We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

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Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence.

Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease.

BACKGROUND Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). MATERIAL AND METHODS The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. RESULTS The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). CONCLUSIONS According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

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Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery.

Pilonidal sinus disease often presents as a chronic problem in otherwise healthy hirsute men. A range of conservative techniques to surgical flaps have been employed to treat this condition. We review the literature on management of pilonidal sinus disease, including conservative and surgical techniques as well as novel laser therapy. Given current evidence, off-midline repair is now considered the standard of care; however, no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap. Treatment should be tailored to the individual, taking into account recurrent disease, recovery time, and the surgeon's comfort with the procedure.

Treatment options for pilonidal sinus.

Introduction: Pilonidal sinus is a chronic inflammatory condition associated with the penetration of hair fragments into the skin. the incidence of pilonidal sinus is 0.07%. We present the first reported case of pilonidal sinus occurring in preauricular area in a 22-year- old male. case report: A 22-year-old male presented with pain and pus discharge from the right preauricular area since two years. On local examination, a scar measuring 2 cm at right preauricular area was found with one external opening. routine investigations were within normal limits. complete excision of the scar with the tract was performed. Primary closure of the wound was done. Histopathological examination confirmed pilonidal sinus. conclusion: Pilonidal disease is a complex condition that causes both discomfort and embarrassment to sufferers. the etiological origin of a pilonidal sinus is controversial. Although reported in several rare areas of the body other than sacrococcygeal area, to our knowledge, this is the first reported case in which pilonidal sinus occurs in preauricular

/pdf/preauricular-pilonidal-sinus-the-first-reported-case-1j7dtk9xqm.pdf

Preauricular Pilonidal Sinus: The first reported case

Pilonidal sinus disease is a common medical condition
that accounts for almost 15% of anal suppurations with high morbidity. Its
management is subject to many variations. In this study, a 25-year experience
from 1984 to 2009 of treating pilonidal sinus disease is being reported. A
total of 252 patients were included in the study. They were treated by phenol
injection, excision and primary closure, or excision and packing. Data showed
that excision with packing had the highest cure rate (85%), followed by
excision and primary closure (65%), and then phenol (55%). As for the healing
duration, the shortest was for excision and primary closure, followed by the
phenol injection. However, excision and packing had the least recurrence rate
(12%), compared to phenol and excision with primary closure 26.5% and 23%,
respectively. The authors recommended excision and packing. However, hospital
stay, missed days of work, recurrence rates, and the surgeon’s familiarity with
the techniques were important factors in the choice of treatment modality.

/pdf/25-years-experience-in-the-management-of-pilonidal-sinus-2go719srug.pdf

Mahmoud Dirani

Papers

25 years’ experience in the management of pilonidal sinus disease