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: 2.45). 05/2008; 23(4):359-64. DOI: 10.1007/s00384-007-0389-5
Source: PubMed


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.

1 Follower
8 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although patients with pilonidal sinus are young and, thus, are expected to heal well, a delayed healing with high risk of recurrence frequently is observed. This study was initiated to test whether disorders in the extracellular matrix (ECM) may be detected in patients with pilonidal sinus and delayed wound healing or recurrent disease, respectively. In 48 patients, tissue specimens were obtained at the index operation. All patients were treated by local excision and primary wound closure. The collagen type I/III ratio, the expression of matrix metalloproteinase (MMP)-1, -9, and -13, as well as the proliferation index (Ki67) and the macrophage infiltrate (CD68) were measured. Patients with an uneventful wound healing by primary intention were compared with those in which the healing by primary intention fails (secondary healing), and patients suffering first onset of pilonidal sinus or to those patients who had undergone previous surgery for pilonidal sinus. Clinical parameters and comorbidity were evaluated. Patients with secondary healing, exhibited at the index operation a significantly lower collagen type I/III ratio (2.34+/-0.4) compared with patients with problem-free wound healing (3.04+/-0.7). Furthermore, significantly higher expression of MMP-1, -9, and 13, and a significantly higher proliferation index (Ki67) were found in the specimens of the patients with secondary healing. In patients in whom the operation was performed because of a recurrence expression of both Ki67 and CD68 were significantly higher. Smokers had an increased risk for suffering recurrent disease, but did not show differences in the collagen ratio. As a novel finding, this study indicates that disturbances of the ECM may predict a delayed wound healing after pilonidal sinus surgery.
    World Journal of Surgery 11/2008; 33(1):130-6; discussion 137. DOI:10.1007/s00268-008-9748-9 · 2.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To study potential benefits of postoperative epilation after pilonidal sinus surgery, the long-term effect of hair removal on pilonidal recurrence was investigated. A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996 in three hospitals of the Deutsche Bundeswehr were eligible for the study. Regular hair removal with a razor was recommended for all patients after surgery. A randomly selected sample of 504 patients was contacted for a follow-up telephone interview. The mean follow-up time was 11.3 (standard deviation, 6.4) years. Overall, pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients. A total of 113 patients followed the recommendation to perform epilation (mean duration, 7.5 months), and 391 patients did not. Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01). Razor hair removal increases the rate of long-term recurrence after surgery for pilonidal sinus disease and therefore should not be recommended. However, the rationale for hair removal in pilonidal sinus disease is compelling. Other epilation techniques such as laser hair removal should be investigated in appropriate studies.
    Diseases of the Colon & Rectum 02/2009; 52(1):131-4. DOI:10.1007/DCR.0b013e3181972505 · 3.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Several surgical techniques are being performed in the treatment of pilonidal sinus disease; however there is no single agreed technique that could be used in all patients. In this study we compared the results of the patients on which we implemented Karydakis Technique and Limberg flap procedure, the two most common techniques and tried to find the better operative modality. Methodology: One hundred thirty three patients operated between January 2004 and November 2008 and followed up regularly were included in the study. Patients who came applied due to recurrence were not included. Seventy three patients were operated with Karydakis technique and 60 patients were operated with Limberg flap procedure. Two groups were compared in terms of hospitalization period, work loss period, recurrence rate, infection rate, and whether seroma and hematom formed or not. Results: Operation period, hospitalization period, work loss period were shorter for the patients on which Karydakis technique was implemented (P<0.05). While no statistically significant difference was observed between the two groups in terms of recurrence rate (P=0.034), wound dehiscence, wound infection, hematom/seroma rate were more in Limberg flap group (P=0.001, P=0.032, P=0.022, respectively). Conclusion: Karydakis technique, which is one of the most practiced surgical techniques in treatment of Pilonidal sinus disease, should be a preferred method in terms of shorter operation time, hospitalization period and less work loss and lower complication.
Show more