The generous excision of the entire fistula system and the subsequent open wound treatment is the most frequently performed treatment method for the pilonidal disease worldwide, also in Germany. The technology has been in use for decades and has not changed over the years.
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The procedure is performed under general anesthesia, usually under inpatient conditions. Many surgeons mark the fistula ducts with a dye solution and then perform the complete excision of the marked tissue. Often wound cavities larger than a man's fist result. Open wound treatment means that the wounds are not sutured; instead, they are provided with tamponades and a cover dressing. The wounds must be showered and re-tied daily, which requires an assistant. Wound healing disorders and stagnation of wound healing are not uncommon. The surgical procedure is easy to perform, low in complications and safe for the patient.
However, the lengthy open wound treatment after the procedure is a major burden for the patient. This is between 1.5 and 3 months and leads to an average inability to work of one month. Thus, the complete excision followed by open wound treatment with regard to healing phase and incapacity for work performs significantly worse than the procedures with plastic covering (e.g. Karydakis, Limberg) and in particular the minimally invasive techniques.
There are numerous studies on the recurrence rate of fistulas after excision and open wound treatment, which is said to be up to 35%. Patients who have already undergone surgery on a tailbone fistula at an earlier point in time and have to undergo another procedure have high recurrence rates.
Literature sources:
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