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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.]

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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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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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