Using this dataset, we assessed the efficacy of common surgical procedures employed in treating PSD as a function of recurrence. We grouped therapeutic procedures for cumulative statistical analyses (Table 1). We thus assembled a database with sources from the first description of PSD in 1833 on, that included reported recurrence, year of publication, timeframes of follow-up, type of study, and patient- and procedure-specific factors. We considered both randomised controlled trials (RCTs) and non-RCTs. The purpose of this meta-analysis and merged data analysis was therefore to obtain a comprehensive assessment of recurrence and to ascertain determinants of recurrence of PSD with respect to specific surgical procedures and follow-up time. However, the data are conflicting, and applied follow-up times often appear to have been randomly chosen, which brings into question the validity of reported recurrence associated with different surgical procedures. Some evidence suggests that recurrence is associated with surgical procedure and correlated with length of follow-up as well 4, 7. Recurrence between 0 percent 5 and 100 percent 6 has been reported for PSD, and wide recurrence range can be seen even within the different surgical approach techniques as open treatment, primary midline closure or flap techniques and others. Recurrent disease may probably affect patients’ long-term satisfaction following PSD surgery 4. In a German military cohort for example, the number of affected patients increased from 29/100,000 in 2000 to 48/100,000 in 2012, and the total number of PSD-related in-patient surgeries exceeded the number of inguinal hernia-related interventions in 20 to 40-year-old patients 3. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time both must be considered when drawing conclusions regarding the efficacy of a procedure.įor unknown reasons, the incidence of pilonidal sinus disease (PSD) has risen continuously during the past 50 years, particularly in European and North American young men 1, 2. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. We assessed data in the manner of a meta-analysis of RCTs further we assessed non-RCTs in the manner of a merged data analysis. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract.
We reviewed 6,143 studies published from 1833 to 2017. We systematically searched available databases.