Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques.

BACKGROUND

The choice of operation for chronic pilonidal sinus disease remains controversial.

OBJECTIVE

To compare the outcomes of common operations for chronic pilonidal disease.

DATA SOURCES: We searched PubMed, Embase, and the Cochrane Library.

STUDY SELECTION: We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers.

INTERVENTIONS: We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations.

MAIN OUTCOME MEASURES: The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials.

RESULTS

Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation.

LIMITATIONS: Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.

CONCLUSIONS

Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.