According to most researchers, the incidence of pilonidal cysts of the sacrococcygeal
area is almost 25 cases per 100,000 in the general population. Despite the constant
search for effective methods of treatment, the results remain unsatisfactory, namely:
a high recurrence rate of 9.7%-33%, prolonged postoperative wound healing, and
aesthetic shortcomings of the post-surgical site. Unsatisfactory results are more often
observed in young patients who become temporarily unable to work during the
treatment period. This disorder is most common in the age range from 15 to 30 years.
The process of postoperative wound healing after excision of a pilonidal cyst takes
from 23 to 98 days due to inflammation. The average duration of wound healing is
59.3 days when using marsupialization, and from 21 to 72 days when using
curettage.
The main causes of recurrences of pilonidal cysts are infection of the postoperative
wound, the development of pathological granulation tissue, the presence of a hollow
in the wound, excessive tissue excision, considerable tension of the tissues when
stitching. The above mentioned causes require the search for new solutions, namely
the development of a method of complex surgical treatment, which would ensure a
reduction in wound healing time, a pleasing aesthetic effect, as well as a reduction
in the recurrence rate.
The aesthetic quality of postoperative scar is hardly considered by the scientific
world. There is also no data on the comparison of surgical treatment methods
regarding the length and the area of postoperative scar, as well as the deformity of
the intergluteal cleft. All the efforts of specialists are focused on finding the best
method aimed at reducing the likelihood of recurrence. According to statistical data,
the male to female ratio among patients is on average 4:1, therefore psychological
comfort associated with the aesthetic effect becomes very important.
This indicates that there is an urgent need to find a more effective method of surgical
treatment in order to reduce the recurrence rate, prevent deformity of the intergluteal
cleft and the formation of a noticeable scar, considering that almost 15% of patients
are female with an average age of 25 years.
The aim of the study is to improve treatment outcomes among patients with
recurrence of pilonidal cyst of the sacrococcygeal area by studying the causes of
their occurrence, developing and implementing comprehensive surgical treatment.
The following tasks were defined to achieve the aim:
1. To study the causes of recurrences of pilonidal cysts of the sacrococcygeal
area when using traditional methods of treatment
2. To study the morphological changes in the tissues of the sacrococcygeal
area with a pilonidal cyst in case of recurrence
3. To determine the composition of the microbiota of pilonidal cysts of the
sacrococcygeal area
4. To substantiate and develop a method of complex surgical treatment of
recurrent pilonidal cysts using polyurethane adhesive with an antibacterial
component
5. To evaluate the immediate and long-term results of surgical treatment of
recurrent pilonidal cysts using the developed method and compare the
results with traditional methods.
The objects of the study were recurrent pilonidal cysts of the sacrococcygeal area.
The subject of the study involved methods of treatment of pilonidal cysts, method
of surgical treatment using cross-linked polyurethane adhesive with an antibacterial
component, microbiota of pilonidal cysts, morphological changes in the tissues of
the sacrococcygeal area in case of recurrent pilonidal cysts.
According to the tasks set, general clinical, microbiological, morphological,
roentgenologic, and statistical research methods were used.
To obtain information on the size and location of the pilonidal cyst, there was
conducted an ultrasound examination in the preoperative period, as well as
fistulography in patients with a functioning fistula for chronic paraproctitis
differential diagnosis.
The research material involved examination and surgical treatment of 120 patients
with recurrence of pilonidal cyst of the sacrococcygeal area. The age of the patients
ranged from 18 to 46 years; the average age was 27±1.2 years. The patients were
divided into 2 groups depending on the method of treatment. In group 1 (60 patients),
surgical treatment was carried out according to the method of economical median
resection developed by the authors with double-row internal extraepidermal sutures
in combination with a cross-linked polyurethane adhesive with immobilized
albucide surgical treatment of pilonidal cysts was performed using the traditional
method of median resection with interrupted cutaneous fixation sutures.
