Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
3rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Colorectal Dis. 2020 Mar;22(3):319-324. doi: 10.1111/codi.14857. Epub 2019 Oct 6.
To present the results of a prospective, nonrandomized comparative study on the treatment of complicated pilonidal sinus by endoscopic pilonidal sinus treatment (EPSiT) compared with Limberg flap surgery, based on experience of a single surgical centre.
A prospective, nonrandomized comparative study. Long-term follow-up of 62 patients with complicated pilonidal disease was analysed (36 operated on using the Limberg flap technique and 26 using the EPSiT method). The median follow-up was 27 months (12-44).
The median operating time in the EPSiT group was 60 min (25-80 min) and in the Limberg group 67 min (35-95 min). In the EPSiT group, primary healing was achieved in 22 out of 26 patients (84.6%) in a median of 42 days with a total complication rate of 11.5%. There were seven recurrences after initial healing. The total success rate of the EPSiT procedure with long-term follow-up was 57.7%. In the Limberg flap group, all patients healed (100%) in a median of 21 days. The complication rate in this group was 26.5%, and there were two recurrences in this group. The total success rate of the Limberg flap procedure was 94.1%.
For patients with complicated pilonidal sinus, the endoscopic procedure has a significantly lower success rate than the Limberg flap procedure, but a lower risk of complications. Such patients should be offered a choice between a safer, minimally invasive procedure with a higher risk of recurrence or flap surgery, which is more effective, but with a higher risk of complications.
介绍一项由单一外科中心开展的前瞻性、非随机对照研究结果，该研究比较了内镜下治疗（EPSiT）与 Limberg 皮瓣手术治疗复杂性藏毛窦的效果。
前瞻性、非随机对照研究。对 62 例复杂性藏毛窦患者进行了长期随访（36 例采用 Limberg 皮瓣技术，26 例采用 EPSiT 方法）。中位随访时间为 27 个月（12-44 个月）。
EPSiT 组的中位手术时间为 60 分钟（25-80 分钟），Limberg 组为 67 分钟（35-95 分钟）。在 EPSiT 组中，26 例患者中有 22 例（84.6%）在中位 42 天内实现了一期愈合，总并发症发生率为 11.5%。初始愈合后有 7 例复发。长期随访时 EPSiT 手术的总成功率为 57.7%。在 Limberg 皮瓣组，所有患者均在中位 21 天内愈合（100%）。该组的并发症发生率为 26.5%，且有 2 例复发。Limberg 皮瓣手术的总成功率为 94.1%。
对于复杂性藏毛窦患者，内镜手术的成功率明显低于 Limberg 皮瓣手术，但并发症风险较低。应向此类患者提供选择，即选择一种复发风险较高但更安全、微创的手术，或选择一种更有效的皮瓣手术，但并发症风险较高。
