Assuta Medical Center, Tel Aviv, Israel.
Isr Med Assoc J. 2022 Feb;24(2):89-95.
Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of minimally invasive surgeries.
To compare the efficacy of wide excision operations and minimal trephine surgery in patients with primary pilonidal disease.
In this retrospective study we examined surgical and inpatient records of 2039 patients who underwent surgery for primary pilonidal disease in five private hospitals between 2009 and 2012. Most procedures were of lay-open, primary midline closure, and minimal surgery types. Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons each performing one type of surgery, regardless of patient characteristics or disease severity.
With a mean follow-up of 7.2 years, 81.5%, 85%, and 88% of patients were disease-free after minimally invasive surgery, wide excision with primary closure, and lay-open surgery, respectively, with no statistically significant difference in recurrence rates. Minimal surgeries were usually performed under local anesthesia and involved lower pain levels, less need for analgesics, and shorter hospital stays than wide excision operations, which were normally performed under general anesthesia. The use of drainage, antibiotics, or methylene blue had no effect on recurrence of pilonidal disease.
Minimally invasive surgeries have the advantage of reducing the extent of surgical injury and preserving patient's quality of life. They should be the treatment of choice for primary pilonidal disease.
传统上，会通过广泛而深入地切除受影响区域来治疗会阴部藏毛窦病。然而，人们越来越意识到微创手术的优势。
比较广泛切除手术和微创环钻术治疗原发性藏毛窦病的疗效。
在这项回顾性研究中，我们检查了 2039 名在 2009 年至 2012 年间在五家私人医院接受原发性藏毛窦病手术的患者的手术和住院记录。大多数手术采用切开、一期中线缝合和微创手术类型。在一个由 53 名外科医生组成的亚组中，评估了 1260 名患者的藏毛窦复发率，每位外科医生只进行一种手术，无论患者特征或疾病严重程度如何。
平均随访 7.2 年后，微创组、广泛切除一期缝合组和切开引流组分别有 81.5%、85%和 88%的患者无疾病复发，复发率无统计学差异。微创手术通常在局部麻醉下进行，疼痛程度较低，对镇痛药的需求较少，住院时间较短，而广泛切除手术通常在全身麻醉下进行。引流、抗生素或亚甲蓝的使用对藏毛窦病的复发没有影响。
微创手术具有减少手术损伤程度和保留患者生活质量的优势。它们应该是原发性藏毛窦病的首选治疗方法。
