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PILONIDAL SINUS

Peter WysockiGeneral Surgeon

Logan HospitalSunnybank Private Hospital, Brisbane, Australia

MorphologyTerminology

Patey and Scarff in 1946 reported a pilonidal sinus in a 31 year old barber’s hand which resulted in congenital theory being abandoned

PATEY DH, SCARFF RW. Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet. 1946 Oct 5;2(6423):484‐6.

ACQUIRED

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

TERMINOLOGY

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

Primary Unhealed Recurrent

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

PRIMARY: midline only

PRIMARY: secondary

UNHEALED

RECURRENT

?PILONIDAL and HIDRADENITIS

1. loose hair enters

2. hair + seropurulentdischarge

Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition Philip H . Gordon and Santhat Nivatvongs. CRC Press 2007 Print ISBN: 978‐0‐8247‐2961‐5eBook ISBN: 978‐1‐4200‐1799‐1

MECHANISM

Karydakis, 1992

Tech Coloproctol (2017) 21:905–906https://doi.org/10.1007/s10151‐017‐1702‐0

Due to friction hair migrates in leading with the root end

Page BH. The Entry of Hair into a Pilonidal Sinus. Br J Surg. 1969 Jan;56(1):32.

International Journal of Cosmetic Science, 2015, 37, 312–320  doi: 10.1111/ics.12201

Hair x

Forcex

Vulnerability

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

Source of hair in 14 pilonidal sinuses: – 71% head– 64% buttocks– 57% lower back

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

CLASSIFICATION

TREATMENT

2nd International Pilonidal Sinus Disease Conference28th September 2019, Vienna

VIENNA September 28, 2019QUESTIONS ?