Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus

Abstract

Our meta-analysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered: open radical excision and primary midline closure should be abandoned. Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches.

The Dufourmentel modification of the limberg flap: Does it fit all?

“…9 During treatment it is important to think about the active population that is most affected by PD, and to tailor the treatment method to the individual patient. 4 In the authors' opinion, the only limitation of the DMLF is in PD that is very long (for example when the sinuses are located very low, close to the anus, or the abscess hole is high in the midline on the back), in which case another surgical method, such as KF or tandem rhomboid flaps, would be preferable. 10 In this clinical situation, the DMLF would result in a very large wound with unnecessary removal of large areas of healthy In other situations, especially when the abscess holes and infected tissue are located laterally to the midline, the DMLF should be the preferred method (Fig.…”

“…13 Some authors find the removal of the infected tissue the easiest part of the procedure, but in the present authors' view it is the most important and the most difficult part, because if it is not performed meticulously and carefully, it can be the cause of recurrence. 4 Usually the lowest part of the PD area is located on the midline and this region has to be very carefully excised, so any methods that shift the rhombic excision to the side may be end up leaving some infected tissue behind, leading to a recurrence. 2,14 Reconstruction is not very difficult and enables tension-free closure of the defect with flattening of the natal cleft 2 (Fig.…”

“…3 The authors of a meta-analysis of 25 trials (2,949 patients) suggested that open radical excision and primary midline closure should be abandoned in favor of sinusotomy/sinectomy or en bloc resection with off-midline primary closure. 4 The authors of the present article performed radical excision with primary midline closure before the introduction of the Dufourmentel modification of the Limberg flap (DMLF), but the outcomes were poor, especially in patients with PD and laterally localized sinuses. This forced us to look for another method.…”

Dufourmentel Rhomboid Flap for Sacrococcygeal Pilonidal Sinus: Technical Details

“…In relation to its surgical treatment, various alternatives have been described including open techniques (open resection), extensive resections (incision and curettage), marsupialization, excision and primary closure, resection and rotation flaps (z-plasty, Limberg technique, Dufourmentel triple L plasty, V-Y plasty, W-plasty, and modifications of some of these) (Petersen et al, 2002;Bannura, 2003;Al-Khamis et al;Aydin et al;Horwood et al;Enriquez-Navascues et al;Yabanoglu et al), and the asymmetric resection (Karydakis technique) (Akinci et al, 2000;Bessa, 2007).…”

“…Wound management may be left to restore by open healing or secondary intention diminishing wound tension, which helps difficulties of free healing without relapse if all sinus are completely removed. On the other hand, wound could be closed by primary intention, applying a different technical options (McCallum et al, 2008;Al-Khamis et al, 2010;Enriquez-Navascues et al, 2014).…”