Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study...

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Epidemiology

Background:

• Pilonidal sinus disease (PSD) recurrence is a significant clinical challenge.
• Surgical outcomes for PSD vary widely depending on the technique employed.
• Long-term recurrence data for many PSD procedures are limited.

Purpose of the Study:

• To systematically review and analyze recurrence rates of various surgical procedures for pilonidal sinus disease.
• To compare the efficacy of different surgical approaches based on available evidence.
• To identify surgical techniques associated with the lowest long-term recurrence rates.

Main Methods:

• Systematic literature search of multiple databases (1833-2017).
• Meta-analysis of randomized controlled trials (RCTs) and merged data analysis of non-RCTs.
• Inclusion of studies in multiple languages with English abstracts detailing treatment and follow-up.
• Assessment of recurrence at 12 and 24 months postoperatively.

Main Results:

• Limberg & Dufourmentel operations showed low recurrence: 0.6% at 12 months and 1.8% at 24 months (RCT analysis).
• Karydakis & Bascom approaches demonstrated very low recurrence: 0.2% at 12 months and 0.6% at 24 months (RCTs and non-RCTs).
• Primary midline closure had high long-term recurrence rates, up to 67.9% at 240 months.

Conclusions:

• Surgical procedure is a critical determinant of pilonidal sinus disease recurrence.
• Karydakis and Bascom techniques appear most effective in minimizing long-term recurrence.
• Future comparisons must consider both surgical technique and follow-up duration for accurate efficacy assessment.