Modified Bascom Cleft Lift Procedure for Management of Sacrococcygeal Pilonidal Sinus Disease: A Prospective Study
Advances in Surgical Sciences
Volume 6, Issue 2, December 2018, Pages: 50-55
Received: Jul. 29, 2018;
Accepted: Aug. 17, 2018;
Published: Sep. 25, 2018
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Mohamed Abdelshafy Mohamed, General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
Abdallah Mohamed Taha, General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
Mahmoud Abdelhameid, General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
Mostafa Mohamoud Sayed, General Surgery Department, Faculty of Medicine, Assuit University, Assiut, Egypt
Hamdy M. Hussein, General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
Ayman Kamal, General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
Background: Many options are available for treatment sacrococcygeal pilonidal sinus disease either surgical or medical, but surgery is preferred. There are many techniques for surgical treatment but there is controversy about the best technique. Until now there is no single procedure is superior in all aspects. The aim of this study was to evaluate modified Bascom Clift lift procedure in management of. Patients and methods: From April 2014 to July 2018, 150 patients with pilonidal sinus were treated with Clift lift procedure and followed. Data collected tabulated and analyzed included complications, recurrence, post-operative hospital stay, days-off work, postoperative aesthetic appearance and patient's satisfactions. Results: There were 150 patients, 129 male and 21 females with M:F ratio. Their ages ranges from 16 to 45 year, with mean age 22.55± 8.5 year. Fifteen patients (10%) had previous operation for pilonidal sinus (recurrent). After operation all patient were mobilized at first day, mean postoperative pain VAS score were about 2(1-3) and discharged from hospital at 2nd day and were returned to daily activities after mean 7 day (6-12 days), return to work at mean (12.5) days with good healing within 10 days, postoperative wound infection had occurred only in three patients (2%). Patients satisfaction score were very good. No recurrence was observed during follow up period. Conclusion: Modified Bascom natal cleft lift is associated with good outcome, it is simple procedure and easy to learn, with early mobilization, short hospital stay early return to daily activities and work, and good patients satisfaction and to somewhat accepted post-operative scar. More studies with larger group of patients are needed especially in recurrent cases to come to consensus.
Mohamed Abdelshafy Mohamed,
Abdallah Mohamed Taha,
Mostafa Mohamoud Sayed,
Hamdy M. Hussein,
Modified Bascom Cleft Lift Procedure for Management of Sacrococcygeal Pilonidal Sinus Disease: A Prospective Study, Advances in Surgical Sciences.
Vol. 6, No. 2,
2018, pp. 50-55.
Hull TL, Wu J. Pilonidal disease. Surg Clin North Am 2002; 82: 1169-1185.
McCallum I, King PM, Bruce J: Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2007 Oct 17;(4).
Aslam MN, Shoaib S, Choudhry AM. Use of Limberg flap for pilonidal sinus-a viable option. J Ayub Med Coll Abbottabad. 2009; 21(4):31-3.
Onder A, Girgin S, Kapan M, Toker M, Arikanoglu Z, Palanci Y, et al. Pilonidal sinus disease: risk factors for postoperative complications and recurrence. Int Surg 2012; 97:224-9.
Eryilmaz R, Sahin M, Alimoglu O, Dasiran F. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 2003; 134:745–9.
Karydakis GE: Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 1992 May; 62(5):385–389.
Da Silva JH: Pilonidal cyst: cause and treatment. Dis Colon Rectum 2000 Aug; 43(8):1146–1156.
Bayhan, Z., Zeren, S., Duzgun, S. A., Ucar, B. I., AlparslanYumun, H. N., Mestan, M. (2016) Crystallized phenol application and modifed Limberg fap proc edure in treatment of pilonidal sinus disease: A comparative retrospective study. Asian J. Surg. 39, 172–177.
Girgin M, Kanat BH. Te results of a one-time crystallized phenol application for pilonidal sinus disease. Indian J Surg 2014; 76:17-20.
Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L. Investigation of a one-time phenol application for pilonidal disease. Med PrincPract 2010; 19:212-5.
Lund JN, Leveson SH: Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum 2005 May, 48(5)1094-1096.
Dogru O, Camci C, Aygen E, et al: Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon Rectum 2004 Nov; 47(11):1934–1938.
Anderson AW. Hair extracted from an ulcer. Boston Med Surg J. 1847; 36:76.
Hodges RM (1880) Pilonidal sinus. Boston Med Surg J 103:485–486).
Surrell JA; Pilonidal disease. Surg Clin North Am., 1994; 74(6): 1309-1315.
McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta analysis. BMJ. 2008; 336(7649):868-71.
Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995; 10(1):39–42.
Bascom J, Bascom T. Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 2002; 137(10): 1146–1150.
Miocinovic M, Horzic M, Bunoza D. The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications. Acta Med 2001; 55:87–90.
Kayaalp C, Aydin C. Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 2009; 13(3):189–193.
Lee SL, Tejirian T, Abbas MA. Current management of adolescent pilonidal disease. J PediatrSurg 2008;43(6):1124–1127.
Dalenback J: Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia-efficient, sufficient, and persistent. Colorectal Dis 2006 Jan; 8(1):73–74.
Morden P, Drongowski RA, Geiger JD, et al: Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int 2005 Oct; 21(10):793–796.
Kitchen PR: Pilonidal sinus: experience with the Karydakis flap. Br J Surg 1996 Oct; 83(10):1452–1455.
Bascom JU: Repeat pilonidal operations. Am J Surg 1987 Jul; 154(1):118–122.
Mentes O, Bagci M, Bilgin T, et al: Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Dis Colon Rectum 2006 Jan; 49(1):104– 108.
Lord PH, Millar DM: Pilonidal sinus: a simple treatment. Br J Surg 1965 Apr; 52:298–300.
Cihan A, Ucan BH, Comert M, et al: Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 2006 Feb;49(2):244–249.
Akca T, Colak T, Ustunsoy B, et al: Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 2005 Sep; 92(9):1081–1084.
Dufourmentel C, Mouly R, Baruch J, et al: Sacrococcygeal cysts and fistulas. Pathogenic and therapeutic discussion. Ann Chir Plast 1966 Sep; 11(3):181–186.
Monro RS, McDermott FT: The elimination of causal factors in pilonidal sinus treated by z-plasty. Br J Surg 1965 Mar;52:177– 181.
Zieger K. Complications after surgery for pilonidal cyst. Anintroduction to a new debate on a “costly” disease. UgeskrLaeger 1999;161(44):6056 – 58.
Khaira HS, Brown JH. Excision and primary closure of pilonidal sinus. Ann R CollSurgEngl1995; 77:242–4.
Iesalnieks I, Furst A, Rentsch M, Jauch KW. Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Chirurg2003; 74:461–8.
Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 2004; 34:419–23.
Azab AS, Kamal MS, el Bassyoni F. The rationale of using the rhomboid fasciocutaneous transposition flap for the radical cure of pilonidal sinus. J DermatolSurgOncol1986; 12:1295–9.
Keighley MRB, Williams N. Pilonidal sinus. Surgery of the Anus, Rectum and Colon. 2nd ed. London: WB Saunders; 1999:539e563.
El- Sayed M. Abel- Razek. Cleft Lift Operation for Recurrent Pilonidal Sinus Repair. Two Years Experience Egypt, J. Plast. Reconstr. Surg., Vol. 30, No. 1, January: 7-11, 2006.
Theodoropoulos G. E., Vlahos K., Lazaris A. C., TahterisE. And Panoussopoulos D.: Modified Bascom’s asymmetric midgluteal cleft closure technique for recurrent pilonidal disease: early experience in a military hospital: Dis. Colon. Rectum. Sep., 46 (9): 1286-91, 2003.
Dudink1, J. Veldkamp2, S. Nienhuijs1, J. Heemskerk3 Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scandinavian Journal of Surgery 100: 110–113, 2011.