Pilonidal disease in a military population: how far have we really come?

Fitzpatrick, Emilie; Chesley, Patrick M.; Oguntoye, Morohunranti; Maykel, Justin A.; Johnson, Eric K.; Steele, Scott R.

doi:10.1016/j.amjsurg.2013.07.038

Cited by 28 publications

(16 citation statements)

References 16 publications

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“…Data on recurrence and follow-up times in primary open PSD treatment pertaining to 21,583 patients were extracted from 205 additional non-RCTs 4 , 60 , 74 , 75 , 111 , 112 , 114 , 115 , 117 , 118 , 121 – 126 , 128 – 134 , 136 , 137 , 141 , 143 , 149 , 153 – 156 , 160 , 161 , 163 , 167 – 171 , 174 , 175 , 177 , 181 , 182 , 188 – 192 , 194 , 196 , 197 , 199 – 201 , 203 , 206 , 208 , 215 , 216 , 218 , 220 , 221 , 223 , 224 , 230 , 233 , 237 – 373 . Among these patients, a recurrence of 3.4% (95% CI 3.1–3.6%) was observed in patients at 12 months, 7.0% (95% CI 6.5–7.4%) at 24 months, 16.8% (95% CI 15.8–17.8%) at 60 months, 32.0% (95% CI 29.6–34.4%) at 120 months, and 67.9% (95% CI 53.3–82.4%) at 240 months (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Data on recurrence and follow-up times pertaining to 3,207 patients treated for PSD by other flap techniques were extracted from 55 additional non-RCTs 4 , 108 , 109 , 115 , 129 , 132 , 133 , 137 , 143 , 163 , 170 , 171 , 177 , 188 , 190 , 193 , 200 , 204 , 215 , 218 , 224 , 230 , 245 , 272 , 279 , 294 , 303 , 313 , 315 , 317 , 318 , 336 , 352 , 358 , 363 , 369 , 593 , 605 – 622 . Among these patients, a recurrence of 1.8% (95% CI 1.2–2.3%) was observed in patients at 12 months, 5.6% (95% CI 4.5–6.7%) at 24 months, 9.4% (95% CI 7.6–11.1%) at 60 months, and 16.3% (95% CI 11.8–20.9%) at 120 months (Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

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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%

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

View full text Add to dashboard Cite

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“…The authors confess, though, that multiple studies not linking postoperative infection and recurrence rate do exist, as demonstrated by al-Hassan et al [ 18 ] and Vogel and Lenz [ 19 ]. Interestingly, the review by Milone et al [ 20 ] of 1,003 patients underlines a significant link between complication and recurrence, and that of Fitzpatrick et al [ 21 ], analyzing a smaller military cohort, agrees.…”

Section: Discussionmentioning

confidence: 91%

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

et al. 2015

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Objective: The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. Subjects and Methods: A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. Results: Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. Conclusion: The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures.

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“…The incidence is also affected by factors such as driving, personal hygiene, and obesity. 17 There are two conflicting theories of PSD pathogenesis: congenital and acquired. It is very important to understand the difference between these two since each requires different principles of treatment.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Results of the Karydakis Flap Procedure and Primary Closure in the Treatment of Pilonidal Sinus Disease Over the Short and Long Term: A Randomized Clinical Study

Kendirci

Akın

et al. 2016

International Surgery

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In the current prospective study, we compared the results of the Karydakis flap procedure (KFP) and primary closure (PC). This study compared the short and long-term results of the KFP and PC techniques. The sample of this study was a total of 352 patients (302 male: 85.7%; median age: 24 years) who underwent reconstruction after pilonidal sinus excision in our clinic. The reconstruction was performed using the KFP (group 1, n ¼ 176, 50%) or PC (group 2, n ¼ 176, 50%). The following data on the patients was obtained; sex, age, body mass index (BMI), duration of operation and hospital stay, length of time patient could walk without pain, length of time patients could sit on toilet without pain, complications (e.g., infection, recurrence). No significant difference was found between groups 1 and 2 with respect to sex, age, BMI, and duration of operation. Moreover, length of time patients could walk and sit on toilet without pain was similar in both groups. On the other hand, the rate of recurrence was significantly lower in group 1 (n ¼ 4, 2%) compared with group 2 (n ¼ 20, 11%, P , 0.001). KFP is preferable to PC since it is easier to learn and perform and has lower complication and recurrence rates.

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Pilonidal disease in a military population: how far have we really come?

Cited by 28 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

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

A Comparison of the Results of the Karydakis Flap Procedure and Primary Closure in the Treatment of Pilonidal Sinus Disease Over the Short and Long Term: A Randomized Clinical Study

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