The success of a pilonidal fistula surgery depends on the removal of the entire inflammatory tissue including all fistulas and cysts. If not all parts of a fistula are removed, this can lead to a relapse and the fistula occurs again. The extent of the fistula system is also decisive for the selection of the surgical procedure.
See, touch, colour
Usually, the extent of a pilonidal fistula is only clarified by a clinical examination. This means that the surgeon orientates himself on the externally recognizable fistula openings and palpates the region for swelling or hardening. A dye (methylene blue) is often injected through a fistula opening immediately before the surgical procedure, in the expectation that it will stain all the fistula ducts and cysts so that they can be caught during the surgery.
However, the dye method is not reliable. Not all fistula ducts can be coloured; cysts may also be present which are not connected to the fistula system and thus escape the colour marking. Occasionally it happens that a cyst filled with dyestuff bursts due to the pressure during the injection, which spreads it over the entire surgical area. Then a distinction between healthy and diseased tissue is no longer possible, with the result that the operation is unnecessarily extended or fistula remains and cysts are left behind.
Advantages of ultrasound examination of the pilonidal fistula
The exact identification of the entire fistula system including the pilonidal cyst can be achieved very well with an ultrasound examination. This finding is not necessarily new, but the ultrasound examination of the pilonidal fistula and cysts is rarely carried out.
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Sinus pilonidalis im Ultraschall (c)
MVZ St. Marien Köln
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Already nearly 10 years ago the advantages of the ultrasonic investigation could be proven with a study. In this examination, 73 patients were first presented to the surgeon, who after his examination marked the supposed extent of the pilonidal fistula on the patient's skin with a coloured pencil. During the subsequent ultrasound examination, fistulas and cysts beyond the mark were discovered in 17 patients (23.3 %), which the surgeon had missed during his examination.
In 14 patients, the surgeon had to correct the extent of the tissue to be surgically removed accordingly. In 2 patients, instead of the originally planned simple excision of the fistula system, a Limberg plastic was performed and the wound was left open in one patient.
The study thus proved that an ultrasound examination is highly recommended in the interest of the patient before planning the operation of a pilonidal fistula.
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