Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.
OBJECTIVE
This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease.


METHODS
From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts.


RESULTS
One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years.


CONCLUSIONS
Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.
Gips
Moshe
M
Pilonidal Sinus Clinic, Surgical Unit, Military Medical Facility, Zerifin, Israel. gipsm@post.tau.ac.il
Melki
Yedidia
Y
Salem
Leon
L
Weil
Ruben
R
Sulkes
Jaqueline
J
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000295:instrumentation*; D003646:Debridement / Q000295:instrumentation*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D010864:Pilonidal Sinus / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D014207:Trephining / Q000295:instrumentation*