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

Abstract

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 6 th . 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.