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The treatment of pilonidal sinus disease requires a personalized approach for each patient, as there is no single standard surgical method. The treatment plan is determined by considering the stage of the disease and the patient's overall condition.
In cases of acute pilonidal sinus abscess, emergency drainage (emptying the abscess) is usually performed. This condition can lead to severe pain and infection. After simple drainage of the abscess, the patient can then be prepared for an elective (planned) operation. Alternatively, there is also a high chance of healing with a single surgery by excising the skin over the abscess cavity in a flap-like manner and allowing the wound to heal by secondary intention.
For chronic pilonidal sinus disease, various treatment options are available. Conservative treatment approaches include encouraging the formation of granulation tissue by irritating the cavity with phenol, cauterization, cryotherapy, silver nitrate, or alcohol. While these methods are less costly, complications such as wound closure problems can occur, and the recurrence rate is approximately 5%.
Surgical treatment methods include:
* Cystotomy: A method where the upper part of the sinus cavity is opened, and the wound is allowed to heal by secondary intention. The recurrence rate is between 5-19%.
* Primary Closure: The wound is stitched edge-to-edge after the sinus is removed. The recurrence rate is around 15%.
* Cystectomy and Secondary Healing: The aim is to allow the wound to close by itself after the cyst is removed, leaving it open. This process can take 1-2 months and requires daily dressing changes. The recurrence rate is between 1-6%.
* Microsinususectomy: This method, preferred especially for small sinuses, involves removing the sinus along with its capsule and performing primary repair. The recurrence rate is approximately 15%.
* Flap Methods (Closed Surgery): In situations where the cavity created after cyst removal is too wide for primary closure, surrounding tissues are mobilized to close the gap. Types include Limburg flap, rotation flap, and Z-plasty flap. These methods are considered superior to others, and their recurrence rates (0-3%) are very low. The reduced tension at the wound edges results in less pain for patients and quicker return to work. The only disadvantage is that the surgical incision site might be slightly larger.
* Endoscopic Pilonidal Sinus Treatment (EPSiT): In this modern technique, a thin camera is used to enter the sinus cavity, and unlike laser, the internal structure of the sinus is thermally ablated under direct vision. It stands out as a new and attractive option due to its painlessness and faster return to daily life. Recurrence rates are similar to laser methods.
During pilonidal sinus surgery, the patient typically lies in a prone position. Anesthesia options can include local anesthesia, spinal (epidural) anesthesia, or general anesthesia. The type of anesthesia to be administered before surgery is jointly decided by the anesthesiologist, general surgeon, and the patient.
What is Pilonidal Sinus Surgery?
In cases of acute pilonidal sinus abscess, emergency drainage (emptying the abscess) is usually performed. This condition can lead to severe pain and infection. After simple drainage of the abscess, the patient can then be prepared for an elective (planned) operation. Alternatively, there is also a high chance of healing with a single surgery by excising the skin over the abscess cavity in a flap-like manner and allowing the wound to heal by secondary intention.
For chronic pilonidal sinus disease, various treatment options are available. Conservative treatment approaches include encouraging the formation of granulation tissue by irritating the cavity with phenol, cauterization, cryotherapy, silver nitrate, or alcohol. While these methods are less costly, complications such as wound closure problems can occur, and the recurrence rate is approximately 5%.
Surgical treatment methods include:
* Cystotomy: A method where the upper part of the sinus cavity is opened, and the wound is allowed to heal by secondary intention. The recurrence rate is between 5-19%.
* Primary Closure: The wound is stitched edge-to-edge after the sinus is removed. The recurrence rate is around 15%.
* Cystectomy and Secondary Healing: The aim is to allow the wound to close by itself after the cyst is removed, leaving it open. This process can take 1-2 months and requires daily dressing changes. The recurrence rate is between 1-6%.
* Microsinususectomy: This method, preferred especially for small sinuses, involves removing the sinus along with its capsule and performing primary repair. The recurrence rate is approximately 15%.
* Flap Methods (Closed Surgery): In situations where the cavity created after cyst removal is too wide for primary closure, surrounding tissues are mobilized to close the gap. Types include Limburg flap, rotation flap, and Z-plasty flap. These methods are considered superior to others, and their recurrence rates (0-3%) are very low. The reduced tension at the wound edges results in less pain for patients and quicker return to work. The only disadvantage is that the surgical incision site might be slightly larger.
* Endoscopic Pilonidal Sinus Treatment (EPSiT): In this modern technique, a thin camera is used to enter the sinus cavity, and unlike laser, the internal structure of the sinus is thermally ablated under direct vision. It stands out as a new and attractive option due to its painlessness and faster return to daily life. Recurrence rates are similar to laser methods.
During pilonidal sinus surgery, the patient typically lies in a prone position. Anesthesia options can include local anesthesia, spinal (epidural) anesthesia, or general anesthesia. The type of anesthesia to be administered before surgery is jointly decided by the anesthesiologist, general surgeon, and the patient.