Minimally Invasive Pilonidal Excision: a video vignette
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Minimally Invasive Pilonidal Excision: a video vignette A. Di Castro1 · F. Guerra2 Received: 8 October 2020 / Accepted: 24 October 2020 © Springer Nature Switzerland AG 2020
Although pilonidal disease (PD) is currently considered to be an acquired disorder and several less invasive techniques have been proposed during the last decade [1, 4], open excision down to the sacrococcygeal fascia is still the most widely performed procedure worldwide [1]. Traditional techniques generally go beyond the extirpation of diseased tracts and remove adjacent healthy tissue often resulting in wide surgical wounds and prolonged postoperative care [3]. Such surgery often requires general anesthesia and carries a relevant risk of wound-related complications, which may result in ruinous aesthetic results and significant impact on public health costs [2, 3]. Still, the current literature fails to provide reliable data to draw definitive conclusions about which surgery can be considered the treatment of choice for PD [1–3]. Although high-level evidence on the subject is still scarce, a growing number of experiences worldwide and data from several meta-analyses demonstrate the benefits of less invasive, conservative surgery [1, 2]. Currently available minimally invasive options include sinotomy, sinusectomy, fistuloscope-assited excision [1, 3] and treatment with fibrin glue [5]. Such procedures have obtained encouraging results, provided that appropriate equipment and expertise was available [1, 2]. However, minimally invasive excision is only performed in a few dedicated centers and has not been widely adopted in clinical practice [1, 2]. In this video, we illustrate the application of our minimally invasive technique for the radical excision of PD [3]. This technique, which is a modification of the technique originally popularized by Gips et al. [4], is performed under local anesthesia on an outpatient basis. Different caliber
trephines are employed to enter the pilonidal cavity and excise median pits and peripheral fistolous tracts. All underlying diseased tissue is thus removed together with neighboring healthy fat tissue by means of scalpel, scissors, and monopolar electrocautery. Trephine skin openings are left open and no drains are used. Postoperatively, daily routine activities are allowed and patients are encouraged to wash the surgical wound area with running water several times a day. Regular epilation of the sacrococcygeal region is also recommended for at least 1 year following surgery [3]. In our experience with this technique [3], the median time to return to daily activities is 2 days, while the median time to complete wound epithelialization is 35 days. The incidence of postoperative complications and disease recurrence is relatively low, with no significant difference between patients receiving surgery for primary orrefractory disease [3]. This technique of minimally invasive excision treats both primary and refractory PD effectively. It combines the clinical advantages of a minimally invasive procedur
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