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Category: Volume 07 Issue 08 August 2019
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Title: A  Retrospective Analysis of the Surgical Treatment Options for Sacrococcygeal Pilonidal Sinus, with Special Reference to Limberg Flap

Author: Arun.S

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.108

Abstract

Introduction: Pilonidal sinus (PNS) is  a vexing  problem for  a   individual.  PNS is   blind  ending  track  lined  with  granulation  tissue  leading  to  a  cystic  cavity  containing  bits and  pieces  of  hair.

Aim:  To   observe and analyse the surgical treatment options for sacrococcygeal pilonidal sinus with a special reference to limberg flap.

Material  and  Methods:  The  patients  presenting  with  PNS  to  the  general  surgery  department  at  a tertiary  care  centre  in  north  Malabar, Kerala for two years  from 2016 were included  in  this  study. All PNS without abscess formation were treated with limberg flap, Z plasty or wide local excision.  Those with abscess formation,  I&D  was  done  primarily.  Later  after  the  abscess  healed,  wide  local  excision  and healing  with  secondary  intention  was  followed.

Results: 39 cases of sacrococcygeal PNS were included in  this  study. Karydakis and  Bascom  method  methods  were  not  used.  There  was  single  recurrence  each  after  wide  excision  and limberg flap and 2 after Z  plasty  in  sacrococcygeal  pilonidal  sinus.

Conclusion: Sacrococcygeal pilonidal sinus is a vexing problem. The  changes  in  the  hormonal  balance  during  puberty  is  the  triggering  factor. Many  treatment  modalities  are  in  the  offering, suggesting  that  a complete  cure  may  not  be  possible  with  any of  those  available. Wide  local  excision  with  primary  closure with  Limberg flap  or Z plasty   or wide local exciion with healing by secondary intention are   viable  options  for  this  condition.

Keywords:  Infection, Limberg flap, Pilonidal  sinus, Sacrococcygeal sinus,Wide local excision,  Z plasty.

References

  1. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. ANZ Journal of Surgery. 1992 May 1;62(5):385-9.
  2. Gidwani AL, Murugan K, Nasir A, Brown R. Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Irish journal of medical science. 2010 Jun 1;179(2):207-10.
  3. Shabbir J, Chaudhary BN, Britton DC. Management of sacrococcygeal pilonidal sinus disease: a snapshot of current practice. International journal of colorectal disease. 2011 Dec 1;26(12):1619-20.
  4. Bolandparvaz S, Moghadam Dizaj P, Salahi R, Paydar S, Bananzadeh M, Abbasi HR, Eshraghian A. Evaluation of the risk factors of pilonidal sinus: a single center experience. Turk J Gastroenterol. 2012 Oct 1;23(5):535-7.
  5. Onder A, Girgin S, Kapan M, Toker M, Arikanoglu Z, Palanci Y, Bac B. Pilonidal sinus disease: risk factors for postoperative complications and recurrence. International surgery. 2012 Oct;97(3):224-9.
  6. Oram Y, Kahraman F, KARιNCAOĞLU YE, Koyuncu E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatologic Surgery. 2010 Jan 1;36(1):88-91.
  7. Coşkun A, Buluş H, Akıncı ÖF, Özgönül A. Etiological factors in umbilical pilonidal sinus. Indian Journal of Surgery. 2011 Jan 1;73(1):54-7.
  8. Dogra S, Rao PP. Z-plasty a rational and effective technique for pilonidal sinus. Hellenic Journal of Surgery. 2014 Jul 1;86(4):208-11.
  9. Gidwani AL, Murugan K, Nasir A, Brown R. Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Irish journal of medical science. 2010 Jun 1;179(2):207-10.
  10. Senapati A, Cripps NP, Flashman K, Thompson MR. Cleft closure for the treatment of pilonidal sinus disease. Colorectal Disease. 2011 Mar1;13(3):333-6.
  11. Sunkara A, Wagh DD, Harode S. Intermammary pilonidal sinus. International journal of trichology. 2010 Jul;2(2):116.
  12. Allen‐Mersh TG. Pilonidal sinus: finding the right track for treatment. British Journal of Surgery. 1990 Feb 1;77(2):123-32.
  13. Osmanoglu G, Yetisir F. Limberg flap is better for the surgical treatment of pilonidal sinus. Results of a 767 patients series with an at least five years follow-up period. Chirurgia. 2011 Jul 1;106(4):491-4.
  14. Yildiz MK, Ozkan E, Odabaşı HM, Kaya B, Eriş C, Abuoğlu HH, Günay E, Fersahoglu MM, Atalay S. Karydakis flap procedure in patients with sacrococcygeal pilonidal sinus disease: experience of a single centre in Istanbul. The Scientific World Journal. 2013 May 14;2013.
  15. Dudink R, Veldkamp J, Nienhuijs S, Heemskerk J. Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scandinavian Journal of Surgery. 2011 Jun;100(2):110-3.

Corresponding Author

Dr Arun.S

Assistant Professor, Department of General Surgery, Government Medical College, Manjeri, Kerala, India-676121