A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents

Gendy, Amir S.; Glick, Richard D.; Hong, Andrew R.; Dolgin, Stephen E.; Soffer, Samuel Z.; Landers, Helen; Herrforth, Michelle; Rosen, Nelson G.

doi:10.1016/j.jpedsurg.2011.03.062

Cited by 30 publications

(14 citation statements)

References 16 publications

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“…Data on recurrence and follow-up times pertaining to 16,349 patients treated for PSD by a Karydakis and Bascom cleft lift technique were extracted from 66 additional non-RCTs 91 , 92 , 136 , 146 , 161 , 163 , 184 , 198 , 206 , 254 , 263 , 313 , 335 , 346 , 348 , 361 , 379 , 391 , 394 – 441 . Among these patients, a recurrence of 0.2% (95% CI 0.1–0.3%) was observed in patients at 12 months, 0.6% (95% CI 0.5–0.8%) at 24 months, 1.9% (95% CI 1.6–2.2%) at 60 months, and 2.7% (95% CI 2.4–3.1%) at 120 months (Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Stauffer

Luedi

Kauf

et al. 2018

Sci Rep

203

191

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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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Section: Resultsmentioning

confidence: 99%

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

Stauffer

Luedi

Kauf

et al. 2018

Sci Rep

203

191

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“…at riskRR in % (95% CI)Nr. at riskPrimary open (2124)2.2 (1.5–2.8)17087.4 (5.7–9.1)73441.5 (30.2–52.8)69NANA 21, 37, 41, 43, 46, 57, 62, 63, 69, 77, 79, 104, 105, 107, 108, 111, 524– 540 Primary median closure (3650)4.3 (3.6–5.1)27548.5 (7.4–9.7)211925.3 (21.9–28.7)38847.9 (37.1–58.6)44 37, 46, 57, 62, 63, 69, 77, 107, 108, 152, 156, 157, 170, 175, 181, 185, 227, 237, 525– 529, 532, 533, 538, 540– 559 Primary asymmetric closure (176)0.6* (0.0–1.7)170*0.6 (0.0–1.7)160NANANANA 257, 560, 561 Karydakis/Bascom (236)0.3* (0.0–0.8)236*2.4* (0.2–4.7)160*NANANANA 21, 41, 562– 565 Limberg/Dufourmentel (164)0.6* (0.0–1.8)156*0.6* (0.0–1.8)145*2.3 (0.0–4.9)120NANA 170, 351, 374, 566 Marsupialization (1475)<...>…”

Section: Resultsmentioning

confidence: 99%

“…at riskRR in % (95% CI)Nr. at riskPrimary open (6351)1.3 (1.0–1.7)57154.2 (3.6–4.8)349613.9 (12.2–15.6)122228.1* (23.9–32.4)241* 20– 122 Primary median closure (15011)3.1 (2.8–3.5)12,4848 (7.4–8.6)695614.9 (13.8–15.9)250527.9 (25.5–30.4)631 20, 24, 27, 29, 31, 34– 38, 44, 46, 48, 52, 54, 56, 57, 59, 61– 66, 69, 73– 78, 81– 84, 86, 89– 91, 93– 100, 106– 108, 115, 118, 122– 248 Primary asymmetric closure (2538)0.6 (0.3–0.9)24321.1 (0.7–1.6)18072.7 (1.9–3.6)12056.3* (4.8–7.7)937* 65, 67, 100, 129, 183, 192, 249– 263 Karydakis/Bascom (6276)0.5 (0.3–0.7)58681.6 (1.2–2.0)36306.3 (5.0–7.5)853NANA 16, 21, 29, 41, 49, 66, 78, 88, 133, 163, 172, 184, 189, 192, 195, 199, 200, 202, 262– …”

Section: Introductionmentioning

confidence: 99%

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

Doll

Orlik

Maier

et al. 2019

Sci Rep

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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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“…In zahlreichen Publikationen werden Rezidivraten zwischen 2 und 6 % angegeben [24,175,181,315,337,396,436,456]. Es finden sich jedoch mit gewisser Regelmäßigkeit auch Arbeiten, die eine Rezidivrate von 15-35 % angeben [23,188,191,223,232,270,312,393,434,443]. Vor allem die voroperierten Patienten scheinen besonders hohe Rerezidivraten zu haben [224].…”

Section: Exzision Und Offene Wundbehandlungunclassified

“…Prospektiv-randomisierte Studien Es liegen keine randomisierten Studien vor, die das Cleft-lift-Verfahren mit den medianen Exzisionsverfahren vergleichen. In den nichtrandomisierten Studien [146,188] traten jedoch nach "cleft lift" weniger Rezidive auf.…”

Section: Cleft-lift-verfahrenunclassified

S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020

2020

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Beteiligte Fachgesellschaften Deutsche Gesellschaft für Koloproktologie (DGK); federführend Deutsche Gesellschaft für Allgemein-und Viszeralchirurgie (DGAV) Chirurgische Arbeitsgemeinschaft für Coloproktologie (CACP) Berufsverband der Coloproktologen Deutschlands (BCD) Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten (DGVS) Deutsche Dermatologische Gesellschaft (DDG) 1. Einleitung und Definition Der Pilonidalsinus oder Sinus pilonidalis (pilus = Haar, nidus = Nest) ist eine akut oder chronisch verlaufende Entzündung im subkutanen Fettgewebe, überwiegend im Bereich der Steißbeinregion.

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A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents

Cited by 30 publications

References 16 publications

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

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

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

S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020

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