Pilonadal disease: Rationale for the original method of radical surgery

Introduction. Considering the dissatisfaction with the results of existing methods for treating the pilonadal disease, the search for the most effective methods of radical surgery is currently ongoing.

Aim. To evaluate the feasibility of using in patients with chronic epithelial coccygeal tract an original method of radical treatment, consisting of excision of the substrate of the disease, plastic surgery of the sacrococcygeal fascia and suturing of the soft tissue defect with vertical polyspaste sutures.

Materials and methods. Main group: 34 patients who underwent an original method of radical surgical treatment. Comparison group: 34 patients who underwent traditional radical excision of the disease substrate.

Results. In the main group, less severe pain was recorded (p < 0.05) on days 1–6 after surgery. In terms of the total number of complications, a significant difference in results was demonstrated with a predominance of the indicator in patients in the comparison group (χ² = 12.324; p = 0.0004). A significant difference (p < 0.05) was also obtained in the healing time of surgical wounds, with thelowest values in patients after the original surgical technique.

Discussion. The study demonstrated an alternative technique, the implementation of which resulted in a significant reduction in the number of wound complications, severity of pain in the intervention area, average wound healing time, and also noted better quality oflife indicators compared to patients who underwent traditional surgery.

Conclusions. The implementation of an original method of radical surgical treatment of the epithelial coccygeal tract can reliably reduce the severity of pain on days 1–6 of the postoperative period, reduce the number of early postoperative complications by 38.23%, and also reduce the average wound healing time by 16 days compared with similar indicators after traditional radical excision of the pilonidal sinus.

1. Шелыгин ЮА, Фролов СА, Кашников ВН, Москалев АИ, Титов АЮ, Благодарный ЛА и др. Эпителиальный копчиковый ход: клинические рекомендации. М.; 2022. 38 с. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/192_2.

2. Korablina SS, Lavreshin PM, Muravyev AV, Gobejishvili VK, Gobedzhishvili VV, Zhirnosenko AO. Method for treating patients with pilonidal sinus complicated by secondary fistulas gluteal-sacrococcyx region. Bulletin of Pirogov National Medical & Surgical Center. 2023;18(4):94–97. (In Russ.) Available at: https://www.pirogov-vestnik.ru/upload/iblock/3f4/ h2y1iql1ngmidpkfhnmgnfwxrok89w2p/2023_4_18.pdf.

3. Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J. 2019;16(2):370–378. https://doi.org/10.1111/iwj.13042.

4. Obokhare I, Amajoyi RC. Pilonidal Disease: To Flap or Not to Flap. Adv Surg. 2023;57(1):155–169. https://doi.org/10.1016/j.yasu.2023.04.011.

5. Gallo G, Goglia M, Senapati A, Pata F, Basso L, Grossi U. An international survey exploring the management of pilonidal disease. Colorectal Dis. 2023;25(11):2177–2186. https://doi.org/10.1111/codi.16760.

6. Wood J. What primary care clinicians need to know about pilonidal disease. JAAPA. 2021;34(11):34–37. https://doi.org/10.1097/01.JAA.0000794972.13932.d5.

7. Dettmer M, Bonni M, Doll D. Thelong-term recurrence rate of minimally invasive methods in pilonidal sinus disease therapy is still unclear. Tech Coloproctol. 2022;26(2):157–158. https://doi.org/10.1007/s10151-021-02509-5.

8. Kalaiselvan R, Bathla S, Allen W, Liyanage A, Rajaganeshan R. Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis. 2019;34(4):561–568. https://doi.org/10.1007/s00384-019-03260-y.

9. Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg. 2021;406(8):2569–2580. https://doi.org/10.1007/s00423-020-02060-1.

10. Kumar M, Clay WH, Lee MJ, Brown SR, Hind D. A mapping review of sacrococcygeal pilonidal sinus disease. Tech Coloproctol. 2021;25(6):675–682. https://doi.org/10.1007/s10151-021-02432-9.

11. Rudd AB, Davis A, Butts CC. Presentation, Management, and Women’s Health Implications of Pilonidal Disease. Nurs Womens Health. 2021;25(4):312–318. https://doi.org/10.1016/j.nwh.2021.06.004.

12. Matera D, Lushefski K, Erchinger T. Pilonidal disease of the anterior perineum: an unusual presentation and review of current practice guidelines. Wounds. 2023;35(3):E120–E122. https://doi.org/10.25270/wnds/22078.

13. Liang NE, Abrajano C, Chiu B. Pilonidal disease in the pregnant patient: A case report. Int J Surg Case Rep. 2024;117:109539. https://doi.org/10.1016/j.ijscr.2024.109539.

14. Agharbi FZ, Eljazouly M, Chahboun FZ, Albouzidi A, Allaoui M, El Ochi MR, Chiheb S. Umbilical pilonidal sinus. Ann Dermatol Venereol. 2021;148(3):204–205. https://doi.org/10.1016/j.annder.2021.03.002.

15. Zubair R, Channa MA. Limberg Flap Technique For Pilonidal Sinus Disease Treatment: An Experience Of Hamdard University Hospital. J Ayub Med Coll Abbottabad. 2022;34(2):230–234. https://doi.org/10.55519/JAMC-02-9371.

16. Immerman SC. Revision of the Failed Cleft Lift for Pilonidal Disease. Cureus. 2023;15(2):e34511. https://doi.org/10.7759/cureus.34511.

17. Lichman LA, Katorkin SE, Andreev PS, Davydova OE, Mihaylichenko AP. Pilonidal Sinus: New Approach to Operative Treatment. Novosti Khirurgii. 2018;26(5):555–562. (In Russ.) Available at: https://www.elibrary.ru/yowczv.

18. Poverin GV, Evdokimov AN. Coccygeal cysts in children (clinic, diagnostic and surgical treatment). Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):105–120. (In Russ.) https://doi.org/10.30946/2219-4061-2019-9-2-105-120.

19. Choy KT, Srinath H. Pilonidal disease practice points: An update. Aust J Gen Pract. 2019;48(3):116–118. https://doi.org/10.31128/AJGP07-18-4649.

20. Царьков ПВ, Тулина ИА, Шлык ДД, Маркарьян ДР, Киценко ЮЕ. Способ закрытия раны крестцово-копчиковой области с пластикой мобилизованными фасциально-жировыми лоскутами. Патент RU 2741255 C1, 01.06.2020. Режим доступа: http://patenton.ru/patent/ RU2741255C1.

21. Гобеджишвили ВВ, Коркмазов ИХ, Лаврешин ПМ, Гобеджишвили ВК, Кораблина СС, Муравьев АВ и др. Способ хирургического лечения хронического воспаления эпителиального копчикового хода. Патент RU 2785491 C1, 08.12.2022. Режим доступа: https://patenton.ru/patent/RU2785491C1.

22. Колбас ЮЮ, Кузнецов ЕВ, Жижин НК. Способ ушивания раны при радикальной операции по поводу эпителиального копчикового хода. Патент RU 2775875 C1, 06.10.2021. Режим доступа: https://patenton.ru/patent/RU2775875C1.

23. Geraci G, Almasio PL, Mongitore M, Patti R, Abbate A, Lo Faso S et al. Recurrent sacrococcygeal pilonidal disease: the efficacy of minimal subcutaneous excision of the sinus and unroofing of pseudocystic cavity. Ann Ital Chir. 2020;91:437–441. Available at: https://pubmed.ncbi.nlm.nih.gov/33162406/.

24. Ray K, Albendary M, Baig MK, Swaminathan C, Sains P, Sajid MS. Limberg flap for the management of pilonidal sinus reduces disease recurrence compared to Karydakis and Bascom procedure: a systematic review and meta-analysis of randomized controlled trials. Minerva Chir. 2020;75(5):355–364. https://doi.org/10.23736/S0026-4733.20.08362-5.

25. Henry OS, Farr BJ, Check NM, Mooney DP. A minimally invasive pilonidal protocol improves quality oflife in adolescents. J Pediatr Surg. 2021;56(10):1861–1864. https://doi.org/10.1016/j.jpedsurg.2020.11.012.

26. Никольский ВИ, Сергацкий КИ, Митрошин АН, Альджабр М. Способ радикального хирургического лечения эпителиального копчикового хода. Патент RU 2798672 C1, 14.11.2022. Режим доступа: http://patents.google.com/patent/RU2798672C1/ru.

27. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127–1131. https://doi.org/10.1016/s0140-6736(74)90884-8.

28. Soll C, Dindo D, Steinemann D, Hauffe T, Clavien PA, Hahnloser D. Sinusectomy for primary pilonidal sinus: less is more. Surgery. 2011;150(5):996–1001. https://doi.org/10.1016/j.surg.2011.06.019.

29. Kalaiselvan R, Liyanage A, Rajaganeshan R. Short-term outcomes of endoscopic pilonidal sinus treatment. Ann R Coll Surg Engl. 2020;102(2):94–97. https://doi.org/10.1308/rcsann.2019.0097.

30. Leventoglu S, Sahin C, Mentes B, Balci B, Kozan R. Bascom’s cleft lift procedure for pilonidal sinus disease – a video vignette. Colorectal Dis. 2023;25(9):1938–1939. https://doi.org/10.1111/codi.16701.

31. Pronk A, Vissink M, Smakman N, Furnee E. Phenolisation of the Sinus Tract in Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Prospective Cohort Study. Cureus. 2020;12(5):e8129. https://doi.org/10.7759/cureus.8129.