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Conservative Sinusectomy vs. excision and primary off-midline closure for pilonidal disease: a randomized controlled trial

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

A Correction to this article was published on 26 May 2020

This article has been updated

Abstract

Purpose

Pilonidal sinus disease (PD) is a common acquired disease, responsible for discomfort and time off work. There is currently no consensus on the best surgical therapy. We aimed at comparing conservative sinusectomy (S) to excision and paramedian primary closure (PC).

Methods

This is a randomized controlled trial compatible with the CONSORT statement standards. We included all patients with chronic PD between 2012 and 2017. We excluded patients with acute abscesses, recurrent PD after surgery with a curative intent and patients needing complex reconstructions with rotation flaps. Patients with chronic symptomatic PD were randomized to S or PC. Primary end-point was the rate of patients healed at 3 weeks, secondary outcomes were total healing time, pain, time off work, patient satisfaction and recurrence at 1 year. Patients were seen at a wound clinic until healed and contacted at 3, 6, and 12 months for follow-up.

Results

After inclusion of 58 patients the study was stopped prematurely due to discrepancy between expected and observed outcomes. Only 4/30 (13.3%) patients in the S group had healed completely at 3 weeks compared with 14/28 (50%) in the PC group (p = 0.01). Median time to complete healing was 54 (23–328) days in the S group compared to 34 (13–141) in the PC group (p = 0.025). Number of outpatient visits, time off work, analgesia requirement, and recurrence rates at 12 months 4 (16%) in the S group and 3 (11.1%) in the PC group (p = 0.548) were similar.

Conclusions

PC leads to faster healing compared to S, with similar healthcare burden.

Trial Registration

The study was approved by the local ethics committee and registered in www.clinicaltrials.gov (REF: NCT03271996).

The study was carried out at the Regional Hospital of Lugano, Switzerland

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Change history

  • 26 May 2020

    The original version of this article, unfortunately, contained an error. The given names and family names of the authors were interchanged and are now presented correctly. The original article has been corrected.]

References

  1. McCallum I, King PM, Bruce J (2007) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev (4):CD006213

  2. Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev (1):CD006213

  3. Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C (2014) Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech Coloproctol 18:863–872

    Article  CAS  PubMed  Google Scholar 

  4. Sakr M, Habib M, Shaheed AA (2006) Assessment of Karydakis technique as compared with midline closure for the management of chronic pilonidal sinus. J Pelvic Med Surg 12:201–206

    Article  Google Scholar 

  5. Polat N, Albayrak D, Ibis AC, Altan A (2008) Comparison between Karydakis repair and primary closure for surgical treatment of sacrococcygeal pilonidal sinus. Medical Journal of Trakya University / Trakya Universitesi Tip Fakultesi Dergisi (TRAK UNIV TIP FAK DE) 25:87–94

    Google Scholar 

  6. Ortiz HH, Marti J, Sitges A (1977) Pilonidal sinus. A claim for simple track incision. Dis Colon Rectum 20:325–328

    Article  CAS  PubMed  Google Scholar 

  7. Gupta PJ (2004) A randomized study between excision and marsupialization and radiofrequency sinus excision in sacrococcygeal pilonidal disease. Curr Surg 61:307–312

    Article  PubMed  Google Scholar 

  8. Mohamed HA, Kadry I, Adly S (2005) Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3:73–77

    Article  CAS  PubMed  Google Scholar 

  9. Oncel N, Kurt M, Kement M, Colak E, Eser M, Uzun H (2002) Excision and marsupialization versus sinus excision for the treatment or limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169

    Article  CAS  PubMed  Google Scholar 

  10. Soll C, Dindo D, Steinemann D, Hauffe T, Clavien PA, Hahnloser D (2011) Sinusectomy for primary pilonidal sinus: less is more. Surgery. 5:996–1001

    Article  Google Scholar 

  11. Gips M, Melki Y, Salem L, Weil R, Sulkes J (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 11:1656–1662

    Article  Google Scholar 

  12. Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD (2018) Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 9:3754–3762

    Article  Google Scholar 

  13. Nordon I, Senapati A, Cripps NP et al (2009) A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg 2:189–192

    Article  Google Scholar 

  14. Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D (2018) Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 1:3058

    Article  Google Scholar 

  15. Anderson J, Yip CO, Nagabhushan JS, Connelly SJ (2008) Day-Case Karydakis Flap for Pilonidal Sinus. Dis Colon Rectum 1:134–138

    Article  Google Scholar 

  16. Ates M, Dirican A, Sarac M, Aslan A, Colak C (2011) Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 5:568–573

    Article  Google Scholar 

  17. Bessa S (2013) Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the Management of Pilonidal Sinus Disease: a randomized controlled study. Dis Colon Rectum 56:491–498

    Article  PubMed  Google Scholar 

  18. Karaca T, Yoldaş O, Bilgin BÇ, Ozer S, Yoldaş S, Karaca NG (2012) Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg 10:601–606

    Article  PubMed  Google Scholar 

  19. Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 3:318–327

    Article  Google Scholar 

  20. Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 1:29–37

    Article  Google Scholar 

  21. CDC SSI Guidelines: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

  22. Sevinç B, Karahan Ö, Okuş A, Ay S, Aksoy N, Şimşek G (2016) Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery. 3:749–754

    Article  Google Scholar 

  23. Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Color Dis 7:705–710

    Article  Google Scholar 

  24. Arda IS, Güney LH, Sevmiş S, Hiçsönmez A (2005) High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 4:469–471

    Article  Google Scholar 

  25. Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, Shamsah A, Zarka ZA, Al-Hajj H, Al-Momen A (2007) Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 3:439–444

    Article  Google Scholar 

  26. Cubukçu A, Gönüllü NN, Paksoy M, Alponat A, Kuru M, Ozbay O (2000) The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Color Dis 3:173–175

    Google Scholar 

  27. Sakr M, El-Hammadi H, Moussa M, Arafa S, Rasheed M (2003) The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. Int J Color Dis 1:36–39

    Article  Google Scholar 

  28. Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffmann S, Doll D (2013) The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Color Dis 28:1555–1562

    Article  Google Scholar 

  29. Kayaalp C (2014) Do smoking and obesity really do not have any negative influence on wound healing after surgery of pilonidal disease? Int J Color Dis 29:1303–1304

    Article  Google Scholar 

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Acknowledgments

We kindly thank Prof. Pietro Majno-Hürst for his critical review of the manuscript and Dr. Luca Fumagalli for the surgical technique illustrations.

Funding

The study was funded by the peer reviewed competitive fund ABREOC (Advisory Board for Research of the Ente Ospedaliero Cantonale).

Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Transplantation, Geneva University Hospitals, Geneva, Switzerland

    Sotirios Georgios Popeskou

  2. Depatment of Surgery, Regional Hospital of Lugano, Lugano, Switzerland

    Barbara Pravini & Mike Schmalzbauer

  3. School of Health Sciences and social work, University of Portsmouth, Portsmouth, UK

    Sofoklis Panteleimonitis

  4. Department of Surgery, Regional Hospital of Bellinzona, Bellinzona, Switzerland

    Antoniacopo Ferrario Di Tor Vajana

  5. Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland

    Alice Vanoni

  6. Department of Surgery, Standort Unispital Clarunis, Universitäres Bauchzentrum Basel, Basel, Switzerland

    Alberto Posabella

  7. Department of Surgery, Regional Hospital of Lugano, Lugano, Switzerland

    Dimitri Christoforidis

  8. Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Dimitri Christoforidis

  9. Vice-Primario, Chirurgia, Ospedale Regionale di Lugano, via Tesserete 42, 6900, Lugano, Switzerland

    Dimitri Christoforidis

Authors
  1. Sotirios Georgios Popeskou
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  2. Barbara Pravini
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Correspondence to Sotirios Georgios Popeskou.

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The original version of this article was revised: The given names and family names of the authors were interchanged and are now presented correctly.

Article Summary

We randomized patients with chronic pilonidal sinus to sinusectomy or excision and paramedian primary closure. The importance of this study is that it showed faster healing times in the paramedian primary closure group with no difference in recurrence rates or “healthcare burden”.

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Popeskou, S.G., Pravini, B., Panteleimonitis, S. et al. Conservative Sinusectomy vs. excision and primary off-midline closure for pilonidal disease: a randomized controlled trial. Int J Colorectal Dis 35, 1193–1199 (2020). https://doi.org/10.1007/s00384-020-03551-9

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