Gallo Gaetano, Goglia Marta, De Simone Veronica, Gravante Gianpiero, Sileri Pierpaolo, Crucitti Antonio, La Torre Marco
Department of Surgery, Sapienza University of Rome, Rome, Italy.
Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, 20132, Milan, Italy.
Int J Colorectal Dis. 2025 Sep 20;40(1):203. doi: 10.1007/s00384-025-04961-3.
Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved postoperative recovery and patient satisfaction, its effectiveness can be limited by incomplete identification of fistulous tracts. Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery. This study evaluates the clinical outcomes of combining IUS with EPSiT in the treatment of complex and recurrent PD.
A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD treated between 2018 and 2021 using IUS in conjunction with EPSiT. All patients had a minimum follow-up of 36 months. The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing.
Nineteen patients were included (14 males, 73.7%; mean age of 35.4 ± 6.4 years). The mean operative time was 42 min, with IUS requiring an additional 6 min. IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention.
Intraoperative IUS identified previously undetected secondary tracts in 31.5% of patients, leading to a modification of the surgical approach. Further comparative studies are needed to validate its effectiveness and assess its potential role as a standard adjunct in the surgical management of pilonidal disease.
藏毛疾病（PD）常伴有高复发率和愈合延迟，尤其是在复杂或复发病例中。虽然内镜下藏毛窦治疗（EPSiT）改善了术后恢复情况并提高了患者满意度，但其有效性可能会受到瘘管识别不完全的限制。术中超声（IUS）可实时显示皮下结构，可能有助于在手术中检测隐藏的瘘管。本研究评估了IUS联合EPSiT治疗复杂和复发性PD的临床效果。
对2018年至2021年间采用IUS联合EPSiT治疗的复发性和复杂性PD患者进行了一项回顾性队列单中心研究。所有患者的随访时间至少为36个月。该研究记录了IUS识别出额外瘘管并导致手术策略改变的病例数，以及包括复发率、伤口愈合时间和伤口愈合不完全发生率在内的临床结果。
纳入19例患者（14例男性，占73.7%；平均年龄35.4±6.4岁）。平均手术时间为42分钟，IUS额外需要6分钟。IUS在6例患者（31.5%）中发现了先前未检测到的瘘管，导致手术策略改变。在36个月的随访中，5例患者（26.3%）出现疾病持续存在（复发或愈合不完全）。复发病例通过额外手术成功处理，再次干预后实现了100%愈合。
术中IUS在31.5%的患者中发现了先前未检测到的继发瘘管，导致手术方法改变。需要进一步的比较研究来验证其有效性，并评估其作为藏毛疾病手术管理标准辅助手段的潜在作用。
