Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing?

Özcan, Rahşan; Hüseynov, Mirzaman; Bakır, Ayten Ceren; Emre, Şenol; Tütüncü, Çiğdem; Celayır, Sinan; Tekant, Gonca Topuzlu

doi:10.1016/j.asjsur.2017.08.006

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…In research by Elsshazly et al, 20 the post‐operative pain in the LIMBERG flap procedure was significantly less than the excision and primary closure procedure groups ( P ‐value<.001). However, in separate studies by Karaks et al, 9 Ozcan et al, 5 and Berthier et al, 13 there was no significant difference between groups regarding the duration of post‐operative pain. Also, in the research of Demiryilmaz et al, 12 the minimum duration of post‐operative pain was associated with the elliptical rotational flap and the maximum duration with primary repair may be due to stretching of tissue in primary repair surgery, which will increase the duration of post‐operative pain.…”

Section: Discussionmentioning

confidence: 93%

“…It has been shown that a tension‐free suture via bilateral rotational flaps having a good vacuum effect at the button of the wound meant for drainage of blood from the bottom of the wound is a key to success of repair without recurrence 17 . However, in a study conducted by Ozcan et al, 5 recurrence was detected in a total of 11 (23.4%) patients. Primary midline closure exhibited long‐term recurrence up to 67.9% in research by Stauffer et al 19 In a systematic review by Berthier et al, 19 it was indicated that all studies have reported data on disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 It is a common anorectal problem most often arising in the hair follicles within the natal cleft of the sacrococcygeal region. [3][4][5] Patients may present with symptoms of acute disease (pain in the sacrococcygeal region due to abscess formation) or may suffer from the chronic form of the disease with purulent discharge from one or multiple sinus tracts. 6 The treatment of pilonidal sinus disease remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Pilonidal sinus is a common problem in young people, affecting most commonly men in the second and fourth decades of life 1,2 . It is a common anorectal problem most often arising in the hair follicles within the natal cleft of the sacrococcygeal region 3‐5 . Patients may present with symptoms of acute disease (pain in the sacrococcygeal region due to abscess formation) or may suffer from the chronic form of the disease with purulent discharge from one or multiple sinus tracts 6 …”

Section: Introductionmentioning

confidence: 99%

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Comparison of three different surgical treatment methods, semi‐open closure, primary repair, and rotational flap for pilonidal sinus

et al. 2020

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Background: Pilonidal sinus disease is a common infectious process that occurs on the natal cleft and sacrococcygeal part. The treatment of pilonidal sinus disease remains challenging and despite the existence of many non-surgical and surgical methods, there is no consensus for the best treatment for this disease. Objective: The goal of this study is to investigate the outcomes of pilonidal sinus surgery by three methods of semi-open, primary repair, and elliptical rotational flap. Methodology This prospective randomized study was conducted on patients suffering from primary pilonidal sinus. The patients were randomly assigned to one of the three groups based on surgical technique, were followed according to a checklist within the first, second and fourth weeks, as well as third and sixth months after surgery. Follow up was done in terms of recurrence, surgical complications, post-operative pain, and duration of hospitalization. Results: One hundred forty-six patients completed the study, including 21 women and 125 men. The mean age of patients was 26.56 ± 5 years. There was only one case of recurrence and the rate of post-operative haematoma and infection were not significant between groups, while the rate of itching problem was significantly different (P-value = .001). The highest degree of itching, haematoma and infection were in the semi-open, rotational flap and primary repair group, respectively. The mean duration of pain relief and time of hospitalization were 25.73 ± 11.36 hours and 4.41 ± 1.56 days, respectively, which were significantly different between groups. The longest mean duration of pain relief and hospitalization were in primary repair and semi-open group, respectively. Conclusions: Elliptical rotational flap is preferred to the other two methods due to less pain, lower recurrence rate after surgery and early return of patients to the economic cycle.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of three different surgical treatment methods, semi‐open closure, primary repair, and rotational flap for pilonidal sinus

et al. 2020

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“…The influence of high body mass index (BMI) and surgical site infection (SSI) on the rate of PSD recurrence is discussed controversially [ 8 , 21 , 22 , 25 , 26 , 27 , 28 ]. While topical gentamycin application lowers the rate of SSI, it does not improve the long-term rate of PSD recurrence [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi‐centric Analysis

Maasewerd,

Stefanescu,

König

et al. 2023

World j. surg.

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Background Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort. Methods We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors. Results We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2–10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3–16.2 vs. 5.5 months, 95% confidence interval: 3.7–9.7). None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05–7.79, P = 0.04). Conclusions We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.

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Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing?

Cited by 13 publications

References 26 publications

Comparison of three different surgical treatment methods, semi‐open closure, primary repair, and rotational flap for pilonidal sinus

Comparison of three different surgical treatment methods, semi‐open closure, primary repair, and rotational flap for pilonidal sinus

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi‐centric Analysis

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