The Limberg transposition flap in surgical therapy of chronic pilonidal sinus

The operative treatment of pilonidal sinus is characterized by an increased rate of wound healing complications and late recurrences. The Limberg transposition flap is an easy method for covering the defect after excision of the pilonidal sinus. The flap smooths out the deep skin fold of the rima ani and counteracts in this manner an important pathogenetic factor of pilonidal sinus recurrence. Between 6/96 and 7/99 we treated 42 patients using this method without complications of wound healing or recurrences. Comparison of literature results of different operative treatments (open granulation, primary suture, Z-plasty) shows lessened complication and recurrence rates for the Limberg transposition flap, which is the method of choice for chronic pilonidal sinus nowadays.     

Factors influencing surgical decisions in chronic pilonidal sinus disease

Summary  BACKGROUND: Pilonidal sinus disease (PSD) may be present as chronic PSD, which may eventually exacerbate. Factors associated with the progression of chronic PSD to acute abscess-forming PSD were investigated. METHODS: Records of 1962 patients admitted to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 with PSD were analyzed. RESULTS: Patients with chronic PSD showed higher sinus numbers (p < 0.001) and longer disease history (p < 0.001), while acute abscess-forming PSD was associated with smoking (p < 0.001). Surgeons were more likely to opt for primary wound closure when fewer sinus were present. Primary wound closure was similarly successful in chronic (67.2%) and acute (66.9%) PSD. Primary wound healing rate was negatively influenced by a high BMI in chronic PSD (p = 0.012). CONCLUSIONS: Early elective surgery in chronic PSD seems justified in patients presenting with a short duration of disease, low sinus number and smoking history.      

The current status of surgical therapy for renal artery disease

The first reports of surgically curable hypertension in the late 1930s led to enthusiasm among clinicians for removing kidneys with arterial stenosis in hypertensive patients. The development of vascular surgical techniques in the 1950s made it possible to achieve successful renal revascularization in many of these cases. However, the cause and effect relationship between a stenotic renal artery lesion and hypertension was poorly understood and many patients treated surgically had no improvement of blood pressure postoperatively. Continued experience in this field during the past two decades has significantly improved our understanding of the natural history and functional significance of renovascular disorders. Patients with renovascular hypertension can now be identified with a high degree of accuracy and successful renal revascularization is possible in most cases. Nevertheless, multiple factors must be weighed in determining whether medical or surgical therapy is more appropriate for a given patient. These include the causal relationship of renovascular disease to hypertension, the adequacy of blood pressure control with medical therapy, the natural history of untreated renovascular disease with particular regard for the risk of sustaining impaired renal function, the medical condition of the patient, the morbidity and results of surgical therapy, and the availability of other therapeutic options such as percutaneous transluminal dilatation.     

Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease

Background/purpose

Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic.

潜毛囊肿和潜毛窦的诊断治疗

目的分析潜毛囊肿和潜毛窦的诊断和治疗。方法回顾性分析8例少见病例——潜毛囊肿和潜毛窦的临床经过,结合国内外的相关报道进行分析。结果 8例潜毛囊肿和潜毛窦患者中,4例诊断明确,进行手术切除治疗,疗效满意。3例曾误诊为肛旁脓肿切开引流、1例以穿刺引流误治,均形成窦道经久不愈。后经CT明确为潜毛囊肿或潜毛窦,进行肿瘤切除一期缝合痊愈。结论潜毛囊肿和潜毛窦在临床上是少见病,手术彻底切除肿瘤是唯一治疗方法。     

The evolution of management of pilonidal sinus disease

Pilonidal sinus disease has for too long been treated by radical methods, probably on the assumption that these were the only ways to prevent recurrence. A review of the literature reveals a sprinkling of papers indicating that simpler methods not only carry less morbidity, but also are associated with a lower recurrence rate. With a detailed 10-year review, the author reports a series of 72 consecutive patients with pilonidal sinus treated successfully as outpatients by conservative methods under local anesthesia. This review, along with the similar experience of others, makes it clear that only simple conservative methods are acceptable in the management of pilonidal sinus.     

Umbilical pilonidal sinus: Ambulatory surgical technique

Hypothesis: Umbilical pilonidal sinus, although uncommon, can become complicated by inflammation, cellulitis and suppuration. Usually it tends to recur after conservative treatment. Various surgical procedures have been suggested for its treatment, but most of them were based on experience with few cases.

Our aim is to describe a modified surgical technique at the day-hospital for the treatment and prevention of recurrent disease.

Design: Retrospective case series.

Settings: Unit of ambulatory surgery, regional day-hospital.

Patients and surgical technique: Twelve consecutive cases of umbilical pilonidal sinus were treated at our hospital by subcutaneous excision of the involved tissue and the deep portion of the umbilicus. The operation was performed under general anesthesia. All the patients were discharged at 5–6 h after surgery.

Results: Minor complications were encountered in two cases: seroma and hyperaemia of the skin treated conservatively at out patient clinic. No recurrent disease was found in two years of follow up. All the patients were satisfied with the cosmetic results of the procedure. This technique was cost effective since it was carried out as an ambulatory procedure.

Conclusions: A simple surgical technique for the treatment of umbilical pilonidal sinus is proposed. Besides its satisfactory results in eradicating the disease it is cost effective.     

The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease

Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0 kg/m², average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing-changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.     

Management of sacrococcygeal pilonidal sinus disease

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.     

Surgical treatment of pilonidal sinus with open surgical technique

BACKGROUND: Personal experience and results about the surgical treatment of pilonidal sinus using the open technique operation are reported. METHODS: Between January 1984 and June 2001, 577 patients (457 males and 120 females) underwent this surgical technique. Eighty-five patients presented recurrences of the under-lying disease previously treated with closed technique in other centres. In order to reduce the risks of recurrence, pilonidal sinus was widely resected in order to remove every fistulous track laterally or towards the anal edge. The surgical wound has to be wide, carefully drained, without vertical walls: the outer part of the wound should be wider than its bottom. The persistence of a hairless scar is a suitable result to avoid relapses. RESULTS: This surgical technique allowed very good RESULTS: Postsurgical morbidity was not observed in these patients; the median time to achieve healing was 8+/-2 weeks. Furthermore, after a 3 year follow-up, only 4 patients (0.69%) relapsed. Recurrent dressings are needed; anyway they neither represent a limit of this technique nor lead to a long term absence from working. The postsurgical period of resting is quite similar to that usually prescribed after other surgical techniques and mainly depends on the patient nature. The treatment with connective tissue repairing drugs may be useful to obtain an effective healing. CONCLUSIONS: In the authors' experience, the open surgical technique may obtain the definitive removal of pilonidal sinus, even if particularly wide, with a safe postsurgical course and a very hight percentage (99.31%) of complete healing without any relapse.     

Volume of the excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery)

Purpose

In previous studies, a lack of antibiotic prophylaxis, smoking and obesity were described as factors that contribute to the development of a surgical site infection (SSI) after pilonidal disease (PD) surgery. In this study, we evaluated whether the volume of the excised specimen (VS) was a risk factor for SSI.

Methods

The patients who underwent surgical treatment for PD from January 2010 through December 2011 were retrospectively evaluated in terms of SSI, time off work and healing time. The single and multiple explanatory variable(s) logistic regression analyses were performed.

Results

One-hundred and sixty patients were included in the study. SSI occurred in 19 (11.9 %) patients. In the multiple explanatory variable logistic regression analysis, VS was emerged as a risk factor for SSI (OR 18.78, 95 % CI 2.38–148.10; P < 0.005). The healing time and time off work were longer when a SSI occurred (P < 0.001).

Conclusions

This study suggests that the rate of SSI after the surgical treatment of PD is higher in patients with a high VS. A SSI significantly prolongs the healing time. Surgeons can use this data for assessing the SSI risk. As a preventive measure, prolonged use of an empiric broad-spectrum antibiotic may be beneficial in patients with a high VS.