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Is there a difference in outcome (long-term recurrence rate) between emergency and elective pilonidal sinus surgery?
1Department of Visceral Thoracic and Vascular Surgery, Philipps‑University of Marburg Marburg, Germany. ddoll@gmx.de
Minerva Chirurgica
|April 25, 2013
Summary
Surgical craftsmanship in pilonidal sinus surgery showed similar long-term recurrence rates for both elective and urgent procedures. However, decision-making biases in urgent surgeries negatively impacted outcomes, despite good surgical technique.
Area of Science:
- Surgical outcomes and patient management in proctology.
- Clinical research on recurrent disease after surgical intervention.
Background:
- Pilonidal sinus disease often requires surgical intervention.
- Long-term recurrence rates and factors influencing them remain an area of investigation.
Purpose of the Study:
- To investigate the impact of surgical craftsmanship and decision-making on the long-term recurrence rate of pilonidal sinus disease.
- To compare recurrence rates between elective and urgent surgical approaches.
Main Methods:
- A cohort of 586 patients undergoing surgery for primary pilonidal sinus disease were interviewed 7-25 years post-operatively.
- Kaplan-Meier statistics were used to determine 10- and 20-year recurrence rates.
- Analysis included comparison of elective versus urgent surgery outcomes.
Main Results:
- Elective surgery (546 patients) had a recurrence rate of 23.1% (actuarial 10.6-17% at 5-10 years).
- Urgent off-time surgery (40 patients) showed a crude recurrence rate of 30% (actuarial 25.6-28.9% at 5-10 years), P=0.028.
- Methylene blue application was significantly lower in the urgent group, despite its known efficacy in reducing recurrence.
Conclusions:
- Surgical craftsmanship quality was comparable between elective and urgent pilonidal sinus surgery.
- Decision-making processes in urgent surgeries were biased, counteracting the benefits of good surgical technique and leading to higher recurrence rates.
