Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic
J M Enriquez-Navascues1, J I Emparanza, M Alkorta
1Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, Universidad del Pais Vasco-Euskal Herria Unibersitatea, Pº Dr Beguiristain s/n, 20014, Donostia-San Sebastian, Spain, josemaria.enriqueznavascues@osakidetza.net.
Background:
There are different open healing and primary closure approaches for chronic pilonidal sinus (CPD) that differ in principles and extension.
Aims:
To compare the results of different closure surgical techniques, we performed a meta-analysis of randomized controlled trials (RCT) comparing: (1) open wide excision versus open limited excision (sinusectomy) or unroofing (sinotomy); (2) midline closure (conventional and tension-free) versus off-midline; (3) advancing versus rotation flaps; and (4) sinusectomy/sinotomy versus primary closure.
Methods:
Data extraction and risk of bias assessment were conducted independently by the authors using the Cochrane Collaboration's tool. Data were pooled using fixed and random-effects models. Primary outcomes were rate of healing, recurrence, wound infection and dehiscence. Twenty-five trials (2,949 patients) were included.
Results:
Four trials compared limited versus radical open healing. Although recurrence rate did not differ, all other outcomes favored the limited approach. Ten studies compared midline versus off-midline primary closure; wound infection and dehiscence were significantly higher after midline closure. Six RCT compared Karydakis/Bascom versus Limberg. No difference was found in recurrence or wound complications rate. Six RCT compared sinusectomy/sinotomy versus primary closure. Recurrence rate was significantly lower after sinusectomy/sinotomy; no significant differences were found in other outcomes.
Conclusion:
Our meta-analysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered: open radical excision and primary midline closure should be abandoned. Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches.
