Pilonedal Fistulae; Three in One Technique for Surgical Management Three Case Reports

Case Series

Austin Surg Case Rep. 2019; 4(1): 1028.

Pilonedal Fistulae; Three in One Technique for Surgical Management Three Case Reports

Elsaady A*

Department of General Surgery, Kafr Elshikh General Hospital, Egypt

*Corresponding author: Ahmed Elsaady, Department of General Surgery, Kafr Elshikh General Hospital, Egypt

Received: February 11, 2019; Accepted: March 14, 2019; Published: March 21, 2019


Pilonidal sinus is well-recognized chronic inflammatory condition, mostly in sacrococcygeal area. Pilonedal fistula is a rare variety of pilonidal sinus with extension of the disease to the anal canal. Three cases of pilonidal fistula were reported. Endo-anal ultra sound was done in the three cases. It demonstrated that the disease opened in anal canal at dentate line at 6th. O`clock. All patients started at sacorcoccygeal area then extended to the anal canal. The connection to the anal canal makes the conservative treatment unreliable in these cases. The management is very challenging because of many factors including; the sphincter, liability of contamination & recurrence, as well as long time for healing and complain from the size of the wound. The study provides three in one technique for better results and less patients suffering. It entails meticulous excision of the fistula and closure of the wound by three different methods; closure in layer proximally, marsupialization in the middle part and left open (fistulotomy) in the distal anal part. The cases reported short time of healing of approximately forty days, good sphincter function and no recurrence. This method of closure seems to be good & promising method in dealing with such special entity but need more case to be evaluated well.

Keywords: Pilonidal fistula; Extensive pilonidal disease; Unusual pilonidal site; Rare pilonidal varieties


Pilonidal sinus is a relatively common disease [1], that occurs mostly in the sacro-coccygeal area, with an incidence of approximately 0.7% [2]. Rarely, the disease extends to the anal canal forming a pilonedal fistula. This variety of the disease represents a real challenge in its management in term of period of healing, liability for wound dehiscence, infection, recurrence rate & the functional outcome of the anal sphincter.

Patients and Methods

Three cases of pilonidal fistula were reported (Figure 1,2). Assessment of the history, gender, age, duration of complains was done. Endoanal ultrasound was done in all cases demonstrating low posterior connection to the anal canal (Figure 3). Conservative measures were used initially to treat the acute inflammatory state, and then surgery was done in all patients. Patient put initially in lithotomy position then turned prone to complete the procedure. This was done in the first case but later on prone position was done from the start. Assessment of the anal extension of the fistula was done followed by fistulotomy, then layout of the sinus & excision of the proximal part with meticulous follow up of side branches. The resulting wound was divided into three parts in its closure shown in Figure 4. An elliptical excision was done in the proximal sacral (vertical part) with some eccentricity as much as possible to be like Karydakis technique. The distal (perineal) part left opened by doing fistulotomy. The middle coccygeal part of the wound which overlies the coccyx marsupialization was done to be a transitional zone between the closed proximal part & opened distal fistultomy part. The study assessed the healing period, occurrence of complications & recurrence.