Treatment optimization of patients with epithelial coccygeal passage complicated by an abscess

Background: Despite the wide variety of epithelial coccygeal passage treatment methods, the choice of the type of surgery is still an issue to be discussed. It is due to the heterogeneity of the clinical material, the variety of pathological processes and development of the pathology. In spite of the absence of serious complications in most cases, it causes a significant deterioration of life quality and reduction of work capacity in patients of the most active age group.

Objective: Improvement of the treatment results of patients with epithelial coccygeal passage complicated by an abscess by means of vacuum therapy of a sutured postoperative wound (Russian Patent 2764499 date 07.04.2021).

Material and methods: The study included 59 patients: 19 people in the main group, who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess, using vacuum therapy according to the proposed method. A retrospective analysis of the medical histories of patients who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess has been carried out by means of the traditional method of wound closure with drainage. These patients were included in the control group of 40 people.

Results: In the control group purulent-inflammatory complications were recorded in 4 (10%) patients. Out of 19 people of the main group operated on according to the method proposed by us, purulent-septic complications were not recorded in any of the patients. Wound bandaging has been performed 71 times in 19 patients of the main group, and 454 times in 40 patients of the control group. For 19 patients of the main group the duration of the antibiotic therapy lasted 96 days, for 40 patients of the control group - 306 days. The average number of bed-days for patients of the control group was 10.63, in the main group - 7.56.

Conclusion: The use of the proposed method of surgical treatment of epithelial coccygeal passage complicated by an abscess, by means of vacuum therapy at all stages of treatment, made it possible to improve treatment results in patients of the main group.

1. Rivkin VA, Bronshtein AS, Fayn SN. Coloproctology guide. Moscow: Mediapractice; 2001:300. (In Russ.).

2. Akinci OF, Coskun A, Uzunkoy A. Simple and effective sur¬gical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Col Rect. 2000;43:701-705. PMID: 10826434. http://doi.org/10.1007/BF02235591

3. Kapan М, Kapan S, Pekmezci S, et al. Sacrococcygeal pi¬ lonidal sinus disease with Limberg flap repair. Tech Coloproctol. 2002;6:27-32. PMID: 12077638. http://doi.org/10.1007/s101510200005

4. Greenberg R, Kashtan H, Skornik Y, et al. Treatment of pilo¬nidal sinus disease using fibrin glue as a sealant. Tech Coloproctol. 2004;8(2):95-98. PMID: 15309645. http://doi.org/10.1007/s10151-004-0063-7

5. Shcherba SN, Polovinkin VV. Application of prolonged flow-aspiration drainage of laparotomy wounds in order to reduce sup-purative septic complications in bowels reconstructive surgery. Grekov's Bulletin of Surgery. 2014;173(4):83-86. (In Russ.). https://doi.org/10.24884/0042-4625-2014-173-4-83-86

6. Osintsev EYu, Slobodskoy AB, Melsitov VA, et al. Optimization of aspiration-irrigation drainage of purulent wounds. Grekov's Bulletin of Surgery. 2012;5:61-64. (In Russ.).

7. Dzhinchveladze DN, Vazhenin AV. Wounds drainage by “Aspiration probe-drainage” after lymphadenectomy. Science and modernity. 2010;4-1:152-155. (In Russ.).

8. Gubin AV, Prudnikov OG, Burtsev AV, et al. Role of postop-erative wound drains in spinal surgery. Genius of Orthopedics. 2017;23(2):180-186. (In Russ.). http://doi.org/10.18019/1028-4427-2017-23-2-180-186

9. Gencosmanoglu R, Inceoglu R. Modified lay-open versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clini¬cal trial with a complete two-year follow-up. Int J Colorectal Dis. 2005;20(5):415-422. PMID: 15714292. http://doi.org/10.1007/s00384-004-0710-5

10. Bali ZU, Akdeniz CB, Muezzinoglu T, et al. Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier's Gangrene. Journal of Urological Surgery. 2020;7(1):42-45. http://doi.org/10.4274/jus.galenos.2019.3013

11. Obolenskiy VN. Modern treatment methods of the chronic wounds. Medical Council. 2016;(10):148-154. (In Russ.). https://doi.org/10.21518/2079-701X-2016-10-148-154

12. Attia A, Elmenoufy T, Atta T, et al. Combination of nega-tive pressure wound therapy (NPWT) and integra dermal regenera-tion template (IDRT) in the lower extremity wound; Our experi¬ence with 4 cases. JPRAS Open. 2020;24:32-39. PMID: 32322648. PMCID: PMC7170806. http://doi.org/10.1016/j.jpra.2020.03.004

13. Nakade DDV, Zade DM, Mehta DJ, et al. Role of vacuum assisted closure (VAC) in treatment of difficult to heal wounds in lower extremity- our experience in 100 cases. International Journal of Surgery Science. 2020;4(1):445-450. http://doi.org/10.33545/surgery.2020.v4.i1h.383

14. Pomazkin VI, Mansurov YuV. The choice of surgery for pa-tients with epithelial coccygeal tract. Grekov's Bulletin of Surgery. 2008;167(1):85-87. (In Russ.).

15. Lavreshin PM, Nikulin DYu, Korablina SS. Diagnosis and treatment of epithelial coccygeal passage. Medical News of the North Caucasus. 2011;4:99-103. (In Russ.).

16. Lavreshin PM, Nikulin DYu. Differentiated approach to wound closing after surgical treatment of pilonidal sinus. Medical News of the North Caucasus. 2010;2(18):18-21. (In Russ.).

17. Revitsky VP, Latynina VI, Yadykina TK, et al. Effective method of the surgical treatment of the chronic suppurative fistulous form of the epithelial coccygeal passage at the abscess stage. Medicine in Kuzbass. 2018;17(2):4-9. (In Russ.).

18. Zubaidov TN, Gulov MK. Surgical treatment of compli¬cated forms of epithelial coccygeal fistula. Bulletin of Avicenna. 2015;3(64):138-143. (In Russ.). http://doi.org/10.25005/2074-0581-2012-14-3-34-39

19. Tatyanchenko VK, Bogdanov VL. New technologies in the di-agnostics and treatment of acute tissue hypertension syndrome in patients with the abscesses of epithelial coccygeal duct. Medical News of the North Caucasus. 2011;3:7-10. (In Russ.).

20. Magomedova ZK, Chernyshove EV, Groshilin VS. Comparative analysis of recurrent epithelized pilonidal sinus and sacrococcygeal fistulas treatment. Medical Herald of the South of Russia. 2015;4:60-63. (In Russ.). https://doi.org/10.21886/2219-8075-2015-4-60-63