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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

Abstract

Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Introduction

The incidence of pilonidal sinus disease is increasing globally. About 100/100,000 inhabitants per year are affected in Germany1, with even higher numbers reported for Turkey2. Since 2013, American, German and Italian societies have published guidelines on best clinical practice3,4,5. While debate over the disease’s etiology and pathomechanisms is ongoing6,7,8,9, we showed recently that recurrence rates in PSD depend essentially on follow-up time and the specific surgical procedure used10. In a meta-analysis and merged-data analysis of surgical treatment options, follow-up times, and recurrence rates in 89,583 patients, recurrence after Limberg/Dufourmentel operations was as low as 0.6% at 12 months and 1.8% at 24 months postoperatively. Recurrence after Karydakis/Bascom procedures was 0.2% (95% CI 0.1–0.3%) at 12 months and 0.6% (95% CI 0.5–0.8%) at 24 months postoperatively. Primary midline closure after 240 months was associated with recurrence rates of 67.9% (95% CI 53.3–82.4%)10 (Table 1).

Table 1 Recurrence rates (RR) in different surgical approaches deriving from including all available studies from all geographical regions for 12, 24, 60, and 120 months follow-up time.

Geography – and thereby specific genetic mechanisms, healthcare settings and socioeconomic factors – has been shown to affect manifold diseases, and must be considered when studying a disease worldwide11,12. However, the global distribution of surgical approaches and the geography of recurrence rates have never been assessed in PSD, one of the most frequent surgical diagnoses1.

We therefore studied the impact of geographic distribution of surgical approaches on the treatment of PSD and the associated recurrence rates in order to evaluate the quality of selected procedures. We used our previously established database of publications from the years 1833–2017 to study PSD treatment strategies, follow-up time, and country of origin10. We hypothesized that geography affects recurrence rates in PSD and an extensive analysis of data will allow specific recommendations for different geographic regions.

Results

Our original search and processing strategy was described previously10. In brief, after exclusion of duplicates, we screened 5,768 studies across various databases. Data pertaining to malignancies, embryonic development, and body regions other than the presacral intergluteal location was additionally excluded, leaving 1,148 articles. Of these, 408 reports lacked data on follow-up time or on recurrence or both. Subsequently, data deriving from 740 studies was included in the merged data analysis10. The flow chart based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) can be found in our first study; the same applies for the heterogeneity analysis of the data involved10.

Looking at the overall results, the recurrence rates at 12 months ranged from 0.3% for the Limberg/Dufourmentel approach (95% CI 0.2–0.4) and the flaps approach (95% CI 0.1–0.5) to 6.3% for the incision and drainage approach (95% CI 3.2–9.3). At 60 months, the incision and drainage approach showed the highest recurrence rate: 36.8% (95% CI 26.3–47.2) (Fig. 1, Table 1).

Figure 1
figure1

All countries: Kaplan-Meier-estimator depicting recurrence free outcome of the study population as a function of follow-up time. The data used include all available studies from all geographical regions. 95% confidence intervals are shown by shaded lines. The number of patients at risk for 12, 24, 60, and 120 months follow-up time are shown in Table 1.

In the United States at 12 months the recurrence rates ranged from 0.3% for the Karydakis/Bascom approach (95% CI 0.0–0.8) to 67.2% for the incision and drainage approach (95% CI 7.5–100). The Limberg/Dufourmentel approach showed the lowest recurrence rate at 60 months, with 2.3% (95% CI 0.0–4.9) (Fig. 2, Table 2).

Figure 2
figure2

United States: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from the United States. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 2.

Table 2 Recurrence rates (RR) in different surgical approaches deriving from including available studies from the U.S.A. for 12, 24, 60, and 120 months follow-up time.

In Germany, patients undergoing the primary asymmetric closure approach had no recurrence at 12 months (95% CI 0.0–0.0), whereas patients undergoing the pit-picking approach had a much higher recurrence rate of 21.0% (95% CI 16.7–25.3). At 120 months four surgical approaches showed recurrence below 20%: the primary open approach (10.0%) (95% CI 7.9–12.1), the primary median closure approach (16.1%) (95% CI 13.1–19.2), the primary asymmetric closure approach (7.1%) (95% CI 0.0–22.1) and the marsupialization approach (8.8%) (95% CI 2.0–15.5) (Fig. 3, Table 3).

Figure 3
figure3

Germany: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Germany. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 3.

Table 3 Recurrence rates (RR) in different surgical approaches deriving from including all available studies from Germany for 12, 24, 60, and 120 months follow-up time.

Patients in Turkey had very good outcomes with the flaps approach at 12 months (0.0% recurrence) (95% CI 0.0–0.0), but the incision and drainage approach was associated with recurrence of 39.4% at 12 months (95% CI 12.7–66.2) and 78.8% (95% CI 25.3–100) at 24 months (Fig. 4, Table 4).

Figure 4
figure4

Turkey: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Turkey. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 4.

Table 4 Recurrence rates (RR) in different surgical approaches deriving from including all available studies from Turkey for 12, 24, 60, and 120 months follow-up time.

Italy delivered outstanding results at 12 months for four procedures: recurrence was 0.0% for the primary open approach (95% CI 0.0–0.0), the primary asymmetric closure approach (95% CI 0.0–0.0), the Limberg/Dufourmentel approach (95% CI 0.0–0.0) and the flaps approach (95% CI 0.0–0.0). Recurrence was relatively low with the marsupialization approach at 12 months (4.1%) (95% CI 0.5–7.7) and with the primary asymmetric closure approach at 120 months (3.6%) (95% CI 2.4–4.8) (Fig. 5, Table 5). Similar specifics can be shown for additional countries and regions such as Australia, New Zealand, Greece and Asia (Supplemental Figs 13, Supplemental Tables 13).

Figure 5
figure5

Italy: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Italy. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 5.

Table 5 Recurrence rates (RR) in different surgical approaches deriving from including all available studies from Italy for 12, 24, 60, and 120 months follow-up time.

Figures 6 and 7 provide an overview of recurrence rates of all procedures studied after 12 and 60 months in various geographic settings.

Figure 6
figure6

Procedure-specific recurrence rates in PSD [%] are shown at the time point 12 months. Extrapolated or interpolated data are marked with an asterisk (*).

Figure 7
figure7

Procedure-specific recurrence rates in PSD [%] are shown at the time point 60 months. Extrapolated or interpolated data are marked with an asterisk (*).

Discussion

We analyzed global data of more than 80,000 PSD patients for the years 1833 to 2017. Whereas in our previous study we only looked at follow-up time dependent recurrence rates of different surgical procedures, we now analyzed the geography’s impact on recurrence rates. Most of the patients analyzed were from the US (8,017), Germany (4,965), Turkey (19,809) or Italy (12,443). Focusing on the surgical approaches used in different countries and regions of the world, we assessed the recurrence rates at different follow-up times and found a correlation between geography and PSD recurrence for a variety of surgical treatments.

Not all surgical approaches were used in all the countries analyzed, and certain preferences exist in the choice of surgical approach in each country, leading to differences in recurrence rates of specific surgical approaches between the geographical regions. Because not all nations and continents report PSD patient treatments in sufficient numbers, some geographical regions had to be excluded to ensure sufficient data quality. For example, countries in Africa, Asia and South America were not included due to missing data, and/or a very low disease burden.

The merged data analysis is potentially less powerful than a systematic review consisting entirely of randomized controlled trials (RCT’s). Many of the studies we cited could have qualified as RCT’s, but our approach enabled inclusion of enough patients to be able to compare all the surgical methods available in different geographical regions. Certain surgical approaches are not being used for treatment in all the analyzed geographical regions. This lack of data provides important information about established treatments in specific health care settings and geographic regions respectively. The patient number or number at risk also differs strongly between regions, probably pointing out specific economic and clinical peculiarities. Also, abrupt drops and interpolations in our figures need to be interpreted with caution because the curves about recurrence rates are influenced by the cohort sizes of underlying studies: The methodologies of the underlying studies may indirectly create a certain bias.

The primary open approach showed insufficient success in most geographical regions, with a recurrence rate of 41.5% being observed at 60 months in the US. This has not been shown before, and is appalling in its magnitude. Reasons for the high recurrence rate are not yet evident. Current evidence implies that non healing beyond 6 month post-surgery should be considered as recurrent disease13,14. The application of metronidazole 10% ointment has enabled a faster wound closure in patients15 and healing can be regularly expected within 6 months, however, some surgical wounds only close after 9 months or later. Further, non-healing wounds must not be confused with a scar overlying the sacral bone. By definition recurrent PSD is defined as a new sinus tract. Although stringent criteria to distinguish healing disorders versus recurrence are available, some variation in recurrence rate observation between countries might unfortunately have been published.

The primary midline closure, which is not recommended for use anymore, showed a recurrence rate of 25.3% at 60 months in the USA. The pit-picking approach had a high recurrence rate of 33.1% at 24 months in Germany and should therefore be used only selectively for the treatment of minor disease in PSD patients. Nevertheless, interim results of current studies on pit picking are more promising. In contrast to the finding in Germany, pit picking showed a very low recurrence rate of 0.8%* at 24 months in Turkey, justifying this treatment in the Turkish medical setting. Strikingly, the Karydakis/Bascom approach in Greek cohorts showed the lowest observed recurrence rate at the 120-month follow-up. Nevertheless, it should be kept in mind that Karydakis never fully disclosed his data details of several thousands of Greek recruits. In Italy, endoscopic therapy approaches of different names are emerging and first results appear to be very promissing16. Given our data base embracing evidence ranging from 1833 to 2017, it is currently too early, however, to comment on their long-term recurrence rate since our data base misses the most recent publications. This approach might become a very promising approach in PSD surgery.

Therapy of open wounds following surgery has not been standardized, and may be performed by either a doctor, a nurse or a family member. This is not sufficiently well described in most of the studies we cited. Even the most recently published US guidelines do not recommend a particular type of wound care for primary open treatment17. As increased duration of open wound treatment may increase recurrence rate14, and elevated body weight with consecutive metabolic derangements may prolong wound healing, body mass index (BMI) in relation to treatment applied may further influence recurrence rate in primary and secondary treatments.

Obviously, there is some mastery of certain surgical methods which are widely applied in some countries, and this contributes to better regional results. In other countries, the same methods used less often may show more dismal outcomes, contributing to the geographic differences in recurrence rates. Recently, Doll et al. have shown that patients with strong axial hair shafts are more prone to pilonidal sinus disease, and Bosche et al. found short cut hair less 2 cm length in the pilonidal nests18,19 indicating that both genetic disposition and cultural hair styles can contribute to regional variation of pilonidal sinus incidence and recurrence rate.

Furthermore, our current study analyzes results published in scientific journals. These studies are often run at large university hospitals. While industrialized countries have better resources and can document, study and report therapy outcomes, more rural countries with less funding may struggle to do so. In terms of economics, the costs of treatment may differ based on location, treating institution and type of therapy.

Our results allow a more differentiated view of PSD treatment. Surgical approaches should be selected carefully based on treatment efficacy in general, and geographical influences have to be taken into account when aiming for optimal treatment efficacy.

In summary, recurrence rates of different surgical approaches used in the treatment of PSD are influenced by geographical factors. Certain surgical approaches – such as primary asymmetric closure and different flap techniques – remain superior, regardless of the geographical region. This is powerful evidence since the clinical settings, the genetic background of the patient population and economic settings do vary between different countries. Methods such as limited excision and phenol treatment should be limited to selected settings due to their high recurrence rates. Under certain circumstances their use can be justified by the lack of need for a hospital stay or as low-cost variant of treatment. Geographic peculiarities were identified, such as high recurrence rates for the primary open approach in the US, suggesting that other methods should be preferred in the American setting. Pit picking should be selectively applied in Germany due to its high recurrence rate, and ways to improve this interesting minimal invasive procedure should be investigated. The same surgical method is already showing promising results in Turkey. In the future, detailed investigation into geographical differences in recurrence rates for the same surgical PSD method may lead to the identification of further co-factors for recurrence in pilonidal sinus disease. Therefore, the standardized definition of recurrence should uniformly be used13,14.

Methods

Our original search was described previously10. In brief, we searched for the NCBI Medical Subject Heading (MeSH) term “pilonid*”, as well as [“cyst” AND “dermoid”] in MEDLINE, Ovid, PubMed Central, PubMed, Scopus, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and other search engines to build the PSD database10. Publications from 1833 to 2017 in English, French, German, Italian, and Spanish were captured10. Reports in other languages were retrieved if recurrence at specific follow-up times and definitive treatment strategies were provided (National Health Service international prospective register of systematic reviews PROSPERO number 42016051588)10. Data were organized with Microsoft Excel (Version 2016, Microsoft Corp., Redmond, WA)10. Specific surgical approaches described in a report were listed in a data row, while columns included citation details (incl. country of origin), follow-up times, number of patients studied, recurrence, and study details10. Regularly recorded information included which hospital(s) participated and which region the patients came from. In the very few studies where this was not obvious, the patient’s country of origin was defined as where the first author’s hospital was located. If all other authors were from one hospital, and the first author exclusively was not, then the hospital of the last author defined the country. If an article addressed several surgical approaches, the data of each treatment strategy were managed separately10. Because the statistical measures were not standardized, mean and median reports were treated equally to take into account the cluster of affected patients who were young adults10. Data presented as range of follow-up times was managed by employing the center of the given time10.

Recurrence rates in each study were then associated with the reported follow-up time. Individual patients were statistically simulated to enable an analogy across all data10. Cochrane analysis and I2 calculation with Chi2 tests were employed to examine heterogeneity of the included data10.

Statistical analysis and figure generation were completed with the software “R” (version 3.1.0, R-studio framework version 0.98.982). Two-tailed statistical tests were performed10. Kaplan-Meier curves of recurrence-free outcome, including pointwise 95% confidence intervals (CI), were generated with ‘survival’ in “R” (version 2.40–1) and implemented in the R package for each therapeutic group in each geographic region.

Data with unknown geographical origin were excluded. The United States, Turkey, Italy, Germany and Greece were defined as single countries; other countries were grouped into regions (Northern Europe, the Mediterranean, North America, i.e. USA and Canada, Australia/New Zealand, Indo-Arabia, Asia and South America) to obtain sufficient sample sizes.

Category

Post hoc analyses of data for a systematic review and meta-analysis, no publication before. No submission in parallel. No full or partial presentation at a meeting or podium or conference.

Ethics

This article does not contain any studies with human participants. Therefore, no informed consent had to be obtained prior to preparation of the current manuscript.

Presentation

The manuscript has not been submitted elsewhere in parallel and has not been published previously. Some of the data were presented at the International Pilonidal Sinus Disease Conference in Berlin on Sept 23, 2017 and at the 2nd International Pilonidal Sinus Conference in Vienna on Sept 28th 2019.

Data availability

All data and calculations are available to readers upon request to the corresponding author.

References

  1. 1.

    Doll, D. H. et al. Stop insulting the patient: neither incidence nor recurrence in pilonidal sinus disease is linked to personal hygiene. Pilonidal Sinus Journal 1, 8 (2015).

    Google Scholar 

  2. 2.

    Duman, K., Girgin, M. & Harlak, A. Prevalence of sacrococcygeal pilonidal disease in Turkey. Asian journal of surgery 40, 434–437, https://doi.org/10.1016/j.asjsur.2016.04.001 (2017).

    Article  PubMed  Google Scholar 

  3. 3.

    Segre, D., Pozzo, M., Perinotti, R. & Roche, B. The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 19, 607–613, https://doi.org/10.1007/s10151-015-1369-3 (2015).

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Steele, S. R. et al. Practice parameters for the management of pilonidal disease. Dis Colon Rectum 56, 1021–1027, https://doi.org/10.1097/DCR.0b013e31829d2616 (2013).

    Article  PubMed  Google Scholar 

  5. 5.

    Iesalnieks, I., Ommer, A., Petersen, S., Doll, D. & Herold, A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg 401, 599–609, https://doi.org/10.1007/s00423-016-1463-7 (2016).

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Doll, D. et al. The presence of occipital hair in the pilonidal sinus cavity—a triple approach to proof. International Journal of Colorectal Disease 33, 567–576, https://doi.org/10.1007/s00384-018-2988-8 (2018).

    Article  PubMed  Google Scholar 

  7. 7.

    Stone, H. B. Pilonidal Sinus. Ann Surg 79, 410–414 (1924).

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Davage, O. N. The Origin of Sacrococcygeal Pilonidal Sinuses. Am J Pathol 30, 1191–1205 (1954).

    CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Sievert, H. et al. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. International Journal of Colorectal Disease 28, 1555–1562, https://doi.org/10.1007/s00384-013-1731-8 (2013).

    Article  PubMed  Google Scholar 

  10. 10.

    Stauffer, V. K. et al. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 8, 3058, https://doi.org/10.1038/s41598-018-20143-4 (2018).

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Lessa, F. C. et al. Burden of Clostridium difficile infection in the United States. The New England journal of medicine 372, 825–834, https://doi.org/10.1056/NEJMoa1408913 (2015).

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Crotty, B. Ulcerative colitis and xenobiotic metabolism. Lancet (London, England) 343, 35–38 (1994).

    Article  CAS  Google Scholar 

  13. 13.

    Doll, D. et al. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum 50, 1928–1934, https://doi.org/10.1007/s10350-007-9031-4 (2007).

    Article  PubMed  Google Scholar 

  14. 14.

    Allen-Mersh, T. G. Pilonidal sinus: finding the right track for treatment. Br J Surg 77, 123–32 (1990).

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Ypsilantis, E., Carapeti, E. & Chan, S. The use of topical 10% metronidazole in the treatment of non-healing pilonidal sinus wounds after surgery. Int J Colorectal Dis 31, 765–767, https://doi.org/10.1007/s00384-015-2269-8 (2016).

    Article  PubMed  Google Scholar 

  16. 16.

    Milone, M., Fernandez, L. M., Musella, M. & Milone, F. Safety and Efficacy of Minimally Invasive Video-Assisted Ablation of Pilonidal Sinus: A Randomized Clinical Trial. JAMA Surg 151, 547–553, https://doi.org/10.1001/jamasurg.2015.5233 (2016).

    Article  PubMed  Google Scholar 

  17. 17.

    Johnson, E. K., Vogel, J. D., Cowan, M. L., Feingold, D. L. & Steele, S. R. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum 62, 146–157, https://doi.org/10.1097/dcr.0000000000001237 (2019).

    Article  PubMed  Google Scholar 

  18. 18.

    Doll, D. et al. Strength of Occipital Hair as an Explanation for Pilonidal Sinus Disease Caused by Intruding Hair. Dis Colon Rectum 60, 979–986 (2017).

    Article  PubMed  Google Scholar 

  19. 19.

    Bosche, F. et al. The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg 42, 567–573 (2018).

    Article  PubMed  Google Scholar 

  20. 20.

    Perruchoud, C., Vuilleumier, H. & Givel, J. C. Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995. Swiss Surg 8, 255–258 (2002).

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Morden, P., Drongowski, R. A., Geiger, J. D., Hirschl, R. B. & Teitelbaum, D. H. Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int 21, 793–796, https://doi.org/10.1007/s00383-005-1543-1 (2005).

    Article  PubMed  Google Scholar 

  22. 22.

    Mueller, X., Rothenbuehler, J. M. & Frede, K. E. Sacrococcygeal cysts. Is Lord Millar’s procedure an alternative to exeresis? J Chir (Paris) 128, 487–490 (1991).

    CAS  Google Scholar 

  23. 23.

    Soll, C., Hahnloser, D., Dindo, D., Clavien, P. A. & Hetzer, F. A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more. Int J Colorectal Dis 23, 177–180, https://doi.org/10.1007/s00384-007-0377-9 (2008).

    Article  PubMed  Google Scholar 

  24. 24.

    al-Hassan, H. K., Francis, I. M. & Neglen, P. Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156, 695–699 (1990).

    CAS  PubMed  Google Scholar 

  25. 25.

    Fazeli, M. S., Adel, M. G. & Lebaschi, A. H. Comparison of outcomes in Z-plasty and delayed healing by secondary intention of the wound after excision of the sacral pilonidal sinus: results of a randomized, clinical trial. Dis Colon Rectum 49, 1831–1836, https://doi.org/10.1007/s10350-006-0726-8 (2006).

    Article  PubMed  Google Scholar 

  26. 26.

    Menzel, T., Dorner, A. & Cramer, J. Excision and open wound treatment of pilonidal sinus. Rate of recurrence and duration of work incapacity. Dtsch Med Wochenschr 122, 1447–1451, https://doi.org/10.1055/s-2008-1047784 (1997).

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Rao, M. M., Zawislak, W., Kennedy, R. & Gilliland, R. A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 25, 395–400, https://doi.org/10.1007/s00384-009-0804-1 (2010).

    Article  PubMed  Google Scholar 

  28. 28.

    Jamal, A., Shamim, M., Hashmi, F. & Qureshi, M. I. Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J Pak Med Assoc 59, 157–160 (2009).

    PubMed  Google Scholar 

  29. 29.

    Dudink, R., Veldkamp, J., Nienhuijs, S. & Heemskerk, J. Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100, 110–113 (2011).

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Gupta, P. J. Radiofrequency sinus excision: better alternative to marsupialization technique in sacrococcygeal pilonidal sinus disease. J Natl Med Assoc 97, 998–1002 (2005).

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Holmebakk, T. & Nesbakken, A. Surgery for pilonidal disease. Scand J Surg 94, 43–46 (2005).

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Kement, M., Oncel, M., Kurt, N. & Kaptanoglu, L. Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. Dis Colon Rectum 49, 1758–1762, https://doi.org/10.1007/s10350-006-0676-1 (2006).

    Article  PubMed  Google Scholar 

  33. 33.

    Kaser, S. A., Zengaffinen, R., Uhlmann, M., Glaser, C. & Maurer, C. A. Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study. Int J Colorectal Dis 30, 97–103, https://doi.org/10.1007/s00384-014-2057-x (2015).

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Mohamed, H. A., Kadry, I. & Adly, S. Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3, 73–77 (2005).

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Testini, M. et al. Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique. Colorectal Dis 3, 427–430 (2001).

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Al-Salamah, S. M., Hussain, M. I. & Mirza, S. M. Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 57, 388–391 (2007).

    PubMed  Google Scholar 

  37. 37.

    Spivak, H., Brooks, V. L., Nussbaum, M. & Friedman, I. Treatment of chronic pilonidal disease. Dis Colon Rectum 39, 1136–1139 (1996).

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Aldaqal, S. M., Kensarah, A. A., Alhabboubi, M. & Ashy, A. A. A new technique in management of pilonidal sinus, a university teaching hospital experience. Int Surg 98, 304–306, https://doi.org/10.9738/INTSURG-D-13-00064.1 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Soll, C. et al. Sinusectomy for primary pilonidal sinus: less is more. Surgery 150, 996–1001, https://doi.org/10.1016/j.surg.2011.06.019 (2011).

    Article  PubMed  Google Scholar 

  40. 40.

    Agren, M. S. et al. A randomized, double-blind, placebo-controlled multicenter trial evaluating topical zinc oxide for acute open wounds following pilonidal disease excision. Wound Repair Regen 14, 526–535, https://doi.org/10.1111/j.1743-6109.2006.00159.x (2006).

    Article  PubMed  Google Scholar 

  41. 41.

    Gendy, A. S. et al. A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 46, 1256–1259, https://doi.org/10.1016/j.jpedsurg.2011.03.062 (2011).

    Article  PubMed  Google Scholar 

  42. 42.

    Duxbury, M. S., Blake, S. M., Dashfield, A. & Lambert, A. W. A randomised trial of knife versus diathermy in pilonidal disease. R Coll Surg Engl 85, 405–407, https://doi.org/10.1308/003588403322520799 (2003).

    Article  CAS  Google Scholar 

  43. 43.

    Eftaiha, M. & Abcarian, H. The dilemma of pilonidal disease: surgical treatment. Dis Colon Rectum 20, 279–286 (1977).

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Holzer, B. et al. Efficacy and tolerance of a new gentamicin collagen fleece (Septocoll) after surgical treatment of a pilonidal sinus. Colorectal Dis 5, 222–227 (2003).

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Seleem, M. I. & Al-Hashemy, A. M. Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience. Colorectal Dis 7, 319–322, https://doi.org/10.1111/j.1463-1318.2005.00808.x (2005).

    Article  CAS  PubMed  Google Scholar 

  46. 46.

    Solla, J. A. & Rothenberger, D. A. Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum 33, 758–761 (1990).

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Spyridakis, M., Christodoulidis, G., Chatzitheofilou, C., Symeonidis, D. & Tepetes, K. The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results. World J Surg 33, 1764–1769, https://doi.org/10.1007/s00268-009-0046-y (2009).

    Article  PubMed  Google Scholar 

  48. 48.

    Chiedozi, L. C., Al-Rayyes, F. A., Salem, M. M., Al-Haddi, F. H. & Al-Bidewi, A. A. Management of pilonidal sinus. Saudi Med J 23, 786–788 (2002).

    PubMed  Google Scholar 

  49. 49.

    Keshvari, A. et al. Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res 198, 260–266, https://doi.org/10.1016/j.jss.2015.05.039 (2015).

    Article  PubMed  Google Scholar 

  50. 50.

    Biter, L. U. et al. The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Dis Colon Rectum 57, 1406–1411, https://doi.org/10.1097/DCR.0000000000000240 (2014).

    Article  PubMed  Google Scholar 

  51. 51.

    Viciano, V. et al. Effect of hydrocolloid dressings on healing by second intention after excision of pilonidal sinus. Eur J Surg 166, 229–232 (2000).

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    Rabie, M. E. et al. Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study. ANZ J Surg 77, 177–180, https://doi.org/10.1111/j.1445-2197.2006.04002.x (2007).

    Article  PubMed  Google Scholar 

  53. 53.

    Stansby, G. & Greatorex, R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg 76, 729–730 (1989).

    Article  CAS  PubMed  Google Scholar 

  54. 54.

    Ommer, A. et al. Pilonidal Sinus–Primary Closure also in Case of Abscess? Zentralbl Chir 129, 216–219, https://doi.org/10.1055/s-2004-822742 (2004).

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Matter, I., Kunin, J., Schein, M. & Eldar, S. Total excision versus non-resectional methods in the treatment of acute and chronic pilonidal disease. Br J Surg 82, 752–753 (1995).

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    Falco, M. D. et al. Il trattamento chirurgico del sinus pilonidalis con trasposizione di lembo secondo Dufourmentel Surgical treatment of sinus pilonidalis by Dufourmentel’s flap technique. Il Giornale di chirurgia 28, 93–97 (2007).

    PubMed  Google Scholar 

  57. 57.

    Lukish, J. R., Kindelan, T., Marmon, L. M., Pennington, M. & Norwood, C. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 44, 282–285, https://doi.org/10.1016/j.jpedsurg.2008.10.057 (2009).

    Article  PubMed  Google Scholar 

  58. 58.

    Ghnnam, W. M. & Hafez, D. M. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 4, 192–195, https://doi.org/10.4103/0974-2077.91251 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Baier, P. K., Baumgartner, U., Furtwangler, A., Holzinger, F. & Schoffel, U. Therapy of the pilonidal sinus–Primary wound closure or open wound after excision. Zentralbl Chir 127, 310–314, https://doi.org/10.1055/s-2002-31557 (2002).

    Article  CAS  PubMed  Google Scholar 

  60. 60.

    Ortiz, H. H., Marti, J. & Sitges, A. Pilonidal sinus: a claim for simple track incision. Dis Colon Rectum 20, 325–328 (1977).

    Article  CAS  PubMed  Google Scholar 

  61. 61.

    Goodall, P. The aetiology and treatment of pilonidal sinus. A review of 163 patients. Br J Surg 49, 212–218 (1961).

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    Kooistra, H. P. Pilonidal sinuses. Review of the literature and report of three hundred fifty cases. Am J Surg LV 1, 3–17 (1942).

    Article  Google Scholar 

  63. 63.

    McKirdie, M. Pilonidal Sinus. Ann Surg 107, 389–399 (1938).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. 64.

    Iesalnieks, I., Furst, A., Rentsch, M. & Jauch, K. W. Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Chirurg 74, 461–468, https://doi.org/10.1007/s00104-003-0616-8 (2003).

    Article  CAS  PubMed  Google Scholar 

  65. 65.

    Doll, D., Matevossian, E., Hoenemann, C. & Hoffmann, S. Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges 11, 60–64, https://doi.org/10.1111/j.1610-0387.2012.08007.x (2013).

    Article  PubMed  Google Scholar 

  66. 66.

    Iesalnieks, I., Deimel, S. & Schlitt, H. J. Karydakis flap for recurrent pilonidal disease. World J Surg 37, 1115–1120, https://doi.org/10.1007/s00268-013-1950-8 (2013).

    Article  PubMed  Google Scholar 

  67. 67.

    Hosseini, M., Heidari, A. & Jafarnejad, B. Comparison of Three Surgical Methods in Treatment of Patients with Pilonidal Sinus: Modified Excision and Repair/Wide Excision/Wide Excision and Flap in RASOUL, OMID and SADR Hospitals (2004–2007). Indian J Surg 75, 395–400, https://doi.org/10.1007/s12262-012-0713-3 (2013).

    Article  PubMed  Google Scholar 

  68. 68.

    Gupta, P. J. Comparative study between radiofrequency sinus excision and open excision in sacro-coccygeal pilonidal sinus disease. Dig Surg 22, 459–463, https://doi.org/10.1159/000092034 (2005).

    Article  PubMed  Google Scholar 

  69. 69.

    Fitzpatrick, E. B. et al. Pilonidal disease in a military population: how far have we really come? Am J Surg 207, 907–914, https://doi.org/10.1016/j.amjsurg.2013.07.038 (2014).

    Article  PubMed  Google Scholar 

  70. 70.

    Patti, R. et al. Use of fibrin glue in the treatment of pilonidal sinus disease: a pilot study. G Chir 27, 331–334 (2006).

    CAS  PubMed  Google Scholar 

  71. 71.

    Nasr, A. & Ein, S. H. A pediatric surgeon’s 35-year experience with pilonidal disease in a Canadian children’s hospital. Can J Surg 54, 39–42 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Baldelli, C. M. et al. A short course of granulocyte-colony-stimulating factor to accelerate wound repair in patients undergoing surgery for sacrococcygeal pilonidal cyst: proof of concept. Cytotherapy 14, 1101–1109, https://doi.org/10.3109/14653249.2012.697147 (2012).

    Article  CAS  PubMed  Google Scholar 

  73. 73.

    Kareem, T. S. Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure. Saudi Med J 27, 1534–1537 (2006).

    PubMed  Google Scholar 

  74. 74.

    Khawaja, H. T., Bryan, S. & Weaver, P. C. Treatment of natal cleft sinus: a prospective clinical and economic evaluation. BMJ (Clinical research ed.) 304, 1282–1283 (1992).

    Article  CAS  Google Scholar 

  75. 75.

    Notaras, M. J. A review of three popular methods of treatment of postanal (pilonidal) sinus disease. Br J Surg 57, 886–890 (1970).

    Article  CAS  PubMed  Google Scholar 

  76. 76.

    Oueidat, D. et al. 25 years’ experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology 4, 5 (2014).

    Article  Google Scholar 

  77. 77.

    Macfee, W. F. Pilonidal Cysts and Sinuses: A Method of Wound Closure: Review of 230 Cases. Ann Surg 116, 687–699 (1942).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. 78.

    Kasim, K., Abdlhamid, N. M., Badwan, B. R. & Allowbany, A. Is There a Relation Between Natal Cleft Depth and Post-Operative Morbidity After Different Methods of Excision of Sacro-Coccygeal Pilonidal Sinus? Indian J Surg 77, 201–205, https://doi.org/10.1007/s12262-012-0762-7 (2015).

    Article  PubMed  Google Scholar 

  79. 79.

    Swenson, S. A., Harkins, H. N. & Groesbeck, H. P. Pilonidal Sinus - Clinical Experiences with the Rogers Operation in thirty-five consecutive cases. Am J Surg 66, 49–57 (1944).

    Article  Google Scholar 

  80. 80.

    Blanco, G., Giordano, M. & Torelli, I. Surgical treatment of pilonidal sinus with open surgical technique. Minerva Chir 58, 181–187 (2003).

    CAS  PubMed  Google Scholar 

  81. 81.

    Hosseini, S. V. et al. The comparison between drainage, delayed excision and primary closure with excision and secondary healing in management of pilonidal abscess. Int J Surg 4, 228–231, https://doi.org/10.1016/j.ijsu.2005.12.005 (2006).

    Article  PubMed  Google Scholar 

  82. 82.

    Fahrni, G. T. et al. Five-year Follow-up and Recurrence Rates Following Surgery for Acute and Chronic Pilonidal Disease: A Survey of 421 Cases. Wounds 28, 20–26 (2016).

    PubMed  Google Scholar 

  83. 83.

    Kronborg, O., Christensen, K. & Zimmermann-Nielsen, C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72, 303–304 (1985).

    Article  CAS  PubMed  Google Scholar 

  84. 84.

    Khatoon, S. et al. Pilonidal sinus: Excision with primary midline closure versus open method. J. Liaquat Univ. Med. Health Sci. 9, 9–11 (2010).

    Google Scholar 

  85. 85.

    Stelzmueller, I. et al. Group Milleri Streptococci in perianal infections. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 12, e121–127 (2010).

    CAS  Google Scholar 

  86. 86.

    Sondenaa, K., Nesvik, I., Andersen, E. & Soreide, J. A. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J Surg 162, 237–240 (1996).

    CAS  PubMed  Google Scholar 

  87. 87.

    Shafik, A. Electrocauterization in the treatment of pilonidal sinus. Int Surg 81, 83–84 (1996).

    CAS  PubMed  Google Scholar 

  88. 88.

    Shah, A., Waheed, A. & Malik, A. Recurrence rates in pilonidal sinus surgery: Comparison of two techniques (Karydakis Versus Conventional Open Excision). Pak. J. Med. Health Sci. 3, 91–95 (2009).

    Google Scholar 

  89. 89.

    Obedman, M. & Vaticon, D. Pilonidal sinus: a high-incidence disease among adolescents. Int J Adolesc Med Health. 6, 21–36, https://doi.org/10.1515/IJAMH.1993.6.1.21 (1993).

    Article  Google Scholar 

  90. 90.

    Bracho Bracho, J. & Lira Soto, N. M. Enfermedad pilonidal: tecnica cerrada Vs. tecnica abierta con anestesia local. Boletin médico de postgrado (1996).

  91. 91.

    Coda, A. & Ferri, F. Sinus pilonidalis: Removal and primary suture with aspirative draining [Sinus Pilonidalis: Escissione E Sutura Primaria Con Drenaggio Aspirativo]. Chirurgia 3, 433–437 (1990).

    Google Scholar 

  92. 92.

    Dahmann, S., Lebo, P. B. & Meyer-Marcotty, M. V. Comparison of Treatments for an Infected Pilonidal Sinus: Differences in Scar Quality and Outcome Between Secondary Wound Healing and Limberg Flap in a Prospective Study. Handchir Mikrochir Plast Chir 48, 111–119, https://doi.org/10.1055/s-0041-111322 (2016).

    Article  CAS  PubMed  Google Scholar 

  93. 93.

    Sondenaa, K., Nesvik, I., Andersen, E., Pollard, M. L. & Soreide, J. A. Recurrent pilonidal sinus: Etiology and treatment. Dig. Surg. 12, 117–120, https://doi.org/10.1159/000172329 (1995).

    Article  Google Scholar 

  94. 94.

    Destito, C., Romagnoli, A., Pucello, D., Mercuri, M. & Marin, A. W. Pilonidal sinus: long term results of excision and closure technic. Review of the literature. G Chir 18, 441–446 (1997).

    CAS  PubMed  Google Scholar 

  95. 95.

    Donati, A. et al. Heterologous lyophilized collagen in the secondary healing of pilonidal fistulae. Minerva Chir 48, 141–145 (1993).

    CAS  PubMed  Google Scholar 

  96. 96.

    Leoni, G. et al. Sinus pilonidalis. Critical review of our experience [Sinus pilonidalis. Revisione critica della nostra esperienza]. Chirurgia 11, 93–96 (1998).

    Google Scholar 

  97. 97.

    Weckner, W. & Zorner, M. Treatment of pilonidal sinus [Beitrag zur Behandlung der Pilonidalkrankheit]. Z. Arztl. Fortbild. 75, 903–906 (1981).

    CAS  Google Scholar 

  98. 98.

    Meier, H. P. Recurrence in sacral dermoid (sinusitis pilonidalis sacralis). Helv Chir Acta 49, 645–649 (1983).

    CAS  PubMed  Google Scholar 

  99. 99.

    Rosato, L., Fornero, G., Luc, A. R. & Clerico, G. The radical treatment of sacrococcygeal pilonidal cysts. Minerva Chir 52, 1277–1279 (1997).

    CAS  PubMed  Google Scholar 

  100. 100.

    Sturniolo, G., Carditello, A., Bonavita, G., Bartolotta, M. & Saitta, E. Evaluation of the results of different types of surgical intervention for pilonidal fistula. Minerva Chir 39, 1161–1164 (1984).

    CAS  PubMed  Google Scholar 

  101. 101.

    Grandjean, J. P. & Al Nashawati, G. Pilonidal disease treated by wide excision and controlled cicatrisation. A report on 73 patients. Lyon Chir 92, 292–295 (1996).

    Google Scholar 

  102. 102.

    Garcia, J. C. & Dupuis, F. Surgical treatment of pilonidal disease. A new simplified technic. J Chir (Paris) 120, 347–350 (1983).

    CAS  Google Scholar 

  103. 103.

    Gupta, P. J. Radio surgery in pilonidal sinus: a new approach for the old problem. Acta Chir Belg 105, 183–186 (2005).

    Article  ADS  CAS  PubMed  Google Scholar 

  104. 104.

    Rouch, J. D. et al. Short- and Long-term Results of Unroofing and Marsupialization for Adolescent Pilonidal Disease. JAMA Surg 151, 877–879, https://doi.org/10.1001/jamasurg.2016.0850 (2016).

    Article  PubMed  Google Scholar 

  105. 105.

    Houston, H. E. One-stage cure of infected pilonidal cysts. Am Surg 43, 517–519 (1977).

    CAS  PubMed  Google Scholar 

  106. 106.

    Shah, S. T. A., Tahir, M., Nasir, M., Paracha, S. A. & Wahab, K. Outcome of open versus closed surgical technique for treatment of chronic pilonidal sinus: a randomized controlled trial. Khyber Med Univ J 5, 146–151 (2013).

    Google Scholar 

  107. 107.

    Tetirick, J. E. Limited excision of pilonidal cyst and sinus. Ohio State Med J 67, 135–138 (1971).

    CAS  PubMed  Google Scholar 

  108. 108.

    Zagory, J. A., Golden, J., Holoyda, K., Demeter, N. & Nguyen, N. X. Excision and Primary Closure May Be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population. Am Surg 82, 964–967 (2016).

    PubMed  Google Scholar 

  109. 109.

    Khodakaram, K., Stark, J., Hoglund, I. & Andersson, R. E. Minimal Excision and Primary Suture is a Cost-Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population-Based Interventional and a Cross-Sectional Cohort Study. World J Surg 41, 1295–1302, https://doi.org/10.1007/s00268-016-3828-z (2017).

    Article  PubMed  Google Scholar 

  110. 110.

    Gupta, P. A comparison of two operations for pilonidal sinus disease. Nig J Surg Res 6, 41–45 (2004).

    Google Scholar 

  111. 111.

    Sasse, K. C., Brandt, J., Lim, D. C. & Ackerman, E. Accelerated healing of complex open pilonidal wounds using MatriStem extracellular matrix xenograft: nine cases. J Surg Case Rep 2013, https://doi.org/10.1093/jscr/rjt025 (2013).

  112. 112.

    Elbanna, H. G. et al. Novel Approach of Treatment of Pilonidal Sinus Disease With Thrombin Gelatin Matrix as a Sealant. Dis Colon Rectum 59, 775–780, https://doi.org/10.1097/DCR.0000000000000604 (2016).

    Article  PubMed  Google Scholar 

  113. 113.

    Yamashita, Y., Nagae, H. & Hashimoto, I. Ambulatory Surgery for Pilonidal Sinus: Tract Excision and Open Treatment Followed by At-Home Irrigation. J Med Invest 63, 216–218, https://doi.org/10.2152/jmi.63.216 (2016).

    Article  PubMed  Google Scholar 

  114. 114.

    Calikoglu, I. et al. Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial. Dis Colon Rectum 60, 161–169, https://doi.org/10.1097/DCR.0000000000000717 (2017).

    Article  PubMed  Google Scholar 

  115. 115.

    Carstensen, E. & Keichel, F. Etiology and therapy of pilonidal sinus. Chirurg 34, 303–308 (1963).

    CAS  PubMed  PubMed Central  Google Scholar 

  116. 116.

    Speter, C., Zmora, O., Nadler, R., Shinhar, D. & Bilik, R. Minimal incision as a promising technique for resection of pilonidal sinus in children. J Pediatr Surg, https://doi.org/10.1016/j.jpedsurg.2017.03.040 (2017).

  117. 117.

    Gerhard, H. On the understanding and treating coccygeal fustulae. Z. Arztl. Fortbild. 57, 841–843 (1963).

    Google Scholar 

  118. 118.

    Ozcan, R. et al. Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing? Asian J Surg, https://doi.org/10.1016/j.asjsur.2017.08.006 (2017).

  119. 119.

    Shirah, B. H. & Shirah, H. A. Factors affecting the outcome and duration of healing of the laid open wound for sacrococcygeal pilonidal sinus: A prospective cohort study of 472 patients. Wound Medicine 18, 52–56, https://doi.org/10.1016/j.wndm.2017.06.005 (2017).

    Article  Google Scholar 

  120. 120.

    Zuin, M., Fogato, L. & Badin, A. Common risk factors for pilonidal sinus disease recurrence impact the onset of new cardiovascular disease in the longterm: a 5-year follow-up study. World J Surg (2017).

  121. 121.

    Danne, J., Gwini, S., McKenzie, D. & Danne, P. A Retrospective Study of Pilonidal Sinus Healing by Secondary Intention Using Negative Pressure Wound Therapy Versus Alginate or Gauze Dressings. Ostomy Wound Manage 63, 47–53 (2017).

    PubMed  Google Scholar 

  122. 122.

    Doll, D. et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis 23, 181–187, https://doi.org/10.1007/s00384-007-0393-9 (2008).

    Article  PubMed  Google Scholar 

  123. 123.

    Bunke, H. J., Schultheis, A., Meyer, G. & Dusel, W. Surgical revision of the pilonidal sinus with single shot antibiosis. Chirurg 66, 220–223 (1995).

    CAS  PubMed  Google Scholar 

  124. 124.

    Kam, B. H. A simple surgical method of treating pilonidal sinus. Arch Chir Neerl 28, 43–53 (1976).

    CAS  PubMed  Google Scholar 

  125. 125.

    Rainsbury, R. M. & Southam, J. A. Radical surgery for pilonidal sinus. Annals of the Royal College of Surgeons of England 64, 339–341 (1982).

    CAS  PubMed  PubMed Central  Google Scholar 

  126. 126.

    Sondenaa, K., Andersen, E., Nesvik, I. & Soreide, J. A. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10, 39–42 (1995).

    Article  CAS  PubMed  Google Scholar 

  127. 127.

    Akca, T., Colak, T., Ustunsoy, B., Kanik, A. & Aydin, S. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 92, 1081–1084, https://doi.org/10.1002/bjs.5074 (2005).

    Article  CAS  PubMed  Google Scholar 

  128. 128.

    Abu Galala, K. H. et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 165, 468–472 (1999).

    Article  CAS  PubMed  Google Scholar 

  129. 129.

    Limongelli, P. et al. D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. Am J Surg 207, 882–889, https://doi.org/10.1016/j.amjsurg.2013.06.013 (2014).

    Article  PubMed  Google Scholar 

  130. 130.

    Khan, P. S., Hayat, H. & Hayat, G. Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; a randomized clinical trial. Indian J Surg 75, 192–194, https://doi.org/10.1007/s12262-012-0430-y (2013).

    Article  PubMed  Google Scholar 

  131. 131.

    Dass, T. A., Zaz, M., Rather, A. & Bari, S. Elliptical excision with midline primary closure versus rhomboid excision with limberg flap reconstruction in sacrococcygeal pilonidal disease: a prospective, randomized study. Indian J Surg 74, 305–308, https://doi.org/10.1007/s12262-011-0400-9 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  132. 132.

    Aldean, I., Shankar, P. J., Mathew, J., Safarani, N. & Haboubi, N. Y. Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results. Colorectal Dis 7, 81–85, https://doi.org/10.1111/j.1463-1318.2004.00736.x (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  133. 133.

    Can, M. F., Sevinc, M. M. & Yilmaz, M. Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg Today 39, 580–586, https://doi.org/10.1007/s00595-008-3926-0 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  134. 134.

    Gilani, S. N. et al. Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate. Ir J Med Sci 180, 173–176, https://doi.org/10.1007/s11845-010-0532-0 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. 135.

    Enshaei, A. & Motearefi, S. Comparison of two surgical methods, primary closure and rotational flap, in patients with chronic pilonidal sinus. Glob J Health Sci 6, 18–22, https://doi.org/10.5539/gjhs.v6n7p18 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  136. 136.

    Emir, S., Topuz, O., Kanat, B. H. & Bali, I. Sinotomy technique versus surgical excision with primary closure technique in pilonidal sinus disease. Bosn J Basic Med Sci 14, 263–267, https://doi.org/10.17305/bjbms.2014.4.139 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  137. 137.

    Osmanoglu, G. & Yetisir, F. Limberg flap is better for the surgical treatment of pilonidal sinus. Results of a 767 patients series with an at least five years follow-up period. Chirurgia (Bucur) 106, 491–494 (2011).

    CAS  Google Scholar 

  138. 138.

    Lorant, T., Ribbe, I., Mahteme, H., Gustafsson, U. M. & Graf, W. Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 54, 300–305, https://doi.org/10.1007/DCR.0b013e31820246bf (2011).

    Article  PubMed  Google Scholar 

  139. 139.

    Onder, A. et al. Pilonidal sinus disease: risk factors for postoperative complications and recurrence. Int Surg 97, 224–229, https://doi.org/10.9738/CC86.1 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  140. 140.

    Galal Elshazly, W. & Said, K. Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease. Alexandria Journal of Medicine 48, 13–18, https://doi.org/10.1016/j.ajme.2011.10.002 (2012).

    Article  Google Scholar 

  141. 141.

    Al-Jaberi, T. M. Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg 167, 133–135 (2001).

    Article  CAS  PubMed  Google Scholar 

  142. 142.

    Khaira, H. S. & Brown, J. H. Excision and primary suture of pilonidal sinus. Ann R Coll Surg Engl 77, 242–244 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  143. 143.

    Gencosmanoglu, R. & Inceoglu, R. Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20, 415–422, https://doi.org/10.1007/s00384-004-0710-5 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  144. 144.

    Tritapepe, R. & Di Padova, C. Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing. Am J Surg 183, 209–211 (2002).

    Article  PubMed  Google Scholar 

  145. 145.

    El-Shaer, W. M. The modified gluteal sliding plication closure in the treatment of chronic pilonidal sinus. Int J Colorectal Dis 25, 887–894, https://doi.org/10.1007/s00384-010-0911-z (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  146. 146.

    Milone, M., Musella, M., Salvatore, G., Leongito, M. & Milone, F. Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Colorectal Dis 26, 1601–1607, https://doi.org/10.1007/s00384-011-1242-4 (2011).

    Article  PubMed  Google Scholar 

  147. 147.

    Serour, F., Somekh, E., Krutman, B. & Gorenstein, A. Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients. Pediatr Surg Int 18, 159–161, https://doi.org/10.1007/s003830100683 (2002).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  148. 148.

    Ertan, T. et al. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 190, 388–392, https://doi.org/10.1016/j.amjsurg.2004.08.068 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  149. 149.

    Alptekin, H. et al. Specimen index may be a predictive factor for recurrence after primary closure of pilonidal disease. J Korean Surg Soc 83, 367–373, https://doi.org/10.4174/jkss.2012.83.6.367 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  150. 150.

    Andersson, R. E., Lukas, G., Skullman, S. & Hugander, A. Local administration of antibiotics by gentamicin-collagen sponge does not improve wound healing or reduce recurrence rate after pilonidal excision with primary suture: a prospective randomized controlled trial. World J Surg 34, 3042–3048, https://doi.org/10.1007/s00268-010-0763-2 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  151. 151.

    Badawy, E. A. & Kanawati, M. N. Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol 23, 883–886, https://doi.org/10.1111/j.1468-3083.2009.03147.x (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  152. 152.

    Lee, S. L., Tejirian, T. & Abbas, M. A. Current management of adolescent pilonidal disease. J Pediatr Surg 43, 1124–1127, https://doi.org/10.1016/j.jpedsurg.2008.02.042 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  153. 153.

    Othman, I. Skin glue improves outcome after excision and primary closure of sacrococcygeal pilonidal disease. Indian J Surg 72, 470–474, https://doi.org/10.1007/s12262-010-0170-9 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  154. 154.

    Courtney, S. P. & Merlin, M. J. The use of fusidic acid gel in pilonidal abscess treatment: cure, recurrence and failure rates. Ann R Coll Surg Engl 68, 170–171 (1986).

    CAS  PubMed  PubMed Central  Google Scholar 

  155. 155.

    Williams, R. S. A simple technique for successful primary closure after excision of pilonidal sinus disease. Ann R Coll Surg Engl 72, 313–314; discussion 314–315 (1990).

  156. 156.

    Tejirian, T., Lee, J. J. & Abbas, M. A. Is wide local excision for pilonidal disease still justified? Am Surg 73, 1075–1078 (2007).

    PubMed  Google Scholar 

  157. 157.

    Shons, A. R. & Mountjoy, J. R. Pilonidal disease: the case for excision with primary closure. Dis Colon Rectum 14, 353–355 (1971).

    Article  CAS  PubMed  Google Scholar 

  158. 158.

    Terzi, C., Canda, A. E., Unek, T., Dalgic, E. & Fuzun, M. What is the role of mechanical bowel preparation in patients with pilonidal sinus undergoing surgery? Prospective, randomized, surgeon-blinded trial. World J Surg 29, 1465–1471, https://doi.org/10.1007/s00268-005-0007-z (2005).

    Article  PubMed  Google Scholar 

  159. 159.

    Aysan, E., Basak, F., Kinaci, E. & Sevinc, M. Efficacy of local adrenalin injection during sacrococcygeal pilonidal sinus excision. Eur Surg Res 36, 256–258, https://doi.org/10.1159/000078861 (2004).

    Article  CAS  PubMed  Google Scholar 

  160. 160.

    Arda, I. S., Guney, L. H., Sevmis, S. & Hicsonmez, A. High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 29, 469–471, https://doi.org/10.1007/s00268-004-7533-y (2005).

    Article  PubMed  Google Scholar 

  161. 161.

    Tocchi, A. et al. Ambulatory closed surgery for the treatment of pilonidal sinus. G Chir 22, 303–307 (2001).

    CAS  PubMed  Google Scholar 

  162. 162.

    Toccaceli, S., Persico Stella, L., Diana, M., Dandolo, R. & Negro, P. Treatment of pilonidal sinus with primary closure. A twenty-year experience. Chir Ital 60, 433–438 (2008).

    PubMed  Google Scholar 

  163. 163.

    Örhalmi, J., Sotona, O., Dusek, T. & Ferko, A. Pilonidal sinus - possibilities surgical treatment. Rozhl Chir 93, 491–495 (2014).

    PubMed  Google Scholar 

  164. 164.

    Russell, J. L. A method of excision and primary closure of pilonidal cysts and sinuses. Can Med Assoc J 60, 267–270 (1949).

    CAS  PubMed  PubMed Central  Google Scholar 

  165. 165.

    Muzi, M. G. et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 200, 9–14, https://doi.org/10.1016/j.amjsurg.2009.05.036 (2010).

    Article  PubMed  Google Scholar 

  166. 166.

    Milone, M. et al. Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method? Surg Today 44, 1638–1642, https://doi.org/10.1007/s00595-013-0741-z (2014).

    Article  PubMed  Google Scholar 

  167. 167.

    Gipponi, M., Reboa, G., Testa, T., Giannini, G. & Strada, P. Tension-free primary closure with autologous platelet gel versus Vivostat- for the definitive treatment of chronic sacrococcygeal pilonidal disease. In Vivo 24, 583–589 (2010).

    PubMed  Google Scholar 

  168. 168.

    Biffoni, M. et al. Pilonidal sinus. Outpatient treatment with local anesthesia. G Chir 30, 173–176 (2009).

    CAS  PubMed  Google Scholar 

  169. 169.

    Inan, A., Surgit, O., Sen, M., Bozer, M. & Dener, C. One day surgery for pilonidal disease. Bratisl Lek Listy 112, 572–574 (2011).

    CAS  PubMed  Google Scholar 

  170. 170.

    Lee, H. C., Ho, Y. H., Seow, C. F., Eu, K. W. & Nyam, D. Pilonidal disease in Singapore: clinical features and management. Aust N Z J Surg 70, 196–198 (2000).

    Article  CAS  PubMed  Google Scholar 

  171. 171.

    Muzi, M. G., Milito, G., Nigro, C., Cadeddu, F. & Farinon, A. M. A modification of primary closure for the treatment of pilonidal disease in day-care setting. Colorectal Dis 11, 84–88, https://doi.org/10.1111/j.1463-1318.2008.01534.x (2009).

    Article  CAS  PubMed  Google Scholar 

  172. 172.

    Sevinc, B. et al. Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery 159, 749–754, https://doi.org/10.1016/j.surg.2015.09.024 (2016).

    Article  PubMed  Google Scholar 

  173. 173.

    Nursal, T. Z. et al. Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199, 170–177, https://doi.org/10.1016/j.amjsurg.2008.12.030 (2010).

    Article  PubMed  Google Scholar 

  174. 174.

    Yildiz, T., Ilce, Z. & Kucuk, A. Modified Limberg flap technique in the treatment of pilonidal sinus disease in teenagers. J Pediatr Surg 49, 1610–1613, https://doi.org/10.1016/j.jpedsurg.2014.06.011 (2014).

    Article  CAS  PubMed  Google Scholar 

  175. 175.

    Cruz, J. & Ram, M. D. Sacrococcygeal pilonidal sinus. Dis Colon Rectum 14, 356–359 (1971).

    Article  CAS  PubMed  Google Scholar 

  176. 176.

    Kaya, B., Uctum, Y., Simsek, A. & Kutanis, R. Primary closure in the treatment of pilonidal disease. An easy and effective method. Kolon Rektum Hast Derg 20, 59–65 (2010).

    Google Scholar 

  177. 177.

    Abbasi, H. R., Hosseini, S. V., Yarmohammadi, H. & Bolandparvaz, S. Comparison between two methods of excision and primary closure of pilonidal sinus. Wound pain 9, 143–146 (2007).

    Google Scholar 

  178. 178.

    Braungart, S., Powis, M., Sutcliffe, J. R. & Sugarman, I. D. Improving outcomes in pilonidal sinus disease. J Pediatr Surg 51, 282–284, https://doi.org/10.1016/j.jpedsurg.2015.10.076 (2016).

    Article  PubMed  Google Scholar 

  179. 179.

    Milone, M. et al. Pilonidal sinus surgery: could we predict postoperative complications? Int Wound J., https://doi.org/10.1111/iwj.12310 (2014).

  180. 180.

    Doll, D. et al. Does gentamycin affect long term recurrence rate in pilonidal sinus surgery? European Surgery 43, 236–243, https://doi.org/10.1007/s10353-011-0615-9 (2011).

    Article  Google Scholar 

  181. 181.

    Ferguson, L. K. Pilonidal Cysts: Treatment by Excision and Primary Suture in Ambulatory Patients. Ann Surg 101, 469–477 (1935).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  182. 182.

    Galati, G., Sterpetti, A. V. & Tartaglia, E. Therapeutic approaches to patients with pilonidal sinus based on specific clinical characteristic. Eur J Plast Surg 35, 595–598 (2012).

    Article  Google Scholar 

  183. 183.

    Talu, M., Yücel, O. & User, Y. Oblique excision with primary closure for the treatment of pilonidal sinus. Eur J Plast Surg 19, 200–203 (1996).

    Article  Google Scholar 

  184. 184.

    Sakr, M. F., Hamed, H. H., Ramadan, M. A., Kantoush, H. E. & Al-Torky, H. M. Pilonidal sinus in Kuwait: Analysis of 801 consecutive patients (2012).

  185. 185.

    Washer, J. D., Smith, D. E., Carman, M. E. & Blackhurst, D. W. Gluteal fascial advancement: an innovative, effective method for treating pilonidal disease. Am Surg 76, 154–156 (2010).

    PubMed  Google Scholar 

  186. 186.

    Muzi, M. G. et al. Long-term results of pilonidal sinus disease with modified primary closure: new technique on 450 patients. Am Surg 80, 484–488 (2014).

    PubMed  Google Scholar 

  187. 187.

    Miocinovic, M., Horzic, M. & Bunoza, D. The treatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing. Acta Med Croatica 54, 27–31 (2000).

    CAS  PubMed  Google Scholar 

  188. 188.

    Sondenaa, K. et al. Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. combined prospective study and randomised controlled trial. Eur J Surg 168, 614–618 (2002).

    Article  PubMed  Google Scholar 

  189. 189.

    Sakr, M. F., Elserafy, M. E. & Hamed, H. M. Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute. Surgical. Science 3, 145–154 (2012).

    Google Scholar 

  190. 190.

    Youssef, T., El-Awady, S. & Farid, M. Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study. The Egyptian Journal of Surgery 34, 85–89 (2015).

    Article  Google Scholar 

  191. 191.

    Mahdy, T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 51, 1816–1822, https://doi.org/10.1007/s10350-008-9436-8 (2008).

    Article  CAS  PubMed  Google Scholar 

  192. 192.

    Saylam, B., Balli, D. N., Duzgun, A. P., Ozer, M. V. & Coskun, F. Which surgical procedure offers the best treatment for pilonidal disease? Langenbecks Arch Surg 396, 651–658, https://doi.org/10.1007/s00423-011-0768-9 (2011).

    Article  PubMed  Google Scholar 

  193. 193.

    Smith, C. M., Jones, A., Dass, D., Murthi, G. & Lindley, R. Early experience of the use of fibrin sealant in the management of children with pilonidal sinus disease. J Pediatr Surg 50, 320–322, https://doi.org/10.1016/j.jpedsurg.2014.11.022 (2015).

    Article  PubMed  Google Scholar 

  194. 194.

    Khanzada, T. W. & Samad, A. Recurrence after excision and primary closure of pilonidal sinus. Pak. J. Med. Sci. 23, 375–379 (2007).

    Google Scholar 

  195. 195.

    Sakr, M. F. & Moussa, M. A prospective controlled randomized trial comparing Karydakis technique and midline closure in patients with recurrent chronic pilonidal sinus. Surg. Chronicles 16, 84–90 (2011).

    Google Scholar 

  196. 196.

    Siddiqui, S. S. & Khan, M. A. Pilonidal sinus: Following the Aristotelian middle! Pak. J. Med. Sci. 24, 845–848 (2008).

    Google Scholar 

  197. 197.

    Benfatto, G. et al. Drainage useful in the excision and closure “per primam” of pilonidal sinus: technical notes. Chir Ital 55, 621–624 (2003).

    PubMed  Google Scholar 

  198. 198.

    Bouq, Y. A., Fazili, F. M., Fawzi, H. A. G. & Parvez, T. Surgical management of pilonidal disease: Our experience. JK Pract. 11, 21–26 (2004).

    Google Scholar 

  199. 199.

    Polat, N., Albayrak, D., Ibiş, A. C. & Altan, A. Comparison between karydakis flap repair and primary closure for surgical treatment of sacrococcygeal pilonidal sinus [Sakrokoksigeal pilonidal sinüsün cerrahi tedavisinde karydakis flep ameliyati ile primer kapamanin karşilaştirilmasi]. Trakya Universitesi Tip Fakultesi Dergisi 25, 87–94 (2008).

    Google Scholar 

  200. 200.

    Toydemir, T., Peşluk, O., Ermeç, E. D. & Turhan, A. N. Comparison of the clinical outcomes of karydakis flap versus primary closure procedures in the surgical treatment of sacrococcygeal pilonidal sinus disease [Sakrokosigeal pilonidal sinüs hastaliǧinin cerrahi tedavisinde karydakis flap ile primer kapama prosedürlerinin klinik sonuçlarinin karşilaştirilmasi]. Med. J. Bakirkoy 8, 78–81, https://doi.org/10.5350/BTDMJB201208206 (2012).

    Article  Google Scholar 

  201. 201.

    Çaglayan, K. et al. The effect of different surgical methods on complications and on the quality of life in pilonidal sinus disease. Turk. J. Surg. 27, 94–97, https://doi.org/10.5097/1300-0705.UCD.950-11.03 (2011).

    Article  Google Scholar 

  202. 202.

    Sakr, M., Habib, M. & Shaheed, A. A. Assessment of Karydakis technique as compared with midline closure for the management of chronic pilonidal sinus. J. Pelvic Med. Surg. 12, 201–206, https://doi.org/10.1097/01.spv.0000217399.78641.43 (2006).

    Article  Google Scholar 

  203. 203.

    Albahadili, M. A. & Awazli, L. G. Pilonidal Sinus Excision Using Carbon Dioxide Laser 10600 nm. Iraqi J Laser 14, 33–40 (2015).

    Google Scholar 

  204. 204.

    Novotny, G. M. E. and Primary Closure of Pilonidal Sinus. A Critical Review of Forty-Five Cases. Med Serv J Can 20, 352–354 (1964).

    CAS  PubMed  Google Scholar 

  205. 205.

    Maniscalco, L., Speranza, G. & Maniscalco, A. The pilonidal sinus: Which managment? [Il seno pilonidale: Come trattarlo?]. Chirurgia 14, 81–83 (2001).

    Google Scholar 

  206. 206.

    Corsi, P. R., Corsi, R., Moura, L. F. R. A., Guerreiro, T. D. T. & Vasconcellos, L. P. Tratamento cirurgico do cisto pilonidal atraves de resseccao e fechamento primario com retalhos cutaneos. Revista brasileira de colo-proctologia (2004).

  207. 207.

    Jarufe, C. N., Bannura, G., Contreras, J., Saxton, F. & Marro, P. Enfermedad pilonidal cronica sacrococcigea. Rev. Chil. Cir. 51, 66–71 (1999).

    Google Scholar 

  208. 208.

    Blake P. P. et al. Tratamiento quirurgico del quiste pilonidal. Rev. Chil. Cir (1997).

  209. 209.

    Alberti, P., Antoci, G., Pasini, M. & Pasini, G. F. Pilonidal sinus: our experience in the surgical treatment by closed method. Minerva Chir 45, 733–737 (1990).

    CAS  PubMed  Google Scholar 

  210. 210.

    Aaser, P. & Gruner, O. P. Pilonidal cysts. Excision and intracutaneous absorbable primary suture. Tidsskr Nor Laegeforen 112, 206–207 (1992).

    CAS  PubMed  Google Scholar 

  211. 211.

    Klug, W., Knoch, H. G. & Holland-Moritz, A. Sinus pilonidalis. Zeitschrift für ärztliche Fortbildung 78, 711–714 (1984).

    CAS  PubMed  Google Scholar 

  212. 212.

    Bissett, I. P. & Isbister, W. H. The management of patients with pilonidal disease - a comparative study. Aust N Z J Surg 57, 939–942 (1987).

    Article  CAS  PubMed  Google Scholar 

  213. 213.

    Sondenaa, K. et al. The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture. J Am Coll Surg 180, 157–160 (1995).

    CAS  PubMed  Google Scholar 

  214. 214.

    Palmieri, B., Gozzi, G. & Rossi, A. Pilonidal cysts: the state of the art and the authors’ personal experiences. Minerva Chir 49, 377–382 (1994).

    CAS  PubMed  Google Scholar 

  215. 215.

    Diana, G., Muscarella, F., Pepe, D. & Speciale, A. Primary closure in the treatment of pilonidal sinus. Evaluation of immediate and remote results [La chiusura per primam nel trattamento del sinus pilonidalis. Valutazione dei risultati immediati e a distanza]m. Minerva Chir. 41, 765–767 (1986).

    CAS  PubMed  Google Scholar 

  216. 216.

    Muller, X. M., Rothenbuhler, J. M. & Frede, K. E. Sacro-coccygeal cyst: surgical techniques and results]. Helv Chir Acta 58, 889–892 (1992).

    CAS  PubMed  Google Scholar 

  217. 217.

    Angermann, P. & Beiter, E. C. [Pilonidal cyst. A sequence treated with excision and primary suture. Ugeskr Laeger 146, 24–26 (1984).

    CAS  PubMed  Google Scholar 

  218. 218.

    Mecchia, P., Tonizzo, C. A. & Flamia, M. Pilonidal cysts and fistulas: radical excision “en bloc” and closure “per primam”. Minerva Chir 50, 553–556 (1995).

    CAS  PubMed  Google Scholar 

  219. 219.

    Rossi, P. et al. The pilonidal sinus: its surgical treatment, our experience and a review of the literature. G Chir 14, 120–123 (1993).

    CAS  PubMed  Google Scholar 

  220. 220.

    Sias, F., Licheri, S., Secci, L., Loi, R. & Daniele, G. M. Ambulatory treatment of pilonidal sinus IL Trattamento Ambulatoriale Del Sinus Pilonidalis. Chirurgia 7, 639–642 (1994).

    Google Scholar 

  221. 221.

    Pozzi, C. & Tritapepe, R. Healing of the operative wound after radical removal of the Sinus pilonidalis [Guarigione per prima intenzione dopo intervento radicale asportazione del Sinus Pilonidalis]. Minerva Chir. 44, 2329–2332 (1989).

    CAS  PubMed  Google Scholar 

  222. 222.

    Virgillo, G., Mendicino, F. & Costanzo, A. Sinus pilonidalis. Brief review of literature and contribution to surgical therapy [Il Sinus Pilonidalis. Rivista sintetica della letteratura e contributo alla terapia chirugica]. 27, 1–40 (1975).

  223. 223.

    Christensen, K., Kronborg, O., Zimmermann-Nielsen, C. & Olsen, H. Incision or primary suture in acute pilonidal abscesses. A prospective randomized study. Ugeskr Laeger 147, 3479–3481 (1985).

    CAS  PubMed  Google Scholar 

  224. 224.

    Sarles, J. C., Sastre, B. & Delecourt, P. Treatment of pilonidal cyst with radical excision and primary closure (author’s transl). Gastroenterol Clin Biol 1, 929–932 (1977).

    CAS  PubMed  Google Scholar 

  225. 225.

    Verbeek, H. O. & Bender, J. Results of treatment of pilonidal sinus by block excision and primary suture. Arch Chir Neerl 26, 311–318 (1974).

    CAS  PubMed  Google Scholar 

  226. 226.

    Schonk, J. W. Some aspects of the treatment of the pilonidal sinus. Arch Chir Neerl 23, 297–302 (1971).

    CAS  PubMed  Google Scholar 

  227. 227.

    Powell, B. C., Webb, C. B., Ewing, J. A. & Smith, D. E. Gluteal Fascial Advancement for Pilonidal Cyst Disease: A 10-year Review. Am Surg 82, 622–625 (2016).

    PubMed  Google Scholar 

  228. 228.

    Ghnnam, W., Ghazy, H., Saed, B. & Farid, M. Limited excision and primary closure for pilonidal sinus. Egypt J Surg 28, 43–47 (2009).

    Google Scholar 

  229. 229.

    Almajid, F. M., Alabdrabalnabi, A. A. & Almulhim, K. A. The risk of recurrence of Pilonidal disease after surgical management. Saudi Med J 38, 70–74, https://doi.org/10.15537/smj.2017.1.15892 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  230. 230.

    Liboni, N. S. & Fregnani, C. H. T. G. Preliminary results from 28 cases of pilonidal cyst treated by excision and primary closure of the wound, reinforced with support suturing. Einstein 5, 148–152 (2007).

    Google Scholar 

  231. 231.

    Roshdy, H., Ali, Y., Askar, W., Awad, I. & Farid, M. Rhomboid flap versus primary closure after excision of saccrococcigeal pilonidal sinus (a prospective randomized study). Egypt J Surg 29, 146–152 (2010).

    Google Scholar 

  232. 232.

    Çaglayan, K. et al. Investigation of Patient Dependent Factors Effecting Complications and Recurrence in Pilonidal Sinus Disease. Kolon Rektum Hast Derg 21, 103–108 (2011).

    Article  Google Scholar 

  233. 233.

    Pomazkin, V. I. & Mansurov, I. V. Choice of operation for treatment of patients with pilonidal sinus. Vestn Khir Im I I Grek 167, 85–87 (2008).

    CAS  PubMed  Google Scholar 

  234. 234.

    Grubnik, V. V. & Bakhar, G. A. The use of a laser in the surgical treatment of an epithelial coccygeal cyst. Klin Khir, 23–25 (1993).

  235. 235.

    de Quinta Frutosa, R. et al. Enfermedad pilonidal. Tratamiento por exéresis en bloque con cierre primario. Cir Esp 68, 570–572 (2000).

    Google Scholar 

  236. 236.

    Wani, M., Shah, M., Wani, K. & Malik, A. Excision and primary closure of sacrococcygeal pilonidal sinus using suction drain. International Surgery J ournal, 837–840, https://doi.org/10.18203/2349-2902.isj20161158 (2016).

  237. 237.

    Bowers, W. F. & Williamson, W. S. Pilonidal sinus; preliminary report on a fresh approach. AMA Arch Surg 73, 931–935 (1956).

    Article  CAS  PubMed  Google Scholar 

  238. 238.

    Abou-Zikry, A. S., Guindi, A. & Hashem, M. Pilonidal sinus and cysts (sacro-coccygeal sinus); report of 22 cases treated by excision and primary suture. J Egypt Med Assoc 37, 696–705 (1954).

    CAS  PubMed  Google Scholar 

  239. 239.

    Frostad, H. Sacral dermoidcysts. Especially with a view to their treatment. Acta chir scand 93, 23 (1946).

    CAS  PubMed  Google Scholar 

  240. 240.

    Muzi, M. G. et al. 389 - Muzi’s Tension Free Primary Closure of Pilonidal Sinus Disease: Long-Term Results on 450 Patients. Gastroenterology 152, S1212–S1213, https://doi.org/10.1016/S0016-5085(17)34034-9 (2017).

    Article  Google Scholar 

  241. 241.

    Darwish, A., Eskandaros, M. & Hegab, A. Sacrococcygeal pilonidal sinus: modified sinotomy versus lay-open, limited excision, and primary closure. The Egyptian Journal of Surgery 36, 13–19, https://doi.org/10.4103/1110-1121.199901 (2017).

    Article  Google Scholar 

  242. 242.

    Ates, U. et al. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. J Pediatr Surg, https://doi.org/10.1016/j.jpedsurg.2017.05.012 (2017).

  243. 243.

    Kose, E., Hasbahceci, M., Tonyali, H. & Karagulle, M. Comparative analysis of the same technique-the same surgeon approach in the surgical treatment of pilonidal sinus disease: a retrospective cohort study. Ann Surg Treat Res 93, 82–87, https://doi.org/10.4174/astr.2017.93.2.82 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  244. 244.

    Ahmadinejad, M., Ahmadi, K., Ahmadinejad, I., Masoud Hashemian, A. & Khademhoseini, P. A Comparison between the Tie-over and Closed Suction Drainage Therapeutic Strategies in Patients Suffering from Sacral Pilonidal Sinus. Int J Biomed Sci 12, 149–154 (2016).

    PubMed  PubMed Central  Google Scholar 

  245. 245.

    Hulten, L. Sacral Dermoid–Pilonidal Sinus. Nord Med 74, 699–703 (1965).

    CAS  PubMed  Google Scholar 

  246. 246.

    Okus, A., Sevinc, B., Karahan, O. & Eryilmaz, M. A. Comparison of Limberg flap and tension-free primary closure during pilonidal sinus surgery. World J Surg 36, 431–435, https://doi.org/10.1007/s00268-011-1333-y (2012).

    Article  PubMed  Google Scholar 

  247. 247.

    Mentes, O. et al. Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Dis Colon Rectum 49, 104–108, https://doi.org/10.1007/s10350-005-0226-2 (2006).

    Article  PubMed  Google Scholar 

  248. 248.

    Akinci, O. F. Limited separate ellyptical excision for complicated pilonidal disease. Colorectal Dis 7, 424–425, https://doi.org/10.1111/j.1463-1318.2005.00824.x (2005).

    Article  CAS  PubMed  Google Scholar 

  249. 249.

    Kitchen, P. R. Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83, 1452–1455 (1996).

    Article  CAS  PubMed  Google Scholar 

  250. 250.

    Marzouk, D. M., Abou-Zeid, A. A., Antoniou, A., Haji, A. & Benziger, H. Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment. Ann R Coll Surg Engl 90, 371–376, https://doi.org/10.1308/003588408X285955 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  251. 251.

    Senapati, A., Cripps, N. P., Flashman, K. & Thompson, M. R. Cleft closure for the treatment of pilonidal sinus disease. Colorectal Dis 13, 333–336, https://doi.org/10.1111/j.1463-1318.2009.02148.x (2011).

    Article  CAS  PubMed  Google Scholar 

  252. 252.

    Maghsoudi, H., Nezami, N. & Ghamari, A. A. Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54, 78–82, https://doi.org/10.1503/cjs.026309 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  253. 253.

    Ciftci, F., Abdurrahman, I., Tosun, M. & Bas, G. A new approach: oblique excision and primary closure in the management of acute pilonidal disease. Int J Clin Exp Med 7, 5706–5710 (2014).

    PubMed  PubMed Central  Google Scholar 

  254. 254.

    Greenberg, R., Kashtan, H., Skornik, Y. & Werbin, N. Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol 8, 95–98, https://doi.org/10.1007/s10151-004-0063-7 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  255. 255.

    Kim, J. K., Jeong, J. C., Lee, J. B., Jung, K. H. & Bae, B. K. S-plasty for pilonidal disease: modified primary closure reducing tension. J Korean Surg Soc 82, 63–69, https://doi.org/10.4174/jkss.2012.82.2.63 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  256. 256.

    Brusciano, L. et al. D-shape asymmetric excision of sacrococcygeal pilonidal sinus with primary closure, suction drain, and subcuticular skin closure: an analysis of risks factors for long-term recurrence. Surg Innov 22, 143–148, https://doi.org/10.1177/1553350614535856 (2015).

    Article  PubMed  Google Scholar 

  257. 257.

    Zimmerman, C. E. Outpatient excision and primary closure of pilonidal cysts and sinuses. Am J Surg 136, 640–642 (1978).

    Article  CAS  PubMed  Google Scholar 

  258. 258.

    Ibrahim, A. M. R. R. Oblique excision and primary closure of pilonidal sinus (sacrococcygeal). Trends Med. Res. 7, 62–69, https://doi.org/10.3923/tmr.2012.62.69 (2012).

    Article  Google Scholar 

  259. 259.

    Bulus, H. & Coskun, A. Is Asymmetric excision primary closure at treatment of pylonidal sinus disease an appropriate choice? J. Clin. Anal. Med. 2, 79–81, https://doi.org/10.4328/jcam.279 (2011).

    Article  Google Scholar 

  260. 260.

    Docimo, L. et al. Primary closure of decentred wounds in surgical treatment of pilonidal sinus [La lateralizzazione della cicatrice nel trattamento chirurgico del sinus pilonidalis]. Chirurgia 11, 239–244 (1998).

    Google Scholar 

  261. 261.

    Karip, A. B. et al. Effect of Triclosan-Coated Suture and Antibiotic Prophylaxis on Infection and Recurrence after Karydakis Flap Repair for Pilonidal Disease: A Randomized Parallel-Arm Double-Blinded Clinical Trial. Surg Infect (Larchmt) 17, 583–588, https://doi.org/10.1089/sur.2015.207 (2016).

    Article  Google Scholar 

  262. 262.

    Yildiz, M. K. et al. Karydakis flap procedure in patients with sacrococcygeal pilonidal sinus disease: experience of a single centre in Istanbul. Scientific World Journal 2013, 807027, https://doi.org/10.1155/2013/807027 (2013).

    Article  PubMed  Google Scholar 

  263. 263.

    Sewefy, A. M., Hassanen, A., Atyia, A. M. & Saleh, S. K. Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease. Dis Colon Rectum 60, 514–520, https://doi.org/10.1097/DCR.0000000000000784 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  264. 264.

    Akinci, O. F., Coskun, A. & Uzunkoy, A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 43, 701–706; discussion 706–707 (2000).

  265. 265.

    Anyanwu, A. C., Hossain, S., Williams, A. & Montgomery, A. C. Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital. Ann R Coll Surg Engl 80, 197–199 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  266. 266.

    Abdul-Ghani, A. K., Abdul-Ghani, A. N. & Ingham Clark, C. L. Day-care surgery for pilonidal sinus. Ann R Coll Surg Engl 88, 656–658, https://doi.org/10.1308/003588406X149255 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  267. 267.

    Guner, A. et al. Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg 37, 2074–2080, https://doi.org/10.1007/s00268-013-2111-9 (2013).

    Article  PubMed  Google Scholar 

  268. 268.

    Arslan, K. et al. Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 18, 29–37, https://doi.org/10.1007/s10151-013-0982-2 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  269. 269.

    Moran, D. C., Kavanagh, D. O., Adhmed, I. & Regan, M. C. Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution. World J Surg 35, 1803–1808, https://doi.org/10.1007/s00268-011-1138-z (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  270. 270.

    Ates, M., Dirican, A., Sarac, M., Aslan, A. & Colak, C. Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 202, 568–573, https://doi.org/10.1016/j.amjsurg.2010.10.021 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  271. 271.

    Bessa, S. S. Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease. Dis Colon Rectum 50, 1935–1940, https://doi.org/10.1007/s10350-007-9049-7 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  272. 272.

    Bessa, S. S. Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon Rectum 56, 491–498, https://doi.org/10.1097/DCR.0b013e31828006f7 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  273. 273.

    Can, M. F., Sevinc, M. M., Hancerliogullari, O., Yilmaz, M. & Yagci, G. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200, 318–327, https://doi.org/10.1016/j.amjsurg.2009.08.042 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  274. 274.

    Karaca, T. et al. Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg 10, 601–606, https://doi.org/10.1016/j.ijsu.2012.10.001 (2012).

    Article  PubMed  Google Scholar 

  275. 275.

    Rushfeldt, C., Bernstein, A., Norderval, S. & Revhaug, A. Introducing an asymmetric cleft lift technique as a uniform procedure for pilonidal sinus surgery. Scand J Surg 97, 77–81 (2008).

    Article  CAS  PubMed  Google Scholar 

  276. 276.

    Gurer, A. et al. Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial. Dis Colon Rectum 48, 1797–1799, https://doi.org/10.1007/s10350-005-0108-7 (2005).

    Article  PubMed  Google Scholar 

  277. 277.

    Keshava, A., Young, C. J., Rickard, M. J. & Sinclair, G. Karydakis flap repair for sacrococcygeal pilonidal sinus disease: how important is technique? ANZ J Surg 77, 181–183, https://doi.org/10.1111/j.1445-2197.2006.04003.x (2007).

    Article  PubMed  Google Scholar 

  278. 278.

    Nordon, I. M., Senapati, A. & Cripps, N. P. A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197, 189–192, https://doi.org/10.1016/j.amjsurg.2008.01.020 (2009).

    Article  PubMed  Google Scholar 

  279. 279.

    Sozen, S., Emir, S., Guzel, K. & Ozdemir, C. S. Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial. Ir J Med Sci 180, 479–482, https://doi.org/10.1007/s11845-010-0549-4 (2011).

    Article  CAS  PubMed  Google Scholar 

  280. 280.

    Al-Khayat, H. et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 205, 439–444, https://doi.org/10.1016/j.jamcollsurg.2007.04.034 (2007).

    Article  PubMed  Google Scholar 

  281. 281.

    Anderson, J. H., Yip, C. O., Nagabhushan, J. S. & Connelly, S. J. Day-case Karydakis flap for pilonidal sinus. Dis Colon Rectum 51, 134–138, https://doi.org/10.1007/s10350-007-9150-y (2008).

    Article  PubMed  Google Scholar 

  282. 282.

    Kulacoglu, H., Dener, C., Tumer, H. & Aktimur, R. Total subcutaneous fistulectomy combined with Karydakis flap for sacrococcygeal pilonidal disease with secondary perianal opening. Colorectal Dis 8, 120–123, https://doi.org/10.1111/j.1463-1318.2005.00872.x (2006).

    Article  CAS  PubMed  Google Scholar 

  283. 283.

    Senapati, A., Cripps, N. P., Flashman, K. & Thompson, M. R. Cleft Closure for the Treatment of Pilonidal Sinus Disease. Colorectal Dis (2009).

  284. 284.

    Tezel, E., Bostanci, H., Anadol, A. Z. & Kurukahvecioglu, O. Cleft lift procedure for sacrococcygeal pilonidal disease. Dis Colon Rectum 52, 135–139, https://doi.org/10.1007/DCR.0b013e31819734f8 (2009).

    Article  PubMed  Google Scholar 

  285. 285.

    Theodoropoulos, G. E., Vlahos, K., Lazaris, A. C., Tahteris, E. & Panoussopoulos, D. Modified Bascom’s asymmetric midgluteal cleft closure technique for recurrent pilonidal disease: early experience in a military hospital. Dis Colon Rectum 46, 1286–1291, https://doi.org/10.1097/01.DCR.0000084409.63183.5B (2003).

    Article  PubMed  Google Scholar 

  286. 286.

    Bertelsen, C. A. Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia: a prospective cohort study of peri- and postoperative pain. Dis Colon Rectum 54, 895–900, https://doi.org/10.1007/DCR.0b013e31820ee852 (2011).

    Article  PubMed  Google Scholar 

  287. 287.

    Buczacki, S., Drage, M., Wells, A. & Guy, R. Sacrococcygeal pilonidal sinus disease. Colorectal Dis 11, 657, https://doi.org/10.1111/j.1463-1318.2009.01818.x (2009).

    Article  CAS  PubMed  Google Scholar 

  288. 288.

    Cripps, N., Evans, J., Nordon, I. & Senapati, A. Sacrococcygeal pilonidal sinus disease. Colorectal Dis 11, 105–106 (2008).

    Article  Google Scholar 

  289. 289.

    Demircan, F. et al. The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 8, 2929–2933 (2015).

    PubMed  PubMed Central  Google Scholar 

  290. 290.

    Kanat, B. H. et al. Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases. Ulus Travma Acil Cerrahi Derg 20, 366–370, https://doi.org/10.5505/tjtes.2014.62547 (2014).

    Article  PubMed  Google Scholar 

  291. 291.

    Bali, I. et al. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics (Sao Paulo) 70, 350–355, https://doi.org/10.6061/clinics/2015(05)08 (2015).

    Article  Google Scholar 

  292. 292.

    Ersoy, E. et al. Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 11, 705–710, https://doi.org/10.1111/j.1463-1318.2008.01646.x (2009).

    Article  CAS  PubMed  Google Scholar 

  293. 293.

    Khan, M. I., Jawed, M., Bhura, S., Shaikh, U. & Arif, A. To evaluate the outcome of sacrococcygeal pilonidal sinus excision using karydakis technique. Med. Forum Monthly 25, 57–59 (2014).

    Google Scholar 

  294. 294.

    Ortega, P. M. et al. Is the cleft lift procedure for non-acute sacrococcygeal pilonidal disease a definitive treatment? Long-term outcomes in 74 patients. Surg Today 44, 2318–2323, https://doi.org/10.1007/s00595-014-0923-3 (2014).

    Article  CAS  PubMed  Google Scholar 

  295. 295.

    Sit, M., Aktas, G. & Yilmaz, E. E. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg 79, 1263–1268 (2013).

    PubMed  Google Scholar 

  296. 296.

    Guner, A., Ozkan, O. F., Kece, C., Kesici, S. & Kucuktulu, U. Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: results in 141 patients. Colorectal Dis 15, e402–406, https://doi.org/10.1111/codi.12243 (2013).

    Article  CAS  PubMed  Google Scholar 

  297. 297.

    Iribarren, B. O., Barra, M. M., Lanzelotti, G. D., Rojas, G. M. & Peña, A. E. Comparison between Limberg and Karydakis flap for wound closure after pilonidal cyst resection. Rev. Chil. Cir. 67, 399–406, https://doi.org/10.4067/S0718-40262015000400009 (2015).

    Article  Google Scholar 

  298. 298.

    Iesalnieks, I., Deimel, S., Zulke, C. & Schlitt, H. J. Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease. J Dtsch Dermatol Ges 11, 1001–1005, https://doi.org/10.1111/ddg.12140 (2013).

    Article  PubMed  Google Scholar 

  299. 299.

    Patel, L. B. & Allen, M. Prolonged delay in healing after surgical treatment of pilonidal sinus is avoidable. Colorectal Dis 1, 107–110, https://doi.org/10.1046/j.1463-1318.1999.00030.x (1999).

    Article  CAS  PubMed  Google Scholar 

  300. 300.

    Sahin, A., Olcucuoglu, E., Seker, D. & Kulacoglu, H. The effect of using methylene blue in surgical treatments of pilonidal disease: a prospective randomized study. European Surgery 46, 148–154, https://doi.org/10.1007/s10353-014-0276-6 (2014).

    Article  Google Scholar 

  301. 301.

    Kumar, N. A. & Sutradhar, P. Karydakis procedure for sacrococcygeal pilonidal sinus disease: Our experience. Indian J Plast Surg 47, 402–406, https://doi.org/10.4103/0970-0358.146615 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  302. 302.

    Mohamed, S. J., Kristensen, B. B., Lindgaard, L. & Bisgaard, T. Acceptable effect of multimodal analgesic treatment after a Bascom cleft lift operation. Dan Med J 62, A4985 (2015).

    PubMed  Google Scholar 

  303. 303.

    Melkonian, T. E. et al. Short-and long-term results with Karydaki’s technique for sacrococcygeal pilonidal disease [Resultados a corto y largo plazo con la técnica de Karydakis para la enfermedad pilonidal sacrocoxígea]. Rev. Chil. Cir. 65, 25–29 (2013).

    Article  Google Scholar 

  304. 304.

    Abdelrazeq, A. S., Rahman, M., Botterill, I. D. & Alexander, D. J. Short-term and long-term outcomes of the cleft lift procedure in the management of nonacute pilonidal disorders. Dis Colon Rectum 51, 1100–1106, https://doi.org/10.1007/s10350-008-9262-z (2008).

    Article  PubMed  Google Scholar 

  305. 305.

    Bostanoglu, S., Sakcak, I., Avsar, F. M., Cosgun, E. & Hamamci, E. O. Comparison of Karydakis technique with Limberg Flap Procedure in Pilonidal Sinus Disease: Advantages of Karydakis technique. Pak. J. Med. Sci. 26, 773–777 (2010).

    Google Scholar 

  306. 306.

    Piskin, T. et al. Orifice location guided excision and flap procedures for treatment of sacrococcygeal pilonidal disease. Adv. Clin. Exp. Med. 20, 481–488 (2011).

    Google Scholar 

  307. 307.

    Sözen, S. et al. Comparison between Karydakis flap repair and Limberg flap for surgical treatment of sacrococcygeal pilonidal sinus (short term results). Turk. J. Surg. 26, 153–156, https://doi.org/10.5097/1300-0705.UCD.609-10.01 (2010).

    Article  Google Scholar 

  308. 308.

    Tokac, M., Dumlu, E. G., Aydin, M. S., Yalcin, A. & Kilic, M. Comparison of modified limberg flap and karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 100, 870–877, https://doi.org/10.9738/INTSURG-D-14-00213.1 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  309. 309.

    Guner, A., Cekic, A. B., Boz, A., Turkyilmaz, S. & Kucuktulu, U. A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach. BMC Surg 16, 18, https://doi.org/10.1186/s12893-016-0134-5 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  310. 310.

    Bannura, C., Barrera, E., Contreras, P., Melo, L. & Soto, C. Ambulatory karydakis procedure for sacrococcygeal pilonidal disease. Rev. Chil. Cir. 61, 256–260 (2009).

    Google Scholar 

  311. 311.

    Larsson, J. C., Aliaga, F. D., Granero, L. & Cornet, M. Tratamiento de la Enfermedad Pilonidal Crónica. Comparación de 3 Técnicas Quirúrgicas. Rev Argent Coloproct 25, 64–70 (2014).

    Google Scholar 

  312. 312.

    Guillermo Bannura, C. Sacrococcygeal pilonidal disease. risks factors and surgical options [Enfermedad pilonidal sacro-coccígea: Factores de riesgo y tratamiento quirúrgico]. Rev. Chil. Cir. 63, 527–533 (2011).

    Article  Google Scholar 

  313. 313.

    Ochoa, E. M., Esquivel, C. M., Badra, R. & Cornet, M. Sacrococcygeal pilonidal disease: results of karydakis flap vs. limberg flap. Prensa Med. Argent. 96, 31–37 (2009).

    Google Scholar 

  314. 314.

    Ramzan, M., Khalid Mirza, M. & Arif Ali, M. Pilonidal Sinus; Experience with Modified Karydakis Procedure Using Subcuticular Skin Closure. The Professional Medical Journal 23, 1499–1504, https://doi.org/10.17957/tpmj/16.3602 (2016).

    Article  Google Scholar 

  315. 315.

    Keshvari, A., Keramati, M. R., Fazeli, M. S., Kazemeini, A. & Nouritaromlou, M. K. Risk factors for complications and recurrence after the Karydakis flap. J Surg Res 204, 55–60, https://doi.org/10.1016/j.jss.2016.04.035 (2016).

    Article  PubMed  Google Scholar 

  316. 316.

    Bannura, G. Karydakis operation for sacrococcygeal pilonidal sinus disease. Rev Chil Cir 57, 340–344 (2005).

    Google Scholar 

  317. 317.

    Cubukcu, A. et al. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis 15, 173–175 (2000).

    Article  CAS  PubMed  Google Scholar 

  318. 318.

    Arumugam, P. J., Chandrasekaran, T. V., Morgan, A. R., Beynon, J. & Carr, N. D. The rhomboid flap for pilonidal disease. Colorectal Dis 5, 218–221 (2003).

    Article  CAS  PubMed  Google Scholar 

  319. 319.

    Mentes, B. B. et al. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 34, 419–423, https://doi.org/10.1007/s00595-003-2725-x (2004).

    Article  PubMed  Google Scholar 

  320. 320.

    Hegele, A., Strombach, F. J. & Schonbach, F. [Reconstructive surgical therapy of infected pilonidal sinus]. Chirurg 74, 749–752, https://doi.org/10.1007/s00104-003-0657-z (2003).

    Article  CAS  PubMed  Google Scholar 

  321. 321.

    Kaya, B. et al. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol 16, 55–59, https://doi.org/10.1007/s10151-011-0799-9 (2012).

    Article  CAS  PubMed  Google Scholar 

  322. 322.

    Yildar, M. & Cavdar, F. Comparison of the Limberg flap and bilateral gluteus maximus advancing flap following oblique excision for the treatment of pilonidal sinus disease. Surg Today 44, 1828–1833, https://doi.org/10.1007/s00595-013-0764-5 (2014).

    Article  PubMed  Google Scholar 

  323. 323.

    Kapan, M., Kapan, S., Pekmezci, S. & Durgun, V. Sacrococcygeal pilonidal sinus disease with Limberg flap repair. Tech Coloproctol 6, 27–32, https://doi.org/10.1007/s101510200005 (2002).

    Article  CAS  PubMed  Google Scholar 

  324. 324.

    Müller, K. et al. Prospective analysis of cosmesis, morbidity, and patient satisfaction following Limberg flap for the treatment of sacrococcygeal pilonidal sinus. Dis Colon Rectum 54, 487–494 (2011).

    Article  PubMed  Google Scholar 

  325. 325.

    Jimenez Romero, C., Alcalde, M., Martin, F., Pulido, A. & Rico, P. Treatment of pilonidal sinus by excision and rhomboid flap. Int J Colorectal Dis 5, 200–202 (1990).

    Article  CAS  PubMed  Google Scholar 

  326. 326.

    El-Khadrawy, O., Hashish, M., Ismail, K. & Shalaby, H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg 33, 1064–1068, https://doi.org/10.1007/s00268-009-9920-x (2009).

    Article  PubMed  Google Scholar 

  327. 327.

    Akin, M. et al. Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today 40, 757–762, https://doi.org/10.1007/s00595-008-4098-7 (2010).

    Article  PubMed  Google Scholar 

  328. 328.

    Milito, G. et al. Modified Limberg’s transposition flap for pilonidal sinus. Long term follow up of 216 cases. Ann Ital Chir 78, 227–231 (2007).

    PubMed  Google Scholar 

  329. 329.

    Daphan, C., Tekelioglu, M. H. & Sayilgan, C. Limberg flap repair for pilonidal sinus disease. Dis Colon Rectum 47, 233–237 (2004).

    Article  PubMed  Google Scholar 

  330. 330.

    Eryilmaz, R., Sahin, M., Alimoglu, O. & Dasiran, F. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 134, 745–749, https://doi.org/10.1016/s0039-6060(03)00163-6 (2003).

    Article  PubMed  Google Scholar 

  331. 331.

    Gwynn, B. R. Use of the rhomboid flap in pilonidal sinus. Ann R Coll Surg Engl 68, 40–41 (1986).

    CAS  PubMed  PubMed Central  Google Scholar 

  332. 332.

    Karakayali, F. et al. Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 52, 496–502, https://doi.org/10.1007/DCR.0b013e31819a3ec0 (2009).

    Article  PubMed  Google Scholar 

  333. 333.

    Lahooti, M., Taheri, P. A., Nezami, B. G. & Assa, S. Sacrococcygeal pilonidal sinus treated by a new fascio-cutaneous flap. Dis Colon Rectum 51, 588–592, https://doi.org/10.1007/s10350-008-9211-x (2008).

    Article  PubMed  Google Scholar 

  334. 334.

    Lieto, E. et al. Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon Rectum 53, 1061–1068, https://doi.org/10.1007/DCR.0b013e3181defd25 (2010).

    Article  PubMed  Google Scholar 

  335. 335.

    Aithal, S. K., Rajan, C. S. & Reddy, N. Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure. Indian J Surg 75, 298–301, https://doi.org/10.1007/s12262-012-0489-5 (2013).

    Article  PubMed  Google Scholar 

  336. 336.

    Milito, G., Cortese, F. & Casciani, C. U. Rhomboid flap procedure for pilonidal sinus: results from 67 cases. Int J Colorectal Dis 13, 113–115 (1998).

    Article  CAS  PubMed  Google Scholar 

  337. 337.

    Aslam, M. N., Shoaib, S. & Choudhry, A. M. Use of Limberg flap for pilonidal sinus - a viable option. J Ayub Med Coll Abbottabad 21, 31–33 (2009).

    PubMed  Google Scholar 

  338. 338.

    Topgul, K., Ozdemir, E., Kilic, K., Gokbayir, H. & Ferahkose, Z. Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 46, 1545–1548, https://doi.org/10.1097/01.DCR.0000089114.56612.06 (2003).

    Article  PubMed  Google Scholar 

  339. 339.

    Urhan, M. K., Kucukel, F., Topgul, K., Ozer, I. & Sari, S. Rhomboid excision and Limberg flap for managing pilonidal sinus: results of 102 cases. Dis Colon Rectum 45, 656–659 (2002).

    Article  PubMed  Google Scholar 

  340. 340.

    Kirkil, C. et al. The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease. Tech Coloproctol 15, 425–429, https://doi.org/10.1007/s10151-011-0782-5 (2011).

    Article  CAS  PubMed  Google Scholar 

  341. 341.

    Darwish, A. M. & Hassanin, A. Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous Limberg flap. J Plast Reconstr Aesthet Surg 63, 1176–1180, https://doi.org/10.1016/j.bjps.2009.05.051 (2010).

    Article  PubMed  Google Scholar 

  342. 342.

    Altintoprak, F. et al. Retrospective review of pilonidal sinus patients with early discharge after Limberg flap procedure. Int Surg 99, 28–34, https://doi.org/10.9738/INTSURG-D-13-00150.1 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  343. 343.

    Omer, Y., Hayrettin, D., Murat, C., Mustafa, Y. & Evren, D. Comparison of modified limberg flap and modified elliptical rotation flap for pilonidal sinus surgery: a retrospective cohort study. Int J Surg 16, 74–77, https://doi.org/10.1016/j.ijsu.2015.02.024 (2015).

    Article  PubMed  Google Scholar 

  344. 344.

    Yoldas, T. et al. Recurrent pilonidal sinus: lay open or flap closure, does it differ? Int Surg 98, 319–323, https://doi.org/10.9738/INTSURG-D-13-00081.1 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  345. 345.

    Katsoulis, I. E., Hibberts, F. & Carapeti, E. A. Outcome of treatment of primary and recurrent pilonidal sinuses with the Limberg flap. Surgeon 4(7–10), 62 (2006).

    Google Scholar 

  346. 346.

    Erdem, E., Sungurtekin, U. & Nessar, M. Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum 41, 1427–1431 (1998).

    Article  CAS  PubMed  Google Scholar 

  347. 347.

    Tekin, A. Pilonidal sinus: experience with the Limberg flap. Colorectal Dis 1, 29–33, https://doi.org/10.1046/j.1463-1318.1999.00007.x (1999).

    Article  CAS  PubMed  Google Scholar 

  348. 348.

    Akin, M. et al. Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis 10, 945–948, https://doi.org/10.1111/j.1463-1318.2008.01563.x (2008).

    Article  CAS  PubMed  Google Scholar 

  349. 349.

    Sabuncuoglu, M. Z. et al. Eyedrop-shaped, modified Limberg transposition flap in the treatment of pilonidal sinus disease. Asian J Surg 38, 161–167, https://doi.org/10.1016/j.asjsur.2015.03.007 (2015).

    Article  PubMed  Google Scholar 

  350. 350.

    Afsarlar, C. E. et al. Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique. J Pediatr Surg 48, 1744–1749, https://doi.org/10.1016/j.jpedsurg.2013.01.029 (2013).

    Article  PubMed  Google Scholar 

  351. 351.

    Yamout, S. Z. et al. Early experience with the use of rhomboid excision and Limberg flap in 16 adolescents with pilonidal disease. J Pediatr Surg 44, 1586–1590, https://doi.org/10.1016/j.jpedsurg.2008.11.033 (2009).

    Article  PubMed  Google Scholar 

  352. 352.

    Altinli, E., Koksal, N., Onur, E., Celik, A. & Sumer, A. Impact of fibrin sealant on Limberg flap technique: results of a randomized controlled trial. Tech Coloproctol 11, 22–25, https://doi.org/10.1007/s10151-007-0320-7 (2007).

    Article  CAS  PubMed  Google Scholar 

  353. 353.

    Bozkurt, M. K. & Tezel, E. Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 41, 775–777 (1998).

    Article  CAS  PubMed  Google Scholar 

  354. 354.

    Colak, T., Turkmenoglu, O., Dag, A., Akca, T. & Aydin, S. A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res 158, 127–131, https://doi.org/10.1016/j.jss.2008.11.005 (2010).

    Article  PubMed  Google Scholar 

  355. 355.

    Cihan, A. et al. Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 49, 244–249, https://doi.org/10.1007/s10350-005-0253-z (2006).

    Article  PubMed  Google Scholar 

  356. 356.

    Manterola, C., Barroso, M., Araya, J. C. & Fonseca, L. Pilonidal disease: 25 cases treated by the Dufourmentel technique. Dis Colon Rectum 34, 649–652 (1991).

    Article  CAS  PubMed  Google Scholar 

  357. 357.

    Ardelt, M. et al. Sequential intervention with primary excision and Limberg plastic surgery procedure for treatment of sacrococcygeal pilonidal sinus: Results of a pilot study. Chirurg 86, 771–775, https://doi.org/10.1007/s00104-014-2963-z (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  358. 358.

    Faux, W., Pillai, S. C. & Gold, D. M. Limberg flap for pilonidal disease: the “no-protractor” approach, 3 steps to success. Tech Coloproctol 9, 153–155, https://doi.org/10.1007/s10151-005-0216-3 (2005).

    Article  CAS  PubMed  Google Scholar 

  359. 359.

    Karakas, B. R. et al. Is the lateralization distance important in terms in patients undergoing the modified Limberg flap procedure for treatment of pilonidal sinus? Tech Coloproctol (2014).

  360. 360.

    El-Tawil, S. & Carapeti, E. Use of a double rhomboid transposition flap in the treatment of extensive complex pilonidal sinus disease. Colorectal Dis 11, 313–317, https://doi.org/10.1111/j.1463-1318.2008.01596.x (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  361. 361.

    Sharma, P. P. Multiple Z-plasty in pilonidal sinus–a new technique under local anesthesia. World J Surg 30, 2261–2265, https://doi.org/10.1007/s00268-005-0632-6 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  362. 362.

    Unalp, H. R., Derici, H., Kamer, E., Nazli, O. & Onal, M. A. Lower recurrence rate for Limberg vs. V-Y flap for pilonidal sinus. Dis Colon Rectum 50, 1436–1444, https://doi.org/10.1007/s10350-007-0276-8 (2007).

    Article  PubMed  Google Scholar 

  363. 363.

    Akan, K. et al. Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study. Ulus Cerrahi Derg 29, 162–166, https://doi.org/10.5152/UCD.2013.2457 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  364. 364.

    Yabanoglu, H., Karagulle, E., Belli, S. & Turk, E. Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease. Acta Chir Belg 114, 52–57 (2014).

    Article  CAS  PubMed  Google Scholar 

  365. 365.

    Azizi, R., Alemrajabi, M., Naderan, M. & Shoar, S. Efficacy of modified Limberg flap in surgical treatment of infected pilonidal abscess: a case–control study. European. Surgery 46, 144–147, https://doi.org/10.1007/s10353-014-0273-9 (2014).

    Article  Google Scholar 

  366. 366.

    Jonas, J., Blaich, S. & Bahr, R. Surgery of pilonidal sinus using the Limberg flap. Zentralbl Chir 125, 976–981, https://doi.org/10.1055/s-2000-10076 (2000).

    Article  CAS  PubMed  Google Scholar 

  367. 367.

    Kicka, M., Toporcer, T. & Radonak, J. Pilonidal sinus–a classical plastic procedure according to Limberg (Limberg flap procedure) or its modified version? Rozhl Chir 90, 482–487 (2011).

    CAS  PubMed  Google Scholar 

  368. 368.

    Karakas, B. R. Comparison of Z-plasty, limberg flap, and asymmetric modified Limberg flap techniques for the pilonidal sinus treatment: review of literature. Acta Chir Iugosl 60, 31–37 (2013).

    Article  PubMed  Google Scholar 

  369. 369.

    Saydam, M. et al. Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow’s triangle in the treatment of pilonidal sinus disease. Am J Surg 210, 772–777, https://doi.org/10.1016/j.amjsurg.2015.03.031 (2015).

    Article  PubMed  Google Scholar 

  370. 370.

    Misiakos, E. P. et al. Limberg flap reconstruction for the treatment of pilonidal sinus disease. Chirurgia (Bucur) 101, 513–517 (2006).

    CAS  Google Scholar 

  371. 371.

    Karaca, A. S., Ali, R., Capar, M. & Karaca, S. Comparison of Limberg flap and excision and primary closure of pilonidal sinus disease, in terms of quality of life and complications. J Korean Surg Soc 85, 236–239, https://doi.org/10.4174/jkss.2013.85.5.236 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  372. 372.

    Yildar, M., Cavdar, F. & Yildiz, M. K. The evaluation of a modified Dufourmentel flap after S-type excision for pilonidal sinus disease. ScientificWorldJournal 2013, 459147, https://doi.org/10.1155/2013/459147 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  373. 373.

    Sungurtekin, H., Sungurtekin, U. & Erdem, E. Local anesthesia and midazolam versus spinal anesthesia in ambulatory pilonidal surgery. J Clin Anesth 15, 201–205 (2003).

    Article  CAS  PubMed  Google Scholar 

  374. 374.

    Roth, R. F. & Moorman, W. L. Treatment of pilonidal sinus and cyst by conservative excision and W-plasty closure. Plast Reconstr Surg 60, 412–415 (1977).

    CAS  PubMed  PubMed Central  Google Scholar 

  375. 375.

    Altintoprak, F. et al. Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease. J Korean Surg Soc 85, 63–67, https://doi.org/10.4174/jkss.2013.85.2.63 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  376. 376.

    Dogra, S. & Rao, P. P. Z-Plasty a Rational and Effective Technique for Pilonidal Sinus. Hellenic Journal of Surgery 86, 208–211 (2014).

    Article  Google Scholar 

  377. 377.

    Rabbani, S. et al. Rhomboid excision with limberg transposition flap in the management of sacrococcygeal pilonidal sinus - a reliable surgical technique. Pakistan J of Medical and Health Sci 8 (2014).

  378. 378.

    Madbouly, K. M. Day-case Limberg flap for recurrent pilonidal sinus: does obesity complicate the issue? Am Surg 76, 995–999 (2010).

    PubMed  Google Scholar 

  379. 379.

    Öz, B. et al. A comparison of surgical outcome of fasciocutaneous V-Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease. Asian J Surg 6, https://doi.org/10.1016/j.asjsur.2015.10.002 (2015).

  380. 380.

    Rao, J., Deora, H. & Mandia, R. A Retrospective Study of 40 Cases of Pilonidal Sinus with Excision of Tract and Z-plasty as Treatment of Choice for Both Primary and Recurrent Cases. Indian J Surg 77, 691–693, https://doi.org/10.1007/s12262-013-0983-4 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  381. 381.

    Moosavi, S. R., Kharazm, P. & Vaghardoost, R. Surgical treatment of pilonidal sinus with a fasciocutaneous rotation flap based on an inferior pedicle. Scand J Plast Reconstr Surg Hand Surg 40, 281–283, https://doi.org/10.1080/02844310600869811 (2006).

    Article  PubMed  Google Scholar 

  382. 382.

    Das, K. et al. Diathermy versus scalpel in Limberg flap in pilonidal sinus surgery. A prospective randomized trial. Ann Ital Chir 85, 148–152 (2014).

    PubMed  Google Scholar 

  383. 383.

    Fahim, M. et al. Limberg FLAP Reconstruction for Pilonidal Sinus Disease: An Experience. Ann Pak Inst Med Sci 9, 215–218 (2013).

    Google Scholar 

  384. 384.

    Shabir, F., Khan, B. A. & Mian, M. A. Rhomboid excision with Limberg flap a novel treatment for sacrococcygeal pilonidal sinus. Pak. J. Med. Health Sci. 8, 687–690 (2014).

    Google Scholar 

  385. 385.

    Bayhan, Z. et al. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study. Asian J Surg 39, 172–177, https://doi.org/10.1016/j.asjsur.2015.12.007 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  386. 386.

    Al-Haifi, M. B. et al. Rhomboid flap - A primary cure for pilonidal sinus. Kuwait Med. J. 42, 282–285 (2010).

    Google Scholar 

  387. 387.

    Tardu, A., Haşlak, A., Özçinar, B. & Başak, F. Comparison of Limberg and Dufourmentel flap in surgical treatment of pilonidal sinus disease. Turk. J. Surg. 27, 35–40, https://doi.org/10.5097/1300-0705.UCD.659-11.04

  388. 388.

    Sellés, R. et al. Complete excision and marsupialization of chronic pilonidal sacrococcygeal sinus: The ideal technique? Cir. Esp. 72, 92–94, https://doi.org/10.1016/S0009-739X(02)72016-2 (2002).

    Article  Google Scholar 

  389. 389.

    Tschudi, J. & Ris, H. B. Morbidity of Z-plasty in the treatment of pilonidal sinus. Chirurg 59, 486–490 (1988).

    CAS  PubMed  PubMed Central  Google Scholar 

  390. 390.

    Abu Galala, K. H., Salam, I. M. A., El Ashaal, Y. I., Chandran, V. P. & Sim, A. J. W. Excision of pilonidal sinus and primary closure by a rhomboid flap transposition. Asian J. Surg. 19, 305–308 (1996).

    Google Scholar 

  391. 391.

    Ferreira Montero, V., Garcia Fabian, A. P., Martinez Laganga, A. & Perez Ruiz, L. Rhombic plastia in the form of an ‘L’ for treating pilonidal cysts [La plastia en “L” de Rombo para el tratamiento de los Quistes Pilonidales]. Cir. Esp. 31, 153–158 (1977).

    Google Scholar 

  392. 392.

    Kushwaha, R., El-Tawil, S., Hibberts, F., Katsoulis, I. E. & Carapeti, E. Treatment of complex primary and recurrent pilonidal sinus with a Rhomboid Transposition Flap. Br J Surg 93, 1–104 (2006).

    Google Scholar 

  393. 393.

    Behdad, A. & Hosseinpoor, M. Z-plasty for the treatment of residual cavity after pilonidal sinus excision. Medical Journal of the Islamic Republic of Iran 14, 317–319 (2001).

    Google Scholar 

  394. 394.

    Lauterbach, H. H. & Konrad, U. Zweiphasenkonzept zur Therapie des infizierten Sinus pilonidalis. Chir Praxis 55, 623–628 (1999).

    Google Scholar 

  395. 395.

    Mutaf, M., Temel, M. & Koc, M. N. A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique. Med Sci Monit 23, 1033–1042 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  396. 396.

    Raza, M. W. et al. Limberg flap for pilonidal sinus. J Rawal Med coll 16, 132–134 (2012).

    Google Scholar 

  397. 397.

    Khanna, A. K. & Tiwary, S. K. Pilonidal sinus disease with especial reference to Limberg flap. Apollo Medicine 12, 163–169, https://doi.org/10.1016/j.apme.2015.07.013 (2015).

    Article  Google Scholar 

  398. 398.

    Mentes, O., Bagci, M., Bilgin, T., Ozgul, O. & Ozdemir, M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg 393, 185–189, https://doi.org/10.1007/s00423-007-0227-9 (2008).

    Article  PubMed  Google Scholar 

  399. 399.

    Oncel, M. et al. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6, 165–169, https://doi.org/10.1007/s101510200037 (2002).

    Article  CAS  PubMed  Google Scholar 

  400. 400.

    Abramson, D. J. An open, semiprimary closure operation for pilonidal sinuses, using local anesthesia. Dis Colon Rectum 13, 215–219 (1970).

    Article  CAS  PubMed  Google Scholar 

  401. 401.

    Abramson, D. J. & Cox, P. A. The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment. Ann Surg 139, 341–349 (1954).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  402. 402.

    Aldemir, M., Kara, I. H., Erten, G. & Tacyildiz, I. Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease. Surg Today 33, 106–109, https://doi.org/10.1007/s005950300022 (2003).

    Article  CAS  PubMed  Google Scholar 

  403. 403.

    Ozbalci, G. S., Tuncal, S., Bayraktar, K., Tasova, V. & Ali Akkus, M. Is gentamicin-impregnated collagen sponge to be recommended in pilonidal sinus patient treated with marsupialization? A prospective randomized study. Ann Ital Chir 85, 576–582 (2014).

    PubMed  Google Scholar 

  404. 404.

    Zimmerman, C. E. Outpatient excision and primary closure of pilonidal cysts and sinuses. Long-term follow-up. Am J Surg 148, 658–659 (1984).

    Article  CAS  PubMed  Google Scholar 

  405. 405.

    Brockbank, M. J. Pilonidal Cyst. Am J Surg 68, 4 (1945).

    Article  Google Scholar 

  406. 406.

    Licheri, S. et al. Radical treatment of acute pilonidal abscess by marsupialization. G Chir 25, 414–416 (2004).

    CAS  PubMed  Google Scholar 

  407. 407.

    Gonzalo Inostroza, L. et al. Pilonidal cyst abscess: Definitive treatment in a single time during the acute, short-term results [Quiste pilonidal abscedado: Tratamiento definitivo en un solo tiempo durante el episodio agudo, resultados a corto plazo]. Rev. Chil. Cir. 63, 54–58 (2011).

    Article  Google Scholar 

  408. 408.

    Perez Oberreuter, G. et al. Tecnica de marsupializacion en quiste pilonidal: 7 anos de experiencia. Rev. Chil. Cir. 50 (1998).

  409. 409.

    Duchateau, J., De Mol, J., Bostoen, H. & Allegaert, W. Pilonidal sinus. Excision–marsupialization–phenolization? Acta Chir Belg 85, 325–328 (1985).

    CAS  PubMed  Google Scholar 

  410. 410.

    Abramson, D. J. Excision and delayed closure of pilonidal sinuses. Surg Gynecol Obstet 144, 205–207 (1977).

    CAS  PubMed  Google Scholar 

  411. 411.

    Abramson, D. J. Outpatient management of pilonidal sinuses: excision and semiprimary closure technic. Mil Med 143, 753–757 (1978).

    Article  CAS  PubMed  Google Scholar 

  412. 412.

    Struijk, D. G., Krediet, R. T., de Glas-Vos, J. W., Boeschoten, E. W. & Arisz, L. Experiences with acute peritoneal dialysis in adults. Ned Tijdschr Geneeskd 128, 751–755 (1984).

    CAS  PubMed  Google Scholar 

  413. 413.

    Sahsamanis, G. et al. Semi-closed surgical technique for treatment of pilonidal sinus disease. Ann Med Surg (Lond) 15, 47–51, https://doi.org/10.1016/j.amsu.2017.02.004 (2017).

    Article  Google Scholar 

  414. 414.

    Arauz, S., Yamaguchi, N., Schmidt Goffi, F. & Zanoto, A. Tratamento cirúrgico da doença pilonidal sacrococcígea: estudo comparativo entre as técnicas de marsupialização e de incisão e curetagem [Surgical treatment of sacrococcigeal pilonidal disease: a comparative study between marsupialization and incision plus curettage techniques]. Rev Col Bras Cir 29, 659–662 (2002).

    Article  Google Scholar 

  415. 415.

    Yildirim, D., Sunamak, O., Pergel, A. & Mounla, M. Combined single step definitive treatment in acute pilonidal sinus abscess. Surg Sci 1, 24–26 (2010).

    Article  Google Scholar 

  416. 416.

    Cavanagh, C. R. & Schnug, G. E. Definitive Treatment of the Pilonidal Abscess. Northwest Med 63, 449–451 (1964).

    CAS  PubMed  Google Scholar 

  417. 417.

    Olmez, A., Kayaalp, C. & Aydin, C. Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol 17, 201–206, https://doi.org/10.1007/s10151-012-0903-9 (2013).

    Article  CAS  PubMed  Google Scholar 

  418. 418.

    Al-Naami, M. Y. Outpatient pilonidal sinotomy complemented with good wound and surrounding skin care. Saudi Med J 26, 285–288 (2005).

    PubMed  Google Scholar 

  419. 419.

    Gupta, P. J. Radiofrequency incision and lay open technique of pilonidal sinus (clinical practice paper on modified technique). Kobe J Med Sci 49, 75–82 (2003).

    PubMed  Google Scholar 

  420. 420.

    Kepenekci, I., Demirkan, A., Celasin, H. & Gecim, I. E. Unroofing and curettage for the treatment of acute and chronic pilonidal disease. World J Surg 34, 153–157, https://doi.org/10.1007/s00268-009-0245-6 (2010).

    Article  PubMed  Google Scholar 

  421. 421.

    Al Homoud, S. J., Habib, Z. S., Abdul Jabbar, A. S. & Isbister, W. H. Management of sacrococcygeal pilonidal disease. Saudi. Med. J. 22, 762–764 (2001).

    CAS  PubMed  Google Scholar 

  422. 422.

    Elsey, E. & Lund, J. N. Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol 17, 101–104, https://doi.org/10.1007/s10151-012-0956-9 (2013).

    Article  CAS  PubMed  Google Scholar 

  423. 423.

    Gidwani, A. L., Murugan, K., Nasir, A. & Brown, R. Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir J Med Sci 179, 207–210, https://doi.org/10.1007/s11845-009-0450-1 (2010).

    Article  CAS  PubMed  Google Scholar 

  424. 424.

    Oram, Y., Kahraman, F., Karincaoglu, Y. & Koyuncu, E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 36, 88–91, https://doi.org/10.1111/j.1524-4725.2009.01387.x (2010).

    Article  PubMed  Google Scholar 

  425. 425.

    Klin, B., Heller, O. N. & Kaplan, I. The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 8, 31–37 (1990).

    Article  CAS  PubMed  Google Scholar 

  426. 426.

    Jensen, S. L. & Harling, H. Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 75, 60–61 (1988).

    Article  CAS  PubMed  Google Scholar 

  427. 427.

    Garg, P., Garg, M., Gupta, V., Mehta, S. K. & Lakhtaria, P. Laying open (deroofing) and curettage under local anesthesia for pilonidal disease: An outpatient procedure. World J Gastrointest Surg. 7, 214–218, https://doi.org/10.4240/wjgs.v7.i9.214 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  428. 428.

    Yalcin, S. & Ergul, E. A single-surgeon, single-institute experience of 59 sinotomies for sacrococcygeal pilonidal disease under local anesthesia. Bratisl Lek Listy 111, 284–285 (2010).

    PubMed  Google Scholar 

  429. 429.

    Sozen, S., Ozturk, V. & Das, V. Day–Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection. Arch Clin Exp Surg 1, 138–141 (2012).

    Article  Google Scholar 

  430. 430.

    Qayyum, I., Bai, D. & Tsoraides, S. S. Loop drainage after debridement (LDAD): minimally invasive treatment for pilonidal cyst. Tech Coloproctol 20, 591–594, https://doi.org/10.1007/s10151-016-1469-8 (2016).

    Article  CAS  PubMed  Google Scholar 

  431. 431.

    Isbister, W. H. & Prasad, J. Pilonidal disease. Aust N Z J Surg 65, 561–563 (1995).

    Article  CAS  PubMed  Google Scholar 

  432. 432.

    Mikkelsen, K. Pilonidal sinus. A follow-up study of out-patients treated by simple incision. Ugeskr Laeger 137, 789–791 (1975).

    CAS  PubMed  Google Scholar 

  433. 433.

    Shirah, B. & Shirah, H. The Effect of Hydrogen Peroxide on the Healing of the Laid Open Wound in the Treatment of Chronic Sacrococcygeal Pilonidal Sinus: A Retrospective Database Analysis of 500 Patients. International Journal of Surgery and Medicine 2, 17, https://doi.org/10.5455/ijsm.woundhealing (2016).

    Article  Google Scholar 

  434. 434.

    Malik, G. A., Choudary, T. H. & Wahab, A. Pilonidal Sinus; Prevalence and comparison of excision and primary closure with lay open procedure. Professional Med J 16, 297–298 (2009).

    Google Scholar 

  435. 435.

    Goswitz, J. T. Sacrococcygeal Pilonidal Sinus Disease. Treatment and Long-Term Follow-up in a Military Hospital Serving Combat-Ready Units. Arch Surg 90, 890–892 (1965).

    Article  CAS  PubMed  Google Scholar 

  436. 436.

    Gillquist, J. Prevention of the recurrence of so-called sacral dermoid. Nord Med 74, 1315 (1965).

    CAS  PubMed  Google Scholar 

  437. 437.

    Senapati, A., Cripps, N. P. & Thompson, M. R. Bascom’s operation in the day-surgical management of symptomatic pilonidal sinus. Br J Surg 87, 1067–1070, https://doi.org/10.1046/j.1365-2168.2000.01472.x (2000).

    Article  CAS  PubMed  Google Scholar 

  438. 438.

    Gips, M., Melki, Y., Salem, L., Weil, R. & Sulkes, J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51, 1656–1662; discussion 1662–1653, https://doi.org/10.1007/s10350-008-9329-x (2008).

  439. 439.

    Zorcolo, L., Capra, F., Scintu, F. & Casula, G. Surgical treatment of pilonidal disease. Results with the Bascom’s technique. Minerva Chir 59, 387–395 (2004).

    CAS  PubMed  Google Scholar 

  440. 440.

    Edwards, M. H. Pilonidal sinus: a 5-year appraisal of the Millar-Lord treatment. Br J Surg 64, 867–868 (1977).

    Article  CAS  PubMed  Google Scholar 

  441. 441.

    Iesalnieks, I., Deimel, S., Kienle, K., Schlitt, H. J. & Zulke, C. Pit-picking surgery for pilonidal disease. Chirurg 82, 927–931, https://doi.org/10.1007/s00104-011-2077-9 (2011).

    Article  CAS  PubMed  Google Scholar 

  442. 442.

    Colov, E. P. & Bertelsen, C. A. Short convalescence and minimal pain after out-patient Bascom’s pit-pick operation. Danish medical bulletin 58, A4348 (2011).

    PubMed  Google Scholar 

  443. 443.

    Mosquera, D. A. & Quayle, J. B. Bascom’s operation for pilonidal sinus. J R Soc Med 88, 45P–46P (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  444. 444.

    Neola, B., Capasso, S., Caruso, L., Falato, A. & Ferulano, G. P. Scarless outpatient ablation of pilonidal sinus: a pilot study of a new minimally invasive treatment. Int Wound J, https://doi.org/10.1111/iwj.12350 (2014).

  445. 445.

    Majeski, J. & Stroud, J. Sacrococcygeal pilonidal disease. Int Surg 96, 144–147 (2011).

    Article  PubMed  Google Scholar 

  446. 446.

    Lund, J. N. & Leveson, S. H. Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum 48, 1094–1096, https://doi.org/10.1007/s10350-004-0905-4 (2005).

    Article  PubMed  Google Scholar 

  447. 447.

    Iesalnieks, I., Deimel, S. & Schlitt, H. J. “Pit picking” surgery for patients with pilonidal disease: mid-term results and risk factors. Chirurg 86, 482–485, https://doi.org/10.1007/s00104-014-2776-0 (2015).

    Article  CAS  PubMed  Google Scholar 

  448. 448.

    Klaiber, C., Staub, A., Ackermann, D. & Akovbiantz, A. The Lord-Millar operation of pilonidal sinus [Die Sakraldermoidoperation nach Lord-Millar]. Helv. Chir. Acta 49, 221–222 (1982).

    Google Scholar 

  449. 449.

    Froidevaux, A. & Marti, M. C. Sacro coccygeal cysts. Results of a new series of 51 cases [Kystes Sacro Coccygiens. Resultats d´une nouvelle serie de 51 cas]. Lyon Chir 73, 269–271 (1977).

    Google Scholar 

  450. 450.

    Jensen, S. L. & Nielsen, O. V. Lord-Millar brush method in ambulatory treatment of pilonidal cysts. Ugeskr Laeger 150, 98–100 (1988).

    CAS  PubMed  Google Scholar 

  451. 451.

    Di Castro, A., Guerra, F., Sandri, G. B. & Maria Ettorre, G. Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients. Int J Surg 36, 201–205, https://doi.org/10.1016/j.ijsu.2016.10.040 (2016).

    Article  PubMed  Google Scholar 

  452. 452.

    Petersen, S. Skin preserving pit excision, so-called pit picking. Pilonidal Sinus Journal 3, 1–7 (2017).

    Google Scholar 

  453. 453.

    Awad, M. M. & Saad, K. M. Does closure of chronic pilonidal sinus still remain a matter of debate after bilateral rotation flap? (N-shaped closure technique). Indian J Plast Surg 39, 157–162 (2006).

    Article  Google Scholar 

  454. 454.

    Polat, C. et al. Is oval flap reconstruction a good modification for treating pilonidal sinuses? Am J Surg 201, 192–196, https://doi.org/10.1016/j.amjsurg.2010.01.025 (2011).

    Article  PubMed  Google Scholar 

  455. 455.

    Krand, O., Yalt, T., Berber, I., Kara, V. M. & Tellioglu, G. Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon Rectum 52, 1172–1177, https://doi.org/10.1007/DCR.0b013e31819ef582 (2009).

    Article  PubMed  Google Scholar 

  456. 456.

    Nessar, G., Kayaalp, C. & Seven, C. Elliptical rotation flap for pilonidal sinus. Am J Surg 187, 300–303, https://doi.org/10.1016/j.amjsurg.2003.11.012 (2004).

    Article  PubMed  Google Scholar 

  457. 457.

    El-Khatib, H. A. & Al-Basti, H. B. A perforator-based bilobed fasciocutaneous flap: an additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease. J Plast Reconstr Aesthet Surg 62, 494–498, https://doi.org/10.1016/j.bjps.2007.11.043 (2009).

    Article  PubMed  Google Scholar 

  458. 458.

    Dizen, H., Yoldas, O., Yildiz, M., Cilekar, M. & Dilektasli, E. Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease. ANZ J Surg 84, 769–771, https://doi.org/10.1111/ans.12818 (2014).

    Article  PubMed  Google Scholar 

  459. 459.

    Turan, A., Isler, C., Bas, S. C., Genc, B. & Ozsoy, Z. A new flap for reconstruction of pilonidal sinus: lumbar adipofascial turnover flap. Ann Plast Surg 58, 411–415, https://doi.org/10.1097/01.sap.0000243999.36577.3f (2007).

    Article  CAS  PubMed  Google Scholar 

  460. 460.

    Schrogendorfer, K. F. et al. Prospective evaluation of a single-sided innervated gluteal artery perforator flap for reconstruction for extensive and recurrent pilonidal sinus disease: functional, aesthetic, and patient-reported long-term outcomes. World J Surg 36, 2230–2236, https://doi.org/10.1007/s00268-012-1639-4 (2012).

    Article  PubMed  Google Scholar 

  461. 461.

    Berkem, H. et al. V-Y advancement flap closures for complicated pilonidal sinus disease. Int J Colorectal Dis 20, 343–348, https://doi.org/10.1007/s00384-004-0699-9 (2005).

    Article  PubMed  Google Scholar 

  462. 462.

    Acarturk, T. O., Parsak, C. K., Sakman, G. & Demircan, O. Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus. J Plast Reconstr Aesthet Surg 63, 133–139, https://doi.org/10.1016/j.bjps.2008.07.017 (2010).

    Article  PubMed  Google Scholar 

  463. 463.

    Schoeller, T., Wechselberger, G., Otto, A. & Papp, C. Pilonidal sinus: experience with the Karydakis flap. Br J Surg 84, 890–891 (1997).

    Article  CAS  PubMed  Google Scholar 

  464. 464.

    Dylek, O. N. & Bekereciodlu, M. Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg 164, 961–964 (1998).

    Article  CAS  PubMed  Google Scholar 

  465. 465.

    Mackowski, A. & Levitt, M. Outcomes of the house advancement flap for pilonidal sinus. ANZ J Surg, https://doi.org/10.1111/ans.13077 (2015).

  466. 466.

    Ekci, B. & Gokce, O. A new flap technique to treat pilonidal sinus. Tech Coloproctol 13, 205–209, https://doi.org/10.1007/s10151-009-0500-8 (2009).

    Article  PubMed  Google Scholar 

  467. 467.

    Lasheen, A. E., Saad, K. & Raslan, M. Crossed triangular flaps technique for surgical treatment of chronic pilonidal sinus disease. Arch Surg 143, 503–505, https://doi.org/10.1001/archsurg.143.5.503 (2008).

    Article  PubMed  Google Scholar 

  468. 468.

    Awad, M. M., Saad, K. M., Tolba, A. M. & Gharib, O. H. A simple novel technique for closure of simple and complex pilonidal sinus with either simple (tongue-shaped) or bilobed rotation flap. Indian J Plast Surg 44, 47–50 (2007).

    Article  Google Scholar 

  469. 469.

    Eryilmaz, R., Okan, I., Coskun, A., Bas, G. & Sahin, M. Surgical treatment of complicated pilonidal sinus with a fasciocutaneous V-Y advancement flap. Dis Colon Rectum 52, 2036–2040, https://doi.org/10.1007/DCR.0b013e3181beb537 (2009).

    Article  PubMed  Google Scholar 

  470. 470.

    Basterzi, Y. et al. Reconstruction of extensive pilonidal sinus defects with the use of S-GAP flaps. Ann Plast Surg 61, 197–200, https://doi.org/10.1097/SAP.0b013e3181587a06 (2008).

    Article  CAS  PubMed  Google Scholar 

  471. 471.

    Saray, A., Dirlik, M., Caglikulekci, M. & Turkmenoglu, O. Gluteal V-Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease. Scand J Plast Reconstr Surg Hand Surg 36, 80–84 (2002).

    Article  PubMed  Google Scholar 

  472. 472.

    Venus, M. R. & Titley, O. G. Outcomes in the repair of pilonidal sinus disease excision wounds using a parasacral perforator flap. Ann R Coll Surg Engl 94, 12–16, https://doi.org/10.1308/003588412X13171221499748, https://doi.org/10.1308/003588412X13373405387339 (2012).

  473. 473.

    Yuksel, B. C., Berkem, H., Ozel, H. & Hengirmen, S. A new surgical method of pilonidal sinus treatment: a bilaterally paralel elliptic fascio-cutaneous advancement flap technique. Bratisl Lek Listy 113, 728–731 (2012).

    CAS  PubMed  Google Scholar 

  474. 474.

    Sahasrabudhe, P., Panse, N., Waghmare, C. & Waykole, P. V-y advancement flap technique in resurfacing postexcisional defect in cases with pilonidal sinus disease-study of 25 cases. Indian J Surg 74, 364–370, https://doi.org/10.1007/s12262-011-0403-6 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  475. 475.

    Ozdemir, H., Unal Ozdemir, Z., Tayfun Sahiner, I. & Senol, M. Whole natal cleft excision and flap: an alternative surgical method in extensive sacrococcygeal pilonidal sinus disease. Acta Chir Belg 114, 266–270 (2014).

    Article  CAS  PubMed  Google Scholar 

  476. 476.

    Kayaalp, C., Olmez, A., Aydin, C. & Piskin, T. Tumescent local anesthesia for excision and flap procedures in treatment of pilonidal disease. Dis Colon Rectum 52, 1780–1783, https://doi.org/10.1007/DCR.0b013e3181b553bb (2009).

    Article  PubMed  Google Scholar 

  477. 477.

    Onishi, K. & Maruyama, Y. Sacral adipofascial turn-over flap for the excisional defect of pilonidal sinus. Plast Reconstr Surg 108, 2006–2010 (2001).

    Article  CAS  PubMed  Google Scholar 

  478. 478.

    Sungur, N. et al. V-Y rotation advancement fasciocutaneous flap for excisional defects of pilonidal sinus. Plast Reconstr Surg 117, 2448–2454, https://doi.org/10.1097/01.prs.0000219170.74059.94 (2006).

    Article  CAS  PubMed  PubMed Central