BACKGROUND: Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT).
METHODS: We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed.
RESULTS: A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients\' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients\' evaluation) and 11.4 ± 4.7 (observers\' evaluation).
CONCLUSIONS: The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.

UNASSIGNED: There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments.
UNASSIGNED: A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research.
UNASSIGNED: Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system.
UNASSIGNED: Thirty-one National Health Service trusts.
UNASSIGNED: Patients aged > 16 years referred for elective surgical treatment of pilonidal disease.
UNASSIGNED: Surgery.
UNASSIGNED: Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features.
UNASSIGNED: Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself.
UNASSIGNED: Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.
UNASSIGNED: Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set.
UNASSIGNED: This trial is registered as ISRCTN95551898.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.
Pilonidal disease is caused by ingrowing hairs between the buttocks. It can cause pain and infection and may need surgery. We do not know which operation gives the best results, or who operations help. PITSTOP aimed to find out which operation is the best and what is important to patients when deciding on surgery, and to suggest ideas for better treatment and future research. We looked at what operations were done and their outcomes. We interviewed patients about their experiences. Some completed a survey to help us understand what operations they might prefer based on risks and outcomes. Surgeons completed a survey about their experiences, and we explored whether a new tool could help us tell the difference between ‘mild’ and ‘bad’ disease. We used findings from these studies to help patients and surgeons give priorities for future practice and research. Six hundred and sixty-seven patients joined PITSTOP. People who had a major operation had more pain and took longer to return to normal activities. Some were still affected 6 months after surgery. However, disease recurrence was lower than after a minor procedure. Patients based decisions about treatment on the likelihood of success and the time to recover. The study and the surgeons’ survey both showed marked differences in practice. Surgeons tended to offer one or two operations learned during training. A classification tool put cases in similar groups, but this did not influence treatment choices. The consensus exercise identified five research priorities, the top one being to put types of surgery into two groups. Of the five practice priorities, the top one was that surgery should not make the patient worse than the disease. There is variation in the treatment of pilonidal disease. Wound issues and impact on daily living should be avoided. The highlighted research questions should be addressed to improve care.

Background Despite pilonidal sinus disease being a prevalent issue, there are still many challenges and controversies regarding its management. This study aimed to evaluate the experiences and practices of surgeons in the Kurdistan region of Iraq in the management of the pilonidal sinus and determine the most preferred treatment method, recurrence rates, and other complications related to different treatment methods. Methods This cross-sectional study was conducted on a convenience sample of 104 surgeons in the Kurdistan region of Iraq from January to February 2024 using an online survey based on Google Forms. A questionnaire was developed for data collection that included data on the experience and practice of pilonidal sinus treatment. Results The most common procedure followed by the study participants to manage the pilonidal sinus included primary open (n = 61/104, 58.7%), followed by primary closure (n = 20/104, 19.2%). The most common reasons or advantages for performing specific procedures to manage the pilonidal sinus were a lower recurrence rate (n = 73/104, 70.2%), safer procedures (n = 60/104, 57.7%), shorter operation times (n = 57/104, 54.8%), and shorter hospital stays (n = 53/104, 51.0%). The primary open method was the most commonly used method (n = 46/104, 44.3%), followed by simple incision and drainage (n = 25/104, 24.0%), primary closure (n = 23/104, 22.1%), and off-midline closure (n = 10/104, 9.6%). Most of the participants agreed that the primary open had the lowest recurrence rate (n = 68/104, 65.4%), while simple incision and drainage (n = 50/104, 48.1%) and primary closure (n = 29/104, 27.9%) were associated with frequent recurrence. Conclusions Standard treatment of pilonidal sinus disease is still not available. Most surgeons in the Kurdistan region of Iraq prefer the open method, which is the easiest, safest, and least recurrent yield method. However, it is the most painful and has the longest recovery time.

UNASSIGNED: We evaluated the clinical effect of utilizing a Limberg rhomboid flap graft in conjunction with Enhanced Recovery After Surgery (ERAS) protocols for the management of pilonidal sinus in the sacrococcygeal region to demonstrate the feasibility of applying ERAS to the treatment of pilonidal sinus.
UNASSIGNED: Between January 2010 and August 2018, prospective data analysis was undertaken on 109 patients who received surgical treatment for pilonidal sinus in the sacrococcygeal region at the Department of Colorectal and Anal Surgery, Jingzhou Hospital affiliated to Yangtze University, and Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine. The patients were randomly separated into two groups based onoperation technique: the control group (pilonidal sinus resection with primary suture) and the observation group (pilonidal sinus resection with Limberg flap graft). Some patients in the above two groups received ERAS after surgery, which included early feeding and early ambulation, etc. Therefore, we further subdivided each group into group A (without ERAS) and group B (with ERAS) according to whether they received ERAS. Comparative analysis was conducted to assess differences in pertinent data before and after surgery across the respective groups.
UNASSIGNED: The length of postoperative hospitalization was shorter and wound dehiscence was more common in control group B than in control group A [(9.00 ± 1.20) vs. (11.07 ± 1.78), 26.7% (8/30) vs. 7.1% (2/28), P < 0.05]. Observation group B exhibited significantly shorter wound recovery periods and postoperative hospital stays compared to observation group A [(8.08 ± 1.20) vs. (9.16 ± 2.21), (26.23 ± 3.97) vs. (29.08 ± 4.74), P < 0.05]. The hospitalization duration and wound healing time in observation group B were notably shorter than those observed in control group B [(8.08 ± 1.20) vs. (9.00 ± 1.20), [26.23 ± 3.97 vs. (43.67 ± 7.26), P < 0.05], but the operation time was longer and scar acceptance was lower [(78.85 ± 10.16) vs. (43.30 ± 6.06), (4.00 ± 0.69) vs. (7.53 ± 0.86), P < 0.05]. The VAS score, infection rate, wound dehiscence rate, subcutaneous hematoma rate and 5-year recurrence rate in observation group B were lower than those in control group B [(5.00 ± 1.39) vs. (7.13 ± 0.78), 3.8% (1/26) vs. 23.3% (7/30), 3.8% (1/26) vs. 26.7% (8/30), 3.8% (1/26) vs. 26.7%(8/30), 7.7% (2/26) vs. 30.0% (9/30), P < 0.05], but the rate of flap ischemia or necrosis was higher [15.4% (4/26) vs. 0(0/30), P < 0.05].
UNASSIGNED: The combination of ERAS with pilonidal sinus resection using Limberg flap graft demonstrated a reduction in infection rates, wound dehiscence, subcutaneous hematoma occurrence, and recurrence rates, along with alleviation of postoperative pain and acceleration of healing time. Comparatively, this approach offers superior advantages over pilonidal sinus resection with primary suture in the management of sacrococcygeal pilonidal sinus.

Introduction Among young male adults, sacrococcygeal pilonidal sinus disease (SPSD) is a prevalent condition. There are several possibilities for treatment, including both conservative and surgical methods. Medical supervision or conservative management is not the cutting-edge and preferred management nowadays. Although not fatal, it negatively impacts young people\'s quality of life in terms of schooling and means of subsistence and is socially awkward. Method About 10 individuals in this case series have serous drainage from the sinus in the sacral region, which is a common symptom. The patients were entitled to a full recovery from their illness. In all these patients, the Limberg flap procedure was recommended, and just one patient out of 10 had a minimal infection. Every patient was satisfied with how the surgery turned out. Overall, the Limberg flap (rhomboid flap) approach is becoming the norm for care since it has a lower rate of recurrence, fewer postoperative problems, and a shorter learning curve. Result Flap necrosis instances were absent in all the cases. And out of 10 cases, one patient came with a surgical site infection during the follow-up, suggesting a complication rate of 10%. Conclusion For the treatment of primary pilonidal illness, rhomboid excision utilising the Limberg transpositional fasciocutaneous flap technique is seen as a safer option that encompasses numerous sinuses. It requires less time in the hospital and has fewer postoperative problems.

BACKGROUND: To date, only a limited number of case reports have documented the co-occurrence of PNS and melanocytic nevus in the medical literature. This study aims to report an exceptionally rare case of posterior chest wall PNS in conjunction with a melanocytic nevus.
METHODS: A 46-year-old female presented with a long-standing black lesion on her left upper posterior chest wall, that had become painful in the two months prior to presentation. There was a painful, dark blue, non-erythematous, and non-tender nodule on the left upper posterior chest wall. Based on the patient\'s desire for cosmetic purposes, the lesion was excised totally with primary closure under local anaesthesia. Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus.
CONCLUSIONS: The rarity of posterior chest wall PNS associated with nevi poses unique diagnostic and therapeutic challenges for clinicians. The distinct anatomical location, different from the conventional region, and the rare association between the two conditions may delay accurate diagnosis and result in mismanagement or inappropriate interventions.
CONCLUSIONS: The posterior chest wall PNS is another type of atypical PNS that is extremely rare. The association between PNS and blue nevus is a fascinating medical finding that deserves further investigation.

Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area. Hemophilia type A is a hemorrhagic disorder caused by a deficiency of factor VIII. It presents with excessive bleeding, either spontaneously or secondary to trauma. The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used. In this article, we present a case of a young man with hemophilia A presenting with recurrent PNS successfully managed with laser ablation with no complications.

BACKGROUND: Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques.
METHODS: From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed.
RESULTS: Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023).
CONCLUSIONS: Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.

暂无摘要。

UNASSIGNED: The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique.
UNASSIGNED: The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time.
UNASSIGNED: Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant.
UNASSIGNED: Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.