Time and rate of sinus formation in pilonidal sinus disease.

Department of Surgery, Military Hospital Berlin, Berlin, Germany.
International Journal of Colorectal Disease (Impact Factor: 2.24). 05/2008; 23(4):359-64. DOI: 10.1007/s00384-007-0389-5
Source: PubMed

ABSTRACT and aims To elicit mechanisms and timing of sinus development, the role of age at onset of symptoms, symptomatic disease duration, and consecutive number of sinuses were investigated.
Analysis of 1,962 medical records of patients admitted for primary surgical pilonidal sinus treatment.
Sinus number ranged from 1 to 16 (median 2), with chronic pilonidal disease showing more sinuses than acute disease (mean 2.6 vs 2.1 sinuses; p < 0.0001; Kolmogorov-Smirnov). Disease duration in chronic pilonidal disease was not linked to sinus formation (p = 0.98; Spearman). In acute pilonidal disease, duration was linked to the development of six sinuses per 1,000 symptomatic disease years (p = 0.0001; Spearman). A larger sinus number correlated with earlier onset of symptoms (p = 0.009; Spearman).
Long-standing chronic disease does not produce sinus per se. As sinus does not substantially arise during the course of symptomatic disease, there must be a time before the start of symptomatic disease when the sinus originates. These findings suggest that sinus can only be acquired up to a certain age, even if occupational exposure continues.

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation. METHODS: Between January 1, 2010 and December 30, 2010, 432 corpses were evaluated in the Istanbul Central Office of Forensic Medicine Institute of the Turkish Ministry of Health. RESULTS: 41 of the 432 cases (9.4 %) had SPSD-related findings. 20 (4.6 %) had at least one sinus tract (clinical SPSD) and all of them had at least three positive histopathologic parameters. 16 of 41 cases (3.7 %) were clinically normal but had at least three positive histopathologic parameters (silent SPSD). CONCLUSION: Prevalence of SPSD with clinical examination is 4.6 %. These data are according to the literature. But with inclusion of the silent cases, the prevalence rate increases to 8.3 %. We conclude that inflammatory process does not result in SPSD in nearly half of the cases.
    Surgery Today 11/2012; · 0.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The influence of topical intraoperative gentamycin on long term recurrence rate in primary pilonidal sinus surgery has not yet been investigated. METHODS: One hundred and eight-seven patients following excision of primary pilonidal sinus disease (PSD) and primary symmetrical midline closure were analysed regarding the use (group 1) or non-use (group 2) of topical application of an intraoperative gentamycin sponge after a median follow-up of 16 years by a specific questionnaire. RESULTS: The actuarial 15-year-recurrence rate in group 1 was 31% (34/111) compared to 26% (20/76) in group 2, which was statistically not different (p = 0.99). Recurrences occurred with a median 2.7 (range 0.1–20.1) years after primary surgery, so time to recurrence did not differ between both groups (4.3 ± 0.8 years group 1 vs. 6.8 ± 1.5 years group 2; p = 0.99). CONCLUSIONS: The suggested positive effects of topical gentamycin application on long term recurrence rate could not be confirmed. Astonishingly though, surgical infection does not seem to alter long term recurrence rate. KeywordsPilonidal sinus–Gentamycin–Gentamicin–Wound dehiscence–Wound infection–Long term recurrence rate–Epidemiology
    European Surgery 01/2011; 43(4):236-243. · 0.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: With pilonidal sinus disease (PSD) incidence increasing, lifestyle issues have been suspected to be responsible to worsen the results of PSD surgery at the same time. The influence of smoking and body mass index (BMI) on long-term recurrence rate in primary PSD surgery has not been investigated yet. METHODS: A total of 534 patients (German military cohort) were analyzed, comparing the wound healing rates of non-smoker with smoker, as well as recurrence rates in either groups. Simultaneously, the impact of BMI on wound healing and recurrence was studied. Recurrence rate was determined by Kaplan-Meier calculation following up to 20 years after primary PSD surgery. RESULTS: Using primary open surgery, smokers' and non-smokers' recurrence rates did not differ statistically (p = 0.83; log rank). Comparable rates occurred following the primary midline closure technique (p = 0.14; log rank). A BMI of 25 and higher was not associated with adverse wound healing neither in the primary midline closure (p = 0.14) nor in the primary open treatment group (p = 0.3); nevertheless, a trend may be seen that a BMI of 25 and above could assist a favorable wound healing rate. CONCLUSIONS: The lifestyle parameter smoking and body weight statistically do not complicate wound healing or long-term recurrence rates for the first 20 years following primary PSD surgery in this study. As the BMI of 25 and above may have a beneficial influence on wound healing in primary open and primary midline closure, this observation has to be investigated for the today's surgical procedures of elective first choice-asymmetrical and flap procedures.
    International Journal of Colorectal Disease 06/2013; · 2.24 Impact Factor