The results of treatment of pilonidal sinus disease, complicated by acute abscess, with operation Bascom I

Abstract

Introduction. Pilonidal disease of the sacrococcygeal region is one of the most common disorders requiring surgical treatment in the general surgery or proctology unit departments.

Objective. To evaluate results of the minimally invasive surgical treatment (Bascom I operation) of pilonidal cyst complicated with acute abscess.

Method and Materials. 114 patients with pilonidal disease complicated with acute abscess underwent minimally invasive Bascom I operation. In all patients 2-step treatment was applied: delayed curative Bascom I operation after the surgical debridement of acute pilonidal abscess. All patients were divided into 3 groups depending on the method of the surgical debridement: group I — patients after standard incisive debridement of acute pilonidal abscess (opening, sanitation and drainage) (52 patients or 45.6%), group II — patients after the abscess drainage puncture (34 patients or 29.8%), group III — patients treated by our proposed method of the low-frequency (25 kHz) ultrasound debridement of pilonidal abscess using the low-frequency ultrasound (28 patients or 24.6%).

Results and Discussion. Mean duration of in-patient treatment in subjects after the standard incisive debridement of acute pilonidal abscess as a first step (group I) was 5.1±0.49 days. Mean duration of out-patient treatment was 10.6±0.94 days, and duration of temporary total disability was 15.7±1.45 days. Mean duration of in-patient stay in subjects after the pilonidal abscess drainage puncture as a first step (group II) was 2.7±0.25 days, mean duration of out-patient treatment was 18.8±1.79 days, and duration of temporary total disability was 21.5±2.09 days. Mean duration of in-patient stay in subjects after the ultrasound debridement of pilonidal abscess using the low-frequency ultrasound as a first step (group III) was 1.4±0.13 days, mean duration of out-patient treatment was 10.9±0.87 days, and duration of temporary total disability was 12.3±0.84 days. Thus, the mean duration of in-patient treatment was significantly (Т > 4,36; Р < 0,001) higher in group I subjects after the standard incisive debridement of acute pilonidal abscess since treatment in subjects of group II and group III was out-patient. The mean duration of out-patient treatment was significantly (Т > 3.97; Р < 0.001) higher in group II subjects after the acute abscess drainage puncture. Hence, the lowest duration of temporary total disability per case of treatment was in group III patients.

In patients after the curative Bascom I operation reported 25 (21.9%) cases of post-operative complications, including 9 (17.3%) in group I, 12 (35.3%) in group II, and 4 (14.3%) in group III. In total, after the Bascom I operation reported 14 (12.3%) cases of post-operative wound infection, 1 (0.9%) case of primary wound dehiscence before the removal of sutures, 3 (2.6%) cases of secondary wound dehiscence after the removal of sutures, 4 (3.5%) cases of post-operative wound hematoma, and 3 (2.6%) cases of disease relapse. During the statistical analysis of post-operative complications frequency, the significant difference (χ² = 6,31; Р = 0,04) was demonstrated only for the frequency of post-operative wound infection due to different methods of surgical debridement.

Conclusions. Bascom I operation is a method the minimally invasive surgical treatment of pilonidal cyst complicated with acute abscess allowing elimination of primary cause of this disease as per theory of acquired origin of pilonidal cyst.

The combination of proposed low-frequency ultrasound debridement of pilonidal abscess and Bascom I operation has been demonstrated as an effective method of curative surgical treatment of the pilonidal cyst. This method allowed to reduce duration of temporary total disability up to 12.3±0.84 days and the mean duration of in-patient treatment to be 1.4±0.84 days. The proposed method of low-frequency ultrasound debridement of pilonidal abscess allowed statistically significant reduction of frequency of post-operative wound infection to 1.9% (Р=0.04) vs. incisive debridement or abscess drainage puncture. Bascom I operation in acute abscess of pilonidal cyst allowed achieving the post-operative relapse rate as low as 0.9%.