Top

Techniques in Coloproctology

Published in:

Open Access 01-10-2018 | Original Article

Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease

Authors: T. S. Sian, P. J. J. Herrod, J. E. M. Blackwell, E. J. O. Hardy, J. N. Lund

Published in: Techniques in Coloproctology | Issue 10/2018

Abstract

Background

Pilonidal sinus disease (PSD) is a common, chronic inflammatory condition involving hair follicles within the natal cleft. It mainly affects young males and creates a significant health, social and economic burden. Traditional surgery is often radical resulting in pain, wound complications, long recovery times and poor cosmesis. The aim of our study was to evaluate fibrin glue as a primary treatment for PSD.

Methods

Fibrin glue procedures for a single surgeon at our institution were identified from operative coding databases and the logbook from January 2011 to January 2016. Patients had curettage of the sinus with fibrin glue obliteration. Recurrence data was collected retrospectively.

Results

One hundred and forty-six patients were identified; (115 (79%) males, mean age 30 (range 16–78 years). One hundred and forty-four (99%) were discharged the same day. Four (2.7%) were treated conservatively for wound discharge. Median operating time was 9 (range 4–28) min. There were 40 (27%) recurrences after one glue application. Median time to recurrence was 4 (range 0.25–36) months. Twenty-four (60%) of the recurrences had repeat glue treatment with 4 (16.6%) recurrences. After 2 rounds of treatment with glue alone, 126 out of 130 (96.9%) patients had healed.

Conclusions

Fibrin glue application following curettage of the sinus is a quick and effective procedure for first and second line treatment of PSD.

Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: Historical review, pathological insight and surgical options. Tech Coloproctol 7:3–8CrossRef

McCallum IJD, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336:868–871CrossRef

Loganathan A, Arsalani Zadeh R, Hartley J (2012) Pilonidal disease. Dis Colon Rectum 55:491–493CrossRef

Kaya B, Eris C, Atalay S, Bat O, Karabulut K, Bulut N et al (2012) Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol 16:55–59CrossRef

Pronk AA, Eppink L, Smakman N, Furnee EJB (2018) The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol 22:7–14CrossRef

Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D (2018) The hair in the sinus: sharp-ended rootless head hair fragments can be found in large amounts in pilonidal sinus nests. World J Surg 42:567–573CrossRef

Gosselink MP, Jenkins L, Toh JWT, Cvejic M, Kettle E, Boadle RA et al (2017) Scanning electron microscope imaging of pilonidal disease. Tech Coloproctol 21:905–906CrossRef

Thompson MR, Senapati A, Kitchen P (2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 98:198–209CrossRef

Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMed

10.

Athem TT, Arulampalam RT (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22:325–331. https://doi.org/10.1007/s10151-018-1803-4 CrossRefPubMed

11.

Salih AM, Kakamad FH, Salih RQ, Mohammed SH, Habibullah IJ, Hammood ZD et al (2018) Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy—a randomized controlled trial. Surgery. https://doi.org/10.1016/j.surg.2017.12.014 (Published Online First: March) CrossRefPubMed

12.

Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. 1990; 77:12–132CrossRef

13.

Lund JN (2017) Less is more in the treatment of pilonidal sinus disease. Dis Colon Rectum 60:e1CrossRef

14.

Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15:179–183CrossRef

15.

Seleem MI, Al-Hashemy AM (2005) Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience. Color Dis 7:319–322CrossRef

16.

Yoldas T, Karaca C, Unalp O, Uguz A, Caliskan C, Akgun E et al (2013) Recurrent pilonidal sinus: lay open or flap closure, does it differ? Int Surgery 98:319–323CrossRef

17.

AL-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006213.pub3 (Published Online First: 20 January) CrossRefPubMed

18.

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 200:318–327CrossRef

19.

Milone M, Velotti N, Manigrasso M, Anoldo P, Milone F, De Palma GD (2018) Long-term follow-up for pilonidal sinus surgery: A review of literature with metanalysis. Surgury. https://doi.org/10.1016/J.SURGE.2018.03.009 (Published Online First: 24 April) CrossRef

20.

Greenberg R, Kashtan H, Skornik Y, Werbin N (2004) Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol 8:95–98CrossRef

21.

Elsey E, Lund JN (2013) Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol 17:101–104CrossRef

22.

Handmer M (2012) Sticking to the facts: a systematic review of fibrin glue for pilonidal disease. ANZ J Surg 82:221–224CrossRef

23.

Keshava A, Young CJ, Rickard MJFX, Sinclair G (2007) Karydakis flap repair for sacrococcygeal pilonidal sinus disease: how important is technique? ANZ J Surg 77:181–183CrossRef

24.

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 198:260–266CrossRef

25.

Isik A, Eryılmaz R, Okan I, Dasiran F, Firat D, Idiz O et al (2014) The use of fibrin glue without surgery in the treatment of pilonidal sinus disease. Int J Clin Exp Med 7:1047–1051PubMedPubMedCentral

26.

Khanna A, Rombeau JL (2011) Pilonidal disease. Clin Colon Rectal Surg 24:46–53CrossRef

27.

Smith CM, Jones A, Dass D, Murthi G, Lindley R (2015) Early experience of the use of fibrin sealant in the management of children with pilonidal sinus disease. J Pediatr Surg 50:320–322CrossRef

28.

Liptrot S, Leveson S, Lund J (2008) Fibrin glue may be better than surgery for pilonidal sinus: results of a prospective, randomized, controlled trial and 2-year follow up. Dis Colon Rectum 51:710–711

29.

Spotnitz W. Commercial fibrin sealants in surgical care. Am J Surg 2001; 182:S8–S14CrossRef

30.

Lund JN, Leveson SH (2005) Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum 48:1094–1096CrossRef

31.

Hardy E, Herrod P, Sian T, Boyd-Carson H, Blackwell J, Lund J et al (2018) Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children. J Pediatr Surg. https://doi.org/10.1016/J.JPEDSURG.2018.07.024 (Published Online First: 8 September) CrossRefPubMed

32.

Lund J, Tou S, Doleman B, Williams JP (2017) Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011923.pub2 (Published Online First: 13 January) CrossRefPubMed

33.

Welcome to the TISSEEL [Fibrin Sealant] Sealing Stops Bleeding. http://www.tisseel.com/us/index.html. Accessed 14 Jan 2018

34.

Bayhan Z, Zeren S, Duzgun SA, Ucar BI, Alparslan Yumun HN, Mestan M (2016) Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: a comparative retrospective study. Asian J Surg 39:172–177CrossRef

35.

Salih AM, Kakamad FH, Salih RQ, Mohammed SH, Habibullah IJ, Hammood ZD et al (2018) Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy—a randomized controlled trial. Surgery (Published Online First: March). https://doi.org/10.1016/j.surg.2017.12.014 CrossRef

36.

Dessily M, Charara F, Ralea S, Allé J-L (2017) Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg 117:164–168CrossRef

37.

Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W (2007) Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum 50:1928–1934CrossRef

Title: Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease
Authors: T. S. Sian
P. J. J. Herrod
J. E. M. Blackwell
E. J. O. Hardy
J. N. Lund
Publication date: 01-10-2018
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 10/2018
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-018-1864-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2018

Perforated sigmoid diverticulitis: Hartmann’s procedure or resection with primary anastomosis—a systematic review and meta-analysis of randomised control trials

Can sidestream dark field (SDF) imaging identify subtle microvascular changes of the bowel during colorectal surgery?

Outpatient laser treatment of primary pilonidal disease : the PiLaT technique

Can fluorescence-guided surgery improve radical resection of colorectal cancer? Comments on the FLICC study

Robotic pelvic lymph node dissection for rectal cancer

Correction to: Biological mesh extrusion months after laparoscopic ventral rectopexy