[Bascom's operation for pilonidal fistula].
BACKGROUND
Treatment of pilonidal fistula often results in impaired wound healing and recurrence. After wide excision of the fistula, impaired healing and recurrence occur in up to 69% and 10-29% of cases, respectively. Based on these facts we decided to implement Bascom's cleft-lift operation.


METHODS
59 patients (53 male) underwent surgery between September 2004 and January 2007. The median age was 27.7 (16-48) years. The indication for surgery was recurrent pilonidal cysts in 17 cases, impaired wound healing after prior surgery in 7 cases and large cysts in 35 cases.


RESULTS
All the patients, with the exception of one, were discharged less than 24 hours post surgery (47 (80%) as out-patient procedures). The last patient needed morphine postoperatively, and was discharged after 48 hours. 28 (47%) patients experienced no postoperative complications. 4 (7%) of the 59 patients underwent reoperation due to infection, but none of these patients received postoperative antibiotics. 26 (44%) patients developed minor wound defects. In 22 (85%) of these cases, the wounds healed spontaneously in less than 3 months. 42 patients were followed for more than 6 months with a median follow-up of 19 (8-29) months. 39 (93%) patients did not experience recurrence while the 3 cases of recurrence were observed after 5, 8 and 9 months.


CONCLUSIONS
Bascom's operation seems to reduce postoperative pain, complications, and the risk of recurrence compared with simple excision with or without primary wound closure. The procedure is simple and can be performed as fast-track surgery.
Bertelsen
Claus Anders
CA
Bispebjerg Hospital, Kirurgisk Afdeling K. info@pilonidal.dk
Jørgensen
Lars Nannestad
LN
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000379:methods*; D013536:Suture Techniques; D014945:Wound Healing