Figure 1 - uploaded by Selim Sözen
Content may be subject to copyright.
Left: An elliptic incision with an apex 2 cm (double head arrow) lateral to one side of the midline natal cleft, including the orifice and whole tract. Right: The lateralized midline cleft at the end of the operation.
Source publication
Different surgical techniques for pilonidal disease have been described in the literature. In this study our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique.
Fifty patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively. The patients were assigned randomly in...
Similar publications
Background: Pilonidal sinus is a relatively common condition affecting men twice as often as women. The estimated incidence is 26 per 100,000 people. The management of pilonidal sinus disease remains controversial, and gold standard treatment modality has yet to be established. Limberg procedure is a safe and reliable technique in the treatment of...
Background
Although there are many therapeutic options to manage patients with sacrococcygeal pilonidal sinus disease, there remains controversy over a gold standard method for treating such patients. Most studies regarding sacrococcygeal pilonidal sinus, collected patients in a single pool, and single modality was performed to all patients so far....
Background: Pilonidal sinus disease (PSD) may be present as chronic PSD, which may eventually exacerbate. Factors associated with the progression of chronic PSD to acute abscess-forming PSD were investigated. Methods: Records of 1962 patients admitted to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 wi...
Citations
... In the current study, the majority of the patients were males. e current study's nding of male predominance conforms to most of the published studies wherein a similar predominant a iction of the males with the PSD has been reported [9,10]. Luedi MM et al., in their study on the gender-speci c prevalence of the PSD, reported 79% a iction of males whereas 21% involvement of females among the PSD cases [11]. ...
... The use of suction drain has been reported to be associated with less wound complications rate in recent studies. Sakr and Ahmet Gurer et al 26,27 strongly recommended the use of suction drain in asymmetrical flap of Karydakis. It is also recommended after Limburg flap and excision with primary closure in the midline. ...
... Routine cavity drainage is recommended in recent studies and we also advocated use of suction drain. 26,28 In this series we excluded the infected pilonidal sinus from the study cases because of fear of the increase risk of wound complications. However Peterson et al 28 reported good results in infected cases although the wound complication rate was higher 21 % vs. 2 % in Karydakis group and open group respectively. ...
Objective: To test the efficacy of the Karydakis procedure in overweight and obese patients and to check the recurrence rates in our patients. Study Design: Multicenter Prospective study. Setting: Sughra Shafi Medical Complex Narowal. Period: May 2011 to July 2021. Material & Methods: Total 146 patients were selected for this study a formal informed consent was taken. Ten patients were lost from follow up and excluded from study. Results: Out of remaining 136 patient 130 were male and only 6 were female. Mean age of the patient was 23 year and 5 months (range 16 years to 49 years). Thirty five patients had a single sinus in the midline, Seventy two had multiple sinuses in the midline, and 38 patients had lateral tract either on the right or on the left side in addition midline sinuses. Mean operating time was 39 minutes (range 23 – 70 minutes), mean blood loss was 26 ml (10 – 70ml) and mean hospital stay was 3 days (range 2- 7 days). There were a total of 21 (15 .05 %) complications. Seven(4.29) patients developed major wound infection requiring opening of the sutures and regular dressing till the wound became healthy to be closed by secondary suturing. Seven patients developed minor wound infection, 6 patients developed seroma and 3 patients had leakage of serous fluid from drain site for a couple of days. There were only 5 (3.67%) recurrences in mean follow up period of 23 months (range 11 months to 4 years). Two (1.47%) recurrence were observed in patient with BMI of below 35 and 3 recurrences (2.20%) were observed in patient with BMI of >35. All of them occurred in obese patient who could not maintain their personal hygiene according to advice given to them. Majority of the patient were satisfied with the procedure. Conclusion: We concluded that Karydakis operation has good outcome in overweight and obese patients. It addresses the etiological factors of the disease, is less time consuming as compared to other flap operation, is not associated with wound scar in the midline, can be easily performed by surgeons in training, is associated with minimum complications, has minimum recurrence rate on short and long term follow up, avoid the painful prolong dressing regimen and well accepted by the patients.
... To fix the deep plane to the bony fascia and suture the skin edge-to-edge off the midline, the Karydakis technique entails a unilateral elliptical excision of the infected pilonidal sinus followed by mobilization of the entire thickness of the contralateral skin margin, including the subcutaneous fatty tissues. Several teams have reported findings that are quite comparable, and this approach has attracted their attention [13][14][15][16][17]. ...
... Gurer et al. reported in their study that the average duration of hospital stay in patients treated with the Karydakis method is four days. 17 In this study, the average duration of hospital stay in the surgical group was 1.6 ± 0.4 days. Patients in the group that was treated with crystallised phenol received day-case treatment. ...
... Routine cavity drainage is recommended to reduce the risk of seroma, hematoma, abscess, wound dehiscence, and infection in surgical methods with flaps applied in PSD. 17 Studies have reported that 2.4% of the patients developed seroma after drainage. ...
Objective:
To compare the results of commonly used treatments (Karydakis Flap method and crystallized phenol application) in the treatment of pilonidal sinus.
Study design:
Comparative study.
Place and duration of study:
Adana Seyhan State Hospital, Adana City Hospital, and Hisar Intercontinental Hospital Pediatric Surgery Clinic, from January 2016 to December 2020.
Methodology:
Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study. The efficacy and complications of both treatments were compared.
Results:
Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method. Of the patients included in the study, 166 (52%) were male and 153 (48%) were female. The mean age was calculated as 15.5 (± 1.4). The mean hospital stay in the surgery group was 1.6 ± 0.4 days. The mean time to return to school was 2.8 ± 1.02 days in the phenol group and 12.3 ± 2.2 days in the Surgery group. Despite the third session of phenol application, recovery could not be achieved in 12 (5.7%) patients. Among those who had surgery, recurrence occurred in 7 (6.3%) patients and they had to be operated once more.
Conclusion:
Crystallized Phenol application can be applied in uncomplicated cases due to high success, low complication, rapid recovery, early return to daily activities.
Key words:
Crystallized phenol, Surgical treatment, Pilonidal sinus disease.
... Several studies have assessed the use of drains after primary closure [72][73][74][75]. The results of a nonrandomized trial have indicated that the employment of drains after pilonidal excision and primary closure was associated with a lower rate of wound healing, without differences in the recurrence rate [72]. ...
... In a randomized comparison between employment of drains vs. no-drains after primary closure, Milone et al. [73] demonstrated that drains did not achieve a faster wound healing, and, on the contrary, they were associated with lower patient tolerance. When adopted after flap techniques, drains are associated with a lower incidence of fluid collections but no actual difference in wound infection [74], while Erdem et al. showed that Limberg flaps with no drains in place result in shorter hospital stays without deleteriously affecting the surgical results of wide excision and primary closure with well-vascularized tissue [75]. A relatively recent metaanalysis [76] of randomized trials in patients undergoing either Karydakis or Limberg flap tried to identify the association between placement of a drain and the infection and recurrence rates, suggesting that, despite a trend toward a reduction in wound infection and recurrence rates, drains were not associated with overall better outcomes. ...
Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a “special interest” in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: “A + : strongly agree; A–: agree; N: unsure/no opinion; D–: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.
... The benefit of placing subcutaneous drainage is still matter of controversial discussions. In two studies [99,125], subcutaneous drainage significantly decreased incidence of postoperative wound dehiscence after Karydakis flap. In contrast, Colak et al. [109] found that drainage placement was associated with a two-fold increase in wound complication rate after Limberg flap. ...
Background
The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations.
Methods
Systemic literature review.
Results
Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent.
Conclusion
Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.
... On the other hand, the effectiveness of the use of drains in reducing postoperative recurrence is controversial. Gurer et al said that routine use of drains during the flap procedure didn't affect the recurrence rate, but reduced fluid accumulation and prevented the development of other complications 22 . In our study, a hemovac drain was used routinely in all cases in both groups. ...
... Der Stellenwert einer Drainageeinlage wird kontrovers diskutiert.Zwei Studien vergleichen die Wunddehiszenzrate nach Karydakis-Operation mit und ohne subkutane Drainageplatzierung und kommen beide zum Schluss, dass der Verzicht auf eine subkutane Drainage zu einer Zunahme der Wundheilungsstörungen führt (32 vs. 8 % bei Gürer[203] und 24% vs. 8% bei Sözen[440]).Zwei weitere randomisierte Studien beschäftigen sich mit der Frage, ob die Platzierung einer subkutanen Drainage bei der Limberg-Plastik das postoperative Ergebnis beeinflusst[105,272]. In der Studie von Colak [105] kamen die Autoren zum Ergebnis, dass das Platzieren der Drainage die Wunddehiszenzrate zweifach erhöht. ...
Background
Pilonidal sinus is an acquired disease in which stiff sharp hair fragments play an important role in the pathogenesis. The aim of these guidelines is to present the advantages and disadvantagesof the various treatment methods and to assist physicians with evidence-based treatment recommendations.MethodsA systemic review of the literature was carried out.ResultsThree types of manifestation of pilonidal sinus can be differentiated: asymptomatic without exudation, an acute abscess and chronic pilonidal sinus. The most frequent form of pilonidal sinus is the chronic stage with intermittent dissociations. At present, there is no universal treatment fulfilling all desired criteria of a simple, painless procedure associated with rapid wound healing and low recurrence rate. Treatment modalities of the various clinically manifested forms should be tailored according to disease manifestation and extent.Conclusion
Asymptomatic pilonidal disease does not need to be treated. A pilonidal abscess should be deroofed, followed by one of the definitive treatment methods after regression of the acute inflammation. The basic treatment method of chronic pilonidal disease is surgical excision. Wide excision and open treatment of chronic disease leads to prolonged secondary healing and a considerable recurrence rate. The volume of excised tissue should be restricted to the absolutely necessary. Excision and midline wound closure is associated with an increased morbidity and recurrence rate and should not be performed at all. The minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease; however, the recurrence rate is higher compared to other more extensive methods. Nevertheless, they may be used in small primary disease. Off-midline methods should be used for disease not suitable for minimally invasive procedures and lead to the lowest known recurrence rates. The Limberg flap and the Karydakis procedure are the two best described methods, which are associated with comparable short-term and long-term results.
... In the study of Karydakis, the complications were mainly wound infections and fluid collection. Other studies that used the Karydakis technique have reported wound infection rate ranging from 0 to 10.7% [5,14,[18][19][20]. Bessa [15] reported complication rate of 7.3% after his modified technique in the form of wound infections and fluid collections. ...
... La edad de presentación de la enfermedad en la mayoría de los trabajos es en la segunda década de la vida 14,[27][28][29] , lo que se reafirma en este y otros estudios [30][31][32] . ...
... En esta serie, a diferencia de lo propuesto por Karydakis 5 , el drenaje se utilizó en sólo una paciente obesa (IMC 32), al inicio de la experiencia. Diversos trabajos sugieren que el uso de drenaje reduce la formación de seromas 30,31 , complicación que no se presentó en esta serie. El uso de drenaje debería ser evaluado paciente a paciente y según preferencia del cirujano 4,30,38 . ...
Introducción:
La enfermedad pilonidal sacrocoxígea (EPSC) es una patología crónica de resorte quirúrgico. Para su tratamiento se han descrito múltiples técnicas quirúrgicas, existiendo 2 grandes grupos: las técnicas abiertas y las cerradas. El objetivo del presente trabajo es comparar y analizar los resultados quirúrgicos de 2 técnicas, una abierta (marsupialización) y otra cerrada (Karydakis).
Materiales y Método:
Estudio de cohorte retrospectivo de pacientes operados electivamente con diagnóstico de quiste pilonidal por un único cirujano, entre julio de 2013 y julio de 2017 utilizando estas dos técnicas.
Resultados:
Se incluyeron 71 pacientes. 30 pacientes con marsupialización y 41 con Karydakis. Todos hospitalizados. Todos de alta al día siguiente de la cirugía. Ningún paciente requirió rehospitalización ni cirugías adicionales. En el análisis estadístico se identifican beneficios de la técnica de Karydakis en cuanto a complicaciones, dolor postoperatorio, dolor para sentarse, incapacidad laboral y tiempo de cicatrización.
Conclusiones:
En este artículo la cirugía con técnica de Karydakis tiene ventajas en relación a la marsupialización, considerándola como primera opción para la EPSC simple.
