A modern look at pilonidal disease and endoscopic approach to its treatment
DOI:
https://doi.org/10.14739/2310-1237.2024.3.303005Keywords:
pilonidal cyst, minimally invasive surgery, laser coagulation, EPSiT, VAAPS, SiLaTAbstract
The aim of the work is to review the literature on the modern view of pilonidal disease and to evaluate the effectiveness of endoscopic methods of treatment based on the results of research in recent years.
Results. The data of the world literature convincingly testify to the high effectiveness of treatment of pilonidal disease by endoscopic techniques. The endoscopic approach is associated with a painless postoperative period, good cosmetic results, a short period of disability and high patient satisfaction. Despite the short-term benefits obtained, randomized controlled trials are needed to definitively confirm the effectiveness of this technique to more accurately determine its effectiveness in the long-term follow-up period.
According to the recommendations of the Italian Society of Colorectal Surgery, it can be considered the gold standard in the treatment of unbranched pilonidal disease.
Conclusions. The endoscopic approach has significant advantages over other standard surgical methods: minimal pain, absence of early postoperative complications (seroma, hematomas, bleeding), short hospital stay (up to 1 day), rapid wound healing and return to everyday life, good cosmetic effect and a small percentage of relapses with short-term observations.
References
Loganathan A, Arsalani Zadeh R, Hartley J. Pilonidal disease: time to reevaluate a common pain in the rear! Dis Colon Rectum. 2012;55(4):491-3. doi: 10.1097/dcr.0b013e31823fe06c
Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10(1):39-42. doi: 10.1007/BF00337585
Iesalnieks I, Ommer A. The Management of Pilonidal Sinus. Dtsch Arztebl Int. 2019;116(1-2):12-21. doi: 10.3238/arztebl.2019.0012
Zakharash MP, Lyshavskyi OV, Dubovyi VA, Stelmakh AI, Yakovleva NM. Ultrasonohrafiia v diahnostytsi ta vybori likuvalnoi taktyky pry epitelialnomu kuprykovomu khodi [Ultrasonography in diagnosis and selection of treatment tactics for epithelial coccygeal course]. Surgery of Ukraine. 2010;0(2):66-71. Ukrainian.
Luedi MM, Schober P, Stauffer VK, Diekmann M, Andereggen L, Doll D. Gender-specific prevalence of pilonidal sinus disease over time: A systematic review and meta-analysis. ANZ J Surg. 2021;91(7-8):1582-7. doi: 10.1111/ans.16990
Rushfeldt C, Søreide K. Kirurgisk behandling av pilonidal sykdom [Surgical treatment of pilonidal disease]. Tidsskr Nor Laegeforen. 2010 May 6;130(9):936-9. Norwegian. doi: 10.4045/tidsskr.09.0345
Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J. 2019;16(2):370-8. doi: 10.1111/iwj.13042
Doll D. Pilonidal sinus disease – 186 years since Mayo. Coloproctology. 2019;2:94-5. doi: 10.1007/s00053-018-0315-z
Nixon AT, Garza RF. Pilonidal Cyst and Sinus. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK557770/
Tsema YV. [The evolution of aetiology and pathogenesis conceptions of pilonidal disease]. Surgery of Ukraine. 2013;0(2):9-22. Ukrainian. Available from: http://nbuv.gov.ua/UJRN/KhU_2013_2_5
Tsema EV, Dibrova YV. [The clinical and morphological aspects of aetiology and pathogenesis of sacrococcygeal pilonidal cysts]. Pathologia. 2013;(3):61-5. Ukrainian. doi: Available from: http://pat.zsmu.edu.ua/article/view/22589
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):2569-80. doi: 10.1007/s00423-020-02060-1
Choy KT, Srinath H. Pilonidal disease practice points: An update. Aust J Gen Pract. 2019;48(3):116-8. doi: 10.31128/ajgp-07-18-4649
Kanat BH, Sözen S. Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history. World J Clin Cases. 2015;3(10):876-9. doi: 10.12998/wjcc.v3.i10.876
Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery. 1980;87(5):567-72.
Bascom J. Current Therapy in Colon and Rectal Surgery [Internet]. 1990 [cited 2024 Sep 3]. P. 32-9. Available from: https://www.pilonidal.org/wp-content/uploads/2016/02/bascom_1990_ps.pdf
Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg. 2002;137(10):1146-50; discussion 1151. doi: 10.1001/archsurg.137.10.1146
Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg. 2007;193(5):606-9; discussion 609. doi: 10.1016/j.amjsurg.2007.01.008
Bascom J. Pilonidals: Distilled wisdom. Societa Italiana di Chirurgia ColoRettale. 2010;25:218-20. https://www.siccr.org/wp-content/uploads/2015/08/ML_Bascom_def.pdf
Dr. Marjan (Jane) Ghadiri. Pilonidal Sinus Treatments [Internet]. Australian Brisbane Private Hospital. 2020 [cited 2024 Sep 2]. Available from: https://drghadiri.com.au/pilonidal-sinus-treatments
Dr. Bernhard Hofer. Anfangsstadium des Sinus pilonidalis [Internet]. Proktologische Praxis München 2023 [cited 2024 Sep 2]. Available from: https://pilonidalsinus-zentrum.de/en/steissbeinfistel-ursache-und-entstehung
Khalilieh S, Horesh N, Cordoba M, Forschmidt E, Zager Y, Nadler R, et al. Surgical Outcomes of Minimally Invasive Trephine Surgery for Pilonidal Sinus Disease and Risk Factors for Recurrence. J Laparoendosc Adv Surg Tech A. 2022;32(3):288-92. doi: 10.1089/lap.2021.0097
Hemmingsson O, Binnermark F, Odensten C, Rutegård M, Franklin KA, Haapamäki MM. Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial. BJS Open. 2022;6(2):zrac007. doi: 10.1093/bjsopen/zrac007
Popeskou SG, Pravini B, Panteleimonitis S, Vajana AF, Vanoni A, Schmalzbauer M, et al. Conservative Sinusectomy vs. excision and primary off-midline closure for pilonidal disease: a randomized controlled trial. Int J Colorectal Dis. 2020;35(7):1193-9. doi: 10.1007/s00384-020-03551-9
Kanlioz M, Ekici U, Tatli F, Karatas T. Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence. Adv Skin Wound Care. 2021;34(2):81-5. doi: 10.1097/01.asw.0000725168.11099.92
Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003;7(1):3-8. doi: 10.1007/s101510300001
Petersen S. Sinus pilonidalis – was ist die beste chirurgische Therapie? [Pilonidal Sinus Disease; What is the Best Treatment Option?]. Zentralbl Chir. 2019;144(4):341-8. German. doi: 10.1055/a-0901-7945
Menzel T, Dörner A, Cramer J. Exzision und offene Wundbehandlung des Sinus pilonidalis. Rezidivrate und Dauer der Arbeitsunfähigkeit [Excision and open wound treatment of pilonidal sinus. Rate of recurrence and duration of work incapacity]. Dtsch Med Wochenschr. 1997;122(47):1447-51. German. doi: 10.1055/s-2008-1047784
Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, 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. doi: 10.1038%2Fs41598-018-20143-4
Cai Z, Zhao Z, Ma Q, Shen C, Jiang Z, Liu C, et al. Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2024;1(1):CD015213. doi: 10.1002/14651858.CD015213.pub2
Melkonian E, Mordojovich E, Baeza P. Karydakis Technique for the Treatment of Pilonidal Disease. Dis Colon Rectum. 2023;66(7):e754-5. doi: 10.1097/dcr.0000000000002556
Hemmingsson O, Binnermark F, Odensten C, Rutegård M, Franklin KA, Haapamäki MM. Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial. BJS Open. 2022;6(2):zrac007. doi: 10.1093/bjsopen/zrac007
Bubenová M, Konečná D, Kala Z. Pilonidal sinus disease: Karydakis flap procedure in our patients. Rozhl Chir. 2020;99(8):350-5. English. doi: 10.33699/PIS.2020.99.8.350-355
Wu P, Zhang Y, Zhang Y, Wang S, Fan Z. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. Int J Surg. 2023;109(8):2388-403. doi: 10.1097/js9.0000000000000447
Zou Q, Zhang D, Xian Z, Wang X, Xie S, Hu B, et al. Prognostic factors of flap techniques for pilonidal disease based on magnetic resonance imaging and clinical parameters. Asian J Surg. 2022;45(1):284-90. doi: 10.1016/j.asjsur.2021.05.021
Tsema YV. [The experience of low-traumatic treatment of pilonidal sinus disease by using bascom’s procedure (cleft lift procedure)]. Modern medical technology. 2013;0(4):78-85. Ukrainian. Available from: http://nbuv.gov.ua/UJRN/Smt_2013_4_18
Immerman SC. The Bascom Cleft Lift as a Solution for All Presentations of Pilonidal Disease. Cureus. 2021;13(2):e13053. doi: 10.7759%2Fcureus.13053
Hatch Q, Marenco C, Lammers D, Morte K, Schlussel A, McNevin S. Postoperative outcomes of Bascom cleft lift for pilonidal disease: A single-center experience. Am J Surg. 2020;219(5):737-40. doi: 10.1016/j.amjsurg.2020.03.005
Ojo D, Flashman K, Thomas G, Tozer P, Senapati A. Cleft closure (the Bascom cleft lift) for 714 patients-treatment of choice for complex and recurrent pilonidal disease (a cohort study). Colorectal Dis. 2023;25(9):1839-43. doi: 10.1111/codi.16688
Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011;15(4):417-22. doi: 10.1007/s10151-011-0769-2
Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol. 2014;18(4):389-92. doi: 10.1007/s10151-013-1016-9
Cahais J. Endoscopic pilonidal sinus disease treatment (EPSiT). J Visc Surg. 2021;158(4):337-42. doi: 10.1016/j.jviscsurg.2021.02.008
Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Sosa Fernandez LM, et al. Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment--a pilot study. Surgery. 2014;155(3):562-6. doi: 10.1016/j.surg.2013.08.021
Milone M, Sosa Fernandez LM, Vertaldi S, De Simone G, Servillo G, Manigrasso M, et al. Video-assisted ablation of pilonidal sinus – a video vignette. Colorectal Dis. 2020;22(5):597-8. doi: 10.1111/codi.14956
Azhough R, Azari Y, Taher S, Jalali P. Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique. Asian J Endosc Surg. 2021;14(3):458-63. doi: 10.1111/ases.12893
Kalaiselvan R, Liyanage A, Rajaganeshan R. Short-term outcomes of endoscopic pilonidal sinus treatment. Ann R Coll Surg Engl. 2020;102(2):94-7. doi: 10.1308/rcsann.2019.0097
Milone M, Velotti N, Manigrasso M, Vertaldi S, Di Lauro K, De Simone G, et al. Long-term results of a randomized clinical trial comparing endoscopic versus conventional treatment of pilonidal sinus. Int J Surg. 2020;74:81-5. doi: 10.1016/j.ijsu.2019.12.033
Manigrasso M, Velotti N, Sosa Fernandez LM, Vertaldi S, Maione F, Gennarelli N, et al. Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis. Int J Colorectal Dis. 2021;36(2):339-45. doi: 10.1007/s00384-020-03767-9
Pappas AF, Christodoulou DK. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis. 2018;20(8):O207-O214. doi: 10.1111/codi.14285
Romic I, Augustin G, Bogdanic B, Bruketa T, Moric T. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci. 2022;37(2):723-32. doi: 10.1007/s10103-021-03379-x
Ersavas C, Erginel B, Yanar F, Azamat İF, Taskesen F, Soysal FG. Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus. Wideochir Inne Tech Maloinwazyjne. 2023;18(1):144-8. doi: 10.5114/wiitm.2022.124206
Milone M, Basso L, Manigrasso M, Pietroletti R, Bondurri A, La Torre M, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease. Tech Coloproctol. 2021;25(12):1269-80. doi: 10.1007/s10151-021-02487-8
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
