Timeline of Recurrence After Primary and Secondary Pilonidal Sinus Surgery

Department of Surgery, Bundeswehrkrankenhaus Berlin, Berlin, Germany.
Diseases of the Colon & Rectum (Impact Factor: 3.75). 12/2007; 50(11):1928-34. DOI: 10.1007/s10350-007-9031-4
Source: PubMed


This study was designed to evaluate the timeline of recurrence of pilonidal sinus disease after primary vs. multiple surgery. Data of medical military service in Germany were reviewed.
Telephone interview of 205 patients after pilonidal sinus disease surgery after median interval of 14.8 (standard deviation +/-3.9) years was conducted. A total of 345 patient charts with pilonidal sinus disease recurrence and fully documented previous surgery history were analyzed.
Pilonidal sinus disease recurred in 41 of 205 patients (20 percent; actuarial survival 22 percent) after first surgery. Median recurrence-free-interval was 1.8 (range, 0.1-16.5) years. Twenty-nine of 41 of all recurrences (71 percent) were observed within four years after primary surgery. Fifteen of 50 patients (30 percent) treated by primary closure had recurrent disease after a median recurrence-free interval of 2.7 (range, 0.2-13.5) years compared with 24 of 144 patients (17 percent), who experienced recurrence after rhomboid excision and open wound treatment after a median of 1.8 (range 0.1-16.5) years (P = 0.081, long-rank-test). Analysis of 345 recurrent disease charts revealed that recurrence time decreased for multiple recurrences compared with first recurrence (R1 vs. R2: P = 0.07; R2 vs. R3: P = 0.03, Mann-Whitney U test).
Long-term recurrence rate was 22 percent and thus higher than previously reported. This may be attributed to the long follow-up interval. Recurrences up to 20 years after surgery were seen. Our data provide evidence that follow-up after first to the third pilonidal sinus surgery should complete or exceed five years, because the majority of recurrences occur during this postoperative interval. Nevertheless, even a five-year follow-up will still miss 25 percent of recurrences.

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    • "In our study, recurrences were detected on follow-up visits upon direct patient examination although we believe that the low recurrence rate in our study (2.3%) is probably due to the laser epilation treatments after surgery. In addition, we agree with the necessity of longer follow-ups of the patients, because 75% of the recurrences were detected a minimum of 5 years after the laser treatment.[17] "
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    ABSTRACT: Chronic pilonidal disease is a common debilitating condition. It is a cause of considerable morbidity and social embarrassment. This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal. PATIENTS UNDERGOING SURGERY FOR PILONIDAL DISEASE WERE RANDOMIZED TO TWO GROUPS: those using laser hair removal methods following completed healing of wounds (group I) or regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II). Group I patients received regular, monthly laser hair treatment sessions using Alexandrite laser for four sessions. Group I patients had a mean age of 23.6 ± 4.7 years. Group I patients had monthly laser hair removal session and then they were regularly followed up within the proposed schedule. They found the procedure comfortable with no complications. Group II patients had a mean age of 23.7 ± 6.6 years; they reported difficulty in maintaining hair removal with these conventional methods, and mostly, by the end of the first year, all cases stopped maintaining regular hair removal. Recurrence occurred in Group II patients (two cases) mostly due to failure in maintaining hair removal and area hygiene. We advocate the use of laser epilation after surgery for pilonidal sinus as it decreases the chance of recurrence but larger studies with long-term follow-up are still needed to approve this conclusion.
    Journal of Cutaneous and Aesthetic Surgery 09/2011; 4(3):192-5. DOI:10.4103/0974-2077.91251

  • coloproctology 12/2011; 33(6). DOI:10.1007/s00053-011-0234-8
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    ABSTRACT: A personal series of 141 patients with postanal pilonidal sinus was treated by the Karydakis operation. Each sinus was totally excised with a vertical eccentric elliptical excision. A thick flap was created by undercutting the medial edge and advancing it across the midline so that the whole suture line was lateralized to reduce the risk of recurrence. Follow-up was achieved in 114 patients for 1-108 months; 79 (69 per cent) were followed for more than 18 months. Overall there were five recurrences (4 per cent) which required further surgery. Thirty-three patients (23 per cent) were referred following recurrence or failure of healing after previous surgery elsewhere; all were cured by this method. The Karydakis operation has a low recurrence rate because it produces a shallow midline furrow free from scar or suture holes which is less vulnerable to hair penetration than a midline wound.
    British Journal of Surgery 10/1996; 83(10):1452-5. DOI:10.1002/bjs.1800831040 · 5.54 Impact Factor
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