Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.

OBJECTIVE: Pilonidal sinus disease is a disease that especially affects the young population and causes loss of workforce. Although many treatment methods have been defined, there is still no \"gold standard\" treatment method. Our objective was to evaluate the postoperative results of bilateral parallel elliptical flap and Karydakis flap in the surgical treatment of pilonidal sinus.
METHODS: This study was conducted at the Colorectal Surgery Department of Ankara Numune Training and Research Hospital. It designed a prospective randomized controlled study. Patients that underwent surgery due to pilonidal sinus were included in the study. The patients were randomly divided into two groups. Surgery was performed with the bilateral parallel elliptical flap (BPEF) technique in one group and the Karydakis flap (KF) technique in the other group. Postoperative pain, length of hospital stay, wound complications, time taken to return to work/school, and recurrence incidence were evaluated.
RESULTS: A total of 102 patients were included in the study, 49 in the BPEF group and 53 in the KF group. The length of hospital stay was similar in the BPEF and KF groups (1.41 ± 0.81 and 1.45 ± 0.84, respectively; p > 0.05). There was less postoperative pain in the BPEF group (2.47 ± 1.02 vs 3.57 ± 1.10, p < 0.05). Wound complications were observed in nine patients in the BPEF group (18.2%) and 14 patients in the KF group (26.2%). The time to return to work/school was shorter in the BPEF group (21.06 ± 6.37 vs 27.04 ± 7.45; p < 0.05). Recurrence developed in two (4%) patients in the BPEF group and three (5.6%) patients in the KF group (p > 0.05).
CONCLUSIONS: The patients who underwent surgery with the bilateral parallel elliptical flap technique had less pain and a shorter time to return to work/school after the operation. The postoperative complication and recurrence rates were similar in both groups.
BACKGROUND: clinicaltrials.gov identifier: NCT05851690. (5/11/2023) (retrospectively registered).

BACKGROUND: Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery.
METHODS: We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups.
RESULTS: PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001).
CONCLUSIONS: PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.

OBJECTIVE: The objective of this work was to compare excision with primary closure according to Karydakis technique (KT) with en bloc resection with secondary healing (EB) in the treatment of pilonidal sinus in adolescents.
METHODS: An observational, retrospective, multi-center study was carried out in adolescent patients (11-18 years old) diagnosed with pilonidal sinus and undergoing surgery from 2011 to 2017. Patients were divided into 2 groups: KT (pediatric surgeons) and EB (general surgeons).
RESULTS: Our sample consisted of 61 patients (KT: 26 patients; EB: 35 patients). Mean total recovery time (days) was significantly shorter in the KT group (37.77 KT vs. 107.76 EB, p< 0.001). In terms of postoperative complications, no differences were noted regarding overall complication rate (53.8% KT vs. 40% EB). However, differences were found in postoperative bleeding (0% KT vs. 25.7% EB, p=0.005), seroma occurrence (23.1% KT vs. 0% EB, p=0.003), and surgical wound dehiscence (42.3% KT vs. 8.6% EB, p=0.002). Recurrence rate was lower in the Karydakis group than in the en bloc resection group (4% vs. 28.6%, p=0.015).
CONCLUSIONS: Both surgical techniques (KT and EB) are acceptable and safe, but in our study, Karydakis technique demonstrated to be more effective than en bloc resection with secondary closure, since it allowed for shorter recovery times and lower recurrence rates. Therefore, Karydakis surgical technique can be an excellent alternative in the treatment of pilonidal sinus in the adolescent population.
UNASSIGNED: El objetivo de este trabajo es comparar la escisión con cierre primario según la técnica de Karydakis (TK) y la exéresis en bloque con cicatrización por segunda intención (EB), para el tratamiento del sinus pilonidal en adolescentes.
UNASSIGNED: Estudio observacional, retrospectivo y multicéntrico en pacientes en edad adolescente (11-18 años), con diagnóstico de sinus pilonidal e intervenidos entre 2011-2017, divididos en 2 grupos: TK (cirujanos pediátricos) y EB (cirujanos generales).
UNASSIGNED: Presentamos una muestra de 61 pacientes (TK: 26 pacientes y EB: 35 pacientes). El tiempo medio (días) de recuperación total fue significativamente más corto en el grupo TK (37,77 TK vs 107,76 EB; p< 0,001). En cuanto a las complicaciones postoperatorias, no se encontraron diferencias respecto a la tasa global de complicaciones (53,8% TK vs 40% EB). Sin embargo, se demuestran diferencias en el sangrado postquirúrgico (0% TK vs 25,7% EB; p= 0,005), aparición de seroma (23,1% TK vs 0% EB; p= 0,003) y dehiscencia de herida quirúrgica (42,3% TK vs 8,6% EB; p= 0,002). La tasa de recurrencia ha sido menor en el grupo de Karydakis respecto al grupo de exéresis en bloque (4% vs 28,6%; p= 0,015).
UNASSIGNED: Ambas técnicas quirúrgicas son aceptables y seguras, pero en nuestro estudio la técnica de Karydakis se ha mostrado más eficaz que la exéresis en bloque con cierre por segunda intención, ya que requiere un menor tiempo de recuperación del paciente, con una tasa de recurrencia inferior. Por ello, la técnica quirúrgica de Karydakis puede suponer una alternativa excelente en el tratamiento de la enfermedad pilonidal en población adolescente.

BACKGROUND: The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF.
METHODS: Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction.
RESULTS: Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of -0.788 (95%CI: -11.55 to -4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9-2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76-1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15-3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39-3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= -0.182; 95%CI: -3.58 to -0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65-3.77, p = 0.01).
CONCLUSIONS: KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.

BACKGROUND: Pilonidal sinus is a disease affecting young age group. Numerous surgical methods have been described in the treatment of pilonidal sinus disease. Currently, there is no treatment method providing a rapid recovery with low recurrence risk.
OBJECTIVE: In this study, we aimed to evaluate the results of our patients who underwent Karydakis surgery.
METHODS: Results of 112 patients operated between 2012 and 2019 were retrospectively evaluated. Only the patients who underwent Karydakis surgery were included in the study.
RESULTS: Of all patients, 20 were female and 92 were male. The mean age was 21 years in the female and 20.8 years in the male patients. The mean BMI was 29.6 Kg/m2. Thye patients were followed up for mean 28 months. Postoperative length of stay in hospital was 2.1 days. The complications included wound dehiscence by 10.2%, infection by 3.6%, and bleeding (hematome) by 7.1%. Four patients developed recurrence during follow up.
CONCLUSIONS: Karydakis surgery is a preferable surgical technique with low rates of complications and recurrence.

An ideal treatment for pilonidal disease should feature a low recurrence rate, minimal incision, and rapid return to daily activities. We compared the outcomes of the well-defined Karydakis technique (KT) and a combination of pit excision (PE) and sinus tract ablation using 1,470-nm diode laser.
In this study, from January 2016 to January 2018, patients diagnosed with uncomplicated early-stage pilonidal sinus disease were enrolled and were treated randomly, using KT (n = 28) or a PE/laser ablation technique (PE + LAT; n = 30).
The mean operative times were 36.4 (25-45) minutes in the KT group and 15.1 (12-20) minutes in the PE + LAT group. Postoperative Visual Analog Scale pain scores were 4.4 in the KT group and 2.1 in the PE + LAT group. The time periods to return to normal daily activities were 2.6 (1-5) days in the PE + LAT group and 12.8 (10-20) days in the KT group. The mean Likert satisfaction scores were 3.8 in the KT group and 4.8 in the PE + LAT group. The groups did not differ in terms of recurrence.
Compared with the KT, the PE + LAT was associated with a shorter operative time, a more rapid return to normal activities, less pain, and a higher level of subjective satisfaction. We found that the PE + LAT was better than the KT for patients with early-stage disease. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series.
Ninety-seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed. Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position.
Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%). The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only. Wound complications, mostly minor skin separation, occurred in 37 patients (38%). Disease recurrence occurred in eight patients (8%). There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups).
Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency. The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease.

BACKGROUND: Pilonidal disease (PD) is associated with significant disability culminating in time off work/school. Recurrence rates remain high following conventional surgical interventions. Flap-based techniques are postulated to decrease recurrence. We performed a systematic review and meta-analysis to compare the effectiveness of the classical Limberg (LF) and Karydakis (KF) flaps in the treatment of PD.
METHODS: The online databases of Medline, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials as well as Google Scholar were searched for relevant articles from inception until May 2017. All randomized studies that reported direct comparisons of classical LF and KF were included. Two independent reviewers performed data extraction. Random effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out.
RESULTS: Five randomized controlled trials describing 727 patients (367 in LF, 360 in KF) were examined. There was significant heterogeneity among studies. On overall random effects analysis, there was a lower rate of seroma formation associated with LF, and this approached statistical significance (OR = 0.47, 95% CI = 0.22 to 1.03, p = 0.06). However, there were no significant differences in recurrence (OR = 1.03, 95% CI = 0.48 to 2.21, p = 0.939), wound dehiscence (OR = 0.53, 95% CI = 0.09 to 2.85, p = 0.459), wound infection (OR = 0.59, 95% CI = 0.23 to 1.52, p = 0.278) or haematoma formation (OR = 2.08, 95% CI = 0.82 to 5.30, p = 0.124) between LF and KF. On sensitivity analysis, focusing only on primary and excluding recurrent PD, the results remained similar.
CONCLUSIONS: LF and KF appear comparable in efficacy for primary PD, although LF is associated with less seroma formation.

Sacro-coccygeal pilonidal sinus disease is classified as an asymptomatic, acutely abscess-forming or chronic subcutaneous inflammation in the sacro-coccygeal region featuring characteristic pits in the bottom cleft. Due to high rates of recurrence, two flap techniques have been established in the course of the past three decades. One of them is the Karydakis operation, the other option is a rotation flap named Limberg procedure. We report about a case of suture granuloma in the area of a Limberg flap after recurrent pilonidal sinus with extrusion of the suture material, thus mimicking recurrence. In case of recurrent pilonidal sinus following plastic coverage or primary closure, respectively, the differential diagnosis of suture granuloma should be considered.