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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.

Techniques in Coloproctology
|May 22, 2014
PubMed
Summary

For chronic pilonidal sinus (CPD), abandoning open radical excision and midline closure is recommended. Limited excision (sinusectomy/sinotomy) or en bloc resection with off-midline closure offers better outcomes for CPD surgery.

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Area of Science:

  • Surgical Oncology
  • Colorectal Surgery
  • Wound Healing

Background:

  • Chronic pilonidal sinus (CPD) management involves diverse open healing and primary closure techniques.
  • Existing surgical approaches for CPD vary in their fundamental principles and procedural scope.

Purpose of the Study:

  • To conduct a meta-analysis of randomized controlled trials (RCTs) comparing various surgical techniques for CPD.
  • To evaluate outcomes including healing rates, recurrence, infection, and dehiscence for different surgical strategies.

Main Methods:

  • Systematic review and meta-analysis of 25 RCTs involving 2,949 patients.
  • Independent data extraction and risk of bias assessment using the Cochrane Collaboration's tool.
  • Data pooling via fixed and random-effects models for primary outcomes.

Main Results:

  • Limited open excision (sinusectomy/sinotomy) favored outcomes over radical excision, with no difference in recurrence.
  • Off-midline primary closure showed significantly lower wound infection and dehiscence rates compared to midline closure.
  • Sinusectomy/sinotomy demonstrated a significantly lower recurrence rate than primary closure, with comparable outcomes in other aspects.

Conclusions:

  • Open radical excision and primary midline closure for CPD are not recommended.
  • Sinusotomy/sinusectomy or en bloc resection combined with off-midline primary closure are identified as preferred surgical approaches for CPD.