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Surgical Treatment of Chronic Pilonidal Disease

Elmira Daskalova, Slavimir Lavchev, Danko Penchev, Bogomil Borisov, Ismail Crunkov, Mustafa Barzev, Kiril Draganov


Introduction: Pilonidal disease is a relatively common surgical disease affecting mainly young men aged 15–35 years (almost 4 times more than women) and with a tendency to increase its prevalence in the last two decades, including also among women.
Although many surgical treatment methods have been described, the rate of recurrence and complications related to wound healing remain relatively high (17.5% and 11.6%, respectively, according to literature data) and worsen the quality of life of the patients for a long period of time.
Material and Methods: For a 10-year period, from 2012 to 2022, 235 patients with an average age of 42.1 years were operated on for a pilonidal cyst in the Clinic for Hepatobiliary, Pancreatic and General Surgery of Acibadem City Clinic Hospital Tokuda. In 37.4% of them, surgical treatment was due to recurrence.
Results: In all patients, after verification of the fistula course(s) with methylene blue and/or a ball probe, a sheet-like excision of the formation was performed. In 24 of the cases (10.2%), transposition with a Limberg flap followed; 118 patients (50.2%) were treated according to the so-called open method, and in 93 patients the resulting defect was closed primarily with imposed drainage.
Conclusion: The ideal therapeutic approach should provide a short recovery period with the possibility of a quick return to normal daily life. Currently there is no consensus on the best operative technique.


pilar/pilonidal cyst, Limberg flap, sacrococcygeal pilonidal cyst disease

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About The Authors

Elmira Daskalova
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Slavimir Lavchev
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Danko Penchev
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Bogomil Borisov
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Ismail Crunkov
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Mustafa Barzev
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

Kiril Draganov
Clinic of Hepatobiliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

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