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
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.
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.
