Modern technologies in treatment of pilonidal sinus

   Objective. Improvement of treatment results and reduction of the number of relapses in patients with pilonidal disease, by developing and substantiating a two-stage treatment method (with the use of laser treatment and subsequent radical surgical intervention).

   Materials and Methods. A prospective analysis of the treatment results of 76 patients at the clinical sites of the Rostov State Medical University was carried out. The patients were divided into three clinical observation groups: In Group I (the main group, 26 patients), two-stage treatment was carried out according to the original technique (patent № 2770283). In Group II (the first control group, 28 observations), we used the "сleft lift" procedure according to the Bascom authentic method Bascom II method modified by Karydakis). In Group III (the second control group, 22 observations), the pilonidal sinus was dissected with the traditional technique of plastic surgery of the sacrococcygeal region with "deaf" sutures along the gluteal cleft.

   Results. Analysis of the results showed that the postoperative period was smoother in Group I patients due to the smaller size of the surgical defect and the radical surgical stage in the absence of local inflammatory tissue reaction. There were no significant infiltrative-inflammatory complications in the patients operated on according to the original two-stage method. There were no recurrences during the one-year outpatient follow-up period. According to the VAS score, postoperative pain syndrome was significantly lower in Group I patients. The duration of hospitalization and period of disability were reduced in the patients of the main group in comparison with the same parameters in the control groups. The indicated pharmaco-economic effect in comparison with the traditional methods of surgical treatment was obtained due to early healing of the operative wounds with a smaller inflammatory reaction of the soft tissues and a reduced risk of suppurative complications.

   Conclusion. The developed method of two-stage surgical treatment of pilonidal sinus helps to increase the effectiveness of radical treatment, reduce the number of relapses and complications, and reduce the duration of patients' disability. The described efficacy of the technology is achieved with early healing and stable qualitative aesthetic result.

1. Bykova N. L. Surgical methods for the treatment of pilonidal sinus. Modern Science. 2020; (5-3): 435–439. (In Russ).

2. Johnson E. K., Vogel J. D., Cowan M. L., Feingold D. L., Steele S. R. The American society of colon and rectal surgeons’ clinical practice guidelines for the management of pilonidal disease // Diseases of the Colon and Rectum. 2019. Vol. 62, no. 2. pp. 146–157.

3. Nechay I. A., Mal'tsev N. P., Pavlov M. V. Surgical treatment of pilonidal sinus. Hirurgija. Zhurnal im. N. I. Pirogova = Surgery. Journal named after N. I. Pirogov. 2020; (12): 99–104. (In Russ).

4. Ekici U., Kanlıöz M., Ferhatoğlu M. F., Kartal A. A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus // Asian Journal of Surgery. 2019. Vol. 42, no. 10. Р. 907–913.

5. Zagryadskij E. A. Operation Bascom II (cleft-lift) for recurrence of the pilonidal sinus. Koloproktologiya = Сoloproctology. 2018; (S2 (64)): 18–18a. (In Russ).

6. Harries R. L., Alqallaf A., Torkington J., Harding K. G. Management of sacrococcygeal pilonidal sinus disease // International Wound Journal. 2019. Vol. 16, № 2. Р. 370–378.

7. Khubezov D. A., Lukanin R. V., Krotkov A. R., Ogorel'tsev A. Yu., Serebryanskiy P. V., Yudina E. A. Results of laser obliteration in the surgical treatment of pilonidal sinus. Koloproktologiya = Сoloproctology. 2020; 19 (2): 91–103. (In Russ).

8. Zolotukhin D. S., Krochek I. V., Sergiyko S. V. Laser thermotherapy or excision - what to offer a patient with a pilonidal sinus. Permskij medicinskij zhurnal = Medical Journal of Perm. 2020; 37 (6): 102–110. (In Russ).

9. Brezhnev S. G., Zhdanov A. I., Korotkikh N. N., Popov R. V. Optimized surgical tactics in the treatment of pilonidal sinus. Koloproktologiya = Сoloproctology. 2017; № S3 (61): 18–19. (In Russ).

10. Korkmazov I. H. Differentiated approach to the treatment of pilonidal sinus. Vestnik nauchnyh konferencij = Collection of scientific conference. 2020; (12-1(64)): 75–78. (In Russ).

11. Bascom J. U. Procedures for pilonidal disease. In: Carter D., Russell R. C. G, Pitt H. A. (eds) Atlas of general surgery. 3^rd edn. London : Chapman and Hall, 1997. Р. 862–872.