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Comparative Studies | Surgery | Oman | Volume 12 Issue 7, July 2023 | Popularity: 6.6 / 10
Modified Moshe-Gips Technique (Pilonidal Sinus Endo Fistulectomy) for Pilonidal Sinus Treatment Case Series
Sharif Radwan Alkoujah
Abstract: Pilonidal sinus is a common condition that predominantly affects young adults of Mediterranean origin, with men being twice as likely to develop the disease. This ailment is characterized by ingrown hair in the natal cleft region, resulting in chronic inflammation and the formation of a sinus tract that may fail to close due to the presence of a foreign body. Many surgical interventions have been developed to manage this condition, but they often require high surgical skills and close medical follow-up due to high recurrent rates and post-operation complications. Minimally invasive techniques, such as endoscopic pilonidal sinus treatment (EPSiT procedure), laser pilonidalis minimal invasive laser excision (smile procedure), and the Moshe-Gips technique, have been developed to reduce recurrence and post-operative complications. All techniques above depend on removing the impact of foreign bodies and destroying the tract from the inside. Moshe-Gips technique depend on removing the external sinus pits then curating the sinus tract to remove all foreign body and irrigating the tract with H2O2 as an antiseptic and hemostatic agent has been approved in the first pilonidal conference in Berlin in 2017 and studied by our surgical team under the name of (Advantages and Efficacy of Minimal Invasive Moshi-Gips Technique in Pilonidal Sinus Surgery) shows very good results and a low recurrent rate. The modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) which was developed by our surgical team involves removing the all tract under the skin by punch puncture as one bulk, eliminating foreign bodies and chronic granule tissue and fibrotic tract walls, and irrigating the tract with H2O2 as a local antiseptic and hemostatic agent. This study aims to assess the efficacy of the modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) and compare it to the original technique. Our findings suggest that the modified technique (pilonidal sinus endo fistulectomy) is as effective as the original technique and may have advantages over the original interventions by reducing the recurrent rate by nearly 0%. The results of this study provide evidence for the feasibility of using the modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) in clinical practice. Significance: The modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) is a novel minimally invasive approach used in the pilonidal sinus treatment developed by our surgical teambased on the original technique. It involves the complete removal of external sinus pits and fibrotic tracts under the skin as one bulk if possible with a small surgical incision using a punch puncture method. The wound is then irrigated with hydrogen peroxide to achieve hemostasis and treat any infections. The Objective of Evaluation: This study aims to assess the benefits and effectiveness of the modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) in pilonidal sinus surgery. Design, Setting, and Participants: From 5\6\2022 till 1/6/2023. Five patients have been operated on by the modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) all patients with primary non-infected chronic pilonidal sinus. Interventions: The modified Moshe-Gips technique involving endo fistulectomy was used to treat pilonidal sinus. The study evaluated several outcomes and measures, including the primary endpoint of the duration of the operation from the beginning of anesthesia to the completion of dressing. Secondary endpoints included the success rates of the procedure, postoperative complications such as bleeding, oozing, infection, recurrence, healing time, time to return to work, and ratings of intraoperative and postoperative pain as well as patient satisfaction. Rate on a score from 1 less to 10a max ?. Results 5 patients operated in modified Moshe ?Gips (pilonidal sinus endo fistulectomy). The average operation time was 16.6 m and SD 2.19. The average post-operation bleeding at 48 h on a scale from 1 to 10 was 2.3 and SD 0.83. Infection was zero. The recurrent rate within 6 m after the operation was zero. Average post-operation pain on a scale from 1 to 10. was 1.25 and SD 0.44. The average healing time in weeks was 4.8 and SD 0.83. The average time back to work by weeks was 5.2 days and SD 0.83. The average post-operation patient satisfaction was 9.6 and SD 0.54. Conclusions and Relevance: The modified Moshe-Gips technique, also known as pilonidal sinus endo fistulectomy, has demonstrated effectiveness in treating pilonidal sinus with minimal postoperative disturbances and faster healing, allowing patients to return to normal activities sooner and at zero recurrent rates in our study. In conclusion, the modified Moshe-Gips technique (pilonidal sinus endo fistulectomy) offers a promising alternative to traditional surgical methods for treating pilonidal sinus and has the lowest recurrent rate among the other procedures even for the original Moshe-Gips technique, with the potential for faster healing and quicker return to normal activities as well as the original technique. Upon the results we have, our recommendation is to start with this technique as the primary surgical procedure for primary non-complicated pilonidal sinus, reserving traditional surgery for recurrent or complicated cases.
Keywords: A minimally invasive technique in pilonidal sinus surgery, a new technique in pilonidal sinus surgery, pilonidal sinus endo fistulectomy, endo fistulectomy, modify gips technique in the pilonidal sinus, gips technique in the pilonidal sinus
Edition: Volume 12 Issue 7, July 2023
Pages: 349 - 354
DOI: https://www.doi.org/10.21275/SR23704205842
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