Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease

Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study

AIM

Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance.

METHODS

Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received.

RESULTS

A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance.

CONCLUSION

Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.

Pilonidal sinus disease: a 25-year experience and long-term results of different surgical techniques

Background

The incidence of pilonidal disease is increasing. The choice of surgical approach differs between surgeons and countries. With better understanding of the etiology of the disease, there is a shift toward more successful concepts of treatment. In many cases, management can be challenging owing to the number of previous failed operations.

Objective

The aim of this retrospective single-center cohort study was to compare recurrence rates and postoperative wound complications between five treatment arms.

Methods

A total of 299 patients who underwent surgery for pilonidal disease between November 1994 and May 2019 were included. Primary endpoint was time to recurrence, secondary endpoint was wound care complication rate.

Results

Median follow-up was 85.8 months in 286 patients. An overall recurrence rate of 16.1% was observed at 24 months, 21.4% at 60 months, and 47.4% at 303 months; 24 months postoperatively, there was a range from 10.5% for excision with primary midline closure to 30.0% for the Bascom I procedure. Recurrence in excision with primary midline closure was 71.8% 268 months postoperatively. No statistically significant differences were observed between the five groups (p = 0.54). The highest prevalence of wound complications (46.3%) was in excision with midline closure. Cox regression showed that previous pilonidal operations are an independent prognostic factor for developing recurrence (p = 0.006). Multivariate logistic regression revealed that previous pilonidal operations have a significant predictive value for developing postoperative wound complications (odds ratio = 4.04, 95% confidence interval [1.61–10.18]; p = 0.003).

Conclusion

In order to improve surgical outcomes, emphasis should be given to adoption of techniques with high success rates.

Outcomes and cost of medical and surgical treatments of pilonidal disease: A single Institution's ten-year review

Background

Pilonidal disease is a chronic inflammatory skin disorder typically located in the gluteal cleft. Treatment varies from antibiotic therapy to extensive surgical resection and reconstruction; however, complications and recurrence are common. To understand risk factors, outcomes, and costs associated with various treatments, we performed a retrospective chart review of all patients treated for pilonidal disease at a single health care system from 2008 to 2018.

Methods

Patients with an ICD diagnosis code associated with pilonidal disease were identified. Charts were reviewed for demographic, clinical, and cost information related to pilonidal disease encounters. Data were analyzed for risk of recurrence by Cox proportional hazards regression and economic burden by Wilcoxon signed-rank test.

Results

During the study time frame, 513 patients were diagnosed with pilonidal disease. Primary treatment included 108 patients (21%) with wide excision, 167 (32%) with antibiotics alone, 79 (15%) with incision and drainage, and 109 (21%) with incision and drainage plus antibiotics. The rate of recurrence following antibiotic therapy, incision and drainage, or wide excision was 36.7%, 35.9%, and 21.3%, respectively. Sex, body mass index, obesity, or hidradenitis suppurativa was not associated with recurrence; however, smokers who underwent incision and drainage had a higher risk of recurrence (P < .0001). The median cost of each primary treatment was $3,093 for excision, $607 for incision and drainage, $281 antibiotics alone, and $686 for incision and drainage plus antibiotics.

Conclusion

Pilonidal disease presents with a high degree of heterogeneity and is often managed primarily with antibiotics, incision and drainage, or surgical excision. Risk of recurrence was less in patients who underwent wide excision; however, these patients had higher overall cost compared to patients that had nonoperative management.

Level of evidence

Level III.

•

Ten-year review of outcomes for pilonidal treatments at a tertiary institution

•

In-depth characterization of the likelihood, timing, and risk factors for recurrence

•

Cost analysis of primary treatments

•

Smoking identified as a risk factor for recurrence in patients with abscesses

Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence

OBJECTIVE

To assess the success of treatment methods at reducing recurrence, the most important problem in pilonidal sinus disease (PSD), along with factors affecting the occurrence of PSD and posttreatment recurrence.

METHODS

The researchers retrospectively analyzed files of patients treated for PSD between 2003 and 2018. Three study groups were created: G1, G2, and G3. G1 included all PSDs with recurrence, and a comparable number of cases without recurrence were selected randomly for the G2 group. The control group, G3, included healthy individuals without PSD. In all groups, the following were recorded: body mass index, skin color and oiliness, family history of PSD, hair overgrowth, smoking habit, time spent sitting per day, and number of baths per week. The following were additionally recorded for G1 and G2: treatment methods, follow-up periods, pretreatment abscess(es), and time of onset of complaints before treatment. The number of recurrences and the period between last treatment and recurrence were also recorded for G1.

RESULTS

G1 comprised 234 patients; G2, 247 patients; and G3, 128 healthy individuals. The significant factors causing recurrence included body mass index, family history, bathing habits, hair overgrowth, skin color and oiliness, time spent sitting per day, smoking habit, abscess(es), and duration of symptom(s) (P < .05). Limberg flap repair was the most successful treatment method. Sixty-three (27%), 135 (58%), and 185 (79%) recurrences occurred in the first 6 months, in the first year, and in the first 2 years, respectively.

CONCLUSIONS

The researchers recommend Limberg flap repair for treatment. It is possible to reduce recurrence by taking preventable factors into consideration.

Pilonidal Disease Treatment By Radial Laser Surgery (FilaC™): The First Finnish Experience

BACKGROUND AND AIMS

Pilonidal disease is common, and it afflicts especially young adults, causing disability. Several types of treatment methods are applicable, but no consensus exists regarding the best method. The aim of our study was to assess the novel radial laser probe treatment in pilonidal disease and report the success rate and recurrence rate.

METHODS

We studied retrospectively 86 patients who, according to our hospital patient records, underwent radial laser probe surgery between January 2017 and September 2019.

RESULTS

In a mean follow-up time of 14 months, the success rate at 2 months was 86%. Most operations were done under local anesthesia on a day-surgery basis. The recovery time was rapid, and median sick leave was 12 days. Of those initially successfully treated, 3% developed a recurrence. Altogether 17% of the patients underwent a re-operation. Spillage of pus during surgery, however, reduced the success rate to 53%.

CONCLUSION

Radial laser probe treatment is a quick, safe, and minimally invasive treatment choice for pilonidal disease, especially when no active infection is present.

[Wound Healing Disorders after Excision and Open Treatment for Pilonidal Sinus]

INTRODUCTION

Pilonidalis sinus disease is a mostly chronic selective infection of the hairy skin in the area of skin wrinkles, mainly in the area of the natal cleft. Open treatment is still the most common recommended therapy. Nevertheless, there may be healing disorders within the framework of open wound treatment, which can significantly complicate the course.

METHODS

The following is an overview of wound healing disorders after excision of pilonidalis sinus. Healing time and frequency are determined on the basis of current data and the causes of the healing disorder are evaluated. In addition, possible treatment options are presented and treatment recommendations are made.

RESULTS

The evaluation of published data on wound healing period showed that the wound usually heals after a mean of two months. The results of the German forces cohort study show by way of example that almost all wounds have healed in the period up to three months. However, a small percentage of non-healing wounds remain. The frequency of significantly delayed wound healing is given in the literature as 2 - 5%. The influencing factors for wound healing after sinus pilonidalis excision are not only the size and symmetry of the excision wound but also other details of open wound treatment. In addition to intensification of the previous open wound treatment, the new excision and refreshment of the wound are mentioned as treatment options in the event of a lack of wound healing. Furthermore, changes in strategy for plastic-reconstructive procedures or other surface treatment are also recommended.

CONCLUSION

The excision wound of pilonidalis sinus should be healed after three to four months at the latest, after which the wound can be regarded as a wound with significantly delayed healing or as a wound healing disorder. Around this time, the findings should be re-evaluated and, if necessary, a change in the treatment concept should be made.

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

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.

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

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.