Sinus pilonidalis – was ist die beste chirurgische Therapie?

Zusammenfassung

Einleitung Der Sinus pilonidalis ist eine meist chronische punktuelle Infektion der behaarten Haut im Bereich von Hautfalten mit der häufigsten Lokalisation im Bereich der Rima ani. Die Erkrankung hat oft erhebliche Auswirkung auf die Lebensqualität der Betroffenen, die Behandlung kann komplex sein und muss dem Patientenbedarf angepasst werden.

Methoden Im Folgenden wird eine Übersicht über die Entstehung sowie die Behandlungsalternativen und deren Besonderheiten gegeben. Dabei werden jeweils die Aspekte frühe postoperative Ergebnisse, Wundheilungsstörung und Langzeitergebnisse dargestellt.

Ergebnisse Der Pathomechanismus der Pilonidalsinus-Erkrankung ist weiterhin nicht abschließend geklärt, es muss auch weiterhin davon ausgegangen werden, dass die Haare in der Rima ani wesentlich zu Entstehung beitragen. Neuere Erkenntnisse weisen jedoch darauf hin, dass die großen Haarbüschel, die immer wieder in der Wundhöhle gefunden werden, am ehesten von der behaarten Kopfhaut stammen. Es lassen sich im Wesentlichen 3 Gruppen der Behandlungsoptionen unterscheiden: Die Standardbehandlung der Exzision und die folgende offene Wundbehandlung hat eine geringe Rezidivrate, weist jedoch erheblichen Aufwand im Rahmen der Wundbehandlung auf und führt dadurch zu langer Krankheitsdauer. Relativ neu in den Fokus geraten sind die lokal destruierenden Behandlungsverfahren, welche die Haut im Wesentlichen erhalten. Wichtige Vertreter sind das sog. Pit Picking, Fistuloskopie und andere Behandlungsformen wie Phenolinjektion oder Laserbehandlung. Bei diesen Behandlungsmöglichkeiten steht die abschließende Bewertung der Ergebnisse noch aus. Die 3. Behandlungsgruppe umfasst die Exzision und plastisch-rekonstruktive Verfahren. Diese Verfahren sind technisch aufwendig, gehen häufig mit stationärer Behandlung einher und führen langfristig jedoch zu relativ guten Ergebnissen.

Schlussfolgerung Die Pilonidalsinus-Behandlung erfordert eine am Patienten orientierte Therapieplanung. Dabei müssen dem Patienten die unterschiedlichen Behandlungsoptionen vermittelt werden und eine Behandlungsempfehlung muss ausgesprochen werden. Hier dient die Exzision und offene Wundbehandlung weiterhin als Standardverfahren, anhand dessen die Vor- bzw. Nachteile der anderen Behandlungsoptionen vermittelt werden können.

Abstract

Introduction Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patientʼs needs.

Methods Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results.

Results The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term.

Conclusion Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.

Schlüsselwörter

Abszess - Sinus pilonidalis - Chirurgie - Wundheilung - Rezidiv

Key words

abscess - pilonidal sinus - surgery - wound healing - recurrence

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