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

Abstract

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.

Surgical Treatment of Chronic Pilonidal Disease

“…However, their relapse rate is higher. In the case of primary closure of the resulting defect (when minimally invasive treatment is not suitable), this must be done away from the midline, as the two most commonly used reconstructive techniques offer-the Limberg flap and the Karydakis procedure (11)(12)(13).…”

Commentary on ‘the review on the progress in the surgical treatment of sacrococcygeal pilonidal sinus’

“…We have read the review on the progress in the surgical treatment of sacrococcygeal pilonidal sinus (SPS) 1 . The subject of the manuscript is interesting and topical.…”

“…The authors evaluated 54 studies and included 3612 patients in their meta-analysis. The review of the medical literature was rigorously conducted 1 . The authors concluded that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques.…”

“…The authors concluded that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Moreover, the author emphasized the importance of adopting a comprehensive approach in formulating individualized solutions that best fit the patient’s needs 1 .…”

“…At the same time, the article also mentioned an interesting phenomenon that different researchers may have contradictory results using the same surgical method, and this phenomenon is particularly prominent in the study of minimally invasive surgery for treating SPS. As analyzed by the authors, studies of minimally invasive surgical treatment of SPS that contain complex SPS may increase postoperative recurrence and infection rates 1 . Therefore, preoperative evaluation of SPS is particularly important; MRI plays an important role in accurately measuring the basic parameters of SPS (size, volume, location, surrounding tissue), providing surgical access, and evaluating the risk factors for postoperative complications and recurrence 3 .…”