A retrospective comparison of the results of wide excision-lay open, primary closure and flap application in surgical treatment for primary pilonidal sinus disease
Öz
Aim: The aim of this study was to compare the results of patients who underwent primary excision of the pilonidal sinus with open excision (GE), wide excision primary closure (PC) and flap application (F).
Materials and Methods: The data of 249 patients were evaluated retrospectively. Twelve of these patients were excluded because of recurrent disease. 101 patients had GE, 68 had PK and 68 had F. Demographic characteristics, duration of symptoms, characteristics of gluteal cleft, perioperative complications, duration of surgery and hospital stay, drain use and dressing status, pathological volume, distance to anus, and recurrence of the disease were recorded.
Results: Mean operative time was 32.62 ± 9.65 in the GE group; 53.23 ± 15.40 in the PK group; In the F group, it was 76.69 ± 17.00 minutes (p<0.001). Recurrence in the GE group 3% (3); 4.41% in the PK group (3); In the F group, it was 2.9% (2) (p=0.855). Postoperative mean follow-up time was 49.4 ± 13.3 month in the GE group; 35.19 ± 12.86 month in the PK group; In the F group, it was 26.56 ± 9.88 month (p<0.000).
Conclusion: All three techniques can be used to achieve low recurrence rates by selecting appropriate
patients. The size of the diseased tissue and selected surgical technique compliance affect the
recurrence rate.
Anahtar Kelimeler
Pilonidal sinus wide excision-lay open primary closure flap application
Kaynakça
- Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. TechColoproctol. 2003 Apr; 7 (1): 3-8.
- DaSilva JH, Pilonidalcyst: cause and treatment. DisColonRectum 2000 43: 1146–56.
- Davage ON, The origin of sacrococcygeal pilonidal sinuses: based on an analysis of four hundred sixty-three cases. Am J Pathol 1954; 30: 1191–205.
- Miyata T, Toh H, Doi F, Torisu M. Pilonidal sinus on the neck. SurgToday 1992; 22: 379–82.
- Brearly R Pilonidal sinus: a new theory of origin. Br J Surg 1955; 43: 62–8.
- Deans GT, Spence RAJ, Love AHG Colorectal disease for physicians and surgeons. Oxford University, Oxford,1998; 294–5.
- Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992; 62: 385–9.
- Bascom JU. Repeat pilonidal operations. Am J Surg. 1987; 154: 118–21. 396 Ege Tıp Dergisi
- Milito G, Cortese F, Casciani CU. Rhomboid flap procedure for pilonidal sinus: Results from 67 cases. Int J ColorectalDis. 1998;13(3):113–5.
- Jósvay J, Sashegyi M, Kelemen P, Donáth A. Clinical experience with the hatchet-haped gluteus maximus musculocutaneous flap. AnnPlastSurg. 2005; 55: 179–82.
- Dilek ON, Bekereciodlu M. Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg. 1998; 164 (12): 961–4.
- Bascom J. Pilonidal sinus: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980; 87: 567–72.
- Karydakis GE New approachtothe problem of pilonidal sinus. Lancet 1973; 2 (7843): 1414–5.
- Lord PH, Millar DM, Pılonıdal sınus: A sımple treatment. Br J Surg. 1965 Apr; 52: 298-300.
- Al-Khamis A, McCallum I, King PM, Bruce J.Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database SystRev. 2010 Jan 20; (1): CD006213.
- Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg. 1985 Apr; 72 (4): 303-4.
- Miocinović M, Horzić M, Bunoza D. Thetreatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing. ActaMedCroatica. 2000; 54 (1): 27-31.
- Kement M, Oncel M, Kurt N, Kaptanoglu L. Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. DisColonRectum. 2006 Nov; 49 (11): 1758-62.
- Solla JA, Rothenberger DA. Chronic pilonidal disease. An assessment of 150 cases. DisColonRectum. 1990 Sep;33 (9): 758-61.
- Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. TechColoproctol. 2002 Dec; 6 (3): 165-9.
- Lee PJ, Raniga S, Biyani DK, Watson AJ, Faragher IG, Frizelle FA. Sacrococcygeal pilonidal disease. ColorectalDis. 2008 Sep;10 (7): 639- 51.
- Al-Salamah SM, Hussain MI, Mirza SM. Excision with or without primary closure for pilonidal sinus disease. J Pak MedAssoc. 2007 Aug; 57 (8): 388-91.
- Kareem TS. Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure. SaudiMed J. 2006 Oct; 27 (10): 1534-7.
- Kaya B, Uçtum Y, Şimşek A, Kutaniş R Treatment of pilonidal sinus with primary closure. A simple and effective method. Turk J ColorectalDis. 2010; 20 (2): 59-65.
- Sodenna K, Andersen E, Nesvik I, Soreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J ColorectalDis. 1995; 10 (1): 39–42.
- Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. IntSurg. 2015 May; 100 (5): 870-7.
- Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg. 2010 Sep; 200 (3): 318-27.
- Ates M, Dirican A, Sarac M, Aslan A, Colak C, Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg. 2011 Nov; 202 (5): 568-73.
Primer pilonidal sinüs hastalığı için cerrahi tedavide geniş eksizyon-açık bırakma, primer kapama ve flep uygulama sonuçlarının karşılaştırılması
Öz
Amaç: Bu çalışmada primer pilonidal sinüs nedeni ile ameliyat edilen hastalarda geniş eksizyon sonrası açık bırakma (GE), geniş eksizyon primer kapama (PK) ve flep uygulaması (F) yapılan hastaların sonuçlarının karşılaştırılması planlandı.
Gereç ve Yöntem: Toplam 249 hastanın verileri retrospektif olarak değerlendirildi. Bu hastaların 12’si nüks hastalık nedeni ile değerlendirme dışı bırakıldı. Hastaların 101’ine GE, 68’ine PK ve 68’ine de F yapılmıştı. Demografik özellikler, semptomların süresi, gluteal kleftin özelliği, perioperatif komplikasyonlar, ameliyat süresi ve hastanede kalış süresi, dren kullanımı ve pansuman durumu patolojik piyes hacmi anüse uzaklık ve hastalığın nüksü kaydedildi.
Bulgular: Ortalama operasyon süresi GE grubunda 32,62±9,65; PK grubunda 53,23±15,40; F grubunda 76,69±17,00 dakika idi (p<0.001). Nüks GE grubunda %3 (3); PK grubunda %4,41(3); F grubunda %2,9 (2) idi (p=0,855). Postopratif ortalama takip süresi GE grubunda 49,4±13,3 ay; PK grubunda 35,19±12,86 ay; F grubunda 26,56±9,88 aydı (p<0,000).
Sonuç: Kullanılan her üç teknik uygun hasta seçimi yapılarak düşük nüks oranlarına ulaşılmasını sağlayabilir. Hastalıklı dokunun büyüklüğü ve seçilen cerrahi teknik uyumu nüks oranını etkiler.
Anahtar Kelimeler
Pilonidal sinüs geniş eksizyon-açık bırakma primer kapama flep uygulaması.
Kaynakça
- Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. TechColoproctol. 2003 Apr; 7 (1): 3-8.
- DaSilva JH, Pilonidalcyst: cause and treatment. DisColonRectum 2000 43: 1146–56.
- Davage ON, The origin of sacrococcygeal pilonidal sinuses: based on an analysis of four hundred sixty-three cases. Am J Pathol 1954; 30: 1191–205.
- Miyata T, Toh H, Doi F, Torisu M. Pilonidal sinus on the neck. SurgToday 1992; 22: 379–82.
- Brearly R Pilonidal sinus: a new theory of origin. Br J Surg 1955; 43: 62–8.
- Deans GT, Spence RAJ, Love AHG Colorectal disease for physicians and surgeons. Oxford University, Oxford,1998; 294–5.
- Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992; 62: 385–9.
- Bascom JU. Repeat pilonidal operations. Am J Surg. 1987; 154: 118–21. 396 Ege Tıp Dergisi
- Milito G, Cortese F, Casciani CU. Rhomboid flap procedure for pilonidal sinus: Results from 67 cases. Int J ColorectalDis. 1998;13(3):113–5.
- Jósvay J, Sashegyi M, Kelemen P, Donáth A. Clinical experience with the hatchet-haped gluteus maximus musculocutaneous flap. AnnPlastSurg. 2005; 55: 179–82.
- Dilek ON, Bekereciodlu M. Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg. 1998; 164 (12): 961–4.
- Bascom J. Pilonidal sinus: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980; 87: 567–72.
- Karydakis GE New approachtothe problem of pilonidal sinus. Lancet 1973; 2 (7843): 1414–5.
- Lord PH, Millar DM, Pılonıdal sınus: A sımple treatment. Br J Surg. 1965 Apr; 52: 298-300.
- Al-Khamis A, McCallum I, King PM, Bruce J.Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database SystRev. 2010 Jan 20; (1): CD006213.
- Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg. 1985 Apr; 72 (4): 303-4.
- Miocinović M, Horzić M, Bunoza D. Thetreatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing. ActaMedCroatica. 2000; 54 (1): 27-31.
- Kement M, Oncel M, Kurt N, Kaptanoglu L. Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. DisColonRectum. 2006 Nov; 49 (11): 1758-62.
- Solla JA, Rothenberger DA. Chronic pilonidal disease. An assessment of 150 cases. DisColonRectum. 1990 Sep;33 (9): 758-61.
- Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. TechColoproctol. 2002 Dec; 6 (3): 165-9.
- Lee PJ, Raniga S, Biyani DK, Watson AJ, Faragher IG, Frizelle FA. Sacrococcygeal pilonidal disease. ColorectalDis. 2008 Sep;10 (7): 639- 51.
- Al-Salamah SM, Hussain MI, Mirza SM. Excision with or without primary closure for pilonidal sinus disease. J Pak MedAssoc. 2007 Aug; 57 (8): 388-91.
- Kareem TS. Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure. SaudiMed J. 2006 Oct; 27 (10): 1534-7.
- Kaya B, Uçtum Y, Şimşek A, Kutaniş R Treatment of pilonidal sinus with primary closure. A simple and effective method. Turk J ColorectalDis. 2010; 20 (2): 59-65.
- Sodenna K, Andersen E, Nesvik I, Soreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J ColorectalDis. 1995; 10 (1): 39–42.
- Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. IntSurg. 2015 May; 100 (5): 870-7.
- Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg. 2010 Sep; 200 (3): 318-27.
- Ates M, Dirican A, Sarac M, Aslan A, Colak C, Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg. 2011 Nov; 202 (5): 568-73.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2019 |
| Gönderilme Tarihi | 24 Ekim 2018 |
| Yayımlandığı Sayı | Yıl 2019 |