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      Endoscopic pilonidal sinus treatment (E.P.Si.T.): a minimally invasive approach Translated title: Tratamento endoscópico do cisto pilonidal (E.P.Si.T.): Uma abordagem minimamente invasiva

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          Abstract

          INTRODUCTION: The pilonidal cyst is a chronic inflammatory process that occurs frequently in the sacrococcygeal region. It is more common in males with a ratio of 3:1 and usually presents itself in the third decade of life. The treatment is mainly surgical with various forms. The search for new technologies as well as for a minimally invasive treatment has become of utmost importance in surgical routines. The technique E.P.Si.T. (endoscopic treatment of pilonidal cyst) developed by Meneiro has been quite interesting in the treatment of pilonidal cysts. SURGICAL TECHNIQUE: Anesthetized the patient in the supine position. Identified the drainage hole of the cyst, and began with the passage of fistuloscope studying the path of the cyst. Performs following the removal of all the tissue inside as the hair followed by cauterization of the path. Removed all devitalized tissue and enlargement of the opening of the cyst.

          Translated abstract

          INTRODUÇÃO: O cisto pilonidal é um processo inflamatório crônico que ocorre com frequência na região sacrococcígea. É mais comum no sexo masculino com proporção de 3:1 e mais presente na terceira década. O tratamento é eminentemente cirúrgico com diversas formas de realização. A busca de novas tecnologias bem como o tratamento minimamente invasivo se tornou prioridade máxima nas rotinas cirúrgicas. A técnica do E.P.Si.T (Tratamento endoscópico do cisto pilonidal) desenvolvida por Meneiro tem se mostrado bastante interessante no tratamento dos cistos pilonidais. TÉCNICA CIRÚRGICA: Paciente em decúbito dorsal sob anestesia. Identifica o orifício de drenagem do cisto, e inicia com a passagem do fistuloscópio estudando o trajeto do cisto. Realiza a seguir a remoção de todo o tecido no interior como os fios de cabelo seguido da cauterização do trajeto. Removido todo o tecido desvitalizado e ampliação da abertura do cisto.

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          Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision.

          T Mahdy (2008)
          Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group I, n = 20 patients) or excision and flap reconstruction (group II, n = 40 patients; modified Limberg flap n = 20, classic Limberg flap n = 10 and adipo-fasciocutaneous flap n = 10). Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Mean follow-up was 21 months. A significant difference was observed between the two groups in terms of length of hospital stay (P < 0.003), time to complete healing (P < 0.001), time off work (P < 0.001), wound infection (P < 0.01), recurrence rates (P < 0.01), times to sitting on toilet without pain (P < 0.002), and walking without pain (P < 0.001). The mean (standard deviation) postoperative visual analog scale scores were 6.1 (1.2) in the primary closure group vs. 7.4 (1.3) in the flaps groups (P < 0.001). In the modified Limberg flap, no wound infection, wound breakdown, or recurrence of the disease occurred. Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence.
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            Surgical treatment of pilonidal disease.

            J Bascom (2008)
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              Sacrococcygeal pilonidal disease.

              The ideal treatment for pilonidal disease remains controversial with many accepted procedures in current clinical use. This case series is focused on the results of the Bascom procedure for the treatment of sacrococcygeal pilonidal disease. The records of 127 consecutive patients treated by the authors for sacrococcygeal pilonidal disease were reviewed. The Bascom surgical procedure was performed on 127 consecutive patients in a clinical surgical practice. The series included 98 male and 29 female patients. The mean age of the patients reported in this series was 23 years, with a range of 14 to 49 years of age. The lateral incision healed in a mean of 12 days, with a range of 8 to 30 days. Recurrent disease occurred in 3 patients in this series. The Bascom surgical procedure for the treatment of sacrococcygeal pilonidal disease was found in this clinical practice series to have an excellent cure rate with a low recurrence rate. Patient satisfaction was high.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jcol
                Journal of Coloproctology (Rio de Janeiro)
                J. Coloproctol. (Rio J.)
                Sociedade Brasileira de Coloproctologia (Rio de Janeiro )
                2317-6423
                March 2015
                : 35
                : 1
                : 72-75
                Affiliations
                [1 ] Santa Casa de Misericórdia da Bahia Brazil
                [2 ] Hospital Geral Roberto Santos Brazil
                [3 ] Sociedade Brasileira de Coloproctologia Brazil
                Article
                S2237-93632015000100072
                10.1016/j.jcol.2015.01.007
                6aceda14-ada1-4112-bf37-e0233c09efbb

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=2237-9363&lng=en
                Categories
                GASTROENTEROLOGY & HEPATOLOGY
                SURGERY

                Gastroenterology & Hepatology,Surgery
                Pilonidal disease,Pilonidal sinus,Fistuloscope,Doença pilonidal,Cisto pilonidal,Fistuloscopio

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