Pilonidal Sinus Surgery with Mechanical Drilling Technique
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ORIGINAL ARTICLE
Pilonidal Sinus Surgery with Mechanical Drilling Technique Ramin Azhough 1 & Pooya Jalali 1 & Samad E J Golzari 1 & Shahriar Hashemzadeh 1 & Roya Savaran 1 Received: 27 February 2020 / Accepted: 11 March 2020 # Association of Surgeons of India 2020
Abstract Pilonidal sinus disease (PSD) is a common condition affecting young and middle-aged adults. Most commonly seen in men, it has significant economic implications and is associated with discomfort and inability to work. Men are thought to be at higher risk because of their more hirsute nature. The aim of this study was to evaluate the efficacy of “Mechanical drilling technique” as a new approach in pilonidal sinus disease treatment. From January 2017 to February 2019, 30 patients were treated for PSD in our center. All patients referred to our center with chronic pilonidal disease in the natal cleft were enrolled with no age or sex limitations and operation previously. After spinal anesthesia, all patients underwent operation in the prone position. Mechanical drilling was performed using drilling trephine apparatus number 368. Smaller pits were distracted using trephine number 859. Thirty patients were operated using this technique. The mean operating time was 15 min. Recurrence was observed in only one patient (3.33%). Wound healing time varied from 7 to 21 days. All patients were operated under spinal anesthesia and discharged after 4 h. The maximum cosmetic satisfaction rate was 90%. Mechanical drilling technique is an effective minimally invasive technique for the treatment of PSD with very low recurrence and comparable rate, and hospital stay compared with excision and primary closure techniques. Keywords Pilonidal sinus . Minimally invasive techique . Mechanical drilling technique . Pilonidal sinus disease
Introduction Pilonidal sinus disease (PSD) is a common disease that mainly affects young adults [1]. Most commonly seen in men, it has significant economic implications and is associated with discomfort and inability to work [1]. Men are thought to be at higher risk because of their more hirsute nature [1]. The major causes of pilonidal sinus infection are hair accumulation, damage to the deep tissue in the coccyx area [2]. Depth intergluteal sulcus, number of loose hairs, lacerations in the skin due to * Pooya Jalali [email protected] Ramin Azhough [email protected]
trauma and weakness of the skin in the midline might lead to hair implantation and accumulation [2, 3]. However, the pathogenesis is unclear and both congenital and acquired causes have been suggested. Numerous surgical and non-surgical treatments have been described in the literature, including excision and lying open, excision, and primary closure of the wound [4], and rhomb flap procedure [5, 6]. The main concern following the treatment in these patients is recurrence. A literature review shows that recurrence varies between 20 and 40% regardless of the technique used [7]. Successful management of PSD depends on principles such as the simplicity of the procedure
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