Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 5/2016

01-08-2016 | Systematic Reviews and Meta-analyses

German national guideline on the management of pilonidal disease

Authors: I. Iesalnieks, A. Ommer, S. Petersen, D. Doll, A. Herold

Published in: Langenbeck's Archives of Surgery | Issue 5/2016

Login to get access

Abstract

Purpose

The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language.

Methods

This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference.

Results

Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials.

Conclusions

An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.
Footnotes
1
The statetment “Open healing is golden standard in Germany” was based purely on consensus and not on scientific data. Ninety-three percent of participants of consensus meeting voted to include this sentence despite a lack of data supporting this declaration.
 
Literature
1.
2.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S, GRADE Working Group (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490PubMedCrossRef
3.
Ommer A, Berg E, Breitkopf C, Bussen D, Doll D, Fürst A, Herold A, Hetzer F, Jacobi TH, Krammer H, Lenhard BH, Osterholzer G, Petersen S, Ruppert R, Schwandner O, Sailer M, Schiedeck THK, Schmidt-Lauber M, Stoll M, Strittmatter B, Iesalnieks I (2014) S3-Leitlinie: sinus pilonidalis. Coloproctology 36:272–322CrossRef
4.
Doll D, Friederichs J, Boulesteix AL, Düsel W, Fend F, Petersen S (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Color Dis 23:839–844CrossRef
5.
Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S (2008) Time and rate of sinus formation in pilonidal sinus disease. Int J Color Dis 23:359–364CrossRef
6.
Hussain ZI, Aghahoseini A, Alexander D (2012) Converting emergency pilonidal abscess into an elective procedure. Dis Colon rectum 55:640–645PubMedCrossRef
7.
Khalil PN, Brand D, Siebeck M, Hallfeldt K, Mutschler W, Kanz KG (2009) Aspiration and injection-based technique for incision and drainage of a sacrococcygeal pilonidal abscess. J Emerg Med 36:60–63PubMedCrossRef
8.
Jensen SL, Harling H (1988) Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 75:60–61PubMedCrossRef
9.
Dogru O, Camci C, Aygen E, Girgin M, Topuz O (2004) Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon rectum 47:1934–1938PubMedCrossRef
10.
Kaymakcioglu N, Yagci G, Simsek A, Unlu A, Tekin OF, Cetiner S, Tufan T (2005) Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol 9:21–24PubMedCrossRef
11.
Olmez A, Kayaalp C, Aydin C (2013) Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol 17:201–206PubMedCrossRef
12.
Aksoy HM, Aksoy B, Egemen D (2010) Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients. Eur J Dermatol 20:476–481PubMed
13.
Aygen E, Arslan K, Dogru O, Basbug M, Camci C (2010) Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease. Dis Colon rectum 53:932–935PubMedCrossRef
14.
Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L (2010) Investigation of a one-time phenol application for pilonidal disease. Med Princ Pract 19:212–215PubMedCrossRef
15.
16.
Sakçak I, Avşar FM, Coşgun E (2010) Comparison of the application of low concentration and 80 % phenol solution in pilonidal sinus disease. JRSM Short Rep 1:5PubMedPubMedCentralCrossRef
17.
Bruce RM, Santodonato J, Neal MW (1987) Summary review of the health effects associated with phenol. Toxicol Ind Health 3:535–568PubMedCrossRef
18.
19.
Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMed
20.
Nordon IM, Senapati A, Cripps NP (2009) A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197:189–192PubMedCrossRef
21.
Senapati A (2003) Failed pilonidal surgery: new paradigm and new operation leading to cures. Tech Coloproctol 7:211PubMedCrossRef
22.
Iesalnieks I, Deimel S, Kienle K, Schlitt HJ, Zülke C (2011) Pit-picking surgery for pilonidal disease. Chirurg 82:927–931PubMedCrossRef
23.
Colov EP, Bertelsen CA (2011) Short convalescence and minimal pain after out-patient Bascom’s pit-pick operation. Dan Med Bull 58:A4348PubMed
24.
25.
Maghsoudi H, Nezami N, Ghamari AA (2011) Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54:78–82PubMedPubMedCentralCrossRef
26.
Gips M, Melki Y, Salem L, Weil R, Sulkes J (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon rectum 51:1656–1662PubMedCrossRef
27.
Soll C, Hahnloser D, Dindo D, Clavien PA, Hetzer F (2008) A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more. Int J Color Dis 23:177–180CrossRef
28.
Soll C, Dindo D, Steinemann D, Hauffe T, Clavien PA, Hahnloser D (2012) Sinusectomy for primary pilonidal sinus: less is more. Surgery 150:996–1001CrossRef
29.
Kement M, Oncel M, Kurt N, Kaptanoglu L (2006) Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. Dis Colon rectum 49:1758–1762PubMedCrossRef
30.
Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H (2002) Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169PubMedCrossRef
31.
Ortiz HH, Marti J, Sitges A (1977) Pilonidal sinus: a claim for simple track incision. Dis Colon rectum 20:325–328PubMedCrossRef
32.
Mohamed HA, Kadry I, Adly S (2005) Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3:73–77PubMedCrossRef
33.
Al-Homoud SJ, Habib ZS, Abdul Jabbar AS, Isbister WH (2001) Management of sacrococcygeal pilonidal disease. Saudi Med J 22:762–764PubMed
34.
Fazeli MS, Lebaschi AH, Adel MG, Kazemeini AR (2008) Evaluation of the outcome of complete sinus excision with reconstruction of the umbilicus in patients with umbilical pilonidal sinus. World J Surg 32:2305–2308PubMedCrossRef
35.
Füzün M, Bakir H, Soylu M, Tansuğ T, Kaymak E, Haŕmancioğlu O (1994) Which technique for treatment of pilonidal sinus—open or closed? Dis Colon rectum 37:1148–1150PubMedCrossRef
36.
McCallum IJ, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336:868–871PubMedPubMedCentralCrossRef
37.
Reboa G, Gipponi M, Testa T, Giannini G, Scala M, Dalla Costa R, Strada P (2007) Regenerative medicine for the definitive surgical repair of pilonidal sinus. A new method of wound reconstruction. In Vivo 21:529–534PubMed
38.
Søndenaa K, Andersen E, Søreide JA (1992) Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 158:351–355PubMed
39.
Testini M, Piccinni G, Miniello S, Di Venere B, Lissidini G, Nicolardi V, Bonomo GM (2001) Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique. Color Dis 3:427–430CrossRef
40.
Al-Hassan HK, Francis IM, Neglén P (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699PubMed
41.
Gendy AS, Glick RD, Hong AR, Dolgin SE, Soffer SZ, Landers H, Herrforth M, Rosen NG (2011) A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 46:1256–1259PubMedCrossRef
42.
Gidwani AL, Murugan K, Nasir A, Brown R (2010) Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir J Med Sci 179:207–210PubMedCrossRef
43.
Iesalnieks I, Agha A, von Breitenbuch P, Schlitt HJ, Fürst A (2006) Chirurgische Behandlung des sinus pilonidalis. Viszeralchirurgie 41:399–406CrossRef
44.
Jamal A, Shamim M, Hashmi F, Qureshi MI (2009) Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J Pak Med Assoc 59:157–160PubMed
45.
Matter I, Kunin J, Schein M, Eldar S (1995) Total excision versus non-resectional methods in the treatment of acute and chronic pilonidal disease. Br J Surg 82:752–753PubMedCrossRef
46.
Rabie ME, Al Refeidi AA, Al Haizaee A, Hilal S, Al Ajmi H, Al Amri AA (2007) Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study. ANZ J Surg 77:177–180PubMedCrossRef
47.
Solla JA, Rothenberger DA (1990) Chronic pilonidal disease. An assessment of 150 cases. Dis Colon rectum 33:758–761PubMedCrossRef
48.
Stansby G, Greatorex R (1989) Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg 76:729–730PubMedCrossRef
49.
Greenberg R, Kashtan H, Skornik Y, Werbin N (2004) Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol 8:95–98PubMedCrossRef
50.
Al-Salamah SM, Hussain MI, Mirza SM (2007) Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 57:388–391PubMed
51.
Popeskou S, Christoforidis D, Ruffieux C, Demartines N (2011) Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J Surg 35:206–211PubMedCrossRef
52.
Gaston EA, Wilde WL (1965) Epidermoid carcinoma arising in a pilonidal sinus. Dis Colon rectum 8:343–348PubMedCrossRef
53.
54.
Iesalnieks I, Deimel S, Schlitt HJ (2013) Karydakis flap for recurrent pilonidal disease. World J Surg 37:1115–1120PubMedCrossRef
55.
Iesalnieks I, Fürst A, Rentsch M, Jauch KW (2003) Erhöhtes Rezidivrisiko nach primärem medianen Wundverschluss bei Patienten mit Pilonidalsinus. Chirurg 74:461–468PubMedCrossRef
56.
Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304PubMedCrossRef
57.
Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W (2011) Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon rectum 54:300–305PubMedCrossRef
58.
Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Meysamie A, Nouritaromlou MK (2015) Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res 198:260–266PubMedCrossRef
59.
Al-Khamis A, McCallum I, King PM, Bruce J (2011) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev :CD006213
60.
Abramson DJ, Cox PA (1954) The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment. Ann Surg 139:341–349PubMedPubMedCentralCrossRef
61.
Aydede H, Erhan Y, Sakarya A, Kumkumoglu Y (2001) Comparison of three methods in surgical treatment of pilonidal disease. ANZ J Surg 71:362–364PubMedCrossRef
62.
Ersoy OF, Karaca S, Kayaoglu HA, Ozkan N, Celik A, Ozum T (2007) Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J Med Sci 23:67–70PubMedCrossRef
63.
64.
Watters N, Macdonald IB (1958) Marsupialization of pilonidal sinus and abscess: a report of 50 cases. Can Med Assoc J 79:236–240PubMedPubMedCentral
65.
Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Color Dis 20:415–422CrossRef
66.
Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M (2009) Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon rectum 52:496–502PubMedCrossRef
67.
Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, Sim AJ (1999) Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 165:468–472PubMedCrossRef
68.
Baier PK, Baumgartner U, Furtwängler A, Holzinger F, Schöffel U (2002) Therapy of the pilonidal sinus—primary wound closure or open wound after excision. Zentralbl Chir 127:310–314PubMedCrossRef
69.
Brieler HS (1997) Infected pilonidal sinus. Langenbecks Arch Chir Suppl Kongressbd 114:497–500PubMed
70.
Denkers D, Girona J (1996) Der abszedierte sinus pilonidalis der Steißbeinregion—Möglichkeiten der chirurgischen Versorgung. Coloproctology 18:257–259
71.
Doll D, Evers T, Matevossian E, Petersen S (2009) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 197:693–694PubMedCrossRef
72.
Dudink R, Veldkamp J, Nienhuijs S, Heemskerk J (2011) Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100:110–113PubMed
73.
Holmebakk T, Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94:43–46PubMed
74.
Lee SL, Tejirian T, Abbas MA (2008) Current management of adolescent pilonidal disease. J Pediatr Surg 43:1124–1127PubMedCrossRef
75.
Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM (2010) Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 200:9–14PubMedCrossRef
76.
Muzi MG, Milito G, Nigro C, Cadeddu F, Farinon AM (2009) A modification of primary closure for the treatment of pilonidal disease in day-care setting. Color Dis 11:84–88CrossRef
77.
Nursal TZ, Ezer A, Calişkan K, Törer N, Belli S, Moray G (2010) Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199:170–177PubMedCrossRef
78.
Tavassoli A, Noorshafiee S, Nazarzadeh R (2011) Comparison of excision with primary repair versus Limberg flap. Int J Surg 9:343–346PubMedCrossRef
79.
Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S (2005) Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Tech Coloproctol 92:1081–1084
80.
Okuş A, Sevinç B, Karahan O, Eryilmaz MA (2012) Comparison of Limberg flap and tension-free primary closure during pilonidal sinus surgery. World J Surg 36:431–435PubMedCrossRef
81.
Patey DH, Scarff RW (1946) Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet 2:484–486PubMedCrossRef
82.
83.
Monro RS (1967) A consideration of some factors in the causation of pilonidal sinus and its treatment by Z-plasty. Am J Proctol 18:215–225PubMed
84.
Monro RS, McDermott FT (1965) The elimination of causal factors in pilonidal sinus treated by Z-plasty. Br J Surg 52:177–181PubMedCrossRef
85.
86.
87.
Akinci OF, Coskun A, Ozgonul A, Terzi A (2006) Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure. Color Dis 8:704–709CrossRef
88.
Bessa SS (2007) Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease. Dis Colon rectum 50:1935–1940PubMedCrossRef
89.
Bessa SS (2013) Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon rectum 56:491–498PubMedCrossRef
90.
91.
Moran DC, Kavanagh DO, Adhmed I, Regan MC (2011) Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution. World J Surg 35:1803–1808PubMedCrossRef
92.
Morden P, Drongowski RA, Geiger JD, Hirschl RB, Teitelbaum DH (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int 21:793–796PubMedCrossRef
93.
Sözen S, Emir S, Güzel K, Ozdemir CS (2011) Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial. Ir J Med Sci 180:479–482PubMedCrossRef
94.
Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150PubMedCrossRef
95.
Guner A, Boz A, Ozkan OF, Ileli O, Kece C, Reis E (2013) Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg 37:2074–2080PubMedCrossRef
96.
Ates M, Dirican A, Sarac M, Aslan A, Colak C (2011) Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 202:568–573PubMedCrossRef
97.
Anderson JH, Yip CO, Nagabhushan JS, Connelly SJ (2008) Day-case Karydakis flap for pilonidal sinus. Dis Colon rectum 51:134–138PubMedCrossRef
98.
Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O (2006) Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon rectum 49:244–249PubMedCrossRef
99.
Akin M, Leventoglu S, Mentes BB, Bostanci H, Gokbayir H, Kilic K, Ozdemir E, Ferahkose Z (2010) Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today 40:757–762PubMedCrossRef
100.
Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 18:29–37PubMedCrossRef
101.
Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200:318–327PubMedCrossRef
102.
Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Color Dis 11:705–710CrossRef
103.
Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M (2015) Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 100:870–877PubMedPubMedCentralCrossRef
104.
Neşşar G, Kayaalp C, Seven C (2004) Elliptical rotation flap for pilonidal sinus. Am J Surg 187:300–303PubMedCrossRef
105.
Eryilmaz R, Okan I, Coskun A, Bas G, Sahin M (2009) Surgical treatment of complicated pilonidal sinus with a fasciocutaneous V-Y advancement flap. Dis Colon rectum 52:2036–2040PubMedCrossRef
106.
Sharma PP (2006) Multiple Z-plasty in pilonidal sinus—a new technique under local anesthesia. World J Surg 30:2261–2265PubMedCrossRef
107.
Lieto E, Castellano P, Pinto M, Zamboli A, Pignatelli C, Galizia G (2010) Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon rectum 53:1061–1068PubMedCrossRef
108.
Quinodoz PD, Chilcott M, Grolleau JL, Chavoin JP, Costagliola M (1999) Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience. Eur J Surg 165:1061–1065PubMedCrossRef
109.
Lahooti M, Taheri PA, Nezami BG, Assa S (2008) Sacrococcygeal pilonidal sinus treated by a new fascio-cutaneous flap. Dis Colon rectum 51:588–592PubMedCrossRef
110.
Polat C, Gungor B, Karagul S, Buyukakincak S, Topgul K, Erzurumlu K (2011) Is oval flap reconstruction a good modification for treating pilonidal sinuses? Am J Surg 201:192–196PubMedCrossRef
111.
Krand O, Yalt T, Berber I, Kara VM, Tellioglu G (2009) Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon rectum 52:1172–1177PubMedCrossRef
112.
Naja MZ, Ziade MF, El Rajab M (2003) Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial. Anaesthesia 58:1007–1012PubMedCrossRef
113.
Schmittner MD, Dieterich S, Gebhardt V, Weiss C, Burmeister MA, Bussen DG, Viergutz T (2013) Randomised clinical trial of pilonidal sinus operations performed in the prone position under spinal anaesthesia with hyperbaric bupivacaine 0.5 % versus total intravenous anaesthesia. Int J Color Dis 28:873–880CrossRef
114.
Bertelsen CA (2011) Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia: a prospective cohort study of peri- and postoperative pain. Dis Colon rectum 54:895–900PubMedCrossRef
115.
Søndenaa K, Nesvik I, Gullaksen FP, Furnes A, Harbo SO, Weyessa S, Søreide JA (1995) The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture. J Am Coll Surg 180:157–160PubMed
116.
Mahdy T (2008) Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon rectum 51:1816–1822PubMedCrossRef
117.
Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, Colace L (2008) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 196:28–33PubMedCrossRef
118.
Milone M, Musella M, Salvatore G, Leongito M, Milone F (2011) Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Color Dis 26:1601–1607CrossRef
119.
Gurer A, Gomceli I, Ozdogan M, Ozlem N, Sozen S, Aydin R (2005) Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial. Dis Colon rectum 48:1797–1799PubMedCrossRef
120.
Colak T, Turkmenoglu O, Dag A, Akca T, Aydin S (2010) A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res 158:127–131PubMedCrossRef
121.
Kirkil C, Böyük A, Bülbüller N, Aygen E, Karabulut K, Coşkun S (2011) The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease. Tech Coloproctol 15:425–429PubMedCrossRef
122.
Eryilmaz R, Sahin M, Alimoglu O, Dasiran F (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 134:745–749PubMedCrossRef
123.
Petersen S, Wietelmann K, Evers T, Hüser N, Matevossian E, Doll D (2009) Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon rectum 52:131–134PubMedCrossRef
124.
Conroy FJ, Kandamany N, Mahaffey PJ (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61:1069–1072PubMedCrossRef
125.
126.
Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E (2010) Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 36:88–91PubMedCrossRef
127.
Demircan F, Akbulut S, Yavuz R, Agtas H, Karabulut K, Yagmur Y (2015) The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 8:2929–2933PubMedPubMedCentral
Metadata
Title
German national guideline on the management of pilonidal disease
Authors
I. Iesalnieks
A. Ommer
S. Petersen
D. Doll
A. Herold
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 5/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-016-1463-7

Other articles of this Issue 5/2016

Langenbeck's Archives of Surgery 5/2016 Go to the issue

ORIGINAL ARTICLE

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

REVIEW ARTICLE

Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights

How-I-Do-It Articles

Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy

ORIGINAL ARTICLE

Appendectomy in the pediatric population—a German nationwide cohort analysis

ORIGINAL ARTICLE

Metastasis to the lymph nodes along the proper hepatic artery from adenocarcinoma of the stomach

ORIGINAL ARTICLE

Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study