Pilonidal Sinüs
Özet
Pilonidal sinüs, ilk kez 1833'te Mayo tarafından tanımlanan, yaygın olarak sakrokoksigeal bölgeyi etkileyen ve erkeklerde daha sık görülen inflamatuar bir hastalıktır. Etyopatogenezinde konjenital ve edinsel hipotezler bulunsa da, günümüzde dökülen kılların dokuda yabancı cisim reaksiyonu oluşturmasıyla gelişen edinsel teori daha çok kabul görmektedir. Risk faktörleri arasında obezite, derin natal yarık, aşırı kıllanma ve hijyen eksikliği yer alır. Hastalık asemptomatik olabileceği gibi akut apse veya kronik akıntılı fistül şeklinde de prezente olabilir; klinik değerlendirmede yaygın olarak Tezel sınıflandırması kullanılır. Tedavi seçenekleri, basit hijyen önlemleri ve kıl temizliğinden, fenol uygulaması gibi minimal invaziv yöntemlere ve karmaşık flep cerrahilerine (Limberg, Karydakis, Cleft Lift) kadar geniş bir yelpazeye yayılmaktadır. Günümüzde EPSIT ve VAAPS gibi endoskopik yöntemler ile PRP ve vakum destekli kapatma gibi iyileşmeyi hızlandıran teknolojiler de başarıyla uygulanmaktadır. Literatürde nüks oranlarını düşürmek ve iyileşme süresini kısaltmak amacıyla farklı yöntemler karşılaştırılsa da, her vaka için geçerli tek bir altın standart tedavi henüz bulunmamaktadır.
Pilonidal disease, first described by Mayo in 1833, is a common inflammatory condition that primarily affects the sacrococcygeal region and is more prevalent in men. Although both congenital and acquired hypotheses exist regarding its etiopathogenesis, the acquired theory, which suggests that shed hairs trigger a foreign body reaction in the tissue, is more widely accepted today. Risk factors include obesity, a deep natal cleft, excessive body hair, and poor hygiene. The disease may present as asymptomatic, an acute abscess, or a chronic discharging fistula, with the Tezel classification commonly used for clinical staging. Treatment options range from simple hygiene measures and hair removal to minimally invasive procedures like phenol application and complex flap surgeries such as Limberg, Karydakis, and Cleft Lift. Modern approaches, including endoscopic methods like EPSIT and VAAPS, as well as recovery-enhancing technologies like PRP and vacuum-assisted closure, are also successfully utilized. Although various methods are compared in the literature to reduce recurrence rates and shorten healing times, a single gold-standard treatment for every case has not yet been established.
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