Minimal Excision and Primary Suture is a Cost‐Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population‐Based Interventional and a Cross‐Sectional Cohort Study

Abstract

BackgroundConventional treatment of pilonidal disease with wide excision is associated with high morbidity. We describe the short- and long-term results and the impact on the health care system of a simple operation performed in the office under local anaesthesia, consisting of minimal excision of pilonidal sinuses with primary suture—the modified Lord–Millar operation (mLM).MethodsAll patients operated with mLM from February 2008 till November 2012 were prospectively followed for recurrence by telephone interviews and examination of symptomatic patients till July 2015. The outcome is compared with that in all patients operated with conventional wide excision from January 2003 till February 2008. The effects on the health care system of a consistent use of mLM is analysed by comparing the management of all patients with pilonidal disease at three hospitals during 2013 and 2014.ResultsSome 129 patients underwent conventional surgical treatment, and 113 had the mLM operation. The mLM operation was more often performed under local anaesthesia, was less often admitted to hospital, had fewer post-operative health care visits (2.4 vs. 14.6, p < 0.001) and a shorter sick leave (1.0 vs. 34.7 days, p < 0.001) indicating faster wound healing. The estimated 5-year recurrence rate was similar (32 vs. 23%, p = 0.091). The cost per operated patient was lower (2231 vs. 6222 EUR, p < 0.001). The hospital consistently applying the mLM operation used less resources for pilonidal diseased patients (34,545 vs. 77,421 EUR per 100,000 inhabitants and year).ConclusionsThe mLM operation is simple, cost-efficient and has low morbidity and good long-term results.

Improving Resource Utilization and Outcomes Using a Minimally Invasive Pilonidal Protocol

“…A paradigm shift in surgical treatment of pilonidal disease is needed to lessen its toll on both the patient and healthcare system. Recent studies express support for such an improvement, showing minimally invasive approaches/procedures as equally effective or superior compared to surgical excision, with decreased morbidity and cost [12].…”

“…Few published studies on sinusectomy have addressed the resource utilization of pilonidal care. Khodakaram & colleagues [12] evaluated the financial impact of the minimally invasive modified Lord-Millar (mLM) treatment in a Swedish hospital system. Compared to traditional wide excision, the mLM group was more likely to have procedures under local anesthesia, fewer postoperative health care visits and shorter sick leave with a similar 5-year recurrence rate.…”

“…For adolescents, the activity restrictions mandated through the perioperative period and the painful, embarrassing side effects associated with recurrences often lead to a disruption of schooling and social life during an important time in development [3,10]. Minimally invasive approaches such as sinusectomy are associated with minimal social disruption and no activity restrictions [11][12][13][14][15]. Additionally, smaller studies have shown promising results in the application of laser epilation in the primary or secondary management of pilonidal disease [16][17][18][19].…”

Less invasive pilonidal sinus surgical procedures

“…Whereas the recurrence rate may seem high, it should be noted that the same method can be used repeatedly with similar results, suggesting that over 90% can be healed with 1-2 operations [17,18,30].…”

“…However, delayed healing may occur in about 10 to 16% [4,6,11]. Khodakaram [17] described a modification of the Lord-Millar method where the wounds from the small midline excisions were closed primarily (. Fig.…”