Sticking to the facts: a systematic review of fibrin glue for pilonidal disease

Handmer, Marcus

doi:10.1111/j.1445-2197.2011.05752.x

Cited by 24 publications

(21 citation statements)

References 17 publications

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“…Other systematic review evidence level 3a evaluated the use of fibrin glue in treatment, and the outcomes measured were healing time and recurrence rate, with a total of seven studies (5 small clinical trials) that included 85 patients with follow‐up periods between 4 and 28 months. Fibrin glue appeared as an equivalent alternative, with the same healing times as conventional treatments, averaging 2–6 weeks, and low recurrence rates between 0 and 17 per cent, but with considerable heterogeneity among the studies . Another systematic review evidence level 3a compared primary suture (‘off‐midline’, Karydakis) versus rhomboid flap (Limberg flap) (six studies and 641 patients).…”

Section: Discussionmentioning

confidence: 99%

“…It is reported to be more frequent in men aged 15–30 . Associated variables described are obesity and sedentariness …”

Section: Introductionmentioning

confidence: 99%

“…There are many alternative and various treatment procedures, although in general terms, all of them consider sinus tract excision, complete healing of the overlying skin and prevention of recurrence . However, in general terms, they are associated with considerable morbidity and high recurrence rates of 6–40 per cent, especially in cases of complex and recurrent SPD.…”

Section: Introductionmentioning

confidence: 99%

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Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

Manterola

Otzen

2018

Surgical Practice

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Aim: Sacrococcygeal pilonidal disease (SPD) is a chronic and uncommon entity. Extensive, complex and recurrent SPD is less frequent, and diverse treatment alternatives have been described. One of these is excision, followed by reconstruction with the rhomboid flap, as described by Dufourmentel. The aim of the present study was to report the results of a series of patients with extensive, complex or recurrent SPD operated on using Dufourmentel's technique, in terms of postoperative morbidity (POM) and recurrence. Patients and Methods: The present study was a case series of patients with extensive, complex or recurrent SPD, operated on at the Clínica Mayor and Regional Hospital in Temuco, Chile, between 2000 and 2015, using excision, followed by a reconstruction with the Dufourmentel's rhomboid flap. The outcome variable was POM measured at 30 days' postoperatively using the Clavien-Dindo classification. Other variables of interest were surgical time, hospital stay, mortality and recurrence. The minimum follow-up time was 18 months. Descriptive statistics were used. Results: Ninety-five patients with extensive, complex or recurrent SPD were operated on in the study period. The median age was 21 years, and 56.8 per cent were female. The median surgical time was 60 min (45-90 min). POM was 13.7 per cent, seroma was 5.3 per cent, wound infection was 2.1 per cent and partial surgical wound dehiscence was 6.3 per cent. Mortality of the series was nil. Median hospital stay, follow up and recurrence were 4 days (3-5), 48 months (18-90 months) and 3.2 per cent, respectively. Conclusion: Dufourmentel's technique applied to patients with extensive, complex or recurrent SPD was associated with adequate postoperative evolution in terms of POM and recurrence.

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Section: Discussionmentioning

confidence: 99%

“…It is reported to be more frequent in men aged 15–30 . Associated variables described are obesity and sedentariness …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

Manterola

Otzen

2018

Surgical Practice

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“…The use of fibrin glue for pilonidal disease was analyzed in a systematic review of 5 reports including 85 patients in 2011 [12]. Four of these reports used fibrin glue as an adjunct to surgical excision.…”

Section: Fibrin Gluementioning

confidence: 99%

Less invasive pilonidal sinus surgical procedures

Andersson

2019

coloproctology

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Less invasive pilonidal sinus surgical proceduresMinimally invasive surgery for pilonidal disease is simple, safe, and cost-efficient, with low morbidity, rapid healing, and a rapid return to normal activity. Although recurrence rates seem high at first glance, the procedures can be successfully repeated for recurrences, achieving healing rates of over 90% for 1-2 interventions. Future welldesigned trials are necessary to aid patient selection.

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“…4 Tissue adhesion or sealing A systematic review summarised the evidence for fibrin glue in the repair of pilonidal disease (the invasion of hair into the skin of the natal cleft). 5 The review included five RCTs in which fibrin glue was used to fill dead space and sinus tracks during surgery. The reviewers reported equivalent or better healing times at an average of 2-6 weeks and low recurrence rates between 0% and 17% at follow-up periods between 4 and 28 months for all patients treated with fibrin glue than for those treated with conventional therapies.…”

Section: Avoidance Of Post-operative Drainsmentioning

confidence: 99%

The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms

Edwards¹,

Crawford²,

Velthoven³

et al. 2016

Health Technol Assess

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BackgroundFibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use.ObjectivesTo systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults.Data sourcesElectronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms.Review methodsThis review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis.ResultsWe included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04;p = 0.13;I2 = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86;p = 0.01;I2 = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays.LimitationsIt was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available.ConclusionsThe effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines.Study registrationThis study is registered as PROSPERO CRD42015020710.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Sticking to the facts: a systematic review of fibrin glue for pilonidal disease

Abstract: There appears to be early promise for the use of fibrin glue in the treatment of pilonidal disease and an impetus for definitive research.

Cited by 24 publications

References 17 publications

Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

Less invasive pilonidal sinus surgical procedures

The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms

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