Materiały źródłowe

• #1 Pilonidal Cyst and Sinus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557770/

  The incidence of pilonidal disease is estimated to be 26 per 100,000 people and affects men 2.2 times more than women. It is estimated that pilonidal disease affects approximately 70,000 people in the United States annually. […] Pilonidal disease is a relatively common and benign disease process where surgery is usually the definitive treatment. Certainly, these patients should be evaluated by a surgeon, but they are usually not the first clinician to which a patient presents. Interprofessional communication is necessary as these patients can present to any clinician, primary care provider, or general practitioner. The diagnosis is clinical, so prompt recognition and diagnosis can lead to faster treatment and resolution. Pilonidal disease is a relatively common disease, and there is an extensive amount of published material. This includes various types of studies, including randomized control studies, cohort and case-control studies, case series, and expert opinions. Pilonidal disease is a broad topic, so narrowing the specific question can provide specific publications and research studies. There are numerous treatment modalities and treatment combinations. There is no single best treatment modality, and treatment must be individually tailored to the patient.

• #2 Pilonidal Cyst and Sinus: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/788127-overview

  Incidence of pilonidal disease is approximately 26 per 100,000 population. Pilonidal disease occurs predominantly in males, at a ratio of 3-4:1. It occurs most commonly in White patients, typically in the late teens to early twenties, decreases after age 25, and rarely occurs after age 45. […] Pilonidal disease affects approximately 26 per 100,000 people. […] Pilonidal disease in the general population has a male preponderance. It occurs in a ratio of 3 or 4:1. In children, however, the ratio is the opposite occurring in 4 females for each male it afflicts. […] Pilonidal disease commonly affects adults in the second to third decade of life. Pilonidal cysts are extremely uncommon after age 45 years, and the incidence usually decreases by age 25 years. The average age of presentation is 21 years for men and 19 years for women.

• #3

  https://journals.lww.com/international-journal-of-surgery/fulltext/2023/08000/progress_in_the_surgical_treatment_of.25.aspx

  A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). The incidence of SPS has gradually increased worldwide in recent years. […] The incidence of SPS is ~26/100 000 in the United States, affecting ~70 000 people every year. The incidence of SPS in Germany is ~48/100 000. From 2005 to 2017, the hospitalization rate for SPS patients in Germany increased by nearly one-third, with regional differences in incidence. […] The incidence of SPS is very low in China, which may be due to the fact that there are few studies on SPS and an incomplete understanding, which increases the probability of a missed diagnosis. At present, there are no definite epidemiological data on the incidence of SPS in China, and analysis of risk factors for the incidence of SPS is also rare.

• #4 Article 1_25_6 | GBMNGeorgian Biomedical News

  https://www.gbmn.org/article-102

  Epidemiological data on pilonidal disease in Georgia are limited, with no available information on the severity of the condition, which plays a key role in treatment decision-making. […] Our research aimed to study the incidence of pilonidal sinus and its characteristics in Georgia from 2020 to 2022. […] The incidence of pilonidal sinus in Georgia (crude rate = 38.2 per 100,000; ASR = 46.4 per 100,000) was significantly higher than the global average (26 per 100,000). […] It is important to note that new cases of pilonidal disease treated in hospitals were significantly higher (ASR=34.1, 95% CI (32.1-36.1)) than those treated in outpatient settings (ASR=12.3, 95% CI (11.6-13.1)), with a standardized rate ratio of 2.8, 95% CI (2.6-3.0). […] This study is the first to examine the epidemiological rates of pilonidal sinus and its age- and gender-specific characteristics in Georgia. […] Based on the results of this study, we can conclude that the incidence rate of pilonidal sinus in Georgia (crude rate: 38.2 per 100,000; ASR: 46.4 per 100,000) is significantly higher than the global rate (26 per 100,000).

• #5 Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8426302/

  Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. […] The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. […] Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. […] The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. […] We therefore explored German administrative data in order to describe population-based rates of inpatient episodes separated by different age groups and investigated potential regional differences within a country.

• #6

  https://link.springer.com/article/10.1007/s00384-021-03944-4

  Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. […] The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. […] Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. […] Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. […] Global incidence rates of pilonidal sinus disease are on the rise, and its burden of disease may exceed those of inguinal hernias in the severely affected age groups.

• #7

  https://journals.lww.com/international-journal-of-surgery/fulltext/2023/08000/progress_in_the_surgical_treatment_of.25.aspx

  Through literature review, we found that Chinese and English literature on SPS has gradually increased in recent years, reflecting the gradual increase in the incidence of the disease both at home and abroad. However, the relationship between this gradual increase in incidence and increased sedentary behaviour and increased BMI requires further investigation of control variables.

• #8 Pilonidal sinus | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pilonidal-sinus?lang=us

  While pilonidal sinuses can potentially occur at any age, they are much less common in children and older individuals (i.e. those older than 45 years old). The peak age of presentation is patients in their twenties. They are up to four times as common in males. […] The risk factors for developing pilonidal sinuses include male sex (3-4x), sedentary occupations and lifestyle, hirsutism, suboptimal personal hygiene, deep natal cleft, and occupational: regular contact with fragmented hair shafts, e.g. barbers, animal grooming.

• #9 Pilonidal sinus | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pilonidal-sinus?embed_domain=hackmd.io%25252F%252540yipuafecsl2jsu8smr5njq%25252Fbnjhjgjghjghjgh&lang=us

  Pilonidal sinuses can potentially occur at any age, they are much less common in children and older individuals (i.e. those older than 45 years old). The peak age of presentation is patients in their twenties. They are up to four times as common in males. […] The risk factors for developing pilonidal sinuses include male sex (3-4x), sedentary occupations and lifestyle, hirsutism, suboptimal personal hygiene, deep natal cleft, and occupational: regular contact with fragmented hair shafts, e.g. barbers, animal grooming.

• #10 Pilonidal Disease | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688635/0/Pilonidal_Disease

  Pilonidal disease results from an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft. […] Incidence: 16 to 26/100,000 per year. […] Predominant sex: male female (3 to 4:1). […] Predominant age: 2nd to 3rd decade, rare in age 45 years. […] Ethnic consideration: whites blacks Asians. […] Surgical procedures show male:female ratio of 4:1, yet incidence data are 10:1.

• #11 Pilonidal Sinus: Origin, Epidemiology, Definition, Etiology, Pathophysiology, Risk Factors, Clinical Features and Management

  https://www.linkedin.com/pulse/pilonidal-sinus-origin-epidemiology-definition-etiology-palak-sodani

  Sacrococcygeal pilonidal sinus is a common disorder among young adults. Observed most commonly in people aged 15-30 years, with a 3:1 male-to-female ratio, it occurs after puberty, when sex hormones are known to affect the pilosebaceous gland and change healthy body hair growth. The onset of pilonidal disease is rare in people older than 40 years. […] Concern surrounding long-term pilonidal disease is secondary to the rare occurrence of squamous cell carcinoma found in the pilonidal sinus tracts.

• #12 Pilonidal Cyst & Sinus: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/pilonidal-cyst-and-sinus/?srsltid=AfmBOorKauGcUUkOF50rFMaaT5K_copy8BbTdWHoPVPM1KUkl-Rx1_0T

  Pilonidal disease typically presents between the ages of 15 and 30 and is more prevalent in males (DynaMed, 2018). […] The disease is associated with significant morbidity and recurrence in 50% of cases (DynaMed, 2018). […] Diagnosis is primarily clinical, based on physical findings (DynaMed, 2018). […] Risk factors include: Obesity, Hairiness, Male gender, Poor hygiene, Deep gluteal cleft, Trauma or irritation, Family history, Characteristics of an individual’s hair, Excessive hair growth (hirsute habitus), Prolonged sitting with poor posture.

• #13 Epidemiology – GPnotebook

  https://gpnotebook.com/pages/surgery/pilonidal-sinus/epidemiology

  About 80% of pilonidal sinuses occur in men, usually from the age of puberty to about 40 years of age, but rarely in older people (1). […] Women who develop a pilonidal sinus tend to be younger. This is consistent with their earlier onset of puberty (1). […] About half of patients present as acute emergencies with a pilonidal abscess (2).

• #14 Pilonidal sinus: finding the righttrack for treatment

  https://ppch.pl/seo/article/01.3001.0009.6009/en

  Pilonidal cyst is usually diagnosed in young males (4 times more often than in females), usually of Caucasian descent, less frequently African or Asian, most commonly after puberty (mostly in 2nd and 3rd decade of life). In females, the disease develops at a younger age, which is probably due to earlier beginning of puberty. […] The following are considered risk factors of developing a pilonidal cyst: limited access of air to the intergluteal cleft, presence of anaerobic bacteria in hair follicles, production of a thick, keratin-rich and highly irritant substance by skin glands, epidermal damage, suction force in the intergluteal cleft during elevation of sacrum, presence of hair, their thickness and structure, dirt and excessive sweating, overweight/obesity, sedentary lifestyle, deep intergluteal cleft, positive family history for pilonidal cyst.

• #15 Pilonidal Disease | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688635/2.4/Pilonidal_Disease

  Pilonidal disease results from an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft. […] Incidence: 16 to 26/100,000 per year. […] Predominant sex: male female (3 to 4:1). […] Predominant age: 2nd to 3rd decade, rare in age 45 years. […] Ethnic consideration: whites blacks Asians. […] Prevalence: Surgical procedures show male:female ratio of 4:1, yet incidence data are 10:1.

• #16 Pilonidal Sinus & Disease Caboolture | Dermoid Cyst North Lakes | Wide Excision Browns Plains

  https://www.drnaeemkhan.com.au/pilonidal-sinus-general-surgeon-gastrointestinal-endoscopist-qld.html

  Incidence is about 26 per 100,000 population and it is more common in males with M:F ratio of 4-1. It mainly occurs in Caucasians in late 19s to early 20s decreasing after 25. […] Other risk factors also play role such as: Positive family history, Sedentary lifestyle, Obesity.

• #17 Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8426302/

  Our dataset not only revealed much higher overall rates of inpatient episodes than the well-cited report from the 1990s but, more importantly, also contradicts the well-accepted notion that patients above the age of 30 would seldom be affected by pilonidal sinus disease. […] Previous research demonstrated considerable worldwide variation in the burden of disease in females. Likewise, our dataset also revealed considerable regional variation in rates of inpatient episodes, not only between continents but also within Germany for both men and women. […] The most relevant advantage of administrative data is their completeness due to the compulsory participation by hospitals and the resulting completeness of inpatient data. […] In conclusion, we reported detailed population-based rates of inpatient episodes for pilonidal sinus disease separated by sex and age. These rates of inpatient episodes are substantially increasing in all age groups except children and have considerable regional variation, whose causes are entirely unclear.

• #18

  https://link.springer.com/article/10.1007/s00384-021-03944-4

  Our dataset not only revealed much higher overall rates of inpatient episodes than the well-cited report from the 1990s but, more importantly, also contradicts the well-accepted notion that patients above the age of 30 would seldom be affected by pilonidal sinus disease. […] Our dataset also revealed considerable regional variation in rates of inpatient episodes, not only between continents but also within Germany for both men and women. […] The vast majority of performed procedures are excisions of pilonidal sinus, whereas reconstructions via flap procedures are used in around 13% of cases. […] In conclusion, we reported detailed population-based rates of inpatient episodes for pilonidal sinus disease separated by sex and age. These rates of inpatient episodes are substantially increasing in all age groups except children and have considerable regional variation, whose causes are entirely unclear.

• #19 Causes, symptoms and details of Pilonidal sinus – Pulse Reference

  https://pulsereference.com/diagnoses/pilonidal-sinus/

  Pilonidal sinus predominantly affects young adults between the ages of 15 and 40, with a peak incidence in the late teens and early twenties. The condition is more common in males, with a male-to-female ratio of 3:1. Other risk factors include a sedentary lifestyle, obesity, hirsutism and a family history of pilonidal disease. […] The prognosis of pilonidal sinus is generally good, particularly with appropriate management. However, the condition is associated with a high recurrence rate, particularly after surgical treatment. Chronic pilonidal sinus can significantly impact a patients quality of life, leading to pain, abscess formation and time off work. Prompt diagnosis and appropriate management are crucial to improve outcomes and reduce the risk of complications.

• #20

  https://medicaljournalssweden.se/actadv/article/view/6569

  Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.313.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement.

• #21

  https://medicaljournalssweden.se/actadv/article/view/6569

  Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up. […] Benhadou F, Van der Zee HH, Pascual JC, Rigopoulos D, Katoulis A, Liakou AI, et al. Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients. Br J Dermatol 2019; 181: 1198-1206.

• #22

  https://link.springer.com/article/10.1007/s10353-022-00767-7

  The incidence of pilonidal disease is increasing. […] The aim of this retrospective single-center cohort study was to compare recurrence rates and postoperative wound complications between five treatment arms. […] An overall recurrence rate of 16.1% was observed at 24 months, 21.4% at 60 months, and 47.4% at 303 months; 24 months postoperatively, there was a range from 10.5% for excision with primary midline closure to 30.0% for the Bascom I procedure. […] Cox regression showed that previous pilonidal operations are an independent prognostic factor for developing recurrence (p=0.006). […] We found out that previous failed pilonidal operations are an independent prognostic factor for recurrence and development of wound complications. […] The highest prevalence of wound complications (46.3%) was in the subgroup of excision with primary midline closure.

• #23 Pilonidal Sinus: Causes, Symptoms, and Treatments

  https://www.healthline.com/health/pilonidal-cyst

  A pilonidal sinus infection mostly affects men and is also common in young adults. Its also more common in people who sit a lot, like cab drivers. […] There are a number of complications that may arise from pilonidal sinus infection. These include wound infection and a recurrence of the infection even after surgery. […] You can prevent a pilonidal sinus infection by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

• #24 Top Published Expert Doctors for Pilonidal Sinus

  https://findexpertmd.com/d/Pilonidal_Sinus

  279 top medical experts on Pilonidal Sinus across 39 countries and 22 U.S. states, including 122 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials ClinicalTrials.gov: at least 63 including 41 Completed, 7 Recruiting.

• #25 Pilonidal sinus and endoscopic surgery—myth or reality? – Milone – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/4281/5120

  Pilonidal Sinus is a disease frequently encountered in clinical practice, nevertheless its treatment has remained controversial, since it was first described by Mayo in 1833. […] No high level of evidential data about treatment choice can be found in current literature. Several data were based on low- or moderate-quality trials. In our opinion, one of the major limitations of current literature is that the most of the published studies had a short follow-up. Basing on the short-term follow-up (1 year), it is impossible to draw definitive conclusions about the recurrence rate of the minimally invasive technique. […] However, some of the questions about the best surgical technique for chronic pilonidal disease have now been answered: Less is more is a worldwide corroborated concept. It is the time to abandon the open radical excision; Open healing showed no clinical benefit over surgical closure; Sinusotomy/sinusectomy or en bloc resection with primary closure could be considered the preferred approaches; Wounds heal more quickly after primary closure, but risk of recurrence is higher; To flat is the gold standard of primary closure.

• #26 Pilonidal disease – Wikipedia

  https://en.wikipedia.org/wiki/Pilonidal_disease

  About 3 per 10,000 people per year are affected, and it occurs more often in males than females. […] The evidence for elective treatment of pilonidal sinus disease is poor. […] A 2018 literature review of 740 records of surgeries that included recurrence rates found that primary midline closure surgeries resulted in a 67.9% recurrence rate within 20 years, and recommended that they should be discontinued due to the high recurrence rate. […] Incision and drainage had a recurrence rate of 25.9% within 2 years, up to 40.2% in 5 years. […] Surgeons can also excise the sinus and repair it with a reconstructive flap technique, such as a „cleft lift” procedure or Z-plasty, usually done under general anesthetic. […] Meta-analysis shows recurrence rates were lower in open healing than with primary closure (RR 0.60, 95% CI 0.42 to 0.87), at the expense of healing time.

• #27 Pilonidal sinus and endoscopic surgery—myth or reality? – Milone – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/4281/5120

  The idea of a less radical treatment of pilonidal sinus goes back to World War II. […] In the last decade, supported by the statement less is more many surgeons developed minimally invasive treatment of pilonidal sinus. […] Minimally invasive techniques for pilonidal sinus consist of sinusectomy, it means the circumferential incision of the pilonidal orifices avoiding cutaneous margins and a selective subcutaneous extirpation of the sinus without closure of the wound. […] A new endoscopic treatment for pilonidal sinus has been recently proposed: the Video Assisted Ablation of Pilonidal Sinus (VAAPS) technique. […] In our preliminary experience is based on 27 patients. Of these all of them immediately returned to normal activities and work and recurrence rates registered were low. […] Although the mechanism of treatment is similar to the sinusectomy, the video-assisted technique benefits from a magnified view by the endoscope that allows the identification of the sinus borders, its lateral tracks, if present, and the presence of hair and debris inclusions in the cavity.

• #28 Pilonidal sinus and endoscopic surgery—myth or reality? – Milone – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/4281/5120

  It is worth mentioning that, according to Milone et al., this treatment could be an effective and feasible treatment for pilonidal sinus, being connected to a similar rate of postoperative complications compared with the conventional treatment. […] On the other hand, it is very important to highlight that the recurrence rate, obtained by current literature, deserves further evaluation over a longer term period.

• #29

  https://link.springer.com/article/10.1007/s10353-022-00767-7

  This paradigm shift represents a pivotal change for the choice of treatment strategy. […] The Karydakis flap group (n=65) consisted of 63.1% smokers and 75.4% patients with overweight or obesity. […] The last investigated group, excision with marsupialization showed a recurrence rate as high as 13.7% at 24 months, 18.1% at 60 months, and an overall wound care complication rate of 23.9%.

• #30 Pilonidal disease – Wikipedia

  https://en.wikipedia.org/wiki/Pilonidal_disease

  Pilonidal cysts can recur, and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress. […] Minimally invasive techniques with no wound and rapid return to full activities have been reported but await double-blind randomized trials. […] The evidence for any treatment is of low quality, and care must be taken not to overinterpret any study in this field.

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