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Minimally invasive surgery for pilonidal disease: Outcomes of the Gips technique-A systematic review and
Marta Amorim1, José Estevão-Costa1, Cristina Santos2
1Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
Background:
Pilonidal disease is a common inflammatory condition that significantly impacts quality of life. Currently, there is a tendency to favor minimally invasive procedures. The present review aims to summarize the evidence and assess the outcomes of the Gips procedure.
Methods:
A systematic review was conducted on MEDLINE/Pubmed, Scopus, Web of Science, and Cochrane Library databases until December 2022. Eligible studies included patients with pilonidal disease submitted to the Gips procedure, reporting at least 1 of the following outcomes: wound complications, wound healing time, time to resume daily activities, and recurrence (International Prospective Register of Systematic Reviews protocol: CRD42023389269). The National Institutes of Health assessment tool was used for risk of bias evaluation. Meta-analysis was performed using OpenMeta[Analyst] and R software, and a subgroup analysis was performed when applicable.
Results:
Thirteen observational studies with a total of 4,286 patients submitted to Gips were included. The pooled wound complications rate was 7.8% (95% confidence interval: 5.1-10.6), the median time to resume daily activities was 1 day (95% confidence interval: 1-2), and the mean wound healing time was 4.7 weeks (95% confidence interval: 3.0-6.4). Subgroup analysis showed that pooled recurrence rate was 6.5% (95% confidence interval: 5.2-7.8) up to 2 years and 38.9% (95% confidence interval: 27.1-50.7) after more than 2 years of surgery. Most results showed substantial heterogeneity across studies.
Conclusion:
Despite apparent favorable outcomes of the Gips procedure, there is a high recurrence rate over time. Because included studies had an observational nature and unstandardized methodologies, comparative randomized controlled trials with longer follow-ups are needed for high-level evidence regarding these outcomes.
Insights
The Gips procedure for pilonidal disease shows favorable initial outcomes, but a high recurrence rate emerges over time. Further research is needed to confirm its long-term effectiveness for pilonidal disease management.
Area of Science:
- General Surgery
- Minimally Invasive Procedures
- Inflammatory Conditions
Background:
- Pilonidal disease is a prevalent inflammatory condition impacting patient quality of life.
- Minimally invasive surgical approaches are increasingly preferred for treating pilonidal disease.
- This review synthesizes evidence on the Gips procedure for pilonidal disease outcomes.
Approach:
- A systematic review of multiple databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library) was conducted.
- Included studies focused on patients undergoing the Gips procedure for pilonidal disease, assessing complications, healing, return to activity, and recurrence.
- Meta-analysis and subgroup analyses were performed on data from 13 observational studies involving 4,286 patients.
Key Points:
- The Gips procedure demonstrated a pooled wound complication rate of 7.8% and a median return to daily activities of 1 day.
- Mean wound healing time was 4.7 weeks, with recurrence rates of 6.5% up to 2 years and 38.9% after 2 years.
- Significant heterogeneity was observed across the included studies.
Conclusions:
- While the Gips procedure shows promising short-term results for pilonidal disease, a substantial long-term recurrence rate is a concern.
- The observational nature and methodological variations in current studies limit definitive conclusions.
- High-quality randomized controlled trials with extended follow-up are essential to establish robust evidence for the Gips procedure's efficacy.
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