Authors
Korablina S.S.1, 2, Lavreshin P.M.1, 2, Gobedzhishvili V.K.1, Vladimirova O.V.1, 2, Gobedzhishvili V.V.3, Hurcaev D.B.1, Uzdenov M.B.4, Kochkarov E.V.4
1 Stavropol State Medical University, Stavropol
2 City Clinical Hospital №2, Stavropol
3 I.M. Sechenov First Moscow State Medical University, Moscow
4 North Caucasian State Academy, Cherkessk
Abstract
Rationale: Coccygeal sinus in mass population survey is observed in 0.5-1% of people under 30–35 years of age. Currently a large number of surgery modifications are proposed, but the results of treatment do not satisfy surgeons and coloproctologists; 6–30% of operated patients have early postoperative complications, from 5 to 24% — recurrences of the disease; 6–17% — hypertrophic scars. Therefore, the search for solutions aimed at their prevention is relevant and timely.
Purpose: Improving the surgical treatment results of patients with coccygeal sinus without clinical manifestations and in remission by developing a method of surgery, optimizing the treatment of patients in the preoperative and postoperative periods.
Materials and methods: The blood supply and innervation of the sacrococcygeo- gluteal region were studied in 15 troupes. The data of examination and treatment of 156 patients with the pathology studied in this work are presented. The observed patients were divided into two groups of equal age, gender composition, and pathology. The comparison group (control group) consisted of 78 patients who underwent traditional excision of the coccygeal sinus and wound suturing with Donati vertical mattress sutures.
When choosing a treatment method for 78 patients of the main group, the topographic-anatomical relationship of the coccygeal-sacral-gluteal region structures, the peculiarities of its blood supply, and the predisposition to pathological scar formation were taken into account. Preoperative preparation of patients has been improved. Modifications of operations and therapeutic measures have been developed aimed at improving blood supply to the wound area and preventing pathological scarring.
Results: In the early postoperative period, 17 (21.8%) complications were detected in patients of the control group, and 4 (5.1%) complications in the main group. The long-term results of treatment were traced in the period from 6 months to14 years. Recurrence of the disease occurred in 11 (14,1%) patients in the control group, in the main group — in 2 (2,5%) operated patients. In 18 (81,8%) out of 22 (28,2%) patients with a tendency to pathologic scar formation it was possible to prevent its development by carrying out anti-scarring therapy.
Conclusions: In the treatment of patients with coccygeal sinus without clinical manifestations and in remission, a thorough preoperative preparation aimed at the destruction of microbial flora in the area of the proposed surgical intervention is necessary. The methods of surgery are proposed, taking into account the topographic-anatomical structure of the coccygeal-sacroiliac-gluteal region. Formation of the intergluteal fold along the entire length after suturing the wound provides better care for it. The use of intradermal suture does not disrupt the blood supply in the area of the wound edges, prevents the wicking properties of the suture material. The use of physiotherapeutic and medications in the postoperative period improves blood supply in the wound, increasing the regenerative processes of tissues. The proposed predictors of pathologic scar formation allowed to determine the group of patients with predisposition to its development and to carry out timely therapy for them, obtaining a good functional and cosmetic effect.
Keywords: coccygeal sinus, pathologic scar formation, coccygeo-sacrogluteal region, blood proteins.
References
1. Sergatskiy KI, Nikol'skiy VI, Yangurazov RF, et al. Surgical aspects of the treatment of epithelial pilonidal cyst: from primary sources to the present. Izvestiya vysshikh uchebnykh zavedeniy. Povolzhskiy region. Meditsinskie nauki. 2022; 2: 92-106. (In Russ.) doi: 10.21685/2072-3032-2022-2-10.
2. Wu, et al. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. International Journal of Surgery. 2023; 109(8): 2388-2403. doi: 10.1097/JS9.0000000000000447.
3. Atak T. Primary closure method after asymmetrical excision of the pilonidal sinus treatment: A retrospective cohort study. J Surg Med. 2023; 7(9): 564-567. doi: 10.28982/josam.7904.
4. Rhiannon LH, Abdullah A, et al. Management of sacrococcygeal pilonidal sinus disease. International Wound Journal. 2019; 16(2): 370-378.
doi: 10.1111/iwj.13042.
5. Tuba A. Primary closure method after asymmetrical excision of a pilonidal sinus treatment: A retrospective cohort study. J Surg Med. 2023; 7(9): 564-567. doi: 10.28982/josam.7904.
6. Nechai IA, Bozhchenko AA, Maltcev NP, et al. Surgical treatment of pilonidal disease with the use of «closed» techniques. Vestnik khirurgii im. I.I. Grekova. 2022; 181(2): 33-38. (In Russ.) doi: 10.24884/0042-4625-2022-181-2-33-38.
7. Vladimirova OV, Lavreshin PM, Minayev SV, et al. The experience of application of antiscar combined agent with boswellic and hyaluronic acids and cepalin in patients with scars at early stages of their development. Ambulatornaya khirurgiya. 2019; 1-2: 140-145. (In Russ.) doi: 10.21518/1995-1477-2019-1-2-140-145.
