Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease
Dietrich Doll1, Alexander Novotny, Ronny Rothe
1Medical School, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa. ddoll@gmx.de
Objective:
To study the potential benefits of intraoperative methylene blue (MB) use in pilonidal sinus surgery, the correlation between long-term recurrence rate and intraoperative MB use in pilonidal sinus surgery was investigated.
Background:
Explicit investigations of MB effects in sinus surgery are scarce and inconclusive; an effect on long-term recurrence rate has never been systematically investigated.
Materials And Methods:
A random selection of 247 patients out of 1,960 patients with primary sinus surgery was drawn, and the patients were subjected to a telephone interview according to a specific questionnaire. The interview covered a recurrence follow-up time of 14.9 years after surgery (mean, standard deviation=3.8 years, range 8.6-25.4 years).
Results:
Recurrence was less likely to occur when MB was used intraoperatively (32 of 197, [16% actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences with MB vs 15 of 50, 30% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.018; log-rank test). This effect was especially pronounced in acute abscess-forming disease (8 of 46, 17% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences with MB; 11 of 33, 33% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.078; log-rank test) compared to chronic disease (24 of 151, 16% [actuarial 20-year recurrence rate, Kaplan-Meier estimate]) recurrences with MB; 4 of 17, 24% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.35; log-rank test).
Conclusions:
MB application halves the long-term risk of recurrence for pilonidal sinus patients. This significant reduction in recurrence rate can be achieved by a single careful injection of non toxic inexpensive dye into the sinus at the start of the operation. MB application should therefore be considered as an integral part of pilonidal sinus surgery.
Insights
Intraoperative methylene blue (MB) use in pilonidal sinus surgery significantly reduces long-term recurrence rates by half. This simple, inexpensive dye application should be considered standard practice for better patient outcomes.
Area of Science:
- Surgical Innovation
- Medical Research
- Clinical Outcomes
Background:
- Limited research exists on methylene blue (MB) in sinus surgery.
- The impact of MB on long-term pilonidal sinus recurrence is not well-established.
Purpose of the Study:
- To investigate the benefits of intraoperative methylene blue (MB) in pilonidal sinus surgery.
- To determine the correlation between MB use and long-term recurrence rates.
Main Methods:
- A cohort of 247 patients undergoing primary pilonidal sinus surgery was randomly selected.
- A telephone interview questionnaire assessed recurrence over a mean follow-up of 14.9 years.
Main Results:
- MB use was associated with a lower recurrence rate (16% with MB vs. 30% without MB).
- The reduction in recurrence was more pronounced in acute abscess-forming disease.
- Statistical analysis confirmed a significant difference in recurrence rates between groups (p=0.018).
Conclusions:
- Intraoperative methylene blue (MB) application effectively halves the long-term risk of pilonidal sinus recurrence.
- A single, careful injection of MB is a cost-effective method to improve surgical results.
- MB should be considered a standard component of pilonidal sinus surgery.
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