Pilonidal Sinus Part 1 | Mr Emin Carapeti

Pilonidal Sinus - The Cinderella in coloproctology Presented by Colorectal surgeon Mr Emin Carapeti Who is Emin Carapeti? : http://www.108harleystreet.co.uk/cons... Mr Emin Carapeti is a Consultant General and Colorectal Surgeon and worked as a Consultant at Guy’s and St. Thomas’ Hospitals. He is a Member of Council of the Section of Coloproctology of the Royal Society of Medicine, a member of the Association of Coloproctology of Great Britain and Ireland and an examiner in surgery at the Royal College of Surgeons of England. He graduated from Guy’s Hospital and undertook his training in London and South East England. His specialist training was at St. Mark’s Hospital in London and Mount Sinai Hospital in Toronto. His thesis and main research was in the treatment of haemorrhoids and anal fissure at St. Mark's Hospital and he was awarded the Doctor of Medicine (MD) degree in 2000. He has published widely on anorectal disorders and pilonidal sinus disease and has pioneered new surgical techniques in complex recurrent pilonidal disease and day case surgery for haemorrhoids. In addition to his colorectal work he also has a extensive experience in the treatment of of abdominal and groin hernia both simple and complicated. He also attended The Shouldice Hernia Clinic near Toronto, Canada where he learnt about the famous Shouldice hernia repair. He is a member of The Gilmore Groin and Hernia Clinic team undertaking repair of groin disruption (Gilmore’s Groin). "Mr Carapeti was an absolute delight, incredibly knowledgeable and the best explanation of aetiology and symptoms I’ve ever had. It’s not often that other doctors who are patients have much praise to give but Mr Carapeti made my day. A privilege to have been seen by him." Areas of Interest Rectal Bleed Colonoscopy Colorectal cancer Management of Fissures Management of Haemorrhoids Management of Pilonidal sinus disease Back to the presentation: Pathogenesis “Nest of hair” Blocked natal cleft hair follicle / In-growing hair Folliculitis / localised dermatitis Follicle swells and ruptures / Abscess Secondary tracks Buttock ‘grinding’ pushes loose hair into sinuses Chronic inflammation / infection Is Hair Essential? Pilonidal sinus in the hairless ? Local hair vs hair from the scalp Influence natural history by laser treatment or any form of depilation Why don’t we get pilonidal sinus elsewhere? Sacro-coccygeal Umbilical: ? true pilonidal sinus Digital web spaces: Anyone seen these ? Epicanthic folds The Challenges Key Slide Deep midline ‘anaerobic’ natal cleft No subcutaneous tissue cushion Proximity to anus Treatment AIM Eradication of Sepsis Complete Wound Closure Low Morbidity Prevention of Recurrence OPTIONS Greater than 60 different operations Simple and complex Decades of literature: Poor data No consensus: Personal choices Growing interest for minimally invasive treatments Treatment - Wide excision only ‘Safe’ Painful Daily dressings 2-3/12 to heal 30% fail / recur Vacuum Assisted Closure Wide excision with primary midline closure Healing problems due to tension Greater than 30% recurrence Asymmetric Primary closure Rhomboid flaps Karydakis Bascom procedure Cleft closure (Bascom 2) Skin Graft (full thickness) Vascular Pedicle Flaps Limberg Flap Z plasty Aims of Treatment Key Slide Eradication of Sepsis Complete wound closure Low morbidity Preventing Recurrence Elimination of Natal Cleft “Stay out of the ditch” No Midline Wound