Recurrent pilonidal disease - individualization and pathogenesis-oriented surgery

Abstract

INTRODUCTIONRecurrence after pilonidal disease surgery are common and difficult to treat. Many options are proposed including cleft lift procedure, Karydakis flap and advanced flaps. The aim of the study is to present and analyze our experience with individualized pathogenesis-based surgery of recurrent pilonidal disease. METHODSFor a 10-year period (2009-2019) patients with recurrent pilonidal disease were operated by authors. RESULTSThe healing time in 60 patients was 14-40 days. 22 patients had concomitant hidradenitis suppurativa in gluteal and/or inguinal regions. In 51 patients modified Karydakis operation was performed. In 9 patients complex advanced flaps were used. General or spinal anesthesia is used. In all patients perioperative antibiotics were administered and closed suction drains were used. Major complications occurred in 7 patients – 3 postoperative hematoma formation and 4 partial wound dehiscence managed conservatively. All patients are recurrence free. CONCLUSIONThe main issues in surgery of recurrent pilonidal disease is to avoid repeated procedures, to prevent new recurrence and to have acceptable functional and cosmetic results. Radical surgery with individualization following principles of cleft lift and avoiding of midline suture lines leads to best results and patient satisfaction. According to our experience and literature, we propose tailored radical surgical treatment of recurrent pilonidal disease:(1) recurrence after primary midline closure or pit piking (Bascom 1), or multiple incisions with midline sinus tract or wound with limited lateral extension – Bascom cleft lift procedure or modified Karydakis flap; (2) recurrence after lay open techniques – Karydakis or advanced flap; (3) recurrence with gluteal extension or combination with hidradenitis suppurativa – advanced flap with avoiding of midline suture line - “modified cleft lift”. &nbsp