Does surgical treatment for complicated pilonidal cyst disease in the sacral region affect anal sphincter functions

Abstract

Introduction: Pilonidal cyst disease is characterized by chronic abscess, discharge, and sinus openings. The anal sphincter functions of the patients, who previously undergone recurrent surgical treatment, were compared using a surgical approach. Patients were divided into two groups by whether perianal soft tissues were preserved in the surgery. Materials and Methods: Between 2014 and 2019, 21 male patients who had either undergone insufficient surgery or had complications with multiple sinus openings applied to our clinic. Excision and reconstruction of the patients were performed. The coccyx, dorsal part of sacrum, anococcygeal raphe, and ischiorectal fossa were additionally included in the excision for patients with biopsy reports of squamous cell carcinoma. All patients underwent rectoanal manometry to evaluate anal sphincter function. Preoperative, postoperative 5th week, and 6th-month anal manometry results were recorded and analyzed by the Shapiro − Wilk test and independent t-test. Results: The anal sphincter function regresses in the 5th week after the reconstruction and improves in the 6 month. The results of the independent t-test, which were used to compare the anal manometry results for each group, showed that the difference in the anal sphincter pressure of the two groups was statistically significant (P < 0.05). If the perianal soft tissues were excised, anal sphincter manometry shows poor results. Discussion: The anal sphincter function, which regresses in the 5th week after the reconstruction and improves in the 6 months, depends on the scar tissue occurring in the perianal connective tissue, while the softening caused by the maturation of the scar in the last phase of wound healing improves the function.