Iesalnieks I, Ommer A, Petersen S, Doll D, Herold A
Department of Surgery, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
End- und Dickdarm-Zentrum Essen, Essen, Germany.
Langenbecks Arch Surg. 2016 Aug;401(5):599-609. doi: 10.1007/s00423-016-1463-7. Epub 2016 Jun 16.
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.
This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference.
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.
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.
本国家指南旨在为参与藏毛疾病患者治疗的医生提供建议。该指南先前已以德语扩展版形式发表。
这是一项系统性文献综述。本指南在一次共识会议上由一个专家小组进行了审查并获得认可。
本指南的一些结论基于低质量至中等质量的试验。因此，在这些情况下有必要达成共识以提供建议。然而，关于最常用手术方法的建议是基于众多前瞻性随机试验得出的。
无症状的藏毛疾病无需治疗。藏毛脓肿应切开引流。急性炎症消退后，应采用确定性治疗方法。切除是慢性藏毛疾病的标准治疗方法。开放伤口愈合术后发病率低；然而，愈合时间长会带来并发症。微创方法（如窦道摘除术）是有限的慢性藏毛疾病的一种潜在治疗选择。然而，与开放愈合相比，复发率更高。切除后进行中线伤口缝合的复发率相当高，伤口并发症发生率增加，因此应摒弃这种方法。非中线手术可作为慢性藏毛疾病的主要治疗选择。目前，尚无证据表明各种非中线手术在治疗效果上存在差异。Limberg皮瓣和Karydakis皮瓣是研究最为深入的非中线手术方法。
