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pilonidal sinus operation - 50?

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pilonidal sinus operation - 50?

Posted by clo on November 28, 2000 at 00:14:45:

I was curious if you'd ever read this article from the Journal of Community Nursing. Seems very thorough and researched...and it states that there is a 4 to 6% recurrence rate for operations left to heal through secondary intention and also says that while recurrence rates are in fact higher for closed operations, that number is still approximately 25%. Now while I have seen different numbers for those two scenarios elsewhere, all have been + or - 5% both of those stats respectively. No where have I been able to find any documented study showing a recurrence rate as high as the 50% that you seem to apply to any operation...irrespective of which closure method is used. Is there any research study that you know of that actually documents a 50% recurrence rate for this operation?



Re: pilonidal sinus operation - Dr STOLL Phenol

Posted by Joey on November 29, 2000 at 10:28:45:

In Reply to: pilonidal sinus operation - 50? posted by clo on November 28, 2000 at 00:14:45:

I notice that this article includes a reference to treatment by phenol injections. I'm going to look up the article in the library, but Dr Stoll what do you think about this? Could it be a potential cure? You replied to someone (in the archives), suggesting that it is likely to work, but be painful and risky for those with ?MCS. Please give your thoughts.

As for the 50% issue. I have seen so many figures, including 50%, but Dr Stoll's explanation of why the recurrence is so high makes perfect sense and is medically 100% accurate. Where is the evidence for this writer's 90% statistics?



Re: pilonidal sinus operation - Dr STOLL Phenol

Posted by clo on November 29, 2000 at 11:58:16:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol posted by Joey on November 29, 2000 at 10:28:45:

The figure is attributed to a study done by J.A. Surrell in 1994 actually as per the footnote. My question remains however, is there an actual study from which this 50% recurrence rate is derived from or is this just a 'ballpark' number based on opinion. How come every other article/research on the subject discusses a difference between closed and open surgeries and yet this site seems to say that the number is 50% irrespective of the closure method. I personally know 7 people who've had a pilonidal cystectomy and the only recurrence's belonged to two of them who had primary closures the first time. Their second surgeries were closed through secondary intention and they have experienced no recurrence rates since, along with the others who had secondary closure the first time. The most recent of these surgeries was 11 years ago as well. So a recurrence rate of 50% sounds kind of high based on personal experience as well, not just all the other research I've done. But I'd be interested to see the study showing a 50% recurrence rate as well so please let me know. Thanks.



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by Walt Stoll on November 30, 2000 at 09:03:11:

In Reply to: pilonidal sinus operation - 50? posted by clo on November 28, 2000 at 00:14:45:

Thanks, Clo.

I have now. I apreciate your showing this article. It gives me a chance to demonstrate how a false impression can be foisted onto the public simply by having the definitions wrong.

First of all, the "acquired" form of what this article is about is NOT a pilonidal sinus (cyst) which is only what they included as "congenital".

Of course, by including these sebaceous cysts (acquired), which are about 95% curable by surgery, their statistics will be skewed.

IF they had enough sense to only include the ones found at the base of the spine, they would get the 50% statistics we have been describing here.

I would be interested in hearing from those who had the "acquired" lesions (in areas other than the tip of the coxxyx) who had trouble like we have archives to describe.

These are both sebaceous cysts but the pilonidal sebaceous cyst is a totally different animal than the rest of them!

These people ought to be ashamed. Of course, perhaps standards in the UK are different. However, I stand by my statistics of true pilonidal disease.

Walt



Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.)

Posted by Walt Stoll on November 30, 2000 at 09:10:32:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol posted by Joey on November 29, 2000 at 10:28:45:

Hi, Joey.

The phenol injection technique is effective IF they hit the nidi AND IF there are not any more that have not yet shown themselves. Of course, that is the problem with the surgery as well. Theoretically, the recurrance rate should be exactly the same for both approaches.

The phenol technique, of course, has the additional chemical sensitivity risk that the surgery does not.

It is too bad that clo is depending on someone else to report to her about this. If she took the developmental anatomy and surgical anatomy courses in medical school, she would be better able to spot the discrepancies in studies like this.

Namaste`

Walt



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by clo on November 30, 2000 at 11:12:24:

In Reply to: Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal. posted by Walt Stoll on November 30, 2000 at 09:03:11:

Thanks for the explanation Dr. Stoll. I see what you're saying. If possible, I'd like to read more about the studies showing the 50% recurrence rate for the true congenital disease. Would appreciate you guiding me in the right direction. thanks again for all your help.



Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.)

Posted by Joey on November 30, 2000 at 12:02:16:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.) posted by Walt Stoll on November 30, 2000 at 09:10:32:

Dear Dr Stoll,

Thanks for your clarification. The phenol method sounds more attractive to me if I am found not to be sensitive to it, and if it is less prolonged a treatment (albeit painful) with a similar rate of recurrence. It's just the constant bleeding is a real pain in the...!

I have another very specific question, which I wonder if you could answer. Last night when my wife was removing the hair around the cyst with cream, she noticed a hair on the cyst. On closer inspection she discovered that it was coming out of the cyst itself, rather than just hanging over it. She pulled it out (painlessy thank God) with tweezers sterilized with an alcohol wipe, but then discovered that it was more than just one hair -- in the end she extracted about twenty hairs, some of them remarkably thick and most of them about two inches long! I'm really confused how to interpret this. Does this mean that hair continues to grow in the cyst (I've had it for about three months now), or could these hairs have been the non-congenital cause or catalyst for a flare-up?

Any advice truly appreciated.
Jawid

The upside of this cyst is that I have discovered your site and about wellness. Thanks especially for that.



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by Walt Stoll on December 02, 2000 at 08:50:31:

In Reply to: Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal. posted by clo on November 30, 2000 at 11:12:24:

Hi, clo.

I do not keep stuff like that since I already have a room full of files about cutting edge stuff. Once something has been established as fact those files go out. THEN, if something comes up that refutes those "facts" the file gets restarted until it is either proven or disproven. The article you showed us does not refute the basic mechanism of the pilonidal problem.

SO, if you went to any medical library (all are open to the public), and looked up pilonidal, you could get the statistics from the horse's mouth.

Let us know what you learn. The only problem is that you cannot check out books from a medical library unless you are enrolled in the school. You would have to read them there.

Walt



Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.)

Posted by Walt Stoll on December 02, 2000 at 08:58:00:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.) posted by Joey on November 30, 2000 at 12:02:16:

Hi, Jawid.

You have discovered EXACTLY what I have been trying to educate the BB participants about the mechanism of causation of this condition for years. THANKS!

The problem is that skin forming nidi are embryologically left buried under the skin. Since all skin has hair follicles, just think what happens when that hair starts to grow with no place to go!

This is precisely what the nurses that wrote that "mixed up" article about pilonidal cysts (responded to yesterday) do not know. I can't imagine how they ever got it published.

This is exactly what happens with any microscopic nidi that is not removed with surgery snd is why there is a 50% recurrance rate after surgery.

Namaste`

Walt



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by clo on December 03, 2000 at 01:51:04:

In Reply to: Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal. posted by Walt Stoll on December 02, 2000 at 08:50:31:

Thanks again Dr. Stoll. Here's another piece of research I came across and it's put out by the American Society of Colon and Rectal Surgeons. The description in this document, both for treatment as well as recurrence rates is the most consistent with all the other research I've done as well as being consistent with the experiences of the several people I've known who've gone through the operation and not had any recurrences when left to heal through secondary intention. This one as most other research I've seen doesn't so much differentiate between acquired and congenital pilonidal disease as being different in and of themselves as you had said, but actually presents them as conflicting theories for the same problem. One would hope that this organization would put out accurate information since this does fall in their area of expertise! Your opinion on this work would be appreciated.



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by clo on December 03, 2000 at 01:52:20:

In Reply to: Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal. posted by clo on December 03, 2000 at 01:51:04:

not sure if the link made it on the previous post. here it is in the comments box to make sure you get it:
http://www.fascrs.org/coresubjects/2000/devos.html
thx



Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.)

Posted by joey on December 03, 2000 at 16:09:24:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol (Archive.) posted by Walt Stoll on December 02, 2000 at 08:58:00:

Dear Dr Stoll,

Thanks for explaining this strange phenomenon. I must admit I was hoping for the impossible and that this might spell an end to the pilonidal problem for me, but I guess not. Oh well, at least I know now to look out for more of them as they grow again in the next month or so!
Thanks,
Joey



Re: pilonidal sinus operation - Dr STOLL Phenol

Posted by PM on December 04, 2000 at 11:44:02:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol posted by clo on November 29, 2000 at 11:58:16:

I would also be interested in any studies that show these numbers (50% recurrence). I am curious as to how you, Dr. Stoll, are so certain that these cysts are originated by this single mechanism when the literature acknowledges several possible mechanisms.

I am considering surgery but will be making my final decision based on a number of opinions, including what I have read here, research, and the opinion of the surgeon.

Thank you



Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal.

Posted by Walt Stoll on December 05, 2000 at 09:16:33:

In Reply to: Re: pilonidal sinus operation - 50? (What a mixup!) Archive in pilonidal. posted by clo on December 03, 2000 at 01:52:20:

Hi, clo.

Well written article, and:

There is NO relationship between any of these conditions and a congenital pilonidal condition EXCEPT that they are in the same part of the body. This is like saying that an abscess on the arm is the same as a broken arm just because they both are of the arm.

This a major flaw of the tenor of the article & confusing to people who read it without the benefit of a full medical education.

The one part of the article that relates to what might a be worthwhile contribution is the part about the different "theories" of causation of the condition known as "pilonidal":

The discussion is of "congenital vs acquired pilonidal conditions". There is little doubt that the mechanism of "acquired" is POSSIBLE although a little far fetched. However the chances of this happening, in separate incidents in the same person more than once, approaches impossibility. In this scenario, there would only be ONE nidi and any initial surgery would be 100% succesful.

It is the reality of multiple nidi (only possible from the congenital causation) that makes the 50% recurrance rate be the bugaboo this condition really is.

The far fetched "acquired" mechanism proposed for this condition would be just as likely happen under the arm and in the groin. The same situation proposed (for "acquired")exists in those areas. Why does it not happen there?

It seems to me that these guys needed something to write about! They did a good job with the other conditions and THAT is worth keeping but the part about "pilonidal" is better left in the wastebasket.

Hope this helps.

Walt



Re: pilonidal sinus operation - Dr STOLL Phenol

Posted by Walt Stoll on December 06, 2000 at 09:39:30:

In Reply to: Re: pilonidal sinus operation - Dr STOLL Phenol posted by PM on December 04, 2000 at 11:44:02:

Hi, PM.

"You pays your money and you takes your choice."

Walt



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