Long‐term efficacy of endoscopic pilonidal sinus treatment: a single‐centre Australian experience

Hinksman, Mathew; Naidu, Sanjeev; Loon, Kenneth; Grundy, Josh

doi:10.1111/ans.17666

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…According to the latest Italian guidelines, EPSiT technology is regarded as the gold standard for the treatment of PS diseases 112 . In the latest study, which is the first single-centre retrospective study in Australia, 13.5% of patients experienced post-healing recurrences after an average follow-up of 56.2 months 113 . In another retrospective study with a median follow-up of 49 months and a mean postoperative follow-up of 19 months, the postoperative recurrence rate was 15%.…”

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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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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“…TA B L E 4 IDEAL checklists for IDEAL Stages 2a and 2b Milone [28] Milone [52] Milone [22] Esposito [31] Esposito [30] Dotlacil [53] Pérez-Bertólez [64] Gulcu [27] Meinero [29] Chia [40] Gecim [49] Sequeira [21] Pini Prato [55] Khafagy [56] Romaniszyn [23] Gökbuget [39] Giordano [42] Gallo [59] Yuksel [33] Baxter [34] Javed [20] Jain [63] Stage Manigrasso [26] Manigrasso [35] Esposito [32] Esposito [24] Esposito [25] Meinero [37] Giarratano [54] Meinero [38] Mendes [41] Kalaiselvan [57] Azhough [58] Foti [60] Gulcu [61] Hinksman [62] A prospective multicentre trial showed a quick postoperative recovery and a good quality of life after EPSiT [37]. A prospective international multicentre study on 122 patients with recurrent PD showed a complete wound healing in 95% of patients, within a mean time of 29 days.…”

Section: Outcomes Of the Techniquesmentioning

confidence: 99%

Endoscopic sinusectomy: ‘a rose by any other name’. A systematic review of different endoscopic procedures to treat pilonidal disease

et al. 2022

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Aim Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition. Although commonly encountered in practice, its ideal treatment is controversial. One of the most validated treatments is video‐assisted surgery. In this context, very similar endoscopic techniques have been published under different names. The aim of this systematic review is to assess the differences among these proposed techniques and their outcomes. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed during all stages of this systematic review. A systematic search of the English literature was performed on multiple databases from 1 January 2014 to 3 April 2022. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measures were the adherence to the IDEAL reporting guidelines, the Blencowe framework and the core outcome set (COS) for studies evaluating the introduction and evaluation of novel surgical techniques, the qualitative assessment using appropriate tools, the procedural variations and outcomes of each technique. Results A total of 38 articles were included reporting a very similar technique under eight different acronyms. The number of patients varied from 9 to 250. Mean follow‐up ranged from 1 to 60 months. There was only one published study of IDEAL 3. The majority (58%) were IDEAL 2a studies. Reporting of domains in the IDEAL reporting guidelines and Blencowe framework was poor, with most studies not reporting the component steps of procedures or efforts to standardize them. Half of COS domains were markedly underreported. The quality of the evidence was categorized as having a risk of bias from moderate to critical level in all nine comparative non‐randomized series. Postoperative complications occurred in 0%–6% of cases, including surgical site infection, poor or failed wound healing bleeding, granuloma, haematoma, and pain requiring intervention. The recurrence rate varied from 0% to 22%. Conclusion The study demonstrates that reporting on technical aspects of interventions for PD is poor, thus warranting a better‐quality control of surgical techniques. It is advisable to group all endoscopic procedures under the umbrella term of ‘endoscopic sinusectomy’, thus embracing the two main principles of this technique, that is, video assistance and PD ablation.

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Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review

Huurman,

Galema,

de Raaff

et al. 2023

Tech Coloproctol

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Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.

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Long‐term efficacy of endoscopic pilonidal sinus treatment: a single‐centre Australian experience

Cited by 3 publications

References 28 publications

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

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

Endoscopic sinusectomy: ‘a rose by any other name’. A systematic review of different endoscopic procedures to treat pilonidal disease

Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review

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