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.
Aim: Bascom's cleft-lift procedure for pilonidal sinus disease under tumescent local analgesia is feasible and well tolerated with favourable short-term outcomes. We aimed to assess the 10-year treatment success rate after cleft-lift under tumescent local analgesia. Method:This was a single-centre cohort study based on prospectively registered perioperative data and survey data with additional data from electronic medical records. The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting at a tertiary referral hospital between 1 July 2008 and 31 March 2014. The primary outcome was the 10-year risk treatment success defined as complete wound healing within 180 days of surgery or no recurrence assessed with competing risk analyses.Secondary outcomes were time to complete wound healing, persistent pain and cosmetic satisfaction.Results: Two hundred patients with complex pilonidal sinus disease were included.Indication was incomplete wound healing after pilonidal sinus surgery in 43 (21.5%) patients, recurrence after previous intervention in 78 (39.0%) or moderate to complex sinuses assessed by a consultant surgeon in 79 (39.5%). One hundred and ninety-five patients had complete wound healing within 180 days with a median time of 29 days (interquartile range 16-47). The cumulative risk of 10-year recurrence was 11.3% (95% CI 6.2%-16.4%) with a median follow-up time of 8.5 (1.0-10.7) years. Treatment success was 86.1% (95% CI 80.6%-91.5%). No significant predictors were associated with recurrence, and 90% of patients experienced no persistent pain. Conclusion:Cleft-lift performed under tumescent local analgesia has an acceptable 10year treatment failure rate, making the method feasible in a day-surgery setting.
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