In the early 1990s, Moshe Gips, an Israeli surgeon, introduced another minimally invasive surgical technique for the treatment of pilonidal cysts and tailbone fistulas, based on the techniques of Lord/Millar and Bascom (pit picking), which is also suitable for advanced findings.
In his process, Gips used punches with an annular knife at the end, which are commonly used in dermatology and dentistry. Before the procedure, which can be performed under local anesthesia in selected cases, all fistula openings are examined with 0.5 to 1.0 mm thin probes to determine the extent of the inflammatory area under the skin. With the punches, which can be up to 9 millimetres in diameter, all fistula openings are removed deep into the subcutaneous fatty tissue, the sinus pilonidalis is opened and the inflammatory tissue and hairs are removed with curettes.
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| Procedure according to Moshe Gips (c) MVZ St. Marien, Cologne, Germany |
The wounds are dressed with tampon bandages, they are not sutured. Due to the risk of postoperative bleeding, which should not be underestimated, patients undergoing the operation as outpatients must be followed for at least one hour and lie consistently on their back during this time in order to compress the surgical area.
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| Lord Lucan, Trephine surgery 2, CC BY-SA 4.0 |
Wound treatment consists of showering several times a day, followed by the application of a new dressing. During the healing phase, which can last several weeks, the wound area should be shaved regularly. If a wound healing disorder is foreseeable, the procedure is repeated in a similar manner and the wound cavities under the skin are cleaned again.
Between 1993 and 2003, Moshe Gips treated about 1400 patients with tailbone fistulas using his method with a follow-up time of up to 80 months. His study, published in 2003, is thus the largest and most comprehensive study on the treatment methods for fistulas of the coccyx. The recurrence rate of his technique was 16 %, another 4 % had not healed wounds at the time of the last contact.
The procedure according to Moshe Gips for the treatment of pilonidal cysts and tailbone fistulas is thus a simple procedure which, like all other minimally invasive methods, leads to a relatively rapid healing and an aesthetically pleasing result. The advantage is that, in contrast to the method of Lord/Millar or Bascom (pit picking), it can also be performed for more extensive findings. The long-term cure rate is higher than that of traditional methods. If recurrences occur, the procedure can be repeated if necessary.
Literature sources:
Gips M, Melki Y et al (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51:1656–1662
Thompson MR, Senapati A et al (2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 98:198–209
Lord PH, Millar DM. Pilonidal sinus: a simple treatment. Br J Surg 1965;52:298–300
