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Pit-picking-Operation bei Patienten mit Sinus pilonidalis

Pit-picking surgery for pilonidal disease

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Zusammenfassung

Einleitung

Die „Pit-picking-Operation“ wurde bereits vor über 30 Jahren von J. Bascom beschrieben, jedoch ist diese minimal-invasive Operationsmethode zur Behandlung des Sinus pilonidalis nichtspezialisierten Chirurgen nur wenig bekannt.

Patienten und Methoden

Die Primärfistel in der Rima ani wird in Lokalanästhesie mit einem max. 1 mm großen Hautsaum sparsam exzidiert. Im Bereich des subkutanen Sinus (meist an der Stelle früherer Abszessspaltung) wird eine etwa 1 cm große Gegeninzision durchgeführt. Eine Nachbehandlung ist nicht notwendig.

Ergebnisse

Zwischen Juni 2007 und November 2010 wurden 157 Pit-picking-Operationen bei 153 Patienten (126 Männer, 27 Frauen) durchgeführt. Die Nachsorgezeit betrug im Schnitt 7,1 Monate, Nachsorgedaten lagen in 123 Fällen vor. Ein Rezidiv trat nach 21 Operationen auf (17%). In der multivariaten Analyse waren folgende Faktoren mit einem erhöhten Rezidivrisiko nach „pit picking“ assoziiert: BMI>25 kg/m2 (p=0,019) und Dauer der Erkrankung ≥6 Monate (p=0,017). Das Vorliegen eines Abszesses erhöhte das Rezidivrisiko nicht. Männer erlitten mehr Rezidive als Frauen (20% vs. 4,5%, p=0,12).

Schlussfolgerung

Die Pit-picking-Operation ist eine minimal-invasive Behandlungsmethode mit einer kurzfristigen Erfolgsrate von >80% bei ausgewählten Patienten. Sie scheint vor allem bei weiblichen und bei nicht übergewichtigen männlichen Patienten zu Beginn der Erkrankung Erfolg versprechend zu sein.

Abstract

Background

The pit-picking method was first described by J. Bascom in 1980, however, this minimally invasive technique is used only by a minority of surgeons yet.

Patients and methods

Surgery was performed under local anesthesia. All primary pits in the midline were removed by excising a border of skin of <1 mm and a 1 cm long incision was made parallel to one side of the cleft to open the chronic abscess cavity. No specific postoperative wound care was given.

Results

Pit-picking surgery was carried out 157 times in a total of 153 patients (126 males) between June 2007 and November 2010. Follow-up information was available in 123 cases and 21 patients (17%) developed disease recurrence after a mean follow-up time of 7.1 months. By multivariate analysis, a body mass index (BMI) >25 kg/m2 (p=0.019) and duration of the disease of ≥6 months (p=0.017) were statistically significantly associated with disease recurrence after pit-picking surgery. The recurrence occurred more often in male than in female patients (20% versus 4.5%, p=0.12)

Conclusion

Patients with pilonidal disease can be successfully treated by the pit-picking procedure in more than 80% of selected cases. Female patients and non-overweight male patients with short-term disease benefit most from this treatment method.

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Danksagung

Wir danken unseren Sprechstundenassistentinnen Frau Tanja Happach (Universitätsklinikum Regensburg) und Frau Petra Potthoff (Marienhospital Gelsenkirchen) für ihre maßgebliche Mitwirkung bei der Patientenbetreuung und bei der Implementierung der Methode.

Interessenkonflikt

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Marienhospital Gelsenkirchen, Virchowstr. 135, 45886, Gelsenkirchen, Deutschland

    I. Iesalnieks, S. Deimel & C. Zülke

  2. Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    I. Iesalnieks, K. Kienle & H.J. Schlitt

Authors
  1. I. Iesalnieks
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  2. S. Deimel
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  3. K. Kienle
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  4. H.J. Schlitt
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  5. C. Zülke
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Corresponding author

Correspondence to I. Iesalnieks.

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Iesalnieks, I., Deimel, S., Kienle, K. et al. Pit-picking-Operation bei Patienten mit Sinus pilonidalis. Chirurg 82, 927–931 (2011). https://doi.org/10.1007/s00104-011-2077-9

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  • DOI: https://doi.org/10.1007/s00104-011-2077-9

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