Pilonidal Sinüs Tedavisinde Geleneksel ve Güncel Yaklaşımlar
Özet
Pilonidal sinüs hastalığı (PSH), sakrokoksigeal bölgede kıl batmasıyla gelişen, kronik ve iş gücü kaybına neden olan edinsel bir enfeksiyondur. Uzun süre oturma, kıl yoğunluğu ve yetersiz hijyen risk faktörleri arasındadır. Hastalığın yönetiminde akut durumlarda insizyon ve drenaj uygulanırken, kronik dönemde cerrahi ve minimal invaziv tedavi alternatifleri mevcuttur. Cerrahi yaklaşımlar arasında eksizyon sonrası sekonder iyileşme, primer kapama ve flep yöntemleri (Bascom, Karydakis, Limberg, Z/VY-plasti) yer alır. Primer kapamada oblik kesiler, orta hat kesilerine göre daha düşük nüks riski taşır. Flep yöntemleri arasında özellikle Bascom yarık kaldırma ve Karydakis prosedürleri, intergluteal oluğu ortadan kaldırarak ve sütur hattını lateralize ederek 10 yıllık takipte en düşük nüks oranlarını (%2.7) sunmaktadır. Limberg flep de etkin bir yöntem olup primer tekniklere göre daha avantajlıdır. Son yıllarda fenol uygulaması, lazer ve endoskopik pilonidal sinüs tedavisi (EPSiT) gibi minimal invaziv yöntemler, kısa işe dönüş süreleri ve düşük komplikasyon oranlarıyla öne çıkmaktadır. Ancak, yaygın ve komplike kistlerde cerrahi tedavi halen temel seçenek ve en güvenilir çözüm olmaya devam etmektedir.
Pilonidal sinus disease (PSD) is an acquired chronic infectious condition occurring in the sacrococcygeal region that reduces quality of life and causes workforce loss, with risk factors including prolonged sitting, high hair density, and poor hygiene. While incision and drainage are performed for acute abscesses, treatment of chronic cases involves traditional surgical or contemporary minimally invasive methods. Surgical approaches include excision with secondary healing, primary closure, and various flap techniques such as Bascom cleft-lift, Karydakis, Limberg, and Z/VY-plasty. Off-midline (oblique) incisions in primary closure provide lower recurrence rates compared to midline closures. Among flap procedures, Bascom cleft-lift and Karydakis operations yield the lowest 10-year recurrence rate (2.7%) by flattening the intergluteal sulcus and lateralizing the suture line. Phenol application, laser therapy, and Endoscopic Pilonidal Sinus Treatment (EPSiT) have emerged as successful minimally invasive alternatives that offer shorter recovery times and minimal morbidity. However, complex and extensive cases still strictly require definitive surgical interventions for long-term success.
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