Pilonidal sinus disease

pilonidal sinus disease
definition
history
etiology
anatomy
management

1. Pilonidal sinus disease Georges Khalife PGY IV GENERAL SURGERY AL-ZAHRAA UNIVERSITY MEDICAL CENTER

2. KEY POINTS An ideal method should reduce complications while providing early recovery, early return to work and good cosmetic outcomes and have a low recurrence rate

3. Karydakis surgery Karydakis believed that hair insertion is the cause for pilonidal sinus Lower recurrence rates due to : Wound placed away from midline Problems Sutured taken over the pre-sacral fascia causing pain

4. Limberg flap transposition

5. Limberg flap transposition R homboid incision encompassing all sinus openings. One end of the incision was extended up to a similar length. A flap was prepared such as to include the gluteal muscle fascia . Then , a drain was placed. Following the stabilisation of the bottom of the flap to the presacral fascia in the cavity, the subcutaneous tissues were closed with absorbable suture number 1. Next , the skin was closed with a 2/0 non-absorbable monofilament suture .

6. The objective of the Limberg flap repair D ecrease the tension by flattening the natal cleft as in Karydakis ’ flap transposition . It is one of the most frequently used reconstructive methods . low recurrence and complication rates

7. Which flap method should be preferred for the treatment of pilonidal sinus?

8. OUR EXPERIENCE

9. Laser epilation Recent advances in laser technology have led to methods of long-term hair removal. The advantages of LE are that it is nearly painless , targets hair selectively, and is fast , treating an area of 50 cm2 in less than a minute. It provides prolonged hair removal in 50% to 80% of patients.

10. Laser epilation The LE therapy was effective in removing the hair in the intergluteal cleft, and no patient had regrowth with a mean follow-up of 24.2 ± 9.9 months. It was clear that significantly hirsute patients in the cohort had improved hygiene with the long-term hair removal. This factor may further reduce the likelihood of recurrence .

11. Of the 731 surgical specimens analyzed, nomalignant lesions were detected .

12. Malignant degeneration remains a rare complication, estimated at 0.1% of patients with chronic PS

13. In 2001, de Bree et al. found 59 cases published since 1900. Most of the patients were over 50 years of age with chronic PS present for over several decades In 90% of the cases, histological analysis showed squamous cell carcinoma .

14. Suspicion of malignant degeneration should arise from the clinical examination : AGE >50 Tissue budding or protruding from the orifice S quamous tissue H istory of prolonged chronic evolution

15. Role of Abx Generally limited to clinical setting of cellulitis Indications Immunosuppression High risk of endocarditis MRSA Concurrent systemic illness

16. Methylene bleu guided sacrococcygeal pilonidal sinus surgery

17. Methylene bleu guided sacrococcygeal pilonidal sinus surgery The application of methylene blue for guidance in surgery may cause inadequate excision of the diseased area . In clinical practice, this condition may later manifest as sinus recurrence or poor wound healing

18. Endoscopic pilonidal sinus treatment ( E.P.Si.T .): 24In 2013, Meinero et al. described a new technique for pilonidal cyst approach with the use of a fistuloscope With this instrument and under direct vision, it is possible to destroy all granulation tissue and to remove the entire infected area of the cyst, leaving a small open wound for drainage.

19. Endoscopic pilonidal sinus treatment ( E.P.Si.T .): the prone position under spinal anesthesia The fistula orifice was catheterized fistuloscope was introduced, using a solution of glycine 1.5 %

20. Endoscopic pilonidal sinus treatment ( E.P.Si.T .): The tract of the cyst was identified and studied, with removal of hair inside the lesion. tract was cauterized , with removal of devitalized tissue

21. Endoscopic pilonidal sinus treatment ( E.P.Si.T .): finally the drain orifice was enlarged.

22. Endoscopic pilonidal sinus treatment ( E.P.Si.T .): The patient has been followed up (during 10 months), with good healing and no signs of recurrence.

23. Take home message

24. Take home message A cute abscess I & D

25. Take home message R ate of recurrence was significantly higher among the patients who underwent primary closure following extensive excision than among the other patients

26. Take home message Which flap method should be preferred for the treatment of pilonidal sinus? LE FLAP V-Y FLAP KARYADAKIS FLAP

27. Take home message M ethylene blue for guidance in surgery ? inadequate excision of the diseased area

28. Take home message Laser epilation ? safe and effective

29. Take home message Is histological analysis of pilonidal sinus useful? Atypical aspect in the presentation or appearance of PS, prolonged duration of development, and patient age over 50 years justifies a systematic histological analysis.

30. Thank you. . . .