Study on Surgical Treatment of Pilonidal Sinus Disease
Condition: Pilonidal Sinus
MeSH terms: Pilonidal Sinus; Paranasal Sinus Diseases
Study type: Observational

Summary: 
      Comparison of limited excision-primary closure, Limberg, and modified Limberg flap techniques
      for the surgical treatment of pilonidal sinus disease, each performed by a separate surgeon,
      in terms of postoperative outcomes and recurrence rates.
    

Detailed description: 
      Pilonidal sinus disease (PSD) is a common chronic disease that generally affects young adults
      below the age of 45. It is most commonly observed at the inter-gluteal region, though it may
      also affect other sites like the umbilicus and the inter-digital area, particularly among in
      barbers. The disease was long thought to be either congenital or acquired; although in recent
      years it has been more widely viewed as an acquired disease. The etiology of PSD is not fully
      understood, however, the most important cause is believed to be fallen hairs accumulating
      within skin folds and implanting within the skin. The skin becomes more prone to maceration,
      sweating and bacterial contamination, which facilitates implantation of fallen hairs,
      creating the necessary conditions for development of the disease. Although PSD is a benign
      disease, it produces symptoms such as pain and discharge, which adversely affect patient
      quality of life.

      There are many approaches for treatment of the disease, including several surgical methods
      such as limited or large excision, primary closure, or flap techniques, and many other
      non-surgical methods. However, no consensus has been reached regarding the ideal treatment
      method. An ideal surgical treatment reduces recurrence and complication rates, and allows for
      minimal hospitalization and rapid return to daily activities. Among patients treated using
      the limited excision and primary closure method, the presence of a natal cleft is associated
      with higher morbidity, resulting in recurrence rates of 7-42%. For techniques that use the
      flap approach, this rate decreases to 0-3%. In patients undergoing the Rhomboid excision and
      Limberg flap techniques, which require a larger surgical area compared to the limited
      excision and primary closure methods, complication rates are lower, and length of
      hospital-stay and time to return to work are reduced. However, using the classical Limberg
      flap technique, maceration and scar formation due to sutures in the inter-gluteal sulcus, and
      the accumulation of hair at the midline may result in recurrence. Application of a modified
      Limberg technique that includes lateralization of the middle line can help reduce wound
      complications and recurrence rates. Several publications report contradicting results
      regarding surgical outcomes using the same technique, which may be attributable to
      differences in practice between surgeons. Therefore, it can be logical to explore the
      superiority of any type of surgical technique performed by the same surgeon for the surgical
      treatment of pilonidal sinus disease.
    

Intervention name(s): surgery for pilonidal sinus disease
Intervention type(s): Procedure
Intervention description(s): surgical treatment of pilonidal sinus disease via primary closure, Limberg flap0 technique and Modified Limberg flap technique.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        A total of 1082 patients who were diagnosed with pilonidal sinüs disease and who underwent
        surgical treatment in a governmental hospital between January 2011 and June 2015.
      
Keywords: pilonidal sinus; complication; recurrence