A mapping review of sacrococcygeal pilonidal sinus disease

Kumar, Mukesh; Clay, W; Lee, Matthew J.; Brown, S. R.; Hind, Daniel

doi:10.1007/s10151-021-02432-9

Cited by 15 publications

(12 citation statements)

References 49 publications

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“…The endoscopic method has the advantage of treating the tracts under vision in contrast to pit picking or laser treatment. In their mapping review on PD, Kumar et al claimed the need for trials comparing minimally invasive procedures with standard care [9]. The authors also confirmed and highlighted the absence of clear, front‐running surgical interventions for PD and the presence in the literature of a great heterogeneity in the definition, measurements and clinical outcomes, as pointed out in a recent systematic review [17].…”

Section: Discussionmentioning

confidence: 93%

“…Similar 'snapshot' have already been taken at a national level. For instance, 983 studies from the literature on the management of PD were the object of a recent mapping review by Kumar et al [9], summarizing eight decades of research on the topic. A total of 36 studies were systematic reviews with/ without meta-analyses, 121 randomized controlled trials and 826 observational studies.…”

Section: Introductionmentioning

confidence: 99%

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An international survey exploring the management of pilonidal disease

Gallo,

Goglia,

Senapati

et al. 2023

Colorectal Disease

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AimPilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The aim of this study was to snapshot the current management of PD across European countries.MethodMembers affiliated to the European Society of Coloproctology were invited to join the survey. An invitation was extended to others via social media. The predictive power of respondents' and hospitals' demographics on the change of therapeutic approach was explored.ResultsRespondents (n = 452) were mostly men (77%), aged 26–60 years, practising in both academic and public hospitals and with fair distribution between colorectal (51%) and general (48%) surgeons. A total of 331 (73%) respondents recommended surgery at first presentation of the disease. Up to 80% of them recommended antibiotic therapy and 95% did not use any classification of PD. A primary closure technique was the preferred procedure (29%), followed by open technique (22%), flap creation (7%), sinusectomy (7%) and marsupialization (7%). Approximately 27% of subjects would choose the same surgical technique even after a failure. Almost half (46%) perform surgery as office based. A conservative approach was negatively associated with acutely presenting PD (p < 0.001). Respondents who were not considering tailored surgery based on patient presentation tended to change their approach in the case of a failed procedure.ConclusionWith the caveat of a heterogeneous number of respondents across countries, the results of our snapshot survey may inform the development of future guidelines.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

An international survey exploring the management of pilonidal disease

Gallo,

Goglia,

Senapati

et al. 2023

Colorectal Disease

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“…Minimally invasive treatments include curettage, laser therapy, endoscopic adjuvant therapy, and radiofrequency ablation (Fig. 13 ) 51 . Although there are many surgical treatment options, the most appropriate surgical treatment for PS disease remains controversial 52 , 53 .…”

Section: Discussionmentioning

confidence: 99%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

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Background: A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. Methods: A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. Results: Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [P=0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P=0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant (P=0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant (P=0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection (P≥0.05). Conclusions: There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient’s wishes, appearance of the SPS, and the professional ability of the surgeon.

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“…Pilonidal sinus is a chronic sinus or cyst that causes clinical symptoms such as hair, ulceration and discharge, swelling, and pain in the lesion and is commonly located in the soft tissue of the sacrococcygeal intergluteal fissure. 1 The disease occurs in young men over the age of 17. 2 In China, the incidence of pilonidal sinus is relatively low compared with Europe and the United States, but in recent years, the incidence of the sacrococcygeal pilonidal sinus has been on the rise.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of sinus resection combined with vacuum‐assisted closure on sacrococcygeal pilonidal sinus

Xiao

Zhao

Shen

et al. 2023

International Wound Journal

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This study was aimed at investigating the effect of sinus removal combined with vacuum‐assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C‐reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum‐assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.

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A mapping review of sacrococcygeal pilonidal sinus disease

Cited by 15 publications

References 49 publications

An international survey exploring the management of pilonidal disease

An international survey exploring the management of pilonidal disease

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Effect of sinus resection combined with vacuum‐assisted closure on sacrococcygeal pilonidal sinus

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