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Twenty-five patients with pilonidal disease were treated by the Dufourmentel technique between 1984 and 1989. In this series, 18 patients (72 percent) were women and 7 (28 percent) were men (mean age, 24 years); hospital stay averaged 4 days. There were no recurrences and no reports of surgical wound infection. Diagnosis was confirmed histologically in all cases.
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.
PURPOSE: The treatment of sacrococcygeal pilonidal cyst, despite being considered a well-defined clinical entity and opinion as to its acquired origin being almost unanimous, has some controversial aspects. Surgery is the principal method of treatment, and several techniques have been proposed. All of them try to reduce morbidity, to offer conditions of fast cicatrization, to have a low recurrence rate, and to offer cure. This study was undertaken to review the available data in the literature about the cause of the disease and to determine the current optimal method of treatment, evaluating morbidity, healing, recurrence, and cure. METHODS: Data available on the topic of pilonidal cyst in the English-language literature were obtained from Index Medicus and MEDLINE and were reviewed and analyzed. RESULTS: There is nearly a consensus that pilonidal cyst is acquired, hair being the agent that causes the disease. Presently, the most-used surgical procedure is excision of the cyst, with open or closed wound for healing. However, many authors prefer to use the method of incision and curettage. New surgical techniques are being proposed. CONCLUSION: The majority of authors conclude that sacrococcygeal pilonidal cyst is an acquired disease, although a minority believe it is congenital. Although excision is the method of choice for most surgeons, in our experience the incision and curettage procedure is the best surgical treatment with regard to morbidity, healing, recurrence, and cure of the disease.
PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.
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The treatment of a patient for multiple recurrent pilonidal disease failed all forms of conventional therapy. After re-excision, a gluteus maximus myocutaneous flap, measuring 15 X 15 cm and based on the superior gluteal artery, was swung to cover the defect. Complete relief from severe pain was obtained immediately. No recurrence is noted after two and one-half years of follow-up.
Pilonidal disease is treated by follicle removal and lateral drainage. The method is suited to outpatient management and gives minimal disability and good long-term control. Other treatment methods for management of the unhealed midline pilonidal incision are discussed. Results are satisfactory to as long as nine years on follow-up. Microphotographs demonstrate that pilonidal disease arises from hair follicles in the skin.
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A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed. One hundred twenty-four were treated using local anesthesia with supplemental diazepam or Innovar. Most patients spent only three days in the hospital, with healing occurring in less than two months. Recurrences occurred in 20.9 per cent of the patients. The recurrences were treated by office procedures in all but one instance. Most patients were pain-free and back to work within two weeks after operation.
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Pilonidal disease in 12 patients was treated by a technique of incision and cryosurgery. All patients had complete healing and no recurrence after the 12 months of follow up. The advantage of abbreviated hospitalization is obvious and the early return to activities of daily living greatly appreciated by the patient. This procedure is recommended as a means of thoroughly treating disease with little morbidity.
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