Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis

Hardy, Edward; Herrod, Philip; Doleman, Brett; Phillips, Hannah G; Ranat, Reesha; Lund, Jonathan N.

doi:10.1016/j.jpedsurg.2019.02.058

Cited by 29 publications

(33 citation statements)

References 38 publications

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“…Recurrence rates are 11-42% in adults and 12% (8-25%) in children. 4,15,16 In contrast, we observed 40% and 28% recurrence (7% needed a re-operation), respectivelyvalues that are higher than in literature reports. Overall, there is general consensus amongst some level 1 studies and multiple systematic reviews, that midline closure is inferior to any type of off-midline closure (including flaps) in terms of infection, healing time, wound dehiscence, and possibly recurrence rates.…”

Section: Discussioncontrasting

confidence: 82%

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Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time

Gezer

Ezer

İnce

et al. 2020

Pediatrics International

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Background: Pilonidal sinus disease (PSD) is commonly seen in young adults but may also affect adolescents. Our goal was to present results from operated patients, with a focus on the original Limberg flap, which we standardized for the first time. Methods: This study was a retrospective review of 60 teenage patients who underwent surgery in a single pediatric surgery center over approximately 15 years. Results: Of the 60 patients, 33 (55%) were male and the mean age was 14.20 AE 1.31 (9-17) years. After pilonidal sinus excision, primary repair and Limberg flap were performed in 45 (75%) and 15 (25%) patients respectively. There were no complications in the patients who underwent the Limberg flap technique, whereas 49% of the patients who underwent primary repair exhibited complications. The mean follow-up was 6.7 AE 4.8 years. Conclusion: We standardized the Limberg flap for the first time in children with measurements and consider that it meets expectations: it is not difficult to perform, it has low complication and recurrence rates, it requires an acceptable period to return to normal activities, and gives satisfactory cosmetic results. We did not identify any complications in patients treated with the Limberg flap excision and post-operative epilation. We consider that findings achieved by the treatment of original, standardized Limberg flap excision is comparable with all of the treatment methods reported in the literature related with children.

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Section: Discussioncontrasting

confidence: 82%

“…symptoms and presenting at the hospital was 6 AE 2.35 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) months.…”

Section: Resultsmentioning

confidence: 99%

Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time

Gezer

Ezer

İnce

et al. 2020

Pediatrics International

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“…However, recurrence and complication are not the only determinants of SPS treatment. In particular, the factors affecting the quality of life such as school attendance, sportive activities and socialization in the adolescent age group should not be ignored when appropriate treatment is selected (6) . In our study, no significant difference was observed between MEPC and LF met-hods in the recovery time and patient satisfaction rates.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, procedures commonly used in the treatment of SPS are either to leave the wound to secondary healing after extensive excision of SPS or to close the wound with flap or without flap (5) . However, each of these procedures has its own advantages and disadvantages (6) . For example, wounds left for secondary healing recover much later than primary closure wounds, but relapse rates are lower.…”

Section: Introductionmentioning

confidence: 99%

“…However, when the wounds closed primarily in the midline or not are compared, the recurrence, wound infection rates and recovery times of the wounds closed in the midline are higher (7) . Therefore, in recent years as an alternative to the procedures described above, surgical and nonsurgical minimally invasive procedures which are easy to apply, allow rapid return to work/school, and have reportedly acceptable recurrence and complication rates (6,8) . Minimally invasive surgical procedures usually performed through a limited incision or excision of the sinuses and orifices.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Minimal Excision and Primary Wound Closure with Limberg Flap Procedure in Adolescent Sacrococcygeal Pilonidal Sinus Surgery

Karaalı¹,

Sayan²,

Sert³

et al. 2020

BUCH

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Objective: Recently, minimally invasive methods have been used in surgical treatment of adult sacrococcygeal pilonidal sinus (SPS) instead of classical wide excisions. However, there are fewer data about minimally invasive methods in the adolescent age group. Therefore, we aimed to compare our adolescent patients undergoing minimal excision and primary closure (MEPC) with those undergoing Limberg flap (LF) method. Method: In this study, the data of 80 patients who were operated for sacrococcygeal pilonidal sinus between July 2014 and December 2017 were retrospectively reviewed. Patients who underwent minimal excision with primary closure (MEPC) or Limberg flap (LF) were included in the study. Patients were evaluated in terms of age, sex, body mass index (BMI), length of hospital stay, time to return to work/school, time to complete healing, complication, recurrence and patient satisfaction levels. Results: No significant difference was found between patient characteristics, complication, recurrence and patient satisfaction rates of these two groups. However, in terms of hospitalization and return to work/ school, MEPC group was found to be statistically advantageous compared with LF group. Conclusion: MEPC procedure has similar success rates in terms of recurrence, complications and patient satisfaction compared with LF. However, the MEPC procedure has advantages such as allowing faster return to work/school and not requiring hospitalization. Therefore, in adolescents with non-complex and uncommon SPS disease, MEPC procedure may be offered as an alternative treatment option to LF.

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Management of Pilonidal Disease

2023

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ImportanceThe management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.ObservationsThere is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.Conclusions and RelevancePilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

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Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis

Cited by 29 publications

References 38 publications

Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time

Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time

Comparison of Minimal Excision and Primary Wound Closure with Limberg Flap Procedure in Adolescent Sacrococcygeal Pilonidal Sinus Surgery

Management of Pilonidal Disease

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