Accepted Article
Received Date : 26-Jun-2014 Accepted Date : 03-Jul-2014 Article type
: Correspondence
Corresponding author mail id:- [email protected]
382-2014 Correspondence
Pilonidal sinus: are we missing something?
Zinicola R*, Cracco N**, Serventi A***, Martina S§, Milone M°, Sallustio P°°, Bondurri A°°°, Giani I^, Figus A^^, Zorcolo L^^^. *Department of Emergency Surgery, University Hospital, Parma, Italy **Department of General Surgery, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy ***Department of General Surgery Galliera Hospital, Genoa, Italy §Colorectal Eporediensis Centre S. Rita Hospital Vercelli Italy °Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy. °°Department of General Surgery Molfetta Hospital Bari Italy °°°Chirurgia 1, L. Sacco Hospital, Polo Universitario, Milan, Italy. ^Proctological and Perineal Surgery, University Hospital of Pisa, Italy. ^^St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK ^^^Department of Surgery, Colorectal Unit, University of Cagliari, Italy.
Invited speakers of “ Pilonidal Sinus Session” 4th National Meeting of Italian Society of Colorectal Surgery (SICCR) - Genoa 2011.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an 'Accepted Article', doi: 10.1111/codi.12777 This article is protected by copyright. All rights reserved.
Accepted Article
Dear Sir, Several randomized clinical trials on pilonidal sinus disease have been published, but the ideal treatment is still debated and there are no clear guidelines(1). This may be because there is no unanimity owing to differences in attitudes to the pathology of the condition. We think that the following considerations should be highlighted.
Sinus Classification Pilonidal sinus may show different degrees of severity. This mainly depends on the extension of the disease, given by the number of pits, their distance from the midline and the depth of the tracks. Different degrees of severity of may require different kinds of procedure. Some classifications have been suggested, but none has been systematically applied in clinical practice probably because they are too complex (2). In a recent meta-analysis only 20% of studies gave a classification(4). An ideal classification should be easy and quick to apply. When comparing different surgical techniques a practical classification should allow analysis of patients having the same disease severity.
Technique classification There is no a simple generally accepted classification. Most studies have compared mainly open with closed surgical procedures (3), but this may be misleading because several surgical procedures of different complexity for patient and surgeon are included all together. We suggest a division of surgical procedures into those which remove the sinus track only (track technique) from those which also remove the healthy tissue around the sinus track (extratrack technique) (Figure 1).This simple classification includes all reported surgical techniques. It will give a more realistic idea of the surgical and clinical impact and will therefore be useful to permit meaningful comparisons. Clinical end points: timing satisfaction.
of
wound healing, recurrence , patient’s
This article is protected by copyright. All rights reserved.
Accepted Article
Time to wound healing, return to work/school and recurrence are usually given as the most important clinical end points(3). In clinical practice these may not adequately reflect the effectiveness of surgery and patient satisfaction. A lay open technique implies an open wound lasting many days or even weeks. Despite this the patient usually experiences only minor discomfort compared with patients undergoing a wide excisional closed technique. Recurrence may often be treated by simple curettage or laying open with minimal discomfort. Such a circumstance may well be accepted by the patient as a further therapeutic step causing minimal disturbance rather than failure. Patient satisfaction would be a more reliable parameter of the surgical outcome, but in a recent Cochrane Review, this was assessed in only two of the 26 trials (3).
References 1. Steele SR, Perry WB, 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; 56:1021-7 2. Irkorucu O, Erdem H, Reyhan E. The best therapy for pilonidal disease: which management for which type? World J Surg 2012; 36: 691-2 3. Al-Khamis A, Mc Callum I, King PM,Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2010 20;(1):CD006213. 4. Enriquez-Navascues JM,Emparanza JI,Alkorta M,PlacerC.Meta-analysis of randomized controlled trials comparing different techniques with primary closure of chronic pilonidal sinus. Tech Coloproctol 2014 Apr 30. Epub ahead off print.
This article is protected by copyright. All rights reserved.
Accepted Article
Figure 1: Surgical classification of pilonidal sinus
TRACK Surgery
Sinusectomy:
EXTRA-TRACK Surgery
Sinusotomy:
Lord Millar
Lay open
Excision
Bascom
Cutting seton
Karydakis
Core out Trephine E.P.Si.T.
This article is protected by copyright. All rights reserved.
Flap
Received Date : 26-Jun-2014 Accepted Date : 03-Jul-2014 Article type
: Correspondence
Corresponding author mail id:- [email protected]
382-2014 Correspondence
Pilonidal sinus: are we missing something?
Zinicola R*, Cracco N**, Serventi A***, Martina S§, Milone M°, Sallustio P°°, Bondurri A°°°, Giani I^, Figus A^^, Zorcolo L^^^. *Department of Emergency Surgery, University Hospital, Parma, Italy **Department of General Surgery, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy ***Department of General Surgery Galliera Hospital, Genoa, Italy §Colorectal Eporediensis Centre S. Rita Hospital Vercelli Italy °Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy. °°Department of General Surgery Molfetta Hospital Bari Italy °°°Chirurgia 1, L. Sacco Hospital, Polo Universitario, Milan, Italy. ^Proctological and Perineal Surgery, University Hospital of Pisa, Italy. ^^St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK ^^^Department of Surgery, Colorectal Unit, University of Cagliari, Italy.
Invited speakers of “ Pilonidal Sinus Session” 4th National Meeting of Italian Society of Colorectal Surgery (SICCR) - Genoa 2011.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an 'Accepted Article', doi: 10.1111/codi.12777 This article is protected by copyright. All rights reserved.
Accepted Article
Dear Sir, Several randomized clinical trials on pilonidal sinus disease have been published, but the ideal treatment is still debated and there are no clear guidelines(1). This may be because there is no unanimity owing to differences in attitudes to the pathology of the condition. We think that the following considerations should be highlighted.
Sinus Classification Pilonidal sinus may show different degrees of severity. This mainly depends on the extension of the disease, given by the number of pits, their distance from the midline and the depth of the tracks. Different degrees of severity of may require different kinds of procedure. Some classifications have been suggested, but none has been systematically applied in clinical practice probably because they are too complex (2). In a recent meta-analysis only 20% of studies gave a classification(4). An ideal classification should be easy and quick to apply. When comparing different surgical techniques a practical classification should allow analysis of patients having the same disease severity.
Technique classification There is no a simple generally accepted classification. Most studies have compared mainly open with closed surgical procedures (3), but this may be misleading because several surgical procedures of different complexity for patient and surgeon are included all together. We suggest a division of surgical procedures into those which remove the sinus track only (track technique) from those which also remove the healthy tissue around the sinus track (extratrack technique) (Figure 1).This simple classification includes all reported surgical techniques. It will give a more realistic idea of the surgical and clinical impact and will therefore be useful to permit meaningful comparisons. Clinical end points: timing satisfaction.
of
wound healing, recurrence , patient’s
This article is protected by copyright. All rights reserved.
Accepted Article
Time to wound healing, return to work/school and recurrence are usually given as the most important clinical end points(3). In clinical practice these may not adequately reflect the effectiveness of surgery and patient satisfaction. A lay open technique implies an open wound lasting many days or even weeks. Despite this the patient usually experiences only minor discomfort compared with patients undergoing a wide excisional closed technique. Recurrence may often be treated by simple curettage or laying open with minimal discomfort. Such a circumstance may well be accepted by the patient as a further therapeutic step causing minimal disturbance rather than failure. Patient satisfaction would be a more reliable parameter of the surgical outcome, but in a recent Cochrane Review, this was assessed in only two of the 26 trials (3).
References 1. Steele SR, Perry WB, 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; 56:1021-7 2. Irkorucu O, Erdem H, Reyhan E. The best therapy for pilonidal disease: which management for which type? World J Surg 2012; 36: 691-2 3. Al-Khamis A, Mc Callum I, King PM,Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2010 20;(1):CD006213. 4. Enriquez-Navascues JM,Emparanza JI,Alkorta M,PlacerC.Meta-analysis of randomized controlled trials comparing different techniques with primary closure of chronic pilonidal sinus. Tech Coloproctol 2014 Apr 30. Epub ahead off print.
This article is protected by copyright. All rights reserved.
Accepted Article
Figure 1: Surgical classification of pilonidal sinus
TRACK Surgery
Sinusectomy:
EXTRA-TRACK Surgery
Sinusotomy:
Lord Millar
Lay open
Excision
Bascom
Cutting seton
Karydakis
Core out Trephine E.P.Si.T.
This article is protected by copyright. All rights reserved.
Flap
