Yasin DURAN, Havva Nur YÜMÜN ALPARSLAN, Kadir A. ÖZER, Fatin Rüştü POLAT, Mehmet İbrahim YILMAZ, Birol TOPÇU

PİLONİDAL SİNÜS CERRAHİ TEDAVİSİNDE V-Y İLERLETME FLEBİ TEKNİĞİ İLE PRİMER ONARIM TEKNİĞİNİN KARŞILAŞTIRILMASI, BEŞ YILLIK SONUÇLARIMIZ

Amaç: Pilonidal sinüs hastalığı cerrahinin problemli konularından biridir. Farklı cerrahi tedavi yöntemleri tanımlanmış olmakla birlikte postoperatif morbidite ve düşük hasta memnuniyeti sebebiyle ideal bir yöntem henüz tanımlanmamıştır. Çalışmamızda, pilonidal sinüsün cerrahi tedavisinde primer onarım yöntemi ile V-Y fleb yöntemi ile tedavi edilen olguları morbidite ve nüks yönünden karşılaştırıdık. Günümüzde pilonidal sinüsün tedavisinde en sık kullanılan primer onarım yönteminin postoperatif yüksek morbidite ve sık nüks görülmesi nedeniyle V-Y flebin alternatif tedavi olup olamayacağını araştırmayı amaçladık. Materyal ve Metot: 01Nisan 2014- 31.04.2019 tarihleri arasında Çorlu Devlet Hastanesi ve Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesinde pilonidal sinüs hastalığı nedeniyle ameliyat edilmiş 250 hasta retrospektif olarak incelendi. Bulgular: 155 hastaya primer onarım (Grup I), 95 hastaya V-Y ilerletme flebi uygulandı (Grup II). Grup I yaş ortalaması 26.083, Grup II yaş ortalaması: 28.073. Ortalama takip süresi V-Y ilerletme flebinde 34.242 ay primer kapamada ise 36.348 ay idi. Grup I’de 13(%8.387) hastada seroma, grup II’de 2(%2.105) hastada seroma gözlendi. Yara enfeksiyonu Grup I’de 15 (%9.677), grup II’de 2(%2.105) hastada görüldü. Grup I’de 9(%5.806) hastada yara ayrışması görüldü. Grup II’de 1(%1.052) hastada yara ayrışması görüldü. Grup I’de 18 hastada (%11.612) nüks görüldü. Grup II’de 4 hastada (%4.21) nüks görüldü. İyileşme süresi ortalama olarak Grup I ‘de 16.04 gün Grup II’de 14.49 gün olarak tesbit edildi. Sonuç: V-Y ilerletme flebi tekniği primer onarım tekniğine göre daha az postoperatif komplikasyona neden olmakta, nüks’ün daha az olması, kolay uygulanması nedeniyle pilonidal sinüs tedavisinde tercih edilebilecek alternatif bir ameliyat yöntemi olabilir.

Comparison of V-Y Advancement Flap Technique with the Primary Repair Technique for Pilonidal Sinus Surgical Treatment; Our Five-Year Outcomes

Aim: Pilonidal sinus disease is a problematic topic for surgery. Though different surgical treatment methods have been described, there is still no ideal method due to postoperative morbidity and low patient satisfaction. In our study, we compared the cases treated with V-Y flap method with primary repair method in surgical treatment of pilonidal sinus in terms of morbidity and recurrence. Currently, the most commonly used primary repair method for pilonidal sinus treatment has high postoperative morbidity and frequent recurrence, so we aimed to research whether the V-Y flap is an alternative treatment or not. Materials and Methods: A total of 250 patients operated for pilonidal sinus disease from 01 April 2014 to 31 April 2019 at Çorlu State Hospital and Tekirdağ Namık Kemal University Faculty of Medicine were retrospectively investigated. Results: A total of 155 patients had primary repair (Group I), while 95 patients had V-Y advancement flap applied (Group II). The mean age in Group I was 26.083 years, while the mean age in Group II was 28.073 years. The mean follow-up duration was 32.242 months for V-Y advancement flap and 36.348 months for primary closure. In Group I, 13 patients (8.387%) had seroma, while in Group II 2 patients (2.105%) were observed to have seroma. Wound infection was observed in 15 patients in Group I (9.677%) and 2 patients in Group II (2.105%). In Group I, 9 patients (5.806%) were observed to have wound separation, while in Group II, 1 patient (1.052%) had wound separation observed. Recurrence was observed in 18 patients (11.612%) in Group I. In Group II, 4 patients (4.21%) were observed to have recurrence. The mean healing duration was identified as 16.04 days in Group I and 14.49 days in Group II. Conclusion: The V-Y advancement flap technique causes fewer postoperative complications, less recurrence and is more easily performed compared to the primary repair technique, and may be an alternative operation method that can be chosen for pilonidal sinus treatment.

PDF

___

1. Bailey HR, Ford DB: Pilonidal Disease. İn: Zuidema GD, Yeo JC. Shackelford’s Surgery of the Alimentary Tract 5th Ed.Vol:4. Philadelphia: Saunders, 2002;480-4.
2. Nursal TZ, Ali Ezer, Çalışkan K, Törer N, Belli S, Moray G. Prospective randomized controlled trial comparing V–Y advancement flap with primary suture methods in pilonidal disease. Am. J. Surg. 2010;199(2):170–7.
3. Thompson MR, Senapati A, Kitchen P. Simple day-case surgery for pilonidal sinus disease. Br. J. Surg. 2011;98(2):198–209.
4. Polat N, Albayrak D, İbiş AC, Altan A. Sakrokoksigeal Pilonidal Sinüsün Cerrahi Tedavisinde Karydakis Flep Ameliyatı ile Primer Kapamanın Karşılaştırılması. Trakya Üniversitesi Tıp Fakültesi Dergisi 2008; 25(2):87-94.
5. Çetinkaya E, Sözen İ, Hatipoğlu ND: Pilonidal Hastalık. İn: Özmen MM; Bölüm 29 (Kolon,Rektum,Anüs); Schwartz (Cerrahinin İlkeleri). Ankara:GüneşTK 2016;1233.
6. Bali İ, Aziret M, Sözen S, Emir S, Erdem H, Çetinkünar S, İlkörücü O. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics 2015;70(5):350– 5.
7. McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. Br. Med. J. 2008;336(7649):868-71.
8. Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech. Coloproctol 2003;7(1):3–8.
9. Schoeller T, Wechselberger G, Otto A, Papp C. Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneus V-Y advancement flap. Surgery 1997;121 (3): 258-63.
10. Tardu A, Haşlak A, Özçınar B, Başa F. Pilonidal sinüsün cerrahi tedavisinde Limberg flep ile Dufourmentel flep yöntemlerinin karşılaştırılması. Ulusal Cerrahi Dergisi 2011; 27(1):35-40.
11. Hamaloğlu E, Yorgancı K. Pilonidal sinüs. İn: Sayek İ. Temel Cerrahi. Ankara:Güneş TK 2004:126;1273.
12. Klass AA. The so-called pilonidal sinus. Can. Med. Assoc J 1956;75:737-42.
13. Karydakis GR. Easy and succesful treatment of pilonidal sinus after explanation of its causative process. Aust. N. Z. J. Surg. 1992;62:385-9.
14. Bascom J. Pilonidal disease. Origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980;87:385-9.
15. Sondenaa K, Andersen E, Nesvik I, Soreide JA. Patient charecterics and symptoms in chronic pilonidal sinus disease. Int. J. Colorectal Dis. 1995;10(1):39-42.
16. Mihmanlı M: Pilonidal Hastalık. Kolon Rektum ve Anal bölge hastalıkları. İn:Alemdaroğlu K, Akçal T, Buğra D. İstanbul:Türk Kolon Rektum Cerrahi Derneği, 2004:185- 96.
17. Tezel E, Bostanci H, Anadol AZ, Kurukahvecioğlu O. Cleft lift procedure for sacrococcygeal pilonidal disease. Dis. Colon Rectum 2009;52(1):135–9.
18. Güner A, Ozkan OF, Keçe C, Kesici S, Kucuktulu U. Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: Results in 141 patients. Colorectal Dis. 2013;15(7):402–6.
19. Berkem H, Topaloğlu S, Özel H, Avsar FM, Yildiz Y, Yüksel BC, ve ark. V–Y advancement flap closures for complicated pilonidal sinus disease. Int. J. Colorectal Dis. 2005;20(4): 343-8.
20. Füzün M, Bakir H, Soylu M ve ark. Which technique for treatment of piloni¬dal sinüs- open or closed? Dis. Colon Rektum 1994;37(11):1148–50.
21. Urhan MK, Küçükel F, Topgül K, Özer I, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus. Dis. Colon Rectum 2002;45(5):656-9.
22. Saray A, Dirlik M, Çağlikülekçi M, Türkmenoğlu O. Gluteal V–Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease. Scand. J. Plast. Reconstr. Surg. Hand Surg. 2002;36(2):80-4
23. Al-Hassan HK, Francis IM, Neglen P . Primary closure or secondary granulation after excision of pilonidal sinüs. Acta. Chir. Scand.1990;156(10):695-9
24. Sondenaa K, Andersen E, Soreide JA. Morbidity and short term results in a randomized trial of open compared with closed treatment of chronic pilonidal sinüs. Eur. J. Surg. 1992;158(6-7): 351-5
25. Sungur N, Koçer U, Uysal A, Arslan C, Çöloğlu H , Ulusoy G. V-Y Rotation Advancement Fasciocutaneous Flap for Excisional Defects of Pilonidal Sinus. Plast. Reconstr. Surg. 2006;117(7):2448-54
26. Öz B, Akcan A, Emek E, Akyüz M, Sözüer E, Akyldız H, ve ark. A comparison of surgical outcome of fasciocutaneous V-Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease. Asian J Surg. 2017;40(3):197–202.
27. Koca YS, Yildiz I, Okur SK, Saricik B, Uğur M, Bulbul MT ve ark. Comparison of Unilateral Fasciocutaneous V-Y Flap Technique with Cleft Lift Procedure in the Treatment of Recurrent Pilonidal Sinus Disease: A Retrospective Clinical Study. Med Sci Monit. 2018; 24: 711–17.
28. Demiryılmaz İ, Yılmaz İ, Peker K, Çelebi F, Çimen O, Işık A, ve ark. Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease. Med. Sci. Monit. 2014;20:1263-6
29. Surrel JA. Pilonidal disease. Surg. Clin. North. Am. 1994;74(6):1309–15
30. Manterola C, Barroso M, Araya JC, Fonseca L. Pilonidal disease: 25 cases treated by dufourmental technique. Dis. Colon Rectum; 1991;34(8):649–52
31. Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali NA. Radical cure of pilonidal sinüs by a trans-position rhomboid flab. Br. J. Surg. 1984; 71(2):154–5
32. Bose B, Candy J. Radicalcure of pilonidal sinüs by Zplasty. Am. J. Surg. 1970;120(6):783–6.
33. Roth RF, Moorman WL.Treatment of pilonidal sinüs an cyst by conserva¬tive excision and W-plasty closure. Plast. Reconstr. Surg. 1977; 60(3):412–5
34. Khatri VP, Espinosa MH, Amin AK. Management of recurrent pilonidal sinus by simple V–Y fasciocutaneous flap. Dis. Colon Rectum 1994;37(12):1232–5
35. Bozkurt MK, Tezel E. Management of pilonidal sinüs with the Limberg Flab. Dis. Colon Rektum 1998;41(6):775–7
36. Monro SR, Macdermott FT. The elimination of causal factors in pilonidal sinüs treated by Z-plasty. Br. J. Surg. 1965;52(3):177–81.
37. Obeid SA. A new technique for treatment of pilonidal sinüs. Dis. Colon Rectum 1988; 31(11): 879–85.