Possible causes of the disease and how it will progress, general information about the disease: Pilonidal sinus is popularly known as “hair rot”. It occurs when the hairs, which are located in the area just above the two hip cavities called the sacral region, or accumulate here and can come from different parts of the body, enter under the skin with the twisting movement and create a space for themselves here. Sometimes this space can become inflamed and form an abscess, if an abscess develops, severe pain occurs, and these abscesses can sometimes open spontaneously. Risk factors include obesity, excessive hairiness, excessive pressure or friction in this area, and being sedentary. It can occur at any age, but is most common in adolescence and young adults. Boys are more affected than girls. Pain is felt in the back first, and then a swelling may be noticed. Although the disease does not pose a life-threatening risk, it has a serious negative impact on the quality of life of the patient and his family. If the pilonidal sinus is not causing any problems, it is sufficient to keep the area clean and hair-free. To achieve this, the area must be shaved. A warm bath can reduce pain and the formation of an inflamed cavity. If the pilonidal sinus is inflamed, redness, pain and an infected-inflamed (abscess) swelling develops around the area. In such a case, it is appropriate to start antibiotics and painkillers immediately. It is necessary to open the abscess and drain the inflammation. If the pilonidal sinus continues to give symptoms, it means it’s time for surgery. If the pilonidal sinus is not causing any problems, it is sufficient to keep the area clean and hair-free. To achieve this, the area must be shaved. A warm bath can reduce pain and the formation of an inflamed cavity. If the pilonidal sinus is inflamed, redness, pain and an infected-inflamed (abscess) swelling develops around the area. In such a case, it is appropriate to start antibiotics and painkillers immediately. It is necessary to open the abscess and drain the inflammation. If the pilonidal sinus continues to give symptoms, it means it’s time for surgery. If the pilonidal sinus is not causing any problems, it is sufficient to keep the area clean and hair-free. To achieve this, the area must be shaved. A warm bath can reduce pain and the formation of an inflamed cavity. If the pilonidal sinus is inflamed, redness, pain and an infected-inflamed (abscess) swelling develops around the area. In such a case, it is appropriate to start antibiotics and painkillers immediately. It is necessary to open the abscess and drain the inflammation. If the pilonidal sinus continues to give symptoms, it means it’s time for surgery. In such a case, it is appropriate to start antibiotics and painkillers immediately. It is necessary to open the abscess and drain the inflammation. If the pilonidal sinus continues to give symptoms, it means it’s time for surgery. In such a case, it is appropriate to start antibiotics and painkillers immediately. It is necessary to open the abscess and drain the inflammation. If the pilonidal sinus continues to give symptoms, it means it’s time for surgery.
By whom, where, how and how the medical intervention will be performed:
This operation will be performed under local, spinal or general anesthesia by a pediatric surgeon in the operating room. The process usually starts with the cleaning of the area to be treated. This procedure is performed under local, spinal or general anesthesia. Surgical treatment of pilonidal sinus can be done by several methods.
a. Treatment of pilonidal abscess: First, the abscess is softened with antibiotics, pain relievers and sitz baths. Then the abscess is drained under local or general anesthesia and the hairs are cleaned. After that, drug treatment is continued, abscess has two options; either completely healed or become chronic. If it becomes chronic, surgical treatment is switched to options.
b. Phenol administration: The most applied conservative method consists of injecting phenol into the sinus. Phenol is a chemical agent with acidic properties. It has antiseptic, anesthetic and potent sclerosing (tissue adhesive) properties. While it is a white crystalline solid at room temperature, it turns into a liquid form at higher temperatures. In the treatment of pilonidal sinus disease, phenol is used in liquid or crystalline forms. In this method, the sinus mouth is widened and the contents are cleaned and all hairs are removed with a clamp. Then, 2-3 ml of 80% phenol is instilled into the pilonidal sinus while maintaining the healthy skin. The purpose of the method is to irritate the inner wall of the sinus cavity with the sclerosing substance, phenol, and to fill it with granulation tissue, that is, to ensure that the walls of the cavity adhere to each other. It can also be used in the recurrence of operations performed with other techniques.
c. Sinus excision and primary closure: It includes removal of the pilonidal sinus pocket and primary closure of the resulting cavity. A closed absorbent drain can be placed in the removed pilonidal sinus cavity, and the skin and subcutaneous tissues are closed with absorbable and non-absorbable sutures. Antibiotic-impregnated ointment gauze is placed on the suture line and non-absorbable sutures are tied to hold the ointment gauze in place. In this method, the patient does not need dressing. Postoperative, 10–12. Sutures are removed on days. Recovery time is usually 2 weeks. One of the advantages of this technique is the short recovery time and the fact that it does not require frequent dressings.
d. Limberg Flap Technique: For the Limberg flap, the incision borders are drawn in the form of a rhombus, provided that all sinus openings remain inside. On the side to be flapped, it is marked as a continuation of the rhombus and with the edges of the rhombus equal to it. The flap may be on either side of the rhombus, above or below. From the point of view of flap nutrition and cosmetics, the flaps that are rotated from below give better results.
e. LASER technique: In pediatric surgery, suitable patients are used in diseases of the anal region such as laser treatment, ingrown hairs, anal fistula and hemorrhoids. After cleaning the inside of the capsule in ingrown hairs, the channel or channels inside are burned with a laser with high burning and cutting power.
Estimated duration and success rate of the procedure: The duration of the operation is between 30-90 minutes under normal conditions, and this time may vary depending on the course of the operation and patient factors. Although the chance of success varies from patient to patient, it is 65% in phenol application, 78-99% in sinus excision and primary closure, and 90-98% in Limberg flap technique.
Benefits expected from the procedure: After the procedure, it is expected that the rectal discharge, swelling, redness and painful abscess and pilonidal sinus area will disappear and the disease will not recur.
Possible risks that may arise in case of rejection: Pilonidal sinus does not require emergency surgery. You can refuse to receive this treatment. Receiving this treatment is optional and if you refuse, there will be no change in the treatment given to you or in our behavior towards you in our clinic thereafter. However, if you refuse the treatment, your complaints will continue in the same way. However, if you do not have surgery, the gap may enlarge. As a result of this growth, abscessing and opening of the abscess to the skin from different points may occur. In this case, emergency surgery may be required. In addition, such a delay may lead to larger tissue removal in the future surgery and an increase in the incidence of surgical complications.
Other diagnosis and treatment options and the benefits and risks of these options and their possible effects on the patient’s health: The alternative to the procedure is sitz bath, local and systemic antibiotics. However, the chance of definitive treatment of the disease with this medical treatment is very low. In addition to the phenol application described above, cauterization of the cavity, silver nitrate, 80-90% alcohol and fibrin glue can also be used for this purpose. There are many defined surgical techniques, but they do not have a clear advantage over each other.
Possible complications of the procedure
Risks of the surgery and possible complications
No life-threatening complications are expected during and after the surgical treatment of this disease. However, in very rare cases, the following situations are possible.
General and Anesthesia-Related Complications:
a. Atelectasis: Small areas of collapse can occur in the lungs, which can increase the risk of lung infection. This may require antibiotic therapy and physiotherapy.
b. Difficulty in intubation and necessity of tracheostomy: If the tube that needs to be placed from the mouth to the trachea for anesthesia cannot be inserted, it may be necessary to insert this tube (tracheostomy) through an incision made in the anterior part of the throat when necessary. This tube may need to be left on for a while after surgery, and some problems with this tube may develop over time.
c. Both local and general anesthesia carry some general risks. Any type of general anesthesia or sedation (sedation) has the potential to lead to the following complications (adverse outcome), albeit very rarely.
i. Clots in the legs (deep vein thrombosis) can cause pain and swelling. Rarely, some of these clots break off and go to the lungs and can be fatal.
ii. Heart attack may develop due to increased heart load.
iii. Bowel movements may slow down or stop completely after surgery. This can cause bloating and vomiting as a result of fluid accumulation in the intestine. May require treatment
iv. Death may occur due to the procedure. This can cause bloating and vomiting as a result of fluid accumulation in the intestine. May require treatment.
**For information about anesthesia and its risks, see the “about anesthesia” information pages. If you have any concerns, you can talk to your anesthetist about the issue. If the information sheet has not been given to you, please request one.
Complications of the surgery:
a. Bleeding: There may be bleeding in the surgical area during and after the operation.
b. Infection: While there may be regional infections, the infection may enter the blood and become a fatal infection that spreads throughout the body and does not respond to antibiotics.
c. Opening the surgical field: In this case, no intervention is made, the tissue is expected to close to its own cat within a few weeks.
d. Scarring: Although care is taken to leave a minimum scar, there will be scars in the incision area depending on the patient’s own genetic structure.
e. Seroma: Lymph fluid may accumulate at the operation site, it is either expected to be self-absorbed or drained with an injector.
f. Recurrence of the disease: There is a 2-30% probability. Recurrence of the disease at the surgery site can be seen in the first year or later. If there is discharge, redness, swelling and pain in the wound, close monitoring and dressing in the surgical center are required. Phenol application or a second surgery may be required 6 months later.
Lifestyle recommendations that are critical for the patient’s health: After the operation is completed, your child can return to his normal life. The patient is free to walk, sit on the wound, and lie on his back. The patient can leave the hospital the same day or the next day, depending on the type of surgery performed.
The drugs to be used after the procedure and important features: Depending on the course of the surgery, your doctor will give you oral antibiotics for the first five days during the recovery period, nonsteroidal anti-inflammatory or paracetamol group pain relievers and stool softeners as painkillers, and locally applied creams and pomades to be applied to the wound area. can give. Closed dressing is applied for up to a week. After a week, the dressing can be removed and bathing is allowed. After two weeks, the stitches are removed and the patient can continue his work. The hair in the entire neck, back, hips and anus area should be cleaned using depilatory creams or laser epilation every 15 days for 3 months, the first 15 days after the operation. Since recovery will take weeks, active sports and activities that will keep the area moist should be restricted. There is no harm in walking and doing light exercises.
If I am pregnant, I have been informed that my unborn child carries a risk during examination/medical intervention/treatment/surgery and anesthesia procedures, primarily radiological procedures. I do not have a missed period or pregnancy.
PATIENT’S CONSENT
I was given the above detailed information about my disease and the planned intervention, and the possible complications and risks were fully explained. I was informed that if these develop, treatments, including surgery, may be required, but in some cases, complete cure or recovery cannot be achieved. I accept the implementation of the above-mentioned intervention and other additional interventions that may be required as a medical necessity during the intervention.
to this section;
The statement “I READ, I UNDERSTOOD, I GOT A COPY” written in the patient’s or Legal Representative’s own handwriting will be written..……………………………………………………………………………………..……………………
TO BE FILLED BY THE PATIENT:
Date of Consent:……………………………
Time :………………………………………………
Signature:…………………………………………………………………………………………
Patient’s (guardian or guardian for restricted and minors) Name and surname:……………………………
TO BE FILLED BY THE DOCTOR INFORMING THE PATIENT AND TAKING THE PATIENT’S CONSENT:
Title, Name and Surname of the Physician Receiving Consent:…………………………………………………..
Signature:……………………………………………………………………………………………
TAKING MEDICAL INTERVENTION
Name Surname Title:……………………………………………………………………..
Signature:……………………………………………………………………………………