Konya’da Pilonidal Sinüsün cerrahi tedavisindeki değişim

Amaç: Konya’ da son 11 yılda pilonidal sinüs (PS)’ ün cerrahi tedavisindeki değişimi belirlemek. Yöntem: Çalışma 1999 Ocak başından 2009 Aralık sonuna 11 yılı kapsamaktadır. Bu dönemde Konya’da Numune Hastanesi (NH), Eğitim Araştırma Hastanesi (EAH) ve Meram Tıp Fakültesi Hastanesinde (TFH), PS ameliyatı yapılan 4009 hastanın ameliyat verileri incelendi. Hastaların yaş, cinsiyet dağılımı ve tedavi yöntemleri değerlendirildi. Bulgular: PS bulunan 4009 vakanın 3591’i (% 89.6)) erkek, 418’i (% 10.4) kadındı. Dönemin ilk yarısında NH ve EAH de flepli tedavi (FT) nadirdi. NH’ nde ilk 5 yılda FT edilen hasta sayısı 14 (% 4) idi. NH’ nde FT oranı 2004 yılında % 43.8, 2005’de % 61.8’e ulaşmakta idi. Sonraki yıllarda oran hep % 50’nin üzerinde olup 2009’da % 82.4’e ulaşmakta idi. EAH’ de ilk 7 yılda FT edilen 15 (% 2.1) vaka vardı. FT oranı 2007 yılında % 44.4, eğitim kliniklerinin kurulduğu 2009 yılında % 92.8 olmuştu. TFH de FT oranı sadece 2000 yılında % 50’nin altında (% 48.3) idi. Oran 2009’da % 79.6’ya ulaşmaktaydı. 1999'dan 2009'a FT'de artış üç hastanede de anlamlıydı. Sonuç: PS’ün FT’si TFH’de baştan beri en önemli tercihtir. Bu değişim Sağlık Bakanlığı hastanelerine 5-8 yıl daha geç intikal etmiştir. Günümüzde PS’ün FT’si üç kurumda hastaların yaklaşık % 80’den fazlasında tercih edilmektedir.

Changes in the surgical treatment of pilonidal sinus disease in Konya

Objective: To determine changes in surgical treatment of pilonidal sinus disease (PSD) in Konya in last 11 years. Methods: We analyzed patients operated in Konya State Hospital (SH), Education and Research Hospital (ERH) and Medical Faculty Hospital (MFH) between the years 1999 and 2010. There were 4009 patients. We evaluated patients in terms of age, gender and surgical procedures. Results: Of the 4009 cases with PSD, 3591 (89.6%) were male and 418 (10.4%) were female. Procedures using flep (PUF) were a rare option in SH and ERH in the first period. Number of patient treated by surgical procedures using flep was 14 in SH in the first period. In SH, the rate of PUF was 43.8% in 2004, 61.8% in 2005 and after that year it was all above 50%. It reached 82.4% in 2009 in SH. In ERH there were only 15 (2.1%) patients treated by PUF in the first 7 years and it reached a rate of 44.4% in 2007 and 92.8% in 2009. In MFH, the rate of PUF was below 50% (48.3%) only in 2000. Increase in the rate of PUF from 1999 to 2010 was significant in all three hospitals. Conclusion: In MFH, PUF has been the method preferred in treatment of PSD. These methods had began to be used in hospitals of Ministry of Health 5-8 years later. Recently in all three hospitals PUF is used more than 80% of patients with PSD.

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  • 1. Karydakis GE.Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg.1992;62:385-9.
  • 2. TC Sağlık Bakanlığı Arşivleri, Hastaneler yıllığı, http://www.saglik.gov.tr/TR/Genel/BelgeGoster.aspx?F6E10F 8892433CFF7A2395174CFB32E1272E3DAA9474FE51.
  • 3. Mentes B, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, and Oguz M. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 2004;34:419–23.
  • 4. Peter j. Morris Souter RG. Perianal pilonidal disease. Oxford Textbook of Surgery,1994: 1154-5.
  • 5. Kelly SB,Graham WJH. Treatment of pilonidal sinus by phenol injection. Ulster Med J 1989;58:56-9.
  • 6. Kayaalp C, Ölmez A, Aydin C, Piskin T, Kahraman L. Investigation of a one-time phenol application for pilonidal disease. Med Princ Pract. 2010;19:216-7.
  • 7. Doğru O, Camcı C, Aygen E,Girgin M, Topuz Ö. Pilonidal Sinus Treated With Crystallized Phenol: An Eight-Year Experience. Dis Colon Rectum 2004; 47:1934–8.
  • 8. Bengisu N, Kisli E, Aytekin S, Pamak S.Curratage or unroofing of the pilonidal sinus tracts after instillation of AgNO3, then excision of the inplanting pitzs will be sufficient; A trial of 987 cases. 40th Congress of the European Socety for Surgical Research (ESSR); 2005 May 25-28; Konya, Turkey. Eur Surg Res 2005;(suppl 1):p.38.
  • 9. Lukish JR, Kindelan T,. Marmon L M. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatric Surg 2009;44: 282–5.
  • 10. Aygen E, Arslan K, Dogru O, Basbug M, Camci C. Crystallized Phenol in Nonoperative Treatment of Previously Operated, Recurrent Pilonidal Disease. Dis Colon Rectum 2010;53:932-5.
  • 11. Soll C, Hahnloser D, Dindo D, Clavien PA, Hetzer F. A novel approach for treatment of sacrococcygeal pilonidalsinus: less is more. Int J Colorectal Dis 2008;32:177–80.
  • 12. Mohamed HA, Kadry, Adly SI. Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 2005;2:73-7.
  • 13. Öncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 2002;6:165–9.
  • 14. Khaira HS, Brown JH Excision and primary suture of pilonidal sinus. Ann R Coll Surg Engl 1995;77:242-4.
  • 15. Washer J D, Smıth D E, Carman M E, Blackhurst D W. Gluteal fascial advancement: an ınnovative, effective method for treating pilonidal disease. Amer Surgeon 2010;76:154-6.
  • 16. Muzi MG, Milito G, Nigro C, Cadeddu F, Farinon AM. A modification of primary closure for the treatment of pilonidal disease in day-care setting. Colorectal Disease 2008;11:84–8.
  • 17. Polat N, Albayrak D, İbiş A C, Altan A. Sakrokoksigeal Pilonidal Sinüsün Cerrahi Tedavisinde Karydakis Flep Ameliyatı ile Primer Kapamanın Karşılaştırılması. Trakya Üniversitesi Tıp Fakültesi Dergisi 2008;25:87-094.
  • 18. Apaçık H. Pilonoidal sinüsün tedavisinde limberg flep ile minimal cilt eksizyonlu gerilimsiz kapatma tekniğinin karşılaştırılması. Dr Hasan Apaçık Uzmanlık tezi. İstanbul 2006.
  • 19. Cihan A, Menteş BB, Tatlıcıoğlu E, Özmen S, Leventoğlu S,Uçan BH. Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery.ANZ J Surg 2004;74:238-42.
  • 20. Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients-Langenbecks Arch Surg 2008: 393:185–189.
  • 21. Arumugam PJ, Chandrasekaran TV, Morgan AR., Beynon J, Carr ND. The rhomboid flap for pilonidal disease. Colorectal Disease 2003;5:218-21.
  • 22. El-Khadrawy O Hashish M Ismail K Shalaby H. Outcome of the Rhomboid Flap for Recurrent Pilonidal Disease. World J Surg 2009;33:1064–8.
  • 23. Kulacoglu H. Choosing the correct side for Karydakis flap. Colorectal Disease 2007; 10:949–50.
  • 24. Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg 2007;193: 606–9.
  • 25. Sharma P. Multiple Z-Plasty in Pilonidal Sinus—A New Technique under Local Anesthesia. World J Surg 2006; 30: 2261–5.
  • 26. El-Tawil S, Carapet E. Use of a double rhomboid transposition flap in the treatment of extensive complex pilonidal sinus disease. Colorectal Disease 2008; 11:313–7.
  • 27. Hull TL, Wu J, Pilonidal disease Surg Clin N Am 2002;82:1169–85.