BACKGROUND: Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches were documented in the literature.
METHODS: A 19-year-old male patient who had a history of recurrent pilonidal sinus disease that was operated on twice 4 months apart. He presented to our hospital for postoperative follow-up, during which the inserted drain was assessed. While withdrawing the drain, part of it was damaged and missed. The location of the misplaced drain was assessed by a lumbosacral region computed tomography (CT) scan. The decision was made to proceed with less invasive methods using interventional radiology techniques to avoid wide excision and incision reopening complications and prolonged healing time. A fluoroscopy procedure was performed to create three-dimensional anterolateral, frontal posterior views. Then the fragmented drain was retrieved successfully by a minimally invasive technique. The postoperative period was uneventful.
CONCLUSIONS: Drain fragmentation and/or dislodgement is a highly challenging event that requires highly innovative intervention. Multiple treatment options are available as open surgery techniques and endoscopic approaches.
CONCLUSIONS: This case highlights the potential role of fluoroscopy as an outstanding effective choice that could be carried out promptly and safely at the bedside under local anesthetic and reduce the patient\'s hospital stay.

BACKGROUND: The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an effect on the method and clinical results in the treatment of pilonidal sinus disease (PSD).
METHODS: Between September 2019 and September 2020, patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey, were matched for age, pit location and number, body mass index (BMI), and sex. The primary endpoint was complete wound healing and the secondary endpoints were quality of life, cosmetic results, and cost.
RESULTS: Twenty-four LEPSIT patients were matched to 72 EPSIT patients. Eighty-one (84.4%) of the included patients were male, and the median age was 26 years (range 16-52 years). The median follow-up time was 9 months (range 3-15 months).Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups. In patients who underwent LEPSIT, the operative time (p = 0.00086) was significantly shorter, time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less. However, the time taken to return to daily activities and the percentage of wound complications were similar in both groups. The pain scores on postoperative -days 1 7, and 14 were significantly higher after EPSIT (p = 0.0083, p = 0.00054, and p = 0.0479, respectively). The postoperative analgesic requirement was significantly higher after EPSIT (p = 0.01492). The total hospital cost was significantly less in patients who underwent EPSIT (p < 0.00001). Significantly better cosmetic improvement was observed in LEPSIT procedure (p = 0.00694). First month quality of life (evaluated with the Short Form 36 Health Survey Questionnaire) was similar except for bodily pain (better after LEPSIT).
CONCLUSIONS: The success rates of LEPSIT and EPSIT are similar. LEPSIT results in better wound healing and patient comfort, and a shorter time to return to work.

Pilonidal sinus disease (PSD) is an acquired pathological condition more commonly seen in the natal cleft of the sacrococcygeal area, although its presentation is not limited to the natal cleft and it can present in other regions of the body such as the breast, umbilicus, scalp and penis. We present the case of a 28-year-old gentleman who presented to his local Urology outpatient clinic with an unusual penile lesion that was later identified as a pilonidal sinus. This was treated with radical circumcision and penile reconstruction with a good functional outcome. For surgeons unaccustomed to PSD presenting on the penis, there is a potential for delay in diagnosis and sub-optimal management of this rare lesion.

UNASSIGNED: Pilonidal disease is a morbid condition of the young population, that could impair quality of life with a high cost for the health care system. No consensus exists on optimal surgical treatment, even if several techniques have been proposed. In this preliminary case-control study we compared excision by knife and diathermy to investigate if wound dehiscence could be related to heat spreading during excision of the sinus.
UNASSIGNED: Between January 2017 and February 2018, 29 patients underwent to sinus excision.16 patients underwent sinus excision by diathermy (named \"Hot\" group, case-group) while 13 patients underwent excision by the knife as the control group (named \"Cold\" group). The temperature data were recorded for both groups. Were considered primary and secondary outcomes.
UNASSIGNED: the cold group has worse outcomes in operative time and blood loss, but better results in post-operative pain at first day and first control, number of weekly and total dressings until healing, time for full wound recovery, days to return to work, patient feeling feedback and scar aspect. Wounds healed within 8-12 days were 84.6% in the Cold group and 18.8% in the Hot one. I° Dindo-Clavien complications were respectively 15.4% and 100.0% for the Cold and Hot group. No differences were recorded for II° Dindo-Clavien complications and in days of hospitalization.
UNASSIGNED: cold excision of the sinus pilonidalis has better results both in terms of precarious healing and quality of life, probably because the tissues are not subjected to diathermocoagulation damage and therefore the healing occurs more quickly. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT03764657, www.researchregistry.com UIN 5003).

BACKGROUND: Pilonidal sinus disease is an acute abscess-forming or chronic subacute inflammation, characterized by a fistula system with typical ostia. Treatment is primarily surgical.
OBJECTIVE: This study aimed to investigate and evaluate the evolution of pilonidal sinus disease in Germany on the basis of data provided by the Federal Statistical Office in Germany (Statistisches Bundesamt).
METHODS: From the diagnosis data of hospital inpatients generated by the Federal Statistical Office in Germany the data on the International Classification of Diseases (ICD) code L05 for pilonidal sinus from 2007 to 2015 were extracted and processed.
CONCLUSIONS: The number of cases increased from 25,835 cases in 2007 to 31,033 cases in 2011, followed by a decrease to 30,235 cases in 2015. Considering the number of patients under 20 years of age, there was also an increase from 40 cases per 100,000 population in 2007 to 50 cases per 100,000 population in 2013. Ever since, the case numbers have remained relatively constant and have reached a plateau. The maximum number of case numbers was in the age group of 20-24 years. The female age group 10-14 years old is the only group among all investigated age groups with more cases than the respective male age group. The investigated data did not permit any epidemiological conclusions for pilonidal sinus disease because outpatient cases have not been included. The higher incidence in the female age group 10-14 years old could be explained by the earlier onset of adolescence. Thus, adolescence appears to have a major impact on the development of pilonidal sinus disease.

Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery.