Pilonidal Sinüs Bilimsel Yayınlar

Hastalığı bilimsel olarak inceleyen bilim adamları ve hekimlerin yayınlamış olduğu ve gerçekliği kanıtlanmış olan pilonidal sinüs hastalığı konusunda en detaylı ve orjinal bilgiler ışığında sizlere aktarmak istiyoruz. Aşağıdaki bilgiler ingilizce olma sebebi verilen orjinal olarak aktarılmasından kaynaklanmaktadır.

Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique

  1. M. Testini1,
  2. G. Piccinni1,
  3. S. Miniello1,
  4. B. Di Venere1,
  5. G. Lissidini1,
  6. V. Nicolardi2,
  7. G. M. Bonomo1


To compare open with closed treatment of chronic pilonidal sinus.

Patients and methods

From 1993 to 1996, 100 patients were submitted to excision of chronic pilonidal sinus, with local anaesthesia and were randomized in two groups: group A in which open treatment and group B in which direct suture were performed. The follow-up, ranging from 37 to 89 months, was performed by outpatient visits or by phone.


Short-term results showed 6 (12.0%) post-operative complications in group A vs 10 (20.0%) in group B. Long-term results showed 9 (18.0%) complications in group A vs 7 (14.0%) in group B. Mean wound healing was 58 days (range: 29–93) in group A vs 12 (range: 9–61) in group B. The return to normal activity was 25.7 (range: 11–77) vs 10.4 (range: 5–32). Wound healing and the return to normal activity were the only statistically significant differences.


Regarding morbidity neither technique has particular advantages over the other. The closed technique produced quicker wound healing and a quicker return to normal activity.



Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial

M. Z. Naja1,

M. F. Ziade2,

M. El Rajab3


Sixty patients scheduled for pilonidal sinus surgery were prospectively randomly assigned to receive general anaesthesia or sacrococcygeal local anaesthesia with a newly-described technique. Patients in the general anaesthesia group spent more time in the operating theatre and recovery room than did those in the local anaesthesia group (p < 0.05). Two thirds (67%) of the patients in the local anaesthesia group left hospital on the day of surgery compared to only 17% of patients in the general anaesthesia group (p < 0.05). Visual analogue scale pain scores performed during the 3-day follow-up period favoured the local anaesthetic technique (p < 0.05). Postoperative analgesia requirements were greater in the general anaesthesia group than in the local anaesthesia group (p < 0.05). The majority of patients and surgeons expressed satisfaction with local anaesthesia. Sacrococcygeal local anaesthesia appears to be a successful alternative to general anaesthesia for pilonidal sinus surgery.

The surgical treatment of pilonidal sinus is often associated with considerable postoperative pain [1] and a hospital stay of up to 5 days [2]. A variety of surgical and anaesthetic techniques have been used in an attempt to decrease postoperative pain or to limit the duration of hospital stay, e.g. the excision and skin flap technique [3], Limberg flaps with no surgical drains [4], Bascom’s operation [5], excision of the sinus down to the sacrococcygeal fascia and simple primary closure of the wound without tension sutures or surgical drains [6], and the use of hydrocolloid dressings [1]. The laser excision technique [7, 8] has also been reported to minimise postoperative pain but does not decrease the duration of hospital stay [8].

In addition to the complications that may result from general anaesthesia, the performance of the operation in the prone position provides further opportunities for patient morbidity that include decreased pulmonary compliance, cardiovascular instability and airway problems [9–12]. Different anaesthetic techniques have been introduced as an alternative to general anaesthesia. Spinal anaesthesia has been reported to decrease the duration of hospital stay slightly but was found to be associated with an incidence of complications such as haematoma, wound infection and minor wound breakdown in 8% of patients [13]. The use of local anaesthesia in combination with sedation [14, 15] has succeeded in decreasing pain [16] and hospital stay [2]. However, the local anaesthetic used allowed only limited surgical procedures [17]. It has been argued that in order to minimise, or even to avoid, hospital admission, the ideal management of patients undergoing pilonidal sinus surgery should include the avoidance of general anaesthesia and the provision of effective postoperative analgesia [18].

The aim of this study was to compare a sacrococcygeal local anaesthesia technique with general anaesthesia for the surgical treatment of pilonidal sinus. The outcome indicators of the study were postoperative pain, consumption of postoperative analgesic medications, duration of hospital stay and the satisfaction of both patient and surgeon.


Following Local Research Ethics Committee approval and written, informed consent, 60 patients scheduled for the surgical treatment of symptomatic pilonidal sinus were included in the study. Patients allergic to lidocaine or with multiple pilonidal orifices were excluded from this study. The patients were randomly assigned by sealed envelopes to receive either local anaesthesia (LA group) or general anaesthesia (GA group). Due to the substantial difference between the two anaesthetic techniques, a double-blind design was not possible. Instead, an observer-blinded design was used, with nurses who were unaware of the anaesthesia technique collecting the postoperative data. In addition to standard demographic and clinical data, the times spent by the patients in the operating theatre and in the recovery room were recorded.

The patients were followed up for 3 days after surgery. Postoperative pain was assessed with a non-graduated 100 mm visual analogue scale (VAS). Pain during movement was assessed at 6, 12, 24, 36, 48 and 72 h after surgery.

During the first 24 h after surgery, intramuscular pethidine 1 mg.kg−1 was given if necessary. If pain relief was not achieved within 30 min of pethidine administration, oral coproxamol was given. For patients who were still in pain after the first postoperative day, further coproxamol was given.

The criteria for discharge from the recovery room were haemodynamic stability, VAS pain scores < 40 mm and full consciousness. The decision to discharge the patient from the hospital was made by the surgeon who performed the operation on the basis of wound haemostasis, pain score < 40 mm and overall medical status.

At the end of the operation, the surgeon was asked whether he was satisfied with the operative conditions. Patients undergoing surgery under local anaesthesia were asked whether they felt discomfort during the insertion of the block or at any time during surgery.

The sacrococcygeal block was performed with the patient in the prone position, after intravenous access had been gained and routine monitors had been attached. The buttocks were pulled laterally with adhesive tape, exposing the sacral area and the pilonidal sinus. After aseptic preparation of the skin, four injection sites were marked: 4 cm above and below, and 3 cm lateral to the centre of the pilonidal sinus on both sides (Fig. 1). A ‘lozenge’ shape is thus formed by connecting the injection sites. At each of the four injection sites, plain lidocaine 1% 0.3 ml was injected subcutaneously using an 8-mm 30G needle (Micro-Fine Plus, Becton Dickinson, Dublin, Ireland).


Figure 1. Diagram detailing the local anaesthetic technique.

Download figure to PowerPoint

Each 20 ml of the local anaesthetic mixture used for the main block contained: lidocaine 2% 6 ml, lidocaine 2% with epinephrine 1 : 200 000 6 ml, bupivacaine 0.5% 6 ml, fentanyl 50 μg.ml−1 1 ml and clonidine 75 μg.ml−1 1 ml. In our experience, this mixture provides excellent postoperative analgesia of surprisingly long duration when used for peripheral nerve blocks [19–22]. A total of 30–40 ml of the local anaesthetic mixture was used, depending on the patient’s weight. The technique is as follows.

A 10-mm 27G needle (Becton Dickinson) is introduced at each of the four injection sites in turn. The needle is first introduced perpendicular to all planes, and 1 ml of the local anaesthetic mixture is infiltrated. The needle is then partially withdrawn and reinserted at an angle of 45° to the skin, aiming towards the centre of the pilonidal sinus, where another 1 ml of the mixture is injected. The needle is then partially withdrawn and reinserted at an angle of 45° to the skin in the direction of one side, and then the other, of the lozenge, 1 ml of the mixture being injected along each side (see arrows in Fig. 1). The above steps are then repeated but with a 33-mm 27G needle (Becton Dickinson).

The injections should be performed slowly so as to minimise discomfort. The procedure takes 10–15 min. The onset time of the block, as determined by sensitivity to pinprick within the incision area, is a further 10–15 min. Even though all LA group patients were offered sedation, none requested or received sedation during the performance of the block or during the surgical procedure.

General anaesthesia for patients in the GA group was induced with intravenous fentanyl 1.5 μg.kg−1 and thiopental 3–5 mg.kg−1, followed by tracheal intubation facilitated by atracurium 0.5 mg.kg−1. The patients were then turned to the prone position. Anaesthesia was maintained with isoflurane 1–3% in nitrous oxide 70% and oxygen 30%. The isoflurane concentration was adjusted so as to maintain blood pressure within 25% of pre-induction values. At the end of the operation, the patient was returned to the supine position and residual neuromuscular blockade was antagonised with neostigmine 0.05 mg.kg−1 and atropine 0.01 mg.kg−1.

The cavity of the pilonidal sinus was marked by injecting 10 ml of Methylene blue through one of the sinus openings. Elliptical incisions (1–2.5 cm from the centre of the sinus) were made using cutting diathermy down to, but preserving, the presacral fascia. Excision of the pilonidal sinus was then performed, followed by careful haemostasis. Depending on the degree of infection of the pilonidal sinus, one of the following two procedures was chosen:

Primary closure using interrupted 2/0 nylon sutures was used if there were signs of modest infection.

If the pilonidal sinus was considered to be significantly infected, the wound was left open and packed with antibiotic dressings (Sofratull, Roussel, England), as recommended by Menzel et al.[23].

Student’s t-test or Wilcoxon’s test was performed as appropriate to determine the difference between the two study groups with regard to age, height, weight, duration of surgery, recovery stay, need for supplementary opioid administration and pain scores. The Chi squared test was used to test the differences in sex, postoperative nausea and vomiting and hospital stay. A probability value of < 0.05 was considered to be significant. In order to detect a 20% difference in the primary study end-point (pain score) with α = 5% and β = 10%, a sample size of 30 patients in each group was found to be necessary.


Demographic and operation data are given in Table 1. Patients in the GA group spent more time in the operating theatre (p = 0.004) and in the recovery room (p = 0.011) than patients in the LA group (Table 2). On average, patients in the GA group spent 10 min more in the operating theatre and 20 min more in the recovery room than those in the LA group. Patients in the LA group had a shorter hospital stay than those in the GA group (p = 0.0001) (Table 2). Two thirds of the patients in LA group (67%) left the hospital on the day of surgery compared to only 17% of patients in the GA group.

Table 1.  Demographic and operation data. Values are mean (SD) or number (%).
  GA Group (n = 30) LA Group (n = 30)
GA: general anaesthetic. LA: local anaesthetic.
Sex; M: F 20 : 10 21 : 9
Age; years 24.8 (5.5) 26.9 (16.2)
Height; cm 168 (8.0) 168 (7.0)
Weight; kg 79.5 (13.9) 79.0 (13.0)
Body mass index
 < 25 kg.m−2 5 (17%) 6 (20%)
 25–30 kg.m−2 18 (60%) 15 (50%)
 ≥ 30 kg.m−2 7 (23%) 9 (30%)
Surgical procedures
 Primary closure 3 (10%) 2 (7%)
 Wound left open 27 (90%) 28 (93%)
Table 2.  Postoperative outcome measures. Values are mean (SD) or number (%).
  GA Group (n = 30) LA Group (n = 30)  
Duration in the operating theatre; min 47 (13) 36 (15) p = 0.004
Recovery room stay; min 87 (38) 64 (32) p = 0.011
Hospital stay
 Discharged same day 5 (17%) 20 (67%) p = 0.0001
 One night in hospital 22 (73%) 10 (33%)  
 ≥ two nights in hospital 3 (10%)  
Number of patients free from postoperative nausea and  vomiting 28 (93%) 29 (97%) p > 0.05
Number of patients expressing satisfaction with  anaesthetic technique 21 (70%) 28 (93%) p = 0.045
Surgical complications
 Bleeding 1 (3%) 1 (3%) p > 0.05

Two patients complained of discomfort during the performance of the local anaesthetic block. The majority of patients expressed satisfaction with the local anaesthetic technique while in the operating theatre (28 patients, 93%). This proportion was significantly higher than the number of patients in the GA group who expressed satisfaction when asked in the recovery room (21 patients, 70%) (p = 0.045). Most surgeons were satisfied with the operating conditions produced by the local anaesthetic technique (28 operations, 93%). Bleeding was the only surgical complication reported, being of equal incidence in the two groups.

All pain scores performed during the fellow-up period (Table 3) were in favour of the local anaesthetic technique, with significant differences throughout this period.

Table 3.  Visual analogue scale scores during the postoperative period. Values are mean (SD) and median [range].
  GA Group (n = 30) LA Group (n = 30)  
VAS = visual analogue scale.
VAS score 6 h after surgery; mm 47.5 (11.5) 15 (18.1) p = 0.0001
50 [0–55] 10 [0–70]
VAS score 12 h after surgery; mm 38.5 (16.5) 15 (18.0) p = 0.0001
45 [0–55] 10 [0–60]
VAS score 24 h after surgery; mm 30 (19.07) 17.6 (19.6) p = 0.0001
37.5 [0–50] 15 [0–55]
VAS score 36 h after surgery; mm 24 (18.5) 10.5 (17.6) p = 0.001
25 [0–45] 0 [0–15]
VAS score 48 h after surgery; mm 13 (16.0) 5.8 (12.1) p = 0.0001
10 [0–45] 0 [0–45]
VAS score 72 h after surgery; mm 8.67 (14.1) 2.5 (6.26) p = 0.002
0 [0–45] 0 [0–25]

The need for postoperative analgesia was found to be higher in the GA group than in the LA group (Table 4). Patients in the GA group required significantly more analgesic drugs (p < 0.01).

Table 4.  Total opioid consumption during the postoperative period.
Time interval Drug GA Group (n = 30) LA Group (n = 30)  
0 h−6 h Coproxamol 22 tablets 2 tablets p = 0.001
Pethidine 1292 mg 147 mg p = 0.0001
6 h−12 h Coproxamol 32 tablets 4 tablets p = 0.0001
Pethidine 890 mg 85 mg p = 0.001
12 h−24 h Coproxamol 78 tablets 14 tablets p = 0.0001
Pethidine 604 mg 155 mg p > 0.05
24 h−48 h Coproxamol 68 tablets 12 tablets p = 0.001
Pethidine 222 mg
48 h−72 h Coproxamol 28 tablets  



These results suggest that the local anaesthetic technique used is a realistic alternative to general anaesthesia, being associated with a shorter hospital stay, lower pain scores and a lower consumption of opioid analgesic drugs. Two thirds of the patients in the LA group became day-stay cases. Two patients in the LA group complained of pain during the performance of the block. This pain may be due to injecting the local anaesthetic mixture in a relatively small space over a short period of time. The pain was transient, lasting only 2–3 min. We therefore suggest that the injections should be performed slowly and progressively to minimise discomfort.

Some authors have reported that local anaesthetic techniques produce poor results in the presence of acute inflammation [24]. However, our technique of infiltrating the local anaesthetic mixture along the border of the lozenge, some 3 cm away from the sinus, and thus affecting the nerves supplying the surgical area, seems to produce an effective block. All patients in the LA group had a clinically effective block, and no patient required conversion to a general anaesthetic. In two patients in the LA group, the pilonidal sinus was highly inflamed, and the surgeon needed to extend the area of incision beyond the anaesthetised area. Not surprisingly, this produced pain for the patients and dissatisfaction in the surgeons. These operations were completed successfully after infiltration of a further 10 ml of the local anaesthetic mixture. Although the surgeons were asked to delineate the extent of the incision before the block was performed, surgeons often decide to extend the incision during the procedure. We suggest that the inflamed area should be carefully palpated before local anaesthetic injection so that the lozenge can be enlarged if necessary.

Patients in the LA group spent significantly less time in the operating theatre than those in the GA group. This may be the result of the additional time required to turn a patient carefully into the prone position. Patients in the LA group were fully conscious during the operation, and were thus able to position themselves comfortably and quickly. Patients undergoing surgical procedures in the prone position under general anaesthesia may experience an increased incidence of a variety of complications [9, 10, 25–27]. The incidence of such complications may be substantially decreased if the patient is awake.

In accordance with our previous published experience [19–22], the period of improved analgesia in patients undergoing surgery under local anaesthesia is remarkably long, exceeding the anticipated duration of the local anaesthetic effect itself. There may be a number of reasons for this. Several studies have reported surprisingly long durations of improved pain relief following the use of the local anaesthetic/opioid/α2 adrenoceptor agonist mixture used in this study [28–30]. This, taken together with the recent finding of decreased pain both at rest and on swallowing for 5 days after the use of a local anaesthetic/α2 adrenoceptor agonist mixture for tonsillectomy [31], may indicate a potential pre-emptive analgesic action of this type of mixture. Another factor is that injecting morphine accurately around the nerves has been reported to improve pain relief of long duration [32, 33]. The decreased need for opioid analgesia in the LA group resulted in a shorter hospital stay.

In summary, the use of the local anaesthetic technique described in this paper for pilonidal sinus surgery seems to result in greater patient and surgeon satisfaction, shorter hospital stay and better overall pain relief.



Viciano V, Castera JE, Medrano J, Aguilo J, Torro J, Botella MG, Toldra N. Effect of hydrocolloid dressings on healing by second intention after excision of pilonidal sinus. The European Journal of Surgery 2000; 166: 22932.info:pmid/10755338

Direct Link:




Bascom J. Pilonidal disease: long-term results of follicle removal. Diseases of the Colon and Rectum 1983; 26: 8007.info:pmid/6641463



Web of Science® Times Cited: 55


Quinodoz PD, Chilcott M, Grolleau JL, Chavoin JP, Costagliola M. Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience. The European Journal of Surgery 1999; 165: 10615.info:pmid/10595611

Direct Link:




Erdem E, Sungurtekin U, Nessar M. Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Diseases of the Colon and Rectum 1998; 41: 142731.info:pmid/9823811



Web of Science® Times Cited: 28


Mosquera DA, Quayle JB. Bascom’s operation for pilonidal sinus. Journal of the Royal Society of Medicine 1995; 88: 4546.


Al-Jaberi TM. Excision and simple primary closure of chronic pilonidal sinus. The European Journal of Surgery 2001; 167: 1335.info:pmid/11266254

Direct Link:




Grubnik VV, Bakhar GA. The use of a laser in the surgical treatment of an epithelial coccygeal cyst. Kliniches Kaia Khirurgiia 1993; 1: 235.


Palesty JA, Zahir KS, Dudrick SJ, Ferri S, Tripodi G. Nd:YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques. Lasers in Surgery and Medicine 2000; 26: 3805.info:pmid/10805943

Direct Link:





Brodsky JB, Oldroyd M, Winfield HN, Kozlowski PM. Morbid obesity and the prone position: a case report. Journal of Clinical Anesthesia 2001; 13: 13840.info:pmid/11331177



Web of Science® Times Cited: 5


Hunter JD, Reid C, Noble D. Anaesthesia management of the morbidly obese patient. Hospital Medicine 1998; 59: 4813.info:pmid/9775276


Web of Science® Times Cited: 3


Palmon SC, Kirsch JR, Depper JA, Toung TJ. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesthesia and Analgesia 1998; 87: 117580.info:pmid/9806704



Web of Science® Times Cited: 10


Archer DP, Ravussin P. Perioperative effects of the prone position: anesthesiologic aspects. Annales Francaises d’Anesthesie et de Reanimation 1998; 17: 1726.info:pmid/9750718



Web of Science® Times Cited: 1


Khaira HS, Brown JH. Excision and primary suture pilonidal sinus. Annals of the Royal College of Surgeons of England 1995; 77: 2424.info:pmid/7574311


Web of Science® Times Cited: 27


Weinstein MA, Rubin RJ, Salvati EP. The dilemma of pilonidal disease: pilonidal cystotomy reappraisal of an old technique. Diseases of the Colon and Rectum 1977; 20: 2879.info:pmid/862487



Web of Science® Times Cited: 15


Senapati A, Cripps NP, Thompson MR. Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus. The British Journal of Surgery 2000; 87: 106770.info:pmid/10931052

Direct Link:





Klin B, Heller ON, Kaplan I. The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. Journal of Clinical Laser Medicine and Surgery 1990; 8: 317.info:pmid/10160877



Ortiz HH, Marti J, Sitges A. Pilonidal sinus: a claim for simple track incision. Diseases of the Colon and Rectum 1977; 20: 3258.info:pmid/862493



Web of Science® Times Cited: 9


Destito C, Romagnoli A, Pucello D, Mercuri M, Marin AW. Pilonidal sinus: long term results of excision and closure technic. Review of the literature. Giornale di Chirurgia 1997; 18: 4416.info:pmid/9471223



Naja Z, El Hassan MJ, Khatib H, Ziade MF, Lönnqvist PA. Combined sciatic-paravertebral nerve block vs. general anaesthesia for fractured hip of the elderly. Middle East Journal of Anesthesiology 2000; 15: 55968.info:pmid/11126507



Naja MZ, El Hassan MJ, Oweidat M, Zbibo R, Ziade MF, Lönnqvist PA. Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair. Middle East Journal of Anesthesiology 2001; 16: 20110.info:pmid/11565433



Naja Z, Ziade MF, Lönnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. European Journal of Anaesthesiology 2002; 19: 197202.info:pmid/12071240


Web of Science® Times Cited: 23


Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001; 56: 11848.info:pmid/11736777



Web of Science® Times Cited: 32


Menzel T, Dorner A, Cramer J. Excision and open wound treatment of pilonidal sinus. Rate of recurrence and duration of work incapacity. Deutsche Medizinische Wochenschrift 1997; 122: 144751.info:pmid/9424422



Web of Science® Times Cited: 7


Meban S, Hunter E. Outpatient treatment of pilonidal disease. Canadian Medical Association Journal 1982; 126: 941.info:pmid/7074492


Web of Science® Times Cited: 4


Caricato A, Pennisi MA, Pappalardo F, Iodice F, Lepore D. Bilateral fixed mydriasis reversible during orthopedic surgery in the prone position. Anesthesiology 1999; 90: 17778.info:pmid/10360879



Web of Science® Times Cited: 3


Miller RD.The immediate preinduction period. In: MillerRD, ed. Anesthesia, 2nd edn. New York: Churchill Livingstone, 1986: 399408.

Web of Science® Times Cited: 6


Toyota S, Amaki Y. Hemodynamic evaluation of the prone position by transesophageal echocardiography. Journal of Clinical Anesthesia 1998; 10: 325.info:pmid/9526935



Web of Science® Times Cited: 23


Bernard JM, Macaire P. Dose-range effects of clonidine added to lindocaine for brachial plexus block. Anesthesiology 1997; 87: 27784.info:pmid/9286891



Web of Science® Times Cited: 77


El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Canadian Journal of Anaesthesia 2000; 47: 9627.info:pmid/11032270



Web of Science® Times Cited: 25


Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesthesia and Analgesia 1996; 83: 104650.info:pmid/8895283



Web of Science® Times Cited: 71


Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Archives of Otolaryngology – Head and Neck Surgery 2001; 127: 126570.


Web of Science® Times Cited: 38


Sanchez R, Nielsen H, Heslet L, Iversen AD. Neuronal blockade with morphine. A hypothesis. Anaesthesia 1984; 39: 7889.info:pmid/6476316

Direct Link:





Mays KS, Lipman JJ, Schnapp M. Local analgesia without anesthesia using peripheral perineural morphine injections. Anesthesia and Analgesia 1987; 66: 41720.info:pmid/3578848



Web of Science® Times Cited: 56




Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure

  1. O. F. Akinci,
  2. A. Coskun,
  3. A. Ozgonul,
  4. A. Terzi

Article first published online: 16 AUG 2006


 Objective We aimed at treating complicated pilonidal sinus (PS) patients by a simple and effective surgical procedure.

 Method Between 2000 and 2004, 24 selected complicated PS patients were treated with ‘limited separate elliptical excision and primary closure’. Patients with extensive or bilateral gluteal involvement, having more lateral, caudal or cephalic sinuses, multiple recurrences and unhealed chronic wounds after pilonidal surgery were included. Asymmetric excision and primary closure was performed to main diseased tissue in the midline. Additionally, small separate elliptical excisions with primary closure were performed in other involved tissues. The fistula tract or granulation tissue were excised subcutaneously if present. All patients were operated under local anaesthesia. The fascial attachments between the skin and coccyx were released at the deep point in the midline and at one side of wound. Suction drains and prophylactic antibiotics were used; subcutaneous tissues were closed with running polyglactin sutures and skin with polypropylene subcutaneously.

 Results The mean age of patients was 28.4 years (range 18–38). The mean follow-up time was 2.8 years. One recurrence, one seroma, one wound infection and one wound breakdown were recorded. Healing was always by first intention except in patients with wound infection and breakdown.

 Conclusion Most of the complicated PS patients can be operated with acceptable rates of recurrences and complications by using ‘limited separate elliptical excisions with primary closure’.


Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus

  1. A. Senapati1,2,*,
  2. N. P. J. Cripps1,
  3. M. R. Thompson1



Many treatments for symptomatic pilonidal sinus disease have been described. Ambulatory treatment with minimal morbidity and a rapid return to normal activity is desirable. Bascom’s operation fulfils these requirements. This paper describes the operative technique and results of treatment.


Some 218 patients of mean age 27 years were treated as day cases. The mean duration of symptoms was 2·4 years. Sixty-eight per cent of patients had complex disease with more than two midline pits and/or a lateral discharging sinus. One hundred and eighty-three patients (84 per cent) were operated on under local anaesthesia.


Ninety-five per cent of patients have been followed up for a mean of 12·1 (range 1–60) months. All except one midline wound healed. Lateral wounds healed after a mean of 4·0 (range 1–15) weeks. Postoperative complications were few, including bleeding in 4 per cent and abscess formation treated by reopening the lateral incision in 6 per cent. Twenty-one patients (10 per cent) have had recurrence and have needed reoperation.


Bascom’s operation is simple and results in considerable financial savings with minimal social disruption and an early return to work. Recurrent disease is no more frequent than after other treatments. © 2000 British Journal of Surgery Society Ltd


About Proktoloji Uzmanları

Bir cevap yazın

E-posta hesabınız yayımlanmayacak.


WhatsApp Canlı Destek
İletişim Bilgileri