Research progress of minimally invasive techniques in the management of sacrococcygeal pilonidal disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIN Qiu , WANG Hua , LUO Li

Department of Colorectal Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210046, P. R. China;

Corresponding author：

LIN Qiu, Email: mumuhehuo@sina.com

Keywords：

pilonidal disease; minimally invasive surgery; research progress

DOI：

10.7507/1007-9424.202006013

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the clinical progress of minimally invasive techniques in treatment of pilonidal disease.Method The relevant literatures about minimally invasive techniques in the treatment of pilonidal disease in recent years were reviewed.Results About hair removal and carbolic acid injection, they had less damage, fewer complications, higher recurrence rate compared to other surgery, and did not affect the second treatment. The fibrin injection could not clarify its role in the treatment of pilonidal disease due to some defects in the clinical design. Bascom Ⅰhad the advantages of fast recovery and no need for hospitalization, with a recurrence rate of 8%–16%. According to the results of some current clinical researches, it was a promising operation. Sinus resection required further clinical evaluation due to the limited results of current researches. A clinical study of more than 1 000 cases over 10 years showed that the recurrence rate in 10 years was 16%. Compared with frequently used pilonidal operations, the trephine technique was associated with a lower recurrence rate and a lower incidence of postoperative complication. Some short-term clinical researches showed that endoscopic pilonidal sinus treatment was a safe, minimally invasive, and less complication treatment.Conclusions Compared with frequently used pilonidal operations, minimally invasive technique has the advantages of shortening the hospital stay, shortening the healing time, and reducing complications. It is worth of application.

Citation： LIN Qiu, WANG Hua, LUO Li. Research progress of minimally invasive techniques in the management of sacrococcygeal pilonidal disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 276-280. doi: 10.7507/1007-9424.202006013 Copy

1.	Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract, 2012, 66(11): 1101-1108.
2.	Mutus HM, Aksu B, Uzun E, et al. Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease. J Pediatr Surg, 2018, 53(2): 293-294.
3.	da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum, 2000, 43(8): 1146-1156.
4.	Papaconstantinou HT, Thomas JS. The ASCRS textbook of colon and rectal surgery. New York: Springer, 2016: 261-275.
5.	Hull TL, Wu J. Pilonidal disease. Surg Clin North Am, 2002, 82(6): 1169-1185.
6.	AL-Khamis A, McCallum I, King PM, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev, 2010, 2010(1): CD006213.
7.	Yoldas T, Karaca C, Unalp O, et al. Recurrent pilonidal sinus: lay open or flap closure, does it differ? Int Surg, 2013, 98(4): 319-323.
8.	Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep, 2018, 8(1): 3058.
9.	Karydakis GE. New approach to the problem of pilonidal sinus. Lancet, 1973, 2(7843): 1414-1415.
10.	Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg, 2002, 137(10): 1146-1150.
11.	Aithal SK, Rajan CS, Reddy N. Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure. Indian J Surg, 2013, 75(4): 298-301.
12.	Lieto E, Castellano P, Pinto M, et al. Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon Rectum, 2010, 53(7): 1061-1068.
13.	Fike FB, Mortellaro VE, Juang D, et al. Experience with pilonidal disease in children. J Surg Res, 2011, 170(1): 165-168.
14.	Lund JN. Less is more in the treatment of pilonidal sinus disease. Dis Colon Rectum, 2017, 60(1): e1.
15.	Can MF, Sevinc MM, Hancerliogullari O, et al. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg, 2010, 200(3): 318-327.
16.	Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum, 2019, 62(2): 146-157.
17.	Odili J, Gault D. Laser depilation of the natal cleft–an aid to healing the pilonidal sinus. Ann R Coll Surg Engl, 2002, 84(1): 29-32.
18.	Pronk AA, Eppink L, Smakman N, et al. The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol, 2018, 22(1): 7-14.
19.	Halleran DR, Onwuka AJ, Lawrence AE, et al. Laser hair depilation in the treatment of pilonidal disease: a systematic review. Surg Infect (Larchmt), 2018, 19(6): 566-572.
20.	Bayhan Z, Zeren S, Duzgun SA, et al. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: a comparative retrospective study. Asian J Surg, 2016, 39(3): 172-177.
21.	Ates U, Ergun E, Gollu G, et al. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. J Pediatr Surg, 2018, 53(3): 452-455.
22.	Furnée EJ, Davids PH, Pronk A, et al. Pit excision with phenolisation of the sinus tract versus radical excision in sacrococcygeal pilonidal sinus disease: study protocol for a single centre randomized controlled trial. Trials, 2015, 16: 92.
23.	Girgin M, Kanat BH, Ayten R, et al. Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation. Int Surg, 2012, 97(4): 288-292.
24.	Stansby G, Greatorex R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg, 1989, 76(7): 729-730.
25.	Emiroglu M, Karaali C, Salimoglu S, et al. Treatment of pilonidal sinus disease: early results of a prospective randomized study. Int Surg, 2016, 101: 127-132.
26.	Gulpinar K, Pampal A, Ozis SE, et al. Non-operative therapy for pilonidal sinus in adolescence:crystallised phenol application, ‘report of a case’. BMJ Case Rep, 2013, 2013: bcr2012008382.
27.	Smith CM, Jones A, Dass D, et al. Early experience of the use of fibrin sealant in the management of children with pilonidal sinus disease. J Pediatr Surg, 2015, 50(2): 320-322.
28.	Hardy E, Herrod P, Sian T, et al. Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children. J Pediatr Surg, 2019, 54(8): 1668-1670.
29.	Lund J, Tou S, Doleman B, et al. Fibrin glue for pilonidal sinus disease. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev, 2017, 1(1): CD011923.
30.	Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery, 1980, 87(5): 567-572.
31.	Senapati A, Cripps NP, Thompson MR. Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus. Br J Surg, 2000, 87(8): 1067-1070.
32.	Ehrl D, Choplain C, Heidekrueger P, et al. Treatment options for pilonidal disease. Am Surg, 2017, 83(5): 453-457.
33.	Delshad HR, Dawson M, Melvin P, et al. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg, 2019, 54(1): 174-176.
34.	Soll C, Hahnloser D, Dindo D, et al. A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more. Int J Colorectal Dis, 2008, 23(2): 177-180.
35.	Oncel M, Kurt N, Kement M, et al. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol, 2002, 6(3): 165-169.
36.	Mohamed HA, Kadry I, Adly S. Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon, 2005, 3(2): 73-77.
37.	Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1, 358 patients. Dis Colon Rectum, 2008, 51(11): 1656-1662.
38.	Di Castro A, Guerra F, Levi Sandri GB, et al. Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2 347 patients. Int J Surg, 2016, 36(Pt A): 201-205.
39.	Speter C, Zmora O, Nadler R, et al. Minimal incision as a promising technique for resection of pilonidal sinus in children. J Pediatr Surg, 2017, 52(9): 1484-1487.
40.	Meinero P, Stazi A, Carbone A, et al. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis, 2016, 18(5): O164-O170.
41.	Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol, 2014, 18(4): 389-392.
42.	Tien T, Athem R, Arulampalam T. Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol, 2018, 22(5): 325-331.
43.	Milone M, Fernandez LM, Musella M, et al. Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg, 2016, 151(6): 547-553.
44.	Esposito C, Izzo S, Turrà F, et al. Pediatric endoscopic pilonidal sinus treatment, a revolutionary technique to adopt in children with pilonidal sinus fistulas: our preliminary experience. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 359-363.
45.	Kalaiselvan R, Bathla S, Allen W, et al. Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis, 2019, 34(4): 561-568.

1. Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract, 2012, 66(11): 1101-1108.
2. Mutus HM, Aksu B, Uzun E, et al. Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease. J Pediatr Surg, 2018, 53(2): 293-294.
3. da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum, 2000, 43(8): 1146-1156.
4. Papaconstantinou HT, Thomas JS. The ASCRS textbook of colon and rectal surgery. New York: Springer, 2016: 261-275.
5. Hull TL, Wu J. Pilonidal disease. Surg Clin North Am, 2002, 82(6): 1169-1185.
6. AL-Khamis A, McCallum I, King PM, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev, 2010, 2010(1): CD006213.
7. Yoldas T, Karaca C, Unalp O, et al. Recurrent pilonidal sinus: lay open or flap closure, does it differ? Int Surg, 2013, 98(4): 319-323.
8. Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep, 2018, 8(1): 3058.
9. Karydakis GE. New approach to the problem of pilonidal sinus. Lancet, 1973, 2(7843): 1414-1415.
10. Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg, 2002, 137(10): 1146-1150.
11. Aithal SK, Rajan CS, Reddy N. Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure. Indian J Surg, 2013, 75(4): 298-301.
12. Lieto E, Castellano P, Pinto M, et al. Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon Rectum, 2010, 53(7): 1061-1068.
13. Fike FB, Mortellaro VE, Juang D, et al. Experience with pilonidal disease in children. J Surg Res, 2011, 170(1): 165-168.
14. Lund JN. Less is more in the treatment of pilonidal sinus disease. Dis Colon Rectum, 2017, 60(1): e1.
15. Can MF, Sevinc MM, Hancerliogullari O, et al. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg, 2010, 200(3): 318-327.
16. Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum, 2019, 62(2): 146-157.
17. Odili J, Gault D. Laser depilation of the natal cleft–an aid to healing the pilonidal sinus. Ann R Coll Surg Engl, 2002, 84(1): 29-32.
18. Pronk AA, Eppink L, Smakman N, et al. The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol, 2018, 22(1): 7-14.
19. Halleran DR, Onwuka AJ, Lawrence AE, et al. Laser hair depilation in the treatment of pilonidal disease: a systematic review. Surg Infect (Larchmt), 2018, 19(6): 566-572.
20. Bayhan Z, Zeren S, Duzgun SA, et al. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: a comparative retrospective study. Asian J Surg, 2016, 39(3): 172-177.
21. Ates U, Ergun E, Gollu G, et al. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. J Pediatr Surg, 2018, 53(3): 452-455.
22. Furnée EJ, Davids PH, Pronk A, et al. Pit excision with phenolisation of the sinus tract versus radical excision in sacrococcygeal pilonidal sinus disease: study protocol for a single centre randomized controlled trial. Trials, 2015, 16: 92.
23. Girgin M, Kanat BH, Ayten R, et al. Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation. Int Surg, 2012, 97(4): 288-292.
24. Stansby G, Greatorex R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg, 1989, 76(7): 729-730.
25. Emiroglu M, Karaali C, Salimoglu S, et al. Treatment of pilonidal sinus disease: early results of a prospective randomized study. Int Surg, 2016, 101: 127-132.
26. Gulpinar K, Pampal A, Ozis SE, et al. Non-operative therapy for pilonidal sinus in adolescence:crystallised phenol application, ‘report of a case’. BMJ Case Rep, 2013, 2013: bcr2012008382.
27. Smith CM, Jones A, Dass D, et al. Early experience of the use of fibrin sealant in the management of children with pilonidal sinus disease. J Pediatr Surg, 2015, 50(2): 320-322.
28. Hardy E, Herrod P, Sian T, et al. Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children. J Pediatr Surg, 2019, 54(8): 1668-1670.
29. Lund J, Tou S, Doleman B, et al. Fibrin glue for pilonidal sinus disease. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev, 2017, 1(1): CD011923.
30. Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery, 1980, 87(5): 567-572.
31. Senapati A, Cripps NP, Thompson MR. Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus. Br J Surg, 2000, 87(8): 1067-1070.
32. Ehrl D, Choplain C, Heidekrueger P, et al. Treatment options for pilonidal disease. Am Surg, 2017, 83(5): 453-457.
33. Delshad HR, Dawson M, Melvin P, et al. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg, 2019, 54(1): 174-176.
34. Soll C, Hahnloser D, Dindo D, et al. A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more. Int J Colorectal Dis, 2008, 23(2): 177-180.
35. Oncel M, Kurt N, Kement M, et al. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol, 2002, 6(3): 165-169.
36. Mohamed HA, Kadry I, Adly S. Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon, 2005, 3(2): 73-77.
37. Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1, 358 patients. Dis Colon Rectum, 2008, 51(11): 1656-1662.
38. Di Castro A, Guerra F, Levi Sandri GB, et al. Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2 347 patients. Int J Surg, 2016, 36(Pt A): 201-205.
39. Speter C, Zmora O, Nadler R, et al. Minimal incision as a promising technique for resection of pilonidal sinus in children. J Pediatr Surg, 2017, 52(9): 1484-1487.
40. Meinero P, Stazi A, Carbone A, et al. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis, 2016, 18(5): O164-O170.
41. Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol, 2014, 18(4): 389-392.
42. Tien T, Athem R, Arulampalam T. Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol, 2018, 22(5): 325-331.
43. Milone M, Fernandez LM, Musella M, et al. Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg, 2016, 151(6): 547-553.
44. Esposito C, Izzo S, Turrà F, et al. Pediatric endoscopic pilonidal sinus treatment, a revolutionary technique to adopt in children with pilonidal sinus fistulas: our preliminary experience. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 359-363.
45. Kalaiselvan R, Bathla S, Allen W, et al. Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis, 2019, 34(4): 561-568.

Previous Article
Clinical status of advanced pancreatic cancer treated with high intensity focused ultrasound

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of minimally invasive techniques in the management of sacrococcygeal pilonidal disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Format

Content