Staging System for Chronic Symptomatic Pilonidal Sinus Disease

Trabzon Numune Training and Research Hospital367 enrolled

Overview

A staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage.

The collected data of patients who underwent surgery for the treatment of pilonidal sinus disease prior to June 2011 were analyzed. Following this analysis, a staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. "Pit-picking" technique was performed under local anesthesia on an outpatient basis in stage I and stage IIa patients. For stage IIb and stage III patients, the Bascom Cleft Lift /modified Bascom Cleft Lift techniques were performed. For stage IV patients, the rhomboid excision with the Limberg flap technique was used. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage.

Study Type

OBSERVATIONAL

Enrollment

367

Conditions

Pilonidal Sinus

Interventions

pit-picking techniquePROCEDURE

midline pits were excised removing a minimal amount of tissue (with a margin of skin of \<1 mm). Incision of 1-2 cm in length was performed parallel to the most convenient side of the midline to be curetted of the chronic abscess cavity. All infected granulation tissue and hair were removed. After establishing hemostasis, the area of the excised midline pits was approximated by absorbable sutures.

Bascom Cleft LiftPROCEDURE

The upper end of the incision was made 1-2 cm lateral to the midline on the more affected side and this was continued vertically over a distance of 1-2 mm from the midline pits. The lower end was fashioned from the midline in a V-shape in order to prevent a dog-ear deformity. The skin on this side of the natal cleft was then elevated and excised. The skin on the opposite side was undermined to the distance required to allow primary closure of the defect away from the midline without tension. Sinus tissue and its extensions were excised. The incision was then closed subcuticularly by absorbable polyglecaprone (3-0), after which a few interrupted mattress polyglecaprone (3-0) buttress sutures were also inserted.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Individuals with symptomatic pilonidal sinus disease. Exclusion Criteria: * \<18 y * Pilonidal sinus disease which identified incidentally and which presented with acute abscesses were not included to the staging system. * Patients who were treated without the use of the suggested algorithm were excluded from the analysis.

Outcomes

Primary Outcomes

Early wound complications

Complications were classified as infection (superficial or deep), collection (seroma or hematoma), wound dehiscence (partial or complete), or anesthesia-related complications. complications will be reviewed from time of surgery to the end of healing. percentage of participants with any wound complication will be evaluated as patients with complication.

Time frame: up to 3 months

Secondary Outcomes

Assessment of recurrence (recurrence is defined when symptoms of the disease recurred after an interval following complete wound healing.)

Patients will be followed up for recurrence for three years. Total number of patients presenting with recurrence will be evaluated at the end of 3rd year.

Time frame: 3 years

Primary healing rate

All surgical site complications were recorded, and patients with prolonged healing were regularly examined until complete healing was achieved. Primary healing was defined as no breakdown of the wound (complication-free healing) at any point along its length.

Time frame: within 3 months

Hospital stay "The interval from the day of surgery to the day of discharge was recorded as the ''hospital stay.''

hospital stay for patients in postoperative period will be measured from the day of surgery to the day of discharge (as days).

Time frame: during first week (one week)

Operative duration (''Operative duration'' is defined as the time between the initiation of the incision and the application of the last suture.)

Time frame: during surgery

Data from ClinicalTrials.gov

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