80 - Freie Mitteilung
3. Juni 2022, 08:30 - 10:00, Panorama 1


Diagnosis and management of presacral fasciitis as underlying reason for recurrent pilonidal sinus disease. An innovative 3-step treatment approach
S. Kreuzer, A. Bruhin, S. Haller, A. Galanti, A. Scheiwiller, J. Metzger, J.-M. Gass, Presenter: S. Kreuzer (Lucerne)

Pilonidal sinus disease (PSD) is a common condition in young patients, affecting a relevant part of the working population, with significant socioeconomic impact. After initial surgical treatment the reported recurrence rate varies from 2 to 35 percent. As the reported observation periods in literature are often short, longterm recurrence rate might even be underestimated. In recurrent disease the underlying pathomechanism seems to be different. From MRI studies we assume an involvement of the presacral fascia and thus a different more intensive surgical treatment strategy is mandatory. The aim of this study was to evaluate MRI scan for the diagnosis of presacral fasciitis as underlying cause for recurrent PSD and to establish a 3-step surgical therapy.
A retrospective analysis of prospectively collected data of patients with recurrend PSD or persistent coccydynia scheduled for MRI was performed. Main interest was the involvement of the presacral fascia. If a presacral fasciitis was present an intensive treatment with a novel 3 step therapy concept was started: radical surgical resection, targeted antibiotic therapy and local antiseptic treatment with irrigation negative pressure therapy.
From November 2019 to October 2021 a total of 12 patients was included (3 patients presented with coccydynia and 9 patients with multiple recurrent PSD). After MRI an involvement of the presacral or precoccygeal fascia as well as a fistula from the scar tissue to the tailbone could be demonstrated. Periostal reaction was described in 3 MRIs. 3 patients presented with an osteomyelitis of a coccygeal vertebral bone. Considering this issue, we introduced our 3-step therapy concept mentioned above. Until abstract deadline 9 patients underwent treatment with uneventful postoperative course. Healing was finished without complications.
We suppose that presacral fasciitis is a frequent condition for the recurrence of PSD. To prevent further recurrence, the treatment of fasciitis is essential. Diagnosis can easily be proven with sacral MRI. Thus we recommend a combined 3 step therapy consisting of sinus excision, adapted antibiotic therapy and irrigation negative pressure therapy. Larger randomized controlled studies to support our hypothesis and the results of the treatment concept in this case series are needed.
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