Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus
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There are different open healing and primary closure approaches for chronic pilonidal sinus (CPD) that differ in principles and extension.
To compare the results of different closure surgical techniques, we performed a meta-analysis of randomized controlled trials (RCT) comparing: (1) open wide excision versus open limited excision (sinusectomy) or unroofing (sinotomy); (2) midline closure (conventional and tension-free) versus off-midline; (3) advancing versus rotation flaps; and (4) sinusectomy/sinotomy versus primary closure.
Data extraction and risk of bias assessment were conducted independently by the authors using the Cochrane Collaboration’s tool. Data were pooled using fixed and random-effects models. Primary outcomes were rate of healing, recurrence, wound infection and dehiscence. Twenty-five trials (2,949 patients) were included.
Four trials compared limited versus radical open healing. Although recurrence rate did not differ, all other outcomes favored the limited approach. Ten studies compared midline versus off-midline primary closure; wound infection and dehiscence were significantly higher after midline closure. Six RCT compared Karydakis/Bascom versus Limberg. No difference was found in recurrence or wound complications rate. Six RCT compared sinusectomy/sinotomy versus primary closure. Recurrence rate was significantly lower after sinusectomy/sinotomy; no significant differences were found in other outcomes.
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.
KeywordsPilonidal disease Sacrococcygeal sinus Outcomes research Surgical techniques
Conflict of interest
- 4.Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Update in Cochrane Database Syst Rev 20:CD006213Google Scholar
- 9.Goligher J (1999) Surgery of anus, rectum and colon, 5th edn. UK Bailliere Tindall, London, pp 221–236Google Scholar
- 24.Polat N, Albayrak D, Ibis AC, Altan A (2008) Comparison between Karydakis repair and primary closure for surgical treatment of sacrococcygeal pilonidal sinus. Trakya Univ Tip Derg 25:87–94Google Scholar
- 34.Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20:415–422PubMedCrossRefGoogle Scholar
- 35.Amorin J, Villani D, Ruiz R, Salinas A (1989) Resection and primary closure vs simple curettage in the treatment of pilonidal sinus: a prospective and randomized study. Rev Venez Cir 42:138–141Google Scholar