Negative pressure wound therapy in primary closure surgeries for pilonidal disease: a meta-analysis

Primary closure with negative pressure wound therapy (NPWT) has been investigated in patients with sacrococcygeal pilonidal sinus to enhance healing and reduce recurrence. To address existing controversies, we conducted a systematic review and meta-analysis comparing primary closure with NPWT versus non-NPWT (control) for treatment of pilonidal disease. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify studies comparing NPWT versus control in primary closure surgeries in pilonidal sinus. Statistical analyses were performed using R Software with a random-effects model. Six studies with a total of 479 patients were included, of whom 164 (34.2%) underwent NPWT. NPWT had an association with lower pain score 24 h postoperative (MD - 0.65 points; 95% CI - 0.81 to - 0.50), shorter return time to activities (MD - 2.57 days; 95% CI - 3.74 to - 1.4). However, there was no difference between groups in the time of wound closure (MD - 18.94; 95% CI - 41.68 to 3.80), rate of wound dehiscence (RR 1.03; 95% CI 0.50 to 2.14), hospital length of stay (MD - 3.05; 95% CI - 15.77 to 9.67), infection rates (RR 0.38; 95% CI 0.05 to 2.84), recurrence rates (RR 0.54; 95% CI 0.07 to 4.48), and pain 6 h post-operative, which showed a borderline trend favoring NPWT but did not reach statistical significance (MD - 1.19; 95% CI - 2.38 to 0.01). NPWT appears to shorten time to resume normal activities and pain 24 h postoperatively. Despite these promising results, more randomized clinical trials are needed for greater analysis.