Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature

Abstract

Surgical site infections occur in up to 24 % of patients after surgical excision of sacrococcygeal pilonidal sinus disease with primary wound closure. Local administration of antibiotics by a gentamicin collagen sponge could reduce this infection rate. The objective of this systematic review and meta-analysis was to evaluate the effect of a gentamicin collagen sponge on outcome after surgical excision in patients with sacrococcygeal pilonidal sinus disease. A structured literature search was performed in the PubMed, Embase, The Cochrane Library, and Scopus databases. Studies comparing surgical excision of sacrococcygeal pilonidal sinus disease with versus without a gentamicin collagen sponge were included. Outcome measures were surgical site infection, wound healing, and recurrence. The search strategy yielded six studies with a total of 669 patients. Three randomized controlled trials, comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge, were eligible for inclusion in the meta-analysis (319 patients), demonstrating a trend towards reduced surgical site infections after administration of gentamicin collagen sponge [absolute risk reduction 20 %, 95 %-confidence interval (CI) 1-41 %, p = 0.06]. The wound healing (absolute risk reduction 22 %, 95 % CI 32-77 %, p = 0.42) and recurrence rate (absolute risk reduction 8 %, 95 % CI 7-22 %, p = 0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections. Therefore, additional larger well-designed randomized controlled trials are required.

Management of sacrococcygeal pilonidal sinus disease

“…A systemic review evaluated the usage of gentamicin-impregnated collagen sponge and included five RCTs and 1 retrospective case-control study. 39 Four of these studies compared primary closure with gentamicin collagen sponge vs primary closure without gentamicin collagen sponge, and found no difference between wound healing and recurrence rate, but with a trend towards significance in a reduction in SSI rates with the gentamicin sponge (absolute risk reduction 20%, 95% CI 1%-41%; P = 0.06). Two further included studies compared primary closure with gentamicin collagen sponge vs secondary wound healing without gentamicin collagen sponge, they reported a shorter healing time with the gentamicin sponge group.…”

“…Topical application of antimicrobials has been advocated for pilonidal sinus disease as local administration can lead to prolonged and higher therapeutic concentrations when compared with systemic antimicrobials. A systemic review evaluated the usage of gentamicin‐impregnated collagen sponge and included five RCTs and 1 retrospective case–control study . Four of these studies compared primary closure with gentamicin collagen sponge vs primary closure without gentamicin collagen sponge, and found no difference between wound healing and recurrence rate, but with a trend towards significance in a reduction in SSI rates with the gentamicin sponge (absolute risk reduction 20%, 95% CI 1%–41%; P = 0.06).…”

Ekscizija ir kiuretažas – optimalus pilonidinės cistos gydymo metodas: literatūros apžvalga

“…Liga pasireiškia jauname amžiuje, vyrams dukart dažniau nei moterims [1,2]. Pacientai skundžiasi išliekančiu ar pasikartojančiu šlapiavimu, diskomfortu ar skausmu tarpsėdmeninėje raukšlėje, dėl to sumažėja darbingumas bei prastėja gyvenimo kokybė [1,3].…”

“…Be jau aptartų aspektų, šios operacijos nusileidžia cistos atvėrimui su kiuretažu (1 lentelė) tuo, kad po jų taip pat dažnesniau pasitaiko chirurginės žaizdos infekcijos (iki 24 %). Kitas gydymo būdas -ekscizija ir žaizdos gijimas antriniu būdu, bet taip labai pailgėja gijimo, hospitalizacijos ir nedarbin-gumo laikas [1]. Literatūroje yra duomenų apie atliktas studijas siekiant pagerinti gydymo efektyvumą tokiomis papildomomis priemonėmis kaip pooperacinė sisteminė antibiotikų terapija, lokalus žaizdos tamponavimas gentamicino kempinėmis, neigiamo slėgio terapija žaizdai gyjant antriniu būdu, tačiau jų veiksmingumas neįrody-tas [1,9].…”

“…Kitas gydymo būdas -ekscizija ir žaizdos gijimas antriniu būdu, bet taip labai pailgėja gijimo, hospitalizacijos ir nedarbin-gumo laikas [1]. Literatūroje yra duomenų apie atliktas studijas siekiant pagerinti gydymo efektyvumą tokiomis papildomomis priemonėmis kaip pooperacinė sisteminė antibiotikų terapija, lokalus žaizdos tamponavimas gentamicino kempinėmis, neigiamo slėgio terapija žaizdai gyjant antriniu būdu, tačiau jų veiksmingumas neįrody-tas [1,9]. Taigi pilonidinės cistos atvėrimas ir kiuretažas pranašesnis už kitas gydymo taktikas ne vien dėl retesnio ligos pasikartojimo, bet ir dėl trumpesnio operacijos atlikimo laiko, gijimo laiko, mažesnio komplikacijų dažnio bei greičiau atgaunamo darbingumo.…”