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Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study

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Abstract

Introduction

Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up.

Methodology

All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan–Meier analyses.

Results

Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan–Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026).

Conclusion

This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.

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Data availability

All figures, tables and data included in this manuscript that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Sheffield Childrens’ Hospital NHS Foundation Trust. The corresponding author can be contacted to request the data: Richard Lindley (Consultant Paediatric Surgeon at Sheffield Children’s Hospital) at Richard.lindley1@nhs.net, with backup contact details of William Giles at williamaegiles@gmail.com.

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Authors and Affiliations

  1. Sheffield Childrens’ NHS Foundation Trust, Clarkson St, Broomhall, Sheffield, S10 2TH, UK

    William Giles

  2. The Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, S10 2RX, UK

    Govind Murthi & Richard Lindley

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  1. William Giles
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  2. Govind Murthi
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  3. Richard Lindley
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Contributions

All authors made substantial contributions to the conceptualisation and design of the work. WG acquired and interpreted the data. All authors were involved in data interpretation. WG wrote the main manuscript test and prepared all tables/figures. All authors were involved in critical revision of the work and approve the work to be published.

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Correspondence to Richard Lindley.

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Giles, W., Murthi, G. & Lindley, R. Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study. Pediatr Surg Int 40, 88 (2024). https://doi.org/10.1007/s00383-024-05668-2

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