Anatomy - Excision of pilonidal sinus with secondary healing - general and visceral surgery

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  • Pathophysiology

    For over a hundred years, the etiology and pathogenesis of pilonidal sinus was considered embryonic. This theory, however, has now been abandoned. To this day, the pathogenesis has not yet been fully understood. At present, a multifactorial etiology is presumed. According to this hypothesis, pilonidal sinus develops as a dimple in the anal cleft (rima ani) directly above the coccyx. Mechanical strain, especially when sitting (jeep driver's disease), may result in stretching of hair follicles, which eventually tear. Constant maceration paves the way for the infiltration of pathogens and especially broken hair, which then leads to acute or chronic inflammation. The pasty soft mass burrows into the sides, and in extreme cases to the anus, via a multi-sinusal fistula system.

    One or more of the following are regarded as risk factors in the formation of pilonidal sinus:

    • Excessive hair
    • Deep gluteal fold (obesity)
    • Local irritation
    • Poor personal hygiene
    • Positive family history

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