I Iesalnieks1, A Ommer2, S Petersen3, D Doll4, A Herold5. 1. Department of Surgery, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany. iesalnieks_igors@hotmail.com. 2. End- und Dickdarm-Zentrum Essen, Essen, Germany. 3. Department of Surgery, Asklepios-Klinik Altona, Hamburg, Germany. 4. Department of Surgery, St. Marienhospital Vechta, Vechta, Germany. 5. End- und Dickdarmzentrum Mannheim, Mannheim, Germany.
Abstract
PURPOSE: The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language. METHODS: This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference. RESULTS: Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials. CONCLUSIONS: An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.
PURPOSE: The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language. METHODS: This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference. RESULTS: Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials. CONCLUSIONS: An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.
Entities:
Keywords:
Pilonidal abscess; Pilonidal disease; Pilonidal sinus; Surgery
Authors: Dietrich Doll; Jan Friederichs; Heidi Dettmann; Anne-Laure Boulesteix; Wolfgang Duesel; Sven Petersen Journal: Int J Colorectal Dis Date: 2008-04 Impact factor: 2.571
Authors: Tenzin Lamdark; Raphael Nicolas Vuille-Dit-Bille; Isabella Naomi Bielicki; Laura C Guglielmetti; Rashikh A Choudhury; Nora Peters; Dietrich Doll; Markus M Luedi; Michel Adamina Journal: Medicina (Kaunas) Date: 2020-07-09 Impact factor: 2.430
Authors: Dietrich Doll; Andriu Orlik; Katharina Maier; Peter Kauf; Marco Schmid; Maja Diekmann; Andreas P Vogt; Verena K Stauffer; Markus M Luedi Journal: Sci Rep Date: 2019-10-22 Impact factor: 4.379
Authors: Silvio Gabor; Murillo de Lima Favaro; Ruy Francisco Pimentel Pedroso; Bárbara Henriqueta Ferreira Duarte; Rafaela Novo; Ana Paula Iamarino; Marcelo Augusto Fontenelle Ribeiro Journal: Plast Reconstr Surg Glob Open Date: 2021-03-23