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Nd-YAG laser treatment of primary and recurrent pilonidal sinus

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Abstract

A pilonidal sinus usually contains hair and extensive vascularization due to inflammation, which theoretically gives Nd-YAG laser waves the potential to destroy the deep fistula systems of the sinus without affecting the overlying skin. We describe our preliminary experience with Nd-YAG laser waves in the treatment of pilonidal sinus. A total of 41 consecutive patients with pilonidal sinus underwent the intended Nd-YAG laser treatment. Structured telephone interviews were carried out in 37 patients (90%). The median duration of treatment and observation time were 5.1 months and 15.2 months, respectively. Three patients (7%) received additional surgery: two had granulomas removed via a minor excision, and one requested more traditional surgery. At follow-up, 28 out of the 37 patients (75.7%) reported freedom from symptoms without supplementary treatment, and 30 (81%) were symptom-free after supplementary laser treatment and minimal surgery, if needed. We have identified a potential treatment for pilonidal sinus that is extremely gentle compared with conventional surgery. We aim to substantially increase the cohort of patients undergoing this treatment and follow up these patients with a register-based technique with a comparable control group. The Nd-YAG laser may prove to be an attractive treatment alternative for pilonidal sinus.

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... The most common symptoms of this disease are generally pain, swelling, and discharge, while the condition can be manifested by abscesses in a smaller percent of patients [23]. In this present study, pain was seen in 80% and swelling in 20%, and all patients had discharge in group 1. ...
... Time to return to daily activities was 2.6 days and 2.8 days in group 1 and group 2, respectively, with no significant difference between the groups (p = 0.92). The results of this study were compatible with the literature findings [9,23]. ...
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The aim of this study was to evaluate the effects of application of platelet-rich plasma in addition to laser pilonidoplasty for the treatment of pilonidal sinus. Twenty-five patients who were treated by laser pilonidoplasty for pilonidal sinus (group 1) and 25 patients who were treated by platelet-rich plasma in addition to laser pilonidoplasty (group 2) at this clinic were included in the study. Patients were classified according to the Irkorucu and Adana Numune’s classification and treatment concept. Duration of stay of the patients in the hospital, time to start daily activities, duration of wound healing, recurrence, and complications were evaluated. Among the 50 patients included in the study, 41 (%82) were males and 9 (%18) were females. The mean age was 25.6 ± 2.4 years and 24.8 ± 3.8 years in groups 1 and 2, respectively. The locations of the pilonidal sinus were similar in the two groups. No statistically significant differences were found in the duration of hospital stay, duration of the procedure, time to return to work, and complication rates between the two groups. Nevertheless, duration of wound healing was 6.1 ± 2.3 and 4.1 ± 0.9 weeks in groups 1 and 2, respectively, and was shorter in group 2. Duration of wound healing was statistically significantly different in the two groups. We concluded in this study that application of platelet-rich plasma in addition to laser pilonidoplasty significantly shortens the time of wound healing.
... Depilation with alexandrite, diode, and Nd:YAG lasers has demonstrated the most consistent evidence. [50][51][52][53][54] The firm texture and quality of the hair is proposed to incite an inflammatory response with sinus formation; therefore, using a laser to permanently remove this factor may help prevent future disease. ...
Article
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Pilonidal sinus disease often presents as a chronic problem in otherwise healthy hirsute men. A range of conservative techniques to surgical flaps have been employed to treat this condition. We review the literature on management of pilonidal sinus disease, including conservative and surgical techniques as well as novel laser therapy. Given current evidence, off-midline repair is now considered the standard of care; however, no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap. Treatment should be tailored to the individual, taking into account recurrent disease, recovery time, and the surgeon's comfort with the procedure.
... Lasers are emerging as primary and adjuvant treatment options for pilonidal sinuses. Depilation with alexandrite, diode, and Nd:YAG lasers has demonstrated the most consistent evidence [29][30][31][32][33] . The firm texture and quality of the hair is proposed to incite an inflammatory response with sinus formation; therefore, permanent removal of hair by the use of laser shall help prevent the recurrence of disease. ...
... The median followup time was 15.2 months. Some patients described temporary soreness and redness at the site of laser treatment [37]. ...
Article
Objective: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the management of pilonidal disease. Methods: The PubMed, Cochrane, Embase, Web of Science, and Scopus databases from 1965 through June 2017 were queried for any papers addressing operative or non-operative management of pilonidal disease. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived for three questions based on the best available evidence, and a clinical practice guideline was constructed. Results: A total of 193 articles were fully analyzed. Some non-operative and minimally invasive techniques have outcomes at least equivalent to operative management. Minimal surgical procedures (Gips procedure, sinusectomy) may be more appropriate as first-line treatment than radical excision due to faster recovery and patient preference, with acceptable recurrence rates. Excision with midline closure should be avoided. For recurrent or persistent disease, any type of flap repair is acceptable and preferred by patients over healing by secondary intention. There is a lack of literature dedicated to the pediatric patient. Conclusions: There is a definitive trend towards less invasive procedures for the treatment of pilonidal disease, with equivalent or better outcomes compared with classic excision. Midline closure should no longer be the standard surgical approach. Type of study: Systematic review of level 1-4 studies. Level of evidence: Level 1-4 (mainly level 3-4).
... Neben anderen dermatologischen Erkrankungen fokussiert sich die Laserbehandlung auch auf die Pilonidalsinus-Erkrankung. Dabei wird das Prinzip minimalinvasiver Techniken mit dem Laser kombiniert. Die frühpostinterventionellen Ergebnisse erscheinen vielversprechend [26,27]. Dennoch ergibt sich zum jetzigen Zeitpunkt keine gute Evidenz, dass diese technisch anspruchsvolle Behandlungsoption sichere Vorteile gegenüber den anderen lokal destruierenden Verfahren bietet. ...
Article
INTRODUCTION: Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patient's needs. METHODS: Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results. RESULTS: The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term. CONCLUSION: Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.
Article
Background: It has been suggested that removal of body hair in the sacrococcygeal area prevents recurrence after surgery for sacrococcygeal pilonidal sinus disease (SPSD). The aim of this study was to review the literature regarding the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD. Methods: A systematic search was performed in PubMed, EMBASE, and The Cochrane Library by using synonyms for SPSD. Title, abstract, and full text were screened by two independent reviewers. Data were systematically collected from all included studies by using a standardized data extraction form. Results: The search and selection yielded 14 studies, involving 963 patients. The study design of the included studies was: retrospective cohort (n = 7), prospective cohort (n = 3), randomized controlled trial (n = 2), and case-control (n = 2).The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months. The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD. Conclusions: This systematic review showed a lower recurrence rate after laser hair removal compared to no hair removal and razor/cream depilation. Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required.
Article
Background Various surgical techniques are available for the management of pilonidal sinus, but there is still controversy concerning the optimal surgical approach. The aim of our study was to evaluate the safety, efficacy and clinical outcome of the laser procedure for the treatment of pilonidal sinus. Patients – Methods Patients suffering from pilonidal sinus were operated with Sinus Laser Therapy (SiLaT) in our Institute. SiLaT was applied under local anaesthesia after a small skin incision of 0.5‐1cm and careful cleaning of the sinus tracts with a curette. A radial fiber connected to a diode laser set at the wavelength of 1470 nm was then introduced into the tracts. The laser energy was delivered in continuous mode. Results Two‐hundred and thirty‐seven (237) patients suffering from pilonidal sinus were operated using the theSiLaT laser procedure in our referral Institute and prospectively evaluated (183 males, median age 24 years, range 14‐58). A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30‐70 days). A second treatment was offered for patients failing in the first session and was successful in 78.3% (18/23). The procedure duration ranged between 20 and 30 minutes and had limited morbidity (wound infection in 7.2%, 17 of 237). Conclusions The Sinus Laser Therapy (SiLaT) proved to be a safe and effective procedure to treat patients suffering from pilonidal sinuses. Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques. This article is protected by copyright. All rights reserved.
Article
Background Based on the presumed role of hair in pilonidal cyst (PNC) pathogenesis, laser epilation has been used to decrease recurrences. However, most of the data rely on case reports and uncontrolled series, the rare controlled studies reported conflicting results. The objective of this study was to investigate the efficacy of laser hair removal (LHR) to decrease the recurrence rate after surgery of PNC versus surgery alone. Methods We conducted a retrospective monocentric case control study in the departments of Pediatric surgery and laser center of Dermatology of the university Hospital of Nice in France from January 2010 to June 2017. We included all patients with PNC who had surgery during the period and we compared patients who had LHR after surgery to those having surgery alone. The main outcome was the prevalence and number of recurrences of PNC in each group. Results Twelve patients ‐ 8 treated with Alexandrite laser and 4 patients with Nd:YAG ‐ were included in the cases group; 29 patients treated with surgery alone were included in the control group. The mean and the median number of laser sessions were 4.2 and 5, respectively (extremes 1‐10). The post‐surgical recurrence rate without LHR was 51.7% and their number varied from 1 to 3. A significant decrease of the recurrence rate was observed after LHR (8.3%) compared to control group (p <0.001). The median duration before recurence was 14 months for surgery alone. The median follow‐up was 18 months (1‐30 months) for LHR group and 30 months (6‐72 months) for surgery alone group. Two patients had abnormal healing or persistent sinus after surgery alone compared to none in the group who undergone laser procedure after surgery. Conclusions LHR decreases the risk of delayed healing and of recurrences of PNL after surgical procedure. This article is protected by copyright. All rights reserved.
Chapter
Erkrankungen an Po und Enddarm sind lange negiert, wenig erforscht und zu lange nachlässig behandelt worden. Bei einer Inzidenz von 38 Erkrankungen je 100.000 Einwohner werden in Deutschland jährlich 40.000 junge Menschen an einem Pilonidalsinus operiert – mit steigender Tendenz. In der Altersgruppe vom 15. bis zum 45. Lebensjahr werden derzeit stationär mehr Pilonidalsinus-Patienten operiert als Patienten mit Leistenhernien. In den letzten Jahren sind der Pilonidalsinus und seine Besonderheiten im chirurgischen Bewusstsein angekommen und werden heute von Prokto-Chirurgen, Allgemeinchirurgen, Viszeralchirurgen, Dermatologen und Plastischen Chirurgen operiert. Ernstzunehmende Forschungsarbeiten mit ausreichend großen Kollektiven und langer Nachbeobachtungszeit sind zunehmend verfügbar, und in Deutschland sind hochkarätige Leitlinien über die Fachgesellschaften und die AWMF publiziert worden.
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We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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The literature review compares laser and traditional surgery for hemorrhoids. The efficiency and possibility of minimally invasive treatment using laser of different wavelengths were analyzed. The review described the innovative technologies of laser treatment of hemorrhoids which make this method promising.
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Purpose Surgical treatment remains the first-line therapy of pilonidal cyst but is associated with high levels of post-operative pain, adverse events and a recurrence rate of 30%. We report our experience with laser hair removal using the Nd-YAG laser for the treatment of pilonidal cyst. Materials and methods Ten patients affected by pilonidal cyst were examined and treated from October 2011 to November 2016. Treatments were carried out using the Nd-YAG laser (Deka M.E.L.A, Calenzano, Florence, Italy) at a wavelength of 1064 nm at 30-day intervals. Results Nine patients were asymptomatic after the second treatment, while in one case the symptom disappeared after the fourth session. After 4-8 treatments, the pilonidal cyst had clinically disappeared and patients subjectively felt healed. In all cases, the soft-tissue ultrasounds performed before the first and after the last session showed the disappearance of the pilonidal cyst. In the follow-up all the patients remained asymptomatic without any disease recurrence. Conclusions Nd-YAG laser is an effective treatment for pilonidal cysts, providing excellent results with quick healing and no risk of serious adverse side-effects. It could be a very attractive alternative to open surgery, enabling patients to prevent the frequent and severe postoperative issues associated with surgery.
Article
Background: Laser hair depilation has shown promise in small series of patients with pilonidal sinus disease. The purpose of this study was to review the published literature on laser hair depilation in pilonidal disease to determine its effect on disease recurrence. Methods: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify all studies published through December 1, 2017 that examined the role of laser hair depilation in the treatment of pilonidal sinus disease. Study characteristics, including design, treatment regimen, number of patients evaluated, rate of recurrence, and duration of follow up were recorded. Results: Thirty-five published studies were included. Of these, 28 studies were retrospective and seven were prospective. There were five comparative studies: two retrospective, one prospective observational, and two randomized controlled trials. The number of patients included in each study ranged from one to 86 patients and patients received between one and 11 laser treatments. The pilonidal disease recurrence rate after laser depilation ranged from 0% to 28% at a mean follow-up ranging from 6 months to 5 years across studies. Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort. Conclusion: Laser hair depilation is a promising therapy in the management of pilonidal disease. However, the literature published to date is heterogeneous and has limited generalizability. Additional research is needed to determine the effectiveness of laser hair depilation to prevent pilonidal disease recurrence.
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Pilonidal sinus disease (PSD) most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.
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The effectiveness of a modified Lord–Miller procedure in the management of pilonidal sinus disease, in terms of wound complications, healing rate and recurrence, was assessed. This is a retrospective study of 44 patients with simple and complicated pilonidal sinus disease, operated on using a modified Lord–Miller procedure from September 2011 to May 2013. Patients were seen in the clinic once a week until completely healed, and again 1 year after surgery. Patients were observed for complications and recurrence. A total of 23 (52%) sinuses were complicated. A total of 21 (48%) patients had a history of previous surgery. All the patients were followed for a period of 12–32 months (median: 17.5 months). Three patients (6.8%) developed wound infection. Complete healing was achieved in 2–7 weeks (mean: 3.6 weeks). The disease recurred in 2 (4.5%) patients, and 42 (94.5%) of the patients were completely cured. A total of 37 (84%) cases were carried out as day case surgery. A modified Lord–Miller procedure was shown to be highly effective in treating complicated pilonidal sinus with a low recurrence rate.
Article
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Hintergrund Der Sinus pilonidalis ist eine erworbene Erkrankung. Haare spielen bei der Pathogenese eine wichtige Rolle. Das Ziel dieser Leitlinie ist, die Vor- und Nachteile verschiedener Behandlungsverfahren aufzuzeigen und eine optimale evidenzbasierte Therapieempfehlung abzugeben. Methode Es wurde ein systematisches Review der Literatur vorgenommen. Die Aussagen der Leitlinie wurden auf einer Konsensuskonferenz verabschiedet. Ergebnisse Es können 3 Erscheinungsformen des Sinus pilonidalis differenziert werden: der blande Befund ohne stattgehabte Exsudation, der akut abszedierende und der chronische Sinus pilonidalis. Die häufigste Erscheinungsform des Pilonidalsinus ist das chronische Stadium mit intermittierenden Absonderungen. Zurzeit existiert keine Therapieoption, die alle Anforderungen an eine einfache, schmerzfreie Behandlung mit schneller Wundheilung und geringer Rezidivrate erfüllt. Schlussfolgerung Ein blander Sinus pilonidalis bedarf keiner Therapie. Bei der akut abszedierenden Form ist eine primäre Exzision möglich, der Vorteil des komplikationsarmen Verfahrens wird durch den Nachteil einer langen Wundheilung und möglicherweise höheren Rezidivrate erkauft. Es gibt Hinweise darauf, dass zunächst eine Abszessexzision und eine sekundäre Versorgung des Sinus pilonidalis durch eine der weiter unten beschriebenen Behandlungsmethoden vorteilhaft sind. Die Ergebnisse einer primären Rekonstruktion bereits im abszedierten Stadium sind aufgrund einer hohen Komplikationsrate nicht zufriedenstellend. Beim chronischen Sinus stellt die Exzision derzeit die Basisbehandlung dar. Die offene Wundbehandlung mit sekundärer Wundheilung ist hinsichtlich der Komplikationsrate ein sicheres Verfahren, das aber mit einer langen Wundheilungsdauer einhergeht. Die minimal-invasive Technik – das sog. Pit-Picking – stellt ebenfalls eine Behandlungsoption für die chronische Erscheinungsform dar, wobei mit einer höheren Rezidivrate im Vergleich zu den Exzisionstechniken gerechnet werden muss. Die Anwendung des Mittellinienverschlusses zur primären Wunddeckung ist in keiner Hinsicht zufriedenstellend und sollte vermieden werden. Alternativ sollten die plastischen (asymmetrischen) Techniken und Verschiebelappen verwendet werden. Ein eindeutiger Vorteil für eine dieser Techniken besteht nicht, wobei Limberg- und Karydakis-Lappen die derzeit am häufigsten angewendeten Verfahren sind.
Article
Background: Minimally invasive procedures have increasingly been used to treat pilonidal disease; however, the mid-term and long-term results have not been evaluated extensively yet. Patients and methods: All patients underwent "pit picking" surgery. The surgery was performed under local anesthesia. The technique of "pit picking" was: all midline pits were removed by excising a margin of skin of < 1 mm. An incision of 1 cm parallel to one side of the natal cleft opened the chronic abscess cavity. No specific postoperative wound care was given. Results: A total of 153 patients (126 males) underwent "pit picking" surgery between June 2007 and November 2010. Follow-up information was available for 148 patients (97 %). Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second"pit picking" procedure. By multivariate analysis, smoking (hazard ratio [HR] 2.1) and occurrence of an abscess during the course of disease (HR 2.7) were statistically significantly associated with the disease recurrence after "pit picking" surgery. Conclusion: Approximately three quarters of selected patients with pilonidal disease benefit from minimally invasive "pit picking" surgery.
Article
Background: The treatment of pilonidal sinus disease still remains challenging. Despite many non-surgical and surgical methods, no consensus emerged for the best treatment. We describe a new innovative technique consisting in the destruction of the pilonidal cyst with a radial laser probe (FILAC(TM), Biolitec, Germany). The energy delivered causes the destruction of the sinus epithelium and the simultaneous obliteration of the tract. Method: In December 2015, we retrospectively studied the data of our 40 first patients operated with this technique between September 2014 and September 2015. The mean follow-up period was 234 days (92-316). There were 33 men and 7 women. The mean age of the patients was 25.2 years (15-46). Results: The success rate was 87.5% (35 patients/40). Recurrence rate was 2.9% (1 patient/35). Hospital stay was 1 day for all the patients with no re-hospitalisation during the follow-up. The mean duration of soiling before healing was 18.6 days (2-35). The mean duration of pain-killers intake was 4.9 days (0-14). Four patients presented complications: 2 hematomas (5%) and 2 abscesses (5%), all medically treated. Conclusion: The destruction of a pilonidal cyst with a laser probe is a safe, simple and minimally invasive technique. The success rate is good. Hospital stay is short, pain is light and complications are few as well as the number of patients needing post-operative care, allowing a rapid return to work or school. This technique could be proposed as a first-line treatment to the majority of patients with a pilonidal sinus disease.
Article
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Background: Laser hair depilation is a promising therapy in the management of pilonidal disease. However, the large controlled trials needed to demonstrate the effectiveness of this practice have not been performed. Methods: We designed a single-center randomized controlled trial that will enroll 272 patients with pilonidal disease. Patients will be randomized to receive laser hair depilation of the sacrococcygeal region or the best recommended standard of care. The primary outcome is the rate of recurrent pilonidal disease at 1 year, defined as development of a new pilonidal abscess, folliculitis, or draining sinus after treatment, which would require antibiotic treatment, additional surgical incision and drainage, or excision within 1 year of enrollment. Secondary outcomes include each of the following at 1 year: disability days of the patient, disability days of the caregiver, health-related quality of life, healthcare satisfaction, disease-related attitudes and perceived stigma, pilonidal disease-related complications, pilonidal disease-related procedures, surgical excision, postoperative complications, and compliance with recommended treatment. Discussion: This study will determine the effectiveness of laser hair depilation to reduce pilonidal disease recurrence in adolescents and young adults as compared to the best recommended standard of care. Trial registration: ClinicalTrials.gov, NCT03276065 . Registered on 8 September 2017.
Article
Background Pilonidal sinus is a disease of subcutaneous tissue, where infections and hair play an important role. Several therapeutic surgical options are currently available but show clear differences particularly with respect to invasiveness; however, there is no procedure that completely combines all advantages of a high healing rate, low recurrence rate and minimal discomfort for the patient. Objective It is unclear if antibiotic therapy can play a supportive role in pilonidal surgery. Furthermore, several minimally invasive procedures, such as endoscopic and laser techniques have been put forward for treatment of pilonidal sinus. Results and conclusion Concerning the currently available worldwide literature there is no compelling evidence for the use of antibiotics by parenteral, enteral or local administration. This must be left to the discretion of the surgeon. Whereas sufficient evidence for laser coagulation of pilonidal sinus alone has not yet been achieved, laser depilation as a means of possible postoperative recurrence prevention might play a role. The results of studies indicate that laser depilation is superior to other methods of depilation (shaving, creams) and is able to lower the recurrence rate. Its use could be considered particularly for problem cases. A final conclusion for the use of endoscopic techniques is currently also not possible. Endoscopic techniques are a new approach and the minimally invasive nature has some advantages. Nevertheless, its advantages compared to the easier to handle and more cost-effective pit-picking methods have to be proven.
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Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13–68), and the median operative time was 26 (range 6–65) min. With a median follow-up of 12 (range 7–25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7–14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.
Article
Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
Article
Zusammenfassung Einleitung Der Sinus pilonidalis ist eine meist chronische punktuelle Infektion der behaarten Haut im Bereich von Hautfalten mit der häufigsten Lokalisation im Bereich der Rima ani. Die Erkrankung hat oft erhebliche Auswirkung auf die Lebensqualität der Betroffenen, die Behandlung kann komplex sein und muss dem Patientenbedarf angepasst werden. Methoden Im Folgenden wird eine Übersicht über die Entstehung sowie die Behandlungsalternativen und deren Besonderheiten gegeben. Dabei werden jeweils die Aspekte frühe postoperative Ergebnisse, Wundheilungsstörung und Langzeitergebnisse dargestellt. Ergebnisse Der Pathomechanismus der Pilonidalsinus-Erkrankung ist weiterhin nicht abschließend geklärt, es muss auch weiterhin davon ausgegangen werden, dass die Haare in der Rima ani wesentlich zu Entstehung beitragen. Neuere Erkenntnisse weisen jedoch darauf hin, dass die großen Haarbüschel, die immer wieder in der Wundhöhle gefunden werden, am ehesten von der behaarten Kopfhaut stammen. Es lassen sich im Wesentlichen 3 Gruppen der Behandlungsoptionen unterscheiden: Die Standardbehandlung der Exzision und die folgende offene Wundbehandlung hat eine geringe Rezidivrate, weist jedoch erheblichen Aufwand im Rahmen der Wundbehandlung auf und führt dadurch zu langer Krankheitsdauer. Relativ neu in den Fokus geraten sind die lokal destruierenden Behandlungsverfahren, welche die Haut im Wesentlichen erhalten. Wichtige Vertreter sind das sog. Pit Picking, Fistuloskopie und andere Behandlungsformen wie Phenolinjektion oder Laserbehandlung. Bei diesen Behandlungsmöglichkeiten steht die abschließende Bewertung der Ergebnisse noch aus. Die 3. Behandlungsgruppe umfasst die Exzision und plastisch-rekonstruktive Verfahren. Diese Verfahren sind technisch aufwendig, gehen häufig mit stationärer Behandlung einher und führen langfristig jedoch zu relativ guten Ergebnissen. Schlussfolgerung Die Pilonidalsinus-Behandlung erfordert eine am Patienten orientierte Therapieplanung. Dabei müssen dem Patienten die unterschiedlichen Behandlungsoptionen vermittelt werden und eine Behandlungsempfehlung muss ausgesprochen werden. Hier dient die Exzision und offene Wundbehandlung weiterhin als Standardverfahren, anhand dessen die Vor- bzw. Nachteile der anderen Behandlungsoptionen vermittelt werden können.
Article
Background Phenolisation of Sacrococcygeal pilonidal sinus disease (SPSD) seems to have advantages over radical excision; however, a randomized-controlled trial (RCT) comparing both techniques is lacking. The aim of our study was to compare sinus pit excision and phenolisation of the sinus tract with radical excision in SPSD in terms of return to normal daily activities. Methods This study was a single-center RCT. Fifty patients who presented with primary SPSD were randomized to phenolisation and 50 patients to excision. The primary endpoint was time to return to normal daily activities. Secondary endpoints were quality of life, complaints related to SPSD, surgical site infection, and wound epithelialization. Patients were treated in a 1-day surgery setting. Complaints related to SPSD were evaluated and symptoms were scored by the participants on a 6-point scale before surgery, and patients kept a diary for 2 weeks on complaints related to the surgical treatment (the same scoring system as preoperatively) and pain, evaluated with a VAS. Quality of life (QoL) was measured preoperatively with a VAS and the Short Form-36 Health Survey (SF-36). At 2, 6, and 12 weeks after surgery, patients were evaluated using a questionnaire containing the following items: patients’ satisfaction (disease, compared with preoperatively, scored as cured, improved, unchanged or worsened), five complaints related to the surgical treatment (the same scoring system as preoperatively and in the diary), QoL (VAS and SF-36), and return to normal daily activities. The wound was assessed 2, 6, and 12 weeks postoperatively by one of the investigators (EF or NS), using an assessment form Results The mean time to return to normal daily activities was significantly shorter after phenolisation (5.2 ± SD 6.6 days vs. 14.5 ± 25.0 days, p = 0.023). 2 weeks after surgery, all patients in the phenolisation group and 85.4% of patients in the excision group returned to normal daily activities (p = 0.026). Pain was significantly lower after phenolisation at 2 weeks postoperatively (0.8 ± 1.0 vs. 1.6 ± 1.3, p = 0.003). Surgical site infection occurred significantly more often after radical excision (n = 10, 21.7% vs. n = 2, 4.0%, p = 0.020). At 6 and 12 weeks, complete wound epithelialization was more frequently achieved after phenolisation (69.0% vs. 37.0%, p = 0.003 and 81.0% vs. 60.9%, p = 0.039, respectively). Conclusions Pit excision with phenolisation of SPSD resulted in a quicker return to normal daily activities, less pain, and quicker wound epithelialization compared to radical excision. Surgeons should consider phenolisation in patients with primary SPSD.
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У статті проаналізовано досвід багаторічного використання металоостеосинтезу ребер за допомогою спиць та пластин для хірургічної стабілізації каркасу грудної клітки при травмі. Встановлено, що використання методу має ознаки комплексного підходу; основний термін застосування – відстрочений (89,1% випадків); використання даного методу дає змогу досягти добрих безпосередніх результатів у 91,9% випадків; частка післяопераційних ускладнень становить 6,8%. Стабілізація переломів ребер є абсолютно необхідною процедурою під час надання допомоги постраждалим з переломами ребер і груднини. Вибір методу хірургічної стабілізації залежить від стану хворого, досвіду клініки та/або хірурга, джерела фінансування.
Article
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Висвітлено епідеміологічні, клінічні та діагностичні аспекти епітеліальних куприкових ходів. Проаналізовано сучасні методи діагностики та лікування даної патології. Розкрито проблемні питання рецидивів даного захворювання.
Article
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Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2-0.4) and flaps (95% CI 0.1-0.5) and up to 6.3% for incision (95% CI 3.2-9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0-0.8) up to 67.2% for incision (95% CI 7.5-100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0-0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Background The treatment of pilonidal sinus disease still remains challenging mainly because of multiple factors responsible for wound healing and its recurrence. With recent advances in surgical field, use of laser found to be an effective technique in the destruction of a pilonidal cyst. Laser Piolonidotomy is a new promising technique. Methodology An exploratory study was planned with the Aim, to evaluate a new technique for the excision of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity the degree of postoperative complications and rate of recurrence and patient’s satisfaction. All the patients with pilonidal sinus were categorized and laser pilonidotomy was planned for patients satisfying inclusion criteria. Data collected in pre-structured, pre-tested proforma and analyzed using SPSS. Results Mean duration of Procedure was 33 min (SD = 11), mean duration of Hospital Stay was 12 h (SD = 3), resumption of normal activity within 4 days (SD = 2), mean duration for Complete Wound Healing by secondary intention 6 Weeks (SD = 1.25). Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient’s satisfaction was 97.84%. Conclusion Laser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient’s satisfaction.
Article
Background In 2014, we started to treat pilonidal sinus disease in our institution with sinus laser-assisted closure (SiLaC) procedure. The aim of the present study was to evaluate the safety and efficacy of the SiLaC procedure in a single institution prospective study on a large cohort of patients and with a long follow-up period, and try to determine what factors that could influence healing and recurrence. Methods A prospective study was conducted on consecutive patients with primary pilonidal sinus disease operated on with the SiLaC procedure at our institution from March 2015 to August 2017. Demographic and surgical data, outcomes, and complications were prospectively recorded and compared between the healed and not healed/recurrence groups to find factors influencing healing. Postoperative follow-up was performed in the outpatient clinic every 2 weeks for 2 months. In March 2018, patients were questioned by mail or phone to assess long-term recurrences. Results There were 200 patients. The healing rate was high (94%) with a mean healing time of 19.5 ± 14.4 days. Mean operative time (9.4 ± 2.6 min) and mean duration of postoperative analgesic therapy (4.72 ± 5.64 days) were short. Postoperative complications (15%) were mainly infection (9.5%). There was a response rate of 77.5% to mail/phone questionnaires about recurrence. The recurrence rate was 14.9%. Mean time until recurrence was 193.5 ± 87.19 days. The incidence of secondary openings, complications, and infection in the healing vs not healed or recurrence groups, was 24.8% vs 56.6%, 19.2% vs 40%, and 8.8% vs 30%, respectively. Conclusions SiLaC is an effective, easy to perform, reproducible, and almost painless procedure. Factors influencing healing seem to be the presence of secondary openings, postoperative complications, and, especially, infection. The SiLaC procedure could become one of the treatments of choice for pilonidal sinus disease.
Article
Background and objectives: An ideal treatment for pilonidal disease should feature a low recurrence rate, minimal incision, and rapid return to daily activities. We compared the outcomes of the well-defined Karydakis technique (KT) and a combination of pit excision (PE) and sinus tract ablation using 1,470-nm diode laser. Study design/materials and methods: In this study, from January 2016 to January 2018, patients diagnosed with uncomplicated early-stage pilonidal sinus disease were enrolled and were treated randomly, using KT (n = 28) or a PE/laser ablation technique (PE + LAT; n = 30). Results: The mean operative times were 36.4 (25-45) minutes in the KT group and 15.1 (12-20) minutes in the PE + LAT group. Postoperative Visual Analog Scale pain scores were 4.4 in the KT group and 2.1 in the PE + LAT group. The time periods to return to normal daily activities were 2.6 (1-5) days in the PE + LAT group and 12.8 (10-20) days in the KT group. The mean Likert satisfaction scores were 3.8 in the KT group and 4.8 in the PE + LAT group. The groups did not differ in terms of recurrence. Conclusions: Compared with the KT, the PE + LAT was associated with a shorter operative time, a more rapid return to normal activities, less pain, and a higher level of subjective satisfaction. We found that the PE + LAT was better than the KT for patients with early-stage disease. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
Article
Background: Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries. Objective: To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus. Methods: Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period. Results: Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication. Conclusion: This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.
Article
We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively. Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin. A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.
Article
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Pilonidal sinus (PNS) is chronic inflammatory process of the skin in the natal cleft. Management of PNS is mainly surgical. Although different types of surgery have been performed, the recurrence rate is still high. To evaluate the effectiveness of laser hair removal (LHR) in the natal cleft area on the recurrence rate of PNS as an adjuvant therapy after surgical treatment. Twenty five patients with PNS were included in this study. Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group. All of the patients were male patients. Their age ranged from 17 to 29 years with a mean of 21.60 +/- 3.13 years. They had Fitzpatrick skin type III, IV and V. The patients have got 3 to 8 sessions of LHR (mean 4.87 +/- 1.64). Follow up period lasted between 12 to 23 months. None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS. Pain was the most frequent side effect and it was seen in 6 patients (40%). LHR can prevent the recurrence of PNS. LHR should be advised as an essential adjuvant treatment after surgical excision of PNS. In non-complicated recurrent PNS, LHR is strongly advocated to be started before and continued after doing surgical treatment.
Article
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 understaken 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.
Article
A 38-year-old woman with a recurrent suppurative pilonidal cyst was successfully treated causally with an Nd-YAG (neodymium-doped yttrium aluminium garnet) laser, and with no recurrence at 3-month follow-up. A similar success was observed for another 15 consecutively treated patients, including suppurative cases. The effect could be attributable to the ability of the YAG laser to operate at a wavelength of 1064 nm and to penetrate the skin to levels deeper than that of most other lasers before the energy is absorbed in melanin and oxyhaemoglobin. Consequently, the contents of the cyst can be reached and destroyed. The treatment could be a very attractive alternative to open surgery.
Article
The surgical treatments for pilonidal sinus disease often result in recurrences, and the patients risk requiring multiple surgical interventions. To evaluate the role of alexandrite laser hair removal after surgery in pilonidal sinus disease. Sixty patients who underwent surgical treatment of pilonidal sinus disease and were treated with a 755-nm alexandrite laser after surgery between 1999 and 2007 were examined retrospectively. The charts were reviewed, and the patients were interviewed on the telephone about their post-laser period and recurrence. The laser parameters, patient history, and surgical details were recorded. The overall recurrence rate was 13.3%, after a mean follow-up period +/- standard error of the mean of 4.8 +/- 0.3 years. The mean number of laser treatment was 2.7 +/- 0.1. Seventy-five percent of the recurrences were detected after a follow-up period of 5 to 9 years. Fifty percent of the recurrent cases had drainage and secondary intention before the laser epilation. Our results strongly suggest that laser hair removal after surgical interventions in pilonidal sinus disease decreases the risk of recurrence over the long term.
Article
Surgical treatment of pilonidal sinus often leads to significant pain, extended period of wound healing and convalescence, and carries a substantial risk of recurrence. Based on extant surgical evidence, the present review suggests a differential step-up surgical strategy to optimise surgical outcome in the treatment of pilonidal sinus.
Article
Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.
Article
Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.
Article
We evaluated the treatment of the human prostate with the Nd:YAG laser using a Cytocare Prolase II fiber. We utilized this first in 12 patients prior to radical prostatectomy and then appropriately serially sectioned the prostate to measure the depth of penetration. The studies clearly revealed that 60 W of power and 60 s of pulse duration gave the most consistent depth of penetration in the human prostate model. This depth of penetration averaged 2 cm in the glands that were removed. At the same time there was absolutely no evidence of damage to the neurovascular bundle or to the capsule of the prostate using the above-mentioned dosimetry regime. This study was then transferred to our initial experience in treating 50 patients with benign prostatic hypertrophy and obstructive voiding symptoms. The first 25 patients were also treated with so-called spot radiation of the prostate, whereas the second 25 patients were treated by total photoirradiation of all visible endoscopic tissue. The results reveal that both groups of patients had a fairly highly satisfactory result as measured objectively with American Urological Association (AUA) symptom scores and uroflow studies. In the latter group (photoirradiation of all visible endoscopic tissue) a significantly higher dose of laser energy was utilized and a smaller failure rate was noted on a long-term basis in patients who subsequently came to transurethral resection of the prostate (TURP) because of failure of the laser procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
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.
Article
The frequency of wound complications following operation for pilonidal disease in our department was compared with results from the literature. The case-records of 88 consecutive patients operated for 100 sinuses (12 recurrences), were evaluated retrospectively, supplemented by a questionnaire. Wound healing problems occurred in 69% of the sutured sinuses. Length of hospitalization was two days in uncomplicated, five days in complicated, and eight days in open treated cases. Convalescence (days off work) took 25 days, 41 days and 26 days, respectively. There was no correlation between previous history of pilonidal disease, wound healing complications, and outcome (recurrence frequency). Relapses occurred in 18%. In conclusion, the closure of pilonidal sinuses had a high frequency of wound healing complications and recurrences.
Article
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. 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. 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. 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.
Article
To compare open with closed treatment of chronic pilonidal sinus. From 1993 to 1996, 100 patients were submitted to excision of chronic pilonidal sinus, with local anaesthesia and were randomized in two groups: group A in which open treatment and group B in which direct suture were performed. The follow-up, ranging from 37 to 89 months, was performed by outpatient visits or by phone. Short-term results showed 6 (12.0%) post-operative complications in group A vs 10 (20.0%) in group B. Long-term results showed 9 (18.0%) complications in group A vs 7 (14.0%) in group B. Mean wound healing was 58 days (range: 29-93) in group A vs 12 (range: 9-61) in group B. The return to normal activity was 25.7 (range: 11-77) vs 10.4 (range: 5-32). Wound healing and the return to normal activity were the only statistically significant differences. Regarding morbidity neither technique has particular advantages over the other. The closed technique produced quicker wound healing and a quicker return to normal activity.
Article
Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patient discomfort. Controversy still exists about the best surgical technique for the treatment of the disease in terms of recurrence rate and patient discomfort. From January 2000 to November 2003, 100 consecutive age- and sex-matched patients with chronic pilonidal sinus disease were randomized to receive surgical treatment in the forms of either excision and primary closure or rhomboid excision and Limberg flap. Time to return to work and to complete healing were recorded. To evaluate quality of life and patient comfort, all patients were asked to complete a questionnaire including short form 36, Visual Analogue Scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Each group was composed of 50 patients. Mean follow-up was 19 months. There was a significant difference between the groups in terms of length of hospital stay (P=.005), time to complete healing (P<.001), time off work (P<.001), and wound infection rate (P=.03). Statistically significant differences were noted between the groups in items of general health perception (71.1+/-11.7 vs 78.2+/-14.1; P=.008), social functioning (87.3+/-32.8 vs 110.4+/-33.8; P=.001), and pain (54.5+/-14.0 vs 67.5+/-18.4; P<.001). Times to sitting on toilet and walking without pain showed significant differences between the groups (P=.006 and P<.001, respectively). The mean postoperative Visual Analogue Scale scores were 6.5+or= 1.7 and 7.4+/- 1.4, respectively (P<.001). Shorter hospital stay, earlier healing, shorter time off work, lower ratio of complications, lower pain perception, and improved general health perception are the main advantages of te Limberg flap technique in pilonidal sinus surgery. All together, these parameters add to patient comfort and satisfaction after surgical treatment.
Article
A 23 year-old woman with a nonsupporative pilonidal cyst was successfully treated causally with Nd-YAG laser, and without any recidivate after 9 months follow-up. The mechanism is presumed to be that YAG-laser has a wave-length of 1064 nm. Consequently, the wave penetration through the skin is deeper than most other lasers before the energy is absorbed in melanin and oxyhaemoglobin, so the contents of the cyst can be reached and destroyed. The treatment could be a very attractive alternative to open surgery.
Article
Treatment of pilonidal fistula often results in impaired wound healing and recurrence. After wide excision of the fistula, impaired healing and recurrence occur in up to 69% and 10-29% of cases, respectively. Based on these facts we decided to implement Bascom's cleft-lift operation. 59 patients (53 male) underwent surgery between September 2004 and January 2007. The median age was 27.7 (16-48) years. The indication for surgery was recurrent pilonidal cysts in 17 cases, impaired wound healing after prior surgery in 7 cases and large cysts in 35 cases. All the patients, with the exception of one, were discharged less than 24 hours post surgery (47 (80%) as out-patient procedures). The last patient needed morphine postoperatively, and was discharged after 48 hours. 28 (47%) patients experienced no postoperative complications. 4 (7%) of the 59 patients underwent reoperation due to infection, but none of these patients received postoperative antibiotics. 26 (44%) patients developed minor wound defects. In 22 (85%) of these cases, the wounds healed spontaneously in less than 3 months. 42 patients were followed for more than 6 months with a median follow-up of 19 (8-29) months. 39 (93%) patients did not experience recurrence while the 3 cases of recurrence were observed after 5, 8 and 9 months. Bascom's operation seems to reduce postoperative pain, complications, and the risk of recurrence compared with simple excision with or without primary wound closure. The procedure is simple and can be performed as fast-track surgery.
Komplikationer efter operation for cystis pilonidalis
  • K Zieger
Zieger K (1999) Komplikationer efter operation for cystis pilonidalis. Ugeskr Laeger 161:6056-6058
Viborg Hospital, PO box 130, 8800 Viborg, Denmark e-mail: jes.s.lindholt@viborg.rm.dk Pilonidal cyst: cause and treatment
  • C S Lindholt-Jensen
C. S. Lindholt-Jensen : M. Beyer : J. S. Lindholt Surgery Clinic, Aarhus, Rolighedsvej 30, 8240 Risskov, Denmark J. S. Lindholt (*) Vascular Research Unit, Viborg Hospital, PO box 130, 8800 Viborg, Denmark e-mail: jes.s.lindholt@viborg.rm.dk Lasers Med Sci (2012) 27:505–508 DOI 10.1007/s10103-011-0990-2 References 1. da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43(8):1146–1156