutaneous myxopapillary ependymoma presenting as a pilonidal sinus.

We describe a rare neurogenic tumour presenting as a pilonidal sinus. This case illustrates the pitfalls associated with the management of a commonly occurring surgical condition. Pilonidal sinuses are often the province of trainee surgeons and while ependymomas are rare, this example emphasises the need to send the pilonidal sinus tract for histological examination.

Adult↗
PubMed2005

Fibrin glue in the treatment of pilonidal sinus: results of a pilot study.

INTRODUCTION: Pilonidal sinus is a common condition of uncertain etiology. There is no agreed best surgical treatment. Treatment of fistula-in-ano has been described with some success with fibrin tissue glue. The use of fibrin glue is investigated in this pilot study. METHODS: Six patients with chronic pilonidal sinus were treated with injection of fibrin tissue glue after curettage of the pits. RESULTS: There were no complications. Postoperative discomfort was minimal and early return to normal activities was possible. There was no recurrence of disease in five of six patients at one year. CONCLUSIONS: Fibrin tissue glue may be a possible novel treatment for pilonidal disease.

Adult↗
PubMed2004

Elliptical rotation flap for pilonidal sinus.

BACKGROUND: The treatment of the symptomatic pilonidal sinus is surgical with one of the most extensive being excision of the diseased tissue down to the sacral fascia. The closure of the defect is the matter of debate. An elliptical rotation flap has been used for pilonidal sinus treatment with no recurrence rate. METHODS: From April 1996 to June 2001, 20 patients were treated with this technique. The surgical procedure is a vertical elliptical excision of the diseased tissue and an elliptical cutaneous rotation flap to close the defect. RESULTS: Twenty patients underwent with this technique, mean age 23.4 years (range 18 to 34). Mean follow-up was 42 months. All patients were discharged on the first postoperative day. Primary healing was achieved in all of the patients in 2 weeks. No recurrence was observed. CONCLUSIONS: Elliptical rotation flap is recommended for patients selected for defect closure. It offers improved patient comfort, shorter hospital stay, and no recurrence rate.

Adolescent↗
PubMed1992

Easy and successful treatment of pilonidal sinus after explanation of its causative process.

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.

Adolescent↗
PubMed2002

Sacrococcygeal pilonidal sinus disease with Limberg flap repair.

Sacrococcygeal pilonidal sinus disease affects younger persons, resulting in long-term loss of productive power. It also has a high rate of morbidity because there is no standard treatment approved by all surgeons. In this study, early and late results of 85 cases treated with excision and Limberg flap in our clinic were investigated. The patients were followed for 9-120 months. The complication rate was 4.7% and the long-term relapse rate was 3.5: Insufficient personal hygiene and inadequate excision were the main causes for recurrence. On the basis of the literature and our previous experiences, we conclude that the Limberg flap is the ideal treatment for sacrococcygeal pilonidal sinus disease with low morbidity, mortality and recurrence rates.

Adolescent↗
PubMed1999

Fine-needle aspiration cytology of metastatic squamous-cell carcinoma arising in a pilonidal sinus, with literature review.

Fewer than 50 cases of carcinoma arising in a pilonidal sinus have been reported, with only 5 patients having documented inguinal lymph node metastases. This is the first report of the fine-needle aspiration (FNA) diagnosis of this uncommon clinical situation of squamous-cell carcinoma arising in a pilonidal sinus, metastatic to an inguinal lymph node. We report on a 59-yr-old male with squamous-cell carcinoma arising in a pilonidal sinus who presented with inguinal adenopathy. FNA biopsy of a lymph node was performed, resulting in a diagnosis of metastatic squamous-cell carcinoma. FNA biopsy is useful in the evaluation of patients with inguinal adenopathy and a history of malignancy arising in a pilonidal sinus. The possibility of this rare complication should also be considered when metastatic squamous-cell carcinoma to an inguinal lymph node is diagnosed by FNA cytology in patients having an unknown primary except for a change in a long-standing pilonidal cyst.

Biopsy, Needle↗
PubMed1984

[Causes of pilonidal sinus and pyoderma fistulans sinifica].

Pilonidal sinus is of the same origin as the Pyodermia fistulans sinifica . Both diseases are retention dermatopathies . These sinuses are not of congenital origin. Our observations have made an acquired origin seem more likely. Deep skin folds in the rima ani, the stiffness of the body hairs, the rolling movement of naturally separated hairs push the hair through the skin like a pin. If a hair is rubbed, it moves in the direction of its root with the peripherally directed hair scales. Excision of the sinus area and transplantation of an epithelial flap is the best therapy.

Adult↗
PubMed1994

Pilonidal sinus disease. The conservative approach.

OBJECTIVE: To examine the role of conservative, nonexcisional methods in the treatment of pilonidal sinus disease. DESIGN: Pilot nonrandomized cohort study and follow-up retrospective study. SETTING AND PATIENTS: In the pilot study, all patients treated for pilonidal sinus disease consecutively over 3 years at an Army community hospital, and in the follow-up study within a closed federal population, all patients admitted with a diagnosis of pilonidal sinus disease over 17 years to an Army medical center. INTERVENTIONS: Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hygiene, and limited lateral incision and drainage for abscess) with initial comparison to excisional procedures. MAIN OUTCOME MEASURES: Occupied-bed days for conservative vs excisional therapy during a 3-year pilot study and the number of admissions and procedures performed for pilonidal sinus disease at an institution dedicated to conservative treatment alone. RESULTS: Complete healing over 83 occupied-bed days was demonstrated in 101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years. With application of conservative treatment over 17 years, only 23 excisional operations were performed. CONCLUSIONS: Conservative therapy effectively controls pilonidal sinus disease in the nonoperative outpatient setting while promoting near-normal work status and is preferred over excisional operations.

Adolescent↗
PubMed2000

Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure.

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

Adult↗
PubMed2004

[Treatment of pilonidal sinus and acne inversa].

A pilonidal sinus is a invagination of the skin over the sacrum containing a tuft of hair which enlarges by repeated friction causing the hairs to penetrate the skin. It may become symptomatic if an infection occurs. There are similarities with acne inversa, which is present in about 23% of cases. Acne inversa is an inflammation of the sebaceous glands and terminal hair follicles, chiefly in the intertriginous areas. The first manifestation can occur at any time from puberty to advanced age. 90% of patients are smokers. Initially giant comedones and indolent subcutaneous nodules are found; they progress to form draining sinus tracts. Conservative treatment, incision and/or surgical removal of the abscesses and fistulas is futile. The method of choice is the early complete surgical excision of the involved skin extending into normal tissue both laterally and at the base. In most cases healing of the defects by secondary intention is uneventful.

Adolescent↗