Cleft closure (the Bascom cleft lift) for 714 patients—treatment of choice for complex and recurrent pilonidal disease (a cohort study)

Ojo, Dotun; Flashman, Karen; Thomas, G.; Tozer, Phil; Senapati, Asha

doi:10.1111/codi.16688

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Conversely around 1 in 10 surgeons perceive a failure rate of less than 5%. There is some good evidence that surgeons with a special interest in pilonidal disease can achieve this level of success and therefore this perception may be justified [11]. Such a difference in outcome prompts two questions.…”

Section: Of Interest Is the Surgeon's Perception Of Failure Of Interv...mentioning

confidence: 99%

A survey of treatment preferences of UK surgeons in the treatment of pilonidal sinus disease

et al. 2023

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AimPilonidal sinus is a common surgical condition which impacts a young and economically active population. There are limited data to guide treatment in this condition. The aim of this work was to assess current practice.MethodA survey was developed as part of the PITSTOP study. It included questions on volume of practice, treatment preferences and training. The survey was delivered to consultant surgeons with a UK practice through social media, specialty surgical societies and through PITSTOP sites. Descriptive statistics were reported.ResultsOf the 200 people who received a link to the questionnaire, 109 completed it (response rate 54.5%). Respondents treated a median of 15 patients per year, with 20% of these having recurrent disease. Estimates of recurrence were higher than reported in the literature and higher than in a survey 10 years ago. Nearly 50% of surgeons advocate nonsurgical treatment in some patients despite limited evidence. Two thirds practised interventions not favoured by guidelines, including excision and leave open and midline closure techniques. Invasive procedures tended to be favoured when minimally invasive procedures may be appropriate. Surgical training programmes were the key training setting for commonly offered procedures, with few other training opportunities reported. For some procedures, no formal training had been given.ConclusionThis survey highlights issues with quality in pilonidal surgery in the UK, with persistence of potentially outdated techniques, no consistent treatment escalation plan, a suggestion of under‐ or overtreatment of disease and a high perception of failure. This may relate to the current system of training and lack of evidence‐based guidance.

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Section: Of Interest Is the Surgeon's Perception Of Failure Of Interv...mentioning

confidence: 99%

A survey of treatment preferences of UK surgeons in the treatment of pilonidal sinus disease

et al. 2023

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Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease

Emengo,

Abrajano,

Dalusag

et al. 2024

Pediatr Surg Int

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Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation

Brown,

Hind,

Strong

et al. 2024

Health Technol Assess

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Background There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. Objectives A prospective cohort study to determine: disease severity and intervention relationship most valued outcomes and treatment preference by patients recommendations for policy and future research. Design Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Setting Thirty-one National Health Service trusts. Participants Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Interventions Surgery. Main outcome measures Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Results Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference −10.1%, 95% confidence interval −18.1 to −2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35–34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Limitations Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Conclusions and future work Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. Trial registration This trial is registered as ISRCTN95551898. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.

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Cleft closure (the Bascom cleft lift) for 714 patients—treatment of choice for complex and recurrent pilonidal disease (a cohort study)

Cited by 3 publications

References 22 publications

A survey of treatment preferences of UK surgeons in the treatment of pilonidal sinus disease

A survey of treatment preferences of UK surgeons in the treatment of pilonidal sinus disease

Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease

Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation

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