Minimally invasive techniques in the management of pilonidal disease

Kalaiselvan, R; Bathla, Sonia; Allen, William; Liyanage, Aloka; Rajaganeshan, R

doi:10.1007/s00384-019-03260-y

Cited by 38 publications

(25 citation statements)

References 28 publications

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“…There was no difference in pain scores, patient satisfaction or time off work between groups. Moreover, a systematic review compared 1RCT and 4 case series applying EPSiT to 5 RCTs reporting minimally invasive surgical techniques (sinusectomy, sinotomy, and trephining) covering 820 patients [ 69 ]. The complication rate and return to work time was similar between EPSiT and other minimally invasive surgical technique but superior to traditional surgical techniques.…”

Section: The Future Of Pilonidal Sinus Surgery: the Shift Towards Endmentioning

confidence: 99%

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

Mahmood

Hussain

Akingboye

2020

Annals of Medicine and Surgery

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Pilonidal sinus disease is chronic acquired condition leading to significant morbidity and associated healthcare costs. Several techniques have been described to manage this condition with no treatment gaining universal acceptance. With the shift towards minimally invasive surgery, Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic Pilonidal Sinus Treatment (EPiST) have gained prominence. The aim of this review is to analyse current treatment modalities and the evidence for endoscopic pilonidal sinus surgery. Reported surgical techniques range from wide excision with or without primary closure to various flap closures. These aim to eliminate the underlying causes driven by natal cleft hair and reducing recurrence. However, long term (≥5 years) recurrence rates range between 10 and 30% with significant complication rates. Trials with endoscopic treatment which have shown comparable short-term results to established treatments with reduced morbidity. However, the potential higher cost, learning curve, patient selection criteria and need for long term outcomes from randomised trials limit widespread application of this promising method. Endoscopic treatment of pilonidal sinus disease therefore provides a minimally invasive alternative to traditional surgical methods with the potential to reduce morbidity. However long-term outcomes data from further prospective randomised trials is needed to establish its efficacy compared to traditional surgical methods.

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Section: The Future Of Pilonidal Sinus Surgery: the Shift Towards Endmentioning

confidence: 99%

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

Mahmood

Hussain

Akingboye

2020

Annals of Medicine and Surgery

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“…Some reports showed that the LF had a lower rate of postoperative complications and greater cosmetic satisfaction than KF 8 , 9 , while others reported that there are no significant differences between LF and KF 10 , 11 . Besides, minimally invasive techniques (MIT) such as phenol injection, unroofing and marsupialization, video-assisted ablation 12 and endoscopic sinus treatment 13 are also emerging as alternative procedures.…”

Section: Introductionmentioning

confidence: 99%

Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis

Sun

Chen

et al. 2020

Sci Rep

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The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical interventions using network meta-analysis. Randomized controlled trial studies were searched systematically to identify all eligible studies in multiple databases and previous publications and Bayesian network meta-analysis was performed. Our primary outcome was the recurrence rate. Differences in the findings of the studies were explored in meta regressions and sensitivity analyses. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using CINeMA (Confidence in Network Meta-Analysis). A total of 39 studies and 5,061 patients were identified and the most common surgical intervention was the Limberg flap. In network meta-analysis, modified Limberg flap and off-midline closure were associated with the lowest recurrence rate. However, the Karydakis flap was associated with shorter operation time by several minutes compared with other interventions and few significant results were found in other outcomes. Modified Limberg flap and off-midline closure provided relatively low recurrence and complications rates. Therefore, they could be two promising surgical interventions for PSD patients.

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“…Despite these findings, the authors reported a preference for surgical treatment by excision and PMC among women because of cosmetic considerations [ 38 ]. Similarly, Kalaiselvan et al stated that reconstructive techniques flattening the natal cleft may cause cosmetic issues that are deemed unacceptable by patients [ 39 ]. Thus, we hypothesize that our method of PC will not be the first choice in patients due to cosmetic concerns ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…In their review comparing EPSiT to other minimally invasive PSD treatment options, Kalaiselvan et al found no significant differences in complication rates and time to return to work or school between groups [ 39 ]. However, minimally invasive treatment strategies proved favorable over excision surgery in terms of lower complication rates, faster return to work, shortened wound healing times, and lower pain scores [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Minimally invasive techniques in the management of pilonidal disease

Cited by 38 publications

References 28 publications

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

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