Minimally Invasive Pilonidal Sinus Treatment: A Brief Review

Authors

DOI:

https://doi.org/10.3889/oamjms.2021.7269

Keywords:

Pilonidal sinus disease, Minimally invasive surgery, Recurrence rate

Abstract

With a prevalence of 26/100,000, pilonidal sinus disease is a frequent natal cleft condition that primarily affects young males. The disease site is often uncomfortable and the disease can result in problems such as abscess formation and recurrent acute or chronic infections. Minimally invasive treatment aims to form a small elliptical wedge of subcutaneous tissue containing all the inflammatory tissue. The sinus and its lateral tracks are removed while keeping the overlying skin intact. Following the notion of “less is more,” novel least invasive treatments such as sinotomy, sinusectomy, trephining, and video-assisted and endoscopic pilonidal sinus surgery have recently been proposed. We look at minimally invasive treatments to explain how research into modern techniques has revealed a low rate of short-term problems.

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References

Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. 2002;82(6):1169-85. https://doi.org/10.1016/s0039-6109(02)00062-2 PMid:12516846

Allen-Mersh TG. Pilonidal sinus: Finding the right track for treatment. Br J Surg. 1990;77(2):123-32. https://doi.org/10.1002/bjs.1800770203 PMid:2180534

da Silva JH. Pilonidal cyst: Cause and treatment. Dis Colon Rectum. 2000;43(8):1146-56. https://doi.org/10.1007/BF02236564 PMid:10950015

Caestecker J, Mann BD, Castellanos AE, Straus J. Medscape. Pilonidal Disease. Available from: http://emedicine.medscape.com/article/192668-overview [Last accessed on 2016 Mar 06].

Karydakis GE. New approach to the problem of pilonidal sinus. Lancet. 1973;2(7843):1414-5. https://doi.org/10.1016/s0140-6736(73)92803-1 PMid:4128725

Clothier PR, Haywood IR. The natural history of the post anal (pilonidal) sinus. Ann R Coll Surg Engl. 1984;66(3):201-3. PMid:6721409

Hardaway RM. Pilonidal cyst neither pilonidal nor cyst. Arch Surg. 1958;76:143-7. https://doi.org/10.1001/archsurg.1958.01280190145027 PMid:13487063

Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: Description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51(11):1656-62; discussion 1662-3. https://doi.org/10.1007/s10350-008-9329-x PMid:18516645

McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: Systematic review and meta-analysis. BMJ. 2008;336(7649):868-71. https://doi.org/10.1136/bmj.39517.808160.BE PMid:18390914

Thompson MR, Senapati A, Kitchen P. Simple day-case surgery for pilonidal sinus disease. Br J Surg. 2011;98(2):198-209. https://doi.org/10.1002/bjs.7292 PMid:21125608

Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Fernandez LM, et al. Videoassisted ablation of pilonidal sinus: A new minimally invasive treatment: A pilot study. Surgery. 2014;155(3):562-6. https://doi.org/10.1016/j.surg.2013.08.021 PMid:24300343

Soll C, Hahnloser D, Dindo D, Clavien PA, Hetzer F. A novel approach for treatment of sacrococcygeal pilonidal sinus: Less is more. Int J Colorectal Dis. 2008;23(2):177-80. https://doi.org/10.1007/s00384-007-0377-9 PMid:17703314

Levinson T, Sela T, Chencinski S, Derazne E, Tzur D, Elad H, et al. Pilonidal sinus disease: A 10-year review reveals occupational risk factors and the superiority of the minimal surgery trephine technique. Mil Med. 2016;181(4):389-94. https://doi.org/10.7205/MILMED-D-14-00729 PMid:27046187

Elbanna HG, Emile SH, Youssef M, Thabet W, El-Hamed TM, Ghnnam WM. novel approach of treatment of pilonidal sinus disease with thrombin gelatin matrix as a sealant. Dis Colon Rectum. 2016;59(8):775-80. https://doi.org/10.1097/DCR.0000000000000604 PMid:27384096

Neola B, Capasso S, Caruso L, Falato A, Ferulano GP. Scarless outpatient ablation of pilonidal sinus: A pilot study of a new minimally invasive treatment. Int Wound J. 2016;13(5):705-8. https://doi.org/10.1111/iwj.12350 PMid:25132617

Milone M, Fernandez LM, Musella M, Milone F. Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: A randomized clinical trial. JAMA Surg. 2016;151(6):547-53. https://doi.org/10.1001/jamasurg.2015.5233 PMid:26819186

Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol. 2014;18(4):389-92. https://doi.org/10.1007/s10151-013-1016-9 PMid:23681300

Chia CL, Tay VW, Mantoo SK. Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech. 2015;25(3):e95-7. https://doi.org/10.1097/SLE.0000000000000131 PMid:26018049

Gecim IE, Goktug UU, Celasin H. Endoscopic pilonidal sinus treatment combined with crystalized phenol application may prevent recurrence. Dis Colon Rectum. 2017;60(4):405-7. https://doi.org/10.1097/DCR.0000000000000778 PMid:28267008

Javed MA, Fowler H, Jain Y, Singh S, Scott M, Rajaganeshan R. Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT). Tech Coloproctol. 2016;20(12):871-3. https://doi.org/10.1007/s10151-016-1546-z PMid:27888441

Jain Y, Javed MA, Singh S, Rout S, Joshi H, Rajaganeshan R. Endoscopic pilonidal abscess treatment: A novel approach for the treatment of pilonidal abscess. Ann R Coll Surg Engl. 2017;99(2):134-6. https://doi.org/10.1308/rcsann.2016.0260 PMid:27551895

Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P. Endoscopic pilonidal sinus treatment: Long-term results of a prospective series. JSLS. 2017;21(3):e2017.00043. https://doi.org/10.4293/JSLS.2017.00043 PMid:28904522

Mahdy T. Surgical treatment of the pilonidal disease: Primary closure or flap reconstruction after excision. Dis Colon Rectum. 2008;51:1816-22. https://doi.org/10.1007/s10350-008-9436-8 PMid:18937009

Brasel KJ, Gottesman L, Vasilevsky CA; Members of the Evidence-Based Reviews in Surgery Group. Meta-analysis comparing healing by primary closure and open healing after surgery for pilonidal sinus. J Am Coll Surg. 2010;211(3):431-4. https://doi.org/10.1016/j.jamcollsurg.2010.06.014 PMid:20800201

Dalenback J, Magnusson O, Wedel N, Rimback G. Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia: Efficient, sufficient, and persistent. Colorectal Dis. 2004;6(6):488-93. https://doi.org/10.1111/j.1463-1318.2004.00693.x PMid:15521941

Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg. 2007;205(3):439-44. https://doi.org/10.1016/j.jamcollsurg.2007.04.034 PMid:17765160

Steele SR, Perry BW, Mills S, Buie WD; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Dis Colon Rectum. 2013;56(9):1021-7. https://doi.org/10.1097/DCR.0b013e31829d2616 PMid:23929010

Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C. Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech Coloproctol. 2014;18(10):863-72. PMid:24845110

Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010;4:CD006213. https://doi.org/10.1002/14651858.CD006213.pub2 PMid:17943897

Iesalnieks I, Ommer A, Petersen S, Doll D, Herold A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg. 2016;401(5):599-609. https://doi.org/10.1007/s00423-016-1463-7 PMid:27311698

Sevinç B, Karahan O, Okuş A, Ay S, Aksoy N, Şimşek G. Randomized prospective comparison of midline and offmidline closure techniques in pilonidal sinus surgery. Surgery. 2016;159(3):749-54. https://doi.org/10.1016/j.surg.2015.09.024 PMid:26531235

Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg. 2011;9(4):343-6. https://doi.org/10.1016/j.ijsu.2011.02.009 PMid:21354343

Käser SA, Zengaffinen R, Uhlmann M, Glaser C, Maurer CA. Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: A multicentre randomised controlled study. Int J Colorectal Dis. 2015;30:97-103. https://doi.org/10.1007/s00384-014-2057-x PMid:25367184

Lavelle M, Jafri Z, Town G. Recurrent pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther. 2002;4(2):45-7. https://doi.org/10.1080/147641702320602564 PMid:12470518

Kayaalp C, Aydin C. Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol. 2009;13(3):189-93. https://doi.org/10.1007/s10151-009-0519-x PMid:19655223

Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S,Duesel W. Timeline of recurrence after primary andsecondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50(11):1928-34. https://doi.org/10.1007/s10350-007-9031-4 PMid:17874268

Davage ON. The origin of sacrococcygeal pilonidal sinusesbased on an analysis of four hundred sixty-three cases. Am J Pathol. 1954;30(6):1191-205. PMid:13207320

Bascom J. Pilonidal disease: Long-term results of follicle removal. Dis Colon Rectum. 1983;26(12):800-7. https://doi.org/10.1007/BF02554755 PMid:6641463

Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, et al. Minimally invasive pilonidal sinus treatment: A narrative review. Open Med (Wars). 2019;14:532-6. https://doi.org/10.1515/med-2019-0059 PMid:31428682

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Published

2021-12-20

How to Cite

1.
Coco D, Leanza S. Minimally Invasive Pilonidal Sinus Treatment: A Brief Review. Open Access Maced J Med Sci [Internet]. 2021 Dec. 20 [cited 2026 Oct. 19];9(F):770-4. Available from: https://oamjms.eu/index.php/mjms/article/view/7269

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Narrative Review Article

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