Retrospective analysis of risk factors according to the staging system in Pilonidal Sinus patients

Aim: Pilonidal sinus disease is a surgical disease that usually occurs in young men with sinus tracts in natal cleft. There are also risk factors such as obesity, family history, and hairy body structure and body hygiene. The stage of the disease is also an effective factor in treatment planning. In our study, we performed a retrospective analysis according to the staging system of the patients we operated for pilonidal sinus. Materials and Methods: A total of 159 patients who were operated with the diagnosis of pilonidal sinus between July 2016 and August 2017 were included in the study. The patients were evaluated according to the staging system in terms of age, gender, length of stay, body mass index (BMI), history of abscess drainage, duration of complaints, family history and morbidity. Results: The patients were between 18-43 years old. The mean age was 23,0. 130 (81.8%) of the cases were male and 29 (18.2%) were female. Number of patients with stage I was 35, number of patients with stage IIA was 49, number of patients with stage IIB was 18, number of patients with stage III was 44, number of patients with stage IV was 3 and number of patients with stage R was 10. Statistically signifi cant correlation was found between disease stage and BMI, duration of complaints, family history and duration of hospitalization (p<0,05). Statistically signifi cant correlation wasn't found between disease stage and age and morbidity (p>0,05). Conclusions: BMI, duration of complaints and family history effect the stage of pilonidal sinus disease. Also the increasing stage of the disease is prolonged hospital stay. Research Article Retrospective analysis of risk factors according to the staging system in Pilonidal Sinus patients Abdullah Senlikci1*, Murat Baki Yildirim2 and Ramazan Guven3 1Turkey High Specialization, Training and Research Hospital, Gastroenterology Surgery Clinic, Ankara, Turkey 2Corum Hitit University, General Surgery Clinic, Corum, Turkey 3Department of Emergency Medicine, Kanuni Sultan Suleyman Training and Research Hospital University of Health Science, Istanbul, Turkey Received: 13 December, 2018 Accepted: 30 December, 2018 Published: 31 December, 2018 *Corresponding author: Senlikci A, et al. head of surgical departments, Infection Control Department, Aljalla Hospital Trauma, Benghazi Libya, Libya, Email: khaledelgazwi@yahoo.com


Introduction
Pilonidal sinus is a common surgical disease, referring to a midline sinus in the natal cleft. It is related with risk of infection, abscess formation and a high recurrence rate [1]. Although it is asymptomatic in some cases, it may be a chronic, complicated, multiple sinus tract and leading to severe impairment of patient quality of life [2]. The name of the disease comes from the Latin, meaning nest of hair. This condition is also known as jeep disease because it is frequently observed among jeep drivers during World War II [3]. Various noninvasive and surgical methods have been developed for treatment. However, many postoperative complications and recurrences are observed.
Male gender, obesity, smoking, family tendency, poor body hygiene, sinus size, and the surgical procedures performed have been confi rmed as primary risk factors for postoperative complications and recurrence [4]. In this study, we aimed to evaluate the factors affecting the pilonidal sinus disease with a staging system retrospectively.

Materials and Methods
A total of 159 subjects who were operated with the diagnosis of pilonidal sinus between July 2016 and August 2017 were included in the study. The study was performed according to patient anamnesis. The study is a retrospective study. We got permission from hospital management for study. All subjects were operated by two general surgeons. All subjects were operated with spinal anesthesia. Subjects with no additional disease were included in the study. Subjects were evaluated with staging system which developed by Guner et al. [2]

Discussion
Pilonidal sinus disease is a common surgical disease that usually occurs in young population. The reason for this is that the sex hormone secretion is more at young ages and increase in the activity of pilosebaceous glands [1]. In the study of Kaymakcioglu et al., 70% of patients were in the 20-30 age range [5]. The mean age was 23,0 in our study.    The staging system can be used to generate a stage-specifi c treatment system and to determine the prognosis of the disease. According to study of Güner et al., pit picking in stage 1 and 2A patients, Bascom Cleft Lift technique (BCL) in stage 2B and 3 patients, modifi ed BCL in stage 4 patients, limberg fl ap in stage 4 patients and BCL or modifi ed BCL technique in stage R patients should be used [2].
When the risk factors for pilonidal sinus are evaluated; A study by Harlak et al., found that sitting time was a risk factor for pilonidal sinus. In the same study, the family history is not a risk factor for pilonidal sinus [3]. In the study of Sondenaa et al., family history was observed in %38 of patients [6]. In the study of Doll et al., the family history increases the risk of pilonidal sinus development and increases the risk of recurrence [7]. Our study shows that the family history is effective on the pilonidal sinus stage. As the disease stage progresses; length of stay and cost of disease increases, the patients length of return to work prolongs [2]. In our study, the relationship between hospitalization time and stage was shown.
There are studies in literature about the effects of obesity in pilonidal sinus and on treatment of pilonidal sinus. Cubukcu et al., showed that obesity increases the risk of recurrence of pilonidal sinus disease [8]. In a study of Balik et al., with 125 patients and 125 control groups, subcutaneous fat tissue of the patient group was shown to be thicker [9]. The depth of the intergluteal sulcus may vary according to obesity or body characteristics of the person. The depth of the intergluteal sulcus can affect the amount of loose hair collected in it [3]. In our study, obesity affects the stage of pilonidal sinus.
As a result; pilonidal sinus staging systems are used in the planning of pilonidal sinus treatment. BMI, duration of complaints and family history are effective on the stage of pilonidal sinus disease. Also the increasing stage of the disease is prolonged hospital stay. We should use the staging system for the management of the disease. We think the staging system is useful.