The one-stop trial: does electronic referral and booking by the general practitioner (GPs) to outpatient day case surgery reduce waiting time and costs? A randomized controlled trial protocol.
(17/51)
Pilonidal sinus - management in the primary care setting.
(20/51)
BACKGROUND: Postanal pilonidal sinus is a skin condition in the midline of the natal cleft. A primary pit forms in the midline, caused by a hair follicle that has become infected, into which loose hairs enter to create a track or abscess. OBJECTIVE: This article explains how a pilonidal sinus develops and presents, and details methods of treatment in the primary care setting and specialist management options. DISCUSSION: The devastation of recurrence with further pain, embarrassment, and time off work or school (in some cases for months or years), plus the prospect of more surgery is still common for patients with postanal pilonidal sinus. This can be avoided with the correct management. Surgery now has methods that produce early healing, low recurrence rates and acceptable cosmetic results. (+info)
Treatment of pilonidal sinuses in Denmark is not optimal.
(21/51)
INTRODUCTION: The standard treatments of chronic pilonidal sinuses (PS) were previously wide excision with primary midline closure or open treatment by non-specialist surgeons resulting in high rates of unhealed wounds and recurrences. An evidence-based shift from the now obsolete midline procedures towards off-line procedures seems to have occurred over the past 3-4 years. We decided to analyse the present state of PS treatment in Denmark. MATERIAL AND METHODS: A questionnaire was sent to all public hospitals and private clinics potentially treating PS. It included questions on the volume of procedures, experience of surgeons, and methods of anaesthesia and procedures in different cases. RESULTS: The questionnaire was answered by 37 departments (response rate 95%) in public hospitals and by 92 private clinics (response rate 84%). Off-midline closure was performed in 75% of the public departments, but some of these are also still performing midline surgery in some case. A total of 54% of the public departments are still performing midline surgery in some cases. Local analgesia is used in only 41% of the departments, and in 58% of these departments, local analgesia is used in fewer than 10% of the cases. In 11 (39%) departments, elective PS is performed by one or two surgeons, and there is a significant relation (p = 0.033) between low experience and large number of PS surgeons per department. Midline surgery seems to be performed in departments with more PS surgeons. CONCLUSION: Too many surgeons are still performing obsolete midline surgery. National guidelines are needed. The number of cases treated under local analgesia is unsatisfactorily low. (+info)
Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.
(22/51)
A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital.
(23/51)
BACKGROUND: There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years. METHODS: We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive. All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results. RESULTS: In all, 121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital. The 107 (88%) patients with infection (46% acute) underwent surgery. At operation, all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen. Vacuum-assisted closure was not used. All patients received antibiotics. The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences. Among the 90 patients in the excised and packed open group, 20 (22%) experienced recurrences and 5 (25%) experienced 2 recurrences. Among the 13 patients in the marsupialized group, 3 (23%) experienced recurrences and 1 (33%) experienced 2 recurrences. Among the 4 patients in the excised and closed primarily without drainage group, 1 (25%) experienced a recurrence and none experienced 2 recurrences (p = 0.12). Each recurrence was smaller than the original. All wounds eventually healed. There were no other complications and no deaths. A multivariable logistic regression analysis revealed that the type of surgical approach was not predictive of recurrence after controlling for age and sex. CONCLUSION: Age, sex and surgical approach were not predictive of recurrence. From our experience, excision and packing open the wound produced a longer morbidity but offered the same results compared with marsupialization or excision and primary closure without drainage. (+info)
Short convalescence and minimal pain after out-patient Bascom's pit-pick operation.
(24/51)
INTRODUCTION: Treatment of pilonidal sinuses with Bascom's pit-pick operation can easily be performed under local analgesia. We describe pain during and after the operation, time to return to work, time to healing and success rate. MATERIAL AND METHODS: The study comprised a cohort of 75 primary pit-pick (PP) operations performed at our department between August 2007 and December 2009. The median age was 30 years (range 15-64 years) and 57 (76%) were male. A total of 55 patients were interviewed daily by phone for one week with a view to registering their ability to return to work and their scoring of maximum pain on a numerical rating scale with a pain score ranging from 0 (no pain) to 10. RESULTS: The mean maximum pain during the first post-operative day was 2.2 (95% confidence interval (CI) 1.8-2.7) and at day four 1.0 (CI 0.7-1.3). Within 24 hours, 51% could return to work and the mean time was 3.2 (CI 1.8-4.5) days. Postoperative infection was related to the presence of secondary sinus (p = 0.03) and increasing number of midline sinus excisions (p = 0.02). Complete wound healing was achieved in 84% of the patients after a mean period of 3.5 (CI 3.1-3.9) weeks. Incomplete wound healing was significantly related to a small number of PPs (p < 0.05), increasing number of midline sinus excisions (p < 0.05) and no postoperative infection (p = 0.01). At one-year follow-up 80% were considered successfully treated. CONCLUSION: The majority of patients with simple pilonidal sinuses can be treated successfully with Bascom's PP procedure as out-patients. This regimen causes only mild postoperative pain and patients can resume work after a few days. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. (+info)